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!

Overdue Updates

I can't even begin to recant all that has gone on here in just over a month. I apologize for not being as diligent as I had promised with these updates, but things have been both insanely busy and emotionally intense. Now for the mundane details of my life here:

I am sharing a beautiful house in a barrio in Quito called Bellavista. It is located on the eastern part of the city valley, and it overlooks Mt. Pichincha and the whole of downtown Quito. It's very safe, and most people would say it's a barrio where you can find many pelucones (Ecuadorian slang for uppercrusties). I'm sharing a house officially with 4 other people (all from the US), though the house is beginning to feel a little bit like a hostel (we will see how long this lasts). My room is very tiny, fitting a double bed, a dresser, and one nightstand, yet despite the size, I am paying a ridiculously low rent. It's a 15 minute walk and busride downhill to work (about 25 minutes coming from work because it is steep and uphill). The house is also an office for a green business that works with Kichwa communities to produce Guayusa tea (pronounced way-you-suh), which is an herb that boosts energy.

Work at Pachamama is excellent; there is never a dull moment or activity. I will dedicate an entire blog entry to the work I'm doing and going to be starting this year, because it is really interesting and covers all sorts of interesting issues. To be brief, I will be working primarily on two projects: Jungle Mamas, which will blossom into a health program for indigenous Achuar women in a community called Pumpuentsa in the Amazonian province of Pastaza. This program was started by a midwife from Berkeley, California, who upon having many discussions about childbearing with the women in the community, found that there was a huge interest in learning about midwifery and non-local birthing techniques. The traditional way women have been giving birth in this community has been by themselves; when it is time to give birth, the pregnant woman walks into the jungle by herself and comes back a day or two later with her child, oftentimes still connected to the umbilical cord. Last year, the project consisted of training women in these communities in Home-Based life-saving skills techniques that also incorporated local knowledge. The problem with this form of treatment was that the last resort in the treatment process always required visiting a healthcare professional or a clinic. The only way to access or leave Pumpuentsa is via airplane, which makes it difficult to leave the community if you don't have the resources to do so. So the training was taken off as a priority (however there are people in the community who have been trained and do actually serve as health providers).

My role in this project will be developing over the next month or so, but for the time being, I will be conducting a lit review of health-related projects conducted among the Achuar people and in the Amazon region in general. I have already made contacts with anthropologists who have conducted medical anthropology-related fieldwork in the area, and have even met some who have collaborated on public health programs among the Achuar. From this lit review and list of contacts, we will be able to not only have a better idea of how projects like these have been received and carried out among the Achuar, but it will also serve as a useful way of informing people in our network of partnerships. Unfortunately, it is not often that the Achuar get to use the information collected about them in studies for themselves, which is one of the reasons why the NAE (Nacionalidad Achuar de Ecuador, Achuar Nationality of Ecuador) have been increasingly opposed to social science investigation in their territories.

After the lit review and meeting with the project coordinators from the community in the jungle (and the community itself), we will be doing some fieldwork and interviewing families about their general perceptions of illness and health, numbers of deaths, births, etc. in the community, among other interesting information that will be useful in the design and implementation of an intercultural health program. I am especially excited about this aspect of the work, because it is very rare that people talk with individuals and families about identifying local needs and healing techniques when creating sound healthcare programs. There is going to be a lot to learn, and I still have much reading and relationship-building to do before everything magically turns into a health program, but I am working with such a wonderful team of people that the collaboration will be fruitful.

The other project I am helping out with is called the RED transfronteriza de territorios indigenas (the transborder network for indigenous territories). Pachamama is currently working with transborder indigenous nationalities from Colombia, Peru, Ecuador, Bolivia, and Brasil to work for the right to libre de transito, or the right of free border crossing to indigenous peoples whose territories are separated by national borders. It is a long and complicated process to get governments to recognize the territorial rights of these people to cross borders (especially when you have border "safety" issues, like the border between Colombia and Ecuador). Feel free to check out the website and radioprograms here and here.

I've been sitting on a really powerful and intense experience about women's health I had to advocate for on New Year's. I hope to have it ready in a few days. Please stay tuned, because it is one of the experiences I have had here so far over the last four years that I think has impacted me the most on a personal and professional basis.