Steven Shem Rode and Dr. John P. Hawkins, Anthropology

Ethnomedical literature rarely addresses the problem of how illness is recognized and understood among Nahualenos in southwest Guatemala. In that area of the world, mother/infant mortality rates remain high, and local perceptions of illness continue to bewilder western biomedical caregivers. This study investigates data collected from doctor-patient communication, linguistics, and traditional medicine to explain how ethnophysiological understandings of illness exemplify effective and ineffective teaching methods about bacteriology and prevention within the liminal Nahualeno society.

For 30 years, the World Health Organization has attempted to integrate three health development strategies within various countries throughout the world, which seem to have all failed. These socioeconomic, case-treatment, and vaccination strategies resulted in virtually no change in the epidemiological situation given the slow pace of socioeconomic development, patients’ lack of compliance with prescribed regiments, drug resistance, and limited efficacy of BCG vaccination. These problems suggest that curative methodologies need to consider the socio-cultural factors facing those healthcare program introduced at the grass-root level.

Over the past 12 years, the indigenous community of Nahuala has struggled to fully embrace vaccinations, prenatal care, and family planning. While the health center in Nahuala is recognized by the Guatemalan government for exemplary work, infant mortality rates continue to plague that area. As of July of 1999, all children under the age of one year old have a 49% risk of death. In spite of such devastating odds, only 57% of all births had received some sort of prenatal care. Though healthcare workers are trying to promote the use of contraceptives, they recognize that the foreign concept of birth control explains why only 5.6% of the sexually active are using it. So although health care providers are working harder and more efficiently than ever before, they have produced moderate results.

In a broad sense, the notion of health is not isolated to biology. Since the counterinsurgency war between Ladinos and Indigenous communities over power struggles and land rights in the 1980’s, Nahualenos are rebuilding their homes, families, and identities. Today, the people of Nahuala are surrounded by national and international efforts designed to monitor the government, improve their city, and provide more opportunity. Among all this commotion exist feelings of rebirth, uncertainty, and the persevering attitude of continual adjustment. People wonder how to preserve their traditional past and look toward the future, while enduring through the present.

The split and diffusive state of the Guatemalan society similarly reflects how perceptions of illness and curing are split and diffusive. On one side of the spectrum stand the powerful Spanish-decent Ladinos. To the other extreme, stand the historically-exploited indigenous natives. This social polarity is symbolically refurbished within medical beliefs as well. Biomedical efforts by Ladinos have influenced Nahualenos to mix their Indigenous ethnomedical curative concepts with western biomedical preventative concepts. Data shows that as Ladino and Indigenous cultures interact with one another within the health care setting, five prototypical models characterized by different physiological beliefs emerge. Results suggest that the reason some Nahualenos accept vaccinations and prenatal care is because such methods coincide with ethnophysiological concepts about illness identification and management which already existed. Likewise, birth control struggles to gain acceptance in Nahuala because it is not being taught in a way which coincides traditional ethnophysiological concepts. Local perceptions about illness and curing reflect not only how contrasting beliefs are changing, but also how the split society is changing.

In reality, medical beliefs among many Nahualenos is as transitory as the Guatemalan society. Both are characterized as being in a liminal state: social positions are changing, identity is ambiguous, and beliefs behind behavior become impromptu. Social healing, as well as physical healing, are passing through another ritualized right of passage, characterized by death and rebirth of body and person.

Change is central to the indigenous understanding of illness management. The data collected in Guatemala explores Victor Turner’s theory on rights of passage pertaining to separation, margin, and aggregation in relation to the traditional process of curing among Nahualenos. Other theorists, such as Mary Douglas, Marcel Mauss, Judith Okely, and Keith Basso, help provide additional insights and support for understanding the cosmological basis for illness as understood by a small amount of Nahualenos. By using traditional beliefs in physiology (ethnophysiology) as moorings, data shows how the liminal state in traditional curing models the same process required for social healing . This is done by explaining how some western biomedical practices (specifically vaccinations, and prenatal care) have slowly been adopted into the Nahualeno beliefs structures about illness, while other practices such as birth control continue to be rejected by the majority of those living in the highlands of Guatemala.

Findings show how ethnomedical knowledge and behavior is related to illness identification and management in the highlands of Guatemala. Information from key-informant interviews provided the necessary background to administer surveys to 203 selected women at a local health center. Questions were aimed at investigating both modern and traditional understandings of etiology, illness conceptualization, and curative frameworks. Data documents the physiological conflicts between traditional belief of illness with the western biomedical belief of illness. Illness causation was identified by key-informant interviews and surveys. Identifying the moorings within current ethnomedical beliefs show how efforts in educating prevention at the local health center have succeeded and failed among indigenous communities in Guatemala. Results recommend that biomedical preventative healtheducation in bacteriology and hygiene should parallel ethnophysiological notions of illness management by addressing the positive and negative benefits of the herbal/curative notions surrounding the traditional hot and cold system.