N E G O T I AT I N G H E A LT H A N D I D E N T I T Y Lay Healing, Medicinal Plants, and Indigenous Healthscapes in Highland Peru

Global health-care models for developing countries urge integration of traditional medicine with Western biomedicine. This article shows how residents of a remote Peruvian village negotiate among biomedicine, traditional medicine, lay indigenous medicine, and local knowledge of medicinal plants. Villagers’ health-care choices reveal that they often resort to medicinal plants before modern pharmaceuticals. Their discourses show that these choices re! ect social and cultural processes beyond the medical: the revitalization of Andean identity, the con! ictual relationship that villagers have with modernity, and the desire to evade or subvert the power that Western medicine has over them. This article elaborates the concept of the healthscape as an individual’s subjective vision of a landscape’s medical resources and institutions, limited by cost and accessibility and shaped by the uneasy coexistence of Western and indigenous medical systems. Although the introduction of Western medicine in developing countries has indisputably increased longevity and decreased child mortality, it has been less effective against chronic disease, and it can be experienced as alienating and dehumanizing (Janes 1999), as it does not take into account the social and emotional realm of health. When Western medical policies and initiatives dribble into places that have preexisting, culturally embedded medical systems, they are often accompanied by hegemonic cultural ideas. Because Western medicine is mostly regarded as superior to alternative forms of medical care (Baer, Singer, and Susser 1997), positive elements of local medical systems have often been rejected, thus contributing to their decline. It is important to consider that many governments in developing countries have put in place biomedical systems not only because of their therapeutic worth but also in the name of social advancement, capitalism, and development (Baer 2003); indeed, “biomedicine has become a metonym for modernity in the domain of healing” (Conner 2001, 7). Yet local medical systems can offer inexpensive and culturally appropriate healing that reinforces social identity. Despite the decline of local medical knowledge, approximately 80 percent of people in developing countries still rely on traditional medicine (World Health Organization [WHO] 2003), and there has been a recent revitalization of indigenous medicine and health knowledge. The realization of this revitalization The authors thank Justo Mantilla Holguín of IEPLAM as well as the people of Añawi. We also thank Nadine Schuurman and Valorie Crooks for their helpful comments. This research was supported by the Social Sciences and Humanities Research Council of Canada. P5625.indb 93 11/2/11 8:26:35 AM 94 Latin American Research Review has led to initiatives attempting to integrate traditional medicine into Western medicine. This integration, however, can be fraught with dif! culty. It is in the spaces, relations, and discourses where local medical systems intersect with and are integrated into Western medicine that the effects of global power relations on local practices can be seen (Del Casino 2004). Thus, health-care choices and the discourses surrounding them are produced within the realm of global power relations. When people seek health care, not only are they seeking to treat their ill health but they also are producing and reproducing narratives that act as metaphors for deeper understanding of “how the social world is constructed” (Miles 2003, 110), their cultural identity, and their culture beyond the medical (Conner 2001; Janes 1999; Wayland 2004). Given the prominent role of local health systems in indigenous cultures, it is crucial to consider and examine the repercussions on indigenous medicine and local knowledge. In a context where biomedicine (itself an expression of a set of cultural values) is introduced, local narratives are a fundamental expression of indigenous people’s encounters with Western medicine and its in" uence on lay indigenous knowledge. This article explores the interstices of Western and indigenous medical systems in a Peruvian village. We describe the processes of transculturation, the negotiations of cultural identity, and health seekers’ con" icting relationships with modernity. The villagers, who self-identify as campesinos, or peasants, have access to a biomedical primary health care (PHC) clinic but rely on long-standing lay knowledge of indigenous medicine, mostly characterized by the use of medicinal plants, which has been passed down from previous generations. Thus, we are concerned primarily with lay medical knowledge as practiced in the family at the household level or in informal social networks, referred to herein as indigenous medicine, as distinct from more formal versions of “traditional” medicine, recognized by external bodies such as the World Health Organization (WHO). Both traditional and indigenous systems of health knowledge can be distinguished theoretically from Western medicine (Waldram 2000) or biomedicine, although they may have incorporated certain practices from Western medicine. The article ! rst examines the literatures on primary health care and medical pluralism and then extends medical pluralism to the study of indigenous medicine, especially the lay knowledge of medicinal plants, in the healthscapes of a small village in the Peruvian Andes. We elaborate the healthscape as a framework for understanding how indigenous campesinos interpret their alternatives for seeking health, and we apply that framework in describing the setting and results of an ethnographic study of the village, focusing on the inhabitants’ discourses concerning healing and medicinal plants. The discussion interprets those discourses as re" ections of the inhabitants’ complex and ambivalent relationship with modernity. We conclude by addressing the lessons that a pluralist approach offers for the debate on integrating indigenous and Western medicine.