The Bone Toss


Note (30/09/2016): Thank you for comments and feedback received. I was asked to add more of a personal reflection, add more pictures and reduce the length of the text. I have added a new picture, further added on my reflection whilst trying to not make it lengthy.


Our traditions, culture and beliefs form a fundamental part of lives and even inform healthcare choices. For many years people would consult traditional healers to connect them with their ancestors for direction on life, wealth and health. The World Healthcare Organization states that over 80 % of populations in developing countries choose to go to local healer, in South Africa consulting a healer is not part of a religion but rather a cosmology. In traditional African healing, the physical, psychological, spiritual and ancestral worlds are interconnected and traditional healers are the mediums through which these worlds are communicated with (Sodi & Bojuwoy, 2011).

A 54 year old patient from Khayelitsha was referred to physiotherapy for mobilization after being admitted for the third time with congestive cardiac failure, she was being seen by my clinician who thought it would be better for her to be seen by me as I would be better equip to understand her, this statement already made me reluctant as I knew that she was implying that the patient spoke a Nguni language. I walked into the ward and introduced myself  and the first thing I noticed was how morbidly obese she was, she was unable to roll which resulted in pressure sores, and beads around her neck, wrists and ankles. During my subjective assessment she reported that she did not want to come to hospital as she was a traditional healer (Sangoma) in training, her husband had contacted her diviner healer (Nyanga) but he was unavailable and an ambulance was called to take her in. I decided to see her at the end of the day after she would go into a trans state every morning at 9am which made it difficult to engage her in activity and scared me as I would be under the impression that that she was going into cardiac arrest.

I am a Christian and this is a fundamental base of my life as it informs my decision-making, beliefs, and practices. I found myself conflicted and scared as I do not personally believe in consulting a traditional healer but can acknowledge that traditional medicine and trade in South Africa is a large and growing trade with 27 million consumers of traditional medicine and the trade of these medicines contributes to an estimated R2.9 billion to the national economy (Jager, 2005). She informed me that she does not take her medication and requested for I make contact with her healer, I explained to her that I was only allowed to make contact with relevant family members and I could not arrange a consultation for her, I later overheard her ask a nurse to call her husband and request he brings incense and her medication which prompted me to inform my clinician and overseeing doctor.I felt it was necessary for them to be aware of this should her health suddenly deteriorate, my concerns were met with polite: “Thank you for letting us know”,it was clearly a bigger issue for me than those involved in active treatment of the patient. The following morning I noticed a cup beside her which had herb extracts in water (Imbiza), I tried to educate her about the importance of taking her medication and the negative effects of other substances could have on her health but she just looked at me with great disappointed and told me that as a black girl I should be more proud of African culture and offered to throw bones and consult the ancestors on my behalf.A toss happened within myself between morality and ethics as on one hand i did not share her beliefs and was of the opinion that her beliefs could be detrimental to her health,  but health professionals are required to make sure that their personal beliefs do not prejudice their patients’ health care.If they feel that their beliefs might affect the treatment they provide, they must explain this to their patients, and inform them of their right to see another health care practitioner ( HPCSA,2008 ).


Outside of clinical practice I would engage her in apologetics and even offer to pray for her so that she can make Christ her Lord and personal savior in order for her to be forgiven for her sins, but I realized that I could not infringe on her rights and beliefs.The principle of respect for a person’s beliefs  in healthcare as part of a patient-focused framework is an important aspect of their health. The understanding of traditional medicine practice is beneficial to Western medicine in order to better understand negative or positive impacts for development and cure creating a bridge towards holistic healthcare.

As a future healthcare professional it is my duty to limit risk and harm to the patient but I acknowledge that they have the right to autonomy and respects which undergirds my duties (Barnard, 2010) and even when I do not agree with their choices which are at times contrary to my moral framework I have a ethical and legal  obligation  to stay within my scope of practice treating all persons fairly. .


Barnard D. Living with doubt. American Journal of Bioethics 2010;10(4):27-28.

Health Professions Council of South Africa. (2008). General ethical guidlines for health professions . Pretoria: HPCSA.

Jäger, A. K. (2005). Is traditional medicine better off 25 years later?. Journal of Ethnopharmacology, 100(1), 3-4.

Liverpool, J., Alexander, R., Johnson, M., Ebba, E. K., Francis, S., & Liverpool, C. (2004). Western medicine and traditional healers: partners in the fight against HIV/AIDS. Journal of the National Medical Association, 96(6), 822.

WHO (World Health Organization). (2002). Fact Sheet No. 271. June WHO, Geneva.

Sodi, T. Bojuwoye, O. (2011). Cultural embeddedness of health, illness and healing:Prospects for integrating indigenous and western healing practices. Journal of Psychology in Africa, 21, 349-356

Video (Traditional medicine)



4 Replies to “The Bone Toss”

  1. Hi Dineo. Your piece was well written. I was very interested in your post till the end. I agree with your conclusion and understand the struggle you had at first. Your structure is good as you include literature to start off, followed by your patient presentation and personal experience. I have also come across ethical and moral issues and i think you handled the situation well and professional. You did not get personally involved and you knew your boundaries. Fear can always be overcome and from your piece I believe you will be able to handle a similar situation even better. You can improve for your next post by including a little more personal reflection with your feelings on how it affected you and will help you in the next situation that can be similar.


  2. Good Day Dineo.
    I thoroughly enjoyed your written piece. It captivated me from start to end. I have not experienced a cultural conundrum as you have however I felt like i was placed in the situation after reading this piece. I made me think what would I have done were I in this situation? I like how well you structured your piece starting it out with a evidence and facts, including literature and following it with your own personal experience. Your ethics and morality was challenged but i feel like you dealt with the situation to the best of your ability i felt. For future i feel you can add more media such as pictures and video footage to make your written piece more compelling. I do agree with a previous comment that for a next post you can make the post more personal and describe what you would do for the future. overall well written, very inspiring and insightful. a great read.


  3. Hey Dineo, I can imagine how this incident made you feel as i know you a very caring person. I realised a long time ago that to much engagement with your patient and their personal lifestyle, is sometimes not a good idea. At the same time it is easier said than done because we can’t predict the impact a situation can have on our emotions. I think your post is well written, you made good use of literature to back up what u say and the use of hyperlinks made it easy to read. I do think it was a bit lengthy.


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