Doktor Kot, Doktor Sla – book doctors, plant doctors and the segmentation of the medical market place in Meghalaya, northeast India

Abstract

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism.

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

“…Our findings on the juxtaposition between ‘white man’s medicine’ and traditional medicine are also reminiscent of the distinction between doktor kot (‘book doctors’) and doktor sla (‘plant doctors’) reported in Meghalaya, north-east India 10. In India, alternative medicines, such as Ayurveda, are officially recognised by the state; their claims to legitimacy rest on specifically local, rather than universalist schema.…”

“…In India, alternative medicines, such as Ayurveda, are officially recognised by the state; their claims to legitimacy rest on specifically local, rather than universalist schema. However, practitioners still suffer from a ‘subaltern’ status, since their patients tend to be poorer rural people whose illnesses ‘were not only untreatable by biomedicine, but not even recognised by biomedicine.’10 Similarly, in Ethiopia, disempowered groups like women and rural people were more likely to consult traditional healers than biomedical practitioners, compared with men and urban people, when seeking care for epilepsy (an illness commonly interpreted as having spiritual or social causes) 26…”

“…Interviews were translated into French and transcribed verbatim; words with no agreed French translation were retained in the original language and checked with data collectors for definitions. Preliminary analyses of interviews and FGDs identified dominant themes to develop a coding structure, using thematic content analysis with elements of grounded theory, namely the constant comparative method and inductive theoretical analysis 10. The final codebook included 35 codes grouped around the following categories: community perceptions of child health, nutrition and illness; care-seeking and child feeding behaviours; and roles in provision of services for child health and nutrition.…”

“…In rural areas, the number of traditional healers is much higher than the number of doctors and nurses, estimated in Africa to be 1:500 traditional healers per population versus 1:40 000 for medical doctors 6 9. In the public health literature, the traditional medical sector is largely framed as a problem for health systems, usually as a source of substandard care or delays in care seeking 10. Few studies examining the roles of CHWs in their communities specifically include traditional healers as part of their analysis, or compare cadres along dimensions of quality of care, dignity and/or respect, cultural competency and social or community cohesion.…”

Therapeutic practices in everyday life: Illness and health seeking in a rural community in Sri Lanka

“…Further, research around the world points to practitioners who straddle multiple therapeutic systems and the complexities that arise therein (Dew, 2003;Khalikova, 2020). While there may be non-biomedical therapeutic practitioners who succeed in carving out a niche for their conservative practices in a predominantly biomedicalised medical market such as that in India (Albert et al, 2017), it is likely that they would have to contend with the demands of treatment seekers who are biomedically-oriented (Naraindas, 2006). This has led some traditional practitioners to integrate biomedical diagnostic procedures and even biomedical pharmaceuticals into their practice of traditional or indigenous medicines, as reported in Sri Lanka (Waxler-Morrison, 1988;Wolffers, 1989).…”