Perceptions of Traditional Medicine in Ecuador
A thesis presented to
the faculty of the Center for International Studies of Ohio University
In partial fulfillment
of the requirements for the degree
Master of Arts
Verónica V. Garrido
April 2021
© 2021 Verónica V. Garrido. All Rights Reserved. 2 This thesis titled
Perceptions of Traditional Medicine in Ecuador
by
VERÓNICA V. GARRIDO
has been approved for
the Center for International Studies by
Nancy E. Tatarek
Associate Professor of Anthropology
Arthur Hughes
Director, Latin American Studies
Patrick Barr-Melej
Interim Executive Director, Center for International Studies
3 Abstract
GARRIDO, VERÓNICA V., M.A., April 2021,
Latin American Studies
Perceptions of Traditional Medicine in Ecuador
Director of Thesis: Nancy E. Tatarek
80% of the population in developing countries uses traditional medicine as their primary response to healthcare issues worldwide (Chivian & Bernstein , 2002).
Nevertheless, traditional medicine does not occupy the place of the mainstream tradition in the medicine field. Instead, Western medicine has taken that place in spite of its multiple problems ranging from access to healthcare to budgetary issues. While traditional medicine (TM) and its holistic approach could present a viable alternative that would contribute to solving some of the health issues worldwide, such an option is not taken into consideration. In order to understand why TM benefits are not being incorporated in mainstream medicine, this investigation has analyzed what people think about TM. In this regard, this investigation has focused on digging deep into the middle- upper class perceptions about TM in Ecuador. This segment of the population is the one that determines what medical theory is valid or is considered true, what truths are told, whose voices are privileged, and which ones are missing. The results show a deep rejection towards most of the components of TM practices. In this regard, this investigation analyzes the roots of such perceptions through a variety of social sciences tools.
4 Dedication
A mis papás, por darme la vida y por tanto amor.
To my parents, for giving me life and love.
5 Acknowledgments
I would like to acknowledge every person that has made this thesis possible. My advisor, Dr. Nancy Tatarek for helping me to stay focused and pushing me to find my voice through the writing process. The members of my committee, Dr. Mariana Dantas and Risa Whitson, for their insightful advice. My Program Director, Dr. Arthur Hughes for always making us understand that we are capable of doing anything we set our minds to. The informants of this research who welcome me in their homes. My friends and family, who have patiently and lovingly supported me during these last two years. A special acknowledgment to my mom Verónica Ojeda who drew the illustrations used in this thesis.
6 Table of Contents
Page
Abstract ...... 3 Dedication ...... 4 Acknowledgments ...... 5 List of Tables ...... 8 List of Figures ...... 9 Chapter 1: Introduction ...... 10 Prologue ...... 10 Research Relevance ...... 12 Research Question ...... 17 Research Sites ...... 17 Chapter 2: Background ...... 19 Traditional Medicine ...... 19 History of Traditional Medicine ...... 19 Health and Disease Conceptions of Traditional Medicine ...... 20 Strengths and Weaknesses of Traditional Medicine ...... 22 Traditional Medicine in Ecuador ...... 23 Western Medicine ...... 25 Origins of Western Medicine ...... 26 Health and Disease Conceptions of Western Medicine ...... 26 Strengths and Weaknesses of Western Medicine ...... 27 Western Medicine in Ecuador ...... 29 Chapter 3: Literature Review ...... 32 Challenging Western Medicine Conceptions and Healthcare Systems ...... 33 Innovative and Simple Solutions for Modern Healthcare Systems ...... 38 Social and other Anthropological Tools ...... 40 Constructivism ...... 40 Perceptions ...... 40 Symbolic Classification ...... 41 Dualism ...... 43 Chapter 4: Methodology ...... 44 Data Collection ...... 44
7 Data Analysis ...... 45 Chapter 5: Results ...... 46 Organization of the Section ...... 46 Research Sample ...... 48 General Perceptions about Traditional Medicine ...... 50 Geography and Traditional Medicine ...... 52 Racism, Classism, and Religion in Traditional Medicine Perceptions ...... 60 Traditional and Western Medicine are Against One Another ...... 68 Perceptions about Medicinal Plants and Traditional Healers ...... 77 Perceptions about Medicinal Plants ...... 78 Perceptions about Traditional Healers ...... 87 Chapter 6: Discussion ...... 94 Positionality ...... 94 The Iceberg of Traditional Medicine Perceptions in Ecuador ...... 96 The Tip of the Iceberg ...... 99 Beneath the Surface ...... 100 Beyond Silence, Short and Monosyllabic Answers ...... 101 Discrimination in Traditional Medicine Rejection ...... 102 Traditional and Western Medicine as Part of a Duality ...... 114 Western Thought and the Bottom of the Iceberg ...... 125 Limitations of the Research ...... 128 Recommendations for Future Research ...... 129 Conclusion ...... 131 References ...... 133 Appendix A: Use of Key Terms ...... 142 Appendix B: Template Used in the Interviews ...... 147
8 List of Tables
Page
Table 1 Sample ...... 49 Table 2 Medicinal Plants versus Drugs ...... 109 Table 3 Dualities ...... 115
9 List of Figures
Page
Figure 1 Research Site...... 18 Figure 2 Organization of Results...... 47 Figure 3 Geography and Traditional Medicine...... 52 Figure 4 Racism, Classism, and Religion in Traditional Medicine...... 60 Figure 5 Traditional and Western Medicine are Against one Another...... 68 Figure 6 Perceptions about Medicinal Plants ...... 78 Figure 7 Taita in a San Pedro Ceremony...... 84 Figure 8 Perceptions about Traditional Healers...... 87 Figure 9 Iceberg of Perceptions ...... 98
10 Chapter 1: Introduction
Prologue
I was 30 years old when my life changed forever. Working in a job I hated, I had moved out of my house although I hated living alone, and I was involved in a very toxic relationship. I knew I could not continue living this way, but I was not willing to do anything to get out of it. I just hoped and prayed that my life would change by some miracle. While waiting for the miracle to happen I would watch TV to forget about my problems, while eating whatever that needed to just be warmed up. One Sunday morning
I woke up with a clear sensation of frustration and a powerful thought crossed my mind
“I do not want to come back to that job ever again”. That same day my throat began to hurt, and the following days I got worse and worse until my family had to take me to the hospital. My pressure was so low when I arrived that I was taken directly to the ICU
(Intensive Care Unit). The doctors had no idea what was happening to me, the only thing they knew was that I was dying, and they did not know how to help me.
I remember that even the slightest movement I made hurt, and I had a lot of difficulty breathing. Weirdly enough all the frustration, anxiety, and sadness had disappeared. It was my fourth day in the ICU, when I felt so tired, I just closed my eyes and let go. I let go of everything and stopped fighting for my life. I felt I had no reason to live anymore, and I decided to let whatever it was that was happening to my body to put an end to the miserable life I felt I was living. In that exact moment I entered the deepest darkest place I have ever been in and I heard a voice telling me “It’s not time yet, you have not done what you came here to do”. I asked the voice what the thing I was supposed to be doing was, but the voice did not answer. Then I told the voice I had no
11 reason to continue living, no more strength, everything was going so bad, I didn’t want to come back to that. Suddenly I saw the faces of my mother, my father, and my siblings. I felt the pain they would feel if I died, I felt the incommensurable love they felt for me.
And a light was turned on inside of me, I regained my strength, and I came back from whatever that place was.
That same day a doctor told the nurses to give me antibiotics, even when the several tests they made showed no sign of infection. My body began to respond to the antibiotics, so the doctors began to treat me with the strongest antibiotics they could find.
In a couple of days, I was out of risk and out of the ICU. The days that followed were definitely the most painful in my life, but also the most peaceful, joyful, and full of love that I have ever experienced. I got better in less than fifteen days and the doctors could never figure out what had happened to me or how I had recovered so quickly. There was only one doctor in the hospital that had an idea of what had happened. He told me that even when he had no proof of it, he believed I had contracted pneumonia due to a bacterium called staphylococcus aureus. Later on, I learned that all of us live with that bacteria in our skin but that when our immune system is down this bacterium takes advantage of any minor cut on the skin to enter the bloodstream and infects the brain or the lungs. Nonetheless, no doctor could explain with absolute certainty what had happened. Therefore, in my last visit to the hospital, a doctor told me that I should simply forget about it all together because my body did not show the typical signs of the trauma I had gone through. But forgetting was certainly not the path I took to regain my health.
Even when Western medicine could not give me any explanation, much less useful advice, alternative medicine made me understand that my whole disease had to do with
12 how sick my immune system was, which was basically caused by my Western lifestyle that made me be extremely irresponsible with the health of my emotional, mental and physical body. At the end I know that my miracle was understanding that I was the only person in my life that could change it.
I share this story for three reasons related to the relevance of this research. First, to share my personal experience of how my Western lifestyle led me to a bed of the ICU of a hospital and almost to death. Second to highlight the fact that there is an alternative approach to health and disease that can give people the possibility to live healthier.
Finally, I share my experience because I learned that the most important thing, I had to do to be healthy is to understand that my health is my responsibility. Being responsible of our own health is the basis of traditional medicine practices.
Research Relevance
Western medicine has made it possible for us to live longer more comfortable lives and has developed technologies to save millions of lives around the world
(including mine). However, Western thought has also condemned people to live in a world full of schedules and duties, computers and televisions, sedentarism and drugs. A world that has found the perfect way to disconnect people from nature, and from themselves. While for the majority of people the Western world lifestyle is simply normal, for human bodies, souls and minds that is no way to live (Portilla, 2017).
However, due to that same Western world where a lot of people have been raised, it is difficult to realize that many are living in an unhealthy body because they have also found the way to disconnect from it. Suddenly one day, out of nowhere, they discover they have diabetes, gastritis, or heart disease. They begin to wonder how they got to be so
13 extremely unlucky, why me? -they say. The doctor tells them that their condition might have been inherited, that they will have to make some changes in their lifestyle, but most importantly that they will have to take some pills for the rest of their lives because that’s a disease that cannot be cured. That is the answer of Western medicine for a lot of diseases; they are simply untreatable, and they happen from one day to the other.
Nevertheless, for alternative medicine traditions, there is no such thing as sudden or untreatable conditions. Diseases are a product of people’s bad habits. Such habits include not eating healthy and nutritious food; not exercising in ways that are enjoyable to people’s bodies; not taking care of one’s relationships; and disconnecting from one’s communities and nature. In sum, diseases are nothing more than the consequences of people’s actions, and therefore they can be cured if they change their habits. But why should they choose to believe that? Isn’t it easier to believe that a disease is inherited, to blame their bad genes, to put all the responsibility of their health in the hands of an expert doctor and all their hopes in pills that will keep them alive? Talking from my personal experience, I would say that it is most certainly easier to choose to believe that I’m not responsible for my health, it is easier to take a pill rather than a smelly homemade remedy. It’s easier to go buy a hamburger than getting into all the trouble of buying and preparing a nutritious meal. It’s easier to turn on the TV and silence my thoughts than to sit in meditation. In sum, yes, it is easier to choose to live a Western modern comfortable life, but the question is, is it healthy? is it sustainable? Most importantly is health a priority in the lives of Western people? For me the answer for the first question would be no, the Western lifestyle is not healthy or sustainable. And for the second question I
14 would also say is no, Western society does not care about their health, not until they lose it, it is only then when it becomes precious, not before never before.
Talking about these matters from TM perspective only might represent an incomplete picture of Western medicine. In this regard, it is important to notice that according to Nathan Wilson (2012) over the last thirty years the practice of Western medicine has taken a turn for the worst due to the problems that modernity has posed to the 21st century society (Wilson, 2012). Such problems include but are not limited to issues related to accessing healthcare; the increase of elderly population, the increase of mental illnesses; and budgetary constraints, both in developed and developing countries
(WGU OHIO, 2020). In Ecuador for instance the public health system guarantees free healthcare for its population, however not everyone has access to a medical center. In particular, people living in rural areas amounting to 36.18% (World Bank, 2018) of the
Ecuadorian population have virtually no access to Western healthcare, since they do not count with medical centers nearby. Furthermore, those living in cities have a negative perception of the public healthcare system, therefore those who can afford it usually prefer to go to a private health professional.
In this regard, it is clear that Western medicine faces great challenges and
Ecuador is only one example of such problems. When studying TM practices it is interesting to realize that their strengths could be paired with the most significant challenges faced by Western healthcare systems in the 21st century. For instance, rural indigenous communities have within their populations traditional healers who pass their knowledge through an oral tradition and use medicinal plants and other holistic treatments. The use of such approaches does not only solve the accessibility issue but
15 provide a less invasive treatment with fewer side effects, if properly applied.
Furthermore, communities that maintain their ancestral traditions are not as prone as other communities to diseases generated by what the Japanese have called Western conditions, including an unhealthy diet, high blood pressure and physical inactivity
(SANDOZ, 2016). Finally, traditional medicine has proven to be effective in conditions where behavioral, emotional, or spiritual factors have a dominant role in disease causation (Wu & Gbodossou, 2000).
Taking these factors into account, some of the benefits of traditional medicine have been identified by pharmaceutical companies and used to develop Western medicines. In particular, according to a study carried out by Harvard’s Medical School, approximately 119 chemical compounds of 90 plant species constitute important medicines that are being used in developed countries. Nearly three-quarters of these chemical compounds were discovered while trying to isolate the active chemicals from plants that are frequently used in traditional medicines (Chivian & Bernstein , 2002).
Nonetheless, the practice of biopiracy1 is not only unethical under Western standards but creates problems for healthcare systems worldwide as they offer medicines that have a series of side effects and tend to create dependency.
Nonetheless, in the case of Ecuador, TM is not being considered as a feasible tool that could contribute to alleviate the problems that Western healthcare systems face nowadays. For instance, policy makers promote the coexistence of the two traditions, as part of a political discourse that promotes inclusion, but are not genuinely interested in
1 Pharmaceutical companies patenting indigenous knowledge for profit.
16 the benefits of traditional medicine. This is the case of the “Hospital San Luis de
Otavalo”2. Women who go to deliver their babies here are offered the possibility to give birth in a traditional way, which is standing up helped by a midwife. They are also offered to be placed in a bed and be treated by a Western doctor. Although such acceptance of TM practices cannot be denied as a great improvement for the public healthcare system in Ecuador, this is an isolated example that is replicated only in a couple of other hospitals in Ecuador. Therefore, a real integration of traditional and
Western medicine appears to be far away in the horizon if visible at all.
In conclusion, even when traditional medicine could offer a viable alternative to solve some of the issues that the Ecuadorian healthcare system is facing nowadays, such an alternative is not taken into consideration as a real option by the Government.
Interestingly enough such rejection has nothing to do with the effectiveness or the scientific proven value of certain aspects of traditional medicine. Therefore, the question at hand is: If traditional medicine works why its incorporation into Western healthcare systems has not even been considered by policy makers? The answer lies in the more general question: If traditional medicine works, why is it so controversial in Ecuadorian society? In this regard, it can be said that the simplest way to answer these questions is to actually ask people. Therefore, this research has focused on studying the perceptions people have about traditional medicine in Ecuador. Analyzing such perceptions has proven as an effective way to understand not only why traditional medicine has become a
2 The Hospital San Luis de Otavalo, is located in the city of Otavalo in the Imbabura province, located in the north part of the country. This province hosts one of the largest indigenous populations in the country with 25, 8% of inhabitants that self-identify as indigenous people (INEC, 2010).
17 controversial topic in Ecuador but most importantly how this perception was constructed.
By the performance of this analysis, we would be a step closer to identifying the issues that have to be overcome in order to incorporate the good practices of traditional medicine into the Western healthcare system. The ultimate goal of such integration will be to provide people with a system that not only responds to health issues but that gives them tools to remain healthy as part of a healthy lifestyle.
Research Question
à What are the perceptions people, especially the elite group, have about traditional
medicine in urban centers in Ecuador, particularly Quito and Ibarra?
Research Sites
The majority of the Ecuadorian population is concentrated in urban areas with
63.82% of Ecuadorians living in cities and 36.18% living in the countryside (World
Bank, 2018). This study focuses on urban centers of the Highlands of Ecuador, in particular in the cities of Quito and Ibarra (see Figure 1). These cities were chosen due to their unique characteristics in terms of number of inhabitants and cultural features. Quito is the Ecuadorian capital and the most populated urban center with more than two million inhabitants. Among its population 82% self-identify as mestizos, this ethnic composition could be representative of a city that has a dominant Western tradition. On the other hand, Ibarra is the capital and most populated city of the Imbabura province with 181.175 inhabitants. This province hosts one of the largest indigenous populations in the country with 25, 8% of inhabitants that self-identify as indigenous people (INEC, 2010), which could lead to the assumption that TM is practiced more there than in other provinces in
Ecuador.
18 Figure 1
Research Sites
19 Chapter 2: Background
Traditional Medicine
According to the World Health Organization (WHO) traditional medicine (TM) is
“a comprehensive term used to refer both to TM systems such as traditional Chinese medicine, Indian ayurveda and Arabic unani medicine, and to various forms of indigenous medicine. TM therapies include medication therapies if they involve use of herbal medicines, animal parts and/or minerals, and non-medication therapies if they are carried out primarily without the use of medication, as in the case of acupuncture, manual therapies and spiritual therapies” (World Health Organization, 2002).
History of Traditional Medicine
Since the prehistoric era, humans all over the world have used a variety of natural products in order to elaborate medicines that could alleviate and treat diseases. Evidence in the prehistoric record has shown, “the human use of plants as medicines may be traced back at least 60,000 years” (Haidan Yuan, 2016). Moreover, the use of natural products as medicines must have posed a great challenge to early humans. For instance, it is highly probable that when experimenting with plants early humans consumed poisonous plants, eventually learning about edible materials and natural medicines. Therefore, traditional medicine represents a valuable repository of human knowledge as it carries information that has been accumulated for thousands of years (Haidan Yuan, 2016). Nowadays, such forms of medicine are called traditional medicine (TM) and are being used by roughly
80% of the world’s population from developing countries (Chivian & Bernstein , 2002).
In the case of the Andean Region of South America, the use of traditional medicine can be traced back to the Initial Period (1800-900 B.C.) with the use of the San
20 Pedro cactus3 during indigenous rituals. The Inca culture (1438-1532 C.E.) (Malpass,
2016) used plants widely in their medical practices (Elferik, 2008), many of which are still being used in the Andean countries particularly in the regions where ancestral knowledge is important and extended. For instance, according to the “Organismo Andino de Salud” (Andean Health Agency) in 2014, each country registered a number of medicinal plants being used in the region. Peru registered the greatest number of plants with 832, followed by Ecuador with 288, Bolivia with 249, Colombia with 139 and Chile with 104 (Le Loc'h, 2014). Particularly in Ecuador 80% of the population depended on traditional medicine and medicinal plants for their health and wellbeing, according to a study carried out in 1999 (Buitrón, 1999). However, there is no current data about the use of traditional medicine in Ecuador (Demon, 2006, p. 147).
Health and Disease Conceptions of Traditional Medicine
Since prehistory, all of the non-Western traditional cultures have had an integral view of life and health. They recognize an invisible bound between body, mind, and spirit, as well as among those elements and spirituality, interpersonal relations, and the environment. Therefore, the expressions of harmony or disharmony in the relationship between any of those aspects, determine the state of health or sickness at the individual as well as at the collective level. Thanks to this vision the traditional systems of medicine in
Africa, the Middle East, China, Europe and America, always focused on transmitting knowledge about healthy living rather than on therapeutically assisting patients.
Therefore, when a traditional healer would assist a patient aside from the therapeutic
3 San Pedro cactus is a source of mescaline-like psychoactive drug.
21 treatment, the healer would identify the mistakes the patient was making in his/her way of life, in order for the patient to correct those mistakes and heal properly from a particular disease (Portilla, 2017, p. 55).
For instance, primal cultures in the Americas, including the Apaches, Aztecs,
Mayas, Aymaras, and Mapuches, had a deep consciousness of their unity with nature. For them nature was the primary source of vitality and wisdom. Therefore, according to their belief system they would only need to consume what they need to subsist, work for the wellbeing of their families and communities, and take any element from nature with respect and only when needed4. In particular the shamanic medicine is defined as a form of instinct, religious and natural medicine; in which sickness is an expression of disharmony in the life of a person, due to the transgression of the sacred laws of coexistence with oneself, with other people, or with the environment. Therefore, a disease would be considered a disorder of one’s “ushai” (vital energy) (Portilla, 2017, p. 55; 64).
In this regard, shamans or yachags (see Apendix A) still now recognize the patient’s alteration in their “ushai”, not merely on the superficial symptoms of the alteration. Then they use the soul of plants, animals, and other sacred and healing objects, in conjunction with rituals specific for each disease, in an attempt to harmonize the energies in the patient. The healing process is performed through rituals that include special beverages and spells to separate negative energies from the patient’s body. Other cleansing processes include hot baths that were especially popular among Aztec, Mayas and Incas (Portilla, 2017, pp. 64-65).
4 This connection drawn by primal cultures has been identified as the first form of religion called animism. According to E. B. Tylor animism is the attribution of life or soul to inanimate objects by primitive people.
22 Strengths and Weaknesses of Traditional Medicine
Traditional medicine is considered to be a holistic discipline that attempt to treat the patient as a whole. In other words, TM believes in treating the body, mind, and spirit together in order to achieve healing, rather than simply treating a person’s specific illness or injury (Ke, 2019). In particular, traditional indigenous medicine in Ecuador has incorporated to this concept the harmonious relationship not only with oneself but also with one’s families, communities and with the environment. This particular holistic approach of health brings positive effects and contributes to a more permanent state of well-being. Although the precise mechanism of such effects may still not be properly understood by science, they have been understood by traditional communities for thousands of years. For instance, TM has proven to be especially successful at treating
“conditions where behavioral, emotional, or spiritual factors have a dominant role in disease causation” which are also conditions that biomedicine has often failed at treating
(Iwu & Gbodossou, 2000). This is especially interesting if we look at data concerning the diseases that are more preoccupying for Ecuadorians. According to a study I carried out in the cities of Quito, Loja, and Cuenca, the disease that most worries people, with
22.24% of the total sample, is stress (Grijalva, Garrido, & Salgado, 2021).
Other strengths of TM include the conception that there are no untreatable diseases, because diseases are caused by bad habits. Therefore, if those habits are changed the disease can also be cured. Furthermore, TM is based on the notion that health is an individual responsibility. In this regard, TM is 90% about educating people regarding healthy habits and only 10% about consulting a health expert. This approach not only empowers people in order to live a healthy life but also lifts most of the
23 enormous burden put on health professionals. Finally, traditional medicine uses medicinal plants, which can be found in nature, to elaborate home remedies. Hence, TM becomes not only affordable but if use properly it does not produce side effects or generates dependency (Portilla, 2017).
Unfortunately, TM have weaknesses also, especially nowadays. For instance, finding an authentic traditional healer in Ecuador has become a difficult task. Some modern traditional healers suffer from various diseases such as obesity, and diabetes, due to their bad habits and nonetheless still offer advice. Other healers abuse the use of medical plants using them as a way to attract tourists and money. Traditional healers have also forgotten about the basis of this TM philosophy and instead of educating the patient, give them medicines and send them home (Portilla, 2017, pp. 65-66). Furthermore, TM is much less effective than Western medicine at treating disease conditions that are attributable to material factors such as physical trauma, poisoning or environmental hygiene (Iwu & Gbodossou, 2000).
Traditional Medicine in Ecuador
According to Jos Demon (2006), studies focusing on TM in Ecuador have been carried out since the 1980s. However, the contributions of such studies are scarce, and investigation efforts have not been regular. Therefore, it is difficult for a researcher to find information about the topic and build a comprehensive picture about traditional medicine in Ecuador (Demon, 2006). Nonetheless, I will do my best to summarize some of the most relevant points about traditional medicine in Ecuador.
Traditional medicine has existed in Ecuador since ten thousand years ago and it has been shaped by different influences in the course of its history as well as by different
24 ethnic groups. Such influences include that of the Incas in pre-history; that of the
Africans with the arrival of African slaves in the colonial period; and that of the
Spaniards during three centuries of colonial domination. Furthermore, Spanish influence was perpetuated by dominant Eurocentric thought during the flourishment of democratic republics (Terán Jaramillo, 2017). Therefore, traditional medicine in Ecuador nowadays is a manifestation of cultural syncretism and it’s practiced as a tradition that mixes and blends different belief systems (Armijos, Lozano, Bracco, Vidari, & Malogon, 2012).
Furthermore, communities with low economic resources are considered to be the ones using traditional medicine practices, due to the affordability of such traditions
(Terán Jaramillo, 2017). Within communities with low economic resources, one of the most representative one is the indigenous that has preserved a rich ethnobotanical tradition which has been transmitted orally from generation to generation (Armijos,
Lozano, Bracco, Vidari, & Malogon, 2012). Traditional medicine in Ecuador encompasses the use of medicinal plants. Such use has been deeply influenced by the availability of a wide variety of plants considering that Ecuador is one of the most megadiverse countries in the world5 (Terán Jaramillo, 2017). Therefore, people in
Ecuador use a variety of medicinal plants to treat and cure different diseases. Such plants have been used over centuries in an empirical way, however nowadays different researchers are trying to discover the active principles that justify and validate its therapeutic use (Armijos, Lozano, Bracco, Vidari, & Malogon, 2012). Moreover, traditional medicine also encompasses traditional healer’s practices which originated in
5 This diversity is due to the location of the country in the neotropics, the presence of the Andes and the influence of the ocean's currents on its coasts.
25 Asia and was brought by hunter-forages to the Americas during the Late Pleistocene
(Evans , 2013, p. 65). Nowadays, a traditional healer can be described as a person who practices traditional medicine using different kinds of animal, plant and mineral substances as well as other techniques based on ancestral beliefs (Ashish & Harilal,
2015). In this regard the most common types of traditional healers that can be found in
Ecuador are shamans, taitas, mamas, yachags, brujos/as, and curanderos/as (see Annex
A).
Western Medicine
While the WHO gives detailed conceptions about traditional, complementary and integrative medicine, Western medicine has not been defined by the WHO. In other words, there is no official definition of Western medicine by the WHO, probably because such discipline has been normalized as the mainstream discipline that should be used all over the world. Nonetheless, we can borrow the definition developed by the NCI
(National Cancer Institute) that describes Western medicine as “a system in which medical doctors and other healthcare professionals treat symptoms and diseases using drugs, radiation, or surgery. Also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and orthodox medicine” (National Cancer Institute,
2021). According to the Ecuadorian anthropologist Santiago Portilla, this discipline is
Western not because it has originated or is mostly practiced in Europe or the US, because nowadays it is practiced all over the world. According to Portilla this discipline is
Western because it has its origins and has developed following the Western way of thinking (Portilla, 2017, p. 85).
26 Origins of Western Medicine
The unquestionable leader of modern Western medicine is Galen of Pergamon
(129 AD - 210 AD). Western medicine bases most of its doctrines, thought, and actions regarding health and disease on Galen’s work. Such work focused on the therapeutic treatment of traumatisms and conditions produced on accidents, or during fighting and confrontations. Galen’s approach became timely and successful at treating fractures, wounds, and bruises. This approach was based on the idea that if a bone has been fractured the health professional must focus on treating that particular fracture. In this regard, Galen’s approach of treating each condition in separation to the rest of the body was transferred to the treatment of other types of ailments. These conceptions became a set of knowledge that were unquestionable for over 1500 years and even today most of its principles are still part of modern Western medicine (Portilla, 2017).
Health and Disease Conceptions of Western Medicine
According to the WHO “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health
Organization, 1946). Furthermore, for Western medicine the responsibility of people’s health is attributable to health systems. Therefore, most of the burden of people’s well- being falls on the shoulders of the government as well as on health professionals. In this regard, Western medicine focuses on the treatment of diseases rather than on the prevention of them.
On the other hand, talking about diseases the WHO has not developed a definition for disease. However, we can borrow the definition of disease from Dorland’s Medical
Dictionary: “a disease is a particular abnormal condition that negatively affects the
27 structure or function of all or part of an organism”. Furthermore, for Western medicine a disease has external causes and, in some cases, unknown causes. Moreover, considering the origins of this discipline Western medicine focuses on treating the symptoms of a disease rather than the root causes (Portilla, 2017, p. 88).
Strengths and Weaknesses of Western Medicine
According to Marice M Iwu and Erick Gbodossou (2000) “the recent advances in molecular biology and physiological chemistry have greatly enhanced our understanding and treatment of diseases”. In particular, biomedicine “is best applied in conditions attributable to material factors such as infection, physical trauma, poisoning, nutrition, or personal and environmental hygiene”. Furthermore, according to Krystina Ostermeyer
(2021) modern medicine is advancing at an astonishing rate. For instance, we can simply watch TV and witness how new medications are being developed day by day. For instance, due to Western medicine the death rate from heart diseases has dropped by 60% since 1970. And the death rate from HIV/AIDS has dropped over 75% since 1995
(Ostermeyer , 2021).
On the other hand, one of the biggest challenges that Western medicine has to face nowadays is the strength of cultural belief systems around the world. Although
Western medicine has a social authority6 that cannot be denied, traditional medicine still holds a significant cultural authority7. The fact that 80% of the population in developing countries still uses traditional medicine as their primary response to healthcare issues
6 The ability of a person to influence the actions or decision making of others based on social status and power (Joralemon, 2010). 7 The ability of a person to influence actions based on shared cultural beliefs (Joralemon, 2010).
28 (Chivian & Bernstein , 2002), poses great challenges for Western medicine to actually be the dominant trend in the health sector. The conflicts Western medicine has with belief systems around the world are so important that some scholars have gone as far as to say that: “The systematic neglect of culture in health and healthcare is the single biggest barrier to the advancement of health worldwide” (The Lancet, 2014).
The reason behind this affirmation has to do with the fact that cultural belief systems determine how people respond to health issues. According to the NCBI “Cultural health beliefs affect how people think and feel about their health and health problems, when and from whom they seek health care, and how they respond to illness” (National
Center for Biotechnology Information, 2021). To understand this concept better we can take as an example the treatment of malaria in developing countries particularly in Africa.
Malaria is a very common disease in African countries and its symptoms are similar to other diseases. Therefore, malaria is usually regarded as a mundane8 disease and is not properly treated. In this regard people usually resort to home remedies and/or healers for treatment. Hence, according to Ventura-García et al. (2013) if we understand the clinical and environmental aspects of a disease and put aside the social and cultural ones, we may only be able to get certain populations to follow treatment (Ventura-Garcia, et al., 2013).
Moreover, according to Nathan Wilson (2012) over the last thirty years the practice of Western medicine has taken a turn for the worst due to the unique problems that modernity has posed to the 21st century society (Wilson, 2012). Such problems include but are not limited to issues related to accessing healthcare, the increase of the
8 Malaria is considered as a mundane disease because it occurs commonly.
29 elderly population, mental illnesses, and budgetary constraints (WGU OHIO, 2020).
Taking as an example accessibility issues it is important to notice that “every day someone struggles to get the medical help they need, even in upper-middle-to-high- income nations with advanced healthcare systems” (SANDOZ, 2016). In fact, according to the Sandoz Healthcare Issues Perception Study (SHIPS) 2016, 55% of the population from 12 countries9 perceives access to healthcare as low, and 67% of medical professionals say that access to healthcare could be better (SANDOZ, 2016). Such issues have to do mainly with location and/or transportation issues, as well as with economic hardship. Taking the United States as a case example, an important part of its population amounting to some 35 million people lack basic health insurance coverage. Moreover, according to the US Census Bureau 60 million people in rural areas receive a lower quality of healthcare compared to urban and suburban centers (Wheel Team, 2019).
Finally, according to the CDC 8.3% (roughly 27 million people) of adults 18 years and older failed to obtain needed medical care due to cost in 2019 (CDC, 2019).
Western Medicine in Ecuador
Over the 2001-2014 period Ecuador achieved substantial economic and social gains. Furthermore, in 2017 Ecuador crossed the World Bank’s upper middle-income threshold, leaving behind its status as a lower middle-income country. In the social arena, key health indicators such as life expectancy and mortality rate at birth have improved greatly. For instance, life expectancy at birth rose from 68.89 years in 1990 to 76.58 years in 2018. The mortality rate at birth dropped from 47.1 per 1000 births in 1990 to
9 Australia/New Zealand, Brazil, Canada, France, Germany, Italy, Japan, Russia, Switzerland, Turkey, UK, USA.
30 13.7 per 1000 births in 2019. Births attended by skilled health staff in 2017 reached
96.7% (World Bank, 2018). All these gains are attributable to the implementation of
Western medicine strategies by the Ecuadorian government.
According to the former Health Minister, Verónica Espinosa, Ecuador experienced a dramatic change in its national healthcare system since the enforcement of the 2008 constitution. The 2008 Ecuadorian constitution established the State as guarantor of the right to health. This in turn brought about a health reform to comply with the constitutional mandate. One of the key elements of this reform was the establishment of a free public health care system and the creation of a new health model that focused on the promotion, prevention, recovery and rehabilitation of health instead of the treatment of illness (Espinosa, De la Torre, & Tambini, 2017).
Since the reform, Ecuador experienced a huge increase in the demand for health services caused by public free health, generating the necessity for more infrastructure, human resources, and medicines. Therefore, the reform process required an investment of
16,208 million U.S. dollars between 2007 and 2016, and an average annual investment five times higher than that of the period 2000-2006. As a result, the national health care system was strengthened through this deep and ambitious reform process (Espinosa, De la Torre, & Tambini, 2017).
However, policy makers in Ecuador have understood that one of the biggest challenges to keep the system running is the implementation of a sustainable financial health care system in the medium and long term (Espinosa, De la Torre, & Tambini,
2017). In 2017, this challenge became an imperative when the government of President
Lenín Moreno issued the executive decree 135 on austerity and optimization of public
31 spending. Through this decree in 2019, thousands of public servants and health professionals were laid off (El Universo, 2019) and a project for the elimination of hundreds of administrative offices at the district level was proposed (La Hora, 2019).
Furthermore, the Ministry of Health acknowledged that the implementation of the reform at the local level was harder than expected and today has not been completely achieved
(Espinosa, De la Torre, & Tambini, 2017). Hence, the Ecuadorian Government is in desperate need of elements that could bring financial sustainability to the health care system. This reform should also make the implementation of a new system possible at all levels, especially the local one.
32 Chapter 3: Literature Review
Writing a literature review for this thesis has been certainly the most challenging part of this work. Although there is plenty research regarding the current problems with the Western medicine system, not many scholars have challenged the Western conceptualization of health and disease. Furthermore, although there is plenty of research regarding the benefits of TM, there are not many focus investigations regarding Western conceptions of TM. Much lees about how erroneous Western conceptions are hampering the integration of the two systems (traditional and Western medicine). Finally, finding scholars who have strived to come up with innovative realizable solutions for the
Western healthcare system weaknesses, has been even harder.
Nonetheless, the investigations that do exist about these topics are extremely interesting and valuable. For instance, although not many have challenged the Western medicine way of thinking, many scholars have engaged in deep conversations about the de-westernization of society. Most of that work has focused on matters related to politics, international relations, racism, and gender equity. Furthermore, although the perceptions of Western society regarding TM have not been thoroughly researched, there are several tools used by anthropologists to study perceptions. Finally, the few scholars that have engaged in the process of finding innovative solutions for healthcare issues around the world have done an amazing job at spotting simply realizable pathways for change.
In this regard, in order to avoid getting lost in the myriad of disperse contributions contained in documents targeting other specific issues. This section will work around the idea of a three steps approach to find solutions for systematic health problems around the world. In this case the first step is to evidence the problems within Western medicine
33 systems. The second step is to challenge Western conceptions regarding health and disease. The third step is to look for innovative and realizable solutions for the current health issues around the world. Considering that the first step has been covered in the background section, this section will focus on the literature that has challenged Western medicine conceptions. I will also go through some innovative solutions for health issues including the use of traditional medicine approaches. Finally, I will cover the various anthropological and other social science tools that I will use for the discussion section in this thesis. The overall purpose of this literature review is to pave the ground for the results and discussion sections.
Challenging Western Medicine Conceptions and Healthcare Systems
As stated, before finding articles or books that have directly challenged Western medicine principles is not an easy job. However, one of the most outstanding works towards this objective is the book “Health and Culture: Beyond the Western Paradigm” written by Collins. O. Airhihenbuwa10 in 1995. Although this book was published more than 25 years ago the critics made by the author are still applicable to the current healthcare systems. Through his work Airhihenbuwa challenges the “valorization of
Eurocentrism and patriarchy in the production and acquisition of health knowledge and health behavior, coupled with the continued oppression and suppression of cultural expressions of non-Western peoples and women” (Airhihenbuwa, 1995, p. ix).
Airhihenbuwa also challenges the modern conception and reliance on devolvement and
10 Nowadays, Airhihenbuwa is a public health researcher. Currently Collins is the Director of the GRAND (Global Research Against Non-Communicable Disease) Initiative and Professor of Health Management & Policy at Georgia State University
34 the standardization of Western thought and Western medicine thereof. Finally,
Airhihenbuwa strongly criticizes the “overemphasis of health promotion and disease prevention practices in the medical model of prevention” (Airhihenbuwa, 1995, p. x) which leaves behind the cultural aspects of health.
In particular, according to Airhihenbuwa health promotion programs are full
“with pejorative cultural codes and meanings anchored in Eurocentric and Westernized ideology” (Airhihenbuwa, 1995, p. xii). For instance, psychoanalysis is a Western practice that concentrates on the individual. However, non-Western cultures have always been more focused on the community rather than the individual. Therefore, psychoanalysis is culturally inappropriate in many countries that have not embraced
Western traditions. Nonetheless, the dominant Western medicine around the world continues to be strongly reliant on individual psychology. In this regard, Airhihenbuwa states that emphasizing the importance of culture in healthcare is equal to challenging approaches that overlook or downplay the centrality of historical, political, and education features in the cultural production of health. The Western approach of health and disease also deepens and perpetuates the possibilities of applying innovative approaches, such as critical pedagogy and cultural studies. In this regard, for Airhihenbuwa it is crucial to deconstruct the current systems of “dominant values in a manner that challenges the very foundation of the social and cultural order” (Airhihenbuwa, 1995, p. xii) otherwise we will be condemned “to commit social and cultural suicide by turning into zombies”
(Airhihenbuwa, 1995, p. xiv).
More recently in 2010 Larry Malerba also challenged Western medicine healthcare systems in his book “Green Medicine: Challenging the Assumptions of
35 Conventional Healthcare”. According to Malerba in spite of all the money and many efforts put on research for new health treatments, real breakthroughs are rare. And the very few cures that are available are usually accompanied by many side effects that in some cases could be worse than the disease itself11. Yet affording quality healthcare is becoming more expensive year after year. For Malerba it is clear that something is wrong, but people seem to be blinded to what is actually happening. In fact, Western healthcare systems are receiving prizes for their good work (Malerba, 2010, p. 1).
However, “the unavoidable truth is that the medical system is sick, and it is making patients sick” (Malerba, 2010, p. 2). In this regard, Malerba works around the idea that
Western medicine holds erroneous assumptions regarding health and disease that in turn lead to erroneous treatments and ultimately to more illness and human suffering.
Therefore, the objective of his work is “to provide a direct and comprehensive appreciation of the flaws in medical thought and their potential remedies” (Malerba,
2010, p. 2).
In particular, according to Malerba while all appears to be well on the surface, a closer look at clinics and hospitals exposes a system that is incapable of providing
11 For example, we can look at drugs such as Humira which reduces the effects of a substance in the body that can cause inflammation. This drug has over twenty possible side effects. According to the pharmaceutical company the list of side effects they have published is not a complete one and other side effects may also occur. The side effects published include: fever, swollen glands, night sweats, general feeling of illness; joint and muscle pain, skin rash, easy bruising or bleeding; pale skin, feeling light-headed or short of breath, cold hands and feet; pain in your upper stomach that may spread to your shoulder; or loss of appetite, feeling full after eating only a small amount, weight loss. New or worsening psoriasis (raised, silvery flaking of the skin); a sore or bump on your skin that does not heal; liver problems--fever, body aches, tiredness, stomach pain, right-sided upper stomach pain, vomiting, loss of appetite, dark urine, clay- colored stools, jaundice (yellowing of the skin or eyes); lupus-like syndrome--joint pain or swelling, chest pain, shortness of breath, patchy skin color that worsens in sunlight; nerve problems--numbness, tingling, dizziness, vision problems, weakness in your arms or legs; or signs of tuberculosis--fever with ongoing cough, weight loss (fat or muscle). Older adults may be more likely to develop infections or cancer while using this drug.
36 services that can effectively heal the sick. For Malerba, these issues have nothing to do with the financing of the system (as many have pointed out) but with the actual practice of Western medicine. For instance, Malerba highlights the function of a quick-fix culture as one of the main problems in Western healthcare systems. Such narrowed minded quick-fix solutions only suppress diseases. Therefore, what usually appears to be resolved smolders silently underneath the surface until it reappears in the form of a more challenging disease. Nonetheless, the strategies used by Western doctors remain virtually safe from scrutiny, as people accept doctors as the highest authority in health given their scientific educational background. In this regard, Malerba argues that there are a variety of healthcare options that respect the human body’s wisdom and its capacity to heal. For instance, traditional medicine practices count with actual methods of healing for long- term well-being. Nonetheless, such options are not given serious consideration by the
Western systems (Malerba, 2010, p. 3) due to a variety of prejudices.
Finally, the Ecuadorian anthropologist Santiago Portilla has also contributed to the challenging of Western healthcare conceptions, by his research during thirty five years. In his book “What is health? What is disease?” from 2017, Portilla claims that diseases are not produced by virus, bacteria, genes, hereditary factors, the environment, age, autoimmunity issues, hormones, or allergies. For Portilla diseases are produced by lifestyles that have serious mistakes when it comes to attending our vital needs.
Therefore, those who do not know how to take care of their health go through fatigue, suffering, limitations, dependencies, and high expenses. In this regard, the purpose of
Portilla’s work (as a naturopath) is to teach people how to live a healthy life. A life full of energy, by feeding properly according to the body’s needs and to the culture
37 environment, by doing integral exercises and practicing deep breathing, as well as by resting enough and taking care of one’s physical and cultural environment, learning to manage one’s emotions, and cultivate our mental health (Portilla, 2017).
When going through Portilla’s arguments one of the most controversial ones for a reader is that diseases are not caused by harmful microorganisms. However, according to the author dismantling Western conceptions around microbes being the main cause of diseases is an easy job. All the academic books regarding infectious diseases say that the majority of people have the microbes that cause a variety of diseases. Nonetheless, the majority of people do not suffer any discomfort thanks to their immune system. For instance, we are all infected with the virus that causes flu. However, whether we are sick with the flu or not depends on our immunity which varies according to our habits. We can remember for example the multiple occasions in which we have been in contact with someone who has the flu, and we did not get sick. In the same way there are other occasions in which we are not in contact with a sick person, and we get the flu. It all depends on how strong our immune system is at any given occasion (Portilla, 2017, pp.
337, 338).
For Portilla this same theory applies to many infectious and even tropical diseases also. For example, there are thousands of people living with HIV. However, there are many that spend decades without showing any symptoms. According to Portilla they are proof that people can live with this virus if their immune system is strong. Others die after six months of acquiring the virus which does not demonstrate that the virus is lethal but that their immune system was not strong to begin with. In this regard, Portilla explains that this disease has spread in certain regions in Africa due to the extreme
38 hunger and poverty conditions in which people live. This situation leads in turn to serious nutritional deficiencies that debilitates the immune system and make people prone to suffer AIDS (Portilla, 2017, p. 338).
According to Portilla the idea that diseases are caused by external agents was first coined by Galen (130-200). However, it was Louis Pasteur (1822-1895) who developed the germ theory of disease causation, which attributes the origin of diseases to virus, bacteria, germs, fungus, bacilli. At the time such theory had many detractors who demonstrated its invalidity. Pasteur himself recognized before dying that his theory was wrong, saying: "Bernard was right--the microbe is nothing, the terrain is everything". In other words, Pasteur recognized that a germ cannot cause a disease if the receptive terrain
(the human body) is healthy12. However, this theory prevailed due to the interests of the industries that began to develop drugs. Nowadays, the germ theory of disease causation is widely accepted by Western medicine (Portilla, 2017, pp. 131-134)and is backed up by big pharma13 which represents one of the most profitable industries around the world14
(Thomas, 2020).
Innovative and Simple Solutions for Modern Healthcare Systems
According to Arvind Singhal, Prucia Buscell, and Curt Lindberg (2010) the health reforms around the world do not work because there is no real shift in thinking. Such reforms are “only about trying harder at what is not working so well now”. Therefore, the
12 A healthy or diseased biological terrain is determined primarily by four things: its acid/alkaline balance (pH); its electric/magnetic charge (negative or positive); its level of poisoning (toxicity); and its nutritional status. 13 Big Pharma is the nickname given to the world’s pharmaceutical industry. 14 A large study published in the journal JAMA in March 2020 reports that large pharmaceutical companies make a much larger profit from their products than other large public companies.
39 idea of these scholars is to stop fighting against what is not working and begin investing in what is working (Singhal, Buscell, & Lindberg, 2010). When thinking about this approach it is interesting to realize that 80% of the population in developing countries around the world still uses traditional medicine to meet their primary healthcare needs
(Chivian & Bernstein , 2002).
In this regard, scholars such as Airhihenbuwa, Malerba, and Portilla have evidenced the importance of traditional medicine practices in their innovative proposals for change. For instance, Airhihenbuwa proposes a model that positions culture at the front and center of health promotion interventions. Through his model Airhihenbuwa attempts to help health educators assess and address cultural features in African countries, where TM is widely used (Airhihenbuwa, 1995). For Malerba “a clear and unflinching awareness of the true nature of health, illness, and cure can lead to methods that promote real and effective healing”. Such methods include the ones used by TM and other alternative approaches to health (Malerba, 2010). Finally, for Santiago Portilla all we have to do to have a healthier lifestyle is to rediscover some of the benefits of our ancestors’ lifestyles. In the Sierra region of Ecuador for instance people had only the guinea pig as the main source of protein, before the arrival of the Spaniards. Therefore, their diet was based on corn, vegetables, beans, quinoa and amaranth. Even when the
Spaniards brought chickens, pigs, and cows, indigenous people maintained their diet and would eat these animals only on special occasions. For Portilla, this is a much healthier way of eating than the Western diet that causes several diseases nowadays (Portilla,
2017).
40 Social and other Anthropological Tools
Constructivism
Constructivism is a research paradigm that emphasizes the central influence of multiple perspectives, contextual factors, and value systems in the development of knowledge (Fram, 2014). Hence, my ontological and epistemological stance in this research has been guided by this approach. Considering that this investigation builds on the idea that Ecuadorians have different perspectives of traditional medicine. Such a variety of perspectives translates into the creation of multiple realities that are expressed in the way Ecuadorians approach issues of health and disease. Furthermore, according to the constructivist approach the aim of inquiry is to understand and reconstruct the constructions people initially hold (Guba, 1998). This research is also in tune with such aim as its ultimate objective is to understand, deconstruct and reconstruct current social perspectives people hold regarding TM in Ecuador. Finally, it is important to note that the hypothesis I have worked around is that these constructions represent the major hurdles that make the proper integration of TM benefits in the Ecuadorian public healthcare system difficult.
Perceptions
The importance of studying perceptions was given by the French thinker Maurice
Merleau-Ponty (1908-61) who stressed the embodied nature of perceptions. According to
Merleau-Ponty we do not have passive bodies that see and understand an objective world
"out there." All experiences of the world are mediated through our perception of it, and such perceptions are captured by the biological, psychological, and spiritual mechanisms of our bodies. In this regard, as the world acts on our bodies, our experience of being in
41 the world affects and shapes the phenomena we perceive (Bowie, 2006, p. 39). In other words, reality is not static or objective, each one of us creates our own reality depending on how we see and conceptualize the world.
Furthermore, our perceptions about the world also determine what we consider to be true or not. In this regard, it is important to notice that the Western thought is guided by a positivist approach that is obsessed with defining what is true based on verifiable evidence. However, according to Overing (1985) the positivist preoccupation with defining ‘what is true’ in terms of verifiable observation obscures the authorizing processes through which truth is created, ‘what truth means’ in other situations and alternative conceptions of reality. In this regard, Niehaus emphasizes the importance to understanding that reality is culturally constituted and relative (Niehaus, 2001, p. 114).
Therefore, pretending to apply a single approach, perception or true regarding health and disease conceptions all over the world results highly ineffective.
Symbolic Classification
According to the German sociologist Max Weber (1864-1920) human beings have the need to impose meaning on the environment in order to classify and regulate their world, and therefore to understand it. In this same way, Fiona Bowie (2000) explains that human beings engage in a classificatory process of other human beings by using labels as well as classificatory tools such as language, age, gender, ethnic and cultural features.
The way human beings classify other human beings and the meanings they give to each category varies from one culture to another, and it is what these categories mean or represent that determines our behavior towards others. In this same way, the meanings people give to these categories might be expressed explicitly or implicitly, consciously or
42 unconsciously; they might be felt as true or fantasy, and as originating from science or from commonsense (Bowie, 2006, p. 34).
These categories might also be conveyed through everyday speech, elaborate rhetoric, high art, social media, the TV, among others (Bowie, 2006, p. 34).
For instance, dirt is not a "thing-in-itself" but a symbolic category, it is a relative idea.
For example: shoes are not dirty in themselves, but it is dirty to place them on the dining table; food is not dirty in itself, but it is dirty to leave cooking utensils in the bedroom, or having residuals of food on clothing; similarly, bathroom equipment in the drawing room; clothing lying on chairs; out-door things in-doors; upstairs things downstairs; under-clothing appearing where over-clothing should be, and so on. In short, our pollution behavior is the reaction which condemns any object or idea likely to confuse or contradict cherished classifications (Bowie, 2006, p. 43).
Furthermore, Bowie stresses the fact that individual classifications are much less powerful than those that have the weight of collective authority, and public categories tend to be more rigid than private ones. (Bowie, 2006, p. 44) . For instance, in his book
Exploring Medical Anthropology, Donald Joralemon talks about the perceived types of authority different people in the medical sector have. According to Joralemon, two types of authorities can be perceived. The first is social authority which is defined as the ability of a person to influence the actions or decision making of others based on social status and power. On the other hand, the second type is cultural authority which is defined as the ability of a person to influence actions based on shared cultural beliefs. In this regard, it is Western health professionals are perceived to have a high degree of social authority and a low degree of cultural authority. On the other hand, traditional healers are
43 perceived to have a high degree of cultural authority and a low degree of social authority
(Joralemon, 2010).
Dualism
Dualism is a term that has been used in a variety of forms throughout the history of thought. In general terms dualism refers to the idea that for any particular domain, there are two types of categories of things or principles. For example, in theology a dualist is a person who believes that Good and Evil are separated entities that have similar forces in the world. Other example of dualism can be elucidated in the area of the philosophy of mind, where it is believed that the mental and physical bodies are separated since they are fundamentally different things (Stanford, 2021). The separation of the mind from the body is called Cartesian dualism and played a key role in the separation of medicine from the supervision of church. Such separation allowed for religion to concentrate on the non-corporeal mind and the domination of the body was ceded to science. Nonetheless, according to Matthew H. Gendle (2016) “in Western medicine, traditional Cartesian dualism facilitates the biological reductionism of disease, supports medical practices that do not necessarily support healing and wellness, promotes a dispassionate and mechanistic approach to patient care, disempowers patients, and discourages humanistic ways of thinking that focus on the whole patient” (Gendle, 2016).
44 Chapter 4: Methodology
Data Collection
I used semi-structured in-depth interviews to collect qualitative data for this research, following IRB approval (project number 19-E-426) from Ohio University. I interviewed 27 people 18 and older living in the Highlands of Ecuador particularly in the cities of Quito, Ibarra, and Loja, identified and recruited with their consent. For the purposes of this thesis, I selected 16 interviews from Quito and Ibarra to analyze in this research. I travelled two times to the research sites in order to collect data. The first time was during winter break 2019 and the second during summer 2020. The interviews were carried out in Spanish and in a place of convenience for the interviewees or via zoom.
Each interview lasted from 10 minutes (the shortest) to one hour and a half (the longest).
I included questions regarding the use of traditional and Western medicine, perceptions about health and disease, perceptions about the use of traditional medicine, perceptions about healers, and perceptions about the benefits or disadvantages of traditional medicine
(see Appendix B). Taking into account that I’m considered to be part of the elite group15 in Ecuador, I worked with a snowball sampling, beginning with my acquaintances. The informants were asked to provide other potential respondents a handout with a summary of the study that included my contact information, and the potential participants were able to contact me if they were interested in participating.
15 Given my level of education and my family and friends’ social circles.
45 Data Analysis
The second part of the methodology consisted in the analysis of the data and the preparation of my graduate thesis as an instrument for disseminating results. In this regard I transcribed and coded the 16 interviews in Spanish. For the coding process I used the software QDA Miner. After coding I translated the specific quotes that have been used in this research to English. Furthermore, this research has been guided by constructivism as well as by a combination of other social approaches to more thoroughly inform this investigation. In this regard, first of all, I have used cultural anthropology and medical anthropology16 approaches to analyze the results. Second of all, I have used critical race theory tools to analyze various aspects regarding discrimination. By using these tools, I have strived to understand individual experiences, which constitutes the basis for understanding the larger Ecuadorian population perspectives. Finally, I have used autoethnography tools since I believe that we cannot be objective in the analysis of any given subject. As Matt Bradshaw and Elaine Stratford (2016) have stated “we fold our own values and beliefs into research, and this can influence both what we study and how we interpret our research” (Bradshaw & Stratford, 2016, p. 68). Therefore, instead of trying or pretending to be objective as promoted by the positivist approach, I have used my personal experiences regarding health and disease in Ecuador, as well as my social, academic, and professional background, to enrich this investigation.
16 One of the first tasks of medical anthropology is to define health in a way that acknowledges different cultural models (Wiley,2013. Medical Anthropology)
46 Chapter 5: Results
Organization of the Section
For the purpose of organization, the results section has been divided into two parts. (1) covers the different aspects concerning people’s perceptions about traditional medicine in general. (2) covers the perceptions about two fundamental but different components of traditional medicine: medicinal plants and traditional healers (see Figure
2). Nonetheless, beyond this organization it is important to mention that the results of this thesis clearly shows that there are certain aspects that people mentioned frequently, such as: people in the countryside uses TM, poor indigenous uneducated people use traditional medicine, medicinal plants are used widely in Ecuador, Western and TM being extremely different, among others. On the other hand, there are some other aspects that were not mentioned that frequently but constitute the constructions behind the more superficial perceptions, such as: racism, classism and education-based discrimination matters. Such phenomenon will be analyzed in the discussion section through an iceberg of perceptions where the most frequently mentioned features would be at the tip and other perceptions would be found beneath the water (see Figure 3)17.
17 The iceberg theory will be further developed in the discussion section.
Figure 2
Organization of the Results
PERCEPTIONS ABOUT TRADITIONAL MEDICINE (1) (2)
General TM component’s perceptions perceptions
TM and Western Racism, classism Geography medicine against Medicinal plants Traditional healers and religion one another
Western medicine Are part of the People from the Indigenous people Are charlatans and is easier and faster Ecuadorian popular countryside use TM use TM dirty than TM culture
People who migrate Ayahuasca and San to cities lose their Poor people use TM TM is a superstition Pedro are to be Are knowledgeable traditions feared or respected
TM goes against the Uneducated people Catholic faith use TM
Research Sample
The sample for this research is composed by sixteen informants. Eleven participants live in Quito and five live in Ibarra. Furthermore, ten are women and six are men. Talking about age groups, eight are in the ages between thirty-six and sixty, five participants in the ages between twenty-eight and thirty-five, and three are sixty-one years old and older. Referring to ethnic self-identification, eleven identified as mestizos, four did not identified with any ethnicity and one identified as mulato. Regarding education, six had graduate degrees, six an undergraduate degree, three had completed high school and 1 was illiterate. Regarding employment, people had a variety of jobs including doctor, housewife, lawyer, anthropologist, therapist, “curandera” (see
Appendix A), government employee, among others. In this regard, one could picture a mestiza woman from Quito between thirty-six and sixty years old, with a high level of education, as the most common informant from this sample (see Table 1).
49 Table 1
Sample
Place of Educational # Sex Age Ethnicity Occupation residence level
1 Ibarra Female 77 Mestiza Illiterate Curandera
2 Quito Male 96 Mestizo Graduate Doctor
Public 3 Quito Female 27 Mestiza Undergraduate Administrator
4 Quito Female 50 Mestiza Graduate Lawyer
5 Quito Female 66 Mestiza High school Housewife
6 Ibarra Male 59 Mulato Undergraduate Businessman
7 Ibarra Female 60 Mestiza Undergraduate Housewife
Emotional 8 Quito Female 46 None Graduate therapist
9 Quito Male 30 Mestizo Undergraduate UN employee
University 10 Quito Male 28 Mestizo Graduate employee
11 Quito Female 52 None Graduate Housewife
Construction 12 Quito Male 55 None High school employee Small business 13 Ibarra Female 55 None High school owner
14 Quito Male Unknown Mestizo Anthropologist Graduate Government 15 Quito Female 31 Mestiza Graduate employee 16 Ibarra Female 31 Mestiza Undergraduate Lawyer
50 General Perceptions about Traditional Medicine
The first finding that it is important to mention is that the term traditional medicine (in Spanish medicina tradicional) caused a lot of confusion among informants.
For some people the term traditional medicine refers to what it’s defined by academic standards as Western medicine. For some others traditional medicine was not a term to which they could give meaning, or link to a specific type of medicine. In this regard, I realized that if I wanted to know what people’s perceptions about traditional medicine were, I had to explain to them what I meant by traditional medicine. Once I gave a quick summary of how the WHO (World Health Organization) defines traditional medicine18, the confusion in people’s faces would immediately disappear. “Oh, you are talking about old medicine (medicina antigua, in Spanish)” said a 77-year-old woman from Ibarra.
Other forms people called traditional medicine were ancestral medicine (medicina ancestral, in Spanish), Andean medicine (medicina Andina, in Spanish), and Indigenous medicine (medicina indígena, in Spanish). Therefore, and considering that the majority of people I interviewed linked the term ancestral medicine to the WHO definition of traditional medicine, I decided to begin using the term ancestral medicine in order to avoid further confusions. Nonetheless, for the purposes of this thesis I will continue using the term traditional medicine.
Once the term traditional medicine was clear for participants, they elucidated rich concepts about what it included and what it implied. Informants began by saying that
18 According to the WHO traditional medicine is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.
51 traditional medicine was an old type of medicine pertaining to the ancestors. For instance, a 59-year-old man from Ibarra said, “traditional medicine comes from the ancestors, from the forefathers”19. In second place they mentioned that traditional medicine includes the use of medicinal plants. For example, according to a 50-year-old woman from Quito traditional medicine is a “medicine based on the use of medicinal plants”20. Finally, they highlighted the practices of traditional healers as part of traditional medicine. For example, a 52-year-old woman from Quito said, “when someone says traditional medicine the image of a shaman comes to my mind”.21 In this same way, according to a
50-year-old woman from Quito traditional medicine includes traditional healer’s practices “[include] certain beliefs such as mal de ojo22 in Ecuador, or espanto23”24.
In summary, the general definition given by the informants was that traditional medicine is a custom coming from ancestors that includes the use of medicinal plants and the practices of traditional healers. However, the perceptions people have about traditional medicine varies depending on what component of traditional medicine they are referring to. For instance, when asked what they thought or knew about medicinal plants informants appeared to be quite eloquent. On the other hand, when they were
19 The original quote: “Medicina ancestral es, como lo dice su nombre de los ancestros, de los antepasados, eso es medicina tradicional de los antepasados”. 20 The original quote: “Si te vas a remontar a la medicina indígena, medicina basada en el uso de plantas medicinales, y a parte de las plantas medicinales, en determinadas creencias, creencias como el mal de ojo en Ecuador, como el espanto, y ese tipo de cosas no”. 21 The original quote: “Cuando me dicen medicina ancestral viene a mi mente la imagen de un chamán”. 22 The evil eye in English. 23 Translated to English as magical fright, “espanto” it’s a condition of being frightened and is defined as a cultural illness primarily among Latin American cultures. 24 Op. cit footnote 4
52 asked about traditional healers or their practices the majority of them appeared annoyed, gave short answers or none at all.
Geography and Traditional Medicine
Figure 3
Geography and Traditional Medicine
PERCEPTIONS ABOUT TRADITIONAL MEDICINE
General TM component’s perceptions perceptions
TM and Western Racism, classism Geography medicine against Medicinal plants Traditional healers and religion one another
People from the Western medicine Are part of the Indigenous people Are charlatans and countryside use is easier and faster Ecuadorian popular use TM dirty TM than TM culture
Ayahuasca and San People who Poor people use TM is a Pedro are to be migrate to cities Are knowledgeable TM superstition feared or lose their traditions respected
TM goes against Uneducated the Catholic faith people use TM
The most highlighted feature described by informants regarding traditional medicine was its intrinsic relationship with rural areas. In other words, people perceived that mostly people in the countryside use traditional medicine while people in the cities use mostly Western medicine. Furthermore, they described the migration from rural to urban areas as one of the main causes for the loss of ancestral traditions in Ecuador.
53 In this regard, this section has been divided into two parts. The first part discusses the relationship people see between traditional medicine and rural areas and the second part discusses the antagonism perceived between traditional medicine and urban areas.
Traditional Medicine Pertains to the Countryside. The majority of informants expressed that it was only natural for people living in rural areas to use traditional medicine. However, the reasons for people using this type of medicine outside of cities were diverse. For some it had to do with the fact that people did not have access to
Western medicine and therefore had no other alternative but to use traditional medicine.
For others the use of traditional medicine in rural areas has to do with maintaining ancestral practices and not having been colonized by the Western thought.
A 55-year-old man from Quito talked about how natural the relationship between
TM and rural areas is in the following way:
“Since I was little, I was fortunate enough to live in the countryside and obviously
in the countryside there were no doctors, no hospitals, instead we used traditional
medicine. Therefore, it was always important to know what plant served each
purpose”.25 Further on during the interview this same man stated: “There is a
tradition at least on the countryside, in all communities, [and] towns that are still
using these types of medicinal plants to cure any type of discomfort”26.
25 The original quote: “Yo desde pequeño tuve la suerte de vivir en el campo y obviamente en el campo no había médicos, ni hospitales, sino se recurría a la medicina tradicional, entonces siempre fue importante saber que planta servía para cada cosa no”. 26 The original quote: “Ahí hay una tradición al menos en el campo en todas las comunidades pueblos que todavía siguen utilizando este tipo de plantas medicinales para curar cualquier tipo de molestia”.
54 Furthermore, the relationship between traditional medicine and rural areas was mostly expressed by informants when I asked them if their parents or grandparents used to use traditional medicine. For instance, the Ecuadorian anthropologist Santiago Portilla said: “My mom still uses medicinal plants […], my mom is 85 years old, and she comes from a culture more of the countryside. She grew up in haciendas27, she grew up in the countryside”28. Moreover, a 30-year-old-man from Quito said that he stopped using traditional medicine when he stopped going to the countryside, in his own words: “[…] my trips to the countryside, where this happened, became less frequent, because my grandparents did not live there anymore, so this rituality was in some way broken”29.
Conversely, a 60-year-old woman from Ibarra said the following when I asked her if her parents use traditional medicine: “They don’t, […] even though [my father] was born in the countryside”30.
Moreover, there was a strong perception regarding the fact that people in the countryside use traditional medicine because they cannot access Western medicine easily.
In this regard, a 55-year-old woman from Ibarra said: “There were no doctors in the countryside, still now in the mountains if you get bitten by a snake, who do you go to? it is hard to get out, there is no doctor, and it is far away. Therefore, they cure themselves
27 A large, landed estate, especially one used for farming or ranching. 28 The original quote: “Mi mamá todavía cree en plantas, pero la mayoría de amas de casa que llegan a los 30, 40, 50 años ya están simplemente comprando medicación y nada más, mi mamá tiene 85 años y ella proviene de una cultura un poco más al campo porque creció en haciendas también, creció en el campo”. 29 The original quote: “Mis viajes al campo que es donde sucedía esto ya no eran frecuentes, porque ya mis abuelos ya no vivían ahí, entonces ahí se rompió un poco esa ritualidad”. 30 The original quote: “Mis papás no casi, porque mis papas, mi papa a pesar de que el nació en medio del campo”.
55 with herbs from the countryside”31. Later on, she stressed the fact that people from the countryside “have no means to come to the city, nor the money and most importantly is far away”32. Additionally, a 46-year-old woman from Quito described the case of a man that had been hurt by a bull and that had been taken to a “fregador”33. When I asked her if that have happened in the countryside she said:
“Yes, it’s on the beach, it’s a very little town where you are lucky if you find a
doctor, there are no doctors, there are no nurses, there are no hospitals. The
nearest hospital was in Portoviejo34, and that was a three-hour trip. Therefore, the
risk of a person travelling for three to four hours is that that person might die in
the road or have a more serious complication”35.
Finally, several informants stressed the importance of having people in rural areas maintaining their ancestral traditions. For instance, the Ecuadorian anthropologist
Santiago Portilla stressed the importance of having an ancestral diet36 as the healthiest
31 The original quote: “Claro antes imagínese en los campos si hay doctores, no había doctores, hasta ahora en las montañas, le pica una culebra donde tiene que acudir, no puede salir breve porque no hay el doctor y es lejos, y ellos se curan con las hierbas del campo mismo, lo de la picada de la culebra”. 32 The original quote: “Claro no tenían ni como venir a la ciudad, ni el dinero, y más que todo lejos”. 33 The word “fregador” could be translated to English as scrubber and is used in Ecuador to refer to traditional healers who treat wounds and injuries caused by accidents or sudden violence. 34 Portoviejo is the capital city of the Manabí Province, located in the coastal region of Ecuador. 35 The original quote: “Sí, es, como te puedo decir, es que es en la playa, en un micro pueblo si es que tienes doctor eres súper súper súper lechón, que suertudo eres si es que consigues un médico, no existen médicos, no existen enfermeras, no existen hospitales, el hospital más cercano era si no estoy mal en Portoviejo, y eso era como a tres horas, entonces realmente irse con una persona que puede fallecer o que el viaje, porque allá no es que va la ambulancia, viene la ambulancia, y le lleva más o menos bien, porque las carreteras de antes no eran así...eran caminos lastrados tan tan, entonces arriesgarte a que una persona viaje así tres o cuatro horas puede fallecer en el camino o puede tener una complicación más grave”. 36 An ancestral diet as described by Portilla is based on cereals and vegetables, with a sporadic intake of animal products and sweets. According to Portilla, before the colonization indigenous people would eat mainly cereals and vegetables and would eat guinea pigs (which was the only animal protein available) only on special occasions.
56 way of eating and highlight that these traditions have not been lost in the countryside, in his own words:
“[Traditional practices] have not been lost, […] they are being lost day by day but
at the same time there is a group that is recovering and revaluing ancestral
knowledge, because if we go to the countryside right now, we will see that many
people are eating corn for breakfast. […] Corn is the god of food in America, and
it has not been lost by the traditional cultures in the countryside”.37 Finally, a 55-
year-old man from Quito remarked “If you are in the countryside, you have the
opportunity to know all the plants […] and to be able to continue with the same
tradition of healing naturally”38.
People who Migrate to the City Lose their Traditions. In the same way traditional medicine is linked to rural areas, Western medicine is linked to urban centers.
In this regard, many informants identified the acquisition of Western culture traditions, in the process of migration from rural areas to cities, as the main cause for the loss of traditions in Ecuador. A 30-year-old man for instance commented the following: “[…] here in Ecuador there is a big migration from the countryside to the city, therefore in that migration other values are incorporated, there is a cultural adaptation, there is more access to information, and there is an influence of cultures outside of Ecuador”39.
37 The original quote: “Yo creo que no se ha perdido, hay una existencia paralela en este momento, y cada vez se esta perdiendo más pero al mismo tiempo hay un grupo que esta recuperando y revalorizando los conocimientos ancestrales, porque si ahorita vamos al campo vamos a ver que mucha gente esta desayunando mote […] entonces el maíz que es el Dios de la alimentación en América no se ha perdido en las culturas tradicionales del campo”. 38 The original quote: “Si tú estás en el campo tienes la oportunidad de conocer todas las plantas y facilidad así de conocer todas las plantas, y poder igual seguir con la misma tradición de curarse naturalmente”. 39 The original quote: “[…] aquí en el Ecuador hay una migración muy grande del campo a la ciudad entonces en esa migración se toman otros valores, se adapta a la cultura, y se mezcla también con el acceso
57 Similarly, a 31-year-old woman from Ibarra described a particular example of this phenomenon, in her own words: “My grandmother told me that she used to use plants a lot […] but that when she moved to the city, she used those customs much less because she acquired knowledge about the scientific medicine40”41.
Furthermore, the Ecuadorian anthropologist Santiago Portilla explained that traditional medicine is rejected in the cities and practiced in rural areas, and he described the reasons for such rejection in the following manner:
“I believe that [the rejection of traditional medicine] is due to the colonization of
science in the cities, I have carried out seminars in many indigenous communities
[…] and the farther I get from the city and [the nearest] I’m to the pure indigenous
people, they still value the knowledge about plants very much. But when one goes
to the city here people believe that that is ridiculous, because here you have
hospitals, there are antibiotics, there are pharmacies every three blocks42, there is
the scientific knowledge that dominates and that at the same time devalues this
ancestral culture as if it was merely superstition”.43
a la información que llegaba más al campo en el que ya tenemos influencia de otras culturas que ni siquiera son del Ecuador”. 40 Scientific medicine used as a synonym of Western medicine. 41 The original quote: “Mi abuelita ella me comento que sí, que utilizaban bastantes plantas cosas […] pero de ahí, ella cuando ya vino a vivir a la ciudad ya utilizó bastante poco ese tipo de costumbres. Porque ella ya tuvo conocimiento de la medicina científica”. 42 Unlike the United States Ecuadorian cities have pharmacies everywhere in the city, therefore no matter where one lives usually one would have a pharmacy one to three blocks away. 43 The original quote: “Creo que es fruto de la colonización de la ciencia en las ciudades, yo he realizado seminarios en muchas comunidades indígenas, en Otavalo he desarrollado seminarios en Cuenca, en Loja, en Ambato, en Riobamba, y mientras me alejo de la ciudad y estoy con el puro indígena de guango, el pueblo autóctono ellos siguen valorando bastante el conocimiento de las plantas, pero cuando uno sale a la ciudad aquí creen que eso es ridículo porque acá ya está el hospital de SOLCA, está el antibiótico, están las farmacias cada tres cuadras, está el conocimiento científico que domina y que al mismo tiempo desvaloriza a esa cultura ancestral como si fuera mera superchería, superstición”.
58 Moreover, it was also mentioned by several informants that traditional medicine is not accessible in cities. For example, according to a 30-year-old man from Quito people do not go to traditional healers “because that information is not accessible for everyone, and because it would not be convenient for the [pharmaceutical] industry, it is not convenient for them. They would not been benefited with that information being divulged”44. Moreover, for a 27-year-old woman from Quito the main reason for which her family does not go to traditional healers is that they cannot find them nearby anymore, in her own words:
“There are not many curanderos45 nearby anymore. There were many more
before. [For instance] where I live there are no more [curanderos] because it’s the
capital city. There are new generations that do not believe in this stuff anymore.
There are new methods to heal, so traditional beliefs have been discharged, there
is no object in believing in them anymore. So that is why people who use to
practice [traditional medicine] and their children stop doing it because it was not
profitable anymore”46.
On the other hand, according to a 31-year-old woman from Quito, the availability of traditional healers depends on what neighborhood of the city, in her own words:
44 The original quote: “Porque es una información que no está al acceso de todo el mundo, porque a la industria no le conviene por supuesto, porque hay alguien que no le conviene que es información esté divulgada”. 45 Is the Spanish word for healer. Curanderos are popular healers who usually use magical plants in the treatment of supernatural illnesses such as “espanto” (magical fright) or “mal aire” (bad air) 46 The original quote: “Ósea yo creo que a nivel de que aquí de donde yo vivo, no hay porque ya como es capital como hay nuevas generaciones que ya no creen en eso, hay nuevos métodos de curarse y cosas así, entonces como que ya se han desechado esas creencias por decirlo así entonces, ya no tiene como objeto, entonces creo que por eso incluso las personas que lo hacían y sus hijos, ósea su descendencia ya no lo fue practicando porque ya no era lucrativo ni nada por el estilo”.
59 “It all depends on the sector of the city. For example, you do not see that in the
economic center of the city where there are companies or middle upper-class
people, you do not find that. However, for instance, you can still find places
where you can get cleaned, plants, and they sell esoteric stuff and those things.
You can find that a lot in the downtown and the south part of the city, but in the
north center side no, and in the very north in the popular neighborhoods, you can
also find it47”48.
Finally, an interesting characterization about traditional healers was made by a
52-year-old woman from Quito. According to the woman, there are key differences between traditional healers living in the city and those living in rural indigenous communities, in her own words:
“A shaman is a person who has special abilities and a deep knowledge of the
human body, he is well respected within indigenous communities because he
knows about herbs. However, when I think about shamans that live in the city this
concept changes, […] I do not trust them, because I have heard of swindles.
Maybe I lack knowledge about it, but I do not trust a shaman that lives in a
city”49.
47 The informant was talking about the capital city Quito where most of the offices are found in the north side of the city and where renting an apartment for example is usually expensive. On the other hand, downtown, the south side and the farthest north side of the city are considered more popular neighborhoods where renting an apartment for example is usually cheap. 48 The original quote: “Depende más que nada en el sector de la ciudad. Porque por ejemplo eso tú no ves en el centro económico de la ciudad donde se supone que hay las empresas, o la gente de clase media alta, pero por ejemplo en el centro tú todavía encuentras los locales donde te hacen limpias, y te venden las hojas y te venden y cosas esotéricas y eso, sí encuentras, encuentras bastante en el centro y en el sur, pero en el centro norte no, y muy muy al norte en los barrios populares también encuentras”. 49 The original quote: “Un chamán es una persona que tiene habilidades diferentes y un conocimiento profundo del cuerpo humano, y es muy respetado en las comunidades indígenas porque sabe de hierbas. Sin
60 Racism, Classism, and Religion in Traditional Medicine Perceptions
Figure 4
Racism, Classism, and Religion in Traditional Medicine Perceptions
PERCEPTIONS ABOUT TRADITIONAL MEDICINE
General TM component’s perceptions perceptions
TM and Western Racism, classism Geography medicine against Medicinal plants Traditional healers and religion one another
People from the Western medicine Are part of the Indigenous people Are charlatans and countryside use is easier and faster Ecuadorian popular use TM dirty TM than TM culture
Ayahuasca and San People who Poor people use TM is a Pedro are to be migrate to cities Are knowledgeable TM superstition feared or lose their traditions respected
TM goes against Uneducated the Catholic faith people use TM
The connection between traditional medicine and rural areas was the most frequent feature mentioned by informants during the interviews. Nonetheless, such a connection appeared to be just the tip of the iceberg of traditional medicine perceptions in
Ecuador. In this subsection I will describe the racist, classist and religious motives for the
embargo, cuando pienso en chamanes que viven en las ciudades el concepto cambia, es algo más místico, no me da confianza. Porque he oído experiencias de estafas. Tal vez al final es desconocimiento, pero no confío en un chamán que vive en una ciudad”.
61 rejection of traditional medicine conveyed by the informants both in direct and indirect ways.
Traditional Medicine is from and for Indigenous People. As natural as it was to relate rural areas to traditional medicine, it was also natural for many informants to relate traditional medicine with indigenous people. For instance, when I asked a 77-year- old curandera from Ibarra if she believed people use traditional medicine, she said: “Of course, poor people do, indigenous people, the indigenous from the Amazon region, they used to heal themselves with herbs, that’s the truth.”50 For others, the relationship was so clear that they would use the terms ancestral medicine and indigenous medicine interchangeably. For example, a 50-year-old woman from Quito said the following when
I asked her to define ancestral medicine:
“Ancestral [medicine] depends on the ancestors, if you are going to go
back to the indigenous medicine, it’s medicine based on the use of medicinal
plants, and on certain beliefs like mal de ojo in Ecuador and espanto, things like
that.”51 Finally, when I asked a 46-year-old woman from Quito where traditional
medicine knowledge comes from, she said: “From the grandmothers, and the
grandmothers [got it] from the indigenous people. My grandmother had a
hacienda when she was little, and the indigenous people did not go to the doctor
ever, obviously.”52
50 The original quote: “Los indios, los indios del oriente, ellos se curan con hierbas, es la verdad”. 51 The original quote: “La ancestral depende de que ancestros, pero si te vas a remontar a la medicina indígena, medicina basada en el uso de plantas medicinales, y a parte de las plantas medicinales, en determinadas creencias, creencias como el mal de ojo en Ecuador, como el espanto, y ese tipo de cosas no” 52 The original quote: “De las abuelitas, y las abuelitas de los indígenas, de los indígenas, mi abuelita tuvo hacienda cuando ella era chiquita, y los indígenas obviamente ellos no se iban al doctor jamás”.
62 However, the fact that informants believe that traditional medicine is practiced mostly by indigenous people, could not be considered a racist opinion by itself. In this regard, it is important to cite some other comments by informants who clearly mentioned the racist component of traditional medicine in Ecuador. In particular, a 31-year-old woman from Quito said in this regard: “Many people believe that [this is a race thing] they say this is from indios53, this is only for longos54, but that is not true […] because we all have something from indigenous people, no one is pure, no race in the planet is pure.”55 Furthermore, a 52-year-old woman from Quito mentioned how this perception could become an issue: “The problem is that we have this silly idea that the traditional has to do with the indigenous people and that is why people do not want to use it, but if you give them a more commercial presentation [of the same thing] they will use it.”56
Poor People are the ones who Use Traditional Medicine. During the interviews, various informants implied in one way or another that traditional medicine is practiced mainly by poor people or, as one informant said, from a low social class. For instance, for the 77-year-old curandera from Ibarra poor people are the ones who mostly use traditional medicine. In this regard, a 96-year-old doctor from Quito explained why poor people would be the ones that mostly use traditional medicine, in his own words:
"The thing is that traditional medicine is always necessary for many people that do not have money for a visit [to the Doctor], […] people who doesn’t have money and that
53 Indio is a pejorative term used in Ecuador to refer to indigenous people. 54 Longo is a pejorative term used in Ecuador to refer to indigenous people. 55 The original quote: “Sí, porque muchas personas creen que…dicen hay esto es solo de indios, esto es para los longos así, y no no es verdad, primero porque todos tenemos algo de indígenas no es que somos puros”. 56 The original quote: “El problema es que tenemos esta tonta idea de que lo ancestral tiene que ver con los indígenas y por eso no quieren usar, pero si les das una presentación más comercial si toman”.
63 need to [seek help] for their diseases [use traditional medicine].”57 As seen in the case of rural areas where people would use traditional medicine because they could not access
Western healthcare, the same idea was applied by informants to the use of traditional medicine. Poor people simply cannot afford Western medicine that is why they use traditional medicine.
Other informants were especially vocal about the classist lenses through which traditional medicine is seen. For instance, citing again the words of the 31-year-old woman from Quito that explained how traditional medicine use depends on the neighborhood, she clearly characterized the rejection of traditional healers as a classist issue:
“It all depends on the sector of the city. For example, you do not see that58
in the economic center of the city, where there are companies or middle upper-
class people, you do not find that. However, for instance, you can still find places
where you can get cleaned, plants, and they sell esoteric stuff and those things.
You can find that a lot in the downtown and the south part of the city, but in the
north center side no, and in the very north in the popular neighborhoods, you can
also find it […]. So, I believe it is more a classist issue let's say.”59
57 The original quote: “Lo que pasa es que la medicina tradicional siempre es necesaria para mucha gente que no tiene para hacer una consulta. […] Sí gente que no tiene dinero y que tiene que hacer consultas por sus enfermedades, ahora hay muchas plantas que sí son, que alivian más que todo”. 58 When the informant says that, she refers both to people who believe in traditional practices and to traditional healers that have places where they perform their rituals. 59 The original quote: “Eso depende más que nada en el sector de la ciudad. Porque por ejemplo eso tú no ves en el centro económico de la ciudad donde se supone que hay las empresas, o la gente de clase media alta, pero por ejemplo en el centro tú todavía encuentras los locales donde te hacen limpias, y te venden las hojas y te venden y cosas esotéricas y eso, sí encuentras, encuentras bastante en el centro y en el sur, pero en el centro norte no, y muy muy al norte en los barrios populares también encuentras, por decirte la vecina de la esquina es la que me sabe limpiar, yo le llevo las plantas que compro en el mercado y ella me limpia,
64 Furthermore, a 28-year-old man from Quito said:
"The health matter is crossed by a class issue. For instance, you and I
come from the privilege [because we have a high level of education] […] so I'm
sceptic. But there is this another universe that doesn't have this level of education
and that use these other alternative methods of solution that are much cheaper
than the Western methods. So, these forgotten people are probably the ones that
benefit the most from this [traditional medicine].”60
On the other hand, a 60-year-old woman from Ibarra disagrees with the perception that traditional medicine is practiced mostly by people from a low socio- economic class. According to her, whether or not a person uses traditional medicine depends on their families' beliefs: "I have seen many different cases, I believe it is something that has to do more with culture when you see in your family that they use that, your high social status does not matter, because you were raised in a family where you saw those things then you do it. [I say that] because I have seen in all social strata that people use it, independently of everything.”61
entonces yo creo que es más un tema clasista se puede decir, pero es algo que es muy arraigado nuestro, entonces no creo que se debería perder”. 60 The original quote: “Porque el tema de la salud en cuestión de medicina parte de..., esta atravesado por un tema de clase sí, los más educados, tú y yo, partiendo desde el privilegio tenemos, tú estás estudiando un postgrado yo tengo un postgrado, tenemos estudios superiores no y en cuarto nivel, nosotros ya estamos en el top de la gente que sabe de estas cosas, que sabe de la investigación y todo eso, entonces yo soy escéptico, entonces por ejemplo claro por todo la construcción que me metieron en la cabeza. Pero hay estas, hay todo este otro universo que no tiene este nivel de formación que sí apunta a tener estos métodos alternativos de solución que son mucho más baratos que los métodos occidentales de curación de enfermedades. Entonces esta gente olvidada posiblemente es la gente más beneficiada de este tipo de cuestiones entonces no sé si con la educación podamos como curar esto, cuando ya hay todo un bagaje de personas que no accede pero que si los usa”. 61 The original quote: “He visto de todo, he visto de todo, he visto pongamos en personas que son, yo creo que es más cultural no, cuando tú ves en tu familia que emplean esa, a pesar de que tengas un estatus social un poco elevado, no importa, pero como tú te criaste en la familia en que veías eso entonces tú lo haces no, eso porque yo he visto en todos los estratos sociales que utilizan eso, independientemente de todo no”.
65 Finally, as I was carrying out the interviews for this research during winter break
2019, I began to worry about the outcomes I was getting from them. People who I interviewed were referees of acquaintances, and nearly none of them practiced traditional medicine. They did not express a strong opinion about traditional medicine either, most of them simply said they knew very little about traditional medicine as it was a tradition strange to them. I felt I was running out of time and I was complaining about it to my mom when she said: “you are not getting anything out of your interviews because your informants are educated people, they do not use traditional medicine. If you want to get something good [about traditional medicine] interview poor uneducated people, those are the people who use it.”62 And there it was; my mom said what most people thought but would not say, although some said it in indirect ways. However, the most interesting part about her statement was that her tone was implying that I had been way too naïve in not understanding this simple fact of life earlier.
Traditional Medicine goes Against the Catholic Faith. The religious component of the rejection of traditional medicine in Ecuador was the least mentioned, but it was also exposed as an important determinant. In particular, a 31-year-old woman from Quito alleged that believing in traditional healers' equals believing in witchcraft.
Therefore, she said people who think of themselves as faithful Catholics might go to traditional healers but would not admit that they did. She expressed such opinion when I asked her if people go to traditional healers: "In the Quito society yes, but people are too
62 The original quote: “Mijita no estás sacando nada de las entrevistas porque estás entrevistando a gente con educación, ellos no utilizan medicina tradicional. Si quieres tener buenas respuestas tienes que entrevistar a personas pobres que no tienen educación, ellos son los que utilizan”.
66 curuchupas63 to admit it, because they perceived ancestral medicine or the belief in energies as something that has to do with witches. And witchcraft is not seen as a good thing.”64
Furthermore, when a 66-year-old woman from Quito was asked if she goes to traditional healers, she said: "I have gone to see the spirit of Doctor Gregorio […] I actually felt the operation, but I did not come back because I am catholic and I believe in
God."65. When I asked her who this Doctor Gregorio was, she said: "I did not know about him either, but a neighbor took me to him because I was paralyzed, […] so Doctor
Gregorio is the spirit of a Venezuelan doctor, who is dead and through a medium he operates, that is why I did not like this. It is better to ask God and not to bother the spirits.”66
Conversely, when I interviewed a 77-year-old curandera from Ibarra, she said she was a faithful Catholic, and she repeatedly cited the bible when explaining how and why she healed. For instance, she told me that she did not charge any money for her services, and when I asked her why she said: “God did not ask us to do that. God said that one has
63 Someone who flaunts his religiosity and has, at the same time, a dubious private life. 64 The original quote: “En la sociedad quiteña sí, pero la gente es muy curuchupa para admitirlo, porque siempre le toman el tema de la medicina ancestral o de las creencias energéticas como algo de brujería y la brujería generalmente es mal vista, porque siempre piensan que te van a hacer los amarres para que te quedes con el marido de otra o alguna webada así, entonces siempre es mal vista la brujería, a pesar de que hay brujería buena y hay brujería mala”. 65 The original quote: “Le cuento que yo me he hecho ver hasta del espíritu del Dr. Gregorio, él me ha visto a mí y dijeron, yo no creía y no volví porque soy católica, pero sentí la operación y me dijeron que me había operado de siete cosas, yo era la más enferma porque yo me paralizaba, entonces, todo es...pero no volví porque...yo soy católica y creo en Dios”. 66 The original quote: “Yo no sabía, sino que me llevó una vecina porque me vio que me paralice, y parece que a la hermana de ella, le había operado los ojos, entonces el Dr. Gregorio es un espíritu de un médico venezolano, que está muerto y un médium por medio de un médium le opera, por eso no me gustó, porque ósea es mejor pedirle a Dios, y molestar espíritus”.
67 to cure the foreigners, the sick, the overwhelmed, but not for money. Our Lord67 did it, he cured in that way, our Lord cured the blind, the disabled, and he never did it for money, so we have to be that way.”68 She further explained how her healing rituals worked and recalled the prayer she uses in the following way: “The cross won, the cross will win, who there died renounces Satan because in the doomsday said Jesus protect me, Jesus be in my favor, defend me from my enemies, deeds from the demon.”69
67 She refers to Jesus when she says the Lord. 68 The original quote: “Dios no pidió eso, Dios dijo que hay curar al forastero, al enfermo, al agobiado, pero no por dinero, nuestro Señor que hizo, él curó así, nuestro Señor curó al ciego, al patojo, curó él, y él nunca fue por interés de dinero, entonces uno se debe ser así”. 69 The original quote: “Cruz venció, cruz vencerá, quien en ella murió renuncia a satanás, porque en el día del juicio dije Jesús me ampare, Jesús me favorezca, defiéndeme de los enemigos, hechanzas del demonio”.
68 Traditional and Western Medicine are Against One Another
Figure 5
Traditional and Western Medicine are Against one Another
PERCEPTIONS ABOUT TRADITIONAL MEDICINE
General TM component’s perceptions perceptions
TM and Western Racism, classism Traditional Geography medicine against Medicinal plants and religion healers one another
People from the Western medicine Are part of the Indigenous people Are charlatans countryside use is easier and Ecuadorian use TM and dirty TM faster than TM popular culture
People who Ayahuasca and Poor people use TM is a Are migrate to cities San Pedro are to TM superstition knowledgeable lose their be feared or traditions respected
TM goes against Uneducated the Catholic faith people use TM
Going further down the iceberg of perceptions, it was clear that the informants perceived traditional and Western medicine as part of a dual system in which these two types of medicine were opposing each other. In this regard, informants mentioned aspects such as Western medicine solutions being faster and easier than traditional medicine ones, emphasizing that Western medicine is backed up by science while traditional medicine is just a superstition. They also made connections between the use of traditional medicine and the lack of formal education, or the use of Western medicine and education.
In this regard, several times during the interviews, informants would compare traditional
69 to Western medicine to explain why they did not believe traditional medicine works, or conversely, why Western medicine practices were erroneous. Although not many informants were clear about the apparent battle into which these two types of medicines had engaged, two of the informants were very vocal about such conflict. The first was a
60-year-old woman from Ibarra, in her own words:
"The two medicines are fighting with each other, and that should not be that way,
because they should complement each other, because if they help each other, that
would be much better. Sadly, that is not the case, and there are many particular
interests at stake from any medicine or any enterprise. Still, those interests do not
have the goal of benefiting humanity but their own interests, selfish interests.”70
The second was a 28-year-old man from Quito who attributed his lack of knowledge regarding traditional medicine to such conflict, in his own words: “I do not know much [about traditional medicine] and that is in part due to this conflict that exists among Western medicine and these other alternative medicines.”71
Moreover, other cases that exemplify the apparent conflict going on are the ways in which people characterized different aspects of Western and traditional medicine. For instance, a 77-year-old curandera from Ibarra explained why she believed traditional medicine was the best type of medicine in the following manner:
70 The original quote: “Las dos medicinas son peleadas y eso no debería ser, porque debería ser complementaria porque si las dos se ayudan sería mucho mejor, pero lamentablemente no es así y son solamente por intereses de cualquiera, de cualquier medicina o cualquier empresa o lo que sea, pero son intereses que no están persiguiendo el beneficio del hombre por sí sino sus propios intereses no, intereses mezquinos, eso”. 71 The original quote: “Si bien no conozco mucho y esto es parte también de este conflicto que existe entre la medicina occidental y estas otras medicina alternativas”.
70 "[Traditional medicine is the best] because it [uses] fresh herbs, those are good
things, instead doctors give me herbs and things that are old, stale, that is why so
many times [they] intoxicate people, or they perform operations wrongly.”72
Additionally, the Ecuadorian anthropologist Santiago Portilla explained how traditional and Western medicine comes from different theories about health, and that is why they are so different, in his own words:
“The concept of Western medicine is associated with the [idea] that if someone
hurts me with a knife, I cannot cure myself; someone else has to cure me. Hence
that concept was transferred to the disease, which means that when I get sick, I
cannot cure myself; something or someone else has to cure me […], and that is
what Western medicine has taught us. […] [Instead] traditional medicine in a 90%
educates the patient [about healthy habits] and in a 10% helps with a therapeutic
strategy […] [because] for traditional medicine health is knowledge and the
practice of that knowledge.”73
Following this train of thought, it was fascinating to hear how incoherent people's beliefs about health and people’s habits were. According to the information gathered, the habits a person must practice to be healthy vary according to their educational or family
72 The original quote: “[La medicina ancestral] Es la mejor. Porque son hierbas frescas, son cosas buenas, en cambio a mí los doctores me dan hierbas y cosas pero son cosas guardadas, pasadas, por eso cuantas veces intoxican a la gente o hacen mal las operaciones”. 73 The original quote: “El concepto de la medicina occidental está asociado a que si alguien me mente a mi un cuchillo yo no me puedo curar a mi mismo alguien tiene que curarme, entonces ese concepto traspasado a la enfermedad significa que cuando yo me enfermo yo no puedo curarme a mi mismo algo o alguien o un producto terapéutico medicinal tiene que curarme y eso es lo que nos ha enseñado la medicina occidental justamente […] porque la medicina milenaria en un 90% educa al paciente y en un 10% ayuda con una estrategia terapéutica, […] porque la medicina milenaria es conocimiento y la práctica de este conocimiento”.
71 background. Nonetheless, the majority of people mentioned having a good diet and practicing exercises as crucial habits to maintain good health. Only a few informants mentioned practices such as taking care of their psychological, emotional or spiritual health. Nonetheless, what was interesting about their responses was that while they were confident about what healthy habits were, the majority of them said that they didn’t practice them or that they did it only to a certain degree. In other words, they knew how to maintain a healthy life, but they failed to do it. By giving these last responses, most of the informants appeared a little ashamed and laughed nervously at the incoherence of what they thought and what they actually did.
According to the Ecuadorian anthropologist Santiago Portilla this behavior is only natural. The reason is that for Western medicine a person can be considered healthy even when that person does not have healthy habits74. Therefore, if a person is apparently well despite his/her unhealthy habits then that person can be considered healthy, as health is only a state. However, if that same person’s habits are looked through the lenses of traditional medicine the story can be completely different. For instance, according to
Portilla for traditional medicine “health is knowledge and the practice of that knowledge.
Therefore, if a person has knowledge [about health] but does not put that knowledge in practice then that person is not healthy.”75 In other words, for traditional medicine, health is not merely a state but a way of life; therefore, a person does not only need to be well or
74 According to the WHO “health is a state of complete, physical, mental and social well-being and not merely the absence of disease or infirmity”. 75 The original quote: “Salud es un conocimiento y la práctica de este conocimiento. Si la persona tiene conocimiento, pero no practica no tiene una vida saludable, porque hay muchos teóricos de la salud que pueden recitar la buena alimentación el buen descanso y pueden decir un montón de cosas, pero no tienen el autocontrol suficiente para poder cumplir ese conocimiento, entonces pueden tener la teoría de la salud, pero no la práctica”.
72 to know what to do to stay healthy but has to practice healthy habits in order to be healthy.
People Prefer Western Over Traditional Medicine because it Offers Easier and Faster Solutions. Its easiness and effectiveness were some Western medicine’s features that informants pointed out as the reasons to prefer this type of medicine over the traditional one. For instance, some informants explained that even when they still use traditional medicine their children didn’t because they wanted faster, less complicated solutions for their discomforts. A 55-year-old woman from Ibarra for example said:
“Of course, that is really good76, but young people nowadays only think of fast
[solutions], of the doctors, they say that medicine heals me quickly. Instead,
natural medicine takes longer but it does cure with time. For example, my
husband has rheumatism. He goes to the doctor all the time, all his life until now,
but he has not been cur; he takes the medicines the doctor gives him. Me instead I
have taken natural medicine it has taken long; I mean it has taken long to heal me,
but I'm cured.”77
In this same way, a 55-year-old man from Quito that uses traditional medicine said the following when I asked him why his children didn’t:
“I believe that is due to their lack of interest, because nowadays everything is very
modern, and they are more linked to pharmaceutical products. Therefore, if
76 She is referring to traditional medicine 77 The original quote: “Claro que es buenísimo eso, pero es que los jóvenes de este tiempo ya ellos solo piensan en lo rápido del doctor que dicen la medicina me sana enseguida. Vuelta la medicina natural eso le dura pero si se cura con el tiempo, le pongo un ejemplo mi esposo tiene la enfermedad del reumatismo, el se hace control todo el tiempo, toda la vida hasta ahorita, y el no se sana, solo pasa con la medicina del doctor, y yo vuelta, yo he consumido la medicina natural me ha durado, ósea me ha demorado en sanarme pero ya me he curado”.
73 something happens, [they say I] do not want to take a tea because I don’t like it,
and I simply take a buscapina78 for the stomachache or a sertal79 and it’s over,
because is faster obviously and I can buy it and I don’t have to go look for
chamomile in a market, then prepare it, and then drink it, so I think that is more
due to the easiness.”80
Finally, according to a 31-year-old man from Quito people want fast results and are not willing to change their habits to be healthier, in his own words: “You are going to find a lot of people in communities and also in the city that want fast results, and that are not willing to make that sacrifice, that engagement of changing their habits radically in order to be healthy.”81.
Western Medicine is Backed up by Science, while Traditional Medicine is a mere Superstition. Another key difference identified by informants between traditional and Western medicine was their relationship with science. According to informants,
Western medicine can be scientifically proven, therefore, is backed up by science.
However, some traditional medicine practices, especially those linked to traditional healers, are part of a superstition system that cannot be verified. In this regard, a lot of the feelings of rejection towards traditional medicine were justified by the lack of scientific
78 “Buscapina” is a fast-acting pain reliever containing Acetaminophen. 79 “Sertal” is an antispasmodic and anti-inflammatory medication. 80 The original quote: “Yo creo que por falta de interés de ellos no, porque hoy en la actualidad todo es muy moderno y practicamente están más ligados a los productos farmaceuticos, entonces cualquier cosa no quiero tomar esa agua porque no me gusta, y simplemente me tomo una buscapina para el dolor de estómago lo que sea o un certal y se ha acabado, porque es más rápido obviamente y se puede comprar y no se tiene que estar...no tiene que ir a buscar la manzanilla, en un mercado, ponerlo a preparar y luego de eso tomar, entonces, pero yo pienso que es más por eso no por la facilidad”. 81 The original quote:” Te vas a topar con mucha gente en lo comunitario sobre todo y bueno supongo que en la ciudad también que quiere resultados más rápidos, y que no está dispuesto a hacer ese sacrificio ese compromiso de tener un cambio radical de tus hábitos para estar saludable no”.
74 evidence about traditional medicine actually working. For example, a 60-year-old woman from Ibarra explained why his father did not use medicinal plants frequently even when he was raised in the countryside: “He became a doctor and basically he was a scientist therefore he used medicinal plants rarely”82. This same woman also explained why her husband stopped using traditional medicine when he went to college:
“We studied to be lab technicians […], and everything was scientific, and
everything had to be proven, we were taught that there is nothing beyond what
our senses can perceive, so we became kind of scientist, so [my husband] stopped
believing in everything.”83
On the other hand, traditional medicine is perceived as part of a superstitious belief. For instance, when I asked the Ecuadorian anthropologist Santiago Portilla which he believed were the reasons for which people rejected traditional healers he said:
“When one goes to a city here people believe that that is ridiculous, because here
you have hospitals, there are antibiotics, there are pharmacies every three blocks,
this is the scientific knowledge that dominates and that at the same time devalues
this ancestral culture as if it was merely superstition.”84
82 The original quote: “Mis papás no casi, porque mis papás, mi papá a pesar de que él nació en medio del campo, él se hizo médico y básicamente él era científico y entonces él no, muy pocos veces le vi utilizando plantas”. 83 The original quote: “Nosotros después estudiamos tecnología médica […] [y nos enseñaban] que todo era científico y que todo tenía que ser comprobado que no había más allá de lo que uno se percibe, entonces éramos como científicos, entonces Marcelo, el dejó de creer en todo no”. 84 The original quote: “Cuando uno sale a la ciudad aquí creen que eso es ridículo porque acá ya está el hospital de SOLCA, está el antibiótico, están las farmacias cada tres cuadras, está el conocimiento científico que domina y que al mismo tiempo desvaloriza a esa cultura ancestral como si fuera mera superchería, superstición”.
75 Furthermore, a 55-year-old man from Quito said regarding traditional healers' practices:
“In the case of limpias85, sometimes one is skeptic in these types of things, but in
reality, they are true, for example […] they have saved many people who have
been going through [espanto and mal de ojo] [due to] the bad energies that are
absorbed by people, but there has to be faith. Even we have passed through this
with our children and [limpias] have been very effective.”86
Educated People use Western Medicine while Uneducated people use
Traditional Medicine. Another important feature noted by various informants was the different relationship education has with Western medicine on the one hand and with traditional medicine on the other. In this regard, it was clear by some informants’ responses that formal education was linked to Western medicine while the lack thereof was linked to traditional medicine. In other words, it was perceived that only those lacking a formal education would be the ones using traditional medicine because they didn’t know any better. Conversely, for some other informants the loss of the valuable benefits of traditional medicine practices was due to mistaken formal education teachings.
85 “Limpia” is the Spanish word for cleansing, and it’s a ritual by which people are cleansed from bad energies with the help of herbs, eggs, and alcohol, and prayers. 86 The original quote: “En este caso las limpias que, mira a veces uno es incrédulo en ese tipo de cosas pero yéndose a la realidad son verdaderas, por ejemplo para un espanto de un niño lo utilizan el trago con un soplo de trago al pasarle y todo entonces prácticamente le curan del espanto, obviamente para otro tipo de limpias de curas cuando están supuestamente ojeados que generalmente le llaman, lo utilizan el ají, el huevo, igual el romero para hacerle una limpia y por ende también ayudados por un rosario no bendito que con eso prácticamente han salvado a muchas personas que han estado atravesando por estos males, prácticamente las energías negativas que les llegan a las personas y sí hay fe e inclusive nosotros hemos vivido también con nuestros hijos que nos ha pasado eso y han dado buenos resultados”.
76 Beginning with the perception that people who have no formal education are the ones using traditional medicine, we can cite the response of a 96-year-old doctor from
Quito. When I asked this doctor what type of people used traditional medicine he said:
“Almost all people, because they have not studied, they practiced it.”87 Later on, in the interview when I asked him if he would be willing to go to a traditional healer this doctor said “no, I wouldn’t.” When I asked him why he wouldn’t he answered harshly: “Because
I have studied.”
Furthermore, a 60-year-old woman from Ibarra expressed particular concern about education when she said: “I believe that everyone has to study […] and these types of curanderos also have to study, I believe in them but not in all of them.”88 Later on, this same woman told me that the mother and grandmother of her husband had been
“curanderas” and that her husband had not continued with that tradition because he had attended College, in her own words:
"In College we are taught to believe that ours is the truth […] that everything has
to be proven, and that there is nothing beyond what our senses can perceive […]
so my husband stopped believing in everything. I do believe, but I think that
everything has to be studied"89. In this same way, a 28-year-old man from Quito
87 The original quote: PI: ¿Qué gente practica esta medicina tradicional? I: Casi toda la genta, sea que no han estudiado pero practican. PI: ¿La gente que no ha estudiado? I: Claro. 88 The original quote: Ccreo que cualquier cosa, cualquier cosa uno tiene que estudiar, no hacer por todo no, yo si creo que el cuerpo es tan inteligente que se puede auto sanar, pero este tipo de curanderos también tienen que estudiar, y creo en ellos pero no creo en todos como en todo”. 89 The original quote: PI: Tu esposo en ese caso a él le fue transmitido ese conocimiento. I: Sí, sí él veía eso pero como nosotros después estudiamos tecnología médica en la universidad nos hacen creer que lo de nosotros es la verdad y no es así, la verdad. PI: ¿Qué es lo de nosotros? I: Lo que estudiábamos, laboratorio y que todo era científico y que todo tenía que ser comprobado que no había más allá de lo que uno se percibe, entonces éramos como científicos, entonces Marcelo, el dejó de creer en todo no, yo en cambio sí creo, pero creo eso digo, creo que todo tiene que ser estudiado”.
77 said the following after explaining his privileged position in society as he had
attained a high level of education: "I'm skeptic [of traditional medicine] because
of this construction that has been put in my head.”90
Following this same idea, a 30-year-old man from Quito said "Ecuador has never had a strong education system where ancestral knowledge is incorporated […]. Not only in higher education but also in middle school and high school it is important to learn these subjects that are never touched because there is a biased, people think that working in the countryside, that people who work in the countryside are poor.”91 In this regard, I went on to ask the informants if they would agree to incorporate ancestral knowledge into the formal education systems in Ecuador. Surprisingly enough, all the informants said that they would agree with the incorporation of traditional medicine benefits into education systems. However, some emphasized that they would agree with such measures as long as the ancestral knowledge to be imparted is only about medicinal plants.
Perceptions about Medicinal Plants and Traditional Healers
As mentioned in the introduction of the results section, informants perceived medicinal plants and traditional healers as integral parts of traditional medicine.
However, they also have diametric different views regarding each of these components.
90 The original quote: “Los más educados, tú y yo, partiendo desde el privilegio […], nosotros ya estamos en el top de la gente que sabe de estas cosas, que sabe de la investigación y todo eso, entonces yo soy escéptico, entonces por ejemplo claro por todo la construcción que me metieron en la cabeza”. 91 The original quote: “Nunca se desarrollo en el Ecuador, lo contrario de lo que creo que pasa en otros países, una, un sistema de educación fuerte, en, que incorpore primero, como el conocimiento ancestral que ya había para la producción en el agro, y que vaya también orientado a que, no solo en la educación superior, sino también en la educación media, en el bachillerato se vean estos temas, que nunca se vieron porque ya ahí viene un sesgo creo de pensar que la gente que trabaja en el campo, ya idealizar que la gente que trabaja en el campo es pobre no”.
78 In this regard, this subsection will describe the perceptions informants hold about medicinal plants on the one hand and about traditional healers on the other.
Perceptions about Medicinal Plants
Figure 6
Perceptions about Medicinal Plants
PERCEPTIONS ABOUT TRADITIONAL MEDICINE
General TM component’s perceptions perceptions
TM and Western Racism, classism Geography medicine against Medicinal plants Traditional healers and religion one another
People from the Western medicine Are part of the Indigenous people Are charlatans and countryside use is easier and faster Ecuadorian popular use TM dirty TM than TM culture
Ayahuasca and San People who Poor people use TM is a Pedro are to be migrate to cities Are knowledgeable TM superstition feared or lose their traditions respected
TM goes against Uneducated the Catholic faith people use TM
The first and most exciting finding of the use of medicinal plants in Ecuador is that the majority of the informants use them in their everyday lives. Nonetheless, while most of the informants were open to talking about medical plants and the different forms in which they used them when they were asked if they knew anything about “plantas de
79 poder”92 their attitude shifted dramatically. Most of them seemed uncomfortable, some laughed ironically, and some others simply hesitated and said a doubtfully “sí algo” (yes something). Therefore, this subsection has been divided into medicinal plants, and
Ayahuasca and San Pedro as examples of “plantas de poder” (see Appendix A).
Medicinal Plants are Part of the Ecuadorian Popular Culture. The majority of the informants explained that they use medicinal plants for minor discomforts such as stomachaches, headaches, or a mild flu, frequently. For instance, the use of herbs such as chamomile and oregano were the most mentioned by informants. Furthermore, people usually drink herbal teas known as “aguas aromáticas”93 or “aguas de viejas” 94on a daily basis. In fact, the use of such plants is so common that they have been detached from traditional practices and have been appropriated as part of Ecuadorians’ popular culture.
For example, when a 52-year-old woman from Quito was asked if she used medicinal plants she said: “I do make herbal teas, but I relate them with our own medicine that of the Ecuadorians not with ancestral medicine. I drink oregano tea for a stomachache for instance.”95
Furthermore, after I interviewed some women in a beauty salon, they began to talk about how common it is for people in Ecuador to use medicinal plants and homemade remedies. They were wondering where that knowledge comes from, and after
92 In English, power plants, also known among traditional healers as sacred plants, are plants that have a powerful effect when administered to human beings. They are also known for their psychedelic effects. The plants that will be covered in this research are San Pedro and Ayahuasca. 93 In English aromatic water, is a tea made with herbs. 94 “Agua de viejas” means water from old women literally and is used to refer to teas made with medicinal plants. The use of the term “agua de viejas” denotes the linkage of the use of herbs and ancestral traditions. 95 The original quote: “Si hago agüitas de viejas, pero lo relaciono más con la medicina propia de los ecuatorianos no de la medicina ancestral. Utilizo agua de orégano por ejemplo para el dolor de estómago”.
80 discussing it for a while, they simply concluded that the knowledge it’s transmitted orally. They said that people use medicinal plants knowing that that remedy was useful to someone they know. In this regard, they explained that the knowledge about medicinal plants is transmitted from one person to the other within their social circles. Once the healing effect of a certain home remedy has been proven successful in someone then that someone recommends it to someone else, and so on. Therefore, people would complain with family or friends about a certain discomfort, and they would get answers such as: “I had the same thing, and I got better drinking or eating [some home remedy].”96 Such knowledge would be pass from one person to the other, and soon it becomes popular knowledge.
Moreover, half of the sample showed a deep and wide knowledge of medicinal plants and home remedies. The cases of a 55-year-old man from Quito and a 46-year-old woman from Quito are particularly interesting. The man has an indigenous ascendance, was raised in the countryside and had graduated from high school, the woman has a
European ascendance, was raised in the city, and had obtained a master's degree in the
United States. Both showed not only a deep and wide understanding of how medicinal plants work but also said that they recurred mainly to this type of medicine when they are sick. For instance, the 46-year-old woman from Quito explained the use of some home remedies in the following manner:
“If your hair is getting darker […] you wash it with chamomile water, rosemary
water is for [your hair] to get darker, homemade mayonnaise with eggs and oil for
96 The original quote: “Yo tenía lo mismo y me mejore tomando esto o aquello”.
81 dry hair, […] to lighten the skin rice water, […] the fig leave water for [women’s]
hormonal issues, corn hair water for the urinary tract, boldo water for the kidneys,
that is what I have in my house, I don’t have pills, but I have my kitchen full of
herbs.”97
In the same way, the 55-year-old man from Quito also gave a lot of homemade remedies recipes during the interview. The following are a few of them:
“When you have a cut anywhere […] they chew alfalfa and that juice is put on
[the cut] and it’s sealed automatically in order to avoid bleeding, there are an
infinity of medicinal plants, among them the nettle, it’s a great plant that is used
in infusion or raw, raw nettle is used for swellings, the nettle cures immediately,
the infusion instead with a little panela98 is excellent for a cough.”99
San Pedro and Ayahuasca are to be Feared or Respected. Although San Pedro and Ayahuasca are also plants used within the traditional medicine realm (see Appendix
A), the perceptions people have about them are very different from the ones they hold
97 The original quote: “Tu pelo se está oscureciendo, no te vas y te vas a tinturar el pelo sino que coges y te pones agua de manzanilla para que se aclare, agua de romero para que se oscurezca, mayonesa hecha en casa con huevo y aceite para mejorar el pelo, para la piel por ejemplo, para blanquear la piel agua de arroz, para, por ejemplo tenías...yo que sé salpullido te ponían vela de cebo, tenías un corte te ponían matico machacaban la planta de matico, le mezclaban con un poco de aceite y te hacían un emplasto, que más... la hoja de higo, yo tengo desarreglo hormonal, yo me tomo agua de hoja de higo todos los días, que más se me ocurre, agua de limón por ejemplo para bajar de peso, que más agua de pelo de choclo cuando estabas con infección a las vías urinarias, agua de boldo para el hígado, eso es lo que tengo en mi casa, no tengo pastillas tengo eso sí la cocina llena de hierbas”. 98 Unrefined sugar commercialized in the form of little bricks in Ecuador and other Latin American countries. 99 The original quote: “En un corte de cualquier te digo mano, pie, lo que sea te realizas un corte, lo típico ahi es de que mastican la alfalfa y ese jugo lo exprimen encima y que...sella automáticamente para evitar que tu vayas a desangrar y asi una infinidad de plantas curativas, entre esas la ortiga te puedo hablar también, que es una planta estupenda, que esta se utiliza tanto en infusión como en vivo, en vivo practicamente cuando tu sufres algún golpe, algun hinchazón por alguna caída, tú te hortigas inmediatamente y no te hace que se te haga un abseso o se te hinche, entonces es una cura inmediata, al igual que la infusión sirve mucho con un poquito de panela para la tos, es excelente la ortiga también para la tos con un poquito de panela”.
82 about other medicinal plants. During the interviews, informants were asked if they had heard about San Pedro and Ayahuasca, and the response given by a 52-year-old woman from Quito summarizes the collective feeling of most of them, in her own words: “Yes,
I’ve heard people drink those things in weird excursions. I know they are very powerful drugs that take you out of reality and you see either angels or demons.”100
Nonetheless, I will focus the next paragraphs on the answers of other informants that described Ayahuasca and San Pedro as powerful plants that have to be both feared and respected. For instance, when I asked a 31-year-old woman from Quito if she had ever tried Ayahuasca or San Pedro she said: “I tried San Pedro once, but not that much, no that strong, it actually was just some drops of it. To tell you the truth I fear or respect those plants, because they make you take your unconsciousness [side] out so I am fearful of what might come out.”101
Furthermore, when I asked a 60-year-old woman from Ibarra what she knew about San Pedro and Ayahuasca she said:
“They are sacred plants, you have to use them carefully, […] the taita102 (see
Figure 3), shaman or whatever you want to call him has to know how to do those
things, and you have to ask for permission [to nature or the plants], because
everything is vibration, everything is energy, so you have to ask for permission.
Even if we believe that those things do not have life, everything is vibrating, so
100 The original quote: “Si he oído que tomaban en paseos medios ratos y se pegaban esas cosas. Sé que es una droga fuerte que te saca de la realidad y ver ángeles o demonios”. 101 The original quote: “Probé San Pedro la otra vez, pero no mucho, no fue muy fuerte, la verdad fueron gotitas nomas, la verdad le tengo mucho, no se si miedo o respeto a esas plantas porque como te llevan a sacar tu inconsciente si tengo miedo de lo que pueda salir”. 102 Taita is a Quichua word that means father. In the realm of traditional medicine is used to designate wise males who communicate with the spirits in order to cure the soul, mind and body.
83 you have to go to people that know about them. Not do it because someone told
you to, no, no, no, or because is cheaper, no, one has to go to someone that has
studied, that has taken [Ayahuasca and San Pedro], that have experience about
it.”103
103 The original quote: “Que son plantas sagradas porque tú tienes que utilizarlas con pinzas, así mismo como te digo tiene que el taita el chamán o lo que se llame tiene que saber hacer las cosas y tu tienes que pedir permiso porque todo es vibración todo es energía entonces tu tienes que pedir permiso porque así creamos que esas cosas no tienen vida o lo que sea todo todo todo está vibrando y entonces uno tiene que saber ósea saber acudir a personas que saben no meterse a, ah porque te dijeron no no no, o porque es más barato no ósea uno tiene que saber ir a donde las personas que han estudiado, que han experimentado sobre todo que ya tienen experiencia sobre eso”.
84 Figure 7
Taita in a San Pedro Ceremony
Finally, one of the informants gave a detailed description of how it feels to drink
San Pedro. According to this 31-year-old-man from Quito, the manner and the place you drink San Pedro determines the experience you have. He first described what his experience drinking San Pedro in a rave was:
85 "The first time I drank San Pedro was in a three-day rave, and it had some other
logic. First of all, I felt I was gone, and I felt very scared […]. I remember I was
fine in that phase of my life, I did not have any big worries, but I remember that
when I arrived home, I think I saw something so scary that I fainted, and I hit my
head. So, this capacity that [San Pedro] has to awaken these states of
consciousness that you have, when you do not do it with a healing purpose, then it
is dangerous. I guess that is why when people drink Ayahuasca without purpose, I
know they can hallucinate, it could turn into a bad experience, and it can cause
traumas or mental illnesses afterwards.”104
On the other hand, he also described how drinking San Pedro during a traditional ritual was:
“[The second time] was with a guide105 in a temazcal106, it was done during a
ceremony with a ritual and especially with a purpose. A personal and a collective
purpose of the people who shared this [experience]. And its result was to give
strength in my case. I truly did not feel the sensation of being gone, not at all, I
did not feel anything somatic similar to a trip or something like that. Instead, I
104 The original quote: “La primera sí, la primera que fue en este rave de tres días con otra lógica, primero que me sentí ido bastante ido, y llegué a sentir miedo incluso, osea creo que yo no me sentí, en ese tiempo de hecho estaba bastante bien no sentía que tenía ninguna preocupación muy grande, pero recuerdo que al llegar a casa creo que fue...vi algo que me dio tanto tanto miedo que me desmayé incluso, me golpeé la cabeza, me acuerdo, entonces como esta capacidad que tiene de despertar estos estados de consciencia que tu tienes cuando no hay un fin que sea sanador puede ser peligroso también, supongo que por eso existe gente que cuando toma Ayahuasca sin ningún fin también yo que sé pueden alucinar, puede ser una experiencia no tan agradable y por la que pueden desencadenar luego traumas o problemas de la salud mental, problemas mentales, entonces esa creo que fue la diferencia”. 105 When he says with a guide, he means with the help of a traditional healer in this case a “taita”. 106 A “temazcal” is a type of low heat sweat lodge, which originated with pre-Hispanic Indigenous peoples in Mesoamerica. A “temazcal” represents the womb of mother earth, therefore getting out of a “temazcal” at dawn symbolizes the rebirth of a person.
86 was very aware, and I tried to face the things that are caused by being in a
ceremony for the whole night, you can feel uncomfortable, you can feel the heat
in the case of the temazcal, you can feel dizzy. In my case [the hardest thing] was
trying to keep [sited] against the pain, I have this back pain, so the last test was
trying to stay still even if I felt pain, and face that, so it was very symbolic for
me.”107
107 The original quote: “Esta última vez fue algo de estar más consciente, fue con un guía, fue en un temazcal, fue y también la otra fue en digamos una ceremonia con un ritual y con un propósito sobre todo, con un propósito personal, y con un propósito colectivo, de las personas que compartimos esto, y que tuvo su fruto para dar fuerza, en mí caso, la verdad que no sentí, esta sensación de estar ido ni nada, la verdad no sentí nada somático parecido a un vuelo, no, más bien creo que fue estar bastante consciente y tratar de enfrentar las cosas, a las que te lleva el estar toda una noche en una ceremonia en la que, puedes sentir incomodidad, puedes sentir calor en el caso del temazcal, puedes sentir mareo, puedes sentir para mi caso fue tratar de estar constante en frente a un dolor, yo tengo este dolor de espalda entonces, el último ejercicio fue tratar de que a pesar del dolor de lo que sentía ahí yo enfrentar eso mismo no, es bastante simbólico, eso”.
87 Perceptions about Traditional Healers
Figure 8
Perceptions about Traditional Healers
PERCEPTIONS ABOUT TRADITIONAL MEDICINE
General TM component’s perceptions perceptions
TM and Western Racism, classism Geography medicine against Medicinal plants Traditional healers and religion one another
People from the Western medicine Are part of the Indigenous people Are charlatans and countryside use is easier and faster Ecuadorian popular use TM dirty TM than TM culture
Ayahuasca and San People who Poor people use TM is a Pedro are to be migrate to cities Are knowledgeable TM superstition feared or lose their traditions respected
TM goes against Uneducated the Catholic faith people use TM
The perceptions people have about traditional healers in Ecuador are various.
However, they could be mainly divided into positive and negative ones, being the last ones the most common perceptions. In this regard, this subsection has been divided into those two types of perceptions, with the features most frequently mentioned by informants. Moreover, this section also covers the type of authority that traditional healers have as perceived by people.
Traditional Healers are Charlatans and Dirty. When asked about what they knew or thought about traditional healers, most of the informants said that they did not
88 know much or that they did not have any particular opinion about them. However, those who ventured to say something frequently said that a lot of traditional healers were not to be trusted since they were usually charlatans. For instance, a 60-year-old woman from
Ibarra recalled a particularly bad experience with a curandera. When she was pregnant with her first child, she was taken to a curandera by her mother-in-law since her belly was not growing, in her own words:
“The curandera tried to move my belly because she said the baby was in a bad
position, but I stood up immediately and left because I did not want anybody to
touch my baby. My mother-in-law got very angry, but I did not care. After a week
of that I went to the doctor and according to the sonogram my baby was fine, he
was in a good position, and I was seven months pregnant [the curandera had said I
was only three months pregnant]. From that day on I distrust these people
more.”108
Furthermore, even when people have not had particularly bad experiences with traditional healers or any at all, they believe one should be careful with them. A 59-year- old man from Ibarra said the following:
“[I would be willing to go to a traditional healer] as long as he is not a charlatan.
Because within this type of medicine there are people who take advantage of
108 The original quote: “Entonces me quiso hacer mover el estómago porque decía que incluso estaba en mala posición, yo me levanté ese rato ipso facto, pero ipso facto porque no quise que me lo cojan a mi hijo, e incluso doña, mi suegra se molestó bastante, pero yo no estaba, osea yo no quería que le hagan nada a mi hijo. Entonces yo cogí me levanté y después pasó creo que una semana, yo me hice, me hice un ecosonograma y el niño venía lindo, venía en buena posición, tenía siete meses de embarazo y toda la cosa entonces desde allí incluso, osea me dio más desconfianza sobre estas personas no”.
89 people’s ignorance and all they really want is to make money. Therefore, if it is
not a charlatan and is a true curandero I would go.”109
According to this same man, modern healers do not perform traditional practices correctly. In his own words:
“The information this people have in part is good but in part is wrong. It is good
because the ancestral [knowledge] is based on nature and on energy and is wrong
because the [original] information has been distorted to the point that what they
know and [practice] now is not the true intention of […] ancestral medicine.”110
Referring to this same issue, the Ecuadorian anthropologist Santiago Portilla said:
"Nowadays, we go to an acupuncturist that supposedly comes from ancestral
medicine and they do not teach the patient. They immediately begin to stick
needles […]. And that is the degeneration of ancestral medicine, because ancestral
medicine is 90% educative and 10% therapeutic.”111
Moreover, another important feature described by the 60-year-old woman from
Ibarra from when her mother-in-law took her to a curandera is that the place was extremely dirty. The woman recalls: “I was taken [to this curandera] but I did not like it.
First, because it was repugnant, the conditions in which she worked, and the sheets were
109 The original quote: “Sí, siempre y cuando no sea un charlatán, porque dentro de esta medicina hay gente que se aprovecha de la ignorancia de la gente y lo único que hace es lucrar, o lo hacen por afán de lucro, entonces si es que no sería un charlatán y sería un verdadero curandero sí acudiría”. 110 The original quote: “Que la información que tienen ellos en parte está bien, y en parte está mal, y está bien porque lo ancestral es en base a la naturaleza y en base a lo energético, y esta mal porque ya la información se ha ido tergiversando, a tal punto que lo que ahora ellos saben ya está tergiversado de la verdadera intención de las tradiciones costumbres y medicina ancestral”. 111 The original quote: “Ahora vamos a consultorios de acupunturistas que vienen supuestamente de la medicina milenaria y no educan nada al paciente sino que de inmediato empiezan a clavar agujas en lugar de mandar pastillas, y eso es la degeneración de la medicina milenaria porque la medicina milenaria es 90% educativa y 10% terapéutica”.
90 dirty.”112 As the informant recalled this particular part of her experience, her face was full of disgust, and her gestures were also showing how disgusting the experience had been.
Finally, as mentioned previously, people see traditional healers in different ways, whether because they believe in them or not, or because they come from the countryside or the city. However, there is a clear perception that Western doctors reject them and see them as part of a system based on superstition that should not be followed. For instance, a
46-year-old one from Quito recalled a story where his brother, who is an acupuncturist, helped a little boy to recover a boy who was near to lose his sight. In her own words:
"We treated him with biomagnetism; obviously we kept on giving him the
medication the doctor has given him, because we were afraid that stopping with
that might be counterproductive […]. We did not want that to be a pretext under
any circumstance for the doctor to say because you stopped giving him
medication the boy could not be healed.”113
Furthermore, she explained that after the treatment,
“the boy was absolutely perfect, he has no problem at all [with his sight] the
doctor even asked [the mother] who had helped the boy, the mother was at first
reluctant to give the doctor the name [of the person who had helped him], because
112 The original quote: “Yo tenía demasiada poca barriga entonces decía que el embarazo venía mal. Entonces me hizo ver pero a mí no me gustó, primero porque era repugnante no, las condiciones en donde trabajaba la curandera esta, y las sábanas sucias”. 113 The original quote: “Se le hizo biomagnetismo, obviamente se le seguía dando los colirios y todo que había mandado el oftalmólogo, porque eso nosotros no retirábamos, por miedo a que sea contraproducente con lo que había operado el oftalmólogo ...entonces nosotros no queríamos... bajo ninguna circunstancia evitar que eso sea un pretexto para que el doctor diga, no ese que porque usted retiro el colirio entonces ahora no se curó el guagua”.
91 she said maybe the doctor might think that I took [my boy] to a shaman or
something like that and he is going to reprimand me.”114
Traditional Healers are Knowledgeable. Although most of the perceptions about traditional healers were negative, some informants characterized traditional healers as knowledgeable. For instance, a 52-year-old woman from Quito said the following: “A shaman is a person who has special abilities and a deep knowledge of the human body, he is well respected within indigenous communities because he knows about herbs.”115 This perception was repeated by a 66 -year-old woman from Quito who said, referring to traditional healers: “They know about their medicine that’s the way people were healed before.”116 Additionally, according to a 96-year-old doctor from Quito: “[Traditional healers] have special knowledge and in many cases, they do heal people when they apply this knowledge.”117 Furthermore, picking up on the general idea that traditional healers are mostly on the countryside, I asked a 46-year-woman from Quito whether she has seen traditional healers in the city, and she said: "Yes, obviously they have to put a sign saying doctor, they are actually not doctors but they are doctors in knowledge, they are not doctors with a title in medicine.”118
114 The original quote: “El niño ve absolutamente perfecto, no tiene ningún problema e inclusive el médico que le estaba tratando el que le operó, le pidió el dato a la mamá, al principio la mamá estaba renuente en darle, porque dijo capaz que piensa que le estoy llevando donde un shaman o alguna cosa y me va a hablar”. 115 The original quote: “Un shaman es una persona que tiene habilidades diferentes y un conocimiento profundo del cuerpo humano, y es muy respetado en las comunidades indígenas porque sabe de hierbas”. 116 The original quote: “Ellos saben su medicina, ellos conocen, antes curaban así”. 117 The original quote: “Ellos tienen conocimientos especiales, en verdad que en muchos casos parece que alivian a las personas, al aplicar sus conocimientos”. 118 The original quote: “Sí, obviamente les toca poner un letrerito que dice doctor fulano de tal, que realmente no es un doctor pero si es un doctor en conocimiento, no es un doctor con el título de medicina.”
92 Moreover, when I ask a 77-year-old curandera from Ibarra, if she believed people still use traditional medicine she said:
“I think yes, because the doctor tells me: you know how to cure yourself, the old
women know better. For instance, when I was in the Doctor's office, he told me
you drink prickly pear119 juice, then a woman came in with a bucket and the
Doctor drank prickly pear juice. I asked him why he drank that, and he said
because those are better remedies, fresher, more powerful. He drinks that every
day […], and you see people don't know about it, we are walking on remedies and
we do not heal ourselves.120”121
Finally, those who attend traditional healers highlight their effectiveness at treating what they called spiritual discomforts. In particular, when I asked a 31-year-old woman from Quito if she goes to traditional healers, she said:
“[Yes] because […] I get mal aire122 a lot, yesterday, for instance, I got mal aire in
the market, I arrived [home] and I threw up even the sins of my past life. […].
[When that happens] I tell my mom to cure me, my mom blows alcohol on my
back, face, chest, and my whole body, making a cross sign. She also prays the Our
119 Tuna in Spanish it’s an exotic fruit from the Andean region. 120 Considering that prickle pear is a common fruit in the region, the woman was trying to express those people have several medicinal plants around them but they do not know it; therefore people are missing the opportunity to heal themselves with those plants. 121 The original quote: “Porque el doctor me dice usted mismo se cura, las mayores de antes sabían mejor. Verá el doctor lo que me dice, dice usted toma el zumo de la tuna, cuando yo estaba donde el doctor entró una señora con un balde y el doctor se tomó el jugo de la tuna, y le digo y doctor usted porque toma el jugo de la tuna, porque son mejores remedios más frescos y más potentes, y el doctor toma todos los días vea que le parece el doctor Cruz, dese cuenta y ya ve que cuanta gente no sabe, que estamos sobre los remedios pisando nosotros y no nos curamos”. 122 As described by the informant, "mal aire" happens when a place is full of bad energies and people absorb them.
93 Father and the creed. She cleans me up sometimes with rue123, with iron scissors,
and with chili. After that I go to sleep, and I feel better.”124
Additionally, a 27-year-old woman who goes to traditional healers recalled a particular experience during her childhood:
“When I was a child I was with doctors for weeks and they were never able to
heal me. Therefore, one time, or so I have been told, I was taken to a shaman, and
then I got better. It was because I had bad energies, I was ojeada125 and those
things, so I am a believer.”126
123 In Spanish “ruda” is usually used by curanderos in cleansing rituals 124 The original quote: “Yo siento que me da mucho el mal aire, ponte ayer me dio mal aire en el mercado, ponte ayer me dio mal aire, y llegué y vomité, pero hasta los pecados que tuve en la vida pasa […]. Le digo a mi mamita que me cure, mi mamita me sopla trago en forma de cruz en la espalda en la cara, en la espalda, cara, pecho, en todo el cuerpo y también sabe rezar padre nuestro, el credo y eso, y a veces también me sabe limpiar con ruda, con unas tijeras de hierro creo que es, de hierro o metal, no me acuerdo de que metal, con ruda, con tijeras, con ají. Ahí me manda a dormir de una y ahí me pasa, porque terminas como súper cansada y ahí me pasa. 125 “Ojeada” is a term used in Spanish to say that someone has been a victim of "mal de ojo". "Mal de ojo" in turn could be translated as the evil eye, which is the popular belief that a curse is cast by a malevolent and envious glare. 126 The original quote: “Cuando yo era niña se supone que pasaba cada, pasaba una semana en el médico y nunca, nunca lograron curarme entonces una vez, ósea me cuentan a mí, que me han llevado a esta especie de chamames y ahí me había pasado y que era porque tenía esto de malas energías, estaba ojeada y esas cosas, entonces creo que por esa parte sí soy creyente en esas cosas”.
94 Chapter 6: Discussion
Positionality
First of all, in order to discuss the findings of this research properly, it is important to understand the positionality of these research informants. In this regard, the most outstanding feature of this sample is that the majority of the informants have a high level of education, with twelve out of sixteen having gone to University127. This particular fact is interesting when we consider that only 6.3% of the Ecuadorian population has attained a high level of education according to the 2010 census (Ecuador en cifras, 2010). Therefore, we have at hand a sample that can be considered to be part of the elite group in Ecuador. Such a group would represent a minority that by having access to higher levels of education usually are also in the position to get better jobs that are well paid. Such positionality would play a crucial role at determining this segment’s perceptions towards TM.
Furthermore, having the sample at hand is important for the purpose of this research considering that the elite group in Ecuador is the one that has control over the government and over the biggest and more important enterprises in the country. In other words, the elite group is the one that decides whose knowledge is valued, what information is privileged and whose interests are served. Therefore, understanding the perceptions of this group could elucidate the obstacles or building blocks for the formal integration of TM into Western medicine systems in Ecuador. In contrast, it is important to notice that the findings of this research could be completely different if the sample
127 See table 1
95 would be a representation of the low-socioeconomic group, which constitutes the majority of the population in Ecuador.
The sample for this research is composed by sixteen informants. Eleven participants live in Quito and five live in Ibarra. Furthermore, ten are women, and six are men. Talking about age groups, eight are in the ages between thirty-six and sixty, five participants in the ages between twenty-eight and thirty-five, and three are sixty-one years old and older. Referring to ethnic self-identification, eleven identified as mestizos, four did not identify with any ethnicity, and one identified as mulato. Regarding education, six had graduate degrees, six an undergraduate degree, three had completed high school, and one was illiterate. Regarding employment, people had a variety of jobs including doctor, housewife, lawyer, anthropologist, therapist, “curandera” (see
Appendix A), government employee, among others. In this regard, one could picture a mestiza woman from Quito between thirty-six and sixty years old, with a high level of education, as the most common informant from this sample (see Table 1). The analysis of each one of these aspects would be developed throughout the discussion section.
Finally, I consider it important to briefly talk about my positionality as part of this research. I was born in a family with nurses and doctors from my mother’s side and with traditional healers from my father’s side. This has given me the opportunity to witness and experience the benefits and weaknesses of both traditions since I was little.
Furthermore, as a 33-year-old woman from Quito that holds an undergraduate degree from a private university, I have been surrounded by the elite segment of the population since I first went to University in 2012. Being considered part of such a group helps me understand their responses better as well as what is behind their silences, short answers,
96 and facial expressions. Ultimately, I worked for the Ecuadorian government for over seven years in different institutions, including the Ministry of Health, where I began to observe the numerous weaknesses of the public national health care system. In particular, the financial difficulties they were going through when striving to find alternative sustainable solutions.
The Iceberg of Traditional Medicine Perceptions in Ecuador
When talking about perceptions, more often than not there are certain features that are widely talked about and others that would be rarely mentioned. In the case of TM in
Ecuador the most frequent features mentioned by informants included: people who use
TM are in the countryside, medicinal plants are part of TM practices, TM comes from the ancestors, and traditional healers are part of TM practices. In a way, those perceptions can be characterized as the tip of an iceberg of perceptions. In other words, as the tip of an iceberg, which is the only visible part of a bigger mass of ice, the perceptions most frequently mentioned are the ones that are found above water. Such perceptions are expressed eloquently and freely, as they do not constitute any controversy. However, as an iceberg, there is much more to discover beneath the surface than what we visualize on the tip. In the case of the perceptions about TM in Ecuador the features that could be considered to be beneath the water were the ones that people were reluctant to talk about.
Nonetheless, the interpretation of such reluctancy, as well as that of short answers, tells a lot about what people really think but prefer to be left unsaid. For instance, matters of classism could be identified in the way informants said that poor people are the ones using TM. Matters of racism could be inferred in the way they said it was an indigenous tradition. Matters of religion would be found underneath when
97 informants said that traditional rituals are witchcraft. Moreover, other features such as the perception that Western medicine it’s easier and faster than TM puts us a step closer to the bottom of the iceberg. In this regard, throughout this section, I will develop an analysis of Ecuadorian's perceptions about TM following the theory of an iceberg of perceptions (see Figure 4).
98 Figure 9
The Iceberg of Perceptions
99 The Tip of the Iceberg
The tip of an iceberg represents the things that can be easily seen as they are on the surface. In the case of TM in Ecuador the perceptions that could be placed on the tip are the ones that were deemed as noncontroversial. Therefore, people usually talk about them openly. Saying things like: “TM is a practice pertains to the countryside”,
“medicinal plants are used by all Ecuadorians”, “poor indigenous uneducated people practice TM”, and “traditional healers practice TM”, were some of the most common perceptions people expressed about TM. These perceptions were in fact elucidated as simple truths of life. For instance, saying that mostly people who live in the countryside practice TM, rather than being an opinion, was expressed by informants as simply stating a fact. Moreover, medicinal plants and its use are other topics that are widely and openly talked about,s the use of medicinal plants has become a popular tradition in Ecuador through the drinking of teas on a daily basis. Moreover, informants mentioned traditional healers as being part of traditional medicine, again as a simple fact of life. However, only a few talked about what they thought about them since this has become a taboo topic in the country. Finally, a common feature mentioned by informants in different ways and most of the time not expletively was their strong belief that it is poor indigenous uneducated people who use traditional medicine. What is behind these last set of beliefs will be further analyzed in the next section.
In summary, the tip of the iceberg of perceptions represents the features that are most commonly known and talked about. Such features shape a general definition about traditional medicine. A definition that could be taken as the public or official discourse of the Ecuadorian society towards traditional medicine. However, the real perceptions
100 people hold about this type of medicine are mostly talked about in private settings, such as in a household among family members or friends. In this regard, I strongly believe that this particular phenomenon was the main reason that made it difficult for me to get certain perceptions out of informants, considering that interviews were recorded and that for them, I was nothing more than an acquaintance. It was especially frustrating to listen to certain responses and knowing that there were several things that they were not telling me. The expressions on their faces or the long and uncomfortable silences that followed answers like “I do not know much about it”, or “I do not really have an opinion about it” told me that they were holding back on giving their honest opinions.
Beneath the Surface
The perceptions are found below are the ones that can be inferred from perceptions on the tip of the iceberg. For instance, beneath the surface, we can find some of the things that lie behind silences, short or monosyllabic answers, or from the common perception that poor indigenous uneducated people are the ones using traditional medicine. Throughout this subsection, I will analyze what is behind those perceptions. In this regard, this subsection has been divided into three parts. In the first part, I will analyze how the silence or short answers say much more than what is explicitly expressed. In the second part, I will dissect the different types of discrimination lying behind people's perceptions about TM. In the third part, I will talk about the set of dualities that Ecuadorians have come up with when making sense of traditional and
Western medicine.
101 Beyond Silence, Short and Monosyllabic Answers
In general terms, all the interviews went well and smoothly until I began to ask informants about traditional healers and their practices. Not only did people seem extremely uncomfortable when I began to ask them what they believed or knew about traditional healers, but their short answers such as "No sé" (I don't know) or "No mucho”
(not much) were followed by a not less uncomfortable silence. The uneasiness increased when I asked them if they had ever gone to a traditional healer. A lot of them seem deeply offended and simply said “no”. Some of the most offended ones answered, “no jamás” (not never). By this point, I knew that the harsh “no” followed by the uncomfortable silence was my cue to stop asking questions related to traditional healers.
Although it was perceived as extremely impolite, I kept going and asked what for me represented the most controversial question: “Have you heard about Ayahuasca and San
Pedro? Have you ever consumed any of them? Would you be willing to consume it?” For the most part after this set of questions, the tension had reached an almost unbearable point, and the answers were a harsh "no". Although, some adventured to say that such plants are dangerous drugs that they would never dare to consume. However, only a couple of the informants were willing to develop their ideas about these plants further.
According to Jeanne Favert-Saada (2002), “when interlocutors for whom witchcraft is involved [in a series of misfortunes] talk about nothing (that is about anything except what matters) it is to emphasize the violence of what is not talked about”
(Favert-Saada, 2002). In the same way, when the informants for this research did not talk about what they believed about traditional healers’ practices or simply utter answers like
“I don’t know” they were expressing something very important (Favert-Saada, 2002, p.
102 293). The subtext of their short and monosyllabic answers followed by an annoyed expression and uncomfortable silence was something like “traditional healers’ practices are against common sense, therefore, even talking about them is worthless and I won’t bother”. In other words, not willing to talk about what they thought of traditional healers was their way to emphasize the non-sense of such practices. In this same way, the only reason for which informants were willing to talk about what they thought was to emphasize the difference between their theory of how medicine works (which also happens to be the true theory for them) and traditional healers’ practices that are only part of a system based on superstitions. In other words, they would gladly explain how
Western medicine was backed up by science, while TM was mere superstition.
Discrimination in Traditional Medicine Rejection
As mentioned previously, certain types of discrimination have been identified from people's perceptions about TM. Such forms of discrimination include racism, classism, and education-based discrimination. In this regard, it is important to notice that when talking about discrimination, I refer to the idea that there is one subset of humans that are superior or above another subset of humans. In the case of racism, for instance, the discrimination usually comes from those who identified themselves as whites towards black or indigenous people. In the case of classism, the discrimination usually comes from those that pertained to a “high socio-economic segment” towards those that pertained to a “low socio-economic segment”. In the case of education-based discrimination, such discrimination comes from the segment that has attained high levels of formal education towards those who have low levels of formal education.
103 Furthermore, even when these three types of discrimination will be analyzed separately, it is important to notice that in reality, they are usually intertwined. For instance, when someone says that poor indigenous people use TM, both a classist and a racist component can be identified in this single phrase. Most importantly, these components are expressed together because they are perceived as being the natural consequence of one another. The same occurs with formal education since people perceive poor indigenous people to be uneducated. Nevertheless, for the sake of clarity, each aspect will be examined separately.
Before diving into these different types of discrimination, it is important to understand where the connections I made between perceptions about TM and discrimination come from. In this regard, it is important to recall the concept of symbolic classifications presented in the literature review. According to the German sociologist
Max Weber (1864-1920), human beings have the need to impose meaning on the environment in order to classify and regulate their world, and therefore to understand it.
In this same way, Fiona Bowie (2000) explains that human beings engage in a classificatory process of other human beings by using labels as well as classificatory tools such as language, age, gender, ethnic and cultural features. The way human beings classify other human beings and the meanings they give to each category varies from one culture to another, and it is what these categories mean or represent that determines our behavior towards others. Moreover, the meanings people give to these categories might be expressed explicitly or implicitly, consciously or unconsciously; they might be felt as true or fantasy, and as originating from science or from commonsense. These categories
104 might also be conveyed through everyday speech, elaborate rhetoric, high art, social media, the TV, among others (Bowie, 2006, p. 34).
In the particular case of Ecuador, people categorize TM practices under the umbrella of indigenous people's practices. Therefore, perceptions about TM are strongly shaped by perceptions about indigenous people. In other words, TM is perceived as a symbol of indigenous people. Therefore, perceptions about indigenous people are mostly the same as perceptions of TM. For instance, Ecuadorians use the labels: filthy, ignorant, poor, illiterate, subordinate, among others, to categorize indigenous people. In comparison, the labels used to categorize TM practices are very similar. For instance, while indigenous people are perceived as filthy, traditional healers are perceived as dirty.
In the same way, while indigenous people are perceived as ignorant, people who use TM are perceived as uneducated. Finally, while indigenous people are perceived as poor, people who use TM are deemed to pertain to a low social status. Therefore, it is clear that the way informants perceive indigenous people has permeated to the way they perceive
TM practices.
From these examples, three important interpretations can be drawn. The first one is that the meaning of these categories is meant to denigrate indigenous people and to render them as individuals who are incapable and not valuable. Therefore, almost everything and anything that comes or is related to indigenous people is usually also considered not valuable. In this regard, traditional healers’ practices and traditional healers themselves are especially devalued. The second interpretation that can be given to this set of categories is that the labels that identify people who use TM are considered to be negative aspects. Therefore, people's behavior towards TM also becomes somewhat
105 hostile. The third interpretation is that the meanings people give to TM are done mostly implicitly, unconsciously and originate from both commonsense and science, according to the informants. In the rest of this subsection, each type of discrimination will be analyzed in more detail.
Racism. To understand the issue of racism as is conceived nowadays in Ecuador,
I would briefly describe its history, focusing first on the larger Latin American case. The arrival of Christopher Columbus to the Americas in 1492 would mark a new era for the
American continent. Among several outcomes of colonization, the native population was severely diminished, both due to their fighting against the invaders and to the spread of new diseases like smallpox. According to Charles W. Mills in some cases “the aim of the
European colonizers was the extermination of indigenous people, [and] where they were permitted to survive, they were not considered citizens” (Mills, 1997). In fact, a long time passed until indigenous people would be considered citizens. One of the most preoccupying aspects of this denial of citizenship was the fact that they could not access formal education, and in turn, they were locked up in an endless cycle of poverty.
Nevertheless, the attempt to exterminate indigenous people is not an issue that remained in the colonial period. During the flourishment of the newly independent republics, governments promoted Eurocentric ideals as the only way to attain progress.
For instance, from 1878 to 1885, the Argentinian government engage in a campaign to conquer traditional indigenous land128. During such events, the indigenous population in this country was nearly brought to extinction. In the Argentinian President, Nicolás
128 In Spanish, this campaign was called "La conquista del desierto".
106 Avellaneda, own words: “The dessert was empty despite human presence. This presence was not white, it wasn't even mestiza; therefore, there was no humanity that could be recognized there” (Bartolome, 2004). More recently, according to a 2015 report of the
World Bank Group, discrimination against indigenous people is still strong in the region.
This segment of the population is characterized as a group that suffers poverty in monetary terms, as in other expressions of poverty such as dependency, discrimination, land insecurity, and political exclusion, which perpetuates and increases their vulnerabilities (World Bank Group, 2015, p. 47).
While racism and hierarchical overture are no longer considered acceptable in the modern world, the original racist and Eurocentric ideals are still strongly instilled in people’s minds (Bowie, 2006). For instance, a well-known example of racism against indigenous people can be found in Jeanine Áñez’s recent declarations. When Áñez became the Bolivian interim president in 2019, she openly talked about his aversion towards indigenous people. In particular, Áñez referred to the ex-president Evo Morales as “a poor Indian” who wanted to stick to power and to indigenous rituals as satanic practices (de Marval & Scelza, 2019). On the other hand, in the case of Ecuador, while its citizens are taught that racism is not acceptable, racist ideas are implanted within social circles almost from birth. Therefore, it becomes normal to act in racist ways when
Ecuadorians are surrounded by family and friends (people who they trust). Hearing expressions like “Indio de mierda”129 “este longo que se cree”130 have become so common that people do not even realize those are acts of discrimination. However,
129 Fucking Indian 130 Who does this Indian believe he is?
107 saying such things in an educational or professional setting is completely unacceptable.
The ambiguity of this situation can be further exemplified by the sole use of “indio”131,
“longo”132, or “cholo”133 to denigrate others, and by people categorically denying the fact that they are racists.
Although using these types of words in the ways they are used are clear acts of racism, I consider that people genuinely believe they are not racists. In fact, according to
Scott H. Beck, Kenneth J. Mijeski, and Meagan M. Stark and their article "Awareness of
Racism and Discrimination in Ecuador"; the majority of Ecuadorians would say racism is non-existent in their country. However, they would be entirely capable of identifying and differentiating among blacks, whites, indigenous, mestizos, and mulatos; as well as to ascribe characteristics to each group. In this regard, the authors named this phenomenon
“race consciousness without racism awareness”. In other words, Ecuadorians are conscious about the concept of race, but they are not aware that believing there are racial differences among humans is in itself a racist act (Beck, Mijeski, & Stark, 2011) . The reason is that racism has become normalized in this country and that the only people that can deny the centrality of this fact are those who are racially privileged (Mills, 1997, p.
76). In this regard, it is interesting to realize that the majority of the sample self-identified as mestizos, which is the privileged group in Ecuadorian society.
Returning to the topic at hand, we can better answer the question about why lingering traditional medicine to indigenous people causes negative perceptions. As
131 Indio is a pejorative term used in Ecuador to refer to indigenous people 132 Longo is a pejorative term used in Ecuador to refer to indigenous people. 133 A person of mixed ascendance, white and indigenous, but that has prevailing indigenous features.
108 mentioned before, when taking traditional medicine as a symbol that represents indigenous people, the characteristics that are used to define indigenous people are also used to define traditional medicine practices. In other words, if indigenous people are treated as not valuable, traditional medicine is not valuable also. In this regard, we can recall an informant’s response, to exemplify how this perception could become an issue:
“The problem is that we have this silly idea that the traditional has to do with the indigenous people and that is why people do not want to use it, but if you give them a more commercial presentation [of the same thing] they will use it” (see table 2).
109 Table 2
Medicinal Plants versus Drugs
SOURCE PRODUCT PERCEPTION
Finally, it is important to mention that there is also an interesting connection between racism and formal education. In particular, the flexibility of the mestizo category is given by people’s level of education. During colonial times, only white and eventually mestizos were allowed to go to school. Therefore, the desire of groups such as indigenous people to become mestizos grew bigger and bigger. Even when one had an indigenous mother, if the father was white or the other way around, the child could be formally educated, which in turn would allow him to have a good job, money, and better
110 social status. Hence, becoming a mestizo turned into an imperative if one wanted to overcome the cycle of poverty indigenous people were condemned to.
Eventually, and after Latin American countries became independent from
European monarchies, education was not limited to certain racial groups. However, the notion that mestizo people were better than indigenous or black people because they were formally educated was perpetuated. For instance, in 1948, through his most famous publication, “La raza cosmica”, José Vasconcelos argued that all Latin American people pertained to a superior cosmic race called mestizos. By doing this, he actually attempted to vanish the identity of other groups as well as to deny the existence of racism in Latin
America. According to Vasconcelos Latin American identity has been defined by practices of cultural and biological mixture; such mixing process had, in turn, produced a homogenous national population where racio-cultural groups had disappeared. Therefore, according to Vasconcelos, by the mixing process, Latin America had avoided the problems derived from racial stratification that affect other countries such as the United
States (Hooker, 2017).
Although Vasconcelos's racial egalitarianism was far from being accurate in representing Latin American reality, he was successful in portraying mestizos as a perceived superior group. In Latin America, being mestizo has become a sign of status in some cases and almost a synonym of education in some others. A clear example of this is that, according to the data collected by PERLA134 in Colombia, Mexico, and Peru, mestizos were sometimes of higher socio-economic status than whites in terms of
134 Project on Ethnicity and Race in Latin America.
111 education and job positions (Telles, 2014). Furthermore, in his book Indigenous
Mestizos, Marisol de la Cadena (2000) describes how in Peru, those who are perceived to be indigenous can become mestizos by attaining higher levels of education. In other words, identifying someone as a mestizo depends more on their level of education rather than the color of their skin (de la Cadena, 2000). In particular, during the interviews, I carried out it was interesting to hear that even those who had a white phenotype would identify themselves as mestizos. In this regard, it could be said that the mestizo ethnicity is a flexible category and is not defined in terms of pigmentocracy135 but as a sign of the level of education a person has attained (Tannock, 2008). Therefore, the discrimination issue in Ecuador is not one related uniquely to racism but also to education-based discrimination.
Education-Based Discrimination. Some of the most visible aspects of discrimination rooted in the Western belief system are racial, class, and gender discrimination. Nonetheless, one type of discrimination that is rarely talked about is education-based discrimination. As mentioned previously the concept of education-based discrimination make people believe that people who have attained higher levels of formal education are above and more worthy than those who have not. However according, to
Stuart Tannock (2007), this is an issue that is usually overlooked and extremely difficult to resolve, in his own words:
“[…] the dominant ideologies […] proclaim that higher levels of education are
and should be linked with greater reward. In a world where education is regularly
135 Ethnic and color-based hierarchies of Latin America.
112 invoked to legitimate inequality, it can appear nonsensical even to raise concern
about education-based discrimination as a matter of social injustice. We need,
however, to challenge those who have taught us not to see what has essentially
become an elephant in our living room. Otherwise, we will find ourselves unable
ever to use our public systems of education for universal emancipation and
empowerment.” (Tannock, 2008, p. 439)
Such type of discrimination has permeated once again to the realm of traditional medicine perspectives. In other words, people's perspectives about TM are profoundly shaped by their education-based discrimination lenses. Therefore, people's perceptions could be translated as: Only people who have no education practice traditional medicine, because if they were educated, they "would know better than that". In this same way, according to people's perceptions, attaining a higher level of education would disrupt erroneous cultural beliefs about medicine. Therefore, once people are educated, they would immediately turn to Western medicine as the natural choice for intelligent people.
Such perception was clearly noted by one of the informants when she said that her husband stopped believing in TM when he went to University. This perception was also clearly expressed when I asked a doctor why he didn't practice TM and he said it was because he had studied. However, here comes the question about who, why and how one type of knowledge is validated over another. Why should people believe that only formal education is the correct way to be educated? Why should people trust a Western approach of health that is relatively young in comparison to a traditional approach that has thousands of years in existence? Those questions remain in the air for me but are usually not a topic of conversation in social or academic circles in Ecuador.
113 Classism. The classist component applied in the shaping of perceptions about TM has been marginally covered in the explanation about how racism came to be.
Nonetheless, it is important to explore classism by itself as well. According to Jeanne
Favert-Saada (2002), witchcraft is put forward as a non-sense theory that peasants can afford to adopt because it is the local theory (Favert-Saada, 2002, p. 293). In the case of
TM, the place people live also seemed to play a vital part in determining people's perceptions about TM. For instance, as described by several of the informants, people who live in the countryside (peasants) are the ones who use TM. These perceptions by themselves do not say much; however, it is important to consider that people from rural areas are defined as poor and uneducated. Therefore, as Favert-Saada describes witchcraft, TM is also perceived as a non-sense theory that peasants can afford to adopt because it is the local theory. In other words, the informants believe that people from rural areas cannot afford Western medicine; therefore, these "poor people" have no other choice but to use TM.
Furthermore, one of the informants also identified classist issues in the practice of
TM within the city of Quito. For instance, traditional healers cannot be found easily in the city. In particular, finding a traditional healer in the economic center of Quito would be next to impossible. Nonetheless, finding one in the south part it’s easier. This observation is important, taking into account that the economic center of Quito is considered to be one of the areas of the city where people of the high socio-economic class live, while the south part of Quito is inhabited by people pertaining to the low socio-economic class. This particular phenomenon explains how people believe that only people from a low socio-economic status would consult traditional healers, for example.
114 In other words, going or not to traditional healers is perceived as a sign of class or social status. Therefore, traditional healers can only be found in neighborhoods that are perceived as pertaining to the low socio-economic class. Nonetheless, according to one informant, socio-economic status does not really matter. What matters, according to her, is what people are taught at home. This particular perception will be analyzed in the next subsections that cover dualities, including belief systems.
Traditional and Western Medicine as Part of a Duality
According to Overing (1985), in order to make sense of the world, people tend to perceive reality in a dualistic way. Therefore, they create certain labels to understand their environment; some common dualistic labels include “good and bad”, “clean and dirty”, “poor and rich”, “educated and illiterate”, “real and imaginary” (Niehaus, 2001).
In Ecuador's particular case, people have also given shape to reality by creating a series of dualities between Western and traditional medicine. Western medicine is “the true approach of health” backed up by science, and traditional medicine is a mere superstition, for instance. These binary conceptions fail to understand Western and traditional medicine's interdependence by creating the idea that these two types of medicine cannot coexist, let alone be integrated (see table 3). I will explore the series of dichotomies that informants perceived when describing TM and Western medicine in the following pages.
115 Table 3
Dualities
Traditional Medicine Western Medicine
Superstition Science
Medicinal plants Drugs
Traditional healers Doctors
Long and hard Easy and fast
Rural areas Urban areas
Cultural belief systems Western knowledge
Science versus Superstition. According to Overing (1985), human beings live in a society where there is a constant preoccupation, shaped by positivism, with defining what is true. Such a society's eagerness to define such trueness through verifiable observation usually obscures the authorizing processes through which truth is created.
Therefore, the positivist approach dismisses truths created in other situations and alternative conceptions of reality. This particular theory helps understand why Western medicine is considered the "true medical practice", as it bases its practices on a positivist approach. At the same time, TM is dismissed as it's based on alternative conceptions of reality. However, Overing argues that it is important to understand that reality is culturally constituted and relative (Niehaus, 2001, p. 114). Therefore, reality cannot be defined from a single point of view, nor can any single approach to health be considered an unquestionable truth, as some have done with Western medicine. Nonetheless, the fact
116 that Western medicine is backed up by science has given this practice the position of “the true medical practice”.
In fact, according to the informants of this research, the most predominant perception regarding the differences among these two types of medicine was their different connections to science. While Western medicine is clearly perceived as a product of science, TM is considered to be in opposition to science as it's perceived to be based on superstition. In other words, while Western medicine is backed up by science, traditional medicine is mere superstition. This perception does not entirely represent reality as the benefits of certain TM practices have been proven effective, especially in mental illnesses, for instance. Nevertheless, the perception remains and the fact that people believe that TM is a mere superstition pushes them farther away from this practice. This phenomenon often takes place in the segments of society that have attained high levels of education. It is in schools and universities where the idea of traditional medicine being a superstition is mostly implanted, as clearly noted by one of the informants. Therefore, it could be said that changing the way TM is depicted at school could trigger a shift in people’s perceptions about traditional medicine.
Furthermore, TM and indigenous people's association also influences how TM practices are perceived as a matter of superstition. For instance, according to Charles W.
Mills (1997), the Americas was dominated by epistemological ethnocentrism during the colonial and postcolonial periods. Such conception implies that knowledge, science and the ability to understand the world in an intellectual way is restricted to Europe, and knowledge could not be attained by indigenous people. Therefore, indigenous people were permanently locked into a cognitive state of superstition and ignorance (Mills, 1997,
117 pp. 44-45). Although this way of thinking is no longer acceptable, the belief that TM is a mere superstition has remained a strong perception in Ecuadorian society, as was mentioned by various informants during this research.
Moreover, to further understand where the perception of TM being a mere superstition comes from, we could also explore the concept of the civilizing process.
According to Zygmunt Bauman (2000), "The etiological myth deeply entrenched in the self-consciousness of our Western society is the morally elevating story of humanity emerging from pre-social barbarity” (Bauman Z. , 2000, p. 12). Therefore, for Western society history has been defined as the victorious struggle between reason and superstition (Bauman Z. , 2000). And in the case of medicine, between science and superstition. In other words, Western society perceives the use and dissemination of
Western medicine as the victory of reason over superstition. And that victory as the only and real way to move forward in the objective of attaining a good healthcare system.
In this same way, Western society perceives the dismantling of superstitious beliefs as the most effective way to overcome the cultural barriers posed by those who still practice TM. However, the question remains as to who decides what is true, who decides what is best, and how are those decisions taken? And most importantly, how those decisions shaped our perceptions about the world, and in this particular case our perceptions about TM. At the end, it seems to me that what science does or does not have to say about TM does not shape our perceptions. In reality, the perceptions that the
Western world has shaped around TM have been and are widely spread through formal education and media, and that Western perception is what shapes ours.
118 Medicinal Plants versus Drugs. Although at first sight medicinal plants and drugs seem to stand at opposite sides of disease treatment, informants of this research expressed using both medicinal plants and drugs when they feel sick. For instance, the majority of them said that when they feel sick, the first thing they use is medicinal plants.
Afterward, if the discomfort was not alleviated, they would self-medicate, which basically implied taking drugs they could buy in a pharmacy. Finally, if none of the previous remedies worked, they would go to the doctor. In this regard, we can observe a practical response to diseases that mix both traditional and Western medicine. In other words, even when people perceive clear differences between traditional and Western medicine, in their everyday lives, they use both. Hence, it is interesting to realize that, like in religion, health practices in Ecuadorian popular culture have acquired a level of syncretism136 by the mixing and blending of traditional and Western medicine.
Nonetheless, it is important to notice that while medicinal plants are widely used, they are mostly considered to be effective only for minor discomforts. Therefore, informants trust that drugs produced by the Western medicine system are effective in treating more severe symptoms or in treating minor discomforts in an easier, faster, and more effective way.
Furthermore, this theory cannot be applied to the whole range of medicinal plants.
In particular, when talking about the use of less common medicinal plants such as San
Pedro and Ayahuasca, the perceptions shift dramatically. As expressed by several informants San Pedro and Ayahuasca are considered to be hallucinogenic drugs that
136 Syncretism is a term used in cultural anthropology to define the amalgamation or attempted amalgamation of different religions, cultures, or schools of thought.
119 should not be used as they are extremely dangerous. Even when these types of plants have proven effective in certain mental illness conditions, people would define Western drugs to treat mental illnesses as 100% safer. As mentioned by one of the informants and as observed in table 2, it all depends on the form in which a certain medicine is presented to people. People can actually be presented with the same medicine in different forms, and they would most likely choose the one that is presented in a bottle with a brand rather than the same medicine in its natural form. Therefore, Western thought has effectively made people believe that their way and only their way of doing medicine is safe.
Traditional Healers versus Doctors. Traditional healers and doctors stand at opposite sides of the health practitioners’ spectrum. While doctors are perceived as an unquestionable authority backed up by science, traditional healers are perceived as charlatans backed up by mere superstitions. However, some informants pointed out that although it is difficult, some traditional healers still practice "true" ancestral knowledge, especially in rural areas. In this regard, Donald Joralemon (2010) talks about the different types of authority health practitioners hold. According to Joralemon, two types of authorities can be perceived. The first one is social authority, which is defined as the ability of a person to influence others' actions or decision-making based on social status and power. On the other hand, the second type is cultural authority, which is defined as a person's ability to influence actions based on shared cultural beliefs. In this regard, it is said that Western health professionals hold a high degree of social authority and a low degree of cultural authority. Conversely, traditional healers hold a high degree of cultural authority and a low degree of social authority (Joralemon, 2010).
120 In this regard, Joralemon's theory could certainly explain some of the perceptions people hold about Western doctors and traditional healers. For instance, the
77-year-old curandera from Ibarra clearly stated that she cured herself because she knew how to do it, but that she goes to the doctor because it is an obligation. In other words, her beliefs about the healing process of the body lie in traditional medicine as is part of her culture. However, the social authority that Western doctors have, given their social status, compels this woman to consult Western health professionals. Furthermore, for some others, the cultural authority that traditional healers have has been affected by charlatans who are only seeking to make money and by their inability to cure new diseases.
Furthermore, it is essential to notice that due to this perception of traditional healers being charlatans, this has become a taboo topic in Ecuador. For instance, one of the informants talked about how many people go to traditional healers' consultation but would not be willing to accept they do. The reason for this is the poor perceptions people have traditional healers have within the urban society. In particular, informants emphasized how traditional healers' practices are based on superstition that pertains to the field of witchcraft. Therefore, going to the consultation of a shaman, for example, is perceived as both a poor judgment (as is a mere superstition) and a practice that goes against the catholic faith (as is associated with witchcraft). For example, one of the informants told a story about a woman who took her son to an alternative health practitioner, and she did not want to tell the doctor about it. She feared that the doctor might think she had taken her son to a shaman. Therefore, she was afraid that the doctor would judge her and tell her she has done something that was extremely unadvisable. 121 Easy and Fast versus Long and Hard. One of the most interesting and decisive perceptions informants hold about TM compared to Western medicine, was the differences in how easy and fast their practices were. In particular Western medicine solutions are perceived to be easy and fast, while TM solutions are perceived as long and hard. For example, when one of the informants was asked why medicinal plants were not used as much these days, she said that people wanted something easy to take and that would work quickly. In other words, people are not willing to wait for a medical plant to work; they prefer to take a pill that would work faster. This way of thinking also determines that people would prefer to go to a Western doctor that gives them an easy and fast answer to their problems instead of going to a traditional healer, which might imply a complete lifestyle change.
Furthermore, talking about easy versus fast practices, while TM concentrates on people being responsible for their health and maintaining a healthy lifestyle, Western medicine has made people believe that only health professionals have authority in health matters. In particular, for TM 90% of people’s health is determined by their lifestyle choices. Therefore, people need to learn to take care of their health and consult a health expert only when they need some guidance. In this regard, it is easier to understand why people are not that interested in TM practices, as they are perceived as long and hard to accomplish. On the other hand, for Western medicine 90% of their practices focus on consulting health professionals, and only 10% on educating people about their own health. In this regard, it is only normal that people would choose Western medicine as it makes them believe that health is not their responsibility.
122 Urban versus Rural Areas. The most mentioned feature expressed by informants about TM was its connection to rural settings. In this regard, it was clear for informants that people in rural areas practice TM, and they usually lose their traditions when coming to the city. Some informants especially emphasized that one of the main reasons for the loss of traditions in Ecuador was the migration of the population from rural to urban areas. In particular, for the case at hand, such migration not only gives people easier access to Western medicine, but also makes the collection of medicinal plants more complicated. Moreover, the exposure of the population to media, Western educational systems, and urban social circles also contribute to the progressive loss of traditional medicine practices.
Moreover, it is important to notice that Ecuador is and has experienced an accelerated process of urbanization. Like many other countries in the region, this phenomenon is associated with the industrialization process of the 1930s and 1970s.
However, in Ecuador, the urban population exceeded the rural one a decade before the rest of the region did. While in Ecuador the urban population surpassed the rural one in
1983, in Latin America in general, that phenomenon took place in 1993, and globally the urban population surpassed the rural one only in 2007 (Alvarado Lopez, Correa Quezada,
& Tituana Castillo, 2017). In this regard, the population living in urban areas by 2018 was 63.82%, while the remaining 36.18% were living in rural areas (World Bank, 2018).
This process of accelerated migration has certainly contributed a great deal to people losing their ancestral traditions and turning to Western medicine as their primary healthcare choice.
123 Finally, it is important to recall the fact that all of the informants live in urban centers, and the majority of them live in Quito. In this regard, considering that they think
TM is a practice from the countryside and not from the city, it would be perceived as only normal then that they do not practice TM. In this regard, even the few that expressed being interested in using TM refer to an accessibility issue as the main reason for not being able to do so. For instance, according to informants, doctors and pharmacies are widely available in the city, while finding traditional healers in urban settings has become very difficult. Therefore, an accessibility feature plays a crucial part when deciding which medical practice, one is going to use. On the other hand, talking about different perceptions among cities, it is interesting to notice that people from Ibarra were more willing to talk about TM practices than informants from Quito. This difference might have to do with the fact that Ibarra is a small city with a higher percentage of indigenous population, while Quito is the capital of the country which could be represented as the most Westernized city in Ecuador.
Cultural Belief Systems vs. Western Knowledge. As pointed out in the literature review, the cultural belief systems around the world determine how people make a decision of what type of medicine to use. As expressed by informants of this research, cultural belief systems are especially important in Ecuador. People usually resort to friends, family, and acquaintances for advice on how to treat a minor discomfort, and in some cases, major discomforts if Western medicine has not helped. In particular, as pointed out in the results section, a group of women I interviewed explained how medicinal plants' knowledge is passed from friends to friends or from parents to their children through an oral tradition. They described how they trust a friend, a family
124 member, or even an acquaintance that has successfully used a certain medicinal plant. In this regard, one of the informants emphasized how important cultural belief systems are in this country by saying that matters of race, class, or education do not matter if the family has a strong belief in TM practices. Therefore, she said she had seen TM practices even in the highest socio-economic segments of the population. Although examples of people who practice TM in this segment of the population are scarce, results of this research have shown that, in fact, they exist.
In this way, while cultural belief systems are dominant among social settings,
Western knowledge has become the authority in more formal settings such as offices and schools. Therefore, the dominant Western perceptions about medicine have become the official discourse of the government and of educational systems. In contrast, TM practices have been relegated to informal settings that have no space in official discourses.137 This particular perception informants have about TM makes it extremely difficult to envision a formal integration of TM into Western healthcare systems. Shifting the belief that TM pertains solely to private settings such as home or friend circles is a difficult task, especially when Western medicine already has a dominant position in formal settings. Nonetheless, little by little people are perceiving how ancestral practices are coming back to life and discrimination issues are vanishing. For instance, the majority of the informants were between the ages of thirty-six and sixty. Which reflected the perceptions of a segment of the population that has certain "old school" ideas instilled in their minds. In this regard, matters of discrimination against indigenous people were
137 Although the national government has recognized the different types of medical approaches as valid, the ministry of health is mostly guided by Western medicine approaches.
125 more notorious in this segment of the population than in the younger segment. In particular, informants that were thirty years and younger would not perceive a connection between racism and traditional medicine rejection, which would prove the theory that discrimination ideas are also being lost day by day.
Western Thought and the Bottom of the Iceberg
Usually, when we have a very complex problem in front of us, we tend to look at it with a microscope and analyze every single detail of it. However, most often than not, the answer to our questions can only be seen when we pull away, and we see the problem in perspective. The use of this tool is called seeing the problem through a macroscope, and it usually teaches us that the answer to a problem is not the most complicated one but the simplest of all. This particular investigation is not the exception. While the complexities of the perceptions about traditional medicine in Ecuador have been explained at length, I will argue that the underlying cause of such perceptions is only one, the Western thought.
For instance, the belief that indigenous people are less valuable than mestizos began with the Spanish colonization and was perpetuated by Eurocentric ideals throughout the next centuries. Furthermore, the belief that only formal education is a valid form of education comes from Western thought that devalues alternative forms of knowledge and education, including the oral traditions used in TM. Nevertheless, it is important to notice that although a variety of forms of discrimination have existed for millennia around the world, the notion of race and formal education is a modern invention brought about by Western thought (Menakem, 2017). Such notions, in turn, have been the basis for the creation of racism and education-based discrimination.
126 Moreover, the deeply entrenched idea that Western and traditional medicine are always in opposition fails to understand that they could actually be interdependent. Finally, the belief that living a comfortable and easy life is only possible by living in the Western world with Western tools puts people farther and farther away from traditional knowledge. In particular, this last feature was the least mentioned but is one of the most influential on informants when deciding what type of medicine to use.
Through the analysis of discrimination practices around the world, one and even about dualities, one would realize that they could and would hopefully be eventually overcome. This could be realizable through different programs of education and awareness. However, the hardest thing to overcome in day-to-day life is to give away the golden ticket that the Western world gives people to live a comfortable and easy life. For example, in my own case, even when I have lived and understood various benefits of traditional medicine in the last few years, I still struggle with my decision to keep on choosing the road of TM in my everyday life. For instance, I still struggle to choose between taking a pill for a stomachache or making a home remedy and being more careful with my diet. I still struggle when I feel anxious or depressed, and I have to choose between drinking my sorrows away (as most young people in Ecuador do) or standing up exercise and engaging with other people. I cannot certainly say that choosing to be healthy in Western society is the easiest job of all. However, I can say that once you get into the habit of taking care of yourself, you begin to realize that that is the only way to live. In the end, when I decided to take on the TM challenge of living a healthy life, I realized that the golden ticket to comfortability, as attractive as it is, has a price that our health will eventually have to pay.
127 In this regard, the decision between TM and Western medicine practices is deciding whether to get into the annoying process of taking responsibility for our health today or remaining with our eyes closed and pay for the consequences tomorrow. People should be warned, however, that Western thought will continue to look for flaws in non-
Western traditions, whether they seem logical or not. For instance, an eating disorder called orthorexia was first coined by American physician Steve Bratman in 1997. The term is derived from “orthos,” which is Greek for “right”. Therefore, orthorexia is an eating disorder that involves an obsession with healthy eating. According to the media, although neither the American Psychiatric Association nor the DSM-5 has officially defined the condition as an eating disorder, the global pandemic for the coronavirus has seen an increase in people suffering from orthorexia (Healthline, 2020).
128 Limitations of the Research
As a Master of Arts degree program thesis, this research does not cover all the complexities involved in the study of the perceptions people hold about traditional medicine in Ecuador. This thesis has focused on the three main reasons identified as the basis that led people from urban centers of the Sierra region to reject certain practices of traditional medicine and prefer Western medicine practices in their everyday lives.
In this regard, this thesis has not covered or has superficially touched the following aspects:
(1) The loss of traditional knowledge over generations in Ecuador.
(2) A thorough study of whether racism is a real cause for the loss of
traditional medicine practices in Ecuador.
(3) Considering that this study has used a qualitative research method that has
focused on two cities of the Sierra region of Ecuador (Quito and Ibarra),
this study should not be taken as an exact representation of the Ecuadorian
urban society as a whole. However, it should be taken as a stepping stone
for future, and further studies of the perceptions people hold about
traditional medicine in Ecuador.
(4) This study focuses on the practices of traditional medicine in the Sierra
region. Hence, it covers Andean traditional medicine and the different
forms it has taken in the present Ecuadorian society. Therefore, my
intention has not been to cover traditional medicine of the Amazon region
or that of the Coastal region. Nonetheless, certain informants have touched
on practices that do not pertain exclusively to Andean traditional medicine
129 during interviews. Those practices have been included as a reflection of
the mixing and blending of different regional traditions in Ecuador.
Recommendations for Future Research
Different aspects of Western thought misconceptions about the world have been widely challenged in the last decades. However, Western medicine conceptions have not received as much attention. Some of the most visualized aspects of such criticism have been those related to discrimination. Racial, gender and class-based discrimination have received a wide array of attention by both scholars and civil society and national governments and international organizations. Nonetheless, as rare as it is to challenge discrimination based on education, challenging Western thought is also rare. In this regard, considering that the underlying causes of negative perceptions about traditional medicine in Ecuador is the Western way of thinking. Future research on this topic should take the form of new ways to deconstruct Western though as a way to overcome negative perceptions. Therefore, challenging Western thought becomes imperative in order to stop the perpetuation of ways of thinking that hurt humanity.
In this regard, we have to remember that the Western way of thinking is the prevalent truth in our modern world but that there are other philosophies that are much older and that have also prevailed. For example, the fact that 80% of the population in developing countries still uses traditional medicine to meet their primary healthcare needs
(Chivian & Bernstein , 2002); gives us a clue as to what the people really believe in. In other words, we should begin to challenge the deeply entrenched belief that the only way to make things better is to impose Western thought on the entire human species. We should stop for a minute and wonder what the world really wants. Begin to look around
130 and realize that there is wisdom everywhere, even in the most remote underserved communities.
Research and efforts in similar directions have already been taken. For instance, according to Arvind Singhal, Prucia Buscell, and Curt Lindberg (2010), the world's health reforms do not work because there is no real shift in thinking. Such reforms are
“only about trying harder at what is not working so well now”. In this regard, they talk about a concept called positive deviance. According to this approach, the key to solving any problem that we encounter is to understand that someone else has already solved it.
For instance, they talk about the first time this approach was implemented in Vietnam, where there was a high percentage of malnutrition among young children. The researchers simply asked if there were any well-nourished children among the many families of a certain community. In fact, there were a few families where the children were not suffering from malnutrition. Therefore, the researchers got in the task of finding out what it was that these families were doing differently. The answers were very simple; they would collect some shrimp and crab from the rice fields and the leaves from sweet potatoes and incorporate them in the rice cakes. These simple and affordable changes to the common rice cakes they were feeding their children with added a high nutritious value to the traditional cakes. Furthermore, the mothers in these families would also stay with the children and make sure they eat. After these findings, the researchers organize workshops to spread this wisdom by practice rather than by theory. Eventually, the rates of malnutrition decreased and remained low. Therefore, the approach was taken up and disseminated by the government all over the country (Singhal, Buscell, & Lindberg,
2010).
131
Conclusion
This investigation shows a deep rejection from the mid-upper segment of the society towards most of the components of TM practices. In particular, such rejection was especially evident in regard to traditional healers and their practices. However, the rejection evidenced through this research is not one that can be easily visualized. Instead, a deep analysis has been necessary to uncover the underlying roots of Ecuadorian perceptions. For instance, perceptions such as indigenous poor uneducated people using
TM have shown underlying race, class, and education-based discrimination issues.
Furthermore, perceptions about TM are also strongly shaped by Western medicine conceptions, which has created the idea of the existence of a dichotomy between traditional and Western medicine. Finally, I have taken advantage of the various tools developed by different scholars to challenge Western medicine as the root of erroneous conceptions about health and disease.
The objective of challenging Western thought through this thesis is to avoid the perpetuation of the endorsement of certain idealized and partial conceptions of healthcare practices as conceived by Western medicine. Furthermore, by challenging Western thought, it is also easier to present TM conceptions as alternatives to enhance medical practices in spite of negative perceptions about TM. Finally, although traditional and
Western medicine is perceived as standing at opposite ends of the healthcare spectrum.
They are, in fact, complementary and, therefore, can be integrated, taking the best of each other. However, negative perceptions of TM that are hampering such integration have to
132 be overcome first. In this regard, this investigation is contributing by identifying the sources of such misconceptions and serving as a stepping stone to correct old misconceptions and build new, more healthy conceptions. The ultimate goal is to offer the Ecuadorian healthcare system a viable and sustainable alternative to solve some of the most pressing problems they face today. In turn, this might provide people with a system that not only responds to particular health issues but that gives them tools to remain healthy as part of a healthy lifestyle.
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142 Appendix A: Use of Key Terms a. Traditional medicine
The use of the term traditional medicine to refer to the health practices rooted in ancestral traditions is not entirely accurate since this type of medicine is not a mere memory from the past but a dynamic practice that is widely used all over the world today.
Nonetheless, I have used this terminology throughout this thesis to denote the continuity of an ancestral tradition (Demon, 2006, p. 147). b. Racism
In this paper, the term racism is used to describe discrimination based on the belief that there are different races among humankind. Although there is no scientific evidence that such races actually exist, the phenomenon of racism has real consequences in our society (Intergroup Resources, 2021). Therefore, such a phenomenon would be considered in this thesis as one of the determinants that contribute to shaping the perceptions people have about traditional medicine in Ecuador. c. Ethnicity
In order to refer to what is commonly known as race, I will strive to use the term ethnicity138. The ethnicities I refer to in this investigation are the following:
• Mestizo. - A person of mixed ethnic ancestry; specifically, in Latin
America, a person of mixed Indigenous and European descent (Gonzalez-
Barrera, 2015).
138 Ethnicity is a product of self and group identity that is formed in extrinsic/intrinsic contexts and social interaction (Bauman T. , 2004, p. 14)
143 • Indigenous. - People who are the original, earliest known inhabitants of a
region, or are their descendants (Dictionary.com, 2021).
• Mulato. - A person of mixed black and European descent (Gonzalez-
Barrera, 2015).
• Montubio. - A mestizo person from the countryside of the coastal region in
Ecuador.
• Afro ecuatoriano. – An Ecuadorian with a black ascendance
In this regard, it is important to notice that Ecuadorians identified themselves in the following manner during the most recent population census of 2010: 72% mestizos,
7% indigenous, 7.4% montubios, 7.2% Afro ecuatorianos, 6.1% whites and 0.4% other
(World Bank, 2018). d. Class
This term is used to refer to the system in which people are divided into sets based on perceived social or economic status (Oxford, 2020). e. Traditional healers
The Western world defines a traditional healer as a person who does not have any formal medical training but is considered, by the local community, as being competent in providing health care. Nonetheless, in this paper, the definition that would be taken as a point of reference would be a person who practices traditional medicine using different kinds of animal, plant, and mineral substances and other techniques based on ancestral beliefs (Ashish & Harilal, 2015). In this regard, the following types of traditional healers can be found in Ecuador: 144 • Shaman. - In the Americas, shamans are defined as gifted individuals
who practice spiritual mediation with the help of hallucinogens in order
to move between the profane world of human life and the spirit world
(Evans , 2013). In Ecuador shamans are male traditional healers that
come usually from Indigenous communities.
• Taita. - Taita is a Spanish word that means father. In the realm of
traditional medicine is used to designate wise males who communicate
with the spirits in order to cure the soul, mind and body. Taitas are usually
from the Sierra region but can also be found in the Amazon region
(AsiHablamos.com, 2021).
• Mama. - Means mother in Spanish. In the realm of traditional medicine is
used to designate wise females who communicate with the spirits in order
to cure the soul, mind and body. Mamas are usually from the Sierra
region but can also be found in the Amazon region.
• Yachak or Yachag. - Is a quichua word that means wise or
knowledgeable. In general terms yachaks are male traditional healers and
spiritual guides from Andean indigenous communities whose knowledge
come from different ancestral traditions. Yachaks would usually be found
in the Amazon region but also in the Sierra region (El Comercio, 2018).
• Bruja/o. - Is the Spanish word for witch. Witches are usually perceived as
people who send bad energies to others in order to harm them. They are
also perceived as people, usually, women, who are gifted and that use
145 oracles, tobacco or tarot for divination and healing purposes ( Gantiva
Clavijo, 2019).
• Curandero/a. - Is the Spanish word for healer. Curanderos are popular
healers who usually use magical plants in the treatment of supernatural
illnesses such as “espanto” (magical fright) or “mal aire” (bad air).
Additionally, curanderos usually recite catholic prayers during their
rituals (Cavender & Albán, 2009). f. Plantas de poder
In English power plants, also known among traditional healers as sacred plants, are plants that have a powerful effect when administrated to human beings. The plants that are covered in this thesis are San Pedro and Ayahuasca.
• Ayahuasca. - “Is a tea made from two plants native to the
Amazon, Banisteriopsis caapi and Psychotria viridis, which, respectively,
contain the psychoactive chemicals harmala alkaloids and
dimethyltryptamine. The tea has been used by indigenous peoples in
countries such as Brazil, Ecuador, and Peru for medicinal, spiritual, and
cultural purposes since pre-Columbian times. In the 20th century,
Ayahuasca spread beyond its native habitat and has been incorporated
into syncretistic practices that are being adopted by non-indigenous
peoples in modern Western contexts” (Tupper, 2008).
• San Pedro. – San Pedro is a cactus from the Andean region that contains
the alkaloid called mescaline and other phenethylamine derivatives with
hallucinogenic properties. This cactus was used in history by a series of
146 different pre-Columbian cultures and civilizations in order for people to connect with their gods (Carod Artal & Vasquez Cabrera, 2006). 147 Appendix B: Template Used in the Interviews
Date:
City:
General Information
First and Middle Names
Last Names
Age
Sex
Racial/Ethnic identification
City of birth
City of residence
Level of education
Degree (if applicable)
Current occupation
Average monthly family income
Type of health insurance
Questions
1. What do you understand by illness? 2. What do you understand by health? 3. What actions do you think should be taken to stay healthy? 4. Of these actions, which ones do you usually practice? 5. When you get sick, what kind of therapist do you go to? 6. When you get sick what kind of products do you consume? 7. What do you understand by traditional medicine? 8. Do you use medicinal plants?
148 9. If yes, what are the medicinal plants you consume and for what purpose? 10. Where does the knowledge you have about medicinal plants come from, if you have any? 11. If the answer is no, explain the reasons for which you do not consume them 12. Do you know if your parents, grandparents or great grandparents used to use medicinal plants? 13. If your parents, grandparents or great-grandparents used medicinal plants and you do not, what do you think are the reasons for this phenomenon? 14. Do you go to healers, shamans, taitas, mamas or other traditional healer with the purpose of curing yourself from any illness, medical condition or physical, emotional or mental discomfort? 15. If yes, what type of healer do you go to and for what purpose? 16. If the answer is no, explain the reasons for which you do not 17. Do you know if your parents, grandparents or great-grandparents used to go to healers, shamans, taitas, breasts or other traditional medicine for the purpose of curing of any disease, illness or physical, emotional or mental discomfort? 18. If the answer to question 17 is yes and the answer to question 16 is no, what do you think are the reasons for this phenomenon? 19. Is or was any member of your family a traditional healer? Has this knowledge been passed on to you? How? If not why? 20. Do you think that the use of traditional medicine has benefits, which ones? 21. Do you think that the use of medicinal plants has benefits, which ones? 22. Do you think that traditional medicine practices should be integrated into modern health systems in the country? Explain your answer. 23. Do you think that traditional medicine practices should be taught in schools and colleges in the country? Why? 24. Would you go to the consultation of a healer, shaman, taita or mama? Why? 25. Would you go to a ceremony of San Pedro, Ayahuasca, or Temazcal? Why? 26. What is your opinion about the use of traditional medicine today? 27. What is your opinion about the use of medicinal plants today? 28. Do you consider that there is a loss of knowledge of traditional medicine and medicinal plants? For what reasons? 29. healers, shamans, taitas, breasts or other traditional medicine for the purpose of curing of any disease, illness or physical, emotional or mental discomfort? 30. Why do you think different generations approach health care in different ways? 31. Is or was any member of your family a traditional healer? If yes can you tell me what resources, he/she uses/used to heal people? 32. Has this knowledge been passed on to you? How? 33. If this knowledge has not been passed to you what do you think are the reasons? 34. Do you think that the use of traditional medicine has benefits, which ones? 35. Do you think that the use of medicinal plants has benefits, which benefits? 149 36. Do you think that traditional medicine practices should be integrated into modern health systems in the country? Explain your answer. 37. Do you think that traditional medicine practices should be taught in schools and colleges in the country? Why? 38. Would you go to the consultation of a healer, shaman, taita or mama? Why? 39. Would you go to a ceremony in San Pedro, Ayahuasca, or Temazcal? Why? 40. What is your opinion about the use of traditional medicine today? 41. Do you consider that there is a loss of knowledge of traditional medicine? For what reasons? 42. Do you consider that there is a loss of knowledge of medical plants? For what reasons? ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
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