‘A thing full of stories’: Traditional healers’ explanations of epilepsy and perspectives on collaboration with biomedical health care in Cape Town

Abstract

The experience of epilepsy is profoundly culturally mediated and the meanings attributed to the condition can have a great impact on its social course. This qualitative study used Kleinman’s Explanatory Model framework to explore traditional healers’ perspectives on epilepsy in an urban township in Cape Town, South Africa. The healers who participated in the study were Xhosa-speaking, had experience caring for patients with epilepsy, and had not received any training on epilepsy. Six individual in-depth interviews and one focus group with nine traditional healers were conducted using a semi-structured interview guide. Traditional healers identified several different names referring to epilepsy. They explained epilepsy as a thing inside the body which is recognized by the way it presents itself during an epileptic seizure. According to these healers, epilepsy is difficult to understand because it is not easily detectable. Their biomedical explanations of the cause of epilepsy included, among others, lack of immunizations, child asphyxia, heredity, traumatic birth injuries and dehydration. These healers believed that epilepsy could be caused by amafufunyana (evil spirits) and that biomedical doctors could not treat the supernatural causes of epilepsy. However, the healers believed that western medicines, as well as traditional medicines, could be effective in treating the epileptic seizures. Traditional healers were supportive of collaboration with western-trained practitioners and highlighted that the strategy must have formal agreements in view of protection of intellectual property, accountability and respect of their indigenous knowledge. The findings suggest a need for interventions that promote cultural literacy among mental health practitioners. Research is urgently needed to assess the impact of such collaborations between biomedical services and traditional healers on epilepsy treatment and care.

Seizures in Namibia: A study of traditional health practitioners

“…The use of plant and animal material in seizure treatment is never standardized and is often adjusted and applied depending on the person's needs and the perceived cause of the seizures. This corresponds to findings from studies performed in other African countries that reported the use of herbs, animal products, and insects during treatment . Success is measured by the complete absence of seizures, which is again entirely possible if the THP is treating the person for what is known as PNES according to Western definitions.…”

“…They do, however, make a distinction between medical seizures, which can be treated by Western medicine, and spiritual seizures that can be treated only by THPs. A study among healers in South Africa reported similar findings where participants provided diverse biomedical and local cultural explanations as to the causes of epilepsy . A distinction is therefore made between seizures as a result of identifiable physical causes and seizures that originate as a result of psychological or spiritual causes.…”

“…In this context, it is clear why people with seizures may seek help from THPs who are familiar with local cultural beliefs and who are often more physically and conceptually accessible. Studies in Africa have shown that THPs play an integral role in the treatment of epilepsy . Despite this evidence, THPs’ role in the treatment of seizures in Namibia remains unrecognized and their practices unregulated.…”

“…As in other African countries, THP practices focus on the person as an individual with a unique diagnosis and treatment plan guided by divination . A typical “treatment session” for THPs does not correspond to the Western concept of 1‐hour psychotherapeutic sessions.…”

“…Until such time when THPs are formally recognized as legitimate service providers and their role in the treatment of seizures acknowledged, their contribution to health care will not be utilized to the fullest extent in Namibia. Especially in SSA, where the seizure treatment gap is significant and access to healthcare facilities is severely limited, the THPs can play a major role in addressing these shortcomings . Regulation of this industry and the introduction of formal training opportunities for THPs may address some of the misgivings of HCPs about the role of THPs in health care.…”