Real Medicine

The Sangoma and the Intern

This is one of those you-know-you-work-in-Africa-when stories:

A young pregnant woman is admitted with severe early-onset pre-eclampsia. She is managed well and her blood pressures and kidney functions normalise. She is discharged for a few days with a return date and lots of medication.

At home, her condition worsens. When she develops anasarca, she seeks the help of a Sangoma. The Sangoma, after the required chat to the ancestors, declares that her client is severely ill and has been cursed. Up to this point, nothing unexpected for this kind of consultation.

Image by Olwen Evans (click for source)
Image by Olwen Evans (click for source)

But then: instead of prescribing a herbal concoction, she declares: if you do not go to the hospital immediately, you will die. Your child will probably not survive either way.

And so the patient returns. Her blood panels reveal nephropathy, elevated liver enzymes, and a platelet count near-zero. She has HELLP syndrome. Labour must be induced. Her tiny infant is unlikely to survive – a sad decision made by Mom to save her life.

She asks me, “Do you believe in demons?”

Do I believe in demons? I believe in good so I must believe in evil.

I know that traditional healers have in many ways been dubbed the evil of medical sciences. Entities that have gained some kind of authority in South Africa and beyond, yet are often exempt from the consequences of their actions.

But this Sangoma? I wish I knew who she was and how she knew that this patient was beyond her skills. Is that not the essence of a good healthcare worker? One who knows when they are out of their depth and refers to the appropriate facility. I wish all Sangomas were like her.

I have always said that traditional healers and doctors need not be at odds. Their presence can, if approached correctly, be used as an adjunct in our resource-strapped setting.

And I received a referral that probably very few other clinicians have received. Because, you know. I work in Africa.

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16 thoughts on “The Sangoma and the Intern”

  1. Sad story for the woman, but also amazing how it all worked out. I am very interested now in learning about Sangomas… I’ve never heard of them before

  2. Well done for that Sangoma.

    Your title bugs me, though. Sangomas and Witch Doctors are not the same thing. Sangomas are healers while so-called Witch Doctors are practitioners of witchcraft and considered servants of evil. In fact, one of the primary responsibilities of a sangoma is to combat witchcraft and to protect the tribe from it.

  3. I completely agree that traditional healers and doctors need not be at odds. In fact, if they were more willing to work together, they could do so much more good in the healthcare system. After all (and obviously I know very little about this, being from Canada), so many people use traditional healers either instead of or in adjunct to Western medicine, that if there was a better relationship between the two areas of healthcare, there could be such better patient care.

  4. Great comments above about healers from different cultures working together. Building on what people trust is so important. In upcountry Liberia elders and chiefs are generally well respected. They were approached by health care workers in the fight against Ebola. The health care workers worked with the elders and chiefs to get their messages and programs in action.
    And I read that the Peace Corps administrative staff (the volunteers themselves had to be evacuated for their safety) were also instrumental. They were very familiar with customs, traditions, and how to get things done.
    Bottom line…it’s all about respect and working with people where they are at.
    Disclaimer….Returned (we never say former!) Peace Corps Volunteer, Liberia 1980-81 (upcountry).
    Why Returned and not Former Volunteer? Well, our third mission is to continue the mission stateside…inform and talk with folks about our experiences where we served.

  5. I am so sorry, sad things happen. I hope your next experiences with the sangoma has a more positive outcome. Glad you can work together for your patients!

  6. It is sad that she waited to come back to see you, but it is good that the Sangoma recognizes that sometimes traditional medicine is not enough. I think similarly we need to realize that sometimes “Western” medicine is not enough.
    Thanks for sharing.

  7. This story sent chills down my spine. That patient could easily have died along with her baby. I wish you could communicate with the Sangoma to commend her skill and candour too. Thank you for sharing this tragic (for mom and likely baby) yet triumphant (for mom if not baby) experience.

  8. A while back I wrote about the Accounting vs Medicine predicament I was in but I am happy to say that I eventually made my decision and today was my first day as an MBChB I student at Stellenbosch University. Thank you very much for your advice and I hope/trust that I wont live to regret my decision.

    1. I’m so glad you managed to make a decision! I hope you will have a fantastic first year – and a fantastic time at med school. It gets hard sometimes, so be sure to nourish yourself. Remember that there are rough patches – but I hope that it will overall be a wonderful experience.

  9. Thank you for sharing this sad patient and hopeful system story about western/traditional healing partnerships. I like that the Sangoma referred her to the hospital. And that you respect the perspective of the patient and her traditional healer.

  10. What a great story! I’m a South African living in Canada, and about to start med school. I actually had HELLP Syndrome, so even more relatable for me. Thanks for sharing!

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