South African isiXhosa traditional healer self-identification, training, practices, and their perceptions of collaboration with medical providers: an exploratory study

In South Africa, traditional healers treat a wide range of health-related problems and culture-bound syndromes considered non-responsive to Western medicine. Given the widespread use of traditional medicine in treating common mental disorders, especially among low-income groups, it is important to explore the self-identification, training, and practices of traditional healers. We also explored traditional healers’ perceptions of collaboration with Western health care institutions (hospitals, clinics). IsiXhosa traditional healers (n = 50, female = 40, mean age = 52.7 years, SD = 14.7 years) were interviewed using both a structured and a semi-structured interview schedule, including the Patient Health Questionnaire-9. Data were analysed using SPSS version 24 and Statistica. Interview notes were typed soon after each interview and thematically analysed. Participants described similar experiences regarding the three steps of becoming a traditional healer and treating clients with mental illness using herbs (90%), candles (82%), and prayer (78%). Self-identification as a spiritualist or sangoma, and type of church attended (African Initiated vs. Mainline Christian) were both significantly associated with traditional healers’ mode of diagnosis and/or treatment. Participants were open about collaborating with Western health care institutions around treating mental health issues. However, this was hampered by mistrust, as evidenced in the reluctance of a few participants to share detailed information about treatment methods.