JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104httpwwwethnobiomedcomcontent1014

RESEARCH Open Access

Bapedi traditional healers in the LimpopoProvince South Africa Their socio-cultural profileand traditional healing practiceSebua S Semenya and Martin J Potgieter

Abstract

Background Bapedi traditional healers play a vital role in the primary health care of rural inhabitants in theLimpopo Province South Africa However literature profiling their social and demographic variables as well as theirtraditional healing practices is lacking

Methods Convenience sampling were used to identify and select two traditional healers from 17 municipalities(resulting in 34 healers being used in this pilot survey) of the Limpopo Province in South Africa Information on thesocial and demographic variables and traditional healing practices of these healers was gathered from January2013 to July 2013 using a semi-structured questionnaire supplemented by field surveys for plant identification andcollection used in the preparation of remedies

Results Males constituted nearly two-thirds of the participants Forty eight percent of them became healersthrough the mentoring of another healer while 38 acquired their traditional healing knowledge from parents and14 from grandparents In contrast to this 62 of the females obtained theirs from their parents 30 from fellowtraditional healers and 8 from grandparents A total of 154 plant species were indicated as used by healers in thetreatment of 52 health-related problems A vast majority (89) of these practitioners reported that prepared herbalremedies do expire which is a temperature-dependent process Determinations of the efficacy of remedies by mosthealers (67) were via consultation with ancestors (90) This study also found that none of the interviewees hadany knowledge of provincial or national environmental legislation

Conclusions The current study has shown that Bapedi traditional healers could play a leading role in both thepreservation of indigenous knowledge and the primary health care sector However of concern is the traditionalmethods (via consulting ancestors) employed by most of these healers in determining efficacy of remedies thusindicating a need for a scientific investigations to establish their safety and effectiveness Equally there is a need toeducate traditional practitionersrsquo regarding the significance of various conservation legislations in their traditionalhealing By addressing these the national and provincial legislators medical fraternity as well as environmentalagencies will be able to better integrate them in primary health care systems and environmental management

Keywords Bapedi Limpopo Province Profile Plant use Traditional healers

Correspondence sebuasemenyagmailcomDepartment of Biodiversity University of Limpopo Private Bag X1106Sovenga 0727 South Africa

copy 2014 Semenya and Potgieter licensee BioMed Central Ltd This is an open access article distributed under the terms of theCreative Commons Attribution License (httpcreativecommonsorglicensesby20) which permits unrestricted usedistribution and reproduction in any medium provided the original work is properly cited

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 2 of 12httpwwwethnobiomedcomcontent1014

BackgroundDue to high levels of poverty traditional medicines areconsidered essential for the physical and mental welfareof especially rural black households in South Africa withmore than 60 of all healing taking place outside theformal western-styled medical system [1] Hoareau andDaSilva [2] stated that traditional medicine in severaldeveloping countries incorporating local traditions andbeliefs is still the mainstay of primary health care wheremodern health care facilities are either sparsely located ornon-existent [3] It is well-documented [45] that in therural areas of South Africa traditional healers operate inclose proximity [6] and association [7] with the commu-nity members to treat various diseases and ailmentsTraditional healers are established health care pro-

viders within their respective communities [8] IndeedVan Rensburg et al [9] expand on this definition bystating that a traditional healer as someone who is rec-ognized by the community in which heshe lives as com-petent to provide primary health care These authorsfurther stated that such a person utilise plants animalsand mineral substances together with methods based onthe social cultural and religious background as well asprevailing knowledge attitudes and beliefs for the physicalmental and social well-being of the community Traditionalhealers are generally divided into two categories Thosethat serve the role of diviner-diagnostician (or diviner-mediums) and those who are healers or herbalists [10]Diviners are experts at applying diagnostic criteria

[11] they not only define the illness but also its originand reason in terms of African belief systems [12] Ac-cording to Gumede [13] diviners identify the origin andreason and prescribe an appropriate plant- and animal-based treatment for the affliction through spiritualmeans [10] Chavunduka [14] reported that divinerscommunicate with spirits when in a state of possessionconveying the demands of ancestors and reasons fortheir dissatisfaction According to Karim et al [12] di-vinersrsquo speciality is divination within a supernaturalcontext through culturally-accepted medium-ship withancestral spirits They are the most important interme-diaries between humans and the supernatural Unlikeherbalist no one can become a diviner by personalchoice [12] As this is an ancestral call diviners regardthemselves as servants of the ancestors [9]Meissner [15] reported that herbalist practice the art of

healing Although this profession tends to run in familiesVan Rensburg [9] indicated that the desire to become aherbalist is an individualrsquos choice and therefore the profes-sion is freely accessible to anyone [12] The World HealthOrganisation [16] regards a herbalist as an ordinaryperson who have acquired extensive knowledge of medi-cinal plant use and who do not typically possess occultpowers They are usually male and are often selected and

mentored by an established practitioner [13] Herbalistsare expected to diagnose and prescribe medicines foreveryday ailments and illnesses prevent and alleviatemisfortune or evil provide protection against witchcraftand to bring prosperity and happiness [16]Traditional healing has always been a component of

health care in African countries and the contributionsof healers to primary health care sectors are well knownin some parts of the African continent For instance inthe Chiawa area of Zambia Ndubani and Hojer [5]interviewed 23 healers about their knowledge practicesand the use of indigenous plants in the diagnosis andtreatment of sexually transmitted infections These au-thors concluded that healers should be integrated in tothe sexually transmitted infections control scheme inZambia However they further noted that the govern-ment should provide them with the necessary health-related information and financial and material supportIn South Africa the roles and profiles of traditional

healers of some cultural groups has been documentedFor example Puckree et al [17] studied the socio-cultural profile of Zulu traditional healers (diviners andherbalists) in Durban KwaZulu-Natal Province Theyinvestigated the following issues the role if healersnumber of patients that consulted traditional healersthe types of conditions treated as well as the frequencyof consultations Their findings indicated that a consid-erable number of patients consulted a traditional healeras a first choice for both physical and mental ailmentsand diviners being the most popular type of healer(visited for these ailments) Bereda [18] reported on therole of VhaVenda traditional healing as a health care de-livery system in the Vhembe district Limpopo ProvinceThe results of this study indicated that a larger propor-tion of male diviners are mostly consulted for the treat-ment of a variety of ailments including asthma diabetesmellitus hypertension tuberculosis and sexually trans-mitted infections Bereda [18] mentioned that since asignificantly large number of patients consult traditionalhealers for a variety of ailments including potentiallylife-threatening conditions health care professionalsshould be proactive in integrating traditional healingwith westernized practices in order to promote healthcare for allAnother study in Vhembe district but conducted by

Mabogo [19] emphasized the role of VhaVenda trad-itional healers and their materia medica This studyfound that both herbalist and diviners are instrumentalin the treatment of various human diseases includingsexually transmitted infections and tuberculosis How-ever diagnosis of ailments was primarily based on thepresentation of symptoms and sometimes traditionalrituals Regarding their herbal remedies Mabogo [19]noted they prepare them from more than 50 plant

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 3 of 12httpwwwethnobiomedcomcontent1014

species According to this author documentation andunderstanding of traditional healing practicersquo knowledgeis very crucial as it might provide solutions to futurechallenges of diseases and contribute to the conserva-tion of useful wild plantsThe current study will therefore further contribute

towards documenting and describing the diverse spec-trum of individuals (only herbalists) but among theBapedi involved with the practice of traditional me-dicine in the Limpopo Province of South Africa It isenvisaged that this information will provide a clearerpicture of the socio-cultural profile and traditional heal-ing practice of Bapedi health care providers who play acrucial role in the primary health care of especially ruralareas

MethodsStudy area and study populationThe study was conducted in the three districts (CapricornSekhukhune and Waterberg) (Figure 1) covering 17 localmunicipalities (Table 1) of the Limpopo Province SouthAfrica The surveyed districts are the cultural home ofthe Bapedi who resides primarily in the central south-ern and western parts of the province where they con-stitute the dominant ethnic group [20] The Bapedipeople are of Basotho descent who migrated southfrom the Great Lakes more than 500 years ago [21] Thevegetation in these districts was classified by Acocks[22] as a semi-arid savanna characterized by a mixtureof trees shrubs herbs and grasses [23] This type ofvegetation has provided a diverse flora with rich medi-cinal plants that the traditional healers of the studyareas have used to treat many illnesses

Figure 1 Study area Capricorn Sekhukhune and Waterberg Districtsdesignates the involved municipalities

Socio-cultural and traditional healing practice surveysand data collectionThis study was conducted from January 2013 to July2013 Prior informed consent was obtained from all par-ticipants in line with the requirements of the Universityof Limpoporsquos ethical prescriptions Thirty four traditionalhealers (2 per local municipality) were identified and se-lected from the municipalities mentioned below (Table 1)by convenience sampling ie with the assistance of fel-low healers and villagers This sampling technique wasutilized due to the numerous advantages it provides Forinstance it is extremely fast easy readily available andcost effective However the results from a study con-ducted with such a sampling technique cannot be gener-alised to the population as a whole or cannot be anaccurate representation of the population [24]A semi-structured interview form was used to obtain

information from healers regarding social and demographicvariables as well as some information related to theirtraditional healing practices The questionnaire addressedthe following issues (i) demographic profile age gender andeducational level (ii) questions dealing with traditionalpractices history of becoming a healer work style diagnosisand treatment (iii) aliments treated and remedy used (iv)expiration of medicine and (v) legislative and conservation-related matters Traditional healers were interviewed (usingSepedi a local dialect) independently from each other inthe confines of their consultation rooms

Plant collection and identificationResearchers collected medicinal plant materials fromboth home gardens and natural communal areas duringorganized tours while being accompanied by a traditional

Limpopo Province South Africa A to Q (in Figure 1 and Table 1)

Table 1 Districts and local municipalities included in this study

Capricorn district Sekhukhune district Waterberg district

Aganang A Elias Motsoaledi (Greater Groblersdal) F Bela-Bela L

Blouberg B Fetakgomo G Lephalale M

Lepelle-Nkumpi C Groblersdal H Modimolle N

Molemole D Makhuduthamaga I Mogalakwena O

Polokwane E Ephram Mogale (Greater Marble Hall) J Mookgophong P

Tubatse K Thabazimbi Q

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 4 of 12httpwwwethnobiomedcomcontent1014

healer The collected specimens were initially identified bytheir local vernacular names while their taxonomic identi-fication was done using the Larry Leach Herbarium of theUniversity of Limpopo (UNIN) Collection numbers ofspecies are presented in Additional file 1 Table S1

Data analysis and reportingDescriptive statistics such as percentages and frequen-cies were used to analyse the data obtained from thequestionnaire The data was organised and analysedusing the statistical program SPSS version 140 and insome cases Microsoft Excel

ResultsGender age and years in practiceThe majority (62 n = 21) of participating healers weremales with females constituting the rest (38 n=13)Only 19 of the male participants were younger than41 while 52 were between 41 and 50 24 between 51and 60 and just 5 older than 60 The largest propor-tion (62) of females was between 51 and 60 with noneolder than 60 or younger than 30 Twenty three percentwas between 41 and 50 and 15 fell within the 30 to 40age categoryFifty two percent of male healers have been in practice

between 5ndash10 years 43 between 11ndash30 years and only

No formaleducation

Primarschooli

76

19

46

MaleFigure 2 Level of education a gender-based comparison

5 have more than 40 yearsrsquo experience Forty six per-cent of female participants have been in practice for 6 to10 years and 54 for between 11 and 30 years

Level of educationThe majority of males (76) but less than half of thefemales (46) in this study had no formal education Alarger proportion of females had primary school educa-tion (31 vs 19) and secondary school education (23vs 5) than their male counterparts (Figure 2)

Sources of traditional healing knowledgeVarious sources of traditional healing knowledge existamong the Bapedi such as fellow healers and familymembers Most males (48 of total) acquired their heal-ing knowledge from fellow traditional healers 38 fromtheir parents and 14 from grandparents In contrast tothis 62 of the females obtained theirs from their par-ents 30 from fellow traditional healers and 8 fromgrandparents

Ailments treated and used remedies (use plant partmethods of preparation and administration)Fifty two health-related problems or ailments were foundto be treated by Bapedi traditional healers in the poorrural areas of the Limpopo Province Such problems

yng

Secondaryschooling

531 23

Female

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 5 of 12httpwwwethnobiomedcomcontent1014

ailments included among others abortion appetiteasthma blood clotting blood purifier body pain breastcancer chlamydia circumcision wound contaminatedblood depression diabetes mellitus diarrhoea epilepsyerectile dysfunction eye infection female infertilitygoitre gonorrhoea HIVAIDS heart problem hyper-tension kidney problems leukemia low sperm countmalaria measles menstrual disorders mental illnessesnose bleeding period pains stomach complains strokeswelled legs tonsils tuberculosis and womb problemsFollowing symptomatic diagnosis the above mentioned

ailments were treated using plant-based remedies pre-pared from 154 species (Additional file 1 Table S1) Differ-ent plant parts including bark bulb fruit leaf pericarprhizome root seed stem thorn tuber twig and wholeplant were utilised in the preparation of remedies Therewas a distinct preference for leaf and root material as wellas for the bark and whole plant (Figure 3) For increasedefficacy traditional healers can combine different parts ofthe same plant during preparation of remedies Similarlysubstances such as cow milk salt Vaselinereg and soft por-ridge are mixed with remedies to enhance its effectivenessRemedies were prepared mostly via boiling (69)

However other methods such as pounding (16) burn-ing (5) macerating (4) steaming and raw prescrip-tion (2 each) crushing frying and squeezing (1 each)were also employed Prepared medicines were adminis-tered in a variety of ways For instance medicines wereadministeredprescribed orally (as a liquid via soft por-ridge as a raw prescription or as smoke) nasally (plantparts were steamed or burned and the resulting smokesteam inhaled topically prepared remedies were appliedby either a patient or healer on the affected body parts)anally (a healer administered remedies via a bulb syringe)The disappearance or the improvement of symptomsreported by patients was perceived as independentverification of the effectiveness of a treatment

Bark13

Bulb 5 Stem

2

Fruit 7

Leaf25

Pericarp 1

Rhizome 1

Root 17

Seed 6

Thorn 1

Tuber 9

Twig 1 Whole

plant 13

Figure 3 Plant parts used to prepare remedies

Expiration of medicineEighty percent of traditional healers reported that pre-pared remedies do expire which is a temperature-dependent process ie medicines expire quicker in hot-ter climates Seventy five percent of respondents indi-cated that liquid medicine stored in a hot environmentwill expire within one week or even less whereas thosekept in cooler places can last for up to two weeks fromtheir date of issue The remaining 25 claimed thatliquid medicine will expire within two to three daysCharacteristics of expired liquid medicine can includeany combination of the following a tendency to changecolour coagulate into a paste develop an odour orbecome extremely sourPounded medicine on the other hand has a far longer

shelf life and can remain effective for up to one year Thedetermining factor seems to be exposure to moistureWhen expired powdered remedies tend to either sticktogether or they wonrsquot mix with water even when shaken

Side effects and assessment of efficacy of medicineSixty percent of Bapedi healers claimed that their prepara-tions were free of side effects This was based on the factthat none of their patients reported side effects after treat-ment Forty percent of healers indicated some preparationsespecially for HIVAIDS-related symptoms (dysentery andloss of appetite) and gonorrhoea (sexual dysfunction) hasside effectsThe assessment of the effectiveness of the medicines is

mostly based on the consultation (through performanceof rituals) with ancestors (deceased family members)with 90 of Bapedi healers claiming that their ancestorsconfirmed the effectiveness of medication Ten percentof respondents noted that it is their treated patients(reported positive feedback) who validated the efficacyHowever 23 of the interviewees reported that patientswith ailments related to HIVAIDS returned for furthertreatment In these situations healers either replenishthe medication or refer the patient to a clinic or hospitalThey hardly if ever send a patient to a fellow traditionalhealer for further treatment

Plant collection ritualsAll healers perform rituals subsequent to harvestingplants 90 of them doing so as a means of expressinggratitude towards ancestors whilst the remaining 10because of cultural normsWhen questioned on the efficacy of their medicine

90 of the healers indicated that their ancestors con-firmed the effectiveness of their remediesBapedi healers believe in order to ensure efficacy of

their medicine plant parts must be collected by a personwho has not had sexual intercourse for at least two daysprior to collection Most healers (79) prefer to collect

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 6 of 12httpwwwethnobiomedcomcontent1014

their own medicinal plants as a safeguard against sexualimpurity In contrast to this preference a minority (21)dispatch trainees for collections however they are carefullyinstructed on the custom of harvesting medicinal material

Harvesting plantsThis study noted that it is customary not to re-fill thesoil after harvesting underground parts or entire plantsThe reasons forwarded were that re-filling the soil influ-ence the effectiveness of harvested plants parts worsena patientrsquos illness and affect the healing progress of apatient Bark was only collected from the side of the treefacing east due to a belief that bark harvested from thisside has the highest nutritional level of all sides

Legislative impactsIn terms of compliance to legislative requirements thisstudy found that none of the traditional healers had a per-mit to collect wild medicinal plants They viewed the per-mit system as an obstacle to their practice Furthermorenone of them has ever heard of the Limpopo Environmen-tal Management Act (LEMA) which governs amongstothers all aspects related to the collection transport andrelocation of plant species in the Limpopo ProvinceWhen made aware of this legislation healers respondedthat environmental statutes have no bearing on theirprofession as they view wild plants as common property

DiscussionGender age and years in practiceIn general traditional healing is a gender-based practicealthough in some communities both men and womenare equally involved in this profession [25] In this studymales constituted nearly two-thirds of the participantswhich is in line with a number of other studies in theLimpopo Province For example Bereda [18] also notedthe dominance of males in traditional healing in theVhembe district areas dominated by the VhaVendatribe Moeng and Potgieter [26] reported that malehealers dominated the trade in medicinal plants in theCapricorn Sekhukhune and Waterberg districts Thisphenomenon might even if only partially be attributedto the fact that these males are generally involved inproviding income for their families in rural areas Moengand Potgieter [26] further noted that the dominance ofmales could be due to that fact that the collection of medi-cinal plants may be physically risky for women as mostplants are found in mountainous areas In the WesternCape Province of South Africa Loundou [27] claimed thatmale dominance could be ascribed to the fact that someplants are located on private land making the collectionof medicinal plants is too risky for women In the ZegiePeninsula North-western Ethiopia traditional knowledgein the family or community is mainly passed from the

father to his first born son It is therefore not surprising tofind that males dominate the traditional healing profession[28] Evidence such as this would support the notion thatthe Bapedi traditional healing industry might in the nearfuture continue to be dominated by malesMost healers are between 41 and 60 years These re-

sults are very similar to that reported by Ndawonde [29]for Zulu traditional healers of KwaZulu-Natal SouthAfrica He found that the majority of participantrsquos agesranged from 45 to 54 Mintsa Mi Nzue [30] reportedthat the majority of male and female Xhosa healersresiding in the Western Cape Province of South Africawere between 41 and 50 According to Ndawonde [29]the dominance of this age category is most probably dueto the fact that they are considered to be responsibleand that most of them are in need of money to educatetheir children and support their basic livelihood needsIn light of the low life expectancy for South Africanmales (451) and females (507) [31] the future prospectsfor the protection of indigenous knowledge might be atrisk This necessitates the urgent and rapid recording ofindigenous knowledge related to this industryThe small number of Bapedi traditional healers between

30 and 40 years of age probably indicate a lack of interestfor this profession or perhaps symptomatic of a transitionalsociety that is losing its cultural identity as it westerniseIn accordance with Gessler et al [32] this study found

that both male and female healers started the traditionalhealing profession in their 20s or 30s However genderdisparities are evident Females due to social responsi-bilities enter the profession at an older age when com-pared to their male counterparts Furthermore it wasfound that females do not occupy the profession as longas males as they seem to retire at the age of 60 withsome males continuing to practice well beyond the ageof 60 Fifty seems to be the gender-divide as most of themales (71) were between 30 and 50 years old com-pared to 62 of the females being between 50 and 60According to Richter [33] the sum of all knowledge and

practices whether they are explicable or not employed inthe diagnosis prevention and elimination of physicalmental or societal imbalance and relying exclusively onpractical experience and observation are handed downeither verbally or in writing from generation to gener-ation With regard to males in this study an even spreadis apparent between young (lt10 yearsrsquo experience) and theolder and more established healers (gt10 years) It can beargued that this balance between experienced and lessexperience individuals can contribute to the long termstability of this profession among the Bapedi

Level of educationThis study found that a significant portion of the healersdid not receive formal education (grade 1 to 12) with

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 7 of 12httpwwwethnobiomedcomcontent1014

only a small portion attending school This is in agree-ment with Mabogo regarding the Venda region [19] andYineger and Yewhalaw in South-western Ethiopia [34]However the result of this study is not in agreementwith other ethnobotanical studies conducted throughoutSouth Africa For instance in KwaZulu-Natal Puranswai[35] found that all Zulu traditional healers had attendedschool while 20 even had a University degree or dip-loma Likewise Mintsa Mi Nzue [30] noted that half ofthe Xhosa traditional healers had attended secondaryschool 35 primary school and 3 a tertiary institutionLow level of education amongst Bapedi traditional healerscompared to the above mentioned South African culturesis an indicative of fewer younger and older Bapedi healersthus indicating a need to document their knowledge ofmateria medica before it get lostRichter [33] noted that nowadays educational skills are

vital to traditional healers to empower them with par-ticular competencies such as reading that might be im-portant for counselling and to understand the necessityto conserve and manage natural resources Thus initiat-ing programmes such as ABET (Adult Basic Educationand Training) is important to empower not only Bapeditraditional healers but all other traditional healers withbasic educational skills such as writing and readingBasic education is therefore vital for healers to broadentheir knowledge regarding conservation issues related toprotected and threatened species and medically-relatedissues such as diagnoses and treatment of ailmentsGreater levels of education and consequently awarenesscould contribute in the long term sustainability of thishighly important profession

Source of traditional healing knowledgeForty eight percent of male traditional medical practi-tioners became healers through the mentoring of anotherhealer This trend was also reported by Cheikhyoussefet al [36] for traditional healers of the Oshikoto regionof Namibia They found that most healers in this regionobtained their healing knowledge from their fellow trad-itional healers Normally indigenous knowledge of me-dicinal plant utilization is transferred from parents tochildren within a family [37] The circumstances persuad-ing established Bapedi traditional healers and the appren-tice to interact are currently unknown However thepossibility exists that some traditional healers might havebeen paid by their mentees for trainingThirty eight percent of male traditional healers have

acquired their traditional healing knowledge from parentsand 14 from grandparents Similarly in the Saperascommunity of Khetawas Jhajjar district Haryana of Indiamale traditional healers also obtained their knowledgefrom parents and grandparents [38] Among the Pedi aculture exists where males are expected to be independent

at an earlier stage Therefore both parents might havetrained them to become independent traditional healersand take advantage of the heavy reliance of rural commu-nities on traditional healing services to make a living fromsuch servicesThe source of medicinal plants knowledge is the main

contributor to the difference in knowledge and use be-tween male and female traditional healers [25] Most(62) female Bapedi healers were trained by both par-ents to become traditional healers Similar observationswere reported in Ethiopia [39] This is not surprising asin African cultures daughters are usually more closelyassociated with both parents than sons Through theseclose interactions Bapedi females might have becomeinterested and motivated by their parents to also practicethis profession Only a small percentage (30) of femalesin this study obtained their traditional healing know-ledge from fellow healers thus reflecting the strongbond between daughters and parents in Bapedi culture

Ailments treated and used remedies (used plant partsmethods of preparation and administration)A considerable number of health-related problems (52)treated by Bapedi traditional healers in the poor ruralareas of the Limpopo Province strengthen the fact thattraditional medicine and traditional health practitionersrepresent the first line of healthcare for the majority ofpeople in this province [40] Furthermore the diversityof ailments treated is an indication that medicinal plantshave a potential of satisfying the varied healthcare needsof poor villagers of the Limpopo Province Most of theailments treated by healers of the current study listed inAdditional file 1 Table S1 including chlamydia [41] dia-betes mellitus [42] diarrhoea [43] epilepsy [34] erectiledysfunction [44] eye infection [45] gonorrhoea [46]HIVAIDS [354748] hypertension [49] malaria [50]menstrual disorder [51] mental illness [52] and tuber-culosis [53] are common amongst the healers of otherethnic groups in South AfricaInterestingly a South African study [47] indicated that

some of the ailments treated by Bapedi healers includingsexually transmitted infections (chlamydia gonorrhoeaand HIVAIDS) chronic diseases of lifestyle (diabetes mel-litus and hypertension) as well as psychological ailments[18] are also commonly treated by traditional healers fromother cultures Thus their documentation in the presentstudy just goes further to buttress this Bereda [18] foundthat in the Limpopo Province professional nurses anddoctors either utilise the service of traditional healers orrefer their patients to them for the treatment of ailmentssuch as mental illness sexually transmitted infections in-fertilities and erectile dysfunction Continuing preferencesof traditional healerrsquos health services over contemporarydoctors are driven by a variety of factors including the

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 3 of 12httpwwwethnobiomedcomcontent1014

species According to this author documentation andunderstanding of traditional healing practicersquo knowledgeis very crucial as it might provide solutions to futurechallenges of diseases and contribute to the conserva-tion of useful wild plantsThe current study will therefore further contribute

towards documenting and describing the diverse spec-trum of individuals (only herbalists) but among theBapedi involved with the practice of traditional me-dicine in the Limpopo Province of South Africa It isenvisaged that this information will provide a clearerpicture of the socio-cultural profile and traditional heal-ing practice of Bapedi health care providers who play acrucial role in the primary health care of especially ruralareas

MethodsStudy area and study populationThe study was conducted in the three districts (CapricornSekhukhune and Waterberg) (Figure 1) covering 17 localmunicipalities (Table 1) of the Limpopo Province SouthAfrica The surveyed districts are the cultural home ofthe Bapedi who resides primarily in the central south-ern and western parts of the province where they con-stitute the dominant ethnic group [20] The Bapedipeople are of Basotho descent who migrated southfrom the Great Lakes more than 500 years ago [21] Thevegetation in these districts was classified by Acocks[22] as a semi-arid savanna characterized by a mixtureof trees shrubs herbs and grasses [23] This type ofvegetation has provided a diverse flora with rich medi-cinal plants that the traditional healers of the studyareas have used to treat many illnesses

Figure 1 Study area Capricorn Sekhukhune and Waterberg Districtsdesignates the involved municipalities

Socio-cultural and traditional healing practice surveysand data collectionThis study was conducted from January 2013 to July2013 Prior informed consent was obtained from all par-ticipants in line with the requirements of the Universityof Limpoporsquos ethical prescriptions Thirty four traditionalhealers (2 per local municipality) were identified and se-lected from the municipalities mentioned below (Table 1)by convenience sampling ie with the assistance of fel-low healers and villagers This sampling technique wasutilized due to the numerous advantages it provides Forinstance it is extremely fast easy readily available andcost effective However the results from a study con-ducted with such a sampling technique cannot be gener-alised to the population as a whole or cannot be anaccurate representation of the population [24]A semi-structured interview form was used to obtain

information from healers regarding social and demographicvariables as well as some information related to theirtraditional healing practices The questionnaire addressedthe following issues (i) demographic profile age gender andeducational level (ii) questions dealing with traditionalpractices history of becoming a healer work style diagnosisand treatment (iii) aliments treated and remedy used (iv)expiration of medicine and (v) legislative and conservation-related matters Traditional healers were interviewed (usingSepedi a local dialect) independently from each other inthe confines of their consultation rooms

Plant collection and identificationResearchers collected medicinal plant materials fromboth home gardens and natural communal areas duringorganized tours while being accompanied by a traditional

Limpopo Province South Africa A to Q (in Figure 1 and Table 1)

Table 1 Districts and local municipalities included in this study

Capricorn district Sekhukhune district Waterberg district

Aganang A Elias Motsoaledi (Greater Groblersdal) F Bela-Bela L

Blouberg B Fetakgomo G Lephalale M

Lepelle-Nkumpi C Groblersdal H Modimolle N

Molemole D Makhuduthamaga I Mogalakwena O

Polokwane E Ephram Mogale (Greater Marble Hall) J Mookgophong P

Tubatse K Thabazimbi Q

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 4 of 12httpwwwethnobiomedcomcontent1014

healer The collected specimens were initially identified bytheir local vernacular names while their taxonomic identi-fication was done using the Larry Leach Herbarium of theUniversity of Limpopo (UNIN) Collection numbers ofspecies are presented in Additional file 1 Table S1

Data analysis and reportingDescriptive statistics such as percentages and frequen-cies were used to analyse the data obtained from thequestionnaire The data was organised and analysedusing the statistical program SPSS version 140 and insome cases Microsoft Excel

ResultsGender age and years in practiceThe majority (62 n = 21) of participating healers weremales with females constituting the rest (38 n=13)Only 19 of the male participants were younger than41 while 52 were between 41 and 50 24 between 51and 60 and just 5 older than 60 The largest propor-tion (62) of females was between 51 and 60 with noneolder than 60 or younger than 30 Twenty three percentwas between 41 and 50 and 15 fell within the 30 to 40age categoryFifty two percent of male healers have been in practice

between 5ndash10 years 43 between 11ndash30 years and only

No formaleducation

Primarschooli

76

19

46

MaleFigure 2 Level of education a gender-based comparison

5 have more than 40 yearsrsquo experience Forty six per-cent of female participants have been in practice for 6 to10 years and 54 for between 11 and 30 years

Level of educationThe majority of males (76) but less than half of thefemales (46) in this study had no formal education Alarger proportion of females had primary school educa-tion (31 vs 19) and secondary school education (23vs 5) than their male counterparts (Figure 2)

Sources of traditional healing knowledgeVarious sources of traditional healing knowledge existamong the Bapedi such as fellow healers and familymembers Most males (48 of total) acquired their heal-ing knowledge from fellow traditional healers 38 fromtheir parents and 14 from grandparents In contrast tothis 62 of the females obtained theirs from their par-ents 30 from fellow traditional healers and 8 fromgrandparents

Ailments treated and used remedies (use plant partmethods of preparation and administration)Fifty two health-related problems or ailments were foundto be treated by Bapedi traditional healers in the poorrural areas of the Limpopo Province Such problems

yng

Secondaryschooling

531 23

Female

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 5 of 12httpwwwethnobiomedcomcontent1014

ailments included among others abortion appetiteasthma blood clotting blood purifier body pain breastcancer chlamydia circumcision wound contaminatedblood depression diabetes mellitus diarrhoea epilepsyerectile dysfunction eye infection female infertilitygoitre gonorrhoea HIVAIDS heart problem hyper-tension kidney problems leukemia low sperm countmalaria measles menstrual disorders mental illnessesnose bleeding period pains stomach complains strokeswelled legs tonsils tuberculosis and womb problemsFollowing symptomatic diagnosis the above mentioned

ailments were treated using plant-based remedies pre-pared from 154 species (Additional file 1 Table S1) Differ-ent plant parts including bark bulb fruit leaf pericarprhizome root seed stem thorn tuber twig and wholeplant were utilised in the preparation of remedies Therewas a distinct preference for leaf and root material as wellas for the bark and whole plant (Figure 3) For increasedefficacy traditional healers can combine different parts ofthe same plant during preparation of remedies Similarlysubstances such as cow milk salt Vaselinereg and soft por-ridge are mixed with remedies to enhance its effectivenessRemedies were prepared mostly via boiling (69)

However other methods such as pounding (16) burn-ing (5) macerating (4) steaming and raw prescrip-tion (2 each) crushing frying and squeezing (1 each)were also employed Prepared medicines were adminis-tered in a variety of ways For instance medicines wereadministeredprescribed orally (as a liquid via soft por-ridge as a raw prescription or as smoke) nasally (plantparts were steamed or burned and the resulting smokesteam inhaled topically prepared remedies were appliedby either a patient or healer on the affected body parts)anally (a healer administered remedies via a bulb syringe)The disappearance or the improvement of symptomsreported by patients was perceived as independentverification of the effectiveness of a treatment

Bark13

Bulb 5 Stem

2

Fruit 7

Leaf25

Pericarp 1

Rhizome 1

Root 17

Seed 6

Thorn 1

Tuber 9

Twig 1 Whole

plant 13

Figure 3 Plant parts used to prepare remedies

Expiration of medicineEighty percent of traditional healers reported that pre-pared remedies do expire which is a temperature-dependent process ie medicines expire quicker in hot-ter climates Seventy five percent of respondents indi-cated that liquid medicine stored in a hot environmentwill expire within one week or even less whereas thosekept in cooler places can last for up to two weeks fromtheir date of issue The remaining 25 claimed thatliquid medicine will expire within two to three daysCharacteristics of expired liquid medicine can includeany combination of the following a tendency to changecolour coagulate into a paste develop an odour orbecome extremely sourPounded medicine on the other hand has a far longer

shelf life and can remain effective for up to one year Thedetermining factor seems to be exposure to moistureWhen expired powdered remedies tend to either sticktogether or they wonrsquot mix with water even when shaken

Side effects and assessment of efficacy of medicineSixty percent of Bapedi healers claimed that their prepara-tions were free of side effects This was based on the factthat none of their patients reported side effects after treat-ment Forty percent of healers indicated some preparationsespecially for HIVAIDS-related symptoms (dysentery andloss of appetite) and gonorrhoea (sexual dysfunction) hasside effectsThe assessment of the effectiveness of the medicines is

mostly based on the consultation (through performanceof rituals) with ancestors (deceased family members)with 90 of Bapedi healers claiming that their ancestorsconfirmed the effectiveness of medication Ten percentof respondents noted that it is their treated patients(reported positive feedback) who validated the efficacyHowever 23 of the interviewees reported that patientswith ailments related to HIVAIDS returned for furthertreatment In these situations healers either replenishthe medication or refer the patient to a clinic or hospitalThey hardly if ever send a patient to a fellow traditionalhealer for further treatment

Plant collection ritualsAll healers perform rituals subsequent to harvestingplants 90 of them doing so as a means of expressinggratitude towards ancestors whilst the remaining 10because of cultural normsWhen questioned on the efficacy of their medicine

90 of the healers indicated that their ancestors con-firmed the effectiveness of their remediesBapedi healers believe in order to ensure efficacy of

their medicine plant parts must be collected by a personwho has not had sexual intercourse for at least two daysprior to collection Most healers (79) prefer to collect

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 6 of 12httpwwwethnobiomedcomcontent1014

their own medicinal plants as a safeguard against sexualimpurity In contrast to this preference a minority (21)dispatch trainees for collections however they are carefullyinstructed on the custom of harvesting medicinal material

Harvesting plantsThis study noted that it is customary not to re-fill thesoil after harvesting underground parts or entire plantsThe reasons forwarded were that re-filling the soil influ-ence the effectiveness of harvested plants parts worsena patientrsquos illness and affect the healing progress of apatient Bark was only collected from the side of the treefacing east due to a belief that bark harvested from thisside has the highest nutritional level of all sides

Legislative impactsIn terms of compliance to legislative requirements thisstudy found that none of the traditional healers had a per-mit to collect wild medicinal plants They viewed the per-mit system as an obstacle to their practice Furthermorenone of them has ever heard of the Limpopo Environmen-tal Management Act (LEMA) which governs amongstothers all aspects related to the collection transport andrelocation of plant species in the Limpopo ProvinceWhen made aware of this legislation healers respondedthat environmental statutes have no bearing on theirprofession as they view wild plants as common property

DiscussionGender age and years in practiceIn general traditional healing is a gender-based practicealthough in some communities both men and womenare equally involved in this profession [25] In this studymales constituted nearly two-thirds of the participantswhich is in line with a number of other studies in theLimpopo Province For example Bereda [18] also notedthe dominance of males in traditional healing in theVhembe district areas dominated by the VhaVendatribe Moeng and Potgieter [26] reported that malehealers dominated the trade in medicinal plants in theCapricorn Sekhukhune and Waterberg districts Thisphenomenon might even if only partially be attributedto the fact that these males are generally involved inproviding income for their families in rural areas Moengand Potgieter [26] further noted that the dominance ofmales could be due to that fact that the collection of medi-cinal plants may be physically risky for women as mostplants are found in mountainous areas In the WesternCape Province of South Africa Loundou [27] claimed thatmale dominance could be ascribed to the fact that someplants are located on private land making the collectionof medicinal plants is too risky for women In the ZegiePeninsula North-western Ethiopia traditional knowledgein the family or community is mainly passed from the

father to his first born son It is therefore not surprising tofind that males dominate the traditional healing profession[28] Evidence such as this would support the notion thatthe Bapedi traditional healing industry might in the nearfuture continue to be dominated by malesMost healers are between 41 and 60 years These re-

sults are very similar to that reported by Ndawonde [29]for Zulu traditional healers of KwaZulu-Natal SouthAfrica He found that the majority of participantrsquos agesranged from 45 to 54 Mintsa Mi Nzue [30] reportedthat the majority of male and female Xhosa healersresiding in the Western Cape Province of South Africawere between 41 and 50 According to Ndawonde [29]the dominance of this age category is most probably dueto the fact that they are considered to be responsibleand that most of them are in need of money to educatetheir children and support their basic livelihood needsIn light of the low life expectancy for South Africanmales (451) and females (507) [31] the future prospectsfor the protection of indigenous knowledge might be atrisk This necessitates the urgent and rapid recording ofindigenous knowledge related to this industryThe small number of Bapedi traditional healers between

30 and 40 years of age probably indicate a lack of interestfor this profession or perhaps symptomatic of a transitionalsociety that is losing its cultural identity as it westerniseIn accordance with Gessler et al [32] this study found

that both male and female healers started the traditionalhealing profession in their 20s or 30s However genderdisparities are evident Females due to social responsi-bilities enter the profession at an older age when com-pared to their male counterparts Furthermore it wasfound that females do not occupy the profession as longas males as they seem to retire at the age of 60 withsome males continuing to practice well beyond the ageof 60 Fifty seems to be the gender-divide as most of themales (71) were between 30 and 50 years old com-pared to 62 of the females being between 50 and 60According to Richter [33] the sum of all knowledge and

practices whether they are explicable or not employed inthe diagnosis prevention and elimination of physicalmental or societal imbalance and relying exclusively onpractical experience and observation are handed downeither verbally or in writing from generation to gener-ation With regard to males in this study an even spreadis apparent between young (lt10 yearsrsquo experience) and theolder and more established healers (gt10 years) It can beargued that this balance between experienced and lessexperience individuals can contribute to the long termstability of this profession among the Bapedi

Level of educationThis study found that a significant portion of the healersdid not receive formal education (grade 1 to 12) with

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 7 of 12httpwwwethnobiomedcomcontent1014

only a small portion attending school This is in agree-ment with Mabogo regarding the Venda region [19] andYineger and Yewhalaw in South-western Ethiopia [34]However the result of this study is not in agreementwith other ethnobotanical studies conducted throughoutSouth Africa For instance in KwaZulu-Natal Puranswai[35] found that all Zulu traditional healers had attendedschool while 20 even had a University degree or dip-loma Likewise Mintsa Mi Nzue [30] noted that half ofthe Xhosa traditional healers had attended secondaryschool 35 primary school and 3 a tertiary institutionLow level of education amongst Bapedi traditional healerscompared to the above mentioned South African culturesis an indicative of fewer younger and older Bapedi healersthus indicating a need to document their knowledge ofmateria medica before it get lostRichter [33] noted that nowadays educational skills are

vital to traditional healers to empower them with par-ticular competencies such as reading that might be im-portant for counselling and to understand the necessityto conserve and manage natural resources Thus initiat-ing programmes such as ABET (Adult Basic Educationand Training) is important to empower not only Bapeditraditional healers but all other traditional healers withbasic educational skills such as writing and readingBasic education is therefore vital for healers to broadentheir knowledge regarding conservation issues related toprotected and threatened species and medically-relatedissues such as diagnoses and treatment of ailmentsGreater levels of education and consequently awarenesscould contribute in the long term sustainability of thishighly important profession

Source of traditional healing knowledgeForty eight percent of male traditional medical practi-tioners became healers through the mentoring of anotherhealer This trend was also reported by Cheikhyoussefet al [36] for traditional healers of the Oshikoto regionof Namibia They found that most healers in this regionobtained their healing knowledge from their fellow trad-itional healers Normally indigenous knowledge of me-dicinal plant utilization is transferred from parents tochildren within a family [37] The circumstances persuad-ing established Bapedi traditional healers and the appren-tice to interact are currently unknown However thepossibility exists that some traditional healers might havebeen paid by their mentees for trainingThirty eight percent of male traditional healers have

acquired their traditional healing knowledge from parentsand 14 from grandparents Similarly in the Saperascommunity of Khetawas Jhajjar district Haryana of Indiamale traditional healers also obtained their knowledgefrom parents and grandparents [38] Among the Pedi aculture exists where males are expected to be independent

at an earlier stage Therefore both parents might havetrained them to become independent traditional healersand take advantage of the heavy reliance of rural commu-nities on traditional healing services to make a living fromsuch servicesThe source of medicinal plants knowledge is the main

contributor to the difference in knowledge and use be-tween male and female traditional healers [25] Most(62) female Bapedi healers were trained by both par-ents to become traditional healers Similar observationswere reported in Ethiopia [39] This is not surprising asin African cultures daughters are usually more closelyassociated with both parents than sons Through theseclose interactions Bapedi females might have becomeinterested and motivated by their parents to also practicethis profession Only a small percentage (30) of femalesin this study obtained their traditional healing know-ledge from fellow healers thus reflecting the strongbond between daughters and parents in Bapedi culture

Ailments treated and used remedies (used plant partsmethods of preparation and administration)A considerable number of health-related problems (52)treated by Bapedi traditional healers in the poor ruralareas of the Limpopo Province strengthen the fact thattraditional medicine and traditional health practitionersrepresent the first line of healthcare for the majority ofpeople in this province [40] Furthermore the diversityof ailments treated is an indication that medicinal plantshave a potential of satisfying the varied healthcare needsof poor villagers of the Limpopo Province Most of theailments treated by healers of the current study listed inAdditional file 1 Table S1 including chlamydia [41] dia-betes mellitus [42] diarrhoea [43] epilepsy [34] erectiledysfunction [44] eye infection [45] gonorrhoea [46]HIVAIDS [354748] hypertension [49] malaria [50]menstrual disorder [51] mental illness [52] and tuber-culosis [53] are common amongst the healers of otherethnic groups in South AfricaInterestingly a South African study [47] indicated that

some of the ailments treated by Bapedi healers includingsexually transmitted infections (chlamydia gonorrhoeaand HIVAIDS) chronic diseases of lifestyle (diabetes mel-litus and hypertension) as well as psychological ailments[18] are also commonly treated by traditional healers fromother cultures Thus their documentation in the presentstudy just goes further to buttress this Bereda [18] foundthat in the Limpopo Province professional nurses anddoctors either utilise the service of traditional healers orrefer their patients to them for the treatment of ailmentssuch as mental illness sexually transmitted infections in-fertilities and erectile dysfunction Continuing preferencesof traditional healerrsquos health services over contemporarydoctors are driven by a variety of factors including the

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Table 1 Districts and local municipalities included in this study

Capricorn district Sekhukhune district Waterberg district

Aganang A Elias Motsoaledi (Greater Groblersdal) F Bela-Bela L

Blouberg B Fetakgomo G Lephalale M

Lepelle-Nkumpi C Groblersdal H Modimolle N

Molemole D Makhuduthamaga I Mogalakwena O

Polokwane E Ephram Mogale (Greater Marble Hall) J Mookgophong P

Tubatse K Thabazimbi Q

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 4 of 12httpwwwethnobiomedcomcontent1014

healer The collected specimens were initially identified bytheir local vernacular names while their taxonomic identi-fication was done using the Larry Leach Herbarium of theUniversity of Limpopo (UNIN) Collection numbers ofspecies are presented in Additional file 1 Table S1

Data analysis and reportingDescriptive statistics such as percentages and frequen-cies were used to analyse the data obtained from thequestionnaire The data was organised and analysedusing the statistical program SPSS version 140 and insome cases Microsoft Excel

ResultsGender age and years in practiceThe majority (62 n = 21) of participating healers weremales with females constituting the rest (38 n=13)Only 19 of the male participants were younger than41 while 52 were between 41 and 50 24 between 51and 60 and just 5 older than 60 The largest propor-tion (62) of females was between 51 and 60 with noneolder than 60 or younger than 30 Twenty three percentwas between 41 and 50 and 15 fell within the 30 to 40age categoryFifty two percent of male healers have been in practice

between 5ndash10 years 43 between 11ndash30 years and only

No formaleducation

Primarschooli

76

19

46

MaleFigure 2 Level of education a gender-based comparison

5 have more than 40 yearsrsquo experience Forty six per-cent of female participants have been in practice for 6 to10 years and 54 for between 11 and 30 years

Level of educationThe majority of males (76) but less than half of thefemales (46) in this study had no formal education Alarger proportion of females had primary school educa-tion (31 vs 19) and secondary school education (23vs 5) than their male counterparts (Figure 2)

Sources of traditional healing knowledgeVarious sources of traditional healing knowledge existamong the Bapedi such as fellow healers and familymembers Most males (48 of total) acquired their heal-ing knowledge from fellow traditional healers 38 fromtheir parents and 14 from grandparents In contrast tothis 62 of the females obtained theirs from their par-ents 30 from fellow traditional healers and 8 fromgrandparents

Ailments treated and used remedies (use plant partmethods of preparation and administration)Fifty two health-related problems or ailments were foundto be treated by Bapedi traditional healers in the poorrural areas of the Limpopo Province Such problems

yng

Secondaryschooling

531 23

Female

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 5 of 12httpwwwethnobiomedcomcontent1014

ailments included among others abortion appetiteasthma blood clotting blood purifier body pain breastcancer chlamydia circumcision wound contaminatedblood depression diabetes mellitus diarrhoea epilepsyerectile dysfunction eye infection female infertilitygoitre gonorrhoea HIVAIDS heart problem hyper-tension kidney problems leukemia low sperm countmalaria measles menstrual disorders mental illnessesnose bleeding period pains stomach complains strokeswelled legs tonsils tuberculosis and womb problemsFollowing symptomatic diagnosis the above mentioned

ailments were treated using plant-based remedies pre-pared from 154 species (Additional file 1 Table S1) Differ-ent plant parts including bark bulb fruit leaf pericarprhizome root seed stem thorn tuber twig and wholeplant were utilised in the preparation of remedies Therewas a distinct preference for leaf and root material as wellas for the bark and whole plant (Figure 3) For increasedefficacy traditional healers can combine different parts ofthe same plant during preparation of remedies Similarlysubstances such as cow milk salt Vaselinereg and soft por-ridge are mixed with remedies to enhance its effectivenessRemedies were prepared mostly via boiling (69)

However other methods such as pounding (16) burn-ing (5) macerating (4) steaming and raw prescrip-tion (2 each) crushing frying and squeezing (1 each)were also employed Prepared medicines were adminis-tered in a variety of ways For instance medicines wereadministeredprescribed orally (as a liquid via soft por-ridge as a raw prescription or as smoke) nasally (plantparts were steamed or burned and the resulting smokesteam inhaled topically prepared remedies were appliedby either a patient or healer on the affected body parts)anally (a healer administered remedies via a bulb syringe)The disappearance or the improvement of symptomsreported by patients was perceived as independentverification of the effectiveness of a treatment

Bark13

Bulb 5 Stem

2

Fruit 7

Leaf25

Pericarp 1

Rhizome 1

Root 17

Seed 6

Thorn 1

Tuber 9

Twig 1 Whole

plant 13

Figure 3 Plant parts used to prepare remedies

Expiration of medicineEighty percent of traditional healers reported that pre-pared remedies do expire which is a temperature-dependent process ie medicines expire quicker in hot-ter climates Seventy five percent of respondents indi-cated that liquid medicine stored in a hot environmentwill expire within one week or even less whereas thosekept in cooler places can last for up to two weeks fromtheir date of issue The remaining 25 claimed thatliquid medicine will expire within two to three daysCharacteristics of expired liquid medicine can includeany combination of the following a tendency to changecolour coagulate into a paste develop an odour orbecome extremely sourPounded medicine on the other hand has a far longer

shelf life and can remain effective for up to one year Thedetermining factor seems to be exposure to moistureWhen expired powdered remedies tend to either sticktogether or they wonrsquot mix with water even when shaken

Side effects and assessment of efficacy of medicineSixty percent of Bapedi healers claimed that their prepara-tions were free of side effects This was based on the factthat none of their patients reported side effects after treat-ment Forty percent of healers indicated some preparationsespecially for HIVAIDS-related symptoms (dysentery andloss of appetite) and gonorrhoea (sexual dysfunction) hasside effectsThe assessment of the effectiveness of the medicines is

mostly based on the consultation (through performanceof rituals) with ancestors (deceased family members)with 90 of Bapedi healers claiming that their ancestorsconfirmed the effectiveness of medication Ten percentof respondents noted that it is their treated patients(reported positive feedback) who validated the efficacyHowever 23 of the interviewees reported that patientswith ailments related to HIVAIDS returned for furthertreatment In these situations healers either replenishthe medication or refer the patient to a clinic or hospitalThey hardly if ever send a patient to a fellow traditionalhealer for further treatment

Plant collection ritualsAll healers perform rituals subsequent to harvestingplants 90 of them doing so as a means of expressinggratitude towards ancestors whilst the remaining 10because of cultural normsWhen questioned on the efficacy of their medicine

90 of the healers indicated that their ancestors con-firmed the effectiveness of their remediesBapedi healers believe in order to ensure efficacy of

their medicine plant parts must be collected by a personwho has not had sexual intercourse for at least two daysprior to collection Most healers (79) prefer to collect

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 6 of 12httpwwwethnobiomedcomcontent1014

their own medicinal plants as a safeguard against sexualimpurity In contrast to this preference a minority (21)dispatch trainees for collections however they are carefullyinstructed on the custom of harvesting medicinal material

Harvesting plantsThis study noted that it is customary not to re-fill thesoil after harvesting underground parts or entire plantsThe reasons forwarded were that re-filling the soil influ-ence the effectiveness of harvested plants parts worsena patientrsquos illness and affect the healing progress of apatient Bark was only collected from the side of the treefacing east due to a belief that bark harvested from thisside has the highest nutritional level of all sides

Legislative impactsIn terms of compliance to legislative requirements thisstudy found that none of the traditional healers had a per-mit to collect wild medicinal plants They viewed the per-mit system as an obstacle to their practice Furthermorenone of them has ever heard of the Limpopo Environmen-tal Management Act (LEMA) which governs amongstothers all aspects related to the collection transport andrelocation of plant species in the Limpopo ProvinceWhen made aware of this legislation healers respondedthat environmental statutes have no bearing on theirprofession as they view wild plants as common property

DiscussionGender age and years in practiceIn general traditional healing is a gender-based practicealthough in some communities both men and womenare equally involved in this profession [25] In this studymales constituted nearly two-thirds of the participantswhich is in line with a number of other studies in theLimpopo Province For example Bereda [18] also notedthe dominance of males in traditional healing in theVhembe district areas dominated by the VhaVendatribe Moeng and Potgieter [26] reported that malehealers dominated the trade in medicinal plants in theCapricorn Sekhukhune and Waterberg districts Thisphenomenon might even if only partially be attributedto the fact that these males are generally involved inproviding income for their families in rural areas Moengand Potgieter [26] further noted that the dominance ofmales could be due to that fact that the collection of medi-cinal plants may be physically risky for women as mostplants are found in mountainous areas In the WesternCape Province of South Africa Loundou [27] claimed thatmale dominance could be ascribed to the fact that someplants are located on private land making the collectionof medicinal plants is too risky for women In the ZegiePeninsula North-western Ethiopia traditional knowledgein the family or community is mainly passed from the

father to his first born son It is therefore not surprising tofind that males dominate the traditional healing profession[28] Evidence such as this would support the notion thatthe Bapedi traditional healing industry might in the nearfuture continue to be dominated by malesMost healers are between 41 and 60 years These re-

sults are very similar to that reported by Ndawonde [29]for Zulu traditional healers of KwaZulu-Natal SouthAfrica He found that the majority of participantrsquos agesranged from 45 to 54 Mintsa Mi Nzue [30] reportedthat the majority of male and female Xhosa healersresiding in the Western Cape Province of South Africawere between 41 and 50 According to Ndawonde [29]the dominance of this age category is most probably dueto the fact that they are considered to be responsibleand that most of them are in need of money to educatetheir children and support their basic livelihood needsIn light of the low life expectancy for South Africanmales (451) and females (507) [31] the future prospectsfor the protection of indigenous knowledge might be atrisk This necessitates the urgent and rapid recording ofindigenous knowledge related to this industryThe small number of Bapedi traditional healers between

30 and 40 years of age probably indicate a lack of interestfor this profession or perhaps symptomatic of a transitionalsociety that is losing its cultural identity as it westerniseIn accordance with Gessler et al [32] this study found

that both male and female healers started the traditionalhealing profession in their 20s or 30s However genderdisparities are evident Females due to social responsi-bilities enter the profession at an older age when com-pared to their male counterparts Furthermore it wasfound that females do not occupy the profession as longas males as they seem to retire at the age of 60 withsome males continuing to practice well beyond the ageof 60 Fifty seems to be the gender-divide as most of themales (71) were between 30 and 50 years old com-pared to 62 of the females being between 50 and 60According to Richter [33] the sum of all knowledge and

practices whether they are explicable or not employed inthe diagnosis prevention and elimination of physicalmental or societal imbalance and relying exclusively onpractical experience and observation are handed downeither verbally or in writing from generation to gener-ation With regard to males in this study an even spreadis apparent between young (lt10 yearsrsquo experience) and theolder and more established healers (gt10 years) It can beargued that this balance between experienced and lessexperience individuals can contribute to the long termstability of this profession among the Bapedi

Level of educationThis study found that a significant portion of the healersdid not receive formal education (grade 1 to 12) with

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 7 of 12httpwwwethnobiomedcomcontent1014

only a small portion attending school This is in agree-ment with Mabogo regarding the Venda region [19] andYineger and Yewhalaw in South-western Ethiopia [34]However the result of this study is not in agreementwith other ethnobotanical studies conducted throughoutSouth Africa For instance in KwaZulu-Natal Puranswai[35] found that all Zulu traditional healers had attendedschool while 20 even had a University degree or dip-loma Likewise Mintsa Mi Nzue [30] noted that half ofthe Xhosa traditional healers had attended secondaryschool 35 primary school and 3 a tertiary institutionLow level of education amongst Bapedi traditional healerscompared to the above mentioned South African culturesis an indicative of fewer younger and older Bapedi healersthus indicating a need to document their knowledge ofmateria medica before it get lostRichter [33] noted that nowadays educational skills are

vital to traditional healers to empower them with par-ticular competencies such as reading that might be im-portant for counselling and to understand the necessityto conserve and manage natural resources Thus initiat-ing programmes such as ABET (Adult Basic Educationand Training) is important to empower not only Bapeditraditional healers but all other traditional healers withbasic educational skills such as writing and readingBasic education is therefore vital for healers to broadentheir knowledge regarding conservation issues related toprotected and threatened species and medically-relatedissues such as diagnoses and treatment of ailmentsGreater levels of education and consequently awarenesscould contribute in the long term sustainability of thishighly important profession

Source of traditional healing knowledgeForty eight percent of male traditional medical practi-tioners became healers through the mentoring of anotherhealer This trend was also reported by Cheikhyoussefet al [36] for traditional healers of the Oshikoto regionof Namibia They found that most healers in this regionobtained their healing knowledge from their fellow trad-itional healers Normally indigenous knowledge of me-dicinal plant utilization is transferred from parents tochildren within a family [37] The circumstances persuad-ing established Bapedi traditional healers and the appren-tice to interact are currently unknown However thepossibility exists that some traditional healers might havebeen paid by their mentees for trainingThirty eight percent of male traditional healers have

acquired their traditional healing knowledge from parentsand 14 from grandparents Similarly in the Saperascommunity of Khetawas Jhajjar district Haryana of Indiamale traditional healers also obtained their knowledgefrom parents and grandparents [38] Among the Pedi aculture exists where males are expected to be independent

at an earlier stage Therefore both parents might havetrained them to become independent traditional healersand take advantage of the heavy reliance of rural commu-nities on traditional healing services to make a living fromsuch servicesThe source of medicinal plants knowledge is the main

contributor to the difference in knowledge and use be-tween male and female traditional healers [25] Most(62) female Bapedi healers were trained by both par-ents to become traditional healers Similar observationswere reported in Ethiopia [39] This is not surprising asin African cultures daughters are usually more closelyassociated with both parents than sons Through theseclose interactions Bapedi females might have becomeinterested and motivated by their parents to also practicethis profession Only a small percentage (30) of femalesin this study obtained their traditional healing know-ledge from fellow healers thus reflecting the strongbond between daughters and parents in Bapedi culture

Ailments treated and used remedies (used plant partsmethods of preparation and administration)A considerable number of health-related problems (52)treated by Bapedi traditional healers in the poor ruralareas of the Limpopo Province strengthen the fact thattraditional medicine and traditional health practitionersrepresent the first line of healthcare for the majority ofpeople in this province [40] Furthermore the diversityof ailments treated is an indication that medicinal plantshave a potential of satisfying the varied healthcare needsof poor villagers of the Limpopo Province Most of theailments treated by healers of the current study listed inAdditional file 1 Table S1 including chlamydia [41] dia-betes mellitus [42] diarrhoea [43] epilepsy [34] erectiledysfunction [44] eye infection [45] gonorrhoea [46]HIVAIDS [354748] hypertension [49] malaria [50]menstrual disorder [51] mental illness [52] and tuber-culosis [53] are common amongst the healers of otherethnic groups in South AfricaInterestingly a South African study [47] indicated that

some of the ailments treated by Bapedi healers includingsexually transmitted infections (chlamydia gonorrhoeaand HIVAIDS) chronic diseases of lifestyle (diabetes mel-litus and hypertension) as well as psychological ailments[18] are also commonly treated by traditional healers fromother cultures Thus their documentation in the presentstudy just goes further to buttress this Bereda [18] foundthat in the Limpopo Province professional nurses anddoctors either utilise the service of traditional healers orrefer their patients to them for the treatment of ailmentssuch as mental illness sexually transmitted infections in-fertilities and erectile dysfunction Continuing preferencesof traditional healerrsquos health services over contemporarydoctors are driven by a variety of factors including the

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 5 of 12httpwwwethnobiomedcomcontent1014

ailments included among others abortion appetiteasthma blood clotting blood purifier body pain breastcancer chlamydia circumcision wound contaminatedblood depression diabetes mellitus diarrhoea epilepsyerectile dysfunction eye infection female infertilitygoitre gonorrhoea HIVAIDS heart problem hyper-tension kidney problems leukemia low sperm countmalaria measles menstrual disorders mental illnessesnose bleeding period pains stomach complains strokeswelled legs tonsils tuberculosis and womb problemsFollowing symptomatic diagnosis the above mentioned

ailments were treated using plant-based remedies pre-pared from 154 species (Additional file 1 Table S1) Differ-ent plant parts including bark bulb fruit leaf pericarprhizome root seed stem thorn tuber twig and wholeplant were utilised in the preparation of remedies Therewas a distinct preference for leaf and root material as wellas for the bark and whole plant (Figure 3) For increasedefficacy traditional healers can combine different parts ofthe same plant during preparation of remedies Similarlysubstances such as cow milk salt Vaselinereg and soft por-ridge are mixed with remedies to enhance its effectivenessRemedies were prepared mostly via boiling (69)

However other methods such as pounding (16) burn-ing (5) macerating (4) steaming and raw prescrip-tion (2 each) crushing frying and squeezing (1 each)were also employed Prepared medicines were adminis-tered in a variety of ways For instance medicines wereadministeredprescribed orally (as a liquid via soft por-ridge as a raw prescription or as smoke) nasally (plantparts were steamed or burned and the resulting smokesteam inhaled topically prepared remedies were appliedby either a patient or healer on the affected body parts)anally (a healer administered remedies via a bulb syringe)The disappearance or the improvement of symptomsreported by patients was perceived as independentverification of the effectiveness of a treatment

Bark13

Bulb 5 Stem

2

Fruit 7

Leaf25

Pericarp 1

Rhizome 1

Root 17

Seed 6

Thorn 1

Tuber 9

Twig 1 Whole

plant 13

Figure 3 Plant parts used to prepare remedies

Expiration of medicineEighty percent of traditional healers reported that pre-pared remedies do expire which is a temperature-dependent process ie medicines expire quicker in hot-ter climates Seventy five percent of respondents indi-cated that liquid medicine stored in a hot environmentwill expire within one week or even less whereas thosekept in cooler places can last for up to two weeks fromtheir date of issue The remaining 25 claimed thatliquid medicine will expire within two to three daysCharacteristics of expired liquid medicine can includeany combination of the following a tendency to changecolour coagulate into a paste develop an odour orbecome extremely sourPounded medicine on the other hand has a far longer

shelf life and can remain effective for up to one year Thedetermining factor seems to be exposure to moistureWhen expired powdered remedies tend to either sticktogether or they wonrsquot mix with water even when shaken

Side effects and assessment of efficacy of medicineSixty percent of Bapedi healers claimed that their prepara-tions were free of side effects This was based on the factthat none of their patients reported side effects after treat-ment Forty percent of healers indicated some preparationsespecially for HIVAIDS-related symptoms (dysentery andloss of appetite) and gonorrhoea (sexual dysfunction) hasside effectsThe assessment of the effectiveness of the medicines is

mostly based on the consultation (through performanceof rituals) with ancestors (deceased family members)with 90 of Bapedi healers claiming that their ancestorsconfirmed the effectiveness of medication Ten percentof respondents noted that it is their treated patients(reported positive feedback) who validated the efficacyHowever 23 of the interviewees reported that patientswith ailments related to HIVAIDS returned for furthertreatment In these situations healers either replenishthe medication or refer the patient to a clinic or hospitalThey hardly if ever send a patient to a fellow traditionalhealer for further treatment

Plant collection ritualsAll healers perform rituals subsequent to harvestingplants 90 of them doing so as a means of expressinggratitude towards ancestors whilst the remaining 10because of cultural normsWhen questioned on the efficacy of their medicine

90 of the healers indicated that their ancestors con-firmed the effectiveness of their remediesBapedi healers believe in order to ensure efficacy of

their medicine plant parts must be collected by a personwho has not had sexual intercourse for at least two daysprior to collection Most healers (79) prefer to collect

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 6 of 12httpwwwethnobiomedcomcontent1014

their own medicinal plants as a safeguard against sexualimpurity In contrast to this preference a minority (21)dispatch trainees for collections however they are carefullyinstructed on the custom of harvesting medicinal material

Harvesting plantsThis study noted that it is customary not to re-fill thesoil after harvesting underground parts or entire plantsThe reasons forwarded were that re-filling the soil influ-ence the effectiveness of harvested plants parts worsena patientrsquos illness and affect the healing progress of apatient Bark was only collected from the side of the treefacing east due to a belief that bark harvested from thisside has the highest nutritional level of all sides

Legislative impactsIn terms of compliance to legislative requirements thisstudy found that none of the traditional healers had a per-mit to collect wild medicinal plants They viewed the per-mit system as an obstacle to their practice Furthermorenone of them has ever heard of the Limpopo Environmen-tal Management Act (LEMA) which governs amongstothers all aspects related to the collection transport andrelocation of plant species in the Limpopo ProvinceWhen made aware of this legislation healers respondedthat environmental statutes have no bearing on theirprofession as they view wild plants as common property

DiscussionGender age and years in practiceIn general traditional healing is a gender-based practicealthough in some communities both men and womenare equally involved in this profession [25] In this studymales constituted nearly two-thirds of the participantswhich is in line with a number of other studies in theLimpopo Province For example Bereda [18] also notedthe dominance of males in traditional healing in theVhembe district areas dominated by the VhaVendatribe Moeng and Potgieter [26] reported that malehealers dominated the trade in medicinal plants in theCapricorn Sekhukhune and Waterberg districts Thisphenomenon might even if only partially be attributedto the fact that these males are generally involved inproviding income for their families in rural areas Moengand Potgieter [26] further noted that the dominance ofmales could be due to that fact that the collection of medi-cinal plants may be physically risky for women as mostplants are found in mountainous areas In the WesternCape Province of South Africa Loundou [27] claimed thatmale dominance could be ascribed to the fact that someplants are located on private land making the collectionof medicinal plants is too risky for women In the ZegiePeninsula North-western Ethiopia traditional knowledgein the family or community is mainly passed from the

father to his first born son It is therefore not surprising tofind that males dominate the traditional healing profession[28] Evidence such as this would support the notion thatthe Bapedi traditional healing industry might in the nearfuture continue to be dominated by malesMost healers are between 41 and 60 years These re-

sults are very similar to that reported by Ndawonde [29]for Zulu traditional healers of KwaZulu-Natal SouthAfrica He found that the majority of participantrsquos agesranged from 45 to 54 Mintsa Mi Nzue [30] reportedthat the majority of male and female Xhosa healersresiding in the Western Cape Province of South Africawere between 41 and 50 According to Ndawonde [29]the dominance of this age category is most probably dueto the fact that they are considered to be responsibleand that most of them are in need of money to educatetheir children and support their basic livelihood needsIn light of the low life expectancy for South Africanmales (451) and females (507) [31] the future prospectsfor the protection of indigenous knowledge might be atrisk This necessitates the urgent and rapid recording ofindigenous knowledge related to this industryThe small number of Bapedi traditional healers between

30 and 40 years of age probably indicate a lack of interestfor this profession or perhaps symptomatic of a transitionalsociety that is losing its cultural identity as it westerniseIn accordance with Gessler et al [32] this study found

that both male and female healers started the traditionalhealing profession in their 20s or 30s However genderdisparities are evident Females due to social responsi-bilities enter the profession at an older age when com-pared to their male counterparts Furthermore it wasfound that females do not occupy the profession as longas males as they seem to retire at the age of 60 withsome males continuing to practice well beyond the ageof 60 Fifty seems to be the gender-divide as most of themales (71) were between 30 and 50 years old com-pared to 62 of the females being between 50 and 60According to Richter [33] the sum of all knowledge and

practices whether they are explicable or not employed inthe diagnosis prevention and elimination of physicalmental or societal imbalance and relying exclusively onpractical experience and observation are handed downeither verbally or in writing from generation to gener-ation With regard to males in this study an even spreadis apparent between young (lt10 yearsrsquo experience) and theolder and more established healers (gt10 years) It can beargued that this balance between experienced and lessexperience individuals can contribute to the long termstability of this profession among the Bapedi

Level of educationThis study found that a significant portion of the healersdid not receive formal education (grade 1 to 12) with

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 7 of 12httpwwwethnobiomedcomcontent1014

only a small portion attending school This is in agree-ment with Mabogo regarding the Venda region [19] andYineger and Yewhalaw in South-western Ethiopia [34]However the result of this study is not in agreementwith other ethnobotanical studies conducted throughoutSouth Africa For instance in KwaZulu-Natal Puranswai[35] found that all Zulu traditional healers had attendedschool while 20 even had a University degree or dip-loma Likewise Mintsa Mi Nzue [30] noted that half ofthe Xhosa traditional healers had attended secondaryschool 35 primary school and 3 a tertiary institutionLow level of education amongst Bapedi traditional healerscompared to the above mentioned South African culturesis an indicative of fewer younger and older Bapedi healersthus indicating a need to document their knowledge ofmateria medica before it get lostRichter [33] noted that nowadays educational skills are

vital to traditional healers to empower them with par-ticular competencies such as reading that might be im-portant for counselling and to understand the necessityto conserve and manage natural resources Thus initiat-ing programmes such as ABET (Adult Basic Educationand Training) is important to empower not only Bapeditraditional healers but all other traditional healers withbasic educational skills such as writing and readingBasic education is therefore vital for healers to broadentheir knowledge regarding conservation issues related toprotected and threatened species and medically-relatedissues such as diagnoses and treatment of ailmentsGreater levels of education and consequently awarenesscould contribute in the long term sustainability of thishighly important profession

Source of traditional healing knowledgeForty eight percent of male traditional medical practi-tioners became healers through the mentoring of anotherhealer This trend was also reported by Cheikhyoussefet al [36] for traditional healers of the Oshikoto regionof Namibia They found that most healers in this regionobtained their healing knowledge from their fellow trad-itional healers Normally indigenous knowledge of me-dicinal plant utilization is transferred from parents tochildren within a family [37] The circumstances persuad-ing established Bapedi traditional healers and the appren-tice to interact are currently unknown However thepossibility exists that some traditional healers might havebeen paid by their mentees for trainingThirty eight percent of male traditional healers have

acquired their traditional healing knowledge from parentsand 14 from grandparents Similarly in the Saperascommunity of Khetawas Jhajjar district Haryana of Indiamale traditional healers also obtained their knowledgefrom parents and grandparents [38] Among the Pedi aculture exists where males are expected to be independent

at an earlier stage Therefore both parents might havetrained them to become independent traditional healersand take advantage of the heavy reliance of rural commu-nities on traditional healing services to make a living fromsuch servicesThe source of medicinal plants knowledge is the main

contributor to the difference in knowledge and use be-tween male and female traditional healers [25] Most(62) female Bapedi healers were trained by both par-ents to become traditional healers Similar observationswere reported in Ethiopia [39] This is not surprising asin African cultures daughters are usually more closelyassociated with both parents than sons Through theseclose interactions Bapedi females might have becomeinterested and motivated by their parents to also practicethis profession Only a small percentage (30) of femalesin this study obtained their traditional healing know-ledge from fellow healers thus reflecting the strongbond between daughters and parents in Bapedi culture

Ailments treated and used remedies (used plant partsmethods of preparation and administration)A considerable number of health-related problems (52)treated by Bapedi traditional healers in the poor ruralareas of the Limpopo Province strengthen the fact thattraditional medicine and traditional health practitionersrepresent the first line of healthcare for the majority ofpeople in this province [40] Furthermore the diversityof ailments treated is an indication that medicinal plantshave a potential of satisfying the varied healthcare needsof poor villagers of the Limpopo Province Most of theailments treated by healers of the current study listed inAdditional file 1 Table S1 including chlamydia [41] dia-betes mellitus [42] diarrhoea [43] epilepsy [34] erectiledysfunction [44] eye infection [45] gonorrhoea [46]HIVAIDS [354748] hypertension [49] malaria [50]menstrual disorder [51] mental illness [52] and tuber-culosis [53] are common amongst the healers of otherethnic groups in South AfricaInterestingly a South African study [47] indicated that

some of the ailments treated by Bapedi healers includingsexually transmitted infections (chlamydia gonorrhoeaand HIVAIDS) chronic diseases of lifestyle (diabetes mel-litus and hypertension) as well as psychological ailments[18] are also commonly treated by traditional healers fromother cultures Thus their documentation in the presentstudy just goes further to buttress this Bereda [18] foundthat in the Limpopo Province professional nurses anddoctors either utilise the service of traditional healers orrefer their patients to them for the treatment of ailmentssuch as mental illness sexually transmitted infections in-fertilities and erectile dysfunction Continuing preferencesof traditional healerrsquos health services over contemporarydoctors are driven by a variety of factors including the

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 6 of 12httpwwwethnobiomedcomcontent1014

their own medicinal plants as a safeguard against sexualimpurity In contrast to this preference a minority (21)dispatch trainees for collections however they are carefullyinstructed on the custom of harvesting medicinal material

Harvesting plantsThis study noted that it is customary not to re-fill thesoil after harvesting underground parts or entire plantsThe reasons forwarded were that re-filling the soil influ-ence the effectiveness of harvested plants parts worsena patientrsquos illness and affect the healing progress of apatient Bark was only collected from the side of the treefacing east due to a belief that bark harvested from thisside has the highest nutritional level of all sides

Legislative impactsIn terms of compliance to legislative requirements thisstudy found that none of the traditional healers had a per-mit to collect wild medicinal plants They viewed the per-mit system as an obstacle to their practice Furthermorenone of them has ever heard of the Limpopo Environmen-tal Management Act (LEMA) which governs amongstothers all aspects related to the collection transport andrelocation of plant species in the Limpopo ProvinceWhen made aware of this legislation healers respondedthat environmental statutes have no bearing on theirprofession as they view wild plants as common property

DiscussionGender age and years in practiceIn general traditional healing is a gender-based practicealthough in some communities both men and womenare equally involved in this profession [25] In this studymales constituted nearly two-thirds of the participantswhich is in line with a number of other studies in theLimpopo Province For example Bereda [18] also notedthe dominance of males in traditional healing in theVhembe district areas dominated by the VhaVendatribe Moeng and Potgieter [26] reported that malehealers dominated the trade in medicinal plants in theCapricorn Sekhukhune and Waterberg districts Thisphenomenon might even if only partially be attributedto the fact that these males are generally involved inproviding income for their families in rural areas Moengand Potgieter [26] further noted that the dominance ofmales could be due to that fact that the collection of medi-cinal plants may be physically risky for women as mostplants are found in mountainous areas In the WesternCape Province of South Africa Loundou [27] claimed thatmale dominance could be ascribed to the fact that someplants are located on private land making the collectionof medicinal plants is too risky for women In the ZegiePeninsula North-western Ethiopia traditional knowledgein the family or community is mainly passed from the

father to his first born son It is therefore not surprising tofind that males dominate the traditional healing profession[28] Evidence such as this would support the notion thatthe Bapedi traditional healing industry might in the nearfuture continue to be dominated by malesMost healers are between 41 and 60 years These re-

sults are very similar to that reported by Ndawonde [29]for Zulu traditional healers of KwaZulu-Natal SouthAfrica He found that the majority of participantrsquos agesranged from 45 to 54 Mintsa Mi Nzue [30] reportedthat the majority of male and female Xhosa healersresiding in the Western Cape Province of South Africawere between 41 and 50 According to Ndawonde [29]the dominance of this age category is most probably dueto the fact that they are considered to be responsibleand that most of them are in need of money to educatetheir children and support their basic livelihood needsIn light of the low life expectancy for South Africanmales (451) and females (507) [31] the future prospectsfor the protection of indigenous knowledge might be atrisk This necessitates the urgent and rapid recording ofindigenous knowledge related to this industryThe small number of Bapedi traditional healers between

30 and 40 years of age probably indicate a lack of interestfor this profession or perhaps symptomatic of a transitionalsociety that is losing its cultural identity as it westerniseIn accordance with Gessler et al [32] this study found

that both male and female healers started the traditionalhealing profession in their 20s or 30s However genderdisparities are evident Females due to social responsi-bilities enter the profession at an older age when com-pared to their male counterparts Furthermore it wasfound that females do not occupy the profession as longas males as they seem to retire at the age of 60 withsome males continuing to practice well beyond the ageof 60 Fifty seems to be the gender-divide as most of themales (71) were between 30 and 50 years old com-pared to 62 of the females being between 50 and 60According to Richter [33] the sum of all knowledge and

practices whether they are explicable or not employed inthe diagnosis prevention and elimination of physicalmental or societal imbalance and relying exclusively onpractical experience and observation are handed downeither verbally or in writing from generation to gener-ation With regard to males in this study an even spreadis apparent between young (lt10 yearsrsquo experience) and theolder and more established healers (gt10 years) It can beargued that this balance between experienced and lessexperience individuals can contribute to the long termstability of this profession among the Bapedi

Level of educationThis study found that a significant portion of the healersdid not receive formal education (grade 1 to 12) with

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 7 of 12httpwwwethnobiomedcomcontent1014

only a small portion attending school This is in agree-ment with Mabogo regarding the Venda region [19] andYineger and Yewhalaw in South-western Ethiopia [34]However the result of this study is not in agreementwith other ethnobotanical studies conducted throughoutSouth Africa For instance in KwaZulu-Natal Puranswai[35] found that all Zulu traditional healers had attendedschool while 20 even had a University degree or dip-loma Likewise Mintsa Mi Nzue [30] noted that half ofthe Xhosa traditional healers had attended secondaryschool 35 primary school and 3 a tertiary institutionLow level of education amongst Bapedi traditional healerscompared to the above mentioned South African culturesis an indicative of fewer younger and older Bapedi healersthus indicating a need to document their knowledge ofmateria medica before it get lostRichter [33] noted that nowadays educational skills are

vital to traditional healers to empower them with par-ticular competencies such as reading that might be im-portant for counselling and to understand the necessityto conserve and manage natural resources Thus initiat-ing programmes such as ABET (Adult Basic Educationand Training) is important to empower not only Bapeditraditional healers but all other traditional healers withbasic educational skills such as writing and readingBasic education is therefore vital for healers to broadentheir knowledge regarding conservation issues related toprotected and threatened species and medically-relatedissues such as diagnoses and treatment of ailmentsGreater levels of education and consequently awarenesscould contribute in the long term sustainability of thishighly important profession

Source of traditional healing knowledgeForty eight percent of male traditional medical practi-tioners became healers through the mentoring of anotherhealer This trend was also reported by Cheikhyoussefet al [36] for traditional healers of the Oshikoto regionof Namibia They found that most healers in this regionobtained their healing knowledge from their fellow trad-itional healers Normally indigenous knowledge of me-dicinal plant utilization is transferred from parents tochildren within a family [37] The circumstances persuad-ing established Bapedi traditional healers and the appren-tice to interact are currently unknown However thepossibility exists that some traditional healers might havebeen paid by their mentees for trainingThirty eight percent of male traditional healers have

acquired their traditional healing knowledge from parentsand 14 from grandparents Similarly in the Saperascommunity of Khetawas Jhajjar district Haryana of Indiamale traditional healers also obtained their knowledgefrom parents and grandparents [38] Among the Pedi aculture exists where males are expected to be independent

at an earlier stage Therefore both parents might havetrained them to become independent traditional healersand take advantage of the heavy reliance of rural commu-nities on traditional healing services to make a living fromsuch servicesThe source of medicinal plants knowledge is the main

contributor to the difference in knowledge and use be-tween male and female traditional healers [25] Most(62) female Bapedi healers were trained by both par-ents to become traditional healers Similar observationswere reported in Ethiopia [39] This is not surprising asin African cultures daughters are usually more closelyassociated with both parents than sons Through theseclose interactions Bapedi females might have becomeinterested and motivated by their parents to also practicethis profession Only a small percentage (30) of femalesin this study obtained their traditional healing know-ledge from fellow healers thus reflecting the strongbond between daughters and parents in Bapedi culture

Ailments treated and used remedies (used plant partsmethods of preparation and administration)A considerable number of health-related problems (52)treated by Bapedi traditional healers in the poor ruralareas of the Limpopo Province strengthen the fact thattraditional medicine and traditional health practitionersrepresent the first line of healthcare for the majority ofpeople in this province [40] Furthermore the diversityof ailments treated is an indication that medicinal plantshave a potential of satisfying the varied healthcare needsof poor villagers of the Limpopo Province Most of theailments treated by healers of the current study listed inAdditional file 1 Table S1 including chlamydia [41] dia-betes mellitus [42] diarrhoea [43] epilepsy [34] erectiledysfunction [44] eye infection [45] gonorrhoea [46]HIVAIDS [354748] hypertension [49] malaria [50]menstrual disorder [51] mental illness [52] and tuber-culosis [53] are common amongst the healers of otherethnic groups in South AfricaInterestingly a South African study [47] indicated that

some of the ailments treated by Bapedi healers includingsexually transmitted infections (chlamydia gonorrhoeaand HIVAIDS) chronic diseases of lifestyle (diabetes mel-litus and hypertension) as well as psychological ailments[18] are also commonly treated by traditional healers fromother cultures Thus their documentation in the presentstudy just goes further to buttress this Bereda [18] foundthat in the Limpopo Province professional nurses anddoctors either utilise the service of traditional healers orrefer their patients to them for the treatment of ailmentssuch as mental illness sexually transmitted infections in-fertilities and erectile dysfunction Continuing preferencesof traditional healerrsquos health services over contemporarydoctors are driven by a variety of factors including the

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 7 of 12httpwwwethnobiomedcomcontent1014

only a small portion attending school This is in agree-ment with Mabogo regarding the Venda region [19] andYineger and Yewhalaw in South-western Ethiopia [34]However the result of this study is not in agreementwith other ethnobotanical studies conducted throughoutSouth Africa For instance in KwaZulu-Natal Puranswai[35] found that all Zulu traditional healers had attendedschool while 20 even had a University degree or dip-loma Likewise Mintsa Mi Nzue [30] noted that half ofthe Xhosa traditional healers had attended secondaryschool 35 primary school and 3 a tertiary institutionLow level of education amongst Bapedi traditional healerscompared to the above mentioned South African culturesis an indicative of fewer younger and older Bapedi healersthus indicating a need to document their knowledge ofmateria medica before it get lostRichter [33] noted that nowadays educational skills are

vital to traditional healers to empower them with par-ticular competencies such as reading that might be im-portant for counselling and to understand the necessityto conserve and manage natural resources Thus initiat-ing programmes such as ABET (Adult Basic Educationand Training) is important to empower not only Bapeditraditional healers but all other traditional healers withbasic educational skills such as writing and readingBasic education is therefore vital for healers to broadentheir knowledge regarding conservation issues related toprotected and threatened species and medically-relatedissues such as diagnoses and treatment of ailmentsGreater levels of education and consequently awarenesscould contribute in the long term sustainability of thishighly important profession

Source of traditional healing knowledgeForty eight percent of male traditional medical practi-tioners became healers through the mentoring of anotherhealer This trend was also reported by Cheikhyoussefet al [36] for traditional healers of the Oshikoto regionof Namibia They found that most healers in this regionobtained their healing knowledge from their fellow trad-itional healers Normally indigenous knowledge of me-dicinal plant utilization is transferred from parents tochildren within a family [37] The circumstances persuad-ing established Bapedi traditional healers and the appren-tice to interact are currently unknown However thepossibility exists that some traditional healers might havebeen paid by their mentees for trainingThirty eight percent of male traditional healers have

acquired their traditional healing knowledge from parentsand 14 from grandparents Similarly in the Saperascommunity of Khetawas Jhajjar district Haryana of Indiamale traditional healers also obtained their knowledgefrom parents and grandparents [38] Among the Pedi aculture exists where males are expected to be independent

at an earlier stage Therefore both parents might havetrained them to become independent traditional healersand take advantage of the heavy reliance of rural commu-nities on traditional healing services to make a living fromsuch servicesThe source of medicinal plants knowledge is the main

contributor to the difference in knowledge and use be-tween male and female traditional healers [25] Most(62) female Bapedi healers were trained by both par-ents to become traditional healers Similar observationswere reported in Ethiopia [39] This is not surprising asin African cultures daughters are usually more closelyassociated with both parents than sons Through theseclose interactions Bapedi females might have becomeinterested and motivated by their parents to also practicethis profession Only a small percentage (30) of femalesin this study obtained their traditional healing know-ledge from fellow healers thus reflecting the strongbond between daughters and parents in Bapedi culture

Ailments treated and used remedies (used plant partsmethods of preparation and administration)A considerable number of health-related problems (52)treated by Bapedi traditional healers in the poor ruralareas of the Limpopo Province strengthen the fact thattraditional medicine and traditional health practitionersrepresent the first line of healthcare for the majority ofpeople in this province [40] Furthermore the diversityof ailments treated is an indication that medicinal plantshave a potential of satisfying the varied healthcare needsof poor villagers of the Limpopo Province Most of theailments treated by healers of the current study listed inAdditional file 1 Table S1 including chlamydia [41] dia-betes mellitus [42] diarrhoea [43] epilepsy [34] erectiledysfunction [44] eye infection [45] gonorrhoea [46]HIVAIDS [354748] hypertension [49] malaria [50]menstrual disorder [51] mental illness [52] and tuber-culosis [53] are common amongst the healers of otherethnic groups in South AfricaInterestingly a South African study [47] indicated that

some of the ailments treated by Bapedi healers includingsexually transmitted infections (chlamydia gonorrhoeaand HIVAIDS) chronic diseases of lifestyle (diabetes mel-litus and hypertension) as well as psychological ailments[18] are also commonly treated by traditional healers fromother cultures Thus their documentation in the presentstudy just goes further to buttress this Bereda [18] foundthat in the Limpopo Province professional nurses anddoctors either utilise the service of traditional healers orrefer their patients to them for the treatment of ailmentssuch as mental illness sexually transmitted infections in-fertilities and erectile dysfunction Continuing preferencesof traditional healerrsquos health services over contemporarydoctors are driven by a variety of factors including the

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 8 of 12httpwwwethnobiomedcomcontent1014

faith people have in the healersrsquo herbal remedies [54]Consequently collaboration between traditional healersand Western doctors regarding the treatment of some ofhuman ailments will be a key to health care for all peopleof Limpopo Province and the rest of South AfricaThe current study further indicated that 154 plant

species are being used by questioned healers to treat 52health-related problems which to some extent reflectthe strength of Bapedi traditional medicine as it presentsalternatives for the treatment of aliments To the best ofour knowledge the following two species Aloe angolensis(appetite) and Turraea obtusifolia (blood purifier) are re-corded for the first time as a treatment of the mentionedproblems New utilizations of these species by healers ofthe current study provide valuable contributions to theethnobotanical records of South Africa and elsewhereLeaves were the morphological plant part most pre-

ferred in the preparation of remedies followed by rootand bark This finding is in partial agreement to that notedby Cheikhyoussef and colleagues [36] in Oshikoto regionNamibia They found that traditional healers residing inthis region use a wide range of various plant parts (twigbark stem tuber pod and seed among others) but rootleaf and even the whole plant play a significantly import-ant role in the preparation of medicinesBapedi traditional healers prepared remedies from

various plant parts mainly as water extracts based onsingle plant species However some preparations used asa treatment of blood clotting blood purifier chlamydiadiarrhoea erectile dysfunction female infertility gonor-rhoea heart attack HIVAIDS hypertension malariatuberculosis and woundgeneral injury included speciescombinations for increased efficacy Most of the speciescombinations were used to treat HIVAIDS (Additionalfile 1 Table S1) This custom of employing multiplespecies is in line with western applications employingmultiple therapeutic agents (cocktails) to combat thesymptoms and progression of HIVAIDS This under-scores the fact that Bapedi traditional healers understandthe complex presentation of this debilitating diseaseVarious extract preparation methods such as boiling

pounding burning macerating steaming raw prescrip-tion crushing frying and squeezing are respectivelyemployed by Bapedi traditional healers Most of thesemethods are very commonly used in the treatment ofailments in South Africa [19485556] and other Africancountries such as Ethiopia [57] and Kenya [58] Similarlyroutes (anal oral and topical) of medicinal administrationsused by healers of the current study are common else-where [345960] Occasionally these healers administeredmedication rectally using a bulb syringe in such cases theypreferred to perform the administration themselves Thelimited use of this method was not surprising as it was in-dicated that the procedure is very dangerous and is mostly

performed by the more experienced healers All inter-viewed healers agreed that incorrect dosages especially incases of an overdose can be fatal Generally the dis-appearance or the improvement of symptoms reported bypatients was perceived as independent indicators of asuccessful treatment of ailments

Expiration of medicineEighty percent of Bapedi traditional healers acknowl-edged that processed plant material do expire The par-ticipants in this study identified temperature as themajor contributor to the expiration of especially liquidmedicine They indicated that medicines stored in a hotenvironment have the potential to expire within a weekor less whereas those stored in cooler places can lastsignificantly longer Of interest is the fact that Bapedihealers and Nepalese [61] medicinal traders have similardiscerning characteristics of expired liquid medicineAmong these the most prominent were any combinationof the following a tendency to change colour becomethick has a rancid smell or become extremely sour Thereliance on empirical observations by Bapedi healers asis probably the case in many other cultures to deter-mine the expiry date of any given prescription is farfrom optimal and thus warrants further investigationThis is in line with Griggs et al [62] who noted that only asmall number of species has been assessed for retention ofactivity over time and that there is not enough scientificevidence available to serve as a decision-making frame-work regarding the expiration dates of ethno-medicinePounded medicines were perceived to have a far lon-

ger shelf life and Bapedi traditional healers claimed thatit could remain effective for up to one year This claimis in agreement with findings of Blackburn [63] who re-ported that tablets and pounded medicine lasts longerthan liquid medication The determining delimiting fac-tor for the shelve-life time of pounded medicine accord-ing to the Bapedi healers is exposure to moisture andcharacteristics of expired pounded medicine includesticking together or an inability to mix withdissolve inwater even when shaken

Side effects and assessment of efficacy of medicineSixty percent of the traditional healers in this studyclaimed that their preparations are side effect freeOyedemi et al [64] also reported similar claims amongthe Xhosa traditional healers in the Eastern Cape Provinceof South Africa These claims by both Bapedi and theXhosa healers are based on patient feedback This ap-proach to determine the presence or lack of side effectswill remain a challenge as alternative medicine is mostlybased on historical or cultural values rather than onempirical evidence This situation can be further con-founded in support of a report by Yineger et al [65] it

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 9 of 12httpwwwethnobiomedcomcontent1014

is considered that there might be an inability to or avery low level of recognition with regard to adverseeffects by healers and absence of antidotes for thoseremedies might sometimes worsen the health problemof patientsVan Wyk et al [66] noted that side effects of remedies

are known by experienced traditional healers Our studyconfirms this observation for the Bapedi with 40 indi-cating that some of their preparations have side effectsThese included side effects for example of gonorrhoea(impotencysexual dysfunction) as well as HIVAIDS(dysentery and loss of appetite) preparations Accordingto Bapedi healers these side effects are signs that themedicine is effectiveSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determinedby consulting ancestors (90) or by patientsrsquo positiveresponses (10) Kamatenesi-Mugisha et al [60] andBhattarai et al [67] noted that traditional healers usepatients as a form of assessment of the efficacy of theirmedicine The use of ancestors by Bapedi healers to con-firm the efficacy of prescribed medicine are not surpris-ing as most African traditional healers believe that theancestors have positive influences on medicinal plantprescriptions [14] The main challenge facing the contin-ued use of traditional medicine is proof that the activecomponents contained in medicinal plants are safe andeffective [68] Despite the traditional methods employedby Bapedi healers in determining efficacy of remediesscientific investigations are required to assure the med-ical field and an increasing knowledgeable public regard-ing the efficacy and safety of the use of medicinal plantsas therapeutic alternatives

Plant collection and ritualsSeventy nine percent of Bapedi healers collected theirown medicinal plants This seems to be a general patternas Kambizi and Afolayan [69] reported almost a similarfinding in the Guruve district of Zimbabwe They notedthat it is only under certain circumstances such as theunavailability of the healer that an ordinary personcould harvest plants on behalf of the healer One reasonfor this preference to collect their own plant material isput forward by Nanyingi et al [58] who noted that inthe Samburu district Kenya healersrsquo preference to col-lect their own plants was to preserve the secrecy of planthabitat locationsNinety five percent of the participating Bapedi trad-

itional healers practiced rituals prior harvesting plantsas a means of expressing gratitude to the ancestorsAccording to them this ensures that ancestors reveal thelocation of plants in the wild and also guarantee thatthe medicine prepared from such species work effect-ively Chavunduka [14] confirms this notion by stating

that the ancestors play a role in transferring indigenousknowledge to healers so that they are able collect the rightspecies process it correctly and safely treat patientsSixty seven percent of Bapedi healers indicated that

their herbal remedies are effective This is determined byconsulting ancestors (90) or by patientrsquos positive re-sponses (10) This is in line with comments fromKamatenesi-Mugisha et al [60] and Bhattarai et al [67]who noted that traditional healers of Uganda and Nepalrespectively use the treated patients as an assessment ofthe efficacy of their medicine The use of ancestors byBapedi healers to confirm the efficacy of prescribedmedicine came as no surprise as most African trad-itional healers believe that the ancestors have positiveinfluences on medicinal plant prescriptions [14]

Harvesting plantsWhen harvesting underground parts Bapedi traditionalhealers did not re-fill the soil because they believe it willworsen a patientrsquos illness This is in accordance to theobservation by Magoro [8] for Bapedi traditional healersin the Sekhukhune district However Kambizi and Afolayan[69] indicated that it is forbidden among Shona traditionalhealers of Zimbabwe not to refill the pit from which theroots are dug and that disregarding this would only worsenthe illness The custom of Bapedi healers of not re-fill theharvesting underground parts might result in plant waterup-take reduction plant carbohydrate reserve depletionand nutrient flow disruption or increase susceptibility tofungal attack which will eventually kill the species [70]In this study the phenomenon of bark harvesting only

from the side facing East was also reported by Mabogo[19] for Vha-Venda traditional healers a cultural groupresiding within the Limpopo Province In a similar veinNdawonde [29] reported bark harvesting by Zulu healerson both the east- and west-facing sides Bapedi Vha-Venda (eastern side) and Zulu (east and west-facingsides) traditional healers mentioned that bark harvestedon these sides provide more healing power than theother sides These healers believe that the east-blowingwind carry with it healing properties and then comesback west bringing the healing powers back

Legislative impactsCurrent legislation requires the possession of a permitwhen plants are harvested from communal land How-ever none of our participants had a permit to collectmedicinal plants from communal land as they perceivedit as an obstacle to their practice This concept of limit-ing access to medicinal plants is in contrast to the find-ings of Moeng and Potgieter [26] who noted that 63 ofthe muthi (medicinal and spiritual plant and animalmaterial) traders (traditional healers included) didnrsquot seethe need for such a permit ie the long-term benefit of

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 10 of 12httpwwwethnobiomedcomcontent1014

such a system It is therefore recommended that anyfuture implementation of the permit system shouldconsider these driving-forcesAccording to the Department of Environmental Affairs

and Tourism [71] and the Convention on Biological Di-versity [72] the lack of knowledge pertaining environ-mental legislation and conservation are key obstaclesthreatening the conservation of South African biodiver-sity This study revealed that none of the interviewedtraditional healers had any knowledge of LEMA [73]This is understandable when viewed against the back-drop of educational levels or the lack thereof In thisstudy 95 of males and 77 of females either had noschooling or only primary schooling This in itself couldlimit the individualsrsquo ability to comprehend legislativedocuments thereby impacting negatively on any conser-vation strategy It is clear that education can play animportant role in empowering them to manage theirresources more effectively

Limitations of the studyThe clearest limitation of this study was the low numberof questioned traditional healers It is worth mentioningthat after an exhaustive literature search as well as con-sultations with the relevant local government officialswe learned that currently there is no official documenta-tion that indicates the total number of healers in eitherthe studied municipalities or districts Indeed we concurwith Espinosa et al [74] that a low number of partici-pants in an ethnobotanical study are not a true reflectionthat findings are representative of the population beinginvestigated

ConclusionsThis study has shown that Bapedi traditional healers couldplay a leading role in both the preservation of indigenousknowledge and the primary healthcare sector Higherdiversity of species used to treat an array of ailments is areflection of the significant of plants in Bapedi traditionalhealing and probably the role of Bapedi healers in thetraditional primary health care sectorsHowever of concern is the traditional methods (via con-

sulting ancestors) employed by most of Bapedi healers indetermining efficacy of remedies thus indicating a needfor a scientific investigations to establish their safety andefficacy Equally there is a need to educate these healersregarding the significant of various conservation legisla-tions in their traditional healing By addressing these wewill be able to better integrate them in primary health caresystems and environmental managementAlthough the current study has achieved its aim of

describing the diverse spectrum of some Bapedi healersand their traditional healing practice (such as plantsused to prepare herbal remedies and ailments treated)

in the Limpopo Province there is a great need to samplea larger proportion of healers in the studied districts andmunicipalities to verify the accuracy of the results

Additional file

Additional file 1 Table S1 Plant species mode of remedy preparationand administration as well as ailments treated by Bapedi traditionalhealers in the Limpopo Province

Competing interestsThe authors declare that they have no competing interests

Authorsrsquo contributionsSSS conceptualized the idea collected the data and analyzed and wrote themanuscript MJP helped to finalise the manuscript Both authors read andapproved the final manuscript

AcknowledgementsThe authors are very grateful to the traditional healers who participated inthis study and for sharing their knowledge on traditional healing practicesWe also thank the anonymous reviewers for constructive comments

Received 12 August 2013 Accepted 30 November 2013Published 10 January 2014

References1 South Africarsquos National Biodiversity Strategy and Action Plan (SANBSAP)

South Africarsquos National Biodiversity Strategy and Action Plan (2005) PretoriaGovernment Printers 2005

2 Hoareau L Da Silva EJ Medicinal plants a re-emerging health aidElectro J Biotechnol 1999 2256ndash270

3 Kambizi L Afolayan AJ An ethnobotanical study of plants used for thetreatment of sexually transmitted diseases (Njovhera) in Guruve DistrictZimbabwe J Ethnopharmacol 2001 775ndash9

4 Gelfand M Mavai S Drummond RB Ndemera B The Traditional MedicalPractitioner in Zimbabwe His Principles of Practice and PharmacopoeiaHarare Mambo Press 1985

5 Ndubani P Hojer B Traditional healers and the treatment of sexuallytransmitted illnesses in rural Zambia J Ethnopharmacol 1999 6715ndash25

6 Langenhen LH Thimann KV Plant Biology and Itrsquos Relations to Human AffairsNew York John Wiley and Sons 1982

7 Amabeoku GJ Leng MJ Syce JA Antimicrobial and anticonvulsantactivities of Viscum capense J Ethnopharmacol 1998 61237ndash241

8 Magoro MD Traditional Health practitionerrsquos practice and the sustainability ofextinction-prone traditional medicinal plants MSc Dissertation PretoriaUniversity of South Africa 2008

9 Van Rensburg HCJ Fourie E Pretorius E Health Care in South Africa PretoriaAcademia 2002

10 Jolles F Jolles S Zulu ritual immunization in perspective J Inter AfrInstitute 2000 70229ndash248

11 Last M Chavunduka GL (Eds) The professionalization of African medicineManchester Manchester University Press and International Africa Institute1986

12 Karim ASS Zigubu-Page TT Arendse R Bridging the gap Potential forhealth care partnership between African traditional healer and biomedicalpersonnel in South Africa Report of the South African Medical ResearchCouncil S Afr Med J 1994 841

13 Gumede MV Traditional healer A Medical Practitionerrsquos Perspective CapeTown Blackshaws 1990

14 Chavunduka GL Traditional medicine in modern Zimbabwe HarareUniversity of Zimbabwe 1994

15 Meissner O Traditional medicine and its accommodation in the South AfricanNational health care system with special attention to possible statutoryregulation PhD Thesis Pretoria University of Pretoria 2003

16 World Health Organization (WHO) WHO Traditional Medicine Strategy2002ndash2005 Geneva World Health Organization 2002

17 Puckree T Mkhize M Mgobhozi Z Lin J African traditional healers whathealth care professionals need to know Int J Rehab Res 2002 25247ndash251

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 11 of 12httpwwwethnobiomedcomcontent1014

18 Bereda JE Traditional healing as a health care delivery system in a transculturalsociety MA Dissertation Pretoria University of South Africa 2002

19 Mabogo DEN The ethnobotany of the VhaVenda MSc Dissertation PretoriaUniversity of Pretoria 1990

20 Monning HO The Pedi Pretoria Van Schaik (Pty) Ltd 196721 The Pedi The history of the BaPedi people is intertwined with the history of

South Africa 2001 Histhttpwwwsouthafricanetzaenarticlesentryarticle-southafricanet-the-bapedi Accessed 13 May 2013 2001

22 Acocks JHP Veld types of South Africa 3rd edition Mem Bot Surv SouthAfr 1988 571ndash146

23 Mucina L Rutherford MC (Eds) The vegetation of South Africa Lesotho andSwaziland Pretoria Strelitzia 19 South African Biodiversity Institute 2006

24 Explorable Convenience sampling 2009 [httpexplorablecomconvenience-sampling] Site accessed 1512 2013

25 Shapi M Matengu K Mu Ashekele H Indigenous Knowledge System PilotStudy - Oshikoto Region Windhoek University of Namibia MultidisciplinaryResearch Centre 2009

26 Moeng ET Potgieter MJ The trade of medicinal plants by muthi shopsand street vendors in the Limpopo Province South Africa J Med PlantsRes 2011 5558ndash564

27 Loundou P Medicinal plant and opportunities for sustainable management inthe Cape Peninsula MSc Dissertation South Africa University ofStellenbosch Stellenbosch 2008

28 Teklehaymanot T Giday M Ethnobotanical study of medicinal plants usedby people in Zegie Peninsula North-western Ethiopia J EthnobiolEthnomed 2007 312 Doi 1011861746-4269-3-12

29 Ndawonde BG Medicinal Plant Sales A Case Study in Northern Zululand MScDissertation KwaDlangezwa University of Zululand 2006

30 Mintsa Mi Nzue AP Use and conservation status of medicinal plants in theCape Peninsula Western Cape Province of South Africa University ofStellenbosch Stellenbosch MSc Dissertation 2009

31 Statistics South Africa Stats in brief Ten years of democratic governancePretoria Statistics South Africa 2004

32 Gessler MC Msuya DE Nkunya MHH Mwasumbi LB Schire A Heinrich MTanner FM Traditional healers in Tanzania the treatment of malaria withplant remedies J Ethnopharmacol 1995 48131ndash144

33 Richter M Traditional Medicines and Traditional Healers in South AfricaDiscussion paper prepared for the Treatment Action Campaign and AIDS LawProject Pretoria Government Printers 2003

34 Yineger H Yewhalaw D Traditional medicinal plant knowledge and useby local healers in Sekoru District Jimma Zone Southwestern EthiopiaJ Ethnobiol Ethnomed 2007 324 doi 1011861746-4269-3-24

35 Puranswai R The role of traditional healers in oral health care in KwaZulu-Natal MSc Dissertation Cape Town University of the Western Cape 2006

36 Cheikhyoussef A Shapi M Matengu K Ashekele H Ethnobotanical study ofindigenous knowledge on medicinal plant use by traditional healers inOshikoto region Namibia J Ethnobiol Ethnomed 2010 9 Doi 1011861746-4269-7-10

37 Koning M Biodiversity prospecting and the equitable remuneration ofethnobiological knowledge reconciling industry and indigenousinterests Inte Prop J 1998 11185ndash201

38 Panghal M Arya V Yadav S Kumar S Yadav PY Indigenous knowledge ofmedicinal plants used by Saperas community of Khetawas Jhajjar DistrictHaryana India J Ethnobiol Ethnomed 2010 10 Doi 1011861746-4269-6-4

39 Bishaw M Attitudes of modern and traditional medical practitionerstoward cooperation Ethiop J Med 1990 2863ndash72

40 Walwyn D Maitshotlo B The role of South African traditional healthpractitioners in the treatment of HIVAIDS a study of their practices anduse of herbal medicines South Afr J HIV Med 2010 201011ndash16

41 Arnold HJ Gulumian M Pharmacopoeia of traditional medicine in VendaJ Ethnopharmacol 1984 1235ndash74

42 Erasto P Adebola PO Grierson DS Afolayan AJ An ethnobotanical studyof plants used for the treatment of diabetes in the Eastern CapeProvince South Africa Afr J Biotechnol 2005 41458ndash1460

43 Bisi-Johnson MA Obi CL Kambizi L Nkomo M A survey of indigenousherbal diarrhoeal remedies of OR Tambo district Eastern CapeProvince South Africa Afr J Biotechnol 2010 91245ndash1254

44 Rakuambo NC Meyer JJ Hussein A Huyser C Mdlalose SP Raidani TGIn vitro effect of medicinal plants used to treat erectile dysfunction onsmooth muscle relaxation and human sperm J Ethnopharmacol 200610584ndash88

45 Mahwasane ST Middleton L Boaduo N An ethnobotanical survey ofindigenous knowledge on medicinal plants used by the traditionalhealers of the Lwamondo area Limpopo Province South AfricaSA J Bot 2013 8869ndash75

46 Tshikalange TE Meyer JJM Hussein AA Antimicrobial activity toxicity andthe isolation of a bioactive compound from plants used to treat sexuallytransmitted diseases J Ethnopharmacol 2005 96515ndash519

47 Peltzer K Mngqundaniso N Petros G HIVAIDSSTITB knowledge beliefsand practices of traditional healers in KwaZulu-Natal South AfricaAIDS Care 2006 18608ndash613

48 Coopoosamy RM Naidoo KK An ethnobotanical study of medicinal plantsused by traditional healers in Durban South Africa Afr J Pharm Pharmacol2012 6818ndash823

49 Olorunnisola OS Bradley G Afolayan AJ Ethnobotanical information onplants used for the management of cardiovascular diseases in NkonkobeMunicipality South Africa J Med Plan Res 2011 54256ndash4260

50 Maharaj R Maharaj V Crouch NR Bhagwandin N Folb IP Pillay P Gayaram RScreening of selected ethnomedicinal plants from South Africa forlarvicidal activity against the mosquito Anopheles arabiensis Malar J 2012320 doi1011861475-2875-11-320

51 Steenkamp V Traditional herbal remedies used by South African womenfor gynaecological complaints J Ethnopharmacol 2003 8697ndash108

52 Hutchings A Scott AH Lewis G Cunningham AB Zulu medicinal plants Aninventory Pietermaritzburg South Africa University of Natal Press 1996

53 Green E Samie A Obi CL Bessong PO Ndip RN Inhibitory properties ofselected South African medicinal plants against Mycobacteriumtuberculosis J Ethnopharmacol 2010 130151ndash157

54 Hegde VH Hegde GR Kholkute SD Herbal care for reproductive healthethno medicobotany from Uttara Kannada district in Karnataka IndiaComplement Ther Clin Pract 2007 1338ndash45

55 De Beer JJJ Van Wyk B-E An ethnobotanical survey of the AgterndashHantamNorthern Cape Province South Africa SA J Bot 2011 77741ndash754

56 Nortje JM Medicinal ethnobotany of the Kamiesberg Namagualand NorthenCape Province South Africa MSc Dissertation Johannesburg University ofJohannesburg 2011

57 Kebu B Ensermu K Zemede A Indigenous medicinal plant utilizationmanagement and threats in Fentalle Area Eastern Shewa EthiopiaEthiop J Bio Sci 2002 2143ndash156

58 Nanyingi MO Mbaria JM Lanyasunya AL Wagate CG Koros KB Kaburia HWMunenge RW Ogara WO Ethnopharmacological survey of Samburu districtKenya J Ethnobiol Ethnomed 2008 2323 doi 1011861746-4269-4-14

59 Pradhan BK Badola HK Ethnomedicinal plant use by Lepcha tribe ofDzongu valley bordering Khangchendzonga Biosphere Reserve in NorthSikkim India J Ethnobiol Ethnomed 2008 422 Doi 1011861746-4269-4-22

60 Kamatenesi-Mugisha M Oryem-Origa H Odyek O Makawiti DW Medicinalplants used in the treatment of fungal and bacterial infections in andaround Queen Elizabeth Biosphere Reserve western Uganda Afr J Ecol2008 4690ndash97

61 DeSouza C Ameyapoh Y Karou DS Anani KT Kpodar ML Gbeassor MAssessing market-sold remedies in Lomeacute (Togo) for hygienic qualityBiotech Res Inter 2011 20101ndash5

62 Griggs JK Manandhar NP Towers GHN Taylor RSL The effects of storageon the biological activity of medicinal plants from NepalJ Ethnopharmacol 2001 77247ndash252

63 Blackburn J A review of medication dosage forms drug administrationpharmacokinetics and abbreviations A knowledge based course fortechnicians Woodlands Texas Texas Tech University 2010

64 Oyedemi SO Bradley G Afolayan AJ Ethnobotanical survey of medicinalplants used for the management of diabetes mellitus in the Nkonkobemunicipality of South Africa J Med Plan Res 2009 31040ndash1044

65 Yineger H Kelbessa E Bekele T Lulekal L Plants used in traditionalmanagement of human ailments at Bale Mountains National ParkSouth-eastern Ethiopia J Med Plan Res 2008 2132ndash153

66 Van Wyk B-E Van Oudsthoorn B Gericke N Medicinal Plants of South AfricaPretoria Briza Publications 1997

67 Bhattarai S Chaudhary RP Quave CL Taylor RSL The use of medicinalplants in the Trans-Himalayan arid zone of Mustang district NepalJ Ethnobiol Ethnomed 2010 614 doi 1011861746-4269-6-14

68 Nshimo C Utilization and Conservation of Medicinal Plants in Africa Dar EsSalaam Tanzania Faculty of Pharmacy Muhimbili University College ofHealth Sciences 1988

Semenya and Potgieter Journal of Ethnobiology and Ethnomedicine 2014 104 Page 12 of 12httpwwwethnobiomedcomcontent1014

69 Kambizi L Afolayan AJ Indigenous knowledge and its impact onmedicinal plant conservation in Guruve Zimbabwe AJIKS 2006 526ndash31

70 Botha J Witkowski ETF Shackleton CM Market profiles and trade inmedicinal plants in the lowveld South Africa Env Conser 2004 3138ndash46

71 Department of Environmental Affairs and Tourism (DEAT) White paper onconservation and sustainable use of South African biological diversity PretoriaGovernment Printer 1997

72 Convention on Biological Diversity (CBD) The strategic plan national reportsand implementation of the Convention on Biological Diversity The Hague2001 httpwwbiodivorg Accessed 13 May 2013

73 Limpopo Department of Economic Development Environment and TourismLimpopo Environmental Management Act (LEMA) (Act No 7 of 2004)Limpopo Province South Africa Provincial Gazette 1986

74 Espinosa MM Bieski IGC Martins DTO Probability sampling design inethnobotanical surveys of medicinal plants Braz J Pharma 2012221362ndash1367

doi1011861746-4269-10-4Cite this article as Semenya and Potgieter Bapedi traditional healers inthe Limpopo Province South Africa Their socio-cultural profile andtraditional healing practice Journal of Ethnobiology and Ethnomedicine2014 104

Submit your next manuscript to BioMed Centraland take full advantage of

bull Convenient online submission

bull Thorough peer review

bull No space constraints or color figure charges

bull Immediate publication on acceptance

bull Inclusion in PubMed CAS Scopus and Google Scholar

bull Research which is freely available for redistribution

Submit your manuscript at wwwbiomedcentralcomsubmit