The Kiss of Death

is the wind deity that brings the rains and droughts, as well as good and evil.

Isica and Yupay feared Fonseca’s diagnosis of colico miserere with its fatalistic implication, so they asked the curandera to pichar (sweep) the sajjra wayra (troublesome wind) away from her stomach by means of a picharada ritual. Fonseca mixed fat from a black hen with copal and hediondilla (Cestrum matthewsii Dun). She stroked Isica’s stomach in a dispelling motion, praying in Quechua, Sajjra Wayra, purijchej (“Be gone, troublesome wind!”). Fonseca left later that evening to deposit the ritual items with money attached at the crossroads so that someone else would find it and carry the evil to their house.

Isica improved, and the family resumed its daily activities. Towards the end of that year, Jovita, a thirteen- year-old sister of Juana, began complaining of chest pains and such fatigue that she felt like falling asleep even while herding goats. Juana examined her and found nothing abnormal. She gave her injections of vitamin B, saying that this would give her energy. Her grandmother said that Jovita was losing too much blood through menstruation and recommended that she drink fresh blood from a freshly sacrificed hen. These folk remedies were unsuccessful, however, and Jovita had to work sitting down. She complained that her legs were so weak that she couldn’t walk, and she lost her breath at the least exertion. She also still had pains in her chest.

Juana reported Jovita’s symptoms to the doctor at the regional hospital, who diagnosed the malady as nervousness and prescribed tranquilizers. He also said that she probably had some irritation in the liver or lungs that was causing the pain. He prescribed an injection of magnesium sulfate.

In September, a few months later, a child arrived at the house to inform Isica that Jovita had passed out while harvesting corn. Isica found the girl lying in the chacra (field). Jovita was trying to vomit and was gasping for breath. She felt very dizzy. Isica gave her chamomile and rose-hip tea, wrapped her in a blanket, and carried her home. After remaining in bed for two days, Jovita again felt “completo” (normal).

Around Carnival of the following year, Juana’s family celebrated the coming of Lent. They danced, drank, and ate for three days. A week later, Isica complained again that she had been unable to defecate for four days. Juana and Jovita rubbed her stomach with chicken fat and herbs, as the curandera had recommended. They gave her tea as a purgative.

Two nights later, Isica became very vexed. At first, it seemed like indigestion; she complained about a severe stomachache. Towards morning, Juana massaged her mother with a solution made from burro dung and boiled hediondilla. Isica got worse and her stomach enlarged. By sunrise, Isica suffered intense pain and could barely breathe. Her stomach was pushing against her heart.

Juana called a nurse from the neighboring health post, who diagnosed it as volvulo. She prescribed an enema but they couldn’t insert it. In desperation, Juana and her father transported Isica in the back of a truck to the hospital in Potosi. The truck traveled for five hours along winding and bumpy roads that agitated the bloated stomach. Isica screamed in pain.

In late afternoon Isica arrived at the public hospital. A doctor said that he needed to operate and wasn’t sure what might happen. Juana said that they didn’t want an operation, only some medication to relieve the pain. The doctor then told them to leave and asked the orderly to remove them from the hospital. His parting comments were: “These peasants wait until the last moment to bring their relatives to the hospital,… they expect miracles,… if the patient dies, they blame the doctor!” His remarks hurt Juana, who understood Spanish and had served the medical profession freely for five years.[25]

Feeling ashamed and rejected, Juana and Yupay transported Isica to a private clinic. An attending nurse explained that Isica’s lower intestines had become so knotted that she could not pass gas and other matter. She needed to be operated upon to remove the knot or she would die. Juanas father agreed and paid the U.S. equivalent of $200 to have the doctor proceed.

When the surgeon had finished, he said that he had removed part of the lower colon, which was damaged. He showed them a small hole on Isica’s left side, a temporary anus (colostomy) to be used until the intestine healed. In several months, he would tie the separated intestines together and Isica could defecate normally.

They were horrified. Yupay told the surgeon that he had said nothing about making such a hole. They argued, but it was too late; the situation could not be remedied. When Isica realized she had a colostomy, matters became worse. A foul odor came from the bandages, and she asked what caused this. Juana explained what happened. Isica said that they should have let her die. Isica refused to cooperate with the nurses when they tried to help her. They tried to instruct her to use a plastic bag to collect the excrement, but she refused.

Juana returned to her community several days later to plant the crops and take care of the cows and chickens. Villagers were coming in and out of her house, and a neighbor told her in tears that her sister Jovita had died that morning. The night before her sister had complained that the pain had returned to her chest. They had found her dead in her chacra, the field she owned and worked and in which she had her earth shrine. “At least,” as Isica said, “she died with Pachamama.”

After burying her sister, Juana visited her mother in the clinic and told her about the death of her youngest daughter. Isica remained silent for a long while and then screamed, “Why do we have to suffer so much?” The doctor arrived to comfort them. He then told Juana that Jovita likely had died from Chagas’ disease and that Isica was also suffering from it. He suggested that all members of the family be tested for it.

Some time after, Juana, Isica, Yupay, and Ramon, the youngest son, were tested for Chagas’ disease. Juana, Isica, and Yupay were found to be infected; Ramon was not infected. Juana has a damaged heart muscle and a slightly enlarged lower intestine. Yupay has severely dilated intestines that are developing into colico miserere. The doctor prescribed nifurtimox for Juana and Yupay to curtail their infection. However, they discontinued chemotherapy because they were unable to pay the necessary $200 a month, roughly equivalent to half a year’s earnings, for nifurtimox.

Dr. Oscar Velasco recently spoke with Juana at a conference for auxiliary nurses in Potosi. She still does not believe that vinchucas contributed to the death of her sister and to other illnesses. She said that peasants had always lived in houses with vinchucas and that they never got sick from their bites; and it is true that in the past vinchucas were not infected with T. cruzi to the extent that they are today. When Dr. Velasco asked her if she had ever seen vinchucas suck blood from humans, she said that vinchucas suck blood from animals but not from humans. Certain nongovernmental agencies have participated in housing-improvement projects to combat vinchucas in Calcha, but she admits that no one in her community pays much attention to their advice.

Of major concern to doctors in Bolivia is that peasants see little connection between severe constipation and possible T. cruzi infection. Constipation is associated with the eating of improper and unbalanced foods, and people with megacolon are said to have died from “dolor de barriga” (stomachache), “se ha hinchado la barriga” (swollen stomach), or “me ha dolido mucho y no he podido hacer qaqa” (severe stomachache accompanied by the inability to defecate). These frequently reported symptoms all can be attributable to T. cruzi parasites, although many Bolivians think they are caused by failing to maintain a balance of the hot and cold and wet and dry principles they associate with natural foods and other objects.

As mentioned before (see Figure 11), a native Andean understands his/her body as the center of a distillation process that takes in fluids (air, water, food) and processes them into useful fluids (milk, semen, blood, and fat) and toxic fluids (feces, urine, and sweat) that need to be eliminated. The circulation of fluids is believed to be a process of centripetal (fluids concentrating in distillation) and centrifugal (fluids going to the peripheral) motions. Volvulus, empacho, is understood as the stopping of the centripetal movement. This has cultural significance in that Andeans thus suffering are unable to connect with the blood and fat outside their bodiesthe energy and life forces of nature.

Chagasic Colonopathy

Chagasic colonopathy has two progressive stages (Koberle 1968: 95). The first stage features no dilatation