Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

Human Ecology, 2012

"ETHNOPHARMACOLOGICAL RELEVANCE: The present conceptual review explores intercultural healthcare —defined as the integration of traditional medicine and biomedicine as complementary healthcare systems— in minority and underserved communities. This integration can take place at different levels: individuals (patients, healers, biomedical healthcare providers), institutions (health centers, hospitals) or society (government policy). BACKGROUND: Contemporary ethnobotany research of traditional medicine has primarily dealt with the botanical identification of plants commonly used by local communities, and the identification of health conditions treated with these plants, whereas ethnopharmacology has focused on the bioactivity of traditional remedies. On the other hand, medical anthropology seems to be the scholarship more involved with research into patients’ healthcare-seeking itineraries and their interaction with traditional versus biomedical healthcare systems. The direct impact of these studies on public health of local communities can be contested. AIM OF THE REVIEW: To compare and discuss the body of scholarly work that deals with different aspects of traditional medicine in underserved and minority communities, and to reflect on how gaps identified in research can be bridged to help improve healthcare in these communities. KEY FINDINGS: The literature covers a broad range of information of relevance to intercultural healthcare. This information is fragmented across different scientific and clinical disciplines. A conceptual review of these studies identifies a clear need to devote more attention to ways in which research on traditional medicine can be more effectively applied to improve local public health in biomedical resource-poor settings, or in geographic areas that have disparities in access to healthcare. CONCLUSIONS: Scholars studying traditional medicine should prioritize a more interdisciplinary and applied perspective to their work in order to forge a more direct social impact on public health in local communities most in need of healthcare."

Evidence-Based Complementary …, 2011

2008

Abstract Background: The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively.

Local medical systems are key elements of social-ecological systems as they provide culturally appropriate and locally accessible health care options, especially for populations with scarce access to biomedicine. The adaptive capacity of local medical systems generally rests on two pillars: species diversity and a robust local knowledge system, both threatened by local and global environmental change. We first present a conceptual framework to guide the assessment of knowledge diversity and redundancy in local medicinal knowledge systems through a gender lens. Then, we apply this conceptual framework to our research on the local medicinal plant knowledge of the Tsimane' Amerindians. Our results suggest that Tsimane' medicinal plant knowledge is gendered and that the frequency of reported ailments and the redundancy of knowledge used to treat them are positively associated. We discuss the implications of knowledge diversity and redundancy for local knowledge systems' adaptive capacity, resilience, and health sovereignty.

This paper uses ethnographic data on reproductive experiences of indigenous Andean migrant women in the lowland eastern Bolivian city of Santa Cruz de la Sierra as a starting point for discussion of different perspectives on the efforts of the Bolivian state to biomedicalise the processes of pregnancy and childbirth. Pregnant women and babies up to six months of age are covered by the state-funded Universal Mother-Infant Insurance (SUMI) that favours the use of biomedical facilities over the services of traditional midwives that are not covered by the insurance. Unlike in the western Andean highlands of Bolivia, most women in Santa Cruz give birth in hospitals while actively negotiating their options. They are not motivated by strictly medical factors as social or economic circumstances also come into play. Simultaneously, the increased levels of hospital deliveries in Bolivia translate into decreased levels of maternal and perinatal mortality, which in turn help Bolivian statistics to fare better from the point of view of the government and international bodies, such as the WHO. However, the restrictions on qualifying for SUMI are such that women in Santa Cruz are often forced to meet the costs of medical services themselves. I argue that the initial socio-biomedical intention of SUMI has become obscured by its political impact.

Journal of Ethnobiology and Ethnomedicine, 2009

This paper examines the traditional use of medicinal plants in Northern Peru and Southern Ecuador, with special focus on the Departments of Piura, Lambayeque, La Libertad, Cajamarca, and San Martin, and in Loja province, with special focus on the development since the early colonial period. Northern Peru represents the locus of the old Central Andean "Health Axis." The roots of traditional healing practices in this region go as far back as the Cupisnique culture early in the first millennium BC. Northern Peru and Southern Ecuador share the same cultural context and flora but show striking differences in plant use and traditional knowledge. Two hundred fifteen plant species used for medicinal purposes in Ecuador and 510 plant species used for medicinal purposes in Peru were collected, identified,. and their vernacular names, traditional uses, and applications recorded. This number of species indicates that the healers, market vendors, and members of the public interviewed in Peru still have a very high knowledge of plants in their surroundings, which can be seen as a reflection of the knowledge of the population in general. In Ecuador much of the original plant knowledge has already been lost. In Peru, 433 (85%) were Dicotyledons, 46 (9%) Monocotyledons, 21 (4%) Pteridophytes, and 5 (1%) Gymnosperms. Three species of Giartina (Algae) and one species of the Lichen genus Siphula were used. The families best represented were Asteraceae with 69 species, Fabaceae (35), Lamiaceae (25), and Solanaceae (21). Euphorbiaceae had 12 species, and Poaceae and Apiaceae each accounted for 11 species. In Ecuador the families best represented were Asteraceae (32 species), Euphorbiaceae, Lamiaceae, and Solanaceae (11 species each), and Apiaceae, Fabaceae, Lycopodiaceae (9 species each). One hundred eighty-two (85%) of the species used were Dicotyledons, 20 Monocotyledons (9.3%), 12 ferns (5.5%), and one unidentified lichen was used. Most of the plants used (83%) were native to Peru and Ecuador. Fresh plants, often collected wild, were used in two thirds of all cases in Peru, but in almost 95% of the cases in Ecuador. The most common applications included the ingestion of herb decoctions or the application of plant material as poultices. Although about 50% of the plants in use in the colonial period have disappeared from the popular pharmacopoeia, the overall number of plant species used medicinally has increased in Northern Peru, while Southern Ecuador shows a decline of plant knowledge since colonial times.