South African Traditional Healers Research Articles

Antifungal Compounds from the Leaves of Rhynchosia minima.

Rhynchosia minima, commonly known as jumby bean, is used as a remedy for respiratory ailments in various parts of the world. It is also used by South African traditional healers to treat heart or chest pain. This study aimed to investigate the bioactive constituents of the leaf extracts of R. minima against selected fungal isolates that have been identified as risk factors in respiratory illness. Rhynchosia minima leaves were extracted sequentially using hexane, dichloromethane, ethyl acetate and methanol in increasing order of polarity. The extracts were subjected to repeated chromatographic techniques, for phytochemical isolation. The extracts and isolated compounds were screened against Candida albicans and Cryptococcus neoformans by determining the minimum concentration that inhibited fungal growth. Six flavonoids, one norisoprenoid and one cyclitol were isolated and characterized by 1D and 2D NMR and HR-ESI-MS. The extracts obtained in the study had moderate to weak antifungal activities, with MICs ranging from 312.5 to 1250.0 μg/mL against both fungi. Four isolated compounds were also screened, with two of them exhibiting activity against C. albicans (MIC=6.25 μg/mL) that was comparable to amphotericin B, the positive control. These two compounds also had better antifungal potential against C. neoformans with an MIC=6.25 μg/mL, compared to the MIC of 12.5 μg/mL of amphotericin B. Seven of the eight isolated compounds were obtained from the extracts of Rhynchosia minima for the first time. Two of the isolated compounds demonstrated activity comparable or superior to amphotericin B activity. The notable potency displayed by these compounds warrants further investigation on their development as antifungal agents.

Use of hyphenated analytical techniques to identify the bioactive constituents of Gunnera perpensa L., a South African medicinal plant, which potently inhibit SARS-CoV-2 spike glycoprotein-host ACE2 binding.

SARS-CoV-2, the causative agent of COVID-19, continues to cause global morbidity and mortality despite the increasing availability of vaccines. Alongside vaccines, antivirals are urgently needed to combat SARS-CoV-2 infection and spread, particularly in resource-limited regions which lack access to existing therapeutics. Small molecules isolated from medicinal plants may be able to block cellular entry by SARS-CoV-2 by antagonising the interaction of the viral spike glycoprotein receptor-binding domain (RBD) with the host angiotensin-converting enzyme II (ACE2) receptor. As the medicinal plant Gunnera perpensa L. is being used by some South African traditional healers for SARS-CoV-2/COVID-19 management, we hypothesised that it may contain chemical constituents that inhibit the RBD-ACE2 interaction. Using a previously described AlphaScreen-based protein interaction assay, we show here that the DCM:MeOH extract of G. perpensa readily disrupts RBD (USA-WA1/2020)-ACE2 interactions with a half-maximal inhibition concentration (IC50) of < 0.001 µg/mL, compared to an IC50 of 0.025 µg/mL for the control neutralising antibody REGN10987. Employing hyphenated analytical techniques like UPLC-IMS-HRMS (method developed and validated as per the International Conference on Harmonization guidelines), we identified two ellagitannins, punicalin (2.12% w/w) and punicalagin (1.51% w/w), as plant constituents in the DCM:MeOH extract of G. perpensa which antagonised RBD-ACE2 binding with respective IC50s of 9 and 29 nM. This good potency makes both compounds promising leads for development of future entry-based SARS-CoV-2 antivirals. The results also highlight the advantages of combining reverse pharmacology (based on medicinal plant use) with hyphenated analytical techniques to expedite identification of urgently needed antivirals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00216-022-04041-3.

“The Question Is Not How but Why Things Happen”: South African Traditional Healers’ Explanatory Model of Mental Illness, Its Diagnosis and Treatment

While there is relatively high patronage of traditional healers in South Africa, their approaches toward mental illness remain shrouded in mystery. The research therefore explored the beliefs and practices of traditional healers at Dube Village, Soweto, South Africa regarding the reasons for and treatment of mental illness and was guided by an Afrocentric theoretical perspective. Qualitative interviews with 14 traditional healers revealed that mental illness could be identified by throwing the bones, observations, and history-taking. They attributed mental illness to spiritual, socio-cultural, psychosocial, and physical factors. Methods used to treat mental illness included removing evil spirits through washing, steaming, induced vomiting, and administering herbal remedies. Findings suggest that while there are many similarities with biomedicine, traditional healing differs in terms of its links with spirituality and the efforts of healers to answer the question why things happen from a collectivist perspective.

Psychological ailments and their treatment protocols: a case study of Swati traditional healers in Mpumalanga Province, South Africa.

Evidence suggests that South African traditional healers (THs) treat various mental complaints. However, there is little literature on Swati THs' accounts on this subject. The current study therefore, sought to address this gap. Data was gathered using qualitative research methods, namely semi-structured interviews with 10 purposely sampled Swati THs practicing in the Kanyamazane peri-urban township (Mpumalanga Province, South Africa). Data was thematically analysed. Results showed that THs treat seven psychological aliments, viz. adjustment disorders, depression, mental illness due to ancestral calling, mental illness due to bewitchment, mental illness due to breaking of taboos, psychotic disturbance and substance induced mental illness. Generally, an integrated treatment protocol was utilised by THs to treat and manage these disorders. Most of these procedures are acceptable from either folkloric or scientific viewpoint, and have demonstrated certain level of efficacy in treating mental illness. Taken together, the evidence presented indicates that Swati THs use different traditional methods to manage various mental complaints. In doing so, they carry a large share of the community caseload for mental health, whilst admitting patients in their homes for extended periods of time, and also referring some (patients) for additional care within the Western health sector.

The influence of ancestral spirits on sexual identity amongst Traditional Healers (iZangoma) in South Africa: A discourse analysis

Over the years South African Traditional Healers have been discriminated against, with claims that they are ‘witch-doctors’. Non-heterosexual Africans are also often faced with the horror of violent attacks stemming from the belief that homosexuality is ‘un-African’. The harsh experiences of homosexual, bisexual and transgender traditional healers are, therefore, unimaginable. This study explored the spiritual (ancestral) influence on the sexual identity of African Traditional Healers, particularly iZangoma. The study revealed that for some iZangoma engaging in same-sex relationships is never a choice but ‘imposed’ or forced by the dominant ancestral guide, depending on which sex the ancestor was attracted to when they were still alive. This paper challenges the idea that homosexuality has never existed in Africa, and is therefore an import from the West. Intradisciplinary and/or interdisciplinary implications: this study may potentially inform contemporary African debates around homosexuality and challenge how it is perceived amongst groups that are regarded as playing significant roles of healing and leadership in African communities. Since homosexuality amongst iZangoma is not a chosen identity but forced by ancestral guides, this calls for an end to discrimination against ancestral possession, homosexuality in Africa, and the double stigmatisation against iZangoma who are attracted to the same sex.

An unrecognized key population? Traditional treatment practices associated with HIV risk among traditional healers in rural South Africa.

To understand the risk of HIV acquisition through occupational exposure among rural South African traditional healers, notably via the practice of traditional skin incisions with razors. A random sample of traditional healers living in South Africa participated in a cross-sectional survey that included a rapid HIV test. Rural Bushbuckridge district of Mpumalanga, South Africa. Traditional healers. Pretest counseling, posttest counseling, and referral to care if HIV seropositive. HIV infection. Among healers who reported a previous positive test result or accepted an HIV test (96%), HIV prevalence was 30% (95% confidence interval: 23-37%). During their careers, 98% of healers reported conducting at least one 'vaccination' (as traditional incisions are called), 32% reported always using gloves when conducting these procedures, 29 (14%) reported patient blood touching their bare skin. Healers who reported exposure to patient blood had a higher HIV prevalence than their nonexposed colleagues (adjusted risk ratio: 2.35, 95% confidence interval: 1.55-3.56, P = 0.001). Nearly all traditional healers are routinely performing minimally invasive skin incisions that could expose them to patient blood. The lack of training and access to personal protective equipment increase their risk of acquisition of blood-borne pathogens, including HIV. Given the widespread practice of traditional skin incisions across southern Africa, and the higher levels of HIV among traditional healers exposed to patient blood, it is likely that traditional healers are a hitherto unrecognized key population at disproportionate risk of acquiring HIV.

Throwing the bones to diagnose HIV: Views of rural South African traditional healers on undertaking HIV counselling and testing

ABSTRACT In 2018, nearly 800,000 HIV positive individuals in South Africa were unaware of their status. Traditional healers see patients who avoid health clinics, including those who refuse HIV testing. This manuscript details the results of a qualitative study to understand traditional healer perspectives on performing healer-initiated HIV counseling and testing HIV in rural South Africa. We conducted 30 structured in-depth interviews between April and June 2019 to elicit traditional healer attitudes towards partnering with local health services to perform HIV counseling and testing with their patients. Healers reported that while some patients are open about their HIV status, others lie about it due to stigma. This creates challenges with concurrent treatment, which healers believe leads to allopathic and/or traditional medication treatment failure. Most healers expressed both an interest and a willingness to perform HIV counseling and testing. Healers felt that by performing testing in the community, it would overcome issues related to HIV stigma, as well as a lack of confidentiality and trust with health care workers at the clinic. Trained traditional healers may be able to bridge the testing gap between “non-testers” and the allopathic health system, essentially “opening” thousands of new testing locations with little financial investment.

Effects of Silver Nanoparticle from Dicoma anomala Sond. Root Extract on MCF-7 Cancer Cell Line and NF54 Parasite Strain: an In Vitro Study.

Biogenic silver nanoparticles (AgNPs) continue captivating researchers in biomedicine field of research. Dicoma anomala Sond. plant, locally known as hloenya, hlonya, maagbossie, inyongwana, is widely recommended by South African traditional health practitioners (THPs) to treat against different health issues. The antiplasmodial effects of novel sesquiterpene molecules (C30H36O7; MW: 509.25) isolated from D. anomala Sond. have been reported by us (Patent US 8,586,112 B2). The aim of the study was to determine the anticancer activity of AgNPs synthesized using D. anomala plant root extract and the antiparasitic potency of AgNP-conjugated sesquiterpene. Nanoparticles have been characterized using different methods. Anticancer activity of AgNPs was evaluated against the MCF-7. This study also revealed that the AgNP-conjugated sesquiterpene has shown better antiparasitic activity against Plasmodium falciparum NF54 strain. One-pot synthesized AgNPs using Dicoma anomala Sond. root extract caused oxidative damage in breast cancer cells. These findings indicate the need for more in-depth research in the use of the AgNPs and sesquiterpene for development into potential leads as an antimalarial candidates and to improve the bioavailability of these sesquiterpenes.

Traditional health practitioners and sustainable development: a case study in South Africa.

To highlight legal and regulatory advances relating to South African traditional health practitioners (THPs) over the past 10 years and discuss the implications for the translation of health policies into guidelines for sustainable practice supporting public health. This is a rapid, structured literature review. A rapid, structured literature review was undertaken to identify relevant studies related to South African THPs involving a search of peer-reviewed literature from three databases and a grey literature internet search. The identified citations were screened, critically appraised, and narratively synthesized. Efforts to regulate THPs in South Africa are underway; however, the lack of a regulatory framework for traditional practices is hampering progress. Several efforts to collaborate with THPs have been made over the years, many of which were not systematically evaluated and not based on principles of mutual respect. Existing collaborative examples need to be further supported by cost-effective evidence to suit the South African public health budget. Furthermore, small collaborative research efforts do not take into consideration the scale up of interventions. THPs in South Africa represent an important healthcare resource. However, the current policy environment does not support indicators to describe, monitor, and/or evaluate the role of THPs in the healthcare system.

Allopathic and traditional health practitioners: A reply to Nemutandani, Hendricks and Mulaudzi.

An earlier paper in this journal reported on the perception and experience of 77 allopathic health practitioners (AHPs) and health managers about working together with South African traditional health practitioners (THPs). The paper stated that the abolishment of the Witchcraft Suppression Act of 1957 and the introduction of the Traditional Health Practitioners Act No. 22 of 2007 is a milestone in the development of traditional health knowledge, and for the eventual incorporation thereof into modern health care practices. The authors also comment that a decolonisation of mindset and a change of attitude is required to change one’s perception of traditional healer practices and to develop them parallel to allopathic health practice. This opinion paper is a response to the paper, to negate its claims about the Witchcraft Suppression Act of 1957 and to provide clarity on the Traditional Health Practitioners Act No. 22 of 2007 and related policies and regulations. Although this Act recognises THP, the Act and other regulations actually require THP to conform to practices analogous to those of AHP. It is rather a systematic and scientific ‘mindset’ that is required to develop THP parallel to AHP. The Traditional Health Practitioners Act of 2007 and the Draft Policy on African Traditional Medicine (TM) for South Africa dictate that a substantial THP sectoral transformation is required before there can be a parallel system. Legislation and regulations have excluded THP and African TM from operating (present and future) in the same space as AHP.

The South African traditional health practitioner as a beneficiary of and provider to medical funds and schemes through the Traditional Health Practitioners Act (Act No 22, 2007)

The South African traditional health practitioner as a beneficiary of and provider to medical funds and schemes through the Traditional Health Practitioners Act (Act No 22, 2007)

Conflicting Voices in HIV/AIDS Education of the South African Youth: School Culture Versus South African Traditional Healers Using Ancestral Worship

The United Nations Agency of International Development (2013) states that an estimated 24.7 million people are living with HIV in sub-Saharan Africa, nearly 71% of the global total. The 2.9 million are young people aged 15–24 and this generation is living in South Africa. These alarming statistics reveal that various HIV/AIDS prevention strategies have met limited success. The question arises: why? The South African youth face the dilemma that they receive conflicting messages from two opposing sources, each with a strong persuasive pull of its own where HIV/AIDS education is concerned. On one hand, the voice of modern medical science proclaims that the disease is caused by a viral infection that suppresses the victim’s immune response, while on the other hand spiritual voices of African traditional healers offer explanations such as witchcraft or angry ancestors. This article is an attempt to discover whether either or neither of these voices is gaining ground amongst the youth. This article is based on a qualitative phenomenological study conducted at an urban secondary school in Pretoria, South Africa. Empirical findings resulted from the purposive sampling by means of interviews conducted with two focus groups of teachers, three focus groups of grade 12 school learners and one school principal. This was followed by thematic analysis involving the identifying, analysing and reporting patterns (themes) within data. Facts emerging from the research were that conflicting voices are stressful for young people who are subjected to societal pressure to conform and comply with unrealistic expectations. The South African social culture of ancestral worship is very powerful, yet school culture has significant countervailing influence that sheds liberating “light” where gloom of fear, uncertainty and superstition used to prevail. It is critical to note in this regard, for instance, that where HIV/AIDS remedies are concerned, there is no standardised solution for the ‘entire world’ and that a unique situation prevails in the South African social cultural environment where ancestral worship exerts a critically real influence on people’s response to the threat of HIV/AIDS.

The decolonialisation of medicine in South Africa: Threat or opportunity?

The South African Traditional Health Practitioners Act 22 of 2007 is now fait accompli. The Act has been promulgated and the Department of Health (DoH) is proceeding with its implementation. An Interim Traditional Health Practitioners Council and a dedicated DoH deputy director have been appointed, the appointment of a registrar is being finalised, and the DoH has conducted a roadshow to introduce the Act and its implications to groups of traditional health practitioners (THPs) countrywide. The objective is eventual formalisation and professionalisation of THP practice to provide appropriate primary healthcare services through co-operation with biomedical service providers. Biomedical practitioners should understand the provisions of Act 22, and how this may affect their own practices.

The in vitro propagation of Helichrysum umbraculigerum

Stilbenoids are a specific class of phenolic compounds, some of which show medicinal potential. Novel stilbenoids have previously been isolated from the South African plant Helichrysum umbraculigerum [1]. These prenylated resveratrol analogues are well known for their applications, which have mainly been discovered in research conducted on Cannabis sativa [2]. The applications include possible anti-inflammatory, antimicrobial and anticancer effects. H. umbraculigerum is known to be used by South African traditional healers. Exploitation of medicinal properties will require large numbers of plants, but H. umbraculigerum has proved difficult to cultivate. The aim of this study was to optimise an in vitro propagation protocol for H. umbraculigerum. Leaf cuttings were sterilised using 70% ethanol followed by 2% sodium hypochlorite containing 1 drop of Tween-20®. They were then washed in distilled water and placed onto Murashige and Skoog (MS) media. Uncontaminated leaf cuttings were placed onto MS media supplemented with different combinations of plant growth regulators. Shoots were produced most efficiently on MS media containing a specific concentration of thidiazuron (TDZ). These shoots were subsequently moved into the light, after which they started producing roots. Plantlets were successfully acclimatised using Jiffy-7C® pellets. The in vitro propagation protocol developed will allow for the production of large amounts of plant material for future research conducted on H. umbraculigerum.

Metallic mercury use by South African traditional health practitioners: perceptions and practices

BackgroundMercury is a toxic metal however its use in traditional healthcare systems remains widespread. The aim of this study was to determine the prevalence of mercury use by South African Traditional Health Practitioners (THP) and to document reasons for use and administration methods.MethodsA cross-sectional study design was employed. A total of 201 THPs were enrolled from two main metropolitan areas of KwaZulu-Natal (South Africa), and 198 were included in the final analysis. Information on demographic characteristics, reasons for using or not using mercury as well as mercury administration methods were collected.ResultsOf the 198 THPs, 78 (39 %) used mercury for healing purposes and 74 (95 %) of the mercury users stated that they were taught to use it by another THP. The two main routes of administration were oral and sub-cutaneous implantations (ukugcaba) at 85 % (n = 66) and 59 % (n = 46), respectively. The most common responses for mercury administration were for child birth (n = 70; 90 %) and protection against guns (n = 39; 50 %).ConclusionThis is the first study to describe the prevalence and practice of mercury use in South African traditional medicine. Socio-cultural mercury use is a potential source of exposure to both THPs and their patients. In light of such findings, public education messages and regulatory measures need to be effected.

Sick certificates issued by South African traditional health practitioners: Current legislation, challenges and the way forward

Traditional health practitioners (THPs) play a significant role in South African healthcare. However, the Basic Conditions of Employment Act (BCEA) does not consider sick notes issued by THPs to be valid. This creates a dilemma for employees, whose right to consult a practitioner of their choice is protected by the Constitution. We assessed the current legislation and highlight the challenges that employees face in selecting a healthcare system of their choice. The services of THPs represent an untapped capacity that can complement and strengthen healthcare services, especially in the workforce. The BCEA legislative technicality, coupled with the delayed establishment of the Interim THP Council, does not relieve the employer's burden of 'illegitimate' medical certificates issued by THPs. While seen as a dilemma for some employers, others have accommodated African cultural beliefs and accept THP-issued sick notes. Finalising the Interim THP Council will allow THP registration and oblige employers to honour sick notes issued by THPs. The empowerment of THPs to play a meaningful role in healthcare delivery is of national importance.

Typha capensis (Rohrb.)N.E.Br. (bulrush) extract scavenges free radicals, inhibits collagenase activity and affects human sperm motility and mitochondrial membrane potential in vitro: a pilot study

The biodiversity in South Africa provides more than 30,000 higher plants, of which more than 3000 are used by traditional healers to treat diseases. Typha capensis (bulrush) is one of the medicinal plants used in South Africa to treat male fertility problems. Considering that South African traditional healers have been recognised by Law and the health benefits of T. capensis have not been scientifically investigated yet, this study aimed at investigating the in vitro effects of aqueous extracts from this plant on male reproductive functions. Both leaves and rhizomes of T. capensis were dried, infused with distilled water and freeze-dried. Motile sperm from 50 men were isolated by swim-up and incubated with 1 μg ml(-1) aqueous extract of Typha rhizome for 1 h at 37 °C. Vitality, motility, sperm production of reactive oxygen species and mitochondrial membrane potential were analysed in the test sample, a control and in the pellet from the swim-up. Results showed that the rhizome extract had significant (P < 0.0001) negative effects on all parameters. The extracts from the leaves and rhizomes revealed dose-dependent inhibitory activity for collagenase and free radical formation. No inhibitory activity for elastase was found. The inhibitory activity for collagenase might indicate possible anti-cancer effects.

“Traditional healers and modern doctors do not understand each other because they learn different things” South African traditional health practitioners training with regards to hearing impairment

Traditional health practitioners offer a variety of interventions for people who choose traditional health practice services. Hearing impairment, which may cause significant difficulties in communication, employment and learning, is a condition for which people consult with traditional health practitioners in South Africa. The training undergone by traditional health practitioners sets the tone for the types of intervention for persons with hearing loss. As there is a paucity of literature in this area, 15 traditional health practitioners were interviewed about the training they had undergone and more specifically with regards to hearing loss. The content thematic analysis which was conducted on the interview transcripts revealed that the training of traditional health practitioners has a significant supernatural component which includes a spiritual possession through which the ancestors pass on the inspired knowledge on how to assess and treat clients. The calling to become a traditional health practitioner is reportedly a divine vocation and cannot be refused. During their apprenticeships, traditional health practitioners learn to interpret the dreams sent by the ancestors and learn to hone their skills in the identification of appropriate treatments for hearing loss. The findings of this study suggest the need for open communication between traditional and modern health care providers so that traditional and allopathic health practitioners can learn from each other so as to provide an effective and appropriate intervention for their clients.

The role of South African traditional health practitioners in the treatment of HIV/AIDS; A study of their practices and use of herbal medicines

Background&#x0D; A large proportion of HIV positive South Africans regularly consult Traditional Health Practitioners (THPs) for their healthcare needs, despite some evidence of negative interactions with antiretrovirals (ARVs) and no published peer-reviewed clinical evidence for the efficacy of traditional medicines in the treatment of HIV. In this study, we investigated the dominant practices of THPs towards HIV positive patients and whether these practices have changed following widespread public awareness campaigns covering HIV and its treatment.&#x0D; &#x0D; Method&#x0D; The study used a semi-structured interviewer-administered questionnaire in the home language of the interviewee. A total of 52 THPs from four provinces (Gauteng, Limpopo, Kwazulu Natal and Eastern Cape) were interviewed. 38% of the respondents were based in the rural areas, and 69% classified themselves as inyangas, with the remainder being sangomas. &#x0D; &#x0D; Findings&#x0D; All of the THPs in the survey offered treatment for HIV, although only 20% claimed to be able to cure the disease. 88% prepared their own medication, mostly from plant material, and sold their products as aqueous extracts in labelled bottles. None of these products had been systematically evaluated, and there was mostly no record keeping, either of the patient, or of the medicine itself. Quality control practices such as expiry dates, controlled storage conditions and batch records were totally unknown in our sample. Only 38% of the THPs had received training on HIV/AIDS although 75% believed that they were well informed about the disease. Our own assessment was that only 50% had a working knowledge of HIV; more disturbingly 37% believe that only traditional medicines should be used for the treatment of HIV and a further 50% believe that both traditional medicines and ARVs can be taken simultaneously.&#x0D; &#x0D; Interpretation&#x0D; Despite ongoing public educational campaigns on HIV, some of which have specifically targeted THPs, the care of HIV positive patients continues to be compromised by the traditional sector. Although some progress is evident, THP approaches to HIV treatment fails to conform to minimum standards proposed by the World Health Organisation and other organisations, and represents a considerable challenge to the integration of THPs with the biomedical sector, and with the antiretroviral treatment programme in South Africa.

Antimicrobial activity of some medicinal plants used for the treatment of tuberculosis in the Eastern Cape Province, South Africa

Artemisia afra Jacq. Ex Willd., Carpobrotus edulis L. and Tulbaghia violacea Harv. were screened for activity against Bacillus cereus, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Mycobacterium aurum A+ strain using a two-fold microdilution bioassay. M. aurum is tuberculosis (TB) related strain that was used in this study. These plants were selected based on their use by South African traditional healers for the treatment of TB and symptoms of the disease. All three plants were extracted with water, ethanol and dichloromethane. The extracts of A. afra were found to be active against all the tested microorganisms. Only in the instance of A. afra and C. edulis did water extract show activity against M. aurum A+ strain. The ethanol extract of C. edulis showed very good activity against the Gram-positive bacteria only. Dichloromethane extracts of T. violacea were found to be highly active against all the microorganisms, except for K. pneumoniae.