Afro-Communitarianism and the Role of Traditional African Healers in the COVID-19 Pandemic - PhilArchive
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PUBLIC HEALTH ETHICS VOLUME 14 • ISSUE 1 • 2021 • 59–71 59
Afro-Communitarianism and the Role of
Traditional African Healers in the
COVID-19 Pandemic
Luıs Cordeiro-Rodrigues,1,*, Department of Philosophy, Yuelu Academy,
Hunan University
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Thaddeus Metz2, University of Pretoria
*Corresponding author: Luıs Cordeiro-Rodrigues, Department of Philosophy, Yuelu Academy, Hunan University, Changsha, China. Email:
lccmr1984@gmail.com
The COVID-19 pandemic has brought significant challenges to healthcare systems worldwide, and in Africa, given
the lack of resources, they are likely to be even more acute. The usefulness of Traditional African Healers in helping
to mitigate the effects of pandemic has been neglected. We argue from an ethical perspective that these healers
can and should have an important role in informing and guiding local communities in Africa on how to prevent the
spread of COVID-19. Particularly, we argue not only that much of the philosophy underlying Traditional African
Medicine is adequate and compatible with preventive measures for COVID-19, but also that Traditional African
Healers have some unique cultural capital for influencing and enforcing such preventive measures. The paper
therefore suggests that not only given the cultural context of Africa where Traditional African Healers have a
special role, but also because of the normative strength of the Afro-communitarian philosophy that informs it,
there are good ethical reasons to endorse policies that involve Traditional Healers in the fight against COVID-19.
We also maintain that concerns about Traditional African Healers objectionably violating patient confidentiality or
being paternalistic are much weaker in the face of COVID-19.
townships, without water or sanitation and depending
Introduction on daily economic relations to survive. The problem in
At the beginning of the COVID-19 crisis, the virus Africa is aggravated by the lack of medical personnel and
seemed to have somehow democratized infection in resources to meet all the population’s needs (WHO,
the sense that it infected both rich and poor and everyone 2020). In fact, this was already a serious problem before
was at the same risk. It is not particularly the mutations the pandemic; it is estimated that the great majority of
of the virus that explain differential harms people face Africans do not have access to healthcare (‘WHO j
from it; it has become clear that the socio-economic Traditional Medicine’ 2014).
disadvantaged individuals are, in fact, more exposed to Given this shortage of healthcare medical resources
it and therefore more likely to be infected. Prevention of and personnel, the solution to places like Africa cannot
the spread of the pandemic requires, amongst other be simply like in the Global North, such as to buy sup-
things, social distancing, isolation, access to clean water plies or for governments to ask for social distancing and
and sanitation. However, these conditions will be more reasonably expect compliance. Instead, there the issue
difficult to maintain for those with more socio- needs to be approached not only from a culturally sen-
economic issues. This is why the World Health sitive way, but also in a manner that uses existing
Organization (WHO) has expressed concerns regarding context-specific resources efficiently. In this article, we
the negative impact of COVID-19 may have in Africa wish precisely to provide a normative argument for how
(WHO, 2020). Broadly speaking, in Africa the socio- to use these resources that considers the important role
economic conditions are not favourable for the contain- that Traditional African Healers could and should play
ment of the disease. Take the case of South Africa, where in the prevention of COVID-19. Our position is that it is
many black communities live in overpopulated crucial to involve Traditional African Healers in the
doi:10.1093/phe/phab006
Advance Access publication on 20 March 2021
V
C The Author(s) 2021. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org60 • CORDEIRO-RODRIGUES and METZ
challenges of COVID-19 poses to Africa. The case is sensitive to cultural differences (Weinstock, 2014) by
more pressing when one notices that, in the case of highlighting the relevance of Traditional African
South Africa (the African country with the most Medicine in the African context.
reported cases), Traditional African Healers have a sig- To establish our argument, we have divided this article
nificant cultural role and influence in some of the most into four sections. In the first section, we outline some
affected provinces (Gauteng and Kwazulu-Natal), and key ideas of Traditional African Medicine and the Afro-
thereby able to influence dwellers positively in these communitarian philosophy underlying it. Then, in the
areas (UNAIDS, 2000; Flint, 2008, 2018; Audet et al., second section, we demonstrate how Traditional African
2017; UNICEF, 2020a, b). Medicine can and should play an important role in the
Particularly, we offer three sets of ethical arguments to prevention of COVID-19. Next, in the third section, we
contend that Traditional African Healers have a crucial address objections, such as that Traditional African
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role in overcoming the challenges posed by COVID-19. Medicine may be harmful for the patients and can spread
Firstly, the philosophy that informs Traditional African rather than prevent the infection of COVID-19. In the
Healers’ practice is compatible and helpful to prevent final section, we respond to further problems, including
COVID-19. Particularly, Traditional African Healers’ that Traditional African Medicine may violate confiden-
practice consists, to a great extent, of giving moral advice tiality and be paternalistic. In both of these sections, we
to cure illness and many of these prescriptions can be contend that the objections are exaggerated that the
expected to be compatible with those of the WHO to expected benefits of including a regulated form of
prevent the spread of COVID-19. Secondly, Traditional African Medicine exceed the costs.
Traditional African Healers are important cultural lead-
ers of the communities who have power to influence
behaviour in desirable ways. Thirdly, concerns that Traditional African Medicine and
Traditional African Healers would objectionably violate Afro-Communitarianism
their patients’ confidentiality or would treat them pater-
nalistically are, we maintain, weaker in the face of the Traditional Medicine is defined by WHO as the indigen-
COVID-19 pandemic. Roughly speaking, less privacy ous therapies that tend to involve herbal medicine, ani-
and more nudging are in fact warranted. In short, our mal parts or minerals as well as non-medication
argument is that a policy that involves Traditional therapies. Some of the treatments beyond herbal medi-
African Healers is justified not only due to the fact that cine include massage, music therapy, self-exercise thera-
they, when it comes to the African context, could bring a pies and psychotherapy (WHO j Traditional Medicine
positive contribution, but also because the Afro- 2014). Traditional African Medicine has, broadly speak-
communitarian philosophy that informs their practices ing, two branches. There is a supernatural branch of
offers positive moral reasons to follow the Healers’ traditional medicine, in which the healer is understood
prescriptions. to be a spirit medium who is able to communicate with
Our proposal has not yet been systematically under- ancestral spirits and divinities (Onwuanibe, 1979).
taken by African governments, but would be innovative These ancestors and gods are then understood to give
and promising not only for challenging many prejudices the information about diagnosis and treatment to the
of the Global North that consider the use of Traditional healer. The other branch of Traditional in African
Health Medicine as problematic for the health of Medicine is herbalism. Herbalists routinely treat patients
Africans, but also as a culturally sensitive and efficient with medical plants such as leaves, seeds, fruits and
way to manage health resources in Africa during this and sometimes parts of animals. This branch of Traditional
other future pandemics. Beyond defending a policy that African Medicine does not necessarily endorse the spir-
has not been adopted yet, our analysis is of interest for itism part (Flint, 2008, 2018).
challenging the scepticism that many bioethicists have Illness for Traditional African Medicine tends to be
towards alternative medicines in general, including understood as a form of lack of balance between the pa-
African Traditional Medicine (Nyika, 2007; Smith, tient and her social setting, including with ancestors living
2012; Shahvisi, 2016); it argues that, in fact, that there in an imperceptible realm on earth, although natural
are good moral and other practical reasons to include causes are often acknowledged as playing a role (Flint,
rather than exclude African Traditional Medicine in 2018). Sometimes illness is attributed to some moral in-
health solutions and systems. Furthermore, the argu- fringement of the person, family or village, with the role of
ment explores an under-appreciated dimension of the the healer being to provide moral guidance on how the
thesis that healthcare systems and provision ought to be agent ought to make up for the wrong. Even some formsAFRO-COMMUNITARIANISM AND THE ROLE OF TRADITIONAL AFRICAN HEALERS IN THE COVID-19 PANDEMIC • 61
of inattention are understood as a form of moral infringe- combination of two elements: identification with others
ment. For instance, the advent of AIDS has sometimes and goodwill towards them (distinguished and recon-
been explained as the result of the mass migration from structed in Metz, 2017). Identification means to be cog-
small to big towns, which involved the neglect of rituals nitively, emotionally and behaviorally invested in ways,
for ancestors, understood by Healers as a moral flaw that share our lives, where our selves are not independent
(Barnett and Whiteside, 2002). Hence, treatment is close- from one another. Rather identities form a continuum
ly related to giving moral guidance to the patients. This and are dependent on each other, centrally by enjoying a
moral guidance will lead the patient to repair broken sense of togetherness and participating cooperatively on
relationships with his social environment (Flint, 2018). projects. Good-will consists of acting and feeling in ways
Other times it is not the wrongdoing of the patient, but that enhance the well-being and excellence of others. It
rather of another person, such as a witch, that is deemed implies that one not only behaves so that others’ good
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responsible for the patient’s illness. Here, the job of a improves, but also desires this to be the case.
healer is, say, to produce charms that will ward off attacks These values have suggested a moral principle that is
or otherwise do what it takes to prevent discord in the well expressed by one influential formulation of an
community (Flint, 2018). Note that the moral guidance African normative ethic:
aspect is not discarded here; routinely, the charms are
An action is right just insofar as it promotes
understood to work only if the patient also behaves
shared identity among people grounded on
according to a certain set of moral rules. For the good good-will; an act is wrong to the extent that it fails
forces will not assist if the patient does not deserve to be to do so and tends to encourage the opposites of
helped because of moral behaviour. division and ill-will (Metz, 2017: 115–116).
What is considered moral behaviour in Traditional
African Medicine is of course linked with local philoso- The principle is consequentialist to the extent that it
phies, i.e., with normative and ontological systems of the requires that one ought to act in ways that promote har-
locality where the medicine occurs (Onwuanibe, 1979; mony. Contrastingly, it classifies as immoral those
Flint, 2018). The dominant indigenous philosophy in actions that promote discord. However, a deontological
sub-Saharan, and especially Southern Africa, is Afro- version is also plausible, according to which one should
communitarianism. Afro-Communitarianism is the honour harmonious relationships or the individuals in-
view that harmonious communal relationships merit sofar as they are capable of them (Metz, 2018). Common
pursuit either as ends in themselves or at least as an es- ground amongst the two approaches is the idea that one
sential means to some other end such as vitality or well- often has a reason to pursue harmonious or communal
being (Metz, 2007; Gyekye, 2011). For Afro- relationships as an end, not merely as a means to some
communitarians, the way one communally relates to other perceived value. Some examples of this way of
others is the moral standard by which to evaluate one’s relating include loving others, possessing courage when
actions and character and thus formulate moral princi- defending others, and being respectful, tolerant, trust-
ples. There are various terms in Africa used to manifest worthy and kind. Notice that the term ‘Ubuntu’ is some-
the moral centrality of communality, but the most com- times used to refer to a positive feature of someone’s
mon is the Southern African one, ‘Ubuntu’. This Nguni character. In South Africa, it is common to hear ‘that
term can precisely be translated as humanness, where person has Ubuntu’, meaning that she has virtue, i.e., is
reference to it signifies that one should live a genuinely someone who is benevolent, friendly, hospitable and
human life and can do so by relating communally or generous, all elements of communal relationship. It is a
harmoniously (e.g., Tutu, 2000: 35). common belief in Southern Africa that character needs to
Hence, the highest good or at least the foremost aim, be, and ought to be, cultivated. It is not sufficient for
from an Afro-communitarian point of view, is to com- morality merely to conform to a certain principle of right
mune and thereby exemplify humanness. For example, action; instead, it is important to acquire the particular
the Nobel Peace Prize winner Desmond Tutu contends, dispositions, emotional, cognitive and behavioral, and
‘Harmony, friendliness and community are great goods. thus to act with Ubuntu towards others (Gyekye, 2011).
Social harmony is for us the summum bonum—the Given that African ethics tends to ascribe final value to
greatest good. Anything that subverts or undermines harmonious relationships, it may be wrongly concluded
this sought-after good is to be avoided like the plague’ that all it implies is the principle of maximizing social
(Tutu, 2000: 35). harmony. However, this is not the way that African
For Afro-communitarians, social harmony or what thinkers tend to understand the implications of the prin-
one owes society tends to be understood to be the ciple. Instead, the principle requires that individuals62 • CORDEIRO-RODRIGUES and METZ
acquire certain characteristics, and, without such char- in Africa are individualist (Oguejiofor, 2007), while
acteristics, the promotion of the value is not possible in others accept that they are communitarian but maintain
the relevant sense. In other words, the promotion of so- that they are inappropriate for the twenty-first century
cial harmony is best understood, pursued, and achieved (Matolino and Kwindingwi, 2013; Taiwo, 2016). We do
by living as virtuously as one can. Genuine social har- not strive to show that an Afro-communal ethic is the
mony means that individuals not only behave in a so- most philosophically justified, instead merely taking it to
cially harmonious way, but also they have certain human be one plausible approach to thinking about healthcare
dispositions such as to be compassionate and respectful. matters that would continue to resonate with much of
It is only by developing a certain form of virtue that the sub-Saharan population.
individuals will be able to act in ways that are
truly harmonious.
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The virtues usually mentioned by Afro- Traditional Healing and COVID-19
communitarians are generosity, compassion, benevo- Afro-communitarianism, the value system normally
lence, tolerance, kindness and good-will, roughly ones underlying Traditional African Medicine, provides a
that bring people closer together. These are salient in the moral framework that is compatible with the current
writings of various African intellectuals. Kwame Gyekye,
prescriptions to address COVID-19. Firstly, Afro-
one of the most prominent Ghanaian philosophers, con-
communitarianism, as a communal driven ethic that
tends that that for his Akan people, ‘ideal and moral
puts relationships of identity and good-will as the high-
virtues can be said to include generosity, kindness, com-
est value, prescribes forms of behaviour that are not ego-
passion, benevolence, respect and concern for others’
istic but instead positively oriented towards others for
(1992: 109). African theologians such as Mluleki
their own sake. What this means more precisely is that
Mnyaka and Mokgethi Motlhabi concur that social har-
one usually ought to act in friendly ways, that is, to act in
mony ‘is best realised in deeds of kindness, compassion,
harmony with others and to enable others to live harmo-
caring, sharing, solidarity and sacrifice’ (Mnyaka and
niously as well. This ethic promotes a sense of common
Motlhabi, 2005: 227). Most famously, Tutu says that
responsibility and reciprocity and, thereby, social obliga-
when one affirms in Nguni that one has Ubuntu (‘Yu u
tion (Sambala et al., 2020). This is an important moral
nobuntu’), one is actually affirming that ‘this person is
groundwork to have regarding COVID-19 precisely be-
generous, hospitable, friendly, caring and compassion-
ate’ (2000: 35). cause, as a highly contagious disease, the framework of
Traditional African Medicine is informed by local thought to prevent it has to be communally driven. The
philosophy and, particularly, by this Afro- actions that can prevent the spread of COVID-19 are
communitarianism. Afro-communitarianism empha- those prompted by consideration of the impacts of the
sizes that morality is concerned with action and the disease on people in the community. Everyone is affected
way it flows from character. For individuals to be moral, by the infection and it has caused the disease, and every-
they need to act, perceive and feel in a certain way. one has an obligation to help fight them. The Ubuntu
Further, it emphasizes that what matters is that individ- ethic entails that a genuinely communal orientation
uals relate to others in the right way, and the right way is would involve making social and economic sacrifices ne-
through virtues that mirror family relations of identity cessary to save many other people’s lives and that doing
and good-will as an aspirational archetype. Particularly, so would in fact be the best for the agent herself in an
it emphasizes acting in friendly, generous and respectful important sense. It is only if one makes sacrifices for
ways as instances of prizing harmonious relationships. others, by behaving in social distancing ways that
So, wrongdoers, traditionally thought to be responsible COVID-19 can currently be prevented. Social distancing
for illness and injury, are those who fail to act in these can be burdensome, meaning losses of connection with
ways and lack Ubuntu. Although we do not invoke this others and of income, but doing so is essential to avoid
metaphysical claim in what follows, we think the Afro- putting others at serious risk. It is worth remembering
communitarian ethic plausibly should guide responses that contributing to the good of those in our community
to the COVID-19 pandemic and in any event must not be is one way of cultivating virtue (ubuntu) in ourselves, the
ignored when engaging with indigenous African peoples. highest good for Afro-communitarianism (Mokgoro,
The African continent being enormous, with 54 coun- 1998: 16–18; Tutu, 2000: 35; Mnyaka and Motlhabi,
tries and thousands of linguistic groups, there are nat- 2005). It is a plausible claim, philosophically speaking,
urally some Africans who reject communitarianism. For but also would likely be of use when motivating Africans
instance, some thinkers maintain that the deepest values and those with similar worldviews. Moreover, accordingAFRO-COMMUNITARIANISM AND THE ROLE OF TRADITIONAL AFRICAN HEALERS IN THE COVID-19 PANDEMIC • 63
to Afro-communitarianism, as everyone has this social or badness of the other is a continuation of our own.
responsibility for the good of the community, it, for ex- Hence, one ought to invest in cultivating the aforemen-
ample, recommends that all should seek to test COVID- tioned core virtues of generosity, compassion, benevo-
19 (unless scarce resources require prioritizing in some lence, tolerance and kindness in order for others to be
way), as this would be valuable to society. Indeed, the well off and thereby for one to exhibit human excellence
recommendation of WHO was precisely to incentivize (or ubuntu). Note how this is relevant to the COVID-19
massive testing to control the pandemic. On top of this, pandemic: it provides a logic for cooperation with
self-quarantine is understood from an Afro- others, as genuine success and survival are possible
communitarian viewpoint, as a communally good only under cooperative conditions (Sambala
form of behavior in a pandemic context to prevent the et al., 2020).
spread of infections to others. The communal explan- Thirdly, the idea that we ought to identify with others
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ation, here, is that quarantine is the right action to the implies for Afro-communitarians is an ethics of inclu-
extent that it protects the good and survival of others in sion that prescribes that individuals look at all other
the community. humans as equally valuable beings, with whom we
Secondly, Afro-communitarianism is an ethic that should make efforts to share goals (Sambala et al.,
puts solidarity as the centre of its prescriptions and pro- 2020). It is not merely those in one’s society who matter,
vides a moral and a logical requirement for cooperation but rather everyone is thought to have a dignity that
(Sambala et al., 2020). More precisely, it not only con- merits respect and hence has a claim of some weight to
siders that people have a duty to behave in cooperative harmonious interaction or at least the avoidance of dis-
ways towards the community, but also that, as a result of cord (Gyekye, 2011: sec. 6). Hence, discordant behaviors
one’s relational and connected nature with other indi- that consist of excluding others, such as leaving
viduals, this cooperation is understood as fostering sur- migrants, the elderly, the poor, disabled and other
vival and good lives. In terms of moral requirement for socio-economic disadvantaged aside, are considered
cooperation, note that by placing solidarity at the centre morally wrong from an Afro-communitarian point of
of its ethics, Afro-communitarianism prescribes that one view. This impartial dimension is crucial for addressing
acts in generous, kind and benevolent ways. This, in turn, the spread of COVID-19; note that albeit the socio-
could help address COVID-19. Particularly, this could economic advantaged are more protected from being
mean, for example, helping those at more risk of becom- infected because of sanitation and possibility of isolation
ing infected by doing their grocery shopping so that they conditions without suffering higher economic costs, the
do not go out. In addition, it could naturally mean highly contagious nature of COVID-19 implies that it is
donating to charities or helping distribute food to the not possible to overcome the pandemic unless there is a
hungry. Still more, it could involve taking steps to ensure holistic approach to it. Forms of social cooperation as
that one does not get infected, not so much because of well as access to healthcare, such as antiviral treatment
self-interest, but because one could then make scarce benefits, cannot be based on exclusionary rationales that
ventilators and other medical resources available to those ostracize people. That is, it is sufficient for some to be
who unluckily need them. When it comes to those in infected for all to be potentially infected, meaning there
business selling medical supplies, like masks and alcohol, are both self-regarding and other-regarding reasons to
for the public, they should not do such in a profit-driven give some real consideration to those who are not com-
manner, but instead think about promoting communal patriots. The inclusive dimension contrasts, for example,
relationships or harmony. Likewise, the ethic prescribes with liberal nationalism (Miller, 2013), and in fact with
using one’s own resources for the good of others in the many countries’ current policies of exclusion of
community, meaning, for example, that those who have migrants during the pandemic, who wish to give priority
the ability and means to make masks ought to undertake in healthcare attendance to national citizens while doing
such activities that can aid their communities. nothing or very little for other individuals.
In terms of providing a logic for cooperation, note Fourthly, an African ethic such as ubuntu is under-
that for Afro-communitarians the good of the self and stood to prescribe deference to elders and to act in pro-
the good of the community are to a significant extent the tective ways towards them (Wade, 2009). This can be
same. This idea well captured by the African art motif of seen in the famous practice Ukweshwama, where Zulu
the Siamese Crocodile with two heads and one stomach. young men kill a bull with their bare hands with the
The art motif is supposed to represent how humanity is purpose of protecting the Zulu King from being killed
ontologically and ethically connected. Whatever the by a lightning strike (Cordeiro-Rodrigues, 2018). As the
head of one crocodile eats affects the other; so, goodness elder generations are much more vulnerable to the64 • CORDEIRO-RODRIGUES and METZ
effects of COVID-19, healers could be enlisted to facili- communication at this point with these Traditional
tate networks of help for them. Elders are given such a African Healers should be to avoid herbal treatments,
significant role for a variety of reasons, but one of the but to inform government of ones they suspect would
main ones is that they are the primary vehicles of trans- be promising, so that they can be empirically tested.
mission of moral learning; for much of moral wisdom To have individuals with such roles guiding social
and virtue is acquired through experience, which comes interactions during the COVID-19 pandemic is crucial
with age. Respect for elders is of strong importance in because they have the social trust of communities and
African worldviews, the thought being that older people the power to influence people in the right direction.
are characteristically wiser and morally better than Firstly note that for measures to be successful, they
younger people (they have more ubuntu). Surely, this need the cooperation of the population and this cooper-
is also relevant for the prevention of COVID-19 as elders ation highly depends on whether people think the meas-
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are in the most vulnerable group and Afro- ures being taken are fair or not and whether they believe
communitarianism prescribes them special protection. others will cooperate (Sambala et al., 2020). Take the
In short, Afro-communitarianism is the philosophy example of the Ebola outbreak in Guinea, Liberia and
that informs Traditional African Healers’ practice, and, Sierra Leone in 2014–2015. The suspension of civil lib-
as these examples demonstrate, the moral prescriptions erties has been largely understood as unfair and dispro-
based on generosity, self-sacrifice, benevolence as kinds portionate by those populations; consequently, there
of communal goodness are compatible with and, indeed, was significant refusal to comply with health measures
helpful for preventing the spread of COVID-19. Given leading to less success of the quarantine measures (Cohn
that much of Traditional African Healers’ practice and Ruth, 2016). With respect to the lack of cooperation,
involves giving moral advice to their patients, these take the example of the rules of the road in early twen-
and other forms of communal aid are something that tieth century Europe, when drivers did not have reasons
Traditional African Healers could prescribe, as they are to believe in others’ compliance and therefore generally
compatible with their philosophy. Beyond the fact that did not follow them (Chwe, 2003). Owing to the fact that
the ethical philosophy associated with Traditional Traditional Healers have an important cultural capital in
African Medicine entails prescriptions that are helpful many communities, this provides moral authority for
for the prevention of COVID-19, it is also the case that the measures and hence reason to believe that others
these healers tend to be the individuals in African com- would comply. That is, given the role of the
munities in the best position to prescribe them. Traditional Healers, people would more likely comply
Healthcare measures need to be culturally sensitive to with the rules, expecting that others will also follow.
work, and because healers normally have substantial Traditional African Healers are uniquely positioned
socio-political capital in African communities, they to do this by demonstrating what local cultural values
have the ability to influence behaviour. Healers are imply for medical treatments, public health interven-
powerful individuals in communities who can lend sup- tions and social cooperation. The aforementioned
port to, or alternately challenge, the legitimacy of rulers, examples of acting in harmonious ways, donating to
set rules for social interaction, and be judges of local charities, helping distribute food to the hungry, doing
crimes. Traditional Healers have a role that has been their grocery shopping, taking care of the elderly, self-
part of African culture for a long time; this is particularly quarantining and so forth, are prescriptions that
true in South Africa, where Traditional African Healers Traditional Healers are in the best position to prescribe.
helped to construct the Zulu Kingdom and resisted co- This is particularly telling in the prescription to take care
lonial occupation (Flint, 2018). of elders. Traditional African Healers could be asked to
Since forms of treatment and vaccination for COVID- help educate their communities about how to avoid
19 are now being rolled out, such that using alternative exposing the elderly to the virus, and to encourage peo-
medicines at this point might even worsen the impact of ple to run errands for them so as to minimize their risk of
the virus, our suggestion is not to use herbal medicines to exposure. The healers, therefore, could have the peda-
treat COVID-19 without empirical confirmation of ef- gogical and also the practical role of showing people how
fectiveness. We reject the promotion of the concoction to demonstrate respect for elders in a context where the
that the government of Madagascar has touted as a cure latter are particularly vulnerable to the pandemic.
for COVID-19 in the absence of demonstrable evidence Traditional African Healers also have the cultural cap-
that it works. Our recommendation is instead that, in the ital and authority to postpone or cancel some cultural
light of the socio-political influence held by Traditional and social practices that may have been planned and that
African Healers in African communities, the could contribute for the spread of COVID-19. There areAFRO-COMMUNITARIANISM AND THE ROLE OF TRADITIONAL AFRICAN HEALERS IN THE COVID-19 PANDEMIC • 65
many communal rituals, such as births, marriages and Traditional African Medicine appear significantly differ-
funerals, which normally involve a significant amount of ent from current forms of scientific enquiry. On top of
people and could propagate COVID-19. Particularly for this, many Traditional African Healers do not have sci-
these rituals, culture has a strong influence and people entific training, sometimes using ‘cures’ that either wor-
do not really tend to act against what they consider to be sen health problems or do no good but cost money and
right, where traditional practices characteristically have offer false hope.
some moral weight in African thinking (biti, 1990). Another harm to others objection is that it is an illu-
Nevertheless, Traditional African Healers, as moral sion to imagine that African Traditional Healers will be
authorities in the community, can have a crucial role willing to contribute to the fight of COVID-19; the re-
for people to accept that such practices ought to be car- inforcement of traditional medicines in Africa is partial-
ried out in a different way, postponed or even cancelled ly due to the racist use to which Western medicine had
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altogether. This is a role an outsider cannot easily play, as sometimes submitted Africans (Tangwa, 2017). One of
it would likely be interpreted as a colonial intervention the reasons why many black people go to African
and hence disrespected. Traditional African Healers Traditional Healers is because of their distrust of
might explain how the moral requirement to exhibit soli- Western Medicine as this had routinely used black sub-
darity with others is now best done by distancing oneself jects for medical experiments. In fact, in a debate on the
from them. Traditional African Healers might also point French television, two doctors recommended that
out that social distancing, despite on the face of it being COVID-19 vaccines should be tested in Africa rather
morally problematic for preventing rituals, is essential to than the rest of the world (BBC News, 2020; Okwonga,
prevent an even greater distancing in the forms of death 2020). Even if the intentions of the doctors were to bene-
and severe ill-health. Additionally, some of the behav- fit African people, widespread reactions were ones of
ioural practices undertaken by healers can indirectly anger, fear and distrust. Hence, African Traditional
contribute to the prevention of the virus. One of the Medicine’s identity is one that emerges in opposition
methods Traditional African Healers use is to change to Western medicine, as a prophylactic; this is something
that African Traditional Healers know and so one might
the organization of the household in terms of the posi-
suspect that they will not undermine their market by
tioning of objects and interactions between family mem-
cooperating with Western medicine. Consequently, per-
bers (Flint, 2018). At the moment, especially if there are
haps it is more reasonable to expect that these healers
infected individuals in the household, the inner geog-
will continue engaging in harmful cultural practices
raphy of the house and the interactions ought to avoid
than in any social distancing measures recommended
the use of the same objects and the same space. Healers
by the WHO.
could give such instructions during the COVID-19 pan-
In reply, the research carried out by WHO in fact
demic and thereby help to prevent contamination.
points to evidence different from one of harm (WHO j
Traditional Medicine, 2014). Surely, sometimes there are
A Concern about Harm to Others harmful practices involved, but the use of Traditional of
African Medicine can often be more beneficial than
One possible objection to our argument is that tradition- harmful. It is important to point out that the underlying
al healing would contribute to the spread, rather than philosophy of Traditional African Medicine is not in-
containment, of COVID-19. One of the issues regarding compatible with the prescriptions of Western medicine
harm to others in the context of COVID-19 is the fact regarding COVID-19. First off, ethically speaking, the
that many healing rituals require communal interactions communal driven prescriptions can be abstract enough
which, during this period, are problematic. Take, for to require social distancing. What matters is roughly that
example, the Ngoma dance, which is a public event harmonious relationships are built up and discordant
used by some Healers in Southern Africa that involves ones reduced, but if these aims can be achieved only
touching and a performance to wake up the spirits and with temporary social distancing, then there is nothing
get rid of various diseases. There is, therefore, the con- contradictory with being a communal driven ethics and
cern that because of the communal nature of African in fact asking for social distancing. Consequently, the
philosophy and the communal treatments sometimes fact that many practices are communal-driven and could
prescribed by African healers, including Traditional contribute to a spread of the disease is not an issue be-
African Medicine in the prevention of COVID-19 may cause what matters is the respect for the principle of the
do more harm than good. Furthermore, at the ontologic- community, and this can mean different things in differ-
al level, the cosmology and notions of causality of ent circumstances.66 • CORDEIRO-RODRIGUES and METZ
Secondly, we note that the metaphysical philosophy and in fact helped contain the pandemic in South Africa.
behind much traditional healing in Africa means that For example, many of the Traditional African Healers
shamans are generally receptive to empirical data. were quite important in teaching communities how to
Often the view is that, even if a witch or some ‘spiritual’ use condoms and how not to engage in sexual risky be-
agent sought to harm a person, they would employ some haviour (UNAIDS, 2000). Although there were prob-
physical mechanisms, such that using the scientific lems at times, we submit that greater communication
method to inhibit those mechanisms would be welcome. and regulation would be expected to make the benefits
To use an example well known to African philosophers, worth the costs. Likewise, in the case of Ebola, healers
consider that a mosquito has bitten a person and spread were extremely active in informing and involving the
malaria (biti, 1990: 165). Traditional African Healers community in the containment of it (Tangwa, 2007).
would readily accept the notion that the mosquito car- Hence, there has been in the past a clear link between
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ries a parasite that has entered the person’s bloodstream. local participation from community intermediaries and
What they and many other Africans would question is individuals with cultural capital, such as Traditional
whether that is the end of the matter. ‘Why did the mos- African Healers, and the prevention of serious diseases
quito bite this person and not some other one?’ they will (Tangwa 2007; WHO j Traditional Medicine, 2014).
be inclined to ask. Answering such a question is typically Thirdly, it is an advantage rather than a disadvantage
thought to require reference to agency of some kind. For for African Traditional Healers to be integrated in the
instance, either the person bitten acted wrongly and is health systems of the countries. This would give them
being punished by the ancestors, or someone is acting more resources and a higher reach of clients. Thus,
malevolently and using magic to direct the mosquito to healers could have an economic incentive to collaborate
harm an innocent party. with Western medicine. In fact, looking at the case of
Now, explaining the disease in terms of a person hav- China, Traditional Chinese Medicine is often incorpo-
ing ‘sent’ the mosquito to bite a person is unfounded by rated in the healthcare system and this has substantially
what appear to us to be humanity’s best methods of benefited these healers for the aforementioned reasons.
empirical enquiry. However, our point is that such a Furthermore, note that what historical evidence suggests
teleological explanation, in terms of an agent’s purpose, is that it has been Western medical professionals who
need not undermine the mechanistic explanation that have been resistant to the inclusion of traditional med-
Traditional African Healers would also readily accept icines in public healthcare systems, not the opposite.
(Sogolo, 1993: 91–118). If a witch is out to do mischief, Looking at the case of British colonialism, although there
Traditional African Healers could well prescribe chloro- were various attempts of Traditional African Healers to
quine to fight the malaria, and if a person has acted collaborate with Western doctors, colonial authorities
wrongly and incurred the wrath of ancestors, have often criminalized such collaborations or prohib-
Traditional African Healers could prescribe the same, ited altogether traditional medicine (Flint, 2018). More
at least consequent to the person having made amends recently, although there is an increase in healthcare pro-
and sought to reconcile with those whom she is per- fessionals accepting alternative and complementary
ceived to have wronged. Similar remarks apply to the modes of treatment, it is often the case that they show
causes of and cures for COVID-19; using mixed methods significant scepticism towards the inclusion of treat-
to treat patients need not mess things up, as different ments beyond Western medicine (Clark, 2000; Stewart
views about why a disease is present are compatible with et al., 2014; Aveni et al., 2017). Take for example, the case
similar views about how to treat it. of the National Health Service (NHS) in the UK.
The objection of the unwillingness of Traditional Homeopaths have struggled to establish a secure pos-
African Healers to cooperate with the WHO and similar ition in the NHS partly because of the common rejection
organizations can be replied to in four ways. Firstly, note by other professionals of their presence (Crawford,
that the criticism relies on a premise that is not totally 2016). Although we are not suggesting the acceptance
accurate; although there are some Africans who totally of homeopathy or any medicine across the board, there
reject Western medicine because they are sceptical about are likely things to learn from non-Western approaches
its intentions, there are also many Africans who use that have been practiced for many generations.
Western medicine in conjunction with local modes of Fourthly, the failure sometimes of Traditional African
healing. Secondly, broadly speaking, Traditional African Healers to comply may have had to do with the way that
Healers have been receptive to dialogue and contributed the dialogue had been carried out. On the one hand,
substantially in avoiding the spread of other pandemics. there had been some approaches that failed where the
In the case of HIV, many healers have received training dialogues were carried out in an arrogant way, with signsAFRO-COMMUNITARIANISM AND THE ROLE OF TRADITIONAL AFRICAN HEALERS IN THE COVID-19 PANDEMIC • 67
of disrespect towards the healer. Contrastingly, more and instead spread information about their condition,
successful approaches have followed ritual ways of talk- particularly to family members. There have been reports
ing and were informed about how to formally address that in the case of HIV, Traditional African Healers have
the healer. Note that reception of science-based medi- spread information about those who are infected
cine in Africa has been largely dependent on how it is throughout the community. Also, their practices tend
offered and who has offered it. Many Africans remain to be paternalistic in the sense that patients of
sceptical about white doctors and other elites giving ad- Traditional African Healers are at times not fully
vice, as they are perceived as colonial interference (Flint, informed about the practice and there is a presuppos-
2018). Taking this on board, the success of the cooper- ition that the healer knows the best, which flouts current
ation depends very much on the approach to speak to the medical ethics at least in the West (Nyika, 2007; Shahvisi,
healer rather than a pre-unwillingness of the healer to 2016). Since the 1960s, Western medicine has changed
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engage in dialogue. So, in the first instance, Traditional its paradigm and now looks at the relationship between
African Healers should be approached by those Africans patient and doctor in a more equal manner, where the
who ‘live in two worlds’, both indigenous and ‘modern’ patient needs to be informed about the treatment and
ways of interpreting reality. the disease. Contrastingly, in African Traditional
The various ways that Traditional African Healers Medicine the healer does not necessarily inform and
could address the emergency situation in Africa suggest might simply act as the one with unquestionable know-
that governments there ought to involve them urgently in ledge received from elders.
the combat against the pandemic. Similar to what hap- In reply, first, note that during the pandemic, the con-
pened with the previous pandemics, such as HIV/AIDS, fidentiality of patients is not being strictly followed, even
governments ought to provide platforms for good com- in places such as Europe and North America. Crucially,
munication and to deliver training to healers to optimize this is because in many countries COVID-19 is included
and upgrade their skills regarding COVID-19. in the category of compulsory reported diseases. Ethical
Governments should also facilitate and integrate trad- considerations demand that people know who is
itional medicine and national health care systems, with a infected, particularly since it is now clear that asymp-
system of licensing, legislation and registration of these tomatic individuals can spread it. Most countries have
healers. It is equally important to supervise the activities to policies for compulsory reporting of diseases that can
guarantee the quality assurance of the practices and sim- put at risk public health, particularly where there is a
ultaneously provide consumers a reliable information on high incidence of the disease, little information about
the proper use of traditional therapies and products avail- how it is spread and little assurance of cautious behav-
able (WHO j Traditional Medicine, 2014). iour from the infected individual. This approach sug-
It may still be objected that there is no way to control gests that the actions of the Traditional African Healers
which Traditional African Healers will follow the guide- of failing to follow confidentiality guidelines may be
lines and which will not. Although this is true, note first justified on grounds of preventing the spreading of the
that this is not different from Western medicine; having a disease. Indeed, even in Western medicine is the case that
medical degree does not guarantee that a code will be if an HIV person is putting others in danger, there is
followed. Hence, the point is that there is a need for a justification from health practitioners to disrespect con-
supervision, both for Western and Traditional medi- fidentiality if necessary to protect an innocent party. The
cines, to be accompanied with the practices. Moreover, case of COVID-19 is not so different, as there are
the existence of any harmful practices on the part of reported cases of people who have received home treat-
Traditional African Healers calls for their regulation, ra- ment for the virus but violated the law by leaving their
ther than prohibiting or side-lining Traditional African homes and contacting with others. Furthermore, com-
Healers. Given that a substantial portion of African pop- paratively speaking, the value of confidentiality is less
ulations will go to these healers anyway, it would, we important than the value of life, meaning that, if infring-
submit, be better to improve the ability of healers to do ing confidentiality were necessary for saving lives, doing
some good rather than make their practices subversive. so would be justified. So, if there are indeed life and death
benefits of involving healers despite their tendency to
A Concern about Confidentiality infringe confidentiality, in this emergency situation it
is justified to drop the confidentiality guideline.
and Paternalism Regarding paternalism, although since the 1960s there
Another kind of concern is that Traditional African has indeed been less paternalism in Western medicine, it
Healers tend not to respect the privacy of their patients would be unreasonable to think that it can or even should68 • CORDEIRO-RODRIGUES and METZ
be entirely eliminated. For example, sometimes what are On top of this, the best way to address severe cases of
called ‘nudges’ are intuitively justified, particularly ones paternalism would be to engage with Traditional African
where life is at stake (Thaler and Sunstein, 2009). It can Healers, and probably to regulate them, as opposed to
be reasonable to place small obstacles in the way of peo- leave them outside of a country’s public healthcare sys-
ple inclined to make poor decisions, or conversely to tem. Here, an analogy can be made with drug use.
make it somewhat easier for them to make good deci- Looking at the case of Portugal, where drug use has
sions. Although we accept that nudges are controversial, been decriminalized and included in the healthcare sys-
and note that nudges are not clearly at stake in the con- tem as a medical condition, the use of drugs as well as the
text of Traditional African Healers, the fact that they are deaths associated with them have decreased substantially
taken seriously as public policy strategies in the West (DiÄrio da RepÇblica, 2020; SICAD, 2020; Ferreira,
reveals that it is not paternalism as such that is clearly 2017). Contrastingly, in countries where the use of drugs
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objectionable, even by Western norms, particularly is less regulated and instead is criminalized, this has often
when the intervention is essential to protect the basic led to an increase in both abuse and death. Moreover,
ability to reflect on one’s choices and act in the light of this exclusion and criminalization tend to give the rise to
such reflection (cf. Nys, 2008: 67–68). parallel markets that normally worsen the quality of the
Some forms of paternalism are softer than others and products as well as help create criminal organizations
might well be justified when necessary to prevent great around them, just like in the case of the prohibition
harm. Consider that from an Afro-communal stand-
laws for alcohol in the United States from 1920 to
point, we are obligated to relate to others not merely in
1933, which contributed to the rise of the mafia
cooperative ways (sharing an identity), but also in ways
(Thornton, 2014; Buccellato, 2015). By analogy, if
expected to meet their needs (exhibiting good-will). In
Traditional African Healers are not legalized and regu-
the ideal case, one would not have to make any trade-offs
lated, they will be driven underground and offer an in-
amongst these relational values, but sometimes one must
ferior product to patients in need of treatment.
balance them. In cases where great harm to others could
be averted only by relating to them in somewhat less than
fully cooperative ways, a characteristically African ethic
would allow––indeed probably require––doing so. A re- Conclusion
quirement to balance considerations of shared identity
COVID-19 is a pandemic that has had a massive inter-
and good-will would permit minor infringements of the
national impact on the health of individuals. Although
former for great gains to the latter, but would forbid
there are some general guidelines on how to address
major infringements of the former for marginal gains
COVID-19, it is crucial that these are also adapted and
to the latter, which we submit is a plausible approach
sensitive to cultural diversity. In this article, we looked at
to matters of paternalism.
Moreover, a pandemic is a time of emergency ethics, the case of COVID-19 in Africa to probe the potentially
similar to a war. In war situations, given that decisions beneficial contribution of Traditional African Healers to
need to be taken fast, it can be justified to break some fighting COVID-19, an approach that has routinely been
ethical codes for the higher good. For example, when neglected so far. Our argument has been that Traditional
there is a genocide about to happen in a certain country, African Healers can provide an important contribution
it may be justified to violate the sovereignty of the state to the prevention of COVID-19. Given the cultural cap-
and the liberty of all its citizens on grounds of avoiding ital of these healers, they could play an important role in
the genocide. Likewise, it is probably justified to violate local communities to inform and guide people to act in
norms forbidding paternalism, as well as those requiring ways that would help to contain its spread. Moreover, we
confidentiality, precisely if the cost of not doing so is the argued that owing to the fact that Traditional African
lives of a significant number of people. Interventions in Medicine is culturally informed by local philosophies,
respect of the coronavirus are to be done not just for the we have also demonstrated how the ethics of Afro-
sake of the patient but also for the many that she could communitarianism (the philosophy that mainly informs
infect. In the case of COVID-19, there is also the issue of Traditional African Medicine) has philosophical resour-
fake news and ill advice being quite harmful for prevent- ces to deal with this pandemic and is consistent with
ing the spread. Thus, in this current situation a pater- much scientific explanation. Further research should
nalistic approach would often be further justified given focus on how Traditional African Healers could be sys-
the context. tematically integrated into medical systems in Africa.AFRO-COMMUNITARIANISM AND THE ROLE OF TRADITIONAL AFRICAN HEALERS IN THE COVID-19 PANDEMIC • 69
Funding Crawford, L. (2016). Moral Legitimacy: The Struggle of
Homeopathy in the NHS. Bioethics, 30, 85–95. https://
Luıs’ research has been funded by Hunan University’s doi.org/10.1111/bioe.12227 [accessed 1
Fundamental Research Funds for the Central October 2020].
Universities, fund number 531118010426. 本 文受湖 DiÄrio da, R. (2020). ‘Lei 30/2000, 2000-11-29’. DiÄrio
南大学‘中央高校基本科研业务费’专项资金资助 da RepÇblica EletrÆnico. 2020. https://dre.pt/pes
(531118010426) quisa/-/search/599720/details/maximized [accessed
1 October 2020].
Ferreira, S. (2017). Portugal’s Radical Drugs Policy Is
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