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Encounters with Talsa:

Worship and Healing Practices for Measles among a
Rural-Urban Migrant Santal Tribal Community in
Orissa, India
Suchismita Mishra and Deepak K Behera
Department of Anthropology, Sambalpur University, Sambalpur
Bontha V. Babu
Regional Medical Research Centre, Indian Council of Medical
Research, Bhubaneswar
Yadlapalli S. Kusuma*
Centre for Community Medicine, All India Institute of Medical
Sciences,
New Delhi
Measles, in biomedical terms, is a common childhood
viral disease with 164 thousand deaths globally per year, and
it manifests through symptoms of cough, fever, body ache
and blotchy red rashes. The present paper reports the rituals
and practices related to prevention and treatment of measles
(talsa) among Santals of Orissa who have migrated from their
native tribal villages to the urban city of Bhubaneswar, the
capital city of Orissa State in India. It is based on
ethnographic data collected from Santal households and
traditional healers inhabiting four Santal dominated slums in
Bhubaneswar City. The data relate to beliefs about illness
etiologies, and folk systems of health beliefs more generally.
The present ethnographic study investigates objectively a
living worldview by stressing illness experiences and
management. The people believe that measles occurs every
year, especially if their village deity is displeased perhaps
because they have not given satisfactory offerings to the deity.
They also think that it occurs due to extreme heat, which the
body cannot bear. The blotchy rashes on the skin are
believed to come from the bone by breaking the bones, so it
appears on the body. To prevent measles in their area, the
majhialam (village head, here the head of the slum in which

*
Dr. Y.S. Kusuma, Centre for Community Medicine, All India Institute of
Medical Sciences New Delhi 110 029, India. Tel.: +91 11 26172832 +91 9868
110233; email: kusumays@gmail.com

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Santals are living) performs a ritual and subsequently every
household sacrifices a chick or a goat. On occurrence of even
a single case of measles, another ritual is performed to
prevent the spread of the disease. The paper describes these
rituals and their linkage with the belief system.
Key Words: Ethnography; measles; medical anthropology, migration;
tribal culture.

Introduction
Measles is an acute highly infectious common childhood
disease caused by a specific virus of the group myxoviruses. It
manifests through symptoms of cough, fever, body ache and
blotchy red rashes. References to measles can be found from
as early as the 7th century. The disease was described by the
Persian physician Rhazes in the 10th century as more
dreaded than smallpox. Measles is endemic virtually in all
parts of the world, and it is associated with high morbidity
and mortality in developing societies. In 1980, before
widespread vaccination, measles caused an estimated 2.6
million deaths each year. It remains one of the leading
causes of death among young children globally, despite the
availability of a safe and effective vaccine. An estimated
164,000 people died from measles in 2008, mainly children
under the age of five (World Health Organization, 2011). In
India in 2005, there were an estimated 92,000 deaths from
measles-related complications among children aged <5 years
(Million Death Study Collaborators, 2010).
Biomedicine applies biological and physiological
principles to understand and treat the disease clinically.
However, the traditional healing system comprises illness
etiologies and folk theories and various health beliefs. The
existing literature on traditional healing systems or practices
provides us with valuable cultural information. Sontags
foundational work Illness as Metaphor (1978) remarked that
the illnesses are socially conceived (Sontag, 1978). The
metaphors link together diseases cause, symptoms, body and
treatment, and cosmology such as mind versus body and
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nature versus spirit (Henry, 1999). As an analytic approach,

systems of beliefs and practices, whether scientific or
animistic, are to some extent able to explain embodied
experience and illness management. Suchman (1983) noted
that the need for health planners to understand the culture
of their population arises from the fact that the meaning of
illness, and behavioural responses to illness, are basic factors
influencing the reactions to public health programs. In this
study, we attempted to explore the metaphoric explanation
of measles used by a migrant tribal community of Santal
living in Bhubaneswar slums. These explanations suggest
that though the categories of natural have been separated
from spiritual, they are not easily separated in practice. It
provides more insights into beliefs that are central to
interpreting illness and its management.
Methodology
For the purpose of the present study, four Santaldominated slums in the city of Bhubaneswar were selected
on the basis of predominance of migrant tribal Santal
population. Most of the Santal families had migrated from
the Mayurbhanj district of Orissa State and a few from its
neighboring districts. To generate the sample for this study,
all four slums are enumerated. Subsequently, in-depth
interviews (Pelto & Pelto, 1978) were conducted with key
informants and traditional healers and parents of children
below the age of 14 years. The mother tongue of Santals is
Santali, however, all people knew Oriya, the local language
of the state. All interviews were held in Oriya. They were
audio-recorded with the consent of the respondents and
were later transcribed, translated into English, and
computerized. Content analysis was carried out by coding
the data. The data were subjected to thorough and repeated
reading. The data were coded while reading. The coded text
was reorganized under various themes, and inferences were
drawn.
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Results
Perceived causes and beliefs surrounding measles
Santalis refer measles as talsa. They also use a word
that relates to the mother goddess to refer to measles.
People report annual occurrence of measles in the
community. They believe that measles occur because the
village deity is displeased with them. It is believed that the
goddess may be pleased if they perform puja and offer food.
By doing so, the goddess may be pleased, and if the goddess
is pleased, she may leave their area for that year and will not
return until the following year. Measles is attributed to
extreme heat, which the body cannot bear. Thus they refer
to the cycle of seasons and weather conditions when this
illness usually occurs. The blotchy rashes of measles are
believed to originate from the bones, and come out by
breaking the bones and so will appear on the skin. Thus, it
appears that measles is attributed to naturalistic causes as in
the cycle of time the body is open to natural processes of
change and transformation when the weather changes or
is severe, the children get illnesses like measles. However, indepth interviews with mothers revealed that measles is also
perceived to occur due to specific personal causes, as a
mother during an in-depth interview stated that Measles is
another disease which is caused due to ones own fault.
Thus, processes observed naturally among people need not
be confined to elements that can be seen or appraised.
Endicott (1970) noted that in animistic thought the natural
world, including both living and non-living things, is
animated by souls possessing both consciousness and
volition. The personalistic components influence the
patterned cycle of events and may act on the daily lives of
humans. It was found that Santals recognize and account for
both personalistic and natural aspects of the cosmos in
explanations of illness, often leading to collective
interpretations for the causes of measles. Interestingly, given
the Santals use of natural causes of measles, a majority of
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respondents attributed the cause of measles to personalistic

explanations. These references were usually offered only in
response to our questions about the reasons for certain
rituals, rather than to our initial abstract questions regarding
the cause of measles.
Practices related to prevention of measles in the community
When investigating practices related to the prevention
and management/treatment of measles in this migrant
community, we found that ritual performances are enacted
as a measure of preventing and treating measles. It may be
noted here that the respondents from the community
(traditional healers, mothers, other community members)
neither recognize the vaccination against measles as a
preventive measure, nor do they seek treatment from the
hospitals (modern biomedicine). Ritualistic practices are
observed in the community to prevent and treat measles
both at the household and the community level. These are
as follows. To prevent measles in their area, the majhialam
(village head) performs a ritual every year. This ritual is
performed on makara sankranti day (the full moon day in the
month of January); according to Hindu astrology, makara
sankranti signifies the transition of the sun into makara rasi
(Capricorn) on the celestial path. It is performed to their
village deity (goddess) and maramguru (god). On that day,
every household sacrifices a chick or a goat, and pray to the
goddess and god that the coming year should be well, and
their area should be free from measles and other diseases.
They promise that they will sacrifice a chick or goat at the
end of the year, if everything goes well without much illness.
The day following makara sankranti is called Jahirabhanga.
Jahirabhanga is one of the most important festivals of Santals,
again in connection with measles. A ritual is performed on
this day by praying that measles should not occur during the
coming year. At the place of the ritual in the field, a plantain
(banana) sapling is planted. Then every male community
member tries to hit this plantain sapling with an arrow, using
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a bow. The person who successfully hits the sapling cuts the
sapling and carries it on his head to the majhialams house.
The person holding the sapling will be carried by fellow men
folk on their head. In majhialams house, the puja is held for
the god maramguru and the village deity. The village deity is
different for different villages/slums. The prayers are
offered to please the god and goddess, for the wellbeing for
the village and to prevent measles, and to prevent evil spirits
and demons from entering their area. The children are
given prasad, a food item such as puffed rice that is
considered holy as it is offered to the god/goddess. All men
will consume the inner spongy tissue of the plantain shoot
and also consume handia (home made rice beer). A curry is
prepared with this tissue and it is consumed only by the male
members, and not by the females.
Recognizing the epidemic of measles, ritualistic practices aimed at
preventing transmission, and treatment
When anybody in the community shows the symptoms of
the disease, particularly the rashes, the Santal perceive that
the disease has already entered their area and it will spread
to other households also. To prevent the spread of the
disease, another ritual called chadano is performed in the
house of the person with measles. To organize the chadano,
the village head (majhialam) calls everybody in the village
(slum) and collects money (around 10-15 rupees, equivalent
to US$ 0.2-0.3) from every household to organize the ritual.
The date on which the ritual is to be conducted is decided
by holding a meeting with the community members. For this
ritual, one new earthen pot, offerings such as banana,
coconut, puffed rice, panchami bhog (sugar balls like toffees),
vermillion and incense sticks are bought from the collected
money. On the day of the ritual, the household members of
the diseased person have to prepare one cake made of rice
flour by spending their own money. The village head,
majhialam and gunia/ojha come to this house to perform the
ritual. The affected person is made to sit facing the East
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direction. The gunia draws three lines of vermillion on the

floor anointed with cow dung to perform the ritual. He asks
the sick person to touch the rice cake, which has been
prepared by this household for this ritual. After that the
gunia offers the other items, which had been presented
previously to the goddess. The earthen pot is held by the
diseased person and again the diseased person returns this
pot to the gunia. After that the gunia touches the diseased
person with his broom by sweeping from head to feet while
chanting mantras. After that they place the offerings and
flowers, whatever have been offered to the goddess, into the
new earthen pot, which has been colored black. It is believed
that evil spirits cant touch the black color. The mouth of
the pot will be covered with red cloth. Symbolically, the red
cloth is the garment of the goddess. Then the gunia sweeps,
symbolically, throughout from the diseased persons house
to one lonely place where roads are intersected as a
junction. It indicates the driving away of the disease, or the
goddess who is responsible for the disease, so that the
goddess can go wherever she wants and they believe that the
goddess will leave the area. For that the gunia draws one line
with vermillion by chanting the mantras. It is believed that
the goddess cant come back from that place into the slum
(village). Thus these people, including majhialam and
gunia/ojha, consider measles as maa (the mother) and
present in the body of the diseased person.
All people perform puja to maramguru and their village
deity by praying that this disease should be limited to that
household only. For that they pray that they will give some
offerings, such as a goat or chick, after 6 to 7 months if the
disease is not spread across the village (slum). If the disease
is spread to other households, they do not perform this puja
and do not sacrifice chick or goat. Another belief prevailing
in this community is that juguni (some demon or evil spirit)
comes to their area to cause measles and kill people. Prayers
are offered to the god and goddess to protect them from
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juguni. In addition to the above, each household performs

another ritual to their ancestral spirits by offering banana,
coconut, panchami bhog (sugar balls like toffees), etc. The
puja is done by the male person and they offer handia rasi
(the supernatant portion in the upper layer of the pot of
country liquor) to their ancestral spirits.
Practices related to treatment/management
Once it is known that a person is affected with measles,
non-vegetarian food and some vegetables, including
pumpkin and spinach, are restricted. When probed why
these food restrictions are being practiced, the respondents
informed us that since the goddess has possessed, i.e., she is
present in the body of the measles patient, these foods are
not given. During this illness, body pain is more common
and people perceive that the pain is due to the reason that
measles (blotchy rashes) are unable to come out from the
body. People believe that it is better that the measles
(blotchy rashes) should come out of the bones. The
preferred food items during measles are fried rice, puffed
rice, and fried horse gram grains. These food items are
perceived to be beneficial, and it is believed that these fried
food items make the measles come out easily from the bones
and thereby help in relieving the pain.
Another practice in the community consists of
restrictions on the movements of the diseased person within
as well as outside the community, since it is perceived that
the disease spreads to other houses. The diseased person is
secluded inside the home for seven days. During these days,
he/she is not allowed to take a bath. Another practice is that
neem (Azadiricta india) leaves are spread on the bed of the
diseased person. It is believed that by doing so, the person
gets relaxed. On the seventh day, the diseased person takes a
bath with hot water boiled with neem leaves. It is believed
that by doing so, the person will be protected from evil eyes,
as the patient is considered to be sensitive to the evil forces.
The diseased person has to take a similar bath for seven
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days.
With regard to treatment of measles, no specific
practices are found in this community. However, restrictions
are laid down that they should not visit any modern doctor.
It was probed why they dont go to the doctor (allopathic or
homeopathic) for treatment of measles, since pluralistic care
is common and people are used to go to hospitals (including
homeopathic clinics, in case of children). The respondents
perceived that doctors dont know much about measles and
are not able to cure this disease. Also, injections are believed
to be contraindicated for measles. It is believed that
injections generally get in touch with the bones and hamper
the measles to come out of the body/bones. Thus measles
will remain inside the body and it may even lead to death if
it remains in the body. If anybody goes to the doctor for
treatment of measles, the person will be penalized and have
to pay a fine (in the form of money) fixed by the village
panchayat. They think that the disease will spread from that
house to other houses if he/she does not do puja and
instead goes to a doctor. It is believed that the goddess gets
angry if puja is not performed and may spread measles to the
other households also. Thus, the ritual is done mainly to
prevent the spread of the disease.
Discussion
As has already been mentioned, the person suffering
from talsa is subjected to seclusion. If the goddess is present
in the body of the diseased, it may be alerted, stimulated to
spread, angered or scared away (inward) due to
inappropriate behavior of the diseased person. Thus
violating the taboo, i.e., restrictions on movement from the
house, may lead to spread of the disease to other members
of the village. The ritual performed by majhialam (the village
head) is used as a means of communicating with and driving
away the measles-causing goddess. The majhialam addresses
the goddess ritually, asking her to come out of the body and
leave the village. The ritual is done both for curative and
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preventive purposes. The food and movement restrictions as

well as covering with neem leaves provide further
explanation for peoples belief system. These daily
household practices are designed to prevent disruption of
the natural process of disease manifestation in the body
and through which the measles goddess becomes
manifested. Though a majority of respondents knew about
the severity of the disease, seeking treatment from the
modern system of medicine is a source of controversy in the
community. In fact, it is a penalized offense in the
community. People believe that the injections prevent the
eruption of measles rashes from the body. Thus the disease
remains inside the body, leading to serious consequences
including death. Another finding is that the children in this
community are not generally vaccinated against measles. It
may be due to non-availability of free vaccination as well as
miscommunication arising from the belief system. It is found
that pluralistic healthcare seeking is prevalent and people
seek treatment from allopathic as well as other systems of
medicine (homeopathy and ayurveda) for other illnesses,
whereas strict restrictions on visiting the doctor for measles
are laid down.
Thus, in the present study of migrant tribal populations
of Santal, measles are attributed to the supernatural forces
and have no link with the modern concept of a virus causing
measles; and the practices surrounding measles are always
ritualistic in nature in order to please the supernatural
forces. Odebiyi & Ekong (1982) reported that in traditional
Yoruba society, episodes of measles are usually attributed to
a variety of causes that have no link with the concept of a
virus. Feyisetan et al. (1997) opined that traditional belief
systems may become less important for diseases for which
cheap and compulsory immunization is made available to all
children and there is public enlightenment on its benefits.
Under these conditions, parents are likely to obtain
vaccination for their children even when their perceptions
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of the etiology of the diseases have not changed. However, it

appears from the present study findings that the
communities are on a continuum of change and that the
traditional belief systems still play a crucial role for
particular diseases including measles. We believe so, because
in the present study community, pluralistic care is sought for
several other illnesses and allopathic medicine is believed to
be beneficial by the people. However, the perceptions
pertaining to the efficacy of the allopathic or modern
systems of medicine are not shared by the community. This
is reflected in the very low immunization rate for measles
among the children of this community and also by the
observation that none of the person suffering from measles
has been taken to the modern doctor. We noticed that the
immunization uptake for measles was not nil, although it was
quite low. Even on the background of a strong traditional
belief system and existing taboos, around 15% of the
children were immunized against measles (Swain & Mishra,
2006). Probably, in order to achieve better coverage and
utilization rates, the health systems efforts in reaching out
to these vulnerable communities and educating them should
involve the community leaders, traditional healers, and
parental groups.
Conclusions
Understanding the Santals perceptions on measles
yielded insights into their beliefs and practices related to
illness etiology, treatment and prevention. The explanation
given for the cause of measles, in terms of involvement of
the goddess, shed light not only on the integration of
natural and personalistic aspects of disease etiology, but also
on a poor track record of biomedical practices for treatment
and prevention of measles. Timely immunization may be
encouraged by incorporating the illness etiologies that are
meaningful to Santals into explanations that are provided to
them by the healthcare providers at the time of vaccination
and other services. It is necessary to put efforts in educating
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the community members with the help of community

leaders, traditional healers and parental groups about the
scientific cause of measles and about the available preventive
measures and treatment.

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