Magister Artium (Child and Family Studies) - MA(CFS) / One of the sustainable development goals the World Health Organization (WHO) has set for member countries is the implementation of universal health coverage (UHC) in order to ensure all citizens have the right to access healthcare. In recognising that the global demand for traditional and complementary medicine (T&CM) continues to grow, the WHO has encouraged the inclusion of T&CM into the national health systems of member countries as a way of ensuring that UHC can be achieved.

The research reviews that the majority of Black South Africans will frequent a traditional African healer as a primary means of health care. This may be partly due to the fact that traditional African healer is accredited as offering more affordable means of health care. Traditional African healing has been esteemed in treating the physical, mental and spiritual health of the population. This paradigm is also respected for its holistic approach which stretches beyond sole biological assumptions in the pursuit of optimum health. Depression is also confirmed as being an illness which is rife in contemporary living. South Africans may also be at an increased risk with regards to this mood disorder, due to harsh psychosocial circumstances including poverty, unemployment and crime. The research offers that the social worker and mental health care professional alike are under increased pressure to obtain ‘cultural competence’ in understanding how traditional African discourse constructs common mental illnesses like depression. Therefore in light the above, the research attempted to explore an understanding of depression amongst a sample of traditional healers in Johannesburg. There is little research done on this subject. Therefore a qualitative research approach was adopted. Qualitative research may offer a more reflective space as a point of entry into a subject which has not been explored. The case study research design, specifically a collective case study was used and semi-structured interviews were conducted, using an interview schedule. The researcher interviewed 10 traditional healers. The interview aimed to explore how traditional healers understand depression. iii The research used a content analysis to draw common themes from the transcribed interviews with the participants who formed part of the sample, selected by means of purposive sampling. The themes derived from the interviews offer some reflections on the traditional healers’ understanding of depression. These themes included: relevancy of depression; distinctions between depression and sadness; intuitive assessments of depression; external circumstances and psychosocial circumstances; relevance of biomedical interventions; treatment by the African traditional healer; counselling; supernatural and spiritual influences; punishment; depression experienced as a collective vs. individualistic cultural experience; somatisation and specific emotional difficulties related to the vocation of traditional African medicine. The research concluded that the traditional healers’ conception of depression was in a state of flux and was very much dependent on the individual interpretations by the traditional healer. This appeared to be influenced by the level of the traditional healers’ acculturation into westernized culture and exposure to biomedical interventions. The relevancy of the concept of depression was viewed as being both redundant and ripe in relevance by the sample. Depression and sadness could not always be distinguished between. However, there was a conceptualization of depression as being a more intense and severe form of sadness. Intuitive assessments of depression were generally adopted as opposed to exploring specific diagnostic criteria. Cognitive distortions such as ‘thinking too much’ and external circumstances were recognized as significant contributors. Depression was mostly indirectly recognized as an illness. Allopathic medicine was both rejected and held in high regard. Counselling was viewed as being necessary. This was not always adopted by the traditional healers. The spiritual significance was graded on a subjective spectrum of making meaning of depressive experiences. However the ancestors were still revered in all assessments and interventions. Depression was viewed on a continuum between individualistic and collective cultures. There were no significant somatic reports. In a nutshell the research concludes that there is no unified perception of depression, but highlights some common cultural variables. The research specifically highlighted the psychosocial and spiritual qualifying factors which may differentiate and qualify this paradigm from other biological and allopathic interventions. iv The research paves the way for further research to be done in this area. Recommendations are made for social workers and mental health care professionals alike to become more fluent in traditional African healing discourse in the area of mental health and depression in order to understand their clients from the African culture. / Dissertation (MSW)--University of Pretoria, 2013. / Social work and Criminology / unrestricted

Les populations autochtones au Canada, comme partout dans le monde, sont moins en santé que leur contrepartie non autochtone. La médecine traditionnelle, notamment pour les populations autochtones, offre une avenue intéressante à une amélioration de leur santé et elle peut être mise en place dans les programmes de santé publique. Par la notion de culture inscrite dans la MT, celle-ci permet d’offrir des soins culturellement adaptés. Bien que de nombreux avantages découlent de la combinaison des médecines, la combinaison dans un contexte de soins primaires présente des défis. À ce jour, il semble que les organisations de santé aient des difficultés à bien arrimer ces deux approches de soins. L’objectif général de cette étude consiste à comprendre et analyser la dynamique d’interactions ayant cours entre les acteurs qui participent à la conception, au développement et à la planification d’une offre de soins et services qui permette une combinaison des MT et la MA. Cette recherche qualitative avec cas multiples est menée dans deux communautés autochtones du Québec, de nations ilnue et crie, ayant des caractéristiques variées. Les données proviennent d’entrevues individuelles et d’ateliers de transfert de connaissances réalisés auprès des aînés et guérisseurs, des patients, des professionnels et des administrateurs de la santé, ainsi que de documents écrits et d’observations sur le terrain. Le cadre conceptuel s’appuie sur l’analyse stratégique de Crozier et Friedberg (1977) et sur le système des professions d’Abbott (1988). Cette recherche met en évidence les multiples dimensions ayant un impact sur une offre de soins combinés. Ces dernières peuvent entre autres être liées à la culture comme les modes de transmission du savoir, et aux contextes organisationnel, administratif, réglementaire et même géographique. De plus, la compréhension des enjeux et des stratégies des parties prenantes permet de mieux comprendre l’organisation de chacun des deux mondes. Nos résultats montrent que, dans les deux cas à l’étude, la combinaison des deux médecines est coordonnée par le patient (modèle du patient coordonnateur). Mais dans un des cas, le patient est davantage soutenu dans sa trajectoire de soins. Une meilleure compréhension des dynamiques d’interaction entre les parties prenantes permet d’avoir un impact sur une offre des soins mixtes améliorant la santé des autochtones. Cette étude soutient le développement d’un modèle de soins qui met de l’avant les médecines traditionnelles et suscite une réflexion sur les facteurs qui influencent la mise en œuvre d’une combinaison des médecines. / Indigenous peoples in Canada and around the world are less healthy than their non-Indigenous counterparts. Traditional medicine, especially for Indigenous populations, offers an interesting avenue for improving their health and it can be implemented in public health programs. Through the notion of culture enshrined in traditional medicine, the latter can provide culturally appropriate care. Although many advantages are derived from such mixed care models, this combination has significant challenges. To date, it seems that health organizations have difficulty to properly engage these two-health approaches. The consideration of Indigenous knowledge and healing practices has begun, but it remains fragmented with discontinuous health services offered to the population. The general objective of this research is to understand and analyze the dynamics of interaction going among actors who involved in the implementation of a mixed care model of delivery of services that combines traditional and allopathic medicines. This multiple case qualitative research is conducted at two Indigenous communities in Quebec, Ilnu and Cree nations, with various characteristics. The data comes from individual interviews and knowledge transfer workshops with elders and healers, patients, health professionals and health administrators, as well as written documents and participant observations. The conceptual framework builds on the strategic analysis of Crozier and Friedberg (1977) and Abbott’s system of professions (1988). This research highlights the multiple dimensions that have an impact on a mixed care offer. These can, among other things, be related to culture such as the modes of transmission of knowledge, and to organizational, administrative, regulatory and even geographic contexts. In addition, understanding the challenges and strategies of the actors makes it possible to better understand both worlds. Our results show that, in the two cases under study, the combination of the two medicines is coordinated by the patient (patient coordinator model). But in one of the cases, the patient is more supported in his care trajectory. A better understanding of the dynamics of interaction between stakeholders makes it possible to have an impact on the delivery of mixed care improving the health of Indigenous people. This study has the potential to impact on the delivery of combined health care services, thereby improving prevention and health promotion for both Indigenous and non-Indigenous peoples. It supports the development of an alternative model of care, putting forward Indigenous traditional medicine. It encourages the reflection on the different factors involved in combining medicines.