Alternative and Traditional Medicine

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Abstract
In South Africa most black women use antenatal care services and deliver in clinics, and a considerable number complement this use of formal health services with traditional medicine. This study reported here examined the knowledge, beliefs and practical experiences of pregnant women, traditional healers and midwives with regard to kgaba (traditional medicine) and explored what constitutes kgaba. Interviews (N=30) and focus group discussions (N=21) were carried out among participants in Mogwase district in the North West Province of South Africa, where the use of kgaba remedies is commonly believed to cause foetal distress and an increase in caesarean sections. Findings indicated that kgaba remedies are ingested not only to prevent or solve physical problems but are also perceived as valuable in protecting against the harm that evil spirits can cause during pregnancy. Experiences with kgaba differed among participants and this may relate to the variety of plants used, their preparation and dosage. The use of crushed ostrich eggshell, which is perceived as inducing labour, emerged as an important finding. The use of kgaba as perceived by the Tswana is an important component in the experience of pregnancy and labour. However, communication about the use of kgaba between pregnant women and health staff was poor and hinders reporting or recording of dosage and evaluation of effects. There is a need to develop strategies that promote open dialogue between health providers and communities on the use of traditional medicine.

Key words: traditional medicine, labour, ethnopharmacology, South Africa Terms used
In this study the term traditional medicine (TM) is used for medicines of plant, animal or mineral origin, which are taken orally. The definition of tradition healer (TH) includes both diviners, who use bone throwing for diagnosis, and herbalists. Nowadays the distinction between these two healers is not always clear and they may be combined. 12 Afr. J. Trad. CAM (2006) 3 (1): 11 - 22

Introduction
Modern and traditional health systems: complementary or contradictory? In developed countries, communities and midwives are showing a renewed interest in the use of herbal and alternative medicine (Belew, 1999). In the African context, traditional medicine (TM) in pregnancy and labour continues to play, as it did in the past, an important role in health systems. Western oriented medicine and health systems, introduced during the colonial era, did not eliminate well established systems of TM and many Africans learnt to use both health systems depending on the availability of medicine or the nature of the illness (Freeman and Motsei,1992). Both systems derive their theories of illness from the beliefs, values, and interpersonal relations of the society from which they evolved (Chipfakacha, 1994). This in turn shapes the strategies and behaviours that community members develop in coping with illness and seeking health care, and whether their first choice will be self-treatment, traditional medicine or biomedicine (Good, 1987). The main difference between African TM and Western biomedicine is the way in which health and illness are conceptualised. Illness in TM implies a social, spiritual and physical imbalance that requires a natural remedy. Additionally, traditional healers try to explain who or what caused the disease and why this person is affected at that particular time (HST, 1999). Magical or supernatural forces and rituals often guide this process, and herbal knowledge can also bring about harm (usually seen as witchcraft) (Haram, 1991). This is reflected in language, and the Tswana word Dikgaba means harm or heartache others can cause (Ulin, 1979). These supernatural elements probably underscore the suspicion many biomedical staff have towards TM and their reluctance to recognise and work with it even when from the same cultural belief system (Barbee, 1986)....
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