1. Central Department of Anthropology, Thribhuvan University, Nepal; khadkanirazan@gmail.com

            * Correspondence: khadkanirazan@gmail.com

Keywords: Traditional Health, Modern Health, Bayalpata hospital

1. INTRODUCTION

Traditional healing refers to health practices, approaches, knowledge and beliefs incorporating healing and wellness while using ceremonies; plant, animal or mineral-based medicines; energetic therapies; or physical/hands on techniques. The health care practices among tribal are the indispensable part of their culture. Primarily deriving from their own indigenous knowledge stock, tribal people have nurtured their own health care system organically linked with culture, tradition and ecology (Verma & Shah 2014). In Nepal, traditional healing system played a strong positive role in maintaining psychological and physical wellbeing of the majority of rural people whom don’t have access to satisfactory modern health services. On the other hand herbal medicine is the use of plants for healing purpose which is claimed as oldest system of medicine in the world. Since the time immemorial, making has used herbs to treat ailments and to promote greater health and wellbeing. Traditional healers focus not only on physical aspects of an illness but on healing the emotional belief shared by rural peoples of Nepal is that illness is caused by the introduction of evil spirit into the body which and cause physical pain symptoms to appear. Like this in Ridikot there were a lot of traditional health system were practicing to maintain psychological and physical well-being. Traditional medicine is a term used for all different types of indigenous knowledge systems used within various societies ever since the dawning of mankind (ibid). It is also sometimes referred to as folk medicine, mainly due to the fact that it was gradually developed over generations. Traditional medicine is also used in the Western civilizations but it may sometimes lead to certain health hazards in cases when it is not used appropriately. In the case of Ridikot there were many traditional healing practices practicing for healing such as folk practices, shamanism, Dhami/Jhakri, local Baidhya and worship.  Even now some of them are still practicing in new form in the community and some of them are replaced by the new modern health services. An old man shared me to the folk practices were continuously practicing since the centuries in the community. People had easy access for these practices, these were available in their own community which were very low costly. People were very poor in the village, so that they obligated to use these particular traditional methods of healing. They didn’t have access for modern methods of healing. Because of the poverty they can’t afford for modern healing methods going out of districts. Traditional healing was being continuous since the centuries; they had internal beliefs and trust on that. Eventually this traditional method was maintaining psychological and physical wellbeing in the community. Therefore, they practiced traditional healing practices, these traditional healing practices were the part of their culture. Traditional healer did their experiments in their own traditional way. Some health problems were healed by traditional healers. So they followed them for wellbeing and maintaining social and cultural participation.

2. MATERIALS & METHODS

This study adopts an explorative and descriptive study design. Such a designs facilitates the comprehensive exploration of the subject matter, allowing for in-depth understanding and analysis of the traditional health practices and healthcare behavior in the community. The nature of the study is qualitative, geared towards uncovering the intricate nuances, perceptions, and experiences of the community members. The research was conducted within the precincts of Sanfebagar Municipality, specifically in Ward No. 07, Ridikot, situated in the Achham district.  This geographical setting was chosen due to its relevance in the examination of traditional health practices within the community. The study utilized: in-depth interviews served as a primary method for delving deeply into the perspectives, experiences, and beliefs of individuals regarding traditional health practices and healthcare behavior. Key informant interviews provided access to individuals possessing specialized knowledge and insights into the traditional health practices of the community, enriching the contextual understanding. The method of observation was instrumental in directly witnessing and documenting traditional health practices, behaviors, and interactions within the community. In addition to primary data collection, a review of secondary literature was also conducted. This entailed a comprehensive examination of existing research, scholarly articles, and pertinent publications to provide context and enhance the depth of the study.

3. RESULTS & DISCUSSIONS

3.1 Folk Practices for Health

Folk medicine refers to the society’s indigenous medical wisdom that is handed down generation to generation usually through oral tradition. Through the process of countless hits and trials of finding the remedies since time immemorial, the folk medicine process is deemed to have been perfected. The folk medicine may have been generated from the contribution from a particular ethnic group or from a specific locality or may have coevolved with age-old culture. Worldwide, folk medicine practices are widespread especially on the traditional societies (Awale, 2008). Folk medicine is the mixture of traditional healing practices and beliefs that involve herbal medicine, spirituality and manual therapies or exercises in order to diagnose, treat or prevent an ailment or illness. Folk medicine is practiced by a majority the Nepali population in Rural Nepal, especially among the poor and uninsured (NCFH, 2011). Far west is very rich tradition of herbal medicines used in the treatment of various ailments. Local communities practice different types of traditional healing practices. In Achham, there were different folk practices are practicing in Ridikot also such as Chhitto Hanne for Headache, Mantarne for body pain, Gana Hanne for stomachache, Jharne for paralysis, local herbs like tobacco used for toothache, Honey used for cough, water prohibited for diarrhea, local herbs used for make women fertile, Sun Pani Phalne for suffering, Rakhani Ghasne for uneasy feeling, Upra Maddne for child health problems. Chitto Hanne means if someone is suffering from headache then a traditional healer hits from local sweeper on her/his head saying sacred verses, which was believed to make well from headache in the community. Mantarne act was done if someone is feeling body pain then a traditional healer says sacred verses touching the hands. Jharne act was done if someone is suffering from paralysis then a traditional healer rub from the iron instrument like knife saying sacred verses, which was believed iron instrument eliminate the virus from the body saying sacred verses. Gana Hanne act was done if someone is suffering from the stomachache then a traditional healer hits from hands in where he/she feels pain saying sacred verses. Sunpani Phalne act was done if someone is feeling uneasy, there was believed that if someone put some drops of water mixing in the gold then bad spirit go far from the body.  Uppra Maddne act was done if a child has a problem to do putty and if she/he continuously crying then a mother massage from the mixture of ashes and local fruits Alikuiya rubbing in her/his forehead and back, which was believed that the herbs eliminate the virus from the body. Like this there were other local traditional healing practices like if someone feeling toothache then he/she put local herbs and tobacco in this teeth. When someone feeling cough then he/she eat honey or local half boiling wine for betterment. There were a beliefs if someone is suffering from a diarrhea then he/she should not eat water. There were an herbs used to make women fertile, who cannot be pregnant. For the little uneasy feeling there were used ashes rubbing his/her forehead before enter home coming from taking part in funeral procession, touched mensuration women and Dalit person.

3.2 Shamanism

Shamanistic medicine is a spiritual form of medicine where a person’s illness is believed to be caused by the spirit possession. The shaman in a trance state will communicate with spirit healers and seek remedy of the sickness. The shamanism is still practiced with gusto in different parts of the world (Awale, 2008). Shamanism is being practice over thousands of years worldwide that has develop time tested healing method. Shamanism is one of the oldest forms of healing that shares some common beliefs worldwide. These are existence of spirits which can be good or evil; they can communicate with the spirits and cure the sickness caused by them and can tell the future. Shamans often perform ritual prescribed by spirits who knows and links between the physical and spiritual world (Walter, 2003). They conduct ceremonial rituals, healing the patients, driving away the evil spirits and appealing for wealth, health and happiness. A Shaman heals both the living and the deceased. In healing those who pass away, the shaman performs a psycho pomp ceremony of helping those who have died cross over to a comfortable and peaceful place. The ceremony may also include clearing a home or land of spirits that are in a state of unrest. The practitioner of shamanism believed to have access to, and influence in the world of benevolent and malevolent spirits. Shamanism in Nepal is mainly practiced mostly by who have associations with the Tibetan culture, but there are also pure Hindu practices. The function of Shamanism in the Nepalese society is to please the bad spirits and cure the ill effects caused on humans or animals by such spirits. The therapeutic expert or professional in this regard was the shaman-healer who treated and cured not only the diseases of the physical body, but also the illnesses of the soul, in order to bring the psyche of the afflicted individual back from fragmentation and alienation into wholeness and well-being (Winkelman, 1992). It is believed that Shamans are the masters of alternate states of consciousness, there are many stories and folklore where shamans explore the landscapes of the mind, the collective unconscious psyche, and return with treasures of knowledge and power in order to benefit humanity. In Ridikot, there were also practicing shamanism such as Jalko Hanne for some fever, Lasado Phalne for some psychological problem, Kapat Phalne for weakness, Maisine for body pain, Bano Halne for uneasy feelings. Jalko Hanne act was done if someone is suffering from fever and other like this then there were supposed to be caught by devils, so the traditional healer make some rituals to run away this devils. In this rituals there were used mix of rice, black lentil, mustard seed, water and ashes thrown on the face and finally these are made rounding above the head of patient and thrown out side. Lasado Phalne act was done if someone is suffering from psychological problem then this was supposed to devils attack and traditional healer suggest that the demand of devils should be fulfilled. After that according to traditional healer the demanding material should be thrown in outside of village where he said asking devils. Kapat Phalne act was done if one is suffering from weakness then there was supposed to somebody other have done magic then traditional healer blow up from mouth saying sacred verses. Maisine process was conducted when someone is suffering from body pain then elder person of the family made round the rice and coin above the head wishing (Kul Deota) lineage god and saying throw it out side to do better. Bano Halne process was conducted for making better from uneasy feelings in which elder person make round the rice and coin above the head wishing (Kul Deota) lineage god and saying to do better and put it under the roof.

3.3 Dhami/Jhakri

Dhami/Jhankri services is a form of shamanic healing for the problems which they thought to be due to spiritual and super natural beings. In Nepal, majority of the people practice traditional medicine for health care. Globally, the use of alternative models, which still do not have scientific proof of being safe, is much common (Sharma & Uprety, 2018). In Nepal, shamanism is the traditional religion of many ethnic groups in the eastern and western hills. Hinduism and Buddhism have been greatly influenced by shamanistic traditions. Called Jhankris, or Dhamis, Nepali shamans wear a peacock feather headdress and carry a double-sided drum. Most Jhankris will prescribe medicinal herbs, about which they are very knowledgeable. As soothsayers, they go into trances and act as spokesmen of the gods while as spiritual sentries, they ward off evil spirits and angry ancestors through either greater strength or trickery (Baniya, 2014). They also officiate during funerals, hand out amulets and promulgate myths. Shamans are known as Dhami and Jhankri although each ethnic groups have their own name as per their dialects. Local shamans hold great power and authority and are respected as a guardian of the societies in Nepal. Shamans devote their life to the community and it is their responsibility to ensure the well-being of the family and community. Shaman as a healer examines animal entrails for signs, collects medicinal plants, performs sacrifices, drive the spirit from the ill person’s body. Each Shaman use sacred objects, drums, chants and dances to initiate and sustain inspiration by deities. Mountain Monarch customizes the Shamanism trekking and tours in Nepal on per the requirement (Maharjan, 2018). In Ridikot there were also practiced Dhami Jhakri. Among them there were practiced Lago Bhago Phalne, Boksi Lageko, Sul Pareko, Sato Gayeko, Masan Chhaleko and Debata Lageko so on.  Dhami-Jhakri find disease in two types one is soul related and another body related. The soul related disease can be healed by mantra which are in different forms. Their healing methods are different too. When they pronounce verses (Mantra), Dhami/Jhakri puts fire-log in front of patients. Every time they touched the fire with brush and brushing the patient’s body. They repeat this act seven times. They say that these verses would disable logo Bhagos (ghost and giants). Jhakris act drama showing how people of ancient periods lived their lives and how they had cured sufferings dramatically. This becomes useful to entertain audiences who are about to live full night. The dramas they perform are usually with tragic them. They use this act for mental balance of patients. Dhami/Jhakris take bamboos, mustard and bunch of Khasru as essential elements in their healing. They believed on them to the extent that Boksi, Daini so on can’t attack if the houses contains a Bamboo’s stick. Similarly they believed that Lago runs away if they pronounced the name of mustard.

3.4 Local Baidhya Method

For millennia, people around the world have healed the sick with herbal or animal-derived remedies, handed down through generations. Herbalism is also a common practice where components of a plant or plants (berries, root, leafs, so on) are used for their medicinal properties. The herbal medicine in far-west Nepal is the basis of treatment of most illness through traditional knowledge. The medicine is made available via ancient, natural health care practices such as tribal lore, home herbal remedy, and the Baidhya, and Ayurveda (Kunwar et. al., 2010). The traditional herbal medicine has not only survived but also thrived in the trans-cultural environment with its intermixture of ethnic traditions and beliefs. There were also practiced local traditional herbal medicine through Baidhya. Through Baidhya there were practiced Kapda Banne for fracture, Ganaune Halne for cut, Mato Hallne for cut, local herbs for abortion, jaundice, piles and local herbs Syali for snake bite. There are a practice if someone had fractured then local Baidhya rubs the local herbs and bind the little bamboo wood from the rope in fracture. And if someone cut from sharp metal then people used local herbs Ganaune put on that and there was put also soil in the cut. If someone is suffering from worm, then Baidhya use roots Siru for healing so on as well. There were many herbs used for treat different problems.

3.5 Healing Choices

Healing choices is the process in which people choose when they need for treatment of health problem. Healing choices come from the mind of people according to their beliefs, knowledge, perception and awareness what should they do for health problem. People choose healing methods according to access of services, trust on health systems, economic condition so on. There are different factors to determine the healing choices of people such as economic condition of family, geographical condition, education status of person, culture of the community so on. People develop their cultural values for healing. In every culture there are their own healing methods. So healing choices became their own cultural values. In the case of Ridikot there were a lot of healing methods used for health problems in the community. Among them many people used traditional healing methods for the healing because of easy access, less time consuming and cheap. But within the traditional healing practices people used different methods according to types of problem. If traditional healing practices cannot solve the problem then people went to the modern health facilities like governmental health post and nearby medical shops at Sanfebagar. Before the establishment of the Bayalpata hospital the first choice of people for healing was traditional health methods and second choice was modern medicine. But now after the modern health services intervention in the community people’s first choice is Bayalpata hospital, second choice is hospitals at beyond the districts and third choice is traditional healing methods. An old women Narpata Kadayat (name changed) said, “Paela Paela aaphna gau ghar ko ausadhi mulo heraun koraun garda chhyau kyana bhanya gharaithi sabae chij hudo chhyo, kharcha pana teti lagdaena ra sabae le tesae hadda chhya”. (In early period we only used our own traditional method of healing, these all were available in front of our own house and were very cheap, everyone followed that.) People had used traditional healing methods such as local herbs, Dhami/Jhankri and shamanism for the health problem because these traditional methods easily and economically available in the local community. Every people believed on the local cultural methods, so they had to follow the tradition. Before the establishment of the Bayalpata hospital the Ridikot was very poor in health. Whatever the health situation people don’t have option for healing except traditional health system. So their first choice of healing was their traditional methods. But in case this methods cannot work then they go for further treatment beyond the district if they can afford only but if they cannot afford then they obligated for premature death. But after the Bayalpata hospital starts to give services from the yard, health status improve in the community. Bayalpata hospital giving easy and effective health services with no cost. Therefore the healing choice of people is transforming traditional to modern methods.

Their cultural beliefs and values about healing choices also changed traditional to modern methods e.g. see my monographs:

a) Beliefs

Health attributions influence health beliefs and subsequent health behaviors. Health attributions are partly shaped by culture. In turn, cultural health attributions affect beliefs about disease, treatment, and health practices. Likewise, culture influences health and healing practices. Other sociocultural factors such as immigration, acculturation, and social support play significant roles in health attributions and medical adherence. Culturally diverse patient populations require that medical educators learn new methods of cultural assessment and treatment in order to be effective (Vaughn et al., 2009). In Nepal, cultural attitudes and beliefs play a major role in influencing decisions about health care. Belief is embedded in the mind of people and practice of community. Belief are generated from the long term practices in the community. People of Ridikot had belief in traditional healing practices for treatment. But in this changing situation in the community the belief of people for health treatment is also changing. Beliefs are determined by the socio-economic and political situation in the community. Health and illness are viewed not only as physical conditions, but are based on perceptual judgments by society. This influences health care choices and decisions to seek health services. Also, this influences the trust relationship between patients, health care providers, and the prescribed treatment regimens. This can also affect actual physical responses to health care treatment. Cultural behaviors and beliefs about health and seeking treatment can adversely affect health care utilization and adherence to medication (Wosti et. al., 2011). All cultures have systems of health beliefs to explain what causes illness, how it can be cured or treated, and who should be involved in the process. Like this the community of Ridikot had also their own beliefs. Gyanu KC shared me to if they had any health problem, first of all traditional healing methods came in their mind unconsciously according to the types of problems. And traditional healer was supposed to problem solving way of health problem. Traditional practices were within the member community because that were practicing form very long time ago. So it was become habitual for people. Traditional practices came in mind together with health problems. But now there are being developing the new cultural belief about health care. The people have their belief on hospital care for their health problems. Therefore the belief is supposed to determine to use of health care treatment methods in the community.

b) Rituals

A ritual is typically an act of honor or reverence that is observed or performed on a regular basis. Rituals often define the customs and traditions of cultures, religions, and belief systems (Sierpina & Sierpina, 2004). However, a ritual can be something as simple as a routine that one follows on a regular basis. The repetitive, care-free nature of rituals can be very healing as they provide an opportunity for effortlessness, and even surrender to a higher power or act. Likewise, there were also the people performing regular rituals for better health and prosperity. But these ritual performing rituals have been changing in this time which is caused by different socio-economic and political circumstances. There were a lot of rituals performed for the health care in Ridikot. Like this Heraune is a process in which if someone has health problem the traditional healer (Jaisi) looks hand and horoscope to find the cause of problems and give idea for solution. And according to traditional healer further process are followed by patients. Heraune is a process to run away the devil from the body of person. A traditional healer organizes the program and perform the rituals such as Dan, Vakal, Kul Puja and Sacrifices of animals so on. Dan is a process for eliminate the problems came from Graha, giving Brahmin as prescribed from traditional healer. Vakal is a process in which people do promise with their got to give something and sacrifice animal if the god make people well. After people became well then people give that thing or sacrifice animal to god as they promised before. Like this people are doing Kul Puja (worship of family god) for better health. They thought if Kul Deota (family god) get angry then they should suffer health problems, so they do Kul Puja. Their belief in ritual performing made them satisfied in life. Therefore people regular performed rituals according their culture. But after the intervention of modern health care services, the development process, process of modernization are contributing to the change the performances of rituals in the community for better health.

c) Customs

Religion, culture, beliefs, and ethnic customs can influence how patients understand health concepts, how they take care of their health, and how they make decisions related to their health (Vaughn et al., 2009). People’s moral ethics drives culture, which influences the health behavior. And following the ethic people believed that make people’s prosperity in terms of health. In some cultures, family members play a large role in health care decision making. Differing roles of women and men in society may determine who makes decisions about accepting and following through with medical treatments. Eye contact or physical touch will be expected in some cultures and inappropriate or offensive in others. In the case of Ridikot there also the difference between male and female for taking decision in health treatment also. In the period of menstruation woman even cannot touch to other person. And regular staring is also supposed to bad sight as witchcraft called in local terms (Najar Lagnu). If she do so then that is supposed to be bad this is caused for illness. Religious faith and spiritual beliefs may affect health care seeking behavior and people’s willingness to accept specific treatments or behavior changes. Disease-related dietary advice will be difficult to follow if it does not conform to the foods or cooking methods used by the patient. Ridikot was a traditional community, where were different customs. Bhane Kumal said to me that there are different behavioral ethics followed by people. People were believed if they treat with politeness, hospitality and well behave then god will keep them well. People of Ridikot gave good hospitality to guests and friendly behave. They thought that they cannot make people annoy. They keep society in harmony and consensus. They participated in every rituals and works in community. If someone had problems then all people supported. They thought that collectivity can solve the many problems in community and health problems as well. They were pray for god in every happiness and problems. But in this periods these behavior of customs are also in changing. People are busy in their professional life. They don’t have time to follow the custom which is followed since the centuries. They concern on only their economic life. If they have health problems they visits Bayalpata hospital but they don’t believed to follow customs.

3. CONCLUSION

Contemporary society has witnessed the remarkable achievements of modern medicine in diagnosing and treating a wide spectrum of medical conditions, particularly those instigated by infectious agents like bacteria and viruses. This stands in stark contrast to historical times when diseases that are now routinely curable often proved fatal. Traditional medicine, with its roots stretching far back into history, played an integral role in recorded human development. A fundamental divergence between modern and traditional medicine lies in their perspectives on health and disease. While diseases are primarily seen as biological anomalies characterized by malfunctions or structural irregularities within organs or organ systems, illnesses entail a more comprehensive viewpoint. They encompass not only physical aspects but also the spiritual, psychological, and social dimensions of the affected individual. Modern medicine, in its quest for scientific precision, frequently bypasses these holistic aspects. Consequently, many traditional medicine practitioners lament the perceived erosion of the art of healing over the past century. This discontent has precipitated a substantial upsurge in individuals seeking solace in traditional medicine, despite the dearth of scientific validation for its efficacy. A significant segment of the population yearns for a spiritual dimension in their lives, a deeper connection to a greater purpose. For these individuals, traditional medicine practitioners offer a multidimensional approach to well-being, addressing not only physical health but also spiritual and psychological dimensions. Within the community of Ridikot, traditional medicine had long been the dominant healthcare paradigm. Its practices were deeply ingrained in the fabric of daily life, and residents relied on these traditional healing methods. Given the limited alternatives available, traditional medicine served as the cornerstone of healthcare. However, this equilibrium was disrupted with the introduction of modern medicine through Bayalpata Hospital. This intervention triggered a noticeable shift in community healthcare behaviors. Some residents began to eschew traditional medicine in favor of modern alternatives. This transformation signifies the ascendancy of modern medicine over traditional practices within the community. The coexistence and evolution of modern and traditional medicine represent a complex interplay between the past and the present. While modern medicine offers empirical rigor and advanced therapeutic modalities, traditional medicine continues to resonate with those seeking a more holistic approach to health and wellness. The simultaneous presence of these two paradigms underscores the importance of offering diverse healthcare options that respect the multifaceted nature of human health. It is a reflection of the intricate interplay between cultural heritage, evolving healthcare choices, and individual preferences. Ultimately, the story of Ridikot and its healthcare transformation serves as a microcosm of the broader dynamics at play in the evolving landscape of medicine worldwide.

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