The visions started when Mirriam Bangisa was a child, coming to her while she slept.
Bangisa would see herself wearing beaded clothing and performing traditional dances of her Xhosa tribe as she helped people at a sacred water site. In her dreams, she heard the voices of her grandparents telling her she was meant to become a sangoma, a type of South African traditional healer.
But the young girl’s father, a pastor in the Dutch Reformed Church, told her she must go to church and focus on God. Bangisa grew up and became a pastor herself, hoping a devout existence would banish the visions.
But they returned again and again, as vivid as a movie.
Bangisa eventually accepted her calling and became a certified traditional healer in 1998. Now 58, she lives in Old Crossroads, one of the most densely populated townships in Cape Town, and serves as a naturopath and trusted advisor to people in her community on issues ranging from heartbreak to high blood pressure.
Bangisa is also a member of the community advisory board for the Fred Hutch’s HIV Vaccine Trials Network (HVTN) site in Old Crossroads run by the Desmond Tutu HIV Foundation. Her dual roles epitomize the mix of modernity and tradition in South Africa, where Western-trained doctors are still greatly outnumbered by indigenous healers – around 30,000 to 200,000, respectively, according to some estimates.
Traditional healers play an integral role on the HVTN’s community advisory boards (CABs), said Nomampondo Barnabas, the community liaison manager at the Perinatal HIV Research Unit in Soweto, Johannesburg, another HVTN site.
Often highly respected in their communities, traditional healers provide an important bridge between network sites and surrounding areas, informing local residents about what the HVTN does and in turn, advising HVTN staff on how to avoid cultural and political landmines.
“We believe that our research should be culturally sensitive, and traditional healers are able to sensitize researchers to what is culturally acceptable,” Barnabas said.
Bangisa also goes into the community and talks with people about the network, telling them about clinical trials and addressing misunderstandings head-on.
Traditional healers are also helpful in discouraging trial participants from combining study drugs and herbal remedies that could result in adverse reactions, Barnabas said. That’s important, she said, since South Africans may consult with traditional healers if something happens in the middle of the night when medical clinics are closed, or may opt to see them over conventional doctors.
“I would define them as the first level of community health care,” she said.
'We don't talk about it'
Traditional healers have long played a prominent role in South African culture. There are two main types, sangomas (diviners) and inyangas (herbalists) but the practices have become mixed over the years and sangoma is now commonly used to describe any traditional healer.
Healers believe they are summoned by their ancestors through a calling known in Zulu as “ubizo.” They are called on to heal physical and emotional ailments, counteract negative forces and assist with birth and death rituals. They use herbal remedies extensively, but may also incorporate plant and mineral items into their work.
Around 80 percent of South Africans rely on traditional medicine to meet their primary healthcare needs, according to a 2012 paper in the South African Medical Journal. Up to 90 percent of people with HIV and AIDS consult traditional healers before seeing conventional doctors.
But South Africa’s history of colonialism and apartheid has marginalized traditional healers and created secrecy around the practice. South Africa is about 80 percent Christian and most South Africans consult with traditional healers, but some fear being judged by born-again Christians who may not approve of them, or being considered primitive or uneducated.
One 30-year-old woman, who asked that her real name not be used, shares that concern. Her family has consulted with a traditional healer since she was a child, she said, including her father, who was educated at Cornell University and was a math lecturer.
But the family sees a traditional healer located a distance from their Durban home so neighbors don’t find out, she said, and don’t discuss it with outsiders.
“Most people go, but we don’t talk about it,” said the woman, an educator at one of HVTN’s South Africa sites. “We keep it private because people judge.”
She said conventional doctors and scientists in South Africa tend not to take traditional medicine seriously. The country passed legislation in 2007 to recognize and regulate traditional healers, but only in 2012 established a national council of traditional health practitioners. In the interim, charlatans have sprung up promising everything from lottery wins to success with errant lovers.
But legitimate traditional healers are an essential part of the HVTN’s work, said Jim Maynard, the HVTN’s associate director of communications and community engagement.
“Traditional healers are so ingrained in South African culture and are often well-respected in their communities,” he said. “Their involvement in the HVTN helps us to establish inroads into the communities where we work. It would be very difficult for us to successfully do that work without them.”
‘It is a gift’
Bangisa grew up in the Eastern Cape province, the ancestral home of the Xhosa people. Her mother was a traditional healer, as were several aunts and uncles, but her father didn’t accept the practice and her parents eventually parted ways over it.
Bangisa was reluctant to follow the same path, but one night in 1993 she dreamed of a house where she knew she would find a mentor. Not long afterward, Bangisa was on her way to town, spotted the house and went to find her mentor. She lived with her mentor, a traditional healer herself for seven years, studying until her ancestors came to her in a vision and told her she was ready.
When the time came, Bangisa went into a thickly wooded area, where she stayed alone for 10 days. Then she crept back covered in a blanket to keep herself hidden, as custom requires. Upon her return, Bangisa’s brother slaughtered a cow to mark the completion of her training.
The wavy, wiry end of the cow’s tail now hangs from the end of the beaded stick Bangisa uses when doing traditional dances. Her ornately beaded clothing is her daily wardrobe, as is the distinctive dotted makeup adorning her face – traditional healers are not supposed to be seen without makeup, she said.
To seek guidance for patients, Bangisa summons her ancestors by making a fire from a native plant and ingesting snuff that she also scatters around her. She sometimes receives visions that tell her to go collect particular plants that someone will need, she said, or reveal who will come for help and what they will be seeking.
“It is a gift,” Bangisa said, speaking through a translator.
Bangisa offers assistance with fertility issues, to help reduce the frequency of epileptic seizures and to make end-stage cancer patients more comfortable. She has long worked in the realm of conventional medicine, serving on a committee at a government-run health clinic in her Crossroads community and providing home visits to people with HIV and AIDS through the local YMCA.
As a CAB member, Bangisa sees herself as a cultural liaison who can help combat myths and suspicion about what the HIV Vaccine Trials Network does.
“My role is to go to the community and inform them what is happening,” she said. “By inviting people to come in, we help dispel misconceptions.”