Concept_of_Health,_Ill_and_Treatment

C HAPTER-I Introduction The World Health Organisation (WHO) has defined health as a 'state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (WHO; 1997). Such a definition could be seen as keeping with what has already been r ecoyised i n the traditional Indian medicine viz. that physical wellbeing alone cannot ensure good health. However, medicine, as it comes to be practiced i n modem times, laid an emphasis on curing illness, and often overlooked the psychological aspect and social dimension of health. The concept of health, disease and treatment vary according to the culture of a particular area. Moreover, a particular culture of' tribal area is guided by the traditionally laid-down customs and each member of'the culture is ideally expected to confbrm to it. Disease and health are universal experiences, which are as old as human is. As our primitive ancestors evolved i n to human forms, so were the disease they brought with them and those they acquired during the evolution became social and cultural facts as well as patholoccal states. For human being i n a given set up, disease threatens not only one's state of well-being and that of other people i n the group, but also it threatens, the very integrity of the community as a whole. Disease according to modem science is only a departure from a state of health and more frequently, a kind of disturbance i n the health of lbody to which any particular case of sickness attributed. Events like death and occurrence of the disease lead to heavy expenses and adverse psychological effects. I n every culture there is a repository of values and belief systems built around important life experiences, viz. birth, illness, death and disease reduces the strength of the people to hunt or gather food, to a b~iculture nd all other a vital occupational and necessary activities. Chief priest, shaman, ojha, sorcerer and the traditional medical practitioner had to find a means to bail the victim out o ftheir misery, otherwise they loses the status according to their abilities in the community. Traditional way of treatment is inevitable among the tribal people although modem treatment is applied in different circumstances. Traditional medicine can be stated as the some total of all knowledge and practices, whether explicable or not used in diagnosis. prevention and elimination of physical, mental or social imbalance and relying exclusive on practical experiences and observation handed down from generation to generation, whether verbally or in writing. The traditional medicine thus inherited is of various kinds viz. Folk medicine, Ethnoniedicine, Ayurveda, Unani, Siddha and Nature care. All systems differ from each other i n term of tools, techniques. ideas and beliefs. lnspite o f these d i t h e n t people belonging in to all sections oCthe population resort to the use of the elements o f these. varied system. 1.1.1 Folk Medicine: T he study of indigenous medical features of a particular community is known as 'ethnomedicine'. It is also known as 'folk medicine'. 'popular medicine' and popular health culture' (Polgar; 1962). The subject of ethnomedicine focuses on the nature of illness as it is conceived by native in their own ways by their criteria of classification of diseases, the causes, the cures, type of therapists and healers who seek to alleviate illness and their skills and social roles preventive measures, the relation between medicine and religion, cultural aspect of ethnomedicine and also ethnopsychiatry (Huges; 1968 and Foster; 1978). Cultural practices hold the key to a great deal of folk and this is especially true of preventive medicines that although oriented to different social process, have unique functional implication for health. Thus remarkable hygienic purposes are served by many religious and magical practices such avoiding the visit to a house where some one has passed away, theories of contagious a "bad body humors" which necessitate daily bathing, distinction of 'hot' and 'cold' food and water requires boiling or hiding of bodily waste for of their use by sorcerers of witches. The causation and grammar of folk medicine is unique and is based on wrath of God's evil spirits, magic and witchcraft. It has it diagnostic tool and techniques, which can heavily depend on divination. Treatment is through propitiation of Gods, exorcism, counter-magic, use of charms, fetishes and amulets and administration of herbal preparations. 1.1.2 T raditional Indian Medicine: The traditional I nd~anmedicine consists of Ayurveda, Siddha, Unani and therapies such as Yoga and Naturopathy. These systems are indigenous and through over the years become a part o f Indian tradition. Prior to the advent of modem medicine, these system had, for centuries, catered to the health care needs of the people; these system are widely used even today because their practitioners are acceptable both geographically and culturally, are accessible and their service and drugs are affordable. 1 .1.2.1 The Ayurvedo: Ayrveda is reckoned as a portion of the Forth Veda or the Adharvana and has been considered the oldest work on Hindu medicine. Although this is claimed by the Aryans as theirs, neither its author nor the.period in which it was written is known; and only fragments of it have come down to us embodied in the certain commentaries of subsequent writers. The modem Hindu ascribe its authorship to their Gods, some to Brahma and others to Siva but in their philosophical writings they are all attributed only to Siva, who in this respect is known as Vaidiswar and Mundehwar (Gods of Medical and Medicine). It is not clear how the human race had access to it as many and various are the legends current about i t. I t is said that, in Kaliyuga, the world would become reprobate and the corruption of the human race will be such as to necessitate a great curtailment of life and to leave the people embittered by numerous ailments. This legend is supposed to indicate the epoch of Ayurveda as intermediate between the c vedic and the Brahminical times- which is about the 9" or the l ouh entury B.C. 1 .1.2.2 The ( Inant: The Arabians had cultivated the science and art of medicine at a very early period, but very little information is known regarding any of their physicians or psychiatrists of repute. The Arabic writers of the 7'h and the 8"' century A.D. were mostly native of Syria, who visited India on many occasions and took away with them many Hindu works, which they translated in to Arabic and Persian languages. They were avowed borrowers of science and were also in the habit of looking forward to the increase of their stock of knowledge by translating into their own lanbwage some of the medical- theological compositions of the Indian physicians. Professor Wilson is of the opinion that they followed the Hindu works on medicine more closely rather than of the early Greeks. 1.1.2.3 The Siddha: The word 'Siddha' comes from the word 'siddhi' which means object to be attained or " perfection or heavenly bliss". Siddhi generally refers to Ashtama, siddhi i.e. the eight great supernatural powers which are enumerated a s Anima, etc. Those who attained or achieved the above powers are known a s s iddhan. Siddhis are also constructed as powers that are attained by birth (according to their previous karma), by chemical means or power of words or by mortification or through eoncentration. 1.1.2.-I Naturopothy und Y o p Medicine: This could be taken as integration of folk medicine, ayurvedic medicine as well as Siddha medicine. The concept was popularised by Gandhiji through personal experiences and observances with nature care This system of health care includes indigenous medicine, dietary regulation, yogic exercise relating to the specific areas of bodies as well as external application like mind, bath, sun bath, body massage as well as exercise on mental concentration. These methods have been very popular in the west and in the Europcan countries in the last few decades. 1.2 Concept of Medical Anthropology: Anthropology combines in one discipline, the approaches of both biological and social sciences. In short, anthropology is a well-defined study of physical, social and cultural aspects of man. Medical sciences have two subdivisions: (a) Aet~ological nd therapeutic activities: and a (b) Management and dispensing of Medical care. Aetiological and therapeutic area deals with the task of identifying and explaining scientifically established causes for the occurrence of diseases and formulation of proper therapeutic procedure as treatment. This area has fixed theory of disease, therapeutic diagnosis, pharmacopoeia and surgical procedures. The second sub-division of medical science concerns it self with the practical application of scientific knowledge dealing with the task of distribution, resourses, allocation and medical care delivery. The practice of medicine is not a personal affair. At a very superficial level, it involves interacting between the giver (Government'hospital, dispensary, doctor, paramedical) and the taker (community, family patient). This interaction is a social interaction, which is governed by some d eal norms, rules. obligations and expectations. 1.3 Definition qf M edical Anthropology: Etymologically, thc word anthropoloby is derived from the Greek system Anthropo(Men) noun ending - logy (Science). Its literal meaning therefore, is 'Science of Man': ( B eak; 1971). Medical anthropology is not only limited to the extent of providing fruitful strategies to the health care planners. It has also contributed greatly in the theory building process of general anthropology too . .. Medical Anthropology is not only a way of viewing the state of health and disease in a society but a way of viewing society i t s elf(Lieben; 1974). Many definition of medical a nthroploby have been offered. One of the broadest, yet most concise, is contained within the mission statement of the Society of medical A nthroplogy's journal, the Medical Anthropoloby Qwarterly. It defines medical anthropoloby a s a field that includes:- . . . .... ,411 inquiries in to health, disease, illness and sickness i human n individual and populations that are undertaken from the holistic and crosscultural perspective distinctive of anthropology as a discipline- that is, with an awareness of species, biological, cultural, linguistic and historical conformity and variation. It encompasses studies of ethnomedicine, epidemiology, maternal and child health, population, nutrition, human development in relation to health and disease, healthxare providers and services, public health, health policy and the language and speech of h ealth and healthcare. ( Med~cal nthropology Quarterly; September 2001). A 1.4 Applied Anthropology in Medicine: Medical anthropoloby is a flourishing branch of anthropoloby and it has emerged as one of the most indispensable areas of anthropological research. The term medical anthropology has come into being only i n the 1960s and since then cultural anthropologist has started emphasising the important of social and cultural aspect of health and medicine i n their studies. The new label medical anthropology permits the researchers in studying both theoretical and applied aspect of the field. Medical sociology and medical anthropology have contributed to a greater awareness of disease and medicine. f4asan (1975) rightfully claims that medical anthropology has a larger and broader base than estimated by Foster. He states Anthropoloby combines in one discipline, " the approzches of the biological science, the social science and humanities. Thus, the biological and ecological approaches are common to anthropoloby; medicine and health provide valuable grounds for collaboration between medical scientists, health professionals and anthropologist. Without this broad bio-cultural approach, the use of the ecological framework has made an initial input in the medical anthropological area". 1.5 The Role of Social and Cultural Anthropology in Health Care: Social and cultural Anthropology studies the origins and histories of Mans' societies and their culture. It is concerned with the evolution and development of culture whether it belongs to the Stone Age ancestor or to the urban societies. Culture 1s the product of agro-facts (products of industry), so&-facts (social organisation), and mentifacts (language, religion, art and so on). For the treatment of different disease medicine has been practiced one way or the other since man become a natural animal. In most culture, there is a specialist who treats illness, injury and disease and quite frequently this person corresponds to the leader of religious practices. The medico-religious practitioner is also considered to be a practitioner of magic, mantric or witchcraft traditionally and he was a man of cultural mind endowed with many abilities and he was dedicated to his vocation. Throughout the ages man has been devising ways and means of curing for the sick in the community. Every culture, irrespective of its simplicity and complexity, has its own beliefs and practices regarding health and disease and the way of treatment. The role of different traditional practitioners who have been providing health care to their community for years have stood the test o ftime. Traditional medical practices have survived even in the midst of some of the most sophisticated and advanced medical thcrapy. Medicine and disease have had an undeniable effect on the history and culture of mankind. Since man is a social and cultural being, every known human society has developed a pharmacopoeia and a therapy- be it magico-religious, secular or empirical or scientific. In order to understand a total culture of a particular period, i t is necessary to pay attention to asses the health status of human group involved. This is done through collecting evidence of the disease, treatment, medical behaviour of that period. As a total study of man, medical anthropology has contributed valuable techniques; concepts and scientific facts to several branches of medicine and public health care delivery systems. The Indian tribal societies vary from state to state and also region due to their ecological, economic, ethnic and other multivariate socio-cultural factors. The influence of culture on dtseasc occurrence in ecosystem includes human beings in contingent upon a variety of factors within culturally oriented behaviour. The concept of health is part of a tripolar conceptualisation, as the term denotes: (a) A balance state of body; (b) mind and (c) divine soul that may be elaborated as: (a) Body [Physical health- Health] (b) Mind [Mental health- Happiness] (c) Soul [Social health- Alma- invisible organisation that operates body and mind] According to Siddhar's ancient theory of medical philosophy, disease in humans does not originate in the self, but terms of macro-cosmic elements. ( Punch hoorhsfive elements, nine planets, twenty seven stars through the zodical s i p with the help of spiritual power of 'ohm' in the vital air region). The force of any change in the macrocosm (ecosystem of the external world) has its corresponding change in the human organism to microcosnl (biological system of internal body) through the doctrine of human patholoby. Tridosa theory is the derangement of three humors in accordance with the traditional system of Siddha, Ayurveda and Unani. 1.6 Health and Indigenous Knowledge: The role of science is to help mankind to meet the various demands exploiting the natural resources in the best possible way without adversely affecting the environment. Thus in the given socio-economic and historical context, the knowledge to make tire is equally significant and important like many of the present day scientitic innovations. In most societies, there dose exist a rich body of scientitic knowledge based on the demands of the concerned societies. In the past, that knowledge was based on oral and almost always transmitted verbally from one generation to other. Such knowledge is in fact still used today in many areas all over the world in the day to day living of many indigenous people. In several parts of Asia, apart from the folk traditions there is also a parallel classical tradition of knowledge. These classical knowledge systems have very sophisticated theoretical foundations and are codified and documented in the thousand of Manu-scripts. They represent non- western knowledge system of the world and very different in their world- view, concepts and principals from the western knowledge systems. Traditional knowledge in medicine and health has been time tested over generations. It is a holistic concept covering a broad base from diseasc prevention, hcalth promotion and healing. It has and can deal with health problems ranging from the common cold, air and water borne diseases to orthopedics and other complicated cases. This system is also based on a wide range of biological resources using thousand of plant species, hundred of animal species and animal parts, various minerals and mental sources. Unfortunately, over the years traditional knowledge and skills have becn neglected and a prejudice has developed towards these non-western sciences. This prejudice has been engineered and encouraged by powerful nations, multinationals in order to subjugate non-western cultures. 1.6.1 Health and Government Policy: (Health Care and Government Plan): Improvement in the health status of the population has been one of the major thrust areas for the social development programmes of the country. This was to be achieved through improving the access to and utilisation of health services with special focus on under - served and underprivileged segments of the population. Over the last five decades, India has built up a vast health infrastructure and manpower at primary, secondary and tcrtiary carc in government, voluntary and private sectors. These institutions arc manned by professionals and paraprofcssionals traincd in the medical colleges in modem medicine, ISM, Homoeopathy and paraprofessional training institutions. The population has become aware of the benefits of health related technologies for the prevention, early diagnosis and effective treatment for a wide variety of illness and accessed available services. Technological advances and improvement i n access to healthcare technologies, which were relatively inexpensive and easy to implement, had resulted in substantial improvement in health indices of the population and a steep decline in mortality. The extent of access and to utilisation of the healthcare varied substantially between states, districts, and different segments of society; this is to a large extent: is responsible for substantial differences between state in health indices of the population. During the 90s, the mortality rates flattened; country entered an era of dual disease burden. On one side there are communiczble diseases which have become more difficult to combat due to insecticide resistance among vectors, resistant to antibodies in many bacteria and emergence of new diseases such as HIV for which there is no therapy; on the other side increasing longevity and the changes in life style have resulted i n the increasing prevalence of non communicable diseases. Under nutrition and micro-nutrient deficiencies and associated health problems consist with increasing prevalence of obesity and life style related noncommunicable diseases. Unlike the earlier era, the technologies for diagnosis and therapy are becoming increasingly complex and are expensive. It is likely that larger investment in health will be needed even to maintain the current health status, co~nmunicablediseases are expansive and this will inevitably lead to escalating health carc costs. 1.7 Tribal Health in India: When onc is concerned with the concept of health among the tribal people i n lndia it is perhaps as well appropriate to be clear about what is generally meant by 'health'. I n the context of Indian socio-economic constraints, it may be then realistic to handle the concept of health in a bi-polar nexus. A s disease and infirmity has been some times distinguished from unspecified " illness". " Illth" may be stand for any amiction whether disease or infirmity or just 'illness'. Of course amiction has to be understood i n such a manner that there might be a conceived amiction without having to undergo perceptible pain or suffering. And we have also to make i t clear the '111th' is an event that happens to people, and that it is not usually motivated or contrived. The concept of medicine, health and disease are largely a product of post- 19" century scientific developments. Ackerknecht (1942) commented that to a seventh century European, American-Indian medicine would not have seemed " strange primitive", i n a much as cupping, building, purging, herbal remedies, somc forms s of surgery and even some exorcism, so also some of the associated beliefs and mystical theories about the causation of illness and the rules of healthv living would have been common to both (Cf. Fortes, i n London ed; p-xii). I n the same vain, it may be visualised the concept of health and disease etc. of the general unschooled rural Indians as not sipificantly different from those of the so-called tribal people of India. This is not to deny that some unique conceptions do not characterised the hcalth concepts of some individual tribal groups i n different eco-historical cultural z.ones of lndia. While still on the problems encountered i n developing satisfactory or adequate concepts, it may has to identify the medically viable and bioecologically feasible indices to define various grades of health status, nutritional status, and determine the standards of normality of the general population of India i n body temperalurc, blood pressure and other physiological conditions etc. These have to be standardised, again in regard to tribal people of India subsisting mainly on roots, tubers, honcy and fruits through food gathering, other depending on cereals, pulses and vegetables for about half of the years, and again those others subsisting on cereals and pulses etc. through out thc year, with their habitant in coastal place or at various altitudes in hills and forest or in deserts. IJnfortunately, there is practically nothing written on the concept of health of the tribal group of India. There are, if at all, some references to the causes, varieties and treatment of diseases, and to the cultural specialists dealing with these diseases. This concern is also a new fangled devclopment since the emergence of Medical Anthropoloby and Medical Sociology, especially after the 1950s. T he cursory reporting on treatment of sickness as covered in the monographs of tribes and the sketchy or tangential references to sickness in the context of sections on religion and magic in the famous surveys of tribes and castes undertaken by the British civilians during the 1" and 2"d decades of the last century, hardly provided adequate material in quantity and quality to do justice to this topic. 1.8 Some Important Concepts and Definitions: 1.8.1 T ribal C on~munities: he term 'TRIBE' is defined as a group of people in a T primitive stage of development, living with in a definite area. They have a different dialect, cultural homogeneity and unifying social organisation. The members of the tribe acknowledge the authority of a chief and usually regard themselves as having common ancestors. The soc~o-culturalback ground, economic status, ecological c ond~t~on the phys~olog~cal and structures of the tribals vary from one another. 1.8.2 Shaman: The shaman like the physician, tried to cure his patients by correcting the causes of his illness. Inline with his culture's concept of disease, this cure may involve not only the administrative of the therapeutic agents but provision of the means for confession, atonement, restoration, into the good grace of the family and tribal intercession with the world of the spirit. The Shaman's role may thus involve aspects of the roles of the physician, magician, priest, moral arbiter, representative of group's world view and agents of social control. 1.8.3 Witchcraft: The witch doctor had an apprentice or an heir apparent. He guarded and carried the medicine man's herbs, divining apparatus, and alI the other items involved in the art of healing. Upon the death of the witch doctor, the apprentice or his close followers always inherited his healing powers. 1.8.4 Ojha: In the Indian villages and specifically among the tribals, o jha is a kind of healer for coping with the misfortunes at different circumstances. Remedy from the capturing of ghost and snake biting, are the two major fields of them. Various types of materials viz. poison sucking stone, mastered, turmeric, vermilion, are used by them through spell of incantation. The role of o jha is very crucial i n the day-today village life of India. They are specially trained by their ancestor to do this type o fjob and the whole technique is transmitted verbally from one to other generation. 1.8.5 Traditional Medicine: Traditional medicine could be defined in a number of ways taking into account the concepts and practices; information about which could be gathered, analysed, evaluated and documented for posterity. The system is so comprehensive that it is very difficult to put the form in a particular slot of medical science. I t mainly centers around two system of traditional medicine broadly: ( 1) Small and indigcnous traditional medicme which include mostly folk system based on socio-cultural aspects as well as magico-religious aspects of smaller groups of people. ( 2) T he second system is called the great traditional medicine or system based on concept o fayurvedic, unani, siddha, nature care and yoga medical system. 1.8.6 T raditional Healing Practices: Every traditional society has its own method of conceptualisation, diagnosis and treatment of diseases based on the rational principles and objective factors in a scientific manner within the s ociocultural background of articular rural and tribal communities. Simple, safe, inexpensive, non-toxic and time-tested remedies existed for the alleviation of disease and disability. To obtain the secrets of traditional medicine, every community irrespective of its simplicity and complexity has its own beliefs and practiccs regarding health and diseases. 1.8.7 T raditional Medicine Men: The role of different traditional practitioners of the rural and tribal communities are to provide healthcare to their community for years have stood the test of time and has survived even i n the midst of the most sophisticated and advanced medical therapies. 1.8.8 Native Doctor: The 'Native' doctor in traditional societies is a man of critical mind endowed with many abilities and he is dedicated to his vocation. He is well informed about the problem of his environment and possesses practical knowledge of botany (herbistry), pathology, psychology (divination), surgery, animal and plants curative agents, climatology, cosmology, sociology and psychiatry. He is a man renowned for his critical abilities. He works within the means and provisions of his culture. Lack of effective media of communication such as those of writing and the keeping of professional records limited the transmission of professional ideas to the future generatlon (Vansia, 1968). The native doctor prescribed dances in accordance with the traditional culture. 1.8.9 Santal H ealth a nd Medicine: The santals are one of the largest tribal g ~oups in India, mainly concentrated in Bihar (now in Jharkhand), Orissa and West Bengal. According to the Santals, a disease free life is possible if there is congenial relationship between human beings, natural and supernatural beings. Any sinful act and infringement of social customs are believed to be the based for creating tllness. In addition to it, the innumerable evil spirits also cause illness. The Bongos (supernatural being) and witches cause illness and disharmony. The Santal priests are then entrusted to look after the propitiation of the spirits. Medicine men and the magicians are involved in the act of the effects of sorcery, evil eye and witchcraft. The institution of local healers and ojlzas are formed by such practices. Apart from the professional medical practitioners, every grown up Sanhl known little bit of the application of herbal medicine and helshe first tries to take the situation hy using this knowledge. Helshe seeks help of the proiessionals when helshe fails i n his attempts and proceeds step by step from very simple remedies to most complicated practice of divination and witchcraft. Thc common people however, lack the knowledge about the invocations, incantations spell and magical iormula, which are the prerogative of the ojhu. The common procedure for the preparation of medicine is to grind the ingredients i n a flat stone and mix with other ingredients later. The new usual earthenware pot is utilised at the time of preparing and administering the medicine because the earthen pot is considered cleaner then the other vessel. Often the unmarried girls are employed for helping in the preparation of medicine. This is because the unmarried girls remain free from any influence of spirit than their married counterpart who is supposed to be under i ht. influence of their husbands' Bongu. Manuscripts on Santal medicine have reported about 261 prescriptions. The reported diseases include the disease affecting head, nose, eyes, teeth, tongue, mouth and throat, bones, nail and other organs of the body. Various types of fever, cough and cold, stomach ailment, epidemic etc, are enlisted in these manuscripts. Sunday is considered to be the auspicious day for preparation and application of the remedies. Medicine are given in an empty stomach in the morning and repeated i n the evening. Splints, the cut piece of so/ (sacechamm sara, L .) are used in the bandage to mend the bone fracture. Medicinal steam-bath is also used as a remedial measure for certain maladies. Santal medicine comprises of ingredients obtain from animal products, cereals and pulse trees and plants. minerals and soil etc. The ingredients of tree and plants products occupy the major place in Santal medicine. Their living in the forest might be the cause of their considerable dependence on ecology and forest products for remedies of various d~seases. The Santal medicine works as contraceptive, hiwe definite effect on sterility, increases flow of mothers milk and help to step its flow when not required. There are medicines, which ensure easy delivery and discharge of placenta normally. It has also the scope of simple surgical method to ensure relief of the patients. The place where pain is felt, is marked with are hot needle or point of sickle to sub due the pain. The available text on Santal medicine confirm the existence of many variation rather than similarities in the prescription for the same disease. Certain disease has a number of prescriptions. The old text mention more details of disease and medicine that the recently written ones. The former deals with the variety of fever like cold and [ever, fever on every alternative day, fever with shivering, fever during nighttime and fever causing bleeding. But the recent text mentions them in an abridged form. From the viewpoint of healing practices, i t is revealed that the recent text have ignored to mention several earlier practices related to the remedies of diseases. The oldest text for instance. have prescribed that, dog bite can be cured by giving the patient hair from the tail of healthy dog inserted i n a piece of ripe banana, to swallow. I n case of scorpion sting it is advised that the a fected person should go to an ant-hill and shout heko, heko several times. By doing so he would get relief, These things are no longer in the recently wrinen text by the Santal Medicine men. An understanding of Santal medicine is incomplete unless it is associated with the whole gamut o f nature, cosmology and superstitious beliefs, their perception of nature and occultisms in order to fight diseases. 1.9 A Review of Related Studies: There are different foreign and Indian scholars completed their studies on the related topics. These studies are very much useful for the better understanding of the present study. Before 1950 there were very few studies in medical anthropology and i t was also applicable in the context of studies among the health and diseases of the tribals. But P. 0. Bodding made some remarkable studies in this context. He (1940) had critically examined different traditional medicine and medical practices among the Santals. He also observed different types of cukural norms and values behind those practices. I n another study Clements (1932) has tried to trace the world-wide distribution of five basic concepts of disease occurrence viz, sorcery, breach of taboo, object intrusion, spirit intrusion and sole loss. Ackernet (1942) collected useful information on the practice of medicine in from various cultural practices including baths, centerisation, surgery, inoculation and also on their pharmacopoeia. After 1950 there were some remarkable studies in the area of health, culture and tribal medicine. V. Elwin, M. Mamot and Oscar Lewis made some conspicuous studies on indigenous belief and practices regarding health, disease and treatment. Acceptance and impact of modem medical system was also another important criterion i n this context. Elwin (1955) has tried to describe and analyse the relationship that exist between culture and tribal medicine. His study claims that there is an extremely close relationship between medicine and other subsystem like morality, religion and magic. Elwin observed that, there are Gods, associated with children's disease, disease of the pregnant women and disease of animals. Most of the disease can be cured by supplicating and propitiating these Gods, directly or indirectly through Shamanism. Mamott (1955) had critically examined the cultural problems involved in introducing more effective technicians to the conservative's Indian village of Krisangari. He took representative from different social strata and found out conflicts that were obstacles to the spreads of western medicine. He suggested that successful establishment of effective medicine could largely depend on extend to which scientific medical practice could divert itself of western cultural impact and adopt itself to the social life of an Indian village. Lewis (1958) had noted that advantage in learning about the indigenous belief and practices of the community is the insight they give into the total world view, which is also reflected in other sphere such as agriculture, politics and interpersonal relations. Different scholars made studies during 60's and 70's touching the different important aspect of medical anthropology viz. folk medicine, ethnomedicine and modern medicine i n the rural and tribal areas. Khare (1963) i n his article 'Folk Medicine i n a North Indian Village' focuses only on medical belief held by the residents of Indian village and stresses the fact that these beliefs quite often l ink w ith the contrasting medical system. This research explicitly shows the i nfluence of these beliefs on the ~mplenientation f modem medical programmes. o Opler (1963) says that. 'different diseases found among the tribes and peasant people are due to the malfunctioning imbalance of forces, which control health, lack of moderation or Inappropriate behaviour i n physical, social and economic matters'. He has tried to give a cultural definition of illness in an Indian village, emphasising the role of cultural factors i n acceptance of medicine and understanding of the nature of diseases. Hasan (1967) in h ~ study 'Cultural frontiers of health i n a village in India' noted two types of social and cultural factors that affect the health of any community: (a) Certain customs, practices, beliefs and taboos create an environment that helps i n the spread of or control of the disease and (b) factors which directly affect the health of communiry as they are related to the problem of medical care to the sick and the invalid. Laslie (1967) contrasts professional and popular health culture on a different basis. He uses professional health culture to refer to the realms of practitioners i n both systems, but does not include the medical sphere of folk speclalist. A distinction is made between professional health culture and popular health cultures. The first term refers to the institutions role, values and knowledge of highly rained practitioners of the indigenous medical system and popular health culture includes the health values, knowledge, role and practices of laymen, and specialists i n folk medicine. Therapeutic practices i n ethnomedicine address themselves to both supernatural and empirical theories of disease causation. Kakhar (1977) in his book, 'Folk and Modern Medicine' has done several in depth studies of the socio-cultural aspects of health and illness. He ernphasises on the folk c oncept o f etiology i n a medium-sized v illage Concerning this, he comes across the practice of three different types of medical systems in three different levels. They are primitive medicine, folk medicine and modern medicine. Next, his interest is on food beliefs and practice and the socio-cultural aspects of malnutrition in different villages of Laudhiana district of Punjab. He categorlses different systems of medical practices as those who are not institutionally qualified and noninstitutionally qualified indigenous medical practitioners, which include the ayurvedic, unani, and siddha systems. During 80's Chaudhuri made some significant studies in the context of tribal health and medicine. In his book Trihol H eol~h: ocio-('ul~urulDimensions on H eol~h, S a detail picture about the tribal health is depicted in the Indian context. In addition to that Chaudhuri (1986) noted the link between 'the cause of illness as the nature of treatment' in his study among the Mundas. He also observed that the Magicoreligious performances occupy a prominent place in the treatment of diseases. For example, if the reason of illness is believed to be evil-eye, sorcery or witchcraft, the tribal always would call their own magicians instead of consulting a western doctor, as they strongly feel that the doctors are quite helpless against such evil forces which can only be counteracted by the magical performances of the magicians. Chaudhuri (1989) in another study revealed the fact that health and treatment also reflect the social solidarity of a community. He noticed among the tribal communities that the illness and the consequent treatment is not always an individual or familial affair but the decision about the nature of treatment may be taken at the community level. In case of some specific d iseaks, not only the i ll person or h isher family, but also the total village community is affected. All the other families are expected to observe certain taboo's or norm and food habits. The non-observances of such practices often call for a ct~on y the village council. One b c annot d m y thc ;mpnct o f this psychological support in the context oftreatment and cure, which is very common in tribal c ommunit~es. Along with Chaudhuri different important studied were also made by different scholars for instance Joshi (1980) i n his article, 'Concept and Causation: Ethnomedicine in Jaunsar-Baur', the Silogan medical system greatly emphasis the normal state of existence between the humans and the outside natural/supernatural forces. In relation of the human with the natural world, the hurnoural ideology ( ~nteractiono f hot and cold forces) appears to be underlying base. This humoural ideology not merely remains at the level of belief system, but also passes through the natural experimentations. Nichter (1981) focused on the innovative medical education, the training of indigenous practitioners, the setting up of the referral networks, the use of allopathic medicine by registered medical practitioners, and basic research priorities i ll the social sciences. He also emphasises that the Improve rural health czre delivery will depend on a n u t d understanding between physicians and patients and co-operation between India's pluralistic medical personal. Goal, Sahoo and Mudgal (1984) have served the purpose of creating a wider awerness about the indigenous uses of plants, their collection, identification, utilisation and conservation. Chaudhury and Ghosh (1984) stated that diseases are thought to be resulting from s i g s , crimes and disobedience of natural and religious laws. Prescribed therapy to cure the disease is the action of appeasing the Gods with prayers, vows, invocations, holy baths and sacrifices. The people believed in luck, talisman, divine strings, divine rings, beads, horoscopes, rites and rituals. Kuruppaiyan (1986) in a research paper on 'Traditional medicine in folk societies' asserted the role of shaman as a priest, magician and medicine men to heal the tribal people in Vynad Kcrala. Shaman s p ~ and beats t he s p aluxls who suffer from hysleria. H e removes some hair and nail from the patient's head and hand, and then fixes it on a nearby tree where intrusion of suspected spirits occurs. He ties amulates, talismans on the arms and necks of the patients to protect them from evil spirits that is spirit possession. Relation between tribal health and forest can be properly understood through the work of Dr. B.K. Roy Burman. He (1990) in a paper 'Development Hazard to Health i n Tribal India' (B. Chaudhuri, ed) indicates how the development of health of the tribal is disbalanced due to commercialisatiorl o f forest. He emphasised upon the four major points to explore the above statement. 1 ) Rapid disappearance of forest 2) Commercialisation of minor forest produce including herbal medicine. 3) Replacement of food crop by cash crop and tendency towards monoculture forestry. 4 ) Privatisation of communal lands. Some recent studies can enlighten the whole situation regarding the concept of health, disease and treatment, which will be more useful for the present study. Parthasarathy (1990) in an article on spirit possession among fishing communities focuses on the divination processes and healing practices among the fisher folks for various disorders of body, mind and soul. Kar (1993) in a paper entitled 'Reproductive Health Behaviuor of the Nocte Women in Amnachal Pradesh' attempted to enlight a qualitative appraisal of some relevant aspects of reproductive health behaviour of Nocte women through a look at their social structure, culture, food habit, morbidity and traditional health seeking behaviour. Bruce Goldberg (1997) in his book titled 'Soul Healing' describes the chapter 'Shamanic Healing' and it reveals shamanism is a religious phenomenon restricted to Siberia and Central Asia. Shaman is a psychopomp (that guides souls). Every medicine men is a healer. The shaman is protected by a spirit of the handduring the ecstatic journeys lorr ofcoul. intrusion of soul. spirit possession, breach of taboo, bad blood, and the war time between demons and disease. Chaudhuri (2003) showed that medical practitioner and public health workers have been reposing that very often people do not utilise the medical facilities available to them. Unless and until the reasons for failure or non-acceptance of these programmes are known, the very development programme cannot be successful. 1.9.1 Comparative Literature: Egypt, Greek, China and India are having evidence of great interest in preserving traditional medicine as they have stood the test of time. Modem drugs leave undesirable side effects. They are also very expensive. Where as traditional medicines are cost- effective and patient friendly. Health and disease are measures of the effectiveness with which a human group has adapted to the environment (Lieban 1973). It is a suitable field for ethnographic research in medical anthropology. (Rivers, 1924; Richard.1934; Jain, 1968; Minal, 1979; Mathur, 1982; Duna Chaudhury and Ghosh, 1984). 1.10 Scope of the Study: The traditional rural and tribal societies in India differ from region to region due their ecological socio-economic and cultural factors. The social and biological functioning of the human are much shaped by culture. The concept of health, disease and method of treatment for curing are traditionally handed down from generation to generation in rural and specifically in the context of tribal communities and it is called traditional medicine. It also gives an idea that the process of traditional way of treatment is different from each community to other community. Th, h,,ltl, s;tunt;on o f the populat;on o f a country like lndia can be improved with the amelioration of the health status of the downtrodden section of population. In lndia th-3e can be achieved through the improvement of health scenario of tribal people residing different parts of the country. 'The present study is made to explain the concept of health, disease, medical system, medical belief, related religious practices, diagnostic and treatment in selected tribal villages of Jhargram sub-division, district Midnapore, West Bengal, lndia and also to study different preventive, curative, rehabilitative, diagnostic, promotive, and protective healthcare services found among the above said villages. 1.11A i m o the Study: f 1) To further development of Ayrveda, Homoeopathy and Allopathy in an integrated manner Indian system of medicine and Homoeopathy (ISM&H) should be fruitful for application when it is merged with Allopathy. Because one can not be self-sufficient with out the help of other. 2 ) To examine the condition of Primary Health Centres (PHC), Sub-centres, Block Hospitals, Gramin Hospitals and Sub-divisional Hospitals. 3) T o find and access solution to reduce the cost of medicines and other medical diagnosis. 4 ) T o emphasise for eradicating the diseases with totally free of cost viz. malaria and tuberculosis. 5 ) hlorc seriousnzss should be taken for giving pulse polio to children under tive v cill:. 6 ) No1 lo mrl-oduce any type, of medicine or medical practices, which directly d ~sturbshe ~ d e o l o ~ f a specific community or religious group. To find out a new t oy way, which will help to eradicate the problem without affecting the soft comer of the community. I . 12 Objectives: The present study deals with the health condition and treatment of different diseases among the tribal people of the selected villages under Jhargram Sub-division District Midnapore. Along with the traditional medical practices the present study observed the impact of modem health care programmes. I ) T o collcct the data and analysis on different tribal communities of the selected villages i n Jhargram S ubdivision of Midnapore district, West Bengal, India. The data will be on different types of conception about disease, healing practice and traditional medicine among the said communities. 2) To examine the different magico-religious healing practices prevalent among them and to access the role of magico-religious healer i n the villages. 3 ) T o evaluate the role and working of the traditional and modem medical practitioners. 4 ) To know the relation between herbal medicine and forest 5 ) To asses the role of medical personal, quack, officers and staff in the Primary Health Centres (PHC), Sub Centers, Rural Hospitals, Sub-divisional Hospitals, i n healthcare programmes and daily treatments. 6 ) To study the ditrerent types of preventive and promotive health care services followed by the various governmental agencies such as [CDS (Integrated Child Developmental Services). 7) To study the actual condition of drinking water and sanitation o fthe areas 8) Special attention is given to the condition of family planning and its traditional and modem ways. 9) To evaluate the modem health care programmes prov~ded y PHC's, sub centres, b rural hospitals and sub-divisional hospital. 10) To study the intra and inter community variation if they arise. I 1 ) To evaluate the health facilities and communication factors of the subdivisional hospital. I . 13 Hypothesis: The following hypothesis can be framed on the basis of the objectives of the study:- # For pursuing the traditional medical system and accepting modem medical system there are some variations in intra and inter community level considering the educational and economic condition of concerned people. The variation between male and female is also another important criterion. # In the tribal areas the fruitful treatment of various disease by the modem medical practitioners are possible when they know the economic, educational and cultural back-ground of the community. # A patient from a tribal community is psychologically assured by the treatment of a traditional medicine man and the magico-religious healer as they belong to the same cultural background. # The inadequate medical f ac~liiyo r a primary health centres, sub-centres, are responsible for lack of faith towards the modern medical system. The accessibility and acceptability of modem medicine depend on the better communication facilities. # Commercial afforestation is the conspicuous factor for the destruction of medical plants and reduction of its accessibility to those tribals who are using herbal medicine. The constraints of the forest policy are also responsible for decreasing the collection of medicinal plants and other related materials. # The social equilibrium of a particular society is destabilised due to introduction of those modem medicine or medical systems which directly strike the ideology of the people of concerned society. # The concordance of traditional medicine and healing practices with modem medical system is necessary for giving new, acceptable, affordable, alternative medical system in the tribal communities. 1.14Selection of the Field: As the present study was done exclusively among the tribals, so the Jhargram Subdivision of Midnapore district was chosen for its tribal dominating character. A rich forest resource of that region was helpful for ethno-botanical study. Three types of villages were selected considering the scope and objectives of the proposed study. For covering the required population two villages were taken under each type. For pursuing specific objectives the villages were selected on the basis of 'type'. The 'type' was done on different criteria viz. distance from the subdivisional town (Jhargram), as well as sub-divisional hospital, communication, modem health facilities surrounding the villages. Type One: It was longest distance from the said urban centre and health facilities were negligible in comparison with the other two 'types'. There was no primary health centres! sub-centres in a short distance. Very i ll- equipped communication to any of the urbanhemi urban places. The absence of quack and private doctors in a shortest distance was another additional criterion. Two tribal villages viz. Agaya and Barashyamnagar of Belatikri Gram Panchayat were chosen under this type. The Santal and the Kora were the inhabitant of those villages. T ype Two: The distance from the urban centre1 hospital was longer than 'type' three but shorter than 'type' one. Further, there was a rural hospital, some private practitioner, and quack i n a short distance. Village Shalukdoba and Valuka under Binpore-1 Panchayat were situated near by the Binpore Rural Hospital and considered suitable for the present study. Those villages were also well communicated to the sub-divisional hospital ( Jharprn). These two villages were exclusively Santal villages. Type Three: Those were nearest to the urban centre (Jhargram) with the modem facilities viz. hospital, nursing home, private practitioner, diabmostic centres etc. But the communication was not so good like 'type' two. Two Santal villages vlz. Laredi and Kutuageriaof Radhanagar Gram Panchayat were chosen under 'type' three. Table: 1A C ategories of the Villages I 1 I I ONE ( Two Shalukdoba I Valuka I~ divisional town), No modem Santal health facilities in close --proximity. Shorter than t ypmne, longer than type- three (distance), Sanlal Binpore rural hospital at stone -throwing distance. Private practitioner in close vicinity. SantaI Well communicated with Jhargram. Shorter distance. modem medical facilities in closes proximity, but not properly well communicated with Jhargram. I 1.15. Methodology Used in the Present Study: The study was conducted in the six tribal villages of Jhargram Sub-division, District Midnapore. As stated above the six villages were taken under three types according to the pre-settled criteria. The Santals are the main population in this study with some Kora people in the village Agaya. A pilot survey of the villages was done during April 2001. Although Santali in case of Santal, Harapa in the context of Kora is the mother tongue but they can communicate through Bangali. It can be said that written language of these tribes are Bengali. The author's knowledge of Bengali enables him to have free interaction with the studied populations. The field-work was conducted in to various phases, it was started from the above mention time and date and extended up to December 2001. There were five divisions of the total field-work. Two to three times o f field-work were done under each division as per the requirement, Division 1:- At the first time the general observation of the villages was done along with completion of Preliminary Schedule Form ( PSF). The details of that form are given in the f orthcoming sections of this writing. Division 2:- Case studies of the disease affected persons were taken on the basis of sample. For time constraints and limitations of the study only last five years diseases(re1ated misfortunes) affected persons were considered for evaluation. Division 3:- Detailed open structured interview was taken from the medical personal including the traditional medical men (Kabira; a nd Ojha,) and modem medical men ( quack, private doctor, health officer, nurses and health worker of PHC's, s ub centres, rural hospital, subdivisional hospital). Division 4:- Evaluation of government health schemes and projects viz. ICDS etc. and interview of the worker helper were also taken in this regard. Division 5:- The actual situation and infrastructure of the sub-centers, PHC's, rural hospital, and sub-divisional hospital were observed under this study and relevant data gathered at the time of each visit in the said institutions. Condition and situations of the nearby diagnostic centres and medical shops were also observed by the researcher during that phase of field- work. Preliminary Schedule Form (Division 1): There are seven subsections in this form. At the first phase of field-work the data collected through that form and each house hold of the villages covered while taking data through preliminary schedule folrn(PSF). The contentlquarries of the form are as follows:- 1. G eneral Information (Family level): a) Serial number b) Informant name c) Age d) Name of the tribe e) Clan name f) Name of the clan deity g) House hold number h) Village name i) Name of the Panchayat j) Date. 2. Demographic Information (Individual level): a) Name b) Sex c) Age d) Relation with head e) Civil condition f) Age at Marriage g) Occupation h) Education. 3. Information regarding Present work (Individual level): a) Birth place (RurallUrban) b) Place of Birth (Home IPHCI HospitaVClinic Nursing Home etc.) C) Who attended ( Doctor/Nurse/ Pharmacist/ Mid-wife etc) d) Disease in last five years e ) C ause of it r) Way of treatment g) Institution1 Person consulted h) Distance of i t i) Procedure of treatment ( M odem ft'raditionall Both) j ) How long i t exist k ) Is i t cure now I) Expanse for the purpose m) Vaccination n) Pulse polio (Under five years) o) Attended ICDS ( for pregnant mother and children) p) Agree in family planning ( for the married adults only). 4. House-hold Information: a) Number of rooms-i) Bed room ii) Kitchen iii) Varanda b) Use of it c) condition of it- i ) Kaccha ii) Paccka d) Place of keeping family deity e) Style of Iconography f ) Purpose of it. 5. l nformation r egarding Domestic Animals: a) List of domestic animals b) their shelter c) Disease of domestic animals which directly affects the family members. 6. H ealth particulars (Family level): a) source of drinking water i) summer ii) rainy season iii) winter b) sanitation i) s ummer ii) rainy season iii) winter c) source o f other water (bathing, washing) i) summer ii) rainy season iii) winter d) Use o f herbal/ traditional medicine in daily life e) source of it i) collected ii) purchased f ) Daily food habit i) morning ii) afternoon iii) evening g) Food pollution h) Consumption of Iiquor and smoking (individual level). 7. E conomic Information (family level): a) Land holding i) home ii) agricultural land b) Income c) Expenditure d) Any Economic Help (Given by Government/ Panchayat). Case Study (Division 2): According to the analysis of PSF the sample of the datailed c ase study of the patient in the six studied villages were chosen. Some important categories were taken for sampling the diseaseaffected people (in last five years). The categories are as follows: 1 ) Tribe 2 ) Sex 3) Procedure of treatment (Traditional/Modem/Both) Family income (HigherILower). From the above category the following table can be drawn. Table IB S ample Table S & lncorne C a t egor Lower Higher Lower Higher / T raditional 1 M odern B oth -1 1 1 1 1 1 1 1 I 1 1 I Following the table and taking one from each category there will be 12 samples for each tribe in a village. If a village comprises only one category of tribe than the tribe and village sample will be the same. But in the context of village Agaya there are two categories of tribes viz. Santal and Kora. Further, in the case of other five villages there is only one category of tribe viz. Santal. After considering the above sampling method some purposive selection procedure is also administered at the time of sampling considering the frequency of different diseases. Case studies were taken according to the availability of the patients. The case studies were taken through the structured (open and close) interview schedule. Division 3: For collection of the traditional healing practice methods the author had to face some problem at the beginning of work. At the initial stage many healers had denied to explain that he i s a traditional healer. They might had misunderstood the author on the ground that the author may be a medical practitioner from some other locality that's why he wanted to know about the secrets of their services, techniques, practices and medical preparation. But, on clarification of nature and objective of the study, the author became successful i n winning their confidence as well as heart too and thus the informants (the traditional medical men) became more friendly and rapport was established. Although there was an open structured interview schedule but the author had met them several rimes in rhcir own healing places to gather data on diseases, types of treatment and healing technique along with the formal interview as prescribed i n the interview schedule. 'The author also visited the adjacent forest for observing the medical plants and the process of its collection. A different open structured interview schedule was used for taking data from the modem medical practitioner. As they were aware about the work so the interview was so formal and friendly. It is remarkable that some suggestion of them regarding this work was an added achievement in this context. Along with the above formal method and technique the author observation regarding various aspect was mentionable in this study. T i e cause of disease within tribe and village creating the disease by religious belief on function and ceremonies in life time, commonly observed religious practices like rites, rituals and festivals to heal the disease, the prevalence of magical beliefs within the community for cause of death like witchcraft, evil spirit and ghost. The prevalence of magical practices that are commonly observed for healing the disease within the tribe and the village, the combination of modem medicine with magicoreligious healing practices has also been covered. The role of Panchayat offices including Pradhan, members and staff were conspicuous in the present study. Author interacted with each above said individuals regarding the various issues covering the present work. Many valuable data gathered through this procedure. The active participation and help of the above said people enlighten the author's knowledge regarding various aspects, which include government health schemes, its implementation and constraints about those schemes. Interview with the concerned Block Development Officers were and added criterion i n this phase of field study The six studied villages were under three grum panchayat viz. Belatikri, Binpore and Radhanagar. The villagers gathered at night to gossip and exchanging news and views. It was only conducive time for researcher to collect data directly from them. Focus group interview was also taken at that time. There were different types of opinion among the villagers and i t was taken from one in front of other that's why in the same time crosschecking of different data could be possible. The researcher visited almost all the shrines, than (religious place) in the studied villages. The researcher's participant observation of magico-religious healing practices, rites and rituals, which were held to ward off evil spell and diseases. The researcher also taken some herbal medicine given by a traditional healer For coping with severe stomach ache. Remedy from the sudden stomach-ache was a memorable h c t at the time of field-work. 1.16 Data Analysis: Anthropological research in human community is inevitably complex and personalised. It is carried through intensive study i n one or few communities (Epstain, 1967). Anthropology is distinctive. It is committed to study all the culture known to the mankind. Anthropological research design lie i n the structure of primary data gathering in the actual field research operations (Pelto, 1970). The anthropological investigations aim to descriptive i ntepation with determination of cause of phenomena (Pelto, 1970; Sarana 1975). This study includes research design on descriptive analysis. Primary source of this study are contined to data on PSF, structured ( opedclose) interview of disease affected persons (last five years), open structured interview of traditional and modem medical men, health o ficial o f sub-divisional hospital, rural hospital, PHC'S, sub centres, ICDS, Malaria, Tuberculosis, Leprosy and Polio eradication projects, general health worker, worker and helper of Anganwadi and participant observation recorded in field diaries. Secondary sources were taken from Census of India (1 991,2001 ), District Statistical Hand Book (1998), Directory of Medical Institute, West Bengal 2000, ancient scriptures, various valuable books, papers on medical anthropology from the Library, Department of Anthropology, Dr. Ambedkar Chair Professor Library, Calcutta University, Library ICSSR, New Delhi and various Internet sights. Data collected were two types (viz.) Qualitative and Quantitative. All the data were analysed and tables were prepared manually. Maps illustrating the location of the largest areas have been included wherever needed. The researcher visited various libraries in Kolkata for collection of relevant information from books, journals, encyclopedias, dictionaries, scientific papers, articles and Ph.D. theses. 1.1 7 Organisation o the Thesis: f T he thesis is divided i n to five chapters:- Chapter-I Introduction: In this chapter the basic concept about health, disease and treatment are discussed. A comprehensive idea about Medical Anthropology is given along with its concept and definition. From this chapter reader can also know about the role of Social and Cultural Anthropology in healthcare. ldea about health and indigenous knowledge can be a crucial section of the chapter. One can know about the out line of health and different Government policies. Analytical discussion is given on scope, objectives and hypothesis of the present study. Process of the present study can be known from the methodological part that is very important for understanding the forth-coming chapters. C hapter41 I ntroducing the Area, Villages and People: Understanding about the locale of the study is the prime approach of this chapter. A snort note about h e State, District and Sub-division is also given for better interpretation. At a glance the health scenario of the said areas can be helpful for realising f orthcoming approaches and circumstances. A detailed idea about the studied villages and people will be added data in this regard. From this c l~apterreader can know about the socio-cultural life of the studied tribes. Chapter-LII H ealth and Disease: Traditional Way of Treatment: Traditional concept about health, disease and treatment of the studied villagers are given in this chapter. Case studies of those patients who avail the traditional medicine in different circumstances is a vital portion of this chapter. Reader can know about the supernatural belief regarding health and disease along with the procedure of worshipping of different deities for protection from those diseases. ldea about the community participation for observing different taboos is also given in here. Role and activities of traditional healers is one of' the crucial parts of this chapter. Knowledge about the herbal medicine can attract the reader in the last section of his chapter. Chapter-IV Modern Health Care Facilities a nd P rogrammes: 'This chapter is divided into two sections, Section-A and Section-B. In the former an over all discussion about the health scenario of the country is given for understanding the coming section. Before g oins t o know the actual health infrastructure of the studied villages reader can look through about the rural health infrastructure of the country. A discussion about the overall tribal health is an added section in this point of view. Precisely the vital point of current National Health policy is also given in this section of the chapter. In the later the detailed discussion about the health facilities and programmes of the studied areas is given. The actual condition of sub-centres, PHC, Rural hospital and sub-divisional hospital is an important sub-sectioil in this chapter. Role and activates of the modem health personal can highlight many issues in the context of modem health facilites of the studied areas. Case studies of those patients who avail the modem medicine and medical facilities in different circumstance is a vital portion of this chapter. Discussion is also given about the health and h ygene of the studied tribe and mother-child health is an important issue in this context. Chapter-V General O bservation a nd Conclusion: A general discussion of all the above raised issues are the main portion of this chapter and a conclusion about the whole work is also given along with the suggestive measures.