And this continued, albeit in a more formalized way, in the scholastic controversy of the Middle Ages. This placed new demands not only on the skills but also on the character of the team members. It is this interconnectedness of the entire reality that so profoundly characterizes IC in general, and medicine and healing in particular.
The subtitle of this book explains the character of the book: 'Combining Western and Traditional Practices'. Indeed, according to Buhrmann, it is in relation to the ancestors that the contents of the unconscious are revealed to the African patient. Buhrmann describes the world of Western medicine (and then she is thinking of psychotherapy in particular) as "primarily scientific, rational and ego-oriented", while "the world of the black healer and his/her people".
She is critical of central aspects of Western culture and eager to communicate African strengths. We come now to consider the effects that Buhrmann's immersion in Xhosa healing practices had on him. Acknowledging that the rational and non-rational parts of the psyche are equally important in the totality of the human being.
The ancestor concept of the Xhosa, especially as it is devised and used by the Tiso school for the purpose of healing.
The Ethos Inherent in the European and the African Practice of Health-care
European medicine has achieved colossal success in eradicating epidemics and treating acute conditions. The result of this success has been a shift in the focus of health care to the management of more or less chronic conditions and in the last years of people's lives. In the background of this respect for patient autonomy is the history of modern European culture in general and philosophy in particular.
This insight is beautifully expressed in the following quote from Pico della Mirandola's Oration on the Dignity of Man. We have placed you at the center of the world so that from there you can more easily observe what is in the world. This view is summarized in the saying that umuntu ngumuntu ngabantu – a human being is a human being through (other) human beings.
This means, first and foremost, that my humanity is both a gift and an achievement. It is not present at the beginning, but is gradually realized through my relationships with others - or not. In the African tradition, health care is seen as only one aspect of this comprehensive and lifelong interpersonal interaction that promotes the realization, development and flourishing of humanity in individuals.
In the field of health care, the power for the growth of humanity through interpersonal relationships is directed in special ways - in herbalism, surgery, ritual dances, counseling, etc. The more I find myself in the community, the more the community finds itself in me. Buhrmann painted a vivid picture of how the ubuntu ethic would manifest itself in health care.
Here, however, I must introduce a more critical note, first in relation to the concept of ubuntu itself and then in relation to health care in the African tradition. Others who criticize the ethics of ubuntu in the name of realism are not so innocent. When it comes to the field of healthcare, the shortcomings of the African tradition are quite obvious.
A Health-care Ethic and the Complementarity of the Two Traditions
Thus I hope to combine what is most characteristic of each tradition into a single theory of health care. In the meantime, I will assume its truth and try to show how you can use it to build an ethical theory of health care. Health care ethics, like the entirety of an ethic that is true to the ideal of ubuntu, must be grounded in human nature if it is to promote personal growth and community.
But if the ultimate goal of human health care is to promote personal growth and community, then the psychological factors in human life are actually all the more important. Psychologists and psychiatrists indeed deal more directly with the actual purpose of health care. Rather, it should be recognized that there is a psychological dimension to all health problems and to all health care.
This personal and traditional knowledge is particularly important for health care if health care is to be built on an attitude of reverence and respect for human nature. A health care ethic that seeks to combine the best of European and African ethical traditions must understand my health as my responsibility as well as that of the community. But we both, myself and the team of health care professionals, are responsible for my personal growth and fulfillment and the growth of the personal community between us.
I will refer to the fundamental interpersonal relationship required by ubuntu in health care as 'caring'. Caring in the context of nursing means the desire to actually do good to a person as far as their health is concerned; it is beneficial. Such desire includes a desire for competence and skill in the diagnostic and technical aspects of nursing.
Healthcare professionals occupy an enormous position of power in their field, and it is easy to abuse it. The activity that best expresses the attitude of care is that which is the active service of the patient's health needs as a whole. The actual health care practice that approaches this ethical ideal of health care is the care associated with the modern hospice movement.
In fact, I see it as a model for all health care that considers every aspect of the person and sees health itself as one of the essential factors in achieving personal growth and community. This concludes our exposition of a healthcare ethic in which the European and the African ethical traditions play complementary roles.
Self-determination and Other-dependence
The relationship in which two people meet is therefore a relationship of mutual "transcendence". Everyone is present to the other and in the other and only thus present to themselves and in themselves. If this sounds fanciful, I recommend John Heron's excellent essay 'The Gaze' (Heron 1970), in which he examines the phenomenon of perceiving the other's gaze, and in particular the experience of mutual gaze: I gaze at you, who gaze at me.
It is the ability that people have to transcend their own limitations by becoming present to the thoughts and feelings of another and also by revealing their most hidden thoughts and feelings to another, of true self-transcendence and self-giving, i.e. the essence of African conception. These features of the intersubjective relations of persons reveal a dimension of human nature that transcends the field of scientific inquiry and is incompatible with physicalism or any materialistic metaphysics. For the relational view, the strictly personal unity of the human individual exists through a duality of relations, the relation to oneself, which consists of self-awareness and self-determination, and the relation to that which is other than oneself, which consists of self-transcendence. and self-donation.
And the relationship to oneself is only possible through the relationship to the other, and vice versa.
Conclusion
It concerns the importance of the African relational view of human nature and the ethics of ubuntu it enables. It is my view that this ethic, and this alone, provides a framework for authentic human community in a pluralistic world. The African idea that one can only realize oneself, discover one's true identity, in the other, embodies a spirit essential to the intercultural co-reflection I have spoken of above.
This spirit of openness to the stranger, of readiness to assimilate what is foreign, of creative synergy, is typical of Africa. From an economic or political point of view, Africa often appears as a kind of 'black hole' in the contemporary international cosmos. Throughout the twentieth century, European culture in its current impoverished form took over the world.
Wherever it has gone, it has wiped out local cultures one after another: the Inca culture in South America, the First Nation people in the north, the Aboriginal culture in Australia, the Maori in New Zealand. That is certainly the opinion of Tony Balcomb, the scholar to whom I have already referred. In Africa it is everywhere – existing alongside, in or in opposition to modern forms of knowledge.
And he concludes that "one of the reasons for this may have to do with the African way of dealing with the other, the Other, the strange." I think this is what we need in South Africa to build our rainbow nation.
