Traditional Healers in South Africa looks at the role played by traditional healers in Southern Africa, the legal framework of traditional healers & the whole phenomenon of traditional healers & sangomas in Southern Aafrica
Traditional healers of South Africa
Traditional healers of South Africa are recognized by the Traditional Practitioners Act as traditional
practitioners of traditional African medicine in Southern Africa.
They fulfill different social and political roles in the community, including divination, healing physical,
emotional and spiritual illnesses, directing birth or death rituals, finding lost cattle, protecting warriors,
counteracting witches, and narrating the history, cosmology, and myths of their tradition.
There are two main types of traditional healers within the Nguni societies of Southern Africa: the
diviner (sangoma), and the herbalist (inyanga). These healers are effectively South African shamans
who are highly revered and respected in a society where illness is thought to be caused by witchcraft,
pollution (contact with impure objects or occurrences) or through neglect of the ancestors.
It is estimated that there are as many as 200,000 indigenous traditional healers in South Africa
compared to 25,000 Western-trained doctors. Traditional healers are consulted by approximately 60%
of the South African population, usually in conjunction with modern biomedical services.
For harmony between the living and the dead, vital for a trouble-free life, traditional healers believe
that the ancestors must be shown respect through ritual and animal sacrifice. They summon the
ancestors by burning sacred plants like imphepho (Helichrysum petiolare), dancing, chanting,
channelling or playing drums.
Traditional healers will often give their patients muti—medications made from plant, animal and
minerals—imbued with spiritual significance. These muti often have powerful symbolism; for
example, lion fat might be prepared for children to promote courage. There are medicines for
everything from physical and mental illness, social disharmony and spiritual difficulties to potions for
protection, love and luck.
Although sangoma is a Zulu term that is colloquially used to commonly describe all types of Southern
African traditional healers, there are differences between practices: an inyanga is concerned mainly
with medicines made from plants and animals, while a sangoma relies primarily on divination for
healing purposes and might also be considered a type of fortune teller. In modern times, colonialism,
urbanisation, apartheid and cross-cultural mixing have blurred the distinction between the two and
traditional healers tend to practice both arts.
Traditional healers can alternate between these roles by diagnosing common illnesses, selling and
dispensing remedies for medical complaints, and divining cause and providing solutions to spiritually
or socially centred complaints.
Each culture has their own terminology for their traditional healers. Xhosa traditional healers are
known as ixwele (herbalists) or amagqirha (diviners). Ngaka and selaoli are the terms in Northern
Sotho and Southern Sotho respectively, while among the Venda and Tsonga people they are called
mungome. The Tsonga people also refer to their healers as n'anga.
A sangoma is a practitioner of ngoma, a philosophy based on a belief in ancestral spirits (Zulu:
amadlozi) and the practice of traditional African medicine. Sangoma perform a holistic and
symbolic form of healing by drawing on the embedded beliefs of the Nguni culture who believe that
ancestors in the afterlife guide and protect the living. Sangomas are called to heal, and through
them it is believed that ancestors from the spirit world can give instruction and advice to heal illness,
social disharmony and spiritual difficulties. Traditional healers work in a sacred healing hut or
ndumba, where they believe their ancestors reside.
Sangomas believe they are able to access advice and guidance from the ancestors for their patients
through possession by an ancestor, or channelling, throwing bones, or by interpreting dreams. 
In possession states, the sangoma works themselves into a trance through drumming, dancing and
chanting, and allows their ego to step aside for an ancestor to take possession of his or her body and
communicate directly with the patient, providing specific information about the problems of the
patient. It can be dramatic, with the sangoma speaking in tongues, or foreign languages according to
the specific ancestor, or dancing fervently beyond their stated ability.
Ancestral spirits can be the personal ancestors of the sangoma or the patient or they might be general
ancestors associated with the geographic area or the community. It is believed that the spirits have
the power to intervene in people's lives who work to connect the sangoma to the spirits that are acting
in a manner to cause affliction. For example, a crab could be invoked as a mediator between the
human world and the world of spirits because of its ability to move between the world of the land and
the sea. Helping and harming spirits are believed to use the human body as a battle ground for their
own conflicts. By using ngoma, the sangoma can create harmony between the spirits which results in
the alleviation of the patient's suffering.
The sangoma may burn incense (like Imphepho) or sacrifice animals to please the ancestral
spirits. Snuff is also used to communicate with the ancestors through prayer.
Divination, diagnosis and healing practices
A sangoma's goal in healing is to establish a balanced and harmless relationship between the afflicted
patient and the spirits that are causing their illness or problem. The healer intercedes between the
patient and the world of the dead in order to make restitution. This is generally performed through
divination (throwing the bones or ancestral channeling), purification rituals, or animal sacrifice to
appease the spirits through atonement.
Sangoma performing a divination by reading the bones after being thrown
Throwing the bones to access the advice of ancestors is an alternative practice to the exhausting ritual
of possession by the ancestor. In a typical session, a patient will visit the sangoma and the sangoma
must determine what the affliction is or the reason the patient has come to them for help. The patient or
diviner throws bones on the floor, which may include animal vertebrae, dominoes, dice, coins, shells
and stones, each with a specific significance to human life. For example, a hyena bone signifies a thief
and will provide information about stolen objects. The sangoma or the patient throws the bones but the
ancestors control how they lie. The sangoma then interprets this metaphor in relation to the patient's
afflictions, what the ancestors of the patient require, and how to resolve the disharmony. In the
same way, sangomas will interpret metaphors present in dreams, either their own or their
When the diviner comes to an acceptable understanding of the problem and the patient agrees, she will
instruct the patient on a course of medicine which may include the use of ngoma, referral to a herbalist,
inyanga (if the sangoma does not have the knowledge themselves), or recommend a Western medicine
Medicines and muthi
The spiritually curative medicines prescribed by a traditional healer are called muthi. They may be
employed in healing as warranted in the opinion of the herbal specialist or inyanga. Muthi is a term
derived from a Zulu word for tree. African Traditional medicine makes extensive use of botanical
products but the medicine prescribed by an inyanga may also include other formulations which are
zoological or mineral in composition. Traditional medicine uses approximately 3,000 out of 30,000
species of higher plants of Southern Africa. In South African English and Afrikaans, the word
muthi is sometimes used as a slang term for medicine in general.
Muthis are prepared, and depending on the affliction, a number of purification practices can be
administered. These practices include bathing, vomiting, steaming, nasal ingestion, enemas, and
Bathing - Herbal mixtures are added to bath water to purify the patient
Vomiting (phalaza)- A large volume (up to 2 litres) of a weak, lukewarm herbal infusion is drunk
and a process of self-induced vomiting occurs to cleanse and tone the system.
Steaming (futha) - Medicinal herbs are commonly inhaled by steaming them in a bucket of boiling
water. A blanket is used to cover the patient and container. Hot rocks or a portable stove may be
included to keep the bucket boiling. The patient sits under the blanket, breathes in the herbal steam and
Nasally - A variety of plants can be taken dried and powdered as snuff. Some are taken to induce
sneezing which may traditionally be believed to aid the expulsion of disease. Others are taken for the
common conditions such as headaches.
Enemas - Infusions and some decoctions are commonly administered as enemas. The enema is a
preferred route of administration of certain plant extracts, as it is believed they are more effective when
administered this way.
Cuttings (umgaba) - Extracts or powders are directly applied to small cuts made with a razor blade in
the patients skin.
An experienced inyanga will generally seek the guidance of an ancestral spirit before embarking to find
and collect muti. The healer, through dreams, or during prayers, will be advised of an auspicious time
for collecting the plants, and in some cases will be told which particular plants to collect for a specific
patient and where these plants are located. The healer supplements the advice from an ancestral spirit
with their own knowledge, training and experience.
Thwasa and initiation
An initiate (ithwasa) being led towards the goat that will be sacrificed at her initiation into becoming a
Both men and women can become traditional healers. A sangoma is believed to be "called" to heal
through an initiation illness; symptoms involve psychosis, headache, intractable stomach pain, shoulder
or neck complaints or illness that cannot be cured by conventional methods. These problems
together must be seen by a sangoma as twasa or the calling of the ancestors. Sangomas believe that
failure to respond to the calling will result in further illness until the person concedes and goes to be
trained. The word twasa is derived from thwasa which means 'the light of the new moon' or from
ku mu thwasisa meaning 'to lead to the light'. A trainee sangoma (or ithwasa) trains formally under
another sangoma for a period of anywhere between a number of months and many years. The training
involves learning humility to the ancestors, purification through steaming, washing in the blood of
sacrificed animals, and the use of muti, medicines with spiritual significance.
An ithwasa after drinking the blood of a goat during her initiation
The ithwasa may not see their families during training and must abstain from sexual contact and often
live under harsh and strict conditions. This is part of the cleansing process to prepare the healer for
a life's work of dedication to healing and the intense experiences of training tend to earn a deeply
entrenched place in the sangoma's memory.
During the training period the ithwasa will share their ailments in the form of song and dance, a process
that is nurtured by the analysis of dreams, anxieties, and with prayer. The story develops into a song
which becomes a large part of the graduation type ceremony that marks the end of the ithwasa's
training. At times in the training, and for the graduation, a ritual sacrifice of an animal is performed
(usually chickens and a goat or a cow). The spilling and drinking of this blood is meant to seal
the bond between the ancestors and the sangoma.
At the end of thwasa and during initiation, a goat is sacrificed to call to the ancestors and appease them.
The local community, friends and family are all invited to the initiation to witness and celebrate the
completion of training. The ithwasa is also tested by the local elder sangomas to determine whether
they have the skills and insight necessary to heal. The climactic initiation test is to ensure the ithwasa
has the ability to "see" things hidden from view. This is signified and proved when other sangomas
hide the ithwasa's sacred objects, including the gall bladder of the goat that was sacrificed and the
ithwasa must, in front of the community, call upon their ancestors, find the hidden objects and return
them back to the sangomas that hid them, thus proving they have the ability to "see" beyond the
Drumming and ancestral dancing
Sangoma in traditional attire dancing in celebration of his ancestors
Sangoma can also literally mean 'person of the drum' or 'the drumming one'  and drumming is an
important part of summoning the ancestors. During times of celebration (e.g. at an Initiation) the
possessed sangoma is called to dance and celebrate their ancestors. The sangoma will fall into trance
where the ancestors will be channeled (which is signified in Zulu traditions by episodes of convulsive
fits) followed by the singing of ancestral songs. These songs are echoed back to the ancestor via the
audience in a process of call and response. The possessed sangoma will then change into their
traditional ancestral clothing and dance vigorously while others drum and sing in celebration.
History and background
The Zulu word with prefix is isangoma (pl. izangoma), alternatively it is also spelled as umngoma (pl.
abangoma), sa ngoma means 'do ngoma and i sa ngoma means "those who do ngoma", so sangoma or
isangoma refers specifically to the practitioner of the ngoma practice.
Sangoma/N'anga in Johannesburg, South Africa, performing a traditional baptism to protect the spirit
of the baby
The term sangoma is often used colloquially in South Africa for equivalent professions in other Bantu
cultures in Southern Africa. Forms of the ngoma ritual are practiced throughout southern and south-
eastern Africa in countries such as South Africa, Swaziland, Zimbabwe, Mozambique, Lesotho, Kenya,
and Batswana. In more northern areas the practices are generally more diverse and less organized than
the southern practices. Among the Kongo, the practice is called loka or more negatively doga, a
term meaning witchcraft.
Ngoma is believed to have come to southern Africa during the western Bantu migration that began
around 2000 BCE and was further influenced by the eastern Bantu migration that occurred until 500
CE. The practice has evolved along with the social problems of its users. In pre-colonial form
ngoma songs dealt mainly with issues of hunting. Over time the system adapted to include the
introduction of guns, and later the racial and class struggles of practitioners under colonial rule. In
Zimbabwe, the civil war experience lead to a revival of ngoma practice with a new emphasis on the
spirits of the victims of war. The service allowed the sangoma to help people cope with their own
violent acts as well as those they had fallen victim to. An example of this is the Tsonga who
believe that one of the main alien spirits that can bestow powers of clairvoyance and the ability to
detect witchcraft, is the Ndau Spirit. The Ndau spirit possesses the descendants of the Gaza soldiers
who had slain the Ndau and taken their wives. Once the Ndau spirit has been converted from
hostile to benevolent forces, the spirits bestow the powers of divination and healing on the n'angna.
In addition, ngoma has been adapted by many to include both Christian and Muslim beliefs.
Sangomas are legally recognized in South Africa as "traditional health practitioners", under the
Traditional Health Practitioners Act of 2007 (Act. 22 of 2007) as diviners alongside with herbalists,
traditional birth attendants, and traditional surgeons. The act calls for the establishment of a national
council of traditional health practitioners to regulate and register a.o. sangomas in the country.
However, it was only in December 2011 that the National Department of Health took action and
opened nominations for seats on an interim council. In October 2012, Health Department spokesperson
Joe Maila advised the Department aimed to have the council up and running by the end of
2012. The Interim Traditional Health Practitioners Council was eventually inaugurated on
12 February 2013.
Previously, the South African Parliament had passed the Traditional Health Practitioners Act of 2004
(Act. 35 of 2004). However, the act was ruled unconstitutional after Doctors for Life International
challenged it at the Constitutional Court, citing the insufficient public participation at provincial level
in the drafting of the act.
The South African Law Reform Commission received a submission from the Traditional Healers
Organisation requesting the investigation of the constitutionality of the Witchcraft Suppression Act of
1957 and the Mpumalanga Witchcraft Suppression Bill of 2007, the drafting of which was
suspended in 2008. On 23 March 2010 the Minister of Justice and Constitutional Development
approved a South African Law Reform Commission project to review witchcraft legislation. In
March 2012 the South African Law Reform Commission advised that Ms Jennifer Joni has been
designated as researcher and Judge Dennis Davis has been designated as project leader for Project 135:
Review of witchcraft legislation. Dr Theodore Petrus, who completed a doctoral thesis on
witchcraft-related crime in 2009, was invited to become part of an advisory committee to assist in
After a successful initiation in Alexandra Township, Johannesburg, Gogo Michelle of the Tshwane
Traditional & Faith Healers Forum welcomes new sangomas (including a white thwasa)
While there are recorded instances of white sangomas before 1994, since 1994 an increasing number of
white people have openly trained as sangomas in South Africa. The question of authenticity is still
an ongoing discussion. According to Nokuzola Mndende of the Icamagu Institute, a Xhosa sangoma
and former lecturer in religious studies at the University of Cape Town:
An igqirha is someone who has been called by their ancestors to heal, whether from the maternal or
paternal side, they can't be called by [somebody else's] ancestors.
Philip Kubekeli, director of the Traditional Medical Practitioners, Herbalist and Spiritual Healers
Association, and Phephsile Maseko, spokesperson of the Traditional Healers Organisation, see nothing
wrong with white sangomas. Kubekeli and Maseko maintain the position that traditional healing knows
Several white sangomas, interviewed by The Big Issue in 2010, claimed that they have been welcomed
by the black community in South Africa, aside from isolated experiences of hostility. On the other
hand, there have also been reports that white sangomas have been less readily accepted by black
A number of the South African traditions (e.g. Swazi and Tsonga/Shangaan) believe that a
foreign or alien spirit can call one to become a traditional healer, especially if there is a significant
extreme relationship between one of the healer's biological ancestors and the foreign spirit that
occurred in the past. Dr Nhlavana Maseko, founder of the Traditional Healers Organisation, explains:
Foreign spirits are not of your family. That is all it means. Foreign spirits are not your ancestors. My
forefathers, for instance, were warriors and they killed some people. When these people were killed,
they become my family's foreign spirits. There must be a working relationship with your foreign spirit
and your ancestors. They have something, an injustice, a murder that must be worked out, must be
healed. During training, as the ancestors come out, you have to finish up with your own ancestors first.
That relationship sorts itself out, then you are ready to work with the foreign spirits. It happens in a
natural way. The ancestors do the work through you. Maybe the foreign spirit want to be the important
or senior ancestor; when the ancestor of your clan comes, well, they may have to fight it out. You
might feel some aches during this time. It is friction among them that is working itself out.
Relationship with Western medicine
Inyanga in her ndumba, a sacred hut used for healing. Behind her are her mutis, medicine stored in
The formal health sector has shown continued interest in the role of sangomas and the efficacy of their
herbal remedies. Botanists and pharmaceutical scientists continue to study the ingredients of traditional
medicines in use by sangomas. Well known contributions to world medicine from South African
herbal remedies include aloe, buchu and devil's claw. Public health specialists are now enlisting
sangomas in the fight, not only against the spread of HIV/AIDS, but also diarrhoea and pneumonia,
which are major causes of death in rural areas, especially in children. In the past decade, the role
of traditional healers has become important in fighting the impact of HIV and treating people infected
with the virus before they advance to a point where they require (or can obtain) anti-retroviral
drugs. A conclusion from a review by UNAIDS in September 2000, regarding collaboration
with traditional healers in HIV/AIDS prevention and care, found that modern and traditional belief
systems are not incompatible, but complimentary.
Estimates of the number of indigenous traditional healers in South Africa ranged up to 200,000 in
1999, compared to 25,000 Western-trained doctors. Traditional healers are consulted first (or
exclusively) by approximately 60% of the African population.
Phephsile Maseko, national co-ordinator of the Traditional Healers Organisation (THO) says:
A true healer is someone who has been through initiation, inducted by an expert in the field, who has
undergone rigorous training and completed external healing courses. If a patient complains of
headaches, they will be given plants with painkilling properties. But the healer will also try to establish
the root cause of the headaches, and treat that too.
This may mean the healer will provide counselling to the patient. Treatment is usually holistic, and a
once-off ointment will generally not do the trick. Many clients come for help with their relationships or
marriages. A potion may be given to open the communication channels between couples, so that they
can speak about their problems. Counselling will also be on offer, but there is no quick-fix solution.
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