The Importance of the African Ethic of Ubuntu and Traditional African Healing Systems for Black South African Women's Health in the Context of HIV and AIDS. Domoka Lucinda Manda 982171342 University of KwaZulu-Natal Submitted in fulfillment for the academic requirements for the degree of Doctor of Philosophy in the Discipline of Comparative and Applied Ethics, School of Philosophy and Ethics, Faculty of Humanities, Development and Social Studies. December 2007 DECLARATION I declare that The Importance of the African Ethic of Ubuntu and Traditional African Healing Systems for black South African women's Health in the context of HIV and AIDS is my own work and that all the sources I have used and quoted have been indicated and acknowledged by means of complete reference in the footnotes and bibliography. MUJJMA Domoka Lucinda Manda i DEDICATION I dedicate this thesis to my beloved parents, Ron and Hazel Manda. ACKNOWLEDGEMENTS I extend my deepest gratitude to my supervisor, Professor Martin Prozesky, Director of Unilever Ethics Centre. I am immensely grateful for his expertise, consistent patience, guidance, kindness and generosity. I will forever be indebted to you for supervising and mentoring me throughout the duration of my studies. I am extremely appreciative of the bursary provided to me for the duration of my studies by Atlantic Philanthropies towards the development of African ethics, and Unilever for providing funding towards the development of young academics. Special thanks are due to Dr Munyaradzi Felix Murove for his invaluable advice, and Professor Nwabufo Okeke Uzodike for his encouragement. Lastly, thanks are due to my parents and siblings for their support, encouragement and love. iii LIST OF ABBREVIATIONS ABC Abstain, Be faithful and Condomize AIDS Acquired Immunodeficiency Syndrome BEE Black Economic Empowerment FNB First National Bank HIV Human Immunodeficiency Virus MRM Moral Regeneration Movement PWA People With AIDS PLWA People Living With AIDS SABC South African Broadcasting Corporation STD Sexually Transmitted Diseases UNAIDS United Nations Joint Programme on HIV/AIDS iv ABSTRACT This study takes the concept of ubuntu, which means humanness and applies it to healthcare issues in general, and women's health, in particular. Ubuntu is based on the reality of interdependence and relatedness. It is a philosophy or way of life that finds its roots and meaning in humanity. The values espoused in ubuntu emphasize caring, sharing, reciprocity, co-operation, compassion and empathy in recognition that for human beings to develop, flourish and reach their full potential, they need to conduct their relationships in a manner that promotes the well-being of others. The values championed in ubuntu are what inform and shape African cultural, social, political and ethical thought and action. The basic premise that motivates this research is that the African principle of umuntu ngamuntu ngabantu, a person is a person because of others, or John Mbiti's famous phrase, "I am because we are, and we are because I am" tends to promote caring, health and well-being for humankind. This is because it is in ubuntu that deeper, more metaphysical, explanations for encouraging care for fellow human beings are offered. The dissertation is an ethical enquiry into the importance of the African ethic of ubuntu and traditional African healing systems for black South African women's health in the context of HIV and AIDS. The research questions are: what values contained in the traditional African ethical concept of ubuntu offer the rest of the world a way of promoting an ethic of care? What role do Africa's traditional healing systems play in addressing issues of health in a way that pays attention to delivering holistic healthcare? The objective is to show how the African ethic of ubuntu and Africa's traditional healing wisdom can be applied to healthcare in general, but more specifically, to the health and healthcare needs of women. v TABLE OF CONTENTS Page Declaration i Dedication ii Acknowledgements iii List of Abbreviations iv Abstract v Introduction 1 1 Setting the context of the research: Ubuntu, Women and HIV and AIDS in South Africa 1 2 Hypothesis 7 3 Research problem 8 4 Outline of research, including theoretical framework 9 5 Research questions and methodology 11 6 Limitations of the study 12 7 Significance of the study 12 8 Study outline 13 Chapter One: Theoretical framework 15 1 Introduction 15 1.1 A discussion on the content and nature of African ethics 17 1.2 Sources of morality 19 1.2.1 The family and community 19 The elders 20 The ancestors 22 1.2.2 The divinities and spirits 25 1.2.3 The Supreme Being 27 1.2.4 Religious Specialists - diviners and spiritual healers 28 1.3 The concept of ubuntu 29 1.3.1 Defining ubuntu 29 1.3.2 Ubuntu as a virtue 33 1.4 Implications of ubuntu for the family and the community 36 1.5 A discussion on the content and nature of virtue ethics 38 1.6 Sources of morality 41 1.6.1 The individual 41 1.7 Implications of virtue ethics for the family and the community 44 1.8 A discussion on the content and nature of the feminist ethic of care 45 1.9 Sources of morality 52 1.9.1 The individual 52 1.10 The notion of care in feminist ethics 53 1.10.1 Defining care 53 1.10.2 Ethical caring 54 11.1 Implications of an ethic of care on the individual and community 55 1.12 Limitations of each ethical theory 56 v Page 1.12.1 Critique of the African ethic of ubuntu 56 1.12.2 Critique of virtue ethics 57 1.12.3 Critique of feminist ethic of care 1.13 Conclusion: a summary of the similarities between the three ethical theories 62 Chapter Two: Black South African women's health 65 2 Introduction 65 2.1 Defining health 66 2.2 Western biomedical definitions of health 67 2.2.1 Health as the absence of disease and illness 67 2.3 African/cultural definitions of health 70 2.3.1 Health as wholeness 71 2.4 Women and health in South Africa 72 2.5 Factors that undermine the health of black South African women 79 2.5.1 Poverty, gender and economic inequality 79 2.5.2 Cultural factors 85 2.6 The consequences of women's increased vulnerability 87 2.7 Conclusion 89 Chapter Three: Women in the African world-view 91 3 Introduction 91 3.1 Perceptions of women in traditional African communities 93 3.1.1 The position and role of the female in African mythology 93 3.1.2 The position and role of women in traditional African communities 99 3.1.3 Women's contribution to life in African communities 101 3.2 Women's healing roles 105 3.3 Conclusion 108 Chapter Four: Traditional African approaches to health and healing 110 4 Introduction 110 4.1 Revisiting the approach to life in the African world-view 111 4.1.1 Defining world-view 111 4.1.2 The approach to life 111 4.2 Contextualizing the traditional African approach to health 116 4.2.1 The symbiotic relationship between life, the community, nature and health 116 4.3 Africa's traditional healing wisdom 122 4.3.1 The term "traditional" in African healing 122 4.3.2 Defining Africa's traditional healing wisdom and system 123 4.4 Healers in South Africa 125 4.4.1 Indigenous healers and Western-trained physicians 125 4.5 The basis of healing in Africa 129 4.5.1 Vital force 129 4.5.2 Holism 135 vi Page 4.5.3 Spirituality 136 4.6 Conclusion 139 Chapter Five: Qualitative data analysis and findings 140 5 Introduction 140 5.1 Research methodology 140 5.2 Data collection 144 5.3 Data analysis 144 5.4 Researcher integrity: ethical issues 145 5.5 Arguments explaining and supporting the choice three distinct groups of informants 146 5.5.1 The academic community 146 5.5.2 The healthcare practitioners 148 5.5.3 "Other" informants 148 5.6 Presentation of findings 149 5.6.1 General themes 150 5.6.2 Specific themes 150 5.7 General themes 151 5.7.1 Understanding ubuntu 151 5.7.2 Characteristics of a person with ubuntu 153 5.7.3 Perceptions of the unique contribution of ubuntu to care 157 5.8 Specific themes 161 5.8.1 The African ethic of ubuntu and healthcare ethics 161 5.8.2 The African ethic of ubuntu and women's health 169 5.8.3 Africa's traditional healing wisdom 176 5.9 Conclusion 180 Chapter Six: Conclusion 181 6 Introduction 181 6.1 Towards an expanded ethic of healthcare through ubuntu 183 6.1.1 The practical application of ubuntu to healthcare practices 183 6.2 Traditional African culture and women 190 6.2.1 The practical application of ubuntu to women's health 190 6.3 Recommendations 195 6.4 Possible areas for further investigation 198 6.5 Final thoughts 198 Bibliography 201 Appendix 212 Letter of invitation to participate in research 212 Sample questions for interviews 214 Interview transcripts 215 vii Introduction 1 Setting the context of the research: Ubuntu, Women and HIV and AIDS in South Africa The global pandemic of HIV and AIDS continues to pose one of the most significant challenges of our time. It has become acknowledged as a threat to human security, along with war, violence and environmental degradation. HIV and AIDS is a major threat to humanity and to our existence, because, traditional definitions of security, which includes HIV and AIDS pose a .. .pervasive and non-violent threat to the existence of individuals, as the virus significantly shortens life expectancy, undermines quality of life and limits participation in income generating activities. The political, social and economic consequences are equally detrimental to the community, in turn undermining its security. The challenge to curb the spread of HIV and AIDS is a complex one because, as Anton van Niekerk observes, the developments in "increased trade, 'uhuru' (liberation from colonialism), urbanization, and more sexual freedom" facilitate the continual epidemic spread of the disease. The increase in cross-border migration and the persistent internecine wars on the continent, that cause the displacement of people from their home countries and force them to seek refuge in other countries, provide further ingredients for the spread of the disease. It has become increasingly apparent that the solution to dealing with the HIV and AIDS pandemic is no longer simply a biomedical one, but it also involves an interrogation of the social contexts in which the epidemic thrives. In South Africa this proves to be a major challenge, especially in relation to poverty and a lack of strong leadership. The problems surrounding the management and possible curbing of the HIV and AIDS pandemic on the African continent, in general, and in South Africa, in particular, stem 1 Hadingham, J. (2000) 'Human Security in Africa: Polemic Opposites'. South African Journal of Inernational Affairs. No. 7, Vol. 2, p. 120. 2 van Niekerk, A.A. (2001) 'Moral and Social Complexities of AIDS in Africa'. Journal of Medicine and Philosophy. Vol. 27, No. 2, p. 143. 1