On a cold winter's afternoon, Thokozile Nguse (my collaborator and research assistant) and I dropped by the homestead of one of the healers we had been working with. She lives in a community I call Entabeni, located in rural, Zulu-speaking South Africa.Footnote 1 When we arrived, we found three gogos (grannies in Zulu) sitting on benches in the sun talking animatedly. After greeting them, we slipped inside the round building that sat in the centre of the homestead to chat with Zintle, the healer and makoti (daughter-in-law) of one of the older women. On our way out, we paused to say goodbye to the gogos who had moved their rough, wooden benches to capture what remained of the quickly diminishing afternoon sun. As we approached, we overheard them complaining about what was wrong with the ‘youth’, a catch-all category for people between the ages of fifteen and thirty-five (we fitted into this category at the time). As they looked up, they spoke directly to us.
The gogos explained that one of the reasons why there were so many problems with the youth today (here, people would most often point to poverty, widespread ill health, pregnancy and death) was that they no longer practised hlonipha. When directly translated, hlonipha means respect, but it also refers to a number of practices enacted to show respect to elders and ancestors; these practices are important for the health and functioning of the family, which the gogos thought had gone awry. In this case, they were talking specifically about food taboos, which are also called hlonipha, such as the ones the gogos had followed when they were first married. In particular, these gogos were upset that the amakoti ignored the prohibition on dairy consumption, drinking milk and eating amasi, without regard for where it came from.Footnote 2 As these and many other gogos explained, for a makoti, following this food taboo is an important sign of respect for her husband's family's elders and ancestors. As such, it is key to her integration into her new family and ancestral line. And integration into this new family is important because a woman's ancestors keep her safe and healthy. For these gogos, this lack of hlonipha – an inattention to customary food taboos as well as a wider lack of respect – is to blame for the troubles of and with youth, and the troubles of Entabeni more generally. If the gogos had followed these customs and life was better in the past, they reasoned, surely it wasn't a coincidence.
In the other two communities in which we conduct research, some 45 kilometres away, Thokozile and I have had very similar conversations about the troubles of and with youth. Too much disease, too few marriages, not enough respect for their elders and ‘tradition’. These were the gogos’ concerns in both places. But in Enkangala and Ethafeni our conversations never touch on hlonipha customs. This is not because we are not interested in hlonipha; in fact, it is quite the opposite. But our conversations about hlonipha in those communities – Enkangala and Ethafeni – focused on the past, when the gogos had been girls or amakoti themselves. As the gogos in those communities explain, while they followed prohibitions on consuming amasi when they were new brides, they did not require the same of their amakoti. Their amakoti could have milk because, as they put it (rather unsatisfyingly), ‘times have changed’. As one gogo said, ‘We don't guard the amakoti to see if they are following customs. If they don't, they don't.’ Significantly, this older woman exhibited no malice whatsoever. This was in part because she saw no negative consequences resulting from the lack of attention to hlonipha. For these gogos, it was simple: there was no reason for the young women who lived in their homes and community to follow these customs any longer.
***
Why are there such differences today in understandings about an important food taboo that was observed throughout the region just over half a century ago? To answer this question, I offer an examination of how hlonipha relates to health and, more importantly, how health relates to food in rural KwaZulu-Natal. To understand hlonipha, health and food, I use a comparative approach, working in three communities in a rural, Zulu-speaking area of South Africa locally known as Pholela. This approach, which offers a comparison both across time and across space, reveals how the differences between these communities have shaped understandings of hlonipha. Comprehending why the elderly (and other) residents of one community are so concerned with hlonipha (the gogos I opened with were not the only ones in Entabeni to explain the trouble with youth through the abandonment of hlonipha), while others just a few kilometres away could not care less, requires looking to the past and thinking critically about food and health in the present.
To do this work, I follow in a long line of geographers, anthropologists and environmental historians to argue that food (like nature) is always simultaneously material and symbolic (for example, Beinart Reference Beinart2000; Castree and Braun Reference Castree and Braun2001; Moore Reference Moore2005). As scholars have shown, food is a combination of biophysical components (micro- and macronutrients) and meanings and social relationships (the result of livelihoods, a symbol of respect, and a point of tension between generations) (Moore and Vaughan Reference Moore and Vaughan1994; Vaughan Reference Vaughan1985). To understand health and healing from Pholela, I follow the work of Africanist scholars who root their explanations of health in the lives and experiences of Africans (Feierman Reference Feierman1985; Reference Feierman2000; Feierman and Janzen Reference Feierman and Janzen1992; Livingston Reference Livingston2005; Langwick Reference Langwick2011; Ngubane Reference Ngubane1977). These scholars recognize that people become sick due to witchcraft, angry ancestors, and a lack of nutrients or a pathogen, and that they become well with the help of healers including izangoma, izinyanga and doctors.Footnote 3 As with food, my understanding of health draws on a nature–society approach, recognizing health to be simultaneously material and symbolic – the combination of physical processes and symptoms and socio-cultural relationships and contexts (Guthman Reference Guthman2011; Jackson and Neely Reference Jackson and Neely2015; Lock Reference Lock1993; Lock and Kaufert Reference Lock and Kaufert2001; Mansfield Reference Mansfield2008; Neely Reference Neely2015; King Reference King2010). Drawing from scholarship on food taboos, I understand hlonipha customs, which connect food and health, as material and symbolic too (Fox Reference Fox2003). Finally, to articulate the material–symbolic relationships that make up food, health and hlonipha, I borrow the concept of entanglement from feminist science studies, which highlights their inextricability (Barad Reference Barad2007; Nading Reference Nading2014).
More specific to Southern Africa and the question of hlonipha and milk, a number of scholars have written about the important role cattle play both materially and symbolically in the region. They explain that cattle are a key financial investment and important for solidifying the social place of absent men, vital for joining families through marriage payments, and critical for understanding and relating to the ancestors.Footnote 4 For example, in his work in Lesotho, James Ferguson understands cattle as both a vehicle for savings and an important marker of social status, asserting that they are always socio-material. As a result, cattle become a flash point in negotiations both over gendered and generational hierarchies and over the resources needed to keep the family going (Ferguson Reference Ferguson1985).Footnote 5 In their work on cattle in South Africa, Jean and John Comaroff argue that cattle are more than simply economic assets; they are capital that ‘linked the material economy of things to the moral economy of persons, and so constructed a total economy’ (Comaroff and Comaroff Reference Comaroff and Comaroff1990: 206). In this account, cattle function as a way to solidify a particular social order, even as they are important materially (as economic assets) and are embedded in the broader political economy. While these insights are important for understanding the role of cattle in Pholela, by defining the material aspect of cattle solely in economic terms, this scholarship misses the important role that cattle play in health. As we will see, for Pholela's residents, cattle were important for the nutrition they offered and even more for preventing ancestor- and witchcraft-related illnesses.
Understanding livestock, food, health and hlonipha as material–symbolic entanglements, I argue that the abandonment of hlonipha customs in Enkangala and Ethafeni in the 1940s and 1950s and the subsequent changes in understandings of hlonipha occurred because milk had become a different food. This was in large part thanks to the efforts of a community health centre and its nutrition programme in the middle of the twentieth century. Through this programme, the health centre introduced powdered milk to the communities in its catchment area in an effort to increase protein consumption. I argue that by changing the social relationships around milk, offering new scientific understandings of milk, food and health, and shifting nutrition-related health – by changing both the material and the symbolic attributes of food – the ‘new’ milk was no longer subject to hlonipha customs; it had become something else.
To understand the changing meanings of food and hlonipha in the context of health, I first offer a note on methodology, describing the mix of archival and ethnographic methods I employ. I offer a short history of the area and its people before turning to Pholela in the 1940s and 1950s, when the government ran the Pholela Community Health Centre (PCHC). Recognizing food as entanglement, I examine how the material and symbolic availability of milk changed over time in different ways in these two areas, investigating that change in relation to health and hlonipha customs. Finally, I return to Pholela in the twenty-first century and the conversation with which I began, to understand hlonipha today.
A note on methods
I completed the research for this article during several research trips between 2008 and 2016, the longest of which lasted for twenty months in 2008 and 2009. During these trips, I spent the majority of my time in three communities in Pholela, which I call Entabeni, Enkangala and Ethafeni, with somewhat shorter stints in various archives. Working with Thokozile, I conducted ethnographic research that included intensive household histories with eight families, dozens of interviews, and participant and direct observation in homes, fields, shops, clinics and other spaces of everyday life.Footnote 6 Conducting research in three different communities offers a ready-made comparison, which helps illuminate the ways in which different micro-histories shape practices and understandings around food, taboos and health, even if those differences are far from straightforward. Key to my research design is a comparison across both space and time, which helps provide insight into important changes in the past, including the abandonment of hlonipha practices.Footnote 7 Indeed, only through a comparison of the specifics of these places do broader insights into central theoretical concerns about the relationships between food and health and between their material and symbolic entanglements emerge.
Key to the insights gained through this specific comparison are a number of baseline similarities. Entabeni, Enkangala and Ethafeni are close to each other. Their residents speak the same language and share a similar history, set of cultural traits and social formations. All three communities face the same environmental parameters – cold, dry winters, mountainous terrain and consistently rainy summers – and they all employ similar livelihood strategies. Moreover, the gogos in all of the communities are concerned about the youth, their lack of respect for their elders, and how things have changed since they were young. The key difference between these places lies in government involvement and the ways in which it was absorbed into everyday life in the middle of the twentieth century. In Enkangala and Ethafeni in the 1940s and 1950s, the South African government implemented an important social medicine programme that centred on health extension work in homesteads and communities. I learned about this programme through oral histories, the publications of the PCHC's doctors, and archival sources from the National Archives in South Africa. In Entabeni, the community in which this article began, the government did not implement a social medicine programme. And so, while conditions today are similar between these two areas, in the middle of the twentieth century they were not.
The history of food, livelihoods, health and milk in Pholela
Prior to their settlement in the late nineteenth century, the ancestors of Pholela's residents were nomadic pastoralists who passed through the area with their cattle to take advantage of the nutritious sourveld that grew on mountain slopes (Kark and Steuart Reference Kark and Steuart1962). During that time, life revolved around cattle and diets were tied to the milk they produced and some food grown in warmer months. As the government settled residents more permanently and as their access to land was restricted, Pholela's residents became sedentary and began to grow what food they could, leading to new agricultural production, livelihoods and food consumption patterns. This forced settlement increased African reliance on the cash economy. The changes that the end of pastoralism catalysed meant that, without the land on which to grow nutritious food or enough money to buy it, nutrition – and, by extension, health – suffered (Webster Reference Webster1986; Wylie Reference Wylie2001).
By the 1930s, Pholela's residents had lived in the area year round for close to half a century.Footnote 8 Households had come to make a living through a combination of wage labour by men who were working away from home on nearby white-owned farms, on the railroad and in the cities (over 80 per cent of the men were away for at least six months a year), and women's subsistence agricultural labour at home (Kark Reference Kark1974: 247; Reference Kark1981: 226). While women worked hard in Pholela's fields and pastures, they had neither the land nor the labour to grow much of what they ate. As a result, households purchased the vast majority, if not all, of their food, mainly in the form of processed maize meal (Kark and Steuart Reference Kark and Steuart1962). As the doctors who worked at the health centre in the early 1940s discovered, Pholela's residents might eat well (pumpkins, beans, potatoes, wild greens called imifino and fresh maize) during harvest, at least when it came to micronutrients, but they ate very poorly the rest of the year.
The mixed livelihood strategy at work in Pholela and the limited land and (male) labour at home had important effects on livestock rearing and milk production, and by extension on nutrition (especially in terms of macronutrients). In 1940, 34 per cent of households had no cattle and the vast majority of those who did had only one cow. This was a significant change from the extensive herds of their forebears just a couple of generations earlier. More important to this article, as a result of these diminished herds, milk made up a much smaller portion of people's diets, especially in less well-off households, than it had for previous generations. Furthermore, the social hierarchies that shaped who consumed important animal products exacerbated the lack of milk for young women. Because men (if they were home) were the first to eat amasi, followed by older women, the chance that young women and children would consume the important protein calories from milk was very low. In a place where there was already a limited supply of milk, this hierarchy of access only intensified nutrient deficiencies for pregnant and lactating women and for growing children (Kark and Kark Reference Kark, Kark, Kark and Steuart1962).Footnote 9 In short, by the middle of the second quarter of the twentieth century, there was an absolute shortage of milk (and of the animal protein it contains) in Pholela for nearly every person throughout the entire year. That said, even though livestock numbers dwindled, cows remained and remain important, especially because of their role in maintaining a family's relationships with its ancestors.
Sarah Mathis argues that the gendered livelihood system in much of rural KwaZulu-Natal was about men's control over women's labour, reproduction and economic power. In Pholela, this manifested in an agricultural labour system in which men sought to limit women's work with livestock. Throughout KwaZulu-Natal, livestock ideally remained under the control of men, who were supposed to herd and slaughter them (Mathis Reference Mathis2011). But by the 1930s, most of Pholela's men were away working. As a result, women and children did much of the labour of livestock rearing. Under these circumstances, ideally, boys, girls and elderly men and women cared for cattle so that the amakoti could keep their distance since they were not yet fully incorporated into their husband's family. But, as I learned through oral histories, school, age and infirmity meant that the amakoti were often tasked with livestock rearing, with the exception of slaughtering, which remained exclusively a man's task. As this shift indicates, even before the arrival of the PCHC, relationships between women and cattle were changing, an indication of shifting gender and generational hierarchies.
Because milk comes from cattle, it was embedded in the same gendered and generational hierarchies as cattle. In particular, milk-related hlonipha restrictions for amakoti were largely about maintaining relationships with the ancestors. Today, residents in Enkangala and Ethafeni explain that this prohibition on consumption lasted anywhere from a few months to several years, as a young woman became a full part of her new family and as her new ancestors learned to recognize her. As many scholars of health and healing have noted, the process of becoming a full part of the new ancestral line was essential for the protection and maintenance of the health and welfare of the makoti and the entire family (Feierman Reference Feierman2000; Ngubane Reference Ngubane1977). In Pholela, and throughout Bantu-speaking areas of Africa, people engage in pluralistic healing practices. Steven Feierman explains that in these places, there are two different kinds of illnesses – illnesses of person and illnesses that are not sent by an individual (what Feierman terms illnesses from God) (Feierman Reference Feierman2000). Illnesses of person are particularly important for understanding hlonipha because the ancestors play a key role in their prevention and treatment. As a result, maintaining relationships with the ancestors is important for preventing illness. As many residents explained to me, in Pholela, if a woman's new ancestors do not recognize her as part of their lineage, she is vulnerable to both illness and misfortune due to witchcraft. Further, if the ancestors do not think that the newest member of their family is showing sufficient deference, they can send her or her children an illness. As a result, non-adherence to hlonipha practices had and in some instances continue to have negative implications for health. To end the prohibition, a woman's husband would hold a ceremony called an umcamo for her, slaughtering a goat for the ancestors to mark his wife's full incorporation into his ancestral line, and he would give her a cow.Footnote 10 Once the ceremony was completed, a woman could consume milk and amasi produced from the cows of the family and still be sure that the ancestors would protect her health. (Before that, hlonipha restrictions curtailed the ability of women of childbearing age to eat animal protein, both meat and milk.) This shift meant that the makoti would get the important protein, vitamins and minerals in milk, thereby safeguarding her health.
A number of scholars have written about food taboos such as hlonipha. Generally speaking, this scholarship can be divided into two main subgroups: scholarship that sees taboos as bio-evolutionary adaptations designed to protect people's biological health (material aspects) (Fox Reference Fox2003), and scholarship that sees taboos as ritual, often religious in nature, designed to uphold various social norms (symbolic aspects) (Adeokun Reference Adeokun1982; Aquina Reference Aquina1969; Gausset Reference Gausset2002; Gluckman Reference Gluckman1938).Footnote 11 To understand changes in hlonipha in Pholela, I draw from the work of scholars who see the material and symbolic attributes of food and taboos as interconnected; these scholars focus on the connections between social and biological aspects of food and taboos, demonstrating that taboos originated in the past to help regulate social behaviour and to protect people from elements in the environment that are dangerous and unhealthy.Footnote 12 But as food production and consumption patterns shift (often in the face of industrialization) – as the material of food changes – taboos evolve or die out (Lepowsky Reference Lepowsky1985; White Reference White2002).Footnote 13 Likewise, the meanings associated with taboos alter as a result of the same new social relationships associated with shifting consumption patterns. And new meanings can also lead taboos to change or die out. These scholars demonstrate that, through changes in taboos, the inextricability of their social and material components becomes clear. This was certainly true in hlonipha practices in Pholela, where in the middle of the twentieth century a major social medicine intervention helped change diets and food in an effort to boost nutrition – and hlonipha-related milk restrictions disappeared.
Nutrition, food and health
A new kind of milk
In April 1940, Sidney Kark and Edward Jali arrived in the part of Pholela where Enkangala and Ethafeni are located with a small team of community health workers to set up the country's first rural health centre, the Pholela Community Health Centre (PCHC). This was a period in South Africa's history before the start of apartheid when the government was interested in improving the lives of the entire population, including Africans. What had begun as part of a larger, global movement in the interwar years to help ‘develop’ the world's poor, particularly those located in Africa, Asia and Latin America, took hold in South Africa under government auspices (Adams Reference Adams2016; Beinart Reference Beinart2001; Kark and Kark Reference Kark and Kark1999; Kark and Steuart Reference Kark and Steuart1962). This effort included comprehensive programming in everything from an Ethnology Bureau tasked with learning about South Africa's native African population to anti-soil erosion and agricultural extension work (called Betterment), to the extension of social welfare grants in the form of universal old-age and disability pensions, to the development of a healthcare system targeted at poor communities (Beinart Reference Beinart2001; Dubow and Jeeves Reference Dubow and Jeeves2005). It was during this moment that the South African government began its experiment in community health, first establishing the PCHC and then the National Health Services Commission under soon-to-be Minister of Health Harry Gluckman (brother of the renowned anthropologist Max Gluckman); the commission was charged with understanding and addressing the health needs of the African population. Out of this commission came the health centre model, which Pholela was already enacting and was replicated in more than fifty sites around the country in the 1940s and 1950s. As one of the most important sites for the development of social medicine in South Africa and around the world, the PCHC sought to treat both illnesses and the underlying social and material conditions that made people sick; theirs was a medical practice that recognized health as material–symbolic entanglement.
Upon arrival, the Karks and their team noticed rampant malnutrition and ill health even before they examined their first patients (Kark Reference Kark, Kark and Steuart1962). When they conducted their first study of malnutrition in 1941, they quickly quantified those early observations, finding that over 80 per cent of residents exhibited marked stigmata of nutritional failure (short stature and skin and hair pigmentation irregularities), and, further, that specific nutrition-related illnesses such as pellagra (a niacin deficiency) and kwashiorkor (a protein deficiency) were ubiquitous (Kark and Kark Reference Kark and Kark1999; Slome Reference Slome, Kark and Steuart1962). And although the causal relationships between infection and malnutrition are complicated, health centre staff also blamed illnesses such as tuberculosis, gastroenteritis, pneumonia and whooping cough at least in part on residents’ lack of nutrition.Footnote 14
As a result of these discoveries, a nutrition programme quickly came to be at the heart of the health centre's efforts. For the PCHC, food was a bundle of nutrients that provided the basis on which to build good health. Following this logic, getting the right balance of macro- and micronutrients was the first step in improving community-wide health; increasing milk consumption was key to this effort. Soon, the health centre began giving out parcels of food as ‘prescriptions’ through its pharmacy. These prescriptions included vegetables from the demonstration garden and packets of powdered milk. The health centre often gave out these food prescriptions to patients whether or not they were sick with kwashiorkor or other forms of acute malnutrition because it understood how important food was to health. The health centre prescribed food (as opposed to vitamins) because it wanted residents to associate health with what it considered a proper diet, a diet they could replicate through scientific gardening and livestock rearing at home, and through the purchase and consumption of healthy food from local shops.
To help residents absorb the meanings that the health centre associated with food, lessons in nutrition accompanied prescriptions. First at the clinic and later with health educators in homesteads, the amakoti in the health centre's catchment area and their mothers-in-law learned about the importance of nutrition, and more specifically about the importance of milk (powdered or otherwise) for their health. In the early years of the PCHC, residents continued to follow hlonipha customs. This was a constant frustration for health centre staff. In annual reports and in publications, the doctors often complained about the ‘backwardness’ of Pholela's residents, pointing to the maintenance of hlonipha customs as proof.Footnote 15 As the second medical director of the PCHC, John Cassel, wrote: ‘Whatever the underlying reasons, it soon became evident that the taking of milk by girls and especially by married women had powerful emotional connotation. In the face of those deep-seated beliefs, no mere conviction of the nutritional value of milk could be expected to change the practice’ (Cassel Reference Cassel1957). Cassel and others who worked at the PCHC saw the unwillingness of women and girls to consume milk as irrational, the result of a lack of education and inferior beliefs. For them, this lack of willingness was completely separate from – and a barrier to – bodily health. As this quote and as health centre documents reveal, despite the health centre's best efforts and its scientifically grounded lessons, residents of the catchment area did not abandon their understandings of the importance of milk and replace them with the lessons of nutritional science in full, at least not at first.
Whereas health centre staff saw this failure as a lack of civilization and knowledge, it is perhaps better to read it as the health centre staff's failure to understand the multiple causes of illness in Pholela. The prohibition on milk consumption stemmed from the importance of cows in maintaining the relationships between the living and the dead, and, by extension, the health of the living. In Pholela, a new makoti could not consume milk or meat from her husband's family's cows until, as one woman in Entabeni explained, her husband had given her milk in ‘a proper way’. From this perspective, what the PCHC faced was not a lack of education, but rather an unwillingness by young women to trade the eventuality of some (ancestor and/or witchcraft) illnesses for possible protection from others (kwashiorkor and infectious diseases).
Nevertheless, residents were eager to get the important nutrients milk contained if they could obtain them in a way that did not conflict with hlonipha. Powdered milk allowed them to do just that. Hlonipha prohibitions and the fear of ancestor and witchcraft illness did not extend to the powdered milk the health centre gave out in its prescriptions. As a result, all residents consumed it, even as amakoti continued to avoid milk and amasi produced at home. The health centre's prescription programme was so successful in changing diets throughout its catchment area that it encouraged a local farmer to sell fresh milk to the communities and encouraged local shops to stock milk powder for sale in the hopes that people would continue to consume these varieties of milk (and the protein they contained) once they stopped getting prescriptions (Kark and Kark Reference Kark and Kark1999).Footnote 16 It worked; soon there was great demand for this milk, providing an easy return on investment and ensuring that residents would continue to consume this important source of protein.
Thanks in part to the work of the health centre, milk, first in powdered form and later fresh, had come to be a very different food compared with what it was when the doctors first arrived. This was, of course, in part because powdered milk was a very different product and in part because of its novelty. But it was also something more; thanks to the work of the PCHC, milk had come to mean something different. For the doctors, milk had always been a bundle of nutrients, and thanks to the health centre's health education efforts, by the 1950s people living in the communities surrounding the PCHC had come to recognize milk as important for the same reason. Because of those nutrients and the health education programmes that accompanied them, food became a ‘medicine’ important for curing illness, and the key to preventing ill health. This new link between milk (a food) and health certainly helped ensure its acceptance. In addition, milk had become a staple in everyone's diet, regardless of age and gender, and it was now something residents could get year round by buying it with men's wages. By relying on a store-bought product and teaching about the importance of nutrition, the health centre had inadvertently found a way around seasonal shortages, gendered hierarchies, and the hlonipha customs that supported them.
Livestock, milk and hlonipha have a long history in Southern Africa. For example, in his article on milk in the Zulu kingdom under King Shaka, Paul Bjerk argues that power was imbued through milk and milking (rather than through cattle, as many others have argued). In this analysis, rather than being simply a food that nourished the body, milk became a way for the royal house to demonstrate and maintain power within the social structure (Bjerk Reference Bjerk2006). On a smaller scale, the same was true in households surrounding the PCHC in the first half of the twentieth century. More specific to questions of hlonipha, Monica Hunter, who conducted research in the 1930s with the Pondo, who live just to the west of Pholela, wrote about the importance of hlonipha practices, particularly around the consumption of amasi, for maintaining hierarchies inside the family (Hunter Reference Hunter1933). And David Hammond-Tooke notes the prevalence of stories of hlonipha from early ethnographers, revealing how common hlonipha practices were in South Africa in the nineteenth and early twentieth centuries (Hammond-Tooke Reference Hammond-Tooke1992). While access to the nutrition in amasi was important for the health of the people who consumed it, scholars writing about hlonipha in Southern Africa have focused more on the role the practices play in maintaining social hierarchies. For example, Benedict Carton argues that hlonipha practices reveal generational tensions by ensuring that the youth honour their elders, as such practices offer a check against efforts by the youth to subvert the hierarchy of the homestead (Carton and Morrell Reference Carton and Morrell2012). Deborah James and Keith Breckenridge also understand hlonipha as part of an effort to uphold a ‘traditional’ way of life and maintain the generational (James Reference James1990) and gender (Breckenridge Reference Breckenridge2000) hierarchies. While clearly important, this focus on the social system is not sufficient for understanding how and why hlonipha changed in Enkangala and Ethafeni.
For the people in the communities around the health centre, powdered milk from the clinic or the shop and fresh milk from the local farmer were not the same as milk and amasi from their husbands’ cows. In other words, it was a change in the food that precipitated a change in hlonipha. After all, industrial cows and even a local dairy farmer's cows were not connected to these amakoti's new ancestors. By purchasing milk with wages, residents had put real and symbolic distance between themselves and the cows that produced that milk. Thanks to the clinic's nutrition programme and its attention to the mixed livelihood strategies of residents, milk had been disconnected from the cow. Further, as South Africa's political economy changed, as livelihoods changed, and as people learned about the importance of protein, the role of milk in people's lives also changed. The symbolic importance of milk for maintaining power, as Paul Bjerk so aptly demonstrates for the Zulu kingdom in the nineteenth century, no longer applied to the communities in the PCHC's catchment area in the middle of the twentieth century. Milk was quite simply a different food.
It would be a mistake to attribute changes in milk consumption and hlonipha solely to the health centre. Men, away working in cities far from the fields and pastures of their home, had to purchase all of the food they ate. As one mkhulu (the Zulu word for grandfather) who spent his youth working in Durban recalled, in the shops of the city, they bought amasi and milk to eat and drink, augmenting a diet largely dependent on processed maize meal. These new spending and consumption patterns developed in the city before the wives and mothers of these men could buy powdered and fresh milk at home. In those days, when the men returned to Pholela, they brought both new preferences and new foods with them, foods that were not enmeshed in the same social relationships and that were separate from health concerns. As a result, when the health centre introduced powdered milk and when local shops began to stock it, Pholela's women were already familiar with these different forms of milk.Footnote 17 This then combined with the fact that amakoti's relationships to livestock were already changing because they had become primary caretakers. While residents today remember that it was the health centre and its prescriptions of milk and vegetables that led them to adopt powdered milk as a staple of their diet, residents' increasingly intimate relationships with livestock, the early store-bought milk preferences of men who migrated for work, and the production and consumption of that milk outside the social relations of the homestead surely affected hlonipha practices as well.
Significantly, the abandonment of milk-related hlonipha customs did not result in the abandonment of other customs that the health centre disapproved of, nor did it mean that the ancestors had stopped being important to the health and welfare of the area's amakoti. (It also did not change residents’ relationships with cattle very much.) Indeed, amakoti still practised other hlonipha customs (such as avoiding certain words), residents still suffered from ancestor and witchcraft illnesses, and families still slaughtered livestock to pay their respects to their ancestors. In other words, the abandonment of this hlonipha practice did not mean that residents had come to understand health and the relationships between health and food in only the way that the PCHC's doctors, nurses and health educators did. Instead, they had come to have different understandings of the multiplicity of material–symbolic entanglements that comprise food and health, relationships that made it possible for these varieties of milk to be different foods. By the 1950s, milk in Enkangala and Ethafeni was significantly different from what it had been just twenty years before. It was a qualitatively different and new food, linked to residents’ health in new ways and taking on new meanings.
Milk and health: new sets of relationships
Health and understandings of health were central to the incorporation of milk into the diets of Pholela's amakoti and to the transformation of milk more broadly. While residents long understood that food was connected to health (through milk, hlonipha and ancestor illnesses, for example), in lessons about nutrition, the PCHC offered a new way to think about the relationships between food and health. For example, residents learned that once they ate nutrient-rich food, the nutrients they consumed went to work building the healthy cells that would help fight off illness. Pholela's residents took these lessons to heart as their eating habits changed. In one conversation, a gogo who had grown up near the PCHC explained that boiling food rather than frying it in oil was important because it preserved the food's nutrients. ‘Nutrients,’ she told me, ‘are important because they help the blood function well.’ Whereas this gogo sees food primarily as a bundle of nutrients necessary to ensure healthy blood and a healthy body, the gogos who grew up in Entabeni may see food as being related to health in a different way. For them, food derived from animals, and amasi in particular, is important for the ways in which it helps solidify relationships with the ancestors, thereby preserving good health.
As these examples of illness demonstrate, health is more than symbolic – it is more than lessons on nutrition and relationships with ancestors; it is material, too. The nutrients that more regular consumption of milk added to the diets of Enkangala's and Ethafeni's residents had a remarkable effect on their bodies. In the first ten years, the numbers of patients seeking treatment for illnesses related to malnutrition dropped from more than eight a month to fewer than eight a year, infant and crude mortality plummeted, and new cases of infectious disease decreased markedly (Cassel Reference Cassel, Paul and Miller1955). At the same time, as resident after resident explain, there was no noticeable rise in witchcraft or ancestor illness. The main health costs of non-compliance with hlonipha had not materialized; residents were largely consuming purchased milk, after all. In short, the material processes at work inside people's bodies, such as the construction and maintenance of healthy and functioning cells, had changed as a result of the milk (and vegetables) people were consuming thanks to the work of the health centre. Moreover, they had changed for the better. People were healthier; they embodied (materially) the changes in food and their changing relationships to food.Footnote 18
As health was improving, residents were also building important relationships with health centre staff as they learned from them that the micro- and macronutrients in their food were to thank for those improvements. When I arrived in Enkangala and Ethafeni in 2008, interested in the work the PCHC had done, it was not hard to find older people with fond memories of the Karks and the other doctors who worked at the health centre. One woman I spent a lot of time with had even named her first born after their eldest daughter. But more than this, it became clear through conversations that the relationships residents had with health centre staff, especially the health assistants who were largely recruited from the communities that surrounded the health centre, were important. Residents recalled with fondness the visits health assistants made to their homes – as often as twice a week – noting that they helped with the gardens and taught them about nutrients and bacteria and why the homestead modifications they were making were important. The lessons were clearly valuable to people's health, but also for what they signalled about the value of these social relationships and the role they played in shaping people's understandings and habits. Many residents wanted to do many of the things the health centre was recommending because they knew and trusted the doctors and health assistants who worked there. This was a healthcare practice rooted in relationships.Footnote 19
The combination of an embodied experience of good health (not to mention seeing children live and grow with much less illness), new food, new knowledge and new, important relationships helped solidify a place for store-bought milk and powdered milk in the daily diet of residents. It was not enough for residents to adopt new meanings thanks to lessons about nutrition and new, more urban tastes in the city; the nutrients in their diet needed to change too. Likewise, it was not enough for diets to become more nutritious without new ideas and meanings for food. By incorporating new forms of milk with new ideas about health and nutrition, ideas conveyed through relationships, the health centre had catalysed a shift in health and nutrition in Pholela.
It is precisely because of the shifting material and symbolic entanglements that made up food that milk and hlonipha became disentangled for the gogos in Enkangala and Ethafeni as nutrition-related health improved and as meanings and cells changed. The influence of these entangled factors is all the more striking when contrasted with hlonipha in Entabeni, where those changes did not occur and where the gogos today articulate the troubles of youth through hlonipha. In many ways, this ongoing concern with hlonipha in Entabeni fits in with the scholarship about hlonipha, which sees it as most important for maintaining a generational hierarchy in the family and community. But Enkangala and Ethafeni tell a different story, one that follows more closely the understanding of livestock in Southern Africa as simultaneously material and symbolic that scholars have long articulated. For hlonipha to change, as it did in Enkangala and Ethafeni, a combination of material and symbolic factors had to come together: long-standing labour migration patterns, the establishment of the health centre and its programmes in the area, the important relationships that undergirded that work, new knowledge, new meanings, changes to residents’ physical bodies and industrial agriculture. If any of these attributes had been missing, there might not have been a shift in hlonipha practices around milk.
Although its start was auspicious, the PCHC did not last, at least not in terms of the work described here. As the National Party's hold on power solidified in the late 1950s and as apartheid became more draconian and more entrenched, the multiracial, progressive work of the PCHC and the units that supported it became impossible. The doctors who had founded and worked at the health centre left the country, taking up academic posts in the United States, Israel and Uganda where they could continue their social medicine work (Geiger Reference Geiger1993; Tollman and Pick Reference Tollman and Pick2002). At the same time, the government decided to abandon the health centre model it had begun to work with in the 1940s, slashing funding to healthcare in South Africa's homelands and to its community health centres in particular. By 1962, the government let the last medical director of the PCHC go and it reduced funding levels to those equivalent to other homeland clinics, effectively shuttering its health outreach and education efforts. The PCHC that had long been so influential for milk consumption and many other reasons ceased to exist. And yet, as my time in Pholela makes clear, the lessons of those two decades of work remain in homesteads, practices and understandings of customs such as hlonipha.
Milk and hlonipha today
Today, in Entabeni, Enkangala and Ethafeni, community health workers regularly visit residents to check on their health and offer advice on everything from nutrition to infectious diseases. The PCHC is back up and running and residents in Enkangala and Ethafeni attend regularly. Entabeni remains relatively remote, but a mobile clinic visits every other week and a bricks-and-mortar clinic within half a day's walk opened in 2017. While not as comprehensive as the PCHC of the 1940s and 1950s, in the post-apartheid era, the South African government has sought to extend healthcare to the country's poorest people, following some of the practices developed at the PCHC.Footnote 20 As a result, in the past twenty years all South Africans, including the people Thokozile and I know in Entabeni, have received at least basic lessons on nutrition and how it relates to health. But these lessons have not been accompanied by prescriptions of powdered milk and the community health workers who deliver these lessons have limited time and are neither highly trained nor well paid. Further, the medicine practised in Pholela is focused on the individual, with very little attention to the family or community; the relationships that formed the bedrock of the PCHC's social medicine in the 1940s and 1950s do not hold the same place in this kind of medical practice.
In addition to differences in medical practices, subsistence agriculture petered out between the middle of the twentieth and beginning of the twenty-first century. As a result, very few households have cows and those that do are not milking them. And thanks to low wages and no electricity, in Entabeni, amasi and milk from stores were still rare in the late 2000s, and few households consistently had powdered milk because it had never held an important position in their diet. The result of this health and food reality is that, while people such as the gogos and their amakoti in Entabeni might have had lessons on the importance of nutrition, they do not have the means or support to translate their knowledge into new eating habits. Without a change in eating habits, their health does not benefit from an infusion of protein. And without this material shift, the material–symbolic entanglement of milk did not change as it had in Enkangala and Ethafeni. In other words, milk in Entabeni continues to be different from milk in Enkangala and Ethafeni in the first decades of the twenty-first century, even in its everyday absence.
In Entabeni today, hlonipha and the milk with which it is and was entangled are not the same as they were in the 1930s, but they are also not the same as they are in Enkangala and Ethafeni. On a different day, Thokozile and I were in Entabeni chatting with women our own age (‘youths’) about hlonipha and amasi. Contrary to the claims of the gogos with whom we began, these women explained that they would follow hlonipha customs when they got married and wait for their new family to give them amasi in ‘the proper way’. They understood how important it was to join their ancestral line – an understanding of the importance of hlonipha much like understandings in the 1940s. In Entabeni, milk from people's cows and hlonipha continue to represent an important connection to the ancestors and a way to uphold a generational hierarchy, even though in practice hlonipha is rarely enacted.
By contrast, the young women with whom we spoke in Enkangala told us that they did not plan to follow hlonipha customs; furthermore, they weren't sure why amakoti had not been able to eat amasi in the past. And their would-be mothers-in-law agreed: there was no reason to follow this milk-related hlonipha prohibition. For these women and their amakoti, milk was a different food.
Very few of these young women (in any of the communities) were or would ever be married – a focus of the gogos’ concerns, as we saw. Formal marriage rates in South Africa as a whole and in rural areas in particular have declined in recent years, although partial marriage payments, which continue to connect families, persist.Footnote 21 And anyway, no one gets milk or amasi from their cows any more – although, as we saw, by the 1940s home-grown milk and amasi were already very uncommon. Nevertheless, these contrasting perspectives on the importance of hlonipha are significant for the different material–symbolic relationships they represent. The residents of Entabeni never felt the benefits of the increased protein in their diets that the residents of Enkangala and Ethafeni experienced and they never received lessons on nutrition from people with whom they had long and deep relationships. As a result, in Entabeni, ideals of milk from the family's cow and milk-related hlonipha customs continue to be important in relation to the ancestors, even though there are seldom opportunities to enact them.
Since the 1930s, the material–symbolic entanglements that constitute milk in Pholela and the broader context in which they sit have changed, but those changes were not the same throughout the region. The time Thokozile and I spend in Entabeni, Enkangala and Ethafeni and the conversations we have with all people, old and young, who live in those communities illuminate how the entanglements of milk vary over time and across space. While the realities of limited livestock mean that milk-related hlonipha restrictions are no longer practical in any of the communities, the meaning and importance of hlonipha in Entabeni in the early 2000s matched much more closely what they had been throughout Pholela in the decades before the PCHC arrived in Enkangala and Ethafeni. This was in part because milk was a different food in Entabeni than it was in Enkangala and Ethafeni; it was a different material–symbolic entanglement. Examining how discussions of hlonipha differ between these places today offers a glimpse of these practices in the middle of the twentieth century, when new ideas and new foods arrived together to the homesteads of Enkangala and Ethafeni and changed understandings of hlonipha for residents. This approach attends to the importance of social hierarchies while moving beyond them to recognize their multifaceted relationships with both the social and material aspects of health. Recognizing hlonipha as at once material and symbolic builds on nature–society literature and literature on livestock in Southern Africa to offer a more nuanced understanding of hlonipha as it relates to health. This vision of hlonipha asserts the primacy of material–symbolic entanglements that bind food, families, health and societies, and which shift and evolve as those relationships build and rebuild over time.
Zulu–English glossary
- amasi:
a liquid, yogurt-like food that comes from ‘sour’ milk
- gogo:
grandmother or old lady
- hlonipha:
respect; food taboos related to the consumption of animal products
- makoti (amakoti plural):
daughter-in-law; also refers to a young woman
- mkhulu:
grandfather or old man
- umcamo:
ceremony where a man sacrifices a goat or a cow to mark the occasion when his wife becomes a full member of his family (after the ceremony she can consume milk and amasi from the cows of her new family)
