Mithun Sikdar Superintending Anthropologist
Anthropological Survey of India, Mysore.
Human existence has never had a chance to stay in a state of tranquillity. Do we really understand the real meaning of wealth in life? Mahatma Gandhi once said, “It is health which is real wealth, and not pieces of gold and silver”. Probably the fast-moving life has made us forget the real meaning of health. Ethnographic accounts of health practices of small-scale societies and repositories of their knowledge systems have gone a long way in contributing to the understanding of human health. In most anthropological writings, we get different definitions of health. A standard definition postulated by the World Health Organisation (1948) states, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In 1986, the World Health Organisation elaborated, “Health is a resource for everyday life, not the objective of living. It is a positive concept emphasizing social and personal resources, as well as physical capacities”. Anthropology with its holistic approach takes an inclusive perspective on health. The genes we acquire have an innate capacity to equip us for a disease-free life, but the entire process of genetic susceptibility sometimes has its dark side as well. I refer to the book titled, Genes, environment, and health: Anthropological perspective edited and compiled by Indu Talwar, Krishan Sharma, R.K. Pathak and Shalina Mehta, where they take cognizance of the holistic perspective on health, collating articles by researchers reviewing health from the perspective of genetic markers as also the social environment. Perils of experiments in eugenics carried out in the beginning of the 20th century have brought to the fore immediacy of “ethics and law” in proposing gene therapies and other critical interventions. They caution: “Gene therapy and establishment of genomic databases require tremendous human scrutiny from experts in different fields/walks of life” (Talwar et al. 2007).
Anthropologists have emphasized the emic perspective to understand the health status of a particular community. Domains of health research pursued by them cover tribal, rural, and urban populations. They have documented with equal rigour the health systems of communities living away from modern technical interventions and those ensconced in modern systems of medicine and growing technology. They never treated the mere absence of disease as a testimony to good health. Among the most remarkable examples of anthropological intervention to understand epidemiology comes from the Kuru disease prevalent in the Fore tribal group of Papua New Guinea. Shirley Inglis Lindenbaum, an Australian anthropologist, took the initiative to understand how kinship bonding and associated cannibalism contributed to the spread of the Kuru disease (Linderbaum, 2008). Importantly her anthropological expedition led to the understanding of prion disease.
The dimension of health in different tribal population groups in India lacks proper understanding. Practitioners of modern medicine and research carried out by them paid scant attention to tribal health. Most interventions on the subject have been made only through anthropological analysis. It is difficult to have a mutual perspective of tribal health across India because of the existence of different transitional phases within different groups (Sikdar, 2019). A significantly large number of tribal communities continue to adhere to their indigenous health care system. However, some of them, particularly those in the vicinity of urban areas have shifted towards modern ways of health care. Urbanisation is a global phenomenon. Its influence has not been resisted by any community in the world and the tribal people are no exception. When examining the dimensions of health, transition patterns become visible without restricting them to any social connotation of “Tribal Health”. The construct of ‘tribe’ is contested across the World and India is no exception. Indigenous populations have been interchangeably referred to as tribes or ‘Adivasi’ in India. Its colonial roots are intertwined with prejudicial connotations like ‘primitivity’ as well as unscientific practises and temper. We often forget that the existence of their health care system is as old as their existence and has permeated to other communities without restricting the social boundaries. The indigenous populations have inherited this system over time tested methods. To quote Gregory (2010), “Indigenous societies had survived for centuries, overcoming all hazards of physical illness and mental depression to attain a spiritual ecstasy, through their time-tested remedies, using the bio-resources within their ecosystem, in combination with their propitiation of supernatural elements”.
Every society passes through some transitional phases in terms of demography and epidemiology. These phenomena have been categorized as “demographic transition” by Warren Thomson in 1929 (Thomson, 1929) and reconfigured by Abdel Omran in 1979 as “epidemiological transition” (Omran, 1979). Indigenous populations or tribal communities are considered within this domain. The conditions of epidemiological transition are well accepted in academia and are well placed when we talk of the transitional phases of different disease patterns in human society. They can vary from one tribal population to another in terms of severity.
Each population group needs special interventions for different stages of demographic transition. In the first stage of demographic transition, a population exhibits high fertility and mortality patterns. The first goal, no doubt, is to lower the mortality rate by enhancing medical support. At the last stage, however, we also must deal with enhancing the family planning program to inhibit the population explosion.
With the help of fertility and mortality data, I could assert that the Sonowal Kachari tribal population of Assam are now passing through the third stage of the demographic transition model, at which stage we must understand the interventions that they need. Each tribal population showed different dimensions of health problems based on their geographic setup. My personal experience among the Tai-Khamti population of Chowkham village, Arunachal Pradesh, in Northeast India showed a very high frequency of hypertension. Whereas the Vasava Bhil population residing in the remote village of Nana Sanja, Gujarat, showed the significant dual burden of malnutrition. The Dubla population of Daman showed a high frequency of sickle cell anaemia.
It is already known that sickle cell anaemia is the result of a single point mutation in the beta-globin gene cluster of chromosome number 11 which multiplies in a population with time if the population practices inbreeding. Tribal populations being endogamous in nature, posit a fair chance of inbreeding thereby creating genetic load in terms of such disease severity. Hypertension is a new inclusion among the tribal population due to the change in lifestyle. These findings reassert the need to redefine tribal health Policies. Generalized interventions with the assumption for the corpus of tribal health are not going to be effective.
The first Deputy Director of the Anthropological Survey of India, Sir Verrier Elwin, speculated that tribal people should be treated separately and should have separate policies with respect to their cultural isolation. Even Pandit Jawaharlal Nehru endorsed his view and asserted the Panchsheel Principles for tribal development. For almost five decades the tribal development policies in Northeast India were dealt with such an anthropological outlook and remained as the Magna Carta. The main concern was to treat and develop the tribal population in isolation. For some, the philosophy towards North-East India is thought to have been responsible for the alienation of this region from the rest of the world. For some, it has contributed to the stratification of non-egalitarian society into classes. The main apprehension is whether these tribal populations are really isolated or whether they needed isolation from their own?
We cannot underestimate the bottleneck effect where isolated populations are always at risk. In this era of cyberspaces and globalization, is it possible to make them avoid contact altogether? This question has been posed by Prof P.K. Mishra, President, Anthropological Association, Mysore, many times in his deliberations. It is only when the media vibrates does the world come to know about such attempts of contact among the uncontacted.
On 17th November 2018, when news of the killing of John Allen Chau by the Sentinelese of North Sentinelese Island surfaced, visual, social and print media turned into a hot topic for outsiders. But a more critical question is related to the sanctity with which these culturally and demographically vulnerable groups are protected by the central and state agencies.
Are we really in a position to say that the most isolated tribes are still uncontacted? Whether strict Government policies can ignore such unnoticed expeditions? Have the Sentinelese never contacted the nearby tribal populations like the Onge who have similar cultural institutions like canoe making? Being one of the Particularly Vulnerable Tribal Groups (PVTG) of India they have traditional technologies to survive natural odds. One of the reports established that the ancient knowledge of the movement of wind, sea and birds might have saved the five indigenous tribes on the Indian archipelago from the tsunami that hit the Asian coastline on 26th December 2005. We are yet to explore if similar indigenous knowledge exists to resist the issues of modern epidemics? The recent pandemic of Covid 19 has taught us that we must prepare ourselves for the modern healthcare interventions for unknown, unexplored uninvited diseases.
Traditional health care systems may not work at this juncture as Covid19 is the product of anthropogenic activity. Many of the anthropogenic disorders do not confine to one geographic location but are spread with the help of air, soil, contact etc. At the same time, we cannot undermine the rich knowledge system present among these communities. The tribal populations have their own understanding of diverse knowledge systems which we commonly refer to as the traditional knowledge system.
My first encounter with the traditional knowledge system came from the ethnographic account of the Apatanis of Arunachal Pradesh by the famous Austrian anthropologist, Sir Christoph Von Furer-Haimendorf. We were introduced to his book “The Apa Tanis and their Neighbours: A primitive society of the Eastern Himalayas” during our graduate coursework. I was so fascinated by his work that I visited the isolated Apatani valley after my master’s examination. Now, the Apatani valley has been included in the tentative list of World Heritage Sites by UNESCO due to the unique traditional knowledge system of high productivity farming as well as their uniqueness in preserving the ecology. My understanding of the traditional ethnomedical knowledge system came from my study among the Nath community of Assam where I could find the use of 62 different types of plants for treating various types of diseases.
There are several instances that demonstrate the use of indigenous medicinal practices for the cure of certain rare diseases. As Prof P.C. Joshi Vice-Chancellor, Delhi University put it: “the traditional healing systems are indigenously rooted arrangements of social relationships, cultural patterns and therapeutic activities involving the use of locally available or adopted resources which are used in the management of illness” (Joshi,2019). Prof. Joshi is one of the pioneers to work on medical anthropology among the Indian tribal populations. His PhD thesis (1984) on, “Illness, Health and Culture: Dynamics of Therapy in a Central Himalayan Tribe”, is one of the earliest documented works on Medical Anthropology in India.
Traditional health management is a diverse field and incorporates not only the tangible cultural heritage but also the intangible one. It cannot be dissolved until and unless its functionality gets diminished in society. In one of the studies by the present Vice-Chancellor of Kalinga Institute of Social Sciences, Prof D.K. Behera, with his team, could understand the cultural continuity of such intangible cultural heritage of identifying and treating measles (locally called Talsa) among the Shantal tribal population of Orissa even after the tribal group migrated from their rural habitat to the urban one (Mishra et al. 2012).
This cultural continuity will tend to exist and can result in medical pluralism in several indigenous populations. The term Medical Anthropology has been used since the 1940s but the formal recognition of such understanding was established lately. It was due to the tenacious efforts of then Professor H. K. Bhat of Mysore University and his team that a Society for Indian Medical Anthropology was registered in Mysore in 1992. The importance of medical pluralism has also been recognized in India with the establishment of a separate Ministry of AYUSH (incorporating the treatment systems of Ayurveda, Yoga, Unani, Siddha and Homeopathy in 2014). Prof R.K. Mutatkar, the renowned anthropologist from Savitribai Phule Pune University, who worked on social aspects of leprosy at the World Health Organisation, chaired the first working group on AYUSH to understand the traditional and non-conventional systems of health and healing systems in India. They felt the necessity to document the wealth of traditional knowledge systems of these communities.
Unlike others, however, the traditional knowledge systems could not withstand the threat from the multinational pharmaceutical companies once they started using it without giving any due recognition to the indigenous communities. Currently, the acts for biopiracy like the Biological Diversity Act 2002 and the Forest Rights Act of 2006 have provided the requisite shield for tribal traditional knowledge systems declaring that the intellectual property rights belong primarily to members of the community.
It is also important to understand that traditional medicine has not developed to such an extent to tackle the global disease patterns. Modern healthcare practice has developed to a great extent with the concomitant development of different disease patterns owing to globalisation. Covid-19 is one such case. It is difficult to understand the severity of such infectious diseases among the isolated tribes where no such information is available. It is difficult when the severity of such diseases demands constant oxygen level monitoring. Even the severity of such diseases varies based on our genetic makeup. Only molecular anthropological understanding could identify that we have inherited some genomic regions from Neanderthals which gives protection against Covid 19 (Zeberg and Paabo,2021).
Though there is a comprehensive health care system available at the national level, there is a predominantly vast array of segmented programs that lack the representation of the tribal population. Access to adequate health care systems, marginalisation related to cultural reasons and language barriers are some of the important reasons which illustrate the lack of consistency between health services and internal dynamics among the multicultural population groups. Sometimes the lack of modern education facilities aggravates the barriers between what must be delivered at the local level and its outcome.
To understand indigenous people, anthropology advocates understanding and learning of the local culture as well as language. There are concerns that if we restrict learning to only local languages, it will not be conducive to the understanding and learning of western culture and language for comprehension of the means to conquer the diseases arising out of western lifestyles. Anthropological understanding shows that every cultural invention, as well as every medical system, has its own merits and demerits, and we must embrace each judiciously to understand the specific function in this pluralistic society. It is imperative to equip ourselves with the understanding of these societal needs but not to dilute our own knowledge system and preserve it for the betterment of human society.
Cultural traits never vanish unless we give them a chance to die out. To quote the former Director of the Anthropological Survey of India, Prof Vinay Kumar Srivastava (2002): “Comparative studies of cultural traits point out that in many cases more similarities than differences exist between cultures and with the passage of time, the number of similarities multiplies. This doesn’t mean that the process of homogenization is underway in India. Efforts of this type have always been defeated, for each culture is a resilient object. It allows sufficient leeway to acquire traits of other cultures that may be of purpose and utility, but it retains its distinctive properties and protects them from being diluted”.
It is here that anthropologists can play a pivotal role to understand the functional aspect of cultural as well as biological traits and provide vital information for policy decisions.
Gregory, S. (2010). “Traditional medicine and healthcare”. In R.K. Mutatkar, et al. (Ed.), Studies on Bio-medical Anthropology. Aryan Books. New Delhi.
Joshi PC. (2019). Ethnomedical practices and Indian scheduled tribes. Rom. Jour. of Sociological Studies. New Series, No. 2, p. 111–124, Bucharest.
Linderbaum S. (2008). Understanding Kuru: the contribution of anthropology and medicine. Philosophical Transactions of the Royal Society B. Biological Sciences. 363 (1510):3715-3720.
Mishra S, Behera D K, Babu B V and Kusuma Y S (2012). Encounters with talsa: worship and healing practices for measles among a rural-urban migrant Santal tribal community of Orissa, India. Mankind Quarterly 52:311-322.
Sikdar M. (2019). Tribal health: the saga of gene-culture interaction. In Development and Tribes: Contemporary Issues and Challenges Ed. Behera MC, 285-303.Serial Publications, New Delhi.
Srivastava VK (2002). Some thoughts on the Anthropology of mental health and illness with special reference to India. Anthropologist. 4(3):149-161
Talwar I, et al. (2007). Genes, Environment and Health: Anthropological perspectives. Serial Publication, New Delhi.
Zeberg H and Paabo S. (2021). A genomic region associated with protection against severe COVID-19 is inherited from Neandertals. Proceedings of the National Academy of Sciences, 118 (9) e2026309118; DOI: 10.1073/pnas.2026309118.