Claiming the Right To Health

“My heart can’t be cured is because I’m too poor to pay my son’s school tuition—and that is breaking my heart” (Korean village woman)

Why are most Asian babies born with a birthmark that looks like a bruise at the base of the spine? Doctors and traditional midwives have different explanations for the Mongolian spot. According to medical experts, the bluish-grey blotch is a genetic gift from the parents that will gradually fade. However, if you ask a Korean rural villager about its origins, you might get a different answer. One old woman told me that babies need a little kick to help them come into this world. Life is so hard, and they don’t want to be born. A three-spirit deity of heaven, earth, and the underworld gives the baby a gentle push, leaving a tell-tale trace on the baby’s back.

In real life, traditional healers, such as three-spirit grandmothers, took charge of maternal and child healthcare once the baby was born. These traditional healers were the consultants on child nutrition, illness, and post-partum recovery for the first one hundred days of the baby’s life. They also performed rituals of prayer, food offers, and songs for ancestors to watch over the infant’s well-being.

Traditional, rural Korea is no exception. In many countries, the largest groups of healthcare providers in rural areas are women known as traditional birth attendants (TBAs) and female traditional healers. Village women often trust their strong moral character and years of experience—qualities that they say are sometimes missing among younger, modern doctors.

For decades, UN agencies such as UNICEF and the UNFPA regarded TBAs as invaluable human resources for providing health services, including immunization, family planning, and nutrition education. Training programs across the world were highly successful in mobilizing their support to reach women and help bridge the gap between modern and traditional health.

“We have sterilized birthing kits,” one healer explained to me, “but we also stick to our traditions, like cutting the umbilical cord on a coin so that the child will have good fortune. Doctors have taught us how to sterilize the coin and knife beforehand.”

Although TBAs and women healers participate in government-sponsored programs, few health policymakers are aware of the problems that these women face when carrying out their work. These women suffer from gender bias that keep them at the bottom of a health hierarchy, much like their counterparts in modern medicine. For example, in Korea, the herbalists and acupuncturists who dominate the upper levels of the traditional medical system are mostly men, many of whom are literate and practiced in cities. Below them were shamans, fortune-tellers, three-spirit grandmothers, and traditional midwives.

Female traditional healers are poor, illiterate, and landless heads of household. Their fees are typically lower than those of male specialists, so even after years of practice, they can still barely make ends meet. It is common for them to be paid in-kind. One shaman I knew usually received bags of rice, chickens, and clothing as payment. She never complained and always accepted whatever the patients could offer because she felt that her mission in life was to serve everyone equally. However, there was never enough money to pay for many homeless friends who dropped in for a free meal or a quick loan.

Another obstacle that TBAs and women healers face is prejudice from doctors who believe these women discourage patients from using modern health services. While this has likely happened, the degree of competition is far less than one might expect. In Korea, Thailand, and Burkina Faso, I found that healers themselves often use modern medicine. For example, one traditional healer had facial cancer and was being treated in a high-tech cancer clinic. In her view, it was not a matter of modern versus traditional medicine, but rather how patients perceived their needs. Healers see themselves as helping to restore the will to live because they typically deal with patients who are discouraged by ailments requiring long-term care, like tuberculosis and cancer. They also help patients survive depression and psycho-social complications after birthing that might interfere with effective treatment by modern physicians.

Much more anthropological research is needed on how medical pluralism affects women healers and their patients. Ultimately, the losers are the poor, many of whom are women, who go back and forth from one system to another, looking for someone who will treat the whole person—mind, body, heart, and soul.