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Shankar, P. Ravi, MD

doi: 10.1097/01.ACM.0000433790.47501.c8
Medicine and the Arts

Dr. Shankar was previously professor, Department of Medical Education, and MBBS Phase I program coordinator, KIST Medical College, Kathmandu, Nepal. At present he is professor and chair, Curriculum Committee, Xavier University School of Medicine, Aruba, Dutch Caribbean; e-mail:

At KIST Medical College, a private medical school in Lalitpur, Kathmandu, all first-year undergraduate medical students have the opportunity to take a medical humanities course called Sparshanam (meaning “touch” in Sanskrit). The module uses case scenarios, activities, paintings, role-playing, and excerpts from literature to explore different aspects of the humanities and their connection to medicine. One such text is Sally Wendkos Olds’ A Balcony in Nepal: Glimpses of a Himalayan Village, which describes a series of visits made by two grandmothers (Olds and her friend) from the United States to a village named Badel in eastern Nepal. Olds describes the warm welcome they received and how, despite differences of language and culture, they were able to establish a relationship with the villagers. In this excerpt, Olds describes their guide Buddi’s experience with faith healing.

In Nepal and in most developing nations, the dominant health care system is rooted in Western medicine, but it has been grafted onto older, indigenous systems of medicine. For a variety of reasons (e.g., better educational facilities, stronger financial status), students enrolled in Western-style medical schools tend to come from urban areas. If these individuals are posted in rural areas after graduation, however, there is often a significant cultural gap between them and their rural patients. In many rural communities like Badel, faith healers and practitioners of complementary and alternative medicine play an important role in partially addressing physician shortages and providing care to rural populations. Faith healers are usually from the local community and enjoy the confidence and trust of the villagers.

We as practitioners of Western scientific medicine tend to look down on practitioners of other types of healing. Western medicine uses scientific evidence to test the safety and efficacy of treatments, and it is in a state of constant development driven by research. However, to dismiss other systems of healing as unscientific and not worthy of attention may be narrow-minded. With the increase in lifestyle diseases and chronic illnesses, the mind–body connection Olds discusses becomes increasingly important. Modern medicine has recognized the important role of the mind in sickness and health, and research to understand this connection is ongoing.

Faith healing is commonly practiced in many countries the world over, and there are many faith healers even in urbanized Kathmandu, Nepal’s capital. The relationship between Western medicine practitioners and faith healers is an uneasy and difficult one. Faith healers do not undergo any formal course of study, their theories of spirit possession and harm caused by evil forces cannot be proven, their practice is usually unregulated, and they are usually poorly educated. Often their recommended treatments, especially for certain psychiatric diseases, may do more harm than good. However, in minor illnesses the intervention of a faith healer may have psychological benefits, creating a sense of support and sometimes improving the illness. In many developing nations, faith healers are becoming directly involved in health care delivery. In Nepal they are used to diagnose and refer cases of lower respiratory tract infection, diarrhea, and eye diseases requiring treatment. They are also trained to provide oral rehydration salts and co-trimoxazole tablets and to instruct parents in their use for children.

Buddi’s experience highlights the ambivalence towards faith healing that develops as individuals become more educated. In developing nations with increasing education and Westernization, people often start to look down on indigenous values and traditions. Seeking understanding of these traditions through experience or through works such as Olds’ can remind practitioners of Western medicine of the importance of the art of medicine, and how the patient’s faith in the doctor is an important factor in the outcome of many treatments.

© 2013 by the Association of American Medical Colleges