Integrating Modern And Traditional Medicine: A Strategic Imperative For Assam

A friend's mother from my hometown, Karimganj, in Assam, was diagnosed with throat cancer and had been travelling to Delhi for chemotherapy. Alongside her treatment, she also takes traditional medicines and visits temples as part of her healing process.

When I asked her why she isn't relying solely on chemotherapy, she explained that visiting the temple gives her the strength to keep going with her treatment. She also mentioned how isolating the chemotherapy experience can feel – whereas visits to traditional healers back home have created a supportive community around her, which gives her emotional support. Hence, relying on both the modern and traditional medical systems simultaneously maximises the chances of a cure, breaks free from the isolation of biomedical care, and builds emotional resilience through culturally aligned support networks.

The dual role of modern and traditional medicine in patient care

In his book Partners to the Poor, Paul Farmer mentions an incident in Haiti where one of his patients believed that sorcery was the leading cause of her disease, yet she continued to take modern medicine. When he asked her why she was using both, she suggested it was due to the complexity of human life and its holistic nature.

Anthropologists Andrew J. Strathern and Pamela J. Stewart, in their book "Curing and Healing: Medical Anthropology in Global Perspective", mention their discussion of health-seeking behaviour among villagers in Papua New Guinea, where people sought biomedical therapy at the same time as consulting a diviner or witch-finder. They stated, "The one does not rule out the other because people perceive them as dealing with different aspects of a complex reality."

WHO defines health as physical, mental, and social well-being, not merely the absence of disease, thus emphasising the importance of holistic care and well-being. Hence, the role of traditional medical practices in the healthcare system is undeniable. People, culture, tradition, and science desperately need space to perform a good tango together.

India has a distinct pluralistic health system, with a modern and traditional healthcare system coexisting and operating at different service delivery levels: national, state, and district. Since India is a very diverse nation with extremely diverse traditional medical practices, there are 'Great' (iterate, authoritative, and centrally regulated) and 'Little' traditional healing practices (popular, unauthorised, and locally variable).

'Great' learned healing systems like Ayurveda, Unani, etc., are more streamlined, while 'Little' traditional healing practices like worship of goddesses like 'AIDSAmma' exist and are localised to some populations. It is interesting to note that practices like temples of 'AIDSAmma' still hold importance in the modern biomedical context. One of the examples is the AIDSAmma temple becoming the focal point of sharing information on AIDS, leading to the evolution of culturally sensitive preventive care.

Deep-rooted beliefs and practices in North-East India

In Assam, a study on the health attributes and beliefs of cancer patients reveals that 52% of the participants believed that their illness was due to supernatural factors. The majority of the participants were dependent on God for their future health. This study complements my observation of patients suffering from diseases like cholera, TB, and even cancer in the region who continue not to access medical or herbal care and instead resort to only faith-based treatments.

Another epidemiological study from Assam suggests that self-medication and reliance on traditional medicines in rural areas lead to delays in the diagnosis of malaria. This study validates my observation, which I complemented with conversations with two ASHA workers from Karimganj town. According to them, people of the region mostly do not want to undergo diagnosis because of their fear that blood drawn for tests could be potentially used for black magic, which is one of the leading causes of delayed diagnosis. This emphasises the firm reliance on traditional healing practices and cultural beliefs against biomedical practices and highlights the urgent need for robust community engagement and a need to bridge the gap between traditional healers and biomedical practitioners to foster a healthcare system that better serves the community's needs.

In North-East Indian context, traditional healing practices hold deep significance in addressing mental health concerns, offering cures and comfort rooted in cultural wisdom. The way these communities talk about mental health is far from the biomedical articulation of mental health, and the cures are also heavily reliant on traditional cures. Most of these regions are resource-scarce and have limited availability of mental health professionals. I recall a boy from my hometown who experienced recurring panic attacks for months. His family turned to a local practitioner who used traditional rituals as cures.

Although such practices are alien to biomedical interventions, these varied practices come together to constitute unique negotiations of individual prospects of traditional beliefs and ideas of health and well-being rooted in the community with longer histories of development and interactions. With the growing complexity of mental health issues, we cannot overlook the role of culture.

From the above anecdotes, it is clear that traditional medicines and cultural healing practices are integral to healthcare practised in the northeast Indian state of Assam. Despite the vast prevalence of traditional medicine usage in the state, there needs to be more conversation between traditional healers and other modern medical practitioners, including community health workers and nurses. During my conversation with one of the nurses, she told me that they generally refrain from communicating with traditional healers because of the fear of being distrusted by the community members. My conversations with doctors also suggested a lack of trust and respect for each other, which hindered their communication.

The ASHA workers agreed that though they are not in alignment with the methodology of traditional healers, they have a significant role to play in people's health-seeking behaviour. They also said that people relied on traditional healers to guide them in seeking medical help. Hence, timely referrals to healthcare centres depended on conventional healers.

One study in the BMJ shows how beliefs and culture significantly shape people's health, and people who sought traditional healing had improved mental health status. The solution lies in fostering collaboration, conducting research, and enhancing education. It necessitates open communication channels and mutual respect among practitioners, underpinned by evidence-based studies on traditional practices' safety and efficacy. Equally vital is training healthcare professionals and traditional healers in each other's methods to ensure a more holistic approach.

Towards a holistic healthcare model -  global examples and lessons

The Union Minister of Health and Family Welfare proposed a centralised solution of building centres of integrated medicines in tertiary healthcare centres. Although structural integration is essential, it is much more important to consider the sociocultural barriers to integration. The focus should be on building trust among modern and traditional medical practitioners and how communities can unite to ensure integration and maintain medical pluralism.

There are several examples of traditional medical practices where traditional medical practitioners from different contexts have helped address vaccine hesitancy by building trust in culturally appropriate communities. Combining traditional medical practices, vaccination, and other preventative campaigns can reduce misinformation, align with patients' beliefs, and increase confidence in modern medical interventions. India's polio eradication campaigns had faith leaders as ambassadors in rural areas, addressing vaccine hesitancy rooted in cultural beliefs. Similarly, China's barefoot doctors and traditional healers in Africa during the HIV pandemic played a significant role in reaching the most vulnerable communities.

This year, the WHO signed a new multi-million five-year agreement with the Ministry of Ayush, Government of India, to boost the development of traditional complementary and integrative medicine. In 2014, the Indian state launched the AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) ministry to ensure the optimal development of traditional healthcare systems and integration. In the Northeastern states of India, like Assam, the policy emphasises building more hospitals and institutions focused on AYUSH and creating entrepreneurial opportunities that focus on making items related to AYUSH. Despite these initiatives, the lack of integration, as mentioned earlier, means that the processes are not streamlined because of the lack of understanding of people's health-seeking behaviour and belief system regarding what constitutes 'health' and 'illnesses'.

Many questions need answering on the 'Hows' of integration. Fortunately, we have examples of countries like China, where they have initiated a program to utilise modern technology in integrating traditional Chinese medicine with Western medicine. From introducing new drugs, understanding the aetiology of certain diseases, developing electric acupuncture, and researching the uses of traditional Chinese medicine, it has also extended to endocrinology, immunology, and other branches. Other countries, like South Korea, Mongolia, Thailand, etc., are in the process of integrating modern and traditional medicine. WHO's framework can guide countries like India, especially North Eastern states, in understanding how traditional medicine can improve health and well-being, prevent diseases, and manage long-term chronic conditions at the primary healthcare level.

Acknowledgements

For this article, the author thanks Abhishek Ranjan Datta for helping her understand how social factors shape people's health-seeking behaviour.

 

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Edited by Christianez Ratna Kiruba

Image by Janvi Bokoliya