Straddled Boundaries of Health Care in a Sri Lankan Village: A Medico-Anthropological Analysis

Abstract

Medical Pluralism (MP) is a vital phenomenon, deeply focused and widely studied in Medical Anthropology and Medical Sociology. Sri Lanka is a medically pluralistic country which offers a wide array of health care/treatment options which are available and utilized successively, alternatively, and/or simultaneously. However, the scholarship on MP in the Sri Lankan context mainly carries the biomedical perspective. In this background, we explored how socio-cultural factors and structures shape MP in a Sri Lankan rural village while there is a rapid proliferation of bio-medicine and health care technologies ranging from basic rural dispensaries to e-health facilities at the macro level. Our objectives were to; identify the dynamics of MP in the chosen village, identify how pluralist medical environment influence the health seeking behavior of the villagers and identify the reasons to cross/straddle and continue medically pluralistic situation in the village. This was an ethnographic study conducted in Dorakumbura Village in Matale district in 2018. The method of data collection included observations, interviews (10), and focus group discussions (05) conducted with a wide array of respondents (ranging from peasants, traditional healers, exorcists, astrologers, doctor, nurses, treatment seekers, to village administrative and related stake holders). We adopted the narrative analysis as the method of data analysis. The research revealed that there are three main sectors of medical pluralism; popular sector, folk sector and professional sector and villagers adopt a combination of treatment practices drawing from local, regional and cosmopolitan medical systems. Kinship and family ties still play a major role in transmitting the traditional knowledge on diseases and related treatments among the villagers studied. The peasants revealed very divers health beliefs and they follow diverse health care/treatment practices from various health traditions which are based on a wide range of social, cultural, ecological and structural factors that shape people’s choices and decisions on health. Although there seems to be a co-existence of several treatment traditions among the villagers, bio-medicine still exerts dominance. Further, cultural propensities and religious faith play a significant role in shaping pluralistic medical practices among villagers studied