Landscape Analysis of Traditional Tribal Healers and Their Healing Practices in The Tribal-Dominated States of India

The indigenous communities in India, known as “Vanvasi”, have been the original inhabitants of the Indian subcontinent for millennia. Their longstanding presence is steeped in a deep connection with nature, reflecting a rich culture and heritage characterized by traditional practices. India boasts a diverse array of more than 700 tribal communities, each distinguished by its exclusive language, culture, and heritage. Notable tribal groups encompass the Bhils, Gonds, Santhals, Mundas, Kols, and Nagas. Indigenous communities are present across India, with notable concentrations in Chhattisgarh, Jharkhand, Odisha, Madhya Pradesh, Gujarat, Rajasthan, and Maharashtra states.

The indigenous communities in India, known as “Vanvasi”, have been the original inhabitants of the Indian subcontinent for millennia. Their longstanding presence is steeped in a deep connection with nature, reflecting a rich culture and heritage characterized by traditional practices. India boasts a diverse array of more than 700 tribal communities, each distinguished by its exclusive language, culture, and heritage. Notable tribal groups encompass the Bhils, Gonds, Santhals, Mundas, Kols, and Nagas. Indigenous communities are present across India, with notable concentrations in Chhattisgarh, Jharkhand, Odisha, Madhya Pradesh, Gujarat, Rajasthan, and Maharashtra states. Healthcare in tribal areas of India faces unique challenges stemming from geographical, cultural, socio-economic, and infrastructural factors. The tribal population often experiences limited access to quality healthcare, leading to health disparities. Therefore, tribal healers play a critical role in providing primary care services to tribal communities in India.  Traditional tribal healers often view health as a state of balance and harmony between the individual, their community, environment, and spiritual realm. This balance can be physical, mental, and spiritual. Illness is often seen as a disruption of this balance. This disruption can be caused by several factors, including physical factors (such as infection or injury), psychological factors (such as stress or trauma), and spiritual factors (such as offending a deity or violating a taboo). Spiritual practices, rituals, and ceremonies are seen as ways to achieve and maintain this balance. Ancestors and spiritual beings are seen as influential in health and illness. Traditional healers believe in seeking guidance, protection, and healing from ancestors and spirits. Rituals and ceremonies are performed to honor and connect with these spiritual entities. Chickenpox, smallpox, unsafe deliveries, fever, snake bites, typhoid, pneumonia, tetanus, malaria, and seizures are among the illnesses that people believe to be brought on by evil spirits and the gods' wrath. 

In every tribal community, there are few individuals who can recognize evil spirits and they are also skilled at controlling those sinister powers. Communities are calling them “Ojha” (exorcists/tribal healers) and they treat persons who are afflicted with various forms of evil magics. Ojha’s not only treat fever, pain, and other serious illnesses in tribal people, but they also assist the entire village's land to retain its fertility, which leads to good agricultural output. 

Apart from this, various myths and misconceptions are also predominant among tribal communities such as taboos related to menstruating girls/women. Due to several preconceived notions about the subject, women in some tribal societies still lock themselves away for five days during their menstrual cycle, eschewing food and all forms of comfort. Menstruating women are forced to sleep on the floor by the “Baiga” tribe. They are dealt with as patients, as though they had a contagious illness. Similarly, Contraception is forbidden in Kashmiri tribal communities known as Gujjar-Bakerwals in the Ganderbal district because they believe that God created children, whereas family planning interferes with nature. Their primitive culture keeps them together and forges beautiful emotional bonds among them, but it is also disappointing that in this contemporary social structure, indigenous peoples also maintain significant cultural variations from the rest of the population. These differences are present not only in spiritual practices but rather social, economic, and health systems too. 

Despite the fact that traditional tribal healers are not medically trained people but the tribal community regards them as competent to provide medical care and treatment utilizing substances extracted from plants, animals, and other natural resources and specific practices in accordance with social, cultural, and spiritual contexts as well as the experience, knowledge, and convictions which are prominent in the tribal community related to the physical, psychological, and social wellbeing coupled with the causes of illness and physical impairments. Traditional healing methods, rituals, and ceremonies vary across diverse tribal cultures and regions and are utilized by tribal healers in a broad spectrum. These practices often have deep-rooted cultural and spiritual significance, focusing on holistic well-being and harmony with the natural and spiritual realms. There are different kinds of traditional tribal healers. They can be informally classified based on methods of treatment into those who:

1. Carry out animal sacrifices and occult practices. 
2. Use only belief systems and tantric rituals.
3. Use herbs and faith (that includes mantras and certain rituals).
4. Use herbs to treat their patients.

Within traditional tribal healers there could be specializations with some healers only focusing on fractures, poisonings, or jaundice, and so on and so forth. Tribal healers deeply understand and respect the cultural values, beliefs, and practices of their community and offer personalized care, considering the individual's physical, mental, emotional, and spiritual well-being. These healers are often accessible and available to community members. They may hold regular sessions or visits to their practice spaces or travel to patients' homes, making healthcare easily accessible and convenient. They actively engage with the community by involving them in healing rituals, ceremonies, and gatherings. This inclusivity fosters a sense of belonging and collective healing. Tribal healers show genuine empathy and compassion towards patients, understanding their pain, suffering, and challenges. This compassionate approach creates a strong bond and trust within the tribal communities.

While they maintain a strong connection with their community, a linkage with modern healthcare remains incomplete for tribal healers. Recognition from modern healthcare systems, stigmatization, limited resources, and lack of formal training are often elusive for them, presenting challenges in collaborating with modern healthcare providers and advocating for their patients. Advancing the integration of traditional healing practices into modern healthcare systems can pave the way for acknowledgment, acceptance, and collaboration, thereby enhancing the preservation and transmission of these valuable practices.

The study design for qualitative research on traditional tribal healers and their healing practices was carefully crafted to capture the richness and complexity of their knowledge and practices. An Ethnographic descriptive cross-sectional study was conducted in 43 districts of 7 states with 1649 tribal healers which comprise of Herbalists (1071), Spiritual Healers (433), Diviners (105), Bone Setters (34), Traditional Birth Attendants (6) to collect qualitative information that aligns with the research objectives, such as phenomenology, ethnography, or grounded theory. The core objective of the study is to in-depth exploration of socio-demographic status of traditional healers, numerous ailments for which community seek their assistance, diverse techniques and processes employed in healing of diseases, and the scope of integration of these traditional healers with public healthcare. The research study was performed in the natural settings of different tribal communities in seven tribal dominated states namely, Chhattisgarh (30.5%), Jharkhand (26.0%), Odisha (22.8%), Madhya Pradesh (21.0%), Maharashtra (9.3%), Assam (12.5%) and Arunachal Pradesh (71.4%). Districts in such states was identified depending on the density of actively practicing tribal healers, cultural diversity, geographic accessibility, and population size of tribal communities. The most suitable approach for this project was the utilization of the "Exponential non-discriminative snowball non-probability sampling" method. In this approach, one respondent (either a tribal or faith-based healer) was initially identified from each tribal community. Subsequently, these respondents were requested to assist in recruiting one or more tribal/faith-based healers from the same or different tribal groups within the same district and state. The study took place with traditional healers who play a central role in community well-being and continue to practice their healing arts and known for their strong connection to nature, ancestral worship, and profound healing knowledge passed down through generations.  Access to the tribal communities and healers was facilitated through extensive engagement with community leaders and youth clubs. 

The study employed various assessment methods, such as unstructured interviews, observations, and record reviews, to delve into diverse aspects of traditional healing practices, community perspectives, and social norms associated with such practices. The utilization of multiple data collection methods facilitated the triangulation of findings, enhancing the robustness of the study. Interviews and interactive observations were conducted in the healers' residences or healing centers, patients' homes, and occasionally in public spaces like markets, temples, or gathering areas. Prior to data collection, the on-field team conducted a thorough review of the study objectives, tools, and specific data collection methodologies to ensure the acquisition of high-quality data in an effective and efficient manner. Additionally, field team extensively studied the tribes, cultures, customs, prevalent diseases, and health-seeking behaviors of the community to establish a solid foundation before engaging in interviews with the healers.

During the initial phase, the on-the-ground team faced difficulties in locating tribal healers. However, with the assistance of tribal councils, youth volunteers, and community leaders, the district coordinators were able to establish connections with the healers. Confidentiality concerns led some healers to initially hesitate in disclosing information about their traditional practices, patients, or opinions. However, through building rapport and engaging in professional and comfortable dialogue, the researchers were able to create a sense of trust, leading to increased participation and cooperation. The healers freely shared insights into their traditional tribal healing methods and provided valuable information about other healers they were connected to. This approach facilitated further engagement with subsequent research participants.

By the time of the mid-term assessment, over 400 interviews with tribal healers had been conducted. The team successfully addressed operational challenges and sought appropriate solutions. They were encouraged to continue reaching out to as many tribal healers as possible, ensuring comprehensive participation and data collection for the study. At the conclusion of assessment process concluded on July 15, 2023, the field team successfully gathered information from 1649 tribal healers across 43 districts in 7 states. Throughout the assessment, the district tribal health coordinators shared their valuable field experiences and highlighted the challenges they faced during the data collection phase. Notably, most interactions with tribal healers revealed their willingness to share their extensive knowledge and expertise acquired from their gurus, as well as their openness to learning new skills and practices, including those related to modern medicine. To ensure data integrity and security, all information collected on-site was carefully transferred to the digital tool, following necessary precautionary measures.

Socio-economic status

The survey primarily covered participants from tribal-concentrated regions: Odisha (30.6%), Chhattisgarh (26.7%), Jharkhand (24.3%), and Madhya Pradesh (10.1%). Interaction with healers from about 240 tribes revealed substantial diversity. Notable tribes included Gonds (n=211), Kandha (n=192), Murias (n=117), Santhal (n=89), Munda (n=76), Oraon (n=67), and Bhils (n=66). While each tribe showcased distinct variations in lifestyle, culture, and language, they shared a common tendency to seek traditional healing for various health issues.

The average age of tribal healers was 52.6 years (SD±11.9), with a significant majority (82.4%) being above 40 years old (n=1358). Literacy rates were suboptimal, with 43.2

Scheduled tribes, comprising 8.6% of India's population, are a diverse and vulnerable community. With 705 unique tribes, they possess distinct languages, cultures, and practices. Despite this diversity, tribal communities share a common reliance on traditional healers for healthcare. Traditional healers, leveraging indigenous wisdom and practices, use medicinal plants, rituals, and beliefs deeply rooted in their culture for health and healing. Belief systems, entwined with spirituality, shape these practices, influencing how communities perceive and treat diseases. These practices encompass tangible (herbal medicine, ritual objects) and intangible (skills, chants) elements in the context of illness. Additionally, traditional healing methods have defined roles, statuses, and behavioral norms within the community.

Socioeconomic status plays a significant role in shaping the scenario. Tribal healers, mostly older and male, lack socio-economic empowerment. The younger generation is hesitant to learn due to a lack of recognition and dwindling herbal resources from deforestation and displacement. Despite challenges, traditional healers are revered for their altruistic service, often accepting minimal offerings from patients. In remote regions with limited healthcare access, tribal healers are a preferred choice due to their availability, community ties, and cost-effectiveness. They extensively use herbs from forests and mountains, applying their knowledge of plants for various ailments. The challenge lies in preserving this traditional knowledge, especially due to dwindling interest among the youth and inadequate documentation.

Tribal communities possess a unique spirituality, distinct from mainstream religious texts, passed down orally across generations. This spiritual essence provides strength and solace during challenging times. Traditional healing systems, deeply ingrained in social interactions and cultural patterns, pass on knowledge of illness management from generation to generation. The challenge lies in documenting and preserving this knowledge for the future. Trust in the public healthcare system among tribal communities is low, driving them towards local healers. However, traditional healers lack formal recognition. Various NGOs and social institutions are assisting these healers, supporting their associations, sharing knowledge, and striving to integrate traditional healing practices with the existing health system. The decline in traditional healers is attributed to the younger generation's disinterest and migration, exacerbated by limited financial incentives and recognition.

Tribal communities' reliance on traditional healers for healthcare underscores the need to preserve and document this indigenous wisdom. Efforts are underway to support these healers and integrate their practices into the broader healthcare system, ensuring the continuation of this vital tradition.