Kampur guruwa 27th nov 2015

MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

The evolving role of the Kampur Guruwa; Medical pluralism and changing religious and health practices in a village in far-west Nepal

Dr Matt MaycockMRC/CSO Social and Public Health Sciences Unit27th November 2015


Medical pluralism

• The presence of multiple medical systems, each with its own practices and beliefs in a society.

• Since 1978 the World Health Organization has indorsed the incorporation of local healing practices in national health systems

Increasing appreciation of the value of many non-Western healing traditions

Growing awareness of the deficiencies of Western biomedicine in addressing a person’s psychosocial context (lack of attention to mind, soul, and social setting)

High cost and lack of access to Western biomedicine


Medical pluralism in Nepal

Subedi found that Nepalis often use herbal remedies before turning to a traditional healer. Modern medicine and health care:

... are only sought as a last resort, usually for the serious and persistent problems. (Subedi 2003, , 155)

This indicates that traditional and modern forms of medicine are both used flexibly and interchangeably, indicating a medical plurality (Kleinman 1980; Pigg 1992, 1996).

Although Subedi does not explore the reason, cost is an important influence here. Seeing a traditional healer does not always incur a cost, whereas using modern medicine does.


Changing medical practices in Nepal


Traditional medicine

The World Health Organization(WHO) defines traditional medicine as “the sum total of the knowledge, skills, and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”.

The World Health Organization(WHO) estimates that up to 80 percent of the world’s population, which mostly lives in rural areas, rely on herbal medicine as their primary form of healthcare.


Traditional medicine in Nepal

• The use of medicinal herbs in Nepal's traditional medical system dates back to at least 500 AD. In Nepal, traditional medicine, although low profile, has been an integral part of the national health system.

• More than 75% of the population use traditional medicine, mainly that based on the ayurvedic system. There are 141 ayurvedic dispensaries, 14 zonal dispensaries, 15 district ayurvedic health centres, and two ayurvedic hospitals.

• Ayurvedic medicine (a system of medicine with historical roots in the Indian subcontinent) is widely practised in Nepal.

• There are 623 institutionally qualified practitioners of traditional medicine and about 4000 traditionally trained practitioners.


Research far-west Nepal, 2009, 2013, 2014

Masculinity, Modernity and Bonded Labour: Continuity and Change amongst the Kamaiya of Kailali District, far-west Nepal (School of International Development, UEA, Norwich)


PhD fieldwork far-west Nepal 2009

Yearlong fieldwork in Nepal:• Three month language training and key informant

interviews• Nine months in two fieldsites

My thesis addressed the the following research questions:• How have the links between Kamaiya bodies and

Kamaiya masculinities changed following freedom?• How are working patterns changing following freedom,

and what implications does this have for Kamaiya masculinities?

• What are the Implications of modernity for Kamaiya masculinities in family settings?

Followed up in 2013 and 2014


Methods

• Household survey

• Life History interviews

• Participant observation• I wore clothes similar to my research participants and made a

conscious effort not to display conspicuous signs of consumption.• I tried to behave like the men of my age at both fieldwork sites as

far as possible. On occasion this involved doing the work that the men in Kampur were involved in, although this did not include driving a rickshaw as the rickshaw drivers found the idea ridiculous.

• I took part in various agricultural and hunting activities.• I took part in the social life, which posed various difficulties for me.• I paid for a number of villagers to get health care and medication

from a local pharmacy when the Guruwa was unable to treat the person


My home for nine months…



The Guruwa

• The Guruwa have been part of Tharu society for as long as anyone could remember in either of my fieldsites, with various edicts referring to the role as far back as 1807 (Krauskopff and Meyer, 2000,160).

• Whether Guruwa should be considered as shamans, traditional healers or priests is not clear, as at different times they seem to undertake parts of what might be expected of each of these roles.

• The Guruwa are always male and always elderly

• All the bastis and Tharu villages that I visited in Kailali had at least one Guruwa, and each of my case study bastis had one.


• The Guruwa are accorded a certain level of respect in their setting due to their knowledge of spiritual and traditional health matters.

• The wider Tharu community often referred to the Guruwas’ knowledge of traditional Tharu customs, as being the most knowledgeable about such customs is part of their role. This was respected in the basti, particularly given the recent revival of pride in traditional Tharu customs resulting from resurgent Tharu politisization. Guruwa are rarely involved in politics as such matters are seen as incompatible with their focus on health and spiritual concerns.

• The Tharu are an ethnic of indigenous group found predominantly in the southern plains or Terai.


• Conventionally the Guruwa were mainly consulted about health matters, and occasionally they also advise about spiritual issues or concerns relating to Tharu culture. According to Guneratne:

• The Guruwa is essentially a healer. When Tharus wish to draw an analogy between the Guruwa and a contemporary institution, they invariably compare him to a medical doctor. (Guneratne, 1999, 12)

• The Guruwa’s work as a healer is not confined to intercession with gods and spirits to discover the cause of illness; the Guruwa also seeks to cure disease through the medicinal use of roots and herbs and other skills. (Ibid, 13)

The Guruwa



The changing role of the Guruwa

• However, more recently spiritual or cultural matters are a more prominent part of their role within Tharu society. I spent some time with the Guruwa in Kampur basti and observed him practicing various rituals. His practice mainly consisted of minor rituals to alleviate minor aches and pains such as backache. The rituals were designed to make the budh (ghost or witch) leave the patient and thus alleviate the pain and refer to a specific cosmology (cf. Guneratne 1999; McDonaugh 1984).


The changing role of the Guruwa

Traditional

healer

Traditional

healer / Cultural

reference

Cultural

reference

Increasing use of pharmacies and western biomedicine


Questions for discussion in small groups

• Reflecting on the readings and perhaps your own experiences, do you think it is inevitable that western biomedicine will subsume traditional medicines?

• What does the increasing influence of western biomedicine mean for traditional approaches to medicine?

• Is medical pluralism sustainable?• What are the potential risks and advantages of the increasing

influence of western biomedicine?• What does the changing role of the Guruwa tell us about

medical pluralism in Nepal?


Key Readings

• Durkin-Longley, M. 1984 Multiple therapeutic use in urban Nepal, Social Science & Medicine, Volume 19, Issue 8, 1984, Pages 867-872, ISSN 0277-9536, http://www.sciencedirect.com/science/article/pii/0277953684904040

• Pigg, S L. 1996. The Credible and the Credulous: The Question of Villagers' Beliefs in Nepal. Cultural Anthropology 11 (2):160-201. http://onlinelibrary.wiley.com/doi/10.1525/can.1996.11.2.02a00020/full

• Subedi, M S. 2003. Healer Choice in Medically Pluralistic Cultural Settings: An Overview of Nepali Medical Pluralism. Occasional Papers in Sociology and Anthropology 8. http://himalaya.socanth.cam.ac.uk/collections/journals/opsa/pdf/OPSA_08_09.pdf

http://www.sciencedirect.com/science/article/pii/0277953684904040

http://www.sciencedirect.com/science/article/pii/0277953684904040

http://onlinelibrary.wiley.com/doi/10.1525/can.1996.11.2.02a00020/full

http://onlinelibrary.wiley.com/doi/10.1525/can.1996.11.2.02a00020/full

http://himalaya.socanth.cam.ac.uk/collections/journals/opsa/pdf/OPSA_08_09.pdf

http://himalaya.socanth.cam.ac.uk/collections/journals/opsa/pdf/OPSA_08_09.pdf


Additional Readings• Baer, H. 2011. ‘Medical Pluralism’ in M Singer and P Erickson (eds) A Companion to Medical Anthropology

Hoboken, NJ: John Wiley and Sons. • Conrad, P and Barker, KK. 2010. ‘The Social Construction of Illness: Key Insights and Policy Implications’

Journal of Health and Social Behavior 51: S70-S79.• Etkin, N. 1992. ‘Side Effects: Cultural Constructions and Reinterpretations of Western Pharmaceuticals’

Medical Anthropology Quarterly 6: 99-113. • Fadiman, A. 1998. The Spirit Catches You and You Fall Down: A Hmong Child, her American Doctors and the

Collision of Two Cultures New York: Farrar Straus & Giroux, (‘Do Doctors Eat Brains’ is available as a digital extract).

• Guneratne, Arjun. 1999. The Shaman and the Priest: Ghosts, Death and Ritual Specialists in Tharu Society. Himalayan Research Bulletin XIX (2).

• Guneratne, Arjun. 2002. Many tongues, one people : the making of Tharu identity in Nepal.• Kleinman, A. 1980. Patients and Healers in the Context of Culture. Berkeley: University of California Press.• Lamb, Sarah. 2000. White saris and sweet mangoes : aging, gender, and body in North India. Berkeley ;

London: University of California Press.• McDonaugh, C. E. J. S. The Tharu of Dang : A study of social organisation, myth and ritual in West Napal.

University of Oxford 1984].• Nettleton, S , and J Watson. 1998. The Body in Everyday Life. London: Routledge.• Pigg, Stacy Leigh. 1992. Inventing Social Categories through Place: Social Representations and Development

in Nepal. Comparative Studies in Society and History 34 (3):491-513.• Saillant, Francine and Derge Genest. 2007. Medical Anthropology: Regional Perspectives and Shared

Concerns. Malden, MA: Blackwell Publishing.• Verter, B. 2003. Spiritual Capital: Theorising Religion with Bourdieu against Bourdieu. Sociological Theory 21

(2):150-174.


[email protected] www.matthewmaycock.com

Contact

Education

Kampur guruwa 27th nov 2015