From the Andean Medicine to the Popular Medical Practices

Regarding popular medicine, Sal y Rosas considers it as a “Creole medicine” with no traditional or historical roots. “The content is mixed, fluid and erratic, with elements borrowed from the most diverse therapeutic origins. It is not a properly medical system, rather a merely curative practice without principles, or randomly tacked from everywhere. It is used in the peripheral neighbourhoods of the city and in the rural coast, and it is the only form of curanderismo with the exclusive goal of personal profit.

It is the only one that interferes with the scientific medicine; this is why it is located on the field of the illegal practice of the medicine” (1972:93). For Seguín, popular medicine consists of a collection of beliefs and practices about diseases, its prevention and treatment, which are maintained through the popular tradition in all spaces, far away from what is proposed in scientific medicine: “It is exercised by the folk, without major theoretic preparation. It is the recipe of the grandmother, or the prescription of the old aunt; such kind of manoeuvres used in the familiar context” (1998:1).

Other definitions of popular medicine outline the rationality, which includes non-lineal parameters and the inherent potential to incorporate other values, whatever their antithetical origins. Lastra asserts, for example, that popular medicine is the body of health solutions integrated to a set of actions among popular urban-marginal sectors of the society, and in which it is possible to find an “indistinctive mixture on the use of proceedings from the traditional medicine as santiguamientos (to make the sign of the cross over oneself), bone-adjustment, quebradura de empacho⁴⁴, etc.; with others from the official medicine, as well as self-medication, consultancy of professionals, etc.

(1993:111). Frisancho defines Andean medicine as synonym of folkloric medicine, because he considers that the popular and traditional are both part of a country’s folklore (1999:4). Cárdenas emphasises the weak frontiers existing between traditional and popular medicine, establishing a differentiation criterion upon the identification of populations sector making use. She argues that popular medicine is an overlapping

44 Empacho is a (culture-bounded) digestive syndrome widely present in Latin America. It is associated with excessive food intake, which causes gastroenteritis and symptoms such as colic, diarrhoea, fever, and vomiting. More commonly found among children, treatments range from the use of medicinal plants

group of practices, knowledge and ideologies regarding health originating both in indigenous and modern medicine and the Catholic religion. In her view, “the social groups located in urban, rural and urban-marginal sectors manage this knowledge, which do not emphasise in the preventive and ecological aspects, but in the context of a mestizo national dominant culture, and the market economy” (1990:195).

Instead of THPs, an equivalent category for popular practitioners is the curioso. The notion of a curioso varies between regions in Peru. A person responsible to offer advice and first aid, whether man or woman, commonly older people, are considered curiosos.

They constitute a sort of intermediate operators, responsible to solve, or provide information about, in low levels of complains that are not attended by THPs. Principal activities of a curioso are to preserve traditional knowledge and to recommend the best treatment or the suitable curandero for a specific given case (Delgado 1999:21). They also act as counsellors by resolving interpersonal or familiar problems in the community. Among the Achuar from the Huasaga River (Delgado 1999:20), the curiosos are healers that use herbal remedies but that do not undergo any initiation process. They acquired the ability to cure while helping the work of other curanderos, not necessarily from the own community.

Self-attention and social participation constitute the basis of the social life in the traditional and contemporary local communities in Latin America. They have existed before the appearance of the first concepts and theories about the development of PHC attention models for developing countries. Its presence and importance is extended besides all aspects comprehended among the health-disease-recovery process, and are indeed important social determinants for health attention.

According to Menéndez, the autoatención (self-care) makes reference to a structural strategy of the social groups, that includes all its daily activities (nutrition, hygiene,

“informal” education, etc.) applied in order to find a provisory or definite solution to the afflictions or problems affecting health conditions of the members of the community (1993:72). The activities employed tend to become appropriated by the group, establishing through this process a dynamic relationship between the individuals,

institutions and products outside (Menéndez 1993:73). Among these activities are the detection of a health problem, the production of a provisory diagnose, the use of a repertoire of diagnose indicators, observation of the development of the disease, the use of criterions on severity or mildness of the disease, etc. These different actions bring the group members to important decisions and actions’ course conducing from “doing nothing” through self-medication, self-prescription of substances or therapeutic mechanisms, the inter-familiar or trans-neighbourhood consultation up to the consultation of biomedicine professionals or “curadores populares”. Popular medicine is identified by Menéndez as self-care and constitutes a sociological and anthropological strategic adaptation of different traditional medicine techniques that are in use among citizens that are non-specialists of TM (1993:72-80). Menéndez lends the technique of the rubbing with the egg as an example of one of the most practised expressions of popular medicine. Besides, the author does not make any distinction between domestic and popular medicine, and considers both as part of the first level of attention in population self-care in Latin America.

Biomedicine knows that it has efficacy, at least in relation to some ailments, and it does not need to implement traditional practices on that. Similarly, TM responds in an effective way to the mitigation of multiple syndromes, for which biomedicine has shown no effectiveness. Nevertheless, the attention to popular medicine and its practices has emerged as a response of civilian associations, community based movements and other social mass media phenomenon (i.e. cyber cultures) that reflect the wish for direct participation of the population in health decisions concerned national programmes, and due to the progressive discredit of both traditional and biomedical practices.

Due to its expansion and importance for PH, some authors consider that popular medicine should be also acknowledged as a medical system and be constituent of health research like other medical systems, such as the conventional and traditional medicine (Eyzaguirre 2005:22). Pedersen considers that popular medicine has arisen principally as consequence of the social expansion of biomedicine into the popular and mass cultures, and the increasingly high-tech implementation of TM, and constitutes per se a

American medical cultures and the medical traditions from other latitudes” (1988:53).

Evidently, popular medicine reproduces an interchangeable process through the daily practice of self-care among the population, and its reproduction’s mechanisms are not necessarily based on oral, community or inter-generational transmission, but rather on several written, visual or mass media resources. It owns an objective value, ratified on the perceptions and direct experiences of the subjects involved, and counts with a varied network of specialists managing different therapies with the most dissimilar origins. A special characteristic is its presence in widely different social, economic and cultural milieus, but always with a popular character, i.e. it is both used among subaltern groups and the hegemonic ones in specific contexts. It is also important here to differentiate between domestic and popular medicine. I consider the first one as part of the first level of care attention, based on the use of mechanisms of self-care, which includes self- medication; well-being practices such as exercise and physical training, nutritional discipline, etc. and that has an essentially preventive focus. On the other hand, popular medicine makes additional use of health resources that exist outside the domestic and private sphere of the groups, but that are characterised by their non-preventive focus.

These resources have either clearly abdicated a knowing biomedical, alternative or traditional approach or make mixed use of some techniques, elements or resources of all them.

In contrast with the mainstream definitions of TM, the studies about popular healthcare practices gain increasingly in interest upon policy research, providing new categories to be considered. Most of the reports outlined concepts and practices earmarked through four principal elements:

(1) Subaltern or subordinate status of popular healthcare practices in relation to TM and conventional medicine;

(2) Prior informal mechanisms of transmission and preservation of knowledge (extra- mural, writing, from mass-media, and non traditional);

(3) Linked to a rapidly changing dynamic in order to respond to socio-economic living conditions of communities and popular sectors; and

(4) Increasingly socio-cultural adherence among the population and progressively epidemiological contextualization

With a statement, Eddowes (1985) illustrates the conformation of perspectives of Peruvian modern social scientists and the definitions provided by international health agencies regarding TM and popular medical practices: “It is a widespread belief that where the magic is, the science must come and replace it. Still, one does not replace the other. The difference between both medicines is sometimes more a desire of the Western scientist as a really change on the part of the customers. That is to say, if the problem was solved, it does not matter how the phenomenon can be explained. Finally, what difference does it make to name a pathogen agent “microscopic bacilli” or “evil spirit”, if in both cases there is harm and the goal is to expulse it?” (1985:6).