292
PERCEPTIONS OF TRADITIONAL HEALERS ON THE
TREATMENT OF DIARRHOEA IN VHEMBE DISTRICT
MUNICIPALITY OF LIMPOPO PROVINCE, SOUTH AFRICA
Tshivhangwaho Austin Netshivhulana, Ndivhaleni Anox Masevhe,
Milingoni Peter Tshisikhawe and Amidou Samie
University of Venda, South Africa
tshisip@univen.ac.za
ABSTRACT
Diarrhoea illness has long been recognised as the cause of death of millions of people
worldwide especially in developing countries (Nkwi, 1994). The disease is treated using
western as well as traditional remedies. The knowledge of traditional healers and their
practices can play an important role in building capacity to promote the appropriate home
management of diarrhoea (Anokbonggo et al., 1990). Traditional healers around the world
have different beliefs and understanding of diarrhoeal disease and its treatment. The aim
of the project was to investigate the perception and concept of traditional healers on the
treatment of diarrhoea in Vhembe district. Twenty traditional healers from two
municipalities (Mutale and Thulamela) around Vhembe district were interviewed. Data was
collected through interviews using questionnaires. Interviews were conducted with
individuals in their own languages and later translated into English. According to Vhembe
traditional healers, diarhoea is described as a disease which can lead to death as a result
of excessive loss of water in a patient’s body through vomiting and frequent visits to a
toilet. Symptoms of diarrhoea include vomiting, loss of weight, and change in appearance
of skin, face and eyes. Traditional healers of Vhembe district have a better understanding
of diarrhoeal diseases. They mention different categories of diarrhoeal diseases. There is
a lack of information when it comes to the description of diarrhoeal illness’s on infants and
children.
Keywords: Traditional remedies, interviews, questionnaires, symptoms, infants.
INTRODUCTION
The knowledge of traditional healers and their practices play an important role in
building strong systems towards promoting appropriate home management of
diarrhoea. Akpede et al. (2001) assessed the role of traditional healers in the
home management of diarrhoea in Nigeria. Green (1985) found that the
involvement of traditional healers on diarrhoeal disease management and control
amongst children and mothers is playing a major role. It was also reported that in
Zambia healthcare workers noted that adults and children visit health facilities
with advanced diarrhoeal conditions (Foster, 1995). In Bangladesh and other
South Asian countries, child survival, health services utilisation, and expenditure
inequities on the basis of gender, favouring males, have been well documented
for several decades (Pandey et al., 2002; NIPORT, 2005). Male children under
the age of five are found to have a lower probability of death as compared to
females of the same age (Gupta, 1987).
PERCEPTIONS OF TRADITIONAL HEALERS ON THE TREATMENT OF DIARRHOEA IN VHEMBE DISTRICT MUNICIPALITY 293
Traditional healers identify symptoms of diarrhoea as fever, watery stools,
vomiting, frequent stooling, hot urine accompanied by pain when urinating,
redness of the anus, and non-stop stooling which lead to the release of blood
(Akpede et al., 2001). People in developing countries still rely on traditional
healers who usually reside among them trusting their ingenuity on the use of
herbs and some other cultural and traditional beliefs (Bisi-Johnson et al., 2010).
Globally, diarrhoeal disease is regarded as the second leading cause of underfive
mortality, accounting for over two million of death per year (Murray and
Lopez, 1997; Jones et al., 2003). Larson et al. (2006) suggested that the majority
of diarrhoeal deaths can be prevented by the timely use of oral rehydration
solution (ORS) and continued feeding of children and infants. Developing countries
like India continue to struggle with nutritional and health challenges which
results in bearing the greatest burden of diarrhoea.
Recently, AIDS patients were reported to develop the diarrhoeal illness, and it
was seen as the leading cause of death among AIDS patients. Haung and Zhou
(2007) reported that hand washing before preparing any kind of food and also
using protection (condom) when having sex limit the danger of being affected by
diarrhoea. Diarrhoeal diseases cause significant morbidity and mortality worldwide
and the effectiveness of home management of diarrhoeal diseases is
achievable if there are enough caregivers that can educate the community about
how to prevent themselves from being victims to this deadly disease (Uchendu
et al., 2011). Patients with diarrhoea, in particular children, are a higher risk of
being affected by dehydration compared to adults. Fluid loss resulting from
diarrhoea and vomiting and can be as high as three times the circulating blood
volume (Sibylle, 2009).
Studies on long-term effects of childhood diarrhoea have also been conducted
and showed a decline on cognitive function, delayed school commencement,
and poor school performance as repercussions of early childhood diarrhoea
(Guerrant et al., 2002). Malnutrition is also a predisposing factor which increased
the frequency and severity of diarrhoea. As a result, malnutrition may lead to
renal failure and subsequent death (Cutting, 1979). This situation is described by
Guerrant et al. (2002) as the “vicious cycle of diarrhoea” which is the cycle that
could consequently lead to impaired growth and development (Farthing, 2000).
The aim of the study was to investigate the perception and concept of traditional
healers of Vhembe district Municipality on diarrhoea. The hypothesis was that
traditional healers in Vhembe district have different ideas and belief towards
diarrhoeal categories, symptoms, causes, diet taken by patients and prevention
thereof. Traditional healers were interviewed individually in order to gain
knowledge of their perception on diarrhoea disease. The objectives of the research
were to investigate the description of diarrhoea diseases, its symptoms,
causes, and categories of diarrhoea illness by traditional healers of Vhembe
district Municipality. The research also investigated different beliefs and practices
of traditional healers pertaining to diarrhoea diseases. The different prevention
methods used by traditional healers in order to ease diarrhoeal problems
were also assessed.
294 INDILINGA – AFRICAN JOURNAL OF INDIGENOUS KNOWLEDGE SYSTEMS Vol 13 (2) 2014
MATERIALS AND METHODS
Study area
The project was carried out in Vhembe district municipality, which is one of the
six district municipalities of Limpopo province in South Africa. The area is rich in
biodiversity. There are many plant and animal species that local people use for
various purposes. The area is surrounded by mountains, rivers, lakes, game
reserve and a number of tourism attractions. The annual rainfall in this area is
250-500 millimeters. Temperature in summer ranges between 29-36oC and in
winter between 20-28oC. Plants in this area have a high chance of survival due
to the fact that the area is fertile and rich in soil moisture.
In Vhembe district people still believe in indigenous knowledge systems and it is
widely practised in rural areas within this district. Traditional healers are the first
to be visited whenever people don’t feel right or if they have some personal
problem. Traditional healers are believed to treat various diseases including
those that may be incurable in hospitals.
There are many traditional healers around Vhembe district that vary according to
their healing practices (Mabogo, 1990). Some of the categories of traditional
healers are herbalists, traditional surgeons, bone setters and tradition psychiatrists.
Study design
The ethnobotanical survey was collected from the knowledge holders, who are
traditional healers, with the aid of a structured questionnaire. Twenty traditional
healers were interviewed during the survey. The survey was carried out from
May to October 2011. Traditional healers were interviewed separately on issues
concerning the description of diarrhoea, symptoms, causes and different categories
of diarrhoea, diet recommended for diarrhoeal patients, and methods of
prevention. Information was recorded in a notebook and then analysed using a
Microsoft Excel spreadsheet.
RESULTS AND DISCUSSION
Description of diarrhoea disease by traditional healers of Vhembe district
municipality
Traditional healers of Vhembe district municipality described diarrhoea as a
disease which may result in death due to loss of water in a patient’s body
through vomiting and frequenting the toilet. They believe it may result in many
changes in a patient’s body such as loss of weight, change of skin, face and
eyes. They mentioned that if those symptoms were not treated, death of a
patient will be the ultimate penalty (Akpede et al., 2001). Seventy five percent of
traditional healers described diarrhoea as one of the diseases related to
HIV/AIDS (Haung and Zhou, 2007).
PERCEPTIONS OF TRADITIONAL HEALERS ON THE TREATMENT OF DIARRHOEA IN VHEMBE DISTRICT MUNICIPALITY 295
Symptoms of diarrhoea as mentioned by traditional healers of Vhembe district
Municipality included: loss of weight, vomiting, small white wounds in the tongue,
sweating, tiredness, as well as changes of eyes, face and skin appearance.
Tiredness was mentioned by forty five percent of traditional healers, they mentioned
that a patient may feel tired as a result of one of the symptoms, followed
by thirty five percent reporting loss of weight. Traditional healers indicated that
patients may lose a lot of water as a result of frequenting the toilet (Sibylle,
2009). The change of eyes, face and skin (twenty five percent) was also reported
as one of the symptoms of a diarrhoea patient. A small wound with whitish spots
on the tongue was mentioned by twenty percent of traditional healers, followed
by fifteen percent reporting vomiting after eating. Sweating of a patient was only
reported by five percent of the traditional healers. The results also showed that
tiredness contributed the highest symptoms above all the symptoms mentioned
by traditional healers.
Causes of diarrhoeas as reported by traditional healers
Eating food not familiar to the body represents the highest reported cause of
diarrhea by the traditional healers with a frequency of forty percent as shown in
Table 1. Traditional healers indicated that a patient must eat food that they are
used to eating since this will strengthen their body and stand a chance of preventing
diarrhoea from entering their body. Eating uncovered/rotten food was
indicated by twenty five percentage of healers as another cause of diarrhoea.
Traditional healers mentioned that food eaten must be covered and protected,
and indicated that food should not be rotten as it could contain some bacteria or
fungi which may result in diarrhoea. Having unprotected sex (fifteen percent) is
one of the serious matters; they recommend medicinal plants and condoms as
the best ways of preventing diarrhoea during sexual activity. The use of dirty
water (fifteen percent) is one of the factors spreading diarrhoea. Anokbonggo et
al. (1990) supported this argument by indicating that water for drinking and
cooking must always be protected and never left open so that bacteria/fungi do
not enter.
Table 1: Categories of diarrhoea disease as reported by traditional healers of
Vhembe district municipality.
Causes of diarrheoa disease Frequency percentage (%) of
responses
Eating food foreign to their body 40
Using dirty water 15
Eating uncovered/rotten food 25
Eating without washing hands 5
Having unprotected sex 15
Bathing diarrhoea patients without wearing gloves 5
Feeding infants with milk formulas 5
Using improper remedies to infants 5
296 INDILINGA – AFRICAN JOURNAL OF INDIGENOUS KNOWLEDGE SYSTEMS Vol 13 (2) 2014
Bathing a diarrhoea patient without wearing gloves (five percent) could possibly
cause diarrhoea, as reported by the traditional healers. Emphasis was made by
traditional healers that, hands should be clean everytime a patient has to come
in contact with food or drinks. Feeding infants with milk formulas (five percent)
rather than using breast milk was also mentioned as a cause of diarrhoea.
Traditional healers indicated that breast-feeding is the best remedy for infants
and children, and it was highly recommended (Green, 1985). The use of improper
remedies for infants (five percent) may result in putting the health of infants at
risk of contacting diarrhoea, which may also lead to the death of such infants.
Table 2: Symptoms of diarrhoea diseases (in vernacular) as reported by traditional
healers of Vhembe district municipality in 2011.
Sign/symptoms of diarrhoea Diseases
Hard stools released with mucus and blood resulting in anal sores “Nowa khulu”
Frequent toilet with loose stools mixed with blood “U inga”/ “Ngubane”
Painful release of loose stools with blood “Tshitswuku”
Loose stools released with blood “U sika”
Frequent toilet with loose stools “U tshuluwa”/“Dangani”
Results from Table 2 represent the signs and symptoms of the diarrhoea disease
indicated by traditional healers of Vhembe district. It was found that thirty five
percent of traditional healers reported “U tshuluwa”; followed by “Nowakhulu”,
twenty five percent; “Tshitswuku” with fifteen percent; and “U inga” was reported
by ten percent of traditional healers. “Ngubane”, Bilhazia, “U sika” and “Dangani”
were reported by five percent of traditional healers. Traditional healers use the
same description and signs/symptoms for different diarrhoeal diseases, for
example the description of a loose stool with blood for Bilhazia, “U sika” and for
frequent toilet visits with loose stools mixed with blood for “Ngubane” and “U
inga” (Green, 1985). Diarrhoea in which a patient releases faeces with blood was
reported as more dangerous than one in which a patient releases faeces mixed
with blood. The name of those diarrhoeal diseases reported came from the place
in which they grew up. It was also found that from the way in which traditional
healers describe the signs/symptoms, they only came from two categories (i)
bloody and (ii) non-bloody (Ndubani et al., 1998).
Prevention of diarrhoea according to traditional healers
Traditional healers also guide their patients on prevention of diarrhoea. Prevention
varies from one healer to another depending on their belief and understanding
of the disease. Figure 1 indicates some of the prevention techniques as
reported by traditional healers.
Figure 1 shows that twenty five percent of traditional healers mentioned the
eating of healthy food. They also indicated that food must be protected and kept
safe from contamination. Twenty five percent of traditional healers mentioned
that they have no idea on how to prevent diarrhoea. Twenty percent recommended
the use of traditional remedies which is required to be used by both
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298 INDILINGA – AFRICAN JOURNAL OF INDIGENOUS KNOWLEDGE SYSTEMS Vol 13 (2) 2014
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