Revitalising oral health traditions can strengthen rural communities’ self-reliance in primary health care
Historically and culturally, oral folk traditions have had a symbiotic relationship with codified Indian Medical Systems like ayurveda, siddha, unani and swa-rigpa. Revitalisation of these rich and diverse local knowledge traditions could strengthen the self-reliance of rural communities in primary health care.
Oral health traditions contain valuable experiences that could be exploited by medical research and commerce. There is a need to spread awareness about the rights of the traditional custodians of health knowledge.
“It would be very valuable if the formal systems can help to standardise regional, plant-based pharmacoepias for primary healthcare that could be used by rural communities. The future of ayurveda which is the samskrit (scientific) dimension of India’s medical heritage must be envisioned without neglecting its prakrit (folk) roots,” Professor Darshan Shankar, vice-chairperson of the Institute of Ayurveda and Integrative Medicine, Foundation for Revitalisation of Local Health Traditions, Bangalore, said recently.
Prof. Shankar was speaking at a panel discussion on ‘Strengthening Self-Reliance of Rural Communities in Primary Health Care’.
Spelling out the need to respect autonomy of traditional healers in India, he said there are no schools, colleges or organisations that were engaged in teaching or disseminating oral health knowledge that is embodied in the community-based traditions. The knowledge has spread through a “people-to-people” process.
There are also around 100,000 herbal healers who treat a range of common ailments and also chronic conditions and even specialised conditions related to the eyes or the ears or the skin and related to muscular and nervous disorders. All these are “health traditions” because they have survived, evolved and adapted for centuries to this day.
“A very significant feature of these traditions is their autonomous nature and the fact that they are not livelihood-dependent and their community support system. The 600,000 traditional birth attendants in India, for example, are not supported by Central or State governments or non-governmental organisations. They are totally supported by village communities,” Prof. Shankar said
There are community traditions related to emergencies. There are estimated to be around 60,000 healers who treat life threatening poisonous snake bites. The traditional visha (poison) healers can distinguish a poisonous snake bite from a non-poisonous one and further between the bite of a krait, pit-scaled viper, russell viper or a cobra and they have treatment for the same. In some regions, they also treat the bite of mad dogs to prevent rabies. In the written tradition, there is a very elaborate description of symptoms for diagnosing the extent of penetration of the poison into body tissues.
India also has a bare-foot orthopaedic tradition. Every cluster of 20-25 villages has a bonesetter. These bonesetters treat sprains and simple fractures and in some parts of the country, they also manage compound fractures with open wounds. No one has done a systematic study but it is a guess estimate that at least 50 per cent of broken bones in rural India are managed by traditional bonesetters. The straightening of a paediatric club-foot has been pioneered by folk bonesetters in Tamil Nadu. They are also experts in sophisticated flexible bandaging techniques.
Apart from the distinct class of folk healers, there are also several millions of mostly rural (and to a much lesser extent urban) knowledgeable households who are also carriers of the community based oral health traditions of India. The households have knowledge of home remedies about local food and their nutritional value. The health traditions of households are based on the local eco-system resources.
Prof. Shankar pointed out due to cultural reasons there has been massive erosion in many segments of the community-based health tradition. It is, thus, very important to understand that any intervention which intends to strengthen community health traditions must not undermine their autonomy and self-reliance, else it will be unsustainable. Governments and NGOs can provide local communities with support to revive their informal educational processes, but they should take care to do so without ‘crippling’ the tradition.
Model Material Transfer Agreement and Information Transfer Agreement need to be evolved for protecting the intellectual property rights of community knowledge. More importantly, an environment needs to be created which promotes local innovations based on the local plant resources, Prof. Shankar said.