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.

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.

A dissertation submitted to the Faculty of Science under the School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master in Science. Johannesburg, June 2017. / In South Africa, the anti-HIV-1 activity of various indigenous plants has not been studied extensively. Most of the phytochemical screening work has focused on anti-cancer activity with less attention given to infectious diseases. A large proportion of South Africans (70-80%) still rely on traditional medicines for treatment of various ailments. And, therefore, there is a need to evaluate and validate the effectiveness of the traditional medicines. The aim of this study was to identify, screen, phytochemically characterize and isolate bioactive compounds from a South African herbal extract that exhibit the best anti-HIV-1 activity. Three extracts were prepared: an ethanol extract, a dereplicated ethanol extract and an aqueous extract from a herbal concoction comprised of a mixture of six plants. These herbal concoctions were investigated for anti-HIV-1 subtype C activity. Phytochemical profiling of the ethanol- and dereplicated ethanol- extracts from the herbal concoctions showed the presence of intermediate polar compounds (flavonoids, alkaloids, sugars and terpenes) for both extracts, while the aqueous extract contained predominantly highly polar compounds. Anti-HIV-1 screening of the three extracts showed that the ethanol and dereplicated ethanol herbal- extracts had the best anti-reverse transcriptase activity. The ethanol extract had mean IC50 values of 56.53, 53.96 and 55.39 μg/ml against MJ4, Du179 and CM9 HIV-1 subtypes C isolates, respectively. The dereplicated ethanol extract had mean IC50 values of 51.87, 47.56 and 52.81 μg/ml against MJ4, Du179 and CM9 HIV-1 isolates, respectively. The aqueous extract was inactive against HIV-1 activity. Moreover, both the ethanol- and dereplicated ethanol- extracts showed activity against HIV neutralization. The ethanol- and dereplicated ethanol- extracts had mean IC50 values of 36.33 and 32.06 μg/ml, respectively. Furthermore, they also potently neutralized Vesicular stomatitis virus (VSV) yielding mean IC50 values of 24.91 and 20.82 μg/ml for ethanol- and dereplicated ethanol- extracts, respectively. All extracts were inactive against Murine leukemia virus (MLV). The isolation and phytochemical characterization of the bioactive compound(s) was done by utilizing various chromatographic and spectroscopic methods. Four homoisoflavanoids were isolated and tested for anti-HIV-1 subtype C activity. Three compounds (1, 3a and 3b) were inactive while compound 2 was found to be bioactive against HIV-1 reverse transcriptase (RT) and yielded mean IC50 values of 7.23 ± 1.88, 12.83 ± 0.41 & 12.81 ± 0.10 μg/ml for MJ4, CM9 and Du179 HIV-1 subtype C isolates, respectively. Compound 2 had a mean CC50 value of 23.08 ± 0.1981 μg/ml against HEK293T cells. Overall, the data suggested that ethanol- and dereplicated ethanol- herbal extracts possess direct and indirect anti-HIV-1 activity. They possess a cocktail of phytochemicals that can inhibit HIV-1 RT, HIV-1 entry. Furthermore, these extracts possess phytochemicals that can lower the activation of inflammatory responses during an infection and, hence, reduction in the number new cells infected during the course of HIV-1 infection. Moreover, they possess phytochemicals that have antioxidant activity which, in relation to HIV infection, results in a boosted immune system response in order to ward off the virus. / MT 2017

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.

M.A. (Psychology) / Please refer to full text to view abstract

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2012. / Background : The current alarming growth of diseases and complications, especially in Africa, makes the integration of traditional and conventional health practices a priority in medical training, research and planning, and the funding of health services. Unplanned and/or unintended treatment non-compliance and unnecessary deaths from diseases like tuberculosis and Human Immunodeficiency Virus are escalating in spite of health information and/or education, support groups and awareness events. The World Health Organisation recommends Directly Observed Treatment Strategy for illnesses like tuberculosis, and suggests the inclusion of traditional health practitioners in the strategy because they are constantly in contact with the community and could therefore be utilized as reminders, support system, doctors and care givers. Therefore it is a high priority that traditional health practitioners be integrated into partnership with conventional medicine practitioners, as they are considered the entry point to primary health care programmes in South Africa. Aim of the study The aim of this study was to explore the nature of the partnership between the African traditional and conventional health care in the eThekwini District. Methodolody : A qualitative, multiple case study design was used to explore the partnership between African traditional and conventional health care within the South African health care system in the eThekwini district of KwaZulu-Natal Province. In attempting to explore and understand the extent to which both these health care systems work together, a qualitative research method was used. All ethical issues were considered after which individual interviews were conducted using an interview guide and a tape recorder. A cross-case synthesis was used to analyse data. Results : Results from the study suggest that a partnership is far from being implemented by both the Traditional Health Practitioners and Conventional Health Care Practitioners. It is apparent that they both do not share a common vision. The government has some responsibility and a major role to play in guiding such a partnership and making sure that the South African community is provided with best practices governed by policies and legislation that are transparent, fair and legally binding to everybody involved.

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

South Africa hosts a plural healthcare system that includes an allopathic sector and a complementary and alternative healthcare sector. This research report seeks to understand the motivations behind why people use the complementary system of Ayurveda, in South Africa and how they decide on its use through processes governing their decision making methods. The literature review summarises the key theoretical framework which moulded the study. The themes incorporated in the review include medicine’s evolution, Ayurveda, medical pluralism and complementary and alternative medicine, the illness experience and help seeking behaviour, the sick role and its relation to help seeking behaviour, and the Health Belief Model. The research was qualitative in nature and entailed semi structured interviews that were conducted with twenty seven Ayurveda users and three Ayurvedic doctors. The findings and analysis draw on the literature review, and when analysed, are developed into three coherent themes namely Ayurveda in South Africa (sets the scene of Ayurveda within the country), Reasons for using Ayurveda (the motivations behind people’s help seeking behaviours toward the system), and the use of Ayurveda in relation to other healing systems. The research found that Ayurveda is currently undergoing resurgence in South African society and in the process links itself to the wider global context that Ayurveda has situated itself. We also discover that participant’s decisions on the use of Ayurveda were decided upon through a multitude of factors and often Ayurveda was also utilised in many different situations rather than for a single case. Such interconnecting factors include their socialisation, lay referrals, interest in alternative systems, a sense of Indian pride and a cynical perception of Western medicine. Alternative or complementary system use was decided upon through factors that linked to people’s access of the alternative services and its affordability. Decisions ultimately were made to use Ayurveda as a complementary system to allopathy. Finally the conclusions of the study indicate that Ayurveda was transferred to South Africa, from India, through the country’s system of indentured labour where knowledge of the practice was passed down along generations. The research also deduces that it is primarily the Indian race that uses Ayurveda in South Africa and as such the healing system is more prominent in Indian areas. In addition, Ayurveda was not found to be a viable health or healing option for the wider South African population for whom its affordability and accessibility pose barriers.