The Kiss of Death

observation about the culture context of the community where they intend to work. Moreover, they then should discuss matters with the people and let them help decide upon a course of action.

Future Hope

Several nongovernmental organizations have recently adopted a culture context model for projects other than Chagas’ disease, and directors of these projects helped me design the culture context model for Chagas’ disease. As already discussed, Oscar Velasco directs a health project in Potosi that includes biomedical and ethnomedical practitioners on an equal basis. They have incorporated biomedicine into the culture context of Andean ethnomedicine (see Bastien 1992). Antonio Prieto, also discussed, has developed an economic development project for peasants of Chuquisaca that focuses on the relationship of productivity to national and international economics within the culture context of the community; and Pablo Regalsky has renovated the culture context of the people of Raqaypampa, Department of Cochabamba, by reintroducing age-old practices of agroproduction that had been lost.

Evaristo Mayda has formed a strong organization of ethnomedical practitioners that serves the needs of the Quechua of Cochabamba. More than 130 community health workers of the Department of Oruro have separated from any institutional affiliation to form their own organization, with their own projects, within Aymara and Quechua culture contexts.

These Bolivians mentioned have recognized the failures and problems of vertically designed and biomedically oriented projects.[75] They are keenly aware of the pressures of global economics, privatization, and capitalization upon the production of peasants. They are actively involved in issues of peasant productivity, microcredit, and the formation of cooperatives. Many of these Bolivian leaders speak Andean languages, have studied anthropology, and have lived for years in peasant communities, appreciating the culture context of the community. Their projects fit the culture context of Bolivian communities; the programs’ success lies in the fact that they are generated by Bolivians with knowledge and sensitivity to the culture context.

For future projects, it is necessary that specialists from all relevant disciplines work together with members of the community and ethnomedical practitioners to reach solutions within the culture context of the community. Solutions should not be ready-made formulas.

International funding sources should seriously consider the following criteria before allocating funds for the prevention of Chagas’ disease. The institution should be knowledgeable about (and able to work within) the cultural, social, and economic systems of the community for which the project is planned. Project personnel should be able to speak the native language and communicate effectively with all members of the community while employing a balanced interdisciplinary approach.

The following pages will examine “cultural correctness” in development projects. One issue to be examined is the integrity of an institution’s objectives in carrying out a project within a culture context. Frequently, nongovernmental organizations (NGOs) use projects to advance their moral, political, or religious objectives. For example, the Roman Catholic relief organization Caritas distributes food donated by the U.S. government and has organized Clubes de Madres (mother’s clubs) in Bolivia while at the same time teaching these mothers the church’s position on family planning. Some medical institutions oppose ethnomedicine and ethnomedical practitioners in their endeavors to bring primary health care to the people. Fortunately, many NGOs in Bolivia now recognize the value of ethnomedicine and include it within their healthcare programs. Perhaps the biggest obstacle is the Western mentality that scientific biomedicine is the only answer to eliminating sickness and bringing about health. However, if one accepts the World Health Organization’s definition of health as not merely the absence of sickness but also the total well-being and happiness of the person, then culture needs to be considered in health programs.

The culture context triangle does not imply that everything within the culture is productive towards the absence of disease. Regarding Chagas’ disease, many types of behavior and values may have a negative impact. The CCT model, however, acknowledges that the culture context is dynamic and that it both can and should accept beneficial changes. Importantly, these changes need to fit into the systems of the culture (economic, social, political, and religious) in order to become permanent. The change must be a culturally acceptable negotiated agreement between project personnel, members of the community, and local ethnomedical practitioners.

CHAPTER ELEVEN Solutions

The challenge of Chagas’ disease is not insurmountable. There are solutions, and this chapter contains some possibilities. Previous chapters addressed housing improvement and hygiene as ways to prevent the disease. I now consider solutions to socioeconomic and environmental issues that have helped precipitate this epidemic. The good news is that many Bolivians recognize these solutions and are applying them.

Interdisciplinary Approach

An interdisciplinary approach is necessary to deal with socioeconomic and environmental factors in the spread of Chagas’ disease. A major problem of the pilot projects was that Chagas’ disease was narrowly considered from a biomedical perspective, with little if any consideration of the cultural, economic, environmental, and social factors involved in this epidemic.[76] These pilot projects thus pointed to the importance of including the social and economic sciences in the effort to prevent Chagas’ disease. Narrowly focused approaches of particular disciplines are insufficient to deal with its complexity. If this book has shown anything, it is that Chagas’ disease is complicated by issues of biology, chemistry, parasitology, pathology, entomology, economics, ecology, sociology, and ethnology. Each of these studies is necessary to deal with Chagas’ control and disease. Detailed and varied perspectives need to be brought together within the culture context. The CCT model converges toward an apex of prevention and treatment of Chagas’ disease.

Anthropologists look at Chagas’ disease from a cultural perspective. Culture is seen as the major influence upon people’s behavior. Anthropologists examine the relationship of people’s values and behaviors with environmental factors related to vinchucas and T. cruzi. They study the etiology of Chagas’ disease and how people deal with its symptoms. They are able to explain the cultural dynamics of shamans, midwives, and curanderos. Anthropologists can be seen as the translators and negotiators between the technical-scientific world views of project personnel and the cultural practices of peasants.

The following anthropologists have contributed to the prevention of Chagas’ disease. Oscar Velasco integrates ethnomedicine and biomedicine in the treatment of Chagas’ disease. Alan Kolata and Charles Ortloff (1989) have shown that the raised-field technique in about A.D. 500 at Tiahuanaco, an archaeological site on the Altiplano, was a more productive farming technique than that used now by the Aymara, which was introduced by the Spaniards. Raised-field techniques also provided better nutrition. Applying this archaeological knowledge, Kolata is reintroducing raised-field techniques to Altiplano Aymaras.

Social anthropologist Xavier Albo has studied Aymara and Quechua political and economic systems to assist his public policy advocacy of their interests, and his studies greatly assist project personnel in these matters. Cultural anthropologist Pablo Regalsky leads an institute that promotes the ethnoscientific knowledge and traditional agricultural systems of peasants in the valleys of Cochabamba and Misqui. He has helped Quechua peasants of Ragaypampa restore traditional methods of crop rotation to enhance production and to maintain