Traditional Medical Research & Publications by Dr. Debie LeBeau Spence
"The book provides an excellent
overview of issues surrounding traditional and Western health care in postcolonial
Namibia and presents LeBeau’s own research, which [...] reflects the complexities
inherent in the topic. [...] The analysis of survey data may be cumbersome,
but other raw data–specifically, the case studies used as examples in the
text and the more detailed accounts in the appendixes–provide a rich layer
of complex information and allow the informants’ stories to be heard in
their own words. In these ways, Dealing with Disorder offers both an interesting
account of health-seeking behaviors in a modern pluralistic context and
a valuable transparency regarding the creation of anthropological knowledge
This publication focuses on a model for the hierarchy of resort between western and traditional medicine. Sub-themes evaluate ethnic differences in illness aetiology and factors which influence urban patients' traditional health care utilization. In Katutura, where there is significant mixing of Namibia's four main ethnic groups, there has also been a great deal of cultural mixing, borrowing and consolidating of traditional health beliefs. Patients in Katutura exhibit cross-cultural health seeking behavior, which makes a wider range of treatment options available.
With the increased demand on western health care systems and its associated costs, there has been a resurgence of interest concerning the uses of traditional medical knowledge. In 1978 the World Health Organization (WHO) recognized the need to utilize traditional healers in their goal to provide health for all. In line with this perspective, the Namibian government has required traditional healers to elect a member from their profession to sit on the Council for Health and Social Services Professionals. The realization that western health care cannot cater to all the needs of African populations, and a general lack of resources to provide adequate western style comprehensive health care to the largely poor African population have caused agencies such as the WHO to look to traditional medicine for relief.
Within Namibia there are diverse systems of thought that coexist, namely the western and the traditional belief systems. These systems are able to function together because aspects of one can be found within attributes of the other. For example, the Christian belief in God as a supreme deity was acceptable to the Owambo because they traditionally have a belief in the supreme being, Kalunga. There are many spirits in Christianity which can be good (spirit of God, Jesus and the saints) or evil (satan and the demons that do his bidding), as are there many spirits in African cosmology that are both good and evil. Similarities also exist in the method of exorcism of evil spirits: a specialist (priest or traditional healer) is called upon to perform tasks to cleanse the place and people and thus rid them of the evil spirit. Often, traditional healers call upon both God and the ancestors for help. The use of traditional healing and western medicine should not be seen as at odds but should be seen as coexisting aspects of holistic healing, both with the aim of ensuring the physical, social and spiritual health of a person.
The focus of Dr. LeBeau’s research into traditional medicine is health seeking behavior in Katutura, Namibia. The research focuses on utilization patterns between western and traditional medicine and factors that influence urban patients' traditional health care. This research used both qualitative and quantitative data collection methods. Qualitative research such as participant observations and semi-structured interviews are the primary sources of research data and are used to determine the cultural context within which healing takes place and to gain an in-depth understanding of health seeking behavior. Quantitative research in the form of a questionnaire was conducted within the Katutura population to provide important statistical data and are used to determine the range of Knowledge, Attitudes and Practices (KAPs) relating to health and illness within the Katutura population. The use of a combination of qualitative and quantitative research methods is internationally accepted in all sub-disciplines of social science research (such as anthropology and sociology) as appropriate for studies of this nature.
People from Katutura have access to various forms of western and traditional health care. However, patients make choices based on their perception of the cause, reason and origin (aetiology) of the illness, rather than access related factors such as time needed to obtain treatment and relative cost. Just as there are two systems of healing, there are two aetiologies of illness which roughly correspond to the healing systems. The most important variables in health seeking behavior are cultural beliefs, which are expressed in the patients' perceptions of the cause of illness and the patients' interpretation of illness symptoms (manifestations).
Patients classify disorders into either western or African illnesses. This classification is based on a combination of two factors: The first is the perceived cause of the illness. An illness can have either a social-spiritual or a natural cause. The second is the manifestations of the illness. An illness can exhibit exclusively African symptoms (such as ghosts) or symptoms that are universally recognized in both the western and traditional medical paradigms.
All of the types of social-spiritual causes identified for illnesses have in common the concept that they are attempts by humans to explain and influence the dark forces that hold sway over people's lives. Existing within the world are conflicting forces of good and evil which are systematically linked; life is the struggle between them. In this case, good is well-being and evil is non-well-being. Illnesses are non-well-being aspects of life to be eliminated. The focus of healing in both the western and the traditional medical systems is to rid patients of the feeling of non-well-being, thereby ridding them of evil.
In most societies around the world there is a belief in witchcraft. In most African cultures witchcraft is only and always evil and meant to harm others or get an unfair advantage over other people. Witchcraft is the most common social-spiritual cause given for illness and misfortune within Katutura's African population. Witchcraft in this context is considered a deliberate attempt by one person or group of people to harm another person or group of people. Witchcraft accusations have several social functions that serve to expose problems within social relationships, explain social inequalities or blame one's social setbacks on someone (or something) else. A person does not bewitch him- or herself but someone else bewitches him or her, therefore, the patient is not to blame for his or her condition.
A common manifestation of witchcraft attacks are witch familiars such as ghosts, demons, evil spirits and tokoloshes disturbing a house or attacking individuals. Witch familiars are usually aimed at a single person but can affect the entire family if the familiar is 'haunting' the house. Witch familiars are typically 'incarnated' or created by a witch and sent to do the witch’s bidding. Not all evil spirits are caused by witchcraft, some can be in the form of the ghost of a deceased person or demons sent by satan.
"Traditional and western medical knowledge systems in Namibia - is collaboration in diversity possible?". In: Namibian Society Sociology, Volker Winterfeldt, Tom Fox and Pempelani Mufune (eds)
This chapter examines whether or not traditional medical practitioners can coexist with modern western medical staff or if the two systems that they represent are mutually exclusive. Within the conceptual framework of post-colonial theory, this chapter examines the future for traditional healers in contemporary Namibia. Can healers offer valuable services to communities that western medicine cannot provide for? Dr. LeBeau conceptualizes the two systems as knowledge systems embedded in very different cultural contexts, reflecting polarities of Namibian society. She states that communities tend to rely heavily on traditional medicine where cultural barriers and constraints alienate them from the western health care system. Dr. LeBeau calls for the legitimization and empowerment of healers in Namibia, as well as for their incorporation into 'official' medical authority structures.
"'Is Witchcraft Real?': The Role of Perceptions in Health Seeking Behaviour". In: Challenges for Anthropology in the 'African Renaissance': A Southern African Contribution, Debie LeBeau and Robert J. Gordon (eds)
Illnesses that have a universally
recognized manifestation, but whose aetiology is in question are frequently
first taken to western medicine and only when western medicine has failed
to treat the health problems are they brought to a traditional healer.
However, a patient's experience with health seeking for previous illnesses
also influences behavior if one health care system has been unsuccessful
in the past. There are certain illnesses with universally recognized manifestations
that are routinely taken to a traditional healer while others are routinely
taken to western health care personnel. The manifestations of these illnesses,
although influential, are not as important in health seeking behavior as
perceived aetiology. This category of illnesses has far more variability
and overlap in health care utilization patterns than illnesses with perceived
clear aetiological causes. The urban nature of the Katutura population
also influences perceptions of illness causation theory and thus also impacts
health seeking behavior.
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