Browsing by Author "Wreford, Joanne"

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    Adaptations, alterations and shifted strategies: the pragmatics of knowledge transfer in HIV and AIDS interventions in South Africa
    (2009) Wreford, Joanne
    The historical relationship between western and traditional health practitioners in South Africa was always uncomfortable and remote. This paper does not rehearse the complex colonial history of this disjunction, but rather focuses on some of the effects of that history on contemporary medical relationships, especially concerning interventions in the prevention and treatment of HIV and AIDS. The controversy about the rights of HIV positive patients to choose 'traditional' African remedies over biomedical antiretroviral drugs (ARVs) is considered first. The paper argues that by attaching the notion of 'pseudoscience' to traditional medicine in this debate AIDS activists' are reproducing an unhelpful contemporary version of the familiar 'scientific knowledge' versus 'traditional belief' dichotomy, an attitude that alienates traditional health practitioners and discourages useful dialogue and cooperation. The paper then introduces ethnographic coverage of an HIV/AIDS intervention in the Western Cape Province, in which Xhosa traditional health practitioners (THPS)1 have adopted and adapted the techniques of HIV/AIDS counselling, and advocacy of HIV/AIDS testing and ARVs, into their conventional practice. The testimony of the healers themselves is used to discover the effects of this process of medicalisation and the extent to which it has changed the THPs' relationship - real and perceived - with western medicine. The paper will show that although these THPs are eager to be involved with western medicine, this does not constitute surrender to a superior system, but is simply a pragmatic act of conciliation in the face of the HIV/AIDS epidemic. In their practical approach, the healers can be recognised not as 'ignorant' or naïve, but realistic. The paper argues that the 'ignorance' and ineptitude of which traditional practitioners are often accused is in fact a consequence of the disinterest shown by western medicine towards them.
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    Facilitating relationships between African traditional healing and western medicine in South Africa in the time of AIDS: A case study from the Western Cape
    (2006) Wreford, Joanne
    As the HIV/AIDS epidemic in South Africa matures, the importance of encouraging a more cooperative approach between biomedicine and traditional African healers (TAHs) becomes paramount. This is not solely based on the potential of the additional human resources which might be released by better relationships with traditional healers - biomedical HIV/AIDS interventions themselves could benefit from a better understanding of traditional ideas of health, disease and healing, ideas which could then be appropriately incorporated into the treatment process. This paper offers a portrait of an innovative project based in the Western Cape Province which aims to make a start in improving cross-sectoral relationships. The paper limits its coverage to the initiatory stages of the scheme, and offers unusual insights into both the potential advantages of cooperation, and into some of the, often mundane, pitfalls and obstacles presented by this sort of approach.
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    Involving traditional health practitioners in HIV/AIDS interventions: Lessons from the Western Cape Province.
    (2008) Wreford, Joanne; Esser, Monika; Hippler, Stefan
    Despite international recognition of the potential value of collaboration between traditional health practitioners and western medicine, examples of this approach in South Africa are rare. Contextualised within the aims and objectives of the HIV/AIDS and STIs National Strategic Plan 2007-2011(NSP), the paper looks at one initiative, based in the Western Cape Province. It presents evidence of the scheme’s success to date, its potential for assisting in the NSP’s goals, and the possibility of further developments, which might enhance HIV/AIDS prevention and care strategies. Finally, the paper explores some key problems, and makes recommendations for future initiatives based on the experience.
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    Missing each other: problems and potential for collaborative efforts between biomedicine and traditional healers in South Africa in the Time of AIDS
    (Taylor & Francis, 2005) Wreford, Joanne
    Supported by ethnographic evidence from ongoing research with African traditional healers, mainly in the Western Cape Province, this paper promotes reciprocal collaborations between traditional practitioners and western trained doctors in South Africa. The emphasis is placed on HIVIAIDS interventions. Some obstacles to effective cooperation are examined, followed by an exploration of government actions (and non-actions) which together tend to influence popular opinion about traditional healing. The relationship between traditional healers and witchcraft - arguably the major contributor to suspicions about traditional healing practice - is analysed, and the implications for HIV/AIDS interventions are examined in the light of these findings. Finally the paper sketches some proposals for practical implementation of collaborative efforts.
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    Myths, masks and stark realities: traditional African healers, HIV/AIDS narratives and patterns of HIV/AIDS avoidance.
    (2008) Wreford, Joanne
    Based on field evidence from anthropological research with Traditional Health Practitioners in the Western Cape Province, this paper presents narratives that demonstrate the use of myth and camouflage in popular responses to HIV/AIDS, as experienced by Traditional Health Practitioners. The narratives are analysed from the perspective of the traditional healers in order to interrogate biomedical assumptions that traditional health practitioners are largely to blame for encouraging denial and non-disclosure, or wilfully undermining western medical efforts to deal with the epidemic. The paper explains the effects of popular explanations of HIV/AIDS on traditional health practitioners, and suggests that they do not simply endorse these accounts, but are prepared to be sceptical and to challenge them when they arise.
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    Negotiating relationships between biomedicine and sangoma: Fundamental misunderstandings, avoidable mistakes
    (2005) Wreford, Joanne
    In South Africa, traditional African and biomedical practitioners operate in parallel, but largely separate, arenas, in which collaboration is largely absent. This paper suggests that any positive benefits of pluralism tend to be undermined by fractious and confrontational relationships between the biomedical and traditional systems, a situation which appears especially the case for traditional practitioners such as sangoma, who call on the spiritual guidance of ancestral agency in their healing work. Motivated in part by the author’s personal experience of training and qualification as a sangoma, this paper seeks to stimulate an intellectual debate about sangoma healing as it relates to the scientific understandings of biomedicine, most especially in the context of HIV/AIDS interventions in South Africa. The collaborative medical relationships advocated here do not deny the technical expertise of biomedicine nor question the commitment of allopathic practitioners to health and healing. Rather the paper seeks to address the risks to biomedicine’s efficacy in the hubris which drives it to remain disengaged from its traditional counterparts. The paper argues that as biomedicine appears uncomfortable with the spiritual aspects of the traditional paradigm, the absence of spirituality in allopathic practice confuses traditional healers, a situation which prejudices working relationships. I will argue that biomedical professionals, rather than denying or decrying traditional African healing, could emulate the few of their number who have engaged with traditional practice. I will demonstrate how a working knowledge of some of the fundamental ideas of African healing and its spiritual evocations - the question of healing and cure, theories of pollution and cleansing, the functions of ritual, the purposes of witchcraft and the healing of witchcraft, to mention a few – may actually empower biomedical practitioners, and enable them to work with rather than against sangoma.
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    The pragmatics of knowledge transfer: an HIV/AIDS intervention with traditional health practitioners in South Africa
    (2009) Wreford, Joanne
    The persistence ofthe binary of scientific and indigenous or traditional medicine in contemporary South Africa is particularly unhelpful in the context of HIV/AIDS and encourages biomedical disengagement from a potentially helpful cohort of health professionals recognised within their communities. This article offers and discusses ethnographic evidence from Project HOPE, an HIV/AIDS intervention involving African traditional health practitioners (isiXhosa: amagqirha) in the Western Cape province of South Africa. The article suggests several possibilities of advantage to the efficacy of western medical interventions in this sort of collaborative approach. Testimony from participants from both paradigms is offered to support this assertion. The article includes a contextual examination of the debate about HIV/AIDS treatment in South Africa which explores the effects of confused interpretations of 'traditional' and scientific medicine in this regard.
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    Rapprochement or resistance?: utilising traditional healing principles and practice to enhance HIV/AIDS treatment in South Africa
    (2007) Wreford, Joanne
    Understanding the obstacles to HIV/AIDS treatment Statistics on HIV infection in South Africa record up to 5.2 million people living with the virus. Highest infection rates are reported from the townships and ‘informal settlements’ where the majority of black people live1.These figures underline the grim reality that, despite improvements to the country’s public health services, access to treatment continues to be highly problematic.
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    Shaming and blaming: Medical myths, traditional health practitioners and HIV/AIDS in South Africa.
    (2008) Wreford, Joanne
    This paper examines some often repeated 'medical myths' about Traditional Health Practitioners (THPs) in South Africa, in the context of the HIV/AIDS epidemic. Narratives have served many purposes in the pandemic: the stories included here provide specific commentary, often implicitly derogatory or critical, on the role of THPs. The anecdotes can be seen to reflect the uneasy interaction generally prevailing between the traditional and biomedical paradigms in South Africa. The paper first examines some of the reasons for the biomedical presumptions that underlie these narratives. It argues that in attributing blame, the stories exert an unhelpful effect and undermine confidence in the possibility of collaborative medical efforts against HIV and AIDS. In contrast, the paper utilises field evidence to suggest that, given mutual respect, THPs can be successfully drawn into biomedical prevention and treatment interventions, and thereby improve their efficacy.
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    ‘Sincedisa – We Can Help!’ A Literature Review of Current Practice Involving Traditional African Healers in Biomedical HIV/AIDS Interventions in South Africa
    (Taylor & Francis, 2005) Wreford, Joanne
    This review describes research literature involved with efforts at collaboration between traditional African healers (TAHs) and biomedical practitioners in HIVIAIDS interventions in Southern Africa. The paper draws on academic texts including published and unpublished research papers, books and reports, and press comments on the subject. The focus is on Southern African literature, but selected texts from elsewhere on the continent are also included. Rather than simply reviewing selected interventions, this pap er interrogates the roles assigned to traditional healers, emphasising in particular diviner-practitioners such as izangoma (sing. isangoma: Zulu; igqirha, amagqirha: Xhosa) in these interventions. The paper investigates the experience of traditional healers of these interventions, and the responses of biomedical professionals, and explores some obstacles which may hinder future collaborations. The paper concludes with some recommendations and proposals fo rfuture schemes and related research.
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    Worlds Apart? Religious interpretations and witchcraft in interpretations and witchcraft in for HIV/AIDS in South Africa.
    (2009) Wreford, Joanne
    Academic research has tended to explain traditional African health practices as part of a belief system, usually understood as religious. Biomedicine meanwhile harnesses this religious definition as validation of the familiar dichotomy between non-factual 'beliefs' and the 'evidence-based' knowledge claims of scientific medicine. This paper rather defines traditional African health practices as a healing system running in parallel to biomedicine as part of the pluralist health service of South Africa. The paper is contextualised on the conference theme of the alignments between religion and health in the harnessing and mobilising social health assets. Focused on fieldwork in the Western Cape Province of South Africa, it presents some assumptions voiced by health workers about the beliefs and practice of amagqirha (Xhosa; pl. igqirha s.: diviner/healers) and considers the various ways in which these are negotiated. The paper first interrogates how health workers' understandings of traditional African healing may be operating to advance or limit the possibilities for cross-cultural health interventions in HIV/AIDS. The second part of the paper considers a particular construction in this equation - the discomfiting question of witchcraft discourse.