The article is based on two research projects conducted for higher degrees by the principal researcher in 2013 and 2021. The first project investigated female traditional healers in same-sex relationships. The second project investigated the same sexualities among rural women in KwaZulu-Natal. The article explores the theme of healing because it was not fully explored in the two projects. The researcher further looked at the changing nature of life and developments in healthcare, as she once had to undergo ukuthwasa [initiation as a healer]. During the initiation process, she experienced life as a traditional healer and the challenges within this practice. Many questions arose: Although traditional healing has long existed and people from various educational backgrounds have undergone ukuthwasa [initiation as a healer], the practice itself does not appear to be improving. The challenges that existed in the past remain present today, particularly the lack of resources and the government’s neglect of this sector of healthcare. As the researcher’s study progressed, it became clear that some of the challenges within indigenous communities require indigenous solutions. Therefore, the researcher chose to examine this issue of healthcare through the lens of indigenous knowledge.

Ethical clearance to conduct this study was obtained from the College of Human Science, University of South Africa, Research Ethics Committee with clearance number 90230868_CREC_CHS_2024, and from the Humanities & Social Sciences Research Ethics Committee at the University of KwaZulu-Natal with clearance number HSS/0260/017D.

As mentioned above, Western healthcare facilities have been well-resourced and carefully maintained since the colonial era. These facilities are located in places where people can easily access them; however, for traditional practitioners, the scenario is different. Sacred natural sites and traditional healing locations that were once freely accessible are no longer easily reached. Sacred natural resources, including forests, mountains, waterfalls, rivers, hills, caves, and the sea, are now under state control rather than community stewardship, as was the case before colonialism (Sinthumule, Mugwena & Rabumbulu 2021:16). In the precolonial era, these sites were the responsibility of the clans residing in the respective areas. Their sacredness and value in the indigenous belief system, rooted in spirits, made these sites crucial for traditional healing practices. The belief in spirits is central to African indigenous beliefs. Spirits are believed to inhabit these sacred spaces, endowing traditional healers with supernatural powers. The term ‘sacred natural sites’ implies areas holy, venerated, consecrated, and connected with religious or belief systems for spiritual purposes (Sinthumule et al. 2021:12).

In South Africa, the Lanwadzongolo and Guvhukuvhu sites near the Phiphidi Waterfall in Limpopo are considered sacred sites used by the Ramunangi for ritual purposes. The waterfall has spiritual significance, and the ancestors are said to protect these places. It is said that these sites are important for both healing and ukuthwasa [initiation]. These sites are meant to be approached with reverence. In most cases, those who approach them must seek permission from the owners of the sites, the ancestors. It is believed that entering the sites without performing the appropriate rituals may lead to severe consequences, including death (Sinthumule, Mugwena & Rabumbulu 2021:7). The challenge is that the sacredness of these sites is at stake as indigenous people lose control over these sacred sites. Various ethnic groups have lost their sacred sites, intensifying debates on land claims and indigenous rights in South Africa. The Khoisan people, in particular, fight for access to their sacred sites, many of which were taken by the colonial government. The violation of Khoisan’s rights, who are indigenous, persists, and the fight for the Table Mountain site is still a matter of ongoing struggle. In the African traditional belief system, sacred sites are considered purified spaces where spiritual communication and the veneration of ancestors take place. These locations serve as gathering points for traditional communities and clans, especially during times of need, such as food shortages or the need for rain, when they call upon their ancestors for intervention. Therefore, the inaccessibility of these sites hinders the performance of such traditional practices.

There are academic discourses about “medical syncretism” which indicate the role of traditional healing (Moshabela et al. 2016:84). Issues raised during informal discussions included the scarcity of herbs and restricted access to harvesting areas. Because traditional healing was not the primary focus of the research, these matters were not explored in depth. Sangomas noted the high cost of travelling to town to purchase herbs, particularly as forests are no longer easily accessible. Some land is designated as government property, while other areas are privately owned, further limiting access. As these insights emerged informally rather than through structured interviews, further probing was not pursued because the study focused on same-sex sexualities rather than traditional healing.

As traditional healers, we have observed much in the practice of healing that shows traditional healing has no place in the formal South African healthcare system. Most of the time, we had to buy herbs in the city. Although some medicinal plants were available in nearby forests and around the homestead, the most essential herbs were often inaccessible. My spiritual healer once told me there are prohibited herbs in the yard because one could be arrested. This meant that traditional healers were restricted by the laws of the country in which they lived. In the lands of their ancestors, there were plants they were not permitted to cultivate, which illustrates that African lands do not belong to Africans.

Ngcukaitobi (2018:1) observed that one of the most exciting achievements of the Advent of a democratic South Africa and Constitutionalism is that a conscientious effort was made to create a Bill of Rights in which the fundamental rights of every person are recognised irrespective of colour, race, creed, and sexual orientation. It is regrettable to observe that the current state of affairs appears to ignore the very principal guidelines of nation-building. The land is rich in history, religion, and traditions of its original owners, so when colonial governments took over the country, they not only stripped indigenous people of their land but also erased their cultural identity. Taking the land from people, their original owners, is like stripping them of their cultural identity. Fuad et al. (2023) further point out that ‘Land holds a profound religious significance across human cultures, extending beyond its economic utility to embody strong transcendental and cultural ties’ (p. 109). Land is fundamental for the development of any society. In the case of Africans, it is not simply real estate, but a source of identity for a people. It is a place where ancestors reside and continuously influence the lives of the living. It represents the present, the past, and the future.

In the African healthcare system, the land is foundational to healing, as all plants and herbs originate from the soil. This connection is evident in festivals such as Nomkhubulwane and Incwala [first fruits festival], where the land is integral to the healing process (Mkasi & Rafudeen 2016:119). These festivals pay homage to land as both their source of livelihood and their future resting place. Traditional healthcare practitioners depend on these sacred sites, and their inaccessibility creates challenges for them to carry out their functions within the community. On the contrary, Western healthcare givers thrive as they receive governmental support and are socially accepted as legitimate. Mokgobi (2013) made a useful observation that Western-trained medical practitioners are reluctant to work with traditional healers because they perceive what they do as harmful and dangerous to their patients. Furthermore, some believe that traditional healthcare is illegal. Clearly, with such negative perceptions by Western-trained medical practitioners, chances of collaboration and integration are small.

The dominant economic models in South Africa prioritise economic growth and profit over conservation and cultural preservation. Access to land and the sacred sites remains a significant challenge as the acquisition of land for development continues in modern societies. Sacred sites face destruction in the name of progress, with tourism infrastructure posing problems for site owners. Development initiatives often bypass local communities, imposing changes under the guise of job opportunities and a better life. Government leaders often seal deals with project owners without proper consultation, as seen in the case of the Khoisan and Amazon’s attempt to build their African headquarters on a historically significant site in Cape Town (Cultural Survival 2022). Similar issues arose in Venda, where the Phiphidi tourist destination at Phiphidi Waterfall was constructed without the consent of the Ramunangi clan, the custodians of the site. This lack of consultation deeply pained Ramunangi elders, emphasising the disregard for indigenous communities in development projects (Sinthumule et al. 2021:7). This raises concerns about the impact on indigenous cultures and the appropriation of their sacred spaces for economic gains. Government policies may authorise the protection of certain sacred sites, but a Fortress conservation strategy reminiscent of colonial practices often restricts indigenous peoples’ access to and traditional use of their ancestral lands. This approach assumes that indigenous people use natural resources carelessly, neglecting the nuanced understanding they have of their environment (Domínguez & Luoma 2020:2). Traditional healthcare practitioners are unable to use natural resources, including plants, trees, and herbs, as it is perceived to be incompatible with conservation efforts. In the past, communities had their lands where they could harvest resources sustainably; they took care of the environment, but modern policies restrict their access, affecting indigenous livelihoods (Sinthumule et al. 2021:15). Fortress conservation strategies that overlap with indigenous territories further exacerbate these challenges.

Although the focus of the envisaged comprehensive development was on rural areas, it seemed like a step in the right direction as a starting point because most of the traditional healing activity is on the outskirts of urban centres. Yet the role of the traditional healers within the society on the continent of Africa and beyond has proved itself to be so, especially as the entire globe was plunged into a deadly crisis. During the coronavirus disease 2019 (COVID-19) pandemic, the world was desperately searching for a cure for the highly contagious disease that threatened human lives. It became evident that the healthcare sector needed all the help it could get, whether through Western or indigenous medicine. It was during this time that we saw the power of the indigenous knowledge system. There were collaborations between different healing methods, regardless of whether they were indigenous or Western. Traditional healers such as izangoma [diviners] and Izinyanya [healers] made a significant contribution to the fight against COVID-19 (Cordeiro-Rodrigues & Metz 2021:9). There was also evidence provided by Mphekgwana, Makgahlela and Mothiba (2021) of widespread use of African remedies for symptoms of COVID-19.

At this time in South African history, government authorities need to implement legislative measures that open the space for traditional healers to freely execute what they believe is their right to heal those who need it most. In other words, the state should ensure that a restorative framework is put in place to begin the process of redressing the imbalances of the past. Lund and Boone (2013) emphasise the importance of respecting property rights, especially as the country has already entered the new administrative era. The rights of indigenous people fall within this category because they were denied access to the land of their birth in the past.

Indigenous knowledge, often referred to as the local knowledge of ethnic groups in specific geographical locations, plays a crucial role in healing. Ossai (2010) defines indigenous knowledge as ‘traditional and local knowledge existing within and developed around specific conditions of indigenous people in a particular area’ (p. 2). An integral aspect of this knowledge is the connection with ancestral spirits, which serves as a vital channel for passing down wisdom of healing and survival skills. Mokgobi (2014:24) pointed out that the role of traditional healers is not only limited to physical healing, but they are also ‘custodians of the traditional African religion and customs, educators about culture, counsellors, social workers and psychologists’. He makes a strong argument for creating channels of communication between the various health care systems in South Africa.

Ancestral spirits can transition from the physical body to the spirit body without any restrictions. They maintain constant contact with the living, especially those within their family or close circles. These ancestors, possessing valuable indigenous knowledge in healing, have a responsibility to transmit this knowledge to the living. Gifted healers, such as izangoma [diviners], izinyanga [healer], seers, prophets, and others with special spiritual gifts, play a role as intermediaries between the living and those who have passed on (Mkasi 2013:18). They transport messages from the spiritual realm through dreams, visions, and consultations, preserving African ways of being, knowing, and doing. This includes healing practices framed in indigenous religion and African culture. For Chidester (2008:46), ‘Zulu dreaming called for responses of ancestral exchange and orientation that were integral to Zulu religious strategies for sustaining ongoing relations between the living and the dead’.

Ancestors communicate with the living in several ways, and each ethnic group has its unique names for these spirits. Among the Zulu-speaking people, they have many names for the ancestors, but the most commonly used terms are amathonga or amadlozi [ancestral spirits], and the Xhosa use the term izintanya [healers] (Thwala & Edwards 2021:77). When communicating with amathonga [ancestral spirits], it is necessary to evoke the presence of ancestral spirits by following specific processes and using correct naming. These practices vary depending on the clan or ethnic group. In recent years, the work of traditional healers has expanded, including the training of initiates and divination, for both adults and the younger generation. This indicates the growing recognition of the value of indigenous knowledge invested in ancestral spirits. Moreover, this shift suggests that contemporary society is realising the enduring relevance of ancient knowledge, influenced by research that has demonstrated the contributions of traditional healing practices to the modern world.

Despite the challenges faced by traditional healing spaces, traditional healing continues to hold a significant place in people’s lives. It remains a healthcare system that is accessible, local, and affordable for households, irrespective of their financial status. Many South African households still rely on indigenous plants and herbs or even an oral type of dealing with health challenges, which has been done for many generations, highlighting the enduring role of traditional healing (Marks 2006: 473). Basic knowledge of using indigenous plants is often passed down through generations within Africa through the medium of oral transmission. This knowledge is widely available, and individuals gifted with healing abilities can seek mentorship from experts, commonly known as Izinyanga [healers]. For the longest time, African societies used oral traditions; however, some of this knowledge is not documented, as healers worry about theft by research institutions. As confirmed by Smith (1999), ‘It is research which, from indigenous perspectives, “steals” knowledge from others and then uses it to benefit the people who “stole” it’ (p. 56).

While traditional healing is perceived as accessible to all, its vulnerability to corruption and commercialisation is a growing concern, particularly in contemporary societies marked by elevated levels of corruption. The manipulation of ancestral spirits poses a significant challenge, emphasising the importance of each household having its own sacred place for direct communication with the ancestors. In IsiZulu culture, as highlighted above, this sacred place is known as ‘umsamo’, where ancestors reside in a home (Mkhize 2009:18). In times of crisis, the family first consults with the ancestors at umsamo before seeking external assistance from traditional healers. According to Umsamo Institute, Umsamo can be defined as follows (Mkhize 2009):

Traditional healing, once regarded as a sacred spiritual gift bestowed upon individuals to serve their communities, is experiencing a shift towards competition and corruption. The desire for recognition has led some practitioners to manipulate the sacred healing space with the practice of ukuthwala [seeking supernatural or magical ways of acquiring wealth and social prestige] and some izangoma [diviners] are not ashamed to tell the public that they offer such services (The Hustlers Corner SA n.d.). The traditional healers of the past did not practise healing as a profession; rather, it was a gift that had to be treated with respect. The competition in marketing healing herbs has arisen because people are now healing for the sake of making a living. When one works out of poverty, one does not think about safety, yet traditional healing is supposed to be practised with integrity. Telling people how the ritual of ukuthwala is performed is putting those who have no knowledge of healing at risk. This is because ukuthwala is associated with obtaining quick wealth without having worked for it. We are living in a time when many young people are unemployed, and life is difficult; as a result, anything that promises quick gains is easily accepted.

The clean and spiritually pure essence of traditional healing is compromised when practitioners resort to unclean methods and dark powers, forces, and dark magic such as ukuthwala. Initiates or trainees become vulnerable to such practices, as the space has its challenges; it does not provide enough financial stability, which causes some to be tempted to practice ukuthwala, which brings wealth. Traditional healers should work hard to reclaim responsibility, accountability, integrity, and selflessness in their practices. Returning to the roots of traditional healing involves understanding the calling, beneficiaries, and the intricate relationship between trainers, trainees, and ancestral spirits (Mlisa 2009:294).

The commodification of traditional healing has transformed it into a business rather than a service to the community. The destruction of the original structure that accommodated traditional healing services by government actions has contributed to the commercialisation of this sacred practice. The roots of traditional healing, once aimed at sustaining a healthy community, have already become irreversible. The contemporary state of traditional healing is deeply entwined with financial motives.

The shift towards viewing traditional healing as a money-making scheme has further strained its relationship with the community. Furthermore, social media platforms used to promote their business have given them the freedom that is also being abused and put traditional healing at risk. For instance, some have tended to popularise themselves using the media and television screens, and their behaviour in many instances has sought to undermine the very basic principles of traditional healing integrity. This is well demonstrated by Izangoma Zodumo in the Mzansi Magic show (Herbst 2020). They have been drawing attention from social media platforms by sharing and revealing traditional healers’ secrets to their fans, even witchcraft-like tendencies. The way they conduct themselves is not well received by other healers, and this may impact the attempt to fight for recognition in the health sector. There seems to be no control or structures that regulate the behaviour of healers, as is the case in Western health structures that control doctors (Dayile 2020).

The post-1994 South African constitution recognised all religions in the country, including African spiritual and traditional healing practices. This constitutional shift allowed izangoma [diviners] and izinyanga [healer], to operate more openly in urban areas, marking a departure from the suspicion they faced before 1994, confined to rural regions (Thornton 2009:17). The increased visibility of traditional healers, including those from diverse racial backgrounds, reflects a more inclusive approach within the traditional healing community. However, while the transformation is evident on the ground, government-controlled healthcare sectors have not changed. The Traditional Health Practitioners Act of 2007, specifically Section 21, was introduced to regulate the work of traditional healers.

Although the World Health Organization supported such regulations to promote safety standards in African traditional healing, the act faced mixed reactions. Doctors for Life International, for instance, did not trust the efficacy of traditional remedies (Le Roux-Kemp 2010:277). Section 21 mandated the registration of traditional healers, outlining specific requirements such as a letter from an accredited institution or traditional tutor (Street 2016:326). This included Adult Basic Education and Training (ABET) Level or equivalent and a minimum 12-month training period covering diagnosis, preparation of herbs, and traditional consultation. However, these requirements overlooked crucial aspects of traditional healing, including the accreditation of trainers [gobela or inyanga], traditional healers’ challenges in attending schools because of their spiritual calling, and the diverse and intricate training process influenced by ancestral and family factors.

The challenges highlighted in implementing this act reveal a need for revisions that align with the intricate nature of ubungoma initiation. Imposing Western methods on traditional healing practices may not fully capture the essence of this ancient knowledge system, deeply embedded in African culture. Without acknowledging these important aspects of initiation, the genuine practice of traditional healing will lose its value. Therefore, there is a need for a more nuanced and culturally sensitive approach to crafting policies that govern traditional healing practices, recognising their unique nature within the broader healthcare framework. The evolving landscape of traditional healing is marked by challenges that practitioners need to address. It requires a collective effort to preserve the authenticity and sacredness of traditional healing while navigating the complexities of a changing world. Reinstating a sense of responsibility, reclaiming the spiritual essence, and fostering community support are crucial steps towards ensuring the continued relevance and positive impact of traditional healing in contemporary society.