Researchers: Professor David Hardiman and Dr Gauri Raje
Start date: 1 April 2004
Completion date: 30 September 2007

Between 2004 and 2007, research was carried out on medical care and various other forms of healing that have been and are practised amongst tribal peoples in the present-day state of Gujarat in India. The main questions posed were as follows:

• How have indigenous systems of healing changed over time, and what is their role today?
• What was the impact of the Protestant medical missionaries who provided the bulk of biomedical care for the tribal people from the 1880s to the 1950s?
• How did Indian nationalists and then – after 1947 – the Indian government seek to meet the health needs of the tribal people?
• How did non-governmental doctors in tribal areas – both self-employed and employed by NGOs and Hindu organisations – respond to these needs?
• What are the causes and implications of the upsurge over the past three decades of Christian faith-healing?

In general, it was found that so long as written records go back, the tribal people of this region suffered from a wide range of health problems. In the past, they largely relied for treatment on their traditional healers known as bhagats. Their cures ranged from the use of herbal medicine and cauterisation to divination and exorcism of evil spirits. They were highly respected in tribal society. Over the course of the past century, they have been partially displaced by biomedical practitioners, as well as Christian faith healers. Despite this, they have proved remarkably tenacious, and have if anything made something of a comeback in recent years, as their skills in the use of forest herbs has attracted a growing interest from pharmaceutical companies and government foresters. Some bhagats have also become more entrepreneurial in their practice, adding certain alternative therapies to their repertoire and marketing themselves aggressively.

The foreign missionaries who worked in tribal Gujarat from the late nineteenth century to the 1960s provided the first effective biomedical care for these people. Although on the whole appreciated for their work, at some junctures they came into conflict with the traditional healers. After Indian independence in 1960, most foreign missionaries had to leave India. From the 1970s onwards a new form of Christian healing came to the fore, that of faith healing of the Pentecostalist type. So popular did this prove that there was a backlash by Hindu fundamentalists in the late 1990s, with tribal Christians being attacked and their churches burnt. The Hindu fundamentalists then sought to provide their own forms of biomedical care. Our investigations found, however, that the latter has not proved popular, while Christian faith healing continues to have large numbers of adherents.

We found that before independence in 1947, Indian nationalists placed a low emphasis on health care work, in contrasts to their excellent educational work amongst the tribals of Gujarat. After independence, the new government established an extensive system of health care. We found that the government clinics were in most cases poorly run and understaffed, with practitioners often earning from private medical work on the side. A lot of the energy of government health officials went into a series of campaigns, one of which – the polio vaccination campaign – we observed in detail. Because of the bureaucratic compulsion to meet targets, the government health workers were, for a change, eager to gain support from the tribals, and made extra efforts to reach them in their villages. Even then, some tribals resisted the campaign, citing internationally-current rumours that the vaccination was a form of mass sterilisation, or that it caused AIDS. This was illustrative of the manner in which global debates on health and medicines are interpreted, translated and come to have specific meanings in local settings.

Most biomedicine was practised in tribal areas by private ‘doctors’, only a minority of whom have full medical qualifications. Some maintain clinics in small towns and villages, while others live an itinerant life, carrying nothing but hypodermic syringes, glucose bottles, and an assortment of pills. In recent years, there has been a marked increase in such dubious ‘doctors’ practising in the tribal villages of Gujarat. In general, they rely on extensive social and political networking to secure local faith in their skills. It was observed that they are fiercely possessive about their clientele. In some cases, they maintained their influence over patients by giving them loans at high rates of interest (up to fifty percent). Such ‘doctors’ thus establish themselves in a patron-client relationship with their patients.

There are also a range of non-governmental organisations involved in health projects of one sort or another in tribal areas. Some have been around for a long time, and have done much excellent work. We found that in recent years the government has been depending increasingly on NGOs to carry out fundamental health work in India, and that this allows for the proliferation of many sub-standard NGOs. It also absolves the government of responsibility for health care. Although it is clear that government health projects are often mistrusted – for good reason – we do not believe that NGOs can ever be an adequate substitute for systematic health schemes implemented by the state.

To conclude, biomedical health care in the tribal areas of Gujarat was found to be highly inadequate, with tribal people being systematically exploited by both legitimate doctors and quacks. Alternative forms of treatment continue to flourish, whether by the traditional healers or by Christian faith healers. Each of these modes of healing can be seen to cater for particular needs, and so long as present socio-economic conditions remain as they are in the tribal regions, and the public health care system exists as it does, it seems unlikely that there will be any significant change in this respect.