Does Decolonisation Include Indigenising?

Note: Continuing the Miami Institute forum on “What does it mean to decolonize global public health?,” Mmatshilo Motsei adds to David McCoy’s essay, “An Anti-Colonial Agenda for the Decolonisation of Global Health” (October 2023) by stressing that “decolonisation of health is not only about challenging the colonial epistemic view of the West as the origin of knowledge. Instead, it is also about a re-assertion and inclusion of Indigenous people’s knowledge of health and wellbeing. Without including the suppressed and repressed knowledges, decolonial debates run the risk of maintaining and reproducing continued erasure of such knowledge.”

This article gives us an opportunity to reflect on the historical impact of international declarations on people that these declarations purport to serve. At the outset, the article reviews Alma Ata Declaration which was adopted at the time when the year 2000 seemed far off. Looking back at what was happening in the late 70s globally, we see glimpses of global economic crises characterised by gross inequalities, political coups across Africa, and the height of apartheid in South Africa. Forty-six years later, in 2024, global inequalities and poverty continues unabated, and the world is engulfed in war in many countries. These, and other related political and socio-economic factors have adverse impact on the state of global health.

Considering the global political era in which the Alma Ata Declaration was adopted, the paper refers to the fact that even though the declaration did not mention the words colonial and colonialism, it was an anti- colonial expression of global health. Here, the author points to the Declaration’s equity-oriented and bottom-up approach using culturally appropriate technology. Fundamental to colonialism, the paper argues, is a power imbalance that allows for relationships of domination and exploitation. Such an imbalance of power is witnessed in the global markets, colonisation of the digital space and colonisation of knowledge.

For Africa, relationships of domination, exploitation and extraction of wealth continues in the post-colonial era. Countries such as South Africa have become increasingly unequal with policies that legitimise exploitation of the poor (who are mainly black) and an extractive means of economic production which largely remains under the control of white people. Gumede (2021) argues that inability to reduce poverty, unemployment and inequality in post-apartheid South Africa is a result of weak performance of the economy as well as an economy structure which has kept levels of income inequality high[1].

While I agree with the contention that the Declaration challenged inequity at the time of its adoption, I argue that this Declaration, and many others that followed, uphold the notion of Western biomedicine as authoritative. Colonialism came about at the time when the germ theory of disease and the use of drugs, including vaccination campaigns, dominated health care in Europe.[2] This model of health care was exported to Africa during colonialism. Indigenous medicine, which existed before colonialism, was criminalised while biomedicine was declared as safe and superior. In the process, a Western theoretical framework about disease causation was incorporated into medical education and practice.[3]

In their role as subjects of the empire, medical missionaries and colonial doctors perceived the use of Indigenous medicine as an obstacle to the conversion to Christianity.[4] By defining biomedicine as a gift from God, they used their medicine to wean Indigenous people from their religion and culture.[5] To this day, health care is still not developed with or for Indigenous communities. Where decolonisation is included as part of medical education and/or practice, it is often added as an appendage and not as a critical tool required to dismantle a historical hierarchy of knowledges.

Even though the terms decolonisation and Indigenisation have been part of the discourse in South Africa for a few decades, this debate was recently heightened by the Rhodes Must Fall and Fees Must Fall student protests. Other than increasing academic awareness and debates on decolonisation of the curriculum, these protests also contributed to the transfer of the discourse beyond academia. Currently, there is a mushrooming of civil society and social movements focused on the broader ideal of decolonisation. Chilisa (2012) outlines five stages in the process of decolonisation.[6] These are:

• Rediscovery and recovery – the colonised rediscover and recover their own histories, identity, and language. This involves interrogating the “captive mind,” a process that eventually leads to the colonised defining reality in their own terms.

• Mourning – this focuses on historical oppression and assault of Indigenous people. According to Chilisa, oppression of Indigenous people and suppression of their knowledge amounts to scientific colonialism. In my research on exploring the role of Indigenous midwives in countering obstetric violence in South Africa, I struggled with using a conceptual framework that privileges Eurocentric ways of knowing to search for knowledge that is founded on Indigenous ways of being and knowing. The result was epistemic trauma which emanated from a feeling of being sandwiched between opposing epistemologies. I loathed the idea that those who have not been colonised do not face the same dilemma. In the end, I employed the use of Indigenous research methodology as a way of dealing with what Wanda Pillow refers to as epistemic witnessing of theoretical oppression.[7]

• Dreaming – invoking histories and related Indigenous knowledge to theorise new possibilities. In my case, my dreaming is about imagining an existence of a birth centre that caters for the biological, cultural, and spiritual needs of a birthing mother, her family and community.

• Commitment – In their commitment to bring about social transformation, Indigenous knowledge seekers become political activists. This involves a commitment to amplify the voices of Indigenous people. To use my example, my commitment is to organise a series of dialogues between biomedical and Indigenous midwives. The overall aim is to decolonise maternal health care in a way that does not erase, suppress or denigrate Indigenous knowledge of birthing.

• Action – This is when dreams and commitment translate into strategies for broader social transformation.

From the above, we can deduce that decolonisation of health is not only about challenging the colonial epistemic view of the West as the origin of knowledge. Instead, it is also about a re-assertion and inclusion of Indigenous people’s knowledge of health and wellbeing. Without including the suppressed and repressed knowledges, decolonial debates run the risk of maintaining and reproducing continued erasure of such knowledge[8]. In its operation as an anti-colonial struggle, decolonisation of global health must therefore honour Indigenous approaches to disease causation and treatment. This encompasses their symbiotic relationship with nature, including responses to land dispossession as well as overall loss of indigenous sovereignty.

The brutal impact of colonialism on subjugation of Indigenous people and their knowledge has resulted in cultural genocide. Many debates on decolonisation continue to exclude a need to dismantle hierarchy of knowledges between biomedicine and Indigenous models of health. Decolonisation can therefore not exist outside of a framework that re-asserts and privileges Indigenous epistemologies.

-Mmatshilo Motsei

Dr. Mmatshilo Motsei is author, midwife, Integrative healer, Indigenous research scholar and Executive Director of Afrika Ikalafe Pluriversity in South Africa.

Endnotes:

[1] Gumede, V. (2021). Revisiting Poverty, Human Development and Inequality in South Africa. Indian Journal of Human Development, August, 1-17

[2] Lock, M.M., & Nguyen, V.K. (2010). An Anthropology of Biomedicine. Wiley-Blackwell

[3] Mc Leery, I. (2015). What is ‘colonial’ about medieval colonial medicine? Iberian health in global context. Journal of Medieval Iberian Studies, 7 (2), 151-175

[4] Marks, S. (1994). Divided Sisterhood: Race, Class and Gender in the South African Nursing Profession. Palgrave Macmillan.

[5] Comaroff, J., & Comaroff, J. (1991). Of Revelation and Revolution: Christianity, Colonialism and Consciousness in South Africa. Chicago University Press.

[6] Chilisa, B. (2012). Indigenous Research Methodologies. Sage Publications, Inc.

[7] Pillow, W.S. (2019). Epistemic witnessing: theoretical responsibilities, decolonial attitude and lenticular futures. International Journal of Qualitative Studies in Education, 32 (2), 118-135.

[8] Sium, A., Desai, C., Ritskes, E. (2012). Towards the “tangible unknown”: Decolonization and Indigenous Future. Decolonization: Indigeneity, Education & Society, Vol 1(2), pp I-XIII