The Unheard Voices of Santalis: Communicating About Health From the Margins of India

Published in Communication Theory in 2004, this article employs a culture-centered approach to explore Santali meanings of health in rural Bengal. The goal was to suggest alternative theorisation and practice in health communication that would facilitate the incorporation of views and needs of marginalised populations into the design and implementation of health campaigns. By using discourse analysis of the conversations with members of these marginalised communities, journal accounts, and fiction and non-fiction literature on Santalis, the researcher identifies four dialectics shaping critical issues and meaningful theories of health that can inform health campaigns targeting these populations. The discursive constructions demonstrate that Santali health beliefs are polymorphic, accommodating multiple treatment approaches to disease and illness, reflecting structural constraints of life in poverty as well as ancient traditions. Findings suggest the need for relocating the definition of health problems under a circumstance deprived of resources as experienced by these communities, while associating the cure to natural resources and lifestyles.

Research Methodologies:

This research employed diverse qualitative methods to document discursive spaces of health issues among the Santali people, a marginalised group living in rural Bengal, India from 1997-2000. The author asserts that while dominant models in health communication interventions focus on individual behaviour and beliefs about expected outcomes of health campaigns, a culture-centred approach begins by seeking participation of the community in defining health problems and identifying their roots. This research sought to present a narrative on how health is defined by Santelis and what factors prevent community members from enjoying good health standards.

Having grown up in areas inhabited by Santalis himself, the researcher employed a participant observation approach drawing on memories and journal notes that captured the everyday life of people in the region. Fiction and non-fiction literature on Santali people provided a framework on discourses and history of this population. Finally, the analysis is fleshed out through conversations with 32 members of a Santali community (18 men and 14 women) about their understanding of health issues, and their treatment choices and preferences. The discursive analysis of these different sources is employed in the writing of a narrative of the health culture of Santalis. In order to deal with issues of reliability in the analysis of different discourses, the researcher sought verifications with key informants by using a constant-comparison technique, comparing and contrasting themes that emerged in conversations about the health in the community.



Key Findings:

Santalis communities in Bengal are the result of a long history of displacement and marginalisation that goes back to the times of colonial rule. Today, Santalis are mostly landless laborers living in extreme poverty. The analysis revealed dynamic and complex cultural processes shaping practices and understandings related to health among Santalis. The researcher identified four key dialectics around health issues, which reflected the paradoxes characteristic of these marginalised spaces: (1) tradition-modernisation, (2) structural limits-individual agency, (3) despair-hope, and (4) assimilation-resistance.

The dialectical discourses identified in the analysis show the contradictions experienced by marginalised cultures, which were pushed to the sides of the modernisation project. On the one hand, Santali voices reminisced about the loss of traditions caused by modernisation and urbanisation. On the other hand, they were regretful of their limited access to the benefits of modernisation enjoyed by the bourgeoisie. In this context, Santalis' understanding of health is associated with nature:

• Being healthy is a natural state.
• Diseases are the caused by spirits that entered the human body when natural processes are disrupted.
• Modernisation projects such as urbanisation disrupt natural environments and are correlated with illnesses.

At the same time, urbanisation is recognised as a source of bourgeoisie comfort.

Santalis believed that medicines mitigate the nuisances of the illness but the cure ultimately occurs if spirits are exorcised from the human body. The practice of exorcism is conducted by a spiritual healer or the ojha. Therefore, the healing process occurs through a combination of medication (allopathic or homeopathic treatments) and visits to the ojha. What can be seen as contradictory is in reality a negotiation between tradition and modernisation, and between structural limits (e.g., lack of adequate medical services) and individual agency (e.g., desire to be cured). Interviews revealed that in many cases Santalis' visits to the ojha compensated for the lack of resources for medical treatment, or the lack of physical access to health institutions. Thus, the spiritual pathway to healing becomes particularly important for those with less means. Religious rituals provide support and hope in desperate situations. Finally, the researcher argues that Santali discourse on resistance and constant struggle for life will be a fertile ground for self-organising efforts to employ more empowering approaches in health campaigns.

Findings suggest that Santali people would tend to engage and respond well to interventions that locate the problem of health in the realm of nature and natural life, and strategies that address the region's structural factors such as limited access to health services. Lack of access to basic resources is a factor that keeps people from experiencing the full range of medical treatments advisable to cure their illnesses.