State, Society and Health in Nepal

Madhusudan Subedi

• Publisher: Routledge India
• Year: 2018
• ISBN:
  9781351180702
• Edition: 1
• Topic: Medicine
• Subtopic: Health Policy

This book focuses on health, healing and health care in Nepal. It presents an intriguing picture: the interplay between the natural processes that cause ill health or diseases and the socio-cultural processes through which people try to understand and cope with them. The work places medical tradition, health politics, gender and health, and pharmaceutical business within the wider politico-economic milieu of Nepal. It also describes the establishment of medical anthropology as an academic discipline, and its relevance for understanding the country's specific health problems, health care traditions, and health policies.

Combining scientific research with practical experiences, the book will serve as a unique resource, especially for health workers, policymakers, and teachers and students in medical schools, those in public health, social medicine, health care, governance and political studies, sociology and social anthropology, and Nepal and South Asian studies.

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Traditions in research on society, culture, and health in Nepal

While health, illness, and the practice of medicine are ancient, and all societies have one or several types of healers, biomedicine is a relatively recent phenomenon. Health and illness are variable and people across different cultures and history perceive, interpret, and seek help in different ways. In a market economy, the dominant ways for understanding health and illness is the biomedical model that focuses on curative aspects of health care. An efficient way of making people healthy, however, is to promote healthy behavior by exploring social and cultural aspects of health and illness, determinants of health and the factors affecting people’s health, and the way they understand and deal with their own health and illness. It is well known that certain social factors like income, education, occupation, and gender are strongly related to people’s health and ill health. Social scientists argue that many causes of health and illness can only be understood from the study of the social, cultural, and the historical surroundings of the people under study. Such surroundings vary from place to place and time to time (Kiefer 2007).

Though Marx and Engels wrote about the health and illness of the laboring population and were concerned with health and illness in relation to living and working conditions, their work did not lead to any development in the sociology of health and illness. Talcott Parsons was the first sociologist who emphasized medicine as a social institution and drew attention to illness as deviance and to the importance of the role of the sick as a mechanism for social control, to the threat that illness constitutes for a society and to the importance, therefore, of the social mechanism. The expansion of medical care to a mass population, with its many problems related to the social organization of intrinsic social interests and technical advances, have added to the range of socio-ethical problems.

Sociology of health has drawn on perspectives and theories from the core sociology ranging from functionalism, interactionism, Marxism, feminism, and post-modernism. The influence of different perspectives varies not just across time, but also between countries.

Social scientists are concerned with social and cultural as opposed to biological factors when explaining diseases. They focus on the etiology of diseases and illness, health seeking behavior, access to and the delivery of health services, consequences of disasters and disability, and ethical, political, and organizational issues in relation to health. Health and illness are shaped and experienced in the light of global, historical, and political forces (Cockerham 2004). The rapid pace of social change – migration, urbanization, and technological advances in medicine – has created new problems in the provision of health care to large sectors of the population. Such conditions and situations not only cause illness, but they also help prevent it. The role of social scientists is to advance thinking and analyzing within a broader framework and to also link micro level events and activities to macro level social issues.

The Alma Ata Conference (1978) strongly reaffirmed that health is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal that requires action by many other social and economic sectors in addition to the health sector. The Ottawa Charter for the Health Promotion (1986) emphasized that health promotion is the process of enabling people to increase control over, and to improve, their health. This Charter stated that the fundamental conditions and resources for health are these: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, and social justice and equity.

Social and cultural contexts of health are the main focus of ‘medical sociology’ and ‘medical anthropology’, sometimes referred to as ‘sociology of health’ and ‘anthropology of health’. I feel it more appropriate to say ‘sociology of health’ and ‘anthropology of health’ instead of the more commonly used terms ‘medical sociology’ and ‘medical anthropology’. Both disciplines provide analytical frameworks for understanding the social and cultural context of health, illness, and health care. Medical anthropology focuses more on the cultural context of health, illness, and health care, while medical sociology focuses on the social context. Politics and economics are often of particular interest in medical sociology and medical anthropology because they tend to have tremendous effect on culture and social structures. Different socio-economic groups, for example, often search and use significantly different levels of health care. Inequalities in wealth result in inequalities in health care. The ultimate aims of these disciplines, in my opinion, are to contribute useful and critical knowledge to promote human wellness, to reduce suffering, to improve the treatment of disease, and to meet the urgent practical and moral challenges in complex societies.

The social and cultural context of health research traditions

Understanding the social and cultural contexts of health and illnesses is important for theoretical knowledge and for practical work to change behavior. The ways in which beliefs and behaviors among the population influence the origin of diseases are significant for their health. Such issues can be studied through large-scale quantitative studies among groups of people, as in epidemiological investigations of the distribution of diseases, but also through qualitative investigation of the patterns of health beliefs and behaviors. Qualitative research often uncovers the reasons why particular patterns of illness persist or change.

Sociology and anthropology open the door to gain knowledge about the causes of ill health or diseases, for instance, the hot-cold balance and harmony of humoral medicine, the Yin-Yang equilibrium philosophy of traditional Chinese medicine, the balance of three humors in Ayurveda, and Allopathy explanations for physical injury or pathological abnormality. One cannot expect a doctor trained in the Ayurvedic tradition to understand a person’s illness in the same way as a doctor trained in allopathic medicine. Normal behavior in one culture may be considered abnormal in another and, for instance, being judged as mental illness.

Due to its ethnic, cultural, linguistic, and ecological diversity and easy access to research in a relatively small area of land, Nepal has attracted many anthropologists and sociologists, mostly American and European. Nepal is now fortunate to have a considerable number of books and academic articles covering multifaceted dimensions of the Nepali society and culture (Gurung 1990). A small booklet can be prepared if one wants to prepare a bibliography of ‘anthropology of health’ and ‘sociology of health’ in Nepal. Most of the research (about 90 percent) has been done by foreign anthropologists, as part of their doctoral work or other projects focusing on Nepal. My intention is not to highlight some and ignore others. I have chosen some themes¹ to make the presentation of information easier.

Shamanism and spirit possession

Health and illness research in its initial phase in western countries emphasized the understanding of ‘other cultures’ (Lewis 1971). The main aim of medical anthropology is to contribute to and improve the efficiency of public health campaigns implemented in developing countries. The priority of the local context became especially important when conducting research. For much of the 20th century, the concept of local healing practices attracted the anthropologists. This concept was used to describe health practices among different groups in developing countries with particular emphasis on spiritual healings and ethno-botanical knowledge, focusing on magical practices and religious issues and exploring the role and significance of popular healers and their medicating practices. For them, such healing was a specific cultural feature among some groups of people, distinct from biomedicine.

The spiritual basis of the health system among the mountain and hill people in rural Nepal has attracted many anthropologists. Shamanism, like all medical systems, is subject to individual variation, but the system itself and the therapies the shaman provides are largely based upon faith healing or spiritual healing (Hitchcock 1967; Stablein 1976). The concept of illness within shamanistic practices in Nepal is largely perceived as spiritual in nature and illness is often the result of evil forces or supernatural forces.

Shamanism can be categorized into specific types: Dhami, Jhankri, Jyotisi, Janne Manchhe, Fukne Manchhe, Jharne Manchhe, and Herne Manchhe – all regarded as mediators between the spiritual world and everyday life among various castes and ethnic groups in Nepal, be it in rural or in urban areas. Healing, fortune telling, and consultation with the spiritual world, ceremonies for the dead and the newly born, spells to remove curses, to change bad luck, or to bring love are all parts of the shaman’s repertoire. Performances are dramatic – colorful costumes, drumming, chanting, whirling and dancing and singing of sacred songs (mantras) to summon deities or expel spirits.

One of the first seminars in Sociology and Anthropology at the Tribhuvan University was held in 1974, and focused on ‘Spirit Possession in Nepal’. The seminar book was published in 1976, John T. Hitchcock and Rex L. Jones (eds.) Spirit Possession in the Nepal Himalayas. This book contains 19 articles on lamaist spiritual possession and historical observations by scholars, mostly anthropologists who had worked in Nepal. The social, religious, psychic, and therapeutic aspects of spirit possession are dealt with on a broadly regional and ethnic basis.

Literature on the Dhamis and Jhankris of Nepal and spiritual healing in general is extensive (see, e.g. Michl 1974; Allen 1976; Hitchcock 1976; Hitchcock and Jones 1976; Jones 1976; Macdonald 1976; Okada 1976; Paul 1976; Reinhard 1976; Winkler 1976; Perters 1979; Shrestha and Lediard 1980; Coon 1989; Desjarlais 1989; Höfer 1993; Gellner 1994; Maskarinec 1995; Miller 1997; Dietrich 1998; Guneratne 1999; Kristvik 1999). Maskarinec’s study, based on extensive fieldwork in a blacksmith community in Western Nepal, enriches the complexity of shamanism by a caste perspective and invites a wider comparison both with other Himalayan and with Siberian forms of ritual healing. Dietrich’s book (1998), Tantric Healing in Kathmandu Valley: A Comparative Study of Hindu and Buddhist Spiritual Healing Tradition in Urban Nepalese Society, and Miller’s book (1997), Faith Healers in the Himalaya, are classic anthropological studies of the sha-mans in Nepal. Miller shows the healers in dramatic action, beginning with their participation in an annual ‘pilgrimage for power’ to a sacred mountaintop, a scene of magical battles in the past.

Many scholars have carefully selected various Himalayan groups, including Tamang, Rai, Sherpa, Gurung, and others, both for their reputations as experienced healers and for their ability to transmit their knowledge to foreign students. A shaman called Dhami in Nepal is considered as a lively mediator between the spiritual world and everyday life. Attacks by spirits – jangalies, masan, bhut, pret, pisach, naagas – are believed to be the most common causes of illness. The Dhami diagnoses come up with the cure, either by making an offering or by suckling out the offending spirit from the patient’s body.

In shamanism, illness is caused by malevolent forces, jealousy, an evil eye, or spirit possession. They will prevent illness through the use of amulets or incantations and they will heal illness through the use of exorcism and other rites. According to Vedic astrology, illness is caused by karma and the will of the gods. Illnesses can be diagnosed through astrological readings based upon planetary forces and movements and these can be determined through horoscope readings and palm and forehead readings (Dougherty 1986; Subedi 2001). After an astrologer has determined the problem they must determine what will help the patient. Illness is karmic or destined, and an astrologer can learn about your illness through your astrological chart. One can do one or any of the following depending on the illness: performing fire rituals, charitable acts, fasting, giving to the poor, or wearing special amulets. Many scholars have focused on the circumstances of spiritual possessions, on the social, political, and cultural implications of possessions, and on the impact of health on people’s lives. They have highlighted, in detail, local social representation and stereotypes.

Nepali scholars have criticized foreign scholars that have tended to focus on shamanistic traditions in Nepal. Mishra (1984), for example, said that there has been too much emphasis on the ideological-spiritual aspect of ethnic groups’ traditional healing practices instead of focusing on actual day-to-day problems like poverty, inequality, and marginalization; how can research in sociology and anthropology be justified when the basic problems facing us at large relate to food and clothing? Fisher (1987), however, remarked that health conditions cannot be improved until local healing practices are well understood. Most of the foreign medic...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of illustrations
• Foreword
• Preface
• Acknowledgments
• 1 Traditions in research on society, culture, and health in Nepal
• 2 Healer choice in medically pluralistic cultural settings: the case of Nepal
• 3 Illness causation and interpretation in a Newari town
• 4 Indigenous knowledge and health development in Nepal
• 5 Food, health, and illness ideology in Kirtipur
• 6 Uterine prolapse: a mobile camp approach and body politics in Nepal
• 7 Communication aspects in health care work in Nepal
• 8 Challenges to measure and compare disability: a methodological concern
• 9 Trade in health service: unfair competition of pharmaceutical products in Nepal
• 10 Health, healing, and health care in Nepal: current issues and an agenda for change
• Index