Traditional healers and modern medicine

Sot

Sci & Med

Vol 9 pp I5 lo 21 Pergamon

TRADITIONAL

Press 1975 Prmied m Great Braam

HEALERS

AND MODERN

MEDICINE

J C BHATU,* DHARAMVIR,~ A TIMMAPPAYA~and C S &U-TAN@ Nattonal Instttute of Health Admmlstratlon and Education, E-16, Greater Kadash-I, New Delhi-1 10048, Indta Abstract-The results of mtervlews wrth 93 tradmonal healers m three states of India are presented m this paper These tradmonal healers are found to be mcreasmgly usmg modern/allopathrc medlcmes m their practxe The assoclanon of use of modern medxmes has also been studled VW&VUtheir background characterlstrcs such as age, educatronal level, patient load, average charges and income

INTRODIJCIION

400,000 [6] (one for every 1300 population as against one qualified doctor of modern system of medtcme for 4700 population) [7l. of course, with considerable mter-State varlatlons [8] These tradmonal healers or IMPS are very popular among the rurahtles and their ranks are bemg augmented every day In view of the inability of the Government to provide adequate medlcal facilities to the rural people and recogmzmg the role these men could play m provldmg at least rudementary medical care, the Government of India, Ministry of Health and Family Planmng put forward a proposal for Rural Health Scheme m the Natlonal Strategy durmg the Fifth 5 Year Plan [9] which envlsaged involvement of 250,000 tradltlonal healers or IMPS to augment the present skeletal rural health services Under this Scheme one practltloner was to be recruited for an approximately 2OOOpopulation on a full time basis and on a monthly remuneration of 150 rupees For any effective utlhsatlon of these practmoners for such a large national endeavour, it 1snot only desirable but necessary to study the background characterlstlcs of these practitioners and to unfold their entlre relationship to modern medlcme The impression 1s prevalent the world over that tradttlonal healers or IMPS treat diseases with age old combmatlon of herbs, OII and secret charms Earher studies conducted by one of the authors, however, have shown that these healers or IMPS are mcreasmgly influenced by modern medicine

Provlslon of adequate medlcal care faclhtles to then populations, wlthm the constramts of financial, physl-

cal and manpower resources, 1s a problem of great magnitude for the developmg countries Compoundmg this problem are the Imbalances existing m the urban and rural areas of these countries MaJorlty of the population of the developmg countries inhabits the rural areas, yet m terms of medlcal faclhtles these are the most neglected segments of the population In India for Instance, while 80 per cent of the population hves m the countryside, 80 per cent of the doctors have settled down m the urban areas Further there are mtra-rural imbalances of services as functionally much of the avallable manpower of either systems 1s datrlbuted m bigger villages [I] The smaller and “difficult to reach” villages have no faclhtles whatsoever Furthermore, avallable estimates m India show that by rural-urban break up of services, urban population has 8-10 times more mstltutlonal facllltles and 12 times more hospital beds [2] Although there has been a considerable improvement m health manpower m India durmg the past two decades, the urban-rural ratio has remarkably remamed unchanged [3] The Governmental medlcal care faclhtles available to Indian villages thus far are mainly through the Pnmary Health Centres (PHCs) Generally one or two doctors at a PHC are supposed to look after a population of more than 100,000 hvmg m an area of 150200 miles’ These meagre facllmes available are also not being properly utlllzed by the rural people due to variety of reasons The studies conducted by the World Health Orgamzatlon [4] and John Hopkms Umverslty Rural Health Research Centre [S] mdlcate that only about 10 per cent of rural population utihze the Governmental medlcal facllltles Thus maJorlty of the sickness cases m the rural areas 1s attended to by the traditional healers or the Indigenous Medicine Practltloners (IMPS) whose number 1sestunated to be about

Cl01 Further studies have shown that these practltloners had not only favourable attitudes towards family plannmg and abortlons but were wlllmg to provide necessary assistance m the pubhc health and family plannmg programmes sponsored by the Government Some of these practltloners were reported to be already provldmg these services to their clients [l I-15] A study conducted by the authors to find out the wlllmgness of these practltloners to Jom the proposed rural health scheme revealed that (a) only about onesixth of the practitioners interviewed were agreeable to Jam this Scheme under the condltlons stipulated therem, (b) the younger practltloners (below the age of 25 years) were more wlllmg compared with those of older

* Senior Research Officer t Assistant Research Officer $ Drrector $ Professor of Eptdemtologq 15

16

J C

BHATIA, DHARAM VIR. A TIMMAPPAYA and C S CHUTTANI

groups, (c) those who had longer experience in profession, higher income and higher patient load were not keen to participate m the scheme, and (d) the majority of those who were ready to partlclpate were not reglstered with any system of medlcme [ 161 The present study was conducted m three different States of India during the last quarter of 1972 and first quarter of 1973 with a view to finding out the salient characterlstlcs of the traditional healers or IMPS and the extent to which they have adopted modern or western medlcmes m their day to day practice

age

METHODOLOGY The study was carried out m three States of India, 1e Haryana, Madhya Pradesh and Uttar Pradesh In the States of Haryana and Madhya Pradesh, three Commumty Development Blocks m three different dlstrlcts were surveyed while m Uttar Pradesh a stratified sample comprlsmg 10 per cent of the villages m five Commumty Development Blocks was selected for carrymg out this mvestlgatlon The villages so selected were vlslted by the first author and an attempt was made to ldentlfy all the tradItIona healers or IMPS* practlsmg m a particular village with the help of villagers, Panchayart members, fellow practltloners and the primary health centre staff, etc The IMPS thus ldentlfied were contacted mdlvldually and every endeavour was made to estabhsh excellent rapport with them They were then mtervlewed at length with the help ofa semi-structured mtervlew guldelme An mtervlew gmdelme was preferred to a completely structured schedule for Its flexlblhty The n-tam risk Involved m using this type of mtervlew techmque, when used by mexperlenced and different interviewers, IS the noncomparablhty of data However, m this case all mtervlews were conducted by the first author who has conslderable experience of carrying out slmllar studies m the past The rehablhty of data was, therefore, ensured The mformation was collected with regard to their salient characterlstlcs such as age, general and professlonal quahficatlons, expertence, reglstratlon status, patlent load, average charges per patlent, Income etc and the extent to which they have adopted modern/Western modes of treatment of diseases FINDINGS

A total of 93 full time IMPS were Interviewed

sahent background characterlstlcs tloners are as given below

The of these practl-

* Persons practlsmg full time any type of curative medlcme wlthout havmg a recogmzed quahficatlon m modern medlcme, have been defined for the purpose of this study as traditIona healers or IMPS Both these terms are used synonymously The practices fallmg wlthm the above defimtlon would m&de (I) Ayurveda, the tradltlonal Hmdu system of medlcme based on vedlc scriptures, (2) Sldha, closely related to Ayurveda, but roots m South Indian Dravadlan culture, (3) Unam, a system Introduced by the Moguls which orlgmated m Greek and Arabic Medlcme, (4) Generahsts practlsmg medlcme drawn from multlple systems but wlthout formal trammg m any As the rehglous and spmtual healers usually pradtlse part time as a hobby and for love, they were excluded from the purview of this study t An elected vtllage Council $ This degree/diploma ISgenerally of 3-5 years duration

Age A httle more than one-third (37 6 per cent) of the IMPS Included m this survey were m the younger age group of below 35 years, while two-fifths (4307 per cent) were of middle age (35 54 years) The remaining one-fifth (19 4 per cent) were 55 years or old General educational level The dtstrtbutlon of the IMPS accordmg to their hteracy level reveals that 18 2 per cent of them were Just literate (could read or write one or more Indian lan-

guage), 22 6 per cent had studied up to middle level (8th standard), 53 8 per cent had passed High School or Higher Secondary, while the remammg 5 4 per cent of the IMPS were College Graduates Professronal qualzficatfons So far as the professional educatlonal status of the IMPS 1sconcerned, 11 8 per cent of them had obtained degree/dlploma$ m one of the mdlgenous/mtegrated systems of medicine after having undergone trammg m the mstltutlons of mdlgenous systems of medicme recogmzed by the Umversltles and/or State Boards of Indigenous, Homoeopathi or Blochemlc systems of medlcme, 540 per cent of the IMPS had obtamed various diplomas m Indigenous or Homoeopathlc systems of medicine from mstltutlons not generally recogmzed by any Government authorities, after undergomg trammg through the so-called correspondence courses or appearing m the exammatlons through private study The remaining one-third (33 3 per cent) of the IMPS did not possess any professlonal quahficatlons, whatsoever Duration of practuze

About one-fifth (204 per cent) of the IMPS mterviewed were of less than 2 years standmg m medical practice, a httle less than one-fourth (23 7 per cent) were m practice for more than 2 years but,less than 10 years The remammg 53 9 per cent were reported to be practlsmg for more than 10 years Famdy profession

Approximately half of the IMPS stated that the practice of curative art IStheir family profession which they have mherlted from their ancestors Reglstratlon status

Each Indian State has a Board of Registration for the IMPS The registration of the IMPS IS done either on the basis of recogmzed professional educatlonal quahficatlons m mdlgenous/mtegrated system of medlcme or specified number of years of experience About three-quarters (73 1 per cent) of the IMPS covered by this mvestlgatlon were reported to be registered with the State Boards Patrent load The medtan value of patients per week as reported by the IMPS works out to be 46 6 A httle more than

Traditional

healers and modern

half (54 8 per cent) of the IMPS were reported to be havmg less than 50 patients per week, another onethird (32 2 per cent) had a weekly patient load between 51 and 150 The remammg 12.9 per cent of the respondents attended to more than 150 patients m a week Average charges per patient

One-thud of IMPS (31 2 per cent) were charging on an average less than Rs 100 per patrent, 60 2 per cent were charging between Rs 1.00 and 3 00 while the remammg 8 6 per cent of the practttroners charged on an average more than Rs 3 00 per patient Monthly income

The median net mcome of an IMP works out to be Rs 22700 per month Further 22 7 per cent of the IMPS had a net monthly income between Rs 101 and 200, 24 9 and 25-8 per cent were m the income range of Rs 201-400 and Rs 401-loo0 respecttvely There were only three IMPS m the sample who were earnmg more than Rs 1000 per month Use of modern medicine by the IMPS About 90 per cent of the practtttoners mterviewed reported use of modern medrcmes* although to varymg degrees, ‘while only about 10 per cent denied the use of any modern medrcmes m their practice and reported using only mdrgenoust medicmes on then patients A further analysts of the data shows that out of the group who was makmg use of modern medtcmes (83 IMPS), 9 64 per cent were entirely depending upon modern medrcmes of all types with no mdrgenous medrcmes at all, 61 64 per cent were using these medtcmes on then patients most of the time exclusrvely or m combmabon with mdrgenous medicmes, while the remammg 28 91 per cent used modern medicines but to a lesser degree The later category of the IMPS reported that they dispensed mdigenous medrcmes to the malortty of then patients but to some patients who wanted “quick cure” they had to resort to allopathrc modes of treatment, whtch,was however, restricted to the asprm group and certam anti-brottcs Possession of modern equipment

Of the IMPS interviewed 77 4 per cent reported possessing thermometers, 87 1 per cent possessed syringe and needles, 68 81 per cent had stethoscopes with them while there were two IMPS who had blood pressure apparatus Extent of use of mJecttons

A question was posed to all the IMPS covered by this study that out of the total number of patients seen by them durmg 1 week prior to the date of mvestiganon as to how many had actually been given mlec* Modern Medlcme Includes all sclentlfic (“Western” or allopathlc) and patent medlcmes t Indigenous Includes Ayurvedx. Unam and Homeopathlc medlcmes

medlcme

17

trons The analysrs of the data gathered reveals that 13.98 per cent of the IMPS stated that none of their patients had been administered mlecttons, 8 60 per cent of the IMPS had given mlecttons to less than onetenth of their patients, 18 28 per cent of the IMPS mlected to 1I-20 per cent of the patients attended to by them, 29.03 per cent of the respondents stated that between 21 and 30 per cent of then patients had received mlecttons while 15 05 per cent of the practrtroners treated 31-50 per cent of their patients wrth mlectrons The remammg 15.05 per cent of the IMPS administered mlections to more than half of then patients Performance of minor surgery

Two-third of the IMPS reported that they were performing minor surgery such as mcrsmg the wounds and applying stnches, etc Another two-fifths of the practitioners mterviewed were reported to be domg dental surgery such as extraction of teeth etc Referral services

On bemg specifically asked rf they had referred any of their patients to other practitioners or hosprtals durmg a period of 3 months prior to the date of mvestiganon, about 90 per cent of the IMPS interviewed answered m the affirmative On bemg further probed as to where most of then patients had been referred to 21 5 per cent of the IMPS stated that they dtd not make any specfic recommendation and asked the patients to go to any place of then choice, 11 83 per cent of them reported that they referred then cases to the Primary Health Centre (PHC) and other rural dispensaries, 25 80 per cent of the IMPS referred most of then cases to the urban hospitals Further 5 38 and 36 56 per cent of the respondents reported that most of then patients who were referred were advised to go to partrcular private practitioners practismg m the rural and urban areas respecnvely Contacts wzth referral mstltutlons and other practltioners

Some IMPS stated (5.38 per cent) that they have personal contacts wtth the doctors at the Prrmary Health Centre (PHC) and an equal number of them reported having contacts with the doctors at urban hospnals where they could refer then cases with confidence Another 27.95 per cent of the practitioners had personal and friendly contacts with the private medrcal practmoners practismg m the urban areas and the cases which are beyond theu comprehenston and needmg expert advrse are referred to them Laboratory tests and mvestlgatlons

Each of the IMPS included m the study was asked _tfduring a period of 1 year prior to the date of mvesttganon, they recommended any of their patients to go m for any kmd of laboratory tests or other mvestrgatrons Seventeen out of 93 IMPS mterviewed gave positive replies, seven of them reported to have referred the

.I C BHATIA,DHARAMVIR, A

18

TIMMAPPAYA and C S CHUTTANI

patients for X-ray, Urine, Stool and Blood tests, four IMPS recommended Urine for Sugar test only, two practltloners each sent m then patients for X-ray only, X-ray, urine and urme, stool respectively Out of the group of 17 IMPS who had recommended various tests and mvestlgatlons only five stated that they could read the results of the mvestigations recommended by them

System of medwne preferred and system of medzcme practlsed

Trammg m modern medwne

An attempt was made to sohclt mformation from the IMPS who were using modern medzmes m their practice, if they had recetved any trammg m the modern system of medlcme Out of 83 IMPS who used modern medlcmes, 20 18 per cent did not have any trammg whatsoever, 7 22 per cent had received trammg m the Integrated systems of me&me from the mstltutlons recogmzed for the purpose, 8 43 per cent had learnt the use of modern medlcmes from the unrecogmzed “teaching shops”, 14 45 per cent were apprenticed for varying periods under MBBS or other practitioners of modern me&me having hcentlate quahficatlons, 7 22 per cent had apprentlceshlp under the qualified practltloners of integrated system of medlcme and the remammg 42 16 per cent received their trammg m the use of allopathlc drugs and modes of treatment from unqualtfied practltloners of modern medlcme This group of IMPS who was using modern medlcmes was further asked about the source of their knowledge about the latest mechcmes, 2258 per cent of them stated that most of their mformatlon about new medicmes comes from the DruggIsts who voluntarily tell them about the efficacy of various drugs and their dosage, etc, 27 95 per cent were reported to be receiving guidance from the me&al representatrves who visited them once or twice a month, the remammg IMPS replied that they were only using the medlcmes they already knew and did not want to risk the use of new medlcmes * Background characterlstxs were tabulated with responses (use of modern mechcme only, mainly and use of mdqenous medxmes only, mamly) as follows patient load < 100 and > 100, income Rs 1 00, general educational level I 8th standard and > 8th standard, age < 35 years and > 35 years

Of the total number of IMPS interviewed 34 41 per cent expressed then preference for modern allopathlc system of medicine, 51-61 per cent had a preference for Ayurvedlc system, 9 68 per cent preferred Homeopathy while the remaining 4 30 per cent did not have a particular hkmg for any system of medlcme An analysis of the data about the system of medlcme preferred with that of system of medicine actually practlsed reveals that many of the practltloners who were practlcmg modern allopathlc system of medlcme either only or mainly did not have preference for tins system. while all those practlcmg mdlgenous system of medlcme only or mamly expressed a definite hkmg for their own mdlgenous systems and none of them gave preference for modern allopathlc system of medicme Two two-fold x2 tests were performed on the data in Table 2 to determine if the background characterlstlcs of the IMPS such as age, general educational level, patlent load, average charges, income were slgmficant factors m predicting the adaptation of modern/Western modes of treatment by IMPS Patient load and income proved to be the characterlstlcs most highly associated with the use of modern medlcmes by the IMPS (P value for each after applying Fisher’s exact test = OWOO), followed by average charges (P < 0001, x2 = 17 66), general educational level (P < 001, x2 = 9 69) and age (P < 001. x2 = 9 12)* The above analysis shows that IMPS who were using more of modern medlcmes m their practice had larger chentele, earned more Income, charged more, had a better education and belonged to younger age groups I DISCUSSION

AND

CONCLUSIONS

The existence of a large number of traditional healers or mdlgenous medicine practitioners m the rural areas of India and that the people are wlllmgly paying for their services, ISa good indicator of effective demand for health services Further, the fact that an overwhelming majority of them, at most of the times are depending upon modern/Western medications to effect cures, brings to light the revolution m health consciousness which has taken place m the countryslde

Table 1 System of medlcme practlsed by the tradItIonal healers m dssoctation with the system of medlcme preferred by them System of medicine preferred System of me&me practised only or mainly Allopathlc Ayurvedic Homoeopathx Total

Modern Number % 32 0 0 32

54 24 0 0 3441

Ayurvechc Number % 19 29 0 48

32 20 10000 0 5161

Homoeopathlc Number % 4 0 5 9

6 78 0 10000 9 68

No preference Number % 4 0 0 4

6 78 0 0 4 30

Total 59 29 5 93

Tradltlonal healers and modern medlcme Table 2 Characterlstxs

of the tradmonal healers m relation to the type of medxatlons

Modern only Chdracterlstlcs Patlent load (weekly) up to 50 1a1-150 151-200 151-200 201-250 251-300 Above 300 Income (monthly Rs ) up to 100 161-200 201-300 301-400 401-600 601-1000 Above 1000 Average charges (Rs ) UptoO 0 51-l 00 101-2 00 201-300 ’ Above 3 01 EducatIonal level Merely literate Middle (8th std ) High school Graduates Age (m years) Up to 25 2634 35-44 45-54 Above 54

19

No

%

0

@O

2 2 2 0 0

2 2

0

2 2

2 3 2

Type of medlcatlons used* Modern Indigenous mamly only No % No %

used by them (n = 93)

Indigenous mainly No %

Total

667 1333 66 67 2500 5000 00

23 8 13 I 3 2 1

45 10 53 33 86 67 33 33 7500 5@00 lOOW

18 6 0 0 0 0 0

3529 4000 00 00 00 00 0.0

10 0 0 0 0 0 0

19 61 0.0 00 00 00 @O 00

51 15 15 3 4 4 1

00 4 55 5.88 33 33 1667 8 33 33 33

4 7 13 4 10 11 2

1905 31 82 76 47 66 67 83 33 91 67 66 67

10 11 3 0 0 0 0

47 62 5000 1765 00 00 00 0.0

7 3 0 0 0 0 0

33 33 13.63 0.0 00 00 00 00

21 22 17 6 12 12 3

0.0 6 25 741 6.89 37 50

1 8 19 18 5

769 5000 70 07 62 97 62 50

8 4 4 8 0

61 54 25 00 1481 27 58 0.0

4 3 2 1 0

30 77 1875 741 345 00

13 16 27 29 8

5 88 9 52 600 4000

5 9 35 2

29 41 42 86 70.00 40.00

7 7 9 1

41 18 33 33 1800 20.00

4 3 3 0

23 53 1429 600 0.0

17 21 50 5

55 56 1071 5 56 00 00

3 19 13 14 2

4444 67 86 72 22 63 64 1111

0 5 4 6 9

@O 1786 22 22 27 27 5000

0 1 0 2 7

0.0 3 57 0.0 909 38 89

7 28 18 22 18

* Modern only 8 (8 60%). modern mainly 51 (53 84%), mdlgenous only 24 (25 81%), mdlgenous mamly 10(1075%)

during the last two decades under the aegis of develop-

mental plans The people are mcreasmgly becoming aware of the miracles possible through modem medlcme and an insatiable demand for modern medical care services has been created. The villagers who for ages had been depending upon traditional sources of medlcal care or magical remedies, by and large, are withdrawing then patronage from the tradltlonal systems of medicine even when they are comparatively cheaper. The Government services, however, have lagged behind to meet this rising demand Even the paltry services which have been provided mostly, remain unutlhzed This IS mainly because of the lack of proper orientation on the part of doctors tramed m modern medicine and mostly belongmg to ehhst urban society to understand the village “social structure” resultmg thereby m a degree of distance and suspicion between the doctor and the recipients of services This has created a peculiar situation that the villagers hke

modern or allopathlc modes of treatment but not the doctors of the allopathlc systems of medlcme available at the Government facilities Cl73 The tradlhonal healers or mdlgenous me&cme practitioners have shown a considerable degree of adaptability to fill this vacuum though at no cost to the Government but considerable cost to the consumer There were many practitioners m our sample who although preferred traditional systems of medicine but were actually practicmg modern medlcme to suit the demands of the villagers On bemg asked as to why they practiced allopathlc system of medlcme contrary to their preferences, they replied they did not want to face extmctlon. Those practitioners who contmue to practice mdlgenous medicine find that they are losing patients These are the people who mostly belong to the older age group and “not well educated” class Many m this group who contmue to practice tradltlonal medicine, mherlted the profession and continue

20

J C BHATIA.DHARAMVIR. A TIMMAPPAYAand C S CHUTTANI

to practice merely to perpetuate the memory of their ancestors An important finding which emerges out of this study 1s that the practltloners who were actually tramed m traditional medlcme at mstltutlons recogmzed for the purpose, by spendmg approximately 5 years m residence, were mostly practlcmg modern/ Western medicine There were SIXpractitioners belongmg to the “mstltutlonally quahfied” category m our sample, out of which three were not at all using any mdlgenous medlcmes while the remaining three used these medlcmes rather very rarely In India at present there are 97 mstltutlons of trammg m Ayurvedlc and Unam Medicine with admlsslon capacity of over 3000 [18] How many of those who receive trammg from these mstltutlons, make use of the trammg imparted to them IS a matter which needs further mvestlgatlon The revival of Ayurveda m India, It seems, 1s associated with great Indian traditions of the centuries and has a certam sentlmental value Does it have any relevance to the present day demands of the populace or IS based on any economic conslderatrons 1s a matter which needs further research effort Under the terms of the Indian Drug Act [lS] various medlcatlons may not be sold except by prescription from a registered medical practltloner These are the drugs which include antlblotlcs, sulphammlde group, barblturlc acid and its derivations and some others Majority of the practitioners included in this study were using these drugs Efforts made m the past to prohibit the use of these drugs by the mdlgenous medicine practlhoners have not met with much success As these practitioners have adopted modern modes of treatment and possess modern equipments, it becomes rather difficult for an Ignorant villager to dlstmgulsh between a quahfied and non-qualified practltloner Moreover, by mdlscrlmmate use of inJections and other antlblotlcs which have long range actions, these practitioners are able to affect “quick cures” to then patients and gam the confidence of the rural commumttes Any attempt, therefore, to dislodge them or restrict them to the use of indigenous medicines only,

which are not m great demand by the villagers, might cause resentment among the villagers, unless of course, alternative services of better quality and acceptable to people are made available The developmg countries can not afford the services of highly quahfied and experienced doctors to treat minor ailments although their services are mvarlably needed for referral servtces The feaslbthty of using some of these practitioners particularly those who are younger m age and are better educated, as multlpurpose health workers wlthm the framework of exlstmg health care system to provide elementary medical care, preventive and family planning education and motlvatlon need to be explored. Studies have shown that they have favourable attitudes towards family planning and have a leadership potential [20] Other countries who are on the threshold of development too have similar problems of provldmg ade-

quate medical care for their people They also have traditional systems of medicine which are undergoing rapid changes with the spread of western medicine The Indian experiment could be a learnmg experience to all these countrtes Acknowledgements-The authors are grateful to Dr J R Bhatla, Professor of Public Health Admmlstratzon Natzonal Institute of Health Admmzstratzon and Education. New Delhi for hzs valuable comments on this paper The first author 1s deeply indebted to Dr Alfred K Neumann, School of Public Health, Umverszty of Calzfornza, Los Angeles for suggesting this important area of investigation and for hzs constant encouragement

REFERENCES

1 Chuttanz C S , Bhatza J C, Dharam Vlr and Tlmmappaya A A survey of mdigenous medical practitioners m the rural areas of five different states of India Indzan J rned Res 61, 6, 1973 2 Ministry of Health and Family Planning Government of India, D G H S C B H I Health Stutzstzcs of Indza, 1965-1968 3 Gandhz H S and Bhatza J C Assessment of health needs m the rural areas and working of the existing P H C complex during the last 20 year-11 Natrod Semznar on Rural Medzcal Relzef-Future Pattern, New Delhz, S-7 August 1973 Indian Medical Assoczatlon, 1973 4 Griffith D H S Final report on public health programmes, Andhra Pradesh WH 0 Project, India 151, SEA/PHA/30 7 June 1963 John Hopkins University, Department of International Health Functzonal Analyszs of Health Needs and Seruzces Mzmeographed, 1970 6 Alexander C A Traditional healers m a region of Mysore Sot Scz & Med 5, 575, 1971 I Government of India, Mmlstry of Health and Family Planning, D G H S C B H I Pocket Book of Health Statzstzcs 1973

8 LLX czt 1 9 Government of India, Mmlstry of Health and Family Planning Natzonal Health Scheme for rural area Mimeographed, May-June 1972 10 Neumann A K, Bhatla J C , Andrews S and Murphy A K S Role of mdlgenous medicine practitioners m two areas of India-report of a study Sot Scz & Med 4, 137, 1971 11 Bhatla J C and Neumann A K Practitioners of mdzgenous medicine and India’s family plannmg programme Indzan J Sot Work 34, 1, 73 12 Neumann A K and Bhatla J C Family planning and mdlgenous medicine practztzoners Sot Scz & Med 7, 507, 1973 13 Bhatla J C and Mehta S R Induced abortlonsopmzons of the mdlgenous medicine practitioners Indznn J Sot Work 22,4,

1972

14 Bhatza J C Abortzonzsts and abortion seekers Indzan J Sot Work 34, 3, 1973

15 Bhatza J C. Dharam Vzr, Tzmmappaya A and Chuttam C S Role of practitioners of z~nhigenous medzcme m the family planning programme J Fam Welfare 20, 3, 1974

TradItIonal healers and modern medlcme 16 Bhatra J C, Dharam Vlr, Tlmmappaya A and Chuttam C S Indigenous medlcme practltkoners and then attitudes towards the proposed rural health scheme NIHAE Bull, 1972 17 Bhatla J C and Gandhi

H S Orlentmg doctors for rural health needs and services Manpower J 9.2. 1973 18 LLX CIZ7

21

19 Government of India, Mmlstry of Health The Drugs Act, 1940as corrected up to 1961. Government of lndla Press, Slmla. 1966 20 Bhatra J C and Dharam Vu Indigenous Mrdmne Practttronerc-A Potenml Rural Leadershy Unpubhshed. 1973