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The practice and meanings of spiritualhealing in NepalAsha Lal Tamang a & Alex Broom ba School of Humanities and Social Sciences, University ofNewcastle, Newcastle, Australiab Discipline of Behavioural and Social Sciences in Health,University of Sydney, Sydney, Australia

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To cite this article: Asha Lal Tamang & Alex Broom (2010): The practice and meanings of spiritualhealing in Nepal, South Asian History and Culture, 1:2, 328-340

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South Asian History and CultureVol. 1, No. 2, April 2010, 328–340

ISSN 1947-2498 print/ISSN 1947-2501 online© 2010 Taylor & FrancisDOI: 10.1080/19472491003593084http://www.informaworld.com

RSAC1947-24981947-2501South Asian History and Culture, Vol. 1, No. 2, Jan 2009: pp. 0–0South Asian History and CultureThe practice and meanings of spiritual healing in NepalSouth Asian History and CultureA.L. Tamang and A. BroomAsha Lal Tamanga and Alex Broomb*

aSchool of Humanities and Social Sciences, University of Newcastle, Newcastle, Australia; bDiscipline of Behavioural and Social Sciences in Health, University of Sydney, Sydney, Australia

Most of the Nepalese population use various forms of traditional medicine (TM) as theirprimary form of health care. Biomedical health-care services are currently extremely lim-ited and are largely situated in urban settings. Despite widespread reliance on TM in con-temporary Nepal, we know relatively little about the roles and uses of traditional medicineand the sociocultural impacts of a diverse therapeutic landscape. Drawing on a series of in-depth interviews with eight Nepalese spiritual healers, this article explores the character ofspiritual healing; processes of training and knowledge transfer and the interplay of bio-medicine and spiritual healing. The results illustrate the importance of metaphysical refer-encing and the master–disciple tradition in securing the socio-medical authority ofspiritual healers and the protection of ‘the art’ of healing. Furthermore, their accountsreflect the impact of recent biomedically driven development programmes on the contem-porary practice of spiritual healing in Nepal. We use this data to argue for further researchto examine interplay of different forms of TM and biomedicine in Nepal, and to illustratethe importance of such an understanding for health development projects in the region.

Keywords: spiritual healing; Nepal; biomedicine; health care; traditional medicine

IntroductionIn recent years global health policy has increasingly recognized the diverse health-caresystems in developing countries, and there has been a renewed focus on promoting tradi-tional practices in conjunction with biomedicine within health development programmes.1The perceived accessibility, affordability and ‘cultural appropriateness’ of traditionalhealth systems2 are important factors in arguments for a policy of ‘integration’ rather thanbiomedicalization in developing countries. Given this current trend in policy, social scien-tists have become interested in the issues surrounding this contemporary health-care ‘plu-ralism’, including potential patterning in population usage of different therapeuticmodalities and the (in)commensurability of tradition and biomedical philosophies ofcare.3 This work, among others, has illustrated the important role of traditional medicine(TM) in the context of various health problems, but, importantly, problems associatedwith inter-professional conflict4 and population inequalities in access to forms of care.5

The sociology of TM is beginning to illustrate the complexity of health-care ‘plural-ism’ in developing countries, and the relationships between TM and biomedicine develop-ment in grass-roots contexts. However, despite the prominence of TM in Nepal and recenthealth development work focusing on promoting ‘multiple systems of medicine’,6 there hasbeen no sociological research examining the roles of traditional healers in Nepalese society.

*Corresponding author. Email: a.broom@usyd.edu.au

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In this article, we explore some of the roles played by TM in Nepal from the perspective of aselect group of spiritual healers. It is argued that while traditional beliefs, including notionsof spirit possession (metaphysical referencing) and lineage-based training systems (versusthe master–disciple tradition), potentially conflict with techno-scientific ideology/training,mutual respect for professional difference, evident in these healers’ approaches to biomedi-cine, will be critical for coexistence of such diverse therapeutic modalities.

Background: Nepal in contextIn order to conceptualizse the positions of the various therapeutic modalities in Nepal it isfirst necessary to introduce its cultural landscape. Nepal is home to more than 100 differentethnic groups who follow more than eight religions.7 Add to this the political divergencesbetween different groups (those supporting the recent insurgency and those in opposition)and one begins to see the highly complex socio-political landscape of contemporaryNepal. Nepal’s therapeutic diversity is in turn embedded in its diverse social, cultural andphysical environment, with huge differences evident in local climate, culture and politicalorientation in regions relatively close geographically. This diversity also manifests inhealth service delivery, both in terms of ideology (support for traditional versus modernsystems) and structural constraint (access to forms of care).

Another factor in Nepal’s plural medical system is the influence of the recent civil con-flict. Ten years of civil war between Maoist rebels and government security forces resultedin major civil violence and isolation, with even greater reductions in the provision of healthservices.8 Even larger numbers of people living in rural areas were cut off from formalizedbiomedical health-care services,9 and traditional healers provided (and continue to provide)health-care services to the majority of the Nepalese population. Their central role emergesfrom a long history of reliance and support for TM in Nepalese society.

Nepalese traditional medicineVarious religious documents and oral traditions indicate that TM has been used amongNepalese people from the ancient period.10 Ayurveda, originating in Vedic times around5000 BC, has a strong cultural heritage.11 Ancient scholars used to travel frequently fromone state to another in search of medical knowledge, educating their then rulers andpeople.12 According to historical records, Nepalese kings used to promote Ayurveda, andthe Lichhavi kings in the fourth to seventh centuries established Ayurvedic hospitals.13

The Malla kings of the Kathmandu valley, who ruled up to eighteenth century, also sup-ported the development of Ayurveda, and King Pratap Malla (AD 1641–1674) establishedan Ayurvedic dispensary during the mid-seventeenth century at the royal palace inKathmandu.14 Other major forms of TM practised in Nepal include Amchi, homeopathyand spiritual therapies. Amchi or Tibetan medicine is a healing practice popular in theupper Himalayan region15 and homeopathy is practised often in urban areas.

Spiritual therapies, the specific focus of the study reported here, are the most commonform of Nepalese TM and they are central to the everyday life. They are more dominant inrural areas and a large proportion of the population depend almost exclusively on spiritualtherapy practitioners. Spiritual therapy practitioners, known generally as ‘traditional heal-ers’ or ‘spiritual healers’, follow a range of ethno-traditional, tantric, spiritual and Ayurvedictraditions.16 They can be broadly divided into dhami-jhankris, pandit-lama-gubhaju-pujarisand jyotishis.17 The dhami-jhankris are Shamans, pandit-lama-gubhaju-pujaris are priestsof the different ethnic and religious groups and jyotishis are astrologers.

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The Nepalese health-care system: formal/informal sectors and the master–disciple traditionBiomedicine and TM are both to some degree incorporated into the Nepalese nationalhealth-care system. The Department of Health Services provides biomedicine services andthe Department of Ayurveda, established in 1981, is responsible for delivering, providingand regulating TM services. At a policy level, the Nepalese government acknowledges theimportance of incorporating TM into its national health-care system. The Nepalese NationalHealth Policy adopted in 1991 emphasized the need to develop a primary health-care systemthat combined biomedicine with non-biomedical locally supported practices includingAyurveda, Unani and homeopathy. Despite policy-level acceptance of the importance oftaking a multi-modality approach to support Nepalese health needs,18 little progress has beenmade and the limited state-supported health services are largely biomedical in character. Thecontemporary formalized Nepalese health-care system does not recognize many of thewidely used traditional healing systems including spiritual therapies.19 Most South andSouth-East Asian countries have, to some extent, formalized/legalized forms of traditionalmedicine, yet only Indonesia has included spiritual healing within its national health-caresystem.20 Spiritual healers form part of the extensive private health sector in Nepal – a sectorwell beyond the government’s reach in terms of regulation or accreditation.

The ‘professionalization’ of biomedicine and selected Nepalese TMs took place virtu-ally concurrently. For example, biomedicine was formally established in Nepal in 1889with the construction of the Bir Hospital in Kathmandu whereas the Naradevi Ayurvedahospital was established in 1917.21 To train traditional practitioners, an Ayurveda teachingcampus was opened in 1928 within the Naradevi Ayurveda hospital. This became the firstformal health professional educational institution in Nepal. The formalized teaching ofbiomedicine came much later in 1972 with the establishment of an Institute of Medicinewith the assistance of Japanese government. Despite its late entry, biomedicine expandedquickly, becoming the government’s priority programme, and gained momentum throughfinancial support from other countries and the World Health Organization. With a surge inthe centrality of biomedicine at a health development level, Ayurveda and other traditionalhealing practices maintained a relatively low profile in state policy as a ‘conserved’programme in the national health-care system.22

At a grass-roots level the Nepalese people continue to strongly support and use TM, withan estimated 400,000 traditional practitioners currently practising.23 The limited researchavailable indicates the importance of and support for TM, with one study finding that beforecoming to a biomedical health post, 64% of people have already visited a traditionalhealer.24 However, research also indicates that use of TM in Nepal is highly differentiatedand situated in structural forms of inequality. Disadvantaged groups have been found to visitthe traditional healers much more frequently than the general population,25 and geography,caste and class may each play critical roles in the mediation of health-service use.

While formalized systems of training in traditional medicine have developed, informalsystems dominate with lineage and metaphysical prowess (possession and contact with thespirit world) central to the transmission of healing through the master–disciple tradition.26

Through this process, the knowledge of traditional Nepalese medicine has been transmit-ted and evolved from generation to generation, with some healers currently practising whoare the 23rd generation in their family.27 In a context of civil violence and geographicalisolation, the master–disciple tradition is an important cultural practice for maintainingtraining systems and community regulation of therapeutic practice in isolated regions.Moreover, and as shown in this article, the master–disciple tradition places control of

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health practices/knowledges firmly in the hands of traditional healers rather than the state(e.g. through formalized training programmes and regulation), protecting traditional local-ized knowledge and skills from co-option, translation and forms of modern forms ofrationalization.

MethodsThe study was carried out in two rural villages in eastern Nepal. We focused on the mean-ing and importance of traditional healing practices from the perspectives of traditionalhealers themselves. This formed part of a wider sociological study on the health and socialimpacts of civil conflict in Nepalese society. Data collection took place between July 2008and June 2009 and we completed in-depth interviews with eight healers for 1–1.5 hours.Informal discussions with clients and observations of spiritual healing sessions were alsoconducted. With the permission of the participant, the interviews were digitally recordedand subsequently fully transcribed and translated into English. The interviews were rela-tively unstructured, exploring the basis and character of spiritual healing practices, theroles of traditional healers in Nepalese society and the dynamics between traditionalhealers and biomedicine in Nepal.

The methodology for this project draws on the interpretive traditions within qualitativeresearch, focusing on establishing an in-depth understanding of the experiences of therespondents. This involved taking a comprehensive and exploratory approach to data col-lection, aimed at documenting both the subjective and complex experiences of therespondents. The aim was to achieve a detailed understanding of the varying positionsadhered to, and to locate these within a broader underlying beliefs and/or agendas. Theapproach was developmental, in that knowledge generated in the early interviews waschallenged, compared with and built upon by later ones.

ResultsTraining, knowledge transfer and social responsibilityIn the interviews we explored the character of Nepalese spiritual healing and how it ispractised and taught in rural Nepalese culture. It emerged that spiritual healing was largelyviewed as a gift from the gods or supernatural forces. Moreover, this spirit was often afamily spirit, passed on from a healer (guru) to their son (or disciple). While the gods werenot always critical to the actual everyday practice of healing (i.e. there were establishedprocedures to treat various conditions that may not reference any metaphysical processes),the ability to heal was viewed as emerging from a supernatural source. While there werecases where healers were merely skilled, most had a supernatural source telling them to actin certain ways and giving them advice on how to heal people. Distinctions were made in theinterviews between such healers. A person who has learnt spiritual healing supernaturally iscalled a dhami and a person who is trained in the skill of healing (i.e. without direct super-natural guidance) is called jhankri. However, in the majority of cases, healers are trainedby a healer and have supernatural powers and thus healers are commonly known asdhami-jhankris. The distinction between those with direct supernatural influences andthose without direct contact is a form of ascribing legitimacy and potency in the context ofa range of forms of knowledge transfer and skill acquisition. Regardless of the influenceof supernatural powers, healers were taught by a guru (master) as a shisya (disciple). Themain guru has supernatural power or is an experienced traditional healer (or both). The

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following excerpts taken from respondents illustrate some key elements to the practiceand training of spiritual and traditional healing:

Traditional Healer: I am a Jhankri. I learnt from Baidhang [scripture]. I am the fourth gen-eration in our family. We have a hand written Baidhang from my father’s grandfather. We donot know from where he got this Baidhang. The Baidhang has explained different problemsand mentioned ways for curing such problems. The curing methods include both Mantras andJadi-Butis [local substances, herbs and plant roots]. I did not learn from lineage gods. I learntfrom Baidhang and I also have made disciples. One disciple is in Dhankuta. Another is inHasandaha. 10 to 15 disciples are in the hills. Disciples are increasing and patients are cured.Until now, I have not heard something had gone wrong because of this work. To become adisciple you should have evidence of Jhankri: a kind of sickness to become a Jhankri. It takesabout 5 to 6 months to train a disciple. However, anybody can learn Baidhang.

Another respondent:

Traditional Healer: An old man came and taught me Mantras in my dreams. He asked me touse it to cure patients. I have practised it to help many people. My maternal grandfather was aDhami. It is said at least one member of family is followed [by the deceased Dhami] tobecome a Dhami. Mantra should not be taught everyone. It can be taught to a disciple or to afamily member before my death…You can learn Mantras only if the god likes you. First, godmakes you sick. Then, if you could identify him you can learn Mantras and become aDhami… I use only one Mantra. But methods of applying it are different according to theproblems faced by a patient. My Guru taught me the methods. I did as said by my Guru and itcured patients. I have improved it by using for many years with many patients. When I closemy eyes and ask my Guru, a kind of shadowed figure appears and I can hear holy voicesinstructing me the things to be done for a sick person.

Another respondent:

Traditional Healer: I am asked to keep Jata [keeping long hair and never get it cut]. The godShivaji said, ‘I do not need anything. You just keep Jata. When a patient comes, sink the Jatainto water and then hit the patient with this Jata.’ But I did not do it because I have to do myfather’s Shradda [a traditional ritual] in which I must shave my head. My religion did notallow me. Shivaji has not harmed me yet. I requested him I had to pay parents’ loan [a tradi-tional Nepalese belief ]. If I do not, I will be punished. I have talked with Shivaji in dreams. Ican not do it now. We forget what we have read but I have not forgotten what I have learntfrom my age seven. I will remember the knowledge I have learnt until I die.

In these interviews most of the healers discussed having a supernatural guide, informingthem of how to treat a particular condition. Often a tension with the requests of the godswas evident, as shown in the last excerpt, and the healer lived in fear of and deference tothe supernatural source/guru. Furthermore, the guiding spirit would often go from onegeneration in a family to the next, as the father (the healer) takes his son as his assistant.At this point, the son is not a practitioner until the supernatural power possesses the son,thereby making the son a dhami. In cases where this is not observed as occurring, the sonis able to become a healer after his father’s death because he was observed as a ‘learnedperson’. This is both less likely and less desirable, as the metaphysical association is per-ceived to make the healer more potent in treating illness.

The chance of continuity of the healing practice within family lineage is high due toseveral key culture practices that protect and reproduce traditional knowledge and skills.First, healers will not share their mantras with anyone other than their disciple (often theirchild) because of the belief that the healer would lose their power if they did this. Second,it is thought that if one learns traditional healing in an ‘improper way’ (without being a

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disciple or without a guru’s permission) the person will become insane or sick. Finally, itis believed that the failure of a traditional healer (refusal to take up the profession) willresult in suffering of the family and even the end of a family lineage. These cultural beliefsystems effectively protect the art of spiritual healing as passed on from individual to indi-vidual, and, furthermore, secure the knowledge within families through the master–discipletradition. The necessary nature of the ‘supernatural’ further secures the art through theconstruction of healing as gift/connection and not merely documented knowledge/skill.This metaphysical credentialling also reduces the potential for formalization of training orthe co-option of healing practices outside accepted families or community boundaries.

There also exists a gendered nature to the practice and training of traditional healing. Byfar the majority of healers are men and they will select a male for ‘possession’ of their spiritand teaching of skills. Given the patriarchal structures of Nepalese society, women arelargely engaged in household chores and thus traditional healing is viewed as an ‘unneces-sary extra’ to the domestic role. The restrictions placed on women as healers are reinforcedthrough the idea, discussed in the interviews, that if women learn traditional healing there isa real risk that they could become a boksi (witch). This cultural rationalization is clearly situ-ated within wider social structures dependent on women playing particular roles within thedomestic sphere. Cultural beliefs, including the fear of black magic, emerge in turn to justifysuch ideas, and, as a result, very few women in Nepal become spiritual healers.

It was interesting to note that throughout the interviews, the idea of duty or dharma (afeeling of social service for eternal life) was articulated as important in the philosophy andpractice of healing, and yet this idea emerged in tension with traditional healing as a pro-fession or family business. In our initial discussions it seemed that the healers offered theirservices free of cost or for whatever the client could afford:

Traditional Healer: I am told [by the gods] not to be greedy in my life. I should behave sim-ilarly whether a patient is a poor or a rich. I should not ask them to give me more and more. Ican take whatever a patient gives me. I am instructed to do my responsibilities withoutexpecting anything from patients. I am told, ‘You do your work. Do not abandon.’

Another respondent:

Traditional Healer: People do not give me much for my service. Some give five rupees.Some give 10 rupees. I do not ask. It’s their wish whether give or not. When I go far away,they give me transportation fare.

Despite the representation of healing as purely a gift to the client or as a community service, inour informal discussions with their clients, the healers were not perceived to do healing ‘prop-erly’ if the client did not offer dakshina (ritual offering usually given to a priest), gifts or food.Furthermore, the more famous the healer or the more serious the condition, the larger the needfor a financial contribution. In our discussions with their clients, there emerged a sense of thelink between money, effort needed and the ‘chances of success’. While represented as com-munity service, implicit notions of ‘you get what you pay for’ also operated.

Spirits, health and the paranormal in everyday lifeThe grounding of spiritual healing in the paranormal dominated the discussion within theinterviews. Healing was viewed as intuitive yet metaphysically inspired and involveddeference to the gods. The healers’ role within the community was multifaceted giventheir spiritual knowledge, and they each played key roles in local religious practices and

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rituals including weddings and funerals.28 The medico-spiritual combination emergesfrom the belief that these healers act as mediators between the material world and thespirit world, restoring order and balance to the lives of clients and their communities. Illhealth is thus often conceived as the result of evil spirits or demons, and untreatable bydoctors:

Traditional Healer: I look [at] a patient and know whether I can cure him. If he is sufferedfrom bad spirit, I can cure him. If not, I send him to a doctor. Patients of all ages, children toelderly, come here. More uneducated people than educated ones come here. A patient thatshould be treated in a hospital is also brought here. Anyway, I first look after the seriouspatients. When I look, I can see whether I can cure or not. It seems like a photo. If it is a god,he appears and gives his introduction. I am taught by them playing and mingling. I am notscared of them.

Another respondent:

Traditional Healer: If somebody comes to consult me, I ask them not to tell anything. It ismy responsibility to find out what is the problem. If the patient says his problems beforehand,what is the meaning of consulting me!

Another respondent:

Traditional Healer: If you believe in god, you can feel something. If parents worship gods,their children do not even suffer from headache. The load is born[e] by the parents.

Another respondent:

Traditional Healer: I have knowledge that I have learnt from my age seven. I am not fromlineage Dhami. I have universal knowledge. If I play a plate and call my Guru, I can travelworld within a moment.

Another respondent:

Traditional Healer: Doctors cannot cure every patient. There are some problems that thedoctors can not cure. They either give injections or medicines. If a patient is affected by a badspirit, doctor’s medicines do not work. The patient thinks, the medicines cure him but hisproblem becomes more severe. The infliction by a bad spirit does not leave without doinganything. We do something to remove the bad spirit from the patient. After removing the badspirit, the patient can consult a doctor again. Now, the doctor’s medicine may work.

The beliefs articulated in the excerpts above regarding evil spirits causing disease receivewidespread support in Nepal, particularly in rural and more isolated communities. Whilewe can also see acknowledgement of the role of biomedicine in these healers’ narratives,they also provided clear distinctions between the roles of healers and doctors, and theimpotence of doctors to treat many conditions considered ‘spiritual’. The gift/physicpower of the healer was often used to illustrate the difference between modern medicineand healing, focusing on the importance of transcending a purely physical/skills-baseddiagnosis. Being dhami was important in this way, and while several had gained lineagedhami (thus gaining legitimacy from receiving an already recognized spirit guru from afamily member), others became dhami from their own transcendental experience. Theclaims to legitimacy and methods of gaining metaphysical prowess/credentials were thus

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multiple, yet they were closely monitored and categorized in order to ensure the authentic-ity of spiritual healing.

Dynamics between TM and biomedicineAll the traditional healers we interviewed were aware of and had an understanding of bio-medical health-care services, whether in their local community or in larger urban centres.Several had attended training in basic biomedical techniques (biomedical ‘solutions’ topneumonia or tuberculosis) and each said they recommended patients to visit a health postif they were not cured through spiritual healing. There was a clear conceptual divisionbetween the potential of healing versus biomedical treatment, with certain conditions(HIV infection) or situations (snake bite) viewed as inappropriate to treat with spiritualhealing. These distinctions were generally articulated as the works of the gods versusphysical problems (a spiritual/mechanistic dichotomy), with certain conditions viewed as‘not of the gods’. Yet, there was also a dominant theme that if the gods were not consid-ered, biomedical treatment may not be effective:

Traditional Healer: There is a health post in our village. I do my responsibility. Doctorshave not obstructed my work and I have not obstructed them. They also advise patients, ‘Con-sult Dhami-Jhankris, you may be healed.’ I am also a high blood pressure patient. I go tohealth post for the medicines. I am well now. A patient can be cured only if a doctor and aDhami complement each other. I can not cure every patient, ‘God does something. God alsodoes not do the things that a doctor should do. The works of a doctor should be done by a doc-tor.’ If a patient has pain in abdomen because of gastritis or stones in internal organs, heshould consult a doctor. I can not cure it. I do my responsibility because people believe me.Then, I refer them to a hospital. I can cure if a patient is suffered from a bad spirit or if a god/des[s] is angry. I know it. I send TB patients to a health post. I have not seen AIDS patient yet.

Another respondent:

Traditional Healer: If I know something that helps other people, then I do for them. We cannot cure those patients who need a doctor. If it helps I do, if it does not I do not and send themto doctors. I can not help patients of abdomen, blood pressure, paralysis, fever and pneumo-nia. I ask them to go to a doctor. If roots and herbals can treat, I give them. I do not have suchmedicines for all types of problems. I have some learnt in dreams. I first eat and then give it toa patient. In the present context, some believe, some do not. A healthy person also can use mymedicine, it has no side effects.

Another respondent:

Traditional Healer: Another is goddess Maharani. She told me, ‘Do your responsibility tothem who come on their own wish, who believe you.’ I look and know whether I can cure. IfI can not cure, I send the patient to a doctor. I can do only within a given boundary. I madethis temple for the god’s shelter. It took me 15 years. I was told not to ask anybody to help meto make this temple. This is my private temple.

Another respondent:

Traditional Healer: Wherever I go, I help people but I never say I can do or I am an expert.Doctors and Dhamis should not be compared. For example, if a patient having ulcer needsoperation, it is done by a doctor. If we can do it, hospital is not needed. Doctors can do theirwork and we can do our work. Bad spirit also causes fever. Fever can be cured by a doctor. If

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the fever is caused by a bad spirit, a doctor can not cure it. Doctor’s world is different and ourworld is different. We should complement each other.

Doctors and biomedicine were viewed as critical for certain areas of health and well-being,and there was virtually no animosity expressed, despite other studies illustrating inter-pro-fessional tensions between biomedicine and traditional healing in other South Asiancontexts.29 The complementary positioning of spiritual healing (and lack of explicit tension)in relation to biomedical potentially lies in the clear metaphysical/mechanistic split betweenspiritual healing and biomedicine, and the lack of clear cross-over (or comparability) interms of either the artefacts of treatment (herbs/pharmaceuticals) or treatment objectives.The attitudes and perspectives of Ayurvedic practitioners operating in Nepal may be verydifferent given the overlap in potential treatment options and bodily (versus spiritual) focus.

There was a dominant discourse around the importance of knowing what you cannottreat, with infectious diseases consistently discussed as key examples. Given the develop-ment programmes in and around HIV infection and TB in Nepal, it seems likely that tradi-tional healers are distancing themselves from these conditions. With the increasedavailability of biomedical interventions, and significant social awareness of these problems,the biomedicalization of infectious diseases and public health interventions may interplaywith the healers’ perceptions of the limits of healing and thus contemporary TM practices:

Traditional Healer: Dhamis can not cure sexual diseases, bird flu and AIDS. The unseenpower can not heal such problems. If someone says he can do, it is easier to say but very diffi-cult to do it. Someone may say, ‘Herbals can work.’ If the herbals did not work, then he is fin-ished. I tell the patients clearly. When I look I know whether I can cure or not. I have one to2% failure rates. The god never says, ‘I kill you.’ We should not make them angry.

Another respondent:

Traditional Healer: I see and cure simple problems, for example, dizziness, fever and headache.I can not do the severe ones and I have not tried yet. I do not have enough time to do it. I also cannot do it because I am also a patient of nerves. Some Dhamis are famous and people come fromdistant to consult them. I am not among them. I just see my neighbours and close relatives.

Another respondent:

Traditional Healer: I go to patient’s home even in distant. They give me transportation farein advance. Now I am coming from Patthari. I also went to Mangalabare. I do this work. If itis doctor’s work, I tell the patient, ‘I cannot do, go to health post.’ I have treated 15–16 epilep-tic patients. Others were suffered from bad spirit and witch. I cured them. Doctors treatpatients. I also do. I also have some Jadi-buti. Doctors could not cure an epileptic patient inPatthari. I cured him. I have cured many patients. I cured an 18 years epileptic girl inLharumba. Her guardians took me in a taxi. It takes more than two hours by a taxi.

These excerpts and dialogue in the other interviews reflect an increasing awareness amongstspiritual healers of biomedicine, disease types and physiological processes. It seems likelythat a key factor is the recent and ongoing attempts to biomedicalize (or ‘mobilize’) TM inNepal. Indeed, both governmental and non-governmental sectors have tried to ‘train’ tradi-tional practitioners in ‘primary health care’ to expand delivery of biomedicine services.30

For example, from 1994 to 2003, a non-governmental organization ‘trained’ 422 tradi-tional healers on primary eye care services in 18 rural districts of Nepal. The evaluationof the programme showed that the traditional healers were largely convinced to stop the

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use of traditional medicines (e.g. extracts of the roots, leaves of trees, seeds, herbs, powderedglass, and so on) for vision problems and to refer patients to biomedical clinics.31 Before thetraining, 72% of the healers applied traditional eye medicines in their patients’ eyes, whereasonly 5% of them continued to use traditional eye medicines following training. An interventionstudy was done for acute respiratory infections in 10 rural communities with similar results.32

Such processes raise important questions about the intersection of tradition and modernity andthe potential loss of traditional knowledge as a result of biomedical health development.

Indeed, while these traditional healers would be selective of what they treated regard-less of biomedical intervention or community programmes, it seemed in the interviewsthat health development programmes were shifting and influencing their everyday prac-tices. Such community and development interventions appear to have created an inter-professional dynamic whereby spiritual healers do not treat conditions they are warnedagainst treating from government authorities and biomedical organizations. This mayreduce the use of traditional medicine for certain conditions, but not necessarily the belief(patient or healer) in the assumptions underpinning the traditional practices:

Traditional Healer: I also have medicine for snake bite but I do not use it. The snakes arevery poisonous and if something happened to a patient, I will be in problem. Nowadays, manypeople think they are clever. I am ready to treat snake bites. I also have collected medicines.I know Mantras.

The potential for community or government ‘retribution’ where accepted biomedicalintervention is available (e.g. anti-venom) was an interesting theme in the interviews, andlikely to be a factor in the willingness of traditional healers to treat in certain contexts.Development programmes have created strategic ‘awareness’ amongst traditional practi-tioners of the importance of treating selected problems exclusively with biomedical inter-ventions and importance of ‘referring’ to biomedical health posts – a change of actionrather than ideology. Furthermore, this process of re-education seems to have instilled theidea of the potential for punitive action if referral to biomedical treatment is not acceptedas necessary by traditional healers.

A further complication is the lack of availability or access to biomedical care for largesections of the Nepalese population. While intervening in the practices of spiritual healing(and influencing healers’ responses to HIV, TB or snake bites) may be an ideologicalboost for proponents of biomedicine, it has not been accompanied by sufficient biomedi-cal health service provision in most areas of Nepal. Herein lies the inability of biomedi-cine proponents to significantly intervene in or shape traditional healing practices andrural health beliefs, and the ongoing role and popularity of spiritual healing. Lack ofaccess to biomedical clinics or money to pay for modern health-care services means that,even where both healer and patient believe biomedical intervention may be the ‘best prac-tice’, many Nepalese people will not visit a public biomedical service outlet, regardless ofwhether the healer refers them. Furthermore, traditional and indigenous health knowledgeare deeply embedded in local laws, customs and traditions,33 and regardless of the positionof healers, individuals may view their health issues from a traditional perspective ratherthan a biomedical perspective.

ConclusionTraditional medicine remains popular in contemporary Nepalese society, and in many ruralareas people fully depend on the spiritual healing system. The interviews illustrated severalimportant features of contemporary Nepalese spiritual healing, including key processes of

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lineage training, metaphysical referencing and the emerging influence of biomedicaldevelopment programmes. The role of the spirit world emerged as ubiquitous in the prac-tice of spiritual healing and spiritual healers play central roles in their communities in andaround the mediation of the material and metaphysical realms. While national health pol-icy in Nepal centres on physical intervention and biomedical/public health knowledge dis-semination, this study illustrates the centrality of superstition and belief in the paranormalin everyday life, and the importance of integrating an understanding of the cultural import-ance of the metaphysical in Nepalese health development programmes.

The interviews also revealed the shifting practice of spiritual healing in development initi-atives in and around key population health issues (e.g. HIV infection, TB). In particular, thesehealers’ accounts illustrate some of the impacts such interventions are having on traditionalhealing practices and willingness to treat. Biomedicine, particularly given its purely mecha-nistic (versus spiritual) focus, seemed only a minimal threat to the status and role of the spirit-ual healer, and yet community action programmes seem to be shifting the practice of healingbut not necessarily the beliefs of spiritual healers (or people in their communities). Undoubt-edly there is real value in educating spiritual healers on elements of biomedical practice giventhe large numbers of healers and their potential for supporting public health programmes.However, ideological incongruence may allow both coexistence (neither biomedicine norspiritual healing are in direct competition) and disjunction in terms of the underpinnings of ill-ness. How to reconcile the strength of belief in the influence of gods and spirits (amongst spir-itual healers and the Nepalese people) and the mechanistic/physical focus of biomedicine isan important question in future health-care development programmes. Given the centrality ofthe paranormal and metaphysical in practice and training, including lineage and gift-basedpractice, the compatibility of organized health-care services and traditional healing may beheld in question. The wider role of spiritual healers in communities and their embeddednessin everyday life suggest that re-education (absorbing traditional healers into a biomedicalprimary health-care system) would be met with limited success. Incorporating key traditionalvalues and spirituality into biomedical development programmes while supporting ‘modern’health development may be more successful in improving health outcomes in Nepal.

AcknowledgementsWe acknowledge support of Gokul Mishra and Gyanendra Shrestha for assisting in the fieldwork inNepal. The financial support for this study was provided by AusAID and School of Humanities andSocial Science of the University of Newcastle.

Notes1. Bodeker et al., WHO Global Atlas; SPHERE, Humanitarian Charter; and WHO, Legal Status

of Traditional Medicine.2. WHO, Legal Status of Traditional Medicine.3. Broom and Tovey, ‘Inter-Professional Conflict and Strategic Alliance’; Broom et al., ‘The

Inequalities of Pluralism’; and Tovey et al., Traditional, Complementary and AlternativeMedicine.

4. Broom and Tovey, ‘Inter-Professional Conflict and Strategic Alliance’.5. Broom et al., ‘The Inequalities of Pluralism’.6. For example, Giri, ‘Present Status of Ayurveda System’.7. CBS, Population Census 2001 and CBS, Rastria Jana-Gananaa 2058.8. AI, Amnesty International Report 2007.9. Ibid. and Singh, ‘Impact of Long-Term Political Conflict’.

10. Koirala and Khaniya, ‘Health Practices in Nepal’.11. Shankar et al., ‘Healing Traditions in Nepal’.

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12. Ibid.13. Koirala and Khaniya, ‘Health Practices in Nepal’.14. Shankar et al., ‘Healing Traditions in Nepal’.15. Ibid.16. Koirala and Khaniya, ‘Health Practices in Nepal’.17. Shankar et al., ‘Healing Traditions in Nepal’.18. Giri, ‘Present Status of Ayurveda System’.19. Koirala and Khaniya, ‘Health Practices in Nepal’.20. WHO, Legal Status of Traditional Medicine.21. Parajuli, Naradevi Ayurveda Hospital.22. DHS, Annual Health Report 2006/2007.23. Koirala and Khaniya, ‘Health Practices in Nepal’.24. Tamang, ‘Assessing Community Members’ Understanding and Practices’.25. Subba et al., Assessment of Health Situation in Eastern Development Region.26. Giri, ‘Present Status of Ayurveda System’.27. Koirala, Health Challenges of 21st Century.28. See also Pigg, ‘The Social Symbolism of Healing’.29. For example, Broom and Tovey, ‘Inter-Professional Conflict and Strategic Alliance’.30. CBS, Nepal in Figures.31. Poudyal et al., ‘Traditional Healers’ Roles’.32. Holloway et al., ‘Community Intervention to Promote Rational Treatment’.33. Koirala and Khaniya, ‘Health Practices in Nepal’.

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