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For ages, I've been meaning to post about traditional healers (the politically incorrect, early-1900s anthropologist term would be "witch doctors"). They're completely fascinating -- I just hope that I don't make them uninteresting by talking overmuch about vocabulary. You guys will let me know if this entry is confusing, right?

Traditional healers are a major facet of Swazi consciousness, and South African too, and probably in other nearby countries as well, though I'm not sure how present they are in non-Swazi non-Zulu culture. (Swazi culture and Zulu culture seem quite similar to me, though I'm sure there are many important differences that an insider could swiftly enumerate!) These magicians are heavily intertwined with traditional ancestor worship and other religious beliefs. They're referenced in everything from movies -- if you haven't seen "District 9" then you really should -- to advertisements. My personal favorite piece of Swazi ephemera that I have so far collected is a leaflet from Nando's Restaurant that characterizes all the food in the terms of magical cures. For instance, over a picture of Burger Meal it says "To make your boss like you," over a picture of Full Pack Meal it says "To fix the family problems," and over a picture of Half Chicken Meal it says "To give your man more power." On the back it says, "Dr. N. A. Ndos Lemon and Herbalist: With New Powerful Herb, the African Bird Eye Chili," and gives further effects, such as "Makes employees happy at you", "Makes you to save the electricity," and "Makes enemies jealous." And on the bottom it says, "It's like magics." I love it so much.

The siSwati words for "traditional healer" are inyanga, plural tinyanga; also sangoma, plural tangoma; and a much less-used term, umfembi, plural bafembi. I am not entirely sure how most Swazis view the differences are among these terms; I tried to get some clarity on that question by asking around about the difference between tinyanga and tangoma during training last year, and ended up more confused:

* My host grandmother said that there is no difference.
* My friend's host sister said that tangoma are female but tinyanga are male, which doesn't seem to be 100% true from my experience.
* And the Peace Corps Training Manager, who is also Swazi, said the only difference is that tangoma dress traditionally while tinyanga don't.

After those three variant data points, I gave up ... you can already tell that it's tough to get good information on traditional healers, especially as an outsider. (Although at least one non-Swazi has undergone the initiation to become an inyanga. He wrote a book and everything!)

A Traditional Healer is Born

An oldish book about traditional healers by Lydia Phindile Makhubu informs me that tinyanga uniquely possess kushaya ematsambo, the bone-throwing skill, endowed upon them by the ancestors, which they use to diagnose illnesses. In contrast, tangoma diagnose by means of kubhula, communication with supernatural powers. The umfembi is similar to a sangoma, but rather than being tutored by benevolent spirits, an umfembi will be possessed by whatever evil spirits are causing the problems ze is diagnosing. Makhubu writes that for bafembi, "the spirits involved belong to people killed by members of the umfembi's family, perhaps in past wars." (In other sources, I've seen tinyanga referred to as "herbalists" as opposed to tangoma being "diviners".)

A traditional healer. Image taken from this site.

Makhubu mentions yet another type as well, the lugedla, which "evolves from those three" and whose skills are "acquired" rather than supernaturally inspired. That is, the lugedla learns how to be an traditional healer from existing healers ....

Which brings me to kwetfwasa. This is a process by which "ancestors manifest their presence in the subject who will eventually become a traditional healer," and it seems always to be attended by madness, illness, and/or omens. A lugedla does not undergo this, but the other types do. A person undergoing kwetfwasa is referred to as a litfwasa (plural ematfwasa); Makhubu describes past ematfwasa who disappear to a destination "as if hibernating", then return. Other accounts include:

* Periods of amnesia.
* A three-year submersion in water while learning techniques from "a woman with many necklaces".
* The litfwasa killing a python with his bare hands, then walking around with it wrapped around his neck.
* Families giving ematfwasa up for dead.
* Prophesies coming true, such as a cow behaving according to prophesy on the morning of a litfwasa's return.
* Loss of one's previous job has also been described as a kwetfwasa omen for at least one traditional healer.

Makhubu writes that "hibernation has disappeared" in "modern kwetfwasa," but a stage of incurable illness remains. A modern traditional healer named Priscilla Dlamini gave a lecture to Peace Corps Swaziland Volunteers in which she described her own kwetfwasa. She said that she experienced terrible aches and pains, but only between 6pm-7am, and that the aches defied all diagnoses. She went for everything up to and including an arthritis test and the doctors found nothing. These problems persisted until she had a dream of her call to healing, and then she felt quite suddenly better. (She was also careful to note that there's no consistency across healers -- two different healers can experience a completely different kwetfwasa.)

Sometimes ematfwasa are tested by their communities upon their return, to ensure that they're really enlightened -- like for example a family might hide articles and demand that a litfwasa use supernatural powers to find them. Or, as in one story, hide sacrificial animals and then demand that the litfwasa kill the animals without using a weapon -- just bare hands.

Illnesses and Remedies

Traditional healer treatments include bleeding patients through small cuts; administering enemas; saunas; various types of baths; and a huge number of herbal treatments, including poultices, drinkable solutions and burnt herb inhalation. There are also many more ritualized and/or mystical treatments. One description depicts the healer taking an axe to the patient's shadow, pouring medicine on the ground, blowing a whistle and calling the patient's name while requesting the return of the patient's soul. Another involves a type of madness attributed to actual beetles in the brain; the patient may be forced to vomit or sneeze the beetles out.

But there's a lot more than ritual to the paradigm difference between traditional healing and modern Western-style medicine. For one thing, the modern traditional healer Priscilla Dlamini told us that the healers tend to treat each physical symptom as its own illness -- for example, the headache and the sneeze will be treated separately, rather than the flu being treated. (As a matter of fact, the siSwati verb for "treat" is the same as the word for "cure.") In some ways this could be better than Western medicine -- for example, Dlamini said that traditional healers are often better than Western doctors at pain management.

But Western medicine can cure some diseases that traditional healers can't, and the traditional approach is incredibly problematic for a long-term, largely invisible disease like HIV. (Also, HIV myths cited by some traditional healers apparently include that HIV is contracted by sleeping with a woman on her period, or with a woman on the contraceptive pill, or with a woman who has had an abortion, or basically any other excuse to demonize women who behave in a so-called "unnatural" way ....)

For another thing, traditional healers are often sought out not just for problems that Westerners would typically consider illness or injury, but also family problems, evil omens or community issues. (Remember the Nando's Restaurant leaflet I mentioned above, and the effects it advertises?) In many ways this is awesome -- it's really important to acknowledge the effects of one's social environment and context on one's health, and Western medicine does a bad job of that.

In some ways, though, this approach makes me very uneasy. For example, from what I understand, most problems end up blamed on angry ancestors ... or on a wicked sorcerer. The sorcerer -- umtsakatsi (plural batsakatsi) -- can then be pointed out by a traditional healer and punished by the community. Batsakatsi are supposedly capable of causing harm in a number of ways, including magical poisonings, magical infliction of illness, bad luck enchantments, and lightning control. (Fun fact: Swaziland has more lightning strikes per capita than any other country in the world. Storms can be incredibly gorgeous.) One account from the writer Makhubu even includes an admitted failure from an inyanga, who says that he wrongly diagnosed a litfwasa as ill -- in fact, the inyanga accused a community member of being an umtsakatsi who had made the litfwasa ill.

The problems of one person being able to identify a community scapegoat who is then harshly punished are obvious. If I learned anything from living in a housing co-op, it's that small groups will find scapegoats on their own, and it's not a fun process to watch. Of course, another thing I learned from the co-op is that sometimes a given person can be legitimately bad for a small group, and the best thing for everyone may be to encourage that person to leave. Which makes me think that there are probably occasions on which the umtsakatsi approach has a grain of truth to it. But I still think that the scapegoating extreme is best avoided -- especially here! After all, it's pretty easy for an urban American to move out of a co-op if they're scapegoated; it's much harder for a poor rural Swazi to leave the community where they grew up.

Traditional Healer Activism

Priscilla Dlamini wrote her thesis on facilitating interaction between traditional healers and Western-style medicine. She is herself both a traditional healer and a lecturer at the University of Swaziland, and she heads the Swaziland Institute for Research in Traditional Medicine, Medicinal and Indigenous Food Plants. Herbal treatments are often emphasized by healer activists; for example, the Traditional Healers Association sometimes asks for large amounts of money so as to test traditional treatments vs. Western-style medicine. But some traditional healers are guided to plants by the ancestors, which is not a scientifically testable process. And Dlamini admits that there is little "transparency" -- many healers won't tell or show anyone else about the plants they use, not even other healers.

The lack of transparency understandably exists in part because traditional healers are heavily stigmatized. Mainly, this seems due to the influence of Christians and white colonists, who opposed all "backward godless native tribal beliefs." In other words, the stigma against traditional healers is driven by stigma against traditional culture. A 1904 act on "witchcraft" is still in effect, characterizing all traditional healers as "witches" and criminalizing their actions; it's not enforced, though. Dlamini noted that a King's Act from 1964 (a few years before King Sobhuza attained full independence for Swaziland) tried to protect traditional healers and bring them within his sphere of influence. Interestingly, King Sobhuza cast traditional healing as fully reconcilable with Christianity: after all, he pointed out, Mary Magdalene was also an ancestor.

Just in the short time I've been here, I've seen many newspaper reports on false traditional healers, unethical ones, and even murders carried out for the sake of harvesting people-parts for traditional healer medicines (in siSwati, the medicines are called muti). I've read that African albinos are in particular danger of being murdered for their body parts, especially in Tanzania; the movie "District 9", which features aliens landing in Johannesburg, suggests that the aliens would be slaughtered for muti. My friend and fellow Volunteer Brooke's host sister was murdered last September. When the body was found, Brooke told me that some of the locals were perplexed because nothing had been harvested. "They didn't even take her parts," said one puzzled gentleman.

When I asked about those things, Priscilla Dlamini admitted that accusations of ritual murder and "witchcraft" may be true for some traditional healers. She also said that there are definitely fakers out there, and problematic "status wars" among healers who wrongly insist that their treatments always work. She explained that as one example from her own experience, she was sure you can't bestow guaranteed luck on another person: you can try but "when you do it, you are not sure yourself if it will work." But she makes an argument that's often made about marginalized populations, one that I agree with: if we bring them into the light, decrease stigma and empower them, then it will be easier to separate the bad apples and reward the good.

Although Swaziland works hard on promoting its native culture, traditional healers are still an obvious intersection of more anxiety and distrust than pride. Many Swazis, especially progressive and/or very Christian ones, seem to both have faith in traditional healing and to be embarrassed by it. Dlamini mentioned that a priest once came to see her -- at 11pm, so he wouldn't be seen. (Late-night visits to traditional healers are practically a cliché, they're so common.)

I recently went to an (awesome) lecture on snakes with Swaziland's premier snake expert Thea Litschka-Koen, who is white but born and raised in Swaziland. At one point Thea was talking about traditional healers and snakebite, and she tossed off a side comment that I found fascinating -- "Of course I believe in the healers. We all believe in them." I suppose it's somewhat racist of me, but I had assumed that the largely-separate white Swazi community would ignore or scorn Swaziland's ethnic traditional healers. Apparently not, though! It makes me wonder how many of those midnight visitors are white ....

Ultimately, it's clear that health workers ignore traditional healers at our peril, because they are so influential. Their influence is waning -- in 1983 one estimate put the number of healers per Swazi citizen at 1 per 110; now, it's estimated at more like 1 per 10,000. Still, an enormous number of people consult traditional healers; I know for a fact that my host family visited an inyanga at least once. Currently, there are a lot of efforts focusing on intertwining HIV initiatives with the healers. The United Nations and the World Health Organization have both made efforts to work with them, for instance, and negotiations are afoot with the Swazi government's Ministry of Health to establish a National Traditional Healer Council that would give healers an official presence and legal power.

I still have not met a traditional healer around the community, although I keep meaning to go introduce myself to some of those who keep a high profile. At my old site there was a traditional healer right in the middle of town who had once been interviewed by the BBC -- I tried visiting him, but never managed to catch him at home. Near my new place there's a traditional healers' office, and one of these days I'll go for a chat. For all the recently-fashionable goodwill, though, it's not clear that most healers can be easily reached. At my old site I talked to the clinic about traditional healer initiatives; the nurse told me that they'd had a training for healers some years ago and that many healers had shown up for the workshop, but she'd never seen them again. And there are still plenty of advertisements in the newspapers' classified ads in which traditional healers offer to cure HIV. (Remember how there's no difference in siSwati between the words for "treat" and "cure"?)

Priscilla Dlamini encouraged us as Peace Corps Volunteers to try and teach healers about hygiene (e.g. "wear gloves when you bleed patients!"), to seek healers' assistance in distributing condoms, and to figure out how healers actually function in the community. But the most vivid healer image that comes to my mind is from one of the ubiquitous "edutainment" dramas -- siSwati plays, performed at health events, that address HIV issues. I saw one at my old site in which a healer came onstage doing a traditional dance ... and everyone laughed. It wasn't that he was doing anything particularly funny. I think it's more that people kind of automatically laugh nervously as soon as healers come up.

By the end of the play, the healer character was dead of AIDS -- he had contracted the disease by bleeding someone in a ritual treatment. My host sister described the whole plot to me, including the healer's fatal error, with a superior smile. And then she went with the family to see an inyanga.

These are deep waters, and I'm not confident that I could navigate them.

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