Practices of Healing in Tribal Gujarat

David Hardiman (D.Hardiman@warwick.ac.uk) is with the department of history, University of Warwick, UK. Gauri Raje is with the Centre for the History of Medicine, University of Warwick, UK.

SPECIAL ARTICLEMarch 1, 2008 EPW Economic & Political Weekly44parliamentary and state assembly seats. In Gujarat, for example, the tribal vote is crucial in 33 out of a total of 181 state assembly seats (18.23 per cent), which in a tight election may be enough to determine the result. For this and other reasons, different factions of the dominant classes have a strong interest in extending their hegemony over the tribal peoples, and health and healing provides one means towards this end. 1 Tribal Health and Healing in the PastEvidence from early missionary reports was evaluated, and it was found that in the past the tribal people of western India suffered from a wide range of diseases and maladies such as malaria, tuberculosis, smallpox, pneumonia, dysentery, worm infestation, eye infection and various skin complaints. There was a devastat-ing epidemic of cholera during a severe famine in 1900, and many died from influenza in 1918. This undermines the argument put forward by some historians that tribal people were in the past protected from many diseases by their isolation. The missionary evidence revealed that their hills and forests failed to safeguard them in this respect, no doubt because there was considerable ongoing communication and trade between the plains regions and the hilly areas of western India. Left to their own devices, the tribal peoples sought to cure such diseases and disorders in a range of ways. If a disease persisted for more than a day or two, the tribal people generally sought a cure from a ‘bhagat’, or ritual specialist. The bhagats had particu-lar skills in the use of various herb, root, tree or animal products in healing, and they would perform rites as they both extracted the plant from the forest and administered it to a patient. Thus, even a herbal preparation was seen not merely as a “natural” medicine for an illness located in the physical world, but a remedy that possessed numinous qualities that might be endowed with benign power through ritual. This duality was seen in other forms of treatment, such as cauterisation of the site of pain, applied with a red-hot iron. The rationale for this practice was that it drove away the malign spirit that was causing the problem, as such spirits feared fire. Exorcism, also carried out by bhagats, performed the same function. It was assumed that invisible forces or spirits pervaded the world, affecting the lives of the living. These forces were Janus-faced, being both benign and malign in differing proportions. The bhagatswere important figures in tribal society.1 Besides diagnosing and treating individual and collective illnesses, they also performed priestly rites on significant days of the calendar for household and village guardian spirits. They were in all cases male, as women were seen to be ritually polluting. In demeanour and appearance, they resembled any other tribal person. They understood their work as a form of devotion to their deities, describing it as their ‘bhakti’ (devotion). In this way, they believed that they were divinely granted their skills and power. There could be several ways in which a person started out on the route to becoming a bhagat – through dreams of particular deities, or the possessions of a person by specific deities of healing, death and divination. They subsequently had to serve an apprentice-ship under an existing bhagat, honing their knowledge of plants and forms of treatment. In tribal western India, any male could potentially acquire such skills. It was expected that they practise their craft in an ethically circumscribed and disciplined way, which involved periodic fasting, abstention from sex and alcohol, and a general avoidance of any conspicuous accumu-lation of wealth. Although the bhagats were highly respected and had consider-able influence and power within their own societies, colonial officials, missionaries and the western-educated Indian elites were invariably unsympathetic towards them and their healing practices, which they characterised as being based on superstition and a wrong understanding of disease and disease causation. The missionaries, indeed, depicted them “witchdoctors” or “wizards”, and often described them as their most difficult opponents. 2 EuropeanandAmerican Protestant MissionariesThe first missions to focus specifically on the tribals of Gujarat began work in the last two decades of the 19th century and first decade of the 20th century. The relevant missions were all Protes-tant – there were no Roman Catholic missions working in these tribal tracts until the 1960s. The Protestants were mostly British and American. They found that they could win sympathy and converts through medical work, and they therefore invested much energy and finance in establishing dispensaries and hospi-tals. They were the first people to provide biomedical care for the tribals – a healing system known to the latter as “English” (‘angreji’) or “foreign” (‘vilayati’) medicine (‘dawa’). In many cases, the missionaries lacked any formal medical qualifications, and travelled around the tribal villages providing basic remedies, such as quinine for malaria, the cleaning and dressing of wounds, and eye drops. In this way, they often managed to gain an ear for their preaching. It was in this way, for example, that the Ameri-can missionaries Amos and Flora Ross managed to gain a hold in the tribal villages around Vyara in South Gujarat in 1906.2 Despite being medically unqualified, they became known as “doctors”, and they quickly built up a flourishing medical practice.3In a few cases, missions were able to employ foreign doctors who established and ran hospitals that provided a much wider range of treatment, including surgery. Such doctors generally enjoyed a high reputation, which was based in part on their skill and in part on their religious identity. The fact that they prayed over patients when they provided cures or before they carried out surgery was particularly appreciated as a mark of their devotion to their own deity. In this, they were in accord with tribal notions of what constituted a legitimate healer. The main problem was that such clinical facilities were expensive to set up and run, and it was also often hard to obtain qualified doctors from the west. The Church Missionary Society hospital at Lusadiya, for example, was for many years run by nurses who could not provide any surgery, and only fairly rudimentary care, as no volunteer doctors could be found in Britain.It was found that the medical work of the missionaries also gave rise to complex local politics, with, in some cases, the bhagats seeking to defend their power by opposing the medical work of missions. On the whole, we found that the bhagats did not oppose the missionaries when they provided everyday remedies for a range of minor complaints, or even cured infectious

SPECIAL ARTICLEEconomic & Political Weekly EPW March 1, 200845diseases. However, in the case of a chronic malady for which the medicine of the missionaries was often less effective or took much longer to work, the bhagats generally believed that the cure lay in propitiation or exorcism, and that failure to act might expose their wider society to danger from malign forces. In such cases, the bhagats placed intense community pressure on the afflicted person, normally forcing them to undergo the relevant rites. In the case of a non-Christian tribal person, there was little that the missionaries could do against this; but if a convert was involved, intense and fractious battles often ensured between the missionaries and the tribal healers. These were examined, using rich material from the mission records.4 These struggles were most intense during the first three decades of the 20th century; thereafter, missionaries adopted a more relaxed approach, with a belief that the tribal people would be won over in time to “scientific” remedies through a process of education. As it was, they were unable to sustain any such medical education themselves, as in most cases, the mission hospitals were closed and the medical missionaries left India in the two decades after Indian independence.53 Nationalists By the early years of the 20th century a more westernised middle class was emerging in India that was taking advantage of biomedical treatment. Members of this class were trained in medical schools to practise biomedicine. Many were critical of the use that missionaries made of medicine to gain a foothold in the tribal areas. Nationalists went to work in the tribal areas from around 1918 onwards, carrying out social work of various sorts with the aim of winning popular support for their cause. In some cases, this involved handing out medicine, as during the severe influenza epidemic in the tribal belt of south Gujarat in 1918.6 We found, nonetheless, that health initiatives of this sort did not become a major feature of subsequent nationalist work in tribal Gujarat. The main emphasis for the Gandhian nationalists was on education, with schools and hostels being established for tribal children. They taught basic sanitary principles. Many such nationalists, following Gandhi himself, had a sceptical attitude towards biomedicine, favouring naturopathy.7 Another problem in this respect was that Gandhian nationalists were before 1947 almost entirely excluded from the extensive tribal areas under princely rule, so that they had no chance to carry out any sort of social work there. However, even after they were able to enter these tracts after 1947, no medical work was carried out in theearly years. It was only from the 1970s onwards that younger medically-qualified people associated with the Gandhian Sarvodaya movement began to provide biomedical care in certain tribalareas,andthey have carried out some excellent work in certain pockets. 4 Government-ProvidedHealthcare Before Indian independence the colonial state and princely rulers provided almost no biomedical facilities for tribal regions. The government of independent India sought to rectify this situation after 1947 through a programme of state-provided biomedical treatment in a network of primary health centres (PHCs). Jeffrey has argued that in India, in general PHCs were chronically under-funded and failed to provide adequate care for the mass of the Indian people [Jeffrey 1988]. A study of one PHC in a tribal area on the border between Maharashtra and Gujarat found that the system was operating to good effect, with a diligent local staff, but it was probable that this situation was the exception rather than the rule [Kamat 1995]. Other studies have found that PHCs provide a very poor level of care in most tribal areas [Ashtekar and Druv 2001]. There is absenteeism by staff, or, when they are present, they treat tribals with an attitude of superiority and contempt. High fees may be extracted for treatment, even though this contravenes government rules. Another set of questions relate to the medical and semi-medical campaigns carried out by the state, such as vaccination and inoculation programmes, and family planning drives that involve mainly female sterilisation and male vasectomy. In general, these “campaigns” have a reputation for poor planning and inappropri-ate and insensitive implementation, none of which builds confi-dence in government-provided biomedicine. In our research, we found that many of these criticisms of government-provided healthcare applied also to the tribal areas of Gujarat. In a case study of the Dangs district, we found that those employed at the understaffed government-run Ahwa Civil Hospital tended to lack interest in their work. It was common for the hospital to be staffed for stretches only by nurses, and no doctors. There was also very little medicine available at its pharmacy. There were six PHCs and numerous sub-centres in this district; as well as field level paramedical staff who were respon-sible for administering preventive health services, maternity services and providing a limited amount of curative medicine. One of the greatest points of popular mistrust of the public health system was found to be its provision of free healthcare, which, while availed of, is also widely regarded as being of low quality. There is a popular belief that if healthcare is available free of charge, the doctor lacks accountability, and the quality of medical advice and of medicine accordingly suffers. This is why private doctors are generally preferred to government ones. Indeed, many of these government health workers take advantage of their position to run private practices that make use of the government infrastructure. In the process, governmental health-care languishes.While we were carrying out our fieldwork in the Dangs district, the government was pouring a lot of the resources and energy of its health infrastructure into a polio eradication campaign. This campaign was commissioned by the World Health Organisation, with the aim of total global eradication of the disease, and government health officials implemented it. The campaign was conducted with great fanfare, with government jeeps driving about in clouds of dust, and with banners flying and posters plastered on walls. Women health workers toured the villages, recording the names of eligible children. None of this was new to the villagers, for over the past two years they had grown used to these strident campaigns. Many knew that the onus was on the officials to reach the required target, and that they would if necessary go house-to-house to administer the polio vaccine. Compliance, in most instances, was not a problem, as most appreciated the fact that government workers were coming to

SPECIAL ARTICLEMarch 1, 2008 EPW Economic & Political Weekly46their homes for a change. This in itself, becomes a moment of reversal for the Dangis, who are normally treated in an off-hand and brusque manner in the health centres. While health workers complain loudly about the “laziness” of the tribal who will not even walk to the polio booth in their village, many Dangis responded by noting that it was the one time that the ‘sarkar’ was meant to visit their homes, so why should we give up work in the fields or at home to wait in queues? A few Dangis, however, refused to accept any vaccination. These were in almost all cases members of the satipati sect. The sect stands for the self-assertion of tribal peoples, and non-cooperation with the Indian state, which is seen to be anti-tribal [Lal 1983]. Satipati households refuse to take government employment, buy cheap grain from government ration shops, use state transport for travel, or make use of government health facil-ities when ill. They actively refused to comply with the polio eradication campaign, arguing that its propagation by the state and its functionaries made it suspect. The health workers tried to persuade them to comply, arguing for the health benefits of vacci-nation, but they proved deaf to all such entreaties. There were rumours current within this sect that the polio vaccination campaign was in fact a surrogate form of mass sterilisation, or that it caused acquired immune deficiency syndrome (AIDS). The former rumour appears to have originated among church groups in theUS during the 1980s, with similar stories being current in West Bengal in the 1990s [Curtis 1992; Banerjea and Coutinho 2000]. The rumours about AIDS related to reports that the virus might have contaminated the polio vaccine that was widely administered in equatorial Africa between 1957 and 1960. This suggestion was published in a local vernacular daily in 2003-04. The local health authorities forced a retraction from the newspa-per, but by then, the damage had already been done. Many members of the satipati sect keep copies of this article in their homes, and produce it to justify their refusal to be vaccinated. This is all illustrative of the manner in which global debates on health and medicines are interpreted, translated and come to have specific meanings in local settings. 5 Private Biomedical DoctorsThere are now numerous people who practise as “doctors” in the tribal regions, only a minority of whom have full biomedical qualifications. What they share is a prestigious title – that of “doctors” – that gives them an entry into tribal villages. A range of these “doctors” were interviewed, some with legitimate medical qualification, some with qualifications that were inappro-priate for the practice of biomedicine (such as an ayurvedic or homeopathic degree), and some with no qualifications whatso-ever. Some of those with legitimate medical qualifications were themselves tribal people, and they tended to be very rooted in their community, and knew how to relate to their fellow-tribals well. The other “doctors” presented themselves in a very differ-ent way. They generally claimed to be able to provide “fast-working” cures for a range of illnesses. Some maintain clinics in villages, while others live an itinerant life, practising on roadside at village markets or peddling their services through the differ-ent villages. They were addressed locally with an honorific ‘Dr’ before their name, being distinguished in this way from other local healers, most notably the bhagats. While they have not displaced such diviners and exorcists, they exist alongside them providing an additional service for all those who choose to avail of it. Because of their limited training they tend to focus on a rather narrow range of treatments. In particular, they give injec-tions and administer glucose drips – treatments much in demand, even when not medically appropriate. When biomedical facilities of any sort are available – and in many cases they are not – tribal people will use them. It is, for example, widely believed that certain problems, such as fever and headache, yield well to biomedical drugs and injections. These are often described as ‘angrezi bimari’ or “English illnesses”. Nonetheless, while taking the “English medicine” from “doctors” – who may be qualified or unqualified – tribals will still consult their own ritual specialists so that the efficacy of the biomedical cure is enhanced with charms, ‘mantras’ and exorcism. Although it was found that some educated tribals had a better grasp of biomedical principles, the majority, including many educated tribals, continue to understand disease in this dual manner. One particularly notable belief that has developed in the tribal areas is that the strongest and most certain cure for many complaints is through an injection, as it provides a particularly “fast” remedy. Injections are thus demanded, even when not appropriate. This appears to have been a post-1940 development. When the mission doctor Margaret Johnson set up a health insur-ance scheme at Lusadiya in north-east Gujarat in 1946, injections were considered too expensive and exceptional a remedy to be covered by it – those who wanted one had to pay extra. Nonetheless, she also reported at this time that injections were becoming increasingly popular.8 By the late 1950s, she was reporting that villagers were commonly demanding “an injection and medicine” in the first instance. There was a strong belief that all that was required was a single injection.9 This had no clinical base, for biomedical practice requires that in most cases antibiot-ics and most other drugs be administered as a course of treat-ment – alone they might bring a seeming improvement, but fail to provide any long-term cure. Despite this, the belief in the power of the single injection soon spread to even the most out-of-the-way places. One doctor who volunteered his services within the Gandhian Sarvodaya movement was surprised to discover when he began his medical work in a remote tribal tract in south Gujarat in the mid-1960s that people who had almost no previous contact with biomedical doctors demanded “an injection” from him, regardless of his diagnosis. He tried his best to educate his patients as to when injections were necessary, and when they were not, and how they should be administered.10 He was unable to make many inroads into shaking this belief: anNGO doctor who today operates a regular travelling clinic in this area told us in an interview that the demand for injections is almost universal among the tribal people.11 Anyone who can give an injection is now a potential “doctor”. More recently, glucose drips have become increasingly popular, as again it is believed they provide fast-acting fortification and strength. A fertile ground has thus been created for flourishing practices in tribal areas by quacks

SPECIAL ARTICLEEconomic & Political Weekly EPW March 1, 200847wielding syringes and bags of glucose. Because of this demand, drugs – in particular, analgesics and antibiotics – are adminis-tered through an injection rather than in tablet form, at inevita-bly much greater cost to the patient. In recent years, there has been a marked increase in dubiously qualified “doctors” practising in this way in the tribal villages of Gujarat. In general, they rely on extensive social and political networking to secure local faith in their skills. As a career, it provides potential social status, and also good earnings, though it is inherently unstable. Their limited medical skills may be exposed when wrong diagnosis, inappropriate prescriptions or dosages, and possible allergies cause disastrous side effects, leading to a loss of reputation and sudden end to a career. We saw some such “doctors” breaking into a cold sweat when a patient suffered pain through a wrongfully administered injection or other form of treatment. They are also vulnerable to periodic directives by the district health bureaucracy against the malpractices of private doctors, which may lead to them having to curtail their practice, for a time at least. In some cases they maintain their influence over patients by giving them loans at high rates of interest (up to 50 per cent). For the patients, this is on a par with familiar modes of transaction with local shopkeep-ers or the economically and politically powerful people of their villages. Such “doctors” thus establish themselves in a patron-client relationship with their patients. 6 Traditional Healers TodayWith biomedical facilities remaining so poor in most tribal areas, and with a continuing belief in supernatural causation for many maladies, the bhagats continue to command a large tribal clien-tele. We found that many bhagats had an impression that in recent decades their practice had been compromised and that they were losing their healing power because of the destruction of the forest and the medicinal plants that were found there. One older and more respected bhagat who had been practising for nearly 50 years told us it was becoming increasingly hard to find plants in the forest, as it was being destroyed. Due to this, bhagats were becoming secretive about places where plants could still be found. Another problem was that the forest department now placed a high value on medicinal plants, and was trying to stop bhagats extracting them.12 This bhagat also voiced a common concern that many of his colleagues were developing an increas-ingly commercial attitude, and that they were exploiting the people for their own gain.13 Some bhagats had however managed to adapt to the times with panache. One such person was Mangubhai Bhagat of Shiva-rimal village in the Dangs. A large billboard at his house proclaimed that he was a “bhagat vaidyaraj” who could cure cancer, blood pressure, paralysis, diabetes, kidney stones, and sickle cell anaemia (vernacularised to “sicker”). While the claim to these cures was not uncommon among the other more “tradi-tional” bhagats that we had met, it was the conscious and strident advertising of the healers’ skills that was new. His particular novelty was however a ‘sauna’ bath (steam bath) that he claimed he had used to cure cases of cancer, paralysis and sickle cell anaemia. He charged his patients a fixed rate of Rs 60 per half hour to use the ‘sauna’, while having no fixed rates for divination sessions, as is usual among bhagats.14 He has become a contro-versial figure among other bhagats, as they feel that his practice has become overcommercialised. He has certainly earned very good money – enough to be the only Dangi to own a Scorpio – one of the most expensive Humvee-type cars in the Indian consumer market. He was critical of the more traditional bhagats, who he claimed had failed to move with the times. They were unable, he said, to cope with many new, imported maladies, such as diabe-tes, a complaint previously unknown in the region. Despite this, he still believed that disease and misfortune could be caused by witchcraft, and stated that he, like other bhagats, was able to divine cases of witchcraft. He held that tribal peoples were more prone to witchcraft than non-tribal people, simply because there were more persons in tribal areas with the knowledge and where-withal to carry out witchcraft practices. We, therefore, observed that Mangubhai not only attempted to incorporate elements of mainstream biomedical classification of diseases and their causes, but went further to highlight areas of illness that biomedicine was unable to take cognisance of. Other “modernising” bhagats were adopting a variety of strat-egies to adapt to the times. One had given up all forms of divina-tion and exorcism, and focused entirely on providing herbal remedies. He describes himself now as an ayurvedic doctor. The Shivarimal bhagat made no such claim to be a “doctor”. Signifi-cantly, he made a distinction between the divinatory and non-divinatory aspects of his practice, but did not deny that the core of his practice rather than just his training fell within the realms of bhakti. In that sense, unlike the bhagats who had begun to call themselves “doctors”, Mangubhai continued to call himself a bhagat. However, there were definite selective processes operat-ing wherein certain features of his learning and practice were foregrounded at the cost of others. Today, with biomedicine under increasing attack, traditional modes of treatment are attracting a new interest, including those of the tribal healers. Development programmes often call for an increasing awareness of the tribal heritage of healing. Increas-ingly, official health agencies are emphasising the importance of getting local practitioners on their side so that they can imple-ment their medical programmes more effectively. The state has started to run training programmes and workshop for bhagats. The bhagats have also been encouraged to establish associations of traditional healers so as to legitimise their practice. Most bhagats, however, suspect such programmes as being a cover for attempts by the authorities to wheedle knowledge of medicinal plants from them for exploitation by outsiders. Because of this, little has come of such initiatives. Some of the more significant and popular of the private “doctors” are now strong rivals to the bhagats, offering medicinal cures that claim to heal faster and with fewer restrictions on dietary and lifestyle restrictions. The private biomedical “doctors”, for their part, have learnt to relate to their patients in an informal way similar to the bhagats. Most of these “doctors” refrain from overtly criticising the indigenous healers, and never dissuade their patients from seeking advice and divination sessions from them. As one such “doctor” explained: “Divination

SPECIAL ARTICLEMarch 1, 2008 EPW Economic & Political Weekly48practices are a matter of belief for the patient, and if it helps them cope with the illness or gives them hope in getting well, what is the harm?”. However, they do not hesitate to criticise the more severely ill patients who did not approach their clinics first on falling ill. They also criticise the bhagats in various subtle ways when providing treatment. 7 Non-GovernmentalOrganisations Continuing in the tradition established by the missionaries, many non-governmental organisations are now involved in health projects of one sort or another in tribal areas. Some are purely secular, but a growing number have religious and political affilia-tions. We found that they are faced with a variety of local problems, and that they adopt many different approaches to healing. Some adhere strictly to biomedicine; others are more eclectic in their approach. Much depends on the particular ideological leanings of each group. Some are much more successful than others. In certain cases dedicated work by committed doctors has achieved admirable results in particular localities. It is not evident, however, that such models can be duplicated on a wider basis, given the severe lack of such dedicated medical workers in India in general. Also, what happens when the committed doctors who run such projects retire or depart the scene? Some NGO health workers spoke about the problem of provid-ing healthcare in areas in which a large number of poor tribal people migrate out of the area on a seasonal basis, only returning to their villages during the monsoon. MostNGOs and other health projects are village-based, which means that migrants have no access to such facilities for most of the year. Being considered “non-residents” in the plains regions where they work, they are unable to access effective healthcare there. The migrant work camps are also very unhealthy and insanitary places, with no protection from mosquitoes, and corresponding high rates of malaria, including the potentially lethal falciparum variety of the disease. The harsh working conditions also undermine the health of migrants, and they are often unable to sustain many seasons of such work.We also found that the government has been depending increasingly onNGOs to carry out fundamental health work in India. In this, the Indian government is merely following wider directives laid down by bodies such as the World Bank and World Trade Organisation that have an ideological commitment to decreasing governmental welfare programmes. Funds are being increasingly channelled into theNGO sector. This allows for the proliferation of many sub-standard, or even bogus NGOs. It also absolves the government of responsibility for healthcare. The NGOs may lack the appropriate qualifications and facilities for the tasks they take on, and they are also not accountable to the electorate. Although it is clear that government health projects are often mistrusted – for good reason – it is clear that NGOs can never be an adequate substitute for systematic health schemes implemented by the state.One important development in recent years has been the growth ofNGO groups that are sponsored and financed by Hindu religious organisations. The very influential Swaminarayan sect has, for example, been reaching out to tribal people in a concerted way in recent years. For example, one of its sadhus, P P Swamy, was sent to the Dangs district in 1998 to start work amongst the tribal people there. He established anNGO project that soon attracted government funding. He is involved in health activities, including anHIV awareness project. Various organisations connected with what is known as the Sangh parivar have also become active in tribal areas. One such organisation is the Vanvasi Kalyan Parishad (vKP), first founded in 1952 and which now claims to have active units in 20,000 villages in 276 districts of India that have tribal populations. It seeks, according to its website, “to wean the vanvasi (tribal) away from the evil influ-ences of foreign missionaries, anti-social, and anti-national forces”. As the missionaries found a century before, philanthropic activities provide a point of entry into tribal villages. ‘Dharma raksha samitis’ (religious protection committees) are formed, which organise religious discourses and song-worship sessions. Their members are given calendars adorned with Hindu deities and they are encouraged to celebrate Hindu festivals that are unfamiliar to tribals [Baviskar 2005].This organisation is active in certain tribal areas of Gujarat. Although it focuses mainly on educational work, it also runs medical clinics and mobile medical vans.15 We observed one mobile service run by the VKP in the Dangs. It began operating in 2001, and initially provided a relia-ble service. In recent years, however, its visits have become infre-quent and unpredictable. The biomedicine that is dispensed is very limited, and seems to consist mainly of injections. In this respect, it resembles the sort of inappropriate medical care provided by quack “doctors”. It hands out unreligious propaganda to the people who come for treatment, and patients are required to bow before the god Rama prior to being treated. On the whole, the people of the Dangs have no faith in these clinics, as they see that they have an ulterior purpose. The VKP workers talk openly of using healthcare to counter the Christians, and this seems to be almost their only rationale. Even the Rashtriya Swayamsevak Sangh (RSS) president in Navsari was dismissive of the medical work of the Sangh parivar, stating in a conversation with us that it was not a major element of their tribal work. More important, he said, is the more purely religious side to their activities. On the whole, therefore, theNGO health work of Hindu fundamentalist organisations is less important than we initially supposed it might be. 8 Christian Faith Healing By the 1960s it had become clear that medical missionaries had to a large extent failed to provide a distinctively Christian approach towards healing the sick. Their approach was rooted in a scientific medical practice that might have evolved in Christian lands, but had soon freed itself from that connection as it spread throughout the world in the 19th and 20th centuries and became a largely secular practice. In tribal Gujarat, their medical work had won much sympathy, but it had failed to bring about any large-scale conversions to Christianity. In 1961, there were a total of about 10,500 Christians in the tribal areas of Gujarat in which the Protestant missionaries had been most active, representing about 11.5 per cent of all Christians in Gujarat as a whole (the

SPECIAL ARTICLEEconomic & Political Weekly EPW March 1, 200849large majority of Gujarati Christians were from a dalit background and were concentrated in central Gujarat). The total tribal population of Gujarat in 1961 was 2,064,522, so that only about 0.51 per cent were Christians. It was in this context that new missionary initiatives were inaugurated, with greater success. During the 1960s, the Roman Catholic Church began for the first time to open up missions in the tribal belt in Gujarat. They estab-lished dispensaries staffed by nuns, rather than full-fledged hospitals. The focus was on providing basic primary biomedical healthcare that was largely free to patients. The nuns also toured the villages treating people and giving out medicine.16 To a large extent, this work followed the same pattern as that of earlier Protestant denominations, the difference being that the Roman Catholics had the funds and personnel – in particular nuns who were often from south India – to make an impact at a time when the older Protestant missions were winding down their health activities. The other initiative, which was to have the greater success, was by some Indian Christians from Tamil Nadu, working through an evangelical denomination called the Friend’s Mission-ary Prayer Band (FMPb). Arriving in the 1970s, they soon began to win converts on a significant scale, largely through faith healing of the sort that had been developed elsewhere by the Pentecostal churches. A belief became widespread that those who had converted enjoyed better health and a new prosperity, and soon large numbers were coming forward [Dasan 2000]. Ebenezer Dasan, a Tamil priest of theFMPb who worked for many years as a missionary in the Dangs, described its work as providing a “power encounter” with Christ, in which Christ healed the adivasi converts, expelled evil spirits that were blighting their lives, reformed their morals and ethics, broke the hold of the bhagats, and allowed them to stand up to the shopkeepers who exploited them (ibid p 162). Whereas, the older Protestant denominations had deployed biomedicine so asto gain a sympathetic audience for their preaching in tribal villages – rather than as an active tool for mass conversion – the FMPB sought primarily to heal through prayer so as to reveal the compelling spiritual power of Christ. Stories of conversions through such means lay at the heart of their proselytising work. Once they were converted, Christians generally stopped going to the traditional bhagats for treatment. Nonetheless, when biomedical treatment was needed, the pastors did not discourage them from seeing doctors.The other important Christian mission in tribal Gujarat was that of the Pentecostalists, who are known locally as the “Halle-luiahs”, due to their frequent repetition of this refrain in their worship. They began to have an impact in the 1980s, slightly later than theFMPB. By the 1990s they were holding monster rallies, with up to 50,000 tribals coming each day. This attracted the attention of the Hindu right, with adverse consequences. In 1998, there was a wave of violence instigated by Hindu fundamental-ists against Christians in the Dangs, and since then, there have been no large rallies of that sort.17 Pentecostalist are wary of being questioned by researchers – understandably, given this history – which makes investigation of their work difficult. Nonetheless, we managed to meet some of them and attend their meetings for worship in the Dangs in 2005 that incorporated healing testimonies (‘sakshi’). Although outsiders, who were mainly missionaries from south India, brought the Pentecostal church to tribal Gujarat, it is now largely run and financed by the tribal peoples themselves. They stress that they became Chris-tians entirely of their own free will, implicitly countering the criticism of the Hindu right that poor tribals are duped into converting through the allure of foreign funds. Conversion was seen as providing a means to transform their lives for the better, in which they abandoned the old wild ways of traditional tribal life, and became sober, hard-working and god-fearing. They had, clearly, entered into a bargain with god – if they gave him their faith, he must in turn give them benefits. God had accepted these terms by bestowing on them good health and prosperity. There is a strong emphasis on the healing of all maladiesandsicknessesthrough the power of faith alone. They consider that malign forces cause ill-health, and that these forces can be countered through prayer and faith. The belief in evil forces clearly accords with existing tribal perceptions, though the remedy for Christians is no longer divination and exorcism by a bhagat, but prayer to god. Because of their strong beliefs in this respect, they do not, as a rule, provide any support for healthcare activities. There is a sharp contrast here with the older Protestant denominations, the Catholics, and even the FMPB, which has in recent years supported initiatives in providing biomedical healthcare. In tribal Gujarat, however, Pentecostalists for the most part continue to adopt a fundamentalist approach –theuseofbiomedicine is seen as a sign of moral failure, to be avoided as much as possible. 9 ConclusionBefore the coming of the missionaries, power conflicts over health and healing were largely internal to tribal communities, often revolving around accusations of witchcraft. The bhagats exercise considerable power in this respect, as they were consid-ered to have the ability to discover witches through divination. The missionaries, after they arrived, believed that the bhagats would soon be discredited when the tribal people realised the superiority of their scientific medicine. As it was, the tribal people continued to believe that evil spirits, divine displeasure, or witch-craft caused many maladies, and they continued to utilise the services of the bhagats. Official biomedicine, as provided in government clinics in the years after independence, made no serious inroads into the tradi-tional forms of healing, due to the low quality of what was provided and frequent staff absenteeism. The government presence was felt more in spasmodic health campaigns. Although the existing literature suggests that these could at times be highly oppressive, especially when they involved family planning, our research found that the recent polio vaccination programme saw, if anything, power shift to the side of the tribal people, as government officials had to cajole them into compliance due to their need to reach bureaucratic targets. Even then, some refused vaccination, deploying a number of rumours about the vaccine that had gained international currency. In this case, a global system of communication provided a new rationale for tribal self-assertion.

SPECIAL ARTICLEMarch 1, 2008 EPW Economic & Political Weekly50The main rivals to the bhagats within the villages today are the private “doctors”, the majority of whom lack adequate training and qualifications for the medicine that they practise. They are able to gain a foothold because their services are in demand for a particular kind of “fast” cure. They do not set themselves up as competitors against the bhagats as such, whom they accept have the ability to cure certain maladies in psychosomatic ways. Although they maintain something of a patron-client relationship with their patients, as when they provide loans at high rates of interest, their position is inherently instable, due to their lack of qualifications, limited abilities and periodic official clampdowns on quacks. They have to be sensitive to local opinion, maintain-ing their position through their personal appeal. Although they clearly exploit the tribal people, charging high amounts for very simple and cheap medication, it is not an altogether one-sided relationship of power. We found a situation in which three forms of understanding of disease causation and healing coexist as paradigms that constantly interact without any displacement of one by another. These three forms are, first, modern biomedicine as practised by Notes 1 In some parts of tribal Gujarat such people are known as ‘buvas’; in this paper we shall however refer to them generically as ‘bhagats’. 2 The Missionary Visitor, Vol 28, No 3, March 1926, p 69. 3 Annual Report (Church of the Brethren), to March 31, 1907, pp 10-11. 4 For further details, see Hardiman (2006), pp 137-67. 5 Of a total of eleven Protestant mission hospitals in Gujarat, six closed between 1956 and 1966 due to lack of funds, leaving only five remaining. Boyd (1981), pp 189-90. 6 The severity of this epidemic is described in detail in Stover (1919), pp 64-74. For nationalist health work during this epidemic, see Bhatt (1970), pp 320-21. 7 Interview with Prabhodh Joshi in Vyara. He was a leading Gandhian social worker in the tribal belt of Surat district and a firm believer in naturopathy. 8 ‘Mrs Johnson Writes’,Church Missionary Society Report of the Mission to the Bhils for the Year 1946, Mission Press, Surat 1947, p 16. 9 Report of the Lusadia Mission Hospital and Biladia Dispensary for the Year 1957, Wesley Press, Mysore 1958, p 8. 10 Interview with Dr Navnit Fozdar, Gora Colony, Kevadia, Narmada district, December 8, 2004.11 Interview with Dr Daxa Patel, Dharampur,Navsari district, December 2, 2004.12 Ramalyabhagat, Bhendmal, Dangs district, May 2005.13 This has been observed of traditional healers elsewhere. Commercialisation is, for example, said to have brought a loss of confidence in the ‘nyanga’ healers of Mozambique, providing an opening for Pentecostalist groups [Pfeiffer 2005]. 14 Mangubhai, Shivarimal, Dangs district, April 2005.15 www.hinduwev.org/home/seva/vanvasi/vanvasi.htm 16 Suria (1990), Interview with Fr Valentine deSouza, Baroda, December 21, 2002. Fr de Souza was one of the pioneers of the Catholic mission to the tribals of Gujarat. He was sent to work at Vyara in 1961.17 Interview with Valentine de Souza, Baroda, December 21, 2002. ReferencesAshtekar S and M Druv (2001): ‘Who Cares? Rural Health Practitioner in Maharashtra’,Economic & Political Weekly, 36, 5 and 6, p 449.Baviskar, Amita (2005): ‘Adivasi Encounters with Hindu Nationalism in MP’,Economic & Political Weekly, 40, 48, p 5108.Banerjea, N and L Coutinho (2000): ‘Social Produc-tion of Blame: Case Study of OPV Related Deaths in West Bengal’,Economic & Political Weekly, 35, 8 and 9, pp 709-17.Bhatt, Anil (1970): ‘Caste and Political Mobilisation in a Gujarat District’ in Rajni Kothari (ed), Caste in Indian Politics, Orient Longman, New Delhi, pp 64-74.Boyd, Robin (1981): Church History of Gujarat, The Christian Literature Society, Madras, pp 189-90.Curtis, T (2000): ‘The Origin ofAIDS: A Startling New Theory Attempts to Answer the Question, Was It an Act of God or an Act of Men?’,Rolling Stone, pp 54-60. Dasan, Ebenezer D (2000): ‘Conversion and Perse-cution in South Gujarat’ in Krickwin C Marak and Plamthodatil S Jacob (eds),Conversion in a Plura-listic Context: Perspectives and Context, ISPCK, Delhi, pp 161-64.Hardiman, David (2006): ‘Christian Therapy: Medical Missionaries and the Adivasis of Western India, 1880-1930’ in David Hardiman (ed), Healing Bodies, Saving Souls: Medical Missions in Asia and Africa, Editions Rodopi, Amsterdam and New York, pp 137-67.Jeffrey, R (1988): The Politics of Health in India, University of California Press, Berkeley, pp 170-71 and 261-80. Kamat, V (1995): ‘Reconsidering the Popularity of Primary Health Centres in India: A Case Study from Rural Maharashtra,’Social Science and Medicine 41, 1, pp 91-92.Lal, R B (1983): ‘Socio-Religious Movements among the Tribals of South Gujarat’ in K S Singh (ed), Tribal Movements inIndia, Vol II, Manohar, New Delhi, pp 299-303.Ross, Amos W (1926): Early Days of Vyara: Experiences among the Simple-Hearted Country People of India in the Successful Endeavour to Build a Christian Church, Brethren Publishing House, Elgin, Illinois, p 21.Pfeiffer, James (2005): ‘CommodityFetichismo, the Holy Spirit, and the Turn to Pentecostal and African Independent Churches in Central Mozam-bique, Culture Medicine and Psychiatry, Vol 29, p 257.Stover, W B (1919): One Year’s Visiting with our Missionaries in India: A Story, Brethren Publishing House, Elgin, Illinois, pp 64-74.Suria, Carlos (1990):History of the Catholic Church in Gujarat, Gujarat Sahitya Prakash, Anand, pp 369-70, 394-99, 404-20.people who are known popularly as “doctors” – who may work for the state or be in private practice, and may be fully qualified, partially qualified, or without any recognised medical training, second, healing by bhagats and other such traditional healers, and third, the practice of Christian faith healers. None of the three has had the power to entirely displace the other, so that they exist in a situation in which each has to elicit support. Thishelps to enhance the power of the patient as against that of the practitioner. Conventional narratives of medical progress have maintained that in time – as education and scientific understanding advances – belief in supernatural causation will give way to an understanding of disease primarily in physical terms, requiring an adherence to biomedical forms of healing. The present research shows that this has not been the case in tribal Gujarat. Each of these three very different 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 healthcare system exists as it does, it seems unlikely that there will be any significant change in this respect. Call forPapers Announcing a Special Issueon ‘Community Organisation in India’ in Community Development Journal, published by Oxford University Press.The journal provides aninternational forumfor discussing political, economic and social issues and covers a widerange of subjectsincluding community action, local and regional planning, community studies and rural and tribal development.This special issue critically explores contemporary debates and dilemmas,ideological dimensions of community organization and strategic and practice innovations in India. Those interested incontributing tothis Special Issue should send anAbstract(500 words) and article outlinenolaterthan March 31st, 2008 toour Guest Editor Professor Janki Andharia, Tata Institute of Social Sciences, Deonar, Mumbai, India, 400 088.Email: andharia@tiss.edu, jankiandharia@gmail.com