Health in the Andes: The Modern Role of Traditional Medicine (Part II)

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 don't know their habits and values, and they believe that they run the risk of being operated on or perhaps even sterilized without their consent.

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.”

In Peru, almost 50% of deliveries are conducted at home, mostly by traditional midwives or by a family member.

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.

The vertical position for delivery has been practiced for centuries in Peru, as illustrated in a copy of a pre-Incan piece of pottery that shows a woman standing upright during delivery while being helped by a man holding her from the back.

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), who 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 as 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.

Of the deliveries carried out at home, 83.2% of them happen in rural areas that have a slightly higher maternal mortality rate than the national average.

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 according to traditional beliefs.

The official status of traditional medicine in Peru changed dramatically in 1990, when the National Institute of Traditional Medicine was created as an autonomous entity under the Ministry of Health, says Dr. Fernando Cabieses, head of the institute.

Scientists, public health administrators and other traditional medicine experts work in 17 branches of the institute to strengthen the links between traditional and modern medicine. One of its activities is promoting the study and identification of medicinal plants to be industrialized and exported.

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 their acceptance of an intimate relationship between the body and the land, the indigenous peoples in the Andes look to their bodies as a guide to understanding the land (and vice versa). As anthropologist Dr. Joseph W. Bastien has remarked, "The community and mountain interphase with the physical body, and disintegration in one is associated with disorder in the other."

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 llama.

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.

As Bastien has written, "These mysterious medicine men, who are rapidly passing from the scene, nevertheless remain the hope of the incurables and are the healers of the Indian… Because doctors and nurses are scarce in the Andes, traveling curers treat the sick in places where doctors refuse to live".

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.

The Pan American Health Organization (PAHO) (the regional office of the World Health Organization (WHO) works with the academics, scientists and traditional healers, here and elsewhere throughout the Americas, to study the potential use of herbs and traditional medicines.

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.