When the Sangoma read my bones…

It’s Christmas time so I’m going to keep it light; a little story about my time with a local traditional healer (not meant to say ‘witch doctor’..) – The Sangoma.

'I'm right!' - 'No, I'm right!' - Differing approaches to healthcare

‘I’m right!’ – ‘No, I’m right!’ – Differing approaches to healthcare

Part of our job here is providing primary health care to the rural clinics out in the bush. A couple of weeks ago a South African doctor Jeanie and myself set off in the buckie into the heart of the savannah to visit Mshudu and ZamaZama clinics. Nothing out of the ordinary, the bulk of our workload focussed on community HIV care. After a long hot day we stopped in a local tavern for a sunset beer. Halfway through my 850ml quart of Castle lager I noticed a man dressed in various robes and animal skins in the homestead next to us and so I enquired. It appeared that this was Gumede, the local Sangoma. Everyday in the hospital I talk to my patients about their relationships with the Sangoma. He has the power to reduce all sorts of symptoms and suffering through his ceremony, but also to persuade our patients to stop taking their HIV drugs or ingest liver/kidney toxic herbs. It’s a strained relationship to say the least. We try our best not to let our patients get trapped in a tug-of-war between us, but to compromise and work with rather than against their cultural beliefs. Anyway I was well up for meeting Gumede, so I asked if he’d have a look at my gammy back.

It's not just in the UK that doctors spend the entire afternoon getting leathered

It’s not just in the UK that doctors spend the entire afternoon getting leathered

We were led around the corner to his hut to meet the man, a stern figure who emanated authority and mystery. Some people just instill the urge to do a little bow when you meet them. This guy was good. He spoke Zulu so another local joined us to translate. We entered the dark and dusty room. Hundreds of jars of various herbs and potions surrounded us and I could feel my liver melting with every breath of their sweet aroma. Grass mats were laid down and we sat cross-legged in front of Gumede. It became apparent that we weren’t just going to talk about my problematic lumber spine. Gumede was bringing down his basket of bones. He was going to read my future and look into my past. Jeanie shuffled back a bit, it looked like I was up first.

The next 10 minutes were dedicated to instilling a particularly intense atmosphere. The incense was lit and the evening sun streamed through the cracks around the door casting long beams through the smoke. Gumede laid out the various bones and shells that made up his crystal ball. He cowered over them, gathering up the pieces in his hands, piling them up and casting them down with a clatter, over and over again as he chanted repetitive Zulu phrases, his companion responding in subdues tones. The last drops of alcohol seaped into my blood and a wave of goosebumps spread from my arms up to my back and into my core. I was primed and it was time to begin.

Modern Family

Modern Family

The bones were piled up and one final cast made across the floor. Gumede used a wooden stick to poke around, recognising patterns made by the fallen pieces. I was asked permission if he could go ahead and read my bones, but it appeared to be a rhetorical question, the ball was already rolling and I couldn’t back out now. He fixed on an area and he told me what he found, through our translator of course..

‘You have a problem with your waist.’

Not completely sure what he was going for here. Was he was focussing on my lower back pain or something a little more private?

‘You cannot ever enjoy sexual intercourse because you have problems with your performance.’

A little surprised with the opening gambit to be honest. And I mean, sure, we all have good days and bad days, who doesn’t? Oh dear, he’s touched a nerve.. Is this guy for real? I could feel Jeanie creasing herself behind me, but not a peep from either of us. The critique of my private life didn’t stop there…

‘You have a problem when you urinate. You feel burning when you pass water.’

So he’s gone down the sexually transmitted infection route. I bet Jeanie was looking forward to putting this on the hospital whatsapp group later. Unbelievable. After initially focussing on my genitals, Gumede thought we should get a little deeper.

‘You have one main problem in your life. You are not able to love other people.’

Woah wow woah, hold on a minute there. Easy tiger. I know I’m self-centered but I can love other people can’t I? Then why am I living in the middle of Africa pushing the people I thought I loved away from me? Why don’t I have a girlfriend when everyone else is getting married? Can I really ever love other people without loving myself first? Ok this was getting a bit much now. Gumede asked if I wanted to say anything. I wanted to take the conversation forward. I thought that any comments on the preceding forecasts would cue a smug ‘Ooh, my lady doth protest too much’ comment from Jeanie later in the car. I asked if there were any more positive aspects of my life we could explore.

‘You have bad luck in your life. But sometimes you can have good luck. But there is a lot of bad luck.’

Ok well I had a go. I asked why I was suffering so, and what I might be able to do about it.

‘You have problems in your life because you do not pay respects to your grandfather. You must make a ceremony to remember him and everything in your life will be ok. Is there anything else you would like to know?’

By this point I was feeling viscerally unwell and thought it best to cut my loses and pass the batten to Jeanie. For some insane reason I thanked Gumede for looking so astutely into my life.

Jeanie was next. Bruised and battered I took myself off to the back of the hut to watch from afar. Jeanie has one of the purest souls of any person I know. Kind and generous, a brilliant boyfriend, pleasing on the eye. She was no doubt going to get a gleaming report which was going to make the car journey back home very awkward. I didn’t want her sympathy. Anyway the ceremony started again and the bones were thrown down.

‘You have a problem with your menstruation. There is a bad spirit in your womb. You may be infertile.’

Yes! In your face Jeanie! Who’s got such a perfect little life now eh? In my mind I gave Gumede a little wink and a thumbs up, I knew I could trust him to be deeply dispiriting and offensive. So much more fun when you’re not in the hot seat.

‘You have a boyfriend. (I wasn’t too impressed as this is information had been divulged earlier when Gumede’s brother had asked if Jeanie would marry him). He appears to be involved in the relationship but in fact he does not love you. He will never love you.’

Ouch! Ok it’s always a bit of fun with the genital-based slurs but that’s a little out of order. Her boyfriend Leon is completely committed to her and drives 6 hours from Durban every other weekend to see her. I guess living a lie takes lot of effort…

‘You will not have luck in your life. Your life will end when you die in a car crash.’

You think it can’t get worse – then he brings out the car crash line. Kick a girl when she’s down. And I have to drive back with her! Shouldn’t have had the beers. Wow this is a lot to take on board. We are completely fixated. We are in a trance. Every comment he makes sets off a chain reaction in our brains of what it all means. He lays a small foundation upon which our minds are free to build around in whatever way is meaningful to us. That’s the way to get someone’s attention; talk about them. She asks what she can do about it.

‘You must buy these medicines from me and wash yourself in them every day. Then none of this bad luck will happen and you will live a good life.’

With an hour car journey ahead of us on bad roads we confer and agree to take the herbs. Some crushed dried leaves are brought out which could easily pass for Sainsbury’s Italian Mixed Herbs and a few spoonfuls are lifted into a plastic bag. It’s time for us to go. We are rather shaken and have a lot to talk about. Neither of us is particularly keen on getting to know Gumede much more. We take a few pictures, give Gumede 100 Rand, and load up. We don’t know whether to laugh or to cry. What we do know is that a particularly long debriefing is in order.

Jeanie does well to cover up her cramping dysmenorrhoea

Jeanie does well to cover up her cramping dysmenorrhoea

POST-MATCH ANALYSIS

It turns out that our visit to Gumede has been one of the most important experiences of my time here. I used to pour scorn on my patients for listening to the Sangoma and not me, but now they have my greatest empathy because the Sangoma is a very powerful man. By creating an eerie atmosphere and addressing the most common human insecurities he can rattle most of his customers. Every woman in rural Africa is worried about infertility and whether their boyfriends love them. All of the guys are concerned with their performance in the bedroom. A huge percentage of the population have STIs, and car crashes are a common cause of death. Life is confusing, and we all relish the opportunity to hear causal relationships that make sense of it all; why has this problem occurred, and what can I do to make it better. The Sangoma can answer those questions, and offer the solution right there and then.

I like to think of myself as a rational human being, and my educational background allows me to produce a reasonable framework of how the Sangoma may operate. But that afternoon he got under my skin. However much Jeanie and I spoke about how it was all a load of rubbish, a part of us still wondered. Even now I can’t bring myself to write ‘Sangoma’ without a capital ‘S’ (just in cases..). Imagine how a local man or woman with no educational background responds, whose upbringing has been centered around the mysticism of Zulu culture. You do what the Sangoma says. He’s more powerful than a white boy banging on about something called a virus that goes in your blood and how if you take a tablet which makes you feel unwell it will go away, but not forever, and you have to take it for the rest of your life and you shouldn’t have sex with all sorts of delicious looking people.

But let’s not patronise the Zulu people. If you think that you are immune from the workings of the Sangoma how wrong you are. Every time we buy magazines with dieting advice, every time we watch an advert that depicts a perfect life that’s better than our own, every time we walk into Holland and Barretts. Every time we do these things we entertain our deepest human insecurities, and someone much cleverer then us profits as a result. The workings of the human body are complex. We are far far off understanding how it all works and that’s the reason the alternative medicine section in Waterstone’s is so much bigger than the science section. We don’t like not knowing, and we like someone giving us a good causal relationship that makes sense of it all. And we’ll pay good money for it too. Do we get value for money? Well yes, that’s how market forces work. I’m not saying it’s wrong, I’m just saying it’s pretty similar to how the Sangoma works. Let’s not get caught up and call it evil just because of all the animal skins.

I don’t think Gumede is a bad man. I don’t think that he goes back around the hut and laughs with his mates about how he’s tricked another customer. I think he has a deep spiritual connection to his work. I think that he truly has a set of rules in his mind that recognises patterns of fallen objects and translates them accordingly. And I think that by trial and error over the years the predictions that elicit a response from customers have survived through natural selection. The power he has over the behaviour of our patients far outweighs my own. There can be no contest. Some Sangomas go through training which verses them in various aspects of Western medicine too, but many do not and that’s where the challenge really lies. Every day I talk to patients who have stopped taking their HIV medicines as a result of advice from the Sangoma. Given a break from the drug their HIV forms resistance patterns that render those medicines useless taking their HIV from being a treatable disease to a palliative case. These are the challenges we face in this environment. Universities and laboratories can spend as much money as they like developing clever drugs, but actually getting it down people’s throats and stemming the HIV epidemic is another matter all together. Something is working as the prevalence of HIV has reduced from 45% of the population a few years ago to 35% of the population now. But with a third of people still infected there’s still along way to go. I imagine that getting the Sangomas on board would far outweigh the benefits of employing us lot.

I seemed to have rambled on a bit but it’s just such an interesting place to work. I am relishing every minute of worrying about challenges like these rather than the bureaucratic challenges of the NHS. It truly is what tropical medicine is all about. Happy Christmas everyone and let the capitalist Sangomas of Christmas infiltrate all our hearts and minds. After all isn’t Christmas about making sense of it all?

ZamaZama clinic

ZamaZama clinic

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2 thoughts on “When the Sangoma read my bones…

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