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7/31/2019 Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia
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Can Andean medicine coexist with biomedicrural communities in P
Journal of Ethnobiology and Ethnomedicine 201
Sarah-Lan Mathez-Stiefel (sarah-la
Journal of Ethnobiology andEthnomedicine
mailto:[email protected]%7Dmailto:[email protected]%7D -
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Can Andean medicine coexist
healthcare? A comparison of in Peru and Bolivia
Sarah-Lan Mathez-Stiefel1*
*
Corresponding author
Email: [email protected]
Ina Vandebroek2
E il i d b k@ b
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services provided, physical accessibility, and fin
practices such as childbirth. Preference for natural
with biomedical healthcare that was both accessibleshow that greater access to biomedicine does n
indigenous medical knowledge, as represented by
bound illnesses.
Conclusions
The take-home lesson for health policy-makers frouse of biomedicine in resource-poor rural areas m
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lower level. We combined a qualitative resear
households therapeutic strategies and use of reme
incidence of culture-bound illnesses in local ethnobi
Medical pluralism refers to the coexistence of variou
a widely used model developed by Chrisman and
overlapping sectors in pluralistic health care syst
provided by the sick persons themselves, their fam
2) the folk sector (health care provided by tr
bonesetters, midwives, mediums, and magicians); aprovided by practitioners and institutions in biom
di l h Chi A di d U
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located in two different countries, these study s
sociocultural, and ecological similarities despite di
services, as shown in Table 1.
Figure 1Map of the study sites [35]. Research wasDepartment of Cusco, Peru (a) and in Waca Playa SuDepartment of Cochabamba, Bolivia (b)
Table 1Variables of human development, health,
facilities in Waca Playa and PitumarcaWaca Playa (Bolivia)
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sites display a similar anthropogenic landscape, co
parcels, remnant patches of native forests (e.g. Po
Eucalyptus spp. and Pinusspp.), rivers, rocks, and gr
Figure 2View from the village of Tres Cruces in W
Figure 3Valley of Pitumarca, Peru. The town of P
Both study sites are inhabited by indigenous Q
community property rights over their territory afterand from 1968 to 1975 in Peru). At the village level
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and children up to the age of five living in condition
SEG (Seguro Escolar Gratuito), which gave free
under age 17 . In 2005, Peruvian Law 28588 extendof age, living in conditions of poverty or extreme p
ofPitumarca. The United Nations Development Prog
higher in Pitumarca than in Waca Playa, which im
higher income per capita, better education, and longe
Figure 6Waca Playas health post, Bolivia
Methodology
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Health-seeking behavior of households was investig
Households were invited to explain their concepts
common illnesses that occurred in their family, ththeir health-seeking strategies. Preliminary informa
to identify three prevalent strategies in the comm
remedies (medicinal plants, animals, and minerals);
visits to the health center. During the open-ended i
of these three strategies they chose as a first optio
option if the first strategy did not work. They
pharmaceutical or natural remedies (including plant
remedies they preferred. In addition, households w
h l h ki h i d f d id
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causes, and reference to the humoralhot/cold classi
American medical systems. The incidence of CBIs
percentage of total responses on medicinal use givefree listing exercises. A response is a report on th
household Z. The z-test for comparison of proporti
compare the results for the incidence of CBIs from th
Methodological limitations of the study
This work should be understood as an exploratorqualitative approach with quantitative analyses. Th
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In Waca Playa, half of all participants preferred c
option when self-treatment failed. Six of these nine h
in the healers knowledge to heal them or diagnos(which might include going to the medical post). F
medical post was more costly because they would ha
that the medical post was not efficient and did not he
Of the ten Pitumarquino households that chose the h
that they did not consult healers because there was n
CBI that required the knowledge of an indigenous
could be treated at home with natural remedie
h i l Th h h ld id h h
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the health center could treat new illnesses that cam
decades by means of pharmaceuticals and injecti
elsewhere in Latin America refer to the same corresponding choice of treatment made by local pe
the earlier concept of folk dichotomies in healt
concept see [42], cited by [5]. This categorization of
Aguils distinction between mythical and natura
of health and illness in Potosi, Bolivia [43]. Accor
result of aggression by a supernatural being procee
Pacha Mama (Mother Earth) that produces a lesion
contrast, a natural illness is aggression by an extern
i h l f h b d i h di i id
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Malamuds work on medical pluralism in the Boliv
individuals select from the various medical system
cultural identity and access to economic, social, apluralistic setting, another study showed that individ
etiologies consistent with their understanding of
negotiation [46]. These studies and our own result
various medical systems are fluid and that there ma
and conceptions between them [14].
The third consideration regarding households health
choices at the study sites were sometimes the
i f diff di l F
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10). Crandon-Malamud also recognizes that resista
of medical dialogue ([14], p. 32). Our results thu
can be simultaneously complementary and conflicNgokwey [9] in Brazil, who reported both m
pharmaceutical drugs and differential expectation
remedies, resulting from the perceived superiority of
Contrary to what other researchers have shown [5
seeking strategies of households in Waca Playa an
the level of access to biomedicine, except for some
both study sites, self-treatment with natural rem
d d Thi fi di i b d b h di
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Knowledge about culture-bound illnesses
The households from Waca Playa andPitumarca millnesses cured by medicinal plants, animals, or
purposes, these illnesses were grouped into 50 illn
sites, 17 of which can be defined as culture-bound
and described in Table 2, according to anemic pers
participants gave a total of 778 (Waca Playa) and 15
medicinal use of natural remedies,respectively. O
(Pitumarca) were omitted and reserved for further a
illnesses that were too poorly defined, such as seri
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Table 2Description of culture-bound illness categories (CBIs) and their incIllnesses (local names inQuechua and/or Spanish)
Symptoms and/or etiology
Arrebato Mostly experienced by women. Symptoms include headache, fe
Calorinterno Internal inflammation, fever; caused by heat exposure
Caracterfuerte, agitacin Strong character, irritability, agitation
Colerina, clico (W), clera(P)
Stomachache, headache, bitter mouth, nauseas, vomiting; caused
Costado Strong side pain, hemorrhagic cough, stomachache; caused by c
Empacho, clico (P) Indigestion, stomachache, constipation; caused by ingestion of c
Enfermedad de yatiri (W),
enfermedad depaqo (P)
Several illnesses cured or rituals performed by healers: possessi
divination and diagnosis, animal sacrifice
Enfriamiento, enfermedad
del frio
Stomachache, headache, body pain, cold feet; caused by cold ex
Japega (W), mancharisqa
(P), susto
Mostly experienced by children. Fright sickness: insomnia, co
an evil place, fright, and soul loss
Madre, erita (P), cncer (P) Experienced by women. Symptoms of uterine or ovary inflammswollen hands and feet, back pain; caused by heat or cold expos
Mal de bilis, hgado Biliary sickness: nausea, dry and acid taste in mouth, liver inflgreasy food, also caused by anger
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There was a significant difference between the incidPitumarca (42.8%) (z=8.428; P=
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knowledge and practices from indigenous and bio
achieved through a social learning process tha
biomedicine and indigenous medical systems baseequitable participation of representatives from existi
Competing interests
The authors declare that they have no competing inte
Authors contributions
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35. Mathez-Stiefel S-L, Vandebroek I: Distributi
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Di ib i f l b d ill
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Waca Playa Pituma
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Waca Playa
61%17%
22% 0%6%Pituma
94
Figure 8