A lay carer's story about epilepsy in an urban South African context: they call it an illness of falling or an illness of fitting because a person shakes and eventually falls.

In South Africa, epilepsy is poorly understood and managed. The different cultural understandings and terms used to explain the condition across the diverse population groups exacerbate this problem. In this article, we describe the findings from a single story about epilepsy which we elicited through a semistructured interview guide in the respondents' natural setting. We used Kleinman and Benson's mini-ethnographic questions to explore the lay carer's explanatory models about epilepsy. Our respondent had different descriptors for epilepsy which include 'an illness of falling', 'an illness of fitting', and 'a thing'. His explanatory models concerning epilepsy were predominantly sociocultural, psychological, economical, and political in nature and were supported by personal examples from his past and present experiences. Key to this man's story is the reality of a strong cultural base of understanding epilepsy, with the added reality of an urbanized world in which people feel alienated from one another and do not necessarily share the same cultural beliefs and practices. Instead of viewing understandings of epilepsy as either 'traditional' or 'western', community-based health promotion interventions must therefore recognize both cultural issues and urban realities and should also incorporate approaches that foster a common ground for patients and carers with very diverse views. The findings of this one interview cannot be generalized but have implications for managing epilepsy in an urban African context.