Episode #264: The Cure Lies Within
“There's a lot of Western perceptions of traditional medicine being unhygenic, not effective, or useless,” says Shalini Sri Perumal. “A lot of it is Western-centric and Euro-centric, and has a bit of a colonial hangover. This perception of traditional medicine— although it's not necessarily unfounded, because there is some traditional medicine that can be harmful, and that might need to be reconsidered— but because they came about from a time [where] it’s not applicable anymore, and the belief systems maybe don't make sense now.”
Originally from India, Shalini grew up in Africa and in other parts of Asia. Her experiences in diverse cultures helped open her eyes to the power of indigenous medicine. A turning point in her life came in 2016, when she became a volunteer at the renowned Mae Tao Clinic in Mae Sot, on the Thai/Burmese border, “one of the only refugee-run charity organizations in the world where all the staff is refugees or migrant workers themselves, and the service is free.” The clinic serves 100,000 Burmese migrant patients annually, predominantly ethnic minorities who have few, if any, other options for medical treatment.
Today, she is a Communications Officer at ActionAid India, where she combines her passions of traditional medicine and advocacy for refugee rights. These two areas of focus have led to a strong connection with Burma, and she regularly consults with a handful of community-based women’s organizations there, including The Kachin Women's Association and the Finnish Refugee Council.
Reminiscing about her time at the Mae Tao Clinic, Shalini describes her admiration of Dr. Cynthia Maung, its Karen founder who began her work in 1988. Since that time, Dr. Maung has accomplished much under extraordinarily difficult circumstances, and the clinic is now a community-owned social enterprise with an eye towards sustainability. For Shalini, it is “an amazing place,” adding that “over the years they've offered about 135,000 antenatal care consultations, more than 75,000 family planning consultations, and 34,000 deliveries— and this is all since 2007. So it’s one of the region's largest provider of reproductive health services for migrants, refugees, and even displaced populations. A lot of displaced populations travel across Southeast Myanmar and come to MTC because it's really the only healthcare service they can access! So it really provides a lot of hope for women and men as well, and children facing challenges and of displacement and like limited access to healthcare. So yeah, it's an amazing place.”
Discussing the myriad challenges faced by Burmese refugees across the border, Shalini notes that although Thailand is not a signatory to the 1951 Refugee Convention, it is officially committed to the principle of “non-refoulement”—that is, safeguarding the rights and well-being of those fleeing persecution. Yet, as Phil Robertson poignantly pointed in a recent podcast conversation, migrant populations in Thailand lack access to important services based on their undocumented status, including health care. In addition, as Kenneth Wong addressed in another episode, many migrants lack proficiency in Thai, which Shalini says is also an impediment to securing assistance. With these issues in mind, the Mae Tao Clinic is partnering with the general hospital in Mae Sot, working together to provide treatment options. Even so, migrants still have many concerns about receiving medical attention. “They don't feel comfortable being in a Thai hospital because of the legal repercussions that they might face, [like if] they don't have all the documentation that they need, or they’re living quote-unquote ‘illegally' in Thailand. So there's a lot of fear, and they feel safer with community-based and Burmese indigenous community-based healthcare services.”
Shalini’s involvement on the Thai-Burma border is not just personal and professional, but academic as well, as she wrote her Master’s Degree thesis on how reproductive health services are provided to Burmese migrant women in Thailand. She focused on indigenous Karen medicine, and studied how herbs, plants, and other concoctions have historically been used as cures by holistic healers. The Karen approach to medicine pulls from both Chinese and Indian Ayurvedic influences, and continues to be used when modern treatments are unavailable. Shalini’s interest is not only in how Karen methods work, but also the wider context of how traditional forms of healing are spreading throughout the modern world among indigenous communities and wherever immigrant communities have established themselves. “There's a resurgence of indigenous medicine, not just in Asia, but worldwide in indigenous communities,” she says. “In the US, Southeast Asia, or Latin America, connecting with your indigenous roots, traditional medicine, and decolonizing is part of the discourse around medicine, and healing from atrocities, and [is part of] your own inner spiritual, physical, and mental-emotional growth.”
Shalini asserts that the value of traditional practices for these communities transcends the need for scientific validation. “It might not be scientifically proven necessarily, but science is not enough, because a lot of people coming from the Global South, it comes from their experience over the years, from their ancestors’ experiences in which these ideas of medicine came about.” In fact, Shalini asserts from her personal experience, Shalini affirms that some of these traditional remedies can be highly effective. She describes how there are particular foods to combat stomach pains, herbal concoctions, acupuncture for asthma, and various medicinal teas. At the same time, however, Shalini believes that scientific research is also needed to assess the effectiveness of different traditional practices, acknowledging that not all are safe. For example, some dangerous abortion methods used by medicine women in Burma have led to high maternal mortality rates.
Shalini points out that much of the existing medical literature concerning Burma, including studies on traditional medicine, is authored by western
writers, with few works authored by Burmese, either men or women. “It would be wonderful to see more works authored by members of the Burmese community,” she says.
It is not just about physical health, however, as Shalini is also keen to explore its connection with spiritual well-being. “Part of what I want to talk about is how spiritual health is so connected to medicine, and you don’t see that in Western medicine. Spirituality is so important for traditional societies.” That said, Shalini also sees value in Western medicine, particularly in areas where traditional practices may not be as effective. Ideally, she envisions an integration of the two systems, and emphasizes the need for more research into traditional practices to better understand their potential and to integrate them effectively with Western medical practices.
Returning to her experiences on the border at the Mae Tao clinic, Shalini notes that many Karen women are now trying to resurrect and safeguard their ancient medicinal knowledge, which has been under stress due to the conflict, forced migration, competition with Western medicine and stigmatization by the Burmese and Thais. They see their medicinal lore and practices as a crucial to preserving their cultural identity. And since these practices (which include traditional reproductive health practices like midwifery and abortion services) are performed by those who share the same cultural background as their patients, it helps overcome language barriers and reduces the risk of discrimination based on ethnicity or nationality—and this is all the more true when it’s displaced persons seeking treatment.
Shalini draws attention to how medicine women hold a particularly crucial role in traditional practices, especially within matriarchal cultures like the Karen. She highlights the harm that colonization and persecution have inflicted, particularly sexual violence, which makes the womb-based services provided by medicine women even more vital. Yet despite the importance of medicine women, Shalini explains that that their expertise is often viewed as being limited to reproductive services, and thus, the full range of their knowledge base and expertise are often undervalued.
Shalini has not only worked with Burmese refugees at the Mae Tao clinic, but also inside Burma, so she’s also quite conversant with the problems that refugees are also facing in her own country, in the state of Mizoram. As Angshuman Choudhury addressed in a recent episode, approximately 40,000 mainly Christian Chin refugees are taking shelter there. Resisting the Modi administration’s demands to turn them away, the Mizoram state government has instead ensured that their basic rights and material needs are met. This is because of the close cultural and religious connections between the Mizo people and the Chin (a point made by Sanjay Gathia on a recent episode). Some Chin refugees do look for better opportunities farther afield, particular in urban centers such as New Delhi. However, moving out of Mizoram can pose significant challenges. For example, after relocating, refugees have little opportunity to receive that support elsewhere. And perhaps the biggest concern is that, similar to Thailand, India is not a signatory to the Refugee Convention. That means the Chins' “refugee status” is not officially recognized, which affects their ability to work, go to school, and access health services. It also engenders the constant fear of being forcibly delivered into the hands of the Burmese military across the border.
Related to the difficulties refugees face in India outside the support offered the Chin in Mizoram state, Shalini notes particularly bad news for the huge Rohingya population that has settled in Delhi and Kashmir to escape the Rohingya genocide in Burma. The Indian government has recently passed the “Citizenship Act,” which affords legal recognition to all refugees … except those who are Muslim. To Shalini, the sole purpose of this law seems to be “a discriminatory act against the Rohingya, which has left many refugees in fear. Those who live in Delhi are fearful about the outcome [of the Act], and about being deported back to Burma.
Transitioning from the broader challenges faced by refugees, Shalini shifts her focus to the future of Burma, emphasizing the importance of ethnic unity. “These communities are such an integral part of Burma, and without their voices, there’s no Burma! And all of them are against the military,” she says. “They don't they don't agree with the military's tactics and the crimes it's committing.”
Building on the theme of unity and resistance, Shalini turns her attention back to Thailand. “There is hope for some advocacy-level work that can take place for changes in the Thai healthcare system, or even in Thai service employment laws, when it comes to migrant workers living in Thailand. For example, the Kachin Women’s Association is doing research on Kachin migrant women living in Thailand,” she says. “And Karen women face similar experiences, whether it’s being paid less or facing unsafe work environments. There’s so much scope for advocacy efforts towards the Thai government to make changes.”
Shalini closes by emphasizing the need to address the lingering impacts of colonialism on traditional medicine. “We have to remind ourselves that colonialism severed traditional medicine women and men from their ancestry and their spirituality, and maybe if they're able to reconnect to this and there's more research and more opportunities and platforms to provide them space to understand their ancestry under traditional medicine, like what’s good and what's bad, then there’ll be less stereotypes about it. So I'm really hoping that's the future.”