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Why A Snakebite Victim In An Indian Village Won't Walk Through A Door

When a young boy in a village in Jangjir, India, came home with a snakebite, his family needed to get him to a clinic. But they didn't dare take him out through the front door. Instead, a handful of men dismantled the thatch roof of his home. Then family members inside lifted the boy up, out through the roof and over a six-foot wall into their arms.

"You can't take the patient out through the doorway," says the boy's neighbor Bedmathi, who goes by one name. "The venom gets stronger and they die. I've seen it with my own eyes."

Fortunately, the boy survived — although not because of his rooftop exit. The family was able to get him to a clinic that's a 90-minute drive away, where he was treated with antivenom.

Amid the dense forests of Chhattisgarh, a rural state in central India, many traditional beliefs about health and survival are passed down through generations. Some are positive: using twigs from the neem tree to clean teeth, eating wild vegetables.

But some traditions — like taking snake-bite victims out through the roof of their homes — clearly don't help. Others can be harmful.

"They just don't believe in the systems we have," says Pankaj Tiwari, a doctor with , a nonprofit community health organization in central Chhattisgarh that treats thousands of tribal people each year with support from donors and grants from institutions like the Sir Ratan Tata Trust. Tribal people, India's indigenous citizens who often lived off the grid and have only recently been pushed into mainstream culture, make up 38 percent of the population in Chhattisgarh.

Tiwari, 26, who has lived most of his life in cities, says he has learned many lessons in his two years treating tribal patients. For one, the most isolated tribes are wary of doctors and terrified of hospitals, he says. Admitting patients is difficult — and doctors say, even then, they often jump up and leave after just a few days, as the closed-in wards clash drastically with their lives in the village.

One day in August, Tiwari plays his tambourine in the back of a bouncing jeep full of medical staff as they make their way — over narrow, often unpaved roads — to a satellite clinic about 95 miles away in Achanakmar, a wildlife sanctuary and tiger reserve that is also home to dozens of villages.

When the medical team arrives — after wading through a river with their gear — patients are already lined up along the corridors at the clinic, a simple structure with cow-dung floors. Villagers wait to be treated for malaria, anemia and other conditions common in these communities.

For most villagers in these remote regions, health care is hard to come by; it's just not part of their culture. Clinics are scarce, so they're only likely to seek a doctor during an emergency.

On this day, Manju Thakur, a community health worker with the organization who is originally from a nearby village, speaks to a support group of 20 psychiatric patients suffering from bipolar disorder, schizophrenia and depression as well as others who came to work on anger management. Most patients in Bhamni, one of the larger villages in Achanakmar, blame their behavior on the supernatural — a common belief in a culture that widely accepts spirits in both humans and nature.

Thakur tells them the mind is like the body — it needs to be maintained and treated. Thakur says she has to be very convincing and sensitive to steer patients away from traditional healers, who perform rituals or prescribe herbs. She visits homes frequently and shares stories of other people who have recovered in hopes they will consider another type of treatment.

"[The village healer] said there's a ghost or spirit in me," says Chotilal Gond, a 30-year-old construction worker who has been hearing voices in his head. Gond had visited the tribal healer before a community worker identified his issue and referred him to the clinic, where Thakur diagnosed him with schizophrenia and convinced him to take the drug olanzapine. Now, he comes to the monthly meetings she holds in the village.

"I've been doing this for over 15 years," she says. "You have to go back again and again to build trust."

Across the corridor, another group meeting is in session. Pregnant mothers step on a scale as health workers give them tips on eating a proper diet, taking folic acid and curbing morning sickness.

Thakur's team has been fighting a dangerous postnatal practice: Many women believe they shouldn't eat for five days after delivering a baby in order for the waste fluids and placenta to leave the body. It's a tradition passed down over generations. In a state where both malnutrition and maternal mortality are among the highest in the country, dispelling such beliefs are a must. Programs involving group discussion and nutrition advice for young mothers have done a lot to change this mindset — albeit slowly.

Tulsi, a 20-year-old woman at the clinic who is three months pregnant, talks about her post-delivery plan. "I'll eat at least once a day and a full meal of normal food," she says. "They said if you don't eat, the baby won't grow."

For Tiwari, working with India's indigenous communities has meant understanding culture and mindset — not just their medical issues. It's about knowing why a snake bite victim can't walk through a door and balancing those traditional beliefs with his treatment.

What are the most interesting traditional healing practices you've heard of? Tweet us at @NPRGlobalHealth or let us know in the comments below!

Copyright 2020 NPR. To see more, visit https://www.npr.org.

Ankita Rao