"We Pray at the Church in the Day and Visit the Sangomas at Night": Health Discourses and Traditional Medicine in Rural South Africa

Research within geography and cognate disciplines has worked to demonstrate the significant impacts of human disease on social and ecological systems. Although human disease fundamentally reshapes demographic patterns and regional and national economies, scholarly and policy research has tended to concentrate at the macroscale, thereby reducing attention to local-level dynamics that directly influence health decision making. This absence is notable given the invocation by various governmental agencies of the importance of traditional cultural practices, including the employ of traditional medicine, in responding to illness. South Africa's particular experience is representative of this, with national and provincial governmental agencies continuing to advocate traditional medicine in managing human health. Yet understandings of disease within South Africa remain deeply contested and expose underlying tensions about how health decision making is shaped by varied perceptions of illness and treatment options. This article draws on research that began in 2000 to analyze perceptions of health and the use of traditional medicine within rural areas. I work to uncover the divergent, and often conflicting, views on traditional medicine, and examine how they intersect with sociocultural systems that mediate health decision making. The article concludes that future geographic research on human health needs to engage with the social and cultural systems that contribute in shaping health perceptions and decision-making in various settings.