A spiritual model of healing or: why doctors should learn about culture

There are so many things we take for granted living as men and women in the United States. Does your health insurance cover birth control? In Ecuador, most insurance policies will not cover oral contraceptives even if it is for a properly diagnosed medical condition. Perhaps you or a loved one has had to use emergency contraception, Plan B? In Ecuador, you cannot find it. The closest thing that comes to plan B here is the rigorous prescription of progestin pills (and this is only used by the most "rogue" of doctors). It seems that the heavy influence of Catholicism in Latin America has put restrictions on the access to certain levels of family planning. Enter machismo. I have spoken to many women who have had difficulties with their boyfriends, husbands, and lovers because they refuse to wear condoms; largely having something to do with the idea that condoms take away your virility. Because of this, the incidence of early pregnancy and the transmission of sexually transmitted diseases is particularly high in Ecuador (if you see any sort of STD statistics in Ecuador, you should assume it's higher because most cases go unreported and just as condoms are looked down upon, so are getting blood tests).

At one point since I've been here, I found myself serving as an ally to a young woman (I will refer to her as "Rosa" throughout this entry, which is obviously not her real name) who became pregnant due to a condom malfunction. Living in an extremely traditional and machista family, Rosa feared that her family would beat her and disown her for getting pregnant out of wedlock. The partner was out of the picture as a supportive figure as he preferred to be unfaithful and verbally abusive. If this type of situation were to arise in the US, an abortion would be a feasible option. In Ecuador, however, such procedures are illegal. This forces many women to go underground in search of "rogue" doctors and in some cases people unqualified to perform such procedures. This woman was determined to go to a doctor and have a "procedure." This put me in a difficult position because I wanted to be supportive of her, yet I was concerned about the doctor she was going to visit, so we went together to have a consultation before any procedure. The doctor had excellent bedside manner, was responsible, and most of all, knowledgeable in practice.

Despite knowing what to expect from the procedure, Rosa was very nervous. The procedure went smoothly and she went under with anesthesia. It usually takes approximately 30 minutes for someone to come out from anesthesia, typically experiencing nausea and hallucinations. Rosa had a particularly strong reaction to the anesthesia, and it took her nearly 3 hours to come out. As she was coming out of the anesthesia and could begin to talk again, she was complaining of the inability to see, that she had "gone blind." It was at this moment that I was unfamiliar of how people respond differently to medicine (the doctor had to leave the room to release a patient from the hospital), so I used my privilige to the best of its ability and called my doctor father in the United States. He mentioned that often when people undergo traumatic procedures, they often experience psychological symptoms, such as temporary blindness. He told me briefly of a patient of his who lost a child while giving birth and subsequently lost her ability to see. My father knew that she was very religious, so he asked her to look out in the direction of the window and try to focus on seeing Jesus. After several moments of intense focus and prayer, the woman was able to see again.

I made sure to check to see if Rosa's eyes constricted by flashing a light into her pupils. Sure enough, they constricted, indicating that physiologically, she was "fine." When one is coming out of anesthesia, they often do not have the ability to show much emotion, it is what is typically called "la indifference," so the emotions one would feel about having had an abortion (coming from a machista and Evangelical family) were suppressed. Rosa is a very devout Evangelical Christian (Pentecostal), and I had known from previous conversations that she would often talk of experiences of going to Church and becoming healed by just a touch or a breath of air in prayer. I was left with no choice; either allow Rosa to continue feeling like she was going blind, or to "puppet" an Evangelical laying of hands and prayer healing moment. I should mention here that I do not identify myself as religious at all, perhaps slightly spiritual in that I believe in the power of energy (yes, somewhat woo-woo) and I respect people's various religious beliefs, especially when they are used in healing contexts. So, I felt rather uncomfortable at first with the idea of praying and talking to Jesus. But it was clear that this would hopefully help Rosa in her process.

So I took a deep breath, trying my best to recall some charismatic healing techniques I had read about in various anthropology texts and using what woo-woo knowledge I have grown up with regarding energy healing and meditation, and I put my hand on her heart and her forehead. I have to stray for a moment and mention that I have spent the majority of my academic life reading and problematizing the so-called boundary between anthropologists studying religion and the idea of "belief;" it is a very tricky line to cross. There have been many anthropologists who have indeed "crossed that line," (lines of 'objectivity' are overrated) and have actually had moments of belief or embodied experiences (Michael Taussig and Ayahuasca, Roy Wagner and the human hologram, Thomas Csordas and charismatic healing, to name a few off the top of my head). But at this point, I was not playing the anthropologist role (however this does not stop me from trying to make sense of this experience using what I know, which is anthropology). I was a concerned ally and willing to do whatever it took to make Rosa feel comfortable.

I began to speak to her, asking her to remember that God and Jesus were with her, that they will always be with her and will never stop loving her. I had her focus on each part of her body, starting at her toes, and I asked Jesus to fill her toes with love, strength, and health. I repeated this little phrase for each part of her body, something like this: "Imagine Jesus filling your toes, now your toes and your feet, now your toes, your feet, and your legs with the warmest love, strength, and health. He will always live inside of you. Feel the warmth of love radiating from your heart." I have to say that while I was focusing on helping her through this prayer exercise, my discomfort with "acting" like I was speaking in tongues (because I myself am not Evangelical, nor a "believer") totally disappeared. It was a meditative exercise, so I found myself actually being embodied by a warm sensation - it actually felt like my energy was different. After finishing this prayer/meditative exercise, I asked if Rosa could see. And to my surprise (or not), she regained her vision AND was talking with improved clarity.

Certainly, this is not a technique they teach you at medical school. I did find it interesting, however, that catering the healing process to this woman's identity as a devout Evangelical Christian actually helped her when conventional medicine or treatment would have failed. I am not claiming myself to be an energy healer nor an evangelical one at that, but definitely having an understanding of her religious and cultural background helped make her experience in the clinic a less traumatic one. Even if you're not a believer or a practitioner, reading a little bit about other cultures and belief systems could indeed come in handy one day! So go out and do some reading or better yet, learn from and listen to the people around you!

Achuar Territory - Pumpuentsa, Part I.

I have just returned to Quito from spending the past week in an Achuar community called Pumpuentsa. It is so deep "inside" the Amazon, that the only way to feasibly enter it is to board a Cessna plane and fly 30 minutes south from a small aerospace town called Shell. Yes, it's called Shell because of the company. The airline, Aerotsentsak, is an Achuar-run cooperative that serves as the main form of transportation for people living inside Achuar territory and those coming from "outside." I put quotations around these words because in Ecuadorian Spanish, they refer to going "adentro" (inside) upon entering the Amazon, or spending time "afuera" (outside). While many Achuar people have indeed been outside of the jungle in surrounding urban areas (the closest is the barter town of Puyo), one definitely gets a sense of a permeable border; something akin to a membrane. I don't want to imply at all that these communities are bounded, as so many stereotypes of what indigenous communities are like tend to stem from assumptions that they are somehow "primitive," "untouched," "pure," "care-free to the corruptions and problems of the 'modern' world," but it definitely takes a lot of effort to get into and out of the jungle.

We met with the local government and discussed their priorities and exactly why were were there and what we hoped to do while we were in the community. This program has been around for about a year and a half, working with local community members in workshops that trained people in what's called "Home-based life-saving skills." There was great interest and participation last year in the workshops, except for the fundamental issue was that the last resort always required access to a clinic, hospital, or a reliable form of health care infrastructure. The community is located near a river, which serves as their main source of water. The unfortunate problem is that the water is heavily contaminated with human waste, diapers, cans, batteries, and waste from dead animals. Families do not have latrines, so they eliminate their waste in their gardens. When it rains heavily, the waste washes down the hill. We went to visit the community to do individual family interviews to get people's opinions and perceptions of why the water is contaminated, what it is like to be sick in the community, and how people treat themselves with local plants and healing techniques. We visited about 20 families and learned a great deal about the state of health in the community and how people negotiate illness within and outside the community.

The most common and alarming illness and cause of death in both adults and children (mostly children) is diarrhea. In one month alone, two children died of diarrhea. Many families do not know how to prepare oral rehydration solution, or seem to think that giving their child food or water during violent periods of diarrhea will only make things worse. When discussing water contamination, most people do identify water as one direct cause of diarrhea. When asked about whether people treat or boil their water before drinking it, most women say that it takes too much time to boil when they have so many house-related responsibilities, and most men argue that its taste is inferior to that of the river. It is easy for development workers to say "well, you should just boil your water then," but this has so far not convinced people to start boiling water. People often explain away causes of illness due to diarrhea as a result of shamanismo, witchcraft, and/or malaire, all pertaining to the idea of the source of illness as an agentive human force. I'll provide a more in-depth discussion of shamanismo and malaire in an upcoming post...

There will be more soon! There is so much for me to digest and put into coherent and concrete descriptions, so I will be tackling this in chunks.

Be well!