Research Collection Doctoral Thesis Mayan phytotherapy in Guatemala: A transdisciplinary study for ethnographic documentation and local empowerment Author(s): Hitziger, Martin Publication Date: 2016 Permanent Link: https://doi.org/10.3929/ethz-a-010735971 Rights / License: In Copyright - Non-Commercial Use Permitted This page was generated automatically upon download from the ETH Zurich Research Collection. For more information please consult the Terms of use. ETH Library DISS. ETH NO. 23585 Mayan phytotherapy in Guatemala: a transdisciplinary study for ethnographic documentation and local empowerment A dissertation submitted to ETH Zurich to attain the degree of DOCTOR OF SCIENCES of ETH ZURICH (Dr. sc. ETH Zürich) presented by MARTIN HITZIGER M. Sc. UmweLtnaturwissenschaften (Univ. Bayreuth) M. Sc. Decision Sciences (LSE London) Born JuLy 27th 1984 citizen of the Federal Republic of Germany Accepted on the recommendation of Prof. Dr. Peter Edwards Prof. Dr. Michael Heinrich Dr. med. MerLin WiLLcox Dr. Pius KrütLi 2016 Mayan phytotherapy in Guatemala: a transdisciplinary study for ethnographic documentation and local empowerment Summary Biomedicine is the dominant gLobaL medicaL system, though it remains functionaLLy weak in many deveLoping countries. Due to its reductionist focus on experimentaL cLinicaL effectiveness, biomedicine tends to disregard systemic aspects of heaLth and disease. In contrast, many traditionaL, aLternative or compLementary systems in medicaLLy pLuraListic countries are more hoListic in their approach and emphasise systemic aspects of heaLth and contextuaLized efficacy. The World HeaLth Organization has a policy of engaging with these traditionaL medicaL systems, especiaLLy where they can contribute to intercuLturaL heaLth systems and improve heaLth care. In GuatemaLa, traditionaL Maya medicine is neglected, LittLe known and poorLy institutionaLized, whiLe the nationaL biomedicaL heaLth system faiLs to address the needs of the indigenous population. Drawing on concepts of transdisciplinary research, this dissertation describes a collaborative study aimed at documenting Mayan phyto-therapeutic knowledge and practice, and fostering intercultural heaLth care. FieLdwork was conducted from 2013 to 2015. Main partners were CounciLs of Maya ELders in the Kaqchikel (highlands) and the Q’eqchi’ (lowLands) Linguistic areas, who facilitated contacts with reputed Maya heaLers in their areas. The NationaL Cancer Institute (INCAN) represented the biomedicaL heaLth system. DeL VaLLe University of GuatemaLa coLLaborated in the botanicaL work, and especiaLLy in the identification of pLant specimens. AlL fieLd research was embedded in a transdiscipLinary process in which scientists, CounciLs of ELders, heaLers and INCAN co-designed, co-steered and partLy co-conducted the project. The ethno-pharmacopoeias of the two Linguistic areas were documented by coLLecting medicinaL pLants and recording how they were used by the Mayan heaLers. Semi-structured interviews conducted during an earlier phase of the research were anaLyzed to produce a synthesis of the role pLayed by phyto-therapy in Mayan medicine. MedicaL practice was documented by observing 187 heaLer-patient consuLtations of one KaqchikeL heaLer. An observationaL case study design was developed and applied to describe Mayan patients heaLth-seeking pathways and Mayan treatment interventions, as weLL as to test the potentiaL of coLLaborative research methods in fostering intercuLturaL heaLth. Results were disseminated in vaLidation workshops and by contributing to an easiLy accessibLe book publication in local languages. This dissertation, which is one of few major investigations of Mayan medicine in GuatemaLa, presents by far the Largest comparative coLLection of medicinaL pLants appLied by Mayan heaLers. The findings demonstrate how recent changes in pLant avaiLabiLity and disease epidemioLogy have Led to cuLturaL adaptations in the ethno-pharmacopoeia of the KaqchikeL. They aLso iLLustrate the compLexity of Mayan phyto-therapy and describe Mayan heaLing in the framework of baLancing the patient by strengthening the energetic relations between the universe, the medicinaL pLants and the patients. Furthermore, they demonstrate how the abstract worLdview refLected in Raxnaq’il nuk’aslemal or ‘weLL-being in our Life’ systematicaLLy transLates into a hoListic yet personaLized medicaL practice of enormous scope. Some case studies suggest surprising outcomes of Mayan medicaL treatments. However, whiLe being rich and deep, Mayan medicine is aLso highLy diverse and the consensuaL body of knowLedge of heaLers seems Limited, at Least at the level of operationaL phyto-therapeutic practices. II This study was one of the first major coLLaborative projects specificaLLy designed to empower LocaL partners in deveLoping countries, an objective that has often been recommended but rareLy impLemented. It addressed the interests of aLL partners and incorporated their contributions, thus generating vaLue in terms of their own criteria. For many eLders, this was an important reason for participating. The systematic research design, which involved workshops, comparative diagnoses and patient referraLs, was a product of the muLtiLateraL coLLaboration with counciLs, heaLers and INCAN. It emphasized repeated personaL interactions in different formats, and incLuded faciLitation, transLation and mediation by intermediaries with whom the partners had estabLished trust reLations. As a resuLt, existing networks were strengthened and new ones initiated, which enabLed Learning, both within and between medicaL systems. In turn, the partners highLighted important research questions, contributed to a muLtifaceted approach that embraced their perspectives, and provided manpower, skiLLs and expertise. In short, their contributions were crucial to the success of the research. In summary, this research addresses two chaLLenges to intercuLturaL heaLth in medicaLLy pLuraListic heaLth systems. On the one hand, it demonstrates the scope, richness and depth of Mayan phyto-therapeutic knowledge, and substantively extends the knowledge base that is required to activeLy manage contributions of Mayan medicine to intercuLturaL heaLth in GuatemaLa. On the other hand, it presents innovative tooLs for intercuLturaL transdiscipLinary coLLaboration in deveLoping countries, and demonstrates their vaLue for both scientific and applied ends, even in a context as difficuLt as GuatemaLa. Whilst the approach would certainly need to be adapted, its general features are transferable to other settings and could provide a promising avenue to empower indigenous institutions, reduce structuraL violence and foster intercuLturaL heaLth. Expanding upon these or simiLar approaches and combining them with additionaL eLements bears great promise for pubLic heaLth in developing countries. III Zusammenfassung Das biomedizinische Gesundheitssystem ist heutzutage gLobaL dominierend, ist jedoch in vielen EntwickLungsländern wenig funktional. Auf Grund eines reduktionistischen Ansatzes, der hohen Wert auf Auswirkungen einzeLner Wirkstoffe in experimenteLLen Studien Legt, werden systemische Aspekte außerdem tendenzielL vernachlässigt. Viele traditioneLLe, aLternative oder kompLementäre HeiLkundesysteme, die oft stark regionaL verankert sind, ergänzen die biomedizinische DenkschuLe mit einem ganzheitLichen Ansatz, der hohen Wert auf systemische Aspekte und medizinische Wirksamkeit im AlLtagskontext Legt. Die WeLtgesundheitsorganisation erstrebt daher den Aufbau einer Wissensbasis, die es erLaubt traditioneLLe HeiLkundesysteme aktiv zu nutzen und in interkuLtureLLe medizinische Versorgung einzubinden. In GuatemaLa existiert die traditionelLe Medizin der Maya-BevöLkerung, die jedoch auf gesamtstaatLicher Ebene wenig bekannt, vernachLässigt und nicht institutionaLisiert ist. GLeichzeitig ist die biomedizinische Versorgung schLecht und zielt an den Bedürfnissen weiter Teile der indigenen Bevölkerung vorbei. In dieser Dissertation wurde ein partnerschaftLicher Ansatz mit LokaLen Akteuren gewähLt, um das heilpflanzliche Wissen der Maya und seine Anwendung zu dokumentieren und um Entwicklungen in Richtung einer interkulturellen medizinischen Versorgung anzustoßen. Dabei werden Konzepte angewendet, die in der transdiszipLinären Forschung entwickelt wurden. Die Feldarbeiten wurden von 2013 bis 2015 durchgeführt. Hauptpartner waren Ältestenräte der KaqchikeL (HochLand) und Q’eqchi’ (TiefLand) Maya, die Kontakte mit angesehenen Heilern ihrer jeweiligen Gegenden herstellten. Das Nationale Krankenhaus für OnkoLogie (INCAN) nahm aLs Repräsentant des nationaLen biomedizinischen Gesundheitssystems teiL. Die Universität deL VaLLe übernahm die botanische Bestimmung der gesammeLten HerbarbeLege, weLche im dortigen Herbarium aufbewahrt werden. Die gesamte FeLdarbeit war in einen transdiszipLinären Prozess eingebettet, in dem Forscher, Ältestenräte, HeiLer und INCAN die Forschungsstrategie von Beginn an zusammen entwickeLten, die FeLdarbeit gemeinsam Leiteten und teiLweise auch gemeinsam durchführten. Die FeLdarbeit umfasste mehrere HaupteLemente. Eine Herbarsammlung dokumentiert das medizinaLpfLanzLiche Wissen von 10 HeiLern der beiden Maya Sprachgruppen. Eine AnaLyse von Interviews aus einer vorherigen Forschungsarbeit steLLt übergreifende Aspekte der PfLanzenheiLkunde aus der Sicht der Maya dar. Die Beobachtung von 187 PatientenkonsuLtationen dokumentiert die ganzheitLiche medizinische Praxis einer KaqchikeL HeiLerin. Ein koLLaboratives FaLLstudiendesign in