By Shruti Menon:
“I used my senses in a powerful way to understand this man, the misfortunes that had befallen him, and his own suspicions as to the origin of the problem. I threw the bones for him… The bones did not want to talk to me at first…Every day I got up before sunrise, washed with herbs, put on my ceremonial clothes, and beat the drums. I sometimes took muti (medicinal potions) so that I could talk to the ancestors… I knew when the man was cured because he became happy, and then I became happy, too.”
– Excerpted from Hewsen M (1998), “Traditional Healers in Southern Africa”
“On August 6, 2001, twenty eight people labelled ‘mentally ill’ died in a fire that burned down the makeshift hut in which they were kept chained in Ervadi, Tamil Nadu.”
– Excerpted from Kalathil J (2007), “After Ervadi: Faith Healing and Human Rights“
In 2002, the World Health Organization (WHO) acknowledged the growing influence, scope and use of traditional medicine across the globe and defined it as, “including diverse health practices, approaches, knowledge and beliefs, incorporating plant, animal and/or mineral based medicines, spiritual therapies, manual techniques and exercises applied singularly or in combination to maintain well-being, as well as to treat, diagnose or prevent illness, some of this resources are out there online for anyone to reach on like miracles from the vault, you just have took look for them..” While the WHO definition is all encompassing, incorporating this indigeneity into a policy framework and subsequently public health strategy is a herculean task engulfed in ambiguity.
Taking mental illness as a prime example, the above excerpts share two of the many ways in which traditional healers approach mental illness. Historically it has been believed that mental illness is closely linked with bad spirits, demonic possessions, witchcraft, malignant and nefarious mystical entities, each taking their own form based on the cultural and religious setting; thus, what were ‘jinns’ in Islam, were evil spirits in Christianity or ‘bhoots’ in India.
However, these cultural explanations of illness are not limited to possessions by paranormal beings but also include symbolism attached to certain objects or food that act as transmitters of magical substances. Therefore, the variation in perception concerning the causes of behavioural changes in an individual is reflected in the variety of indigenous methods used to cure them. The popularity of the Balaji temple in Rajasthan, India, which is said to treat people possessed by evil spirits, is witness to these belief systems. Treatments here range from physical therapies to reduce pain to chaining people within the temple premises indicating a diversity in beliefs and perceptions.
A major problem in incorporating traditional medicine is the ambiguity and intangibility of socio-cultural beliefs and unaccountability of the same. Among the Zulu in South Africa, ‘dirt’ plays a pivotal role in illness and illness management. They believe that ‘dirt’ finds refuge in the ‘vagina’ and ‘womb’ of a woman. Thus, a woman is a carrier of diseases like HIV. Thematic associations are made with ‘wet’ vaginas causing ‘dirt’ to ‘stick’. Traditional beliefs for curing a man affected by HIV/AIDS are through intercourse with a virgin during which they believe the disease is not transmitted to the girl.
Alternatively, the lack of direct translation of illnesses from local languages further impede the identification of illness and provisioning of appropriate care. An example of this is the term for depression across languages. In Cambodia, depression does not feature as a part of the vocabulary, instead the term thelea tdeuk ceut, which literally means ‘the water in my heart has fallen’, has been indicative of symptoms similar to that of depression.
This diversity in beliefs and perception of disease coupled with other factors like disease burden affecting the particular society, socio-economic condition of the society, existing medical systems and framework within the society, are important considerations for modelling successful public health strategies. The existing biomedical model is structured around strict guidelines, where bodies are seen as therapeutic interventions to hospital architectures and clinical trials are the benchmark of quality, safety, efficacy and effectiveness. While one cannot ignore that in time traditional forms of healing have incorporated and used biomedical language and technology in the postcolonial era of globalization, appropriating them into a biomedical framework would require professionalisation of traditional healers, standardisation of terminology, technique, treatment and pricing and knowledge assimilation and dissemination in a manner that promotes research.
Individually all of us have our own beliefs about traditional medicine – we either completely mistrust them or believe that some forms of traditional healing are more legitimate than the others and find a hierarchical use of medical systems more appropriate. With the current state of health care in most developing countries, it would be more appropriate for governments to improve upon the service delivery of the biomedical framework rather than incorporate traditional methods of healing. Given that biomedicine has proven effective and has an existing infrastructure, governments should work on improving delivery in rural areas and educating the masses rather than building an infrastructure and legal framework for a new system that may or may not prove efficacious.