Where Medicine Tells a Story …

Across many African traditions, children are taught to repeat the names of their ancestors as far back as the mind can remember. These children will not have a sense of time in the way that time dictates the movements of every possible action in the West. Instead, the legacy of their ancestors seeps into their play and family-life and schooling. Death becomes a boundary removed. Communication of knowledge from an ancestor overrides physicality and actuality. Earlier this year, I had the honour of visiting a Sangoma who lives and works in a township on the periphery of Cape Town. In 1967, Cape Town hosted the first successful heart transplant setting a precedent for pioneering transplant surgery across the world.

Over forty years later, not so far out of view from this hospital, is a tin shack where over 20 patients visit per day for treatment of various ailments from infertility to HIV. As I entered, the African sun disappeared abruptly and I was immersed into a stark darkness. Only a flicker from a lone candle in the consulting area lit up my surroundings. In contrast to the white, bright clinics in the West, I could barely take in all I could see. There were fur coats from many animals draped over the walls, dried snake skins dangling from the ceiling, various plants and herbs drying soon to be made into potions and join the many bottles on tables, on floors and on shelves on the wall. The Sangoma offered me his hat which had been used by his forefathers in their medical days. I asked the Sangoma how he gained his knowledge about the human body. He answered, “From my great-grandfather”. I noticed that on occasion, the Sangoma would briefly close his eyes and then his head would jerk up and he would be alert again. I asked if he was okay. Again, he replied in reference to his ancestors with “I talk to my great-grandfather during the night for advice, having little sleep as a result”.

In his culture – Zulu – illness is not a segregated pathology of the body. Illness is instead an aspect of a person’s lifestyle and a reflection on their moral character. Moreover, the body is not owned by just one person. This means that the body, the person, and their spirits are possessed by their ancestors. Perhaps the only instance where medicine in the UK can resonate with the unifying experience of illness that is evident in Zulu culture is in palliative medicine. Increasingly, over the last decade or so, palliative care has focused on the experience of the ending of a person’s life both for the individual but also for the whole family. We are beginning to learn that the body is not confined to its physical boundaries of where it begins and ends.

This is a difficult lesson for us because of how our cutting-edge technology can introspect in minute detail the hidden world of inside our body. My visit to the Sangoma, however startling and also rather intimidating, clearly revealed the importance of releasing illness from beyond cells and organs and seeing illness not solely as pathology but part of what provides the human experience.

By Ayesha Ahmad.

  • Deborah Kirklin

    Ayesha thank you for this fascinating insight into a completely different way of understanding what it means to be ill. A timely reminder of why anthropolgical perspectives are so important to the medical humanities project.I’m reminded of the need to remember that we all bring different healthcare beliefs with us to the clinical encounter. Some of these may be subtle and related to healthcare beliefs within our family. But as I GP in London I’m daily reminded that some may be more dramatic, deriving from countries and cultures I’m unfamiliar with.