Dr Lindiwe Gumede is head of department, Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg.
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South Africans are often reminded that the country has committed itself to building a more equitable healthcare system, as part of recognising and preserving indigenous knowledge.
However, the reality in healthcare centres, including public hospitals and clinics, shows a different picture. Often, the issue isn't with the health practitioners but with patients.
Take this scenario, for instance. A patient arrives at a public hospital with worsening symptoms. The physician asks about prescription medicines, allergies, and previous illnesses. The patient answers every question except one: She has been taking traditional medicine for weeks before seeking hospital care. But she was not asked about it and therefore remained silent.
This silence, or non-disclosure, is more common than many people realise, and it has far-reaching implications for patient safety and quality of care. This silence occurs not because patients want to mislead their physicians; rather, they fear being judged, dismissed, or told to stop using a practice that is deemed alien. This is despite the use of traditional medicine being part of their family and community practices for generations, and the government having committed to promoting the practice.
Addressing a Traditional Medicine Summit in 2023, Deputy Health Minister Dr Joe Phaahla noted that about 60 – 80% of the world’s population, mainly from developing countries, depend primarily on traditional medicines.
He went on to say that across the world, traditional medicine either is the mainstay of healthcare delivery or serves as a complement to it. Of course, South Africa has one of the most culturally diverse healthcare landscapes in the world.
While millions of people rely on conventional medicine provided through hospitals and clinics, many also rely on traditional medicine to prevent illness, manage chronic conditions, or seek healing that aligns with their cultural and spiritual beliefs.
For many patients, these are not competing choices but complementary ones. Yet conversations about traditional medicine rarely happen openly in the consulting room. For years, efforts to improve disclosure have focused on patients.
Patients have been encouraged to speak freely and honestly with healthcare professionals. While this message is important, physicians overlook a crucial question: what kind of healthcare environment are patients disclosing into?
A study I conducted exploring how allopathic medicine practitioners working in district public hospitals in Gauteng discuss traditional medicine with patients revealed a more complex picture than a simple communication problem.
Rather than simply examining why patients disclose or do not disclose, the study examined how physicians themselves construct the legitimacy of traditional medicine and how these beliefs influence clinical conversations.
Doctors and nurses are generally seen as being insensitive and rude to patients’ needs and circumstances. In the case of my study, however, many practitioners expressed valid concerns about patient safety.
They worried about unknown ingredients, the lack of standardised dosing, possible toxic effects, and interactions between traditional medicines and prescribed allopathic medicines. These concerns are by all accounts reasonable. Every healthcare professional has a responsibility to minimise harm and make evidence-informed clinical decisions.
At the same time, many practitioners also acknowledged that traditional medicine remains deeply embedded in South African society.
They recognised that patients often seek traditional healing because it reflects their cultural identity, family traditions, spirituality, and personal understanding of illness. These two perspectives frequently exist side by side.
Physicians valued scientific evidence while recognising that patients' healthcare decisions are shaped by far more than evidence-based data alone. The challenge arises when one knowledge system is consistently positioned as authorised while the other is viewed primarily as a risk.
In these circumstances, patients quickly learn what is acceptable to disclose and what is better left unsaid, which is not simply about communication skills but also about power.
It stands to reason that healthcare consultations are social encounters where knowledge, authority, and culture intersect. When patients believe that discussing traditional medicine will result in criticism or mocking, silence becomes a form of self-protection.
Unfortunately, that silence can prevent clinicians from obtaining a complete understanding of the patient's health practices, increasing the risk of adverse interactions, delayed diagnoses, or missed opportunities for collaborative care.
Decolonising healthcare does not require doing away with scientific medicine. Nor does it mean accepting every traditional practice without question. Rather, it calls for recognising that different forms of health knowledge coexist within South African society and that respectful engagement is essential for safe, patient-centered care.
This is where the concept of cultural safety becomes particularly important. Cultural safety moves beyond cultural awareness or competence by encouraging healthcare professionals to reflect on how their own assumptions, professional authority, and institutional practices shape interactions with patients.
It asks whether patients feel respected, heard, and safe enough to share information that may be significant to their care. Listening, therefore, becomes more than good bedside manners. It is useful when it becomes a clinical skill and an ethical responsibility.
Therefore, healthcare professionals should feel confident asking patients about traditional medicine in a non-judgmental way, just as they routinely ask about prescription medicines, over-the-counter drugs, and dietary supplements. Patients, in turn, should be reassured that disclosure is not about criticism but about ensuring safe and effective treatment.
Medical and health sciences education also has an important role to play. Future healthcare professionals need opportunities to engage meaningfully with indigenous knowledge systems, understand why patients use traditional medicine and develop communication skills that foster trust rather than fear.
Such education does not diminish scientific standards; it strengthens them by preparing practitioners to care for diverse populations.
South Africa has repeatedly committed itself to recognising indigenous knowledge and building a more equitable healthcare system. Achieving this vision requires more than policy statements, but it requires changing what happens every day in consulting rooms across the country. Patients should never have to choose between being true to their culture and receiving quality healthcare.
The first step towards decolonising healthcare is not speaking more. It is listening better. When patients believe they will be heard without judgment, conversations could become more honest, care could become safer, and healthcare will move closer to the inclusive, patient-centred system that South Africa deserves.
*Dr Lindiwe Gumede is head of department, Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg. *
