This dissertation presents an ethnographic account of a socially diverse, public breast cancer clinic in Johannesburg. The findings of this qualitative research radically challenge the unproblematised and overdetermined use of the categories of race and gender in existing literature concerning this disease. The growing breast cancer epidemic in South Africa affects all demographic categories of women including young women. Yet, previous research frames this as a racialised and gendered crisis. Black women have been depicted as ignorant “problem patients” who resist biomedical treatment, and all women are described as having a particular relationship to their breasted bodies and a deep fear of mastectomy. Departing from these stereotypes, this ethnography reveals unanticipated data showing, firstly, that race, class, age and level of education did not determine women’s relationship to breast cancer and biomedicine. Secondly, socially diverse women commonly experienced breast cancer as a life-threatening disease that evoked confrontation with existential concerns regarding suffering, death, family, and faith. Due to these commonalities, an intimate and powerful sociality existed amongst women at this clinic. Thirdly, within this sociality, women accepted mastectomy as a necessity in creating a healthy body. Breastlessness was normalised and women generally were reluctant of breast reconstruction, thus destabilising the conceptual relationship between breasts and gender. This dissertation’s deconstruction of the use of hegemonic social categories is a significant intervention in a context where these categories are often viewed as absolute determinants of social and health phenomena, and therefore prompts more nuanced approaches to understanding experiences of illness in post-apartheid South Africa.

In medical anthropology there has been a tendency to dichotomize western biomedical . healtb services, on the one hand, and traditional health care practices on the other. Much attention has been focused on the comparison between these two approaches in the hope that they might be reconciled. The problem with this approach is twofold. In the first place, it has not always acknowledged the local, historic~1, political and economic contexts in which different approaches to health care have evolved and in the second place, health care services which belong to neither the western nor traditional healing spheres and which are driven by commercial interests have been almost completely neglected because they fall outside of the basic dichotomy. Amayeza stores have been a feature of South African towns and cities for many years. They mayor may not be run by Africans, but their clientele is almost exclusively African in this region. They deal in a bewildering variety of products and remedies, from untreated herbal and animal products to pharmaceuticals specially prepared for the African market, to Dutch and Indian Remedies. These stores both reflect transfonnations in indigenous perceptions of health care and, by virtue of the choices they offer, generate change. In this empirical study three stores in the Eastern Cape are selected for detailed study - two in King William's Town, the regional capital, and one in the small town of Peddie. The approach is holistic, emphasizing the social, political and economic context, the business histories and running of each shop, and, in particular, the perceptions and choices of a sample of the customers in each case. The success of the amayeza phenomenon derives from its eclecticism and syncretism. These stores impose neither a western nor a traditional model of health care on their clients, but offer them a range of choices that reflects the complex multicultural history of their own South African society.

Thesis (MPhil)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Paarl, in the Western Cape, has been identified as one of the 15 national sites where antiretroviral treatment (ARVs) would be made available to people living with HIV/AIDS. Paarl Hospice initiated a support group for people to deal with this disease in 2003. Since February 2004 Paarl Hospice has been recruiting people from the surrounding informal settlements for ARVs. By means of participant observation I explored how HIV/AIDS-related disclosure experiences unfolded in places, spaces and events associated with the support group in the context of factors enabling and preventing people from accessing Hospice House. I did this by considering the insights drawn from an anthropological approach. I found the meanings of disclosure in the majority of studies to be limited and restricted. Available studies approached disclosure in a top-down fashion by regarding the definition of disclosure as the announcement of HIV-positivity at the time of diagnosis only. These studies have not considered social differences relating to disclosure neither did they focus on the actual process of disclosure. By means of a constructivist approach to grounded theory I seek to broaden the definition of disclosure to account for the range of ways in which disclosure practices take place. I found that disclosure could not be separated from the situational context in which it occurs and that it can only be understood in relation to the circumstances and relationships in which it takes place. In this study, disclosure was an ongoing process, situated somewhere between active, public announcement of an HIV-status and complete secrecy and somewhere between voluntary and involuntary revealing of the disease. / AFRIKAANSE OPSOMMING: Paarl in die Wes-Kaap is geïdentifiseer as een van die 15 nasionale areas waar antiretrovirale medikasie beskikbaar gestel sou word aan mense wat leef met MIV/VIGS. Paarl Hospice het gedurende 2003 ʼn ondersteuningsgroep geїnisieer om aan MIV/VIGS aandag te gee. Sedert Februarie 2004 is Paarl Hospice in die proses om mense te werf uit die omliggende informele behuisingsgebiede vir antiretrovirale behandeling. Met behulp van antropologiese insigte en deelnemende waarneming kon ek nagaan hoe verskillende maniere van MIV/VIGS-verwante bekendmaking ontvou in plekke, ruimtes en gebeurtenisse wat verband hou met die ondersteuningsgroep. MIV/VIGSverwante bekendmaking is ondersoek te midde van inhiberende en fasiliterende faktore wat mense verhoed of aanhelp om Paarl Hospice te besoek. Ek het bevind dat die definisie van bekendmaking in die meeste navorsing gebrekkig is. Beskikbare navorsing het bekendmaking volgens ‘n bo-na-onder-wyse benader as die openbare bekendmaking van ‘n MIV-status na afloop van diagnose alleenlik. Met behulp van ‘n konstruktiewe benadering van die begronde teorie het ek gepoog om die definisie van bekendmaking uit te bou om sodoende die verskeidenheid maniere waarop bekendmaking plaasvind te akkommodeer. Ek het vasgestel dat bekendmaking onlosmaakbaar deel is van die situasionele konteks waarin dit plaasvind en dat dit slegs begryp kan word in verband tot die verhoudings en omstandighede waarin dit plaasvind. In hierdie studie was bekendmaking ʼn voortdurende proses, gesitueer tussen aktiewe openbare bekendmaking en volledige geheimhouding van ʼn MIVstatus, asook tussen volkome vrywillige en onvrywillige bekendmaking van ʼn MIVstatus.

South Africa, many plants which are used in traditional medicines are collected from wild populations. The high demand for trade and use of these medicinal plants place an enormous pressure on their natural populations, especially because they are indiscriminately harvested. The most affected of these plant species are those harvested from their underground parts, among which is Gunnera perpensa L. Gunnera perpensa is of considerable ethnobotanical interest in traditional medicine because of its wide usage. The rhizomes are widely used and indiscriminately collected in large quantities from the wild to meet the ever increasing demand in traditional medicine markets. As a result, this valuable medicinal plant species is being endangered. According to the Red List of South African Plants, the conservation status of G. perpensa has been listed as ‘declining’. The ethnobotanical survey conducted as part of this research confirms the plant species as threatened. It is, therefore, important to develop propagation and conservation strategies for this medicinal plant. Clonal propagation of G. perpensa was conducted using varying lengths of the rhizome (1, 2, 3, 4 and 5 cm) segments as propagules. While regeneration was possible with all the rhizome lengths, most of the growth parameters were significantly higher in the 5 cm rhizomes than the other rhizome segments. The appropriate planting depth for the rhizomes was also determined and 4 or 5 cm planting depths were found appropriate. No significant difference was observed in the growth parameters amongst the planting depths; nevertheless, 4 cm depth gave higher growth and yield. The results of this study show that regenerating G. perpensa.

This thesis is an investigation into the socio-economic constraints that influence the decisions of tuberculosis sufferers in the health seeking process and therapeutic management of tuberculosis in Grahamstown, the Eastern Cape. It is shown that structural violence influences experiences and perceptions of tuberculosis at all levels. Management of tuberculosis in the formal health sector is explored at local levels and related to national and global strategies of health care. The role of health workers, and particularly voluntary health workers, is explored and it is shown that they work within a context of growing burden of sickness and co-infections and a lack of government commitment to deal with increasing TB and HIV incidences. Kleinman’s notion of explanatory models is explored and it is evident that although knowledge of the aetiology of tuberculosis is well-known to patients and general members of the communities, they are nevertheless victims of increased stigmatisation and marginalisation as a result of illness. The importance of social support in curing tuberculosis is explored using Janzen’s concept of therapy managing groups. Social capital is a fundamental component in adhering to biomedical therapy, but is commonly weak among the structurally poor. The availability of temporary social grants for people living with TB influences health seeking behaviour. In a context of structural poverty the sick are faced with what Nattrass terms “perverse incentives”, having to choose between the right to health and the right to social security, both guaranteed in the South African Constitution, for him/herself and dependants. Although adherence to biomedical therapy is essential in curing tuberculosis, it is shown throughout this thesis that ignoring wider structural causes of disease limits the patient’s ability to get well. The ethnography shows that the right to health is a social and economic right which is not the reality for most South Africans.

Increasing numbers of medicines are being used by pregnant South African women in the public sector during pregnancy, for the treatment of different biomedical and supernatural disease states and conditions. The motivation for the research is to support the development of more local pregnancy registries in order to strengthen evidence for the safety and efficacy of medicines used in pregnancy. A mixed methods approach was used. Women in their ninth month of pregnancy in a public sector setting, and four community pharmacists were identified. The women who met the inclusion criteria were recruited. One in-depth semi-structured interview was conducted with each woman before giving birth and data on their pregnancy outcomes were collected after labour. Coincidentally, the mother of one of the participants was found to be a traditional healer. She was also interviewed on the topic. A structured questionnaire was administered to the pharmacists. Ten pregnant women between the ages of 19 to 39 who had used or were using a traditional medicine during the pregnancy were recruited. All the participants had had at least one antenatal check up during their pregnancy with one having attended five times. No abnormal results were reported from any of the check ups or tests done during the visits. All of them had been to school and had at least Standard 8/Grade 10 education. Ten babies were seen between one and four days postpartum and no birth defects were obvious or were reported for any of them. The traditional healer did not provide additional information to what the women had said and confirmed that some of the practices the women reported were known to her as traditional medicine practices. All four pharmacists indicated that they considered complementary and alternative medicines (CAMs) to be “somewhat effective” and sold them at their pharmacies although none of them were aware of whether or not they were registered with the MCC. None of the pharmacists appeared to have an in-depth knowledge of traditional, complementary and alternative medicines (TCAMs). All four pharmacists said that it is important to have a basic understanding of TCAMs before using them, although they did not agree on the reasons for this. All of them felt that pharmacists have a professional responsibility to provide information on TCAMs (especially herbal preparations) and two felt that providing this information is part of a medical doctors’ responsibility. No harm from taking TCAMs could be shown. However herbal medicines have numerous ingredients some of which are unknown and taking these medicines is risky. The pharmacists in this sample were unsure whether they were accessing unreliable CAM information. Reliable sources of information and reference materials on CAMs to assist pharmacists and other healthcare professionals are needed. The apparent widespread use of TCAM in pregnancy indicates a need for documentation about its efficacy and safety. The establishing of TCAM pregnancy registries should seriously be considered. Due to the increase in CAM use, CAM education during pharmacists’ training as well as continuing professional development (CPD) in CAM for pharmacists in practice should be encouraged.

This study encompasses an anthropological investigation of healing practices in the Zion Christian Church with reference to the Marabastad congregation in Pretoria (Tshwane), South Africa. The Zion Christian Church functions as an extremely successful healing ministry, and can thus be characterised as a spirit-type African Initiated Church, a type known to attract members through healing activities. The concepts of ill-health, health, healing and curing are crucial to understanding the church’s role, as all activities at the Zion Christian Church revolve around the attainment of absolute health. The embedded nature of healing in the church is explored through an analysis of the spatial and material aspects of the church’s healing practices, including codes of conduct, roles of participants, religious services, and intangible and tangible instruments of healing. The study is further contextualised against the broader history of the emergence and growth of African Initiated Churches from the late 19th century onwards / Anthropology & Archaeology / M.A. (Anthropology)

This study encompasses an anthropological investigation of healing practices in the Zion Christian Church with reference to the Marabastad congregation in Pretoria (Tshwane), South Africa. The Zion Christian Church functions as an extremely successful healing ministry, and can thus be characterised as a spirit-type African Initiated Church, a type known to attract members through healing activities. The concepts of ill-health, health, healing and curing are crucial to understanding the church’s role, as all activities at the Zion Christian Church revolve around the attainment of absolute health. The embedded nature of healing in the church is explored through an analysis of the spatial and material aspects of the church’s healing practices, including codes of conduct, roles of participants, religious services, and intangible and tangible instruments of healing. The study is further contextualised against the broader history of the emergence and growth of African Initiated Churches from the late 19th century onwards / Anthropology and Archaeology / M. A. (Anthropology)

This study focuses on the use of the Athrixia phylicoides plant in Tshwane, Gauteng, South Africa. The plant is used within the domestic domain as a beverage, for medicinal purposes, as well as for the manufacturing of domestic brooms. The aim of the study was to investigate the use and market of Athrixia phylicoides in two of the Tshwane markets, namely; Denneboom and Marabastad. Case study design, participant observation and interviews were employed to collect data. A literature review was conducted to construct a theoretical framework. The study reveals that traditional healers, broom makers and customers have a remarkable knowledge about Athrixia phylicoides, which has been untapped thus far. In addition, the study indicates that possible extinction of the Athrixia phylicoides plant, due to over-harvesting and lack of conservation, will pose a challenge to the market. / Anthropology / M.A. (Anthropology)

Cultural factors have been shown to play a role in human decision making and behaviour. The main objective for this research was to identify and evaluate the possible influence of Shangaan cultural beliefs, myths and behaviours, on the spread of HIV within the Mnisi tribe. A qualitative method of investigation was followed; interviews with three participants and observations of the Mnisi culture were used in the construction of the investigation and findings. Through the information obtained two cultures influencing the spread of HIV in the Mnisi tribe were identified, they are (1) The culture of power-rule and fear, and (2) The culture of poverty. / Psychology / M.Sc. (Psychology)