Bay Doktor

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.

Biomedical doctors are doktor kot [book doctors] where they learn in a proper setting whereas we are doktor sla [leaves/plants doctor] whose knowledge has been passed down from one generation to the other. (FG2 KH028, M)

Bay Doktor

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Indeed, the codified knowledge bases and practices of doktor kot loomed large in the accounts of healers. Known departures from these bodies of orthodoxy were variously defended on the grounds of greater efficacy (in the examples above of specific local conditions) or, as here, by reference to local tradition and community norms. But if doktor kot was a constant referent for the healers in accounts of their own practice, there appeared to be little direct interaction between healers and biomedical doctors, and few opportunities for formal referral between the sectors. One exception was of referrals made in cases of suspected TB, which were encouraged through government-sponsored awareness programmes conducted as part of the DOTS (Directly Observed Treatment, Short course for TB) initiative, as well as the work of the local university, which had recently organised training workshops as part of a pilot project to training healers to become DOTS providers in rural areas. Healers reported that they had been eager to learn from this opportunity, but a few narrated conflicts with biomedical doctors at such meetings, and experiences of disrespect stemming from biomedical disdain for their knowledge:

I feel sad when I cannot treat a patient, but I tell them that if you feel that it is not helping you, come and inform me so that I can send (phah) you to another doktor sla or to a doktor kot. (FG2 KH030, F)

And if in a span of three days if the treatment does not help, we tell them to seek help [pyrshang] from others and not to waste their time and money with us. If I understand that I cannot treat this particular condition I tell them to go and visit doctors who are specialized in that particular condition like those doktor kot. (KH013, M) 2351a5e196