When Illness is more than just a Sick Body: Probing How
isiZulu- Speaking Nurses’ Construct Illnesses and Healing
Maheshva...
224 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
and Baker 2009: 65). As Whyte, van der Geest and Hordo...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
226 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
nurse. This is how they are customarily addressed in t...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
228 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
conditions of ‘self’”, Hahn shows an understanding of ...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
230 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
bring the child back to the hospital. However, by the ...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
232 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
an overdose of medication to kill himself… He said to ...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
234 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
(Vilakazi 1965: 92).
Within the Zulu culture and many ...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
236 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
with other beings is crucial to eco-systemic anthropol...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
238 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
Corbin J, Strauss A (2008). Basics of qualitative rese...
When Illness is more than just a Sick Body:
Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing
The Orie...
240 Maheshvari Naidu and Gabriel Darong
The Oriental Anthropologist
Bloemfontein, South Africa.
Vaughn LM, Jacquez F, Bake...
of 18

Naidu and Darong 2015. When Illness is more than just a Sick Body

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Transcripts - Naidu and Darong 2015. When Illness is more than just a Sick Body

  • 1. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing Maheshvari Naidu and Gabriel Darong ABSTRACT Particular communities and groups of people develop particular prevailing points of view, including how health and illness is understood. Our prevailing points of view, ‘worldviews’ or positioning, are a result of the ‘dialogue’ between us and our wider society (see Creswell 2009:8) and is a process of “active construction” (Fox 2001: 23). As such, we approach reality from our particular point of view which has been constructed and developed over time (see Rosaldo 2003: 583). Different societies have in turn, their specific practices and beliefs, as well as their approach to health and illness (see Naidu 2013: 257; Naidu 2014: 147; Vaughn, Jacquez, and Baker 2009: 65). As Whyte, van der Geest and Hordon (2002: 118) assert, many factors “influence people’s response to ill-health, including entrenched beliefs”. As such, the understanding and approach to illnesses vary from one society to another, one setting to another, and one belief system to another. This paper looked at what isiZulu-speaking nurses understand by illness and healing. It explored what sickness means to the Ama Zulu African nurses. In exploring this understanding of nurses, the paper explored the wider cultural belief system of the isiZulu-speaking nurses within which their understandings are deeply embedded. INTRODUCTION Particular communities and groups of people develop particular prevailing points of view, including how health and illness is understood. Our prevailing points of view, ‘worldviews’ or positioning, are a result of the ‘dialogue’ between us and our wider society (see Creswell 2009:8) and is a process of “active construction” (Fox 2001: 23). As such, we approach reality from our particular point of view which has been constructed and developed over time (see Rosaldo 2003: 583). Different societies have in turn, their specific practices and beliefs, as well as their approach to health and illness (see Naidu 2013: 257; Naidu 2014: 147; Vaughn, Jacquez, The Oriental Anthropologist, Vol. 15, No. 1, 2015, Pages 223-240 © OICSR, Allahabad Corresponding Author E-mail : naiduu@ukzn.ac.za *Address for Communication: * Senior Lecturer in Anthropology, School of Social Sciences, University of KwaZulu-Natal, South Africa. * PHD Candidate in Anthropology, School of Social Sciences, University of KwaZulu-Natal, South Africa.
  • 2. 224 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist and Baker 2009: 65). As Whyte, van der Geest and Hordon (2002: 118) assert, many factors “influence people’s response to ill-health, including entrenched beliefs”. As such, the understanding and approach to illnesses vary from one society to another, one setting to another, and one belief system to another. This paper looked at what isiZulu-speaking nurses understand by illness and healing. It explored what sickness means to the nurses. In exploring this understanding of nurses, the paper explored the wider cultural belief system of the isiZulu-speaking nurses within which their understandings are deeply embedded. METHODS AND METHODOLOGY Research site Barnard (2000: 4) regards ethnography as “the practice of writing about peoples”. The situatedness of a study plays a vital role in the understanding of any given phenomenon, how the data related to that phenomenon is collected, and how the data impacts on the outcome of the study. This research was an ethnographic study conducted at a non-profit based private hospital in Durban, in the Province of KwaZulu- Natal, South Africa. For reasons of confidentiality, the hospital is referred to as Bambanani Hospital. Bambanani is a district hospital with a capacity of admitting more than 500 patients. Carrying out this study within the hospital created room for an in-depth participation and observation of the activities of the nurses involved in the study, especially how they cared for patients. Sampling and sample selection techniques This paper is derived from a wider study conducted in 2014. The wider study involved 20 isiZulu-speaking nurses from Bambanani hospital. Three of these participants were purposefully recruited. Purposive sampling in ethnography is a process whereby a researcher purposively chooses who he/she thinks is of relevance to the study to be conducted (Sarantakos 2005). The three initially recruited nurses later assisted in identifying and ‘snowballing’ the researcher to other isiZulu-speaking nurses within the hospital who showed interest in the study and the researcher’s presence there. Snowball sampling is a process where a few people link a researcher to other potential participants until the number of participants reaches the number needed (saturation) by the researcher (Frank and Snijders 1994: 53). Participants who were professional nurses and were above the age of 22 were purposively recruited as they were deemed to have been more clinically experienced than younger nurses or nurses of a lower qualification.
  • 3. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 225 Data collection The research took place in the months May to October 2014. The qualitative nature of the study enabled a sharing in the experiences of the nurses, (at least within the hospital spaces), in order to observe how they attached meanings to their daily practices within the hospital. As such, the researcher was able to ‘participate’ and observed them carrying out their clinical duties from which the researcher was to later gather data. In gathering data, the researcher made use of semi-structured interviews. Semi-structured interviews have been defined as a method of interview conducted using a set of prepared questions during the interview as a guide to the discussion- yet not strictly using the questions or the order in which they are written (Polkinghorne 2005: 5). As such, the questions were open-ended and flexible and the length of answers depended on the readiness and openness of the participant to share. Using this approach, the researcher was able to allow the participants to feel comfortable to expand the discussion, a process which helped gain their trust. Letting the interviewee guide the interviewer, says Corbin and Strauss (2008: 28), is the responsibility of a sensitive interviewer. The researcher had at least three interviews with each participant, lasting between 45 minutes to an hour, when they were on breaks. Between interviews, the researcher also had informal and casual conversations with the participants during the work times while the researcher assisted in several minute ways such as holding the hand of a patient while they injected the patient or feeding a patient. Most interviews were carried out within the hospital space while some were carried out at the participants’ homes. With the permission of the research participants, the researcher recorded some of the interviews using an electronic recorder. While recruiting the research participants, the researcher fully informed them about the study and the role they were to play. Each participant then signed the informed consent form which states that they are willingly participating in the study, can withdraw at any time without any repercussion, that their identities will remain confidential, and that there was no financial benefits for participating in the study. Data processing and analysis After collecting the data, the researcher transcribed all electronic recordings and afterwards coded the transcribed data based on themes. All participants were given pseudonyms for ethical reasons and for easy codification of the data. After collecting and transcribing the data, the researcher began the analysis and discussion based on the themes the researcher formed from the transcribed data. This ‘microanalysis’ of the data was a necessary process to help make sense of all the gathered information from the ethnography. Corbin and Strauss (2008: 58-59), define microanalysis as a detailed form of open coding which allows the researcher to “break open the data to consider all possible meanings.” Sr. refers to female Sister/Nurse, while Sir refers to a male
  • 4. 226 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist nurse. This is how they are customarily addressed in the hospital. FINDINGS Illness and the body …to be sick means that there is a certain part of a person’s body that is feeling unwell. One will be experiencing some sort of illness and is able to tell the next person what is wrong with them (Sr. Nothando). These were the words of one of the research participants. During the time with the nurses, they shared various understandings of what they felt ‘being sick’ meant and how each illness could be interpreted based on its cause. The idea and linkage of illness to the body came out strongly. In one of the conversations with Sr. Nothando, she said: “what we do here has to do with what is wrong with the patients’ body”. Sr. Nothando was not the only participant with an understanding of illness based on the state of one’s physical body. Sr. Phindile also shared a similar conception of illness. She said we should not “mix up” what it means to be sick with our “old traditional beliefs” but understand from what we have been taught (referring to the nursing training). She continued: …it means the person’s body or system is not functioning in the normal way that it is supposed to be functioning and it could be caused by anything. This can be due to certain circumstances, maybe the weather, maybe allergy. You know when the pollens are opening up before summer; some people are allergic to pollen. So when you inhale the pollen, your system stops to function normally because you are allergic to those. Even in windy conditions somebody will inhale dust, your body will not function well. Maybe it was due to a reaction. Maybe there was a bee sting or whatever; but it will make your system not work properly…. Here Sr. Phindile and Sr. Nothando did not only state the strong connection they had of illness to the body, but also stated how the body gets to this “ill” state. Their view of the body as a “system” portrays it in a rather mechanical manner whereby each part can be separated from the person. Viewing the body in this manner works towards the dissection of the human person into various body part. This approach shows how some of the nurses have adopted the dissected view of the human person as practiced in much of biomedicine. As asserted by Capra (1982: 346), biomedical specialists are keener on body parts rather than the whole person, thus prompting the promotion of biomedical personnel to become specialists in certain body parts. Sr. Nontokozo also had a similar conception and the link of ‘illnesses to the body’.
  • 5. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 227 In one of the conversations with her about an elderly woman who had been brought in by the paramedics, she shared; Illnesses are partly natural because we are in the human body, and if there is something wrong with that body, one will get ill. So it can just be the body deciding to go, otherwise from its natural state due to maybe old age just like that granny (referring to the patient we had seen been taken into the ward) and there is nothing we can do about it hey (Sr. Nontokozo). Similar to Sr. Phindile and Sr. Nothando, Sr. Nontokozo showed that illnesses are situated within the human body, and in this case, caused by advancement in age. She was of the opinion that although the woman might have been suffering from several illnesses, the age of the woman played a role in her ‘proneness’ to such illnesses. This, she said, was because at the woman’s age, her body and immune system was too weak to fight against some minor illnesses as the body of a younger person would. Such an understanding of illness as a phenomenon of the body, is not foreign within the biomedical field. As Parle (2003: 108) stated, such an understanding has been “inherited through Western biomedical models of approaching illness”, an approach within which the nurses have been trained. Biomedicine, says Capra (1982: 348), does not make “practical attempts to deal with psychological and social aspects of illness therapeutically” but deals mainly with just the physical body. Twigg (2002: 426), for example, stated that in the modern world, especially in biomedicine, “the body becomes an object for scientific enquiry, to be studied in terms of scientific causality.” As Naidu (2012: 78) in her later study showed, it is through the body that “we are increasingly obliged to enact illness and health”, and there is need for an increased caution “of the dominant ideologies of illness and body” as illnesses impact on people as whole beings. The state of ill health, however, can be caused by a variety of phenomena or factors. Passing through the OPD to the X-Ray Department of the hospital, conversation ensued between Sr. Nosipho and the researcher; … you see, as many of these patients are here (spreading her arm towards the patients waiting in the OPD’s corridor), so too are their illnesses. And even those who might have the same or similar illness, each person’s might have been caused by something different from the other- yet they all end up with certain diseases or some emotional imbalance. Scholars have put forward different definitions of what ‘sickness’ is (see Aronsson, Gustafsson and Dalner 2000: 502; Finney 1963: 206; Goldstein 1958: 773). One such definition comes from Hahn, an American epidemiologist and anthropologist. He asserted that sickness means “unwanted conditions of self or substantial threats of unwanted conditions of self” (1995: 22). Arguably, by referring to sickness as “unwanted
  • 6. 228 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist conditions of ‘self’”, Hahn shows an understanding of a person as a whole, physical, psychological and spiritual. This understanding is more encompassing as opposed to the ‘traditional’ Western view that tends to delineate other aspects of the human person and only gives regard to the physical body when understanding ill-health. Sickness however, one is reminded, is an umbrella term for both disease and illness. Disease is regarded as “the outward, clinical manifestations of altered physical function or infection” and this definition is entrenched in the belief that a person’s health is a “clinical phenomena, defined by the pathophysiology of certain tissues within the human organism” (Brown et al. 2005: 11). Most approaches to a person’s state of well-being within the biomedical sphere are in turn shaped by this operational definition of disease. Illness, however, as Brown himself notes, “Encompasses the human experience and perceptions of alterations in health as informed by their broader social and cultural meanings” (Brown et al. 2005: 12). Thus, amongst the Nguni,1 ill health is regarded as an “intrapsychic, interpersonal or social disharmony” with either one’s environment or others, including the ancestors (Edwards 1985). The various explanations of ill health, its causes and how it is viewed by the research participants such as Sr. Nosipho, Sr. Nontokozo, and Sr. Phindile, led the researcher to probe what such factors could be. As writers (see Bates 1997: 1447; Parle 2003; Quah 2003) have stated, health and illness is understood amongst the amaZulu somewhat differently as conceived in Western societies. This was the critical point of insertion for this study. Our environment can also be dangerous, you know” This (ill health) can be due to certain circumstances, maybe the weather, maybe allergy of food or other things. You know when the pollen is opening up before summer; some people become allergic to the pollen grains. So when you inhale the pollen, your system stops to function normally because you are allergic to those. Even in windy conditions somebody will inhale dust, your body will not function well. Maybe it was due to a reaction. Maybe there was a bee sting or even maybe say a plant or whatever; your system will not work properly, and this shows that our environment can also be dangerous, you know (Sr. Phindile). These were Sr. Phindile’s words as the researcher sat with her in her office assisting her in arranging a pile of documents. She cited an example of how she had seen the possibility of the natural environment impacting on one’s health. Something happened around my community. People ate something that they thought were good mushrooms. They ate the mushrooms that are grown in the field that are not meant to be eaten, they ate them and they fell terribly sick. They
  • 7. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 229 should have known that those are not meant to be eaten but they still went on and ate them. I am not sure whether some people died or whatever, but one can die from those. Another participant, Sir Jabulani, a senior nurse, also shared a similar view of the possible “dangerous” impact the environment can make on our health. He was one of the friendliest (male) nurses the researcher met at the hospital and was always willing to explain anything he was doing with the patients, from blood transfusions to administration of medication. This 31 year old nurse shared; There are so many things that can cause this ill health. It can be the environment, it can be what a person eats, it can also be the type of job a person does, it can also be where a person stays, if it is not conducive enough. It can also be allergies that a person is having. Dubos (1987: 1-2), states that the “very process of living is a continual interplay between the individual and his [sic] environment, often taking the form of a struggle resulting in injury or disease”. It has also been noted by Kirsten et al. (2009: 4) that if a person’s environment ceases to be healthy, his or her wellness will also suffer an adverse effect of the environment’s state of being. This relationship of a person’s health with his/her environment is a belief that is at the heart of both eco-systemic anthropology and traditional medicine. It is a belief which asserts that for a person to be well, there needs to be a healthy environment in which he or she lives in. “…he was bewitched because he was clever at school” Some of the nurses’ also had stories on how patients claim to be bewitched or how they or their children were bewitched at one point or the other in their lives. Sr. Andiswa for instance, narrated an incident where a child’s illness was regarded as bewitchment by the child’s family as a first form of reaction. While playing with the children, she told the researcher about many incidents she had seen, where bewitchment was claimed (by the family) to be the cause of the person’s illness. One of such was the case of a 12 years old child admitted in her ward. There was a 12 year old child who was admitted here with TB and meningitis. He was admitted post operation because the mother told us that the child complained of headache and the following day he did the same. They gave him Panadol and he went to school, but on the third day on his way from school, the child fell and collapsed. The first thing they said it was bewitchment. Sr. Andiswa went on explaining to the researcher how the family took the child to an inyanga and yet the child’s condition did not improve; hence, they were ‘forced’ to
  • 8. 230 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist bring the child back to the hospital. However, by the time the child was brought back, he was unconscious and they had to refer the family to another hospital for treatment and it was discovered that the child had TB and meningitis. He was resuscitated and treated in that hospital. Even though the explanation was given that this child had meningitis, the family still believed that it was not meningitis. That he was bewitched because he was clever at school, the family was doing well and so they believed that someone was against them. I understand why they kept thinking so because I know that these things (bewitchment) happen because some people can have great powers to do so. We have some connection to each other and we are supposed to keep up with the common spirit of living connected as it has always been from old generations, but unfortunately some people use it wrongly (Sr. Andiswa). The connection people share may be through a familial bond, as in family relatives, but also by sharing the same communal space or beliefs. Most of the participants expressed a deep belief in an interconnection with people within one’s family and community2 . The pan African worldview of a person as a communal being linked to other beings through some “vital force” in the cosmos, plays a huge role in the development of contemporary amaZulu’s worldview. This concept means that a person exists within the community, but his or her life can be greatly influenced by the “vital force” and shared spirituality of other beings (Nussbaum 2003:107). Sr. Xoliswa alluded to this possibility of people using the connection they have with others and the power in them to harm others as opposed to the expected norm of mutual harmony. Sayings such as umuntu ngumuntu ngabantu – it is through others that one attains selfhood (Edwards, Makunga, Thwala, and Mbele 2009: 1) stem from such views and expectations of communal harmony. Thus the Shonas of Zimbabwe will say “ndarara, rana mararawo – I slept well, if you slept well, and taswera kana maswerawo – my day has been good, if your day has been good” (see Asante 2006: 154). Also narrating another incident of a patient who was said to have been poisoned, Sr. Xoliswa shared how she was once faced with a patient whom she thought had TB but did not respond to the appropriate treatment of TB. I failed to understand why the child was not responding to the treatement even though he shows all the symptoms of TB. Then the aunt said she believes that the problem was caused by idliso (food poisoning) because the in-laws were against her. That they wanted to kill her, so they had put some idliso in her food and she shared the same food with this child and that is why they have the same symptoms. So it was eye opening because from our side we did everything that we could but could not help the child.
  • 9. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 231 Here not only did Sr. Xoliswa believe, as did the child’s family, that the child had been bewitched; she went on to state how the child would have been possibly bewitched, and that it was through food poisoning. Food poisoning was one way in which a number of the participants felt people can be bewitched, aside from spells or other forms of bewitchments. Sr. Phindile also asserted a similar view to Sr. Xoliswa in relation to the possibility of food bewitchment thus leading to a person getting sick. There are some (illnesses) that cannot be related to natural cause, like taking food that is poisoned. That is not natural. Maybe somebody put something in your food. Maybe you eat something that is not meant to be eaten. Even with the traditional medicine that might have been gotten from an isangoma. When you eat the food you will become sick and that is also bewitchment (Sr. Phindile). Conventionaly, poisoning can be carried out using any form of medication, ranging from an overdose of prescribed medication to an intake of harmful medication. Here, Sr. Phindile and Sr. Andiswa refered to the form of poisoning made from “traditional” medicine with the purpose of harming one’s “victim”. Research (Ashforth 2000; Geschiere 1999: 213; Golooba-Mutebi 2005: 938-939; Niehaus 2003: 184; Parish 1999: 430) has shown that in many African societies, there is still a preoccupation with witchcraft. Such a preoccupation continues to persist (Ashforth 2000; Fisiy and Geschiere 2001: 227; Moore and Sanders 2003). Dr Fredrick Golooba-Mutebi, a Ugandan anthropologist and Social Scientist and Stephen Tollman, an Associate Professor of Public Health at the University of Witswatersrand, have written extensively about witchcraft as practiced in contemporray South Africa. In one of their writings, they assert that many afflictions are attributed to human agency such as witchcraft, sorcery and poisoning (2007: 66), especially within the Zulu culture. Sir Jabulani shared; We had an incident of a patient here some time back, the patient had a high position at work, and you know the kind of jealousy that is amongst the Zulus, we use traditional medicine to deal with jealousy by attacking people we do not like. So after all sorts of tests and scans we were not able to detect what was wrong with the patient. Unfortunately that patient died. I am sure he was bewitched because of his wealth and the new promotion his family said he had just received from work (Sir Jabulani). Sometimes, family members are also accused of having bewitched one person or the other within the family just as in the narrative below told by Sr. Nontokozo. I had a gentleman like two weeks back who wanted to commit suicide and was rescued and brought to the hospital. When I asked him what made him want to do that, he told me that sometimes when he is on his own, he hears voices and all of a sudden he felt like killing himself to stop hearing those strange voices. So he took
  • 10. 232 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist an overdose of medication to kill himself… He said to me that he felt that his granny from the rural area is the real cause because she has bewitched them. That she killed his father and now she wants to kill him… So he feels it is some sort of a family curse and I understand him because I have seen those things. Sr. Nontokozo claimed that she knew that the boy was bewitched as she has seen that happen many times. With the skills she had gathered from her previous degree in Social Work and her awareness of the possibility of such situations, she said she was able to approach the patient’s situation calmly. “Becoming a nurse”, however, she said allows her “to be more practical in helping people rather than just advising or directing them”. Thus, she tried to approach the patient’s situation from the living sociocultural reality of the patient, which is a belief in bewitchment- and which she also shares. “…this is a Zulu thing …the ancestors were not happy” From antiquity, a belief in some supernatural or metaphysical being has proven to have a great influence on people’s ways of life and attitude towards life. Many participants shared views of how they believed their ancestors played a role in inflicting people with pains. Such inflictment is believed to be a form of punishment from the ancestors to the person for not giving due reverence to the ancestors either through some expected ceremonies or rituals, or a warning of something that may befall the person. Sr. Nosipho, whose duty post at the children’s Intensive Care Unit (ICU), told me of an incident which occurred to her child. I have seen an incidence that I did not know what it was at first but later realised that it had to do with the ancestors and it was with my child. She was vomiting, losing weight, and feeling very sick. So I brought the child to the hospital. They noticed that she was dehydrated and we were referred to another hospital for more tests but they could not find anything wrong with her. We were again referred to a higher hospital, they did all kinds of test and they all came back as NAD (No Abnormalities Detected). But what I noted was that her right side was not working. She failed to write. I had to write a letter to their teacher to tell her that she has to understand. She was 14 years then. I could see that it has something to do with traditional things, but I was not sure. Then I had to call the family from her father’s side and we sat and discussed about it. They said no, this is a Zulu thing and it is something that should be corrected from the family. So they carried out some rituals and she became well. So they said the ancestors were not happy with some of the happenings in the family that was why. The family did not pay the damages when the child was born and they did not carry out her birth ceremony (Sr. Nosipho).
  • 11. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 233 A narrative by Sr. Andiswa, whom the researcher called “the Children’s Angel” due to her fondness for the children, displays a similar incident as experienced by Sr. Nosipho’s child. We as parents believe in the hospital treatment, but we also believe that some illnesses are caused by something else and need to be culturally treated. And there are some things that are in our culture that you have to do to a child. When a child is born, at about three months old, you have to remove what is called inyioni. This is done after the first ceremony that introduces the child to the ancestors. So this is to keep the child connected with the ancestors. The child is given herbal enema once a week for three weeks and then the child will grow healthily without any issues. Sometimes when parents complain that the child has hipper pigmentation behind his head, that type of pigmentation is called inyioni and it will get the child sick always. We do not wait until the child is sick before removing the inyoini; we do it when the child is still young. So sometimes when the child is sick, it could be because they did not take out the inyioni (Sr. Andiswa). Certain ritual ceremonies are performed by amaZulu at different stages of a person’s life, such as at birth (imbeleko), maturity and even after a person dies. After childbirth, a woman is expected to remain in the house for a period of ten days to carry out certain rituals using a white goat in thanksgiving to the ancestors for enabling her a safe delivery and protecting the baby. In a ceremony the researcher was invited to by Sr. Nelisiwe, she explained to the researcher the importance of having an animal during the ceremony. She said it shows that the person whom the ceremony is been performed for is able to go out of his or her way to appreciate or appease the ancestors. Failure to carry out this ritual is said to lead to many misfortunes in the life of both the mother and the baby (Pauw 1994: 12). Sr. Andiswa asserted that it is common for children to get ill amongst many contemporary amaZulu families because of how many children are not “properly” welcomed into the world, either because they do not know their fathers, or their fathers deny them. She said the cause of this is because many men seem to either “disappear” after impregnating the ladies, or deny fatherhood of the children. Thus, the children are unable to undergo the appropriate initiation ceremony, especially to the father’s ancestors. There was also a patient in the hospital that Sr. Andiswa said was suffering from a similar situation because his inyioni was not taken out, but they were still waiting to see if the child would respond to any of the treatments they were trying on him. Another ritual is carried out at the age of maturity of males. This ritual is known as ukushwama.3 Failure to perform any of the ceremonies expected of a person (in the opinion of many AmaZulu) can have a highly negative impact on the person that does not carry out the ceremony. This is believed to be the expected consequence on the person or his/her family as they would have angered or disrespected their ancestors
  • 12. 234 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist (Vilakazi 1965: 92). Within the Zulu culture and many wider pan African soceities, ancestors are generally regarded as the “living dead” members of a clan based on their supposedly active role in the lives of the living clan members (Buhrmann 1984: 27-28). Thus, the concept and belief in ancestors has psychosocial dynamics which impacts on the everyday life of people who believe in their existence (Edwards et al. 2009: 1). As stated by Bogopa (2010: 1), “ancestor worship is founded on the belief that the dead live on and are capable of influencing the lives of those who are still living. They are capable of both blessing and cursing those who are still living”. The extent to which ancestral belief is embedded in the life of African people relates to the degree of influence on their health-related attitudes. Thus, according to Bogopa, “one cannot talk about health in South Africa without acknowledging the reality of ancestral belief” (Bogopa 2010: 1). Many of the research participants gave the researcher the impression that they also believed strongly in ancestors and in the possible role they play in the lives of the people. Many of the participants spoke about the ancestors as being a part of them. Edwards et al. (2009: 3) asserts that “there exists an “intimate relationship between the living and the dead” and it shows itself in how much revernce is given to concepts such as umphefumulo (soul), umoya (spirit) or isithunzi (shadow). The ancestors, says Edwards et al. (2009: 4), hover over their living descentants, and that is known as ukufukamela. Bogopa (2010: 3) states that the “Zulu-speaking people believe that if a particular ancestor had a temper (enolaka), he would come down with great harshness when he felt offended”. This punishment can be an illness, an accident, or a lack of progress in one’s job or profession (Buhrman 1989). Although the ancestors may not directly inflict any pain on people per say, but by taking away the protection they would normally give to the people, people are left exposed to numerous misfortunes such as violence, drought or even a decrease in health (Adams 1999). While some illnesses are regarded as a curse from the ancestors due to failure to carry out a ritual, some illnesses seem to come as a sign to show that a person has been “specially chosen” to follow the cultural path of becoming a healer. Sr. Andiswa who is married into a “traditional” family4 narrated how her child was “chosen”. Something happened to my child who is now 3 years. After his birth, he was just normal, and then at the age of 18 months, I found out that the fontanel was still open. So I went to the doctor and the paediatrician said let us go for a scan. The results came out and it was declared hydrocephalous, but it was non communicative hydrocephalous. Then I talked to the family, my in-laws, and they said no, this is not hydrocephalous. It, being hydrocephalous means he needs
  • 13. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 235 to be taken for an operation to put up a shunt. So the family said no I do not have to go for an operation. That this normally happens in the family when a child in the family is “chosen” until they are entrenched (referring to the indoctrination of the child into the family’s cultural practice). There are some kids in the family who had the same problem and you have to consult the family’s isangoma first before you even go and do whatever operation you want to do. Now we are doing the rituals for the whole of this year. Although signs to know if a person is chosen or not, differ, usually some unusual circumstance occurs- such as illness, persistant dreams or nightmares, and sometimes accidents, especially if a person does not want to respond to the call to be a healer. As Ngubane (1977: 102) asserted, in Nguni culture, “a person does not choose to become a diviner, but is chosen by ancestors, who bestow clairvoyant powers”. It is expected that the person carries out a rite, which can last for several months as a way of accepting and being trained in the “ways of the healers”. The ritual of accepting the call is known as ukuvuma idlozi, which “implies death to the old way of life by undergoing training to be “reborn”, ukuthwasa (Edwards et al. 2009: 4). As mentioned, many African societies, including the isiZulu-speaking communities, are of the belief that there exists a cosmological and hierarchical relationship in the universe (Parle 2003: 107). This hierarchical relationship is arranged in this manner: “a ruling deity, less powerful spiritual entities, ancestral spirits, living persons, animals, plants and other objects” (Truter 2007: 57). Placide Tempels, a French philosopher who lived in Congo and who wrote extensively on the Bantu, attempted to analyse this linear relationship and the notion of ‘being’ and ‘existence’ within the African setting. He introduced the notion of ‘vital force’, referring to some form of strength and power that is enshrined in each being (Tempels: 1959: 58). This power, he claims, makes the African peoples capable of a ‘to and fro’ relationship in the universe. The ‘connective’ effect of vital force confirms the African ideology of an interconnected and harmonious rapport between all existing beings. Like a spider’s web, beings are attached to, and necessarily influence each other. Thus, a person’s or being’s vital force can be used to increase or diminish the force of another. Valenkamp and Van der Walt (2006: 11-12) also wrote about this metaphysical connection that exists within beings when they said that the cultural or “entrenched” aspect of the human person, involves the spiritual realm. This cultural aspect and belief in an interconnectedness of beings contributes to the amplification of the bio-psychosocial model to health, as asserted by Valenkamp and Van der Walt (2006: 12). Thus, amongst the amaZulu, illnesses are often attributed to a spiritual or social cause, and a person can be made ill by another through witchcraft and sorcery and not only physiological or biological (see Naidu 2013:253-254). Understanding the connection between the health of a person and his or her relationship
  • 14. 236 Maheshvari Naidu and Gabriel Darong The Oriental Anthropologist with other beings is crucial to eco-systemic anthropology. Eco-systemic anthropologists are of the belief that a dysfunction in the relationship can bring a misbalance in a person’s health (Kirsten et al. 2009: 6). These narratives and beliefs display how people’s reverence of the ancestors and the supposed connection between the living and the dead can have on people’s daily well-being and activities. The narratives and stories portray how the isiZulu-speaking nurses regard the environment, the ancestors and other community members as factors that can be connected to ill health state. This ill health, as shown in this paper, can be physical, spiritual, emotional or social, causing disharmony between the person and his/her ancestors or other members of the community (see Cumes 2004: 90, Golooba- Mutebi and Tollman 2007: 65-66). CONCLUSION These narratives and experiences show that cultural factors cannot be done away with in diagnosis, treatment, and patient care. Biomedicine, however, has over the years attempted to overlook the possible impact of cultural beliefs on patients and nurses’ health beliefs and values. Thus due consideration needs to be taken of how nurses’ explanation of aetiology and patients care is being influenced and affected by their cultural constructions of health and illness. In this paper, the researcher has attempted to explore isiZulu-speaking nurses’ understanding of illness and healing. The captured narratives in this paper show how many of the nurses had strong beliefs in the cultural approach to health. These beliefs have either been shaped by their upbringing, or their personal experiences or those of their close relatives. As such, they have particular understandings of what it means to be sick, which have been shaped by both the biomedical training and their cultural beliefs and practices. Some of the beliefs, as seen in the paper, are the belief in the interconnectedness of all beings and that all beings are able to influence each other. The participants also expressed a belief in ancestors and witchcraft as contributory factors to determining people’s state of health. Thus, it is inevitable that such beliefs5 , to a large extent, shape their understanding of biomedicine and its practice within the hospital space. Notes 1 Nguni is a name used in collectively referring to “a major group of Bantu-speaking peoples. The Northern Nguni comprise of the Swazi, Zulu, and Ndebele peoples of the high veld; and the Southern Nguni include the Xhosa, Thembu, Bomvana, Mpondo and Mpondomise” (South African History Online 2014). 2 Living together, however, there is always a possibility of misunderstandings and tension amongst people. While some may take to the formal dispute resolution process of reporting an offender to the community head or the civil authority, others may resort to the use of “traditional” medicine (muti)
  • 15. When Illness is more than just a Sick Body: Probing How isiZulu- Speaking Nurses’ Construct Illnesses and Healing The Oriental Anthropologist 237 in order to poison or “bewitch” a person they dislike or who they feel has wronged them. 3 After this ceremony has been carried out, before a person gets married, several rituals take place during the ilobola (bride price) negotiation process. This particular ritual is believed to create a strong bond between the new couple and to serve as an introduction of the couple to the clan’s ancestors (Pauw 1994: 13). Vilakazi (1965: 91-92) also notes that certain rituals take place after a person dies. There is the slaughtering of a goat by the family and a farewell ceremony known as hlamba izindla, performed a week after the person has been buried. This ceremony is followed by zilela ofile, another ceremony carried out a month after the person’s burial. 4 By this the researcher is referring to a family which holds and practices cultural rites and has some members who are “traditional” healers. 5 A separate study analyses how these beliefs in turn impact on and possibly shape the specific patient care that the nurses offer the patients and whether there is a degree of tension and conflict experienced by the nurses regarding their bio-medical training and their own constructions of illness and health. References Adams KA (1999). The role of Izangoma in bringing the Zulu Goddess back to her people. The Drama Review, 43(2): 94-117. Aronsson G, Gustafsson K, Dallner M (2000). Sick but yet at work: an empirical study of sickness presenteeism. Journal of Epidemiology and Community Health. 54(7): 502-509. Asante M (2006). The rhetoric of Globalization: dealing with Westernity. Journal of Multicultural Discourses, 1(2): 152-158. Ashforth A (2000). Madumo: a man bewitched. Capetown: David Phillip Publishers. Barnard A (2000). History and theory in Anthropology. Edinburgh: Cambridge University Press. Bates M S, Rankin-Hill L, Sanchez-Ayendez M (1997). The effects of the cultural context of health care on treatment of and response to chronic pain and illness. Social Science & Medicine, 45(9): 1433- 1447. Bogopa D (2010). Health and Ancestors: the vase of South Africa and beyond. Indo-Pacific Journal of Phenomenology, 10: 1-7. Brown PJ, Barrett RL, Padilla, MB (1998). Medical Anthropology: an introduction to the Fields. Understanding and Applying Medical Anthropology, 10-19. Buhrmann MV (1984). Living in Two Worlds: communication Between A White Healer and Her Black Counterparts. Cape Town: Human & Rousseau. Capra F (1982). The Turning Point: Science. Society and the Rising Culture. London: Wildwood House. Creswell JW (2009). Research design: qualitative, quantitative, and mixed methods approaches (3rd Edition.). Los Angelos: SAGE Publication, Inc.
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