Why are most Asian babies born with a birthmark that looks like a bruise at the base of the spine? Doctors and traditional midwives usually have different explanations for this “Mongolian spot.” According to medical experts, abuse has nothing to do with it. The bluish-grey blotch is merely a genetic gift from the parents and it will gradually fade. However, if you ask a Korean rural villager about its origins, you might get a different answer. One old woman once told me that babies need a little kick to help them come into this world because life is so hard that they don’t want to be born. A “three-spirit” deity of heaven, earth and the underworld gives a gentle push, leaving a telltale trace on the baby’s back.
In rural Korea in the 1970s, traditional healers such as “three-spirit” grandmothers on Cheju Island took charge of mother and child health care once the baby was born. Until the first 100 days of life had passed, these traditional healers were the family consultants on child nutrition, illness and postpartum recovery. They also performed rituals that included prayers, food offerings and songs so that the ancestors will watch over the infant’s well being.
In many countries a large group of health care providers in rural areas are women known as traditional birth attendants (TBAs) and female traditional healers. Village women often trust them because they have qualities that are sometimes missing among younger doctors, including a “caring feeling,” “strong moral character” and “years of experience.”
For decades, UN agencies such the UN Population Fund (UNFPA) have regarded local village health workers as invaluable human resources for providing services such as immunization, family planning and nutrition education—all part of an effort to improve maternal and child health. Maternal mortality continues to be one of the greatest challenges for health planners. In Afghanistan 1 out of every 11 women dies in childbirth. According to the World Bank, for every woman who dies during childbirth in Sweden, 815 women in Somalia and 495 die in Nigeria.
Training programs in countries like Nepal, Nigeria and Burma have been highly successful in mobilizing village workers to help bridge the gap between modern and traditional health beliefs. As one Burmese traditional birth attendant explained to me, “We have sterilized birthing kits, 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 traditional women healers have participated in government-sponsored programs, few health policy makers are aware of the problems that these women face in carrying out their work. Female traditional healers are often heads of household, poor, illiterate and landless. Their fees are typically lower than those of male specialists so that even after years of practice, they still can barely make ends meet. It is common for them to be paid in kind.
Another obstacle facing women healers is prejudice on the part of doctors who think that they discourage patients from using health services. While that happens on occasion, the degree of quackery and competition is probably far less than is assumed. In Thailand, Indonesia and Burkina Faso I found that healers themselves often used modern medicine. Women traditional healers typically deal with chronic ailments or conditions that require prolonged care like tuberculosis or cancer when patients may lose the will to live.
Depression and psychosocial complications that may accompany birthing or illness often interfere with effective medical treatment. When women feel defeated by their ill health, they may even give up trying to recover. There are also conditions that patients believe have spiritual origins for which modern medicine has no cures. For these and other reasons such as proximity and failure of medical treatments, patients may choose alternative medical care. Ultimately, the losers are the poor–many of whom are women–who go back and forth from one system to another. Like many patients in Europe and the US, they are looking for someone who will treat the whole person–heart and soul as well as mind and body.
The soaring use of alternative medicines and healers—even in industrialized countries—should alert modern medical practitioners to the shortcomings of their practice. Yet time is short to learn from the past. The ageing group of traditional birth attendants and healers is fast disappearing in many villages. With an abrupt and unannounced exit, their knowledge and experience will likewise be gone—and that may be a loss for us, all.