This thesis examines health care choices patients make when illness and misfortune occur. Research on health seeking behaviour was conducted in Katutura (the African township outside of Windhoek in Namibia) during 1996 and 1997. Due to the availability of a wide range of health care options from both the western and the traditional medical systems, utilisation of traditional medicine represents a conscious choice by patients and is not due to a lack of other alternatives. The use of traditional medicine can therefore be attributed to social, cultural, and personal factors rather than access, cost, and distance to modern health care facilities. A set of theoretical postulates is constructed to explain health seeking behaviour, including western and African concepts of ill health, which integrates both macro and micro-level analysis. Through macro-level analysis, this model postulates that western and traditional medical systems are able to exist within a single society due to the presence of co-existing ideologies (Medical Systems Theory). This model further postulates that social change is a significant attribute of post-colonial Namibian society (Post-colonial Theory). Rapid social change causes social disequilibrium leading to insecurities within the population which increase traditional health care utilisation, especially due to witchcraft accusation. Thus, macro-level theories are used to explain the existence and form of health care alternatives in Katutura; while micro-level analysis is used to examine how people make rational health care choices based on individualised variables within the enabling and constraining umbrella of Namibia's social structure. These variables include the individual's means, goals, desires, and environment of physical and social objects. Health seeking behaviour is influenced by the individual's previous experiences (history), personal constraints, and access to information. Based on data from the 1996 Tradition and Health Survey administered as part of the research for this dissertation, a model for health seeking behaviour is developed to guide the analysis of qualitative data. This model postulates that different patterns of utilisation depend on perceived causes, reasons and origins (aetiology) as well as manifestations of illness. Some illnesses are perceived of as clearly African and some are seen to be clearly western (both of these perceptions result in a single utilisation pattern). Some illnesses have a social/spiritual aetiology but universally recognised manifestations (resulting in a simultaneous utilisation pattern), and some illnesses are of indeterminate aetiology until treatment begins (resulting in a multi-faceted utilisation pattern). In addition to a utilisation pattern based on the aetiology and manifestation of illness, previous health seeking experiences influence, to a certain extent, subsequent health care choices; whereby the failure of one medical system to produce satisfactory results can cause health seekers to shift to another treatment regimen. In Katutura choices patients make are also influenced, to a certain extent, by the urban nature of the health seeking environment. Urban patients seek traditional medicine for a range of social/spiritual aetiologies, due to rapid social change and the experience of new and threatening situations. Urban patients also have more knowledge and experience with the western concept of contagious transmission as opposed to the traditional concept of social/spiritual contamination. In addition, health seeking patterns vary slightly between the different ethnic groups in Katutura. Traditional aetiological beliefs of the different ethnic groups in Katutura are reflected in current cultural beliefs about the cause of illness.

The traditional health care system as it prevails in South Africa is part of African culture and intricately linked with the African world view. It embraces traditional norms and values that have survived to this day. In this sense it is more than a constituent part of medical pluralism which has become a global phenomenon. The role of the traditional healer is far more extensive than that of the modern medical doctor. He advises on all aspects of life, including physical, psychological, spiritual, moral and legal matters. He shares the client's world view. He understands the significance of ancestral spirits, the belief in supernatural forces and the reality of witches. It is in this context that modern scientific medicine has not been able to replace traditional medicine, and arguably never will. Traditional medicine is faced with enormous challenges at present. Firstly, the traditional social order is fast disappearing, making way for the state and the individual whose rights as contained in the Bill of Rights of the 1996 Constitution of the Republic of South Africa may seriously clash with traditional norms. Secondly, especially in an urban environment, the healer may encounter stiff competition from more progressive colleagues and modern physicians. Thirdly, scientific medicine basically regards traditional activities as unscientific, unregulated, often harmful and sometimes fatal. Fourthly, anti-witchcraft legislation hinders the traditional practitioner to deal with witches in the culturally appropriate manner. Traditional medicine will not go away. It is therefore necessary to find ways and means to see it practised in a safe and competent manner. As healers agitate for official recognition, it will be regarded as their corresponding duty to professionalise the traditional sector, create a traditional medical council and establish a register of bona fide healers who possess stipulated qualifications and are subject to rules of conduct and discipline. The modern and traditional sectors are essentially complementary and should be accommodated within a legal framework of official health care that protects healers and healed alike. The legal implications of this strategy are discussed in a global as well as regional African context. / Jurisprudence / LL.D.

The traditional health care system as it prevails in South Africa is part of African culture and intricately linked with the African world view. It embraces traditional norms and values that have survived to this day. In this sense it is more than a constituent part of medical pluralism which has become a global phenomenon. The role of the traditional healer is far more extensive than that of the modern medical doctor. He advises on all aspects of life, including physical, psychological, spiritual, moral and legal matters. He shares the client's world view. He understands the significance of ancestral spirits, the belief in supernatural forces and the reality of witches. It is in this context that modern scientific medicine has not been able to replace traditional medicine, and arguably never will. Traditional medicine is faced with enormous challenges at present. Firstly, the traditional social order is fast disappearing, making way for the state and the individual whose rights as contained in the Bill of Rights of the 1996 Constitution of the Republic of South Africa may seriously clash with traditional norms. Secondly, especially in an urban environment, the healer may encounter stiff competition from more progressive colleagues and modern physicians. Thirdly, scientific medicine basically regards traditional activities as unscientific, unregulated, often harmful and sometimes fatal. Fourthly, anti-witchcraft legislation hinders the traditional practitioner to deal with witches in the culturally appropriate manner. Traditional medicine will not go away. It is therefore necessary to find ways and means to see it practised in a safe and competent manner. As healers agitate for official recognition, it will be regarded as their corresponding duty to professionalise the traditional sector, create a traditional medical council and establish a register of bona fide healers who possess stipulated qualifications and are subject to rules of conduct and discipline. The modern and traditional sectors are essentially complementary and should be accommodated within a legal framework of official health care that protects healers and healed alike. The legal implications of this strategy are discussed in a global as well as regional African context. / Jurisprudence / LL.D.

There are two independent streams of health care in South Africa: traditional healing and Western medicine. Proposals to formally integrate the two streams have been made by the World Health Organization and by the South African Department of Health. In this study, the philosophical background behind each of the two health care models is discussed, as well as literature on the possible integration of the two systems. It has not been clear if Western-trained health-care practitioners would be prepared to work with traditional healers. The purpose of this study was therefore to examine health care practitioners’ opinions, attitudes, knowledge and experiences with traditional healers, and to determine to what extent these variables would predict their intentions to work with these healers. A Within-Stage Mixed Model design was used, and data were collected using a selfdeveloped questionnaire. A total of 319 health care practitioners from State hospitals and clinics in Gauteng and Limpopo provinces participated in the study. The results of the study revealed significant differences between groups of health care practitioners in terms of their opinions, attitudes, experiences and intentions to work with traditional healers. Psychiatric nurses and psychiatrists showed more positive opinions, more positive attitudes, more knowledge and more willingness to work with traditional healers than do general nurses and physicians. Psychiatric and general nurses also had more experiences with traditional healing than did psychiatrists and physicians. The results also revealed that attitudes, knowledge, opinions and experiences predict Western health care practitioners’ intentions to work with traditional healers, with attitudes being the strongest and experiences the weakest predictors. Health care practitioners’ views of traditional healing were contradictory and ambivalent in many instances. This implies that integration of the two health care systems will be complex, that the current potential to integrate the systems is weak and that such integration can only be realised with considerable effort from all stakeholders. / Psychology / D. Litt. et Phil. (Psychology)

Thesis (M.Sc. (Botany)) -- University of Limpopo, 2013 / Traditional medicine plays a major role in the primary health care of many people residing in rural areas. People in these areas still consult traditional healers who utilise plants as medicine. Medicinal plants have come under increasing pressure due to a number of factors, which have resulted in the decline of certain species, extinction in others, and a general decrease in biodiversity of high use areas of South Africa, Blouberg Mountain included. To date there has been a lack of information on how traditional healers utilise the Blouberg Mountain with respect to amounts and species removed, or where the most important collecting sites are located. Thus, no conservation strategy exists for the Blouberg Mountain to ensure sustainable management of its natural resources. Furthermore, there is a perception amongst elders of this area that, as with indigenous knowledge around the world, the knowledge centered around Blouberg’s medicinal plants is declining, and little formal documentation of that knowledge has taken place. Consequently, this study investigated aspects related to medicinal plant use such as collection, patterns of collection, legislation, storage and packaging of medicinal plants by traditional healers around Blouberg Mountain. These were documented via a semi-structured questionnaire and a data collection sheet. Furthermore, traditional harvesting methods employed by traditional healers, and in situ conservation issues related to species removal from the mountain were investigated. Data was collected between September 2010 and September 2011. Sixteen villages in close proximity to the mountain, and 32 healers (two per village) were selected. In addition 16 consulting rooms were sampled (one per village) in order to gather information on the number of species collected from the mountain and stored in the consulting rooms. The 16 most used (indicated by village traditional healers) collection tracks, (one per village surrounding Blouberg Mountain), were travelled with traditional healers to record botanical and vernacular names of the medicinal plants, vegetation type, habitat, parts used, harvesting method, replacement value of plant species and perceived rarity of collected material. A Garmin GPS was used to record waypoints for the beginning and end of each track. Co-ordinates were logged automatically every 10 m. A map using Quantum GIS software to capture the position of the healers’ collection tracks, overlaid with topographical and vegetation information, and protected area information of the Blouberg Mountain, was generated. Geographic Information System software was used to geo-process the collection tracks of the healers with respect to where medicinal plants were collected relative to the various vegetation types. This gave information on vegetation types important to healers. The majority of traditional healers were females. Most of them had no formal education, with only a minority reaching secondary school. Due to their low level of literacy they tended to shy away from sources of written information, with the result that none of the questioned healers had any knowledge of the various national or provincial environmental legislations. The majority of them see between 15 and 20 patients per month. Most of the healers had more than 30 years of experience in traditional healing. The study found 64 plant species commonly used for medicinal purposes. Most of them were harvested for their roots and bark. According to the healers, Boophane disticha and Hypoxis hemerocallidea are declining in Blouberg Mountain, with Warburgia salutaris, endangered in South Africa, not perceived as rare or declining. However, a number of plant species recorded in the Red Data List as of least concern, or not threatened, are seen as rare by the healers. These include Clivia caulescens, Erythrina lysistemon, Lannea schweinfurthii and Maerua juncea. No exotic species were documented from the surveyed tracks. However, two naturalised exotics were collected from the mountain, namely Cassytha filiformis and Corchorus tridens. Cocculus hirsutus, a naturalised exotic and Abrus precatorius, an exotic species were found in one of the consulting rooms. Dichrostachys cinerea, Philenoptera violacea and Tarchonanthus camphoratus, which are indicators of bush encroachment, were identified on selected tracks. Tracks on which indicators of bush encroachment are present should be investigated more thoroughly to ascertain the extent and severity of such a threat. vii Investigations into healers’ collection tracks showed that the Soutpansberg Mountain Bushveld vegetation type is the most heavily utilised of the five vegetation types around Blouberg Mountain. This vegetation type is vulnerable to human population densities as most species were collected from it, therefore it should be conserved and managed if possible as it is targeted for plant species of medicinal value. The most travelled tracks were found in the Catha-Faurea Wooded Grassland community. Solutions to the problems of over harvesting of medicinal plants require local innovations and the full participation of traditional healers in resource management initiatives. The development of medicinal plant nurseries together with propagation of key species will be a crucial management tool, as this will reduce over harvesting of natural resources from the wild. In conclusion, it was found that although most species utilised around Blouberg Mountain are abundant and not threatened, healers are nevertheless concerned about dwindling medicinal plant supplies. They would welcome conservation initiatives and the use of GIS maps would be useful in prioritising conservation areas.

There are two independent streams of health care in South Africa: traditional healing and Western medicine. Proposals to formally integrate the two streams have been made by the World Health Organization and by the South African Department of Health. In this study, the philosophical background behind each of the two health care models is discussed, as well as literature on the possible integration of the two systems. It has not been clear if Western-trained health-care practitioners would be prepared to work with traditional healers. The purpose of this study was therefore to examine health care practitioners’ opinions, attitudes, knowledge and experiences with traditional healers, and to determine to what extent these variables would predict their intentions to work with these healers. A Within-Stage Mixed Model design was used, and data were collected using a selfdeveloped questionnaire. A total of 319 health care practitioners from State hospitals and clinics in Gauteng and Limpopo provinces participated in the study. The results of the study revealed significant differences between groups of health care practitioners in terms of their opinions, attitudes, experiences and intentions to work with traditional healers. Psychiatric nurses and psychiatrists showed more positive opinions, more positive attitudes, more knowledge and more willingness to work with traditional healers than do general nurses and physicians. Psychiatric and general nurses also had more experiences with traditional healing than did psychiatrists and physicians. The results also revealed that attitudes, knowledge, opinions and experiences predict Western health care practitioners’ intentions to work with traditional healers, with attitudes being the strongest and experiences the weakest predictors. Health care practitioners’ views of traditional healing were contradictory and ambivalent in many instances. This implies that integration of the two health care systems will be complex, that the current potential to integrate the systems is weak and that such integration can only be realised with considerable effort from all stakeholders. / Psychology / D. Litt. et Phil. (Psychology)

This qualitative study was aimed at exploring midwives’ responses and attitudes towards women in labour, as well as their perception of the pain experienced during labour. A non-probability purposive sampling method was followed, and the data collection methods selected were in-depth individual interviews and focus-group interviews, with the aid of an interview guide for both methods, the researcher being the main data collecting instrument. More than one data collection method (triangulation) was used to ensure the trustworthiness of the study. Concerning the perception of midwives towards women experiencing labour pain, the study revealed that firstly, labour pain is unique to individual women, it is natural and bearable. Secondly, labour pain may be unbearable, and the women in labour need to be given medication for pain. Furthermore, certain behaviour was identified and viewed as unacceptable by participating midwives because it could put both the lives of the mother and the unborn baby at risk; these include: drinking herbal medicines during pregnancy and childbirth; extreme activities like jumping out of bed and rolling on the floor. These behaviours were sources of frustration to midwives. / Health Studies / M.A. (Health Studies)

M. Tech. Entrepreneurship / The purpose of this study is to develop a consumer profile of traditional Chinese medicine consumption in South Africa. The research was based upon a nomethetic survey, a total sample size of 321 respondents was selected according to the convenience sampling technique to participate in the research. Descriptive data analysis was performed indicating that behaviour control and social impact norms primarily influencing the purchase of traditional Chinese medicine.

Thesis (MSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: In traditional medicine, there is a long-standing culture of combining herbal drugs to increase the therapeutic efficacy. The improved medical action is thought to be due to synergistic interactions between different plant bioactive components. The aim of this study was to test the pharmacological interactions in a medicinal plant combination which consisted of Agathosma crenulata, Dodonaea viscosa and Eucalyptus globulus. The rationale for the analysis of this particular mixture is that it had noteworthy antibacterial activity and exhibited the highest activity out of seven medicinal plant mixtures previously investigated. Using chromatographic analysis, the phytochemistry of the plants was also assessed. The chloroform: methanol (1:1; v/v) extracts or hydo-distilled essential oils (A. crenulata and E. globulus) were screened individually and in combinations (double and triple plant combination) for activity against five respiratory pathogens using a microdilution assay. The antimicrobial interactions in combinations were assessed with the fractional inhibitory concentration (FIC) and the isobolograms. The organic extracts generally showed the highest antimicrobial activity with E. globulus having the highest activity with MIC values below 1 mg ml-1 representing noteworthy activity. The overall activity of the aqueous extracts was poor. The essential oil activity of E. globulus was mostly noteworthy (0.5 to 2 mg ml-1) while A. crenulata essential oil displayed moderate activity (1 to 4 mg ml-1). The ΣFIC values for double combinations (1:1) of A. crenulata with D. viscosa, A. crenulata with E. globulus and D. viscosa with E. globulus were calculated from the minimum inhibitory concentration (MIC) data and the interactions were classified as synergistic, additive, indifferent and antagonistic. The highest synergistic interactions observed were for a 1:1 combination of A. crenulata with E. globulus against K. pneumoniae, S. aureus and B. subtilis with ΣFIC values of 0.07. There was only one incident of antagonism noted in the study for D. viscosa with E. globulus (1:1) against C. neoformans with ΣFIC value of 4.25. The double combinations against selective pathogens (K. pneumoniae, S. aureus and E. coli) were further analysed for interactions using isobolograms. Mostly, the antimicrobial interactions as presented by the isobolograms were congruent with FIC results which further validated the occurrence of relevant antimicrobial interactions in those combinations. The ΣFIC values for triple combinations (1:1:1) revealed mostly synergistic interactions. When the triple combinations were analysed further against certain pathogens based on the predictions of the Design of Experiments software program (MODDE 9.1®), the MIC values remained the same despite the different combinations that were tested Thin layer chromatography (TLC) was used for a quick chemical fingerprinting of the plant extracts. This was followed by a bio-autographic assay. The chemical profiles of the organic extracts and essential oils from two of the study aromatic plants (A. crenulata and E. globulus) were further analysed with liquid chromatography mass spectrometry (LC-MS) and gas chromatography mass spectrometry (GC-MS) respectively. For combined plant extracts, a multivariate data analysis using principal component analysis (PCA) and hierarchical clustering analysis (HCA) was used to determine the relationship of the chemical make-up of combinations with that of individual plant extracts. According to the TLC analysis, E. globulus extracts had more compounds than the other two plants in the study. For the bio-autographic assay, E. globulus and combinations that included this plant showed greater inhibition zones than A. crenulata and D. viscosa. For the LC-MS analysis, PCA and HCA showed a close relationship between A. crenulata with D. viscosa, D. viscosa with E. globulus and the triple combination. Twenty one components were identified in the essential oil of A. crenulata representing 88.83% of the total oil composition. The oil was dominated by oxygen-containing monoterpenes (46.25%). In the essential oil of E. globulus, twenty six compounds were identified making up to 95.62% of the oil composition. Oxygen-containing monoterpenes (32.98%) also dominated the E. globulus essential oil. There was no great variation in essential oil metabolites of the individual plants and their combination as shown by both PCA and HCA. The enhanced in vitro antimicrobial activity and pharmacological interactions (synergy and additivity) in some of the combinations (double and triple) that were tested in this study adds scientific support to the use of medicinal plant combinations in Western Cape traditional medicine. The metabolic profiles of plants in combination might be unique due to interaction of the different plant bioactive molecules and thus result into defined antimicrobial activity. / AFRIKAANSE OPSOMMING: In tradisionele geneeskunde is dit ’n lank bestaande kultuur om kruiemiddels te kombineer om die terapeutiese werking daarvan te verhoog. Dié verbeterde mediese werking word toegeskryf aan die oënskynlik sinergistiese interaksies tussen verskillende bioaktiewe plantkomponente. Die doel van hierdie studie was om die farmakologiese interaksies in medisinale plantkombinasies van Agathosma crenulata, Dodonaea viscosa en Eucalyptus globulus te bestudeer. Daar is op die ontleding van hierdie spesifieke mengsel besluit omdat dit oor beduidende antibakteriese waarde beskik en omdat dit uit sewe medisinale plantmengsels wat voorheen bestudeer is, as die doeltreffendste een aangewys is. Die fitochemie van die plante is ook met behulp van chromatografiese ontleding beoordeel. Deur middel van ’n mikroverdunningstoets is die chloroform:metanol- (1:1; v/v-)ekstrakte of hidrogedistilleerde vlugtige olies (A. crenulata en E. globulus) individueel sowel as in kombinasie (dubbele en drievoudige plantkombinasies) nagegaan vir hul werking met betrekking tot vyf respiratoriese patogene. Die gekombineerde antimikrobiese interaksies is met behulp van fraksioneel stremmende konsentrasie (FIC) en isobologramme ondersoek. Die organiese ekstrakte het oor die algemeen die meeste antimikrobiese aktiwiteit by E. globulus getoon, met MIC-waardes onder 1 mg ml-1 wat as noemenswaardige aktiwiteit beskou is. Die algehele aktiwiteit van die waterekstrakte was swak. Die vlugtige-olieaktiwiteit van E. globulus was merendeels noemenswaardig (0,5 tot 2 mg ml-1), terwyl die vlugtige olie van A. crenulata matige aktiwiteit getoon het (1 tot 4 mg ml-1). Die ΣFIC-waardes vir dubbelkombinasies (1:1) van A. crenulata en D. viscosa, A. crenulata en E. globulus, en D. viscosa en E. globulus is uit die minimum stremmende konsentrasie (MIC) bereken en die interaksies is as sinergisties, additief, neutraal en antagonisties geklassifiseer. Die sterkste sinergistiese interaksies is by ’n 1:1-kombinasie van A. crenulata en E. globulus met betrekking tot K. pneumoniae, S. aureus en B. subtilis opgemerk, met ΣFIC-waardes van 0,07. Die studie het slegs een geval van antagonisme opgelewer, naamlik by D. viscosa en E. globulus (1:1) met betrekking tot C. neoformans, wat ’n ΣFIC-waarde van 4,25 geregistreer het. Die werking van die dubbelkombinasies met betrekking tot gekose patogene (K. pneumoniae, S. aureus en E. coli) is voorts met behulp van isobologramme vir interaksies nagegaan. Die antimikrobiese interaksies wat uit die isobologramme geblyk het, was meestal in pas met FIC-resultate, wat die bestaan van tersaaklike antimikrobiese interaksies in daardie kombinasies verder bevestig het. Die ΣFIC-waardes vir die drievoudige kombinasies (1:1:1) het meestal sinergistiese interaksies aan die lig gebring. Toe die drievoudige kombinasies verder op grond van die voorspellings van die sagteware Design of Experiments (MODDE 9.1®) met betrekking tot sekere patogene ontleed is, het die MIC-waardes onveranderd gebly, ondanks verskillende toetskombinasies. Dunlaagchromatografie (TLC) is vir ’n vinnige chemiese ontleding van die plantekstrakte gebruik en is gevolg deur ’n bio-outografiese toets. Die chemiese profiele van die organiese ekstrakte en vlugtige olies van twee van die aromatiese plante in die studie (A. crenulata en E. globulus) is verder met vloeistofchromatografie-massaspektrometrie (LC-MS) en gaschromatografie-massaspektrometrie (GC-MS) onderskeidelik ontleed. Vir gekombineerde plantekstrakte is veelveranderlike-ontleding in die vorm van hoofkomponentontleding (PCA) en hiërargiese groepsontleding (HCA) gebruik om die verhouding van die chemiese samestelling van kombinasies in vergelyking met dié van individuele plantekstrakte te bepaal. Volgens die TLC-ontleding beskik E. globulus-ekstrakte oor meer verbindings as die ander twee plante in die studie. Vir die bio-outografiese toets het E. globulus en kombinasies daarmee groter stremmingsones as A. crenulata en D. viscosa getoon. In die LC-MS-ontleding het PCA en HCA op ’n hegte verhouding tussen A. crenulata en D. viscosa, D. viscosa en E. globulus, en die drievoudige kombinasie daarvan gedui. Een-en-twintig komponente is in die vlugtige olie van A. crenulata gevind, wat 88,83% van die algehele oliesamestelling uitmaak. Die olie is deur suurstofhoudende monoterpene (46,25%) oorheers. Die vlugtige olie van E. globulus het 26 verbindings opgelewer, wat 95,62% van die oliesamestelling uitmaak. Suurstofhoudende monoterpene (32,98%) het ook die vlugtige olie van E. globulus oorheers. Nóg PCA nóg HCA het op enige beduidende variasie in die metaboliete van die vlugtige olies van die individuele plante en hul kombinasies gedui. Die verhoogde in vitro- antimikrobiese aktiwiteit en farmakologiese interaksies (sinergie en additiwiteit) in van die kombinasies (dubbel én drievoudig) wat in hierdie studie getoets is, bied wetenskaplike stawing vir die gebruik van medisinale plantkombinasies in Wes-Kaapse tradisionele geneeskunde. Die metaboliese profiele van plantkombinasies kan verander weens die interaksie van die verskillende bioaktiewe plantmolekules, en kan baie bepaalde antimikrobiese aktiwiteit tot gevolg hê.

<p>The aim of this study was to investigate indigenous knowledge of vegetation resource utilisation, in particular the use of traditional medicinal plants in the provision of health care in the community of Khayelitsha and to determine traditional resource management approaches.</p>