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Healer and Healing a study on Khasi Health care system at Mokam Punji in Sylhet region of Bangladesh

               == An Anthropological Exploration

1.1 Introduction:

    Population per physician    Hospital beds per 10,000 population     
Bangladesh    12,378    23    

Table1.1: Relation of physicians and hospital beds population in Bangladesh (WHO, 1980)

This is particularly in our societies where one medical system along cannot adequately meet the health needs of the entire population. The fifth basic needs of human being are healing, i.e. medical treatment. But health and health oriented ideas and beliefs have been change with in human ideological and cultural change. Modern medical science and ethno medicine differ in their explanation according ideas, beliefs and also their healing practices. In the present time most of the people live in a medically plural society. So their health seeking behavior is an important side of human being. Through gathering information, to find out the indigenous medical knowledge of Khasis and to investigate the available health care options, understanding their perception about alternatives in health care system, explore the health seeking behavior of Khasi people.

Health and care belief and practices differ according different culture. Cultural belief and practices strongly influence people’s health, culture is not only the factor involved, personal, educational and socio-economic factors all influence illness and health. Health problem often viewed as cultural phenomena. There are some reasons for that. Such as:

a) They often find their origin in people’s living and working condition (socio-economic status, gender position) and life style (behaviors). Poverty is associated with many diseases. Women are particularly vulnerable due to both their reproductively and their position in society. Life styles (such as smoking, unbalance diet, or intravenous drug use) and specific customs, dietary restrictions and others culturally determined health practices might also contribute to ill health.
b) They are communicated to others in ways that are culturally prescribed. In one culture a sick person may be expected to show his/her pain, while in another (s) he is expected to do the opposite. Again a patient in our culture may seek the company of others; while another cultural setting (s) he suffers in isolation.
c) They are explained and labeled in accordance with existing cultural concepts. Dominants cultural beliefs and that provides illness explanation include hot/cold ideas, beliefs in spirits, fear of witch craft or trust in natural science.
d) They are experienced in a way that has been influenced by prevailing cultural ideas. Whether an illness is regarded as serious or harmless can vary from one cultural to another. Such ideas also affect how patient experiences the illness episode.

If illness is a cultural phenomenon, health must be one as well people in different culture have different ideas about health. The culture bound character of the concept of health will be demonstrated by comparing the concept in various cultures (Applied health research manual, anthropology of health and health care).

The term “healing” evokes a variety of complex and overlapping treatment systems. Various medical anthropologists created typologies that recognize the phenomenon of medical pluralism in complex societies. Based upon their geographic and cultural settings Kleinman suggested that, in looking at any complex society, one can identify there over lapping and inter connected sectors of health care, the “popular” sector the “folk” sector and the “professional” sector (Helman, 2000).

In our country Khasi is an excluded community. They are often known as an ethnic community. They have a different cultural believes and practices. They are different in their life style with the Bengali. They have an indigenous medical knowledge. The healer of their community is known as 'Bonagi'. The physiian practices their knowledge insider of their community. But now a day’s people of the Khasi community also take service of allopathic, Homeopathic and Ayurvedic etc of various health problems. From different concept, observe in this research retention and reproducing process of their indigenous medical knowledge is considered.

    Bangladesh is a land of variety. The charm of its landscape, Hills, hillocks and woods are as alluring as those of the primitive people who inhabit its solitary woodlands. The Khasis of Mukam Punji have exotic cultural life which is remarkable for its simplicity of beliefs. In the context of Bangladesh when it is in the ethnic communities such as Khasis Healer and healing is extremely a part of culture. Because of it marginal position from the modern biomedicine, Khasis are far from the mainstrim medical services and their ethno medical knowledge are not well organized with in text, beside this it is ignored in a long time. So the Healer and healing among the Khasis is considered as an area of anthropological investigation. Of course, this investigation is not absolutely true as like as the other research of social sciences. But it is the nearest point of the real life of the Khasis community.

1.2 Statement of the problem:

In both developed and developing countries, the standard of health services public expected was not being provided. The service does not cover the whole population. There is lack of services in some areas and unnecessary duplication in others. A very high population of the population in many developing countries and especially in rules does not have ready access to health services. The health service favored only the privileged few and urban dwellers, although there was the recognition that health is a fundamental human right, there is a denial of this right to millions of people who are caught in the vicious circle of poverty and ill health. There are marked differences in health status between different groups in the same country; the cost of health care is rising without much improvement in their quality. The ethic communities have been detached from the mainstream of the health and health care sectors including the public health care also. In Bangladesh there are 31 ethnic communities are existing and khasis are one of them is totally beyond the researchers and the policy makers. The ethnic community is living in Sylhet division since several centuries, but Anthropological study yet has not been conducted the health and health care. Here by, I have prepared myself from a philanthropic view to study on that issue. I believe that this is the way of knowledge by which a community will be known to them who will be enthusiastic about the Khasis community alike me. I think that this study is an endeavor from my Anthropological mind, which is really prepared to study on the indigenous medical knowledge on the traditional medical system of Khasis.

1.3 Background of the study population:

The Khasis are often called the most advanced people of the hills in the north eastern region of India. They live within the territory, bounded on the north by Kamrup and Nowgong, on the east by the United Mikir and North Cachar Hills, on the south by Cachar and Bangladesh district of Sylhet and on the west by Garo hills; they can be broadly divided into:

1. The Pnars of Jaintia inhabiting on the east,
2. The Bhois inhabiting on the north,
3. The Wars inhabiting on the south,
4. The Lyngngams inhabiting on the west,
5. The Khynrimas inhabiting the highland middle portion.
Each of there peoples follow slightly different custom, but fundamentally they are all the same, reckoning descent from the mother, the mothers mother, back to the common ancestress. ----- Ka Lawbei which means law
= grown up ripe on old and bei
= mother, a primeval ancestress of a clan

The documentary history of the dynasty actually commences from the beginning of the 17th century when diplomatic relation was established for the first time between the Ahom king Pratap Singha (1603-1641) and then Jayantia king. The first Jaintia king whose name has been preserved by strong tradition and supported by historical evidence is Dhan Manik who was supposed to have ruled in the later half of the 16th century. Gurdon (1914) made a very cryptic reference to the Malyngiang  syiemship as follows:
The weird tale about the Siem of Malyngiang is the pride of the maskut people, for in older days their king, i.e. the Siem of Malyngiang, is supposed to have been a very powerful monarch amongst the Khasis.
Dr. Bareh note here important information provided, based on tradition that the contemporary Khasi chiefdoms of Malyngiang kingdom ware the syiemship of the Jaintia in the east, Mawron Marpri, Syiemship in the middle region and Syiem long towards the west. Malyngiang vice royalties extended up to Beltola in kamrup. Malgul (Mulagul) and Sylhet in the Surma valley. The powerful Marbaniang clan was at that time ruling over Mawsynral. At the time British came up into the hills, Ador was ruling and it was he who made a treaty agrement, with the east India company in 1831 (bareh, 1967). Dr. Bareh also recorded that many in the plains of the Assam valley such as Noahkhala. Durmaria (Dimarua) Sonapur, Beltilla, Dani Audam, Palas Bari present Jogi road etc, were under the occupation of the Khasi race.

1.4 Objectives of the study:

The broad objective of my study to know the available health care option of Khasi people and it means to find out the indigenous medical knowledge of Khasis.
Specific objectives:

The specific objectives of my research to know:
a) Conceptualizing folk modes of disease classification.
b) Explore the health seeking behavior of the local people.
c) Understanding their perceptions about alternatives in health care system

1.5 Theoretical Frame Work:
In the research medical ecological theory has applied, which is coined by McElory and Townsed (1985:4). Herden, A et. All (1903:17-18) states also that human adaptation to environment. Cultural phenomena are seen first and foremost as human solutions to problems posed by natural environment. By viewing culture as a continuing adaptation to both nature and culture, McElory and Townsed seen that medical ecology considers health to be a measure of how well population adapt to its environment. Social, biological and environment factors interact and influence health. Fabreg states that medical ecology is holistic, that is it deals with the entire system of factors that effect health (cited in McElory and Townsed: P.6). A key idea of medical ecological approach in that health is a measure of environmental adaptation and health can be studied through ecological model. Among the Khasis, this model has been applied to analyze the health and health care. McElory and Townsed states (1 bid: 14) the environment can be broken down into three part the physical on abiotic environment the biotic environment and the cultural environment no doubt these parts of models are inter linked as well as inter related. Ecological approach indicated the diseases as a result of several causes in the studied community. And it has shown that health and diseases are part of a physical, biological and cultural subsystem that continuously affects one another.

Fig 1.1: The environment that impinges on a human population is made up of physical, biological and cultural components forming a total ecosystem.

1.6 Conceptual issues:

 Three sectors model:   
In the research    Kleinman model has applied, He states that, in looking at any complex society one can identity three overlapping and inter-connected sector of healthcare: the popular sector, the folk sector and the professional sector.

The popular sector:
        This is the lay, NON-Professional, NON-Specialist domain of society, where ill-health is first recognized and defined and health care activities are limited. It includes all the therapeutic option that people utilize without any payment and without consulting either folk healer or medical practitioners. Among these options are: self treatment or self medication advice or treatment given by a relative friend neighbor or workmate, healing and mutual care activities in a church, cult or self-help group or consultation with another lay person who has special experience of a particular disorder. In this sector the main area of health care is the family. Most ill health is recognized and then treated.
Chrisman points out, the main providers of health care are women, usually mothers or grandmothers who diagnose most common illness and treat them with the materials at hand .It has been estimated that about 70-90 present. Of health care takes place within this sector, in both western and non western societies. The popular sector usually includes a set of beliefs about health is also maintained by the use of charms, amulets and religious medallion to ward off ‘bad wok’ including unexpected illness and to attract good luck and goods health. Most health care in this sector place between people already linked to one another by ties of kinship, friendship neighborhood or membership of work or religious organization.

The folk sector:
 In this sector which is especially large in non western societies, certain individuals specialize in forms of healing which are either sacred of secular or a mixture of the two. These healers are not part of the official medical system and occupy an intermediate position between the popular and professional sectors. There is a wide variation in the types of folk healer found in any society from purely secular and technical experts like bone setters, midwifes, tooth extractors of herbalists, to spiritual leathers from a he erogenous group with much individual variation in style and outlook but sometimes they are organized into associations of healers, with rules of entry, codes of conduct and the sharing of information..

The professional sector:
This comprises the organized, legally sanctioned healing professions, such as modern western scientific, medicine, also known as allopathic or biomedicine. It includes not only physicians of various types and specialties but also the recognized Para- medical professions such as verses, mio (wives or physio-therapists). In most countries, scientific medicine is the basis of the professional sector. It is important to realize that western scientific medicine provides only a small proportion of health care in most countries of the world. Medical manpower is often a scarce resource, with most health care taking place in the popular and folk sectors. In most countries especially in the western world the practitioners of scientific medicine from the only group of healers whose positions are upheld by law. They enjoy Niger social status, greater income and more clearly olefin rights and obligations than other types of healers. In hospital they can tightly control their patient’s diet, behavior, sleeping patterns and medication and can initiate a variety of tests, such as biopsies, x-ray or venesection.

1.7 Operational Definition:

Disease is the definition of a health’s problem by a medical expert (Anita Harden Anthropology of Heath and Health care 1995:12)

Human body:
The human body is more than just a physical organism. It is also the focus of set of belief about its Social and psychological significance, its inner structure (anatomy) and function (Physiology) This set of belief are called the body image and are largely culturally determined (Ibid:11)

Sickness is the social role attached to a health problem by the society at large (Ibid: 12)

Illness refers to the experience of the problem by the patient (Ibid: 12)

Nutrition is a state of complete fitness of body i.e. free from disease, ability to protect disease and having general growth.

Health is a state of complete physical mental and social well being and not merely an absence of disease or infirmity (WHO (1948)

Health care:
    Health care is a public right and it is the responsibility of governments to provide this care to all people in equal measure.

1.8 Research methodology:

a. Study Area:  The study area   is a Khasis community. It has been known that the studied people are Khasis community, which situated Sylhet and Moulivibazar district .The study area is named "Khasi punji " existing at Jaintia  Thana in Sylhet district. It is 40 kilometer far away from Sylhet zero point at eastern direction .Bus line is only mode of communication.  It is boarder area of Bangladesh. The western side of the village is Shilong of Assam  i.e. India .It is basically a small type village .It is situated  1 kilometer  inside of the Jaflong to Sylhet road .At the west-southern side, Shilong  and Rangapani river  , the east of Mokam Punji ,another Bengali and Khasis villages  and the north ,such  tea garden  exist .

b. sample size :
    For selecting as samples simple random sampling procedure has chosen by the researcher.  The sample size is taken 20 households.

c. Techniques:
In any anthropological research work, collection of data is an importance matter. In this research data has been collected from different sources but all the source be grouped into two such as,
Primary source.
Secondary source.

PRIMARY SOURCE:  Data collected directly from village community people and the field observations are primary sources .The data has been collected from khasis community people through participant observation, unstructured interview, Focus Group Discussion, key informant and case study are under this category. Data has been collected from the respondents directly considering individual and household as units.

1. Participant observation:
 Participant observation method has been followed for collecting ethnographic data .Participant observation   is usually regarded as the most important for the research. Here researcher stayed with community people and observed their socials lines with close vision. Also local community people’s health and health care systems observed for collecting valuable information a health issues.

2. Unstructured Interview:
 This unstructured interview has been used as a great aid in the second stage.  Informal sittings with the informants helped in establishing a kind of intimacy in turn helped to come to the discussion, In this case the subject matter of discussion is to be memorized and as soon as possible is noted down on arriving residence .In some cases twice or thrice unstructured interview with single. . Maximum data was collected through this method for the whole study.

3. Key Informant:
As a main strategy for collection of data the key informant technique was taken due to following reasons:
() As an aid to be familiarized with people and the environment and also as an strategy for deep observation.
() To understand and local linguistics accent, culture relationship through Emic              perspective.
() To be acquainted rapidly with the study area.
()  To acquire in-depth information within relatively shorter time.
() To encourage people to supply with concrete information for the sake of the study.

4.  Focus Group Discussion:
Focus Group Discussion (FGD) is an important technique in field research. When a group of people sit and talk there some valuable information come out .The researcher places the topic with in the group. Then they are talking about it. When they talk about it there are a lot of information comes out. To acquire in depth information within relatively shorter time a rare case the researcher have used Focus Group Discussion in this research..

5.  Case study:
Case study was expected as an aid to reflect the nature of the problem in a very nutshell. This will be adopted as an aid to the in depth finding of the study. This is one of the strategies for scaling town study as brief as possible. Because through this the brief scales of the study were enlarged .it is necessary for the study.

Secondary sources:
    Newspapers, periodicals health related research works various journals, information of union and office of jainta , information of public health office of jainta etc are the secondary sources of the research. They were considered a indirect of secondary sources in the present research work.

Tools for the management of field notes:
To conduct the field works the used various research tools such as

 Field Diary:
          A diary was kept during the data collection period on which collected data, personal experience, fields situation and degree of relationship and observable phenomena to elaborately write.

A digital recorder was always kept during the field work period; the researcher will maintain a recorder facing the problem of listening and understanding.

Field note:
    The researcher was regularly maintaining field note in a descriptive manner from the collected information. Field notes will be also played the rate of mediator between the researcher and the supervisor of the study even supervisor valuable direction will be preserved in this field note.

1.9 Limitations of the study:

Every research might contain some limitation. In other wards no research can conducted without any limitation. Though I acted as an active participator and collected most of the information’s through unstructured interview and other anthropological techniques but I have some limitation in research purpose.
            The limitation of this research language .Because every Khasis men and women can not speak in Bangle.
            The next limitation was the respondent was not always available. When the research was conducted in those times every informant was more or less busy. As a result I was not able to take intensive interview in all the time. And the next limitation was available books, journals etc. Khasis related.

Review of Literature:
For better understanding of the conceptual issues of the research, review of literature is needed. Few health related books have reviewed for this research after which described in below:
Anita hardon(1992) has written Applied  health research manual :  Anthropology  of health and health care. He aims to acquaint the participants with the conceptual and methodological tools of Medical Anthropology. The first twelve modules  includes in this manual give a general introduction to the Anthropological approach to health  and health care and to Anthropological research on  specific problems  areas ,the rest of modules focus on the methodological tools for applied health research .
The Authors first assumption is that human body is more than just a physical organism but have a cultural mind which influence people’s health. As the  formulation of them, disease is the definition  of a health problem by a medical  expert, illness refers to the  experience of the problem by patient and sickness is the  social role  attached  to  a health problem  by the  society at large. From the Lay theories of illness causation, Young (1983) distinguished internalizing belief system which occurred within individual either due to incorrect behavior or lack of social and economics resources or could be the result of personal vulnerability; and externalizing belief systems attribute the causes of an illness episode to the natural world, to the social world or to the supernatural world. Again another classification proposed by Foster and Anderson (1978), in personalistic systems, illness is due to the purposeful intervention of an agent, either supernatural or human. In naturalistic systems, illness is explained in impersonal systematic terms, it can be caused by natural or by imbalance within the individual the view taken for instance in humoral medicine.
Within the general framework of Anthropological approach: Structural Functionalism could view illness is a dysfunction of the body and health care contributes to the maintenance of society as a whole by repairing the sick individual .In the ecological model health is regarded as the result of successful adaptation to environment and disease the outcome of the failure to adopt .Medicine both curative and preventive is seen here as a cultural device to restore optimal adaptation. The Marxist political economy model viewed health and quality of health care are largely determined by social competition between groups of people (classes) and the unequal distribution of scarce resources. The transaction list perspective can be applied both health workers and their clients. The activities of health workers may be motivated by profit making considerations and patients may use health services  to further their individual interests, Question such as :what is illness, how  do people explain and label illness, how do they choose between  various curative alternatives and how they communicate with health practitioners   may be usefully addressed from a symbolic point of view the described approach should be seen as complementary but critical Anthropology which has integrated the politico-economic and symbolic views and tries to connect macro and micro level insights in social processes. Illness is presented as the embodiment of Society's most basic problems and conflicts.
The Authors argued health  system  as part of a cultural system which includes patterns of belief about the causes of illness  norms governing choice and evaluation of treatment, socially-legitimated statuses ,roles power relationships, interaction setting  and institution they also focused, medical pluralism is ultimate reality of the western and non western world, that is why varies it varies. The popular sector comprises the lay, non-professional domain where illness is first recognized and treated. Self-care is an example .The folk sector consists of local healers such as herbalists, bone-setters, spiritual healers’ diviners and traditional birth attendants. The professional sector is the domain of medical specialists who enjoy a privileged position in the sense that they are legally protected and control memberships, knowledge and quality of medical practice by means of formally recognized professionalization.
Authors further elicit other classification of health system, public /formal medicine is offered by the state and is either inexpensive or free, Private/informal medicine tends to be the domain of non-government organization or private entrepreneurs. A health system is an integral part of the wider culture and society in which it is found, they explicitly argued for the mutual understanding of traditional and modern medicine and respect for each other.
    The outcome of individual decision making process for selecting therapy is to a large extent this result of cost-benefit analysis: not only in economics but also in social terms.
Self-care is one kind of the therapetic decision which include are activities undertaken by individuals themselves to treat or prevent ill health .The Authors firmly argued Anthropological research focuses on popular notions of the disease and transmission related behavior. On the other hand the next part of this explicitly analyzed the methodological consideration in respect of mutual understanding of both qualitative and quantitative approach but emphasize more.

    Thomas M. Johnson  and Carolynt  Sargent(1990) has written, Medical Anthropology :A hand book of theory and method, is to present the state of the Artin medical anthropology, capturing  the range  of theoretical orientations  research findings and method characterizing the  discipline to day. The first section is a collection of five chapters addressing core, theoretical issues in the discipline in order to present the breadth of current theoretical concerns in medical Anthropology. To understand the therapeutic process, Thomas J. Csordas and Arther  Kleinman tend to emphasize the symbolic and non symbolic aspects of healing. Again to be explicit of its nature, they seek to distinguish therapeutic process from therapeutic procedure on the one hand and from therapeutic outcome on the other.
The idea of therapeutic process is analogous to the idea of ritual process and categorization of it ,the first formulation the treatmental  event has been described as the process which is understand as the sequence  of actions, Phases or stages undergone by the participants, on the other  hand, process  within  therapeutic events is constituted by elements of verbal interaction  and interpersonal relationship  between therapist and client .The second conceptualization of experiential or intrapsychic process with a focus the sequence of mental states, the emergence of insight, interpretation of religious experience, and endogenous symbolic or Somatic process, Third sense-that of progression or course of an  illness episode, defined by a sequence of decision leading to diagnosis and treatment. The final sense-social and ideological control exercised through healing practice that may consider political that is the sense in which therapy and healing articulate with broader social issues and concerns.
Their approach to understanding health and healing focuses on the personal illness experience and the local ideological control inherent in healing. On the other hand Csordas and Kleinmen also advocate for more macro social analysis that demands attention to the role of broader economics and social dynamics in the therapeutic process.
Much as these Authors insist that health and healing can not be understand without attention to individual experience, cultural meanings and the structure of society .Section 2 contain five chapter covering aspects of medical system. The first three chapters consider various dimensions of ethno medicine a term that has connected non western medical systems in a discipline that has traditionally dichotomized medical systems.

    Francis x. Grolling S.J and Harold B .Hale (1976) has written “Medical Anthropology”. They stated basically it’s a precongress conference articles on medical anthropology covered up with four themes: Native cultural aspects of healing; Specific subject papers; Interaction of traditional and western medical practices; and theoretical aspects of medical Anthropology.
The first formulation assumed that most cultures have kind of expertise or specialists who treats illness and disease might be identified as Shaman or witch doctor, And the society's basic attitude is that if he can cure disease then he can causes disease, Again if the Shaman has the power to retrieve the spirit, it is quite reasonable to consider that he would also have the power to destroy a person by talking the spirit away. But he was accused of being jack of all trades but master of none, further more has no formal scientific training in modern science by his professional colloquies in modern medicine .but in reality African native doctor was a man of critical mind and well informed about the problems of his environment and possessed practical knowledge of Botany Pathology, Psychology (divination) Surgery animal and plant curative agents Climatology, Cosmology, Sociology and Psychiatry.
    From views of African native doctor, disease is an external force which enters a human body in a specific way and enters feres with the normal bodily functions, which can be classified into two classes: role of spirits of dead ancestors, sickness in human body has an organic basis. A witch doctor treated effectively the three broad categories of disease recognized in modern or scientific medicine: specific disease were well known to the witch doctor, by administering herbs, he get expected result, symptomatic disease involved both herbal treatment and a psychological therapies in addition to bibliotheraphy by using, a witch doctor able to improve the patients feeling without necessary changing his pathological condition. In North African Yanoama group perform using Shamanism and protection from evil spirits etc and other Shamanistic by shaman with help of their subjected assistant spirit, hekula. The feature of Shamanism is the chanting by which Shaman calls hekula to his aid; Snuffing is used during this period.
In Peru, Coca is locally used medical practice for using various diseases. But with European intervention; it became used widely as a medical element to create various medicines. Within institutionalized framework.
In study of African society leads to view that belief system as part of the structural components are causally related to illness. Thus illness is not only a highly personal affair but also a variety of feelings in the sick person and those who close to him in search for treatment choices and alternatives are considered within the framework of existing knowledge and experience. Thus illness is subjectively defined, past experiences of similar illness dictates the initial definition and diagnosis and here the initial treatment. The choices of therapy are determined by several factors, especially the availability of a hospital and of the Nganga-African medicine men.

The cure which  is meaningful the patient is the one which  sets his mind at rest .For example, a person  may be somatically fit, but if he is psychologically convinced that he is not, it is the latter not the former state which is  relevant. Thus diagnosis and therapeutic measures acquire meaning through subjective perceptions and a definite world view in which apparent irrationalities assume meaning and sense Learning the skills and arts of healing might be categorized  in various ways: After payong a certain sum of money to Noanga, therapy are learned by the persons who are initially patients and have already cured, the others are trained herbalists, holders of certificate from herbalists association; and the last category to have attained skills through dreams or visions, A community used method of  diagnosis is divination. Illness is believed to be caused by a myriad of factors, most illness carry aspects of mysticpson; most of the diagnosis is equally mystical.
    Turner, in discussing Ndembu medicine sees the dual aspects i.e. natural and social aspects of medicine. Certain Ndembu medicine cures are private and involve only herbolists while other disease involve mystical causes and therapy becomes a matter of selling up the branches in social relationships simultaneously with ridding the patient of his pathological symptoms. In the case of Rama snakebite cure is asocial as well as natural phenomenon .The cure utilizes endo-psychic and exo-psychic symbols. The social of nature of the cure is reflected in the fact that the patient is integrated isolated at several levels of the social structure during the cure.
Socio-economic summary of the Khasis:

Anthropological study in conducted on the basis of ethnographic observation. Respondent’s age, sex, economic position, literature condition occupation housing etc are the most primary information of a person and there are simultaneously treated as an important influential indicators of person on his / her world view perceiving about all.

3.1. Geographical Location:
Sylhet is surrounded by in three side .to the north of it there are Indian state Meghaloy in the east there are Jainta, Jaflong district of Asam, Tripura is south of it west of it there are district of Bangladesh Mymensing and Comilla district.
The district was a second largest undivided district of Bangladesh (Bangladesh bureau of statistics 1983) the geographical density of the area is 4783 miles.
The weather of Sylhet is hot and humidity the temperature is started to rise with in between March to November and the rainy reason is from May to August the annual average rainfall is 131 degree Fahrenheit.
The population of Sylhet has increase over time. The ancient data found in 1789 where it shows that the 492945. The present number is more than 1719539(source: Md Abdul Aziz 1982p-22)

3.2: Cultural distinctiveness:

 3.2.1: Family and property inheritance
 The Khasis have families of  matriarchal and matrilocal mother is the head of the family and the children get the family names from their mothers heritage title are derived from the mother reserves the right of distributing the family wealth among her children although traditionally the daughters get prominanence during this process mother now a gives some past of her wealth to her sons  usually the son gets half of the share of the  daughter sons also usually get the wealth of their maternal uncles who on their  art can take their wealth to their respective wives house after the marriage it has been practiced since generation after generation .
In a family father have a lot of moral duties he has to take care not only his children but also nephew and nieces in Khasis society the mother has a divine place.

3.2.2: Kinship
Kinship is a crucial factor among the Khasis  in social cultural and  religious  aspect kinship is playing an important role all the relatives of egos mothers side are called ‘kur’ and ‘kikha’ is called for fathers sides all the nearest relatives have an ancestor mother or adimata who is termed “ lanwbei tynral”  the adimata.

3.2.3: Marriage
    Marriage is in the core of blood relationship of the Khasis the marriage are held according to the traditions of the society the couples usually grow liking for each other and then take consent from their parents and relatives and the marriage takes place marriage in the same clan is not allowed divorce can take place by mutual context of the couple.

3.2.4: Identities the lineage
The lowest daughter of family is treated the most important person of a family she controls the expenditures of social religious and familial activities.

3.2.5: Religion land ritual
The Khasis are worshipers of nature they do not have fixed religious rituals but usually they ‘pray in the evening at the prayer center ‘youngblai’ by lighting candles this evening prayer is known as ‘Nulaibliba Khasis has a tradition of song dances and rituals in Mokam Punji there are two rituals were famous these are

In the winter month of ‘magh’ they celebrate the festival of ‘haktoi’ during which males and females of the community dance together and prey for the well being of their dead relatives.

Funeral ceremony is very expensive in Khasis community dead body is burned and ‘burned ashes’ and bones are preserved at family graveyard.

3.2.6: Political organization
 A headman is the local leader of the Khasis community once upon a time king ruled Jainta but during British ruling kingdom has fallen and the headman role the Mokam Punji. The people are paying all the taxes and obey all the governmental laws. But at first they go to the headman to meet their problems basically among the Khasis both role are seen.

3.2.7: Agriculture and other economic activities
The Khasis live in the hilly areas and employ the jhumming system for growing crops. Rice and special type of ‘par’ are their two main crops. Traditionally they like to live in green forest and therefore, they take care of the plants surroundings them. The males are also involved in praying of the wild animals like pigs, wild cats and rabbits and also fish and turtles. They also grow potatoes and different vegetables.

3.2.8: Housing:
In the hilly areas where the Khasis live they have made the ‘machongs’ or high houses to have extra protection against the wild animals, which used to live in the brests at the time of their immigration to the area. The machongs are made of woods and its lower floor is used as storehouse of agricultural equipment and products. On the top of the ‘machong’ are the rooms for living. In modern things the richer Khasis live in bungabw pattern houses while the poor people continue to live in the traditional ‘machongs’.

3.2.9: Food habits:
The Khasis take their traditional foods. The main food item is rice. It is taken with fish, meat, vegetables, and lentil whichever is available. They like to have pork, wild chicken and wild cats during different festivals, but they never eat beef due to their religious belief. They also eat meats of the homegrown birds like chicken, duck and pigeon. They eat all kind of fish expert the frozen sea fish, but they are very found of died. Fish called ‘tung’ more recently the Khasis are getting accustomed to different Bengali foods.

3.2.10: Social control system:
The administrative and judiciary system in the Khasis community are still run traditionally .There is a ‘minister’ in each ‘punchi’ who along with his two advisors. Collectively solve any dispute arising in his territory. The minister and his advisors are democratically selected and women are given very much prominence in this council. The minister usually keeps close contract with the existing administration and judicial framework of the state.
3.2.11: Social changes:
From the cultural point of view, the Khasis of Sylhet here a great sense of individuality. With passage of time, they have taken up some cultural elements from the outside community. They have taken up dressings furniture and foods from the Bengali and western society. Yet they are nurturing their have been marked changes in the life style of the Khasis. Previously they used to live their own house and Punji but now they are going out for education, business and service. With time, different types of fauna and flora have ceased to exist. Now many Khasis have lost interest in growing their traditional ‘Pan’due to economics. Non-profitability, many Khasis families are taking up other economic activities to support their living. Some are even building houses in others areas. Christian missionary is also working at the khasis community. The personnel of that make an attention to the people that if people become Christian, then they will provide various facilities including medical services.

3.3: Number of selected household
I observed that there is 44 household are living at Mokam punji among them 10 is Patra community and rests of them are Khasis among these households 20 were selected for study.

3.4: Number of the respondents
 Among the 20 households there are 30 respondents have been intensively interviewed  in this study in every household both the males and females have been conducted for interviewed in such issues particularly both households and wives  have been interviewed  on that issue.

3.5: Households house and its materials in construction
In the Khasis community there are 44 households and there are 3 types of housing. Each of these groups is seen as below:

Table 3.1: Housing condition on the basis of economic position

Housing condition    Rich    Middle    Poor     
Buildings    4    0    0     
Half buildings    10    15    0     
Made by bamboo    0    5    10    
                                                                          Source: Anthropological research 2005
Buildings are replaced for the meaning ‘pucca’ here roof , floor and wall are made by breaks half buildings is to refer to those houses of which roof is made by tin wall is made by bricks with mud or bricks ‘kacha Gha’ is made by bamboo . One kind of long grass called chan is used to make for roof bamboo is used for wall and floor is made by mud.
Besides that in that village Mokam pujie there has a registered primary school a small pucca road crossed the a church and a community club house is existed.
Health and Healing System of Khasi Community

4.1 Three sectors model has applied among the Khasis community
    In this study Kleinman model has been taken an analytical tool. So, Kleinman model among the Khasis community has been applied. Among the Khasis community one can identity three overlapping and inter connected sector of health care;

         The popular sector,
         The folk sector,
         The professional sector.

Each sector has its own way of explaining and treating ill-health, defining who the healer is and who is the patient and specifying how healer and patient should interact in their therapeutic encounter.
The popular sector:

It includes all therapeutic options that people utilize without any payment and without consulting either folk healer or medical practitioner; advice or treatment given by a relative friend neither; healing and mutual one activities in a church, self help group or consultation with anther lay person who has special experience of a particular disorder. C; here most ill-health is recognized and then treated. It is the real site of primary health care in a Khasis community. In Khasis family the main provider of health care are women, usually mothers or grandmothers, who diagnose most common illnesses and treat them with the materials at hand. A woman who has had several pregnancies for example can give informal advice to a newly pregnant younger woman, telling her what symptom to expect and how to deal with them. Most health care among the Khasis community in this sector place between people already linked to one anther by ties of kinship, friendship neighborhood or membership of work or religious organization.

The folk sector:
    They also depend on the folk sector. From ancient period to the present day the Khasis people have been using this traditional herbal medicine. There is no side effect of healer medicine. So, most of the Khasis people use these medicines without any hesitation. The herbal medicine is less cost and easily available, which all classes people. Many kinds’ herbs vines are slowly extinct and declining in the area. This herbal treatment is more effective for the Khasis community. The herbal doctors can early remove bonesetters by using wild tree leaves.

The professional sector:
    Nowadays Khasis men and women take allopathic treatment. Though the allopathic treatment is extensive in the community, they take less expensive traditional herbal and indigenous treatment which they learned from their grand parents and neighbors of the Khasis community.  Primarily   they receive their indigenous treatment. In the care of failure they seek EPI Technician Ismail Ali, Jainta Thana Health Complex, go through a skill doctor according to their suggestion and take some medicine from them.
    In the same time they take both the modern and indigenous treatments. But they can’t identify which treatment was effective to recover their diseases and both the treatment exists under same circumstance.
    Financial problem is another vital cause in this regard. Most of them have not sufficient financial ability to fulfill the modern doctor’s demand. As a result they receive to indigenous treatment, which is cheap comparatively.
    Availability is another fundamental criterion to exist indigenous treatment. As the modern doctors live outside the community on the other hand indigenous practitioners are with in village and under their control they come to them for protection to their primary treatment.

4.2 Personal hygiene care of Khasis:    
        Normally the Khasis people go to the field everybody either for jum cultivation or collecting food items. As a matter of normal practice, they take both in the nearby Rangapani River or cascade everyday while returning from the jungle or field. Other than this the Khasis people are not much serious about general cleanliness. They do however; wash their teeth every day in the morning with charcoal. The Khasis men also use twigs of name or guava tree as tooth brush, whereas the women and children commonly use charcoal and salt for cleaning their teeth. Most of the children, however, co not clean their teeth.
    Hair doing is every popular practice among the Khasis women. They seem to be quite serious and careful about their hair. To clean their hairs the Khasis women use soap and lemon juice. In addition they also use a kind of fruit of jungle tree to clean their hairs. They believe that the use of this fruit not only clean their hair, but also helps in getting rid of lice from hair.
    Cutting of hair is a common practice among the Khasis men-children. There is no professional barber. Normally the Khasis men kept short hair. They go to the Jainta market for cutting hair. The grown up girl and women of this community do not cut their hair. They use oil on their hair and they make tight buns of hair on the top of the head.
    As there has no provision for latrine in their house, normally they relieve themselves in the nearby jungle and they clean themselves with the help of leaves. They do nit use water for cleaning.
    I saw Khasis women having no concept of personal hygiene and cleanliness particularly at the time of their menstruation period. They consider menstruation as normal as urination. They do not use any protective materials like sanitary pad, cotton, used clothes etc.
    The Khasis people are not very particular about trimming and cleaning their nails. Occasionally they trim their nails with the help of blade.
    Although the Khasis people are not very much conscious about cleanliness in general, on any important religious occasion they are very particular about taking bath with soap and wearing clean clothing.

4.3 Indigenous treatment system
At that time there was no doctor and modern medicine to treat the patients’ people had to depend on indigenous treatment. Herbal doctors utilize the plants for preparing herbal medicine. Herbal doctors had learned this kind of treatment from generation to generation. Khasis men and women as try had started their permanent settlement in this area began to treatment different herbal trees for indigenous treatment

Table 4.1: The traditional treatment species are shown as below:

Leaf/trees roots and others    Khasis name    Treatment     
White flowers    Chelenai    Stomachache     
Crade    Bone setters     
Sathapata(tamakpata)    Dumba    Tooth pain     
Sapri pata    Sampriam    Stomachache     
Morich pata    Chometheo    Skin diseases     
Bel pata    Belo    Ulcer     
Tulsi pata    Tulsi pata    Stomach ache     
Nim pata    Sheteboot    Iches     
    Filifomentra    Dysentery     
    Fisichary    Verities     
    Filifpriang    Varities     
    Filiflani    Varities    

Source: Anthropological research 2005

4.4 Women health:

4.4.1 .Pregnant women and childbirth practices:

There is no special treatment and care for the pregnant women in this community. The pregnant women perform all routine works for the households as well as outside unless one is very sick. Normally however, they do not go to the fieldwork after six months of pregnancy up to the 3 months after child birth. During the child birth pregnant women as kept is an isolated room. Normally the older women assist when pregnant women feel labor pain. Sometime the Khasis women follow the herbal doctor’s advice for early delivery after delivery women follow food early delivery women follow food rituals. Normally no special food is prepared for sick persons either. However their rice is cooked softer. Although there is no prescribed food for pregnant mother, they prefer to eat items which taste. After the child is born the mother eats rice with boiled chicken with salt and pepper for one month. They take only simple food like rice, vegetables etc. the pork, hilish fish, egg, duck meat, putifish(small fish) are restricted. They think that it may be harmful for their baby after fifteen days meat of pork, egg, duck are restricted for her. The restrictions of the first type are those related to superstitions, like not letting out the pregnant women out of their house after the dusk, not opening the back door of the room, where a pregnant woman is in labor etc. There is no restriction to provide mother breast to the newly born babies. During childbirth there are some taboos. The pregnant mother is to wear an Amulet which is termed is local language (tabiz). They believe that if and an amulet is worn by pregnant women, she will give birth to a-well developed, mentally sound and a beautiful child. Hair cutting of the born baby is done after 3 month expecting Saturday and Tuesday. So hair cutting is done either by uncle. After 3 months they name the new born baby with advice of an astrologer who recommends the name considering the time and date of birth. As a traditional practice the names of the babies correspond to the name of various stones and flowers. The astrologer is given some gifts and goods for helping in naming the child.
4.4.2 Child rearing practices:

             In case of child care mother plays an important role. Daily care including feeding cleaning etc, are done by the mother only. Mother is considered in the Khasis as machine that conceives year after year .The term mother is to them “mai” .A mother “mai” conveys some sort of regards and affections. Mothers are also regarded as a collection of responsibilities of respective families ,babies and as well as some economic factors .So mothers are playing an important role in that community .In this regard ,mothers are considered as the providers of health to the children particularly to the babies. The new born baby is bathed with boiled water containing different types of herbs and charms This exercise protects the child from all types of evil spirits that may be harmful to the baby .The mother of the baby gets special care to ensure that she maintains good health after delivery.

4.4.3 Impact of evil spirit:

The Khasis women are afraid with several prejudicial effects of evil spirits, during their Antenatal period. They always maintain some Rules regulation to free from these evil spirits, also for the prosperity of herself and the Organism growing in her womb. In my research Village Mokam punji the concept of foiling Evil spirits are existing among the pregnant woman.

a. Detrimental winds( BAU BATAS) the pregnant women believes, if any time of the day, they stay in the area or middle of a circular current of air they may be victimized by BAU BATAS which can cause various harms for the pregnant and also her baby, like the following:

1)  She may give birth long days before or after the particular period.

2) The organism growing in her womb may die and she might give birth dead child.
3) She may give birth in complete organism. For instance has being delivered of organism during six month of her pregnancy period, consequently they assumed that she was attacked through evil wind (bats).

B. Coeternally the pregnant women do not stay outside of the house during mid noon, evening and last place of night to stay from the invasion of evil spirit.

C. The pregnant women never seen death body, as they believe that, she may give birth and death body.

D. They also try avoiding enjoying snake charming lest she may give birth a snake or serpent.
It should also mention that due to technological and economic change in villages the tear of evil spirit is decreasing day by day.

4.5 Child health:
Child health is considered throughout the world as the most significant one in health sector. Among the Khasis, children are considered as the encounter in their society. And particularly female children are more encouraged, during illness. They expressed several opinions about child health.
These can be shown below:
Table 4.2: Opinions about child health

Opinions    Frequency    Percentage     
The robust baby    15    50%     
Free from diseases    8    27%     
Who have normally growth    7    23%    
                                                                          Source: Anthropological research 2005

This table shows that robust body i.e mota toza sharis is means good child health. Free from diseases, which is a basic condition of the definition of health given by who, has been stated by only 23 percent of the total respondents normal growth.

4.6 Health care service:
     a. Government organization:
        The jainta thana health complex which was established since 1960 is in Sylhet district. The officials always supply the Khasis peoples some medicine in any sort of diseases during office hour. It has been seen that Khasis are not standing in the mainstream of health care facilities by the support and field services unit or clinical services. But it is reality that modern treatment or clinical services is increasing gradually in the Khasis community day by day. Despite this indigenous treatment, like healer and saint are existing under same circumstances, especially for the purpose of pregnancy and bone setters etc.
    I observed that Khasis women have come at the hospital returned without having treatment. A doctor child department does not prescribe to the rich patients rather orally suggested to visit him at evening in his private chamber of if she/he provides better treatment.
    Khasis of mokam punji are not so isolated from the state system. At the citizen of Bangladesh, they cast their own vote. But they seem that they are deprived from various facilities that are provided to other Bengali community.
       Khasis seem that they are not provided health care facilities as other Bengalis people get. But Bimola or other Khasis woman don’t agree with this argument rather they agreed that they receive medical facilities alike Bengali or other people. Mothi and other Khasis are of the rich of the Khasis community.
       The Khasis people who comes to their center during office hour, they supply them necessary suggestion and which medicine is not available in the center, they suggest them to buy from outside pharmacy.

b. Non government organization:

    1. BRAC:    BRAC is working providing health care facilities in mokam punji. in mokam punji BRAC is working with a small canvas through the micro credit programs and some sort of drug selling and providing service. But most of the respondents seem that the woman is more interest at to make profit rather servicing them.
2. CHRISTIAN MISSIONARY:     Christian missionary is also working at the Khasis community. The personnel of that make an attention to the people that if people become Christian, then they will provide various facilities including medical services. But after being Christian people state that they have not received such facilities as that have promised. And then they become sufferer that the local heaters done provided them medical services, on the women who have fame in providing them. And there has no chance to back in own religion “chinog”.

    3. SIMANTIK:    A non governmental organization established in 1998 and 1st January and working in home and abroad. In mokam punji simantik is working some sort of drug selling and providing services.
    They provide facilities such as various diseases such as diarrhea, sexual disease, STD, etc.

4.7 Opinion on health services community people:
        Though the officials try to prove them as highest service supplies in the conversation, the community people also represent some accusation about them such as,
The officials never provide the service without any payment and generally they are fond of completing this job unofficially.
b.    As the Khasis people are illiterate they cannot count their specific day to visit satellite clinic, and in this regard though the official’s duty to inform them before meeting but most of the cases they desist.

4.8 Ecological surroundings of the Khasis community:
In the study the ecological model has been taken as analytical tool. So the ecological setting of Khasis community should be discovered. In study of British medical Association (BMA), Gilpin (D98.9) has divided three sets of environmental condition that are –
1. The combination of physical conditions that effect and influences the growth and development of an individual on community.
2. The social, cultural and economic conditions that affect the nature of an individual or any community.
3. The surrounding of an inanimate object of intrinsic social value. And these divisions are may be converted into such categories. Among the Khasis community the ecological setting are as follows-
a. The biotic factors such as the lands condition i.e. the village landscape are one kind of valley types. Heavy rainfall is occurred but rainwater cannot exist water i.e. as for landscape not ponds are seen at the village atmosphere i.e. the materials of the setting.
b. The biotic factors of this community i.e. population and population density flora and fauna.
c. The cultural factors include the ideological setting of that people such as the perceptions, causes of perceptions social organization, technology i.e. which mechanism are use for water, housing, sanitation etc.
            All that factors as influenced the health system behaviors of the Khasis community. And through this process the community has been surviving i.e. called adaptation.
The Concept of illness, sickness and diseases

5.1 Concept of   illness, sickness and diseases:                      
    The meaning of illness and sickness were same to the Khasis people. Most of them seen that illness and sickness are the person’s own idea. It is meant that a person might have imagined him or she becomes sick or ill or in some cases, the person might have been fit but the neighbors or others family members identified him/her is on ill or sick person. So Becoming ill was depended not on the person him or herself only but on the societies also Khasis people believe that when a person was identified with any unpleasant situation then she/he becomes ill or sick person. So in the case of Sunita, it may be stated that the other person sometimes identifies illness and sickness. Though a person can never feel uneasy, to identify the meaning of disease the studied community have some sort of differentiation but almost agreed with such on the opinion that it kabiraz i.e. traditional healer or any recognized doctor or pharmacists identify any person as illness then it is called diseases or Rugi and locally termed as ‘Tse’ the identification of any diseases, the person is called ‘sick’ ‘Rugi’ or’Tseui’. Herdan et. Al (1995:12) state that diseases is the definition of health problem by medical expert, illness refers in the experiences of the problem by the patient   and sickness in the social role attached in a health problem by a society at large.
    On the other hand, the Khasis people also believe that diseases may be treated as a malfunction or ill function of body. They also seem that body may be well but it ones mind is not be strengthened, then she/he will be sick. So on the basis of the perception about illness, I can witness as below-


Figure 5.1:    Witness of illness, sickness and diseases
In this figure,   I see that illness of a person is infect  embedded in the individual level, sickness is in social level but  it depends on the certification of on expert, who may be institutionally recognized on not but socially acceptable one. So, it can be concluded as Ostergoard, L(1992:111) apparently state that “the concept of diseases is more easily defined than the concept of health”. The above discussion will be salutes to demonstrate the perception of illness, sickness and diseases of the Khasis community.

5.2 Concept of diseases:
               I have seen that most of the poor and middle statuses Khasis are more victimized by various diseases. I saw the most of the people was suffering from various diseases. I have seen all the diseases of all people in general. Diarrhea and malaria are mostly seen among the children of the Khasis skin diseases are treated by various local names on the basis of type of skin diseases. It is also seen that diarrhea is treated by various local terms due its color, smell of faces and the agony of children. Various terms of diarrhea is not unique of Khasis rather it in seen in various societies though out the world. Women are suffered from diarrhea diseases particularly dysentery or blood dysentery, skin diseases and cough. The older people are suffered from T.B. diseases particularly Asthma, cough, heart attach.

5.2.1 .Major types of diseases:
        In the Khasis community, various type of diseases the seen through the year most of the Khasis perceived that   there is nothing unknown disease among them.
    In the following table we can see the major type of diseases and its local language and its percentage.
Table 5.1: Distribution of diseases

Diseases    Percentage     
Diarrhea diseases including dysentery, cholera    35.00     
Fever including malaria, cough, Asthma, headache, jaundice    35.00     
Gastro intestinal diseases i.e. gastric ulcer    5.00     
Skin diseases including measles ,small pox, water pox, Asthma    25.00    
                                                          Source: Anthropological research 2005

    This table shows those diarrhea diseases, fever and skin diseases are the major types of diseases among the Khasis.

5.3 Diseases in the various seasons:

        In Bangladesh, though called there has six seasons, but strict demarcations are not easily found. Khasis believes that there has three basic types of seasons can be realized, and these are summer, rainy season, winter. In the following table, we can see that-
Table 5.2: Seasons and diseases

Seasons    Khasis language    Diseases     
Summer    Telang    Jaundice, malaria, diarrhea, dysentery, lever, cholera, Hepatitis-b, T.B. heart attach etc.     
Rainy    Meslai    Skin diseases, diarrhea, malaria, headache etc     
Winter    Telang    Cough, skin diseases, diarrhea, small, water pox, Asthma, gastric, headache, paralysis etc    
                  Source: Anthropological research 2005
    This table shown that there has some sort of demarcation among the seasons but indeed there has overlapping. In the summer season many Khasis suffer from jaundice, malaria, diarrhea, dysentery, lever, cholera, hepatitis-B, TB. and suffer from phenomena skin diseases headache diseases in the rainy season. They also suffer badly during winter season from cough, skin, diseases, small pox, Asthma, gastric, paralysis etc. this ethnic group count three seasons in the year while they believe that every diseases harm people in different seasons.
5.4 Causes of diseases
The Khasis settlement the settler had suffered from contagious and infectious diseases.

5.4.1 Environmental factor of diseases causation:

    Informant chills all that is external in the agent and the host. There are many environmental in the agent and host.  There are many environmental factors, which may be divided into three parts health and health care:
i.    Physically
ii.    Biological
iii.    Socio-economic.
 a. Physical factors:   
Physical environment includes geographic, geologic and climate. Geographic locations of the Khasis community there in its relation in neutral carry or avenues, to human travel influence diseases causation. Soil and climate are other features of geographic location. It was rainy season of the first phase of my field work, it has been seen that rainfall occurred suddenly and after a while it goes again. Climate change frequently and which is a cause of various diseases. Particularly its can be stated that the infants who are not will adapted to this geographical location.
b. Biological factors:  

Biological factors includes such agent i.e. nutritive elements: carbohydrates, proteins, fats are regarded as that physiologic factor i.e. age, pregnancy are considered one the other hand “invading living parasite” is treated as the another factor of illness and diseases causation. A parasite is an animal or plant that lives in or lives on and obtains its foods from a living organism called the host. Parasites are the largest groups of diseases agent. And among the Khasis, the domestic animals have no separate space; dogs have frequent movement inside the houses flower, physical and environment also included psychic factors that are the consciousness and subconscious mental state of on individual. Among the Khasis I have seen that fear in treated as a cause of diseases. Basically fear is nothing but psychic factors illness.
c. Socio-economic factors
Socio-economic factors influence health by indirect and direct means Ostarguard l (1997:111) state that economic, political and cultural conditions etc. I have seen various kinds of diseases among the Khasis community over a year. During rainy season and winter they are suffered enough. Rainy season is alarming for now water ’shetbut’ which causes of skin diseases and winter is same but for lack of water. Individually risk factor is also an alarming factor in the community. Smoking, teeth brushing, long nail etc is may be treated as individually risk factor, particularly in the children. But if one can focus more on that then it would be biased and social economical causes may lied beyond that research

5.4.2 Causes of diarrhea and diarrhea diseases:

    The Khasis have such own mode of thought on the cause of diarrhea among them and their children. We can show these factors graphically,

Good punishment    Environment    Water    Bath    Hit    Fear    Evil    Man’s  food habit     
60%    60%    30%    20%    60%    20%    20%    70%    

Figure 5.2: Cause of infectious diseases taxonomy of the people

In this figure, it is seen that environment in treated by the women as 60%. Environment is means to them an excess of heat, an excess rainfall, an excess of cold and sudden change in weather. Water is treated by 30.00 percent women only. 20.00 percent women treat bathing in the cascade of the children as a cause of diarrhea diseases. Hot and cold food is the vital cause of diarrhea diseases of any person, recognized by Khasis 60.00 percents. Fear aloneness etc are treated by 10.00 percent of the respondent. Evil eye is an important cause of diseases, not only merely the Khasis community rather another part of the world people, treated by 20.00 percent women. And lastly diarrhea diseases are treated as punishment from good on the parents through providing illness is the children, has been identified by 30.00 percent of Khasis women.

5.4.3 Poverty

Poverty is treated as the most serious carrier of ill health and diseases (Ostergaard L1997:113, chowdhury 1984; koester 1995; Dayal r 1985). In Mokam punji not all is economically better off. Housing dress up density etc are the major indicators of ill health and all are almost outcome of poverty. “Unsafe water and poor sanitation are two other direct derivations of poverty Ostergaard(1 bid:115) and it may be stated hat poor housing in the another addition of that among this Khasis community. It has been seen that women spend good time for water collection from the cascade. Among he Khasis community carrying capacity of the women in family and the distance of the cascade are the decisive factors determining actual supply of water. In winter or during pregnancy the capacity is limited and if the quality of water is poor, the level of hygiene become low and many water born diseases and infection as well as parasitic will occur. And Ostrgaard (1bid: 115) apparently states that their daily and direct conduct with water makes women particularly susceptible to water related diseases.

Dietary System of the Khasi Community

    Food is more than just a source of nutrition. In all human societies it plays many roles, and is deeply embedded in the social, religious and economic aspects of everyday life. For people in these societies it also carries with it a range of symbolic meaning, both expressing and creating the relationship between man and man, between man and his diet and man and the natural environment food, therefore is an essential part of the way that any society organizes itself, and of the way that it views the world that it inhabitants.
    The anthropologist Claude Levi-Strauss has argued that just as there is no human society which close not have a spoken language , so also is there no human group which does not supply through cooking. In fact, the constant transformation of raw into cooked food is one of the define features of all human societies, a key creation of culture as opposed to nature.
     Anthropologists have further pointed out how cultural groups differ markedly from one another in many of their beliefs and practice related to food. For example, there are wide variations throughout the world   in what substances are regarded as ‘food’ and what are not ‘food’ which are eaten in one society or groups are rigorously forbidden in another. There are also variations between culture as to how food is cultivated, harvested, prepared, served and eaten. each culture usually has a set of implicit rules which determine who prepares and serves the food and to whom which individuals or groups eat together, where and on what occasions the consumption of food takes places; the order of activities of dishes within a meal ; and the actual manner of eating the food . All of these stages in food consumption are closely patterned by cultural and are part of the accepted way of life community.

6 .1 Food perceptions:
Food is major concern of the mankind starting from the time of conception and extending through the entire life span of individual (Ghai, 1990:36) religious and cultural factors determinate, which are foods, which are not.
The Khasis take their traditional foods. The main food item is rice. It is taken with fish, meat, vegetables and lentil which ever is available. They like to have pork, wild chickens and wild cats during different festivals, but they never eat beef due to their religious belief. They also eat meats of the homegrown birds like chicken, duck and pigeon. They eat all kind of fish   except the frozen sea fish, but they are very fond of dried fish called tung. More recently, the Khasis are getting accustomed to different Bengali foods.

6.2 Nutrition perception:
The scientific aspect of nutrition are of interest not only to physiologist and physicians but also to sociologist, economists and the political structure, of the state, because effects of nutrition gap on the development of individual and the community have for reaching socio-economic and political implications (Ghai, 1990:37) nutrients are necessary for growth of the individual and repair of worn out again tissue. Basic constituents for synthesis of digestive juices, enzymes and hormones are derived from food. Health nutritional status is one of the problems in Khasis community. They seem that there is no problem for nutrition.
In the Khasis community too, there is a clear relationship between health and income.  Most of the people already weakened by poor nutrition and also suffered from infectious and other communicable diseases. These diseases are often transmitted with the help of polluted water supplies, poor sanitation and inadequate housing (all of which can be improved by an adequate income).
 The general level of nutrition and hygiene among the Khasis community are not low or high. The population is generally healthy and robust with an associated high fertility rate. Women have a long child bearing period and frequently a woman gives birth to her last child well after her eldest daughter gives birth to her first. The average   number of children at the census was (4-5) per couple. No couple in this punji was infertile. Few people know their own age. The figure (4-5) gives an indication of a high reproductive rate in the population.
The controls on natural growth, birth is limited to herbal medicines of doubtful efficiency and these are used mainly by woman, who have already produced a number of children.
Generally healthier conditions in the punji one would expect infant and child mortality to be appreciably lower than in the village of the area.
Among the Khasis community, inadequate food supplies and ignorance of family members about nutritive values. In the Khasis community lack of food,  lack of elementary knowledge of food , lack of elementary knowledge of food and nutrition, refusal to take food, fad foods and lack of teeth..
6.3 Daily food taking manners
Food intake of individuals is influenced by cultural, economic status, food production, etc. Rice is the staple food for the Khasis people. Pork and duck meat are their popular meat items. These people also like to eat various fruits of which banana, lemon, orange are very common ones. Besides they also collect other jungle fruits, various types of leaves, herbs are root crops from the forest. The Khasis men are fond of liquor, beer etc. Liquor, beer are, However less popular among the women and children .Traditionally they eat liquor, beer, etc .In this community no festival is complete with

Table 6.1: Daily food items among the Khasis community

Name of food stuff    Khasis name     
Rice    Echii     
Vegetables    Che     
Fruits    Fa     
Guava    Faperian     
Mango    Pani     
Egg    Hunchi     
Mutton    Bela     
Fish    Hi     
Chicken/hen    Ei     
Frog    Chro     
Fox    Mersing     
Duck    Repcho    
                                                                          Source: Anthropological research 2005

Uses of Water and sanitation system
“Too much water; too little water” the khasis punji is a place any encounter can agree with the statement. The necessity of water is universal. It is important to understand that the improvement if health is not possible without sanitary disposal of human excreta. However, neither sanitation nor water supply alone is good enough for health improvement. It is now well established that health education or hygiene promotion must accompany sufficient quantities of safe water and sanitary disposal of excreta to ensure the control of water and sanitation related diseases.



Figure 7.1: Interrelationship between water, sanitation and health Condition

    Water is absolutely essential for man, animals and plants. Without water life on earth would not exist. Men use water not only for drinking and culinary purpose but also for bathing laundering and other domestic use. It is difficult to imagine any clean and sanitary environment without safe, adequate and accessible supply of water combined with proper sanitations is basic needs and essential components of primary health care. The large the quantity and the better the quantity of water, the most rapid and extensive is the advancement of the public health.

7.1 Sources of water:

Among the khasis community natural cascades are the main sources of water in the both domestic and other uses. Almost in the middle point of that village, a cascade is falling water, for all day long with a pope of five inches; the water falling is made useful for the villagers. Besides Indera, is the same source of water, water of cascade was piped from cascade and made several points for using of the villagers.
But these are less used. The source of water and the distribution of uses on the
Basis economic status are given in the following-

Table 7.1:   Sources of water distribution of user on economy status.

Source of water    Poor    Middle    Rich    Total     
Water of natural cascade    2.5(1)    14.5(7)    5.00(2)    22.00(10)     
Water of kiwa, well cascade    17.5(7)    32.5(13)    0         
Ring tube well    0    10.00    18.00(7)    50.00(20)     
Indera    5.00    0    0    18.00(7)     
Tube well    0    0    5.00    5.00(2)    
     Source: Anthropological research 2005

    In that table it has been shown that majority of the people takes water from natural cascade. Every group of people has their rationality to take water from particular source. In this section the rational of individual group will be discussed as follows and it is more important as for the generative approach of using water or the people’s perceptions which is vital for understanding the naturalist view of the community to use such kind of water.

First group:
    Those who have taken water from the natural cascade directly they seem are existed near by the ‘Jharna’. They seem that since it is a current flow of water so it is not impure, hence they take from that resource.

Second group:
    Some of the respondents take water from the walled cascade. They are near for away from the first cascade. Among them some feel comfort to take water from the walled cascade. Basically it is separated from the first, only for its wall. But during winter drought, this become very thin and not suits for using. By that, the main cascade is treated the only source of water.

Third group:
    In that village, there are three tubes well are existed. But there are rarely used during winter the rich people use these mainly on the other hand during rainy season the two cascades are fallen with big flow. So the user of the group attended in the two cascades.

Fourth group:
    The fourth is Habitat in ‘indera’ in this village some ‘indera are seen, but only one family is found among the responders who take water from that all the year round.
Fifth group:
    The fifth group consists of two rich people of the community. Not only among the respondents, rather out of the village, there are two families who take tube well water and Mothi is one of them setup tube well for her safety then considering safe water in mind.

7.2 Use of water:

There has no person who can help her to bring some water from the cascade. In morning male go to punji for cultivation and women are engaged for cooking. Coming back from the jum they do not enter the room and but take clothes standing outside of the room and go to have bathe. After having bathe they take the clothes unwashed to the home and when wives go to bathe, wash their clothes. Most of the respondent, including men, have stated that cooking is a work of women. For cooking women gather water from that cascade. Every morning they collect water. At the place, they after maintaining times and seldom their husbands or other family members bring water, particularly n rainy season when that path is risky for the women who baar ‘jar’’kashi’ with full of water. Preparing food is another job of women that is a safe of water using. Women have stated that they prepare their food for the children3 times in a day. And in that case another question has been raised about the washing hands of the women i.e. mother. Everybody has stated that they wash their hands with normal water in both cases to prepare food for children and to handling food for their own family. And the female respondents have been astonished and some of them were annoyed that it is impossible for mothers that who do not wash hands with water to prepare food for her children. All the female respondents have stated that either in winter or summer, until the delivery the daily routine has not been changed. On the other hand the male respondents also seem that a since they are become in cultivation, so the women has to do these work. Cascade ‘Jharna’ is situated at the middle of the village. But it is below 50 feet from the households. Kakaith is the nearest woman but her distance is 70 feet. There has settlement up to the Jharna and at the Jharna near about 20 families are taking water bathe washing clothes. And these have a favorable condition for spreading germs of infectious diseases. And the villagers strongly believed that since several generations they have been drinking and use this water and they live hence this water is pure.

7.3 Perception of sanitation

7.3.1 Use and types of latrine:
Health is essentially connected with sanitation (Rahman; 1982:223) and latrine is one of the three components of sanitation in Bangladesh is not satisfactory. It is on enthusiastic data that there are only two Semi-pucca latrines situated in the village. so avoiding any kinds of table, if can be stated that all one sing open latrine is meant that bush of bamboo down side of small ’tila’ and small cannel namely ’chare’ are that place. Kallaw Khasis one of the oldest person among the community, seems that he has been passing without latrine and his father and grandfather have been used the bank of cannel and mostly did not use water rather leaves after defecation which name is Nongpendihon. In that community there is twelve latrines are seen and all belongs to the Patra and Hindu Khasis. There is only two semi-pucca latrines are seen for Hindu Khasis and Christian Khasis usually use not semi–pucca latrines .They use open latrine .They don’t use soap or other material to clean the hands after latrine .In that case of using latrine economics condition on literacy is not only factor those influence their latrine condition or using. They perceive that latrine is not essential that it will be well constructed by break, cement and so on.
Considering the observations, there has two types of users of the latrines are enable to go to the certain place, and the other includes the children who cannot become able to go to the certain place. And at night all are urinate the edge of courtyard. It has been seen that, those children who are at least 5 years old, can go to the certain place for defecate at courtyard. But all the adult people use the certain place to defecate, both at day or night time on the other hand , during working period at’ jum’ they use the bush of nearby the ‘jum’.

1 টি মন্তব্য:

  1. The author of this blog has no idea what rubbish he/she has posted on this page on Khasi people and their lifestyle.
    The content and info of this page as provided by the blogger is of PATHETIC QUALITY and needs verification.
    Khasi names for Rice is 'U khaw', avegetable is 'U Jhur', Fruit is 'U Soh', Mutton is 'Doh bl-ang', Chicken is 'I khun siyar' and for Fox is 'U mersiang'.
    I think the author cum blogger should have a thorough knowledge of his own culture first before trying to write an article on other cultures and tribes. Never behave like a "JACK OF ALL TRADE BUT MASTER OF NONE."