Biomedical Hegemony and Democracy in South Africa


In Biomedical Hegemony and Democracy in South Africa Ngambouk Vitalis Pemunta and Tabi Chama-James Tabenyang unpack the contentious South African government’s post-apartheid policy framework of the ‘‘return to tradition policy’’. The conjuncture between deep sociopolitical crises, witchcraft, the ravaging HIV/AIDS pandemic and the government’s initial reluctance to adopt antiretroviral therapy turned away desperate HIV/AIDS patients to traditional healers.

Drawing on historical sources, policy documents and ethnographic interviews, Pemunta and Tabenyang convincingly demonstrate that despite biomedical hegemony, patients and members of their therapy-seeking group often shuttle between modern and traditional medicine, thereby making both systems of healthcare complementary rather than alternatives. They draw the attention of policy-makers to the need to be aware of ‘‘subaltern health narratives’’ in designing health policy.

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Ngambouk Vitalis Pemunta, Ph.D, (2009), Central European University, is lecturer of Global Health at the School of Public Health and Community Medicine, University of Gothenburg. He has (co-)authored three monographs and scholarly articles on sexual and reproductive health, and environmental governance.

Tabi Chama-James Tabenyang holds an MA in Social Anthropology from Walters Sisulu University, South Africa and is a doctoral candidate in the same field at the University of Bayreuth, Germany.
List of Illustrations
Local Words and Expressions

1 Prelude: the Globalization of Traditional Knowledge Systems
 1.1 Introduction
 1.2 Definition of Concepts
 1.3 The International Context of TCAM Practices
 1.4 Different but Complimentary?
 1.5 Lay Out of Work

2 Subject Matter, Method and Theoretical Framework
 2.1 Introduction
 2.2 Choice of Study Area
 2.3 Methodological and Theoretical Framework
 2.4 Data Analysis
 2.5 Ethical Considerations and Reflexivity
 2.6 Theoretical Framework
 2.7 Conclusion

3 Traditional Medicine, Colonialism and Apartheid in South Africa
 3.1 Introduction
 3.2 Biomedical Capitalism
 3.3 Colonialism, Biomedical Hegemony and Alternative Healthcare
 3.4 The Pre-Colonial Era
 3.5 The Colonial Era
 3.6 The Post-Colonial Era
 3.7 Conclusion

4 Democracy, Witchcraft and Traditional Medicine
 4.1 Introduction
 4.2 The HIV / AIDS Policy Context, Traditional Medicine and Democracy
 4.3 The Lingering Socioeconomic Inequalities of the Apartheid Era
 4.4 The “Return to Tradition” Policy
 4.5 Shortages of Human Resources for Health
 4.6 The Adoption of Democracy and the Promotion of Cultural Rights
 4.7 Traditional Medicine as Cure and a Curse for HIV / AIDS
 4.8 The Preference for Traditional Healers
 4.9 Biomedical Hegemony?
 4.10 Conclusion

5 The Sociocultural Context of HIV / AIDS in the Eastern Cape Region
 5.1 Introduction
 5.2 The Eastern Cape Region and the Legacy of Apartheid Era Policies
 5.3 The Sociocultural Context of HIV / AIDS
  5.3.1 Labour-related Migration
  5.3.2 Gender Identity and Unprotected Sex
  5.3.3 Multiple Partnering and Intergenerational Relationships
  5.3.4 Gender Inequality and Gender-based Violence
  5.3.5 Teenage Pregnancies
  5.3.6 Substance Abuse
  5.3.7 Cultural Factors: Initiation Rituals Ukuthwala Virginity Testing
 5.4 Conclusion

6 The Debate on the Integration of Traditional Medicine into the Mainstream Healthcare Delivery System in South Africa
 6.1 Introduction
 6.2 The Debate for and against Traditional Medicine
 6.3 Primary Healthcare and the Changing Pattern of Disease
 6.4 Traditional Medicine and the HIV / AIDS Pandemic
 6.5 Conclusion

7 “African Diseases” and the Epistemology of South African Healers’ Knowledge
 7.1 Introduction
 7.2 The African Concept of Health
 7.3 The Process of Becoming a Healer
 7.4 Typology of African Traditional Healers
  7.4.1 Disease as Prelude to Divinership
 7.5 Prospects for the Integration of Traditional Medicine into Official Healthcare
 7.6 Enhancing Cooperation between Traditional Healers and Biomedicine
 7.7 Conclusion

8 The Integration of Modern and Traditional Medicine in Qokolweni Location
 8.1 Introduction
 8.2 Respondents’ Opinions on Traditional Medicine
 8.3 Opinions on Traditional Medicine
  8.3.1 Case Study 1: Vuyo (Fictitious Name)
  8.3.2 Case Study 2: Bate (Fictious Name)
  8.3.3 Case Study 3: Monde (Fictious Name)
 8.4 Perception of Nurses and Traditional Healers
 8.5 Conclusion

9 The Daily Use of Traditional Medicine in Qokolweni Location
 9.1 Introduction
 9.2 The African Concept of Health
 9.3 The Concept of Traditional Medicine in Qokolweni
 9.4 The Use of Traditional Medicine in Qokolweni
 9.5 Attitudes and Perceptions towards African Traditional Medicine in Qokolweni
 9.6 Users of African Traditional Medicine
 9.7 Recommendations
 9.8 Conclusion

All interested in the history of the interaction between traditional and modern medicine in South Africa.