Abstract
Science and myth have been closely linked and argued upon by philosophers, educationalists, scientists, enthusiasts and the general public. Faith healing, when added as an adjuvant or alternative aid to medical science, will not necessarily be confined to mere arguments and debates but may also give rise to series of complications, medical emergencies and even result in death. We present an unusual case where reliance on faith healing led to the death of a young man.
Introduction
Nepal is a landlocked country with geographical variations comprising valleys, plateau, hills, mountains and plains. The socio-economic and geographic disparities in these regions have restricted access to allopathic medicine and technologies normally offered by modern medicine to people living in rural and hilly areas. These people frequently rely on the traditional thorny, ambiguous and absurd procedures offered by faith and religious healers. But even worse, some of these procedures are not confined to rural areas but have also found their way into developed cities. It is ironic that, with government facilities and foreign aid pouring into rural areas, traditional believers are seeking modern medicine while some educated citizens are opting for faith healing.
We present an unusual case where reliance on faith healing led to the death of a young man.
Case report
The dead body of an engineering student, dressed in his college uniform, was brought to the mortuary for medico-legal autopsy. There was a history of sudden death; the body was found around 8:30 a.m., just outside the walled compound of his house. His face appeared congested and petechial haemorrhage was noted over conjunctiva of both eyes. Finger and toe nails showed bluish discolouration. There were no fresh injuries found on the body except for a few fresh abrasions on the back of both elbows.
On internal examination, while removing the organs en-masse, a foreign object was discovered lodged in the oropharynx which proved to be a slug with its head extending out into the oropaharynx (Figure 1). Epiglottis and inner wall of trachea appeared congested. Blood-mixed mucoserous froth was present in the bronchi. All internal organs on cut section were congested, and the stomach was empty. Careful autopsy did not reveal any injuries to the internal organs.
Head of the slug extending out from trachea into the oropharynx.
On questioning his classmates, it was revealed that they had witnessed the deceased ingest live slugs a couple of times earlier to treat his long-standing arthralgia. He would pick them randomly from walls and shady places around his house and swallow them. Further enquiries revealed that the deceased had tried different allopathic medicines before finally switching to faith healing; his ‘healer’ had advised him to ingest live slugs till the pain was relieved.
It was suggested that after ingestion, the slug, due to its moist and slippery texture, might have slipped into the windpipe or might have choked the victim while he tried to ingest it alive. Congestion around the epiglottis and other notable signs of asphyxia ruled out the possibility of post-mortem movement of the slug into oropharynx. The question that still remained unresolved among autopsy surgeons was whether the slug had offered some resistance in the oropharynx against the suction force produced by the peristalsis of the oesophagus aided by inspirational ‘air push’ towards the trachea, which led the slug to lodge in the upper part of windpipe thereby causing death by choking.
Discussion
The World Health Organization (WHO) in 2003 reported that traditional healers and methods are a significant factor in developing countries like Nepal as they are not only accessible and affordable but also are socially acceptable by a majority of the urban population. In Uganda, Ghana and Kenya traditional healers are 50 to 100 times more prevalent than allopathic health-care providers. 1 The term traditional medicine (TM) is used in Africa, Latin America, South-East Asia and Western Pacific, and complementary and alternative medicine (CAM) is used when referring to Europe, North America and Australia. The comprehensive term TM/CAM used in a general sense to all unorthodox treatments refers not only to TM systems such as Traditional Chinese Medicine, Indian Ayurveda and Arabic Unani Medicine but also to various other forms of indigenous medicine. Traditional healing has found its way into the population throughout the world especially Africa, Asia and Latin America where it aids the meeting of primary health-care needs. Collectively known in Nepal as Indigenous Healer’s Services or Traditional Healing Methods 2 , these comprise not only world renowned Ayurvedic healers (herbalists, homeopathy) and those who practice Chinese medicine who in former times imported skills from neighbouring countries but also faith healers, who apply the knowledge, skills and practices gained from indigenous experiences which are passed on from generations to diverse cultural and ethnic groups of Nepal.
Between the 7th and 13th centuries, the neighbouring states of India witnessed what was called a Tantric period (Tantra refers to magic). Following the Mughal invasion of India, Hindus fled and reached Nepal and Tibet where this culture flourished once more under different religious and ethnic groups. This later became an integral part of faith healing and has now found its way into the health-care delivery system. 3 Over a period of time, these faith healers became divided and came to be known as Dhami-Jhankri (Faith healers, Shamans), Pundit-Lama-Gubhaju-Pujari (Priests) and Jyotishi (Astrologers) depending on which services they provided. 4 The Shamans locally known as Dhami-Jhankris are believed to be the mediators between the spiritual world and the real world we live in. In cases where the common causes of illness are attributed to alleged attacks by ‘bad spirits’, these colourfully dressed, drumming, chanting, dancing and singing Shamans are supposed to diagnose the type of spirit, and based on complications and symptoms, either make an offering of a rooster or a black goat and frighten away the spirit or suck the offending spirit from the patient’s body using a spirit bone which is usually the human femur.5,6
Various attempts and projects are being launched by WHO to provide faith healers with training so that they can play a useful role in primary health-care activities like education; promotion of proper nutrition, management of safe water and sanitation; maternal and child health care (including family planning, immunisation against major infectious diseases); prevention and control of endemic diseases, first aid, provision of essential drugs, etc., with the aim of improving rural community health. 7 Despite these strategies, spiritual and faith healing in its traditional form is still rampant in rural areas and has found its way into the urban areas and can at times be life threatening as demonstrated by this case report. The deceased’s belief in faith healing methods led to his death. It is essential to raise awareness of the dangers resulting from uncritical trust in faith healing in Nepal which is widely prevalent among its general population.