Encountering Illness: Local Knowledge,Institutions and the Science of Healthcare Practices among the Chuktia Bhunjia Tribe of Odisha,India

Abstract

This paper documents local knowledge-based healthcare practices of Chuktia Bhunjia tribe of Odisha, India, and attempts to ascertain the socio-cultural rationale explaining its persistence against escalating modern healthcare facilities. Focusing on the coexistence of culture, ecology and healthcare, it describes the associated beliefs, rituals, institutions and practices concerning the healthcare. Data, collected using formal interview, observation and case study, reveal that the healthcare practices of Chuktia Bhunjia revolve around the customary beliefs, ecology and laws governing the access to healthcare services. Despite provision of modern medical facilities in their locality, their submission to culture, backed by purity-pollution, customary laws and absence of resource to afford modern medicine, continues to become determinant forces towards relying on traditional healthcare. With malfunctioning of the conventional healthcare institutions, coupled with communication constraint and lack of capability, ethno-ecological and community-based knowledge healthcare fill the gap between demand and supply of their healthcare services. Nevertheless, owing to the declining pathways of transmission of those knowledge bases due to state intervention, forest policies, migration of younger generation, socio-cultural transformation and disassociation of people with plant resources because of tiger project, healthcare knowledge and institutions are under threat. Therefore, given the implication of knowledge-based healthcare and possible threats to its existence, documentation of such practices would sustainably offer a solution to their healthcare, provided cultural diversity upholding those practices are preserved. Alternatively, owing to threats over cultural reproduction knowledge, any integration of their knowledge base with modern healthcare system can best just their healthcare practices in sustainable way.

Keywords

Sunabeda Wildlife Sanctuary ethno-ecological knowledge health functionaries ethnomedicine healthcare institutions customary laws magico-religious healing faith healing ritual selling gender

Introduction

A closer look to the studies on health¹ generally provides two distinct forms of analysis. One group documents the ‘problems’ – morbidity and mortality – and favours access to modern medical system while other group emphasises on local category of illness and modality of healing practices. Without much describing the former, which is believed to influence by poverty, malfunctioning of healthcare institutions and communication constraint (Marmort, 2005; Sarkar and Singha, 2019; Sato, 2012), the culture-based healthcare practices, especially among tribal population, reflect ‘belief’ as integral part of health model in which healthcare behaviour is assumed to have direct sequence to the framework of ‘non-western medical systems’ – medicine, magic and religion (Chaudhuri et al., 2020; George et al., 2020; Islary, 2014; Jaiswal and Premi, 2014; Kleinman, 2000; Price-Williams, 1962; Sahoo and Pradhan, 2021; Satrianegaraa et al., 2021; Zimmer et al., 2016). However, the meanings and perceptions of health, illness and health seeking behaviour are not the same across cultures. Each human society irrespective of its simplicity and complexity has its own beliefs and practices concerning diseases. They evolve their own system of medicine and methods for coping up with diseases and eventually create a body of its own medical system to maintain their well-being and respond to diseases according to how they interpret illness. For example, epilepsy in Zambia is believed to be caused by witchcraft and thus the appropriate response is treatment with plant and animal products (Baskind and Birbeck, 2005). Similarly, malaria – carried by mosquitoes – is believed by some people to be due to excessive contact with external heat which unbalances ‘blood equilibrium’ (Agyepong, 1992). Pati’s (1998) work on colonial Orissa also shows how the outbreak of smallpox epidemic was attributed to witches and how they were made to undergo ritual tortures as a means of curtailing their destructive power and controlling the epidemic.

Among tribals or in population where exposure to modern systems remains low, illness and diseases are shaped by their culture and beliefs in which supernatural force is believed to cause illness. Clements (1932) identifies five basic categories of events or situations said to be the causes of illnesses: (1) sorcery, (2) breach of taboo, (3) intrusion of disease object, (4) intrusion of disease curing spirit and (5) loss of soul. Rubel (1964), while viewing illness as a system among Susto in Hispanic, observes that culture determines the aetiology and perception, explanation and treatment of diseases. Foster’s (1978) dualistic classification as ‘personalistic’ and ‘naturalistic’ medical systems is well marked in the folk system of medicine. In personalistic system, illness is believed to have been associated with the action of supernatural being – deity or gods or non-human agents – ghosts, evil spirit – or human agents – witches or sorcery – whereas in naturalistic system, illness is said to be caused by the disturbance in human body. The tribals in India also classify illness according to its nature. The Jenu Kuruba tribe of Karnataka, for example, classifies four types of illness: (1) body linked illness (sharilada kayeli), (2) deity linked illness (daivada kayeli), (3) spirit linked illness (galiyetu) and (4) sorcery linked illness (matada kayeli) and each illness is cured separately by specific healer (Vijayendra and Bhatt, 2004). The role of ecology on healthcare practices in India is well documented, especially in terms of the use of plant-based medicines (Chander et al., 2014; Ishtiyak and Hussain, 2017; Reddy et al., 2010; Shanmugam et al., 2012; Tripathi et al., 2000; Venkatachalapathi et al., 2018). However, the nature of collection of plants, techniques of medication and methods of treatment differ from community to community.

Tribals in India are considered most vulnerable groups with very low Human Development Index (HDI)² and high Human Poverty Index (HPI)³ compared with non-tribals. The health condition of tribals is marked by very high morbidity and mortality, and with regard to health indicator, they fall much below their non-tribal counterparts. As per the report by Ministry of Tribal Affairs, Government of India (2014), popularly known as Xaxa Committee Report, the infant mortality rate (IMR) among scheduled tribes population is 62 per 1000 live births and under 5 mortality rate (U5MR) was 96 per 1000 live births. Compared with the rest of the population, IMR was higher by 27% and U5MR rate was higher by 61% (Ministry of Tribal Affairs, Government of India, 2014). Besides, with a per capita per day energy intake of 1990 kcal against 2188 kcal in rural area (WFP, 2019), malnutrition level among them is estimated to be very low compared with non-tribals as reported from high prevalence of underweight, stunting and wasting in a rate of 40%, 40%, and 27%, respectively (Kshatriya and Acharya, 2016). The situation of health among the tribes of Odisha is alarmingly low than the national average where the poverty rate is estimated as 32.6% (Planning Commission of India, 2013), with a rural headcount poverty ration being 66.03% among scheduled tribe compared with 25.2% in others (National Sample Survey Organisation (NSSO), 2011). Their per capita per day consumption of energy is lower than the non-tribals, that is, 2143 kcal than the recommended one, that is, 2181 by Indian Council of Medical Research (ICMR) (Government of Odisha, 2020), signifying a high prevalence of child malnutrition at –2SD with an estimated figure of 48.5% underweight, 45.5% stunting, and 27.8% wasting compared with 20.6%, 21.0%, and 12.8%, respectively, in other social groups. The substantially higher proportion of tribal women are underweight (body mass index (BMI) < 18.5 kg/m²), that is, 36.5% compared with 16.3% in others. With high prevalence of anaemia (<11.0 g/dL) among children between 6 and 59 months, that is, 46.5% against 28.2% in others and 30.4% against 18.0% in others among adults, IMR (₁q₀) among scheduled tribe is estimated as 51.8 compared with 31.5 in others (International Institute for Population Sciences (IIPS), 2017).

In recent past, government, mandated to achieve Sustainable Development Goals (SDGs), has come up with a number of healthcare schemes – National Rural Health Mission (NRHM),⁴ Janani Suraksha Yojana (JSY)⁵ and many more. The Government of Odisha has also implemented schemes like Biju Swasthya Kalyan Yojana (BSKY)⁶ and Mamata⁷ to improve the health condition of people living in rural areas, including tribals. Yet, despite various institutional provisions to access health facilities, along with escalating modern medicine and medical facilities, large shares of rural population rely on traditional forms of healthcare – especially magico-religious and plant-based – as a way to encounter illness at community level. The World Medicines Situation report estimates that between 70% and 95% of the population in developing countries consume traditional medicine (World Health Organization (WHO), 2011), which is reflected in the rapid growth in number of herbal outlets, clinics and hospitals (Van der Geest and Whyte, 1988), and 1.5 million traditional medical practitioners in India use medicinal plants for preventive, promotional and curative purposes (Pandey et al., 2008). The figure in India shows that 65% of the population rely on ethnomedicine as a primary source of healthcare (Sharma et al., 2016). Such figures are evident despite rapid economic and social development and therefore beg important questions like ‘Why do people continue to utilise traditional medicine when modern medicines are available?’ and ‘What kinds of economic, social and procedural rationales can explain this behaviour?’ Owing to attempts made to integrate the traditional form of healthcare into modern, affordability of the later by poor tribals and sustainability of the former are questionable because of the ‘lack of tribal community’s engagement with biomedicine and other state public health interventions’ (George et al., 2020; Mishra, 2011).

On this background, this paper documents traditional health care practices of the Chuktia Bhunjia tribe living interior to Sunabeda Wildlife Sanctuary (SWS)⁸ of Odisha, India. It describes the methods, techniques, beliefs, practices and taboo pertaining to healthcare. Using the functional concept of health, the paper explores how the healthcare practices of the Chuktia Bhunjia are structurally shaped by various socio-economic and cultural institutions that are substantiated with case studies in context in support of the rationale of traditional healthcare practices at their community level.

Research methodology

This study was conducted among Chuktia Bhunjia tribe living inside SWS of Odisha (Map 1) (1) to document their traditional healthcare practices and (2) to explore the socio-cultural rationales shaping their healthcare practices against the modern medical system. Data were collected during April-October 2020 and May-June 2021 and were largely concentrated in four villages (Table 1). Data pertaining to disease causation, aetiology, associated health beliefs, rituals and norms were collected from laymen, magico-religious practitioners and herbalists, identified using snowball technique, through formal interview and narrative approach. However, observation of different medication practices, where possible, helped us to comprehend their knowledge system. The first author witnessed medication by herbalists, treatment procedures by magico-religious healers, treatment of snakebite by specialists and extraction of medicinal plants for medication in a number of times. A focus group discussion was also conducted in each studied village combining both laymen and healers to understand their perception about persistence of local knowledge-based healthcare practice and feasibility of access to modern medical system. The Anganwadi workers, ANM (auxiliary nurse midwife) and Accredited Social Health Activists (ASHAs)⁹ workers appointed in the studied villages were also interviewed to explore their roles in motivating the Chuktia Bhunjia in accessing modern medical facilities and to understand their perception about knowledge-based healthcare of the Chuktia Bhunjia. The dependency rate of Chuktia Bhunjia on Primary Health Centre (PHC) and nature of dependency were accessed from the accession register of PHC located in Sunabeda. The officials of the Chuktia Bhunjia Development Agency (CBDA)¹⁰ – a micro-project established by Government of Odisha in 1994 for the socioeconomic development of the Chuktia Bhunjia – were also interviewed to comprehend their role in imparting the health facilities to the inhabitants of micro-project area and challenges, if any, faced by them in facilitating the healthcare services to the Chuktia Bhunjia.

Map 1.

Study area.

Table 1.

Studied villages.

Village name	No. of households	Population
Village name	No. of households	Male	Female	Total
Sunabeda	188	336	328	664
Koked	15	31	31	62
Gadbhata	75	150	137	287
Bhaosil	64	112	103	215

Source: Baseline survey of Chuktia Bhunjia Development Agency (2017). Sunabeda: CBDA.

Bhunjia is one of the tribal groups largely distributed in central India. They are divided into two broad social groups: Chinda Bhunjia and Chuktia Bhunjia. In Odisha, Bhunjia are reported to have settled majorly in Nabarangpur, Mayurbhanj, Nuapada and Baleswar district with a total population of 12,350, sex ratio of 1012 and literacy rate of 44.93% according to Census 2011 (Government of India, 2013). The Chinda Bhunjia – also known as Oriya Bhunjia – is an acculturated section of Bhunjia tribe and they inhabit all the districts mentioned above. The Chuktia Bhunjia (the subject of this study) inhabit only Nuapada district of present-day Odisha. They are identified as one of the Particularly Vulnerable Tribal Groups (PVTGs)¹¹ in the state and exclusively inhabit SWS bordering the state of Chhattisgarh. According to a baseline survey by Ota, Mohanty and Mohanty (2020), their total population is 3086 (1593 males and 1493 females from 938 household). They live in 35 villages/hamlets of SWS. With a sex ratio of 937, the literacy rate of Chuktia Bhunjia is estimated as 24.54% (29.14% male literacy and 20.00% female literacy). They belong to Dravidian language speaking group (Russell and Hiralal, 1916) who speak Bhunjia dialect (mixture of Oriya and Chhattisgarhi) for intra-group communication and local Oriya for inter-group communication. Although they were reported to practice hunting-gathering form of economy, inclusion of their habitat into the protected area forced them to become settled agriculturists. Still, collection of minor forest produces (MFPs) constitutes an important source of their livelihood. They are animistic in nature and worship a number of natural objects either as totemic symbols or as a place for deities. Their major festivals are surrounded with collection and consumption of various wild edibles and agricultural practices.

Cultural construction of health: illness, belief and well-being

The term health is viewed differently across communities. The same communities living in different territories also shares differential ideas and treatment concerning particular illness. The Chuktia Bhunjia define a person as healthy in terms of ‘ability of a person to perform his or her regular work’ such as attending household work and agricultural duties. They also perceive health in terms of blood in the body. For example, red blood is considered a good sign of healthy body and believed that as the person grows older red blood turns to blackish red and the quantity of blood decreases indicating lesser bodily strength. Similarly, the acute bodily discomforts and specific symptoms are visible indicators on the basis of which they identify illness. The persistence of longer duration symptoms is considered ‘severe illness’ and is always attributed to unseen spirits.

The Chuktia Bhunjia perceive supernatural forces or ‘personalistic agents’ – evil spirit (Masan), sorcery (Pangan) and ancestral deities (duma) – being the carriers of illnesses; albeit, change in weather is not completely ignored. They classify evil spirit into two categories: Masan and Chirngel. They believe that when a person dies, he or she becomes Masan. When a pregnant woman dies, she becomes Chirngel. Therefore, they do not bury her corpus in their general cremation ground; rather, it is cremated far away from village territory. Although Goddess Sunadei – the proprietary deity of the territory – is always worshipped to protect the inhabitants of the region from any misfortunes, Mata (deity of chicken pox) and Chhatigudi (deity of scabies) are regularly worshipped and offered liquor and sacrifice to protect them from diseases. Anyone getting injured by falling down from trees is also believed due to malevolent spirits. So, they try to appease them by offering a leaf cup of local liquor. Older trees are always perceived being the abodes of evil spirits. Thus, they are afraid of going there during noon and evening. The unmarried persons are believed to be prone to spirit attack. The ancestral spirit (Duma) is also considered as one of the attributes causing illnesses within the clan or family. The illness caused by ancestral spirits (dumas) is not so harmful which, they believe, attacks only to the family members. Any failure to worship them in a regular interval and offer new crops is believed to cause illness in the family. They believe that if a woman touches their kitchen room (Lalbangla)¹² during their perceived pollution periods – puberty and monthly menstruation – the home deities get annoyed and attack the family members. In this case, the head of the family offers a leaf cup of local liquor to appease those spirits. Sorcery (pangan) is seldom reported but is applied as a revenge for personal rivalry. It is secret and acted upon using a deity of its own or totemic object. ‘If one has to make loss of somebody’s property or take action against others because of his personal conflict, he sends the deity or object to make disturbance in the family of enemy, but having been good solidarity and relationship with others, including neighbouring caste groups, application of sorcery is nearly absent’, shared a woman.

The Chuktia Bhunjia believe that any forms of malevolent spirits are dangerous and bring misfortunes in the village. They drive those spirits away by ritualistic way in a regular interval. A strange ritual concerning warding off the malevolent spirits was documented during fieldwork, where a group of elderly persons along with village headman, village priest and shaman go to a place away from the village in the day of amavasya (lunar eclipse) for this purpose. A day before the ritual, Gana – a person from scheduled caste assigned the post of messenger – informs the villagers to keep a leaf cup of rice to be collected next morning. The next day morning, the assistant of village priest collects the rice by visiting door to door. They draw small amount of money from corpus fund to buy a hen or two, usually of black colour for sacrifice purpose. Once all the paraphernalia (collected rice, hen, mandar flower (Hibiscus chinensis), vermilion) are ready, they go to the selected site, bordering with another village, for ritual. On reaching there, they clear the place and smear cow dung to begin the ritual. After keeping a fist of rice in the place and lightening the lamp, the priest requests Shaman to see any malevolent spirits around their village territory which he can identify through his spiritual power. A small chicken is also left in the site as an offering to the spirits besides sacrificing the hen in the name of village deities. This ritual is locally called Ragi-Bahla. The sacrificed hens are cooked in the site and are served to everyone present there.

Ritual selling of newborn – a form of health belief – is also reported among Chuktia Bhunjia. During fieldwork, two such cases – one in Sunabeda and one in Bhaosil village – were documented where newborns were sold to scheduled caste family. Bhaktaram Chhatriya (age 26) of Sunabeda was blessed with a baby boy, but the newborn had difficulty in urinating and was felt thrilling like fevering. They perceived that they might have forgotten to offer their vow to their ancestral, if any. They offered a hen and local liquor to their home deities. Still, the child experienced the same problem. The neighbouring households suggested him to sell the child to a scheduled caste family. He immediately asked Lachaman Deep, a scheduled caste family from the same village, and sold the baby for 11 rupees. The child, named as Dom Budha (now age 4) after the Lachman’s caste, was left his natal family. Lachaman occasionally takes Dom Budha to his home. Dom Budha also sometimes asks his parents to go to Lachaman home. He addresses Lachaman as father and his wife as mother. Lachaman family also gives him new dress in each festival. He is now healthy and 4 years old.

A similar form of belief was reported in Bhaosil village where Buchhu Barik sold his baby to a scheduled caste family for 5 rupees 27 years back. Recollecting those days, he shared that his son Khedu was very weak after birth. He was very worried for his son’s survival and started offering hen and goat to his deities. His elder brother suggested him to sell the baby to a Gana, a scheduled caste family. He invited Hadu, a scheduled caste, from same village. Hadu purchased Buchhu’s son for 5 rupees. Hadu named the baby as Khedu and gave the child back to his natal parents. In the mean time, he used to go to the Hadu’s family calling him father and his offsprings as brother and sister. Occasionally, Hadu’s family used to take Khedu to their home. He remembered his son taking food in Hadu’s family. When Khedu grew to a marriageable age, Buchhu repurchased Khedu by returning the principal amount with interest along with a dhoti and towel for Hadu and a saree for his wife. He also gave a feast to the village council or Panch¹³ and affine groups after purification of Khedu by an affine by sprinkling water, mixed with milk and blood of sacrificed hen, over Khedu to be considered a member of Chuktia Bhunjia community. He is now married and father of a baby girl.

Healthcare providers

There are three major healthcare providers among the Chuktia Bhunjia: (1) the Gunia (magico-religious healer), (2) the Baids (herbalist) and (3) other healthcare specialists (bone settler, Gardi (specialist in treating snakebite), birth attendant, etc.). A total of 64 healthcare providers were identified in the studied villages, of which a majority of them were Gardi (n = 35), followed by Baids (n = 11), bone settlers (n = 7), birth attendant (n = 6) and Gunia (n = 5) (Table 2). The profile of identified health functionaries (Table 3) shows that all health functionaries are aged above 30 years and many practitioners were between the age group of 45 and 60 years. Eight among them were female – six birth attendants and two bone settlers – all above the age of 50 years. Since they reside interior to SWS with no communication, there were no schools in their time, a majority of them never attained any formal schooling and therefore illiterate. Only eight healthcare providers belonging to age group of 30 to 45 years were literate. It was learnt that a majority of them are small agriculturists and secondarily engage themselves in wage labour, collection of MFPs, and other forest-related quarry jobs to supplement their survival. All of them said to have encroached forest land for cultivation long back and practised slash-burning cultivation. The lands are now owned by them with proper documentation from the revenue department. A formal interview with health providers reveals that they learnt the knowledge of healthcare from various sources, including that of parents, grandparents, friends, non-tribal teachers and imitation or self-learnt. Parents are found as dominant transmitters of knowledges in all domains of healthcare, except the case of Gardi who are said to have formally learnt from a non-tribal master. They are also highly ranked in Chuktia Bhunjia social structure and enjoy a space as important public functionaries in many socio-political institutions of their society and therefore are always respected.

Table 2.

Health functionaries in studied villages.

Village name	Gunia		Baid		Bone settlers		Gardi		Dai
Village name	Male	Female	Male	Female	Male	Female	Male	Female	Dai
Sunabeda	2	–	2		2	–	14	–	2
Koked	1	–	2		1	–	6	–	2
Gadbhata	1	–	4		2	–	7	–	1
Bhaosil	1	–	3		2	–	8	–	1
Total	5	–	11		7	–	35	–	6

Source: Fieldwork by authors.

Table 3.

Profile of the health functionaries.

Health providers	N	Sex		Age group (n)	Occupation	Education (n)	Transmitters (n)
Health providers	N	Male	Female	Age group (n)	Occupation	Education (n)	Transmitters (n)
Gunia	5	5	0	⩾45 (5)	Agriculture	Illiterates (05)	Father (5)
Baiga	11	11	0	⩽45 (3)	Agriculture	Illiterates (11)	Father (7)
				⩾45 to ⩽60 (8)			Friends (2)
				⩾45 to ⩽60 (8)			Non-tribal teacher (2)
Bone settler	7	7	0	⩽45 (2)	Agriculture	Illiterates (07)	Father (2)
				⩽45 (2)			Friends (2)
				⩾45 to ⩽60 (5)			Imitation (1)
				⩾45 to ⩽60 (5)			Non-tribal teacher (2)
Gardi	35	35	0	⩾30 to ⩽45 (30)	Agriculture	Literate (08)	Non-tribal master
Gardi	35	35	0	⩾45 to ⩽60 (5)	Agriculture	Literate (08)	Illiterate (27)
Dai	6	0	6	⩾45 to ⩽60 (6)	Agriculture	Illiterate (06)	Mother-in-law (6)

Source: Fieldwork by authors.

Magico-religious healers: Gunia, Shaman and Healing

The Chuktia Bhunjia are found to ward off illnesses through religious ways, especially with the help of Gunias, the medico-religious healers, who are specialised in curing patients attacked by personalistic agents, including evil spirits – witchcraft, black-magic and sorcery and village deities. Their role is resorted only when the causes of illness are attributed to ‘personalistic agents’. A formal discussion with the identified Gunias portrays that they possess similar form of knowledge about the spirit attacks. Anyone vowed to offer any sacrifice to the village deities and forget the same is frequently attacked by the village deities. However, urinating in the sacred sites and entering the worshipping places during pollutions – monthly menstruation, death of family member – are perceived being other causes for attack. They follow similar methods and techniques to drive the spirits away as narrated below:

If a person is attacked by evil spirits, his or her pulse becomes cool and the patient appears restless. He or she talks abnormally. Once Gunia reaches the patient’s house, sometimes the spirit becomes calm. After noticing the behaviour, the Gunia chants the mantra inscribing the name of popular deities while simultaneously throwing raw rice over the face of the patient.

Then Gunia presses the little finger of the patient to identify the spirit. The spirit immediately tells the motive behind attack. He orders the spirit to go out of the body. If the spirit is reluctant to go, he drives the spirit away by some other means like beating with broom, iron chain, making smoke by burning rubber and dried red chillies. He often pours the juice extracted from tulsi (Ocimum sanctum) leaves and applies kohl (kajal) on patient’ nostrils and eyes.

The annoyed ancestral spirit (Duma) often attacks the family members if they forget to offer mahua liquor and sacrifice hen at regular intervals or if any woman enters cowshed or Lalbangla during monthly menstruation and disobeyed customary law of Lalbangla. In this case, the Gunia, after ascertaining the proper cause, suggests the head of family for relevant procedures, including offering of mahua liquor and flowers of different colours or performing a specific sacrificial ritual to appease annoyed spirit. However, many times the spirit himself/herself demands specific rituals and sacrifice of hen or male goat.

The Gunia does not handle the cause of sorcery or black magic alone, rather is assisted by other Gunias and Shaman (Dihari) in the process of driving the spirits away. They all attempt to cure the patient by magical method. They fix a date, preferably amavasya (lunar eclipse) to ward off the spirit from the patient’s body. They prescribe the head of household to arrange required paraphernalia like black goat, black chicken, a mirror, kohl, comb, vermilion and different varieties of millets. In a fixed date, usually at night, they ask the patient to sit on the spot arranged for this purpose. Gunias and Shaman begin the magical ritual by chanting mantra, beating the drum and singing the song so that the patient automatically dances and tells the name of the spirit, his or her motive and the procedure to appease him or her. This ritual form is locally called as Kulanacha. In the same night, they take the patient to a river stream or jungle and tell him or her to go away from the patient body. They catch the evil spirit through mantra and keep in a pottery (tani) which is later buried in a place followed by fixing four iron pins around it. A goat and a chicken as suggested are left in the jungle alive. It is locally known as Talen. Anyone eating that goat or hen is believed to be attacked by the spirits.

The Shaman (Dihari) is also another religious functionary among the Chuktia Bhunjia whose help is rendered when the cause of illness is unknown. He works along with Gunia in warding off the spirits and tells the feasibility of any further attack through his magical power. So, he is always considered as a messenger between people and invisible. When Gunia fails to cure the patient, he suggests the patient to consult Baids – the herbalist. Thus, there is a relationship between Gunia and Baids.

The Baids: herbalists, ecology and science of healing

Baids – the herbalists – are specialists in curing diseases caused by natural agents by administering herbal medicines. They are found to cure diseases like gynaecology, diarrhoea, headache and jaundice. Of nine Baids identified in studied villages, all were male. No professional female herbalists were identified, although few of them said to occasionally administer medicines for gynaecological disorders. They possess enormous knowledge on medicinal plants but their treatments are endowed with set of beliefs pertaining to collection of medicinal plants and administration of medicines. For example, Sunday is considered auspicious for treating gynaecological disorders. The herbalists either visit patient’s home or ask the patient to come to their place. Some medicinal plants – without disclosing their names – are collected in specific days and from particular direction of the village. Some plants even require to be collected with bare body in early morning. ‘The plant species collected without observing these rules become powerless and valueless’, said an herbalist. The plant species collected in Sunday are believed to have more curable value. Medicines are prepared with extracted root, bark and leaves of identified species (Table 4). The patients are required to follow specific precautions during medications that vary from disease to disease.

Table 4.

Medicinal plants used by herbalists.

Plants/herbs (vernacular)	Part used	Diseases	Medications
Abrus precatorius (Gunj)	Seeds	Birth control	Seven black seeds are soaked in water overnight and grinded paste is taken orally for 3 times on alternate days to avoid pregnancy.
Adhatoda vasica (Basanga)	Root	Delivery expedition	Root paste grinded with seven black peppers is given to women to drink.
Adhatoda zeylanica (Basak)	Leaves	Asthma	The patient is suggested to consume the leaves of Adhatoda zeylanica in the form of smoke.
Andrographis paniculata (Bhuineem)	Seeds	Dysentery	It is used for infants only. A teaspoon of grinded seed paste is given to the infant in the morning.
Asparagus racemosus (Satabari)	Root	Lactation	Root powder mixed with cow milk is taken orally to enhance lactation in the nourishing mother.
Asparagus racemosus (Satabari)	Root	Epilepsy	Root paste is also taken orally to cure epilepsy.
Azadirachta indica (Leem)	Leave	Eczema	Leaves are finely grinded with raw turmeric and are applied topically on the affected part to cure eczema.
Bombax malabaricum (Semel)	Root	Leucorrhoea	Root paste mixed with sugar candy powder is taken orally for leucorrhoea.
Bombax malabaricum (Semel)	Barks	Diarrhoea	A teaspoon of juice extracted from bark is taken orally to arrest diarrhoea.
Caesalpinia sappan (Lal muter)	Root	Menstrual disorder	Fresh root paste grinded with seven black peppers is consumed orally on an empty stomach.
Cassia fistula (Sunari)	Bark	Headache	The grinded bark paste is applied topically on forehead.
Calotropis gigantea (Kuder)	Bark	Ear ache	The bark is rubbed in a stone to extract juice and a fine drop is poured into the ear.
Centella asiatica (Brahmi)	Bark	Abortion	The grinded bark paste is consumed orally on an empty stomach to avoid pregnancy.
Christella semigagitata (Raktabidar)	Root	Excessive bleeding during menstruation	Filtered root paste is consumed orally in the morning with cow milk.
Chloroxylon swietenia (Bheru)	Leaves	Leucoderma	The leaves paste is applied on skin to cure leucoderma.
Cissus quadrangularis (Hadsakra)	Stem	Bone fracture	The warm stem paste is applied on fractured bone and covered with a cloth.
Cheilocostus speciosus (Keukanda)	Rhizome	Headache	The rhizome is properly washed and grinded with cord. The paste is applied topically on the forehead.
Cuscuta reflexa (Binmulia)	Root	Birth control	Finely grinded paste of fresh root with nine black peppers is given to the women to consume in the morning.
Cynodon dactylon (Dhub)	Grass	Skin abscess	The paste is applied topically over the affected part for 3 days.
Erythrina variegata (Raktamandar)	Bark and leaves	Dysentery	Equal proportion of bark and leaves is grinded. The paste is given orally to the patient on an empty stomach in the morning.
Eulophia nuda (Batudi kanda)	Fruit	Abdominal pain due to irregular menstruation	The raw fruit paste grinded with five black peppers is given to the women once a day for 7 days on an empty stomach.
Geodorum densiflorum (Kukur miria)	Bark and Root	Dog bite	It is cured by mantra therapy where poison is removed through steel plate, after which bark and root paste of kukur muria is consumed orally twice a day before meal. The paste is also applied on the part affected.
Gloriosa superba (Barish kanda)	Rhizomes	Piles	Rhizome paste grinded with five black peppers is applied on anus to cure piles.
Hemidesmus indicus (Sugandhi)	Roots	Sexual enhancer	Dried root powder mixed with cow milk is taken against sexual debility.
Hemidesmus indicus (Sugandhi)	Roots	Piles	Root powder with unboiled cow milk is taken twice a day for 7 days to cure piles.
Hibiscus chinensis (Mandar)	Leaves	Skin abscess	Finely grinded leave paste is applied topically over skin for 3 days.
Launaea acaulis (Balaraj kanda)	Rhizome	Diabetes	Boiled rhizome is consumed to reduce the diabetes level.
Leonotis nepetifolia (Tipiri)	Leaves	Delivery expedient	Leaves paste grinded with seven black peepers is consumed orally after meal.
Loranthus longiflorus (Mahul Madang)	Twigs	Skin inflammation	Twig paste is applied on the whole body to get rid of skin inflammation.
Lawsonia inermis (Menzati)	Leaves	Skin itches	Leaf paste is applied over affected parts to cure skin itch.
Lawsonia inermis (Menzati)	Roots	Jaundice	A teaspoon of root paste is poured in nostril and a teaspoon is given to the patient to drink on an empty stomach.
Mallotus philippensis (Sunderi)	Seeds	Menstruation disorder	Seeds paste grinded with five black peppers is consumed orally on an empty stomach in the morning with warm milk.
Phyllanthus fraternus (Bhuamla)	Bark	Jaundice	The bark paste is taken orally on an empty stomach in the morning.
Phyllanthus fraternus (Bhuamla)	Seeds	Leucorrhoea	The seeds are pounded with unboiled rice and taken orally with warm water to cure leucorrhoea.
Pongamia pinnata (Karanja)	Seeds	Skin disease	Oil extracted from the seeds is applied on skin for general skin diseases.
Pongamia pinnata (Karanja)	Seeds	Dental pain	Twigs are used as toothbrush for dental care.
Pueraria tuberosa (Patalkumdha)	Tuber	Lactation	A teaspoon of tuber paste is mixed with finely grinded Bombax ceiba root paste. The paste is taken orally with warm milk twice a day for 7 days to enhance lactation in a nursing mother.
Punica granatum (Dalim)	Fruit	Dysentery	Finely grinded raw fruit paste is taken orally to control dysentery.
Shorea robusta (Sargi)	Resin	Burning	The matured resin is finely grinded and is mixed with ghee. It is applied on the affected part of the patient.
Sida rhombifolia (Chitki)	Twig	Dental pain	Twigs are used as toothbrush to cure dental problem.
Smilax zeylanica (Ramdatum/Mutri)	Root	Infertility	Root paste grinded with nine black peppers is taken orally twice daily to treat infertility.
Sphaeranthus indicus (Bhuikadam)	Root	Migraine	Root paste grinded with five black peppers is mixed with curd and is applied on forehead to cure migraine.
Strychnos nuxvomica (Kochla)	Bark	Dysentery	A teaspoon of bark paste is consumed orally to arrest dysentery.
Thespesia lampas (Bankithoko)	Whole Plant	Dental pain	The root paste is applied topically below the cheek and upper site of the mandible. Twig is also used as toothbrush to cure dental problem.
Ziziphus mauritiana (Boro)	Leaves	Skin abscess	The leave paste is applied topically on the affected part to cure skin abscess.

Source: Fieldwork by authors.

Some herbalists were found to expertise in curing both human and livestock diseases. They shared that there is a communality in the healing of both human and livestock disease using medicinal plants. Two respondent herbalists expressed that they often work as ethnoveterinarians particularly in the treatment of fractured bone, insect infection and castration. The medicinal plants commonly used for the treatment of a number of conditions suffered by human beings are also used for similar conditions affecting livestock. For example, Satabari (Asparagus racemosus) is used to enhance lactation and Dalim (Punica granatum) is used in the treatment of dysentery in both human beings and animals, although doses vary. Furthermore, the administration of plant-based medicines is also found to be associated with gender position where ‘it is not advisable to consult herbalists during monthly menstruation and childbirth simply to avoid possible risks because of changing body composition during those period’, said a Baid.

All the Baids interviewed expressed that people’s belief over their knowledge have become a pathway to sustain their practice. If case any Baid fails to treat the specific illness, he suggests the patient to consult a qualified doctor. The male patients do prefer to consult the doctor. The ambiguity arises with female patients as access to modern medicine is governed by customary laws, including the feasibility of ritual purification, temporary excommunication from social interaction and monetary penalty or feast or both. So, there is an interdependence among patient, Baids and qualified doctor as found among the patient, Gunia and Dihari (Figure 1).

Figure 1.

Relationship between patient and health practitioners.

Other healthcare specialists: knowledge, practice and well-being

There are other specialised health functionaries among Chuktia Bhunjia who are found to treat particular health problems as described below.

Bone settlers

A total of seven bone settlers – all male – were identified in the studied villages. All the bone settlers interviewed possess similar form of knowledge about the methods and techniques in the treatment of bone fracture. All of them use the medicine prepared from Hadsakra (Cissus quadrangularis) species for this purpose. There is a folk story about the medicinal value of Hadsakra species as narrated by an herbalist in Koked village as follows:

In a very old day, a Chuktia Bhunjia couple went to forest to collect MFPs. They also collected firewood and searched a climber to tie those to bring to their home. They used Hadsakra for the purpose. On reaching home, they found that all the firewood become tight and strong in such a way that they had to use an axe to separate the firewood. The same couple later made an experiment with this plant species to be used for treating bone fracture of human and livestock. They become successful and famous in their locality.

The herbalists prepare medicine out of Hadsakra species in the method as narrated below:

Two-third of a collected Hadsakra (Cissus quadrangularis) is finely grinded in a stone. The third portion is grinded separately. The grinded paste of two-third portion is heated in a mud vessel and is allowed to be normal warm. The bone settler then arranges the fractured bone by pulling back and forth. The boiled paste is orally applied over the affected parts and a new cloth is tightly covered around it so as to keep the medicine in tack. The grinded paste of third portion is properly filtered in a new cloth and is applied over it to tighten the medicated part. The patient is suggested to visit again to remove the cloth after a month.

Those who have experienced of getting cure by bonesetters have positive behaviour towards the knowledge. A young man from Gadbhata village shared,

I felt down from a tree while collecting Tetel (Tamarindus indica) and my hand got fractured. My parents immediately took me to the bone settler for treatment. He applied herbal medicine and after a month my hand became normal. Now I am able to carry even heavy loaded work as doing before.

It was found that no bone settlers charge anything in cash to the patient for their services rather than a coconut and local liquor to be offered to their local deity after the patient is cured. However, some patients voluntarily offer them a token of gifts in the form of cloth (dhoti) and/or a hen with local liquor. Such voluntary free treatment allows them to be special invitee in family occasions of many patients.

Gardi

Gardis are specialists in healing snakebite. A total of 35 Gardis were identified in studied villages. All the Gardis interviewed share a common knowledge and method on curing the patient and said that they learnt it from a non-tribal teacher from plain region. They extend their service on voluntary basis and do not change anything to the patient. Once the news of snakebite is informed to a Gardi, it is passed on to others. They immediately assemble at patient’s home with required medicinal plant and chant mantra by holding the patient in sitting position. Two among them remove the poison through mouth from affected part. One among them grinds the bark of Kochla (Strychnos nux-vomica), fruit of Patalgarud (Rauvolfia serpentina) and Akashgarud (Radermachera xylocarpa) separately and pours a tea spoon of finely grinded paste into patient’s nostril while simultaneously chanting mantra. After an hour, the patient becomes cured. No Gardi accepts any form of consumable – water and bidi (cigar) – until the patient is completely cured.

Birth attendant (Dai)

Birth attendants (Dais) are found in all studied villages and occupy a special position in their society. However, mother-in-laws were earlier acting as birth attendants; nowadays, each village has one or two trained birth attendants who join the family upon informed. Their roles include boiling of horse grams to be given to the delivering woman after childbirth, taking care of both mother and newly born child, serving food to mother usually for 21 days, warming up newborn, and making the newborn bath. Horse gram is believed to recover blood loss during childbirth. The birth attendant is considered pollutant for a month so as the mother and new born. Their work is voluntary but is often offered with grains, a saree and a coconut after the purification ritual (Hanichhia) as a token of rendered service.

A formal discussion with Dais reveals that they share a similar knowledge about child delivery which they said to have learnt from elderly Dais, usually mother-in-law, through imitation and informal training by accompanying them. They adopt a number of techniques and methods to help woman in child delivery as narrated below:

All male members are asked to leave the delivering home, usually a separate wide-opened hut, till the child is born, if it is daytime.

They open the boxes and locks of the house perceiving otherwise would lock women’s uterus.

They wash their hand before examining the woman.

The woman is asked to lie with their ankles crossed so that no air can enter into the body.

Dais hold her waist and leg properly so as to relax the delivering mother.

Delivering women is given boiled horse gram, immediately after delivery, in order to recover the blood lost during the childbirth.

Non-specialist’s knowledge: faith healing and household therapy

The Chuktia Bhunjia of the studied villages do have experience of treating various ailments in their household without consulting any health functionaries which they said to have learnt from their forefathers. These household therapies are always endowed with specific belief, ritual and ecology, besides adaptation of specific methods and techniques. The followings are some of the examples of household therapies by the Chuktia Bhunjia:

Mata (Chicken pox): It is believed to be caused by Goddess Mata. The patient is perceived being the incarnation of Goddess Mata and is respected till he or she is cured. The patient remains untouched and is suggested to sleep separately over banana leaves. The head of the household or any elderly male of the family offers mahua liquor to the deities, usually in the evening, requesting to cure the patient. The patient is asked to sit on the ground and the head of the family puts a fingertip of Shorea robusta resin (Dhup) over fire in a leaf cup made of either Kurei (Holarrhena pubescens) or Palasa (Butea monosperma) and smears cow milk and mahua liquor downwards over patient’s body for 7 times for three consecutive days. The patients were found to be cured during fieldwork.

Kirum (Intestinal worm): It is one of the frequently reported diseases among the Chuktia Bhunjia children which is believed to be caused by increasing salt proportion in the body. They cure it orally by giving seed paste of Bhuineem (Andrographis paniculata) to children to drink on an empty stomach.

Abdominal pain: The patient is first asked to lie down over the ground. A teaspoon of castor oil is applied over his or her abdomen. An earthen lamp is kept over patients’ belly which is then covered with an aluminium jug. The jug is believed to pull pain out from the stomach and automatically is removed once the pain relieves. This method is known as Upka.

Fever to infant: The head of household brings a rhizome of Barish kanda (Gloriosa superba) on Sunday. He crushes it and puts in a bucket of water for a while. A Kasna (an iron rod fixed in plough) is then heated and is kept on the ground. The rhizome mixed water bucket is kept on the roof of house or plinth of 5 ft height. The child is held in-between the water bucket and Kasna. The water is then put over child in such a way that the gas evaporated from Kasna must pass through the child which is believed to have medicated curable character. The application of the root paste of Gloriosa superba and Arakh (Calotropis gigantea), collected in full-moon day, around abdomen and whole body is abundantly reported to cure fever in children.

Feet cracking: They apply the hot pulp of Bhelwa (Semecarpus anacardium) seeds to cure feet cracking.

Cough: They orally take juice of sacred basil with honey to cure cough. They also tie warm salt around abdomen and neck.

Scabies: They apply leave paste of neem (Azadirachta indica) and raw turmeric paste to cure scabies. The Karanja (Pongamia pinnata) oil is also believed to work as medicine for it.

Makra-muta (spider pee/urine rashes): The Chuktia Bhunjia are found to cure urine rashes simply by applying the gas of wax, preferably of Madhuca indica. They first put the wax in fire till it becomes reddish; after which, it is put in a jug of water to create evaporation. The affected ear is immediately faced towards the container in such a way that the gas enters into it and removes the pulp. It is repeated for 3 times or till the pulp comes out.

Ring worm: They apply leave paste of Biskhapri (Tridax procumbens) on wound to cure bleeding and ringworm.

Access to modern healthcare: unreached institution vs customary norms

Availability of resources does not guarantee accessibility; rather, it is determined by other internal and external agencies. In the context of Chuktia Bhunjia, despite having a PHC at Sunabeda village, the Chuktia Bhunjia women in particular, mandated by customary norms, rely on herbalists for any kind of health disorders. It is customary among them that no Chuktia Bhunjia women are allowed to consult any trained doctors/nurses as men, considering him or her as ‘outsiders’ for their caste background, even during childbirth and gynaecological disorders; otherwise, the concerned family has to answer the village council and may face social ostracism. It is because of these taboos attached to women about access to modern healthcare facility, no institutional delivery is reported among them and is done by traditional birth attendant (dai), leaving the health risk over fate simply to hang on the cultural value and practices.

It was learnt that as a practice, on the onset of delivery pain, the delivering woman is secluded to a corner of room or a small hut meant for child delivery for a period of 1 month. She is considered pollutant and impure while giving birth and thus no other members of the family are allowed to touch her except husband and birth attendant (Dai; who may be either her mother-in-law or expert) who takes care of both mother and child. As soon as the child is born, father of the new born cuts the umbilical cord with an arrow and buries it in front of Lalbangla so as to avoid it from being used for black magic or sorcery. The mother remains untouched for a month because of perceived impurity and pollution. She is therefore restricted to touch their Lalbangla and cowshed and abstained from going to sacred sites like ponds, forest and groves. She takes bath in the kitchen garden until purification ritual is performed. She is given food in a leaf plate which is garbaged immediately. The other members of the household also take appropriate caution that food taken by the mother is not brought back to Lalbangla. After a month, they perform a purification rite called Chhati where an invited female affine takes her to Lalbangla to make her touch the vessel meant for cooking, followed by sacrifice of a hen and offering of a leaf cup of liquor made up of Mahul flower to their ancestral deities. Her entrance into the Lalbangla signifies that she is free from pollution.

The submission to these customary ritualistic practices compels them to be refrained from access to hospital during childbirth. The accession register of PHC shows that no Chuktia Bhunjia women have approached the PHC in last few years. Those male members approached are mainly for ailments such as malaria, cough and sneezing. However, appointment of Chandini¹⁴ as an ANM has moulded few of them, the perception of doctors being ‘outsiders’ still enforcing many of them to remain hitherto at their tradition. In case any woman consults modern medical doctors for any ailments, other than childbirth and gynaecological problems, she is purified by a member of affine group who gives her a palmful of water in a Sunari (Cassia fistula L.) leaf to the person to drink as a form of purification besides sprinkling the same over the woman before allowing her to enter into the Lalbangla. Sometimes, member of certain clans who consulted trained doctors also requires to drink water mixed with blood of sacrificed fowl in a Sunari leaf as purification.

The Chuktia Bhunjia being marginalised socio-economically, government has initiated measures to curve out the vulnerability by establishing a micro-project known as CBDA that monitors the development of this tribe. Government has also established a PHC to facilitate better health service to the inhabitant of the SWS and also made provision of free access to healthcare services to Chuktia Bhunjia. But its access is hardly reported among them because of those cultural mandates. CBDA has failed to address those cultural elements whereby the healthcare initiatives meant for Chuktia Bhunjia remain futile. The reason being, according to the Chuktia Bhunjia code of law, anyone consulting doctors for women-related disease, including childbirth, is considered disobedience to culture and perceived as Hinduisation. If it is the case, the concerned family is asked to answer to the village council for their disobedience to customary laws and is temporarily excommunicated until expatiate a fixed amount of monetary penalty and a communal feast to be readmitted into the community.

How the fear of temporary social ostracism obstructs the Chuktia Bhunjia to access to the modern healthcare institutions can be exemplified through the case of Banita (disguised name) of Sunabeda village below. Her husband shared,

My wife had hectic labour pain and was not in a position to bear the pain while delivering the child. The birth attendant even could not handle. So immediately I consulted the female nurse appointed in PHC. Nurse helped her to deliver the baby. After seven days, I was served a notice by the village council to give the explanation as to why I violated the customary laws. I was temporarily excommunicated from the community interaction until I paid the penalty of one thousand and community feast to the village council required for readmission into the community. After this, I could able to invite affine group for purification ritual of my wife and newly born baby.

There are many instances as that of Babita’s, portraying as to how existing customary laws and practices become a hindrance in availing the modern healthcare provision among the Chuktia Bhunjia. Although the younger generation expressed their willingness to access modern healthcare service, communication constraint and expensiveness of the modern healthcare restrict them to go to district headquarter hospital for any severe cases, as the existing PHC does not have facility, and they rather remain with traditionally developed knowledge-based healthcare system. It is reported that in case of emergency, the Ambulance Services find it difficult to reach the SWS area. Thus, despite having a provision of mobile health facility, the un-approached location of the Chuktia Bhunjia restricts the facility to come to their doorstep. The failure of the NRHM in this region is due to the same reason. Owing to these difficulties, the Chuktia Bhunjia have no option rather than to rest on traditional health providers, the dependency of which is shaped by time, age and gender.

Discussion and conclusion

This study found that the Chuktia Bhunjia have their own perception about health, illness and disease causation. The narration of cultural construction of health by the Chuktia Bhunjia shows that for them a person’s ‘working capacity’ is positively considered as ‘healthy’ and illness is believed to be caused by ‘non-human agents’ and ‘natural agent’. Both function in a different modality to encounter diseases and response to illness through culturally developed practices of knowledge, beliefs and faith. Their health functionaries play important roles in arresting the supernaturally and naturally caused illness differently as in the case of other tribal communities (Jaiswal and Premi, 2014; Mishra et al., 2012; Otten, 2010), but the accessibility to healthcare institutions is governed by sets of customary laws, taboo backed by purity-pollution and self-notion of ‘outsiders’ surrounding with material culture – especially Lalbangla. Each factor is structurally interrelated at functional level in determining their healthcare practices and access to healthcare institutions. In encountering the supernaturally caused diseases, religion and magic are assumed to have invisible power in the healing process where cultural paraphernalia, especially mahua liquor and hen, become requisites towards appeasing deities causing the illness. So, rituals become important parts in warding off the supernaturally caused illness.

The diseases caused by ‘natural agents’, on the contrary, are arrested contextually at different levels. The local ecology does have significant association with their healthcare practices as evident from the frequent use of medicinal plants by herbalists and laymen in the treatment of ailments. However, the access to those plant species is governed by sets of customary beliefs and laws so as the treatment methods. The herbalists who are entrusted with enormous knowledge on medicinal plants are found to voluntarily render their service by administering plant-based medicines. It makes the Chuktia Bhunjia more reliant over the herbalists. Nevertheless, their knowledges and practices are under threat due to the restriction of forest department to exploit the medicinal plants after the declaration of SWS as a tiger reserve. It has resulted in gradual decrease in plant-based healthcare and the younger generation, particularly male, are found to incline towards modern medicine as evident from accession register of PHC located in Sunabeda. Since access to healthcare among the Chuktia Bhunjia is contextualised in gendered term, no females are reported to have consulted trained doctors at PHC, especially for female-related diseases, because of cultural restriction. Those male members who consulted the doctors were largely for ailments like wound, malaria and typhoid. Furthermore, since villages in the SWS are scattered widely, it becomes difficult for people from other villages to reach Sunabeda and thus people feel easy to have their own medication that makes them economical. Such faiths of the Chuktia Bhunjia over herbalists, coupled with availability of medicinal plants, have sustained their knowledge-based practices (Leonard, 2003; WHO, 2002). So, availability does not guarantee accessibility; rather, it is governed by existing cultural factors and communication.

Furthermore, the science of healing among the Baids reveals that no specific tool or technologies are used to heal the illnesses rather than following specific formulation in the preparation of medicine out of required part of plant species. The only requirement follows in the healing is the precautions applied to the patients. Such knowledge which the herbalists said to have gained by experiments may or may not be called ‘science’ in conventional way because of its ‘localised’ and ‘context’ specification, the reliability it has claims to be calling those practices as ‘science’ – a localised science. Besides, the way the herbalists and laymen have structured their relationship with plant species about exploitation for medication, entrusted with beliefs and taboo, portrays a philosophy towards ecological restoration so as to ensure their healthcare practices in a sustainable manner. ‘Mantra therapy’ coupled with medicinal plants is found as a powerful tool in curing disease such as smallpox, fever of infant and urine rashes and insect infection. Also, the frequent utilisation of plant species makes them to be submissive to protect those species through sustainable collection and cultivation so as to ensure their healthcare practices are sustainable.

The traditional healthcare practice of the Chuktia Bhunjia can be looked in terms of sustainability of social network, institution and social relationship. The social relationship of patient with the health functionaries is kept pace with ‘familial relationships’ where patient’s family expect the health functionaries to be a special invitee in any familial occasion. This makes their bond stronger than usual. The voluntary and humanitarian un-chargeable service rendered by health functionaries is found to not only strengthen their social bondage and healthcare institution but also replace cost-intensive medical service and make their practices cost-effective as healers do not charge – either in cash or kind – or often accept different modes of payment like dhoti, saree, coconut as a token of service rather than by a flat rate payable in advance as is often the case when visiting a physician (Hausmann et al., 2000).

The nature of healthcare practices among the Chuktia Bhunjia reveals that there are two forms of healthcare modalities – magico-religious and herbal therapy. The function of each modality is influenced by a number of factors in the process of healthcare. The former is found to revolve around beliefs, rituals and magical power. Although no cultural specificity is attached to ward off the diseases in magical ways, the ritualistic performance in the form of sacrifice, vow and offer of specified materials particularly local wine in time and context is always believed to reduce the power of supernatural forces, especially of malevolent spirits, causing illnesses. Ritual selling of new born as a form of health belief, albeit not a regular phenomenon, has a definite social epitome in terms of fastening people not of two different families but of two different caste groups as well, and thus strengthens the social bondage. The herbal therapy, on the contrary, with many dimensionalities hangs on around the ecology, that is plant species, the practice of which are conditioned by experiment and knowledge of the practitioners, including that of professional herbalists, disease specialists, and laymen. The customary laws, ideas of purity-pollution and taboos are found to shape their healthcare practices particularly in terms of governing the collection of medicinal plants. Unlike the accessibility to magico-religious form of healing which is conditioned by ‘time’ and ‘context’, the access to herbal therapy is governed by the idea of ‘purity’ and ‘genderedness’.

The gendered nature of Chuktia Bhunjia’s healthcare is also observed from the participation of women in the knowledge-based healing practices and access to modern medical services. Table 2 shows that no Chuktia Bhunjia women are engaged as healthcare functionaries. When asked for the reason, it was learnt that the daughter after marriage is considered member of her husband household and village and therefore becomes ‘outsider’ even if she marries within the village. Thus, the knowledge, unlike other immovable properties like ‘land’, getting transferred to outsiders is mere excuse to remain ‘male line’ of the society or perceived as cutting as of the male line. It is because of this perception, learning of knowledge about healthcare from mother is merely absent as revealed from Table 3 due to the fact that women possess no healthcare knowledge to transmit to next generation.

The gendered access to modern medical services requires a little elaboration. It was learnt from the narrations about the access to conventional medical facilities by the Chuktia Bhunjia that there are two determinant cultural forces debarring them to avail the medical facilities – ‘notion of purity-pollution’ and ‘idea of outsider’. Both are surrounded with the existing material culture – Lalbangla – that shapes their socio-economic and health seeking behaviour. The narrations reveal that although no males are subjugated to the customary laws about access to modern medical facilities, it is only the women who adhere to such behaviour. It is believed that doctor being outsider because of their caste background, any consultation with them affects the sanctity of their women and may cause annoyance to their family deities and may bring harm to family members. With this belief, ‘if any woman consults trained doctors, other than gynaecological disorder or childbirth, at PHC or other paramedical personnel like ANM, they immediately ask a member of their affine group to purify the woman before allowing her to enter into the Lalbangla – the abode of deities’, said an octogenarian. Any non-compliance on their part is handled by their existing village council that may give summon to the concerned family to give explanation as to why they became disobedient or went against their customary laws or the village council temporarily excommunicates the accused family from social interaction and society until the family expatiate a community feast along with giving a fixed monetary penalty following a ritualistic purification by a member of an affine group. It burdens them economically. So, the fear of social ostracism has historically forced them to remain hitherto at their traditional healthcare practices. It is because of these factors not only the institutional delivery is meagrely reported but the pre-natal and post-natal care as well.

At the policy level, such culture-driven healthcare behaviour continues to become challenges to attain SDGs as no Chuktia Bhunjia are found to participate in those conventional healthcare programmes. There are many such instances where it becomes difficult for Chuktia Bhunjia to accept any development programmes when these refer to ‘change in culture’. These indicate that the healthcare practices among the Chuktia Bhunjia are male-centric and women are marginalised in terms of access to healthcare services. Furthermore, the access to healthcare services by the Chuktia Bhunjia as a whole is influenced by communication constraints, lack of affordability due to low level of income, and lack of awareness of health services meant for them. Neither the state, particularly CBDA that aims to develop the Chuktia Bhunjia in all aspects, tries to address those cultural hindrance nor taking any measures ensuring the healthcare institutions reachable. As a result, with no alternative, coupled with availability of health functionaries, eye witness and social acceptance, they prefer to rely on traditional medicine not only to reduce their dependency on cost-intensive healthcare but also to make the practice sustainable and to uphold their culture, beliefs and identity concerning healthcare practices. Therefore, ‘often invited by non-tribals living in the sanctuary area to cure any diseases, they never refute simply to have a stronger social relationship with them’, said an herbalist. Such behaviour about healthcare practices in the Chuktia Bhunjia society has not only strengthened their knowledge, institutions and networks but also, coupled with the idea of culture and beliefs, reinforced such practices to be a ‘structure’ and ‘system’ as represented in Figure 2.

Figure 2.

Healthcare system among Chuktia Bhunjia.

To conclude, the science of healthcare among the Chuktia Bhunjia is inextricably associated with their own culture, beliefs, knowledge and ecology. The customary laws, taboo, magic and rituals occupy significant space and influence the access to healthcare institutions. Their healthcare practices are structurally so static that it becomes difficult for the Chuktia Bhunjia to accept the modern healthcare services when development means change in culture. This perception continues to become an obstacle in the success of healthcare programmes. The CBDA that monitors the development initiatives of the Chuktia Bhunjia also fails to influence them in the matter of access to modern healthcare simply because of the lack of knowledge about those cultures. Furthermore, given malfunctioning of existing health institutions, knowledge-based healthcare practices continue to become a hope for the Chuktia Bhunjia and bridging the gap between the demand and the supply of healthcare services. Yet, the poor management of available PHC, coupled with meagre staffs, is found to have been giving a further scope to untrained medical mafias to be involved with their healthcare system to make money out of their cultural simplicity. Also, their knowledge being hereditary, usually from parents to son to retain their family line, the trend of cultural transmission of those knowledges is gradually diminishing due to migration, state intervention, economic transition and other disturbing pathways of knowledge transmission. Therefore, documentation and promotion of such knowledge-based practices would offer the possibility of a solution to healthcare sustainably provided those knowledges are culturally transmitted to the next generation. Although the customary norms and taboo associated with the healthcare practice among them continue to become an instrument in this line, unless there is a structural change in their society accessibility to modern medical system becomes impossible. Yet, owing to the socio-economic transition and restriction by the forest department to collect medicinal plants, in particular, any integration of their knowledge base with modern healthcare system or the coexistence of multiple healing practices or ‘medical pluralism’ can best just their healthcare.

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Bhubaneswar Sabar

Notes

Author biographies

Bhubaneswar Sabar is a PhD Research Scholar at Department of Anthropology, Vidyasagar University, Midnapore, West Bengal, India. He is also working as Assistant Professor at the Department of Anthropology and Tribal Studies, Maharaja Sriram Chandra Bhanjadeo University (Erstwhile North Orissa University), Baripada, Odisha, India. His academic interests include tribal studies, ecological anthropology, public policy, and critical ethnography. He has published research papers in peer-reviewed journals like Economic and Political Weekly, Social Change, Journal of the Indian Anthropological Society besides authored a book titled Food Insecurity, Coping Strategies and Particularly Vulnerable Tribal Groups (2015). As one of the recipients of Endeavour Research Fellowship, 2012 and Adivasi Fellowship, he was affiliated to the University of Sydney, Australia and London School of Economics and Political Science (LSE), University of London respectively.

Dr. Dipak K. Midya is a Professor of Anthropology at Department of Anthropology, Vidyasagar University, Midnapore, West Bengla, India. His academic interests include indigenous people, ethnic identity, tribal problems and maoist violence. Having guided Ph.D students, he has undertaken many research projects in the areas of extremism, ethnic unrest, health and marginality. He has authored 04 books and published articles in the journal of international reputation including Journal of Indian Anthropological Society, Journal of the Anthropological Survey of India, Man in India, Summerhill: IIAS Review, etc.

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