Medical pluralism among the Tharu people of Far West Nepal: The logic of shamanism at the jungle frontier

This medical ethnography employs a critical integrative biocultural perspective on illness and healing in a predominantly Tharu community of Far West Nepal. The 1.2 million Tharu people indigenous to Nepal's southern lowland plain (tarai) represent the kingdom's fourth largest ethnic group. Medical pluralism at the field site includes village herbalists, midwives, spirit healers, biomedical pharmacists and government health workers. This study examines the historical impact of malaria, migrant resettlement and the political deployment of biomedicine. Interviews and participant observation explored the social, cultural and ideological implications of medical pluralism in the experience of shamanism and biomedicine at the field site.;The Tharu's alpha-thalassemia hemoglobin variant provides partial immunity to regionally holoendemic malaria. Biomedical projects to control malaria in Nepal were explicitly designed by non-indigenous national and international groups to control frontier territories where the Tharu reside and aid in the resettlement of non-indigenous groups. Nepali national elites sought to exploit the land and forest resources of the tarai while international interests, organized by the United States Agency for International Development (USAID), sought to direct Nepal's demographic growth away from the political center. The indigenous Tharu conception of the jungle as sacred space conserves habitat and protects some species. Non-indigenous national and international conceptions view the jungle as a resource to be exploited for economic or geostrategic gain.;The guruwa (indigenous Tharu spirit healer) offers social and psychological healing which biomedicine fails to deliver at the frontier. Spirit healers enforce social codes and relations to sacred spaces such as the jungle ecosystem. The guruwa is an integral part of the self-sufficient village barter economy. Biomedicine functions in the cash economy and promotes the concept of health as a commodity.;Villagers' resistance to centrally planned biomedical interventions complicates and undermines global health projects in numerous ways, notably by promoting conditions for the evolution and global outbreak of micro-organisms resistant to antibiotic and anti-parasitic therapy. The ideological deployment of biomedicine must be exposed and rejected for scientific advances to effectively address the urgent health needs of all the world's peoples.