Health_beliefs_healing_practices_and_medico_ritual_frameworks_in_the_Ecuadorian_Andes._The_continuity_of_an_ancient_tradition._Final

Health beliefs, healing practices and medico-ritual frameworks in the Ecuadorian Andes The continuity of an ancient tradition Elizabeth Currie, John Schofield, Fernando Ortega Perez, Diego Quiroga Author details Elizabeth Currie (corresponding author): Department of Archaeology, King’s Manor, University of York, Exhibition Square, York YO1 7EP, UK; Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD UK; Universidad San Francisco de Quito, Campus Cumbayá, Diego de Robles s/n, Quito 170157, Ecuador Tel: +593-(0)958981022; email: elizabeth.currie@york.ac John Schofield: Department of Archaeology, Kings Manor, University of York, Exhibition Square, York YO1 7EP, UK Tel: +44 1904 323903 email: john.schofield@york.ac.uk Fernando Ortega Perez: Universidad San Francisco de Quito, Campus Cumbayá, Diego de Robles s/n, Quito 170157, Ecuador Tel: +593-(02) 297-1700; email: fortega@usfq.edu.ec Diego Quiroga: Universidad San Francisco de Quito, Campus Cumbayá, Diego de Robles s/n, Quito 170157, Ecuador Tel: +593-(02) 297-1700; email: dquiroga@usfq.edu.ec ABSTRACT This paper introduces the European Commission-funded project ‘MEDICINE: Indigenous concepts of health and healing in Andean populations’, which takes a time-depth perspective to its subject, and uses a framework of interdisciplinary methods which integrates archaeological-historical, ethnographic and modern health sciences approaches The long term study objective is ultimately to offer novel perspectives and methods in the global agenda to develop policies sensitive to indigenous, refugee and migrant people’s social, economic and health needs; and culturally sensitive approaches to the conservation of their ‘intangible cultural heritage’ This paper focuses on the project’s first phase, the critical examination of archaeological and ethnohistorical evidence and accounts from contemporary indigenous practitioners of Andean Traditional Medicine These sources then shape the development of health beliefs and practices models which have informed the development of questionnaires for the second ‘survey’ phase of three indigenous Andean populations in the Central Sierra region of Ecuador KEYWORDS Andean Medicine, Ethnomedicine, Health Beliefs, Health Models, Healing Rituals, Traditional Medicine INTRODUCTION Understanding how cultures construct their beliefs is critical to the understanding and interpretation of that culture’s experience and practice of what we now call ‘medicine’ Without such an understanding of these different concepts, perspectives and beliefs, we are left with a partial or erroneous view of how health, illness and therapies were understood and practiced in the past In modern biomedicine, health beliefs and medical practices are always distinct from religious-ritual concepts and practices, possibly excluding some aspects of Complementary and Alternative Medicine (CAM) which are still widely distrusted by the modern biomedical and clinical establishment Yet in many traditional cultures around the world, the two are innately part of the same phenomenon This was, and in many cases still is, the case for indigenous Andean cultures in South America Traditional Andean understandings of the nature and functioning of the cosmos and belief systems encompassing the human body, of health, illness and healing have been under sustained assault since the arrival of Renaissance European and Christian philosophical and metaphysical paradigms in the 16 century Throughout the 500 year process of th evangelisation, encompassing the persecution of indigenous Andean religion and of traditional religious specialists (which encompasses ‘medical’ and healing practices), what survives of these belief systems and practices now? How we reconstruct the core basis of beliefs that shaped notions of the Pre-Columbian universe and reach an understanding of concepts of self, body image, health and illness so different from our own? The Study Cultural and health belief systems and related rituals or behaviours sustain a people’s sense of identity, well-being and integrity This study explores how Andean people’s experience of their world and their health beliefs within it is fundamentally shaped by their ontology: their inherent beliefs about the nature of being and identity in relation to the wider cosmos The Andean example is indicative of a wider issue, and one increasingly relevant in a shrinking world of transience and mobility: that people holding such beliefs move (often without choice) into new and unfamiliar cultural settings where such beliefs are neither recognised nor understood By recognising the issue, and documenting it through a single example, policy makers and practitioners may begin to recognise pathways to good and sensitive practice The first phase of the research sought to identify core Pre-Columbian and early historical ethnic Andean concepts and beliefs about the human body in its wider cosmological setting, and how health and illness are understood within this within indigenous populations of the Sierra region of present day Ecuador (Figures 1a, 1b) Figure (a) South America with inset showing Ecuador (b) Ecuador, with the Study region Figure (Continued) Three sources of data have been used for this:  Archaeological: i) archaeological material culture (principally pottery and decorative motifs) demonstrating Pre-Columbian beliefs and practices; ii) bio archaeological data from human remains of people with medical or surgical interventions; iii) ethnobotanical data from plant remains; iv) ‘circumstantial’ data from the interment of supposed healers or ritual specialists (shamans);  Early colonial period Spanish documents which detail, through their own words, the beliefs, rites and practices of many of the indigenous religious specialists who found themselves prosecuted before the Jesuit ecclesiastical courts;  Ethnographic studies of the beliefs and practices of more recent historical or contemporary Amerindian peoples Based upon health beliefs and practice-based models constructed from the study’s first phase, the second phase of the work determines what survives of pre-European Amerindian systems of knowledge and medicine in indigenous Andean cultures now, through a survey of three Kichwa speaking indigenous Andean populations in the Ecuadorian Central Sierra Current practices of Andean Traditional Medicine (TM) have evolved within historical contexts into new forms which can tell us about the nature of Pre-Columbian and historical indigenous belief systems and demonstrate how these beliefs and associated rituals and practices have adapted and survived in social climates of persecution and repression In the longer term it will also demonstrate the continuing role, relevance and use of TM in presentday communities and the role of indigenous healers within this Through the identification of what constitutes ‘authentic TM’ in traditional Andean populations today, a further study objective is to develop culturally sensitive policies to recognise and, if appropriate, protect Andean Kichwa peoples’ intangible cultural heritage, as defined in the 2003 UN Convention for the Safeguarding of Intangible Cultural Heritage ARCHAEOLOGICAL AND ETHNOHISTORICAL EVIDENCE In recent years, new research into Andean ontology and cosmology has led to new theoretical approaches to existing and new archaeological data (e.g., Bray 2015; Eekhout and Owens 2015; Rosenfeld and Bautista 2017; Shimada and Fitzsimmons 2015; Staller 2008; Weismantel 2015a) Complementing an extensive literature on the corpus of early colonial period ethnohistorical documentation (e.g., Brosseder 2014; Duviols 2008; Griffiths 1996; Mills 1997; Salomon and Urioste 1991), these data and approaches have significantly advanced our understanding of Pre-Columbian belief systems, which allow us to interpret the nature of the world that Pre-Columbian peoples experienced, their likely understanding of life and death, states of wellness and illness, the medical practices employed by them and the way these were a reflection of the cosmological whole Pre-Columbian Beliefs about the World and Health The so-called central Andean ‘health axis’ (Camino 1992) and associated medico-ritual practices are of longue-duree, stretching from Ecuador in the north to Bolivia in the south, and employed healing knowledge centred principally on the administration of medicinal and psychoactive plants (Bussmann and Sharon 2006a; Cavender and Alban 2009; Glass-Coffin 2010; Torres 1996) In the archaeological record in Andean South America, there is a demonstrable relationship between shamanistic cosmologies and practices, and healing traditions and healing scenes from earliest times (e.g., Kaulicke 2015) Healers (curanderas/os) are sometimes depicted in pottery vessels or ceramic figurines, occasionally representing ‘otherworldly’ forms such as owls (see Bussmann and Sharon 2006a fig 2) In Ecuador, representations of shamanistic themes in ceramics are found from the earliest pottery producing Valdivia culture (ca 3800-1500 BCE; Staller 2001; Stahl 1985); elsewhere (particularly in monumental sculpture) from the Early Horizon Chavín Culture of Peru (ca 1200 - 400 BCE; Conklin and Quilter 2008; Cordy-Collins 1977) and sporadically from then on, with most deriving from the highly naturalistic ceramic tradition of the Moche culture on the North Coast of Peru (ca 100 CE - 800 CE), where the finding of such ceramic vessels and figurines interpreted as healers is rather more common (Glass-Coffin, Sharon and Uceda 2004) Figure 2: Curanderas advertising the range of conditions treated Historical centre of Quito, Ecuador In recent years there has been much new research into the history and contemporary use of psychoactive and medicinal plants in Ecuador, Peru and Bolivia (Armijos, Cota and González 2014; Cavender and Albán 2009; Bussmann and Sharon 2006b; 2009a, 2014; Mathez-Stiefel and Vandebroek 2012), which has broadened our understanding of the integral role that the native herbal still plays in traditional cultures in the region today An extensive survey of the ancestral knowledge and use of medicinal plants in Sierra regions of Ecuador is currently in progress, which will further contribute importantly to our understanding of the key role still played by Traditional Medicine throughout the region (F Ortega, personal communication 2017) Indigenous Andean concepts of health and the practice of traditional medicine is embedded in a Pre-Columbian ontology which views spirit and matter as an undivided whole, where Cartesian dualities of mind and body were never recognised Recent surveys carried out for the project ‘MEDICINE’ of three contemporary indigenous Andean communities confirm that this is still the case for over ninety per cent of the respondents interviewed Harmony or balance were (and are) of critical importance: for the balance between the spiritual and physical dimensions of human existence; and for the health and physical well-being of both the community and the individual as a part of that Such balance was achieved through the maintenance of harmonious reciprocal relations between people and the spirits who were resident in the natural phenomena around them Through the enactment of ritual performances and the offering of libations and sacrifices to the sacred entities embodied by mountains, springs, waterfalls, stones and rocks (the Andean wak’as), imbalances in the wider world, and in community life and the health of an individual sufferer could be restored An individual person was (and still is) never seen as separate from the community of which they are a part, or of the wider landscape and environment to which the community belonged Individual health and many experiences of illness were (and are still) widely interpreted as being an expression of psychological or socio-economic imbalances within the structure of the community, or the individual sufferer’s relationship to their family or community (Bastien 1981; Greenway 2003) Wak’as: the embodiment of the Andean sacred Critical to our understanding of the functioning of the pre-Columbian world is the role played by the sacred Andean (non-human) being known as Wak’a (also ‘huaca’) Whilst at its most basic simply meaning: ‘a sacred thing’ (Bray 2015), it is a difficult concept for people from a European ontological background to understand Wak’as can be both of human manufacture or natural, portable as well as natural loci in the landscape, or natural phenomena, but with the power to transform into human-looking beings or animals, and back again (Bray 2015; Brosseder 2104; de la Vega 2005; Mills 1997; Salomon and Urioste 1991) They were pivotal in every aspect of Andean life and are still important in many indigenous communities today throughout Sierra regions of both Ecuador and Peru (see Figure 5) Chase explains that: ‘Human life bent around and pivoted on wak’as both in perception and in effective historical fact’ (In Bray 2015: location 1962) Wak’as were served by community religious specialists and according to several early colonial period ethnohistorical accounts, there were many categories of such specialists in the Andes at the time of the arrival of the Spanish, who included healing within their repertoire of powers (e.g Brosseder 2014; MacCormack 1991) Religious specialists acted as intermediaries between the wak’a and the community, and through serving this entity and interpreting its oracular pronouncements, the health of the community and individuals could be maintained In turn, the wak’a would demand feeding with ritual items such as coca, chicha (maize beer), guinea pigs, llama fat, or other offerings Concepts of the human body in the Andes In recent years there has been increased attention to how peoples in pre-modern (including prehistoric) societies conceptualize the human body In archaeological terms this has greatly enhanced our capacity to interpret mortuary behaviours and from these understand the significance accorded to concepts of ‘personhood’ or ‘individual’ and the human body itself (e.g., Classen 1991; Thomas 2000; Weismantel 2015b) Bastien and Classen (2003) point out that the relationship between Andean cosmology and the human body was complex, with the human body seen to mirror the physical cosmos In addition to breaking down the human body into its constituent physical components, Andean peoples, and Inca physicians in particular, subdivided it into physical, cosmological and metaphysical parts In an analysis of medicines used in Quechua ‘soul-calling’ rituals in the southern Peruvian Andes, Greenway (1998) discusses how the identity of patients is encapsulated within different items in sacrificial bundles called despachos and examines the differences between Andean and Western concepts of ‘embodiment’ In the treatment of illness, symbolic healing is achieved through the manipulation of medicines, altering the experience of the lived reality of the patient Symbolic healing rituals still comprise much of Andean ethnomedicine today (see Continuity of Indigenous Religious Practice and Beliefs below) Health and Medical Practice in the Pre-Columbian World Whatever the practice of esoteric rituals and interpretation of their function in treating a broad spectrum of illnesses, or the application or ingestion of herbal remedies, more skilled surgical interventions are also evidenced in the Pre-Columbian world The human skeletal aspect of the archaeological record testifies amply to the expertise of Pre-Columbian doctors and surgeons, with a very sophisticated understanding of the human body and the different pathologies affecting it However that human body in its wider cosmological context was visualised or understood, there is evidence for a wide range of sophisticated medical interventions including bone setting, craniotomy and trephination demonstrating a clear anatomical knowledge (Andrushko and Verano 2008; Elferink 2015; Marino and GonzalesPortillo 2000; Mendoza 2003) However, it is clear that the Spanish completely misunderstood or underestimated indigenous skills, and that, following the rapid demise of the Inca Empire in the later 16 century, such early medical wisdoms and skilled th interventions were wholly lost Although the skilled herbal knowledge of indigenous specialists was occasionally more tolerated, or encouraged (Griffiths 1996), there was still an innate distrust of it throughout the colonial period, particularly the ritual context within which it was used, and the potential occult powers of the specialists who employed it Archaeological Evidence for Pre-Columbian Medicine What, then, are we looking for in the archaeological record to demonstrate medical practices, outside of a conventional ‘modern’ clinical context or GP surgery with attendant equipment? What might constitute such a context in a Pre-Columbian setting? The answer is there is relatively little that is clear and unequivocal, that does not require ‘insider’ knowledge of Pre-Columbian ontologies and cosmologies in order to interpret what is seen in the material record (Weismantel 2015a) Archaeological evidence of medical practices may derive from erratically surviving material culture, such as pottery and related decorative motifs, but is ‘mute’ and cannot be easily ‘read’ Complex analytical systems such as attribute analysis are sometimes employed to construct databases with which to interpret these kind of ‘mute’ data, but are still subjective and determined by the researcher In contrast, bio-archaeological and osteo-archaeological data appear to be more ‘objective’ and robust than qualitative analytical techniques, but the actual system of belief these represent must still interpreted For example, trepanning was a not uncommon procedure in Pre-Columbian Peru, with over 80% survival rates as seen in skeletal records in some contexts (Andrushko and Verano 2008); however, why was this procedure performed? The phyto-archaeological record in South America amply confirms the use of a range of plant species which are commonly associated with healing, with inducing altered states of consciousness or even in the manipulation of blood pressure for human sacrifice (Burger DEVELOPMENT OF ANDEAN HEALTH BELIEFS MODELS Phase One of MEDICINE has used bibliographical, archaeological and ethnohistorical sources to define ethnic Andean cosmological beliefs related to states of health, illness and healing These data have been used to construct theoretical models of these belief systems, two of which are presented here Table presents a ‘superordinate’ conceptual level of core belief domains and Table demonstrates specific expressions of actual beliefs by present day Andean peoples Table Andean Health Beliefs Positive/ State (of being) Manifested as Ritual Outcome Birth Naming Identity/ Negative Positive Alive (being born) Legitimacy Negative Dead Death: social Funerary/ancestry breach/disconnection Ancestral identity/ legitimacy Positive Wholeness/Integrity Individual within family, Community performance & community ritual participation: feasts, Order/Health sacrifice etc Negative Incompleteness Sin Ritual cleansing, sacrifice, Order/Health correction/confession Positive Lineage/ethnicity Origin/ancestor Mythic/remembrance Identity/ legitimacy Negative Alien Positive Balance/equilibrium Displaced/rootless/social Adoption by or reconnection to Restoration of disconnection community, lineage, customs, Identity/ Health traditions, legitimacy Community rituals, feasts, Order/Health sacrifice Negative Imbalance/ Incompleteness Illness ‘Completion’ therapy; divination, ritual cleansing, Order/Health sacrifice Table Causes of Illness in Traditional Ecuadorian Andean Medicine CAUSES OF ILLNESS IN TRADITIONAL ANDEAN ECUADORIAN MEDICINE SUPERNATURAL CAUSES Divine Inhuman Human NATURAL CAUSES Imbalance or Disequilibrium Natural in the strict sense Gods Ghosts Witches Natural forces/being human Traumas Saints Spirits Ancestors Hot/cold Accidents Demons Ordinary people Transgression of taboos Intoxications Sexual transgressions Parasitosis Extreme poverty Infections Rainbow Eating disorders: malnutrition Hereditary Fumes Psychological disorders: excessive Illnesses of ‘white’ emotions, emotional pain, people: cancer, sores Souls Goblins Shaman/yachak madness, bad temper, insomnia Physical or intellectual excess of work SOURCE: Ortega, Fernando Ciencia Médica Andina Primera Parte: Las Culturas Médicas Tradicionales Pag 127-152 En: Ciencia Andina 2- Sabiduría y Rescate CEDECO- ABYA-YALA Quito 1990 Identification and Discussion of Core Concepts The model represented in Table demonstrates the essential dualistic state of the Andean cosmos in that there are two horizontal dimensions, being positive and negative experiences of the same state of being Dimensions are at both individual and communal level, which are intrinsically interlinked into the economic and social order, and to the wider environment The core positive states identified here are: ▪ Alive (being born) ▪ Wholeness/integrity ▪ Lineage/ethnicity ▪ Balance/equilibrium These have their corresponding negative states Perceived ‘State’ (of being) is ‘Manifested’ as a particular individual/social condition This is either affirmed/reinforced through, or addressed and remediated by ritual action, leading to a sought outcome, which is either ‘Identity/legitimacy, or Order/health’ Table demonstrates traditional beliefs about the causes of illness in indigenous Kichwa Ecuadorian medicine, wherein the principal division is between illnesses of supernatural origin and those with natural causes The advent of westernized biomedical diagnostic concepts can be seen with the inclusion of the category ‘white persons’ illnesses’ As discussed earlier, we not know exactly how many of these classifications of illness come from Pre-Columbian times, and how many have evolved through ‘cross-fertilisation’ with European and African ideas of the supernatural, particularly the concept of ’mal’ (evil) Both have clearly played an important role given the intensive admixture of races and cultures in the melting pot of society following the conquest of the region by Spain in 1532, and much has been influenced by European interpretations of Andean religion through medieval and Renaissance beliefs about demonology and witches (see above) Whatever their origin however, Table is a summary representation of the model of illness in the Andean world that exists today, and the framework for the diagnosis and therapies employed by contemporary indigenous healers such as Don Rubelio These (and additional) models will be ‘verified’ through the survey phase of the study and more refined multi-dimensional models will be developed with the long term objective to offer a novel perspective and methods in the global agenda to develop policies sensitive to indigenous people’s social, economic and health needs CONCLUSION The health beliefs models developed here and presented above summarise the important first phase of the study ‘MEDICINE’, based upon analysis of the archaeological, ethnohistorical and ethnographic sources These have since informed the development of the questionnaires of the second survey phase, which have sought to verify the continuity of these beliefs and practices in three contemporary indigenous Andean populations A better understanding of what present day indigenous peoples believe in terms of health and illness is critical to the provision of inter-cultural health care which can inform the policy issues relevant to indigenous peoples’ traditional cultures This will more equitably address and remedy the current tendency to impose modern systems of biomedicine which take no account of how these peoples still live their lives and perceive and practice their traditions as a part of this In the Andes, these traditions have in the main evolved (or perhaps, better said, devolved) from complex Pre-Columbian systems of belief of which continuing research is gradually improving our understanding In addition, a better understanding and mapping of these beliefs and practices will allow policy to better address and plan for the protection of these traditions as ‘intangible cultural heritage’ as recommended by the 2003 UNESCO Convention for the Safeguarding of Intangible Cultural Heritage ACKNOWLEDGMENTS This project ‘MEDICINE Indigenous concepts of health and healing in Andean populations The relevance of traditional MEDICINE in a changing world’ is funded through the European Commission Horizon 2020 Research and Innovation programme Grateful thanks are expressed to the Comunidade de Huasalata, Salasaka, Tungurahua, Ecuador, including Jorge Caisabanda and his family for their hospitality and help during fieldwork visits Particular thanks are also expressed to Don Rubelio Masaquiza Jiménez of Huasalata for his permission to include personal information and photographs to the benefit of this paper Notes (http://www.andeanmedicine.net/blog/mountains-moons-andrainbows-1512933603) REFERENCES Acosta, J de 1987 [1590] Historia natural y moral de las Indias (Seville: Juan de Leon, 1590) Edited by José Alcina Franch Madrid: Historia 16 Andrushko, V A., and J W Verano 2008 ‘Prehistoric trepanation in the Cuzco region of Peru: a view into an ancient Andean practice’ American Journal of Physical Anthropology 137 (1): 4-13 Armijos, C., I Cota and S González 2014 ‘Traditional medicine applied by the Saraguro yachakkuna: a preliminary approach to the use of sacred and psychoactive plant species in the southern region of Ecuador.’ Journal of Ethnobiology and Ethnomedicine 2014, 10:26 http://www.ethnobiomed.com/content/10/1/26 Avendaño, F de 1904 ‘Relación sobre idolatría.’ In La imprenta en Lima, edited by José Toribio Medina, 380– 83 Santiago: José Toribio Medina Bastien,J.W 1987 Healers of the Andes Kallawaya Herbalists and their Medicinal Plants 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Weismantel, M 2015b ‘Many heads are better than one’ Chapter Two In I Shimada and J.L Fitzsimmons (editors) Living with the Dead in the Andes, 76-100 Tucson: University of Arizona Press Additional information Author information Elizabeth Currie Elizabeth Currie is a Marie Sklodowska-Curie Experienced Researcher and Global Fellow at the Department of Archaeology, and Senior Visiting Research Fellow at the Department of Health Sciences, University of York, United Kingdom Elizabeth has regularly worked across disciplinary and methodological boundaries throughout her rich and varied career which has consisted of two principal trajectories: that of South American archaeology and anthropology, and health sciences and health workforce research In recent years she developed her lifelong interests in ethnographic and ethnohistorical study of Latin America, during which period she lived and worked with indigenous Andean communities in Ecuador, researching Andean traditional culture and medicine John Schofield John Schofield is Head of the Department of Archaeology at the University of York where he is also Director of Studies in Cultural Heritage Management John is a Fellow of the Society of Antiquaries of London, a Member of the Chartered Institute for Archaeologists and a Docent in Cultural Heritage, Landscape and Contemporary Archaeology at the University of Turku (Finland) He is also Senior Research Fellow at Flinders University, Adelaide He has published extensively in the fields of cultural heritage, archaeology of the recent and contemporary pasts, and the archaeology of conflict Fernando Ortega Perez Fernando Ortega Perez has directed the National Institute of Nutritional and Social Medicine Research (Instituto Nacional de Investigaciones Nutricionales y Medico Sociales) throughout the 1980s and was manager of USAID health programmes for Ecuador He was also Dean of the School of Public Health He has carried out many research programmes and evaluations in Anthropology, Demography, Epidemiology, Public Health, Nutrition, Parasitology, Traditional Medicine and Intercultural Health Fernando has a keen professional interest in Ancestral and Traditional Knowledge, Genetic Remedies, Health and Environment; Tropical Diseases and Human Parasitology; Environmental Conservation and Climate Change, Global Traditional Medicine and Research Ethics Diego Quiroga Diego Quiroga is Dean of Academic Affairs and Professor of Anthropology as well as Vice President of Research at San Francisco de Quito University He has a PhD in Anthropology from the University of Illinois, Urbana, USA He both lectures and leads research primarily on medical anthropology, human ecology and race and ethnicity He is the USFQ representative for the ‘Alliance’, an association of several national and international organizations responsible for the USAID Project Conservation of the Galapagos Marine Reserve Diego is Co-director of the Galapagos Academic Institute of Arts and Sciences (GAIAS) and has done research on topics that range from Biodiversity Vulnerability, to Religion and Traditional Medicine Funding The grant is held as a Marie Sklodowska-Curie Actions Global Fellow award to the University of York department of Archaeology dated 2016 (commenced 1st November) The MarieCurie Awards are part of the Horizon 2020 research and Innovation scheme Details of the award are: Grant agreement 705225 Marie Skłodowska-Curie Global Fellowship (H2020MSCA-IF-2015) MEDICINE: Indigenous concepts of health and healing in Andean populations: understanding the relevance of traditional MEDICINE in a changing world