Abstract

Health defined as a state of ‘well being’ is understood from a functionalist perspective among tribes – a perspective which considers a person as afflicted by disease often only when one’s capability to perform one’s expected roles in life is impeded either partially or completely. When such situation arises they seek health services from various health care systems influenced by socio-cultural factors where one lives in. Often one finds them shifting between health care systems or using more than one health care system at the same time. This study brings out concept of health as conceptualization by the tribal communities in India, their health issues and status, and health seeking behaviour from socio-cultural perspective. The study is based on review of secondary literature and attempt made to develop a model of health seeking behaviour among the tribes.

Introduction

Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of diseases or infirmity’ (WHO: 1948). Thus the state of well-being of a person at personal as well as social levels with all aspects is taken into consideration as the determinants of health. According to Clements (1932) as cited in Bailey (2000) health is a global concern and is of universal interest; and keeping with this tune the World Health Organisation (WHO) in 1977 initiated and launched a movement of ‘Health for All’ by 2000 with an aim of attaining a level of health status that would improve the quality of life of all.

Health is also understood as a state of dynamic equilibrium between an organism and its environment. Thus involving a constant and complex interaction of organism with the physical – environmental and geographical variations such as mountainous, plains, plateaus and deserts, as well as cultural differences- customs, practices, food taboos etc. Good health would mean ‘dynamic stability, normal function and homeostatic control’ (Sonowal & Praharaj 2007) and ill health correspond ‘to a state of instability, loss of function and failure of self-regulation’ (Sonowal 2010) with oneself and the environment. This concept of health as related to the environment has found expressions in public health policies too, where human health is considered from an ecological relationship point of view with all things in nature and ‘human-made habitats’ (Milio 1988: 263-274).

In keeping with the above understanding of health the Indian context presents a varied and diversified health issues (i) by the varied climatic conditions and environmental variations ranging from the sub-freezing mountainous ranges in the North and some parts of Northeast to the warm topical and costal climatic conditions in the South to the arid and dry climate in the North Western regions and; (ii) there are differences in customs and practices among the people made complex by conditions of social, economic and political inequality.

Methodology

The study is based on the assumption that perception of health and disease varies across cultures, which in turn influence the health seeking behaviour among people. This finds expression even more evidently among tribal communities since most are alienated not only from the mainstream society but also among themselves. It is qualitative in nature and reviews and analyses literature and secondary data to understand health as conceptualized by tribal communities and behaviour in health seeking practices.

Understanding Tribal Health

The status of tribal health in India is ‘very poor’ and is affected by the general ‘widespread poverty, illiteracy, malnutrition, absence of safe drinking water and sanitary living conditions, poor maternal and child health services ineffective coverage of national health and nutritional services’ which make for the ‘dismal health conditions prevailing among these vulnerable population’ (Singh 2008: 118).

In India the tribal groups differ from each other in various aspects- language they speak, cultural practices and traditions and socio-economic categories. As the majority of them live in remote areas like forest and hilly terrains, they often remain isolated and untouched by civilization and are largely unaffected by the developmental processes that go on around them.

Tribal health is closely related to culture, environment and the social structure as can be observed from the cultural and medical system in their classification of diseases and its aetiology making ‘health, disease and medicine’ as inseparably linked with their ‘social relationship’ and the ‘magico-religious world’ (Kaushal 2004: 301-30). Health in a tribal society is understood not as phenomena in isolation but in relation to the magico-religious fabric of existence. Also most tribal communities define health, medical care and aetiology of disease in relation to social context (Sonowal & Praharaj 2007). Tribal health according to Singh (2008: 106-107; 154) is largely ‘influenced by interplay of the complexity of social, economic and political factors’… and their health behaviour by their culture. Thus understanding the culture of tribal groups is important in understanding the concept of tribal health.

Among the tribes health is understood more in functional terms than clinical (Mahapatra 1994; Kshatriya 2004). This inference is derived from general observed phenomena among them wherein withdrawal from work when they are not well is seen. Thus ill-health or affliction by disease among tribes is often taken as incapacitation of an individual from perform his/her normal or routine work which s/he is expected to carry out in society. This functional understanding of health among tribes make them often neglect symptoms of cough, cold, headache, weakness etc., as not serious since such symptoms often do not hinder them from carrying out their daily activities.

Also one universality of perception of disease at individual, family or society level among tribes is the interpretation of ‘breach of trust’ either by commission or omission of act (committed or omitted by either an individual, family or a society) which displease the spirits or disease causing agent. Such perception are revealed in the rituals that they perform by burning of incense sticks, ghee and offering of liquor and meat to propitiate the gods/spirits or the disease causing agent/s that have been displeased by either commission or omission of some act by an individual or the people (Kshatriya 2004: 28-29; Singh 2008). Diseases such as measles, chicken pox, unsafe delivery, snake bite, fever, typhoid, malaria, pneumonia, tetanus, fits are believed to be caused by evil spirits and curse of gods (Singh 2008). A study by Pramuk & Palkumar (2006: 4) among the tribes of the Eastern Ghats found existence of belief that ‘whenever any person is possessed by evil spirits, the person’s pulse becomes very weak and his/her hands become as cold as ice and the patient appears restless’ and they resort to treatment by performing rituals (which are often dramatic) to cure the patients.

Broadly speaking tribal connumities believe in four types of supernatural powers ‘(1) protective spirits who always protect them; (2) benevolent spirits who are worshipped at the community and familial level regularly otherwise they may bring diseases or death; (3) malevolent spirits-the evil spirits who control smallpox, fever, abortion, etc. and (4) Ancestral spirits, the spirits of the ancestors who always protect them (Sonowal et al. 2007).

Forrest Clements in his ‘Primitive Concept of Disease’ (1932) identifies five categories of disease causation concepts based on illustration on their worldwide distribution. They are (1) Sorcery, (2) Breach of taboo, (3) Intrusion by disease objects, (4) Intrusion by spirits and (5) Loss of spirit (Bailey 2000).

Tribal health has also to be understood from cultural contexts, as well as a part of social structure and organization which is changing continuously and adapting itself to changes in a wider society (Sachchidananda 1994). ‘Interpretation of illness is a culturally informed process’ (Singh 2008: 138). This cultural context may range from simple food habits to a complex traditional practices and ‘health culture’ that people practice. Health culture of a community is referred to as the ‘cultural factors influencing the health of a community, cultural meaning of health problems, diffusion of health practices from outside, cultural innovations by the current generations to deal more effectively with health problems and the overall health-related behaviour of the community’ (Basu 1996 quoting Banerjee 1973). According Basu understanding the health culture of a community is important because health problems and their care are influenced by complex socio-cultural factors and understanding of such socio-cultural factors help in the implementation of health services (1996: 195). If understanding of such health culture of the people are neglected intervention at the community levels will not be effective.

Tribal health has also to be understood from the context of it being placed in the modern world with all its modernity and the tribal concepts and understanding of their health related to practices and beliefs. It is a state of dilemma between the two opposing forces of ‘tradition’ which people feel has worked in the past and the ‘modern’ which perceives new as better than the old.

Disease Patterns and Health Concerns

Tribes are known for living in isolation from the mainstream society as well as from among themselves. They have their own traditions and practices related to beliefs, means of livelihoods and health practices. Disease or illness as aforementioned is generally understood among them as incapacitation of an individual from performing one’s work. It is this ‘functional’ concept of health and illness coupled with their habitation characterized by backwardness and terrainous ecological niche, blended with lack of awareness, ignorance, and lack of personal hygienic practices that often make the tribes have disease patterns and health concerns that are specifically of them. These health concerns have to be addressed specifically each with different strategy. It becomes thus a challenge and a task in addressing this concern. Some of the disease patterns and health concerns among the tribals are discussed below.

The Commissioner Report for Scheduled Tribe and Scheduled Caste, 1986-87, states at the primitive tribal communities of India have special health problems and genetic abnormalities like sickle cell anemia, G-6-PD red cell enzyme deficiency and sexually transmitted diseases. And Kate (2000) summarised the health problems of among tribal communities of Maharashtra in following points:

• • Deficiency of essential components in diet leading to malnutrition, protein calorie malnutrition and micro nutrient deficiencies (vit A, iron and iodine) are common. Goitre of various grades is also endemic in some of the tribal areas.
  • Water borne and communicable diseases: Gastrointestinal disorders, particularly dysentery and parasitic infections are very common, leading to marked morbidity and malnutrition. Malaria and tuberculosis still remain a problem in many tribal areas, while the spectrum of viral and venereal diseases have not been studied in-depth.
  • High prevalence of genetic disorders mostly involving red blood cells: Genetically transmitted disorders like sickle cell anaemia, glucose 6 phosphate dehydrogenise deficiency and different forms of thalassaemia are also common. All these defects lead to the early destruction of red blood cells and add to the overall anaemia.
  • Excess consumption of alcohol: The brewing of alcohol from Mohua flower and fruits has been practiced traditionally. However, the switch over to commercially available liquor is likely to be a major threat.
  • Superstitions particularly related to health problems.
  • Extreme poverty.

Kate (2000) also revealed that sickle cell anaemia and thalassemia are the major public health problems in India. Thalassemia was found to be prevalent amongst all population groups irrespective of caste, religion and creed and sickle cell disorder is mostly confined to socio-economically backward groups, like scheduled castes (SC), scheduled tribes (ST) and nomadic tribes (NT). About 13 lakh tribals in India are affected by G-6-P D deficiency. The prevalence of this deficiency is especially high among the tribes and scheduled castes of Madhya Pradesh, Maharashtra, Tamil Nadu, Orissa, Assam (more than 15 per cent) especially in hyperendemic malarial zones (Basu 2000: 67).

There is also a variation in the health issues among the tribals related to their nutritional intake that is influenced by socio-economic, socio-cultural and ecological setting. Often health issues related to lack of iodine that cause goitre and mental retardedness is found among the tribals especially living in the hilly, terrainous and forest areas. Basu (2000: 67) points out that nutritional anemia are rampant among women in India especially among the tribals and rural India. Malnutrition is common not only among children but also among women, especially pregnant women. Among some tribal community in India ‘expectant mothers are advised to take lesser amount of food by the sixth month of the pregnancy in order to reduce the size of the baby to avoid the problem of delivery’ (Sonowal & Praharaj 2007). This makes them weak and incapable of coping with the stress that related to work and daily activities of life thus making them vulnerable. Tribal diet has been found to the ‘deficient in calcium, vitamin-A, vitamin-C, riboflavin and animal protein (Basu: 2000). Anemia is found to be more common among women than men in tribal community (Health Status… ICMR 2003: 2-3).

Upper respiratory tract infection is again found to be rampant among them. A study by ICMR (2003: 3) reveals that upper respiratory tract infection is second to anemia that affected the tribals of Orissa ((14.9% in Bondo, 16.6% in Didayi, 13.6% in Kondha and 8.3% in Juanga) and similar observation was seen among the tribals of Madhya Pradesh (Birhor (11.2%) and Sahariya (57.5% in children aged 0-4 years and 56.9% in children aged 5 –14 years).

Malaria is found to the most wide spread health concern among the tribals of India. Of the total population affected by malaria in India about 25% of the cases are among the tribal communities of which Orissa contributes 23% of malaria cases- 40% of Plasmodium falciparum cases and 50% of malaria deaths in the country (ICMR 2003: 3). These figures are important because the tribes constitute about 8.8% of the total population of India. Malaria is also found to be endemic in many of the tribal regions.

Waterborne diseases like gastrointestinal disorders such as diarrhoea is found to be causing high morbidity and mortality among the tribal population. This problem is related to unhygienic living conditions, lack of safe drinking water and poor sanitation coupled with low literacy, low socio-economic development, superstitious beliefs and lack of access to medical service. Often diarrhoea and cholera are found to break out every year especially during the rainy season (ICMR 2003: 3).

Intestinal protozoan and helminthic infestations (Intestinal Parasitism) are also found to be rampant among the tribal communities of Orissa and Madhya Pradesh. It was observed that children aged between 0-14 years were more affected than adults. the main cause of the disease was found to be indiscriminate defection in the open field, barefoot walking an lack of health awareness and hygiene (ICMR 2003: 3-4).

Nutritional disorder due to lack of consumption of balanced diet and diarrhoea which causes loss of nutrients from the body cause micronutrient deficiency in the body. Tribals often consume diet that are low in iron, iodine, vitamin-A, vitamin -B, vitamin-C etc. These micronutrients are vital for physical growth and overall development of the body and mind. Thus due to lack of such micronutrients tribal people are likely to suffer from anemia, goitre, night-blindness etc. It is also observed that deficiency of iodine during pregnancy has been ‘linked with intra-uterine brain damage and possible foetal wastage’ (ICMR Bulletin 2003). Nutritional anemia is found to be a ‘major problem among women in India’ especially in tribal and rural belt (Singh 2008: 120).

Lack of health awareness and personal hygiene leads to skin problems like scabies among the primitive tribal communities. A study carried out in Orissa showed that 20.6% of Bondo, 6.9% of Didayi, 10.7% of Juanga and 15% of Kutia Kondha tribes were affected by scabies (Health Status… ICMR 2003). Hand wash by soap is rarely practiced among tribes even after use of toilet (they often use mud and water to wash after defecation) and though mouth and teeth are washed daily, few use toothpaste and brush while majority use sticks and twigs for the purpose (Naik 2001).

Communicable diseases like Tuberculosis, leprosy, yaw, and venereal diseases are also found to be of common among various tribal groups. (Singh 2008: 131). These diseases are mainly related to the unhygienic living condition and lack of personal hygiene coupled with lack of awareness and non availability of health care facilities. Diseases such as Tuberculosis, Malaria and stomach disorder are also related to the ecological imbalance arising out of greater global crises (ibid: 131; Basu 2000: 68) thus placing the tribal people living in close proximity to nature at great risk. Leprosy according to Singh is prevalent among some tribes of Jharkhand, Chhattisgarh, Assam, Orissa, Uttar Pradesh, Tripura, Gujarat and others (Singh 2008: 131).

Sexually Transmitted Infections and Sexually Transmitted Diseases (STIs/STDs) were found to be highly prevalent among the tribal people. ‘VDRL was found to be positive in 17.12 per cent cases (reactive in dilution of 1:8 or more) of polyandrous Jaunsaris of Chakrata, Dehradun. Out of 17 per cent, 9.92 percent was found among males and 7.19 per cent among females. Among the Santals of Mayurbhanj district, Orissa, 8.90 per cent cases (reactive in dilution of 1:8 or more of VDRL were observed, out of which 4.99 per cent were females and 3.91 per cent were males’ (ibid: 67).

Mother and Child health issues are of great concern among the tribal community. The need for such concern arises due to customs and traditions that are related to sexual behaviour and child bearing. Studies have revealed that there are practices among some tribes of limiting the consumption of food from sixth month of pregnancy with an intention of making the process of delivery easy (Sonowal &Praharaj 2007). Anemia is rampant among women (especially among the pregnant women) which causes not only slowness in the development of the foetus but also causes mental retardedness- thus raising morbidity and mortality among tribal women and children (Singh 2008: 120).

Maternal mortality is high among various tribal groups. The main causes are unhygienic and primitive practices of parturition such as self delivery practices among Kutia Khondhs in half squatting position supporting herself by holding on a rope tied to the roof of the hut, or some crude method practices like among the Kharias, Gonds, Santals, Kutia Khondhs of Orissa. Maternal morbidity and mortality is also aggravated due to non-intake of balanced diet. Often pregnant mothers are not allowed to consume some food and in some cases in limited amount for fear of vomiting, or the foetus growing too large (Basu 2000: 65-66).

Besides these, the tribal expectant mothers are not inoculated against tetanus while vitamin, iron and calcium intake has been found to be limited among tribal women while most of them continue to consume alcohol even during pregnancy. They also continue to carry out normal activities of labour and work which are often strenuous. It has been observed that 90% deliver at home assisted by some elderly lady of the house or neighbourhood. Also unhygienic practices during the delivery process increase susceptibility to various infections to both the mother and the child (ibid: 66).

Infant morbidity and mortality too is high among tribal groups. The health of the foetus is directly related to the health of the mother. Thus a malnourished pregnant mother is going to give birth to a child who is retarded and underdeveloped (Singh 2008: 119-120). ‘Low birth weight indicates that the infant was malnourished in the womb and/or that the mother was malnourished during her own infancy, childhood, adolescence and pregnancy’ ( Navaneetham & Jose 2005, a draft paper before publication). And after delivery the babies are often not initiated to early breastfeeding and more than often colostrums is discarded (Singh 2008: 127). Often vaccination and immunization is low among tribal children thus causing them to be highly susceptible to whooping cough, diphtheria, measles, influenza etc. IMR varies from 36/1000 in Kerala to 168/1000 in Uttar Pradesh among tribal population.

Tribal health has to be understood in relation to the Social, Cultural & Economic system; Geophysical environment, Religious Beliefs and Practices of the people. These factors influence health seeking behaviour among the tribal community thus making them seek either from traditional or modern systems of medicine. There is consistent relationship between factors that influence treatment of disease and the availability, accessibility, effectiveness, socio-cultural beliefs, awareness level, and attitude of providers.

Tribal health has to be understood in relation to the social, cultural and economic system; geophysical environment, religious beliefs and practices of the people. These factors influence health seeking behaviour among people of tribal community thus making them seek either from traditional or modern systems of medicine and sometimes to even use self treatment for illnesses. There is consistent relationship between factors that influence treatment of disease and the availability, accessibility, effectiveness, socio-cultural beliefs, awareness level, attitude of providers.

Often these socio-cultural factors coupled with inadequacy of health infrastructure and services rendered among them aggravates their issues related to health thus resulting in frequent outbreak of diseases, and high morbidity and mortality rates among them.

Health Seeking Behaviour: A Socio-Cultural Perspective

Health seeking behaviour among tribal groups is determined by their socio-cultural and magico-religious beliefs (Kaushal 2004: 301-30), beliefs, customs and practices (Singh 2008: 148) and the choice of their health care system by socio-economic and cultural factors (ibid: 69). According to Sharma (2004: 72) beliefs, customs and practices determine the health seeking behaviour of tribals and ‘health status are indicated by social and economic conditions, nutrition and living conditions, dietary habits, housing, education, child rearing practices, socio-religious beliefs, taboos and superstitions, etc.’

However, in today’s world of globalization accompanied by generation of mass awareness through media and communication (especially in areas related to reproductive health services, including institutional delivery, safe abortions, treatment of RTIs, and family-plan­ning services, to meet unmet needs while ensuring full reproductive choice to women, National Rural Health Mission (NRHM) with its components of Information, Education and Communication (IEC) and Behavioural Communication Change (BCC) have been targeting to bring about change in health seeking behaviour among people especially in rural- including tribal areas) the tribal people have come closer to the main stream society and system. The ‘unprecedented wave of non-traditional elements entering into their social and cultural life (Sonowal & Praharaj 2007: 136) has not only affected their economy and commerce but also the health care systems- thus putting their traditional health care system into a complex situation of medical pluralism.

The tribal communities seem to be taking a turn towards modern system of medicine though they still have faith in the traditional medicinal system. A study by Sonowal and Praharaj (2008: 140-141) shows that though the Santhals of Orissa believe in the traditional system of medicine the percentage of those accepting traditional system of medicine was declining irrespectively of their level of education and age. The study also revealed that younger generation are more inclined than the older ones to turn towards modern system of medicine. The factors related to such a shift according to the authors are effectiveness, availability and affordability of health care service provision, and good behaviour of the service providers under the modern medical system. The study also revealed that the choice of health seeking behaviour of the tribal people depend on their perception of the agent that caused the disease. The overall tendency to access modern medical health care service if it was accessible was high. The coming in of the pluralism in the health care system in society has affected the health seeking behaviour of the tribal groups which can also be seen among the Santhal Tribe of Orissa.

A study carried out by Muthu et al. (2006) on the other hand found that among the rural people in Kancheepuram in Tamil Nadu people preferred the traditional medical system for treatment of both ‘simple and complicated diseases’ like cold, cough, fever, headache, poison bites, skin diseases and tooth infections though western medicine was accessible. A study carried out by Raj Pramukh & Palkumar (2006) among the tribal communities of the Eastern Ghats and the Western Ghats found the association of disease to supernatural – ‘when possessed by evil spirits the person’s pulse becomes week and… hands become cold like ice…’ and treatment was done by invoking the spirits through rituals and chanting of ‘mantras’. They also have methods of diagnosis- for both identification of which ghost or spirit possesses the patient and what kind of disease is affecting the patient and thereafter recommended treatment accordingly.

Factors that affect health seeking behaviour of tribal people have been analysed by different researchers. Some of these factors that are responsible are socio-cultural and magico-religious beliefs and traditions (Kaushal 2004: 301-30; Raj Pramukh & Palkumar 2006: 5; Singh 2008: 150), beliefs, customs and practices, and socio-economic factors, illiteracy and unawareness (Singh 2008: 148; 151), destruction of forests leading to non-availability of herbal and medicinal plants, accessibility and affordability of modern medical system and globalization (Sonowal & Praharaj 2007: 140) and effectiveness. In short it can be concluded that tribal people though seek medical treatment from traditional medical system are shifting towards modern system of medicine. This can be largely attributed to the availability, accessibility and affordability of modern medical system that is provided to the people under Government controlled administration and implementation besides education playing a major role. There is general agreement among researchers that tribal health is affected by ‘socio-cultural setting and eco-systems’ (Singh 2008, 153).

Health seeking behaviour among tribal women related to parenthood is taking a gradual change. This could be due to efforts made to provide quality reproductive health services- including institutional delivery, safe abortions, treatment of RTIs, and family-plan­ning services, to meet unmet needs while ensuring full reproductive choice to women. National Rural Health Mission (NRHM) with its components of Information, Education and Communication (IEC) and Behavioural Communication Change (BCC) have been targeting to bring about change in health seeking behaviour among people especially in rural as well as tribal areas. This has given some result since more rural women including tribal are accessing the health care services provided by the PHCs for antenatal services (ANC), delivery as well as post natal services (PNC). However health seeking behaviour among tribal women including during pregnancy was found to be directly related to their socio-economic and educational level (Maiti et al. 2005: 37-39). Hand it is observed that among tribal groups no ‘special care’ is given to pregnant woman except in critical cases (Singh 2008: 151) which could be due to lack of awareness and education.

It has been observed that tribal people in parallel with the treatment by traditional system of medicine also adopt allopathic system of medicine for aliments and had more faith in private practitioner than the government doctor. Tibals want immediate relief and so often ‘prefer injection to medicine’ (ibid: 151).

Another factor that affects the health seeking behaviour among tribal groups is the degree of autonomy that one exercise in making of choices relating to treatment of diseases- often their decisions are related to some advice based on experiential knowledge of elders or some senior member in the family. This is even more among women folk and especially in areas related to sexual and reproductive health. The kind of social network also determines the health seeking behaviour among people- thus a group of people who believe that traditional system is better will resort to traditional while a group that believes in modern system will resort to modern- sometimes such social network may even prove to be detrimental for success of public health programmes; for example it has been found that among some religious groups there is a belief that polo drops cause impotency later in life (though this is reducing) thus causing failure in the achievement of target.

Lack of awareness and education among tribal groups also determine their health seeking behaviour. In Jharkhand lack of awareness and education coupled by difficulty in accessing the service caused 72% of the births to tribal mothers to have no antenatal check-ups as they felt it customarily not necessary, compared to 65% of non-tribal women’ (Maiti et al. 2005: 41). Among the tribal communities of Manipur a study carried out by Nembiakkim (2008: 20-21) showed that awareness and education imparted by Christian missionaries has led to practice of hygienic practices and decline in them seeking health care services from quacks and traditional practices. Following the above discussion the following framework of health seeking behaviour is constructed.

Figure 1: Socio-culturally determined health seeking behaviour model

• External environment : geophysical environment, politics, policies, health systems, media.
• Personal predispositions : beliefs, socio-cultural structures and status of an individual and demography that are to be influenced by socio-cultural setting.
• Perceived morbidity : functionalist understanding of health and illness which is highly determined by socio-cultural backgrounds.
• Behaviour : choices between traditional, self and modern treatment of illnesses.
• Traditional system : folk medicine embedded in tradition.
• Self therapy : treatment of self by application of herbs or other drugs which are available on preparation or procurement.
• Modern system : the allopathic (biomedical model of approach).

Factors like external environment, personal predisposition and perceived morbidity influence the health seeking behaviour of individuals. The behaviour can and often moves between different options– traditional, self therapy and modern. These practices can be seen as they are accessible, affordable, available and acceptable to all.

Traditional/Indigenous medicine is embedded in folk systems and literate tradition. They consist of treatment by use of herbs, animals, minerals and other substances. The skills are learnt by observation of symptoms and practical by application of herbs, animals, minerals or such other substances which are available in nature, culturally acceptable, cheap and affordable and based on ancient knowledge and wisdom. These herbs, animals, minerals, and other substances used have both preventive/promotive and curative effects which in turn reinforces the traditional system of medicine in a tribal community. Given option backed by availability and affordability there is a high tendency of seeking health service from modern system. There is also a tendency of reverting back to traditional system if modern system fails.

Conclusion

The concept of health is understood more in functional terms than clinical among the tribal groups. It is related to environment, habitat and socio-cultural and magico-religious beliefs and customs, social and economic conditions, nutrition and living conditions, dietary habits, housing, education, child rearing practices, socio-religious beliefs, taboos and superstitions. The health seeking behaviour among them is closely related to their conceptualization of diseases and health. However the great dilemma in health seeking behaviour that a tribal individual often faces is the choice that s/he has to make between custom bound practices and beliefs which are laden with socio-religious values, and the modern system which is often projected as better than the other by media and professionals who are often strangers.

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