Whilst hospitals are the dominant institutions through which Western biomedical treatment is delivered, it is also argued that these institutions do not reproduce a distinct notion of a biomedical model, but instead assume different configurations, reflecting and replicating wider socio-cultural processes. In South Africa, this includes a reflection and replication of challenges arising from an eclectic therapeutic landscape in which biomedicine is but one avenue. The challenge presented is that South Africa’s dominant therapeutic cultures of African traditional medicine, said to be used by an estimated 80% of the population, and Western biomedicine, reflect two distinct, and arguably conflicting, ontological and epistemological paradigms. A recognition of this is encompassed in many hospital ethnographies exploring how biomedical professionals confront and manage the collision of these therapeutic systems within the institutional space. Whilst such studies have been carried out in a number of African country-settings, this interface of therapeutic cultures in South African hospitals has received scant attention. Using a range of interpretive research methods that include narrative, informant, and respondent interviews, this project, carried out within two public hospitals in the town of Barberton, South Africa, explores the views, experiences, and perspectives of hospitalbased biomedical professionals, and hospital-bound tuberculosis patients, on the articulation of African traditional medicine and Western biomedicine. Barberton tuberculosis hospital Using a narrative approach, an exploration of TB patient’s stories of navigating the plural therapeutic landscape is undertaken. These examine the complex navigation of a plural medical ecology, the conflict arising as a result, as well as how personal accounts reflect broader meta-narrative illness archetypes. Alongside this, is an examination of the conflict between nurses and patients within the hospital-confines that arises as a result of the interface between African traditional medicine and Western biomedicine. This is examined in the context of a TB treatment facility that reflects strong Foucaultian characteristics of institutional control, and observation of patient bodies and behaviours. Barberton general hospital Using informant and respondent interviews, an exploration of the positioning, views, and sometimes allegiances of nurses and doctors towards African traditional medicine and Western biomedicine, is undertaken. This includes an examination of the described articulation between these therapeutic cultures within the biomedical space. A particular emphasis is placed on examining the role of nurses as brokers of culture, as they mediate and broker conflict arising as these therapeutic systems collide. This study presents a complex milieu of views and positions regarding the interface between African traditional medicine and Western biomedicine. Tuberculosis patients portray convoluted and meandering health seeking journey’s between healing systems, and both nurses and tuberculosis patients, describe an institution attempting to position itself as distinctly biomedical. Whilst African traditional medicine does emerge within this hospital space, this is largely clandestine, and is actively discouraged by biomedical staff through vigilant observation and oversight that is interpreted by patients as overt, and excessive biomedical control. In the general hospital, nurses and doctors described how African traditional medicine is encountered and confronted, where it is largely viewed as clouding and complicating biomedical healing and treatment endeavours. The range of views on these ontologically distinct systems, are broad, where health professionals who reject traditional medicine, and those, mainly nurses, who use traditional medicines, work side-by-side – sometimes leading to internal conflict. An exploration of the role of nurses as culture brokers is complex, where nurses describe encountering significant conflict in mediating between patients expectations, expectations demanded by professional roles, and their cultural allegiances. This is embedded within a complex political landscape, where biomedical practitioners who position themselves against African traditional medicine, feel reluctant to voice concerns in a post-apartheid institution that prioritises cultural pluralism, and respect for personal beliefs. This project uncovers the conflict and tensions arising from the plural medical landscape within, and without Barberton’s hospitals, as well as how the stance towards therapeutic pluralism by biomedical professionals differs between these institutions depending on context.

Dissertation submitted in fulfilment of the requirement for the degree of Master of Education in the Department of Educational Psychology at the University of Zululand, 2001. / This research study examined the prospect and scope for traditional medicine in the South African education support services. The first aim was to assess teachers' perceptions of the need for traditional medicine practices in the school. The second aim was to investigate the problems experienced by learners which require traditional medicine practices as solutions within the school. The third aim was to determine the procedures that can be followed in order to provide traditional medicine to meet the learners' needs. The fourth aim was to provide certain guidelines regarding traditional medicine intervention within a school. The fifth aim was to find whether teachers' perceptions of traditional medicine in schools are influenced by the teachers' characteristics. Lastly, to find out whether there is any agreement among ranks assigned by the respondents to: ♦ job opportunities amenable to creation through the use of traditional medicine. ♦ afflictions amenable to treatment by traditional medicine. A Likert scale was constructed to measure the areas indicated by the aforementioned aims of study. The quantifying instrument was administered to a representative sample of teachers. Sixty six completed questionnaires were analysed. The Chi-square Test and frequency distribution methods were used to analyse data. The important findings revealed that teachers endorsed scale items on positive rather than negative perceptions.

In South Africa, indigenous plant species are used and traded for traditional medicine (muthi) and so are alien plant species. A literature review of 40 previous studies and survey work at various outlets, including muthi markets and muthi shops in Johannesburg, Durban and Pretoria, found that 320 alien plant species are used and/or sold for traditional medicine in South Africa. Fifty three of the 320 species were found to have weed and/or invader status. Surveys at Faraday and Warwick muthi markets in Johannesburg and Durban respectively as well as muthi shops in Johannesburg, Durban and Pretoria were conducted from October 2010 to February 2011. The following aspects regarding the plant material traded were recorded: the differences in the number of volumes traded; the differences in the number of alien species sold in the markets and shops (and also in Indian and Black-owned shops); the source and origins of these and the viability of propagules sold in the muthi trade. The surveys found that 49 alien plant species were sold and approximately 87 x 50kg-size bags of alien plant material was present in the markets and shops during the time of the survey. Muthi shops sold more than double the number of alien plant species than were sold in the markets and the same result was found for Indian versus Black-owned shops. Alien species were either harvested in South Africa, predominantly in KwaZulu-Natal (KZN), or imported from India. Indian-owned muthi shops sold more species imported from India than alien species that were naturalised and harvested in South Africa. In contrast, the majority of alien species sold at markets and Black-owned shops were harvested in KZN. Viability tests found that 24% of alien plant species sold in this study had greater than 50% viability. Six invasive species are traded in low volumes with viable propagules sold for five of these, highlighting a possibility of spreading through the traditional medicine trade. The study concluded that the total trade in alien plant species is trivial in comparison to the trade of indigenous plant species.

The relationship between human activity and the environment has created ecological, socio-economic and cultural patterns and feedback mechanisms that govern the presence, distribution and abundance of plant species assemblages. The trade in traditional medicinal plants in South Africa is estimated to be worth approximately R2.9 billion per year with 27 million consumers throughout the country. Bulbous species compose about 14% of the traded medicinal plant species in South Africa, however the majority of research at the species or generic level has concentrated on a limited number of life forms and plant parts and the ecological consequences of harvest and use of commonly used bulb species is poorly known. Ethnobotanical studies generally focus on ‘ethnospecies’ – i.e. the traditional name that a species may be known by. Species-specific evidence of the effects of trade and harvest is needed to provide more clarity on the implications of trade, especially since increased commercialisation of medicinal plants has often resulted in over-harvesting and, in severe cases, near extinction of valued indigenous plants. The overall aim of this study was to determine the ecological consequences, as well as some of the economic implications of harvesting important bulb species for the regional medicinal plant trade. Traditional medicinal bulb species are susceptible to over-exploitation because they are destructively harvested in large quantities. Four perennial bulbous genera were surveyed: two within the Amaryllidaceae (Boophone and Crinum) and two in the Hyacinthaceae (Bowiea and Drimia). Some discrepancies were noted where traders and traditional healers recognised species that have been synonymised by taxonomists. In order to understand the impacts of all recognised forms, original nomenclature was used to describe different bulb forms that had been synonymised. The proposed ‘functional taxonomy’ does not aim to re-examine the taxonomic revisions by previous taxonomists but rather provides a way to identify forms that have no accepted species name. In this way, the impacts on harvesting of different bulb forms can be quantified. Based on this functional taxonomy, the genus name Urginea has been used although Urginea is currently synonymised under Drimia. However, this is only to describe the different bulb form and is not meant to replace the current taxonomic nomenclature. Surveys were conducted in two national level and two small regional level markets to determine the impacts of trade. Bulb characteristics were described and used together with taxonomic literature to produce a key to bulbous species commonly traded in the markets of South Africa. Distribution data and other important information were collected and combined to provide species-specific information. Identification based on vegetative characteristics was possible, with certain features being more useful than others for creating a key. The most useful identification characteristic was the bulb scale type in the Hyacinthaceae together with bulb shape and colour, while bulb size was least useful. For the Amaryllidaceae, bulb colour and characteristics such as tunics cannot always be used due to similarities between species. However, bulb size and shape are helpful indicators and can group species into classes of similar species. Leaf characteristics are very important and may be the only way to accurately identify some species. The adaptation of taxonomic information and previous keys into more ‘vegetative’ friendly keys can provide ethnoecologists with an identification tool not solely based on ethnospecies name. The ability to identify species will allow ethnoecologists to provide more comprehensive assessments on the impact of the trade. The diameter of bulbs sold at Faraday market (Johannesburg), Warwick market (Durban) and smaller Free State markets were recorded for four genera (Bowiea, Boophone, Crinum, and Drimia – including Urginea forms), and the data were used in a variety of ways to determine the effects of trade. Populations of species of anthropogenic importance should show a corresponding decrease in the frequency of individuals in large size-classes and a decreased number of size-classes with time. Size-class distributions of Drimia delagoensis and Bowiea volubilis followed an inverse J-shaped curve, often indicative of a regenerating population (high frequency of small bulbs); however, in this case intense harvesting pressure has resulted in a highly skewed population structure. High rates of harvesting will ultimately result in regeneration failure because smaller bulbs are unable to reach maturity before harvest. All species studied tended towards smaller mean market bulb diameters over time. These trends suggest that without appropriate mitigation, bulb populations will be further impacted in the future. Bulb diameters in the market were also smaller than diameter records collected from herbarium material and literature records. Bowiea volubilis is the most severely impacted by the medicinal plant trade, with approximately 87% of bulbs <4cm in diameter, and significantly smaller than both bulb diameters in medicinal plant markets in 2001 (p<0.0001) and pressed bulbs from several herbaria (p<0.0001). The large bulbed Amaryllidaceae species Boophone disticha and Crinum species also showed a decrease in bulb diameter between the 2001 and 2007 Faraday surveys (by 1.5cm and 2.7cm, respectively), while Urginea epigea (Hyacinthaceae) showed a 1.2cm decrease in mean size in 6 years. Traditional healers, traders and harvesters can provide a wealth of information on species populations in the wild. Trader and harvester preferences may affect the impact of harvesting and trade on wild populations. Information on trader/harvester preferences and perceptions was gathered from Warwick and Free State markets. Overall, the average earnings per month per trader selling medicinal plants were low (approximately R833 in Warwick and R2,100 in Free State). Bulb species contributed 10-40% of the total earnings per trader at Warwick and 10-50% in the Free State markets. The relatively large contributions of bulb species to trader incomes emphasise the importance of popular bulb species economically and socially. The number of bulbs (equivalent in size to the mean bulb diameter) harvested annually was large and provides an order of magnitude estimate of harvesting impacts on medicinal plant species populations. The number of Drimia elata harvested was greatest in the Free State (between 600,000 and 1,400,000 dependent on estimation method). In Warwick, species sold in the largest quantities were D. robusta, Crinum species, B. volubilis and U. epigea (approximately 400,000 – based on actual volume). The high variability of number of bulbs harvested between traders suggests that these numbers should be treated with caution. The number of populations required and the rate of population regeneration needed to sustain harvesting for the traditional medicine trade is extremely high; and, without mitigating factors, the increased commercialisation of the medicinal plant industry may have potentially dramatic, negative implications on popular bulb populations. Social surveys and ethnobotanical work in local markets are the first steps in understanding patterns of demand for particular plant species, and integrated with population structure and size-class distributions, it allows for an amalgamated and complex awareness of the impacts of resource harvesting. With over 30,000 species of animals and plants that are detrimentally affected by trade worldwide, market surveys are increasingly important to provide information on the extent of trade. The varied data collected in this study included: size-class distributions, temporal changes in bulb diameter, volume and number of bulbs harvested, economic value and trader perceptions. Overall, the results suggested that all species studied were negatively impacted by harvesting to various degrees. In South Africa, harvest and trade is sometimes the only form of income generation and harvest can threaten species populations. By quantifying the volume, value and the number of individuals harvested for bulb species, together with perceived scarcity and popularity and place of harvest, a better understanding of the state of the resource-base has been provided. Continued use of market surveys as monitoring tools is important, because in the current (2011) socio-economic context of South Africa, trade and harvest is likely to increase.

This study was undertaken to explore trainee and registered psychologists' perceptions of indigenous healing, its recognition, its inclusion in the formal mental health care system, and its role in the mental health care system. A qualitative, exploratory, and descriptive study was conducted in Durban. Unstructured interviews and focus group interviews were conducted with registered and trainee psychologists respectively. Data was analyzed using thematic content analysis. Based on the findings the following conclusions were drawn: In comparison to student psychologists, intern and registered psychologists held more positive views about indigenous healing, its recognition, its role, and its inclusion into the formal health care sector. Most participants reported that they would not refer to indigenous healers unless a client made an explicit request; registered psychologists were more confident about their ability to collaborate with indigenous healers; and most participants reported a need for more knowledge on indigenous healing. The implications of these findings are discussed. / This study was undertaken to explore trainee and registered psychologists' perceptions of / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

Thesis presented in partial fulfilment for the degree of Master of Management (in the field of Public Sector Monitoring and Evaluation) to the Faculty of Commerce, Law, and Management, University of the Witwatersrand March 2016 / The South African public health care system is and continues to experience shortage of professional health care workers like other developing countries. These professional health care workers leave the country for better salaries and working environment for private sector and developed countries. The aim of the study is to gather and analyse information on how to integrate traditional health practitioners into the South African primary health care system to address the shortage of the health care workers. This qualitative study used a cross-sectional design to explore the perception, knowledge and recommendation of the national and district Department of Health officials, the western practitioners, the traditional practitioners and the SA citizens in Pretoria, South Africa on how to address this problem. Thirteen individual in-depth interviews and one focus group with the four categories of the research participants were conducted using a semi-structured interview guide. The results indicated that the SA government in partnership with the Interim Traditional Health Practitioners Council have opted for a parallel system to integrate the traditional practitioners into the primary health care level. For the parallel system to be fully implemented there are still issues that need to be achieved by the key stakeholders, one is for the government to build the traditional health care facilities for traditional practitioners, whilst the ITHPC finalise the registration of the traditional practitioners and approval of the Traditional Health Practitioners Regulations of 2015. Lastly, the District Health System has to prepare themselves for a new entrant, which is the traditional health care, into the primary health care to complement the existing system. / MT2017

Thesis (M.A. (African Languages)) -- University of Limpopo, 2011 / The mini-dissertation investigated the ways in which one qualifies as a traditional healer in Tshivenda. The study has discovered that a person cannot choose to become a traditional healer, he or she is chosen by the ancestors into this profession and they make their wishes known to the person concerned through continuous illness and dreams. Nowadays, there is an increased number of traditional healers in the community. It seems as if the community is confused as to whether all these healers have gone through the proper ways of becoming a traditional healer in Tshivenḓa or they are largely interested in the economic gain.

This study sought to ascertain the role that is played by traditional healers in healthcare delivery among the Nguni people of South Africa. Its objective is to ascertain who the traditional healers are, how they are trained for the profession, how they practice their profession including how people consult with them, how they gather information relevant to identify the problems of their clients, what interventions are put in place once health problems have are identified and generally the role traditional healers play in the wellbeing and upliftment of living conditions of their communities. Three traditional healers were interviewed and observed, generating important information for the study. The study found out that traditional healers are respected traditional or community leaders whose main contribution to the community is practicing healthcare delivery by which they bring well-being to the generality of the people. Traditional healers are called to their profession by their ancestors. The training of traditional healers is by apprenticeship with experienced renowned traditional healers and the training takes place between two and six years. Training takes place in the skills of diagnosis or the gathering of information, through observation, interviews, divination and the interpretation of dreams to arrive at a decision as to the probable healthcare needs or health problems of patients. Traditional healers are generally trained to be capable of identifying different kinds of problems affecting people, whether these be physical, mental or interpersonal relationship problems. Training in skills to intervene in health matters are provided including herbal medication, interpersonal interactions and as in group healing or ritual ceremonies as well as training in the skills of prevention of ill-health and promotion of health. Other skills in which traditional healers are trained include those of advocacy, mobilization and being custodians of the people's traditional culture. Traditional healers are generally trusted for their competency and the efficacy of their intervention strategies and this explains the reason for the people's generally positive behaviour tendency towards the utilization of traditional healer's services. Traditional healers generally bring about well- being to the people in their communities. / Thesis (M.Ed.) - University of KwaZulu-Natal, 2007.

Aflatoxin B1 (AFB1), a potent hepatotoxic and hepatocarcinogenic mycotoxin synthesised by toxigenic fungi (Aspergillus flavus and Aspergillus parasiticus), is a common contaminant of many cereal commodities consequently posing a major threat to human and animal health. Sutherlandia frutescens (SF), a traditional medicinal plant endemic to Southern Africa, is commonly used by many cultures as a tonic for various health-related conditions. Incidentally, the present study aimed at investigating the potential hepatoprotective capacity of SF and L-canavanine (L-can, a major constituent of SF) against AFB1-induced cytotoxicity in human HepG2 cells and used a standard treatment procedure of 24 h. Cell viability was evaluated using the methyl thiazol tetrazolium (MIT) assay, which effectively demonstrated the ability of SF, when administered individually and in combination with AFB1, to be significantly cytotoxic to HepG2 cells in a dose-dependant manner. Reactive oxygen species (ROS) and consequent peroxidative damage caused by AFB1 are considered to be the main mechanisms leading to hepatotoxicity and was confirmed by the thiobarbituric acid reactive substances (TBARS) assay which revealed that AFB1 mediated a significant increase in lipid peroxidation. Additionally, comet assay analysis demonstrated the most pronounced effect to be observed following administration of AFB1. In contrast, AFB1-mediated genotoxicity was significantly reduced by SF and L-can. Such amelioration can be attributed to the marked increases in glutathione (OSH) levels observed after the co-administration of SF and L-can with AFB1. Cytoprotection by SF and L-can against AFB1-induced toxicity was further substantiated by the significant increases in heat shock protein 70 expression. Moreover, when SF and L-can were co-administered along with AFB1, analysis by flow cytometry revealed that AFB1 induced increases in apoptosis and necrosis were reduced. The findings of this study propose that SF and L-can may be selectively effective in alleviating AFB1-induced cytotoxicity and lends pharmacological credibility to the suggested ethnomedical uses of SF. However, the exact mechanism of action and the extracts efficacy in humans requires further authentication. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

Chronic non-communicable diseses are a global public health challenge that continuously threatens the development and health of humans. Risk factors such as unbalanced diet-the high consumption of processed food or food from animal origin are responsible for NCDs. NCDs result in weakened immune system, making the host susceptible to opportunistic infections. Thus, the NCDs burden is most times chronic and multiple with the illness and suffering of the affected person numerous. The lack of cure for NCDs, the high cost of drugs, their high side-effects, and the emergence of multiple drug resistance has given rise to the investigation of other sources for therapeutic cure such as medicinal plants. The ethanol, n-hexane and ethyl acetate extracts of Olea europaea were analysed for their antioxidant and antimicrobial activities. The essential oil was also analysed for their chemical constituents. The n-hexane extracts of O. europaea exhibited no inhibition against all of the microorganisms tested, while the ethyl acetate and ethanol extracts exhibited inhibition, with minimum inhibitory concentration values between 0.625 mg/ml to 1.25 mg/ml. The ethanol leaf and ethyl acetate stem extracts exhibited significant activity in the inhibition of 2, 2-azinobis-(3-ethylbenzothiazolin - 6-sulfonic acid diammonium salt (ABTS) free radical, the n-hexane leaf extract had the overall significant lipid peroxidation inhibition activity, while in the inhibition of 2, 2- diphenyl-1-picrylhydrazyl radical (DPPH), the ethanol and ethyl acetate leaf extracts had strong activity. Nonanal, phytol, α-Pinene, α-Phellandrene, spatulenol and farnesol were some of chemical components identified after the GC-MS analysis of O. europaea oil. In the final part of the dissertation, Euryops brevipapposus essential oil was assessed for the antioxidant activities using free radical scavenging assays. In addition to this, the antimicrobial activities were assessed and the chemical composition was analysed using GC-MS. The essential oil demonstrated significant antioxidant activity against 2, 2-diphenyl-2-picryl-hydrazyl free radical (DPPH), 2, 2′-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) and lipid peroxides with IC50 value of 0.0000000671 mg/ml, 1.05 mg/ml, and 1.170 mg/ml respectively. The essential oil also showed significant activity against all microorganisms tested with minimum inhibitory concentration (MIC) values between 0.055 mg/ml to 0.5 mg/ml. α-pinene, α- Phellandrene, germacrene D, β-pinene, trans- β.-Ocimene, bicyclogermacrene and β -Phellandrene were some of the chemical compounds identified in E. brevipapposus oil. The study has shown that E. brevipapposus and O. europaea are abundant in phytochemical compounds which were thought to be the root cause for the activities demonstrated. Therefore, these therapeutic properties observed validate and elucidate the traditional usage of the both plants in the treatment /management of diseases.