Health in India - Healing with Amulets and Antibiotics
Traditional and modern healing methods exist in India in parallel. Both approaches can supplement each other
Although Gabriele Alex and Vibha Joshi belong to different departments at the Max Planck Institute for the Study of Religious and Ethnic Diversity in Göttingen, both scientists are studying the wide range of healing methods used and traditions followed in Indian society. Here they show from different perspectives how the supposed contradictions aren’t really all that incompatible in practice.
Text: Birgit Fenzel
In India, those who fall ill can choose between Western biomedicine and a vast array of indigenous healing methods. They can ease their pain with Ayurvedic oils, nasal douches
or enemas, or try their luck with conventional homoeopathic granules or naturopathic plant salves. They can also realign their body’s unbalanced energies with the help of a therapy prescribed by a Siddha doctor, involving vomiting, purging or hot compresses. Patients can also consult a Unani specialist working according to the Greek four humour principles to restore the correct balance of blood, phlegm, and black and yellow bile. In particularly acute cases, specialists even offer services that stray into the realms of metaphysics.
According to Gabriele Alex’s observations, whether a patient with a broken leg consults a surgeon or relies on the exorcism skills of a spiritual healer very much depends on the presumed cause of the illness, the distance from the patient’s home to the health services available and, above all, his or her socio-economic status. "It’s basically the same as it is for us " we try to cure certain ailments using home remedies and visit the doctor only for more serious illnesses."
Anthropologist Vibha Joshi has carried out research into the flexibility with which many Indians combine elements from different religions with modern and traditional medicine to treat illnesses, based on her study of the Angami in Northeast India. According to local custom, they mix Christian, animistic and other religious elements when treating illness. Unlike Gabriele Alex, who, as a member of Steven Vertovec’s team, is concerned mainly with socio-cultural diversity, Joshi belongs to Peter van de Veer’s department, which focuses on aspects of religious diversity.
Studying the causes through dreams and trances
In her recently completed book Christianity and Healing: the Angami Naga of Northeast India, Joshi describes the relationship between Christian belief and healing among the Angami Naga in Nagaland, more than 85 percent of whom are converts to Baptism, Catholicism or other Christian denominations. "In some cases going back three generations," says the Max Planck researcher.
Although Christianity is a long established religion in this region, it has not totally superseded the indigenous spiritual world of the Angami. Even today, they still have mediums and shamans who are reputedly able to make contact with the ancient guardian spirits.
Some predict the future, while others enter dream or trance states to identify the causes of illnesses and how to cure them.
In a case study in her book, Joshi describes the matter-of-fact way in which people mix the different healing services offered by biomedicine or folk medicine, Christianity and the traditional spiritual world. The study concerns the illness of a young woman from a Baptist family whose affliction priests declared to be caused by possession. After a febrile illness and initial asthma attacks, aggressive behavioural changes suddenly appeared in the patient, directed at everything and everyone. On a visit, the researcher was told about all the different efforts to find the correct diagnosis and therapy. First the family had turned to local healers, at the same time calling in the head of a nearby prayer centre who also practiced as a folk healer. He diagnosed an evil spirit as the cause of her blackouts. The family also sought advice from biomedicine and took the girl to the local hospital for blood tests, but the doctors there failed to come up with an explanation for the patient’s condition. A doctor from Assam finally did manage to treat the young woman’s asthma.
The family then sought Christian assistance in the form of a pastor who tried to drive out the evil spirit with prayers. Still the fits of rage persisted, and other priests consulted concluded that a really large evil spirit must have lodged in the girl’s body for so long that it was extremely difficult to separate it.
The family received a second diagnosis from another preacher, who attributed the girl’s fits of rage to a sin committed by her great-grandfather. A third theory, finally, explained her condition as the result of the patient’s refusal to accept a divine gift when she was a child. The Angami believe that shamans and spiritual healers are called by dreams and visions to use their powers to help people. Refusing such a call puts both body and soul in jeopardy.
Bible quotations help the treatment
At the time of the researcher’s visit, the girl was still not cured despite all the therapies that had been tried. The anthropologist, however, was not interested in the success or failure of the different treatment methods. To her, this patient history was a clear example of the non-dogmatic flexibility of the Angami’s attitude to the broad spectrum of secular and spiritual medicine and treatment traditions. It is by no means exceptional for priests to be consulted on health problems. Joshi believes that this close link between Christian belief and healing has to do with the history of the mission in Nagaland.
The first Christian missionaries who arrived in the region at the end of the 19th century tried to spread their message among Angami society through education and medical assistance. "At that time, it was common for treatment to be linked to bible quotations, in order to bring the compassionate side of the Christian God closer to the people," says Joshi. And this is still the case, as she discovered during her field research in Nagaland. "In some primary health clinics, I saw bible verses hanging over the entrance or in the treatment rooms." In addition, the Christian churches in the region still foster the culture of prayer and healing, and belief in miracle cures is widespread. As an example of these Christian establishments whose treatment methods follow in the footsteps of the Lord, she names the Revival Church of Nagaland, whose specialities include healing through the laying on of hands, and which runs healing camps specifically for this purpose.
The healing offered by other churches concentrates more on the power of prayer. "These are mainly groups of women and people who are believed to have unusual powers, who say special prayers for the sick," explains Joshi. Her observations confirm the link that still exists between Christianity and medicine. "Now the church’s role is to reconcile the various warring factions of the Naga nationalists and thereby heal the Naga community."
Joshi’s colleague, ethnologist Gabriele Alex, also came across images with Christian overtones while conducting research in the folk-medicine-based healer shops of the Vagri in Tamil Nadu. The Vagri are one of the three population groups chosen by Alex for her study on healing systems and traditions in Tamil Nadu. "I was particularly interested in how low-status castes perceive medical therapies and what methods they use to treat illnesses," she said as she talked about her project.
In fact, the inhabitants of India’s most southerly federal province have access to a wide choice of healthcare systems. For one, there is traditional folk medicine with its extremely comprehensive and varied arsenal of remedies and prescriptions against illnesses of all kinds. "These include grandma’s household remedies based on healing herb teas, root mixtures and soups, and professional healers who run their own practices or even clinics and treat broken bones, animal bites and skin diseases," says Gabriele Alex, enumerating some of the specialities of the nattu maruntu tradition.
The common factor in all these treatments is that they stem from knowledge of medicinal recipes and healing plants from the local natural environment, handed down from one generation to the next. The tradition clearly includes an ideological element. "This type of medicine is strongly associated with India’s romantic past and an image of nature and naturalness that is at odds with the modern world," says Alex. For another, the people living in rural areas also now have access to basic biomedical services. Like everywhere else in India, the range of public healthcare services in Tamil Nadu has been visibly improved by the introduction of basic healthcare establishments.
Health is the link to progress
"Besides this, the Indian government has also integrated traditional medical traditions and knowledge systems into governmental health policy," says the ethnologist. As a result, Ayurveda, Yoga, Unani, Siddha, homeopathy and natural healing have been standardized and incorporated into government training, research and healthcare pro-vision. According to Gabriele Alex, "There are also more private doctors than there used to be 20 years ago. When I began my initial research in 1998 in Madukottai, only one doctor was based there - and he wasn’t a real doctor, just a quack who had worked as an assistant to a biomedical doctor for many years before eventually setting up on his own."
Eleven years later, the village boasted three private doctors, a government health centre where a doctor, a nurse and a laboratory assistant were available on weekday mornings, and a primary health sub-centre with a pharmacist, birthing room and consulting room.
These improvements in biomedical services, available even in rural areas, have come about on the back of the Indian government’s development programs. "Health is a major theme in this discourse, and is directly linked to economic growth and progress," says the researcher. As part of her study, she wanted to find out whether improved access to public biomedical clinics is actually displacing traditional healing systems. The fact that no or only very low costs are charged for the government service would seem to support this.
"But despite government interest in the topic of healthcare provision, hardly any studies have been conducted on this," says Alex. "It is still assumed that providing a good service means that people will use it." In addition to the Vagri, she also chose for her study the Mutturaja and the Paraiyar, who represent the traditional lower castes, both of which live from agriculture. The Vagri, in contrast, who do not practice as peripatetic healers or run healer shops but sometimes offer treatment from their homes, are travelling salesmen like their forefathers, selling cosmetics at the roadside. Others live from hunting and setting traps for small animals.
"Vagri healers are known for their special folk medicine and miracle cures against ageing, impotence and infertility," says Alex. Their medical repertoire includes oils for external application, as well as powders and pastes, for which the healing plants used are mostly standard folk medicine remedies. On her visits to healer shops, she also saw how these folk medicine practitioners stir and pulverize very special ingredients in pots and pans. "But they also use animal fats, snakes and meat as ingredients in medicine, and this differentiates them from the other folk medicine healers." Other Vagri specialities include fortune telling and protective medicine, for which unusual items are sometimes used. "For instance, they buy amulets containing fox horn," explains the scientist, describing another specialism of the healer’s art. "This small horn supposedly comes from the skull of the fox and transfers the animal’s potency and strength to its wearer."
Among the Hindu Paraiyar in Madukottai, too, the cami (lords) are responsible for ritual healing. "The members of this caste worship mainly deities to which animals are sacrificed and that project a certain wildness and danger, such as Kaliamman and Karuppa, as well as Muni, who is both a deity and a spirit," Alex explains. These beings are apparently responsible both for causing illnesses and for healing them. The ritual specialists of the Paraiyar thus also play a healing role.
Women prefer giving birth in the hospital
So, when they fall ill, how do these people choose from the many treatments on offer, ranging from folk healing traditions to biomedical institutions? This was one of the core questions in Gabriele Alex’s study. To find the answers, she worked in the field using qualitative and quantitative methods for collecting ethnological data. She recorded the medical histories of her interviewees in one-on-one conversations, in order to identify examples of, and changes in, health behaviour. The scientist also used standard questionnaires to record the types of illnesses and their assumed causes, and the choice of healers and doctors, relating them to factors such as age, gender, education level, caste and place of residence. This methodology produced illuminating data on the medical options actually available to members of these castes and how they perceive and use these options. Analysing the data she had collected gave Alex insight into the main causes of illness in this region. "The most common ailments reported are fevers, colds and flu infections, as well as diseases of the digestive tract," she summed up. Illnesses associated with modern civilization, in contrast, play almost no role.
The researcher was also the first person to document the fact that at least some sections of the population confound the assumptions of health policy-makers. "Public health clinics are visited to a limited extent only," she says. "State hospitals are preferred only for births, because there, Caesarean sections are not performed unnecessarily - instead, babies are brought into the world slowly."
On the other hand, most survey respondents said that they preferred visiting private hospitals for fever. "Because antibiotics are often prescribed there and the drugs are considered to be more effective," the researcher explained. She also discovered that patients seeking a cure combine the various treatment methods or alternate biomedical methods with home remedies or traditional healing arts.
Malnutrition is the biggest problem
A key factor in the choice of therapy direction is the assumed root cause of the patient’s ailment. "People there have a clearly differentiated concept of the causes of illness," says Alex, "they distinguish between natural and supernatural causes." Biomedical doctors are competent to deal with the former, spiritual specialists with the latter.
As the scientist also discovered, the castes differ in their preferences for certain healthcare institutions. Paraiyar and Mutturaja clearly prefer government doctors and clinics or go to pharmacies and medical shops, which Gabriele Alex attributes to the socio-economic status of these castes. "These people are day labourers and simply cannot afford hospital visits, because that would mean losing a day’s work," she says. "Medical advice from pharmacies is normally free of charge and vaccinations cost just five to ten rupees."
On analysing her questionnaires, Alex also discovered an interesting paradox: of all people, the Vagri, whose response to public healthcare institutions was the most positive in the questionnaires, use them the least of the three groups. "They feel private hospitals provide better and more effective treatment. This has to do with the discrimination experienced by the members of low-status groups in public hospitals."
The researcher finds it particularly interesting that, when asked for suggestions on how to improve the healthcare system, most of the participants in her study cited optimization of nutrition as the most important measure, and especially improved protein intake. "All the government programs are aimed at expanding the healthcare system - yet the people in the countryside see malnutrition as their biggest health problem."
Scholastic medicine tradition developed in southern Asia. The main Siddha influences are rooted in yoga philosophy, Tantric theories and practices, and alchemical and Ayurvedic concepts.
Scholastic medicine tradition, originating in Greece and further developed in the Arab region. The current form incorporates traditional healing arts from Egypt, Syria, Iraq, Iran, India, China and the Middle East. Unani probably reached India in the 12th century.
"Folk medicine", a collective term embracing countless healing and folk medicine practices, refers to medical healing traditions that are based on drugs of plant and animal origin and that cannot be ascribed to the scholastic traditions (Siddha, Ayurveda).