In its efforts to strengthen primary health care and public health systems, the National Rural Health Mission, among several other measures, has sought to mainstream Ayush (Ayurveda, Yoga, Unani, Siddha and Homeopathy forms of medicine) and revitalise local health traditions.
The latter – LHT — refers to the undocumented knowledge possessed by individuals and communities including birth attendants (dais), bone setters, herbal healers, poison specialists as well as the knowledge on locally available medicinal plants possessed by household members. The recent National Health Policy (2015) reinforces the need for documentation, validation and promotion of such community based local health tradition. While these policy intentions are laudable, their operationalisation rests on simplistic and vexed assumptions.
How does the state approach local health traditions? How and whose knowledge matter for documentation? Local health practitioners like dais, bone setters, poison specialists and myriad others have been referred to as those not institutionally trained, not registered practitioners and not formal providers. They hence could be anyone that is not biomedical or Ayush affiliated.
Such a lens of the state to locate practices and practitioners of local health traditions has been limiting in that it situates them in litotes – that is the use of negatives like non-institutional, non-official and non-codified. It is instructive to look at the origin of the word litote, drawn from the Greek for the word litos meaning, plain or simple.
Our fieldwork revealed that the deployment of litote in identifying local health traditions in fact simplifies – straightjackets even – a complex plurality of practices and persons into a meagre register of state legitimacy and science, comprising documentation, validation, licence, certification and registration.
Through a two-year long ethnographic research study in three southern states, we interacted with 50 practitioners of local health traditions. These interactions challenged a “not” based distinction of their knowledge and practices. Quacks and hacks certainly exist, and are decried by these practitioners, who, far from the fuzzy category of ‘others’, identify themselves as ‘paramparika vaidyas’.
The reference to parampara (lineage) implies specific mode of transmission of knowledge, learning through observing and practicing and repository of such knowledge across generations that in some sense are ordained to carry it. Knowledge is transmitted through a rigorous process of learning that demands specific qualities in a learner – commitment, perseverance and sincerity.
Motivations of profit
These properties have to be both inculcated and nurtured – tasks that befit their imparting within a lineage, where conditioning and training may begin at very young ages. The knowledge – and the calling to possess it is in many cases considered sacred. It cannot be profaned through motivations of profit and commercialisation (which is the basic motivation of quacks).
While to an outsider such knowledge may be obscure, the vaidyas explained to us how the knowledge comprises an elaborate epistemology of the body and the cosmos-linked through iterative and intricate interactions in local ecology. Thus, paramparika knowledge has its own ethos, ethic, rules and boundaries of legitimate practice and practitioners.
A more comprehensive, accurate, and ethical engagement with local health traditions may mean a reorienting of the lens of pluralism itself – as manifest in discourses and policymaking in India thus far. A pluralism lens puts systems of medicine and knowledge in a hierarchy thus obfuscating the strengths and limitations emanating from any one systematic body of knowledge. Current efforts towards the revitalisation of local health traditions have thus far involved marathon documentation of such knowledge in formats catered to socialisers of institutionalised systems of medicine.
Revitalisation through such documentation will create a fragmented and fractured data base on such knowledge which will likely serve a limited purpose. A pluralism lens does little to question the binaries of official/unofficial, modern/folk and scientific/unscientific — as a starting point.
The agenda of the revitalisation of local health traditions needs to have a lens of plurality, whereby, rather than being construed in terms of what local health traditions are not, they may be understood for what they are – what they mean to people, what they can and cannot do.
(Arima teaches at Azim Premji University and Devaki is a Research Scientist in Public Health Foundation of India. This write up is based on an ongoing collaborative research study on local health traditions)