Relations within the Health System among the Yanomami in the Upper Orinoco, Venezuela. Submitted by José Antonio Kelly Luciani for the Degree of Ph.D. Department of Social Anthropology and Darwin College University of Cambridge September 2003 Preface This dissertation is the result of my own work and includes nothing which is the outcome of work done in collaboration. i Relations within the Health System among the Yanomami in the Upper Orinoco, Venezuela. Abstract This thesis is an analysis of the relationships between doctors and Yanomami, and between the latter themselves, that converge around the operation of the health system. On the one hand, the health system is the prism through which we analyse an inter-ethnic relationship between Yanomami and Whites. Related to this, the health system becomes a network of sites and people through which to analyse a wider issue: an aspect of the Yanomami experiences of the Venezuelan state. Two other alternatives were available but rejected: relations converging on missionary schools or within the context of indigenous movements and party politics. Thirdly, this is an ethnography of the health system and how it is incorporated into daily life in the Upper Orinoco. All these matters are interrelated to give us a picture of transformations occurring among the Yanomami, products of multiplied exchanges with agents of national society. The health system in this thesis is, then, mainly a function of a political anthropology of Yanomami-White relations: at once the angle, the connecting network, and the object of study. ii TABLE OF CONTENTS Preface _____________________________________________________________ i Abstract_____________________________________________________________ii Acknowledgements__________________________________________________ viii Introduction _________________________________________________________1 The problem in the field ___________________________________________________ 1 The anthropological problem_______________________________________________ 2 What kind of theory? ____________________________________________________ 12 Use of, and contribution to, Yanomami ethnography __________________________ 16 Fieldwork and its limitations ______________________________________________ 18 Structure of the thesis____________________________________________________ 20 Chapter I: Ocamo, the health system and the daily round____________________23 I. 1. The Yanomami and Ocamo ___________________________________________ 23 I. 2. A river network from the health service’s point of view ____________________ 26 I. 3. Indigenous organisations _____________________________________________ 29 I. 4. Historical health-related presences and the current health system ___________ 31 I. 5. Current functioning of the health system ________________________________ 34 I. 6. Area of coverage ____________________________________________________ 37 I. 7. Institutional ideologies and inter-institutional relations ____________________ 40 I. 8. Changing tides ______________________________________________________ 43 I. 9. Daily life of doctors in Ocamo _________________________________________ 44 Chapter II: Particularising the health system’s ‘front end’___________________49 II. 1. Getting to the Upper Orinoco _________________________________________ 49 II. 2. Last year medical students: ‘pasantes’ _________________________________ 57 II. 3. First impression accounts ____________________________________________ 60 II. 3. 1. The naturalised Indian __________________________________________________60 II. 3. 1. The difficult Yanomami _________________________________________________64 II. 4. The rural year scheme among the Yanomami ___________________________ 66 II. 4. 1. A discontinuous ‘front end’ ______________________________________________66 II. 4. 2. Inexperience and anxiety ________________________________________________68 II. 4. 3. Non-corporeality and a ‘cold system’ ______________________________________68 Concluding remarks _____________________________________________________ 69 Chapter III: Epidemic diseases, criollos, and the morality of being human______71 III. 1. A baseline ________________________________________________________ 71 III. 1. 1. Constituent parts of the person __________________________________________71 III. 1. 2. Aetiology ____________________________________________________________73 III. 1. 3. Illness and socio-geographical space ______________________________________76 III. 2. Origin of shawara (epidemic diseases) _________________________________ 79 iii III. 3. Shawara, napë, manufactured objects _________________________________ 81 III. 4. Extractivists: criollos as enemies______________________________________ 83 III. 4. 1. The morality of being human____________________________________________87 III. 5. Missionaries: criollos as friends ______________________________________ 89 III. 5. 1. The trade-off _________________________________________________________90 III. 5. 2. Cocco’s quasi-kinship and making kin ____________________________________92 III. 6. Shawara today: ontologically napë ____________________________________ 98 Concluding remarks ____________________________________________________ 100 Chapter IV: Becoming napë and the ‘napë transformational axis’ ___________102 IV. 1. Becoming ‘civilizado’; becoming napë ________________________________ 103 IV. 1. 1. Becoming napë: a change of body/habitus ________________________________103 IV. 1. 2. Becoming napë: acquiring napë knowledge _______________________________108 IV. 2. Reading/writing and seeing _________________________________________ 110 IV. 3. Translation and shamanism ________________________________________ 112 IV. 4. The ‘napë transformational axis’ played out on a river __________________ 115 IV. 5. Awakening_______________________________________________________ 122 IV. 6. Napë and Yanomami positions in the context of exchange ________________ 123 IV. 7. ‘Napë transformational axis’ elsewhere _______________________________ 125 Concluding remarks ____________________________________________________ 127 Chapter V: Theoretical discussion _____________________________________129 V. 1. The givens and human agency _______________________________________ 130 V. 2. Making society and making kin ______________________________________ 133 V. 3. ‘Becoming napë’ and ‘domesticating outsiders’ _________________________ 134 V. 4. Criollos and potential affinity ________________________________________ 138 V. 5. Reciprocity with the napë yai ________________________________________ 144 V. 6. General and powerless criollo potential affines__________________________ 145 V. 7. A linear component in concentric and diametric dualism _________________ 146 Concluding remarks ____________________________________________________ 147 Chapter VI: Doctors and criollo potential affinity _________________________149 VI. 1. Doctors as napës: non-medical contexts _______________________________ 149 VI. 1. 1. Doctors as ‘providers of objects’ ________________________________________149 VI. 1. 2. Potential affinity: generality and powerlessness____________________________151 VI. 1. 3. Doctor – Yanomami relations as factional/affinal ones ______________________153 VI. 1. 4. Collectivising doctors, differentiating Yanomami and obviating meetings ______158 VI. 1. 5. Where is society? _____________________________________________________160 VI. 2. Yanomami: ‘malcriados,’ ‘vivos,’ ‘unpredictible’: the ‘inconstancy of the savage soul’ all over again _____________________________________________________ 162 VI. 3. Doctors as napës: medical contexts ___________________________________ 165 VI. 3. 1. Asking for medicine___________________________________________________165 VI. 3. 2. Performance in doctor-patient relations __________________________________167 VI. 3. 3. Controlling doctors ___________________________________________________174 VI. 3. 4. Patient negotiations ___________________________________________________177 VI. 4. Doctors as pivots or relations _______________________________________ 182 iv VI. 4. 1. Acting through criollos ________________________________________________182 VI. 4. 2. Political enhancement _________________________________________________183 VI. 4. 3. A health meeting in Ocamo ____________________________________________184 VI. 5. Upriver differentiation_____________________________________________ 190 Concluding remarks ____________________________________________________ 193 Chapter VII: Articulation of medical systems_____________________________197 VII. 1. Therapeutic options and itineraries _________________________________ 197 VII. 2. Complementarity of bio-medicine and shamanism _____________________ 201 VII. 3. Doctors as shaporis and vice-versa __________________________________ 217 VII. 3. 1. Doctors and the ‘inside’_______________________________________________217 VII. 3. 2. Coming to know; knowledge ranking ___________________________________220 VII. 4. Extending multinatural and multicultural conventions _________________ 223 VII. 5. Napërami and the extension of the invisible world______________________ 226 VII. 6. Medicine as hëri and wayu substance ________________________________ 229 Concluding remarks ____________________________________________________ 230 Chapter VIII: State-Yanomami direct encounters _________________________234 VIII. 1. A general pattern________________________________________________ 235 VIII. 2. ‘Health’ in Yanomami – criollo institutional encounters________________