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In the markets, Folk found hundreds of healers bartering and selling plants among the vendors' stalls, separated by makeshift walls or stacks of plants and jars. People were grinding muti and eating plants. Some stood with hacksaws in front of dried animal limbs hanging on display.
"It was in virtually every stall," Folk says of sutherlandia.
To study whether the plant worked, Folk needed a doctor who could measure psychological responses and translate the South African concept of quality of life into American terms. Aside from the differences in their preferred health care, Africans are still dealing with the cultural shifts after the end of apartheid in the early '90s. The country's already fragile infrastructure has further deteriorated as people have migrated from rural to urban areas. And though there are institutions comparable to those in the United States, such as universities and hospitals, they're surrounded by poverty and disease.
Folk sent out a call to Missouri's universities when he first considered studying the plant in 2002.
"Kathy surfaced as the person who had the expertise and had the interest," Folk says. "She knew AIDS. She's been working on it her entire career and she's done it everywhere."
Folk's open call was the first time that Goggin had heard of sutherlandia. She started visiting South Africa soon after and now travels there at least three times a year.
Folk and Goggin wrote a grant proposal, and the National Institutes of Health awarded the University of Missouri-Columbia $4.4 million to conduct research with the University of the Western Cape. Most of the work would be with a hospital, Edendale, one of the few in South Africa where healers and Western-trained doctors coexist. The hospital was also home to a tuberculosis ward, a large, open room where the majority of patients were HIV-positive. It wasn't unusual to see healers there.
Goggin learned one lesson early: Western doctors are afraid of healers.
After all, a South African healer knows what's wrong with a sick person before ever meeting the patient. After lighting incense to clear the examination room, the healer tosses animal bones on the ground to get a message from the ancestors. When the healer appears before the patient, dressed in the right colors to honor the spirits, the patient doesn't speak. The healer tells the patient what the trouble is the patient may be tormented by an evil witch or might have neglected to pay proper respect to the ancestors. Most times, the healer prescribes a muti, ingested or inhaled, though enemas are common, too. Sometimes the healer must cut the patient and rub the muti into the bloodstream. In more extreme cases, the healer will channel spirits while dancing and pounding drums and speaking in tongues.
There is more to a Western-trained doctor's apprehension than professional embarrassment. South African emergency rooms are filled with patients dying from problems that a healer has failed to treat. All those anally inserted mutis some reports say Zulu children have up to three enemas per week have caused gastrointestinal problems so common that South African doctors recognize a condition called ritual-enema-induced colitis. And healers bear some responsibility for transmitting HIV: When they cut a patient to administer the muti, it's usually with a knife that hasn't been cleaned.
Healers don't trust Western medicine, either. Researchers have come looking at their methods before, and healers have seen the herbs they've discovered and prescribed to patients for thousands of years show up as supplements in health stores. Rarely do they see any of the profits. And though they're accredited by the South African government, they still sometimes feel that they are seen as inferior to the doctors in white coats mainly because there is still no degree program to recognize them. (Healers like Mhlongo are trying to have one established.)