The politics of UMOYA: Variation in the interpretation and management of diarrheal illnesses among mothers, professional nurses, and indigenous health practitioners in Khayelitsha, South Africa

Philosophiae Doctor - PhDThis study deals with the social interpretation of childhood diarrhea among the Xhosa speaking people of the Western Cape in South Africa. It highlights how in the Western Cape political consciousness and moralist discourses strongly influence relationships between different health care systems and the production of continuing conflicts around problems of health care delivery. It is argued that if meaningful relationships could be found between socially based health-seeking strategies and biomedical classifications of enteric and other diseases of women and children, they could facilitate the provision of more equitable, effective and widely acceptable health care. Furthermore, it compares the etiological explanations of childhood illness signs and symptoms of mothers and health practitioners of two kinds, i.e., professional nurses trained in biomedicine and indigenous African health practitioners (IHPs). The comparison focuses particularly on the interpretation of stool quality and associated symptoms. For stool quality the study refers to the color and texture of children's feces that mothers and health practitioners identify and associate with distinctive conditions of affliction. The study found these descriptive categories do not exhaust the variety of interpretations known to Nguni people in the area. There is variation, even ambiguity, in the interpretation of commonly understood illness categories and with respect to diarrheal illnesses, knowledge remains contested between mothers and professional nurses. Moreover, the availability of a wide range of therapeutic options m Khayelitsha diversifies the mother's causal explanations. It was found this diversity in causality and management of illnesses is manifested in the quality of children's stools, "green" feces in particular. Here too, different hues are not separable from the media in which they appear. Their interpretations draw on senses of value, ideas, social histories, different forms of power, systematic knowledge, and a great variety of other forms of significance that are embedded in the concrete domains of everyday life. In addition to the notion of isuntu,(that is humaneness) the study more importantly reveals that among Nguni of the Western Cape a tripartite relationship of umoya,(vital force) inyongo,(gallbladder) and ithongo (ancetral dream) is the dynamic philosophical component that describes Nguni experiences of health and illness. vi https://etd