• 헤리티지:역사와 과학
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• 제37권
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• pp.243-266
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• 2004

필자는 2003년 7월 6일부터 2003년 7월 24일까지 중국 동북의 소수민족을 답사하였다. 답사 대상 민족은 허저족(赫哲族), 다우얼족(達斡爾族), 어룬춘족(顎倫春族), 어원커족(顎溫克族), 몽골족이었으며 답사지역은 헤이롱지성(黑龍江省)과 내몽골의 동북부 지역이었다. 본 고에서 연구대상으로 하는 민족은 퉁구스계 민족인 허저족, 어룬춘족, 어원커족이다. 그동안 한국의 청동기인을 형성한 것으로 인식되어온 퉁구스는 고고학적, 역사학적, 언어학적 증거로 볼 때 한민족과는 별개의 민족임을 알 수 있다. 물론 구체적인 결론은 각 분야의 학자들의 좀 더 심도 있는 연구가 이루어진 후에야 증명될 것으로 보인다. 그러나 현재 까지 이루어진 연구성과로 볼 때 한민족의 족원을 퉁구스에서 찾기는 어려울 듯하다. 퉁구스의 가신신앙과 한국의 가신신앙을 비교연구한 결과 마루신앙, 조왕신앙, 삼신신앙에 있어 공통점을 발견할 수 있었다. 그 원인으로는 두 가지를 들 수 있는데 하나는 전파나 접촉이고 다른 하나는 이주에 의한 결과이다. 전파나 접촉은 퉁구스와 한민족이 역사적으로 매우 근접한 거리에 거주하였기 때문에 발생한 것이고 이주는 고구려, 부여 등의 멸망으로 인한 유이민에 의한 것이다. 퉁구스와 한민족의 가신신앙은 위에서 언급한 공통점과 함께 차이점도 보인다. 첫째, 한민족의 가신신앙은 농경을 기반으로 형성된 것으로 정착형의 가옥에 집의 안과 밖을 구분하는 성속(聖俗)관념이 발달하였으나 퉁구스민족은 이동식의 주거인 시에런주(xierenzhu)를 기반으로 하기 때문에 집에 대한 성속관념이 한국보다는 약하다. 둘째, 한국의 가신은 신의 성격이 분명하며 신의 기능에 따라 모셔지는 장소가 다르다. 퉁구스의 경우 모든 가신이 마루(malu)에 모셔지며 일부는 가신이 아닌 신들이 모셔지기도 한다. 셋째 한국의 가신은 성주를 중심으로 가족을 이루고 있다. 퉁구스의 가신들 사이에 이러한 가족관계는 전혀 발견되지 않는다. 한국의 가신신앙을 중국과 비교할 때 가장 큰 특징이라면 성주신앙을 중심으로 혈연관계를 맺으며 단단히 결합되어 있다는 것이다. 중국의 가신신앙에서 성주는 강태공이나 치우로 한국과는 구분되며 중국의 가신들은 혈연관계를 맺고 있지도 않다. 한국의 가신신앙 중 측간신이나 조왕신의 일부 내용은 중국 한족과 관련을 맺고 있으나 언어학에서 문법이 그러 하듯 가신신앙의 기본 구조는 중국과 다르다. 이러한 견고한 틀을 형성하고 있는 한국의 가신신앙 중 마루, 조왕, 삼신이 퉁구스민족과 관련이 있다는 것은 한국 가신신앙에 퉁구스적 요소가 매우 중요한 역할을 하였음을 알 수 있다.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• 동양고전연구
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• 제69호
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• pp.297-324
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• 2017

이글은 조선후기 성리학이 균열되고 확장되는 과정에서 종교적 윤리성이 강화되어 현세의 윤리적 실천이 내세의 복으로 이어진다는 세속적 생활윤리로 변화되고, 또 한편에서는 유불도 사상이 결합된 도교 권선서가 유입된 이래 언해, 간행되어 민간에 널리 퍼져 생활 이념화되었던 상황을 배경으로 한다. 본고에서는 이러한 유교의 세속화 및 조선후기 권선서의 윤리적 이념성이 19세기 한글필사본 소설인 "저승전"의 윤리관과 연결되고 있음에 주목하여 19세기 권선서(勸善書)가 갖는 시대적 의의를 살펴보고 "저승전"의 이념성을 확인하고자 하였다. 조선후기 권선서(勸善書)는 크게 두 가지 축으로 구분할 수 있으니, 유교를 바탕으로 하되 귀신이나 명계(冥界), 선행으로 인한 내세의 복리(福利) 등 종교적 실천을 강조한 유교적 권선서와 주로 중국 도교 권선서의 언해로 유불도 사상이 결합되고 옥황상제, 문창성군 등 도교의 신을 존숭(尊崇)할 것과 선행으로 인한 복을 받은 이들의 예화를 적극 수록한 도교적 권선서가 그것이다. 이 중 유교적 권선서는 조선후기 경학 연구자였던 심대윤(沈大允)의 "복리전서(福利全書)"에서 그 일단을 찾아볼 수 있는데, "복리전서"의 서문(序文)에서 드러나듯 이 책은 일반 백성들의 행동 교화를 목적으로 하여 기본적으로 유학자의 입장에 있으면서도 저서 곳곳에서 귀신과 저승의 보응을 강조하여 천인감응의 인과론과 이승에서의 선행을 적극 강조한다. 심대윤의 사상은 성리학의 관점과 달리 내세와 보응을 중시하고 불교의 윤회설과 유사한 듯하지만, 이는 철저히 현실에서의 선행과 그로 인한 복리를 강조한 것일 뿐 귀신을 섬기거나 현실을 부정하는 종교적 태도와는 다르다. 조선 후기 권선서 유행의 다른 한 축인 도교 권선서는 충효 등의 유교 윤리를 권선징악적 입장에서 강조하고 그 실천을 통해 복을 누릴 수 있다는 것을 내용으로 한다는 입장에서 유교적 권선서의 태도와 유사하다. 다만 중국 도교 권선서의 언해인 경우가 대부분이라 도교의 신들을 엄히 신봉하고 탄신일을 지키며 일상에서 지켜야 할 덕목을 지나치다 싶을 정도로 세세하게 제시한다. 이는 현실에서의 행동 하나하나가 모두 신의 감시 하에 있으며 그에 대한 점수가 사후와 직결된다는 의식이 강했기 때문이다. 이들 도교 권선서는 임금의 명과 지식인들의 적극적 개입뿐 아니라 민간에서는 책을 간행, 배포하는 것만으로도 복을 받는다는 의식 때문에 파급력이 매우 컸다. 특히 도교 권선서에는 이승에서 선악을 행한 뒤 저승에서 겪는 구체적 사례를 매우 다양하고 방대하게 수록하였는데 도교 권선서의 이러한 서사성은 여성을 비롯한 하층민에게 도교 권선서가 효과적으로 영향을 끼칠 수 있었던 원인이 되었다. 생활 속 실천 윤리의 강조와 보응이라는 소박한 종교적 태도의 유교 권선서와 종교적 성향은 훨씬 강하긴 하지만 일상 생활에서 지켜야 할 행동 규칙을 세세하게 제시함으로써 권선의 목적을 확실하게 드러낸 도교 권선서는 종교의 차원을 넘어 조선후기 서민들의 일상 속 윤리 교과서의 역할을 효과적으로 담당하였다. 19세기 필사본 한글소설 "저승전"은 선승인 지선이 득병(得病)하여 저승에 다녀온 내용으로, 일반적 불교 저승체험담의 형식을 지니면서도 이념 지향 면에서 독특한 면모를 지닌다. "저승전"은 기본적으로 불교적 인물의 저승 체험이라는 불교적 외피에, 옥황상제나 각종 도교적 신들의 위계에서 보듯 도교적 상상력과 삼강오륜 등의 유교적 윤리가 어우러져 있다. 그중에서도 주인공이 목격한 저승의 심판 장면은 매우 구체적이고, 단지 추상적 선(善)을 강조한 것이 아니라 직분과 신분에 따라 지켜야 할 사항을 일일이 제시하며 이를 어긴 자에 대한 처벌 또한 상세히 묘사하였다. 이러한 "저승전"의 특징은 바로 19세기 권선서에서 일반 백성들에게 선행과 보응의 엄밀함과 선행의 구체적인 사례를 제시하여 생활 속 실천으로 이끌고자 하던 당시의 사회 문화적 분위기와 연결된다고 볼 수 있다.