Exploration of the articulation of African traditional medicine and Western biomedicine in hospital spaces in the town of Barberton, South Africa
Andreadis, Petros Isidoros
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.