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Diversity and Division in Medicine

Health care in South Africa from the 1800s


Anne Feinstein (Digby)

This is an innovative investigation of pluralism in health care. Using both extensive archival material and oral histories it examines relationships between indigenous healing, missionary medicine, and ‘western’ biomedicine. The book includes the different regions within South Africa although focusing in most detail on the Cape, the earliest area of white settlement. In a wide-ranging survey the division in medicine between ‘western’ and indigenous medicine is analysed through an exploration of the evolving practices of healers, missionaries, doctors and nurses. The book considers the extent to which there was a strategic crossing of boundaries in the construction of hybrid practices by these practitioners, and the extent to which patients pursued health by sampling diverse care options. Starting with missionary penetration during the early nineteenth century, the volume outlines interventions by the colonial state in medicine and public health, and the continued resilience of indigenous healing in the face of this. The book ends by relating past to present in scrutinising the legacy of historical structures – including those of the apartheid state – for current health care, and in briefly discussing the huge challenges that the HIV/Aids pandemic poses in impacting on them. The book thus provides an inclusive history of medicine for the ‘New’ South Africa.
Contents: Setting the scene within historiography – Medical diversity within a single region: Kuruman voices – Health care providers: missionaries, ‘western’ practitioners - doctors and nurses, African indigenous healers – Role of women as missionaries, as nurses, as healers – ‘Western’ medicine and extension of ‘civilisation’ – Disease, race and empire – Nurses as culture brokers in the community – Resilience of indigenous medicine – Medical pluralism: crossing boundaries in practitioner eclecticism, and crossovers in patient pluralism – Retrospect and prospect - past structures and present prospects – Segregation and apartheid in health care – The HIV/AIDS pandemic – Attempts to create a unified health care system for the nation.