Reflections on accessing indigenous research settings: Encounters with traditional health practitioners and leaders in Vhembe district,South Africa

Abstract

Conducting research in indigenous settings in rural villages, where traditional leaders are the custodians of communities remains a challenge. Traditional health practitioners have to adapt their protocols to the needs of the cultural setting. When gaining access to a setting, researchers have to follow a process that respects the autonomy of individuals, thus adhering to one of the ethical principles of research with human participants. In this paper, the researchers reflect on gaining access to conduct research with traditional health practitioners and traditional leaders in Vhembe district, South Africa. Researchers participated in sharing circles, and identified five reflective themes. The themes included initiating agreement and rapport, continuous negotiation and compromise, Them and Us, adhering to local dress code and ritual performance. Researchers planning to conduct research with traditional health practitioners and traditional leaders should consider these themes in the preparation phase.

Keywords

reflection adhering to local dress code traditional health practitioner indigenous community gaining access

Introduction and background

Modern health care researchers struggle to gain access to indigenous research settings because communities may be suspicious of the unfamiliar. There is a misconception that some African researchers are automatically given access to conduct research in their own communities (Masiye et al., 2017; Roberts & Sanders, 2005). However, despite being from the same community, African researchers can still be regarded as strangers by their own community members. This perception may arise from a dual role, namely that of researcher and community member, that researchers assume. This duality demands that African researchers be competent and knowledgeable in two worlds, which is often not the case (Lavallée, 2009; Roberts & Sanders, 2005).

African researchers are usually trained according to a western paradigm that is often alien to their own culture. In the end, African researchers are also learners in the protocols on how to approach communities (Keane et al., 2016). The gap among African researchers, traditional health practitioners (THPs) and traditional leaders has also been widened by common misconceptions. Traditional health practitioners have been previously marginalised and their trade viewed as witchcraft (Nemutandani et al., 2016). These myths, mistrust, and disrespect have created barriers among western trained health care practitioners, THPs and traditional leaders, particularly in developing countries such as South Africa and subsequently hindered the ability of researchers to gain access to community settings. The promulgation of the traditional health practitioners Act 22 of 2007 has led to THPs being recognised as part of the health care system in South Africa. In South Africa, western trained health care practitioners, THPs and leaders are three separate groups which operate differently on their mandates.

Recognition as part of the health care system has resulted in western trained researchers being more interested in collaborating and working with THPs and traditional leaders, often leading to a better understanding of traditional health care practises. Researching traditional health care practises in Africa is challenging because gaining access to traditional settings requires that protocols and ethical principles are sensitive to African culture. African culture pertains to the similarities and differences of African people including their descendants in terms of beliefs, values, protocols and philosophies. Gaining entry to traditional settings requires self- preparedness, comprehensive planning, perseverance and emotional maturity (Kondowe & Booyens, 2014). Researchers need to follow a process that respects the autonomy of individuals, which is an ethical principle that applies to human participants of all cultures. To accommodate communities, we replaced the principle of respect for “individual autonomy” with respect for “autonomy of persons” which acknowledges a communal relationship (Behrens, 2017). Staunton et al. (2018) emphasize that when conducting research in Africa including South Africa, researchers should view their actions through an African communitarian lens which recognises that decisions are made by individuals in engagement with families and communities. Researchers often have to engage in lengthy negotiations and constantly endeavour for acceptance by gatekeepers and participants (Munhall et al., 2002). Gaining access to communities is a long process which involves identifying gate keepers and seeking informed consent. The gatekeepers will often base their decisions on whether the proposed research will benefit the majority. Consulting with community members also ensures a form of transparency regarding negotiations for sharing intellectual property, research outcomes, benefits and patents. In this article, we describe the reflections of researchers on gaining access to a traditional setting whilst conducting research with traditional health practitioners and traditional leaders in Vhembe district.

Problem statement

In communities where indigenous traditional cultural practices are preserved and maintained, researchers often have to observe protocols and rituals when encountering traditional health practitioners. Not following the correct procedures may lead to delays or access to the setting being denied. Gatekeepers may choose to deny access to protect and avoid exploitation of cultural values, beliefs, and healing practices of indigenous communities (Lavallée, 2009).

When gaining access to indigenous settings, many researchers do not follow or consider certain protocols that are important for acceptance by indigenous communities (Fitzpatrick et al., 2016) such as dress code, tone and local spoken languages, conduct and behaviour, or fail to familiarise themselves with the setting. Various studies have highlighted gaps in explaining the process to obtain access to indigenous research settings (Miller & Gibler, 2011; Riese, 2019). Failing to describe how to gain access to the research setting may be viewed as a mechanism to silence the voices of participants, especially of disadvantaged indigenous people (Oates & Riaz, 2016).

Conversely, whilst negotiating the research process, researchers may fail to share and discuss research methods with the participants. Uncertainties among the participants may also arise if researchers are not transparent regarding their financial status. Researchers should adhere to the suggested, negotiated and agreed dates and times of appointments whilst preparing to gain access to the research setting. Researchers should explain the details of the study using the local language to show respect for cultural values and customs (Kawulich, 2011). Researchers should establish and maintain trusting and truthful, honest relationships with the participants to demystify the research process (Tomlinson & Lewicki, 2015). In many indigenous settings, knowledge holders have experienced colonialization, and may perceive researchers as ‘thieves’ who steal crucial knowledge for personal financial gain, often neglecting the source of knowledge, namely, the participants. Researchers may also misappropriate the gathered knowledge to suite their decisions (Keane et al., 2017), subsequently indigenous knowledge holders tend to conserve their information or refuse entry to their setting. All researchers should be transparent about their activities on risks and benefits of the study.

Research design and method

Researchers reflected on gaining access to an indigenous research setting during two sharing circles. Sharing circles are ceremonial sacred focus group discussions or group meetings which are done for different purposes including cultural growth, transformation and to build true working relationships amongst researchers (Lavallée, 2009; Simonds & Christopher, 2013). Sharing or talking circles is an open-structured, informal style approach that respects story sharing within family, community or society following cultural protocol within their context (Tachine et al., 2016). It is stated clearly that story telling has a holistic nature that offers a means for sharing (Kovach, 2010). It has been in practice since time immemorial within indigenous communities by Indigenous people for generations to generations without acknowledged in academia. According to Achebe (1958) as reported by Tuwe (2016), indigenous African people use to gather around the central fire after dinner, upon the sound of a teasing drum, and settle down to hear and listen to stories narrated by elders. Chilisa (2012) indicates that talking circles is based on participants’ respect for one another.

Ten researchers participated in each sharing circle. The meetings had a dual purpose, researchers also discussed a memorandum of understanding for collaborating with traditional leaders and THPs. The following main question was used to elicit more indepth information on sharing circles; How can researchers gain access to a community that prefers to isolate itself from external influences and curiosity? This main question was followed by the following sub-questions to strengthen the data: How should the access method be designed in order to create communication conditions that are favourable for effective data collection? What should be avoided to prevent the usual initial distrust from further deepening? Are there very specific expectations, beliefs, and behaviors which are not yet known to the research community and which therefore require special attention in certain cases studies? What attitudes should researchers have in order to be accepted by the investigated community and to expand the opportunities for deeper insights? The researchers selected sharing circles because they have an indigenous healing component that accounts for the heart, mind and soul of each person. Sharing circles allow researchers from diverse cultural, ethnic groups, religious and spiritual backgrounds to share their experiences during a reflective process (Lavallée, 2009; Mehl-Madrona & Mainguy, 2014). Sharing circles foster a sense of unity, and healing power that allows researchers to share their reflections in a non-hierarchical manner and to listen to each other with respect. The researchers reflected on the process of gaining access to indigenous communities in four steps, namely looking back, thinking back, describing what has been learnt and planning what to do next (York-Barr et al., 2005). The statements indicate that researchers looked back at what happened at the initial and the second visit whilst negotiating access. They thought back through reflections of what happened during the encounter. They described their experiences as interesting because they were from diverse backgrounds. The researchers’ experiences revealed that parties viewed themselves as disparate and still in two camps: ‘the Them and the Us’. Researchers learned a lot from our first encounter that assisted us to plan and cope with future encounters.

Upon reflection, researchers revealed that they struggled to come to terms with the rituals that were performed because they were trained in a western paradigm. The researchers applied a four staged access model which addresses getting in, getting on, getting out and getting back (McCalman et al., 2013). Continuous reflexivity was ensured through researchers’ awareness as part of data they gathered (Polit & Beck, 2017). The following reflective themes were identified: initiating agreement and rapport, continuous negotiations and compromise, ‘Them and Us’, adhering to the local dress code, and performance of rituals.

Discussion of results

Initiating agreement and rapport

Before initiating agreement and establishing rapport, all researchers were aware of the ethical principles related to the research process. These ethical principles are similar to the Kaupapa Maori as a theory of giving Maori an increased self-determination and autonomy in their lives. Furthermore the theory encourages them to have ownership of their culture. This background confirm that countries have similarities and differences in their cultural practice (Denzin et al., 2008). At all times, researchers reflected on, and observed these principles which include beneficence, respect for human dignity and justice (Polit & Beck, 2017). These ethical principles need to be embedded in all the phases of research (Botma et al., 2010). In this study, all researchers viewed the process of initiating agreement and rapport as pivotal, supporting procedures in gaining access in an indigenous environment. All researchers agreed that gaining access required several months of preparation because consistency in reaching agreement and establishing rapport had to be maintained (Irwin & Johnson, 2005). All researchers agreed that initiating agreement and establishing rapport had to occur before starting fieldwork (Johl & Renganathan, 2010). In the scenario above the researchers demonstrated what the Maori calls it an invitation for dialogue between Maori and non-Maori. The researchers in this study were partially at some stage entered into the dialogue with one another (Denzin et al., 2008).

During the ‘agreement’ phase, researchers shared research objectives, time and resources with THPs and traditional leaders (Tomlinson & Lewicki, 2015). Agreeing on a time was complicated by the different methods used by THPs and traditional leaders, who used different methods of determining time by using sizes and movements of shades of houses and trees. Once researchers negotiated a time and gained access, researchers, THPs and traditional leaders started to negotiate entry into the research setting. All researchers agreed that successful negotiations relied on good interpersonal skills, effective communication and an acceptable appearance (Johl & Renganathan, 2010). At this stage, researchers agreed that they were still in the ‘getting in’ phase, while the relationship was still ongoing. Getting in phase is the initial stage of negotiating agreement to conduct research. The researchers get into the research area to negotiate and reach agreement. An effective ‘agreement phase’ ensured a harmonious relationship between researchers, THPs and traditional leaders from the start of the project (Ryan & Dundon, 2008).

During the ‘agreement phase’, rapport had to be built to foster confidentiality, respect for human dignity and trust amongst researchers, THPs and traditional leaders. These ethical principles are a cornerstone of Ubuntu. The African philosophy of Ubuntu is derived from the Zulu nation proverb ‘umuntu ngu muntu nga bantu’. Loosely translated Ubuntu means a person is a person because of other persons. The interconnectedness of individuals also recognises the value of redistribution and communal sharing of resources. These sentiments are similar to the idea that resources should be shared communally to address existing pitfalls. All researchers agreed that rapport was established during negotiation of agreement and depended on the behaviour of the researchers, THPs and traditional leaders in terms of developing relationships and demonstrating commitment (Le Dantec & Fox, 2015). Researchers, THPs and traditional leaders established rapport during prolonged engagement, which allowed researchers to reflect on daily practices. Whilst establishing rapport, researchers demonstrated ethical behaviour through respect, regular visits and continuous interaction with THPs and traditional leaders. Using these behaviours, researchers could establish sustained and effective, moral and ethical interactions.

During the ‘agreement phase’, researchers had to recognise that the research site had unique cultural practices such as language, values and norms. Language plays a critical part in initiating rapport and forming relationships. Researchers reflected that language differs from area to area and can affect relationships either positively or negatively (Cortés, 2005). All the researchers acknowledged the dynamics and complications of spoken languages, which ranged from Xitsonga, Tshivenda, Tswana, Sepedi to Setlokwa. Traditional health practitioners and traditional leaders also spoke a variety of languages. All researchers shared experiences and had similar perspectives regarding the ‘agreement phase’ and confirmed that most THPs and traditional leaders expected to use their local language throughout the research process. Initiating agreement and rapport is a continuous process, which feeds into the next theme, namely continuous negotiation and compromise.

Continuous negotiation and compromise

All researchers agreed that conducting research in a traditional setting, especially on healing was complicated because the indigenous traditional community viewed healing as sacred. In sharing views, each view was discussed and debated amongst the researchers and the traditional health practitioners until the consensus was reached. The traditional leaders and traditional health practitioners are thus inclined to limit access. Researchers may not be able to access a setting because traditional leaders, local municipal politicians, traditional associations and THPs do not grant access. These structures act as gatekeepers, who have the authority and power to call and instruct community members to attend and participate in activities, especially in rural communities where African traditional cultural practices are still maintained (Baydala et al., 2013; Haines et al., 2017). Continuous negotiations with gatekeepers required that researchers acknowledge traditional protocols. Researchers, who were not conversant with protocols, including sitting arrangements and hierarchical structures, were at times frustrated. The executive members of the THPs were sitting according to their seniority, from the Chief, Induna, Chairperson of the Traditional Council, Secretary and the other committee members followed. The Chairperson of the Traditional Council introduced all the members according to their hierarchy, their roles and responsibilities. The researchers were given the opportunity to ask questions to air their frustrations and all their queries were clarified. Traditional leaders are usually viewed as leaders in the community, and are integral and pivotal in preserving the indigenous knowledge base (Haines et al., 2017). Involving community elders in research matters usually leads to increased willingness to share and transfer sacred knowledge, closing the knowledge gap in matters of community health and education. In this case, researchers agreed that involving traditional leaders assisted in gaining access to THPs practising in the community, and contributed to shared wisdom, experience and skills (Boven & Morohashi, 2002).

In this study, traditional leaders willingly cooperated and collaborated because they valued the reciprocal contribution of research to the education of future health care professionals in their own communities. The THPs’ were treated as co-researchers and the decisions taken were community-based. These THPs were actively involved in problem identification, writing of the proposals and manuscripts. During the process we were learning from each other. Researchers viewed the commitment of traditional leaders and THPs as an acknowledgement that knowledge is not static but dynamic (Haines et al., 2017).

Researchers observed that traditional leaders ensured that the research adhered to stringent indigenous principles. The indigenous principles are based on the core values or the 5 R’s, namely, respect, relationships, responsibility, reciprocity and redistribution. In an African context, respect is often viewed as the cardinal point of any relationship, and mutual respect is emphasised. Researchers reflected that respect is expressed through dress code, greetings, and participating in song and dance. Flicker et al. (2015) assert that community elders are responsible enforcing correct indigenous processes and guide, lead, advise and allow access to participants.

In this study, researchers recognised that they gained and learned cultural awareness, cultural sensitivity, cultural competency and mutual respect. Cultural awareness was ensured when the researchers openly acknowledged other peoples’ language preference and skills. Cultural sensitivity refers to the researchers when they took their time to listen to the THPs, values, beliefs and concerns. Cultural competency on the part of researchers meant that they had emotional feelings about their culture, their practices and their viewpoints about culture. Regarding mutual respect the researchers showed respect to the THPs’ cultural values and beliefs. Working together, allowed researchers, traditional leaders and THPs to form partnerships based on respect, positive relations and support (Viscogliosi et al., 2017). The traditional leaders and THPs were supported with the travel expenses and refreshments.

Them and us

In this study, researchers initially struggled to communicate and interact with THPs. During interactions, THPs wore traditional regalia which reinforced researchers’ perceptions. Researchers’ western socialisation stereotyped them to view THPs and their practices as unscientific and unclean. The negative stereotyping about THPs occurred in schools, churches, gatherings and also in homes that THPs practice sorcery and witchcraft. The negative opinion about THPs as narrated by Mokgobi (2014) was bracketed to allow learning through storytelling be experienced. Manganyi and Buitendag (2013) assert that the negativity on THPs, cultural beliefs and practices was linked to some western belief that in Africa, there was no religion before Christianity which is more associated with biomedical practices. Similarly in China and India there was no cooperation between the allopathic and THPs because they did not trust each other (Abdullah, 2011). African researchers who grew up in indigenous settings were taught at schools, church and in their own homes that THPs practice witchcraft and have power and magic enabling them to see through you and know what you are thinking. Researchers found it difficult to ignore these engrained myths, attitudes and beliefs, and even hesitated to make eye contact with THPs. During initial encounters, THPs and traditional leaders viewed researchers as strangers, with apprehension and mistrust. The initial feelings of discomfort dissipated when THPs started singing familiar songs, encouraging researchers to participate. Researchers then started to feel at home. Researchers reflected that singing and dancing was a lengthy but valuable process. Drumming, singing, dancing and performance of rituals is an indigenous form of communication and researchers recognised these customs created a safe and conducive environment for discussion and dialogue.

Upon conclusion of these rituals, traditional leaders as a link between the researchers and the THPs would start talking and directing THPs. Researchers explained that the first visit usually took the form of one circle and the second visit comprised of four, smaller groups. In these smaller groups, THPs used storytelling to share information with researchers. Throughout the research process, researchers became more and more proficient in using storytelling to share indigenous knowledge. Storytelling allows THPs to share unwritten information which is derived from lived experiences, spanning across many generations. Researchers felt that interactions between THPs and themselves had to be continuously recorded and noted (Haines et al., 2017). Towards the end of the research process, researchers felt that the gap between the ‘Them and Us’ had narrowed. The gap between the ‘Them and Us’ was also narrowed if researchers adhered to the dress code of the THPs, making them feel respected and honoured.

Adhering to the local dress code

Whilst negotiating for access, researchers recognised that they had to abide with traditional dress. In Africa, adhering to the dress code of traditional communities indicates respect and association with national, regional, tribal or religious identity (Allman, 2004; Rovine, 2009; Richins, 1994). Researchers shared that they were shown to dress with a cloth or minwenda, according to the Vhavenda culture. Nwenda is a traditional wrap-around cloth which is long and goes beyond the knees and is used mostly by females.

Researchers were expected to wear long dresses and skirts, no sleeveless dresses, and no trousers for females. Two researchers, who were inappropriately dressed, shared that an elder helped them to dress appropriately by providing traditional materials to wrap around their waist. In Vhembe district, dress code offers opportunities to express ethical and cultural bound values. There are various dresses worn during occasions such as for the young and old, during traditional weddings and other cultural occasions. By conforming to social traditions of dress code, researchers respected the dignity of both individuals and the community at large (Rheeder, 2017). Hong Kong, Beijin and Tokyo share similar sentiments in adhering to the dress code in a range of costumes in public places and at the family themed events and this is done to reaffirm their identity (Peirson-Smith, 2013). Dress code is an immediate and visible indicator of how a person fits into his/her cultural system. The study conducted in Riau Malay on traditional clothes revealed that traditional attire is a representative of their ethnicity customs and laws (Na'am et al., 2019, p. 652). Moreover, globally, each community has its own culture, which includes traditional dress code, that is worn or expressed differently, according to age, gender, class, season and occasion. Differentiation, in this regard, referred to the notion of clothing or elements of clothing helping individuals to differentiate matured women from youth and men to suit Vhavenda dress code. The traditional dress code across the globe demonstrates the importance of culture as a unique phenomenon.

Researchers realized that observing and respecting dress code was important for the dignity of women, who would often sit on the floor with their legs stretched out during discussions. Long dresses, skirts and traditional cloth served as extra cover for women. Traditional dress code was expected to be worn not only during rituals and it can also be worn during traditional ceremonies such as weddings. The nature of clothing was based on gender and some form of social respect. The dress code is self made or a tailor could be identified to make such dress codes.

Ritual performance

Performing traditional rituals is a way of communicating with ancestors to open the gathering and protect the attendees from harm. Rituals are performed to bring peace and harmony between the two worlds, the living and the living-dead (Lebaka, 2018). Wojtkowiak (2018) added that rituals are found to bring emotions and thoughts through representative actions. Depending on location and the type of ceremony, THPs perform different rituals before commencing with functions. Before the start of proceedings, THPs and traditional leaders would sing indigenous songs, drumming, burn indigenous herbs, clap hands, while others danced. Usually, a female THP, who was fully dressed in traditional attire, would start throwing bones and talking to ancestors, while other THPs would kneel and hum. Researchers associated the throwing of bones with X-rays which are used for diagnostic purposes. Researchers compared the traditional attire worn by THPs to academic regalia worn during graduation ceremonies or to healthcare professionals’ uniforms. The traditional attire is commonly called traditional dress code and it is worn as a sign of respect for ancestors (Sandlana, 2014). This dress code differentiates an ordinary citizen and the THPs, irrespective of their various expertise in healing the clients. The academic regalia displays the level of expertise the person has, while the healthcare professionals’ uniforms signify the category of the professional, for example, professional nurse wearing white uniform with distinguishing devices on the shoulders. Manwa and Ndamba (2011) asserted that traditional attire forms part of identifying the person and provides nonverbal communication with those around him/her regarding cultural practices and beliefs.

During rituals, THPs nominated women who were responsible for opening the ceremony to appease the ancestral spirits. The nominated women requested everyone to participate in the ritual. The ritual involved putting snuff on the ground, talking to the ancestors and chanting respectfully and calling the clan names of ancestors. Researchers participated in the rituals without judging the cultural practice of the THPs and traditional leaders. Rituals are performed by most African people at gatherings and ceremonies (Adamo, 2011). The rituals are usually performed in sharing circles under specific trees or fireplaces.

In the current study, researchers observed THPs and traditional leaders forming a sharing circle under the shade of a tree at the local village’s community hall. Traditional health practitioners and traditional leaders performed rituals before researchers could enter the hall and immediately after entering the hall. The rituals were followed by ululations by THPs and traditional leaders, and dancing to indicate happiness and acceptance of the researchers. These ululations and jubilations were notification and presentation processes to the ancestors and the Supernatural being (Keane et al., 2016) about the arrival of researchers as visitors in the setting. Once the proceedings were underway, African traditional protocols were observed such as the sitting arrangement in the meeting. Males and females do not seat on the same side, but in opposite, not directly facing each other. Males are allowed to occupy the seats (chairs) while females seat on the floor or on traditional mat if available. The sitting arrangement stems from the culture of respect for elders and ancestors in a patriarchal manner.

The performance of rituals is not unique in South Africa, and Africa in general, it is also practised globally. In Australia rituals are performed to ensure that vital components of the ancestral spirits, cultural and religious beliefs, practices and lore of Aboriginal communities stay intact (Queensland Government, 2008). The rituals are performed in the form of ceremonies by dancing, singing and chanting traditional songs as a way to teach youths the rules and philosophy of the tribe and the obligations that accompany them; trials of endurance and the air of secrecy. The rituals are designed to impress youths so that neither the rituals, nor their associated meanings, will ever be forgotten. Walker (2008) alluded that the healing power of ritual can be reclaimed through rituals of acknowledgment, truth-telling, apology, and forgiveness. These sentiments reveal that it is uniqueness across the globe.

Wells and Dietsch (2014) are of the view that Hindu sacraments by Indian women were allowed to perform their rituals in Australia to accommodate their birthing cultural beliefs. Rituals maybe performed for various activities including death in the family and community. In Canada, the communities developed rites and rituals to help in the passing of life to honour the person who is in a terminal stage of illness and about to die or has died as a way of courage and perseverance (Gordon, 2015). Bahar et al. (2012) explained that different religious and cultural beliefs determine the rituals performed during mourning and burial in families. The rituals include bathing of the dead, closing his eyes, not allowing pregnant women to attend funerals, returning to work after 3 to 4 days after burial and burial rites. These are some of the rituals performed in other countries globally, though the practice is very common in African countries.

In some other countries, rituals are also performed during happiness to appease the ancestors. Tateyama (2016) revealed that in Pacific Asia, the Tolai performs rituals to provide an ethnographic account of the tubuan performance at the festival in comparison with the practice of tubuan dances and rituals in their original context, using drums, kudu horns and body decorations to appease the ancestral spirits.

Conclusion and recommendation

To gain access to an indigenous setting, researchers recognised that acceptable protocols and procedures had to be followed, even though researchers are regarded as strangers and learners on how to approach traditional communities. Researchers emphasised that they had to be prepared and emotionally mature to display respect during lengthy negotiations with gate keepers. In this study, researchers were able to unite and share their experiences through the principle of respect for persons and African communitarian values. Researchers from diverse cultural backgrounds shared information, creating an opportunity to learn from each other about how to work with THPs and traditional leaders. All researchers agreed that mutual respect, responsibility, reciprocity, relationships and redistribution are important factors to be considered when gaining access to traditional settings. All these aspects need to be observed and adhered from the beginning to the end of the project. Initial traditional protocols such as rapport, performance of rituals, adhering to local dress code and continuous negotiation and compromise are pivotal for successfully gaining access to traditional settings. Researchers should follow proper processes and implement the principles of African ethics when negotiating entry to conduct research in indigenous settings. We also recommend that cultural values and traditional protocols be part of western research methodology education. When cultural values such as respect, communication and conduct are observed, the social and economic benefits may be achieved. Traditional protocols also assist health care providers to learn and provide congruent health care. The intention may assist future researchers to enter the traditional setting for research, with understanding and knowledgeable about basic cultural values and protocols.

Footnotes

Acknowledgements

The following are acknowledged in contributing to the success of the paper: Drafting and finalisation of the paper (MDP, FMM, SRR, RNN, MMR). We acknowledge also the University of Pretoria, Vhembe district, Limpopo Province, SA, Traditional health Practitioner Department of Health of Mpumalanga Province in South Africa for providing us with the permission to conduct the study. Parents for agreeing to serve as participants.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: There was financial support by NRF: No: N00696-93180.

ORCID iD

MD Peu

Author biographies

MD Peu, an Associate Professor at the University of Pretoria. I have PhD, MCur, BCur (Hons) and BCur. I specialises with Community Nursing, Primary health care, qualitative and quantitative research methodologies. I have supervised 8 PhD students and 38 MCur students. I published 44 articles.

FM Mulaudzi, HOD of the Department of Nursing Science and Professor at the University of Pretoria. I have Doctor of Philosophy, MCur, BCur and BCur. I specialises with Idigenous Knowledge System and qualitative and quantitative research methodologies.

SR Rikhotso, I am Senior lecturer at the University of Pretoria. I am responsible for undergraduates and post graduates nursing students in the Department of Nursing Science. My Qualification: Operating theatre Nursing Science (BG Alexander - 2000). B Cur (Ed et. Adm-2006). M Cur (NWU - 2011) and PhD (University if Pretoria - 2017). My current research focuses on Indigenous Knowledge Systems. I supervise masters and PhD students. I published more than six article in peer-reviewed journals in groups and individually. I presented in international and national conferences annually.

RN Ngunyulu, My niche area is in community nursing science, midwifery and neonatal care, indigenous knowledge system with the main focus in indigenous practices that are used by the traditional birth attendants and traditional health practitioners during the care of mothers and neonates during postnatal period, after their discharge from the hospital.

MM Rasweswe, is a lecturer and PhD student at the University of Pretoria. She specializes in medical-surgical (Operating theatre) and Community Health Nursing Science. Her research interest is women’s health and indigenous knowledge system. She is a member of Nursing Educators Association (NEA) and operating theatre society.

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