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Hindawi Publishing Corporation Journal of Anthropology Volume 2013, Article ID 987584, 9 pages http://dx.doi.org/10.1155/2013/987584 Research Article Health: Cognition and Threshold among the Oraon Tea Garden Labourers of Jalpaiguri District, West Bengal 1 2 3 Subrata K. Roy, Sujata Kar Chakraborty, and Arupendra Mozumdar Biological Anthropology Unit, Indian Statistical Institute, 203 B.T. Road, Kolkata 700 108, India CINIYUVA, Child in Need Institute (CINI), Golpark, Kolkata 700029, India Population Council, 42 Golf Links, 1st Floor, New Delhi 110003, India Correspondence should be addressed to Subrata K. Roy; email@example.com Received 17 September 2013; Revised 15 November 2013; Accepted 29 November 2013 Academic Editor: Kaushik Bose Copyright © 2013 Subrata K. Roy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There is scarcity of health information in many subpopulations in India, which needs to be explored for formulating eeff ctive public health policy. Studies on the tea garden population revealed that poor socioeconomic conditions, ignorance due to illiteracy, culture and food habit, overcrowding, and unhygienic living conditions make the population vulnerable to various communicable and noncommunicable diseases and malnutrition. Data were collected from the labourers of Birpara and Dalgaon tea gardens of Jalpaiguri district, West Bengal. The objective was to identify the primary health care available vis- a-v ` is the health problems. eTh results were based on mortality data, subjective well-being, frequency of ailment symptoms, perceived health status, and selected health practices as well as some observations, which indicate their cognition and threshold regarding health problems, presented as case studies. Mortality rates were high in the population; comparative mortality data shows no considerable change in mortality rate over time and space. A very high frequency of anaemia was prevalent among females along with sore throat and abdominal pain. Perceivedhealthstatusofmostofthe people wasgood,althoughthatwas notalwaystrue, becausethe perception of thepeople oen ft depends on their threshold and cognition about health and disease. 1. Introduction alcohol and tobacco . eTh re are also other health problems, which are related to their occupation. It is well known that the tea is an important agroindustry Roy  reported that though the individuals of the tea of West Bengal and Assam in Eastern India, which holds a gardens feel ill (sometimes they do not feel ill despite having considerable potential for the economic development, as it the illness), the society does not permit them to become sick earns substantial foreign exchange and provides employment (in the tea garden the term “sick” carries some special mea- to a large number of unskilled labourers in India . Tea ning that the sick individual has the liberty to enjoy leave industry opened up new occupations and exercised a consid- with 80% of pay provided the tea garden doctor considers erable influence on the socioeconomic life of the people. the individual sick). Furthermore, people do not like to go It has been revealed from many studies that poor socioe- to the hospital for ailments like fever, stomach pain, or pro- conomic conditions, ignorance due to illiteracy, overcrowd- blems like cough and cold, skin diseases, and other minor ing, and unhygienic living conditions in the residential colo- ailments. Actually, tea garden labourers work hard in a harsh nies make tea garden population vulnerable to various com- environment to meet their basic needs and health is not municable diseases and malnutrition. Scattered reports indi- always their rfi st priority. eTh rfi st priority is to earn for food cate higher prevalence of undernutrition and infectious con- and shelter. ditions like filariasis in this population [ 2–6]. A recent study It is worthwhile to define some of the terms, which have showed that NCDs (noncommunicable diseases) like hype- been used in the present paper. Primary health care denotes rtension is emerging as an important public health problem essential health care based on practical, scienticfi ally sound, among them, which may be partly due to the excessive use of culturally appropriate, and socially acceptable methods. 2 Journal of Anthropology It is universally accessible to people in their communities, 2. Materials and Methods involves community participation, is integral to, and a central Data were collected as a part of a biomedical project to assess function of the country’s health system, and is the rfi st level the health status of the tea garden labourers belonging to the of contact with the health system. It includes family planning, Oraon group from the Birpara Tea Garden and Dalgaon Tea clean water supply, sanitation, immunization, and nutrition Estate in the Jalpaiguri district of northern West Bengal. Data education that are designed to be ao ff rdable for both the poor were collected on demography, morbidity pattern, nutri- people who receive the services and the governments that tion and diet intake, physical activity, anthropometry, lung providethem; theemphasisisonpreventingdisease as well as function, blood pressure, and haematometry. For each kind curing it .Cognition is a mental function such as the ability of data,samplesizes varied.Morbidity data were collected to think, or being aware of thoughts or perceptions, including from 206 males and 294 females. Details of all other kinds understanding and reasoning [10–12]. Threshold indicates of data were published elsewhere [18, 19]. No statistical the starting point for a new state or experience, which is sampling of the individuals has been done because of some considered to be the smallest detectable sensation [13, 14]. In difficulties in the eld fi such as suspicion against selection other words, threshold is that point of the discomfort that of individuals for better medical or other social benefits by triggers any act to get away from the discomfort or smooth agreeing to participate in the study. But the participants were it out. The definition can be easily understood with the chosen without any conscious bias; actually the participants following example. eTh “normal” body temperature of human whocould be persuadedtoparticipate in thestudy and is considered as 98.6 F; however it varies across individuals. volunteered for participation in the study were included in So if somebody’s temperature falls within a range of say +/−1F the sample. of 98.6 it is considered as “normal” and the person does not The Oraons are numerically dominant in the Jalpaiguri feel either “fever” or hypothermia, because the temperature is district and they are predominantly a larger group in most of well within the threshold. However, if the temperature raises the tea gardens in the district as well. Oraons are well known up to 100 or 101 F many people may feel that they have fever. for their efficiency as tea garden labourers because tea garden They will start looking for medicine or will visit a doctor to authoritiesusedtopreferOraonsthanthe locals,because consult but may not stop going to work. This is because the local people used to suffer from malaria very frequently, temperature is high enough to trigger a treatment seeking which hampers the work of the tea gardens. Oraons are sup- behaviour but have not crossed the threshold for stopping posedtobethe inhabitantsofChotonagpur andSantalpar- work. If the temperature rises up to 102 or higher, the person ganas of Bihar (presently Jharkhand State); they were brought may seek an admission to a hospital and with a great certainty into this area by the labour contractors as labourers in dieff - will notgotowork. rent industrial sectors (especially in the tea gardens) at the Reliable information on health problems of a population end of the last century . Linguistically the Oraons belong is an essential prerequisite for formulating health care system to the Kurukh or Dravidian speaking group . The study to address health needs. Various sociodemographic factors, wasrestrictedtoanendogamousand single ethnic group— nutritional improvement, improvement in health infrastruc- the Oraons. tures including eradication, elimination, and control of major The tea gardens are situated in the northeastern part communicable diseases are mainly contributing to a health of the Jalpaiguri district, which forms the foothill belt of transition and disease pattern in India, where communicable the Himalayas, where the elevation gradually increases from and deficiency diseases are gradually receding while noncom- the alluvial plain to about 2000 meters and above. Owing municable diseases (NCDs) are escalating. However, among to the proximity to the hills, the rainfall is heavy and the thepoorsocio-economicgroups, thepaceofepidemiological temperature is excessively high. eTh atmosphere is highly transition is slow, where communicable diseases and under- humid throughout the year. Usually tea garden authorities nutrition are still the major causes of disease burden [15–17]. engage all adult members (both sexes) of a simple family in India is a vast country and variation occurs in the disease the garden work and each individual labourer gets an average pattern due to the socio-economic gradient and other factors. monthly payment of Rs. 1200/= (U.S $20 approximately) plus There is scarcity of health information in many subpo- food grains at subsidized rates. Beside these, the labourers are pulationsinIndia,which needstobeexploredfor formulat- also provided with free housing, piped water, free medical ing eeff ctive public health policy. facilities for family members and education facilities for The information available on primary health care and children up to primary level. According to census 1991 , problems of the tea garden labourers are not adequate for theliteracyrateofJalpaiguridistrictwas 56%for malesand public health planning. eTh present paper is a part of a 33% for females but in the tea gardens the literacy rate was large bio-medical survey conducted among the tea garden too low (18% and 7%, resp.). labourers of Birpara and Dalgaon tea gardens of Jalpaiguri eTh results of the present study are based on the following district, West Bengal. The objective of the present paper is to kinds of data: morbidity pattern, perceived health status or identify the primary health care available to the people vis- subjective well-being, selected health practices, and some a-vis ` the health problems. eTh ndin fi gs will allow discussing qualitative observations on cognition and threshold of health their cognition and threshold regarding health problems status of the participants, presented here as case studies. All against the backdrop of their socio-economic condition and these data were collected among the adult members (≥18 lifestyles, which will have important public health implica- years of age) of the sample using the pretested questionnaires tion. Journal of Anthropology 3 from earlier studies by the rfi st author [ 8, 22–25]Data available: lightpinkand lightblack;mostofthe patients had on morbidity pattern included self-reported frequency of been givenany onekindofthatsyrup irrespective of the ailment symptoms in last three months among and were disease or illness. (6) There was another clinic of the garden, collected along with other demographic parameters . which was situated 3 km away from the hospital and was run Data on perceived health status or subjective well-being were by the pharmacist (Compounder) supported by an assistant. measured by asking the adult participants to rate their current (7) Most of the assistants had education up to primary level state of well-being into a ve fi scale rating: “very good,” “good,” andsomeofthemusedtomovearoundthe labourer linesin “fair,” “bad,” and “very bad”. eTh question followed by some order to see patients, who were incapacitated to move to the additional questions on why they perceive their health-status hospital or clinic for treatment. (8) It is generally known that as reported. Because there is hardly any objective method most of the antibiotic medicine has some specific dose, which to measure cognition and threshold of perceived health had never been maintained. status, the observations (case number) were presented here This was the picture of the treatment provided by the tea as supporting data; those were several incidents observed by garden authorities to the labourers, but there was exception, the rst fi author throughout the efi ld work of 10 years among that the ocffi ial staffs and managerial staffs used to get proper the study population. treatment. All data for this study were collected by doing eld fi work Now, it wouldbebettertoclarify some points through at different spells throughout the year between 1982 and 1992. some specicfi cases. eTh ethical committee of the rfi st author’s institution revi- ewed all the aspects of scientific research involving human Case Number 1. A middle-aged woman whose age was around subjects.Thebloodsamplesforthelargerbiosocialstudywere 40 years, found to suffer from acute tuberculosis; she refused collected aeft r verbal consent form the adult participants and to participate in our spirometric survey, where maximum their family members using n fi ger prick; no residual blood forced expiratory volume was required to be measured. eTh samples were stored for any future use. refusal was caused by the knowledge that she was sueff ring from tuberculosis and might cough fresh blood during forced expiration. She visited Tea Garden Hospital 2-3 times and 3. Results little medicines had been given to her each time but the It would be worth to mention some background information doctor did not consider her as sick because sick means that regarding medical facilities available to the labourers of the the sick individual has the liberty to enjoy leave with 80% of Tea garden. tea garden labourers get free medical facilities pay. Ultimately, she died aer ft a year or so. Doctor said that from the hospital of the respective tea garden for their family. full dose of the medicines is never handed over to the patient Each tea garden has a small hospital of its own, which is (labourer) because labourers have the habit of consuming 3-4 generally run by one doctor and few assistants irrespective of tablets at a time assuming quick recovery, sometimes all at a labourer strength of the garden. Some observations had been time, and sometimes their small children consume tablets; it made during 3 and 1/2 years stay at the Birpara Tea Garden creates severe problem. Hospital: (1) to an outsider Tea Garden Hospital atmosphere was very beautiful, with a well maintained flower garden Case Number 2. Generally, no childbirth had taken place where a variety of seasonal flowers were always refreshing the in the hospital, although a number of childbirth occurred hospital atmosphere, hospital rooms, beds, and surroundings during that time at their respective homes with the help were very clean unlike other PHC (Primary Health Centre) of local untrained midwives of the labourer line. Generally, or BPHC (Block PrimaryHealthCentre) or city hospitals thebirthplaceusedtobeinanunhygieniccorneroftheir in India. (2) Generally no patients were allowed to become kitchen. Most of the pregnant women of the labourer line admitted in the beds of the hospital to keep the hospital were askedfor antitetanusdoses,but no womanusedto clean and to avoid burden of care like food and nursing; complete the doses, because of ignorance, pain due to all the patients were treated as outdoor patients irrespective injection, and so forth. Sometimes they were given a packet of seriousness of the disease. (3) In most of the cases, the containing 100 iron (iron with folic acid) tablets but only 2- doctor used to listen to the problem of the patient(s) for a 3 tablets were consumed and rest of the tablets were thrown moment and was used to prescribe on a very small piece of away because it causes constipation. People do not prefer to paper without any physical examination. (4) The medication come to hospital for mere childbirth. Neonatal and postnatal (e.g., tablet, syrup, etc.) was always followed by an injection. cares were far beyond expectation of the newborn mothers eTh syringe and needle were generally cleaned/disinfected except stipulated leave. The obvious and resultant eeff ct was once in the morning with boiling water and the same was that the newborn used to be small and weak; therefore, used throughout the day. Most of the times the assistants infant mortality rate was high. In case of birth complication used to draw a large amount of medicine in the syringe sometimes the mothers also die. In case of diarrhoea of and was used to inject the patients one after another to at the newborn, many parents of the labourer family did not least 4-5 individuals simultaneously without proper cleaning think their babies were seriously ill even if they were slowly or changing the needle. (5) Pharmacist (Compounder)(the dying from dysentery. Dehydration was not associated with person whousedtoassistthe doctor andprepare medicine) diarrhoea nor was it considered to be life threatening. Most of used to preparesomekindofsyrup with some formulation the parents tried to avoid seeking treatment from Tea Garden mixed with a huge amount of water; two types of syrup was hospital. ey Th used to consult with local herbalist and black 4 Journal of Anthropology magician (ojha)(as well as religious practitioner, who performs andwas advisedtoconsult doctor.Theman took theadvice some ritual for driving out evil demons or spirits from places, very casually because he did not realize any health problems persons, or things in which they are thought to dwell)and out of this and was feeling tfi (due to low level of cognition). sometimesusedtogotogarden hospital if theirchildrenwere He continued his work in the tea garden without consulting very ill or had developed a physical disability. the doctor and died suddenly aer ft 3 months. Beside these, there are many other case studies, which Case Number 3. No labourers irrespective of age and sex were have not been illustrated here. It is apparent from the case willing to visit doctor or hospital in case of minor ailments studies that people of the tea garden especially the labourers like fever, headache, stomach problem, cough and cold, skin are careless and very reluctant to visit or consult doctor diseases, and so on. os Th e ailments were not considered by for their health ailments due to poor cognition and lack of them as disease, because the doctor would not allow them to awareness. In many instances, it had been found that the get sick (leave with 80% pay) for these ailments. When they doctor was operating or stitching any severe wound of the become incapacitatedorunabletodoany work,thenitwas patient without any anaesthesia; the assistants were forcefully considered to be a disease. eTh cognition of disease of the holding the patient with outdoor table. The patients felt tea garden labourer revolves around the concept of sickness pain but not to that extent which was intolerable to them. concept of the tea garden. Although, in general sickness refers It obviously reflects that the sensation or the level of body to disease and/or illness and may be defined as a process with discomfort was at the high end in other word the threshold worrisome behavioural and biological signs, particularly one level of pain feelings was at the extreme level of those people, that originates in a disease and is given socially recognizable whichalwayshelpthemtofeelfitand neverbotherwith meanings. er Th efore, sickness is a process for socializing minor ailments. To our knowledge, there is no objective disease . Any kind of disease (diagnosed or undiagnosed), method to test the threshold level of body discomfort or to curable or noncurable, was accepted by them very casually, measure tolerance limit of pain or body discomfort of human even if it was a cancer or something equally serious. being. eTh refore, the observation may give some light on the issue. Case Number 4.Onedayitwassurprisingtoseeamalepatient Now let us look at selected health practices of the people (age around 50 years) admitted to “infectious disease block” and subjective assessment of health and reported ailment of the Tea Garden Hospital. It was heard that the patient symptoms. Table 1 shows some selected health practices and was sueff ring from a severe problem of kidney failure. In perceived health status of Oraon tea garden labourers of the evening, the patient was missing, the doctor was very Birpara and Dalgaon tea estate in Jalpaiguri district. eTh angry, and then the night guard (Choukidar) of the hospital subjects were asked about their perceived health status during informed that the patient had gone to see video films in one-week preceding the survey and 82.5% of the labourer themarketplace.Atlatenight,the patientreturnedtothe reported that their health status is “good” (even if they were hospital and survived for a day. suffering from any long-standing diseases like heart problem, TB, and so forth, this may be their nature of answering Case Number 5. During health survey, the blood pressure questions or to avoid other discussions). In case of other measurement was taken of a man (aged around 57), it was health practices, 76.5% reportedly kept regular meal times found that the systolic and diastolic blood pressure was (workers usually take a meal at 6:30 am, then a lunch at 3:00 184 mm-Hg and 140 mm-Hg, and he was advised to visit pm and dinner at 8:30 pm) 93.7% got enough food to eat doctor immediately and take rest. He did not understand as and 73.8% consumed nonvegetarian foods during one-week to why such measurement is harmful for his health and went prior to survey. A large number of Oraon tea garden labourers away for consuming country liquor. Next day, we heard that (89.7%) informed that they did not keep any domesticated the man died last night with severe heart arrest. animals inside the house because they felt that it might cause diseases. Majority (83.7%) of the study population informed Case Number 6. During the survey, once we noticed that that they drink water from tube well (which is around 50 feet aBlack magician (Ojha) (of the same community) was deep and it is primarily surface water). Majority of the house arranging to make some performances in the courtyard of a provided to them by tea garden authority had no toilet, and home.Wecametoknowfromour guidethatanunmarried hence they use the riverside (61.4%) for easing and ease inside woman (aged around 20) of that house was not experiencing the tea garden (36.8%). her monthly periods for the last 4-5 months and she was not The subjective well-being and frequency of reported pregnant (reported by the local midwives). eTh woman was ailment symptoms often provide important information on very weak and bed ridden; the performance was to please the health status of individual as well as population. At this gods.Weadvisedherparentstogotothehospital,andconsult point, the prevalence and pattern of diseases in the study doctor. Aeft r two days the patient was admitted to hospital, area may be worth mentioning. Hooker and Hunter anddoctortried hisbest. Unfortunately, it wasafailure,  reported malaria as an endemic disease in the locality because the patient party tried with indigenous medicines even in the nineteenth century. eTh y had added a few more earlier and came to hospital at the last stage of the patient. diseases to malaria like enlarged liver, splenetic afflictions, anaemia, goitre, diarrhea, and dysentery. eTh West Bengal Case Number 7. During haematological survey, a man (aged District Gazetteers, Jalpaiguri district , furnished a more around 35)was foundtohaveahaemoglobinlevel of 4.5g/dL. or less similarlistofdiseasesonthe basisofhospitaldata. In Journal of Anthropology 5 Table 1: Selected health practices and perceived health status. Response Frequency Percentage Health practices (𝑛=446 ) Yes 341 76.46 Keep regular meal time No 105 23.54 Yes 418 93.72 Get enough food to eat No 28 6.28 Yes 329 73.77 Consumption of sh/me fi at/egg in the last week (preceding the survey) No 117 26.23 Yes 46 10.31 Habit of keeping cattle, pig, and other animals inside the house No 400 89.69 Tube well 373 83.63 Source of drinking water of the household Well/river 5 1.12 Piped water 68 15.25 River side 274 61.43 Inside the TG 164 36.77 Easing habit and place Railway line 6 1.35 Toilet 2 0.45 Very good 2 0.45 Good 368 82.51 Self-assessment of present health status (at the time of survey) Fair 29 6.50 Bad 43 9.64 Very bad 4 0.90 Birpara tea garden helminthic infection rate was reported to than males. A very high frequency of anaemia was prevalent be 99.07% . among females. Skin disease is comparatively high among However, Table 2 shows the frequency of occurrence malesmay be duetopoorhygienichabitsthanfemales. of ailment and nutritional deficiency symptoms of the tea Table 3 represents infant and adolescent mortality rates garden. eTh data may have some unavoidable limitations of Oraon married females working as tea garden labourers of like possibilities of under- or overreporting due to recall Birpara and Dalgaon tea estates. The table shows that both lapses. eTh frequencies of occurrence of ailment symptoms infant and adolescent mortality are relatively high among the have been categorised as “most frequent” (>50%), “frequent” mothers of 45+ years age group and low among mothers aged (25%–50%), and “less frequent” (<25%) for the convenience 25–34. The total infant and adolescent mortality are 15.50 and of explaining the result. eTh “most frequent” category of 25.04, respectively, among Oraon mothers of the tea garden. ailment is absent among male labourers. The ailments like However, according to 1991 census , infant mortality rate cough, anaemia, sore throat, abdominal pain, headache, of Jalpaiguri district was 6.1. backache, skin disease, chest pain, and diarrhoea are “fre- Comparison of mortality data of Oraon tea garden labou- quent” ailments prevalent among the male labourers. No rers of Birpara and Dalgaon tea estate, Jalpaiguri district, with case of blindness, chicken pox, and leprosy were reported. other comparable populations has been presented in Table 4. All other ailments are “less frequent” among males. Among eTh table shows that infant mortality rate was found to be females, the “most frequent” category includes ailments quitelow in thepresent studypopulationthanSantals and like anaemia, sore throat, backache, headache, cough, and Birhors . The adolescent mortality is higher among the abdominal pain. The ailments like coughed out phlegm, chest Mundas of Ranchi district and lower among the Oraons of pain, diarrhea, and night blindness are the “frequent” ail- Andaman and Nicobar region compared to the present study. ments among female labourers. No case of blindness, measles, Infant mortality exhibits significant relationship with a filarial, and leprosy had been reported. All other ailme- variety of socioeconomic variables, which includes income, nts are “less frequent” among female labourers. birth spacing, family size, child rearing practices, and so forth The result indicates that a number of ailments show to be . It had also been observed in the present study that “frequent” among males are “most frequent” among females poor child rearing practices, hygienic habits, and the mother’s that suggests “males sueff r less than females” or in other health have a great influence over infant mortality though the way males perceive less sickness than females due to higher relationship has not been presented in the study because of threshold. Night blindness is relatively higher among females paucity of data. 6 Journal of Anthropology Table 2: Frequency and percentage of ailment symptoms. Male (𝑁=206)Female(𝑁=294 ) Reported ailment symptoms No. % No. % Sore throat or runny nose with fever 71 34.47 158 53.74 Coughed for more than a week 76 38.89 151 51.34 Coughed phlegm for more than 2 weeks 64 31.07 132 44.90 Coughed out blood more than a day at a stretch 3 1.46 1 0.34 Repeated indigestion and stomach upset 37 17.96 59 20.07 Vomited several times for more than a day 14 6.80 26 8.84 Diarrhoea more than 5 days 54 26.21 98 33.33 Abdominal pain lasting more than a day 72 34.95 147 50.00 Blood mixed in stool frequently 33 16.02 50 17.01 Passed worm 4 1.94 9 3.06 Fresh blood dripping with stool — — — — Repeated pain over the chest 57 27.67 120 40.82 Shortnessofbreathaeft rlight work 8 3.88 33 11.22 Sudden attack of weakness and fainting — — 7 2.38 Feeling tired frequently 11 5.34 37 12.58 Frequent backache 70 33.98 164 55.78 Frequent headache 71 34.47 164 55.78 Waking up with stiff joints 12 5.83 48 16.33 Fever with shivering more than 3 days 12 5.83 18 6.12 Pain in the ear for more than 1 week 4 1.94 20 6.80 Discharge from the ear for more than 1 week 1 0.49 9 3.06 Red eyes for more than 3 days 3 1.46 1 0.34 Night blindness 36 17.48 74 25.17 Blindness — — — — Skin diseases 63 30.58 72 24.49 Accident 1 0.49 — — Measles 3 1.46 — — Chicken pox — — 1 0.34 Diagnosed case of filaria 1 0.49 — — Diagnosed case of goitre 6 2.91 43 14.63 Diagnosed case of T. B. 3 1.46 3 1.02 Diagnosed case of leprosy — — — — Deficiency symptoms Cheilosis — — — — Glossitis 2 0.97 19 6.46 Angular stomatitis 2 0.97 3 1.02 Anaemia 73 35.44 238 80.95 Table 3: Mortality rate by age group of married women. Age group of Number of Total no. of live No. of deaths No. of deaths Infant mortality Adolescent married women married women births <1yr. (0–14) yrs. rate mortality rate (yrs.) <25 210 298 41 53 13.76 17.79 25–34 140 521 55 88 10.56 16.89 35–44 83 464 76 116 16.38 25.00 ≥45 160 1085 195 336 17.97 30.97 Total 601 2368 367 593 15.50 25.04 Journal of Anthropology 7 Table 4: Comparison of mortality data. Infant mortality Adolescent Population Area Source rate mortality rate Munda Ranchi district, Bihar — 29.82 Kumar et al.  Rangat and Mayabunder Island, Bhattacharya et al. Oraon —12.77 Andaman and Nicobar region  Santal Hazaribagh district, Bihar 18.52 — Verma  Birhor Hazaribagh district, Bihar 25.00 — Verma  Oraon Jalpaiguri district, West Bengal 15.50 25.04 Present study 4. Discussion of itspresence(becausethe individual lackssensitiveness and threshold level is at the high end) then there is no question The present study is based on cross-sectional data, which of knowledge and cognition of the discomfort. (2) The has inherent limitations and perhaps cannot depict the true individual is aware of its presence—(individual is sensitive picture of ailments and diseases of the community because and threshold level is at the lower limit) but neglecting it of theperceptionlevel of theindividuals.Seasonalvariation becausetheindividuallacksknowledgeandcognitionofwhat was also not taken into account. The possibility of under- are the consequences of such ailment/symptoms. estimation and/or overestimation of ailments and diseases In most of the cases described in the rfi st part of result cannot be ruled out, because of poor literacy level of the section, the individuals show lack of perception, knowledge, labourers especially of the females and, secondly, inability andcognition;their thresholdlimit wasatthe high end. Case of the individuals to express their problems due to poor number 1 showed that the individual was aware of the disease. cognition, lack of awareness, and a high threshold level of the However, ignorance and lack of knowledge and cognition physical discomfort duetoailment or disease. pushed hertodeath.Casenumber2again depictedsuch The health practices ( Table 1) of the people depict that ignorance about the future consequences. Case number 3 individuals’ claim of getting sufficient food to eat but the depicted that the threshold level of the people was so high actual situation is dieff rent because the food they are con- which did not allow them to feel the ailments or symptoms. suming is not a balanced diet. eTh y are consuming sucffi ient In Cases numbers 4 and 5, the individuals were completely amount of cereals (rice and wheat flour) to meet their hunger. unaware of their disease, because their threshold level was at Most of the individuals reported that their source of drinking the high end. Actually, they failed to perceive their physical water is tube well. It is true, but the tube well is 50 feet deep, discomfort in proper time, which debar them from seeking which has capacity to lift surface water only, and perhaps medical help. The threshold level of the present population is it is the primary reason that people oeft n sueff r from water very high which we call severity and crosses tolerance limit of borne diseases. It is very clear from the result (Table 2)that other populations of same time and region. females of the tea garden sueff r more than the males; even The term “threshold” here refers to the minimum sensa- vitamin deficiency diseases are more frequent among females, tion of body discomfort. Let us take an example of educated may be due to frequent child bearing or pregnancy. A very city people, who generally recognise any body discomfort at high frequency of anaemia among females was reported its inception and try to seek medical help. But the Oraon due to deprivation of food . Overall mortality rates tea garden labourers cannot recognize their body discomfort are higher in the present tea garden population (Table 3) early as described in Case numbers 1, 4, 5, and 7. Secondly, compared to census data of the district, perhaps due to living their threshold level and tolerable limit is very high, com- in unhygienic condition and poor nutritional status of the parable with severity and crossing tolerance limit (Figure 1) mothers. Comparative mortality data of the population shows of normal humans. So far, our knowledge is concerned; the (Table 4) that there is no change in mortality rate over time threshold level (which can be measured objectively to some and space (the present population is a migrated group). extent) varies individual to individual and there are wide Let us look to the schematic diagram, which explains variations within and between different sense organs (eye, ear, some of the relationship between major concepts more clear. nose, tongue, and skin). Again, the tolerance limit of physical Health is a complete state of physical, mental, and social discomfort has some individual variation. However, many of well-being. Anthropologists are primarily concerned with the body sensations, for example, pain, burning sensation, physical well-being because of its objectivity; therefore, any and so forth, are not objectively measurable [34–36]. deviation from physical well-being may be termed as illness. However, the individual should perceive deviation from However, interpretation and messages relating to body physical well-being at the inception and the perception devel- discomfort as well as tolerance limit of body discomfort can ops from the cultural background and make-up of the indi- be aeff cted by several factors, for example, (1) emotional and vidual. Again, the perception is also a product of knowledge psychological state, (2) memories of past pain experiences, and cognition. For an example, if an individual is experienc- (3) upbringing, (4) attitude, (5) expectations, (6) beliefs and ing a physical discomfort (ailment/symptom), then it can be values, (7) age, (8) sex, and (9) social and cultural influences thought in two ways: (1) the individual is completely unaware [37, 38]. All these sufferings (poor food and unhygienic 8 Journal of Anthropology health practices, which will help to understand the health Health problems more comprehensively. Treatment seeking behaviour Acknowledgments eTh authors are indebted to the people of the study areas for Severity of disease tolerance level their unhesitating help and cooperation. Tea garden autho- rities of Birpara Tea Garden and Dalgaon Tea Estate had Threshold level of physical provided necessary permission to work in the labour lines discomfort or pain owing to disease and deserve sincere thanks. Financial and logistic support hadbeengiven by theIndianStatistical Institutetoconduct Health ailments or disease this work. eTh study was performed in accordance with the responsible committee on human experimentation (Scien- Figure 1: The schematic diagram explaining the relationships ticfi Ethical Committee for Protection of Research Risks to between/among the major concepts of health related behaviour Humans, Indian Statistical Institute, Kolkata). (which is unique to any specific cultural group). References living) and the diseases (which are the resultant eect ff of  M. R. Choudhuri, The Tea Industry in India. A Diagnostic industrialization) made the simple living of Oraon tea garden Analysis of Its Geoeconomic Studies,OxfordBookandStationary labourers more complicated. Company, Calcutta, India, 1978. 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