Global Health Policy Toward Traditional Healers: A 21st Century Update

Kathy Oths, author

Kathy Oths, author

Introduction

Much has occurred in the world of traditional medicine since the World Health Organization first appealed for the integration of Bio- and traditional medicines at Alma Ata in 1978. In the interim, while most efforts to include traditional healers’ services in hospitals and clinics foundered on the basis of distrust and unshared epistemology, paradoxically, worldwide interest in ‘alternative’ medicine only continued to grow.

An unfortunate result is that while the prestige of some traditional medicines heightened, and bioprospecting “integrated” traditional knowledge in pursuit of profits, concern about the survival of folk healers themselves subsided. Climate change, poverty, hypermobility, and globalization, among other factors, have led many young persons with healing potential to choose other career paths, or if they do enter healing fields, to choose professional paths that relocate them to urban areas far from the places of greatest need. Thus, one wonders whether folk healers will survive past the next generation, and what role governments and agencies might play in assuring that they do.

Background

The WHO’s Alma Ata Declaration stated “the need for urgent action …to protect and promote the health of all the people of the world.“ Article VII-7 reads: Primary health care relies, at local…levels, on health workers, including physicians, nurses …as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team …”   While the WHO continues to encourage and support traditional healers, these same healers are officially outlawed in some countries, such as Peru, where I work, though there have been efforts to legalize them and standardize their practice (WHO 2001, 2005).

Since Alma Ata

Don Felipe

Don Felipe

Complicating the picture is the rise of “CAM” or “Complementary and Alternative Medicine,” which is a term even scholars find confusing. Is traditional medicine a subset of CAM, or vice versa? Is a practice traditional in its primary cultural context and CAM if it is exported? While there are no easy answers, WHO would agree with the latter (2001). Great Tradition/Professional medicines such as Ayurvedic, Chiropractic, Traditional Chinese Medicine, etc., are larger, well-organized, and better funded than the small folk traditions found in local contexts, such as midwifery, herbalism, shamanism, and bonesetting (Kleinman, 1980), and thus are given more attention by physicians willing to operate holistic, integrated clinics (Keshet & Popper-Giveon 2013), and by WHO and other regulating bodies. Opinions of professional healers carry more weight when policy is shaped. Yet while in Latin America no Great Traditions exist, socialist-leaning governments in several countries have been at the forefront of sincere, respectful efforts to truly integrate traditional practitioners with biomedicine (Peru is not one of these, despite sincere efforts by CENSI). A recent example is Bolivia, where one finds notable efforts to refashion state health care delivery to accommodate traditional medicine in a spirit of interculturalidad (Johnson 2010).

Loss of Traditional Healers

In the late 1980s in Chugurpampa, Peru, a highland hamlet in the northern Andes of La Libertad, morbidity and mortality were low, in no small part due to a plethora of biomedical and traditional healers (Oths 1998). Since then, drastic environmental changes, such as drought, deluge, unseasonable temperatures, and invasive flora & fauna, have substantially reduced agricultural yields. The ensuing diaspora—one third of the population has fled to the coast for survival—has left the region with few healers, as people are subsistence farmers first and healers as a secondary occupation. Young adults do not have the economic nor residential stability to apprentice to existing healers.

pathway model

Bonesetter Conference, Julcan, Peru – 2013

Don Felipe Llaro, 80, is the last remaining healer in Chugurpampa and one of the region’s few bonesetters. (He is also a midwife, herbalist, and soul caller.)

  • A National Committee on Traditional, Alternative and Complementary Medicine operates out of a prestigious medical school in Lima. Its membership includes hundreds of physicians, healers, and others. They regularly hold conferences with much fanfare about reconnecting with their illustrious Incan past.
  • I accepted the Committee’s invitation to lecture about Don Felipe—twice—and given their insistence on meeting Don Felipe, I arranged a small 2-day conference on their behalf. They clamored to meet him and asked that I bring him to Lima, not considerate of the fact that he is elderly, unfamiliar with urban life, and would be outside of the cultural context in which he best functions. Not being an abstract thinker, he shows and teaches only in the act of working on an injured client.
  • In 2013 we hosted an “intercultural” conference in the rural highland Hospital of Julcan, the district capital near Chugurpampa, to showcase his talents and to promote apprenticeship to him while he still can teach. It was a success, drawing doctors, academics, healers, and others from around Peru, as well as local injured peasants who came for the free treatment they would get as demonstration patients. However, while a dozen D.s from Lima registered, in the end not a single one showed up. (Free room and board was provided to all.)
  • We achieved our goals—honor Don Felipe, re-acquaint local medical personnel with his practice, film the event, and identify an apprentice – his own granddaughter. However, who ultimately chose to attend the event, as opposed to who did not, speaks volumes.

    Treating a woman with a back injury from being thrown from her horse.

    Treating a woman with a back injury from being thrown from her horse.

Upshot

Romanticized notions of a glorious medical heritage collide with the reality of the healers—usually impoverished—who struggle to carry on their traditions. If the self-professed M.D. salvagers of traditional medicine are of no utility, the task of preserving traditional knowledge becomes that much harder. Bolivia’s WHO-assisted government initiatives to privilege traditional medicine in its state-run health care system, while not entirely successful—and with opposition from biomedicine and USAID-–provide an illustration of potential new approaches. Treating folk knowledge as valuable though folk healers as dispensable is not a viable long term strategy.

The Last Bonesetter, an ethnographic film of Don Felipe and the conference, will be shown at SfAA in Vancouver in March and at other future venues.


Biocultural Systematics is written by members of the University of Alabama Biocultural Medical Anthropology program. Kathy Oths, a professor in the department, has worked in the highlands of Peru off and on for over 30 years.

“Bioculturalism”–An Interview with Jason DeCaro [reposted from Somatosphere]

This article is part of the series: 

“Bioculturalism” resumes this week with the first of three new interviews with self-professed biocultural anthropologists. This series aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. New interviews will be published every other week, followed by a new piece by series organizer Jeffrey G. Snodgrass on Internet gaming, which has progressed in tandem with the series’ publication.

In this interview, Jason DeCaro responds to questions posed by Snodgrass.

How and why might cultural anthropologists and social scientists interested in health benefit from integrating biological variables/biomarkers into their research and analysis?

This is hard to answer in the abstract because it depends so much on the research question, but I will give it a shot. In psychological and medical anthropology, we talk a lot about embodiment. The body is deeply encultured, to the extent that I am completely convinced neurological functioning can’t be understood properly without reference to the shaping of the nervous system through culturally-constructed developmental experiences throughout the lifespan. Perhaps that is more a case for why biologically-oriented anthropologists should attend to culture. But here’s the thing. It seems to me that the reverse is equally compelling. Twenty years ago, who would have thought that inflammation has a role in depression? (It does.) And we’ve known for a while that physical activity does as well. And undernutrition. And so on and so forth.

Another way of looking at this is that biomarkers provide one part—not the whole, just a piece, but an important one—of the picture regarding the subjective impact of daily experience. I emphasize “subjective,” even though we’re talking about a quantifiable bio measure, because brain-body connections are so pervasive that subjectivity influences a wide array of biological parameters. It’s sort of boring, honestly, when the biomarkers just confirm what you already thought based on talking to people. But on the other hand, when the biomarkers tell you something counterintuitive or surprising—like that some group (or even an individual) is biologically responding in a way that you wouldn’t expect based on what you otherwise know about them—it’s illuminating. Such was my reaction, for instance, when I and collaborators recently completed a data analysis (unpublished but presented at AAA 2015) showing that, once food security was controlled for, a biomarker of chronic stress was “worse” in young children from households with greater material assets in an East African community where I work. I won’t give away the end of the story, which would take too much space anyway, but these “huh?” moments lead us to re-examine what we know about people—re-open those interview transcripts and field notes—and ask “what is the body telling us here?”

How would you respond directly to one potential cultural anthropological or social scientific critique of such an integrative “biocultural” approach?

Not going there anymore. I’m no longer investing energy in endless scripted arguments about the purported value or purported dangers of biocultural research as a general class (which are really just a subset of arguments about integrative holism in anthropology, and don’t seem to have changed much since I was a first year graduate student in 1998). Biocultural research isn’t for everyone, nor is it the best approach for every research question, but ideally it complements cultural anthropology nicely, especially in medical anthropology. On the other hand, done poorly, yes indeed it can be dreadfully reductionist and everything else people fear. So my view boils down to this: do it very well, with careful ethnographic contextualization and a thorough understanding of biology… great. Don’t do it at all, great. AAA is a big conference with plenty of room in those cavernous hotels we rent out. I hope we’ll all see each other in some sessions, but if not I’ll certainly give a friendly wave in the hallways.

What is one potential caution you’d have for cultural anthropologists or social scientists considering a biocultural approach?

To do biocultural research well requires a high level of sophistication regarding social/cultural anthropology and human biology at the same time. For one thing, this means that teamwork is incredibly valuable… I work almost entirely in collaborative teams now, because I just can’t be good enough at everything. And the research question (along with any measures that are going to be employed while addressing it) should flow from theory. If the theoretical framework doesn’t naturally call for an integrative biocultural approach, that is a red flag. Theory can and should be stretched of course, but it’s important to ask ourselves: will including a biomarker or a biological interpretation really tell us something substantially more than we could learn without it? Will it address a theoretically interesting question in a new and exciting way that moves the field forward? I ask students these questions all the time, and if they don’t have strong answers, I send them back to the drawing board. If they do, then I’m the biggest cheerleader they could want for their integrative approach.

What is one piece of research (ideally your own) that points to the benefits of such an integrative approach?

I’d like to point to some work that was done by my colleague Lesley Jo Weaver, on which I am honored to have been a co-author:

Weaver LJ, Worthman CM, DeCaro JA, Madhu SV. 2015. The signs of stress: Embodiments of biosocial stress among type 2 diabetic women in New Delhi, IndiaSocial Science & Medicine 131:122-130.

In brief, Jo found that congruence with gender roles among women with diabetes in India protected against the adverse effects of diabetes on mental health and inflammation, even when biomarkers showed the diabetes to be poorly controlled. Trade-offs among biological, social, and cultural dimensions of well-being that can only be identified within an integrative framework that joins ethnography and biomarkers with clinical outcomes. Good stuff.

What are some other references to help cultural anthropologists or social scientists interested in such an approach get started?

DeCaro JA. 2015. What’s biological about biocultural research? (Part 1)Anthropology News 56(3):e1-e2.

DeCaro JA. 2015. What’s biological about biocultural research? (Part 2)Anthropology News 56(6):e1-e2.

Jason DeCaro, PhD, Associate Professor of Anthropology at the University of Alabama, is a biocultural medical and psychological anthropologist and human biologist. His research concerns interactions among the social and cultural architecture of everyday life, cognitive processes, and physiologic systems in human development and the production of differential well-being across the lifespan. His primary international research site is Mwanza, Tanzania, where he has conducted research on child care practices, household adversity, caregiver mental health, and young child growth and development. He also is active in the Southeast U.S., where he has investigated emotion regulation and the biological stress response during the transition into grade school. He directs the Developmental Ecology and Human Biology Lab, which supports the analysis of blood and saliva biomarkers related to immune function, stress physiology, metabolism, and nutrition.

Bioculturalism” aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. It is edited by Jeffrey G. Snodgrass.