Advocacy for Personhood: Integration of African Christian Rituals and Intimate Care on the Touched Human Body

Abstract

Intimate care relates to essential nursing care nurses provide that requires touching the patient’s body. It is noted that the human body goes through many rituals from birth through all life stages. Rituals done on one’s body symbolize the need for acceptability in the family, community, and society. The purpose was to integrate African-Christian rituals into nursing care to improve the quality of care for the touched human body. Ubuntu paradigm was used to understand the rituals and nursing intimate care practices on the human body in an African context. African-Christian leaders were sampled using snowball sampling from three Southern Africa countries (Eswatini [former Swaziland], South Africa, and Zimbabwe), and nursing practitioners were purposively sampled from two selected hospitals in South Africa. Naïve sketches and semi-structured interviews were used to collect in-depth data. Rituals of the identity of the person through naming and initiation into family and community. The body is constantly touched during ritualization and provision of care. Advocating for personhood asserts that individuals needing physical or spiritual care should be treated with dignity and respect. As a human person embraces the physical and spiritual realm, integration of nursing and spiritual care is critical for healthy families and communities.

1. Introduction

The human body goes through many rituals from birth through all life stages. Rituals done on one’s body symbolize the need for acceptability in the family, community, and society. The African and Christian religions are among the communities that conduct rituals on the human body. A ritual is a social construction of a body by which the person is afforded a particular sense of identity. It simultaneously empowers the person by indicating their individuality within a community [1]. Wulf further describe rituals as social constellations in which individual and communal social actions and how they are interpreted produce structures and hierarchies [2]. The rituals are performed on the body of a person. A human person is a biological entity with a capacity for certain intentional states, such as believing, desiring, and intending [3]. The human body is not an isolated entity but a biological, sociological, and ecological organism [4]. The body mediates all action; it is the medium for internalizing and reproducing social values and the simultaneous constitution of self and world social relations [1]. The body is the medium through which health and illness are experienced, it gives social meaning [5]. Thus, rituals are fundamental to human transformation and personhood. The person is guarded by three premises: cultural, religious, and healthcare. Each aspect of life is critical: a child is born into a family (cultural) and presented to the religious community and healthcare sector for identity. Acquisition of culture is a result of the socialization process. Every human being growing up in a particular society is likely to be infused with the culture of that society, whether knowingly or unknowingly, during the socialization process [6].

The body is the most individual and intimate aspect of human existence. It is inseparable from individual identity, thus difficult to distinguish between having a body and being the body [7]. The body is used to make sense of one’s world as it extends beyond biological and physiological boundaries; it encompasses social and cultural dimensions [5]. The body is the site of concrete, an individual experience of tension between local cultural life and its global conditions [7]. Therefore, a person comes into existence in the reciprocal relatedness of individual and community, the human person is a holistic well-being within a web of relationships and a supreme being [8]. This proposition attests that humans have a dual nature, comprising the body and the spirit which exists beyond physical disappearance from the human world [9]. The mind finds its expression in the physical body as the body interprets what goes unseen. Clothing reveals the human essence to the world. It tells the world one story, inner thoughts, who the person is, and who they want to be. Therefore, dressing reveals personality, and cultural and religious affiliations [10]. Physical, emotional, and even spiritual closeness is established when rituals are conducted on the human body. One’s body is exposed to people outside the family circle. Understanding the importance of rituals that promote healing and wholeness is vital in caring for an African human body. The culture of respect and dignity of the body can be extended to other cultural spaces, as what matters and upholding the integrity of the person.

1.1 The nakedness of the body

During the performance of rituals on the human body, the person is exposed to other people viewing and touching their naked bodies. The perspective of nakedness can be viewed within the biblical, cultural, and nursing care premises with the view of giving a voice to the body that is touched.

The book of Genesis gives credence to the story of Noah, who appeared naked and in a shameful situation (Gen 9:21–23). The act of the two sons covering the body is seen as an act of care for their drunk and naked father. Even passages that speak of the treatment of lepers are safeguards against the disease that could ravage society. Not touching the body in that context was seen as practicing care for one’s body (Lev 13–14). Nevertheless, nakedness as such should not always be viewed in the negative, at least biblically. When the character Job was faced with challenges as he lost property, children and good health, he found comfort in the fact of his own body. “Naked I came from my mother’s womb, and naked I shall return there. The LORD gave, and the LORD has taken away. Blessed be the name of the LORD” (Job 1:21). This is a sign of the sacredness and special nature of the body, notwithstanding the challenges one is going through. It is probably an understated fact that Jesus would have been naked when he was crucified. Jesus’s torturers cast lots to determine ownership of the special garment. “And they crucified Him, and divided up His garments among themselves, casting lots for them to decide what each man would take” (Mark 15:24). Of course, the aim of Jesus’ tortures was not to uplift and honor Him but rather to humiliate him even further. Yet in the story of Adam and Eve, their state of nakedness was the result of their sinning against God, nakedness was not in the world but came because of sin. In Gen 3:3 “then the eyes of both of them were opened and they knew they were naked and they sew fig leaves together and made themselves covering,” thus nakedness is equated to sinfulness.

The African meaning of nakedness of the body is not far from the biblical context. As it is seen body image refers to personal construction and public projections of one’s body, thus, body image involves one’s perception, imagination, and emotional and physical sensation [11]. African cultures are conservative, a person is not just a product of nature, but a product of his/her culture. Culture informs the person how to relate with others, roles, norms, and expectations that shape how people relate to each other [10].

In African societies, women are often expected to cover their bodies, especially breasts, hips, and buttocks [12]. Unfortunately, the African body has been subjected to protracted racial slurs and symbolic objects of sexuality [11]. The body in its physical form, informs how it is read or perceived and what values are attached to it that inform social order. The sexual gaze on women alludes to women as objects of the male gaze, problematic ideas of what the female body should look like and defining when and how this body should be seen [13]. In some cases, women use naked body protests to illustrate their vulnerability and at the same time, naked bodies can disrupt, turning vulnerability into empowerment [14]. The unclothed body was previously read in a nonsexual manner, but now it is sexualized. Thus, the naked body is seen as irrational, uncontainable, and outside of normative constructive reason and African modernity [15]. In some instances, nakedness may be used to express vulnerability as a method of confrontation resistance and as a conflict resolution [14].

1.2 Objectives

The chapter aligns with the understanding that the human body is sacred and that each person goes through various bodily rituals for a sense of belonging. Therefore, the objectives were to:

• Explore and describe the rituals on the human body used in the African Christian religion for inclusive quality care.

• Integrate African-Christian rituals in nursing intimate care of the human body.

2. Methods

2.1 Theoretical framework

2.1.1 Ubuntu

Ubuntu can be generally defined as a worldview of African societies and a determining factor in the information of perceptions that influence social conduct [16]. Ubuntu is an African ethics that is based on ethical beliefs, and moral judgments associated with communal relationships. Ubuntu has its roots in the South African Nguni oral traditions which are made up of the prefix “ubu-” meaning being in potency or an enfolded being and stem “ntu” meaning being in actuality or unfolded being. The general impression of personhood and humanness is expressed. Therefore, ubuntu has emphasized the true meaning of being human, and what it means to be a person [17].

The notion of ubuntu places one as a person (human) bound into a community through relationships of care. Therefore, every person should be valued and respected, care and personhood cannot be separated as it gives one a sense of identity and humanness. Ubuntu refers to the critical values of group solidarity encompassing compassion, respect, human dignity, conformity to basic norms, and collective unity [18]. It advocates for communitarianism, where relations are forged and emphasizes reciprocal relationships that place an obligation on one another. Thus, a person cannot exist of themselves, as they come from a specific community that serves to nurture the realities of being human [19]. Its values represent personhood, humanity, humaneness, and morality. Many African philosophers, such as Mbiti and Ramose focus on ubuntu as a philosophy rather than practice, an ethical framework of relational justice. Ubuntu in a profound sense, implies an interactive ethic or an ontic orientation in which who and what a person can be as a human being is always shaped in interaction with others [20]. Ubuntu advocates for human connectedness with others, it assists in the facilitation of social connections. Ubuntu as a philosophy is grounded on the generic life values of justice, responsibility, equality, collectiveness, relatedness, reciprocity, love, respect, helpfulness, caring, dependability, sharing, trust, integrity, unselfishness, and social change [21]. “Ubuntu brings the human face to every aspect of life.” In this study, Ubuntu was used as a framework to understand the human body’s interconnectedness through rituals. The importance of personhood and humanness during initiation and caring for the person. It posits that every person should have a sense of belonging through identity in the family and community.

2.2 Research design

A qualitative exploratory-descriptive design was used. Qualitative research technique is a process where the research problem is studied in its natural setting, it gives room to a deeper understanding of the subject matters as they exist in their unique environment [22]. It intends to generate knowledge grounded in human experience [23]. Exploratory-descriptive design seeks to explore and describe the experiences of people. Exploratory research is a broad-ranging, purposive, systematic, prearranged undertaking designed to maximize the discovery of generalizations leading to the description and understanding of social or psychological life [24]. For this chapter, the rituals on the human body from Christian, African, and nursing perspectives were explored and described. Their descriptions gave meaning and a voice to the touched body with an in-depth understanding of the interconnectedness of human life.

2.2.1 Population and sampling

The population was divided into two groups:

2.2.1.1 Group 1: African-Christian leaders

The population were African-Christian leaders from the three countries in Southern Africa, which were Eswatini (former Swaziland), South Africa, and Zimbabwe (Figure 1 shows the geographic map of these countries). The individuals were involved in leadership in their churches and communities. For this group, snowball sampling was used to recruit the participants. Snowballing is a sampling method in which the participant is requested to refer individuals who meet the prescribed criteria. The first participants in the three countries were purposively selected. From there, other participants were recruited from the reference of the initial participants. Nineteen individuals participated in this group: eight African-Christian leaders from mainline churches (with a European history) such as Catholic and Lutheran, Pentecostal churches; seven African indigenous churches, such as Zionist church and three African indigenous practitioners.

Figure 1.

Southern Africa map (from Google Maps).

2.2.1.2 Group 2: registered nurses

This group comprised of registered nurses working in two selected hospitals in midwifery, medical and surgical units. The participants were purposively recruited based on their experiences in nursing practice: three years or more experience in nursing practice and an understanding of providing intimate care to diverse patients. They were from 35 to 50 years of age. Eight registered nurses participated in the study.

2.2.2 Data collection

2.2.2.1 Naïve sketches

Naïve sketches are defined as brief essays by participants on the formulated questions, it is used to obtain descriptions of personal experiences concerning the research phenomenon, considering the social and cultural context of the study [25]. Naïve sketches were used for the African-Christian leaders. The questions were divided into four sections: Section A focused on demographic data linked to inclusion criteria, which were age, gender, and experiences as a leader in a specific group. Section B led to the discussion on the rituals for the birth of a child, and Section C care of the sick person. The participants were invited to respond to the questions in Table 1.

Author 1 emailed the information sheet, informed consent, and naïve sketches to the participants, they were requested to answer the questions as honestly as possible. After the completion of informed consent and naïve sketches, they were emailed back to author 1. The two researchers independently read the answers for completeness. Follow-up interviews were conducted to probe participants to explain the provided information for better understanding. The three Indigenous African practitioners requested to be interviewed and author 2 conducted the interviews using the questions in Table 1 after signing the informed consent.

Sections	Questions
1. Birth of a child	What happens when a child is born in your respective Christian community? How does your religious group relate to children born of parents who are not members of the religious group? Or even children born outside what is contemplated in number 1 above? Who is allowed to touch a newly born baby and how?
2. Life of a person	As a child grows up, are there any practices that reinforce initiation in the group? What are these and how are they celebrated?
3. Sickness of the person	When a person gets sick, what practices or rituals are performed on the sick person? In your religious grouping who is allowed to touch the sick person? Where in the body can the person be touched? Is the sick person in a position to accept being touched or not?

Table 1.

Naïve sketches and semi-structured interview guide for group 1.

2.2.2.2 Semi-structured interviews

Semi-structured interviews entail having an interview guided by questions aimed at addressing the research objectives. The interview guide includes open-ended questions with follow-up probe questions with the interviewer to refer to throughout the interview [26]. The interview guide was developed to understand the caring rituals that are done on the person in healthcare institutions. Semi-structured interviews were conducted with group 2–registered nurses. Three main questions were used as a guide:

• What nursing practices are performed at the birth of a child?

• How is the healthy well-being of a person maintained during the life span?

• When a patient is admitted to the hospital, how is the body of a person cared for?

• Discuss intimate care and touch practices on the human body during hospitalization.

The interviews were conducted between June and September 2022. During the interview, a digital audio recorder was used to capture the narrative data. The participants were informed about the recording of interviews and consented. The duration of interviews was 20–30 minutes.

2.2.3 Data analysis

Narrative analysis refers to procedures used to interpret the narrative generated during data collection. The narrative meaning of data is transferred at different levels and gives greater meaning to the phenomenon experienced by the participants. Narrative analysis aims to unfold the ways individuals make sense of their lived experiences and how their telling enables them to interpret the social world and their agency within it [27].

The narrative analysis steps discussed by [27] were used to analyze data. Authors 1 and 2 independently analyze the naïve sketches and semi-structured interviews. Firstly, the authors familiarized themselves with the content and structure of the narratives by transcribing audio-recorded interviews and reading and rereading the transcripts in search of the rituals performed on the human body to understand the events, experiences, and explanations of the events. Secondly, a summary of the key elements and recording thematic ideas from the transcribed data. Thirdly, identify emotive language, imagery, or symbols used for the rituals and passages that may indicate the feelings expressed by the participant. The thematic ideas were linked to literature and theoretical framework.

2.2.4 Trustworthiness

Rigor/trustworthiness refers to the quality of qualitative enquiry and is used as a way of evaluating qualitative research [27]. Credibility addresses the rift between the participant’s views and the researcher’s representation of them [23]. Prolonged engagement and observations were conducted to gain an in-depth understanding of the rituals of the body. Triangulation was applied for credibility. Two multidisciplinary fields embarked on the study (Author 1—scripture scholar and theologian, and Author 2—nursing practitioner with experience in indigenous knowledge systems). Three population groups were purposively sampled which were Christian leaders, African indigenous practitioners, and nursing practitioners. Thick descriptions were provided for the reader to make a judgment about the transferability of the study to their site. Confirmability is concerned with establishing that the researchers’ interpretations and findings are derived from data to demonstrate how the conclusion and interpretations were reached [23]. The audit trail was used to ensure the logical process of the research which is traceable and recorded for the reader to understand how the study was conducted. After the naïve sketches analysis, the participants were contacted to explain ambiguous statements through probing to represent the participants’ views correctly.

2.2.5 Ethical considerations

The study received ethical clearance from the University of South Africa with reference number 90414357_CREC_CHS_2021. All participants were informed about the purpose and objectives of the study. The information leaflet and informed consent were given to all participants. They were informed about voluntary participation in the study, and they were free to withdraw at any time of the study. All participants signed informed consent before participating in the naïve sketches and semi-structured interviews. Participants’ personal information was kept confidential by using codes and saved in password-protected files on the authors’ computers. The researchers signed a confidentiality agreement to protect the identity of study participants. Permission was obtained for the photos used under the findings section.

3. Results

3.1 Participants characteristics

3.1.1 Group 1: African-Christian leaders

Seventeen (n = 17) individuals participated in this group with seven females and ten females. Seven (n = 7) Church Leaders (CL), seven (n = 7) African Church Leaders (ACL), and three (n = 3) African indigenous practitioners (AIP). The age ranges were from 36 to 60 with experiences from 3 to 35 years in leadership (Table 2).

No.	Participants code	Age	Gender	African-Christian affiliation	Years in leadership	Country
1.	CL-01	48	M	Lutheran	16	S Africa
2.	CL-02	36	M	Catholic	6	Eswatini
3.	ACL-01	59	F	Africa Indigenous Church	20	Eswatini
4.	ACL-02	56	M	Africa Indigenous Church	26	Eswatini
5.	CL-03	41	M	Catholic	8	Eswatini
6.	CL-04	41	M	Catholic	8	Eswatini
7.	CL-05	55	M	Catholic	27	Eswatini
8.	ACL-03	39	F	Africa Indigenous Church	3	Zimbabwe
9.	ACL-04	45	M	Africa Indigenous Church	4	Zimbabwe
10.	ACL-05	59	F	Africa Indigenous Church	20	Eswatini
11.	ACL-06	40	M	Africa Indigenous Church	6	Eswatini
12.	CL-06	27	M	Pentecostal	4	Eswatini
13.	ACL-07	45	M	African indigenous church	15	S Africa
14.	CL-07	58	F	Pentecostal	15	S Africa
15.	AIP-01	60	F	African indigenous practitioner	35	S Africa
16.	AIP-02	48	F	African indigenous practitioner	15	S Africa
17.	AIP-03	50	F	African indigenous practitioner	25	S Africa

Table 2.

Summary of African-Christian leaders’ characteristics.

3.1.2 Group 2: registered nurses

Eight registered nurses were interviewed, five (n = 5) females and three (n = 3) males. They were between 35 and 50 of age. They had working experience of five years and more. Three (n = 3) from the maternity ward, three (n = 3) medical, and two (n = 2) from the surgical wards (Table 3).

Participants code	Age	Gender	Unit/ward	Position	Years of experience
PRN-01	35	M	Surgical	RN	7
PRN-02	45	F	Maternity	Midwifery practitioner	8
PRN-03	40	F	Maternity	Midwifery practitioner	5
PRN-04	43	F	Maternity	Midwifery practitioner	6
PRN-05	42	F	Medical	RN	8
PRN-06	39	M	Medical	RN	7
PRN-07	49	M	Surgical	RN	10
PRN-08	50	F	Medical	RN	20

Table 3.

Summary of registered nurses’ characteristics.

3.2 Presentation of findings

This section presents major findings from the two population groups.

3.2.1 Theme 1: identity of a person

The identity of the person starts from conception. Pregnancy is celebrated by the expecting parents and family as the new life is to be welcomed. Once the child is born, he/she is given a name and welcomed into the family. Three sub-themes are discussed which are the protection of an infant, naming ritual, and initiation into the family and community.

3.2.1.1 Sub-theme 1: protection of an infant

The protection of the unborn child begins in the womb. Rituals in the birth of a child start from conception the child and parents perform the necessary rituals that will assure the safety of both the mother and the child [28]. African Traditional medicines are used for protection.

“During pregnancy, the woman is given isihlambelo and imbiza to assist with progress of labour and pains during childbirth” (AIP-03)

Isihlambelo is an oral African Medicine taken in the third trimester for quick labor, fetal growth, and well-being [29]. Whereas imbiza herbs are said to facilitate pregnancy by preparing the uterus to accept the fetus and are mostly used in the cleansing process during pregnancy [30]. When birth occurs at home, men and people in a state of impurity are forbidden to be present in the house where the delivery place as the child will be ashamed to be born [31] leading to prolonged labor.

The midwifery practitioners emphasized the protection of the fetus using antenatal healthcare services.

“As midwives, we provide care to the mother and the child during pregnancy. The women are always encouraged to start antenatal clinic once they notice that they are pregnant so that we can identify pregnancy problems for the mother and foetus” (PRN-02)

Antenatal care is a unique preventative public health initiative and intervention offered routinely to pregnant women, with the overall objective of improving the outcomes for the mother and child through early detection of complications [32]. The Department of Health advocates for eight visits to receive significant care in which pregnancy is monitored through health promotion screening, diagnosis, and disease prevention [33].

Within South Africa, midwifery practitioners expect pregnant women to use traditional medicines.

“Sometimes pregnant women come to the clinic late or they do not attend at all as they believe in traditional medicines. We normally educate women to use it carefully to avoid complications and even when following their practices, they must come to the clinic so that we can test to see if they are fine, including the baby. At times they overdose the traditional medicines, and we have to deal with maternal and neonatal emergencies” (PRN-04)

Understanding African traditions is important in midwifery care, to support women in their pregnancy journey, which can be stressful. Traditional medicines must be administered safely to prevent complications such as premature labor, fetal distress, and uterine rupture due to excessive uterine contractions [29].

After birth, the child is protected from the outside world by keeping him/her in a safe space. The mother and child remain in a room for three months or until “ukuwa kwenkaba” (the fall or drying up of the umbilical cord) as it symbolizes the growth of the child.

“the child goes out after three months when the umbilical cord has dried up (inkaba iwile) and ukhakhayi luvalekile “closure of fontanelle”. Even when you go out with the child, you must cover the child so that he/she cannot get evil spirits.” (AIP-01)

It is also believed that a small child can easily get various spirits that may affect the child negatively.

“There are people who carry strong medicines which are not good for the child. the child senses it and responds with their bodies by getting sick. Sometimes the fontanelle is affected “ukwehla kokhakhayi” [sunken fontanelle],” (AIP-02)

Sometimes traditional medicines are given to the child, especially through small cuts through the skin (ukugcaba).

“to protect the child, we make small cuts on the body and put powdered medicine which will be absorbed into the body. The specific areas of the body are culturally specified, but the important part is the head” (AIP-01).

During the period when the mother and child are excluded from public life, the woman is treated specially for three months, this time enables the nursing mother to recover and take proper care of the baby [31]. Interestingly, one Christian leader acknowledges the duties of family and midwifery practitioners during the birth of the child:

“The first person to touch a newborn baby is the midwife who helps in the delivery of the child. Then mother of the baby to receive him or her after delivery. At home family members who can handle the baby with care would hold the baby to welcome him or her into the family” (CL-02)

In nursing practice, immunization is administered to protect and strengthen the immune system of the child.

“When the child is born, his/her immunity is weak, therefore at birth or before discharge, the child is immunised. We follow the Expanded Immunisation Programme which starts at birth to 12 years of age. When the child is immunised three drops for polio prevention are given and an injection on the left arm is given in such a way that it will make a mark as a sign that the child was successfully immunised for Tuberculosis. The child is then registered in the institution birth register and the Road to Health card is given and is used to record all consecutive immunisations” (PRN-02)

Immunization is used to improve the children’s immune system. It assists in preventing dangerous preventable diseases that, if not administered may result in malnutrition and child development delays [34]. In South Africa, the expanded program on immunization was introduced in 1994 as a powerful and cost-effective public health program to improve child survival [35]. Through an immunization program, the children’s right to health, safety, development, and survival is promoted.

3.2.1.2 Sub-theme 2: naming ritual

Naming is a ritual used to give identity to a child. The parents or family does the naming of the child. The name gives meaning and direction to the life of the child.

“[…] the name has meaning which the child will follow in life […]. Sometimes the name is more of the circumstances of the pregnancy, the relationship of the family especially the parents […]”. (AIP-02)

“[…] giving a good name to a child is important as it becomes the way of life, if given the name of a family member who was not a good person, the child will follow it and cause chaos in the family and community” (AIP-01)

“In the Christian community, the parents or family who offer the child to the church give the name to the child. As Christian leaders, we only advise parents on the importance of their children’s names. Giving a positive name to a child is always encouraged. Because when we bless the child, he/she is called by the given name and it reveals the future path of the child”. (CL-07)

The participants believed that the infant comes from the spirit world with important information and is bringing unique talents and gifts to the family and community. On this basis, the naming of the child is an important occasion marked by rituals. The naming ritual takes place a few days after the birth of the child, he/she receives a personal name which marks entry into the family, prayers are offered, and ancestors are invoked [31].

The child has to be treated with love and dignity, a sacred being that needs to be respected:

“Each human person is made in the image and likeness of God, irrespective of their social background. All children deserve to be treated with dignity for human life is sacred” (CL-03)

In nursing care, when a child is born, the surname of the mother is used to identify the child “Baby [surname of the mother]”. This practice is within the South African Family law which advocates for the child’s right to a name.

“As midwives, we do not interfere with the naming of the child. We have social workers from Home Affairs who come to the unit to assist mothers in registering their children before they are registered. This works well if the mother has the name of the child. But if that is not the case, the birth confirmation documents are given to the mother on discharge to go to Home Affairs to register the birth of the named child” [PRN-02]

Section 28 of the South African Constitution states that “every child has the right to a name and nationality from birth.” Therefore, the birth of the child must be registered within 30 days after delivery and be in the possession of a birth certificate. The birth certificate provides the person’s identity and thus gives the child the human right to equality, freedom of movement, and dignity.

3.2.1.3 Sub-theme 2: initiation into family and community

When a child is born, he/she must be welcomed into the family and community. This act is linked to the Ubuntu practice, which advocates for solidarity and communal living. Within the Christian community, a child is baptized, in African practice, a child is blessed and in nursing care, immunization is used to strengthen the immune system.

3.2.1.3.1 Initiation through Baptism

The baptism of a child and an adult are distinct. For mainline churches (Catholic and Lutheran), baptism can be performed to infants. This is done to welcome the child to the church family and protect him/her from evil spirits.

“The religious group mainly in charge of baptism of the child, whereby the Godparents and priest touches the baby during baptizing” (CL-01)

“A newborn child is a gift from God. Christians celebrate birth by welcoming the child into the church through the sacrament of baptism of which the sponsor and parents pledge to walk them (children) in the way of Christ” (CL-05)

Baptism is a ritual through which new members are engrafted into the body of Christ and it is a symbolic guarantee that a person has become a member of the Christian church [36]. Baptism is a sacrament by which people are incorporated into the Church, built into a house where God lives in spirit, thus, the sacrament creates a bond with all who abide by it [37]. Figure 2 shows a child being baptized. The priest pours holy water on the forehead for the cleansing and purification of the child.

Figure 2.

Baptism of an infant.

When a child is baptized, the priest touches the chest of the child as he makes the sign of the cross. After this, he will pour water on his/her forehead and thereafter anoint the forehead with oil. The symbols of the sign of the cross, water, and oil are used to purify any sin, which is considered an evil spirit [37].

In some Christian churches, the dedication ceremony is conducted for the young children. The parents dedicate the child to God:

“Dedication is a ceremony whereby the child might even wear beautiful white clothes. Parents can even invite relatives to come and witness the dedication. At church, the child will be dedicated to God and prayed for” (CL-16)

3.2.1.3.2 Initiation through blessing

In African churches, baptism is only conducted when a person is an adult and can make an informed decision. When the child is young, she/he is blessed using water and incense. Therefore, a young child is welcomed into the family by introducing him or her to the ancestors and blessing.

“The parents present their child to church through the senior member (pastor). The pastor blows incense in his/her direction for blessing. The child is brought for blessing after three months from birth” (ACL-05)

The initiation rituals such as baptism, blessing, and dedication welcome the child into the family and community. It symbolizes a sense of belonging and personhood. These practices are linked to the ubuntu principles that perceive the sense of self to the family and part of the community. In the photo below children are presented by parents and Godparents to the priest for blessing (see Figure 3).

Figure 3.

Children receiving a blessing from a priest.

3.2.2 Theme 2: preservation of the person’s life within the community

3.2.2.1 Sub-theme 2.1: meaning of the body

In the African context, the body is the vessel for the ancestors, which needs to be respected and honored.

“we respect the body, as people who have the spirit of the elders. We do not perform rituals when we are not well [during menstrual periods]. When my body is not well, I will burden the person I am praying for, for example when I am on my monthly periods as a woman, I do not pray for the person because we respect his/her body.” (AIP-03).

The body is the subject of practice and the object towards which much of that action is directed, it gives cultural identity and visibility to the ancestors both in family, society and moral life [38].

For Christians, the body is considered the Temple of God. In the Gospel of John 2:19, Jesus referred to His body as a temple and Apostle Paul in the letter to the Corinthians 6:19–20, explains. “Do you know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own, you were brought at a price. Therefore, honour God with your bodies”

In nursing, the body is a physical, mental, and spiritual being that is controlled by the patient’s cultural and religious systems.

“As a nurse I respect the person according to the patient’s belief system, first treating the body with dignity, respecting their ancestors or God in them. I ask the patient what their family practice is so that I can treat them accordingly” (PRN-01)

3.2.2.2 Sub-theme 2.2: caring for the sick body: the healing ritual

Illness may be inevitable; therefore, the body may go through physical, mental, and spiritual difficulties that require interventions.

Before African indigenous practitioners intervene in the illness of an individual, they need to consult the ancestors through prayer or throwing of bones to get the message relating to the illness.

“The sick person needing help comes to eNdumbeni “consultation room” and I consult with his/her ancestors to understand the illness and how it can be solved. I listen to the message and deliver it to the person.” (AIP-03)

“During ukuhlola “consultation” with the ancestors, they will give directions on how to treat the illness and we give the information to a sick person. He/she is free to make a decision to be treated or not.” (AIP-01)

Figure 4 shows an African indigenous practitioner during a consultation session in the eNdumbeni.

Figure 4.

African Indigenous Practitioner consulting in eNdumbeni.

The Catholic church prescribes the sacrament of healing which is spiritual and physical and can be done in the church, home, or hospital.

“We have the sacraments of healing. Spiritual healing is related to the sacrament of confession sins and physical healing which is the sacrament of anointing of the sick. The priest touches the sick person by laying of hands on the head. The oil is also used to anoint the forehead and hands. The sick person always must request the sacrament or a relative consent if the patient can no longer do it himself or herself” (CL-04)

Patients come to the hospital when they have exhausted all the care available in the safe home environment. When providing basic nursing care, physical exposure of the body is experienced.

“We conduct a physical examination, bathing the patient and elimination- inserting a urinary catheter or serving a bedpan. During this procedure, we see the naked body of the patient and touch their bodies. These are very sensitive procedures, at times embarrassing for me as a nurse and a patient receiving care” (PRN-08)

Being naked or nearly naked can be a major constraint in quality nursing care as the patient and nurse must negotiate a safe space for this care with mutual respect [39]. It is in the hospital space where the human body is exposed to diverse healthcare practitioners, therefore, the promotion of privacy and careful exposure of the patient’s body should be well-planned to improve the quality of life for the patients.

Gender issues are critical in nursing and African indigenous practices as proximate physical contact occurs in a private space. The female African indigenous practitioners and church leaders expressed the limitations in providing interventions to male clients:

“When performing healing rituals on the person, when he is a man, we give them instructions on what to do, like “ukufutha” [steaming], I don’t put him on it as I cannot see him naked. I give him instructions such as going to the room and undressing and then using the steam etc. If it is a woman, I go in with her and help her in the process. Ukugcaba (small cuts on the skin to put powder medicine] is done […].” (AIP-02)

“The prophet(s) and leaders depending on gender can touch the person. Touching can be done in any part of the body with dignity being observed. The decision of the sick person whether to be touched or not is respected. In case of severe illness, their relatives are asked for consent” (ACL-03)

The importance of giving information to a participant in a ritual and allowing them to make an informed decision gives them the form of dignity and reclaiming their personhood during illness.

4. Discussions

The chapter attempted to explore and describe the rituals on the human body used in the African Christian religion for inclusive quality care. Also, to integrate African-Christian rituals in nursing intimate care of the human body. Two major themes emerged from the findings: Identity of a person and the preservation of the person’s life in the community.

The African and Christian religions are among the communities that conduct rituals on the human body. A ritual is a social construction of a body by which the person is afforded a particular sense of identity. The body mediates all action; it is the medium for internalizing and reproducing social values and the simultaneous constitution of self and social relations. As the body is constantly touched, the rituals on the human body must be integrated to enhance one’s identity as a person worthy of being respected and cared for. This section looks at rituals in three contexts: Christianity, Africanity, and nursing practice.

4.1 Identity of a person

When the child is born, he/she needs to be protected from the impurities of the world’s spirit and environment. The participants expressed the meaning of an infant’s weak immune system and evil spirits.

The naming of the child is important as it gives meaning to the future of the child. When a child is born in the hospital, the midwifery practitioners deliver the infant and keep warm to prevent hypothermia (kept dry, warm, and safe). The child is not washed until 24 hours after delivery. The first bath is important as it assists in the observation of the baby and the mother is welcome to participate in this activity. Before the infant is released from the hospital, he/she is immunized in the presence of the mother. The first immunization for TB and polio protects the child from contracting the communicable disease at a young age. The mothers are taught on how to take care of the umbilical cord: keep it dry to avoid infection.

The child is initiated into the family and community through baptism and blessings. In Christian churches, baptism symbolizes cleansing and purification from any sin and unites one with God. Through blessing, the child is welcomed into the family and community.

The practice of the Christian church is in such a way that the rituals contain an element of touching the person. This is true for baptism and other rituals that accompany the initiation of the human person into the Christian Church. The New Testament presents a more liberal approach to the body, especially regarding touching it: John the Baptist baptized people in the river Jordan (Mk. 1:4–5). Baptizing a person requires pouring water over the other person as the baptizer stands close to them. Jesus would even go so far as to touch people with various diseases, which was seen to be taboo. He touched a sick mother-in-law of Peter (Mk. 1:31), he touched the leper (Mk. 1:40–42), the woman who suffered a hemorrhage touched him, and he touched the dead daughter of Jairus (Mk 5:21–43). With the example of Jesus touching the other, in the Christian religion, touching a diseased body becomes standard as James exhorts thus: “Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven” (James. 5:14–15). Through the scriptures, the sacraments find a way into human life.

4.2 Preservation of the person’s life within the community

The participants perceived the human body as a sacred vessel for the ancestors and a temple for God. This places value on the importance of a human person. The bodies distinctively bear emblems of cultural identity and visible ideologies that organize both society and individual life [38].

The body is so valued in the Christian religion that Paul would call it the Temple of the Holy Spirit (Cf. 1 Cor. 6:19–20). He also used the metaphor of the body to teach about the unity that is supposed to exist within the Christian community (Cf. 1 Cor. 12:12–27). As a result, the body is good to be cared for and protected. Caring for the body is foreseen even before the person is born, as she/he is viewed as desired by God. For this reason, the prophet Jeremiah says, “Before I formed you in the womb, I knew you, before you came out of your mother’s womb, I consecrated you and constituted you a prophet for the nations” (Jer. 1:5). Therefore, speaking of being known in the womb brings out the utmost respect for the human body. The person should still be valued notwithstanding how he was conceived, where he was born what race or religion he belongs to and even his orientation.

The body plays a crucial role in assigning meaning to the experiences of illness and provides guidance on what actions are required for social experiences [5]. Therefore, humans have a dual nature comprising of the body and spirit which continue to exist beyond physical disappearance [9]. Elders in the family (immediate or extended) are responsible for caring for their loved ones. Same gender is used; therefore, cross-gender is not accepted. The children cannot see or touch the naked body of their parents. Before outsourcing this care, the indigenous healer is consulted to “throw bones”—consult the ancestors to see what needs to be done for healing. The incense, water, and indigenous plants are used for cleansing and as a form of medication. During these rituals, a body is repaired and refashioned through rites of healing [1]. The healing ritual enables the participants to communicate with the spirit world and is possible through the intermediary of priests or ritual leaders who will consult divinity on behalf of the participants and relate the message from the spiritual realm to them [28].

When the attempts fail, the individual will seek further management in the hospital. This is done as the last resort and, at times may seem a failure for the family. Thus, becomes critical for healthcare practitioners to understand the diverse backgrounds of their patients for professional autonomy and empathetic care. During the patient’s admission to the hospital, basic nursing care requiring touch is provided to maintain the patient’s well-being. Procedures such as bed baths, and insertion of urinary catheters are implemented. These procedures are considered intimate as the patient and nurse share a confined private space. Intimate care can be defined as task-oriented care that requires proximity between the patient and nurse [40]. The patient is given an identity belt to identify them while in the hospital using their names and allocated hospital numbers. Hygiene, elimination, and nutrition including medication are provided to enhance the patient’s healing. The identity of the person is validated through rituals of naming, and initiation (baptism, blessings, and dedication) into the family and community. Symbols such as water, oil, incense, etc. are used to transform the body. A sense of belonging assists in maintaining the multifaceted human person: body, mind, and spirit.

5. Conclusion

This chapter sought to advocate for integrated personhood. To arrive at this, an exercise was made to integrate African Christian rituals and intimate care on the touched human body. The chapter concentrated on three countries in Southern Africa, namely Eswatini (former Swaziland), South Africa, and Zimbabwe. Some direct interviews were conducted with people who subscribe to different belief systems. This included adherents of African indigenous churches, mainline churches (those with a European background), Pentecostal churches and African indigenous practitioners. Semi-structured interviews were also conducted with registered nurses in selected hospitals. The important matter, or area of convergence, is that all the groups are for the advancement of the human person, that is for integrated personhood. This includes rituals that require the priest, leader, or elder to touch the human body. It is thus urgent that among these groups there must be constant sharing of experiences and advancements in practice. When confronted with a sick body, it is required that this body benefits from the experiences of the rituals on the human body so that healing may take place. When this is done there is an assurance that the body is treated with respect and dignity.

Acknowledgments

We acknowledge all participants who shared their valuable knowledge on the subject. This study is funded by the South African National Research Foundation Thuthuka Grant Reference: TTK210318590345.

Conflict of interest

The authors declare no conflict of interest.