Nurse Sonto Magagula locks the Horo Clinic and heads to a clean thatched-roof rondavel nearby. After
changing from a red blazer into beads and feathers, she spends an hour with her patient. She spits in a circle around him, smells his back and prescribes a mixture of roots. They hug and she gives him freshly cut herbs to take to his mother.
The much-anticipated traditional clinic down the road is shuttered after less than a year of operation, its windows broken.
The hospital downtown has run out of hand soap and CD4 reagents, which are essential for measuring HIV. In the chaos a new healthcare provider is gaining prominence: the after-hours nurse-healer.
“At the clinic we see almost 200 people every day, but with the financial crisis we cannot afford basic tests and medicine,” said Magagula. “The patients know I understand prevention of mother-to-child transmission of HIV and opportunistic infections.
“They trust me and they know the limits of the clinic. So, when the clinic closes, they come for traditional medicine.”
Hospitals and the bailout
The nation’s capital-city hospital, Mbabane General, reeked of faeces when the Mail & Guardian visited in February. Orphans slept on the floor of the abandoned children’s ward and developmentally disabled teenagers were in toddler basinets asking for food.
Health Minister Themba Xaba has recommended that individuals take their CD4 tests at private clinics. The test costs R150. According to the World Bank, 70% of Swazis lives on less than R16 a day. Next year, R2.3-billion will be spent on the new international airport and other projects if the proposed budget is approved. The health ministry’s total budget will be R1.1-billion. Last year R381-million of that came from a single organisation, the United States President’s Emergency Plan for Aids Relief.
Traditional medicine’s visibility
At least 80% of Swazis regularly consult one of the nation’s 8000 healers, according to the African Studies Review. In 2009 healer James Hall wrote in the Swazi Observer that traditional healers would never disappear because “the people of this region are poor and the only affordable healthcare is a traditional healer”.
That same year in Pretoria, a group of healers stormed the health department’s offices when the planned South African National Health Insurance did not cover traditional medicine. They were hit with pepper spray, according to Business Day.
Most traditional remedies in Swaziland involve either drinking mixtures made from plants or receiving kugata, thick pastes rubbed into small razor incisions. “The danger of traditional medicine is that the medicine is not dosed properly and sometimes the razors are not clean,” said Vusi Vilane, a graduate student and instructor at the University of Swaziland’s Institute for Research in Traditional Medicine, Medicinal and Indigenous Food Plants.
Another danger is that healers have begun incorporating Western medicine. “They buy Viagra and pound it into their concoction with umvusankuzi (herbal sex booster) and other herbs,” said Vilane. “Emvembili Traditional Clinic was supposed to regulate this.”
The viability of the herbs aside, razor incisions can spread HIV and Viagra can cause heart attacks. A clinic would institutionalise these practices, potentially staving off the spread of HIV.
Emvembili Traditional Clinic
Emvembili Traditional Clinic opened to great fanfare in 2010, officiated by the health minister himself. “It was supposed to pick up cases the Horo Clinic could not solve and take care of the people who did not want to go to a Western hospital,” said Vilane. “It had been a dream for a long time.”
The clinic would turn traditional herbs into pill form. Nurses would be trained in sterilisation procedures. Nhlavana Maseko, the head of the Traditional Healer Organisation, was put in charge. “A huge fraction of our patients come to consult us even after receiving medical attention from modern-day clinics,” its head nurse, Busisiwe Makhabane, told the Swazi Observer.
But, since February 2011, Emvembili has been closed. Broken windows let dust settle on the chairs. Makhabane, who originally agreed to an interview, dropped our calls.
“They were giving herbs to drink instead of ARVs. People found out that it did not work,” said Magagula, whose Horo Clinic is just across the street. “They were dying so the clinic failed. It was simple.”
The Traditional Healer Organisation is defunct. Its well-formatted blog, starting in September 2011 and ending December 2011, has 60 posts mostly copied from other websites.
Portrait of Magagula
Nurse Magagula is a smart, well-spoken woman. Two of her children are at the University of Pretoria and one at the University of Stellenbosch. Her oldest daughter, studying for a master’s degree in chemical engineering, is a healer too.
Magagula tosses the bones — a collection of knuckles, dominoes and seashells — and points to one: “You see this, this is that you are pregnant, or should worry about the police, or are buying a new house. And then I give people ARVs and condoms. And that is the session.
“There are many other nurses working the traditional way,” said Magagula, who estimates that more than half of the nation’s nurses practise traditional medicine and everyone has a healer to whom they refer difficult patients. Obtaining reliable statistics in this regard is difficult. “Healer training is much harder,” Magagula said. She took time off from nursing to complete her healer training from 1989 to 1991. “As a healer, you have to work for the medicine before it works for you. And you have to spend much more time with the patient.”
When her training was finished, Magagula’s career soared at the large regional hospital in Piggs Peak. She was soon appointed to run Horo Clinic under sister Dudu Dlamini, who oversees the region.
Magagula sees three to five patients every night. “Most are mothers with babies, usually HIV-related. Otherwise it is men coming in for impotence.” As a nurse she knows to be careful. “I break my razors into four pieces with my hands. I put the medicine on a leaf or a stick to rub it in,” she said, waving a twig. “Then I give the patient all the little pieces to throw out themselves so they have no doubt.”
A correct diagnosis
Half an hour after the clinic closes at 3.30pm, Magagula arrives at her indumba, a traditional healer’s thatched mud-and-grass hut. Several women are already waiting. Inside the indumba she strips naked and cloaks herself in the costume of a healer: red cloth, bead necklace, seashell anklet.
Her first patient is a morbidly obese woman who is having difficulty walking and breathing. Magagula decides she needs kufemba, cow tail brushed on the body. Magagula goes into a trance while the spirit of her patient’s paternal grandmother speaks for an hour. Her patient replies. Their conversation is heated. By the end, both are crying.
When she comes out of the trance, Magagula has no memory of the exchange and a witness must help. The diagnosis? The patient is sick; her father is not being honoured; jealous people are casting spells.
The cure? “I will take her to a prophet at my Zionist church and they can sort out the problem. We work with the Zionists often. Then I will test her for diabetes at the clinic. Because I think it is diabetes too.”
Magagula falls quiet. “But we don’t have insulin,” she said.
Nellie Bowles is the 2011-2012 US Fulbright Fellow to Swaziland
Have something to say? Tweet us on @Bhekisisa_MG or Facebook us on @Bhekisisa.Health
Swaziland shrugs off attempts at isolation
Walking over the wounded
We invite you to our Policy Dialogue at the 9th annual Aids Conference.
Since the country’s rollout, less than a quarter of people who’ve started taking the HIV prevention pill are young women — despite high HIV rates.
Bhekisisa editor Mia Malan asks reproductive health doctor Tlaleng Mofokeng why older men prey on younger women.
Bhekisisa means "to scrutinise" in isiZulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.