Between rivers, beliefs, and clinics: An anthropological study of health-seeking practices in the char areas of Gaibandha Sadar, Bangladesh

Abstract

Health-seeking practices in geographically isolated riverine islands (chars) of northern Bangladesh remain underexamined despite persistent climate vulnerability and infrastructural constraints. This qualitative study explores therapeutic decision-making among residents of Mollar Char and Kamarjani unions in Gaibandha Sadar. Drawing on 32 in-depth interviews, focus group discussions, key informant interviews, and field observations, the research examines how environmental instability, socio-economic precarity, and cultural belief systems shape patterns of medical pluralism.

Guided by the culture-centered approach (CCA) and the health belief model (HBM), the study analyzes how perceived barriers, risk perceptions, relational trust, and institutional accessibility influence healthcare trajectories. Findings indicate that traditional healers and informal providers constitute the primary entry point into care, while biomedical facilities are typically approached only when illness is perceived as severe. Maternal health vulnerabilities are shaped by the intersection of geographic isolation and gendered norms operating within limited-service availability.

The study highlights how therapeutic pluralism functions as both pragmatic adaptation and response to infrastructural constraints. Evidence-informed policy implications include strengthened referral linkages, mobile service integration, and context-sensitive health infrastructure planning for climate-vulnerable settings.