Traditional practices of both preventive and curative health care have existed for thousands of years, and today they are often used in conjunction with modern medicine.
Of the over 476 million indigenous people in the world today; an estimated 42 million live in the Americas. They represent thousands of different cultures and ethnic groups whose survival is due, in part, to the efficacy of their traditional health practices.
Indigenous peoples in this region have, over several centuries, developed a complex series of practices as well as an understanding of the human body. During several trips to the region, I was able to see the use of traditional medicine among the population of the Andean countries.
In the South American Andean countries of Ecuador, Bolivia and Peru, traditional medicine still plays a prominent role in the health care of indigenous communities, particularly those in remote rural settings beyond the reach of governmental health services.
Equilibrium and harmony with nature is considered the basis for good health. Illness results when that equilibrium is altered. Healing is achieved when harmony is restored between the sick people and their environment. Health also depends on compliance with social norms and moral obligations. Clinics in some countries in the region practice both traditional and modern medicine.
A clinic in Ecuador
During a public health mission in Ecuador I visited the Jambi Huasi clinic in Otavalo, a town located 70 miles north of Ecuador’s capital Quito. The clinic has developed a highly effective approach to meeting the health needs of the indigenous people in the area. Jambi Huasi means “house of health” in Quechua, the region’s predominant language.
The clinic provides a blend of both modern and traditional medicine. Among the traditional practitioners are a doctor (yachac), a midwife (mamahua) and a chiropractor (jacudor). Western medical services include internal medicine, gynecology, pediatrics, minor surgery and dentistry. Each service also includes culturally appropriate counseling and health promotion activities.
According to Dr. Myriam Conejo, coordinator of Jambi Huasi, one of the center’s primary objectives is to link traditional and Western medicine while providing health care to the surrounding indigenous community. A second goal is to revive and validate the role of traditional healers, who are also considered community counselors.
Treatments are based on the holistic indigenous concept of health. As Conejo says, “We view the patient not only as an individual but as a biological, psychological, and social being, in relation to the family and the social environment.”
As an advocate of cultural understanding, Dr. Conejo has improved the health and quality of life of indigenous women in Ecuador. In 2006, she was honored by UNFPA (United Nations Fund for Population Activities) with the International Award for the Health and Dignity of Women.
Health Care with a Traditional Touch
Traditional medicine incorporates diverse remedies and practices such as the use of herbs, amulets, guinea pigs (cuys) and incantations to eliminate disease or cleanse the body. In Ecuador, over 900 different plants are used for medicinal purposes.
The Jambi Huasi center trains community volunteers and provides expertise to help locals create medicinal plant gardens. In addition, a mobile clinic regularly visits the 10 communities in the Otavalo Canton district.
As in traditional Chinese medicine and other ancient medical practices, a diagnostic procedure Ecuadorian healers use is looking at the tongue of the patient. Other practices include examining the urine in a clear container illuminated by candlelight; viewing a fresh egg that has been passed over a patient’s body (similar to a rural Laotian practice), and looking at a guinea pig’s innards after the animal has been held over the sick person’s body for signs of the person’s ailment. If an organ of the animal looks sick, it is believed that the same organ is also sick in the patient. This technique is also used among indigenous communities in Peru and Bolivia.
Luis Guambaña is a traditional healer and president of the Confederación de Nacionalidades Indígenas del Ecuador (CONAIE). His practice is located in Cuenca, Ecuador’s third largest city. In his view, the core of traditional medicine is the respect for the Pachamama, or Mother Earth, as well as for all living entities. This entails a particular world view, cosmovisión, which encompasses humankind and its role in the universe. It manifests itself not only in medical practices but also in the use of organic fertilizers, and in the respect for the mountains, rivers and natural water sources.
Some of the techniques used in traditional medicine in the Andes have come into vogue in the fashionable spas of Europe and the United States, and are part of the therapeutic practice of holistic alternative medicine. Examples are aromatherapy, lodotherapy (mudtherapy), and the use of flower extracts and crystals to help restore the patient’s natural balance.
According to Dr. Alberto Quezada R., former director of the Research Institute at Cuenca University, understanding traditional medicine is a prerequisite for indigenous people’s acceptance of modern approaches. “For example,” says Quezada, “oral rehydration salts for the treatment of diarrhea are much more easily accepted if they are connected with traditional medicine practice.”
Indigenous people in Andean countries believe that diarrhea is brought on by very specific causes, such as emotional states (anger or anxiety); as punishment by Mother Earth for failing to feed the earth shrines, to care for animals or to participate properly in community activities; bad wind; fright; excessive cold; or indigestion.
Each one of these causes, furthermore, requires a different remedy. Among the remedies that Andean indigenous people use are water from fresh plants, chamomile, egg and onion soup, dried banana peels, cinnamon, chocolate and coca teas, and bread and cheese.
An understanding of traditional practices and cultural preferences is also important when delivering babies. Indigenous women prefer to be taken care of by traditional midwives — and not just because of difficult geographic or economic access to modern approaches.
According to Dr. Alberto Quezada R., indigenous women prefer traditional midwives because they share the same background, values and beliefs, and they feel understood and respected by them. In addition, indigenous women dislike giving birth in clinics or hospitals because they feel that the professionals there don’t know their habits and values. They also believe that they run the risk of being operated on or perhaps even sterilized without their consent, a practice that was used among them in the past.
Indigenous women also prefer traditional midwives to physicians because midwives follow the traditional modality for delivery, with distinct and well-defined rites and procedures that are part of the cultural heritage of the communities where they live. Andean mothers dislike bright lights in the delivery rooms because they feel that they injure the baby’s eyes. The rooms where they give birth are normally kept almost dark, illuminated only by candles.
Dr. Quezada says that rural and indigenous women are reluctant to deliver if the doctor/healer is a man, if the process is not carried out at home, and if it is carried out in the horizontal position. There is the widespread belief among women in these communities that the best position for delivering babies is the vertical position, or kneeling down.
For Dr. Quezada, the most positive and salient aspects of traditional medicine are the use of herbs for treating disease, the belief that delivery should be carried out in the vertical position, and the use of manual techniques by traditional chiropractic doctors to deal with trauma of different kinds.
As Dr. Conejo of the Otavalo clinic says, “It is important that both the traditional and Western doctors become aware of the possibilities of each other’s medicine, which is why we strive to educate them both.”
Home births in Peru
In Peru, almost 50 percent of deliveries are conducted at home, mostly by traditional midwives or by a family member. Some sectors of the population are reluctant to use modern health care because women feel that it is too impersonal and does not take into account their emotional needs and beliefs. Traditionally, husbands in indigenous communities not only help during delivery, but also take care of the child after birth and help with house chores.
In Andean culture, the vertical position for delivery has an important symbolic value. It is believed that during delivery women should push downwards, towards Mother Earth (Pachamama), that protects both the mother and her child. The presence of family members during delivery is considered critical to provide the pregnant woman with an atmosphere of care, aside from helping in the process itself.
Although the practice of vertical delivery has a sound physiological basis, a joint study carried out by the Peruvian Ministry of Health and USAID did show some drawbacks of traditional practices for delivery. Among these are the lack of hygiene, insufficient knowledge of risk factors and warning signs and delayed care of the newborn.
Some traditional practices have been incorporated into the work of modern practitioners, such as allowing the presence of family members during delivery; using the vertical position for delivery; allowing pregnant women to drink teas believed to facilitate the process of delivery; and giving the placenta to family members for them to dispose of it according to traditional beliefs.
Bolivia’s traveling healers
Distrust of Western medicine among indigenous populations is also present in Bolivia, where efforts are currently underway to integrate the practices of modern health professionals and traditional healers called kallawayas. The Bolivian kallawayas still treat the sick with herbs and traditional rituals that originated in pre-Incan times.
Medical practitioners who deal with physical disease and specialize in herbal curing are called curanderos, while the hechiceros or yatiris deal primarily with mental disease and the cultural, environmental, psychological and social causes of disease. The hechiceros cure by joining the patients in a special ritual with members of their family and their community. In that context, the hechiceros’ role is to reveal this conflict and to redress it through a ritual, after which the conflict is resolved and equilibrium is re-established.
Bolivia’s kallawayas live in the province of Bautista Saavedra, northeast of Lake Titicaca, one of the poorest areas in Bolivia. From there, they travel by foot all over Bolivia and also to Peru, Ecuador, Chile, Argentina, and as far North as Panama (the word kallawaya derives from kolla–waya, which means “he who carries medicines in his shoulders”). After their travels, most of them return to Bautista Saavedra, where they grow potatoes, corn and wheat, and raise sheep and llamas.
The kallawayas share the same worldview as the traditional healers from Ecuador and Peru: that human beings should venerate Mother Earth and live in harmony with their environment. They believe that mountains have particular deities who protect those who live near the mountains from misfortune. The kallawayas fill an important need in these unique rural areas where there are no doctors, nurses or health posts.
Villagers here will eagerly await a visit by a kallawaya and hold deep respect for these healers and the knowledge they possess — which is carefully protected and cherished, being passed down from father to son in a language known only to them. It is called “Machai Juyai,” and probably dates from the days of Incan rule.
At the Center for Comprehensive Training and Services for Development in Bolivia, the traditions of the kallawayas are studied and modern health practitioners are trained in traditional medicine approaches. At the beginning of the XX century, a former priest and anthropologist Joseph E. Bastien wrote, “Kallawaya curers can, for example, calm mental illness by floripondio [datura], a nightshade plant from the Solanacea family, set bones with plaster of Paris casts, and stretch muscles with frog skins…Their pharmacy includes remedies that are nature’s equivalents of aspirin, penicillin, and quinine and others that have yet to be discovered by modern medicine.”
Although many more studies and clinical trials are needed to assess the effectiveness of traditional medicine, these efforts show that rich cultural and medical traditions have a chance to be used and preserved for future generations.
Dr. César Chelala is an international public health consultant.