HEALTH SEEKING BEHAVIOUR OF RAJBANSHI COMMUNITY IN BAIJANATHPUR AND KATAHARI OF MORANG NEPAL

Abstract

Nepal is a country of multi cultural, multi-religious, multi-lingual, pluralistic and mosaic society. Ethnic communities have their own distinct healing practices. It has been widely felt that access of modern medication in the rural as well as in urban community is very low; despite the service outlets have been made available even at periphery level by government. Health Care practices -Modern, Traditional, Self-medication, Alternative are existed in almost each and every community, are indispensable part of our health system. Merely establishment of Sub-Health Post, training for Health Workers cannot ensure the access of health service, also requires attempt on the Socio-economic assessment, cultural and behavioural diagnosis. Rajbanshi are one of the ethnic groups, living in Morang and Jhapa districts. Their estimated population is fairly above than 0.1 million (CBS, 1991). This study was an exploratory, descriptive, cross-sectional, and qualitative study based on household survey. Study has assessed the disease prevalence, healing or caring practices and determinants of health seeking behaviour.

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Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
1
HEALTH SEEKING BEHAVIOUR OF
RAJBANSHI COMMUNITY IN
BAIJANATHPUR AND KATAHARI OF
MORANG NEPAL
Nawa Raj Subba
2001
Copyright © 2001, Nawa Raj Subba

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
2
Summary
Nepal is a country of multi cultural, multi-religious, multi-lingual, pluralistic and mosaic
society. Ethnic communities have their own distinct healing practices. It has been widely
felt that access of modern medication in the rural as well as in urban community is very
low; despite the service outlets have been made available even at periphery level by
government. Health Care practices - Modern, Traditional, Self-medication, Alternative
are existed in almost each and every community, are indispensable part of our health
system. Merely establishment of Sub-Health Post, training for Health Workers cannot
ensure the access of health service, also requires attempt on the Socio-economic
assessment, cultural and behavioural diagnosis.
Rajbanshi are one of the ethnic groups, living in Morang and Jhapa districts. Their
estimated population is fairly above than 0.1 million (CBS, 1991). This study was an
exploratory, descriptive, cross-sectional, and qualitative study based on household
survey. Study has assessed the disease prevalence, healing or caring practices and
determinants of health seeking behaviour.
This study was undertaken in two Village Development Committees (VDC) of Morang
district with the Specific objectives of: (1) to find out the practices of using traditional
and modern medicine in the community. (2) Assess the satisfaction and dissatisfaction
with traditional medicine and modern medicine or health services available. (3) Assess
the expenses on health care. (4) Know various methods of self- care and types of
therapies used by consumers. Attempts to 175 households' visits were made particularly
head of the households as respondents of the study. A Rajbanshi graduate and one more
interviewer were trained prior to going to community. With the help of these two-trained
interviewers, the researcher had carried out interviews and conducted Focus Group
Discussions.
Major findings:
Rajbanshi ethnic in Katahari and Baijanathpur VDC were found having literacy rate 65%
in the taken sample. Principal occupation is agriculture. Majority of people falls in the
category of having no land to less then 2 bigahas. Average family size is 5.76 persons.
Attempts to interviews with mostly head of the 175 households were made in two VDCs.
And there were 61% male and 39% female reported sick.
Common type of ailments was reported such as headache, bodyache, weakness (50.8) and
then ARI (44), fever (30.8), Eye/ENT(18.8), diarrhoea (13.7) was reported respectively.
Distribution of reported illness was highest on over 66 year of age then 55-65 and 46-55
years of age respectively. People were found adopting Modern medication, Self-
medication and Alternative-medication. Dhami Jhakri/Shaman, retailers were common
practices under self-medication. 72.0% patients used private clinics whereas only 15.4%
patients had used health post service.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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Poor were adopting self-medication higher than other economic strata that was found
statistically significant (P=0.0160). Similarly, rich were adopting alternative medication
more than poor that was statistically highly significant (P=0.0000). Uneducated people
used self-medication more than educated that was found statistically highly significant
(P=0.0000063).
An average treatment cost has found Rs. 1031.64 (SD=6). 73.1% patients were reporting
to be unable to afford the expenses for treatment. They had taken either loan (14%) or
had to sell land, animals, grains or personal belongings (53%). The bulky proportion
(57.8%) expenses felled on buying drugs and for fees (19.55%) thereafter, for
transportation 5%, helper 3.74%, others 13.84%. Therefore, the concern of
unaffordability of treatment cost for modern medication is one really striking.
Utilization of PHC services: They were found familiar to go to EPI-Camp (79.4%) for
getting vaccination for their children. They are also familiar with FCHV and recognize
her services. Most of the people know their FCHV (50.2%) and used to take service from
her. On the other hand, more than 89.2% population was found still unknown to MCHW,
TBA and PHC-ORC and its services.
Cost: The proportion of people paying between Rs.51-200 was 39% of sample. But
average expenditure per patient was Rs. 1031.64 (i.e. mean; and SD=6) for a treatment. It
is unaffordable for 73.2% people; so, they take either loan or sell their belongings to
accomplish the treatment. Most of the proportion of their expense goes for buying drugs
and paying fees. Rest portion was expensed for transportation, helper cost and other.
Satisfaction: Rich were found satisfied with alternative medication that was found
statistically significant (0.0050). Educated were also found satisfied with alternative
medication that was statistically highly significant (P=0.0000).
Recommendations:
Based on the findings, following recommendations could be made as follows: Since
majority of the poor people go for self medication and the private clinic was perceived to
be expensive; the personnel of the self-medication or service provider such as Dhami/
Jhakri/ Shaman, retailer need to be oriented on referral system. Since 73.2% people are
unable to afford treatment; free mobile health camp should be provisioned for the poor.
Since 89.2% of the population was unknown to MCHW, TBA and PHC-ORC services;
training and awareness program should be provisioned to both service providers and
users.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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Chapter- I
1.1.Introduction.
Access of modern medication in the rural community is very low even series of service
outlets are being provided by government. HMG has attempted service deliveries through
extensive outlets for periphery people. But there are many questions arising about quality,
access of service and acceptance of services. Merely establishment of health institutions,
training of health workers cannot ensure health service without assessment of their socio-
economic status, cultural and behavioural diagnosis. Since a complete health system
approach has not yet been considered, any progress report published by government or
NGO are found unable to reflect holistic situation of a health system. Since, traditional
medicine exits in all cultures to degree and terms such as traditional medicine; indigenous
medicine or folk medicine etc. These are used to describe as Local practices. These
medicine dates hundred or even thousands of years depending on the country and culture
concerned. Because two thirds of the world's population (mainly in the developing
countries) relies entirely on such Traditional medical therapies, WHO has declared its
intention actively to encourage Traditional medicine worldwide in order that their goal of
Health for all can be attained. It is interesting that even where western medical care is
available, the majority of the people in the third world choose to remain loyal to its
indigenous medical systems. The WHO has pledged itself to foster realistic approach to
traditional medicine; to explore the merits of Traditional medicine in the light of modern
science in order to discourage harmful practices and encourage useful ones; and to
promote the integration of proven valuable knowledge and skills in traditional and
western medicine. A WHO report indicated , for far too long traditional system of
medicine and modern medicine have gone their separate ways in mutual antipathy.
(Annex - IV)
While explaining the worldwide prevalence of Alternative Medications Agarwal (n.d) in
his book A guide to Alternative Medicine, two-third of the world's population is still
being treated by traditional health workers especially in underdeveloped and developing
countries according to the estimate of the WHO. Considering the importance of these
practices, WHO has recognized its value and included these in their ongoing programs
achieve the goal of "Health for All"

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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Nepal is a country situated in between China and India. It is in brick shaped, east west
length is 885 Km, and North-South mean width 193 Km. It's total area is 147181 Sq. Km.
Total population of Nepal in 2000 is 229,03,598 (MOPE). Nepal has got topographically
three belts upper Mountainous, middle Hill and lower Terai region extending east to
west. Despite being small in area and population, there is wide variation socially,
culturally and geographically. Mostly due to geographical reason there is less access of
health services in the remote areas.
Nepal has a population of 20 million (1996) and this is steadily growing at 2.1%
annually. There is world’s highest mountain towering above populated valleys,
Himalayas and plains. It is land locked country, bounded to the north by Tibet region of
People’s Republic Of China and to the south east and west by India. There are more than
75 ethnic groups religiously consisting of Hindus (89.5%) and Buddhist (5.3%), Jain
(0.1%), Christians and others (0.23%). The different ethnic groups have their own
dialects; however Nepali is the Lingua franca. Nepal is one of the least developed
countries in the world with per capita income ranging from US$ 180 to 200 per annum.
The existing health situation is characterized by severe shortage of basic requisites such
as sanitation, sanitation, safe drinking water, appropriate nutrition and health services.
Immunization coverage is low, there is high rate of unmet demand of family planning
services/ devices and several epidemics, diseases leading high rate of morbidity and
mortality in the country. The life expectancy at birth is around 55 years (HDR1998), IMR
is 79/1000 LB, MMR 539/10000 LB, CMR 118/1000 LB, TFR 4.6 per woman, CBR
42/1000 population, CDR 13.3/1000 population (CBS, 1995, NFHS, 1996).
Modern health facilities provided by HMG/N are grossly inadequate especially in areas
of difficult terrain due to roads and shortages of medical and paramedical staff.
According to the reports of DoHS 1998 there are 3187 SHPs, 764 HPs, 11 Zonal
hospitals, 14 DPHOs, 61 DHOs, 117 PHCs/HCs, 155 Ayurvedic clinics. Besides there
are 894 doctors, 1220 nurses, 42427 FCHVs, 12682 TBAs and more than 4000 VHWs.
Some of the districts out of 75 are without district hospital and the performance of SHPs
and HPs and PHCs delivery in the rural areas is far from satisfactory. The utilization rate
of of SHPs and HPs is averaging 0.2 visits per person per year (Asima, 1991). There is
thus clearly a gap to be filled up. The population will either be visiting the conventional
traditional health practioners or private drug retailers for their needs. Due this
circumstances and doctor- patients' uncontrolled ratio, doctor could not provide efficient
services. Thus patient’s satisfaction is not found satisfactory.
Kafle and Gartaula (1993) have pointed out that developing countries have insufficient
financial means to purchase drugs; and frequently management and health care
infrastructure are less than adequate the availability of essential drugs in the rural areas.
As a result, people have to rely on the health care system and herbal medicines where
these are still available. Nepal is no exception to the above. The government owned
pharmaceutical organization is unable, due to financial limitations, to ensure an adequate
supply of allopathic drugs throughout the year. It is estimated that less than 20% of rural

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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health care are provided by public health care institutions. Most of the year people are
thus forced to turn to the market for their health care. This consists of drug shops and
various types of practitioners of traditional medicine (Ayurvedic, Chinese, Homeopathic
etc.). Also included in this category are spiritual practitioners such as shamans, priests,
dhami/jhakris and astrologers. People also have the option of using herbal medicines
(root, grasses, plants etc.) which they can either collect themselves in the forests or
purchase from practitioners or shops.
There are so many communities; strata of society or group of people and Indigenous
people, which are, still far from access of health services both in remote and urban areas.
As we know that socio - economic, cultural, genetic as well as educational factors
determine the health of people. Therefore there are variation of disease prevalence and
health seeking behaviors of different groups of people accordingly in the country.
Gartoulla (1998) wrote a book entitled Therapy pattern of conventional medicine with
other Alternative Medication. He found that Alternative medication practices in Nepal are
a distillation of Nepalese culture and also acculturation through a long and slow process
of history... Even today, there are such wide differences in the beliefs and practices of the
various tribes within Nepal that any attempt to generalize must be hedged with caution.
1.2.Statement of Problem
Globally, the figure presented in WHO (1997) report suggested that only 30% people are
getting health service from local health providers. A report by Moin Shah et al, cited
from Dixit (1999), has stated that government health services are providing barely 10%
of all consultations for people seeking health care. Dixit (1999), referring to Shrestha R.,
Shrestha M., highlighted the existing health delivery system of Nepal, what has been
accepted even by the the authorities is that the health services provided by the
government reach no more than 10-15% of the population. It is also noted from the study
undertaken by Chalker, who worked with BNMT, cited from Dixit (1999), the traditional
healer is the first provider of health care. It lets us to rethink why people are not
accepting the health services provided by the government for such long time. Why those
people are reluctant to accept the health education message or are proven untouchable to
them though several decade long IEC intervention. These are such problem, which need
to be assessed today.
Agarwal (n.d.) in his book entitled A guide to Alternative Medicine writes in a very strict
sense Traditional medicine is the original medicine but factors such rapid development in
the field of science and technology, social and political reasons, organized efforts of
medical and health industries, westernisation etc. have led the traditional and age old time
tested systems of health care into a depression. People naturally started assuming that
newer and more expensive care must be better and guided by the medical profession; they
were brainwashed into believing that anything that was not Orthodox western medicine
was either harmful or useless. This led to legislation, which controls the practice of
medicine by people who are doctors in most of countries.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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Agarwal (n.d) has made remark that as with so many things today the whole subject
revolves around money. Orthodox medicine receives billions of dollars to set up theories,
test them and report on the results. Almost no funds are available in the traditional
medicine so the research does not get done. It's vicious circle. No money, no research. No
research means there is naming it as such unscientific. And this led lagging behind to
such traditional medicine that is serving two third populations.
Usually government as well as NGOs reports is having reflection of merely achievements
as service provided through programs quantitatively. This is more likely as a view
looking from their side. In the same time there is always lacking of holistic picture of a
health system comprising of both qualitatively and quantitatively. Because we can not
ignore any practice of a community in the endeavor of assessing their health seeking
behaviour.
Therefore there is a place for qualitative study about Rajbanshis' health seeking
behaviour that explore their behaviours, perception, as well as suggestion that could
facilitate by providing information about their health service utilization process,
affordability, and satisfaction.
1.3. Rationale of the problem.
As we go through the community it is easier to rectify that there are certain group of
people having lower living standard, low social status as well as poor health status. Most
of the indigenous people are not interested for education may be due to their culture,
economy or low educational status or else. Being deprived in education they naturally lag
behind by socially, economically as well as in health status. HMG/MLD National
Committee for Development of Nationalities, Prospectus(2000) has noted, there are
more than 61 ethnic groups in the country. Subba (1999) feels that these ethnic people
have been marginalized since last 40 years so they are now deprived and far from access
of any facets of development. Bhattachan (2000) has advocated the need of social justice
for indigenous people; which are deprived and marginalized since unification of Nepal.
Due to the limitation of time shortage and given the inadequacy of available information
on this subject in country like Nepal, the proposed study is bound to be in a large measure
descriptive and exploratory. The A few tentative research questions have been formulated
so that the perspective while conducting the field enquiry is consistent. Even a casual
acquitance with the situation in Nepal will convince anyone that Health seeking
behaviour and users satisfactions from medication practices are more prevalent in modern
medicine then ethno or alternative medicine. But why so ? The affected people may
resort to them either because they have a complete faith or because they have no other
option. It may also be that the different medical systems are not competitive and are taken
recourse to under different situation. These medical systems may also have their own
target population. The factors of age, sex, level of education and income, religion, ethnic
affiliation, rural-urban background etc. may also be some of the determinants of health
service use and satisfactions.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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According to M.P. Shrestha (Lecture 14.8.2000) there are more than 76 Traditional
Health systems existing in Nepal. And Nepal Health Research Council has also set due
priorities for research in the field of traditional medicine. I think, efforts should be made
to recognize the practices of traditional medicine and modern medicine found in the
Rajbanshi community. With this study it is been expected to assess the impact of health
service provided by the government in the group of people.
Gartoulla (1998) has mentioned in his book an introduction to Medical Sociology and
Medical Anthropology; despite the health facilities provided by the government more
than 50% of health problems never reach the health services. They are treated through a
system of ethnomedicine and plural medications, which are based on home-remedies.
Other methods of unconventional treatment include commercial sales of over the counter
(OTC) drugs often combined with religious healing practices and culturally based
treatments, which are economically beneficial to the people. Medication differs in levels
of :- (1) The kind of providers, consumers, and the referral system; (2) Socio-economic
aspects of ethnomedicine and other alternative medications; and (3) The various methods
of medication.
Gartoulla has also given importance assessing Ethno-medicine and therapies as health
care practices due to following reasons. First, the progress of western medical education
is a recent phenomenon in third world. Secondly, institutional infrastructure for reaching
modern medical treatment for everyone is far from adequate. Thirdly, the spread of
general education itself is not yet satisfactory. Due to all these and others causes,
ethnomedication and other traditional healing practices have continued to be our
endeavor. UNICEF (1996) in Atlas of South Asian Children and Women outlines that the
formal government health system is primarily allopathic. There are as many practitioners
of Ayurvedic, Unani and Homeopathic medicine as practitioners of allopathic medicine.
These alternative medical systems are prevalent in the private sector, and are popular
among lower socio-economic groups.
“Needless to say, neither Rivers nor Clements nor any of their contemporaries engaged in
collecting data on primitive medical system had any idea that they were doing research
on health seeking behaviour and consumers satisfactions, but it is through such efforts
that health care practice owes its origin, and came to be defined as “those belief and
practices relating to disease which are the products of indigenous cultural development
and are not explicitly derived from the conceptual framework of modern medicine”.
(Foster,et,al 1978 and Gartoulla, 1998).
As our primate ancestors evolved into human from, the disease they brought with them,
and those acquired along the evolutionary ways, became social and cultural facts as well
as pathological stages. For human beings disease threatens not only the well being of
sufferers and their fellows, but also the integrity of the community. Illness and death are
disruptive events that impose high economic, social and psychological costs wherever
they occur. Quite apart from humanitarian reasons, therefore, it is of primary importance

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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to the members of every group to try to maintain their health and to restore health to
those who fall ill. (Gartoulla, 1998).
Every human community has responded to this challenge by developing a medical
system, i.e. the pattern of social institutions and cultural traditions that evolves from
deliberate behaviour to enhance health. Written sources tell us about the history of some
medical system. In addition to contemporary scientific medicine, we know much about
the origin and development of traditional Chinese medicine, Indian Ayurveda, Muslim
Unani and ancient Greek medicine and its modern descendants the humoral pathology of
Latin American and the Philippines. Other medical system of those people who until
recently have lacked a literature reveal little of their medical history. However, through
the studies of anthropologists and others such as missionaries and doctors, these
alternative medication practices have also been receiving some attention. (Gartoulla,
1998)
In recent years the field of public health has grown rapidly, but since this is a relatively
new field, a widely shared definition of the field itself, and agreement about the
boundaries is emerging slowly among the community health scientists. One definition is
that public health encompasses the study of medical phenomena as they are influenced by
social and cultural features and social and cultural phenomena as they relate to medical
practices. (Lieban, 1973) Also, public health enquiry elucidates the factors, mechanisms
and processes that play a role in or influence the way in which individuals and groups are
affected by these problems with an emphasis on pattern of behaviour. (Fabrega, 1972) In
any case, what is of prime importance is the fact that a greater understanding of
behaviour relating tto health and diseases and enables one to effectively intervene in
social welfare measures. (Gartoulla, 1998)
Self-medication comprises of Shaman/Dhami/Jhakri, Herbal/ root/ plant etc., drug
retailers, grocery, kit bag, neighbour, following old medicine and prescriptions etc.
Likewise, an Alternative medication consists of Ayurvedic and Homeopathic medication
along with traditional practices as explained in self-medications. Popular medicines are
both self medication and alternative medications. The reason, why they used to go to
health facility and what was the outcome as satisfaction; is one of the essences of this
study. In Nepal a modern medical system is not yet widely prevalent. In modern
medicine, as it has developed, over the past three, four centuries in the west, it is assumed
that medicine will be administered by qualified and authorized medical practitioners. It is
true that the medicine-man formed a distinct category in the most of the primitive
civilizations but the requirement of patient being treated by a duly qualified doctor has
become a characteristic of modern society. (Gartoulla, 1998). Partly because of historical
reasons and partly due to various socio-cultural and economic reasons the situation is to a
large extent otherwise in Nepal. Despite the growth of modern medical facilities in the
resent past the people do not always report to a duly qualified doctor, but rather they seek
medical advice privately and not from the government run hospitals and
/PHCsHPs/SHPs. Researcher has also collected their perception of health services,
service providers and their suggestion and expectation as well.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
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Chapter- II
Literature Review.
2.1 Global Situation.
Studies on health seeking behaviour, self-care practices have been done by various
organization and scholars. But all such studies does not describe and explain this issue in
all its social aspects as a whole. For obvious reasons, every study has partial focus on
specific areas and topics. Nevertheless, many of them are useful and hence, have been
drawn upon for their methodology and contents.
Researcher has been reviewed on disease prevalence and health-seeking behaviour
related literatures. The literature has used both primary and secondary sources such as
articles, journals, magazines, abstracts, leaflets and books. Researcher finds some studies
done about disease prevalence and health seeking behavior in particular district and group
of people. But nothing literatures found about Rajbanshi community on disease
prevalence and health seeking behavior.
Bastola (1999), cited from Gartoulla R.P.; in his thesis paper has stated as among the
occasional studies that make references to the cultural and behavioral aspects of health
care practices and medications by the local people, more appear to have been done in
USA, or Europe or in Africa (Sjask, 1982). The kinds of drugs used and geographic
distribution of primary health care in Guatemala and Belgium (Saldon, 1981), the
medicalization of of social life through self medication in el. Salvador (Anne, 1981),
study of injectionists and quacks in Thailand (Lark, 1970), the system and practice of
traditional medicine in Africa and Asia (Bonnerman, 1983), Chinese Accupuncture
(ATCM, 1975), Hypnotism practices in Africa and South Asia including India (Sorbin,
1972), Socio-economic factors effecting the psycho-therapy and Alternative medications
in South Asia (Nicther, 1978), and utilization of self-care and cost patterns of refferal in
rural areas in India and Nepal (Parker, 1979) are some of the relevant and helpful
reference that have helped us to formulate the problem for the purpose of the present
study.
Chaturvedi,et.al explain the health seeking behaviours and users satisfaction from
services of the people of south Asian people in the UK experience greater delays than
Europeans in obtaining appropriate specialist management, but the causes are not known
(Chaturvedi,et.al, 1997) In the Health behaviour ethnology, Kilonzo,et.al describe as
human plague has been an important public health problem in Tanzania for over century.
Efforts to cures the disease through conventional methods have been applied every year
but plague cases and death continue to occur in area. (Kilonzo,et.al,1997). This means
patients /users satisfaction would not be satisfactory due to the presence of problem/
diseases.
Other studies have done by different scholars explain that the cost of treating the disease
in the country has not been documented in Ghana (applies to Nepal too). Knowledge
about the cost of treating malaria can affect the health care seeking behaviour of people

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
8
and justify increased expenditure for malaria (disease/problem) control.
(Aseno,et.al,1997). One of the health education messages given in sexually transmitted
disease (STD) control is patient’s adopting appropriate health seeking behaviours. This
includes reporting to health facilities for appropriate diagnosis and treatment. Of the total
74.5% admitted to self medication before reporting to the clinics for STDs (Adu,1997).
Health seeking strategies and sexual health among female sex workers in urban India
indicate that women’s understanding of (sexual) health, treatment-seeking and service
utilization are shown to be generally (biomedically) appropriate, but subsequent “non-
complaint” therapeutic practices give cause for concern. Operational research and policy
formulation on the provision of effective health services (Evans,1997) suggested.
Explanations for illness used by Ciskeian villagers (South Africa) to account for
conditions ranging from diarrhoea and tuberculosis to anxiety and hypertension (Segar,
1997) suggest the patients satisfactions from the treatment is inadequate. A study in
Philippines by Buston in January 1992 shows that malarial cases was substantial under
reporting and there was strain specific immunity establishing the incidence (Bustos,
1997) lead users towards chronic problem and while contacting to healers made more
critical and doctors treatment took long time which made them unsatisfactory for them
due to their own causes but blame to providers services.
Modern medication practices (Allopathy) is scientific because of enormous research
accomplished, so, it has got predominant role in the health system of country. Contrary to
this, Self-medication is an often chosen practice in Nepal. Gartoulla (1998) has stated as
self medication consists of drug shops and various types of practitioners of traditional
medicine (Ayurvedic, Chinese, and Homeopathic etc.). Also included in this category are
spiritual practitioner such as shamanism, priests, dhami/ jhakri, and astrologers. People
also have the option of using herbal medicine (roots, grasses, plants etc.) which they can
either collect themselves in the forests or purchase from practitioners or shops.
Haak, H. and Hardon, A.P. in their study have shown the indigenous medical concepts
are being applied to western pharmaceuticals. They found that the integration of western
pharmaceuticals into the local culture is achieved in various ways:
Traditional concepts of efficacy are used to describe their effects; Western
pharmaceuticals are sold alongside other daily requirements in small neighbourhood
shops; Pharmaceuticcals are used in a culture-specific way: and Pharmaceuticals receive
local names and conversely, give their names to traditional medicines. All too often
programs for rational drug use focus on health care providers, on the assumption that
their education will lead to a more rational drug use. Prescription only drugs, however,
are used widely in self-medication, the practices are culture-specific and cannot be
ignored.
Herxheimer,A. and stimson, G.V. have argued that people assign meaning to medicines
and that these meaning differ between groups and within the between cultures. People’s
medication practices and beliefs are discussed extensively. It is concluded that most

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
9
treatments of every day illness are not obtained from a doctor. Self-treatment is a norm.
(Herxheimer,et.al 1983).
Tan, M.L. raised questions about the validity of labels such as ‘western’ ‘alternative’ and
‘traditional’ as applied to medical systems. Pluralism in diagnostic and therapeutic
procedures must be recognized even within one system. A review of socio-historical
factors that influence medical systems highlights important processes such as cultural
reinterpretation and indigenization that characterize ‘traditional’ medical system (Tan,
1989), Overgaard, L.B. and Holme, H.E. (1985) have analyzed medicine behaviour seen
from user’s point of view.
Conrad, P. (1985) has also presented a paper with an alternative patient-centered
approach to managing medications. The study focuses on the meaning of medication in
people’s everyday life and looks at why people take or do not take their medication.
Blum, R. and Kretman, K.(1983) described the factors that affect the habits of medicine
users. They show how medication varies with the symptoms of the patients, their sex and
also their lack of knowledge of the current use of medicines. Foster, G.M. (1984)
suggests that modern medicine in recent years has become the first choice for most
traditional peoples most of time. With respect to the use of traditional curers in primary
health care, it is pointed out that: they are not replacing themselves; they may have
become ‘neotraditional curers’ making extensive use of modern drugs; and
Spiritualist curing is replacing much traditional medicine.
Geest, S. Van der, et.al.(1990) are of the view that public health field does not suggest
that programmes for ‘rational drug use’ can be easily implemented. The commercial
context of medicines and the new meanings they acquire in local settings give rise to very
complex situations.
The study by Ashraf, A.,et.al. (1983) disease and health care in rural Bangladesh sought
to find out how the fields of traditional, folk and allopathic medicine were related to each
other and what processes could be discerned in these interrelationships. The outcome was
that traditional medicine has almost disappeared in this area.
Batia, J.C. et.al.(1957) studied 93 traditional healers in three states of India showing that
they are increasingly using modern/ allopathic medicines in their practices.
Self-medication: WSMI (2001) says "Self-medication is the use of specifically designed,
labelled and authorized medicines available legally without prescription for the treatment
or prevention of common illnesses, which can be recognized by the people. Traditional
medicine frequently is not included in the national health system. If traditional medicines
are legally available without a doctor's prescription, then they are included in what we
call self-medication. Self medication as perceived by different scholars in the past is as
follows

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
10
The active medicine user fall under self-medication. (Overgaard,1985)
Parker defines self-care as culture, medicine and psychology of people. (Parker, 1979)
The illegal distribution and use of western medicine is self-care. (Sjaak,1982)
Lay diagnosis and practice of any medications and popular healing practices is self-
medication. (Chaturvedi, 1997)
Any object used for illness is self-medication. (Herxheimer, 1983)
Self-medication is indigenised pharmaceuticals in developing country. (Haak,et al, 1988)
Self-medications is that medications which are applied by users either contacting to
providers or self except the present prescriptio of a duly qualified medical practitioners
(Gartoulla, Ferguson, Geeest, et.al)
Traditional and transitional medicine system is the component of self-medication. (Tan,
1989)
Popular medicines are those which are used as polypharmacy, ethnomedicines, herbal
and amulet objects, animal objects selected either by users or given by sellers/ providers.
Ethnomedicine is that the herbs and herbals used by local people collected from local
yards and have shamanistic usage.
Traditional medicine includes both ethnomedicines, shamanism, priesthood and
worshiping together.
Commercial pharmaceuticals medicine used by self either buying directly or by provided
by untrained retailers is also called self-medication. (Ferguson,1981, Ashrof,et.al)
Individual use of medicine is self-medication. (Blum, 1983)
The overwhelming belief and practice of herbal plants as medicines and use of allopathic
medication by kit box (bag) is self-medication. (Bennerman, 1983)
WSMI (2001) has pointed out that Alternative medicine is medicine which is outside the
regular allopathic medicine. Similarly Alternative medication as perceived in the past:
Mabuhang (2000) wrote an article entitled Policy approaches to indigenous people's
health issues where he has mentioned a lot about Indiginous people especially the relative
situation with reference to different conference, declaration and global data as well. It is
now almost three decades before for the first time, when population was considered as an
integral part of socioeconomic problem, the Bucharest Conference, 1974 has said:
It is recommended that health and nutrition programs designed to reduce morbidity and
mortality be integrated within a comprehensive development strategy and supplemented
by a wide range of mutually supporting social policy measures, special attention should
Alternative medicines are defined by the health seeking behaviour. Those medicines used
by the users at second time than the first time.
Self-medications, popular medications, ethnomedicine or traditional and or alternative
medicines have been used in different situations.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
11
be given to the formulation of policies to widen their coverage so as to reach, in
particular, rural, remote and underprivileged groups.
Mexico Conference on Population and Development (1984), cited from
Mabuhang(2000), also gave guidelines for government as:
Government should, as a matter of urgency, make universally available information,
education and the means to assist couples and individuals to achieve their desired
number of children...Particular attention should be given to those segments of the
population which are most vulnerable and difficult to reach (UN, 1995).
Bucharest conference highlighted the increase attention should be paid to relative
importance of various socioeconomic and environmental factors in determining mortality
differentials by region or socioeconomic and ethnic groups. Later Mexico Conference
(1984) recommended that "Government should ensure the rights of indigenous and other
groups."
Under its plan of action, after twenty years of efforts made in population and
development, the International conference on population and development 1994, cited
from Mabuhang (2000) has said:
Indigenous people have a distinct and important perspective on population and
development relationships, frequently quite different from those of the populations with
which they interrelate within national boundaries. (UN 1994)
In May 1994, the forty-seventh World Health Assembly adopted resolution WHA 47.27,
in which it called upon the Director General, inter-alia, to increase cooperation between
the World Health Organization (WHO) and other United Nations Organizations to help
meet the health needs of indigenous people, provide member states with technical
support, to assist governments and IPs in addressing health needs in culturally effective
manner, to consider the contribution WHO might make to promoting respect for, and
maintenance of, indigenous knowledge and to ensure that relevant research projects
undertaken by WHO and other United Nations Organizations were conducted in
consultation with, and for the benefit of indigenous people and communities( Daes,1996;
cited from Mabuhang (2000).
The world women's conference -1995 held in Beijing uncover," the major barrier for
women to the achievement of the highest attainable standard of health is inequality, both
between man and women and among women in different geographical regions, social
classes and indigenous and ethnic groups" Mabuhang (2000).
The World Summit for Social Development was held in Copenhagen on March 6 to 12,
1995. The largest gathering yet of world leaders - 117 Head of States or Governments
came together to talk about global responsibilities for the eradication of poverty and
unemployment and fostering of social integration. In the final declaration among others,
among others, direct reference to IPs health is found commitment 6(g) (cited from
Mabuhang (2000):

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
12
Recognize and support the right of indigenous people to education in manner that is
responsive to their specific need, aspirations and cultures, and ensures their full access
to health care.
International Consultation on Health of Indigenous Peoples, held in Geneva from 23-26
November 1999, organized by the World Health Organization. In the part 1, declaration
focuses the rights and interests of world's IPs. Declaration affirmed "the right to the
highest attainable physical, mental, social, cultural and spiritual health and survival,
commensurate with Indigenous Peoples' definition of health and well being." It was
called on the WHO to make a substantial contribution in the context of the International
Decade of Indigenous People (1994 to 2004) (cited from Mabuhang (2000).
The second part of Geneva declaration says: "IP's concept of health and survival is both a
collective and individual intergenerational continuum encompassing a holistic
perspective incorporating four distinct shared dimensions of life. These dimensions are
the spiritual, the intellectual, Physical and emotional. Linking these four fundamental
dimensions, health and survival manifests itself on multiple levels where past, present,
and future co-exist simultaneously. For indigenous peoples, health and survival is a
dynamic equilibrium, encompassing interaction with life processes and the natural law
that govern the planet, all life forms, and spiritual understanding. Expressions of culture
relevant to the health and survival of indigenous peoples includes, but is not limited to
individual and collective relationships, family and kinship systems, social institutions,
traditional justice, music, dances, ceremonies, rituals performance and practices, games,
sports, language, narratives, mythology, stories, names, land, sea and air and their
resources, designs, writings, visual compositions, permanently documented aspects and
form of indigenous culture including scientific and ethnographic research reports, papers
and books, photographs, digital images , films and sound recordings, burial and sacred
sites, human genetic material, ancestral remains, and artifacts (cited from
Mabuhang(2000).
Kleinman (1984) has noted that the individual, family and community assume a vital
responsibility for health promotion as well as for the curative care of its members. In
many society as much as 70-90% of all curative activities may take place within this
network. Several studies, carried out in western and non-western societies, support this
statement (cited from Mabuhang (2000). Global situation in changes in the rank order of
diseases is also of great concern. CHD for instance considered rare before two decades
has now become common in urban Nepal. Word Bank has assessed the global situation in
this changing pattern issue of disease prevalence. (Annex - III)

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
13
IPs Health Indicators in Comparison of Non-IPs by different Regions of the world.
Region Rate of Disease Mortality Rate IMR LE
Arctic, Rate of disease prevalence Death Rate is 10.4/1000 IMR is 48 to 53 IPs 54 yrs.
Russia. 50% higher among IPs than among IPs against per 1000 among NIPs 65
yrs.
NIPS. Meanwhile psychological 6.6/1000 among NIPS. IPs against low
disorders were 2.5 times high level among NIPS.
among IPS.
Alaska. Pneumonia among native people
Prevalent 60 times more than
US population.
Australia. During 1979-91, aboriginal areas IPs:
have the higher rate of diseases, IMR has declined for M-54
yrs.
Infection and parasites(22 times), IPs but it is still over F-61
yrs.
Cancer of Cervix 12 times, 3 times higher than NIPs.
diebetes17 times in females. National average. M-72.8
yrs.
RIT(12 times for female),Genito- F-79
yrs.
urinary system(17 times) and
Homicide(15 times for female
Bolivia. among the IPs children live birth
about 20% die before attending
their first birthday.
Canada. By the age of 19 yr. 63% of IMR is 28/1000 IPs-
66yr.
Indians and Inuit smoke against which are 3 times NIPS-
71 yr.
43% for NIPs,Cancer is increasing
in IPs
India. About 63% of villages in the A total of 3,821 Korku
state were declared malaria IPs children <6 died in
affected in Manipur. the past 4 years from
Starvation/malnutrition
Mexico. About 12% of IPs children die
before reaching school age
against 4.8% of general population.
Panama. The highest MMR was
reported in the Kuna
community of San Blas.
Source: WHO,1999. Note: LE= Life Expectancy. M=male, F=female, IPs= Indigenous Peoples, Non-
IPs = non-indigenous peoples, IMR= Infant Mortality Rate, MMR= Maternal Mortality Rate.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
14
Indigenous Peoples:
World Bank (1991) proposed the following definition of IPs:
"A close attachment to ancestral territories and to the natural in these areas; self-
identification and identification by others as a member of a distinct cultural groups; an
indigenous language, often different from the national language; presence of customary
social and political institutions; and primarily subsistence oriented production."
ILO's convention 169(ILO,1996) says, cited from Mabuhang (2000):
" Peoples in independent countries are regarded as indigenous people on account of the
descent of the population who inhibited the country, or geographical region to which the
country belonged at the time of conquest or colonization or the establishment of present
state boundries".
Health Seeking Behaviour : WHO defines Health as a state of complete physical, mental
and social as well as spiritual well being not merely the absence of disease and infirmity.
Oxford Learner’s dictionary defines Seeking means having, doing, looking etc. and
Behaviour means habit, performance, culturally and socially motivated activities. Health
Seeking Behaviour is an usual habit of a people or a community that is resulted by the
interaction and balance between health needs, health resources, socio-economic, cultural
as well as political and national/ international contextual factors. Health Seeking
Behaviour in this study as assessing the habits of Rajbanshi in the use of modern, self and
alternative medications. It also explores the causes, cost and satisfaction of treatment and
practice.
Modern Medicine: Allopathic medicine prescribed by duly qualified medical practitioner.
Second contact as an alternative usually found after self medication.
Alternative medicine: as indicating Ayurvedic and Homeopathic medication only.
Self-medication: Kafle and Gartaula (1993) and Gartaula (1998) have categorized self
medication as Shamanism, Priest, Dhami-Jhakri, herbal, drug retailers, grocery, kit-bag,
drug peddler, neighbour, following old medicine prescriptions etc and except the present
prescription by a qualified medical practitioner. Worship of god as well as go to the
traditional healers are accepted practices, while getting sickness are commonly. Anybody
readily do this practice herself or himself even before start any treatment. So, Self
medication has comprise of Herbal, Drug retailer, Grocery, Kit bag, Drug peddler,
neighbor, and following old medicine and prescription and traditional healers as well in
the study.
2.2 Studies related to health seeking behaviour in Nepal.
According to Dixit (1999), the reality is that the expansion of the health has not occurred,
neither in the government nor the private sector to the extent that is even required for the
increase of the population. Onta (2000) feels, commitment of the government towards
assuring health of people can be largely assessed through analysis of the national public
policies of the country. To ensure that every citizen has equal opportunity of access to

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
15
health services and no one is left out and marginalized, the health system should be
guided by the spirit of social justice and equity.
In Nepalese belief, illness is often associated with spirit possession therefore the
appropriate healer is the faith healer. Blustain (1976) suggests that if health care in Nepal
is to be improved one must that the villagers faith in their own healing techniques be they
herbal or ritual is not going to be shaken by the occasional visits of medical teams or
even by the building of hospitals. Chalker et al (n.d.) also suggests, in the countries like
Nepal, Government should be concerned with traditional health care and professional
traditional practitioners and are drawn into partnership with the government health
delivery system, in order to provide basic health care to rural people.
Poudel et al (1998) has undertaken a study conducted in Kavre district. It was found that
100% of the sample respondents have ever been to a traditional healer for any kind of
treatment during their lifetime. Among them 75% used healer during last six months for
their last sickness. Whereas 91.6% respondents have first report to healer even though
healing practice of healer did not satisfy majority (61.66%). Mostly the healer used
multiple healing practices like blowing with wisdom (95%), worship (37.5%), Egg
sacrifice (15.83%) etc. Whereas animal sacrifice was rarely practiced (10.83%) and found
no other harmful healing practices was there. Majority of respondents (65.84%) provided
in their home like alcohol, meal, cigarette, cereals etc. as a treatment charge. The
respondents used healer because of their strong cultural belief and long term
relationships.
They have find in their study conducted in Kavre district of Nepal that there are
significant relationship between educational level of respondents and utilization of healer,
economic status of the family and the utilization of the healer. Whereas there are no
relationship between utilization of healer with other variables like distance of health
institutions, types of family and age of the decision makers on health seeking behavior in
the family.
Various studies have been done in the field of health seeking practices and health status
covering both the modern and traditional system of medical care. But a few major studies
that have kept in view while conducting the present one are described below on the basis
of their focus and coverage.
Jaustice, Judithene had done a study in 1981 on health planning in Nepal. She discussed
the system and structure of health administration in the past as also the contemporary
period. K. K. Kafle has examined the current situation regarding training for health
workers at various levels in the presentation of drugs. Important criteria for rational use
of drugs are:
National drug policies based on the essential drugs concept, accurate information to
health care professionals and effective national system for excluding needlessly
expensive and harmful drugs. Problems and constraints include lack of adequate drug

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
16
information, inadequate drug supply and non-utilization of services. Recommendations
are made as to how the situation could be improved (Kafle, 1987).
The performance of health workers in Primary health care in Nepal, (IOM, 1985) the five
year (1974-79) experience of a community health program in Lalitpur (Kathmandu
valley) to train local indigenous midwives, (Mugedal, 1979) an account of basic health
care work done from 1979-82 in Dolakha district of Nepal as a part of IHDP (Aehard,
1983) may be mentioned in this connection. Poverty , unhealthy living conditions and
malnutrition, the later particularly among women and children as a contributory to poor
health and the evolution of Nepalese primary health care (PHC) system has been
described by Mathema (1987). The purpose of the study the study in Sindhupalchok of
Nepal was to document the nature of available indigenous and modern nutrition and
public health services in rural communities (Shrestha, 1986). Over the last decade many
developing nations have embraced primary health care (PHC) within their national health
plans. Linda stone in her study has emphasized community participation on the one had
and the actual approach taken on the other (stpme, 1986). In the last two decades, the
great expansion of primary health care in rural areas of developing countries has not been
matched by significant improvements in health standards and Nepal is no exception
(Oswald, 1983).
A study in alternative medications indicates various forms of health seeking behaviours
of the consumers in the communities of Nepal (Gartoulla, 1998). Ethnomedicine are the
primary concern of medications in Nepal (Gartoulla, 1998). Essential drugs utilization in
TU teaching hospital indicates most of the drugs in antibacterial group were from
essential drug list (Kafle,et.al 1988) which reduced the cost for people. Laboratory use
for urine examination brought another report to support patients satisfactions in Nepal
(Tuladhar,et.al,1987). The unpublished report of child survival pharmaceuticals in Nepal
indirectly explains patients satisfactions and behaviours (MSH, DMP, New Era, DDA,
BNMT, IOM, 1988). Medical services stands for clinical contraceptives and VSC in
Nepal (Bhatta,1990) explains patients satisfaction; Drug funding schemes in Nepal shows
13% of the population attended a health post or hospital each year (Chaler,1997) which
means health seeking institutions in the hospital/ HP is poor. Quality control of
pharmaceuticals and medicines in Nepal has about 350 samples to analyze (Karkee,1994)
indicates poor services. Self medication and its impact on essential health drugs schemes
in Nepal indicates more than 50% people contact /practice self medication Gartoulla,1992
Kafle et.al,1993). Drug prescribing in-out patient in Teaching hospital explains vitamins
and minerals were prescribed in more than 20% of cases (Kafle,et.al,1991) means
patients have a financial burden and the long term consequence is almost
dissatisfactions. Almost any drug may give rise to problems of used improperly, but there
are certain drugs which are especially problematic (Joshi,et.al, 1991). Physician’s
practice pattern; private safer indicates the fact that generic prescribing in the private
sector is almost non existent (Ghimire, 1992) in Nepal. Average number of drugs
prescribed per patient was 8.1 (Joshi,et.al, 1992) means burden financially affecting
patients satisfactions negatively in Nepal.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
17
Thus, many literature and studies indicate the importance of the explorations on health
seeking behaviour and consumer’s satisfaction from service providers. They are
searching options which is less expensive, adjustable, faith and affordable. This study
assesses what types of medication are being used by consumers and what about the
satisfactions.
Chapter-III
3. Methodology.
Methodology Framework
3.1. Educational basis: Rajbanshi both literate and illiterate were selected and assessed
whether or not they were getting satisfaction from Traditional medication or Modern
medication. Researcher has assessed the reason for choosing health services, treatment
cost and trend.
Rajbanshi.
Literate Illiterate
Cause
Cause
Traditional M. Modern M.
Traditional M. Modern M. (cost & Trend) (cost & Trend)
(Cost & Trend) (Cost & Trend)
Satisfied Dissatisfied
Satisfied Dissatisfied (cured) (uncured)
(Cured) (Uncured)
Satisfied Dissatisfied
(Cured) (Uncured) Satisfied Dissatisfied
(Cured) (Uncured)
Effect (Causality of Health care outcome).
The above chart indicates the possible factors associated with medication pattern as well
as local healing practices. The possible indicators for both literate and illiterate are:
cause, cost and trend, cured/uncured satisfactions/dissatisfactions from traditional and
modern medications. This provides the entire process of why they choose the specific
system or practices.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
18
3.2. Economic Basis: To assess the sickness, affordability, satisfaction on the basis of
economic status is essential. So, researcher has done study on this issue. It was assessed
the treatment cost, and what they do people those who are unable to afford.
Rajbanshi
Economical basis.
Low level Medium Level High level
Cause Cause
Traditional Modern
Medicine Medicine
Traditional Modern
Medicine Medicine
Cause
Traditional Modern
Medicine Medicine
S D
S D
Satisfied Dissatisfied S D
Satisfied Dissatisfied
(Cured) (Uncured) (Cured) (Uncured)
Satisfied Dissatisfied
(Cured) (Uncured)
Note: Economic status: 0-1Bigahs=Low,1.1-4 Bigahs = Medium,4.1above=High Level
Animal husbandry, types of houses, family size are other elements to select economic
status.
The above chart indicates one of the major factors determining health, i.e., and economic
base. The indicator for determining the health on it- the economic level on which decides
to medicate locally that might be traditional or modern one.
S = Satisfied, D = Dissatisfied.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
19
3.3. Distance of Health Institution: It is a researcher's concern what is the role of distance
for choosing health facility. So, it was also assessed as a determinant of choosing health
facility.
Rajbanshi
Distance of Health Institution.
Less than 30 mins. More than 30 mins.
Cause Cause
Traditional Modern Traditional Modern
Medicine Medicine Medicine Medicine
Satisfied Dissatisfied
(Cured) (Uncured)
Satisfied Dissatisfied
(Cured) (Uncured) Satisfied Dissatisfied
(Cured) (Uncured)
Satisfied Dissatisfied.
(Cured) (Uncured)
Note: Both modern health institution and traditional all sorts institutions/persons.
The indicators shown above for determining home treatment is long distance to reach
government health institution which are categorized as <30 and >30 minutes of walking/
bus transport. And due to the distance for medication they choose (either traditional or
modern) the level of their satisfaction from treatment has been seen and also cured and
uncured. Thus, distance is a major component of home treatment.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
20
3.2 Variables.
For this study, the dependent variable is Health Seeking Behaviour and or self-
medication, and or alternative and or popular medications in community level. The
independents are local resources, socio-economic-cultural factors and distance.
Variables
Dependent. Independent.
Health seeking Behavior 1.Socio-Cultural Factor.
(Modern medicines and or 2.Economic Factor.
Self-medication and or 3.Educational Factor.
Alternative medication). 4.Health practices and facility.
5.Distance of Modern H.Facility
6. Local resources.
For the above indicators it was observed that the dependent variables were determined by
the independent variables. Self-medication was done due to their long-term relationship
(cultural relationship), with local providers, low cost, easy to meet, healers come to user's
house, walking distance, socially accepted and culturally sanctioned.
3.3. Operational Definitions of Variables.
Health Seeking Behaviour: It is the treatment seeking behaviour of Rajbanshi community
for the latest illness as reported by them. This will be categorized as (a) Modern
medication as Hospital, HP/SHP and private clinic (b) Allternative medication such as
Ayurvedic, Homeopathic and Unani system of medication; and (c) Self-medication such
as Dhami/Jhakri (Shaman healers), drug retailers, grocery keepers, drug peddlers,
household medicine and other than modern and alternative medication.
Dhami/Jhakri =Shaman who exorcise evil spirits from the bodies of sick people and they
use drum and sticks in their nightlong healing rituals.
Education:
Uneducated = Illiterate and literate below SLC.
Educated = as SLC, IA, BA and above.
Economic status:
Possession of land as reported by the respondents which was categorized as:
0-2 Bigahas=Low, 2.1- 4 Bigahs = Medium, 4.1 Bigaha above=High Level.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
21
3.4 Conceptual Framework. (For qualitative analysis).
The determining factor of health seeking behaviors has been conceptualized as above.
Health seeking behavior is closely related with traditional medicine, Shamanism,
religious act, self-medication etc. These are also influenced by tradition, family pattern,
cultural appropriateness, faith, low-cost, inter-personal relationship, curedness, advice
from siblings/relatives, availability, personal chosen etc. Availability and access of
modern medication facilities such as SHP/HP, Hospitals, and private clinics determine
the health seeking behaviour of a community.
Traditional
Med./ herbs
Shama
nism.
Religious Act
Se
lf
m
ed
ica
tio
Health
Seeking
Behavior
HP
Dist
Hosp.
Central
Hos
p
.
Tradition
Low
cost
Cured
ness
Advice
IP -Relation
Zonal/ Reg
hospitals
Cultural
appropriate
Faith
Family
pattern
Personal
chosen
Health
Seeking
Behavior
Traditional
Med.
Shama
nism
Religious Act.
Self-
Me
d
SHP
Availa
bility
Pvt.
Clinic
District Hospitals
Central Hospitals

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
22
3.5 Research Questions.
1. What are the practices as well as cause in seeking traditional and modern health cares?
2. Whether they are of satisfied or not with their medications and behaviors?
3. What is the cost for curing an illness or disease or cost borne for their medications?
3.6 Limitations:
1. Availability of sufficient medical facilities in Biratnagar which are nearby of
these VDCs has played a bias role in the study.
2. Only past three months history has been taken during filling the questionnaire. So,
it may produce variation in morbidity data and be unable to represent morbidity of
a complete whole year.
3. Since, only two VDCs - Katahari and Baijanathpur which are situated nearby
Biratnagar; were subjected as a sample; may not represent the picture of whole
Rajbanshi.
4. It may represent the cross-sectional picture of only Katahari and Baijanathpur
VDCs of Morang district.
3.7 Objectives.
General Objectives:
To assess the health seeking behaviors in Rajbanshi community.
Specific Objectives:
To find out the practices of using traditional and modern medicine in the community.
To assess the satisfaction and dissatisfaction with traditional medicine and modern
medicine or health services available at the community.
To assess the expenses for their health expenditure.
To know various methods of self- care and types of therapy used by consumers.
3.8. Study Design.
This was an exploratory, descriptive and cross-sectional study based on household survey
the quantitative analysis and Focus Group Discussion (FGD) and observation for
qualitative information. This study has assessed the healing and caring practices under
health-seeking behavior of Rajbanshi community.
3.8.1 Study Area.
This study was conducted in two different Villages, Katahari and Baijanathpur of Morang
district, selecting purposively based on thick settlement. Morang is a district having 49
Sub-Health Post, 11 Health Post, 7 PHC, One district level Rangeli Hospital and regional
level Koshi zonal Hospital. These two VDCs are located nearby the Koshi zonal Hospital
Biratnagar.
3.8.2 Study Population.
Both male and female were taken as study population. Those who have ill/ sick/ disease
or medication within three months were the study population and mostly the head of

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
23
household was the respondent for quantitative and mostly users were for FGD for its
quantitative information.
3.8.3 Sample Size.
According to a study conducted in Kavre district it was found, more then 90% people are
using traditional medicine. So, we have, p=90, q=10.
Required Sample size (n)= 4pq / L2
If, L = 5 % of p. = 90 X 5/100 = 4.5
n = 4pq / L2 = 4 X 90 X 10/4.5 2 = 3600/20.25 = 175.
Total
Sampling
175 households of two VDCs were selected from the VDCs rosters using random number
table for convenience and to cover the expected households.
3.8.4 Process:
1. The households were visited on the basis of random number table. They were asked
relevant questions with the history of illness/disease within three months from interview
date. Of those who were ill/sick person of the above criteria, only demography was taken.
And the case was only consulted for detailed information.
2. Roster analysis of VDC, DDC.
3. Secondary Sources.
4. Instruments.
5. Consent-Verbal
6. Interview.
7. Focus Group Discussion. The participants for FGD were requested to have one and
half an hour’s sessions for the reason of their self-medication during household visits.
Personal contacts with self medicated population within three months of study period
were made to have 8 persons one FGD and total ten FGD with 80 persons.
3.8.5 Instrumentation.
Development of Tools.
Structured and in-depth questionnaire was prepared to interview the people having
disease or not. So, the interview would explore their health-seeking behavior.
1. Individual Interview.(With schedule i.e. questionnaire to be applied for provider, user
or respondents)
2. Observation of medicines if any.
3. Focus Group Discussion guidelines.
Nepal
Rajbanshi
82,177
(1991, CBS)
Morang.
Rajbanshi 175
Samples

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
24
3.8.6 Data collection procedure.
At first there was a visit to DDC, DPHO and VDC to have a meeting for discussion about
its relevance and its importance of study. It was expected to have permission from
concerning authorities as well as attempted to ensure their necessary help.
3.8.7 Ethical Consideration.
The purpose of this study was to give first preference to the respondent at the time of
interview. Data was collected with verbal consent not forcefully. There was taken care of
full confidentiality.
3.8.8 Data generation, data storage and data safety procedure.
At the end of the day it was ensured completeness and accuracy of filled questionnaire.
All information belonging to respondents are kept confidential.
The result will be used only for the purpose stated in study.
3. No information will be published which will break the anonymity of the respondents.
3.8.9 Data Processing.
First, all data collected was coded as required then all data collected was entered into a
computer for data processing. After this, analysis was carried out with the software EPI-
Info-6 in the compute to get result or outcome. The information of Focus group
discussion were transcribed and generalized manually.
3.8.10 Analysis.
Basically this study was done on quantitative and descriptive methods; qualitative
methods were used manually while analyzing the data. The main focus for quantitative
was given on frequency, mean and percentile. These all was calculated by using above
mentioned computer or EPI-Info-6 software to see related significance test. For this it
was used chi-square test in computer.
3.8.11 Interpretation.
All the data was tabulated with various types of singular or cross tabulation. Charts and
tables are being used to analyze the data and to summarize the data.
3.8.12 Discussion.
After accompanying the analysis and interpretation of data the discussion was held based
on objectives and indictors. Regular consultations with guide were made.
3.8.13 Write-up.
Discovery draft was prepared first and Investigator revised this. Then this report was
submitted to supervisor and other experts for necessary guidance and revision. For the
second time it is again be revised and corrected then submitted to supervisor. Now this
report will be finalized and documented as a thesis report. The final report has
documented as a thesis report and has submitted to research committee.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
25
3.9. Relevancy and Applicability:
This study has measured the level of use of modern, self and alternative medicine as well
as status of literacy, economic condition, and distance of health facility. It has assessed
the level of satisfaction with their traditional healers and health facilities in the
community. As stated in the introduction, statement of problem, conceptual framework
and rationale of study it is now almost been clear that the identification, assessment, and
description of health status, health practices of a Indigenous people (i.e.Rajbanshi) would
be a substantial as well as potential outcome for the community self and for other
relevant authorities. District authorities, concerning government authorities or
NGO/INGO could take benefit from result of the study. In the context of implementation
of decentralization, bottom up planning process, the behavioral picture of a particular
ethnic group could provide some picture for planning process. Therefore this study is a
dedication for Rajbanshi ethnic group. So, this study has a potential that can supplement
for the assessment of overall health system of the country.
3.10 Validity and Reliability of the Tools.
- Validity and Reliability were maintained by pretest and necessary modification.
- Consultation was done with supervisors/guide/subject experts.
- Other concerned persons were requested to read the questionnaire and give feedback.
- Fieldwork was done by researcher self.
- Data were gathered promptly after collecting from field.
- Scientific tools were applied.
- Feedback from workshop will be honored.
- Respondents were mostly head of the households with the age group of 20-65 yrs.
- Eight persons in one Focus group discussion were collected according to the WHO
FGD manuals.
Chapter-IV
4.1 Findings and Presentation of data.
4.1.1 Economic Condition.
Most of the people were occupied in agriculture sector. And rest involved in working as
labour, business, service and dependent.
Table No.1: Occupation.
Occupation Number Percentage
Agriculture 91 52.0
Business 11 6.2
Service 14 8.0
Labour 42 24.0
Dependent 17 9.7
Total 175 100.0
Table 1 presents people how involved in different occupation. The figure shows that out
of 175 respondents; 52.0% people ( 91) was engaged in agriculture followed by 24.0%
(42) labour, 9.7% (17) dependent, 8.0% (14) service and 6.2% (11) business.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
26
Table 2: Land.
The information on land of the respondents had taken to know their economic status.
Economic Status Number Percentage.
0-2 Bigahas (Poor) 107 61.1
2.1-4 Bigahas (Medium) 22 12.5
4.1- above (Rich) 46 26.2
Total 175 100.0
Table 2 presents the economic status of people in terms of having land. People having
more than 4.1 bigahas were found 26.2% (46), people having land between 2.1 to 4
bigahas 12.5% (22) and people having no land to 2 bigahas were 61.1% (107) in the
Rajbanshi community.
Economic Condition and Sickness.
Table 3: Economic Status and Sickness.
Here the land proportion and sickness has been shown to know the sickness status
associated with land ownership.
Economic Status (Land) Sickness. Proportion Percentage
0-2 Bigahas (Poor), (N=107) 107 100.0
2.1-4 Bigahas (Medium),(N=22) 22 100.0
4.1- above (Rich), (N=46) 46 100.0
The table 3 indicates that out of the total 175 respondents, 100% (107) poor people were
getting sick likewise medium 100% (24) and rich 100% (46) were reported sick.
Medication Poor (n=107) Medium (n=22) Rich (n=46) P - Value.
Modern Medication 104 (97.2) 20 (90.9) 44 (95.6) 0.3871
Self-Medication 68 (63.6) 14 (63.6) 18 (39.1) 0.0160
Alternative Med. 19 (17.7) 7 (31.8) 40 (87.0) 0.0000
Table 4: Economic condition and medication.
There is close relationship between economic status and health seeking behaviour.
Table 4 presents that 97.2% poor, 90.9% medium and 95.6% rich people were adopting
modern medication respectively. Poor 63.6%, medium 63.6% and rich 39.1% people
were adopting Self-medication respectively. Similarly Poor 17.7%, medium 31.8% and
rich 87.0% people were adopting Alternative medication respectively. There was no
difference in the use of modern medication among different economic level that is
statistically insignificant (P= 0.3871). It was found that there has highly significant
practice of self-medication been adopted by poor i.e., statistically significant (P=0.0160).
Likewise, rich are largely adopting alternative medication that is statistically highly
significant (P= 0.0000).

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
27
4.1.2 Education
Majority of people was uneducated as shown in the following table. Out of the 175
respondents 35.4% (62) were illiterate, followed by literary only 38.8% (68) both
combined as uneducated 74.0%, SLC 20.5% (36), intermediate 3.4% (6), and BA - over
1.1% (2) altogether 26.0%.
Table 5: Educational Status.
Educational Status Number Percentage
Illiterate 62 35.4
Literate only 68 38.8
SLC 37 20.5
Intermediate 6 3.4
BA abd above 2 1.1
Total 175 100.0
Table 5 presents the educational status of the Rajbanshi in Katahari and Baijanathpur
VDCs. In this study Illiterate and literate only were taken in the category as Uneducated
and SLC to above are being taken as Educated. There is 74 percent uneducated
population which determines for having self-medication and or followed traditional
healing practices.
Table 6: Education and Sickness.
Education Sickness (n) Percentage
Educated 45 26.0
Uneducated 130 74.0
Total 175 100.0
Table 6 presents the status of sickness on the basis of educational level in the community.
It shows that out of 175 respondents; uneducated 74.0% (130) and educated 26.0% (45)
were found to be sick.
Education and Medications
Table 7: Education and medication.
Medications Uneducated (n=130) Educated (n=45) P - Value
Modern Medication 126 (96.9) 42 (93.3) 0.3753
Self-Medication 85 (65.4) 14 (31.1) 0.0000063
Alternative Med. 27 (20.8) 13 (28.8) 0.2635
It was found that there was no difference in the use of modern medication between
educated and uneducated that is statistically insignificant (P=0.3753). But use of self-
medication by uneducated was significantly higher than educated that is statistically
highly significant (P= 0.0000063). And there was no difference in the use of alternative
medication between educated and uneducated that is statistically insignificant (P=
0.2635).

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
28
4.1.3 Distance of Modern Health Facilities and trend of using medication:
Figure 1: Showing the number of people with their distance for modern health facility.
Outs of 175 respondents 94.2% (165) were living within 30 minutes walking/
transportation distance.
4.1 Reported Illness.
In accordance to Prescription, observation, and history taking; diseases were noted in the
survey. Headache/bodyache/ weakness - such type of symptomatic ailments were found
mostly in the community. And then ARI, fever, eye ENT/oral problems, diarrhoea/
dysentery, Gastritis, Skin disease, TB, R. Arthritis, was reported respectively. The disease
pattern may not resemble with national status. It may due to the coverage of illness
history of only past three months.
165
10
<30 mins.
>30 mins

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
29
Table 8: Illness condition encountered in Rajbanshi community.
S.No. Diseases Frequency Proportion
1 Headache,bodyache,weakness 89 50.8
2 Acute Respiratory Infection (ARI) 77 44.0
3 Fever 54 30.8
4 Eye/ENT/Oral Problems 33 18.8
5 Diarrhoea/Dysentry 24 13.7
6 Gastritis(APD) 24 13.7
7 Skin diseases 13 7.4
8 Tuberculosis 10 5.7
9 Rheumatoid Arthritis 9 5.1
10 Asthma (COPD) 7 4.0
11 Dogbite 5 2.4
12 Typhoid 4 2.2
13 Paralysis 4 2.2
14 Accident/Fracture 3 1.7
15 Diabetes 3 1.7
16 Jaundice 2 1.1
17 Gynae/Obs. 2 1.1
18 Kala-azar 1 0.5
(Note: Response by duplication; one person had more than one problem/ illness. Thus, of
the total 175 respondents, 364 responses on illness found. The average illness found to be
2.0. )
They reported that the illness nature changes as the weather changes. When the old
prescription at their home were analysed, the disease such as ARI, TB, Kalazar, Asthma
were mentioned clearly in the prescription by health care providers. Some cases were
observed by the researcher himself. Headache/ bodyache/ weakness was reported by
50.8%, ARI by 44.0%, Fever by 30.8%, Eye/ENT/Oral by 18.8%, Diarrhoea by 13.7%,
Gastritis by 13.7%, skin diseases by 7.4% respectively.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
30
Morbidity by Sex.
Figure 2: Latest sickness according to sex.
Figure presents as males were found to be reported sick by 61.1% and female by 39.9%.
This might be due to the gender bias in the facility and opportunity to report the illness
problems in the health institutions. Rajbanshi females are powerful at household
decisions but outdoor facilities are minimum by local tradition.
4.1.5 Use of PHC-Services.
Table 9: Use of PHC services by any member of the Rajbanshi households in the last
3 months recall period.
PHC Services Service takers (n=175) Proportion Percentage
EPI Camp 139 79.4
FCHV 88 50.2
VHW 50 28.5
MCHW 19 10.8
PHC-ORC 16 9.1
TBA 10 5.7
Most of the people were found using EPI-camp (79.4%) for immunizing their child. Half
of the people have taken service by the FCHV (50.2%). But TBA, PHC-ORC and
MCHW were of relatively low access. However, it was encouraging to note that majority
of people were aware of immunization.
Reported Sickness by sex
61.1%
39.9%
Male
Female

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
31
4.1.6 Use of Health Care System.
Modern medication means allopathic medication through health care providers followed
after self-medication an alternative.
Table 10: Medication sought by the family in any kind of latest illness in the past three
months.
Medication Number (n=175) Proportion Percentage
Modern medication 168 96.0
Self-medication 100 57.1
Alternative Medication 40 22.8
Table 10 showing the pattern of health care practices adopted as 96% people are adopting
modern medication as an alternative after self care. Alternative medication was adopted
by 23% either in Homeopathic or in Ayurvedic one. This indicates that poly-practices in
poly-pharmacy and or in polyclinics/HP/SHP/PHC/Hospital are the indicators of
Rajbanshi health seeking behaviour.
Figure 3: Illustrates the category of modern medication.
In the community out of 168 people private clinic was used by 72.0%, hospital by 33.3%
and SHP/HP by 15.4%. In other words, people often go to private clinic rather than to
hospital and health post.
Figure 3. Category of modern medication.
121
56
26
72.0% 33.3% 15.4%
0
50
100
150
Private clinic Hospital SHP/HP

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
32
(b) Self-medication
Kafle and Gartaula (1993) and Gartaula (1998) have categorized self medication as
Shamanism, Priest, Dhami-Jhakri, herbal, drug retailers, grocery, kit-bag, drug peddler,
neighbour, following old medicine prescriptions etc and except the present prescription
by a qualified medical practitioners. Worship of god as well as go to the traditional
healers are accepted practices, while getting sickness are commonly. Anybody readily do
this practice herself or himself even before start any treatment. So, Self medication has
comprise of Herbal, Drug retailer, Grocery, Kit bag, Drug peddler, neighbor, and
following old medicine and prescription and traditional healers as well in the study.
Figure 4. Category of self-medication.
People were found using DJ by 51% (66), retailer by 31%(40) and herbal by 17%(22)
and following old medicine from prescription by 1%.(1)
Table 11: Dhami/Jhakris' Healing Practices.
Healing Practices. Number (n=66) Proportion Percentage
Phukphak 61 62.4
Worship 53 80.3
Sacrifice 25 14.2
Self-medication was found adopted commonly in the Rajbanshi community.
Dhami/Jhakris were doing Phukphak, Worship and Sacrifice.. People used to go to
Dhami/Jhakri /Shaman and were found still having strong belief upon their healing
power. They regard DJ as a part of life and without them their lives become incomplete
that need in every ritual. They were also familiar with the retailer's shop and used to buy
drugs and preparing herbal medicine at home conventionally.
Figure 4: Category of Self-Medication (n=100).
66
40
22
1
0
20
40
60
80
DJ/ Shaman Retailer Herbal Old Med.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
33
On the theoretical level, medical belies and practices constitute a major element in every
culture; consequently they are interesting in their own right and also for the insights they
give into other aspects of culture of which they are a part. On a practical level, a
knowledge of indigenous medical beliefs and practices is important in planning health
programmes for, and in delivering health services to traditional peoples. In describing
medical systems other than own anthropologists show increasing embarrassment over the
problem of terminology. All terms commonly used imply quantitative gaps among
medications where ‘modern’ medicine is product of indigenous cultural developments.
There is dichotomy emphasized by contrastive terms such as ‘scientific’ versus
‘primitive’, ‘western’ versus ‘non-western’ and ‘modern’ versus ‘’traditional’. Although
the qualitative gap exists, in an era of extreme culture relativism many people are
disturbed by terms that suggest evaluation. (Gartoulla, 1998)
In surveying the ethnomedicine practices in the Rajbanshi community dealing with
causality concepts, it was found that only a few cognitive frameworks were necessary to
explain the presence of disease. It was found that a dual division is sufficient to
distinguish major categories, and these may be termed personality and naturalistic, as was
suggested by Foster (Foster, 1978).
A personalistic system can be identified when illness is believed to be caused by the
active, purposeful intervention of an agent who may be supernatural being (a deity or a
god), a non-human being (such as a ghost, ancestor, or evil spirit), or a human being (a
witch or sorcerer). The sick person literally is a victim, the object of aggression or
punishment directed specifically against him, for reasons that concern him alone.
A sick person can be treated through any one more of the following:
Propitiation of gods and goddesses. Propitiation or driving away the evil spirit(exorcism
and witchcraft); Treatment by magic. Use of charms and amulets; and application of
empirical medicine. (a) Western medicine (b) Ethnomedicine.
(Gartoulla, 1998)
The characteristics of the traditional healers in this community found as follows:
In Nepal, as in the rest of the world, there are doubts about the creation of universe, but
credit for creation is frequently given to a supernatural power, to gods and goddesses.
Most people at times of trouble turn to the god for help. Blessing from the gods is always
sought before commencing any new ventures. The concept of atma (spirit or soul) is also
important in understanding the health care practices in the communities in Nepal. If the
“atma” is disturbed, the system will be in disequilibrium with possible mental or physical
stresses and strains. (Gartoulla, 19998)
Prayag Raj Sharma in his study of the divinities in the western Nepal has found that there
are some striking features in the religious practices of the people. The leading divinities
in the karnali basis resolve themselves into five classes. In the first category come the
Mastos who are 16 in number (in the region where he carried out his study). He has not
however mentioned that the name and number of such Masto divinities may very

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
34
because, in fact they are the clans deities and every family would know what Masto to its
Kul devata (clan deity), or benefactor to whom references may be made if there is any
cause of distress.
In the second category are included a number of divinities whose names so not bear
Masto suffix, but whose nevertheless wield considerable power and prestige. In the third
category fall the deified spirits. In the fourth category comes the female goddesses, and in
the last are included Chandan Nath and Bhairav Nath, who wield much influence upon
the fate of the females in particular. Sharma has mentioned that most of the leading
deivinities manifest themselves through a human medium, the oracle, who in the local
parlance, is called the. The institution of Dhami is based on the principle of reincarnation.
When an old Dhami dies, the vacated position is filled up, after a certain time, by another
person of the sasme family or clan group in whom the divinity chooses to reappear
(autinu). (Gartaulla, 1998)
Hitchock presents that four types of spirit possession in the Nepal Himalayas can be
distinguished on the basis of time and scope-reincarnate possession, utterly possession,
oracular possession and peripheral possession. (Gartoulla, 1998)
Recourse to Shamans, that the Dhami and Jhakris is a common practice everywhere and
with all communities in Nepal. One of the smallest groups among the Tibeto-Burman
speaking population of Nepal are the channel of the Dhaulagiri zone. Of them, Wolf
Mitchael wrote that they claim to be Hindus but they are much less influenced by
Hinduism than even the northern Magars. Among the deities worshipped by the Chantal
only a few belong to classic Hindu pantheon, the most important, however, being the
local deities, like Bhume , Bara and Siddha. Witchs (bokshi, dayani), globlin or demon
like being (bir, Masan) and the spirits of dead (moc, prêt, siyo) play a dominant role in
the religious beliefs and observances of the Channels. (Gartoulla, 1998)
The various appellations by which shamans are called in Nepal vary from community to
community, and also there are subtle differences in the practices of some of them. Such
appellations are as follows: Dhami, Jhakri, Lama, Guvaju, Fedangwa and Bijuwa.
Fedanwa is a shaman from Limbu community and Bijuwa is from Rai community. The
Guvaju are Newars and it must be noted that Guvaju is used for shamans priests as also
some others. But there is some interesting difference between the Dhami and Jhakris.
Most important of all, the Dhami belong to Brahmin, Jaisi or Chhetri castes where Jhakris
who do not belong to such twice born categories. In a story, The Jhakris could not reach
the heavens with the help of his incantations and magic while Lama could achieve the
same.
Alternative Medication.
Dr. Ritu Prasad Gartoulla has mentioned about Alternative medication in a book Therapy
pattern of conventional medicine with other alternative medication: A study in medical
anthropology in Nepal as follows:
“Alternative medicine is a rather vague term used loosely to distinguish ancient and
culture bound health care practices which existed before the application of science to

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
35
health matters. Some frequently used synonyms are indigenous, unorthodox, folk, fringes
and unofficial healings.
Alternative medication practices have different meaning to different people. Some
are inclined to include even ethnomedicine in it while others prefer to restrict, various
practices excluding ethnomedicine under this category. Beside the supernatural healing
practices, medications done without contacting modern/ allopathic medical practitioners,
like contacting drug retailers, over the counter sales, using private kit-boxes, consulting
neighbours and various other legitimacy with reference to the supernatural realm, and
resorted to before contacting the modern medical practitioners.
Medication practices have taken several forms in different parts of the globes. The
history of modern medicine can be traced undoubtedly from remote past and also from
the practices evolving gradually and indigenously among various people not only from
the west alone but also from the eastern societies. But one important differentiating factor
has been the application of experimental logic to the modern science of medicine. The
therapeutic intricacies are examined and how exactly the medicine works and why have
been sought to be unearthed. In alternative medication practices the whole channel of
cause and effect relation is not sufficiently explicit, even though investigations are being
conducted into some of them in recent times to reveal the inner relations, as in the case
of, say, acupuncture, which has been one of the alternative medication practices evolving
in China.
Acupuncture and moxibustion have been applied in China for the last 2000 years
or so. The simplicity of their application, their minimum side-effects, and their low cost
and rapid effect have made to remain popular. It may be pointed out that some
practitioners of acupunctures still adhere strictly to traditional medical theory, while
others use it empirically, without reference to the indigenous Chinese belief, and strictly
in accordance with westers style diagnosis and concepts of pathophysiology.
Internationally there is a diversity of opinion regarding the techniques of acupuncture, the
pre-requisite qualification of an acupuncturist, the usefulness of the notion of channels
and the specificity of the acupuncture points.
Accupuncture, Unani or Chandsi medication (indigenous to eastern Bengal), like
many other recent ones such as Homeopathy, have made their inroads into Nepal through
diffusion of culture. But, here, in this account of the alternative medication practices in
Nepal, such items are not included because they are external influences and also because
they are by and large urban centred even now.”
Ayurvedic and Homeopathic medication have earned a good reputation though
services were available in the urban only for small number. They were possessing the

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
36
beliefs that source of many modern medicines are Ayurvedic raw materials. So they were
friendly in using Ayurvedic medicines. Likewise they were having belief that despite its
slow action Homeopathic medicine can eliminate the root of disease.
Table 12. Category of Alternative medicine.
Alternative medication (n=40) Number Percentage
Ayurvedic 28 70.0
Homeopathic 12 30.0
Table 13 illustrates the categories of Alternative medicine i.e., Ayurvedic and
Homeopathic. Out of the total 175 respondents 22.8% (40) were adopting alternative
medication and among them 70.0% (28) had adopted Ayurvedic and by 30.0% (12)
patients had adopted Homeopathic medication. Remaining had gone to other area.
4.1.7 Causes of taking Services.
Some studies say that people's behaviour of taking care was mainly guided by
their perceived satisfaction. Places where they get good investigation, diagnosis and
treatment, as well as good inter-personal communication were place of their choices.
Other determinants were distance, custom, cost and other. Patient mostly used to go to
health facility with the advice of his/her family, neighbour/friends and by self-
knowledge, IEC such as Radio and TV, and health workers.
Table 13. Reasons for taking health services.
Reasons Number (n=175). Proportional Percentage.
Satisfaction 145 82.8
Short distance 49 26.2
Custom 24 13.7
Cost/ Cheap 16 9.1
Other 1 0.5
(Note: Response by duplication).
This table shows that why people were going to take a particular health care service.
82.8% people were driven towards where they felt satisfied. Second guiding factor was
short distance (26.2%) and custom (13.7%) cost (9.7%) and other 0.5% respectively.
Figure 14. Advice for referral.
Advice for refer Number (n=175) Proportional Percentage.
Family member 107 61.1
Self 80 45.7
Neighbour/ friends 16 9.1
IEC/Radio/TV 2 1.1
Health Workers 1 0.5
The contribution on giving advices for referral by family members the proportion was
61.1% and self-knowledge 45.7%,, neighbour/ friends 9.1%,, IEC/Radio/TV 1.1%, and
Health workers 0.5% respectively.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
37
4.1.8 Frequency of Visits.
Table No.15. Frequency of visits for treatment.
Frequency Number (n=175) Percentage.
Once 57 32.5
Twice 62 35.4
Thrice 26 14.8
Four times 10 5.7
Five or more times. 20 11.4
Out of 175 patients 57 (32.5%) patients visited once and 35.4% visited twice for
treatment. Similarly, 14.8%, 5.7%, 11.4% patients visited thrice, four times and five or
more respectively for the treatment.
Figure 5: Satisfaction and number of visits.
Table indicates that patients were satisfied with their second visit rather than first visit. In
their first contact 57.7% patients were satisfied with the treatment and 90.2% satisfied
with second visit.
4.1.9 Expenses for Treatment.
Table 16: A cross-section of an average expense (in Rupees).
Buying drugs 598.35
Paying fees 201.68
Transportation 52.30
Helper 38.58
Other 142.77
Average expenditure per sick is Rs.1 031.64. Bulk amount of expense was (58.0%) for
purchasing drugs and paying fees (19.5%). And 5.0% for transportation, 3.7% for helper
and 13.8% for others.
Figure 5: Satisfaction Vs. Visit frequency
57.70% 90.20%
42.30%
9.80%
0%
20%
40%
60%
80%
100%
120%
First Contact Second Contact
Unsatisfied
Satisfied

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
38
Figure No. 6: Cost of Treatment.
It was found that usually people (39%) were paying 50-200 rupees for their treatment.
Likewise, 23% had paid Rs. 501-1000, 18% paid 201-500, 12% paid 1001-5000, 5% paid
less than Rs.50 and 3% paid more than Rs.5000. But it was indeed; found that average
person was paying Rs. 1031.64 per sick for a treatment. Bulky proportion of money used
to go for the cost of drugs and fees for doctor or healer. Rest of their money was
expensed for helper, transportation and others.
4.1.10. Affordability.
Table 17: Affordability as perceived by the Respondents.
Affordability Number Percentage.
Yes 47 26.8
No 128 73.2
Total 175 100.0
Table 12. Suggests that 73.2% people were reported to be unable to afford the cost for
treatment. Only 26.8% people were able to afford treatment cost. So it is striking to note
that, only less than one-third people were found to be able to afford the cost for treatment.
Figure No.6. Money expensed for treatment.
9
68
32 40
21
4
5% 39% 18% 23% 12% 3%
0
20
40
60
80
<Rs.50
Rs.51-200
Rs.201-500
Rs 501-1000
Rs 1001-5000
>Rs 5000

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
39
Figure No.7. Bearing of the cost for treatment.
Figure suggests that 32% people took help or burrowed from their family members. 53%
sold their belongings such as agricultural products, land etc., and 14% took loan for
treatment. More than two third people were found unable to afford cost for the
accomplishment of treatment.
4.1.11 Satisfaction.
User’s satisfaction from service providers determines by the local people who
might have taken various forms depending on who administers what medicine to whom
and how. Sometimes it happened that even when modern medicine is used, it is done
without the advice of a regular doctor. Such cases occurred when a person consumed
medicine on his own or procured it from someone who did not possess the necessary
knowledge in medicine. In such cases it is immaterial whether the medicine administered
is the correct one. Despite having skills and knowledge a doctor or a paramedical could
not function well in a hospital/PHC/ HP settings at desired level due to limited resources,
support and burden of works. It also plays a vital role on the satisfaction of a consumer.
There are several chances of being misuse of health human resources in our health
system. A Village Health Worker who has got training for certain preventive and
promotive in public health areas. They are supposed to work in the field of immunization,
health education and sanitation. But people expect more during their frequent visits. So,
sometime VHW/ MCHW or paramedical are providing services more then their expected
level.
Kirana shops Keepers (Grocers) are those who hold shops of daily use such as
rice, pulse, oil etc. But they sell certain medicines such as Paracetamol, Antihelminths,
Antibiotics, ointments for eye, skin etc. It is easily estimated that there is maximum
irrational use of drugs from the grocery but it is not easy to control since large number of
people were getting service from there.
Fi
g
ure No. 7. Peo
p
le how the
y
bear the cost for treatment.
32%
53%
14% Help from family
member
Selling Agricultural
Products
By having loan

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
40
Dhami-Jhakris are regarded as the representative of the supernatural powers and
with their aid they can cast off evil spirits that cause affliction to people. While curing the
patient through some rituals practices, they are held to be in communion with gods and
goddesses.
Despite the health facilities provided by the government more than 50 percent of
health problems never reach the health services. They are treated through a system of
self-care and plural medications which is based on home remedies. Other methods of
unconventional treatments include commercial sales of over the counter (OTC) drugs
often combined with religious healing practices and culturally based treatments which are
economically beneficial to the people. (Gartoulla, 1998)
Figure 8: Satisfaction with the process of investigation during treatment.
Figure noted that 94.0% patients were found satisfied with the process of investigation
during the treatment. Only 6.0% were dissatisfied with the process of investigation during
treatment.
4.1.12 Usual Visit to taking cares.
It was found that people were taking services from multiple medications such as -
Modern medication, Self-medication and Alternative medication practices.
Figure 8: Satisfaction with process of investigation.
165
10
94% 6%
0
50
100
150
200
Satisfy Unsatisfy

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
41
Figure 9: Usual visit for medication.
Usual place to visit for 96.0%(168) people was modern medication, self-medication for
57.1%(100) and Alternative medication for 22.8%(40). (N=175).
Figure No 10: Satisfaction as perceived from their medication practices adopted.
Out of 175 respondents 158 (90.2%) were satisfied with modern medication, 102(58.2%)
satisfied with self-medication and 60 (34.2%) satisfied with alternative medication. It was
due to the cure rate, low cost, provider behaviour, free medicines, good counselling
which are the causes for satisfaction.
Following points are viewed by users for satisfaction.
Medicine facility, experienced service provider, emergency services, quick
services, previous experience, quality of care, better examination, good behaviour of
service provider, proper treatment, proper advice, Female service provider for female
cases, service availability, laboratory facility, x-ray facility etc.
Figure No.10. Satisfaction from medication.
158
102 60
34.2%58.2%
90.2%
0
50
100
150
200
Modern Med. Self-Med. Alternative M.
Visit for medication
160
100
40
96%
23%
23%
0 50 100 150 200
Modern
Self
Altrenative

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
42
Likewise, Following points are viewed by users for dissatisfaction.
Irregular presence of service providers, Physical facility, water, sanitation,
expensive medicine, No lab, No latrine, No x-ray, Wrong behaviour of service providers,
No home visits, No surgical facility, No specialist service, No transportation service,
necessary medicines are not available etc.
4.1.13 Satisfaction of medication on the basis of Education.
Figure No.18. Satisfaction of medication on the basis of education.
Medication Educated (n=45) Uneducated (n=130) P - Value.
Modern 41 (91.1) 111 (85.3) 0.3271
Self 14 (31.1) 45 (34.6) 0.669
Alternative 42 (93.3) 39 (30.0) 0.0000
There was no difference between educated and uneducated in the use of modern
medication that is statistically insignificant (P=0.03271). Similarly, there was no
difference between educated and uneducated in adopting the self medication that is
statistically insignificant (P= 0.669). But educated were adopting more alternative
medication practices than uneducated that is statistically highly significant (P=0.0000).
4.1.14. Satisfaction from different medication practices on the basis of economic status.
Table No.19. Satisfaction with medication on the basis of economic status.
Satisfaction Medication
MeM Poor (n=107) Medium (n=22) Rich (n=46) P - Value
Modern 99 (92.5%) 18 (81.8%) 41 (89.1%) 0.28947
Self 42 (39.2%) 5 (22.7%) 13 (28.2%) 0.2000
Alternative 56 (52.3%) 10 (45.4%) 36 (78.2%) 0.0050
It was noted that there was no difference among poor, medium and rich in the use of
modern medication that is statistically insignificant (P=0.28947). Similarly, there was no
difference among different strata in using self medication that was statistically
insignificant (P=0.2000). But rich were adopting alternative medication more than other
economic strata that is statistically significant (P=<0.005).
Focus Group Discussion
The situations created during different Focus Group Discussions with Rajbanshi
people in Katahari and Baijanathpur VDCs of Morang district that facilitate the study to
experience the real situation by taking their views, by interacting with the groups. So, the
discussions helped to collect their ideas about their health seeking behaviours. They
expressed their views regarding modern, self and alternative medications. They were
found eager to express their demands to the government and Institute of medicine as well.
There were found different NGO/INGO intervention in these VDCs. Many people said
that they have already taken different trainings. They also want more training about

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
43
health they expressed. Here are some views regarding our health system which are
somewhat critical too. Researcher has felt that these FGD were not only useful to collect
or explore things but also useful in evaluation of data collection as well.
Total FGD = 10
Group No. Male Female Total
1 8 0 8
2 0 8 8
3 3 5 8
4 6 2 8
5 7 1 8
6 1 7 8
7 6 2 8
8 5 3 8
9 2 6 8
10 3 5 8
Total 41 39 80
Point No.1. Could you please explain your views on medication pattern at your village?
Response General Responses
1 We use modern, self and alternative medications.
2 Modern medication is effective but also going to be expensive.
3 Self medications are cheap and common. It comes in first step. If it does not
cure we go to the clinic.
4 Ayurvedic drugs and doctors are cheap. No side effect.
5 Homeopathic drugs are slow in action but eliminate cause. Drugs, fees are heap.
Point No.2.Describe about consultation practice at your village ?
Response General Responses
1 Our usual visits are private clinic because it is easy to access all the time.
2 First our practice is self medication thereafter modern medication.
3 First our practice is self medication thereafter Ayurvedic or homeopathic.
4 Health post and hospital services are expensive and not so good but we use it.
5 family member and sometimes Faith healer decide where to go to cure.
Point No.3. People’s faith with Faith healers and their impact on health.
Response General Responses
1 We partly believe on faith healer. It can make us free from fear and tension only.
2 We believe in the faith healers it can cure mental diseases.
3 They are decreasing in number so government should give training for faith
healer.
4 We believe them. Because they need in our every rituals.
5 Some faith healers are cheating us, but we cannot ignore them.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
44
Point No.4. People’s faith with Pandit/ lama/ astrologer and their impact on health.
Response General Responses
1 We partly believe them. But sometime we need them urgently.
2 They can make our fortune good. So we take advice from them.
3 Their number is very few so we cannot say.
4 They are our traditional healer. Today they are our service/ advice providers.
5 We need to ignore their healing because we have modern medicine in easy ccess.
Point No.5. People’s faith with Ethnomedicine and their impact on health.
Response General Responses
1 It is disappearing day by day. It is slow in action.
2 It is still existed. We need to preserve it. It work for many things.
3 Ethnomedicine is difficult to access today rather than modern medicine.
4 Because it is cheap and if not get well contact the modern, alternative cares
5 It takes time so we have no time to go to ethnomedicine. Modern medication-quick
Point No.6. People’s faith with Supernatural beings and their impact on health.
Response General Responses
1 We partly believe them.
2 We believe it but we cannot say more.
3 We cannot say about it.
4 It is responsible for sickness but we are not sure.
5 We ignore the supernatural beings because it is not scientifically proved.
Point No.7 Source of information for medication.
Response General Responses
1 Radio, TV, Health worker, friends
2 Family member, neighbour, Faith healer, FCHV
3 Friends, HP, Hospital, teacher, students, radio, TV
4 Family member, neighbour, Faith healer, TV, Radio
5 Radio, TV, Health worker, friends, neighbour.
Point No.7 Any other suggestions/ information on the health care practices.
A middle aged gentleman at Katahari VDC(Group No.6) said: Modern medication is
good but it has many side-effects.
Other gentlman said (Group No.7) : Since doctors are not looking as good at hospital and
health post as like their private clinics, so they should not be allowed to open their
private clinic by government.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
45
A middle aged women at Baijanathpur VDC (Group No.2) said: Drugs as well as
doctor’s fees are much expensive. So, drugs should be available at cheaper price at
clinic, shop, HP and hospital.
A young man at Katahari VDC (Group No.9) said that Health Post’s doctor does not
examine us properly so s/he cannot diagnose the disease. Therefore, it is worthless to
visit health post.
A woman (Group No.8) The same doctor examine well in his clinic. Drugs should be
purchased either in health post or in his clinic. So, I prefer to go to private clinic.
A old man (group no.4) said; Dhami/ Jhakris are needed in every rituals and they can do
something for our ailments. We always go to DJ for almost all health problems. If he
gives suggestion then we go to seek care such HP, hospital, clinic or else.They are
accepted as a part of our culture till now.
But a middle aged gentleman (group no. 5) said as : DJ are cheating us they cannot cure
our disease. They can only make us free from fear and free of tension.
A middle aged women at Baijanathpur asked: Since the Dhami/Jhakris’s numbers are
going to decrease today. Dhami/Jhakris also should be made available by the
government.
A gentleman (group no.10) said that; But they need to be trained and should be
recognized by the government.
A young man (group no 5) said: I am using Homeopathic drugs from Biratnagar. It can
eliminate the root cause of disease so it cannot let disease relapse again.
An old man said (group no.4) that : Iam using Ayurvedic medicine. Ayurvedic is the main
source of drugs of modern medicine so I prefer the Ayurvedic medicine.
Another gentleman (group no.1) added that it takes long time to cure so it is useless in
emergency.
Expectations and Suggestion
1. Provision of cheap drugs to be provided for them while in treatment..
2. Provision of free-mobile health camps.
3. Training and health education programs should be provided to Rajbanshi.
4. Such provision should be made that either Hospital doctor/paramedic should see
patient as like as their clinic or Government doctor/ paramedical should not be allowed
to see patient in private clinic.
6. Dhami/Jhakri should be provided training and be recognized by government.
Thereafter they should be made available in the community by the government.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
46
4.2 Discussion.
Rajbanshis live in Morang and Jhapa districts in Nepal. Rajbanshi ethnic in
Katahari and Baijanathpur VDC were found having literacy rate 65% in the taken sample.
Principal occupation is agriculture. Majority of people falls in the category of having no
land to less then 2 bigahs. Average family size is 5.76 persons. Attempts to interviews
with mostly head of the 175 households were made in two VDCs. And there were 61%
male and 39% female reported sick.
Common type of ailments was reported such as headache, bodyache, weakness
(50.8) and then ARI (44), fever (30.8), Eye/ENT (18.8), diarrhoea (13.7) was reported
respectively. Distribution of reported illness was highest on over 66 year of age then 55-
65 and 46-55 years of age respectively.
Private allopathic clinics conducted by paramedics were abundant in the local
market, which were familiar in the community. So, minor injuries and ailments were
being treated there. People were getting satisfaction through private clinics (72.0%)
rather than from nearly situated Sub-health post (15.4%). There was relatively lager
number of people going to private allopathic clinics where they got good treatment in
terms of examination, counseling and drugs which made them satisfied. It was noted that
despite being easy access majority of people was found unsatisfied with the treatment
given by Sub-Health Post. Large number of people was reporting that there is no
worthwhile to go to Health posts. Since they don't examine properly, they are unable to
diagnose the disease and consequently treatment becomes worthless. It was just to waste
time and money.
They have also got facility of Koshi Zonal Hospital for emergency and special
services. People those who need sophisticated facilities such as Emergency, obstetrics
and chronic cases, used to go to higher service centers at Biratnagar, Dharan, Kathmandu
and India accordingly.
Likewise people were found to be deeply attached with their Self-medication
practices. They readily go to Dhami/Jhakri/Shaman due to cultural factor and because of
their satisfaction. And sometimes lack of adequate money to pay modern medication also
drive to Self-medication. Since cultural belief was deep rooted, people would feel oneself
incomplete without the presence of Dhami/Jhakri/Shaman or Self-medication in the
society. It was felt that even people those blaming Dhami/Jhakri as merely cheating in the
name of healing; were also admitting that they could make us at least free from tension
and fear.
There was no difference in the use of modern medication among different
economic level that is statistically insignificant (P= 0.3871). It was found that there has
highly significant practice of self-medication been adopted by poor i.e., statistically
significant (P=0.0160). Likewise, rich are largely adopting alternative medication that is
statistically highly significant (P= 0.0000).

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
47
It was found that there was no difference in the use of modern medication
between educated and uneducated that is statistically insignificant (P=0.3753). But use of
self-medication by uneducated was significantly higher than educated that is statistically
highly significant (P= 0.0000063). And there was no difference in the use of alternative
medication between educated and uneducated that is statistically insignificant (P=
0.2635).
They were found familiar to go to EPI-Camp (79.4%) for getting vaccination for
their children. They are also familiar with FCHV and recognize her services. Most of the
people know their FCHV (50.2%) and used to take service from her. On the other hand,
more than 89.2% population was found still unknown to MCHW, TBA and PHC-ORC
and its services.
There was no difference between educated and uneducated in the use of modern
medication that is statistically insignificant (P=0.03271). Similarly, there was no
difference between educated and uneducated in adopting the self medication that is
statistically insignificant (P= 0.669). But educated were adopting more alternative
medication practices than uneducated that is statistically highly significant (P=0.0000). It
was noted that there was no difference among poor, medium and rich in the use of
modern medication that is statistically insignificant (P=0.28947). Similarly, there was no
difference among different strata in using self medication that was statistically
insignificant (P=0.2000). But rich were adopting alternative medication more than other
economic strata that is statistically significant (P=<0.005). They were also found having
some critical perception regarding modern medication practice; as it is expensive and
doctors and paramedics are not treating patients as like their private clinics. Self-
medication practices are common for minor and common type of ailments. And it is an
integral part of their culture. Likewise they are relatively less familiar with Alternative
medication because of unavailability locally. But they keep believe in its usefulness for
chronic diseases and assume its potentiality of eliminating disease slowly.
An average treatment per case cost has found Rs. 1031.64 (SD=6). 73.1%
patients were reporting to be unable to afford the expenses for treatment. They had taken
either loan (14%) or had to sell land, animals, grains or personal belongings (53%). The
bulky proportion (57.8%) expenses felled on buying drugs and for fees (19.55%)
thereafter, for transportation 5%, helper 3.74%, others 13.84%. Therefore, the concern of
unaffordability of treatment cost for modern medication is one really striking.
People go for health care where they are supposed to get satisfaction and feel
reliable. So, it was found that choosing of medication was mainly influenced by their
perceived satisfaction. The satisfaction was in terms of curedness, process of
investigation, interpersonal relationship, and treatment. Patients were usually visiting
more than one time. Second visit had provided more satisfaction. Similarly other guiding
factors were distance, usual custom, cost etc. Family members and self-knowledge were
driving forces to adopt certain medication. People also expressed the need of service of
Dhami/Jhakris, training for Dhami/Jhakri and recommendation by government.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
48
Chapter - V
5.1 Conclusion
1. Major occupation of Rajbanshi in Katahari and Baijanathpur was agriculture. And
Other were labour-work, business, and service etc.
2. Most of the people fall in the category of having no land to less than 2 bigahs.
Common type of ailments was reported such as headache, bodyache, weakness (50.8)
and then ARI (44), fever (30.8), Eye/ENT(18.8), diarrhoea (13.7) was reported
respectively. Distribution of reported illness was highest on over 66 year of age then
55-65 and 46-55 years of age respectively.
3. People were found using Modern medication equally. Higher use of Self-medication
by poor was significant (P=0.0160). Similarly higher use of alternative medication by
rich was statistically highly significant (P=0.0000).
4. Literacy rate in sample was 65%.. The 29% percent people were found educated
(above SLC). Uneducated people were using more self-medication was found
Statistically highly significant (P=0.0000063).
5. More than 90% Rajbanshi in these two VDCs had got modern health facilities within
30 minutes distance. Utilization of PHC services: They were found familiar to go to EPI-
Camp (79.4%) for getting vaccination for their children. Half of the people know their
FCHV (50.2%) and take service from her. On the other hand, more than 89.2%
population were found still unknown to MCHW, TBA and PHC-ORC and its services.
7. Self-medication- Dhami/Jhakri/Shaman were main service providers of Self-
medication. They used to Phukphak, worship, and sacrifice 62.4%, 80.4%, 14.2%
respectively. Retailer and herbal were also common in this community.
8. Causes: People were mostly guided by their perceived satisfaction (82.8). Other
determinants of choosing certain practice were distance, custom, cost etc. Family
member and self-knowledge had played the driving role to decide the probable
options.
10. Visits: Most patients go more than one time to take health care and their second visits
provided significant satisfaction.
11. Cost: The proportion of people paying between Rs.51-200 was 39% of sample. But
average expenditure per case was Rs. 1031.64 (i.e. mean; and SD=6) for a treatment.
It was reported to be unaffordable for more then 73% people so they take either loan
or sell their belongings to accomplish the treatment. Most of the proportion of their
expense goes for buying drugs and paying fees. Rest portion was expensed for
transportation, helper cost and other.
14. Satisfaction: Rich were found satisfied with alternative medication that was found
statistically significant (0.0050). Educated was found satisfied with alternative
medication was highly significant (P=0.0000).

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
49
5.2 Recommendations
Based on the findings, following recommendations could be made as follows:
Since majority of the poor people go for self medication and the private clinic was
perceived to be expensive; the personnel of the self-medication or service provider such
as Dhami/ Jhakri/ Shaman, retailer need to be oriented on referral system. Since 73.2%
people are unable to afford treatment; free mobile health camp should be provisioned for
the poor. Since 89.2% of the population was unknown to MCHW, TBA and PHC-ORC
services; training and awareness program should be provisioned to both service providers
and users.
The suggestions received from qualitative study match with that of the findings from
qualitative analysis; and thus the following recommendation was made as follows.
Since consumers were reporting that doctors or health workers used check up a patient
very well in their private clinics with giving sufficient time and effort than in a HP/ SHP/
Hospital, so they preferred to go to a private clinic than HP/SHP. Some specific rules
were expected from the respondents to get changed the situation from the government.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
50
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Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
52
Appendix-I.
Questionnaire
Name of the Interviewer: ......................... Date: 2057/ /
Name of the Respondents: ...................... Age: ... Sex: ... Education: ......
Family Number: ...
Dist................ VDC.................... Ward No..... Village Name: ......
Demographic Information.
Household No....
S.
N. Family
members Relation-
ship with
HH
Age
(A)
Sex
M/F
Educa-
tion
(B)
Profe-
ssion.
(C)
Prop-
erty
(D)
Illness
within 3
months.
Y/ N
1
2
3
4
5
6
7
8
9
10
Note:
A= (a) 0-10 (b) 11-20 (c) 21-35 (d) 36-45 (e) 46-55 (f) 56-65 (g)66-over.
B= (1) Illiterate. (2) Literate. (3) Primary (4) SLC (5) IA (6) BA and over.
C = (1) Agriculture (2) Business. (3) Service. (4) Dependent.
D = Land (1) 0-2 bigahas, (2) 2.1-4 bigahas (3) 4 bigahas and over.

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
53
Appendix-II.a
Tribhuvan University
Institute of Medicine, Central Campus
Maharajgunj, Kathmandu, Nepal.
A Dissertation in a partial fulfillment of the requirement for the Master in Public Health
(MPH).
Topic:- Health Seeking Behavior of Rajbanshi Community in Katahari and
Baijanathpur VDCs of Morang.
Questionnaire Form. Name of Interviewer: ........ ... ... Date: 2057/ /
Name: Demographic No.
Religion.............
1. What illness or diseases you got during last three months? (serially)
1.......................... 2..................... 3........................ ...
2. What you did ?
1.Self-medication 2.Modern medicine
3.Alternative Medicine 4. Nothing done
2.1. If self medication which of the following:
1. Shaman/ priest/ dhami/jhakri. 2. Herbal/ root/grass/plant etc.
3. Drug Retailers. 4. Grocery. 5. Kit bag.
6. Drug peddler. 7. Neighbour. 8. Following old
medicine.
If any other...............................................
2.2. If modern medicine which of the following?
1. HP/SHP 2.Hospital. 3. Private clinic/Nursing home
4.Other.......
2.3. If Alternative medicine which of the following?
1. Ayurvedic. 2. Homeopathic. 3. Other.......................
3. What was the total process that your consulted unit followed ?
.................................... ......... ........ ... .......
.................................... ............ ................ ...... .......

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
54
Appendix-II.b
3.1.When you have visited the Shaman/Dhami/jhakri/priest what he did?
1. Phukphak. 2. Worship. 3. Sacrifice.
4. Other...........
4. Why did you visit /do so?
.............................................................................................................
4.1.What factor influenced you to go there?
1. Quality/Satisfaction 2. Near. 3. Cheap.
4. usual practice. 5. Other................................
4.2.Were you satisfied with the care's investigation process ?
1. Yes. 2. No.
Why ................
5. Were there any more visits to other place?
1. Yes 2. No
5.1.If Yes, Where ? .........................................Why............
5.2. How many times you visit to: - ...............
6. How much money you did expenditure for a sickness?
1. Less than Rs.50. 2 .Rs.50-200 3. R.201-500.
4 Rs.501-1000 5. 1001- 5000 6. Rs. 5001 and over
7. What was the cost for?
1. Transprtation.........
2. Helper.........................
3. Medicine........................
4. Any other......................
8. Could you afford that cost ?
1. Yes 2. No
8.1. If No, how did you manage the cost?
1. Self had 2. Loan 3. Selling 4. Other..................
9.Were you satisfied with the first contact ?
1. Yes 2. No
Why ..............................................................................
10. If had second contact; were you satisfied?
1. Yes 2. No
Why

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
55
Appendix-II.c
11. Who advised or referred you to go to take service for sickness?
....................................................................................................................................
12. your mostly first visit to health care is: -
...................
13. Are you satisfied with Health Worker/Doctors or with treatment?
1. Yes 2. No
Why ..............................................................................
14. Are you satisfied with Shaman/Dhami/jhakri/priest etc.?
1. Yes 2. No
Why ..............................................................................
15.Are you satisfied with Ayurvedic/Homeopathic doctor or health workers ?
1. Yes 2. No
Why .................................................
16. Did you take service from: -
1. FCHV 2.TBA 3.MCH Worker.
4. VHW 5.EPI-Camp. 6. PHC-ORC Camp.
7. Mother's Group.
17. How far is your nearest Sub-Health Post or Health Post ?
1. Less then 30 mins. 2.More then 30 mins.
18. Could you please explain your views on?
18.1. Medication pattern at your
villages.....................................................................................
....................................................................................................................................
......
18.2. Consultation practices at your villages.
..............................................................................
.........................................................................................................................................
18.3. People's faith with ................. and their impact on health.
(a) Faith Healers.
.............................................................................................................
(b) Pandit/lama/guvaju/Astrologer.
.................................................................................

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
56
(c) Ethnomedicine.
..........................................................................................................
(d) Supernatural beings.
..................................................................................................
19. Sources of information for medication.
..............................................................................
20. Any other suggestions/ information on the health care practices.
Appendix - III
Guidelines for Focus Group Discussion.
Could you please explain your views on medication pattern at your villages?
………………………………… ....................................................................................
....................................................................................................................................
Describe about consultation practices in your village ?
……………………………………………......................................................................
....................................................................................................................................
3. People's faith with ................. and their impact on health.
(a) Faith Healers.
.............................................................................................................
(b) Pandit/lama/guvaju/Astrologer.
.................................................................................
(c) Ethnomedicine.
..........................................................................................................
(d) Supernatural beings.
..................................................................................................
4. Sources of information for medication.
..............................................................................
5. Any other suggestions/ information on the health care practices.
....................................................................................................................................
......

Health Seeking Behavior of Rajbanshi Nepal by Nawa Raj Subba, 2001
57
Appendix-IV.
Global Situation. Changes in the rank order of diseases. (World Bank)
Changes in the rank order of disease burden for 15 leading causes, world, 1990 -2020.
Disease burden measured in Disability-Adjusted Years (DALYs)
1990. 2020
(Baseline scenario)
Disease or injury Disease or injury
Lower Respiratory Infections 1 1.Ischaemic Heart Diseases.
Diarrhoeal Diseases. 2 2. Unipolar major Depression
Condition arising during perinatal. 3 3. Road Traffic Accidents
Unipolar major Depression. 4 4. Cerebrovascular Diseases.
Ischaemic Heart Diseases. 5 5. Chronic Obstructive
Pulmonary D.
Cerebrovascular Diseases. 6 6. Lower Respiratory Infections
Tuberculosis. 7 7.Tuberculosis.
Measles. 8 8. War.
Road Traffic Accidents. 9 9. Diarrhoeal Diseases
Congenital Anomalies. 10 10. HIV/AIDS.
Malaria. 11 11. Condition during perinatal.
Chronic Obstructive Pulmonary D. 12 12. Violence.
Falls 13 13.Congenital Anomalies.
Iron Deficiency Anaemia. 14 14. Self inflected injuries.
Protein Energy Malnutrition. 15 15. Trachea, bronchus and lung
cancers.
16 19
17 24
19 25
28 37
33 39
So, this changing pattern of diseases easily affects the health system, Manpower,
Financial as well as technology of a country. It is a great burden and challenge for the
poor country Nepal.