My class on the GLOBAL HEALTH, LOCAL HEALING (SOCIO 4071) honors course, focusing on medical pluralism in Nepal

1. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
The evolving role of the Kampur Guruwa;
Medical pluralism and changing religious and
health practices in a village in far-west Nepal
Dr Matt Maycock
MRC/CSO Social and Public Health Sciences Unit
27th November 2015

2. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Medical pluralism
• The presence of multiple medical systems, each
with its own practices and beliefs in a society.
• Since 1978 the World Health Organization has
indorsed the incorporation of local healing practices
in national health systems
 Increasing appreciation of the value of many non-
Western healing traditions
 Growing awareness of the deficiencies of Western
biomedicine in addressing a person’s psychosocial
context (lack of attention to mind, soul, and social
setting)
 High cost and lack of access to Western biomedicine

3. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Medical pluralism in Nepal
Subedi found that Nepalis often use herbal remedies before
turning to a traditional healer. Modern medicine and health care:
... are only sought as a last resort, usually for the serious
and persistent problems. (Subedi 2003, , 155)
This indicates that traditional and modern forms of medicine are
both used flexibly and interchangeably, indicating a medical
plurality (Kleinman 1980; Pigg 1992, 1996).
Although Subedi does not explore the reason, cost is an
important influence here. Seeing a traditional healer does not
always incur a cost, whereas using modern medicine does.

4. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Changing medical practices in Nepal

5. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Traditional medicine
The World Health Organization(WHO) defines traditional
medicine as “the sum total of the knowledge, skills, and
practices based on the theories, beliefs and experiences
indigenous to different cultures, whether explicable or not,
used in the maintenance of health as well as in the
prevention, diagnosis, improvement or treatment of
physical and mental illness”.
The World Health Organization(WHO) estimates that up to
80 percent of the world’s population, which mostly lives in
rural areas, rely on herbal medicine as their primary form
of healthcare.

6. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Traditional medicine in Nepal
• The use of medicinal herbs in Nepal's traditional medical
system dates back to at least 500 AD. In Nepal, traditional
medicine, although low profile, has been an integral part of the
national health system.
• More than 75% of the population use traditional medicine,
mainly that based on the ayurvedic system. There are 141
ayurvedic dispensaries, 14 zonal dispensaries, 15 district
ayurvedic health centres, and two ayurvedic hospitals.
• Ayurvedic medicine (a system of medicine with historical roots
in the Indian subcontinent) is widely practised in Nepal.
• There are 623 institutionally qualified practitioners of traditional
medicine and about 4000 traditionally trained practitioners.

7. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Research far-west Nepal, 2009, 2013, 2014
Masculinity, Modernity and Bonded Labour: Continuity and
Change amongst the Kamaiya of Kailali District, far-west
Nepal (School of International Development, UEA, Norwich)

8. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
PhD fieldwork far-west Nepal 2009
Yearlong fieldwork in Nepal:
• Three month language training and key informant
interviews
• Nine months in two fieldsites
My thesis addressed the the following research questions:
• How have the links between Kamaiya bodies and
Kamaiya masculinities changed following freedom?
• How are working patterns changing following freedom,
and what implications does this have for Kamaiya
masculinities?
• What are the Implications of modernity for Kamaiya
masculinities in family settings?
Followed up in 2013 and 2014

9. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Methods
• Household survey
• Life History interviews
• Participant observation
• I wore clothes similar to my research participants and made a
conscious effort not to display conspicuous signs of consumption.
• I tried to behave like the men of my age at both fieldwork sites as
far as possible. On occasion this involved doing the work that the
men in Kampur were involved in, although this did not include
driving a rickshaw as the rickshaw drivers found the idea ridiculous.
• I took part in various agricultural and hunting activities.
• I took part in the social life, which posed various difficulties for me.
• I paid for a number of villagers to get health care and medication
from a local pharmacy when the Guruwa was unable to treat the
person

10. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
My home for nine months…

11. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

12. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
The Guruwa
• The Guruwa have been part of Tharu society for as long as
anyone could remember in either of my fieldsites, with
various edicts referring to the role as far back as 1807
(Krauskopff and Meyer, 2000,160).
• Whether Guruwa should be considered as shamans,
traditional healers or priests is not clear, as at different
times they seem to undertake parts of what might be
expected of each of these roles.
• The Guruwa are always male and always elderly
• All the bastis and Tharu villages that I visited in Kailali had
at least one Guruwa, and each of my case study bastis had
one.

13. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• The Guruwa are accorded a certain level of respect in
their setting due to their knowledge of spiritual and
traditional health matters.
• The wider Tharu community often referred to the
Guruwas’ knowledge of traditional Tharu customs, as
being the most knowledgeable about such customs is
part of their role. This was respected in the basti,
particularly given the recent revival of pride in
traditional Tharu customs resulting from resurgent
Tharu politisization. Guruwa are rarely involved in
politics as such matters are seen as incompatible with
their focus on health and spiritual concerns.
• The Tharu are an ethnic of indigenous group found
predominantly in the southern plains or Terai.

14. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
• Conventionally the Guruwa were mainly consulted about health
matters, and occasionally they also advise about spiritual
issues or concerns relating to Tharu culture. According to
Guneratne:
• The Guruwa is essentially a healer. When Tharus wish to draw
an analogy between the Guruwa and a contemporary
institution, they invariably compare him to a medical doctor.
(Guneratne, 1999, 12)
• The Guruwa’s work as a healer is not confined to intercession
with gods and spirits to discover the cause of illness; the
Guruwa also seeks to cure disease through the medicinal use
of roots and herbs and other skills. (Ibid, 13)
The Guruwa

15. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

16. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
The changing role of the Guruwa
• However, more recently spiritual or cultural matters are
a more prominent part of their role within Tharu society.
I spent some time with the Guruwa in Kampur basti and
observed him practicing various rituals. His practice
mainly consisted of minor rituals to alleviate minor
aches and pains such as backache. The rituals were
designed to make the budh (ghost or witch) leave the
patient and thus alleviate the pain and refer to a specific
cosmology (cf. Guneratne 1999; McDonaugh 1984).

17. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
The changing role of the Guruwa
Traditional
healer
Traditional
healer /
Cultural
reference
Cultural
reference
Increasing use of pharmacies and western biomedicine

18. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Questions for discussion in small groups
• Reflecting on the readings and perhaps your own
experiences, do you think it is inevitable that western
biomedicine will subsume traditional medicines?
• What does the increasing influence of western biomedicine
mean for traditional approaches to medicine?
• Is medical pluralism sustainable?
• What are the potential risks and advantages of the increasing
influence of western biomedicine?
• What does the changing role of the Guruwa tell us about
medical pluralism in Nepal?

19. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Key Readings
• Durkin-Longley, M. 1984 Multiple therapeutic use in urban Nepal,
Social Science & Medicine, Volume 19, Issue 8, 1984, Pages 867-872,
ISSN 0277-9536,
http://www.sciencedirect.com/science/article/pii/0277953684904040
• Pigg, S L. 1996. The Credible and the Credulous: The Question of
Villagers' Beliefs in Nepal. Cultural Anthropology 11 (2):160-201.
http://onlinelibrary.wiley.com/doi/10.1525/can.1996.11.2.02a00020/f
ull
• Subedi, M S. 2003. Healer Choice in Medically Pluralistic Cultural
Settings: An Overview of Nepali Medical Pluralism. Occasional Papers
in Sociology and Anthropology 8.
http://himalaya.socanth.cam.ac.uk/collections/journals/opsa/pdf/OPS
A_08_09.pdf

20. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Additional Readings
• Baer, H. 2011. ‘Medical Pluralism’ in M Singer and P Erickson (eds) A Companion to Medical Anthropology
Hoboken, NJ: John Wiley and Sons.
• Conrad, P and Barker, KK. 2010. ‘The Social Construction of Illness: Key Insights and Policy Implications’
Journal of Health and Social Behavior 51: S70-S79.
• Etkin, N. 1992. ‘Side Effects: Cultural Constructions and Reinterpretations of Western Pharmaceuticals’
Medical Anthropology Quarterly 6: 99-113.
• Fadiman, A. 1998. The Spirit Catches You and You Fall Down: A Hmong Child, her American Doctors and
the Collision of Two Cultures New York: Farrar Straus & Giroux, (‘Do Doctors Eat Brains’ is available as a
digital extract).
• Guneratne, Arjun. 1999. The Shaman and the Priest: Ghosts, Death and Ritual Specialists in Tharu Society.
Himalayan Research Bulletin XIX (2).
• Guneratne, Arjun. 2002. Many tongues, one people : the making of Tharu identity in Nepal.
• Kleinman, A. 1980. Patients and Healers in the Context of Culture. Berkeley: University of California Press.
• Lamb, Sarah. 2000. White saris and sweet mangoes : aging, gender, and body in North India. Berkeley ;
London: University of California Press.
• McDonaugh, C. E. J. S. The Tharu of Dang : A study of social organisation, myth and ritual in West Napal.
University of Oxford 1984].
• Nettleton, S , and J Watson. 1998. The Body in Everyday Life. London: Routledge.
• Pigg, Stacy Leigh. 1992. Inventing Social Categories through Place: Social Representations and
Development in Nepal. Comparative Studies in Society and History 34 (3):491-513.
• Saillant, Francine and Derge Genest. 2007. Medical Anthropology: Regional Perspectives and Shared
Concerns. Malden, MA: Blackwell Publishing.
• Verter, B. 2003. Spiritual Capital: Theorising Religion with Bourdieu against Bourdieu. Sociological Theory
21 (2):150-174.

21. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
matthew.maycock@glasgow.ac.uk
www.matthewmaycock.com
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