Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

7/31/2019 Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

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Can Andean medicine coexist with biomedicrural communities in P

Journal of Ethnobiology and Ethnomedicine 201

Sarah-Lan Mathez-Stiefel (sarah-la

Journal of Ethnobiology andEthnomedicine
mailto:[email protected]%7Dmailto:[email protected]%7D


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Can Andean medicine coexist

healthcare? A comparison of in Peru and Bolivia

Sarah-Lan Mathez-Stiefel1*

*

Corresponding author

Email: [email protected]

Ina Vandebroek2

E il i d b k@ b


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services provided, physical accessibility, and fin

practices such as childbirth. Preference for natural

with biomedical healthcare that was both accessibleshow that greater access to biomedicine does n

indigenous medical knowledge, as represented by

bound illnesses.

Conclusions

The take-home lesson for health policy-makers frouse of biomedicine in resource-poor rural areas m


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lower level. We combined a qualitative resear

households therapeutic strategies and use of reme

incidence of culture-bound illnesses in local ethnobi

Medical pluralism refers to the coexistence of variou

a widely used model developed by Chrisman and

overlapping sectors in pluralistic health care syst

provided by the sick persons themselves, their fam

2) the folk sector (health care provided by tr

bonesetters, midwives, mediums, and magicians); aprovided by practitioners and institutions in biom

di l h Chi A di d U


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located in two different countries, these study s

sociocultural, and ecological similarities despite di

services, as shown in Table 1.

Figure 1Map of the study sites [35]. Research wasDepartment of Cusco, Peru (a) and in Waca Playa SuDepartment of Cochabamba, Bolivia (b)

Table 1Variables of human development, health,

facilities in Waca Playa and PitumarcaWaca Playa (Bolivia)


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sites display a similar anthropogenic landscape, co

parcels, remnant patches of native forests (e.g. Po

Eucalyptus spp. and Pinusspp.), rivers, rocks, and gr

Figure 2View from the village of Tres Cruces in W

Figure 3Valley of Pitumarca, Peru. The town of P

Both study sites are inhabited by indigenous Q

community property rights over their territory afterand from 1968 to 1975 in Peru). At the village level


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and children up to the age of five living in condition

SEG (Seguro Escolar Gratuito), which gave free

under age 17 . In 2005, Peruvian Law 28588 extendof age, living in conditions of poverty or extreme p

ofPitumarca. The United Nations Development Prog

higher in Pitumarca than in Waca Playa, which im

higher income per capita, better education, and longe

Figure 6Waca Playas health post, Bolivia

Methodology


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Health-seeking behavior of households was investig

Households were invited to explain their concepts

common illnesses that occurred in their family, ththeir health-seeking strategies. Preliminary informa

to identify three prevalent strategies in the comm

remedies (medicinal plants, animals, and minerals);

visits to the health center. During the open-ended i

of these three strategies they chose as a first optio

option if the first strategy did not work. They

pharmaceutical or natural remedies (including plant

remedies they preferred. In addition, households w

h l h ki h i d f d id


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causes, and reference to the humoralhot/cold classi

American medical systems. The incidence of CBIs

percentage of total responses on medicinal use givefree listing exercises. A response is a report on th

household Z. The z-test for comparison of proporti

compare the results for the incidence of CBIs from th

Methodological limitations of the study

This work should be understood as an exploratorqualitative approach with quantitative analyses. Th


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In Waca Playa, half of all participants preferred c

option when self-treatment failed. Six of these nine h

in the healers knowledge to heal them or diagnos(which might include going to the medical post). F

medical post was more costly because they would ha

that the medical post was not efficient and did not he

Of the ten Pitumarquino households that chose the h

that they did not consult healers because there was n

CBI that required the knowledge of an indigenous

could be treated at home with natural remedie

h i l Th h h ld id h h


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the health center could treat new illnesses that cam

decades by means of pharmaceuticals and injecti

elsewhere in Latin America refer to the same corresponding choice of treatment made by local pe

the earlier concept of folk dichotomies in healt

concept see [42], cited by [5]. This categorization of

Aguils distinction between mythical and natura

of health and illness in Potosi, Bolivia [43]. Accor

result of aggression by a supernatural being procee

Pacha Mama (Mother Earth) that produces a lesion

contrast, a natural illness is aggression by an extern

i h l f h b d i h di i id


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Malamuds work on medical pluralism in the Boliv

individuals select from the various medical system

cultural identity and access to economic, social, apluralistic setting, another study showed that individ

etiologies consistent with their understanding of

negotiation [46]. These studies and our own result

various medical systems are fluid and that there ma

and conceptions between them [14].

The third consideration regarding households health

choices at the study sites were sometimes the

i f diff di l F


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10). Crandon-Malamud also recognizes that resista

of medical dialogue ([14], p. 32). Our results thu

can be simultaneously complementary and conflicNgokwey [9] in Brazil, who reported both m

pharmaceutical drugs and differential expectation

remedies, resulting from the perceived superiority of

Contrary to what other researchers have shown [5

seeking strategies of households in Waca Playa an

the level of access to biomedicine, except for some

both study sites, self-treatment with natural rem

d d Thi fi di i b d b h di


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Knowledge about culture-bound illnesses

The households from Waca Playa andPitumarca millnesses cured by medicinal plants, animals, or

purposes, these illnesses were grouped into 50 illn

sites, 17 of which can be defined as culture-bound

and described in Table 2, according to anemic pers

participants gave a total of 778 (Waca Playa) and 15

medicinal use of natural remedies,respectively. O

(Pitumarca) were omitted and reserved for further a

illnesses that were too poorly defined, such as seri


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Table 2Description of culture-bound illness categories (CBIs) and their incIllnesses (local names inQuechua and/or Spanish)

Symptoms and/or etiology

Arrebato Mostly experienced by women. Symptoms include headache, fe

Calorinterno Internal inflammation, fever; caused by heat exposure

Caracterfuerte, agitacin Strong character, irritability, agitation

Colerina, clico (W), clera(P)

Stomachache, headache, bitter mouth, nauseas, vomiting; caused

Costado Strong side pain, hemorrhagic cough, stomachache; caused by c

Empacho, clico (P) Indigestion, stomachache, constipation; caused by ingestion of c

Enfermedad de yatiri (W),

enfermedad depaqo (P)

Several illnesses cured or rituals performed by healers: possessi

divination and diagnosis, animal sacrifice

Enfriamiento, enfermedad

del frio

Stomachache, headache, body pain, cold feet; caused by cold ex

Japega (W), mancharisqa

(P), susto

Mostly experienced by children. Fright sickness: insomnia, co

an evil place, fright, and soul loss

Madre, erita (P), cncer (P) Experienced by women. Symptoms of uterine or ovary inflammswollen hands and feet, back pain; caused by heat or cold expos

Mal de bilis, hgado Biliary sickness: nausea, dry and acid taste in mouth, liver inflgreasy food, also caused by anger


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There was a significant difference between the incidPitumarca (42.8%) (z=8.428; P=


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knowledge and practices from indigenous and bio

achieved through a social learning process tha

biomedicine and indigenous medical systems baseequitable participation of representatives from existi

Competing interests

The authors declare that they have no competing inte

Authors contributions


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6. Elling RH: Political economy, cultural hegemodern medicine.Social Science & Medicine 1981

7. Hanazaki N, et al: Diversity of plant uses inAtlantic Forest coast.Brazil. Biodiversity and Cons

8. Caniago I, Siebert SF: Medicinal plant ecoKalimantan, Indonesia.Econ Bot1998, 52(3):229

9. Ngokwey N: Home remedies and doctors' rem

Medicine 1995, 40(8):1141.


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21. Hausmann Muela S, et al: Medical syncreTanzanian community.Social Science & Medicine

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23. Pool R, Geissler W:Medical Anthropology. Und

University Press; 2005:172.

24. Calvet-Mir L, Reyes-Garca V, Tanner S: Is t

knowledge and Western medicine? A case studyl f h b l d h d 4


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35. Mathez-Stiefel S-L, Vandebroek I: Distributi

knowledge in the Andean Highlands: a case study

Complementary and Alternative Medicine. 2012:18.

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Di ib i f l b d ill


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Waca Playa Pituma


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Waca Playa

61%17%

22% 0%6%Pituma

94

Figure 8

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Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia