Untouchable Healing

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Untouchable Healing: A Dalit Ayurvedic Doctor from Nepal Suffers HisCountry's IllsMary M. Cameron a

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To cite this Article Cameron, Mary M.(2009) 'Untouchable Healing: A Dalit Ayurvedic Doctor from Nepal Suffers HisCountry's Ills', Medical Anthropology, 28: 3, 235 — 267To link to this Article: DOI: 10.1080/01459740903070865URL: http://dx.doi.org/10.1080/01459740903070865

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Untouchable Healing: A DalitAyurvedic Doctor from Nepal

Suffers His Country’s Ills

Mary M. Cameron

Ayurvedic medicine thrives in Nepal. Even so, barriers of untouchability thathave long prevented Dalits from establishing equal relationships with uppercastes have made medical education out of reach for them. Hence, nearly allAyurvedic practitioners are high caste men. Forty years ago, an ‘‘untouch-able’’ man from the Himalayan foothills with a thirst for knowledge aboutAyurveda traveled south into India where he changed his caste and ‘‘became’’a Brahman for 14 years as he studied the theory and practice of Ayurvedicmedicine in a Haridwar college. Rasaliji’s life story, recorded initially in 2000and continued through 2007–2008, encompasses a period of rapid moderniza-tion that spawned a state health policy promoting biomedicine, a proliferationof pharmaceutical drugs, and a national election that swept the CommunistParty of Nepal-Maoist into power and saw an unprecedented 9 percent Dalitselected to the Constituent Assembly. This article presents Rasaliji’s currentconcerns with the state of medicine and social justice in Nepal.

Key Words: Ayurvedic medicine; Dalits; medical education; Nepal

‘‘What are Dalits? Dalits are scientists. They are artisans. They know thetechnology of making tools, shoes, all kinds of things. This has never beenrecognized. Look at the midwives, many of whom are Dalits. They have somuch knowledge about delivering babies.’’

MARY M. CAMERON is a medical anthropologist and Associate Professor in the Department

of Anthropology, Florida Atlantic University. Her research interests include gender and caste in

Nepal’s farming communities, the impact of Western science and modernization on Ayurvedic

practices in Nepal, women Ayurvedic doctors and healers, and alternative medicine and adoles-

cents in the United States. Her publications include On the Edge of the Auspicious: Gender and

Caste in Rural Nepal (University of Illinois Press, 1998). Correspondence may be directed to her

at the Department of Anthropology, Florida Atlantic University, SO 176, 777 Glades Road,

Boca Raton, FL 33431-0991, USA. E-mail: [email protected]

Copyright # 2009 Taylor & Francis Group, LLC

ISSN: 0145-9740 print=1545-5882 online

DOI: 10.1080/01459740903070865

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MEDICAL ANTHROPOLOGY, 28(3): 235–267

Downloaded By: [Florida Atlantic University] At: 04:14 11 March 2010

Durga Sob, Founder and Executive Director, Feminist Dalit Organization(FEDO), Patan, Nepal. March 30, 2005

THE QUEST FOR HEALING KNOWLEDGE: WHY A DALITBECAME A BRAHMAN

Ayurvedic medicine thrives in rural and urban communities throughoutNepal. People regularly utilize the country’s rich diversity of medicinalplants, called jadibuti, and consult with formally and informally trainedpractitioners, called baidya, about dietary regulation and humor-balancingtherapies for preventing and curing illness. While the medical system isavailable to all, and often free of charge, the social organization of Ayurve-dic medicine is not egalitarian. It is unusual to find Dalits, people ofso-called lower or untouchable caste, treating the sick who are not familymembers. Barriers of untouchability have long prevented Dalits from estab-lishing social, political, educational, and economic relationships equal totheir upper caste neighbors and citizens (Cameron 1998; Parish 1996). Asa consequence of educational exclusion in the past, particularly fromSanskrit-based subjects like Ayurvedic medicine, formally trained Dalitmedical professionals are rare in Nepal. It would be an exceptional personwho could overcome caste barriers to master the art and science of healingin the Ayurvedic tradition, and to do so throughout all stages of trainingfrom student to professional healer while retaining his or her caste identityas Dalit would be nearly impossible. Indeed, after his application to anAyurvedic college was rejected 30 years ago, one bright young Dalit manwith a strong desire to study Ayurvedic medicine in Nepal regrettably dis-covered that it would be unfeasible to do so. So Kabiraj Prasad Rasali,1

who as a youngster had become passionately interested in jadibuti fromhis baidya father and paternal grandfather, vowed to study formal Ayurve-dic medicine in India where no one knew him or his caste. From his storypresented here, we learn how a long-standing form of social marginalityin South Asia, namely caste discrimination, was overcome in the pursuitof medical knowledge. In describing one Dalit man’s journey to becomingan Ayurvedic doctor, however, I also wish to show how overcoming suchobstacles produced a radicalized self, empowered to speak against manykinds of ‘‘ills’’—social, economic, political—in the modernizing new democ-racy. In presenting the baidya’s views on indigenous medicine, medical edu-cation, biomedical and economic dependency, caste discrimination, andsocial transformation, this article speaks to recent studies of marginalityand health in South Asia that aim to understand how social inequalitieslike caste affect health both regionally and globally (Ecks and Sax 2005).

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Utilizing the well-established biographic form in anthropology, this articlefollows in a line of South Asian Dalit biographies that together portrayenormously rich, resourceful, and courageous responses to the harshly repe-titive indignities of social exclusion (Alter 1999b; Jadhav 2007; Khare 1985;Viramma 1997).

From Rasaliji’s perspective, this article shows how the pursuit of medicalknowledge interfaces with social hierarchy, state-sponsored health caredevelopment, and modernizing forces to transform a person seeking socialand medical justice. Through his evolution from artisan-scientist todoctor-scientist, Rasaliji links health care inequality to social injusticethrough his experience as an untouchable, and presents insightful andimpassioned views on the problematic role of Western biomedicine inNepal. He speaks of the importance of Ayurvedic medicine to Nepalis inresolving health care conflicts with India over uncontrolled exploitation ofHimalayan medical plants, and he cautions about the flow of Indian Ayur-vedic drugs into Nepal’s markets.2 As the doctor situates his story locallyand globally, Ayurveda emerges as representing autonomy from Indianinfluence and from biomedical dependency. In critiquing internationallyfunded health care development and local caste oppression, Rasaliji deploysAyurvedic metaphors of illness and health to describe Nepal’s currentimbalanced situation. His voice resonates with Indian Ayurvedic providers,described by Langford, that find Ayurvedic therapies to be effective curesfor that country’s postcolonial imbalance (Langford 2002), rememberingthat Nepal, while never colonized, is experiencing of late its ownpost-monarchy adjustment. Finally, Rasaliji reminds us that modern healthcare development potentially further marginalizes the poor (Farmer 2005) asDalits and others are increasingly unable to afford it. The article ends with adiscussion of the importance of addressing caste in South Asian medicalanthropology.

AYURVEDA IN NEPAL

Typically associated with India, Ayurveda has uniquely evolved in Nepalfrom the ancient and dynamic theory of tridosa (three humors of vata, pittaand kapha) found at the core of South Asian Ayurvedic medicine to producea variety of related forms of practice that offer to the Nepali people an inex-pensive and culturally relevant approach to maintaining well-being and tocuring illness. With the aid of skilled baidya, people balance the body’shumoral essences with seasonal diet, appropriate behavior, and medicinalplants, often with noteworthy consistency (Dixit 1995; Himalayan AyurvedaResearch Institute 1996). The systematic cataloging of Nepal’s botanical

UNTOUCHABLE HEALING 237


resources for over two centuries, begun in 1802 with British botanistsworking initially in India, confirms the longstanding and widespread abilityof people to identify, harvest, and use plants for a variety of purposes,including medicinal ones (Manandhar 2002).3 Ethnographic studies overthe years, while not always focusing on medicine per se, have developed apicture of the Nepali people as knowledgeable users of medicinal plantsfor many ailments, and of the Nepali culture as one that employs a funda-mentally Ayurvedic principle of dynamic humoral ‘‘balance’’ in sustainingthe physical and mental well-being of the individual. During my ownresearch in the rural Far West,4 Nepali friends on many occasions wouldselectively pick the leaves and pull the roots of wild jadibuti, later to beadministered in home and community medical treatment (although occa-sionally consumed immediately) (Cameron 1996), and they daily attendedto the body’s humors (particularly heat, pit or pitta, and wind, vat or vata,with its potentially unhealthy cooling effect on the body) by way of regulat-ing diet, physical labor, bathing, travel, and many other activities. A distinctcharacteristic of Nepali Ayurveda that derives from the country’s agrarianroots, then, is its emphasis on plants in healing, engaging lay people and for-mally trained practitioners alike in informed and shared knowledge and useof medically useful plants (Cameron 2009c). This emphasis on jadibuti dis-tinguishes Nepali Ayurveda from the Ayurveda described for India, wherecultural identity with Ayurveda and a return to an imagined tradition areemphasized (Langford 2002). In contrast, Nepali Ayurvedic practitionersand modern urban middle-classes alike deploy a language of modernity thatincludes Ayurveda’s global appeal and its ‘‘natural’’ plant-based therapies inarguing for Ayurveda medical educational development and in consumingAyurvedic products.

The importance of Ayurveda as a formal system of medicine in Nepalbefore the middle of the last century is evident in several historical facts.Gurkha military units were accompanied by assigned baidya in the first dec-ades of their British employment.5 Former baidyas to the Rana courts inKathmandu told me of the important support the Ranas gave to Ayurvedicmedicine. The royals maintained a group of Ayurvedic family doctors andestablished important Ayurvedic institutions during their reign, a practicethat was gradually stopped in the latter half of the 20th century after there-ascension of the Shah monarchy, particularly during the rule of KingBirendra in the 1960s, 70s, and 80s.6 More recently, with the renewed inter-est in the conservation of Nepal’s medicinal plants, instruments are beingdeveloped for the systematic study of ethnobiological knowledge in theNepal Himalaya, and although preliminary, such studies confirmwidespread knowledge of medicinal plants that are the base of Ayurvedichealing.7

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Such widespread ethnomedical and Ayurvedic-based humoral knowledgeand practice might suggest a relatively open approach to Ayurvedic medicaltraining. The portrait of a Dalit Ayurvedic doctor presented here, however,tells a different story. It depicts the rigid social barriers to formally orga-nized knowledge experienced throughout Nepal by highly talented Dalits,a heterogeneous but nonetheless systematically marginalized class of people.More so in the past yet also true today, Ayurvedic practice reflects socialexclusions present in contemporary Nepal that relegate Dalits and womento inferior social and educational positions, thus rendering a career inmedicine difficult for them. The number of people impacted by caste-basededucational discrimination is not insignificant, for Dalits comprise12 percent to 23 percent of the population of Nepal, although precise figuresfor the population vary widely due to the widespread Dalit practice ofchanging surnames to avoid discrimination.8

In Nepal, people who diagnose and treat physical and mental maladieswithin an Ayurvedic framework may develop their skills from their ownfamilies, from the wider community including neighbors and local adepts,and from schools of formal education either in Nepal or India. Baidyamay be highly educated in the halls of formal South Asian medical institu-tions or may be informally apprenticed in medicine with family andnon-family members; healers from both groups live and work as neighborsin the hundreds of thousands of small communities throughout Nepal, withthe highly educated concentrated in urban areas. Baidya who treat peopleoutside the family are usually male and high caste, although it is not unusualto find women recognized among renowned local healers, and women nowconstitute half the doctors-in-training in Nepal’s only graduate program inAyurvedic medicine, Naradevi Teaching Hospital in Kathmandu.

BECOMING A BRAHMAN

Kabiraj9 Rasaliji’s life as a student and practitioner of Ayurvedic medicine isunique among his colleagues. To formally study, he did something notrequired of his educated Nepali high caste colleagues: he changed his sur-name to conceal his Dalit caste to gain entry into a college of Ayurvedicmedicine in Haridwar, Uttar Pradesh (now Uttarakhund), India. He con-cisely describes his harmless deceit: ‘‘I studied while hiding my caste’’ (Jaatlukayera pardeko). A member of the Sarki leather artisan jaat by birth,Rasali ‘‘became’’ a Brahman in India by adopting the last name Bhattaraifor 14 years, eventually graduating with a degree in Ayurvedic medicinefrom the academic center-cum-ashram at Santikunj, Haridwar. He returnedto Nepal to practice Ayurvedic medicine in two rural communities and most



recently in Kathmandu, from where he makes regular excursions into thecountryside to search for medicinal plants used in his urban practice. Ona late June morning in 2000, Kabiraj talked with me for several hours aboutmany things, including the intellectual curiosity that compelled him to riskpursuing medical knowledge.

It was the mid 1970s, and I was deeply curious to know about those subjectsthat we low caste people should not know. So I changed my name toBhattarai, and I studied the four Vedas in India.

Here he refers proudly to his knowledge of the main texts of an educatedBrahman’s formal training in the Sanskrit classics, texts historically deniedto untouchables to read, to study, to touch, and even to hear the magicallypotent words of the sacred Vedas. Adopting a non-stigmatized identity andshedding an inauspicious habitus like Dalit is possible only through greateffort, yet Rasaliji thwarted caste society’s intent to exclude him from practi-cing medicine by transforming his marginal status into high caste educa-tional privilege long enough to receive his medical diploma. Still, in theemerging modern Nepali state with its ideology of equal opportunity forall, recent health legislation requiring formal registration of Ayurvedicdoctors (Cameron 2009a) renders Rasaliji’s diploma worthless, as it bearsthe name of a Bahun (Nepali Brahman) and not a Dalit. Such ironies makemore poignant his critique of modern Nepal and point out the contentiousissue of Dalit surnames.

Dalits in Nepal have been changing and reclaiming their ancestral clan(thar) or sub-caste surnames for at least 50 years to avoid discriminationin the early stages, and to later assert their rights to self-identity.10 Earlyefforts to use new, Bahun or Chhetry (high-caste, conventionally calledBahun-Chhetry), or clan surnames (many of which are the same asBahun-Chhetry surnames) during the Panchayat era could have beenthwarted by officials requiring Dalits to use only their occupational names,such as Sarki (leather artisan), Damai (tailor), or Sunar (goldsmith), butgradually many new names were introduced into the Dalit community, suchas Bishwakarma, Sob, Rasali, Senchuri, and Nepali that made an indivi-dual’s caste status ambiguous. Now, however, these names are recognizedas Dalit names (and some have been rendered closer to their Bahun-Chhetrycounterparts, like changing Nepali to Nepal or Gotame to Gautam),although not always. Dalits now diverge on their surname choices, withsome preferring to retain the somewhat less stigmatized Dalit surnames suchas Bishwakarma, and others choosing relatively unrecognizable namessuch as Rasali (or Rasaily) and Senchuri that have acquired a sense ofempowerment for the bearer (non-Dalits who recognize the Dalit name will

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nonetheless associate it with a modern, professional, and educated personthey should not challenge), while still others reclaim their original clan sur-names that are often the same as Bahun-Chhetry surnames. Dalits speak ofthe pressure they experience from officials demanding certified permissionsand other documents to not change their surnames from the occupationaland other stigmatized names to those that are the same as Bahun-Chhetryor even modern Dalit such as Bishwakarma. Legally, however, Dalits maychange the surname up to the time of high school graduation (when the finalname choice should appear on the School Leaving Certificate, and must cor-respond with other citizenship documents), and women, of course, changetheir surnames at marriage. The community strongly feels it is their rightto use any surname they choose, although many acutely feel the sting ofdiscrimination promulgated by a recognizable Dalit identity.11

Rasaliji left for India in the 1970s at a time when Dalits were required touse their occupational names and progressive caste laws in India had notyet been widely implemented. The name on his citizenship papers (Rasaliis a pseudonym) is also an ambiguous surname similar to many of hisintellectual Dalit peers, instead of his occupational caste name or hisancestral clan name.

SOCIAL, EDUCATIONAL, AND MEDICAL JUSTICE

My previous research on Dalits and gender organization in western ruralNepal (Cameron 1998) led to affiliations with Dalit activists in Kathmanduwho arranged for me to meet Rasaliji, as I had recently shifted my researchfrom caste, gender, and social change back to earlier interests in children’shealth (Cameron 1986), to now examine Ayurvedic medicine and its statuswithin health care development.12 When Kabiraj Prasad Rasali and I metone late morning, it was after weeks of anticipation, as he then lived in afairly distant region of Lamjung and could not easily leave his practiceand his young family to take the long bus trip down from the mountainsand into the Kathmandu Valley. Maoist blockades also threatened thesafety of rural travelers during that period. Once we met, we talked forseveral hours. Or, more precisely, he talked, for he had much to say andwas passionate about his views. After that initial interview, we were outof contact for nearly four years as he relocated to Kathmandu to escapethe Maoist conflict affecting much of rural Nepal, including Lamjung wherethe rebels destroyed communication facilities. In Kathmandu, he establishedan Ayurvedic business in New Baneshwor. When I found him again in 2007with the help of the United States Fulbright Commission in Nepal, weresumed communicating through e-mail and phone.



Born in January 1957, the second child of Sarki parents, Rasaliji spenthis youth in Rampur near Bandipur, a farming community west ofKathmandu comprised of high caste Hindu, Newar, and Gurunglandowners, and Dalit artisans and laborers. He was the eldest of threebrothers and following Nepali kinship expectations, he was raised to beresponsible for them and an older sister; he learned that eventually hewould also be in charge of his parents’ care as they aged. Rasaliji was agood student and studied in the local grade school, middle school, andhigh school, graduating from the eighth grade (the terminal grade inmid-20th century Nepal), itself an achievement for a Dalit boy fourdecades ago. The older generation of village baidyas such as Rasaliji’sfather and grandfather was largely uneducated; from the time of KingJayasthiti Malla in the second half of the 14th century through the endof the Rana regime in the 1950s, only high-caste elites were permitted toenroll in formal education programs.

Caste-based discrimination is illegal in Nepal, but reports of inequity inschools continue even today. During focus group discussions commis-sioned by the Food and Agricultural Administration for its WesternUpland Development Program, which were designed to learn about thesocially disadvantaged and their economic status, Dalit women and menin Dailekh district spoke to me and fellow researchers about the problemsthey and their children continue to experience in schools (Cameron andRai 2000). For example, the students in Dailekh’s primary schools wereprovided powdered food by the United Nations Educational, Scientific,and Cultural Organization (UNESCO) that was cooked at the schooland distributed to all the students, but the separation of castes practicedin private homes occurred in the public schools with no authority figuresintervening. Dalits described to us how two separate lines formed forDalit and non-Dalit students; Dalit students were not allowed to assistin cooking, and high caste children sat apart from the Dalit children whileeating. The Dalit students then organized and protested at the district levelto some effect.

During the project interviews, we also learned how caste discriminationinterfaces with gender discrimination, making Dalit girls and women parti-cularly vulnerable to literacy barriers. One woman from a remote farmingcommunity described the limitations placed on her and other women’sliteracy efforts by their own husbands:

When we participated in the literacy classes run by male teachers, our hus-bands would peer through windows and doors to know what their wives weredoing with the male teachers. One teacher was embarrassed and the classeseventually stopped.13

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Despite such obstacles, today’s Dalit youth are gaining in education com-pared to the generations before them, including Rasaliji’s. Current data onDalit literacy cover up to 2001 and were collected during periods of ongoingpolitical instability. The country lacks a standard definition of literacy anddoes not differentiate between Dalit and non-Dalit youth and adult literacy(Vasily 2004). The general picture, however, is one in which Dalits from thehills, Rasaliji’s geographical region, are less literate than non-Dalit andethnic groups.14 To begin, the entire country’s literacy rate in 2001 was54 percent. Dalit literacy above age 15 in the hills was 47 percent in 2001,compared with 70.1 percent for non-Dalit and 58.3 percent for ethnicgroups. All Nepal adult literacy in 2000–2001 was 48.6 percent, a cohortthat would include Rasaliji. Assuming that these figures are lower for Dalitsliving in the hills, they suggest that Rasaliji was one of a small group ofDalits pursuing high school education in the early 1970s and higher educa-tion in the late 1970s and early 1980s.

Rasaliji’s interest in medicine began at an early age, inspired—like somany of his Ayurvedic colleagues (Cameron 2009c)—by his interest in plants.

I was always very interested in Ayurveda. My father is also a baidya, as is mygrandfather. Though my father cannot read and write, he recognizes all thejadibuti and he would show me the plants and describe their uses when Iwas younger. Buying allopathic medicine when we are ill is something thatis out of reach for us.15 For this reason, although my father did collect andprepare the herbs for curing illnesses, I wasn’t satisfied with it [a family-basedapprenticeship] and I wanted to learn about medicine in detail. I thereforewent to India and studied it for 14 years.

Rasaliji wanted more than what his father could offer him through anapprenticed Ayurvedic education and the limited educational opportunitiesin Nepal. As he once told me, he wanted to ‘‘develop his mind.’’ So at theage of 17, with an eighth grade education, Rasaliji traveled south to Indiaby foot and by bus and then proceeded west across northern India by trainto Haridwar in Uttar Pradesh, a road to India that is well-worn by Nepalis.

Why did Rasaliji choose India over Nepal in the mid-1970s for his highereducation and medical training? Although guru-disciple forms of traditionaltraining called guruparampara were attended by young men throughoutNepal interested in religious and medical training, such centers rarelyadmitted Dalits. Rasaliji knew this, and before leaving Nepal for India, hefirst sought admission into a public Ayurvedic educational institution. Inthe early 1970s, only one institution, Naradevi Teaching Hospital, offereda higher degree in Ayurvedic medicine, and it was in transition due to educa-tional reforms at the time. Fifty years earlier, formal Ayurvedic education



had been initiated by King Chandra Shamshere Rana, who in 1928 estab-lished an educational fund for students to study Ayurvedic medicine inIndia. The Ayurvedic pioneers completed their studies in five years andreturned to Nepal to inaugurate Naradevi Ayurveda Teaching Hospitaland College in Kathmandu, the one to which Rasaliji applied.16 Nepal’snational educational system was restructured in the second half of the20th century, with slogans such as ‘‘education to meet the needs of thepeople,’’ and the Ayurvedic medical program was greatly impacted. ItsSanskrit-based curriculum was eliminated and the four-year degree becamea three-year program in line with other intermediate degree programs.17 TheAyurvedic degree was renamed ‘‘Proficiency in Complementary and Tradi-tional Medicine,’’ dropping the word Ayurveda from the title. Supervisionof the Naradevi Teaching Hospital was moved from the Ministry of Healthto the Institute of Medicine in the Ministry of Education in 1972, whenmodern biomedicine was also introduced as a discipline and a degreeprogram. Thereafter, the graduate degree in Ayurveda began in 1972, wasstopped five years later in 1977 due to a lack of resources, was againreinstated from 1987 until 1991, when it was again postponed, and wasfinally reopened in 1997=98, currently admitting 15 students annually.18,19

Despite the educational transitions of the 1970s, Rasaliji applied to theprogram at Naradevi but was denied admission for what he calls his casteproblem.20,21 So he left his village in Bandipur for India, following the pathof other Nepalis before him to Haridwar where he found lodging, work, anda supportive community near the well-known Santikunj spiritual, social wel-fare, and academic center.22 There he eventually enrolled in the ashram’sAyurvedic program. Although Santikunj is established for the welfare ofthe poor, Rasaliji still had to work to pay for daily living expenses. Andalthough today Santikunj eschews caste-based service and accommodation,in the 1970s and 1980s its policy on caste was unstated. Therefore Rasaliji,fearful of rejection, changed his name on the registration and other formsand was admitted into the college.23 For at least a decade while studying,Rasaliji also worked part-time for Sahal Engineer Construction Companyas a laborer and tunnel digger, and he gradually trained to do electricalwork. But most of his effort and energy went into his medical studies,and he applied a particular passion to his favorite courses on Dravyaguna,pharmacology, which includes medicinal plant identification, preparation,and utilization. The curriculum offered a pure Ayurveda program with nobiomedicine, an educational approach it continues today. A hard-workingstudent—‘‘I worked and studied, worked and studied, and worked and stu-died some more’’—he eventually returned home to Nepal and his hometownof Bandipur, an educated man with an Ayurvedic medical degree bearingthe name of a Brahman, Ramesh Bhattrai, rather than the name of a Dalit.

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In a modernizing country with new medical licensing regulations, the nameinconsistency makes him vulnerable to document fraud accusations andconsequently he practices without a license, like the vast majority of baidya.Currently, Rasaliji holds the Shastri degree and has completed the Acharyacurriculum, but has not taken the exams required for certification at theAcharya level.

Now in his early 50s, Rasaliji is a thin, active man. He has matured froma youthful philosopher pursuing knowledge over social activism, to amiddle-aged man who feels fulfilled in caring for the sick and in pursuingsocial justice for his people. For a rural person of his caste, he is highly edu-cated and is global in his knowledge of the world; in addition to speakingand reading Nepali, Hindi, and Sanskrit, and speaking several local dialects,he can also read English, and has published newspaper opinion piecescalling for an end to caste discrimination.

Rasaliji’s critique of the Nepali state resists conventional understandingsof local and global. In his exuberance for Ayurvedic medicine over modernbiomedicine, he could be called a traditionalist. Yet Ayurvedic medicine tra-vels through international ports and metropolises as freely as acupunctureand other ‘‘alternative’’ medicines, such that users in some contexts are con-sidered modern in their choice of alternatives to allopathic medicine (seeJanes 2002 on the global circulation of Tibetan medicine). Rasaliji certainlyresists the superficial newness of the global project, but not because of anunquestioned belief in the past. In fact, he strongly supports democraticreform and shares with so many of his country’s people the hope in democ-racy’s promise of equality and justice, which was recently affirmed last yearwith the appointment by Prime Minister Koirala of two Dalit Ministers tothe Cabinet (but not retained by the current Prime Minister ‘‘Prachand’’Dahal) and the election of 50 Dalits (approximately 10 percent) to the Con-stituent Assembly. But as we see below, Rasaliji believes Ayurvedic medicinemakes a person independent, strong, and able to resist the seductions ofmodernity. For him, Ayurveda enhances human possibility and works asa prudent antidote to the ills of modern life.

MEDICAL PRACTICE

Shortly before moving to Kathmandu, Rasaliji worked as a baidya in Lam-jung District, having left his natal home of Bandipur because of what hecalls intolerance from the area’s ethnic Gurungs, which made it difficultto practice medicine and lead a life of self-respect.

I was forced to move to Lamjung because they ‘recognized’ me in Bandipur.The people refused to take food and medicine that had been touched by me.



He practiced out of his clinic-cum-pharmacy in Lamjung for nearly 20 years,a place where he initially changed his name again after experiencingdiscrimination.

For a time being I changed my name to Govinda Anuj in the new place[Lamjung], again to hide my caste status. I adopted a fake name in thebeginning [Anuj means brother] and as people got used to buying things frommy shop I revealed to them my true identity. But still today some peoplehesitate to take liquid medicine from me.

Rasaliji is also a self-taught astrologer and a palmist, and he combinesthese skills of prognostication with Ayurvedic skills of diagnosis and medic-inal plant treatment.

I have taken a full course on astrology and I am also a palmist. I have studiedbooks on palmistry written by Cheiro, an English author.24 They have beentranslated into Hindi. I also have two or three other books. I have studiedthe books and they are highly intellectual. For example, Cheiro has clarifiedhow this particular line [tracing a fold in my palm] is related to our mentalcapability.

Following Michael Taussig’s insights into medical eclecticism as onemoment in an ongoing historical chain of mimesis, Langford shows howpractitioners in India who borrow from various medical folk practicesbecome drawn into the familiar dichotomy between religion or magic andscience and a ‘‘site for the consolidation of modern sciences against super-stition’’ (p. 216) by those opposing such mimesis. Often such people arelabeled quacks by those who regard themselves as Ayurvedic purists, butthe quack’s error is not incorrect use of medicine; rather it is improperuse of the name Ayurveda in labeling his or her healing practice. Thus,Ayurveda becomes aligned with modern, scientific methods, while simulta-neously enjoying the status of ancient cultural marker. Similarly in Nepal,many Ayurvedic doctors I work with are committed to presenting Ayurvedaas secular, scientific, universal, and therefore transcendent of traditional andmodern labels. They contrast Ayurveda to the magical and metaphysicalhealing techniques of Nepal’s popular shamans. Through the eyes of a Dalit,however, social factors like caste cannot be discounted when practitionersare judged negatively by their peers and community members.

Mimicking the magician’s skill of seduction, however, Rasaliji one timecaptured the anthropologist’s trade stock, intellect, in tracing on my handthe line representing intelligence, impressing me with his skill of discerningthe unknown. Magical powers are controversial because they are potentiallydangerous, and the shaman’s power is subtly regulated by local communities

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and rejected if used maliciously. Dangerous, too, is transgressing castenorms of Dalit subservience. During the time I searched for Rasaliji in2006, one report came back that he had relocated to Kathmandu becausevillagers in the community where he practiced had ostracized him whenhe predicted a person’s death, a forecast an astrologer is forbidden todivulge. When I asked Rasaliji in a phone conversation in early 2008 hisreasons for leaving Lamjung, he explained that it was due to governmentharassment of Dalits suspected of being Maoist sympathizers.

I left Lamjung due to Maoist terror and political stereotyping. All low castesare thought to be Maoist. That was the thinking of the [Nepali police] and soDalits were the first target of the government and seen as an enemy of thestate. That is why I escaped from the village.

Wherever the truth lies, I include the incident here to illustrate how castediscrimination can erupt in many forms and how it is never far from thesurface of Dalits’ lives and consciousness, even in cases of alleged medicalmalpractice. Rasaliji incorporates healing techniques that he finds effectiveand that are desired by his patients. He tenaciously works to improve hisskills to heal a society that would label him impure and punish him forasserting basic civil and human rights. If he erred once—and I neverasked him about the astrology story—surely a single poorly timed predic-tion throughout years of medical service is negligible, and either way, theharsh punishment of separation from his wife and children reveals moreabout the injustice of caste than it does about the integrity of a Dalitdoctor.

Indeed, as a health care professional, Rasaliji says he is most proud ofthree accomplishments. First, following the principles of Ayurveda as writ-ten in the classic texts and his Hindu-based belief in the merit of giving,Rasaliji has never turned away a sick person who could not pay for medicalcare. Second, he claims that no ill effects have occurred to anyone he hastreated. Finally, Rasaliji claims to be able to identify between 450 and 500different plant species used for treating illness. In this remarkable knowl-edge, he far exceeds the skill of the new generation of formally trainedAyurvedic doctors in Nepal, who do not receive sufficient training in plantidentification (Cameron 2009c). Patients are attracted to Rasaliji’s ability todiagnose illness and to his wide knowledge of local and regional jadibuti asremedies. Typically, he emphasizes plants, diet, and the right mental attitudein treating patients.

Rasaliji combines Ayurvedic and rudimentary allopathic concepts todiagnose patients’ problems. He begins from a foundation in tridosa theorywhere he evaluates the presence of one or more aggravated or depleted



humors by evaluating the pulse, interviewing the patient, and examiningqualities of the patient’s face like color and tone. Then, like many of hiscontemporaries, Rasaliji employs biomedical technology such as thestethoscope to gain additional information that will confirm his initial dosicreading, and to satisfy patients’ demands for modern technology.

I think about tridosa initially, and then I use the stethoscope to check thebreathing, to see if the sound inside the chest is unusual due to disturbances,or if it is clear. This same effect can be found at the wrist. For this reason I readthe pulse as well as listen to the heart with the stethoscope. I also check to seewhat the sound is like, to determine if there are any tiny [microscopic] insects[kitanu], as these may cause an increase in the heart rate and increase the riskof getting sick due to fever.

He uses biomedical instruments in both conventional and non-conventionalways, like detecting pathogens, similar to other practitioners in Nepal andIndia. One popular woman obstetrician-gynecologist I have interviewedand observed in the hospital surprised me with how rapidly she listenedto a patient’s heart and lungs through a stethoscope, and one day I askedher how it was possible to get an accurate reading in fewer than ten seconds.She explained that she uses the stethoscope to make her patients feel confi-dent and happy, and not to get more data. Here she recognizes the role ofthe individual’s mental state in cure. A similar finding from India by Nisula(2006) discusses the patient-driven use of allopathic technology within theMysore Ayurvedic medical community, where many practitioners do notdiagnose with the stethoscope but use it to satisfy their patients’ desire formodern medical techniques. Suggestively akin to magic, practitioners suchas these illustrate non-scientific approaches to healing from within otherwiserationally organized bodies of knowledge like Ayurveda and biomedicine.

Although the appearance to patients of a pluralistic, inclusive approach tomedical diagnosis clearly does not rise to the standard of sufficiently traineduse of biomedical instruments, paradoxically some Ayurvedic physiciansembrace biomedical technology while simultaneously criticizing modernityand its impact on people’s health. His use of modern medical technologyappears to belie Rasaliji’s view on the ills of modernity, too. Far from embra-cing modernity, Rasaliji is critical of several features of modern biomedicine.Specifically, he fears the psychological dependency, the cost, and what he andmany other Ayurvedic doctors consider the harshness of biomedical drugs,introduced into the country by an international health care developmentagenda crafted in far-away places. For medical and cultural reasons, headvocates for Ayurveda as the best form of health care for the Nepali people.Rasaliji finds the medicine produced by many Nepali and Indian Ayurvedicpharmaceutical companies to be of good quality. Lately, however, the high

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standards Rasaliji expects from his profession are not always met in anenvironment that places profits before people, as he suggested to me whendescribing the medicines in his practice. Rasaliji prepares the majority ofmedicines he prescribes for patients himself, using raw plant materials fromthe surrounding forests and hills, from his own medicinal plant garden, andoccasionally from purchased raw plant materials. He supplements thesewith manufactured Ayurvedic medicines purchased in Kathmandu, and talksof clinical experimentation with plant medicines.

I believe in the plant medicines so much that I am looking for a particularplant known as sanjivani and laxmana. I want to experiment with it to see ifit works as it is described. The best time to collect this plant is frommid-September to mid-November. It is most effective during the sharad season[September through November, post-monsoon and harvest season] when it isin the state of sworas, filled with fluid and moisture. I have read that it can alsobe found in Lamjung District and so I plan to search for it in this season.I want to do research on it myself to see if it works as is written in many books.If it is effective, I want to help others to cultivate it.

However, of late Rasaliji has been dissatisfied with the quality ofthe manufactured medicines. ‘‘People say that the medicines made by[one Nepali Ayurveda drug manufacturer] are of good quality. But in myexperience the medicines made by this company lately are not so effective.Maybe they do not have sufficient medicinal herbs, or there could be otherreasons.’’ I asked him if he used products from a Nepali-French Ayurvedicpharmaceutical company for which several Ayurvedic doctors act as consul-tants. He replied,

Yes, I use them often. I also use some preparations from [two family-basedAyurvedic pharmacies and clinics in Kathmandu]. But sometimes I feel thatsome of these are not effective. I think it has to be due to insufficient medicinalplants. There are not people in those companies who can really identify theherbs. It might also be because they use inadequate amounts of actualplant parts, cutting corners in order to make profits for themselves. In Nepal,the practice of selling small amounts to make big profits is causing manyproblems.

Mercenary tendencies harm Ayurveda by placing profit over sometimes rareor expensive plants that companies may substitute. If patients are not curedby adulterated products, a doctor’s reputation and his practice are harmed.Langford, too, describes the corrupting influence of profit motives, andthe Ayurvedic doctors she interviewed objected to practicing medicine formonetary gain. Rasaliji’s critique is different. He cautions that money



corrupts Ayurveda not through practice but through drugs, namely theproblem of using the wrong or spoiled—but cheaper—plants as ingredients.While the Department of Drug Administration in Kathmandu regulates thedistribution and sale of Nepali and imported biomedical and Ayurvedicpharmaceuticals, and regularly issues public service warnings about compa-nies and products, Rasali and other physicians are skeptical that fraudulentpractices can be completely stopped.

SUFFERING THE COUNTRY’S ILLS: CASTE, MODERNITY,DEPENDENCY

Biomedicine’s impact on indigenous healing systems varies across differentcultural and national contexts. Western health care is imported as part ofother larger processes, such as colonial rule of the past and development-based modernization of the present, bringing with it health care resourcesand modern ideologies. A widespread result of biomedical power is thetransformation and potential diminishing of indigenous medical systemsand with it, medical pluralism.

For the Asian region, there is no single model for the relationshipbetween indigenous therapeutic practices, local knowledge, and biomedicalhealth care modernization, because several ‘‘modernities’’ have beendescribed (Adams 2001; Cohen 2001; Lock 1980; Nichter 2001; Pigg 1996;White 2001). In China, White finds that local and state modernities havedefined civilizing projects to include traditional Chinese medicine, as biome-dicine has come to stand for an elite and non-socialist practice (White 2001;see also Adams 2001 on Tibet). The governments of South Asia haveembraced both Ayurveda and biomedicine, although with far greater finan-cial support for biomedicine. Studies in India and Sri Lanka have character-ized the relationship as one of continuity and non-conflictual syncretismgiving rise to pluralistic medical systems (Leslie 1992; Nordstrom 1989).Critics of the continuity and replacement models of medical change haveaddressed the discontinuities in practice of those traditionally trained andtheir texts (Zimmermann 1978), as well as modern-trained Ayurvedic doc-tors (Langford 2002). Medical modernities in India have been shown to alterthe language and practice of indigenous healing and to create new categoriesof symptoms and signs (Cohen 2001). Biomedical signs embedded within themodern classifying of things and conditions find their roots in traditionalcultural values associated with family and community (Cohen 2001), whileother afflictions in both rural and urban patients are associated withmodernity itself (Nichter 2001) and with colonialism, for which traditionalAyurvedic medicine provides an antidote (Langford 2002).

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A new dimension of medical transformation and relationships betweennations and people that emerges from Rasaliji’s accounts of health care inNepal is how Nepali Ayurveda stands for independence from India,particularly from Indian consumer goods, including Ayurvedic and modernpharmaceutical medicines. The doctor believes that the complex role Indiaplays in Nepal’s health care organization—from education to standardiza-tion policy to raw medicinal plant exportation—must change for Nepal topursue its own interests and to reduce Indian dependence.

During our conversations, Rasaliji spoke of three interwoven nationalmaladies. The first is the most chronically serious: caste discriminationand its excesses of exclusion. Dysfunction within the national government,with its ineffective social programs and inadequate enforcement of legisla-tion prohibiting caste discrimination, are in his view responsible for thiswidespread national sickness. Non-governmental organizations (NGOs)that address Dalit rights have not risen to the challenge of eradicating casteas Rasaliji would like, and he finds corruption among them, too.

After the advent of democracy, it was said that there should be no such thingas caste discrimination, but it has not been put into practice. There are numer-ous institutions and organizations such as NGOs who claim to be working toput an end to untouchability and to raise the economic standard of the lowcaste people. But they are merely interested in fulfilling their vested interests.They spend very little of their funds for the welfare of the beneficiaries andbuild big houses for their families in cities like Nepalgunj. No one has beenable to take an effective step and we do not have our own people in the rightplaces that can provide good leadership.

Rasaliji names Nepalgunj as a city where corrupt investments are made.Nepalgunj lies on the Nepal-India border and is a major site of lawfuland unlawful cross-border medicinal plant trading, as well as a key storagearea for illegally harvested medicinal plants. Nepalgunj serves as a transitpoint to the remote western Himalayan regions of Dailekh, Jumla, Bajhang,and Humla. For many Nepalis, Nepalgunj symbolizes the vast plains ofnorth India, a border town that is neither Indian nor Nepali in any puresense, but is a cultural, political, and social hybrid. Diverting fundsto Nepalgunj that are intended for assistance to Dalits is a travesty, inRasaliji’s estimation.

Rasaliji is also critical of high castes like Bahuns who unjustly discrimi-nate against Dalits. Whether due to their overwhelming dominance in posi-tions of power or the specific discriminations Rasaliji has suffered fromthem, he repeatedly criticized the Bahun castes for defrauding people withfalse claims of teaching and healing abilities. As a learned man himself,Rasaliji is deeply wounded by high caste duplicity because of how difficult



it was for him to become educated. As if to remedy the painful experience,Rasaliji denounces the ‘‘backwardness’’ and ‘‘illiteracy’’ of Bahun frauds.

Often the Bahuns make their living out of treating the distressed, as if it is theirright. Although they have not studied in school they call themselves ‘pundits’like those you see on the sidewalks at Ratna Park. They have deceitfully usedthis field of knowledge to earn their living.

Ratna Park is the main bus station in Kathmandu Valley. Hundreds oftravelers per day board and disembark from massive Tata buses from thedusty, expansive grounds of this park. Also a crossroads of petty commerce,the park is enclosed on three sides by tall, teetering brick and cement build-ings in which business and politics are transacted. Overcrowded Tata busesinch their way out of the chaos and past the crouching, unshaven hawkers towhich Rasaliji refers, buses like ancient mammoths swaying down DurbarMarga and out of the valley, heading toward the northern mountains andthe southern tarai cities. The hustle and bustle of Ratna Park is the antith-esis of the generations-old bonds of reciprocity found in the villages ofNepal, where one’s reputation as a healer would be built on one’s integrity.In Ratna Park and other areas of the urban metropolis, relations of classand anonymity have replaced those of caste, ethnicity, and reciprocity(Liechty 2003), giving rise to unregulated exchanges including those betweenfalse healers and vulnerable clients.

Yet even in villages, the high castes can deceive their own people. AsRasaliji notes:

There are high caste baidyas in the villages practicing this occupation withoutsufficient knowledge, and they distribute the wrong medicines. They tend tothink that high caste people can do anything they like. If we Dalits make evensmall mistakes, they punish us severely, but if the high castes commit crimes,they have people at the upper levels, like the Chief District Officer, the policeofficers, and the ministers, who protect them from being punished. These localhigh caste baidyas have connections in the upper level and they are notpunished even when they administer the wrong medicines and make mistakes.

Protective of Ayurveda, insisting it be practiced with knowledge andintegrity, Rasaliji brings to light how social and political forces impedethe practice of indigenous medicine and fail to arrest the suffering wroughtby caste discrimination.

A second national problem is the improper use of medicine by patientsand practitioners alike, as mentioned above in the hands of ill-preparedbaidya. Rasaliji’s critique of this addresses primarily allopathic over-the-counter and prescription drugs, but also includes Ayurveda’s plant-based

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system, as was discussed earlier regarding the quality of herbs used inAyurvedic preparations. Still, he prefers Ayurvedic medicine over allopathicmedicine for many of the same reasons his Ayurvedic colleagues in Nepaland India do, namely because of what they consider to be the harmful sideeffects and medical dependency from allopathic drugs. Dependency on bio-medicine, in his view, can result in physical weakness, morbidity, and evenearly death, not only because of the harmful side effects but also becausethey erode self-determination.

The modern antibiotics could not have been made without the medicinalplants. These medicines have quicker effects because they are made of herbsbut certain chemicals are added which cause harmful side effects. Let me givean example. You can take cetamol [a common fever reducer] when you havefever. It can bring your fever down, but at the same time it has harmful sideeffects. It will decrease your appetite, and make you weak and lethargic.Cetamol is only one example. Take vitamins like the B-complex. People takethem when they think they have physical weaknesses. It will work for sometime but once its effect wears off you are weak again. It is like you are fineas long as you are supported by a crutch but then you crumble once thesupport is taken away.

Rasaliji draws many contrasts between Ayurvedic medicine and modernbiomedicine, and consistently favors Ayurveda’s ability to make one strongand long-living. He recommends avoiding biomedicine, a medical systemhe feels creates a dependency that gradually weakens the person. Like thedangers of modern desires, quick fixes can also seduce a person into anunhealthy existence. The experiences of his family confirm for Rasaliji thegreater benefits of Ayurvedic medicine.25

Ayurvedic medicines are healthy, pure and fresh. You live longer and you arestronger if you can use the herbal medicines. I can give an example. The oldergenerations like our parents and grandparents used herbal medicines. Therewere no hospitals or doctors. My mother still does not know what a ‘‘doctor’’is. She knows about baidyas only. She has not taken any allopathic medicinesyet and she won’t take them. If she has a fever, my father collects some herbs,prepares the medicine and gives it to her . . . I also haven’t used any allopathicmedicines such as antibiotics. And I have not given them to my children. Mychildren say that the allopathic medicines smell very bad and they refuse totake them. Although both my wife and I are lean, our children are well built,strong and courageous. My daughter, who is six years old now, fetches waterin a ten-liter jerry-can from some distance away. She even talks in a toughvoice when she asks me to take the water! I believe that the allopathic medi-cines have some advantages but at the same time they have serious harmfuleffects. Hence I prefer the plant medicines.



In Nepal, modernity has brought with it state health policy intent onpromoting modern biomedicine and regulating Ayurveda. As Nepalemerges from its 10-year Maoist insurgency and forges a new nation freeof monarchy and fully democratic, Ayurveda surfaces as a powerfulsymbol of self-reliance for this one Dalit Ayurvedic doctor. Not onlyhas Ayurvedic healing through jadibuti become for Rasaliji a symbolof healing a nation of the ills of Indian pharmaceutical capitalism andWestern-influenced modernity, but also a means of providing medical,economic, and social strength to Nepal’s fledgling democratic state. Itis tempting to interpret Rasaliji’s position as a plea for retaining thetraditional and rejecting the modern. But globalization has recast oldthemes in new ways, and has rendered unstable the symbols of tradi-tional and modern. Rather, the doctor sees Nepal’s current situationas a struggle between poverty-induced dependency and autonomousself-determination and independence. Specifically, he is concerned aboutthe Nepali people’s dependence on India and the west (but mostly India)for things that it can produce itself. To illustrate his point, he contrasts aself-sufficient Nepal to a dependent one, using symbols for a sacredamulet, buti, and for parasites, parajibi. A buti talisman contains amixture of five or seven plants inside a small cloth, leather or metalcontainer that is blessed by a priest or shaman with a mantra and wornaround the neck, the wrist, the upper arm, or around the abdomen toprotect the wearer from misfortune such as illness; thus, jadibuti(conventionally understood as ‘‘medicinal plants’’) literally translatesas ‘‘protective entities from roots.’’ Butis are worn for protection by peo-ple of all ages and ethnic groups in Nepal. In the following passage,Rasaliji speaks of encouraging people to cultivate jadibuti so as toprevent the country from becoming like parajibi, economic parasiteson India and other donor countries like the United States.

Parajibi means dependency on others for their livelihood—people’s tendencyto do nothing on their own and to rely upon others. Take the case of saltand oil. If India does not provide us with salt and oil, we would have none.And cloth, thread, all the daily necessities we use come to us from foreigncountries. As a result of dependency and development, people in Nepal donot want to do anything for themselves. Even if some of them want to dosomething, others try to stop them. So if the foreign nations do not haveenough medicines to send us, those who are used to the allopathic medicinesmay die. I want to send the message that we can rely upon jadibuti since wehave enough of them in our country. I want to tell people that we can identifythe herbs, plant them, and make medicines out of them. I want to ask themto learn the effects of these plants and cultivate them in order to savethem from extinction.

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Finally, Rasaliji is concerned about the organization of medicine in thecountry. The absence of a political will to fight corruption and to promote acivil society leads also to insufficient support for the development of Ayur-vedic health care facilities. Recently introduced professional statutes by theAyurveda Council within the Ministry of Health would require certain qua-lifications, such as a higher education degree or a three-generation familypractice, to legally practice Ayurvedic medicine, a statute with the potentialto significantly disrupt village practice. Rasaliji notes how the professiona-lization of Ayurveda is causing disagreement between urban and rural prac-titioners and between formally and non-formally trained providers. In theurban centers of learning and governance, control over Ayurvedic medicinetends to reflect an urban professional preference; while many formallytrained Ayurvedic teachers and policymakers come from both urban andrural communities, most now reside and practice in the cities (as do manyfrom traditional Newari lineages). In the context of what he observes as anurban bias in hiring and regulation, Rasaliji finds that rural life is moreconducive to health and to medicinal plant knowledge than urban life,and that fact may be threatening to urban practitioners aware of theirown knowledge gaps in this regard.

The baidyas in the cities do not respect us. They seem to have the feeling thatsince we treat the sick in the villages, fewer patients come to them and theyearn less. They feel less secure and seem to avoid us when we want to meetthem. They also seem to think that those of us who live in villages and treatthe sick do not have much knowledge. But in reality . . . those who were bornin the villages are more intelligent. The people in the cities cannot thinkover matters the way rural [villagers] can. Still, the people in the cities haveprohibited the villagers in many things. For example, we baidyas are not sup-posed to even examine people, and if we do, we could be put behind bars andunnecessarily punished. These things are happening. Those who are found tobe carrying out this profession in an unjust manner also belong to the highcastes. There are not many baidyas from our [Dalit] people in the first place.

Rasaliji perceives caste to poison what should be caste-blind medicallegislation, leaving Dalits vulnerable to high caste duplicity. The lack ofDalit political representation results in his unwillingness to support govern-ment efforts to regulate Ayurvedic practice.

DALITS AND SOUTH ASIAN MEDICAL ANTHROPOLOGY

Understanding the uniqueness of caste as a form of social organizationhas occupied much anthropological work in South Asia. The discussion



presented here about the impact of caste on one Nepali man’s educationaland professional life and how caste shapes his subjective experiences ofotherwise professional, public matters, reminds us of the controversial issuein anthropology over identifying broad cultural forces that may constituteindividuals’ identities and subjectivities and the search for ways to accu-rately represent the connection between the general and the particular. Tothe extent that we write for social justice, we also try to write ‘‘against cul-ture’’ (Abu-Lughod 1991) and cultural difference writ large, in an effort toavoid broader problems of essentializing less powerfully positioned others(Clifford and Marcus 1986). Feminist theory and feminist anthropologyhave spoken to the question of who has rightful authority to represent mar-ginalized others, concerned as these related interdisciplinary fields are withrepresenting women’s global diversity alongside widespread sexism (Fuss1989; Hooks 1991; Mascia-Lees, Sharpe, and Cohen 1989; Mohanty, Russo,and Torres 1991; Moore 1994; Schor 1989; Strathern 1988; Weedon 1987).These two lines of thought, anthropology and feminist studies, inform myown writing about caste. Still, at the risk of essentialist portrayal, I assertthat in the case of Rasaliji—and indeed in the lives of many Dalits withwhom I have worked over the years—caste ideology and practiceprofoundly shape and have shaped his life journey in medicine.

Anthropologists of South Asia have called for an approach to under-standing caste that qualifies it as just one of many social and cultural orga-nizing forces (Appadurai 1992). I, too, agree that a holistic and expansiveunderstanding of Hindu society does describe South Asian culture moreaccurately than one focused exclusively on caste. Elsewhere, I have analyzeddiversity among women from different groups in Nepal using economic, reli-gious, kinship, and historical data to identify and explain the sources ofDalit women’s power (Cameron 1998). However, in focusing on the roleof caste in Rasaliji’s life as he tells the story of becoming a formally educatedbaidya, I find that caste has shaped his life most significantly. Indeed, I haveheard in many conversations with Dalits over the years about the ongoingsuffering caused by higher caste oppression and the disturbing effects of thaton the moral self (see also Parish 1996 on Newars). Even today, Dalits aredenied basic rights of community and social interaction; in many parts ofNepal, they are prohibited from entering high caste homes, entering templesof worship, receiving food or tea inside a restaurant, sleeping inside a hotel,from using water sources in high caste communities, and sharing food withhigh caste people. In addition to social and religious discrimination, Dalitsare discriminated against in educational, political, economic, and profes-sional contexts as well. Fully understanding oppressive social structures likecaste requires listening to narratives from a subject’s position to see howcaste is more than just a matter of identity politics, as it fully ‘‘traverse[s]

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the space between the social world and subjective experience, constituting acentral organizing principle connecting self and world’’ (Duggan 1996: 219).With measured caution should we heed the call to reject so-called monolithiccharacterizations, for in so doing we encounter equal risks of inadequatelyunderstanding social power, local cultural appraisals of it, and the viewof those from marginalized standpoints that may indeed point to singleand singular oppressive power. Rasaliji’s medical journey suggests thatconfronting and subverting caste coercion with that first dangerous butempowering act of ‘‘hiding my caste, I studied,’’ and challenging the legiti-macy of high caste medical privilege, have constituted his subjectivity withan essential but no less real set of social facts. As such, his daily encounterswith the physical and mental suffering of patients are always linked tothe plight of Dalits, making him uniquely able to articulate the need forsocial transformation.

The problem of widespread denial of Dalits’ rights to access variousknowledge forms, such as sacred books and educated elites (like priestsand teachers), has not been approached as a medical or health-related pro-blem by anthropologists of South Asia. Dalits are rarely the standpointfrom which health, illness, and medicine are discussed, despite the strongtheoretical tradition in critical medical anthropology linking broad socialfactors like class and gender to disease patterns, although not necessarilyto providers (Baer, Singer, and Susser 2004). Models of the relationshipbetween society and traditional medicine in South Asia primarily have beenfrom the perspective of high caste male professional and informal healers,particularly shamans (Burghart 1984; Desjarlais 1992; Durkin 1982; Kakar1982; Leslie and Young 1992; Maskarinec 1995; Nichter 2001; Nordstrom1989; Obeyesekere 1992; Parker 1988; Stone 1976, 1986; Trawick 1992;Zimmermann 1978, 1987, 1992; Zysk 1991). Within the field of reproductivehealth, studies of childbirth and birth attendants acknowledge the impuritystigma, similar to caste impurity, associated with that important health role(Jeffrey, Jeffrey, and Lyon 1989). Yet an important recent study of child-birth and social change in South India, for example, organized the dataaccording to class status, providing generalizations about the political econ-omy of birth but with no reference to caste (Van Hollen 2003). This patternof caste-inattentive scholarship is repeated in the specific example of Ayur-vedic medicine, which is represented almost entirely by high-caste Indianmale doctors, emphasizing their healing techniques and the efficacy andsocial relevance of their practice, their encounters with biomedicine, andthe historical and post-colonial development of their discipline (Alter1999a; Leslie 1992; Trawick 1992; Zimmermann 1978, 1987, 1992).Although in some cases scholars mention broader social and political issuesconfronting the region, the focus of scholarship is typically on Ayurvedic



medicine’s function and status within a plural medical system. Langford’simportant work on Ayurveda, post-colonialism, and medical transforma-tion in India includes women Ayurvedic physicians, but the gender andthe caste of her subjects are not integrated into her analysis (2002). Wemight need to ask why it is that ‘‘lower caste boys’’ were thought to becorrupting the system in early 20th century Rajasthan, as a central figurein Indian Ayurveda is quoted as saying (Langford 2002:65). As well itshould be noted that even though the intimate teacher-pupil relationshipis gradually lost in the transition from guruparampara to modern educa-tional institutions, the latter nonetheless has the capacity to admit womenand Dalits, abstract individuals with equal rights and duties though theymay be (p. 107). With the continuing importance of caste segregation inthe lives of perhaps one-fifth of Nepal and India’s population, it makessense to suggest that issues of caste (and gender; see for example, Selby2005) can and should be addressed in South Asian medical anthropology.

Much like the global circulation of Ayurvedic symbols, people’s experi-ences of systematic and structural oppression are shared across local andnational borders, as knowledge is exchanged with citizens of other landsand the oppressed learn of national and international efforts to influencesocial change and create social justice. The case of the Dalit Ayurvedic doc-tor from Nepal described here also extends knowledge from a local to a glo-bal context, such that the conditions of caste are not isolated and containedwithin a local power structure of exclusion and control. Rather, subversiveacts that challenge the conditions of caste’s legitimacy speak to other formsof oppression as well. The public discourse of highly talented and well-educated humanitarians like Rasaliji who possess meager economic meansand negligible political power nonetheless have the moral authority, if youwill, to do two things. First, such people weaken the boundaries of elitistknowledge production through subversive acts of protest, like changingone’s name for purposes of fair admission into an educational institution.Second, they remind the state of its protective duty to all of its citizens,and challenge the state to fully enforce laws against discrimination basedon descent (Cameron 2009b). Within the context of his local medical role,Rasaliji reflects on how the Nepali government has failed to protectuntouchables from discrimination. As Rasaliji describes here, the state isimplicated in the ideology that renders ‘‘impure’’ in the eyes of some patientsthe very medicines he prepares to help them.

Some people still are reluctant to accept my medicine due to weaknesses fromthe government, which could have introduced strict rules to stop caste discri-minations and punish those who do not follow them. Now people are moreaware and they realize that these discriminations should stop, but there is also

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a group of people that is interested in keeping caste discrimination alive.They talk to us nicely outside but they are still using the low caste people as[political] toys. . . . The untouchables have a very low standard of living andthey cannot earn enough to have two meals a day. The government has notadopted any fixed policy to raise the living standard of the untouchables.We are far behind economically, mentally and on awareness. So, concerninghow we can move forward, the first thing is that the government has deprivedus of the right environment to make any progress.

Linking medical and social justice, Rasaliji views the world from the uniquestandpoint of a highly educated medical practitioner from a marginalizedcaste such that for him, medical justice is social justice. Social marginaliza-tion that held him back professionally also limits his ability to bring healthto others, just as it continues to limit other Dalits from fulfilling social,academic, and professional aspirations.

CONCLUSIONS

For a Nepali Ayurvedic doctor from a rural Dalit community, India isnever far from Rasaliji’s mind. From his formative years as a medicalstudent in India, to his middle years as a professional provider and anastute observer of his country’s many political and social transforma-tions, Rasaliji situates his identity and his social critiques not far fromthe subcontinent to the south. In contrasting Ayurveda in Nepal withits Indian counterpart, an important first distinction for him is thatNepal has never been a satellite colony of England or of any other coun-try. Thus, Ayurveda’s signification is not linked to a search for culturalidentity in the wake of a receding colonial power, as Indian Ayurvedahas been described. Rather, Ayurveda has emerged for him as a signof being modern by having autonomy from Indian influence, as a kindof medical modernity that appropriates biomedical technology and refa-shions it to its own ends. But he also faults biomedicine for its role increating physical and mental dependency and believes that Ayurvedacan rebalance that addiction, too. Thus, biomedicine shares the sameconceptual space as India in being forces that trouble Nepali autonomy.From the early stages of establishing Ayurvedic institutions in the firsthalf of the 20th century, through recent legislation to regulate Ayurvediclicensing, and finally to Rasaliji’s suggestion that Nepali Ayurveda canfree people from dependency on biomedical fixes and from Indian poweralike, the desire has not been for cultural identity but for a modern,progressive, and democratic country able to create and sustain social



and medical justice. Much like it has empowered Rasaliji to resist castediscrimination, Ayurvedic medicine can help the Nepali people becomemore self-determined and to see the rightness of an equal social order.

The forms social justice will take in Nepal with its newly elected govern-ment will be significantly shaped by the nuances of inter-caste relationships,as they have been described here in the professional life of a singular DalitAyurvedic physician and in the lives of hundreds of thousands of rural Dalitartisans and laborers. Broad gestures of caste reform promised by the newdemocratically elected leaders will be ineffective if urban legislators fail toconsider sources of Dalit power, whether within the intimate and trustingrelationship of physician to patient or within the reliable and strong laborof Dalit women and men for Bahun-Chhetry landowners in rural villages(Nepali 2008). The story of the Dalit Ayurvedic doctor presented here sug-gests that the effort must link and balance the health care needs of peoplewith principles of social justice.

ACKNOWLEDGEMENTS

The research was funded by the College of Liberal Arts Humanities Devel-opment Summer Grants and a Professional Improvement Leave Grant,Auburn University; a Fulbright Senior Scholar Fellowship; and a ResearchInitiation Grant, Division of Sponsored Research, Florida Atlantic Uni-versity. I would like to acknowledge the kind and enduring support ofNepali colleagues and friends Lokendra Man Singh (deceased), SaritaShrestha, Rishi Ram Koirala, Narendra Nath Tiwari, Siddhi GopalVaidya (deceased), Meena Acharya, Ram Chhetri, and Manu Bajracharya.The help of research assistants Bhupendra N. Khaniya and Bijaya Bistawas invaluable. North American colleagues who have provided helpfulsuggestions are Steven Folmar, Lynn Kwiatkowski, Kelly Alley, andGreg Maskarinec. Editorial assistance was provided by Christie Mayerand I thank her.

NOTES

1. Because Rasaliji practices without a license certified by the government of Nepal’s Ministry

of Health—his medical diploma bears another name—and following the protocols of

human subjects research, I have used a pseudonym to protect his identity. One anonymous

reader questioned the use of a pseudonym for someone who has published opinion pieces in

the Nepali press. Recently enacted guidelines on the licensing of Ayurvedic practitioners

would prohibit him from practicing if identified (see Cameron 2008a), and even though

260 M. M. CAMERON


he gave me permission to use his real name, I will maintain confidentiality in order to

prevent any harm to him from my research.

2. The degree to which global market forces constrain and determine policy and practice of

indigenous Asian medicine may be found in the work of Banerjee (2002) on Ayurvedic

medicine, and Janes (2002) on Tibetan medicine.

3. The first ethnobotanical study on Nepal was written in 1955 and focused on the eastern part

of the country (Banerji 1955), and numerous studies since then have identified more

than 1,500 kinds of plants used for a variety of purposes, from soap to medicine to cloth

(Manandhar 2002: 63).

4. Typically such transactions occurred while walking the paths and byways of a

once-remote farming community in Bajhang District of the Seti Zone, in the far western

region. Seti is the second to last western zone in Nepal, with Mahakali Zone constituting

the border with India. A road has been under construction for some time, linking a

village=regional center near where I lived for a cumulative five years, with Doti (which

has a more reliable airport than that of Chainpur) to the east, and Dhangardi to the

south, in the tarai region. The area has long had important economic, medical, and

political relationships with India and Tibet.

5. Interview with Dr. Lokendra Man Singh (deceased), April 2000, Kathmandu, Nepal.

6. Interview with Siddhi Gopal Baidya (deceased), July 1998, Patan, Nepal.

7. One interesting but limited study finds that the levels of ethnobiological knowledge (based

primarily on Western scientific classification and conceptualization, supplemented by

locally relevant concepts) about two medicinal plant species, as demonstrated by specialist

amchis (Tibetan medical doctors), commercial collectors, dhaamis (shamanistic spiritual

healers), and non-specialists characterized as ‘‘heterogeneous,’’ with specialists exhibiting

greater knowledge than collectors and lay people, who nonetheless also have extensive

and nearly equivalent knowledge of medicinal plants (Ghimire et al. 2004).

8. The government uses different figures in the same year from its own census reports,

depending on the context, and the figures are widely regarded as too low. Dalit NGO

Federation, an association linking many organizations in Nepal interested in Dalit issues,

conducted its own census in 2003 and found the population to be around 23 percent.

9. A title for an Ayurvedic doctor.

10. For examples of ethnic Nepalis changing their identities in response to repressive actions

against non-Hindus in the former Hindu Kingdom and to access greater economic,

political, educational, and social opportunities, see Gellner et al. (1997).

11. I thank several members of the nepaldalitinfo group for discussing and clarifying this

practice with me, January 31 to February 4, 2009.

12. I thank Ms. Durga Sob, founder and executive director of FEDO (Feminist Dalit

Organization) and her staff in Patan, Nepal, for arranging our meeting.

13. Although the Sanskrit language is mandatory in secondary schools in Nepal, in South Asia

in general, the acceptance of Dalits into Sanskrit-based academic and professional

disciplines in general and Ayurvedic medicine in particular is low. Literacy rates for

scheduled castes in India have risen dramatically in the past few decades, but these data

do not inform us of progress in the fields related to non-Western science practices, such

as Ayurvedic medicine, that are grounded in Sanskrit literacy.

14. Data in Nepal are recorded for the four geographical regions of the country, which for

the purpose of this article and general social science research are more relevant than

data recorded on the 75 administrative units in Nepal. Of the mountain, hill, tarai,

and inner tarai regions, 57 percent of Nepal’s Dalits live in the hills, including the subject

of this article, and 37 percent live in the tarai (Nepal National Population Census, cited in

Vasily 2004, fn.4: 2).



15. According to the World Health Organization, formal and informal traditional medical

practices comprise the main source of everyday health care for nearly 80 percent of the

world’s population in developing countries (Chaudhury 2001). Of the several traditional

medical systems in South Asia, Ayurveda continues its preeminence among them, retaining

great popularity throughout the region (Dixit 1995; Himalayan Ayurveda Research Insti-

tute 1996), and being integrated into most countries’ medical bureaucracies, with varying

levels of support and development.

16. Interview Shesh Raj Acharya, Superintendent, Naradevi Ayurveda Teaching Hospital,

March 2004.

17. Ayurvedic education has typically favored Sanskrit as the language used to read the classic

texts. Although these texts are now found translated into other contemporary South Asian

and European languages, some programs still require that students be able to read and

comprehend Sanskrit for the purpose of reading the original language of the manuscripts.

18. Interview with Dr. Lokendra Man Singh, June and July, 2000, and February 2005.

19. The course of study for the BAMS, Bachelors in Ayurvedic Medicine and Surgery, is five

and one-half years; it includes one year of clinical rotation, and biomedicine comprises

approximately 15 percent of the curriculum and is the major component of admission pre-

requisites. The Sanskrit language is once again required, although most courses are taught

in Nepali and English. A new Ayurvedic medical complex on the Kirtipur campus of

Tribhuvan University is near completion after many delays and should open in the next

few years, when the staff and students at Naradevi will be relocated to Kirtipur. For more

on Ayurvedic medical education, see Cameron 2008a.

20. Currently, Mahendra Sanskrit University in Kathmandu runs a one-year certificate course,

although others are attempting to open lower level programs for certification of Auxiliary

Ayurvedic Workers without government approval. The regulation of lower level programs

is complicated by the fact that their oversight body, CTEVT, is under the supervision of the

Ministry of Education, and not the Health Ministry; second, some programs are set up in

remote areas in Humla and Jumla, making travel there for regulatory purposes impractical

and difficult (interview with Bharat Jha, Ph.D, president of Health Professionals Council,

2000). Today, the curriculum for the BAMS, Bachelors in Ayurvedic Medicine and Surgery,

is five and one-half years. However, administrators and the faculty of Naradevi cite an

extreme lack of academic manpower as a major barrier to the professional development

of Ayurvedic medicine in Nepal. The large gaps of time between which the advanced degree

was offered have led to pressure to catch up, and currently there are members of the faculty

studying for advanced degrees in obstetrics and panchakarma therapy (‘‘five actions,’’ a

complex treatment for preventive wellness, balance, and chronic illnesses, wherein for 35

days the patient’s dosas are balanced through a series of bodily purgings and the consump-

tion of large amounts of clarified butter) in India, who will return to teach and see patients

at the teaching hospital.

21. It is impossible to verify Rasaliji’s application to Naradevi because the institution does not

save applications of those not admitted to the program.

22. For more information on Santikunj Ashram in Hardwar, please see its Web site at http://

meltingpot.fortunecity.com/springdale/161/shantikunj/aboutus.htm.

23. Labor migration to India, a relatively easy process requiring little more than an identity

card, carries with it changes in social status for Nepali citizens (Gellner et al. 1997:

8–10). For Dalits, India offers the opportunity to shed a marginalized status, to ‘‘pass’’

by becoming an anonymous member of a homogenous group labeled ‘‘Nepali,’’

‘‘Gorkhali,’’ or ‘‘Bahadur’’—titles that for a Dalit signal status ascendance. Discussion

of Dalits voluntarily changing their surnames, a different phenomenon, is found later in

the article.

262 M. M. CAMERON


24. Cheiro, born William John Warner, is the author of a famous book on palmistry titled

Palmistry: The Language of the Hand, first written in 1894 and republished in 1999. Either

European or Romany (his birth origins are unclear), he was best known for his readings of

famous people’s hands, such as Mark Twain and Sarah Bernhardt. Cheiro claimed to have

learned palmistry in India.

25. His children have been vaccinated. The history of variolation and smallpox inoculation

in Asia means that vaccination as we now know it cannot technically be labeled modern

and allopathic.

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