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Traditional Medicine of Karen, Nepali, and Iraqi Refugees
March 2011
Joseph Huang
Karen Refugees
Background:
Among indigenous groups in Burma (or Myanmar,
the name proposed by the ruling junta in 1989), Karen is
the largest one, with Burmese being the major ethnic
group. Other indigenous groups include Shan, Chin,
Mon, Rakhine, and Katchin. Karens’ origins are thought
to be Tibet and Yun-Nan, China, and Karen actually
consists of different Tibetan-Central Asian ethnic groups
that speak at least 12 mutually unintelligible languages,
85% of which belong to S’ghaw or Pwo language
branches. However, most Karens also speak some
Burmese, the language of the ruling junta. As of 2006, it
was estimated that there were at least 6 million Karens
living in Burma and 400,000 in Thailand. In the Thai
refugee camps, 70% are S’ghaw Karen, 7% are Pwo
Karen, and 13% are Karenni. Sixty-five percent of
Karen refugees are Christians, with the remainder
practicing traditional animism, Buddhism, and Islam.
The religious, ethnic, and political differences often
result in tensions among Burmese ethnic groups.
Karen Culture and Traditional Medicine:
The different religious beliefs have acculturated
themselves with Karen values and practices.
Specifically, Karens incorporate much of Indian
Ayurvedic medicine and Chinese medicine, while they
retain traditional animist beliefs of omnipresence of
spirits. For example, Karens believe that each person
has 37 kla. Some kla live in the body and some live in
the environment. Karens believe that loosing kla makes
one ill, and they try ways to keep kla around. Kla can be
kept by tying a string around the wrist by an
elder/shaman (when an infant is born, a string is tied
around the infant’s wrist to keep his kla). However, kla
still can become detached from the body during
vulnerable times (e.g., sleep or contact with a dead body),
or when a person is attacked by one of the spiritual
powers.
With respect to the human body, Karen people
traditionally believe that the head is the highest and most
respectful part of the body. It should not be touched by
another person. They see the abdomen as the seat of
passions and diseases, which should be especially
protected. Along with the belief that bodily conditions
are a result of interplay of wind, fire, and water (wind is
associated with pride, ambition, and evil desires, etc.;
fire is associated with envy, hatred, and revenge, etc.;
water is associated with peace, love, and patience, etc.),
Karens place great emphasis on using diet and herbal
remedies for health purposes. As one Karen proverb
puts it, “food is medicine, and medicine is food.”
For Karens, therefore, health and illness are
considered in spiritual categories, and they are to be
preferably treated by natural means. For example, health
is associated with harmony among body,
mind/soul/spirit, and the universe. As one’s health is
understood in terms of hot and cold, he would require
treatment with food or medicine in the “cold” categories
when he suffers fever—the “hotness.” Another good
example is that a postpartum woman should rest for one
month, without touching cold water or eating anything
cold. They should eat only rice and soup, hot and spicy.
Because diet plays such an important role in regulating
the human body in harmony with the world, adjusting
levels of tastes (i.e., sour, sweet, bitter, salty, cold, and
hot) in the diet are also used to treat a given illness or to
serve as a preventive measure (i.e., especially bitter and
sour foods).
Karen Environmental Social Action Network
(KESAN) has published at least three references on
Karen Traditional Herbal Medicine in Karen and
Burmese languages. In a study on Karen’s attitude
toward their healthcare experience in the U.S., Dr.
Oleson summarizes several commonly used traditional
medicines among Karen refugees, including common
household items (turmeric, ginger, garlic, honey, table
vegetables, and sesame oil.), plant-based items (roots,
herbs, leaves, fruits, flowers, trees, and mixtures-tulsi),
and animal-based items (snake gallbladder, bear
gallbladder, hen-fat, and the bone, horn, and tongue of
white goats). The interview reports also reveal that even
Christian Karens resort to praying to spirits for healing,
and that Karens sometimes use both traditional medicine
and Western medicine to ensure complete healing.
Challenges:
Although Karens who have had exposure to Western
medicine in refugee camps do not usually oppose
visiting doctors, some Karens still may be embarrassed
and hesitant to talk to their American doctors. For
example, having a vaginal exam in front of male staff
might be a reason that keeps a pregnant lady away from
the hospital.
Karens sometimes see vitamins as medicine and use
them while taking traditional remedies. An interviewee
from Dr. Oleson’s study said that many pregnant women
take more prenatal vitamins than necessary because they
think one tablet a day is not enough. Combining this
with traditional medicine, most pregnant women suffer
from many side effects.
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Because much of the Karen diet consists of rice and
hot chili peppers, likely secondary to their traditional
medicinal beliefs, gastric ulcers are common. Their use
of turmeric (a spice in the ginger family) on babies
sometimes is mistaken for jaundice.
Nepali (Lhotshampas) Refugees
Background:
Ninety-seven percent of Nepali refugees are
actually Nepali-speaking Bhutanese (aka. Lhotshampas,
People of the South, living in southern Bhutan; they are
ethnically Nepalis) who fled from Bhutan to stay in the
seven refugee camps in eastern Nepal since the 1990s.
The remaining non-Nepalis are the Sharchop, Drukpa,
Urow, and Khenpga. Although Lhotshampas have been
living in Bhutan since the 17
th
century and make up 35%
of the Bhutan population, the Bhutanization policy
imposed in the mid 1980s subsequently forced many
Lhotshampas to flee to Nepal, where some refugees
sought asylum in Western countries, and some
determined to fight for the right to return to their own
country.
Most Lhotshampas speak Bhutanese and Nepali, and
those who have attended schools, especially the younger
Lhotshampas in the refugee camps, speak English (35%,
as estimated by UNHCR). Because of the refugee
camps’ proximity to India, Indian culture/influences are
also seen among Lhotshampas. About 60% of Nepali
refugees are Hindus. Other religious groups include
Buddhists, Kirats (traditional animism), and Christians.
Religion and caste status play an important role among
these groups in the refugee camps.
Nepali (Lhotshampas) Culture and Traditional
Medicine:
The majority of Lhotshampas still retain their
traditional Nepali practices while living in Bhutan. The
Lhotshampas who practice traditional medicine see
sickness as imbalance of human passions and/or evil
spiritual influences. Heavily influenced by Hindu
Ayurvedic medicine, Lhotshampas regard wind, gall,
and mucus as three important humors whose
disequilibrium causes disease. The idea of harmony also
comes from Chinese, Buddhist, and Tibetan traditions.
The animist element is found in the practices of some
traditional shamans (dhami-jakhri) who focus on re-
establishing these balances.
The concept of health and disease has much to do
with karma and a person’s relation with his universe.
For example, spirit(s) can inflict harms on a person. The
diet and environment also affect one’s health. To give
strength to babies, for example, they massage a crawling
infant with mustard oil and place him under the sun. In
a study about the Bhutanese perception of malaria,
Lhotshampas are among those who thought malaria is
caused by bad air and by staying in the rain and sunshine.
Therefore, Lhotshampas place great emphasis on food
choice and harmony with the environment.
Western medicine is acceptable among this
population, but it is often put to use after the traditional
remedies fail to achieve the desired results. Common
home remedies, which Lhotshampas are reluctant to
reveal to their American doctors, include basil for
treating coughs and colds, garlic, turmeric, ginger, and
cardamom for stomach aches, and heated mustard oil for
massage to relieve muscular pains.
Challenges:
While less prevalent among the younger generation,
the belief of caste system still has some impact among
the elderly, affecting the roles and arrangement in the
household. Distinct gender roles sometimes do not
allow women to have equal decision-making authority in
the family/community. Women may also be hesitant to
discuss their own health; they often express their
concerns for their spouses and/or children. Because
topics on sex are treated as taboo in traditional
Lhotshampa society, many refugees have not been
exposed to sex education or health related topics.
Lhotshampas also lack the concept of preventive
care, such as routine well child checks or gynecological
exams. They often wait to seek modern medical help
until they fail to respond to home remedies and become
really sick.
Iraqi Refugees
Background:
Decades of wars and conflicts have caused more
than 4.7 million Iraqis to resettle in other countries,
including Syria, Jordan, Egypt, Iran, Lebanon, Turkey,
and other western countries. Because there were Iraqi
immigrants to the U.S. prior to the war, some Iraqi
refugees actually have relatives in the U.S.
Iraqis consist of Arabs, Kurds, and other minorities,
including Armenians, Assyrians, and Turkomen. The
majority practice different traditions of the Islamic
religion (i.e., Shiite, Sunni, Kurds). Shiite Muslims are
the majority, but Sunni Muslims take positions in
politics and military. Although only 3% of Iraqis are
Christians, they make up a large portion of the refugee
population relative to the size of their population. For
example, more than 20% of the Iraqi refugees who fled
to Jordan are Christians.
Major groups among Iraqi refugees include political
dissidents and/or surrendering-deserting members of
Saddam Hussein’s army, Shiite Muslims, and
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Turkomens. Religious persecution is another reason for
Iraqi refugees seeking asylum. Common among these
Iraqi refugees is the fact that they are generally
knowledgeable about the West, often well-educated, and
experienced in the professional workforce.
Iraqi Culture and Traditional Medicine:
Before the war and the rise of fundamentalist Islamic
groups, Iraq was considered a relatively secular state.
During the 1970s and 1980s, many great modern
medical care services and doctors could be found in Iraq.
However, since the Iran-Iraq war and subsequent
conflicts, medicine in Iraq started deteriorating, and
many physicians were lost due to these conflicts.
Iraqi women are well integrated in the workforce
with positions of prestige such as judges, scientists, or
teachers, and there are a few Iraqi elites who no longer
observe their religious practices, but the influence of
Islam still exists. For example, among Iraqi refugees
who are more conservative Muslims, some may refuse to
take medications or treatment during the daylight hours
of Ramadan.
Several traditional Iraqi practices include using
cumin and egg yolk heated in water, dipped onto a rag
and placed on forehead to treat fever. Dental pain is
treated by putting on the gums a powder made of cumin,
ninia seed, and shabak seed. Other topical treatments
include a burn treatment, which involves applying barley
mixed with butter onto the skin as a dressing for 48
hours. Inflammatory symptoms in tonsillitis are treated
by having an adult/elder insert their fingers into the
mouth to push/squeeze the tonsils to alleviate
inflammation. Conjunctivitis is treated by placing a
cloth boiled in tea over the eye. A heated brick covered
with a cloth, on which a person sits, is sometimes used
to treat diarrhea. Joint dislocation is treated with
application of ninia and churned butter mix. Application
of flour dough mixed with sugar is used as a treatment
for cysts, splinters, and pimples.
Some Iraqi women use Henna dye to dye their hair
for migraine headaches. Circular tattoos over the temple
regions are also used to treat migraines. The dye and
tattoos with words, like Allah or Ali, are considered
protection from evil spirits.
Iraqis make many home remedy juices for medical
treatment. Cumin powder dissolved in water or green
tea is used for abdominal pain. Other options for
abdominal pain include Karawya, an herb boiled in
water, which is used for abdominal pain, diarrhea, or
constipation. For diarrhea, lemon juice and plain rice
may also be used as alternative treatment. To alleviate
flank pain, some Iraqis drink juice made from handel (a
kind of bitter fruit). Honey/lemon/orange juice is given
for treating coughs, and anise seed boiled in water is
given to treat sore throat/laryngitis.
Challenges:
While the Iraqi refugees are generally very receptive
to Western medicine, more conservative Muslims view
preventive healthcare as in conflict with their belief of
divine predestination. That is, God has already
appointed a destiny for mankind, and it is not
appropriate to alter this destiny with human intervention.
References:
1. Abdullah, A. and Moussa, M. “Iraqis.” 2006. Refugee Health-
Immigrant Health. 25 March 2011
es.htm>
2. Background Note: Bhutan. 2010. U.S. Department of State. 14
March 2011.
3. Background on Potential Health Issues for Burmese Refugees.
2010. Office of Global Health Affairs. 10 March 2011
.html >
4. Barron, S., et al. “Refugees from Burma-their backgrounds and
refugee experiences.” 2007. Cultural Orientation Resource
Center. 10 March 2011
5. Dhamanda, S. “Traditional Medicine of Bhutan.” 2002. Institute
for Traditional Medicine, Portland, OR. 14 March 2011
6. Dziedzic, C. “Karen-Burmese Refugees—an orientation for
health workers and volunteers.” 2006. Queensland Health. 10
March 2011
efugees1.pdf>
7. Ghareeb, E., et al. “Refugees from Iraq.” 2008. Cultural
Orientation Resource Center. 25 March 2011
8. Maxym, M. “Nepali-speaking Bhutanese (Lhotsampa) Cultural
Profile. 2010. EthnoMed. 14 March 2011
lhotsampa/nepali-speaking-bhutanese-lhotsampa-cultural-
profile/?searchterm=bhutan>
9. Neiman, A., et al. “Karen Cultural Profile.” 2008. EthnoMed. 10
March 2011
profile>
10. Oleson, H. “Health and Healing: Traditional Medicine and the
Karen Experience.” 2009. Minnesota Department of Health-
Metro Refugee Health Task Force. 10 March 2011
eal09.pdf>
11. Ranard, D. “Bhutanese Refugees in Nepal.” 2007. Cultural
Orientation Resource Center. 14 March 2011
12. World Directory of Minorities and Indigenous Peoples -
Myanmar/Burma : Karen. 2008. Minority Rights Group
International. 10 March 2011
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