Tika traveled with Tuta Korota and her relatives to the river to wash themselves and to expel the inner fluids contaminating her. Tuta Korota dispelled Tika’s misfortunes [chijekuna] into the river to be washed away, as Tika narrated it:
…I put one wad in my sandal and the other inside my headband. We filed out the front gate into the mud and rain. Everyone carried a large pack of dirty clothes to wash in the river. We stumbled along in the dark. Tatay [my father] led. Tuta Korota followed. She was old but kept up with us.
…we arrived at the Kunochayuh River and climbed another steep path up the mountain. Tatay showed me a cave alongside the river. “This goes to the Uma Pacha [place of origin and return]” he explained. “It is where we feed our ancestors.”
…Tatay built a small fire inside the cave. Tuta Korota placed one wad in each of my hands. I prayed to Mayu and asked her to remove the chijekuna within my chuyma. I knelt facing the river’s descent. Tuta Korota threw the yolk and white from a duck egg into the water, and then she removed the black wads from my headband and sandal. She broke wool threads around my right and left hands and right and left feet. She put the black wads into an old coca cloth with guinea pigs, rat, coca quids, and ashes. Everyone looked away, as Tuta Korota flung the cloth into the river, saying, “Puriychej chijekuna! Puriychej chijekuna! Puriychej chijekuna” [“Begone Invisible substance!”]
As is the case in other Andean misfortune rituals, the participants entered the icy waters to cleanse their bodies and then returned home. Tuta Korota revealed that sickness was related to corporeal, social, and geographical entities and that the human body in its constitution and dissolution is related to similar factors within the environment. In a sense, every symbol in the ritual suggested returning the misfortune to its place in nature. In a symbolic way, this could be seen as the desired return of vinchucas and T. cruzi to their forest environments.
The misfortune ritual is far removed from the microscopic view of the disease of the paleopathologists who examined Tika’s Inca ancestors. The former found wind, river, and earth; the latter found nests of amastigotes of Trypanosoma cruzi within human tissue. Neither perspective presents an entirely complete picture of Chagas’ disease. Andean ritual symbolically and spiritually adds to microbiology by metaphorically reversing the microscope and seeing the broader context.
Interpreting Symptoms and Locating Causality
Jampiris and yachajs symbolically interpret symptoms of Chagas’ disease and refer to natural deities that have hidden power over our bodies (an apt image for T. cruzi). They rarely refer to disease entities, instead referring mostly to symptoms, which they reinterpret for specific purposes such as to perform a ritual, redress a conflict, or produce a male offspring. Chagas’ disease lends itself to multiple interpretations because of its unclear and varied symptomology, being difficult to diagnose even clinically without laboratory tests by doctors.
After the Bolivian national Chagas’ campaign began in 1991, educational programs educated the rural peasantry concerning the danger of Chagas’ disease and its parasitic cycle relating to vinchuca bugs. Reeducation campaigns strongly push for the destruction of vinchucas by insecticides and housing improvement. Problems exist. Although not publicly endorsed, the insecticide DDT is used. Housing improvement generally is too expensive for poor peasants. Motivation also is low because the relationship of parasites to vectors and hosts is incomprehensible to many peasants, who find it difficult to connect Chagas’ disease to a bug bite years before. (On the other hand, malaria offers little problem in that regard, with its rapid attacks following infection.)
A concern of biomedical ethics is to what degree Western scientists should impose their medical paradigms upon natives and disrupt their cultural systems of dealing with infirmities. Western scientists claim a privileged sense of truth in regard to health questions, but Andeans prefer not to see Chagas’ disease in terms of “biological warfare” or “us versus them.” In the rich biota of the Andes and Amazon, insects play a vital role, and, as any camba (lowlander) will tell you, “the ant is the king of the jungle, and one has to respect them and learn to live with them.”
Jampiris and yachajs are little concerned with clinical definitions of Chagas’ disease, fearing that such classifications relegate the discourse to doctors. They recognize the loss of their patients to medical doctors, and only rarely do doctors refer patients to curanderos. Moreover, Jampiris and yachajs fear that doctors could prohibit their practices. Jampiris and yachajs also do not refer patients with Chagas’ disease to doctors, because doctors and drugs are expensive and they cannot cure Chagas’ chronic forms. Doctors, however, can learn from jampiris and yachajs how to better diagnose the symptoms of Chagas’ disease, something which has potential for the disease’s prevention (see Chapter 10).
Jampiris andyachajs always consult coca leaves to interpret the symptoms of Chagas’ disease. Some examples of how jampiris and yachajs interpret the symptoms of Chagas’ disease follow. An enlarged heart is particularly meaningful to them as chuyma usu (heart sickness), possibly caused by a death, unrequited love, slapping a mother-in-law, or indigestion. Kallawaya diviners throw and “read” coca leaves to uncover hidden causes for chuyma usu. A simple parasitic explanation does not satisfy Andeans’ desires for semiotically rich interpretations of ailments. Inability to swallow might refer to fears and anxieties over some bad deed or, as a worse scenario, that the sufferer told a devastating tale. For typhoid fever, as another example, the coca leaves once read that I was the cause because I had given sugar to a neighbor who was an enemy of the family with whom I lived (Bastien 1978).
Empacho has all sorts of possible explanations connected to cutting oneself off from the nutritive fluids or sustenance of the environment. It is corrected by sharing a meal with the earth shrinesfor example, burning coca, llama fat, and guinea-pig blood in the sacred sites that are spread throughout the ayllu (community). The symptoms of Chagas’ disease, diffuse as they are, are read much as one would play a hand of cardsthat is, according to what is needed at the time.
Kallawaya herbalists recommend enemas and purgatives to cure empacho, fievre, and chuyma usu, which are symptoms of Chagas’ disease but which they understand as a malfunctioning of the body’s hydraulic system rather than the intrusion of a parasite. Kallawayas conceptualize the body as a skeletal-muscular framework with openings, conduits, and processing organs. Fluids enter and are processed into other fluids. Poisons that develop from distillation must be periodically eliminated before they attain toxic levels. Illness is caused by obstructed tubes and accumulated fluids, gas, urine, feces, mucus, and sweat. Therapeutically, Kallawayas employ enemas, emetics, and sweat baths to cleanse the body of these fluids.
Figure 11.
Kallawaya ethnophysiology.
According to their ethnophysiology, megasyndromes of the esophagus, colon, and heart are interpreted by Bolivian peasants as caused by the accumulation of fluids and need to cured by emetics and purges. Megasyndromes are interpreted as the congestion of distillation processes of the chuyma the internal organs. Frequently, the only complaint of peasants stricken with T. cruzi is chuyma usu, “my heart is sick,” quite literally, “I have a congested heart” (as well as other internal organs). The widespread practice of emetics and purges in Andean medicine for the last thousand years results from dealing with the congestions of Chagas’ disease (heart, colon, and esophageal blockages). For this reason, peasants most readily associate Chagas’ disease with empacho meaning their bodily fluids no longer circulate from within the body to the outside but are locked into a centripetal movement. In educating Andeans about Chagas’ disease, a comparison can be made with the parasitic relationship of T. cruzi to triatomines, animals, and humans in that this microorganism flows in and out of the body in what could be called centripetal and centrifugal motion.
Traditional Herbal Cures
For the treatment of constipation and accompanying gastric pain, such as caused by megacolon of
Chagas’ disease, or even for congestive heart failure, Kallawayas used guayusa and sayre with an enema syringe to purge the patients. Tobacco is a particularly favored Andean remedy of long usage; it was widely used as a purgative and narcotic in pre-Columbian times.
Two species of tobacco, Nicotiana tabacum and rustica (sayre), were sources of narcotics in the Americas during the Incario (Elferink 1983; Schultes 1967, 1972). Nicotine was absorbed through the membranes of both the nose and anus by means of sniffing or the insertion of wild tobacco.
Guayusa and sayre were used by Kallawayas as early as A.D. 400, as indicated by a herbalist’s tomb found near Charazani that contained snuff trays and tubes for nasal inhalation, a gourd container for a powder, leaves from Ilex guayusa (Loes.), enema syringes, and a trephined and artificially deformed skull (Wassén 1972). Their purpose can only be guessed at: were they for medicine, stimulants, beverages, or ritual paraphernalia? The leaves are rich in caffeine, and guayusa was, and still is, used as a stimulant beverage in South America; for example, the people of Pasto, Colombia, still drink it. During the seventeenth century and after, the Jivaros of Rio Marañon drank it daily to stay awake, particularly when they feared attack by enemies (Patiño 1968). The Maynas of Peru and the Pinches of the Rio Pastaza region in Ecuador and Peru drank it for stomach disorders.
The ancient Kallawaya medicine man was equipped with enema syringes which were buried with him. One was made from a reed about 14 cm long, with a dried bulb of intestines tied to the tube with a cotton thread. Similar instruments appear in the Ollacha Valley of Bolivia, where Quechua Indians use them for enema syringes. The Jivaros of the Amazona region use similar syringes and prepare enemas from plants to purify the stomachs of male children. Andean diviners sometimes received enemas with narcotic fluids to enhance their spiritual powers (Tschudi 1918). The use of enemas during the Incario was important for warriors, who received douches before battle to become strong in battle (Guaman Poma 1944). Shortly after the Conquest, the medicinal qualities of sayre became known in Spain, where it was called a “holy weed” (Garcilaso de la Vega 1963).
Even today, Kallawayas claim that wild tobacco is an effective vermifuge and parasiticide. The Andean pharmacopeia featured potent parasiticides and vermifuges because of selective aspects or uses of certain plants able to kill predatory organisms. Kallawayas sometimes sniff tobacco leaves to induce sneezing for congestion and blockage of body parts. Air is understandably considered a vital fluid that must flow in and out of the nostrils; mucus must therefore be eliminated. Sniffing tobacco and guayusa not only cleanses these passageways by causing sneezing, tobacco also stimulates the cardiovascular system when nicotine enters the bloodstream. Thus some of the debilitating effects of chronic Chagas’ disease are meliorated.
Andeans conceptualize breath, samay, as a life force animating them and as a fluid element joining them with other vitalizing principles of the environment. Shortness of breath due to cardiac irregularities deeply puzzles Andeans, who feel that their lifeline with the natural world around them is cut off. The blockages of the esophagus, heart, and colon inherent in Chagas’ disease further turn the hydraulic processes inward in a damming effect of centripetal movement. The health of Andeans is believed by them to be a continual exchange of fluids with animals and plants, because they breathe the same air. For example, Kallawaya diviners communicate symbolically with the earth by blowing on their ritual offerings, which are then burned inside the earth shrines. Symbolically, breathing in and out is the means by which Kallawayas become united with their animals, land, and plants. Among a different ethnic group of ritualists, the people ofAusangate in southern Peru call their shamans samayuh runa, “people possessing breath” (Jorge Flores, in Custred 1979). These shamans commune with the hill spirits by taking deep breaths. Breathing in is the way knowledge and power are received from the spirit, and breathing out in ritual context is the way they place themselves in the offering made to the earth.
Within the first millennium, humoral theories in Europe, Asia, and Africa held similar assumptions that the body’s physiology is a distillation process in which productive fluids are distilled from primary fluids of food, air, and liquids, and toxic fluids are eliminated in sweat, urine, and feces. These humoral theories, especially the Hippocratic-Galenic ones, assumed that the humors (blood, phlegm, black bile, and yellow bile) were regulated according to principles of balance.
Kallawayas echoed European humoral theory in regard to fievre (fever), and they still treat acute cases of Chagas’ disease with cooling remedies. Andeans are primarily concerned with balancing the hot with the cold in dealing with fievre, rather than recognizing the fact that it could refer to parasitemia (parasites in the blood) and distinguishing acute phases of malaria, Chagas’ disease, and leishmaniasis. They refuse to bathe someone with a high fever in alcohol, which for them is classified as a hot remedy and should never be used to treat a hot disease (fievre). Because chagasic parasitemia is deadly for infants, health workers need to recommend a therapy that Andeans classify as cool, such as chamomile teas and baths (however, this varies with the region).
Andean humoral theory differs from Hippocratic-Galenic theory in that health is seen not as a balance of humors but a processional motion of concentration and dispersal of the humors (air, blood, and fat) (see Bastien 1985, 1987a). Health is the maintenance of this centripetal and centrifugal motion, and sickness is associated with either loss of fluids or the inability to dispel fluids. Andean pharmacopeia is complete with herbal matés (teas) ingested to increase fluids, and enemas and purges to expel fluids. Incidences of chagasic congestion of the colon, esophagus, and heart provide a physiologically based etiology corresponding to Andean ethnophysiology. This explains why traditional healers use purges and enemas to relieve the megasyndromes of Chagas’ disease. It also provides some insights into their curing rituals.
Kallawaya herbalists employ concepts of hydraulics and centripetal and centrifugal motion in regard to the empirical use of medicinal plants. They attribute problems to the accumulation of fluids within the central organs. Herbalists determine hydraulic forces by taking the pulse. One elderly herbalist, Juan Wilka, classifies bloods as strong, weak, frightened, and exhausted. In one instance, he diagnosed the pulse of a patient as weak because a landslide had thinned her blood with water. He suggested that she receive new blood by transfusion. Kallawaya herbalists refer to the qualities of blood according to four symbols: hot, cold, wet, and dry. These qualities refer to the blood being too fast (hot), too slow (cold), too thick (wet), and too thin (dry). Herbalists diagnose these qualities by reading the pulse. Sometimes they combine qualities: hot and wet blood is associated with energetic people and refers to fast-moving blood with much fat. Herbalists frequently associate symptoms of Chagas’ disease, especially empacho, with a pulse that is cold and wet. This implies that primary and secondary body fluids have accumulated and are unable to flow properlythere is need for strong emetics and purgatives.
An Herbal Cure?
Bolivian herbal doctor Nicolás Carrasco claims to have cured patients of Chagas’ disease with an herbal remedy called “Regenerator” (Zalles 1996). This discovery shows how the path to medical cures sometimes begins in ethnomedicine. Carrasco was born in Sucre in 1902 and lived to the age of ninety. He studied medicine at the Universidad Mayor de San Francisco Xavier in Sucre and received his medical degree in 1927. He received a doctorate in medicine in Ecuador for his studies concerning the use of aralan in the treatment of cancer. He received recognition from the mayor of Cochabamba in 1983 for his medical discoveries.
Bolivian doctors disregarded his discoveries, and Carrasco wrote of “an environment of incomprehension” among them to his findings. Carrasco practiced both biomedicine and ethnomedicine. He was a mestizo who basically adopted European clothing and spoke Spanish, although he spoke and thought more like a Quechua Indian. He identified closely with native curanderos and treated all classes, peasants, cholos, and mestizos. (Boliv
ia has a highly stratified class system, which at the time separated ethnomedicine from biomedicine along class lines.) On weekends he traveled to native communities to search for cures. He asked yachajs and jampiris for herbal remedies to test on his patients.
While he was in the Caranavi region of the Yungas (the eastern lower slopes of the Andes, noted for coca production), he learned from jampiris about the medicinal qualities of a resin from the fruit of the Rotan palm tree (Calamus drago), called Sangre de Drago (Blood of the Dragon). Sangre de Drago has a dark red color, hence its name, and contains many active ingredients, including draconine and benzoic acid, therapeutically used for their astringent and hemostatic properties (Carrasco 1984:8). There is considerable debate about the remedy and its components. Manuel de Luca, famous Kallawaya herbalist of La Paz, identified Sangre de Drago as Croton roborensis HBK and said that it should be used sparingly to treat Chagas’ disease, because it destroys red blood cells. He claimed it improves the immune system. Other herbalists refer to it as Sillu supay (Devil’s Seat), Kuru kuru, and Llausa mora, and frequently employ palm leaves to bathe someone suffering from susto (soul loss), a frequent symptom of depression or fatigue related to Chagas’ disease. The plant’s seeds are toasted, crushed, put into a small glass of pisco liquor, and drunk daily. This purges the body of toxic fluids, changing cold and wet blood into hot and dry. According to their ethnophysiology, it accelerates the centrifugal forces in the body (see Figure 11). The seeds can be crushed, making a salve that relieves rheumatism. Active ingredients of fresh seeds are acetic acid (like vinegar), butyric acid (like arnica oil), glyceride (like soap), and croton oil (castor oil), forming a powerful purgative.[7]
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