|dc.description.abstract||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