The Kiss of Death

Physical aspects of the house touch upon cultural and social environments. Just as the parasitic cycle is dealt with in a total manner, so too housing changes need to be dealt with in a similar manner. This totality includes relationships of people to each other, to their animals and belongings, and to their shrines and household deities. For Andeans especially, the house is still revered as a place of the ancestors. Mummified ancestors were kept in houses well into the sixteenth century, until they were burned by missionaries. A few people still keep clothing of ancestors in their houses. Every house has a cabildo shrine for the male and another shrine for the female. The dead are said to return to the house at the celebratory Feast with the Dead.

• The spiritual spoke refers to the fact that many Bolivians include rituals and prayers in almost everything they do. If project personnel take a strictly secular and scientific approach to housing improvement, they will not be very motivational to peasants. However, project personnel should not use their religion as the spiritual axis. The spiritual axis appropriate to the community is the sum of that community’s religious beliefs and practices, including the cosmology, myths, and rituals of the community. Examples discussed were the use of a roof-thatching ceremony to improve houses, the inclusion of divination rituals before building a house, and the use of a dispelling ritual to get rid of vinchucas.

• The temporal spoke coordinates people by scheduling events and accounting for the intervals between events. Aymaras follow the path of the sun for their daily clock, and they follow the rainy and dry seasons for their agricultural cycle. Frequently, diviners throw coca leaves to determine when and where to plant. In general, peasants follow natural processes rather than the Western calendar. Project personnel continually complain that villagers don’t show up for agreed-upon tasks; however, the reason is that peasants have to take advantage of favorable natural conditions.

Peasants have very busy schedules with little free time to spend on outside projects. Women spin and weave, care for children, and listen to talks at the same time. Projects have to be woven into their schedule and according to their work load. Pilot projects had problems coordinating times with members of the community; often, either household members were absent when technicians were ready or materials weren’t available when the people had time.

As an alternative, Roberto Melogno[73] finds that providing credit to contract skilled laborers is more cost- and time-effective than enlisting volunteer work of community members, who have to be trained and freed from their other activities, only to then do inferior construction.[74]

• The corporeal spoke includes the health of the individual. Health is defined not only as the absence of disease but also as the total spiritual, material, and psychological well-being of the person. Projects need to include doctors and nurses to administer to patients with Chagas’ disease. They also need to include curanderos to deal with the cultural understanding of the symptoms of Chagas’ disease, such as empacho, colico miserere, and mal de corazon. How peasants perceive of their bodies is important, because it provides the basis of therapy. If, for example, it is important to them to balance the wet and dry or hot and cold, then symptoms of Chagas’ disease need to be treated in a complementary manner.

• The ethnomedical spoke connects traditional practitioners to the project and creates a dialogue between biomedical and ethnomedical practitioners concerning the prevention and treatment of Chagas’ disease. Examples discussed in the book include the work of Jaime Zalles, misfortune rituals used to treat Juana, and Kallawaya mesas to feed the earth shrines.

Ethnological research of native ethnomedical practices is necessary to help incorporate them into prevention and therapy measures for Chagas’ disease. This includes surveys of medicinal plants and how they may be used to treat the symptoms of acute and chronic Chagas’ disease. It also includes an understanding of how Chagas’ symptoms are perceived as cultural illnesses and how they are treated by locals. Examples discussed were colico miserere, empacho, muerto subito, and chullpa usu.

The CCT considers ethnomedical practitioners and project workers to be equal members of the elements composing the triangle, so they need to be incorporated into the planning, prevention, and treatment of Chagas’ disease. If they are considered planners and players throughout the project, then they will more likely sustain it. 

• The biomedical spoke is the scientific thread that relates biological facts to pathological, cultural, and social factors. The biological and medical sciences provide facts concerning the natural elements of Chagas’ disease, and this indispensable knowledge needs to be incorporated into Chagas’ control projects. Chagas’ disease is extremely complex and requires some knowledge of biology, parasitology, immunology, pathology, and entomology. It is helpful to have an interdisciplinary team of experts design vector-control projects. The biomedical spoke can be blocked by any one specialist overemphasizing his or her position; for example, entomologists insisting upon insecticides as the only proper response. Some issues are uncertain or are being revised, such as the concept of Chagas’ disease being an autoimmune disease.

Project personnel need scientific knowledge about Chagas’ disease. Many doctors are confused about its treatment, partial immunity, indeterminate phases, and therapy. Recently, the biomedical community in Bolivia has come to better recognize the prevalence of Chagas’ disease; nonetheless, however, many authorities believe that Chagas’ disease is not a major problem and that Chagas’ control projects have been overemphasized.

The biomedical spoke connects project personnel with people suffering from Chagas’ diseasedoctors and nurses treat patients. Pilot projects developed a protocol for treating the acute phase of Chagas’ disease in children younger than fourteen years; however, resources were not provided to treat them. A major concern is to treat the symptoms of heart disease and colonopathy.

• The technical spoke concerns the connecting links of methods, tools, and materials that bring people together to help prevent and treat Chagas’ disease. Sometimes imported technologies separate personnel from community members; the standard guide is to use available technology, native resources, and personnel as much as possible in order to make community members less dependent upon outside sources. Bolivia has skilled laborers in the fields of construction, fumigation, and repair of houses. When household members themselves do such tasks they need to be instructed in proper techniques to make their houses vinchuca proof. Examples cited include the use of cow dung in plaster, improvement of the consistency of adobe, employment of insecticides in paint, and the formation of tile factories. Research is needed to discover drugs and insecticides from medicinal plants that can prevent or treat Chagas’ disease (see Bastien et al. 1996).

• The environmental spoke connects humans with biotic factors related to the parasitic cycle. Animals and plants are important in controlling the Chagas’ parasitic cycle. Its spread throughout the Americas is related to depletion of land, deforestation, and destruction of various species of plants and animals. Noted for their environmental practices, Aymara and Quechua cultures have adapted to mountainous environments in harmonious ways that other cultures can emulate. Lowland peasants of the departments of Santa Cruz and Tarija also understand their environment, and, once they are presented with information about the parasitic cycle of Chagas’ disease, they can assist in discovering ways to break this cycle. Andean concepts such as that of Kallawayas who feed earth shrines of their mountain so that the mountain will feed them are useful images to teach people about the relationship of humans to the land.

Reaching the center is done along all spokes, which intersect within the context of culture. A culture context is the central hub of the spokes. When housing improvement and hygiene are considered part of the culture context, people build these houses with their own resources and continue to maintain them while incorporating their aesthetic, social, and spiritual values. One reaches the center along another spoke when housing hygiene becomes second-nature to the majority of the community and ethnomedical practitioners have adapted features of biomedicine into their native practices and rituals. The CCT model will truly be a success when communities throughout Bolivia incorporate Chagas’ control measures into their communities.

The culture context model is a culturally sensitive and effective plan for the prevention of Chagas’ disease. It respects the culture of people, utilizes their cultural resources, and uses culture as a focal point and dynamic for innovative responses to the problem. Culture context can be seen as the “owner’s manual” of a community.

This model recognizes that a community may be a mix of ethnic classes and groups, such as Aymara and Quechua, with a mix of urban and rural features. Essentially, project personnel learn by participation and by