A Culture of Health - Rimby Whittier College A Culture of Health: Herbal Remedies of the Peruvian Highlands Taken from the top of the Inca ruins at Ollantaytambo, once one of the most important cities in the Incan Empire, this is a quintessential scene in the Peruvian Highlands. Jarred Rimby Whittier Scholars Program Senior Project co-sponsored by Teresa Delfin and Alvin Alejandrino 11/30/17 1 A Culture of Health - Rimby Table of Contents: Introduction and Purpose - The Issue of Global Health…………………………………….5-9 Section I: A Peruvian Model of Health………………………………………………….....10-63 Model of Health, Explained………………………………………………………......10-14 My Standpoint………………………………………………......................................14-15 The Worldview of the Peruvian Highlands……………………………………….….15-20 The Physical Appearance of a Healthy Peruvian Highlander………………………..21-30 A Day in the Life - Activity and Behaviors…………………………………………..30-36 Urban………………………………………………………………………....30-33 Rural……………………………………………………………………….....33-36 Aspects of Health……………………………………………………………………..37-39 Physical Health……………………………………………………………………….39-40 Spiritual Health………………………………………………………………...……..40-42 Spiritual and Physical Health - The Connection……………………………………..42-44 The Roles of Religion and Faith……………………………………………………...44-57 Religion and Catholicism…………………………………………………….46-49 Faith and Shamanism…………………………………………………..……..49-57 The Role of Medicinal Herbs………………………………………………….……..57-59 Divergent Reciprocities as a Peruvian Model of Health……………………………..59-62 Conclusion………………………………………………………………………..…..62-63 Section II: The Use of Herbal Remedies in Health Maintenance Amongst Peruvian Highlanders……………………………………………………………………………….64- Introduction……………………………………………………………………..……64-65 2 A Culture of Health - Rimby Table 1………………………………………………………………………………..66-67 The Various Functional Modes of Peruvian Medicinal Herbs……………….………68-70 Access to Medicinal Herbs……………………………………………………...……71-74 In Cusco……………………………………………………………………....71-73 Outside of Cusco…………………………………………………………......73-74 The Cost of Medicinal Herbs…………………………………………………...…....74 The Keepers of Knowledge…………………………………………………………..74-76 The Special Case of Coca…………………………………………………………….76-78 Muna and Mate……………………………………………………………………….78-79 Ayahuasca…………………………………………………………………………….79-82 Sangre De Grado…………………………………………………..............................82-83 The Medicinal Use of Totora Amongst the Uros…………………………………….83 Herbs for Women on Amantaní…………………………………………………...…83-84 Section III: Chemical Therapeutic Agents and Physiological Function of Key Peruvian Medicinal Herbs…………………………………………………………………………..85- Introduction……………………………………………………………………….….85-86 Coca…………………………………………………………………………………..86-91 Muña.…………………………………………………………………………………91-93 Ayahuasca………………………………………………….93- Sangre De Grado……………………………………………. The Effect of Sangre De Grado on B Lymphocyte Myeloma Proliferation. 3 A Culture of Health - Rimby 4 A Culture of Health - Rimby Introduction and Purpose - The Issue of Global Health: Health, sadly, is not distributed evenly. As Paul Farmer explains, “Five of the leading causes of death in low-income countries – diarrheal diseases, HIV/AIDS, tuberculosis, neonatal infections, and malaria – are treatable infections illnesses that are not found on the leading list of killers in high-income countries” 1. These health disparities are sad for so many reasons, both ethical and practical. Some scholars in the field of global health, including Farmer, argue that health is a human right, which demands a full-fledged international effort to realize. Still, this according to Farmer, would first require the realization of many other human rights 2. As a founder of Partners in Health as well as a professor of both medicine and anthropology at Harvard, I cite Farmer because he has found successful ways to deliver world-class health services in some of the world’s poorest and most underserved communities in Haiti and Rwanda. Farmer is leading the fight to make health truly global, a goal which we are still far from realizing. While there is still a long way to go, there exists a young generation of motivated millennials, who are now becoming credentialed, that wish to work in the pursuit of health as a human right. I count myself among these motivated young people. Richard Horton, one of England's most renowned global health practitioners and the author of countless articles and books on the topic, has been quoted by Farmer as saying “Global health is an attitude. It is a way of looking at the world” 3. Further, it is the lens through which this paper examines the world. I write this paper, in part, to fulfill my Whittier College Whittier Scholar Program (WSP) double 1 Paul Farmer. Reimagining global health: an introduction (Berkeley, CA: University of California Press, 2013), 3. 2 Farmer., 271. 3 Farmer., xv. 5 A Culture of Health - Rimby major in Chemical Biology and Global Health Studies. More importantly however, I write with the hope that this model will be utilized as a tool for the formative evaluation of future public health initiatives that have the goal of promoting health and wellbeing in the Peruvian Highlands. To that end I will design, describe, and explain the functional use of a “model of health” that can be utilized to ensure the culturally sensitive health promotion of Peruvian Highlanders. In doing so, I will examine the plethora of factors that influence health and wellbeing in Peru, and explain how they are conceptualized plus how they relate to one another. Additionally, this paper will explain the use of medicinal herbs in the context of the Peruvian Highlands, while exploring the use of various herbs in detail. Finally, I will demonstrate that many of these herbs, that are often considered by Western biomedicine practitioners to be folk-medicine, are capable of impacting tangible and measurable therapeutic results. I will make it clear that health cannot be defined universally, and “medicine” does not mean the same thing, nor come in the same form, everywhere. The evaluation of public health initiatives is a complex endeavor that begins before, and that takes place during, just after and well after the initiative itself. Program evaluation can be broken down into four distinct categories: formative, process, outcome and impact evaluation 4. It is through formative evaluation that practitioners can “ensure that a program […] is feasible, appropriate and acceptable before it is fully implemented,” 5. Effective formative evaluation builds a foundation that helps to ensure the success of any public health initiative; it requires extensive research and time spent working community contacts, not to mention a detailed recording mechanism for the development process. As the scope of a given health program 4 “Types of Evaluation” Centers for Disease Control and Prevention, 6/5/2017, 11/8/2017, https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf 5 “Types of Evaluation” 6 A Culture of Health - Rimby expands, so necessarily does the complexity of its evaluation. But many considerations must be made even for a small health program. Program developers must perform a needs assessment to determine what resources the target community is lacking, in addition to defining its mission, the scope of intended outreach, and the estimated cost of implementing their programs. Programs must ensure that the target communities will be receptive to the initiatives and that there are concrete methods in place for the ongoing assessment of the program during its operation, ensuring its maximal efficacy. Perhaps most importantly we must develop programs that take into consideration the aspirations that participants have for their own health. To design a program that can successfully promote health in a way that is culturally sensitive, program designers must first understand what health means to the people that they hope to serve. Defining health in various cross-cultural contexts is a complicated yet critical step that program developers must take to create effective programs. I have divided this paper into three related sections, and each subsequent section of this paper builds on the conclusions of the previous sections. Section I seeks to define a “model of health” for people living in the Peruvian Highlands; a tool that can be used to help ensure the accurate interpretation of health in the region. Section I draws heavily on one month of fieldwork that I conducted in the Peruvian Highlands, during which I interviewed residents about their notions of health and wellbeing. My research was based in Cusco, Peru which is the largest city in the Peruvian Altiplano (high plateau). It also extended to more rural parts of the Highlands including, Amantaní, Taquile, and Uros islands, and the village of Wasau. Thus, my fieldwork was both urban and rural and it was supplemented by previous research done in many other communities throughout the same region. My work is based on the anthropological methods of participant observation and ethnography, both of which I have employed with the hope of 7 A Culture of Health - Rimby capturing just what it means to be a healthy resident of the Peruvian Highlands. Part of what it means to sustain one’s health here is the frequent use of herbal remedies in the treatment of various ailments that range significantly in type and severity. Drawing on the conclusions from Section I, Section II catalogues and describes the use of culturally significant herbs in the Peruvian Highlands. I have paid specific attention to the meaning that the use of