Culture and Health: A South African Review

Abstract

This paper explores how cultural factors affect the health of  the South Africans in respect to the use of traditional healers/medicines, the beliefs in ancestors and supernatural beings, gender issues, rites of passage such as male circumcision and marriage, and the people’s perceptions towards illnesses/diseases. The customs, beliefs, practice, taboos, and ceremonies of the various ethnic groups that inhabit South Africa are the focus of this paper. This study exploitative research design when conducting the literature review. Various sources of information are used to collect the necessary data including websites, book, and journal articles. Only sources published within the last five years are used in this study. After conducting the literature review, this study has concluded that culture influences how  the South Africans perceive diseases and the remedies they seek whenever they are ailing. The results of this study will help South Africa’s researchers, companies, health care organizations and the government address the cultural barriers preventing them from achieving their respective goals.

Keywords: Culture, South Africa, ethnic groups, traditional healers, initiation ceremonies, beliefs

Culture and Health: The South African Review

Numerous studies have been conducted on how culture influences various facets of people’s lives such as health-seeking behavior (Wegner & Rhoda, 2015). However, there is no comprehensive study on how the cultures of the different ethnic groups found in South Africa may be negatively impacting the delivery of health care in the country. Over the last few years, the world has experienced many changes as a result of factors such as globalization and technological advancement. On this note, the advancement in the field of medical research has resulted in the change in life expectancy from 48 to 66 years between 1955 and 2000 (Holtz, 2017). Despite the improvement in global life expectancy, there are widespread gaps in terms of access to health care services between first world countries and developing nations. Consequently, the life expectancy of people in developing countries is far below that of individuals living in the first world. For instance, most of the women who die as a result of pregnancy-related complications come from sub-Saharan Africa (Holtz, 2017). In this part of the world, women have limited access to contraceptives and this not only results in them getting many children but also expose them to the danger of dying during pregnancy or while giving birth. Apart from the economic situation of a country, the other major issue contributing to the differences in the access to quality health care among different nations is cultural factors. Despite South Africa is Africa’s economic powerhouse, its population suffers from a myriad of issues.  The Black South Africans can be classified into four major ethnic divisions which are Nguni, Venda, Shangaan-Tsonga, and Sotho-Tswana (South African History Online, 2016). The Sotho and Nguni groups comprise the largest proportion of the total black population in South Africa (South African History Online, 2016). The ceremonies, religious beliefs, customs and social organizations of the Sotho are almost similar to those of the Nguni (South African History Online, 2016). Some of the common cultural beliefs among most of  the South African ethnic groups entail the role of ancestors/witchcraft/supernatural beings, the use of traditional health workers, and the practice of male circumcision. This paper will explore how cultural factors affect the health of the South Africans in respect to the use of traditional healers/medicines, the beliefs in ancestors and supernatural beings, gender issues, rites of passage such as male circumcision, and the people’s perceptions towards illnesses/diseases.   

Literature Review

Background Information on South Africa

South Africa is the country that is found in the Southernmost tip of Africa (Commisceo Global, n. d.). It borders Botswana, Lesotho, Namibia, Swaziland, and Zimbabwe (Commisceo Global, n. d.). According to the 2014 estimates, South Africa has a population of approximately 48 million persons (Commisceo Global, n. d.). Out of the 48 million people, 75.2% are black, 2.6% are Indians, 13.6% are white, and 8.6% are colored (Commisceo Global, n. d.). In terms of religion, 68% of the population of South Africa adhere to Christianity beliefs, 2% are Muslims, 1.5% are Hindu and 28.5% are either animists or hold indigenous beliefs (Commisceo Global, n. d.). The country has 11 official languages but English is the one commonly used for administration purposes. Other official languages include Tswana, Zulu, Xhosa, Southern Sotho, Afrikaans, Northern Sotho, Ndebele, Tsonga, and Swazi (Commisceo Global, n. d.).

The Role of Culture in Influencing People’s Behavior

Culture is one of the biggest factors in determining how a person behaves or performs his/her daily chores.  According to Edward B. Taylor, culture refers to the knowledge, morals, law, knowledge, art, customs and habits acquired by a person as a member of a society (Idang, 2015). Additionally, culture may be considered to be a combination of socially-accepted behaviors, traditions, and religious beliefs (Wegner & Rhoda, 2015). One of the major roles of culture is to distinguish people from others. As such, culture consists of anything about certain people that separate them from other groups such as food, songs and dance patterns, religious and philosophical beliefs, rites of passage, traditional occupations, and social norms, among others (Idang, 2015). These aspects are passed from one generation to the other through a process known as socialization (Idang, 2015). As a child grows up, he/she observes and mimics what the adult members of his/her community are doing. Additionally, the child witnesses the occurrence of certain ceremonies such as the coronation of a chief or king (Idang, 2015). The impact of culture on people’s behavior is well documented in existing literature. According to Wegner and Rhoda (2015), cultural beliefs influence who people are, how individuals interact with their environment, and how persons behave in specific situations. For instance, culture affects health-seeking behavior. On this note, each culture has a specific understanding or perception of what causes diseases and how to respond to certain ailments (Abaerei, 2016).

The Rite of Passage I.e. Circumcision and Marriage and Their Influence on Health.

The major difference between the Sotho and Nguni is in regard to the marriage customs of the two groups (South African History Online, 2016). On this note, the Sotho culture allows men to marry women that they share close blood ties with (South African History Online, 2016). Kin marriages expose people to diseases that run in families such as genetic conditions. Apart from the marriage to kin, polygamy is a common practice among many South African cultures such as the Zulu (South African History Online, 2016). Polygamy is a practice that allows men to have several sexual partners. The practice of polygamy exposes  the South Africans to sexually transmitted diseases such as HIV/AIDS and STIs.

The other common practice among the various ethnic groups in South Africa is the male circumcision. In South Africa, distinct ethnic groups such as Venda, Tswana, Basotho, Ndebele, Pedi and Xhosa practice initiation rites for their young boys (Rathebe, 2018). In South Africa, there are initiation schools which are known as cultural educational institutions whose role is to teach societal norms, customs, traditional beliefs and manhood values to the initiates (Rathebe, 2018). Traditional initiation practices are performed in various parts such as the Eastern Cape (Xhosa), Limpopo (Tsongas), and Free State (Basotho) (Rathebe, 2018). Although both boys and girls attend the initiation schools, only the former get circumcised (Rathebe, 2018). Among the Basotho people, the initiation ceremony is performed to young boys who are being groomed to become young men (Rathebe, 2018). During the ceremony, boys spend several weeks in the mountains where they are taught about their culture and respect for elders, among others. Among the Basotho, boys go through the traditional circumcision ceremony in order for them to be trusted with communal and family responsibilities (Rathebe, 2018). The ceremonies, traditional nurses, and surgeons conduct the circumcision and the initiates are only referred to health care facilities in case they develop some complications such as penile amputation and septicemia  (Rathebe, 2018). One of the things that makes the Basotho initiation practices unique is that the initiates from previous years are allowed to enter the cultural schools in order to provide support to the new initiates (Rathebe, 2018). Although the circumcision ceremonies are an integral part of many ethnic groups in South Africa, the rite of passage expose the initiates to a great deal of danger. For instance, Rathebe (2018) reports that many young boys who go through the ceremony end up dying immediately after being circumcised.

The Role of Ancestors

Additionally, in many South African ethnic groups, the ancestors are considered to be part and parcel of the community. Consequently, their wishes must be understood and respected. The belief in the ancestors is common among the different groups inhabiting South Africa. For instance, among the Zulu group, ancestors offer valuable knowledge to the Sangoma and Inyanga on how the two should perform their tasks of healing the sick (Bahamonde, 2015). Such as, Sangomas are unable to heal the sick without the intervention of the ancestors (Bahamonde, 2015). In the Sotho culture, there is a belief that, if angered, an ancestral spirit known as Balimo has the power to cause misfortune and sickness. This means that the Sotho culture sees pain as a punishment for one’s wrongdoing. Such a view shows that people from this culture are taught that pleasing the ancestors is a remedy to addressing various ailments. Besides, such a view tends to encourage people to endure pain with resilience and stoicism (Abaerei, 2016). Failure to respect elders may also cause one to suffer from various misfortunes such as diseases. On this note, there is a proverb in the Sotho that says that “Children benefit from serving their elders” (South African History Online, 2016, para. 23). Among the Zulu, sacrifices are allowed as a way of pleasing ancestors to ensure that a person has a safe journey (Bahamonde, 2015). In light of this perceptive, diseases are interpreted as forms of punishment from supernatural beings or a curse from elders.

The Role of Traditional Healers

Most of the South African cultures place much emphasis on the role of traditional healers. Traditional healing takes the form of divining, spiritualism, and herbalism (Zuma, Wight, Rochat, & Moshabela, 2016). The South Africa government recognize the role of traditional health workers as evidenced in the enactment of the South African Traditional Health Practitioners Act (Zuma et al., 2016). According to Zuma et al. (2016), in 2010, there were 28000 medical doctors and between 250,000 to 400,000 traditional health practitioners. Besides, eight in every 10 black South Africans seek the intervention of traditional health practitioners either exclusively or in addition to western medicine (Zuma et al., 2016). For instance, the urbanized Sotho-group members usually consult with their medical doctors whenever they have concerns over the pain in their body (Abaerei, 2016). However, once these persons visit their rural homes, they have the high likelihood of visiting traditional healers whereby they are given various local herbs to address their various condition (Abaerei, 2016). Among the Sotho culture, traditional medicines are used to treat different forms of illnesses such as vomiting, diarrhea, and nausea which are signs of HIV/AIDs (Bahamonde, 2015). On the other hand, among the Zulu, the Sangomas and Inyangas are the custodians of the herbal and spiritual medicinal practices (Bahamonde, 2015). Inyangas are male herbalists while Sangomas are female diviners. The Inyangas and Sangomas work together to heal a person of either spiritual or physical sickness. They use local herbs to heal conditions such as AIDS/HIV, mental disorders, and cancer, among others (Bahamonde, 2015).

Religion does not play a big role in preventing South Africans from seeking the services of traditional healers. This is because most of the ethnic groups in South Africa have a distinct perception of illness. On this note, the Zulu believes that “The cause of an unwell body is due to an imbalance in nature and pollution from evil spirits, the traditional healer is still needed to fix this problem” (Bahamonde, 2015, p. 6). According to the Zulu’s understanding of the body, a person’s spirituality, physical health, and mind are intensely connected (Bahamonde, 2015). The use of traditional medicine puts the lives of many South Africans in dangers. For instance, tuberculosis is one of the leading killers in South Africa (Wegner & Rhoda, 2015). On this note, the belief that tuberculosis is caused by the work of witches prompts persons suffering from this disease by visiting hospitals (Wegner & Rhoda, 2015). As already established, the traditional medicines are used to treat symptoms as opposed to addressing the specific diseases affecting the patients. Additionally, studies have demonstrated that traditional healers rarely refer their patients to western medicine practitioners whenever they find it hard to alleviate the patient’s suffering (Sorsdahl, Stein, & Flisher, 2013). 

Gender and Its Influence on the People’s Reactions Towards Illness

In most African cultures, gender plays a crucial role in determining a person’s health-seeking behavior. On this note, the South African society is akin to other African cultures when it comes to its view of gender. According to Abaerei (2016), pain is one of the major symptoms of injury or disease. How people express pain is greatly influenced by culture (Abaerei, 2016).  For instance, the traditions of the Sotho group in South Africa emphasize that men should not reveal their emotions. There is a Sesotho saying that if literally translated means that a man is a cow; he is not supposed to cry (Abaerei, 2016). Similarly, in Sepedi tradition, a man is likened to a sheep while women are compared to goats (Abaerei, 2016). Among many South African cultures, expression of pain by men is considered to be a taboo since it is viewed as a sign of weakness (Abaerei, 2016). However, in these cultures, women are encouraged to express their discomfort in any way possible (Abaerei, 2016). However, there is a common Sesotho folklore that insinuates that a person should not reveal pain. The folklore is about a young girl who endured pain upon the realization that she could not marry her lover. In order to hide the pain, she cried while sitting inside a hut full of smoke. She did so in order to pretend that the smoke inside the hut was responsible for her tears (Abaerei, 2016). The beliefs and taboos held by many South African ethnic groups in regard to the expression of pain may prevent people from seeking health care services and this may expose the patients to serious dangers.

Among many ethnic groups in South Africa, diseases and illnesses are viewed as signs that a person is being controlled by human spirits or demons. On this note, a study conducted by the South African Department of Health revealed that 3% of the participants associate disability with bewitchment (Wegner & Rhoda, 2015). Wegner and Rhoda (2015) conducted a study in which they researched the experiences of therapists offering rehabilitation care to patients in remote areas of South Africa. One of the participating therapists said that there are patients who believe that their diseases and pain are spiritual in nature; hence, Western medicine cannot do anything to alleviate their suffering (Wegner and Rhoda, 2015). Some patients say that they had a dream explaining the cause of their conditions. Additionally, some South Africans view certain conditions as the work of supernatural beings. For instance,  source Wegner and Rhoda (2015) reports about a girl who thought that her psychological gait pattern condition was as a result of her failure to accept her calling of becoming a “ukuthwasa.”

Conclusion and Future Study

In conclusion, culture entails things such as customs, ceremonies, rituals, and taboos, among others. Culture is a major determiner of people’s behavior. In the realm of health, culture determines how people view illnesses,  regardless whether they will seek help, and the approach they will adapt to address the condition affecting them. South African’s many ethnic groups share numerous similarities especially in regard to the aspect of traditional healers, the practice of male circumcision, and the influence of ancestors and witchcraft. In South Africa, cultural factors expose the people to major health problems. For instance, there is a common belief among many ethnic groups in the country that men should not express pain since this is a sign of weakness. Additionally, despite the advancement of the western medicines, a substantial proportion of South Africans still visit traditional healers. In South Africa, patients with conditions such as cancer and HIV/AIDS seek the intervention of traditional healers. Besides, some illnesses such as disabilities are viewed as a punishment for individuals who ignore the words of supernatural beings. Additionally, practices such as male circumcision expose the initiates to harm since it is rarely regulated and is performed by persons who are not well-trained in the field of surgery or medicine. Future studies can be conducted on the changes the various ethnic groups in South Africa have experienced that may positively impact the health of the people in this country.

References

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