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.
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
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.
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.
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.