The term “medical pluralism”, in this paper, is used to refer to the use of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness (Wade et al., 2008). Conventional medicine is when healthcare professionals treat diseases and symptom s using drugs, radiation or surgery. Complementary and alternative medicine, on the other hand refers to the treatment options that fall outside the brackets of conventional, for example, traditional medicine. According to Amzat and Razum (2014), at most times, alternative medicine comes from cultural and historical traditions.
This paper aims at discussing medical pluralism in South Africa, the benefits and limitations, and how and why people use various forms of complementary medicines.
The recognition of African traditional medicine
African traditional medicine is regulated by the law. According to Le Roux-Kemp (2010), although African traditional medicine is recognised, there is no evident incorporation of this part of medicine into all parts of medical care. This means that African traditional medicine is regulated but there are very few efforts made for training, delivery and education. Also, health insurance does not recognise traditional medicine or the practices performed by traditional healers, but only recognizes allopathic medicine (Le Roux-Kemp, 2010). Traditional medicine was regulated long after people have been using it. Some people use traditional medicine because they cannot access medical healthcare facilities. This is often the case with people in rural areas who are unable to travel long distances to access adequate medical care. Some are unable to afford private healthcare because the public healthcare institutions in their areas do not have enough staff, equipment or medication for the people.
Medical pluralism in South Africa
Medical pluralism is nothing new. People have been using multiple medical systems for centuries. In Africa we have people who use traditional medicine, some believe in ancestors, some believe in faith, while others use biomedicine. A case where different medical systems can be used is to cure someone with a mental disorder. Religious people may see the mental disorder as a demon and will resort to prayer and exorcism. Traditional healers may use traditional medicine to cure the patient. People who believe in ancestors may see the disorder as a punishment from the ancestors, in which they may slaughter an animal, usually a goat, as a way of communicating with the ancestors and asking for forgiveness. Medical practitioners will view the disorder as a psychological problem and will refer the patient to a psychologist or psychiatrist. This proves that there are many ways of curing people, but it depends on what people believe in.
Some people choose to use more than one medical system. This could be a way for them to achieve maximum results. An example would be a young married woman who is struggling to have children. Having children in our African societies is considered as very important. Married couples are persuaded into having children as early as possible so that the family has an heir and someone to carry the family name. If so much pressure is put on women, they are bound to feel they have a problem and will want to consult everyone who promises to help them. If this young woman is religious she will pray and even ask church elders or the pastor to also help her pray about it. She may consult a traditional healer who may give her herbs to help clean her womb. She may also visit medical health practitioners to help her conceive. This shows that desperation may lead to people relying on more than one medical system.
Benefits of medical pluralism
Medical pluralism helps people achieve maximum results. Relying on not only one medical system of health is good for people. Some people have diseases and illnesses and when treated with biomedicine, their bodies reject treatment because they are allergic to certain medication. Other alternative medicines can also help in this regard. Medical pluralism means people are able to consult whichever healthcare system they are comfortable with and trust. This means that people do not have to use money they do not have to access western healthcare. Also, this is helpful for people who live in rural areas where there are no proper healthcare facilities. Medical pluralism means they do not have to travel long distances when they can access another healthcare system close by. This may also help decrease the mortality rate due to the inaccessibility of proper healthcare. The use of various health systems could help combat the problem of people not having access to medical services like they should.
Limitations of medical pluralism
As much as medical pluralism is beneficial, there are also negative impacts to it. People consulting more than one medical system can cause confusion. This is often the case with religious women, for example, who struggle conceiving. They consult traditional doctors who promise to cleanse them and help them conceive. They pray and fast and ask other members in church to help them pray about it. Also, they visit medical health practitioners who prescribe certain medication. The problem with medical pluralism is we do not know what works. Because people consult more than one health system, we cannot be certain about what helped cure the disease or sickness.
How and why do people use various systems of health care?
As stated above, people want to achieve maximum results. At other times people use various health systems to get cured or healed faster. This is always the case with me. Growing up I never had a problem of getting sick very often, all thanks to my strong immune system. I would only get the cold. Growing up in a rural area with my late grandmother, I was bound to be exposed to herbs and traditional medicine. In my rural area there was what was known as ‘umhlonyane’, a plant that was boiled and one had to drink to cure the cold. Later on as I grew up, my grandmother introduced me to the lemon and chilli pepper remedy. I had to boil the lemons and drink the ‘tea’ as hot as possible and would sometimes mix it with chilli pepper. I could say this was the natural form of med lemon. Although I drank these home-made remedies, I would also drink over the counter medication like cough syrups, painkillers and lozenges for my throat. It was not that my grandmother did not trust her home-made remedies, but she preferred it if I drank more medication so I could get better faster.
Some people use various health systems because of influence from other people. My uncle used traditional medicine to try and cure his type 2 diabetes. He had heard this from a colleague who had also used the same traditional medicine. When people see things or medication working for other people with the same sicknesses, they are bound to want to try them too in hopes that they will also work for them. The traditional medicine did not cure his diabetes, but he went from depending on insulin shots, to not using them at all. He chose to continue with the traditional medicine with the fear that his diabetes would get worse if he stopped. At times, being a child in a family that believes in using various systems influences your use of various medical systems. I, for example, had no choice as to whether I wanted to drink my grandmother’s home-made remedies, no matter how awful or bitter they tasted. If I didn’t drink the remedies, I would’ve been seen as disrespectful and probably forced into it.
Other people use various health systems because of their beliefs. People can believe in both conventional and alternative medicine. This can be because of their experiences with both health systems and do not see the need to choose one when they can use both. Using various health systems goes with the main reason that people want to achieve maximum results. Some people choose to use natural medicine more than biomedicine as biomedicine tends to have side effects more than traditional medicine.
According to Gilbert (2004), pharmacies are forced to stock alternative medicines as people are asking for them, with 71,4% of pharmacies in higher income residential areas having a big variety of alternative medicine. People now see the importance and benefits of natural medicine, and that it can have more benefits than biomedicine.
People use alternative medicine like diets and lifestyle changes to help biomedicine. A typical example would be someone starting banting (low carbs, high fat diet) in order to cure sicknesses like low/ high blood pressure, joint or muscle pain, asthma, etc. Banting can be used for weight loss too, and has very impressive results if done correctly.
Medical systems should not work against one another, but should work with one another. Traditional healers should be able to refer patients to medical health practitioners whenever they cannot help people and vice versa. Medical pluralism can help combat the inaccessibility of adequate health care in most rural areas. Using alternative is important to achieve great results, and to get cures rather than containing diseases and sicknesses. As suggested by Gilbert (2004), more pharmacies now stock alternative medicines because of the demand for them from the public. Medical pluralism can cause confusion when one has used various health systems and it is difficult to give an indication as to what really helped. In this paper I have discussed medical pluralism and medical pluralism. I have discussed the legal perspective, the benefits and limitations. The reasons for the use of various medical systems have been discussed in-depth. Lastly, I have given my own views on medical pluralism and given examples.