other members of her family became sick with Chagas’ disease. Doctors Oscar Velasco and Francisco Delgadillo treated them and reported on how Juana experienced this disease and how she was treated. Velasco and Delgadillo are skilled in using ethnomedicine in conjunction with biomedicine. They do not subordinate one to the other, but respect each as distinct practices that converge towards a common goal of the patient’s health.
The Department of Potosi is situated in southwest Bolivia, between 18 and 23 degrees latitude and 65 and 69 degrees longitude. It is the fourth largest department in Bolivia and has 300,000 inhabitants living in a variety of ecological zones that range from 3,900 meters (13,000 feet) above sea level, where there is sparse vegetation, scarce rain, and permafrost, to valleys that range from 2,800 to 3,000 meters (9,200 to 9,850 feet) above sea level, where a moderate climate and fertile soil provide many agricultural products and where the majority of the population lives. The lower valleys constitute 38 percent of the territory; its natives speak Quechua and some Spanish. Other local ethnic groups are the Chichas, Chara, Calchas, and Yuras. Despite concerted European culture incursions, these groups have maintained traditional Andean cultures, especially the Calchas and Yuras, who are noted for their ethnocentrism.
Throughout her youth, Juana lived in this temperate valley climate, noted for its vast production of fruits and vegetables. Her parents worked as peasants for vast Spanish estates. During the colonial epoch, Spanish conquistadors and farmers entered these valleys to produce food and materials for the mines of Potosi, situated in a higher and drier zone. Spanish families and religious congregations divided the territory as they established adelantamietos (frontier posts), missions, and parishes. Farmers produced apples, apricots, figs, grapes, and vegetables, primarily to suit Spanish tastes.
Figure 18. Bolivian doctors Oscar Velasco (pictured here) and Francisco Delgadillo work with a patient (Juana C.). Velasco and Delgadillo are skilled in using ethno-medicine with biomedicine as parallel sciences in treating Chagas’ disease. (Photograph by Joseph W. Bastien) When Juana was fifteen, the Calchas elected her to be trained as a Responsable Popular de Salud (community health workerCHW) for their community (see Bastien 1990a for discussion of community health workers). Juana quickly learned how to provide basic medical treatment, give advice on health matters, refer cases to primary-health posts, and collect health data about the people in her community. She also educated Calchas about the care of infants, maternal care, family planning, and how to build a smokeless oven (horno loreno). Juana worked without wages for seven years as a CHW and was so successful that she received financial support to study as an Auxiliar de Enfermeria (auxiliary nurse) in Sucre.
Auxiliary nurses constitute the principal biomedical personnel throughout rural Bolivia. Doctors staff the hospitals in the municipalities and are required to do a year of practice in rural areas (ano de provincia). Many do this grudgingly, making little effort to speak native languages and even less effort to understand Andean culture. Juana excelled in the six-month course and became the first native nurse among the Calchas, receiving a monthly salary of fifty dollars in 1985. She worked in a Posta Sanitaria (health post), where she vaccinated people, attended birth deliveries, and administered medicines and first aid. She educated Calchas in their native language about their health.
Juana became the pride of her family and community, having established herself as the local link between ethnomedicine and biomedicine. She was commended by the Secretaria Nacional de Salud for her work in rural Bolivia. She remained poor, as was her family, but they loved one another and were happy.
The ecology of these Bolivian valleys had changed drastically since the Conquest due to vast deforestation to provide timbers for the mines of Potosi and also to the erosive action of rivers, which during the rainy season carry topsoil from plantations and peasant farm plots to lower regions. Especially devastating, floods and droughts of the 1980s, followed by economic hyperinflation, increased impoverishment and migration among the Calchas and others within these valleys.
These factors also made these valleys endemic areas for Chagas’ disease, with vinchucas inhabiting every community and infecting more than half the population with T. cruzi. People became accustomed to vinchucas, which many say are harmless and don’t bite. Others believe that their bite is only a minor irritation. The fact that the bugs’ bite causes death is foreign to their natural view of more gentle balance and reciprocity. Juana and others have been unaware of the biomedical realities of Chagas’ disease.
As a nurse, Juana dealt with the following cultural illnesses in Calcha: las camaras (diarrhea), la congestion (acute respiratory infections), las fiebres (fevers), las flegmasiasis (inflammation), orejo and susto (soul loss, depression), tabardillo (typhus), las tercianas (three-day fever), and colico miserere (deadly colic). The Calchas attribute these illnesses to a combination of cultural and biomedical factors: las camaras is due to imbalance of the hot and cold foods and unhygienic conditions; las tercianas to bad humors (malde aire, or malaria), susto to social concerns and the loss of fluids; la congestion to the concentration of fluids in the body and respiratory infections. As discussed in Chapter 3, Andean ethnophysiology adheres to a topographic-hydraulic model of the body combined with some aspects of a European humoral theory (balancing the hot and cold and the wet and dry) adapted from the teachings of Spanish missionaries (see Figure 11). Early missionaries taught humoral theory in medical schools throughout Latin America (see Foster 1978, 1987).
Colico miserere approximates the megacolon symptom of Chagas’ disease but also refers to volvulo (volvulus), which is the twisting of the bowel upon itself, and to ileus, which is blockage, both causing obstruction.[24] People of Potosi especially fear this cultural and symptom complex, which cannot be cured and causes death. Far from being caused by a parasite, colico miserere is thought to be caused by the consumption of either very fresh or left-over foods that produce gas and swell the stomach. If the person cannot ventosear (break wind) or zurrar (have a bowel movement) to dispel the cuezcos (cooked things), the stomach is thought to swell more and more until it shuts off the heart and the person dies. Potosinos say that “eating pork and drinking cold water brings colico miserere, and if someone does this, don’t ask why they died.” Eating fresh foods without “hot” foods also causes colico miserere; thus, eating cooked potatoes (a cold food because it grows in the ground) and not chewing coca leaves (a hot food) might cause colico miserere. Rarely do Potosifios violate these dietary practices, which effectively serve as preventative medicine.
All classes of Potosifios and ethnic groups suffer from colico miserere. Unusually fat people are prone to colico miserere. Signs of the oncoming illness are choking, fainting, and indigestion. They are called “personas estrenidas” (constipated, up-tight, and niggardly people), having a stomach that holds things in rather than in a more open exchange with the outside environment.
Juana was frequently called to assist births in neighboring villages and could be away for days at a time. One time, on her return, her mother, Donia Isica, complained that she was “muy estenida” (very constipated) and had been unable to go to the toilet for four days. Juana gave her an herbal laxative that relieved her. A month later, Dofia Isica again became constipated, and her husband, Don Yupay, took her to a famous curandera of Chalca, Dona Fonseca, who was ninety years old. Yupay also brought along coca leaves and a large white guinea pig that belonged to Isica. Fonseca greeted them with coca leaves and soon began divining by means of coca leaves and the guinea pig. Fonseca marked the leaves with neat bite marks to designate wind, road, water, and ajayu (spirit). For more than an hour, Fonseca debated with Yupay and Isica the cause of the constipation. Fonseca then dug her fingers into the belly of the guinea pig, laying bare its intestines, which were bloated with grain. She whispered slowly that Isica was cold in the stomach, most certainly because she had eaten pork and that she had been taken by a mal viento (bad wind). Wayra
