Abstract
My aim in this talk is to consider the increasingly contested topic of how to integrate Indigenous expertise and science as it applies to the case of integrating African Traditional Medicine (ATM) and modern biomedicine in South Africa’s healthcare system. One prevalent narrative against integration is that there is an unbridgeable gap between ATM and biomedicine. Some biomedical practitioners forcefully argue that ATM lacks the scientific evidence base to substantiate its practice. Nyika (2007) argues that ATM should be rejected on ethical grounds: ATM is not guided by Nuremberg code; it is impossible for patients to consent to the ‘unknown’ (i.e., scientifically untested herbal mixtures, or diagnoses and treatment with ‘mystical’ overtones); and ATM is paternalistic. Indeed, the history of the relationship between traditional healers and biomedical practitioners in South Africa is defined by mistrust and conflict. Proponents of a project of integration rely on at least three reasons for the need to find common ground between ATM and biomedicine. The first reason is practical. Studies suggest that up to 80% of Black South Africans consult traditional healers. For many of these people, traditional healers are often their primary source of healthcare before biomedical practitioners. Integration on this reason is to respond to the demand for ATM. The second reason is political. The claim is that recognizing the value of ATM is a matter of social justice and decolonising medicine. The third reason is epistemological – it is the recognition that ATM can contribute invaluable knowledge on disease and healing that modern biomedicine cannot. Building on this latter reason, in this talk, I show how ATM and modern biomedicine in South Africa can be integrated in through an instrumentalist biopsychosocial model of disease. The biomedical model of disease focuses primarily on the biomedical causes of disease prevalence, susceptibility, and presentation. The biopsychosocial model sees disease as a complex interaction of biomedical, social, and psychological factors. This model grounds medical practice in terms of a theory of the patient as a whole person. I argue that this instrumentalist biopsychosocial model accounts for both the prospects and limits of integrating ATM and modern biomedicine. Limits include, for example, reproducing existing hierarchies of knowledge by disregarding the elements of ATM that do not meet Western evidence-based standards of medicine.
