II. REVISIÓN DE LITERATURA
2.3 Necesidades de agua en los cultivos
In various developing countries, traditional healers and traditional birth attendants are a vital link in the sequence of health human resources providing primary health care. Regardless of the establishment of health centres, in times of sickness and childbirth the majority of people still turn to these traditional healers and birth attendants. Hence, it is imperative that a proper interest should be shown in the activities of these traditional practitioners.
Indigenous healers of South-East Asia still retain a considerable number of followers, even in areas where modern health facilities have become available. Their advantage is that they provide culturally significant clarification and interpretation of the illness experience as well as providing culturally approved treatment. Consequently, people have the option of either going to a modern medical doctor or indigenous healer when in need of help in the event of illness. Such people command respect because as Kalangie (1980) states, the curing skills of these healers have mostly been attained by being passed down from generation to generation. A process in which, the hot-cold dichotomy5 is central to the work of most of them. Koentjaraningrat (1979) and Geertz (1960) have both pointed out that most traditional healers in South-East Asia are experts who are particularly recognised for one kind of skill: magic charms, herbal medicine, massage, bone-setting or dental treatment. In each community there are several experts to whom members can come for help in case of illness. A
dukun is a traditional healer who is considered to have all kinds of skills though it is rare for them to go into a trance nor are they possessed when performing their healing sessions.
Geertz (1960) notes that some of the dukun are possessed healers but the so-called specialists are not. It is a very specialised profession and only a limited number of people are believed to be competent to this kind of profession. The reputation of indigenous healers usually depends on how they have become healers. In order to become a practitioner, the healer has to accumulate the essential profound empirical knowledge about sickness and their cures. The dissimilarities in the supernatural relations produce different types of healers, akthough all healers claim to own these relations. There are no formal institutions for traditional healers in South-East Asia; hence the training of healers takes the form of an extended apprenticeship to a skilled and experience practitioner (cf. Jaspan 1969; Koentjaraningrat 1979; Suparlan 1978). Besides learning under a guru or teacher, some indigenous healers establish relationships through supernatural aides or through dreams and visions as well as by fasting and meditating. This gives them the inner strength and their ineffable skills necessary to help patients. As Jaspan (1969) demonstrated, the support of supernatural helpers: the Almighty, saints and spirits of dead healers is considered vital to indigenous clinical practice, for without it there can be no healing. Kleinman (1980) noted
that the healer’s ability to communicate with the spiritual world raises the patient’s hopes of a cure and lends credibility to the healer’s models.
In general, Geertz (1960) and Koentjaraningrat (1979) have both pointed out that traditional healers are engaged in some other occupation besides to medicine. They might be blacksmiths, dalang (the puppeteer in the wayang performance), farmers, civil servants, religious teachers or indeed many other professions. Nowadays, a healing practice can bring some money or material rewards but initially healers were unwilling to accept payment for their medical services because in the traditional system they are not supposed to benefit from the medical help they have offered.
As Adimihardja (1991) states, the Sundanese view of the universe consists of four basic elements: fire, earth, water and air. These elements are regarded as existing in a harmonious equilibrium. Therefore, any disturbance to this balanced state will definitely affect human life. This worldview is carried over into the concept of health and illness as well, and the vision of the human body is that it is composed once again of four essential elements which are soul, mind, heart and flesh. These elements should also remain in equilibrium. When the Sundanese express their concept of health, they use the words ‘damang’ and ‘cageur’, which are usually used to indicate the state of their health. As ‘damang’ in the meaning of ‘healthy’ (sehat) refers to physical health, ‘cageur’ refers to a state of physical as well as mentally and socially desirable condition which is achieved neither by increasing happiness nor by reducing anguish; it is solely attaining a specific state of tranquillity or peacefulness.
Another fundamental concept in the Sundanese perception of health and illness is the balance between ‘hot’ and ‘cold’ substances in the human body. In this theory, ‘hot’ and ’cold’ represent two opposite conditions which should be maintained in equilibrium. Illness is thought to occur when the sense of balance of these opposing elements is interrupted. Foods, body fluids (blood and phlegm), diseases and treatments are classified according to their ‘hot’ or ‘cold’ qualities. An individual might be exposed to the elements ‘hot’ and ‘cold’ in three ways: (1) by the consumption of certain foods and beverages, but the actual temperature of these foods and beverages is mostly not important; (2) by exposure to the elements such as sun, water, wind. This is exemplified by the term masuk angin which literally means ‘the wind enters’. This is used to denote illness caused by exposure to cold or wind; and (3) by blood, for example, after childbirth (cf. Adimihardja 1991).
In addition, Laderman (1983: 35) points out that the practical application of this theory is the aim to reinstate the physical balance by the use of certain foods, sometimes jointly with a ritual offer (sesajen) which will reduce the excess element or increase the deficient element. Beliefs about the postpartum period are alike in all the theories of the humours5 as the new mother is perceived to be entering into a ‘cold’ state, since childbirth is followed by loss of blood, considered the ‘hot’ body fluid. Therefore, ‘cold’ foods are prohibited in the diet of the new mother. This ‘cold state’ will last until forty days after the delivery, after which she will be given her ceremonial discharge from this state. During the pregnancy itself women avoid consumption of ‘hot’ foods, since heat is regarded as unfavourable for the foetus. Another fear is that the consumption of ‘hot’ foods during pregnancy might stimulate a spontaneous abortion. Remarkably, the tape peuyeum, which is a mildly alcoholic kind of food made from glutinous rice prepared with yeast and regarded as very hot is consumed by women, with the aim of cleaning the womb of ‘dirty’ blood after giving birth. In the rural areas of West Java, a sick person is still usually treated with home-made remedies or ubar kampung concocted from medicinal plants. If the home-remedy did not show any improvement, the patient might seek treatment from a traditional healer, usually an elderly person and considered to be wise and experienced in the use of traditional medicine. In the Sunda Region, this traditional healer can
be called Anu Tiasa, Sesepuh, Dukun or Panarosan, and is usually also the head of adat
(culture) or head of an ethnic community or group practising traditional medicine. The traditional birth attendant, who helps in childbirth and gives treatment to mother and child after birth, is known as paraji or indung beurang. In the next important life-cycle ritual for a boy, circumcision is performed by a male-healer known as bengkong or dukun sunat. Usually the healers give their patients medicine derived from medicinal plants on the basis of knowledge they received from their ancestors.
As Adimihardja (1992) observes, people in West Java still believe in traditional healers, like the bengkong or dukun sunat for the circumcision of their child. Besides performing a circumcision, the dukunsunat also frequently performs a ceremony called helaran or carnival which is held at the time of circumcision (sunatan) to ensure that all goes well (nyalametkeun) at the circumcision ceremony. Actually, the main purpose is to protect against the malevolent presence of evil spirits which might possibly disturb the circumcision.
In the firmly female sphere, the traditional birth attendant or dukun bayi (paraji or indung
beurang), who are generally elderly women, are regarded as specialists in matters of pregnancy and childbirth by their community. Importantly, they also live in the community they serve and share the same social and cultural background; in fact they are no different from the other members of an average rural family. According to the Sundanese view, a childbirth may disturb the equilibrium between ‘hot and ‘cold’ substances in the body, hence the birth of the baby and the subsequent loss of blood (the hot body fluid), is seen as the entering into a ‘cold’ state by the new mother. Therefore, the birth attendant (dukun bayi) advises ‘hot’ foods and drinks to restore the equilibrium in the woman’s body. Moreover, as Laderman (1983) notes, pregnant women mostly desire sour foods and eat them without harm, hence sour fruits and vegetables are thought to be ‘cold’. Adimihardja (1991) states that food plants which are classified as ‘hot’ are used to normalise a ‘cold’ state of the body and those which are classified as ‘cold’ to relieve a ‘hot’ state of the body. During the pre-, peri-, and post-natal care, it is the dukun bayi who usually provides the general health care. During her treatment, the dukun bayi massages the patient and gives her herbal medicine to drink. The massage and herbal treatments form the main components in both maternal and general health care. In some cases, the dukun bayi also executes a female circumcision (sunatan). Just as all Muslims, Indonesian Muslims practice female circumcision as well. Generally, a dukun sunat
or bengkong conducts the circumcision when a baby-girl is about forty days old.
Currently, there is also a bidan, a government midwife who has graduated from a school for midwives (Sekolah Kebidanan) before she is assigned to a certain area by the government. In spite of this, most bidan (midwives) are not part of the community they serve and their education and standard of living often exceed those of most of the local inhabitants. Because of this distance, the dukun bayi (traditional birth attendants) are often consulted in preference to, or in combination with the bidan, since dukun bayi offer services which bidan do not include in their duties, such as massages and herbal treatments.
Notes
1 Jamu drinks are prepared from herbal materials such as leaves, bark, roots and flowers. All the ingredients are ground or pounded then added to a simmering pot of water. Afterwards the liquid is strained and put into bottles or containers. The concoction of herbal ingredients usually causes the jamu elixir to become dark yellowish in colour.
2 Becak drivers are the propellers of a becak, which is a vehicle converted from a bicycle by adding two wheels and a seat in front for carrying (at the most) two passengers. It is for hire and it will
carry passengers and goods from one place to another. The passenger seat is equipped with a folding hood to protect the passenger from the sun and the rain, including plastic sheets which can be rolled down to protect the customer from an occasional tropical downpour.
3 In this context, lontar leaves are the classical palm-leaf manuscripts from Bali (Agung 2005). 4 Lulur is jamu, in the form of herbal paste used for exfoliation to obtain a clean, smooth and
healthy skin.
5 The humoural medicine is an ethnomedical system of classical Greek and Persian humoural pathology which conforms to an equilibrium model. Foods, medicinal remedies, and other substances are believed marked both by (usually) unchanging Hot and Cold metaphorical qualities, and by fluctuating thermal temperatures that reflect environmental exposures of the moment. Health is thought to depend on maintenance in the body of a temperature balance, an equilibrium constantly threatened by the metaphorical and thermal forces to which it is exposed. An excess of metaphorical and/or thermal hot or cold insults, which upset this equilibrium, leads to illness, which is treated by therapies that conform to the ‘principle of opposites’, that is a Hot remedy for cold illness or a Cold remedy for hot illness. This ethnomedical system, widely known as the ‘Hot-Cold syndrome’, the ‘Hot-Cold dichotomy’, or, more appropriately, ‘humoral pathology’. [The capitalized first letter of words indicates humoural values and the lower-case letters indicates thermal temperature]. (Foster 1995: 355).