Taking Care of the Caretakers and Interview with a sangoma

While my father’s been busy observing and mentoring the doctors, I’ve been working on a project of my own. It’s based on a few heartbreaking anecdotes related to me by Thuso, the volunteer coordinator for Limpopo. He had witnessed a few cases of elderly women who contracted HIV by caring for their HIV-positive grandchildren because their knowledge of the modes of HIV transmission was frighteningly limited. The focus here in South Africa is really on transmission by unprotected sex; thus, elderly women don’t know that they can become infected by bathing the open wounds and sores of their grandchildren.

With the help of Mulalo, one of the social workers at Hanyani, I started interviewing women over the age of 60 about their knowledge of HIV transmission and how they might have become infected. About ½ of the women I interviewed could have contracted HIV sexually; the other half clearly got infected as caretakers for their children and grandchildren. The common thread was that none of them were ever educated about HIV transmission and were completely unaware that they were at risk by caring for HIV-positive family members. When I brought this up to one of the doctors in the clinic, he was surprised. “We just assume that everyone knows these things,” he said. There’s counseling for testing and counseling for drug adherence available at the clinic, but nothing in the way of preventive education.

Recently, the project has gone in a new direction: two of the women I interviewed were sangomas, or traditional healers, who contracted the virus through treatment of HIV positive patients. One aspect of traditional medicine here in South Africa involves blood-letting-- healers make incisions in certain parts of the body to relieve pains, to cure diseases, and to guarantee luck and long life. Sangomas who treat HIV-positive patients are obviously at a huge risk, and the elderly healers don’t know it.

So, the past few interviews have been with traditional healers-- some HIV positive, some not-- about their methods of healing, their knowledge of HIV transmission, and about what kinds of precautions they’re taking to protect themselves and their patients from HIV. Talking to these women has lead to some interesting, intense, and very surreal experiences.

Yesterday I talked with a traditional healer who works very closely with the Tiyani Health Center, which is a rural outreach clinic that feeds into Hanyani. I’ve tried to write about it here; I’m not sure how well I’ve expressed the experience, but have a look.

Interview with a Sangoma-- Mphephu Shihluri

The hospital truck pulled up to an empty compound of four rondavels, all painted sky blue. When Mphephu didn’t respond to our calls, a neighbor strolling past informed us that she’d be back in just a moment-- she was a few compounds down the road performing an infant initiation ceremony.

When she arrived, Mphephu was as playful and colorful as her rondavels. She greeted us with warm, firm handshakes, and joked to Mulalo, “Oh, so you’ve brought me a white to heal this morning?” She ushered us into her clinic, and busied herself with a few preparations as our eyes adjusted to the dim light.

About one quarter of the round cement floor space of the clinic was carpeted in jars of every size and shape, containing herbs and plant remedies collected and ground by Mphephu herself. On the wall hung five framed certificates listing her credentials as a traditional healer; hung beside those were three public health posters from Tiyani Health Center-- one on diagnosing and preventing the spread of TB, and two about HIV/AIDS awareness. Other than these sparse decorations, the round room was bare, and the only light came from the open door.



Mphephu spread out a straw mat and two impala skins across the cement floor while we pulled up plastic chairs. On one skin, she scattered a handful of shells and animal bones; she positioned herself carefully on the second impala skin, tucking her legs beneath her red and black skirt. She pulled her matching shawl a bit closer around her shoulders, adjusted her headscarf, and indicated to us that she was ready to begin.

Mphephu has been a traditional healer since the age of eight-- her mother also practiced traditional medicine, and passed the art on to her young daughter. She’s been practicing ever since.



She begins each treatment session by casting her bones and shells on the ground-- from the pattern in which they fall, she claims she can diagnose any disease, including HIV. Many of her patients are HIV-positive; after diagnosing their illness she treats them with a sweet herbal remedy, and then refers them to Tiyani Health Center for further treatment. She has a solid relationship with the clinic and nursing staff, and encourages all of her HIV-positive patients to seek medical care in addition to her traditional healing; she says that with that combination, they are all now better.



Mphephu is well-educated about HIV transmission; when asked how much she knew, she quickly rattled off a textbook list. And she knows to take careful precautions when treating HIV-positive patients-- Tiyani Health Center supplies her with gloves and alcohol-based disinfectant, as well as surgical masks. She assured us that she’s very careful about spreading HIV/AIDS, and that she knows it’s a big problem. We got a big thumbs up when we expressed admiration for her knowledge and willingness to work with the clinic.

She was less positive, however, when we asked about other traditional healers, and whether she had imparted any of her knowledge to them. Her face darkened as she told us that most other healers in this area are very resistant to working with the local clinics and hospitals-- that they believe medical institutions take away their clients and don’t respect their beliefs and practices. She said they don’t want to hear about how HIV is transmitted or what part they can play in preventing its spread. We suggested organizing a conference of traditional healers to discuss the important role they play in identifying and treating HIV patients, and Mphephu seemed to think this was a good idea. She even expressed interest in giving a presentation on HIV transmission and prevention-- we got a second thumbs-up at this.



As our conversation came to a close, Mphephu was summoned for a second infant initiation, so she invited us to come along. We walked with her down the dirt road while Mulalo explained to me the purpose of the ceremony we were about to witness: sangomas perform infant initiation rituals to ensure a long life for the baby.

We entered the family compound and were welcomed into a second dimly lit rondavel. Mulalo and I took seats on the edge of a big double bed, while Mphephu sat cross-legged on a blanket on the floor, cradling a one-month old infant in her arms. The child’s mother sat on the opposite side of the bed, her face hidden in the shadows, while the infant’s older sister crouched next to the healer, looking on with wide eyes. Mphephu bounced the baby on her knee as she laughed and chatted with the mother and pinched the chubby cheeks of the sister. Then in one quick motion, she produced a razor blade and made four small incisions on the child’s head-- one above each ear, one in the center of her forehead, and one at the top of her neck. The child begin to wail as the blood trickled down her face; Mphephu smiled at me and shushed the infant’s cries. She wrapped a small plastic bag around her finger, holding it up to me as a demonstration of the serious precautions she takes against the spread of HIV, and rubbed a small amount of ground black seeds onto her fingertip. Then she rubbed the seed into each of the incisions, dragging the mixed blood and seed upward from the cut to the top of the now-screaming infant’s skull. The baby’s sister looked almost as horrified as I felt, but the mother looked happy with the progress; as the infant wriggled to break free from her grip, Mphephu made four more quick incisions-- one on each ankle, and one on each wrist. The moment she dropped the razor blade, the infant stopped crying, and there was a moment of complete silence in the rondavel.

Mphephu bounced the baby up and down a few more times, grinning at her handiwork. She turned to me and smiled, “Would you like me to do this for your child?” I managed a weak laugh, but was too overwhelmed for genuineness. I thanked her again for talking to us as we walked out, and returned her third and final thumbs-up.