Cholo housing provides an insight into how Aymara and Quechua peoples use their housing: as depositories, for the processing of resources, to house cottage industries, for social gatherings, as symbols of ethnicity and class, and for dormitories, kitchens, and eating places. Their multifunctional housing appears cluttered to many Europeans and Americans. It also provides triatomines places to hide and people and animals to prey upon.
Upper socioeconomic classes of mestizos and cholos constitute only a small minority in Bolivia, and the vast majority of campesinos and cholos live in inadequate and unhygienic housing. Such is the case of impoverished urban migrants and dislocated peasants throughout Bolivia. Widespread poverty in Bolivia has created deterioration and crowding of domiciles to such a degree that urban settings have become optimal environments for triatomines and T. cruzi. The number of chagasic patients is increasing in the cities of La Paz, Cochabamba, Oruro, Sucre, Potosí, and Santa Cruz.
Chagas’ disease is related to underdevelopment, overpopulation, poverty, inadequate housing, and the inequitable distribution of resources. The occurrence of Chagas’ disease in Latin America corresponds to those rural areas most deprived of sanitation and primary health care and to the poorest rural regions. Moreover, victims of Chagas’ disease are also being ostracized in certain areas, where being seropositive for the disease has a social stigma impeding employment.
Perhaps the most significant result of this is that it exacerbates the impoverishment and resulting lack of development in rural parts of Latin America. Modes of production on haciendas are semi-feudal; there is both difficulty in marketing products and a lack of technology in the subsistence economy. Communities are isolated, poor, and spread apart. The urban slum dwellers in cities, the landless workers, and those with tiny holdings in rural areas are at high risk for Chagas’ disease, which in turn contributes to their plight.
Political Economy
Chagas’ disease is related to economic, political, and social factors at broad political and economic levels. Lack of integration of peasants into politics and the economy, privatization of communal Indian land, the subsequent dislocation of peasants to areas with temporary housing and overcrowding, inadequate education in rural areas, and destruction of tropical areas are
broader political developments which have contributed to the spread of Chagas’ disease (see Briceño León 1990). Moreover, larger structural processes are more difficult to change than those at the individual or community level.
Microlevel analyses regard the causes within smaller units of society, such as the community, family, and individual. Housing hygiene is an effective way to prevent Chagas’ disease at the microlevel, but this is also difficult to achieve because it involves changing peoples’ values concerning animals (keeping dogs and cats outside), sleeping habits (not crowding together in bed), and basic hygiene (storing things in boxes and sweeping regularly). Changing behavior at the micro-sociocultural level is necessary for chagasic control, and this can be done by individuals and communities by means of specific projects.
Macro-level factors are more difficult to change, in part because Latin American economics and politics are embedded in a colonial heritage of dependent relations to dominant countries, oligarchical hegemonies, bureaucracies, corrupt governments, elitism and class stratification, and ethnocide (destruction of tropical tribes to facilitate the extraction of forest resources—gold, timber, and game), to mention a few. Nevertheless, macro-social factors need to be addressed by international organizations, and it is the responsibility of corporations and governments involved in the above to practice retributive justice by repairing damages incurred because of exploitative and environmentally destructive practices. The fact that Chagas’ disease is becoming a worldwide problem illustrates that destruction abroad can cause problems at home.
Parasitic economic relationships between industrial countries and Bolivia developed in the nineteenth century (although indigenous peoples of Latin America supported others from Spain and Portugal centuries before), which was characterized by excessive exploitation of Bolivia’s resources by foreign interests in collusion with Bolivian capitalists. Railroads were built early in that century for transporting rubber, quinine, tin, timber, oil, and cattle. Riverboats, railroads, and later trucks opened frontiers deep into Bolivia’s forests. While Chagas’ disease, malaria, and yellow fever somewhat held capitalist colonial intruders at bay, the same forests produced quinine bark to treat the illnesses (Bastien 1987a: 143-45). Effects upon the environment included large tracts of land destroyed by timbering, mining, and cattle grazing. A downward spiral began of decreasing biocultural diversity. At first this seemed insignificant amid the multitudinous natural riches of Bolivia; but it soon was out of control, devastating Bolivia’s Indian populations, plants, and animals in tropical zones.
At the end of this millennium, Bolivia is on the crest of a free-market capitalistic wave of radical change (Raterman 1997). This has caused increased unemployment, poverty, environmental destruction, and grave social problems.
Since 1985, Bolivia has halted inflation, and government spending has been reduced to achieve an almost balanced budget. While national debt has grown from $3.3 billion in 1985 to $4.6 billion in 1995, it now takes a smaller percentage of the annual budget to pay for it.
After a series of military dictatorships,[43] in 1985 Gonzalo Sánchez de Lozada, minister of planning and finance, began a series of reforms with new laws to restructure Bolivian society. He later served as president from 1993 until 1997, when he further carried out the new laws. The laws advocate legal and social restructuring needed to support a free-market development model: new tax laws, new custom controls, new banking laws, and laws regarding investment and ownership. They are part of regional and worldwide moves toward economic integration that has culminated in the North American Free Trade Agreement (NAFTA) and the recent Summit of the Americas, with its call for complete economic integration by the year 2005.
Privatization and capitalization are the engines of this model, and there is an attempt to privatize state industries and at the same time keep the control and ownership in the hands of Bolivians. By 1997, state-owned enterprises such as the airlines, the petroleum industry, electric utilities, telephone companies, and mines had been sold to private investors. Downsizing often was necessary to make these corporations efficient, and thousands of workers were laid off. The plan was that revenue from the sale of these enterprises would be available to help start new industries and employ people.
Thus far, these changes have favored the wealthy and ruling classes, especially outside investors who have tapped into Bolivia’s rich natural resources, especially for timbering, cattle raising, and large-scale agriculture. This has further opened the forests and reserves of Bolivia to capital development and helped incorporate Bolivia into the world market, where it is often cheaper to buy products from other countries than those produced by Bolivian peasants.
New laws and economic realignments only highlight Bolivia’s huge social injustices, inefficiencies, and dependencies. The oligarchical leadership of centuries has left more than two-thirds of the people on the margins of economic life and further impoverished. Illiteracy, lack of health care, inadequate housing, increased migration, and high unemployment help reveal the racism and classism of the past. Indigenous people, even though they are the majority, count for very little, their women even less. An elitist class system of control and economic distribution which widens the gap between segments of the population is unsatisfactory. An elitist financial system eventually limits opportunities and hinders the formation of new enterprises.
An integrated market without an integrated society is a contradiction. Free markets need a level playing field, clear rules of the game, and maximum access to the market by all social players. Free markets and feudalism can’t mix. Economic and political development are finally impossible in any given society without investment in and development of all national human resources.
This development includes the education and training of workers in health measures.
Efforts at Incorporation
Questionably to his credit, Bolivian president Gonzalo Sánchez also led the passage of Ley de Participación Popular (Law of Popular Participation) as an endeavor to bring ethnic groups and peasants into the political economy of Bolivia. The law decentralized administrative authority and gave political authority to 380 municipalities throughout rural areas of Bolivia, giving peasants more possibility of political power. Sánchez also instituted health and education reform measures in rural areas.
The impact of these changes on Chagas’ disease is mixed. Peasants now have improved access to national revenues through the municipalities for improving roads, schools, and houses. Proyecto Cardenal Maurer in Sucre is using municipal monies to improve houses to help control Chagas’ disease. Peasants also participate in a national health plan that favors women and children and maternal health care, which indirectly helps restrict Chagas’ disease. One of Bolivia’s leading anthropologists, Xavier Albo, sees this as giving the peasantry more political involvement. Because global integration into world markets is a necessary economic trend in Bolivia, traditional Andeans are becoming involved in the political process of the nation.
On the negative side, however, another leading Bolivian anthropologist, Pablo Regalsky, represents Indian federations that violently oppose this new legislation as leading to the demise of autonomous Andean leadership centered in the community (Andean village) as opposed to the municipality (Bolivian village). Municipalities have replaced communities as political nuclei, and vecinos (mestizos) assume leadership roles over the peasants. Even if peasants get elected to power in the municipalities, critics believe it will only be after they are corrupted by the political parties.
These changes have had a less than positive effect on Chagas’ disease. Peasants have lost large tracts of land to private corporations, for which they often work as migrant workers. In Misqui, Bolivia, for example, a large industrial dairy farm owned by investors has displaced fifty Quechua families who had previously held the land in common and through privatization laws were able to sell it to capital investors. Western property rights emphasize the rights of individuals, whereas Andean property rights emphasize ideas of commonality, exchange, and ecology. Whereas peasants traditionally held land in common and the community had a sense of social solidarity, emphasis now is placed on the individual, with few or no ties to the community. Individuals tend to think less of their commitment to the community than they did under Andean traditional patterns of work exchange, reciprocity, and shared land.
For example, if someone leaves the community to migrate elsewhere and leaves his house in disrepair, it will remain unattended and become a source of infestation for others in the community who have repaired their houses. It becomes more difficult to get community involvement in projects. Another concern is that peasants are rapidly becoming jornaleros (wage workers) for landowners after they sell or lose their land. This drastically changes the cultural constructs of how they perceive their homes and land, as discussed above. Finally, because of increased poverty, considerable numbers of peasants now work as migrant workers in Argentina, Chile, and Brazil. These and many other factors moved the Bolivian people to elect a new group of political leaders in 1997.
Suggestions
Endemic Chagas’ disease in Bolivia is a symptom of its unpaid “social debt.” Since 1985, Bolivians have paid more than $3 billion in debt repayment to institutions and international banks; but money must be reinvested in the environment and people of Bolivia. This must be done, if not for social justice, at least for economic survival, environmental protection, and disease prevention in Bolivia. Bolivia also must have equality of educational opportunity for all its people in order to compete in a global economy. A free market requires a radical educational reform which includes indigenous people and women in both rural and urban districts. Teachers to train other teachers are needed. The economic systems of Andeans need to be incorporated into free-market strategies. Andean communities can utilize their communal structure and economic exchange patterns to form strongly competitive cooperatives, which should be broad based to include credit and housing plans, consumer goods, and production goods.
There also is a need to change certain attitudes. The free market has brought new wealth to certain Bolivians, but this emerging middle class is driven by a consumerism that models itself after the few who are much richer and have no sense of nation building. They dissipate their wealth on such things as luxury homes and cars, investing the surplus in the United States. Bolivia’s wealthy never have believed in themselves or in their own country. The poor of Bolivia have a “solidarity of suspicion” about world economic integration, both in theory and practice. Finally, a national policy is needed to combat Chagas’ disease, because it debilitates members of the work force when they are most productive, leaves children without parental upbringing, and is costly to treat.
However, the political economy alone cannot be blamed for all unhealthy aspects of Bolivian housing. Chagasic control projects need to include the cultural economy of housing with the political economy, which will be the subject of subsequent chapters.
CHAPTER EIGHT
Pachamama Snatched Her: Getting Involved
Chagas’ disease became a major concern for Ruth Sensano in 1989. She is director of Proyecto Britanico Cardenal Maurer (PBCM),[44] which sponsors Chagas’ control projects in the Department of Chuquisaca. PBCM improved 452 houses between 1987 and 1991, another 400 in 1992, and by 1997 it had improved 2,600 houses.[45] PBCM improved the first 452 houses with a budget of U.S. $83,256, out of which the community contributed almost half, or $37,642. By the year 2005, Sensano predicts, she will have improved another 2,500 houses, counting on assistance from tax revenues given to the municipalities for regional improvement, as discussed in the previous chapter.
A native of Sucre and a mestiza, Ruth Sensano learned to be a project director. She controls the accounting process carefully so that there isn’t any graft. Bolivians have a phrase in Aymara that translates roughly, “Sucking from above and sucking from below”; it refers to the mid-level Bolivian project personnel who steal from those above (foreign bosses) and from those below (peasants). Because of the great amount of graft in Bolivia, project directors need to scrutinize expenditures at every level.
Sensano is as shrewd as any native chola market woman and as accurate as an accountant: both skills enable her to deal with the bureaucratic economic systems of project supporters and the informal, dynamic economic systems of peasants. She was lured from a profitable accounting job in 1976 by Cardinal Maurer, a German immigrant and Bolivia’s first Roman Catholic cardinal, to extend health care to peasants within the Department of Chuquisaca. Since then, Sensano has established a medical program that serves 54,500 people in 168 communities in three zones of Yotala, Yamparaez, and Tarabuco. She accomplished in fifteen years what the Bolivian Secretary of Health with triple the personnel and budget was unable to do in thirty years.
When I met Sensano one June morning in 1991 in Sucre, Bolivia, she told me why she became involved: “About twenty months ago, we started the Chagas’ disease program. We found that campesinos came in with bulbulos, hardened and impacted intestines, and they couldn’t go to the bathroom. They say that they eat cold food, their intestines fill, harden, and they can’t defecate. This was caused by Chagas’ disease.” She also showed me a picture of a peasant with bulbulos who hadn’t defecated for months (see Figure 9).
Figure 21.
Ruth Sensano is director of Chagas control in the Department of Chuquisaca, Bolivia. She has been a leader in the eradication of this disease, and her program is a model for other projects throughout Bolivia. (Photograph by Joseph W. Bastien)
“We realized,” Sensano continued, “that in many communities people were sick with Chagas’ disease. The people are accustomed to vinchucasin their beds, thirty to forty in th
eir beds. They are used to the bites. They say, ’All night we are taking off their heads and destroying them. We have to sleep outside the huts to escape them. Sometimes we don’t sleep all night because we have to kill vinchucas.’ When vinchucas bite, they scratch it.
“Campesinos see a person working and then fall asleep and die with two or three drops of blood coming out of the nostril. They say she died ’asustado’ (frightened), or ’La Pachamama ha agarrado’ (Mother Earth snatched her!). In reality, la vinchuca got her, just as they got me!” (Sensano interview 6/17/91)
I noticed that her left eye had the carbuncular sore beneath the eyelid characteristic of acute Chagas’ disease, Romañia’s sign, so I asked her if she had Chagas’ disease.
“I would be surprised if I wasn’t infected,” she replied, “seeing that I have slept in peasant huts many times. But that’s my job! More than likely, all my workers have Chagas’ disease. We are all in this together.”
Before I parted, an old Quechua lady came in with a face twisted from Bell’s Palsy. She was crying. Sensano hugged her, as a mother. Firmly, she advised the lady to take a taxi, providing her with the fare, to the Bolivian Supreme Court in Sucre.
Figure 22.
Ruth Sensano assisting an Indian woman who had suffered Bell’s Palsy and had been released as a maid because of her facial deformity. Sensano served as arbitrator in the Bolivian courts over this matter. (Photograph by Joseph W. Bastien)
“I’m also a social worker,” she explained to me. “This lady was fired as a maid after working thirty years for a wealthy family. They threw her out of the house because her disfigured face embarrassed them. They gave her no severance pay. Now, she is without a home and money.” Sensano is contesting this in court, and she hired a lawyer to defend the woman. The case was prolonged for six months. Ruth Sensano sighed, “So much suffering and so little justice in Bolivia.”
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