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Passion Flower

A Passion Flower (Passiflora sp.)

Discovering Curanderismo

By Cristina Orc? Fern?ndez
From the book Healing Latinos

I have sprained my ankle three times in my life, and I received three very different kinds of treatments for it. The trials and tribulations of this poor ankle can provide some insight into the comparative methods of Western medicine and the curandero of Latino culture. The first time I sprained my ankle, I simply tripped on a crack outside my parents' house in Los Angeles. But my ankle quickly swelled to three times its normal size and I was in so much pain that I asked to be taken to the emergency room. There, after a four-hour wait, I was treated by an American MD who ordered x-rays, prescribed anti-inflammatories, painkillers and rest, and handed me a brand new pair of crutches which I used for two weeks. She was very nice. She never touched my ankle.

The second time I sprained my ankle, I was in rural southern Mexico, teaching bank skills to the managers of an 870- member weavers' cooperative at their store in San Cr?st?bal de las Casas. Instead of visiting a physician this time, a friend took me to see a local huesero, or bonesetter. Don Lupe sat in a chair opposite me, took my affected ankle in his hands, and after a short invocation to the saints, went to the task. His technique involved hands-on manipulation of the sprain (luxacion) using a combination of pressure, traction and resistance to realign my tendons and muscles, and thus restore movement and function. His push-and-pull therapy seemed to go on forever, and it was incredibly painful. Don Lupe wasn't as personable as my American MD had been, and he certainly caused me a lot more pain in the short term. But I'd gone in his door limping and I left walking.

I was still in Mexico the third (and last) time I sprained my ankle. This time I visited another huesero, Don Pancho, famous for a technique called la ventosa which he had learned from his father-in-law. He tucked a piece of cotton into a ball of wax placed in a brandy snifter. He lit the cotton with a match, then placed the mouth of the snifter right above my lateral malleolus. When the flame went out, a vacuum was created. Don Pancho then moved the glass up and down the side of my leg, and the vacuum literally lifted my muscles and tendons and returned them to their rightful places. The inflammation went down almost immediately.

My experience with curanderos and their ways of healing, however, began well before I visited Don Lupe in Chiapas in 1992. My grandmother Jesusita, a practicing herbalist, used to give me foul-tasting but oddly-comforting remedies when I was ill. From her, I learned the value of the herb-based, ritualistic remedies so important to healing in the Latino community. I also began to understand how these remedies could complement the treatment available at the doctor's office. I became a student of herbs while I was in Mexico working with the weaving cooperative. During my time in San Cr?st?bal de las Casas, I had the opportunity to study the connections between curanderismo and Western medicine in a very intimate way.

An understanding of curanderismo is a valuable tool for practitioners who want to help Latino patients manage health, prevent disease and engage healing responses more effectively. Curanderismo is not a single approach or technique. Rather, it is a dynamic system with its own theory of the origins of disease and a diverse array of healing modalities offered by a variety of specialists. Together, these disciplines address the whole human being at the physical, emotional and spiritual levels.

Transmitted by word of mouth, curanderismo is a remedy-based system in which faith, prayer (or visualization), traditional wisdom, observation and the scientific method combine to effect healing. The oral pharmacopoeia of curanderismo?the collective knowledge of the culture?is constantly being shared, recreated and augmented. Curanderismo, in a similar way, is constantly transforming itself, embracing new tools and healing modalities that have proven effective through time and worthy of faith. In this way, curanderismo is not a substitute for Western medicine, but actually embraces it as one of its modalities.

But I had little formal understanding of the world of curanderismo when I arrived in Mexico. The project that initially brought me to Chiapas aimed to help establish economic self-sufficiency among the women of the area. My immersion in the world of traditional healing came as a result of that work, an involvement I would not have predicted when I arrived. As women brought textiles from their remote communities to the cooperative store in San Cr?st?bal, I noticed that many of them were ill and needed medical attention. I discussed what I was seeing with one of the Indian store managers, Micaela Hern?ndez, and we decided to expand our services to help them. Suddenly, we became health promoters. We sought out gynecologists and general practitioners charging reduced fees, non-profit organizations delivering both traditional medicine and Western health services, foot reflexologists and Indian acupuncturists. We also forged alliances with the nursing staff in government clinics and hospitals.

Between 1992-1994, we helped many women and families gain access to health services, as well as reproductive and pre- natal care. In 1995, the MacArthur Foundation awarded our non-profit organization, ICinalAntsetik (Women's Earth), a generous grant to run a two-year Health Promoter Training Program in which 35 women and 5 men participated. During that time, thanks to the vision and the hard work of RN Blanca Espinosa, we also formalized a relationship between K'inal health promoters and the nursing staff and social workers of the Hospital de Campo in San Cr?st?bal.

While it was certainly my goal to demystify Western medicine for the Indian women, as a non-specialist, I could under stand the confusion and frustration visits to the physician occasioned. Our family doctor prescribed antibiotics for everything?diarrhea, colds, coughs, sinus infections, you name it.

But we got sick often enough in Chiapas?six or seven times a year?which reliance on them would soon build up resistance. And a close reading of the box for chloramphenicol, the only medicine available for typhoid fever (a common ailment in Chiapas) revealed that it can cause aplastic anemia! It all seemed very dangerous to me. So when the health promoters visited the Organization of Traditional Indian Doctors Of Chiapas (OMIECh) I was introduced to a vast supply of herbal remedies good for everything from expelling intestinal worms to recovering lost souls. We all stocked up on a few basic herbs and set to the task of healing ourselves and our families. I became the herbalist and health advocate in my household as did the health promoters in their own communities. I still relied on the doctor for the diagnosis, but 1 began listening closely to old wives' tales for the remedies. Cornsilk and parsley for 10 days for urinary tract infections. Wash te vomol for typhoid fever for 20. Dandelion for gastritis. Tizana betel for the nerves. Shredded raw potato leaches out the poison of a dog bite. Belladonna can kill; stay away. Put cut aloe vera fronds on burns or around the neck for tonsillitis. Cayenne pepper staunches the flow of blood immediately from deep knife cuts. Never eat when you're angry. Pass an egg all over a fussy baby's body, front and back. Wear a red sash under your clothes to ward off the evil eye. I was also astonished to learn that Indian shepherd women observe what their sheep eat when they have diarrhea or fever, and use the same herbs when it is time to cure themselves.

In my quest for healers, I met bonesetters and midwives, paramedics and health promoters, German acupuncturists and Indian seers, old women and urban conjurers. I also met a lot of MDs who had found that integrating the techniques and tools of curanderismo made them more effective in establishing rap- port with and healing their patients. MDs who work in remote locations, whether they're fulfilling community service requirements or their mission in life, are faced with serious obstacles. The communities they serve often have few resources and a very poor health infrastructure, if there is one at all. The practice of medicine based strictly on pharmaceuticals is virtually impossible. In Chiapas before 1994, most rural community clinics couldn't even be counted on to have the most basic first aid materials, like alcohol and gauze.

Claudia Meza, MD, who works with the COLEM Women's Collective in San Cr?st?bal, says that her solid knowledge of local herbs and healing modalities is critical to her work. She builds rapport readily with her patients, Indian and non-Indian alike, because she is familiar with their healing traditions and works them into her treatment plans. She also asks about other practitioners they've visited and what their diagnoses were. She prescribes soothing herbs for the nerves, bitter herbs for gastritis and a pharmaceutical drug, Zentel, to expel worms. She also recommends that her patients go to the mystical herbalist for a limpia, or cleansing, to clear negative energy.

"Since most of our patients are very poor," says Dr. Meza, "we can't rely on pharmaceutical medicine alone. I am limited to the samples and donations that our organization gets. Besides, some of my patients don't have faith in pharmaceuticals and prefer to use natural means to cure themselves." But she also agrees that pharmaceuticals are increasingly accepted in the local community, even deified to an extent. More and more young people are saying that herbs don't work and professing their faith in antibiotics. Still, Dr. Meza prefers to use herbal and nutritional cures, because she knows that malnutrition, common in her patients, opens the way for other diseases.

The highlands of Chiapas provide a fascinating microcosm in which the healing disciplines that make up curanderismo are interwoven in a rich tapestry. In the curanderismo model, health is not simply the absence of disease in a person, but a state of emotional, physical and spiritual balance. When that balance is upset, disease follows. Illnesses fall into three categories:

These ailments can be treated by any number of therapies. Relatives and friends are certain to recommend their favorite modalities and practitioners. Ultimately, however, patients choose their practitioners based on what their faith tells them. These are some of the curanderos I met during my years in Chiapas:

Yerberas (herbalists)

Mothers are the foremost herbalists and curanderas. Old wives and their tales are their teachers, the home is their laboratory and the oral pharmacopaeia is their textbook. They administer herbs to manage the health and disease of their children as a matter of course. They are also the health promoters in their families: they monitor their sick and take them to the appropriate practitioners.

Professional yerberas base their practices on herbs, rituals and prayers for protection and healing. They concoct, prescribe and administer teas, broths and tinctures and apply mudpacks and herbal poultices and liniments. They generally treat diseases with physical and emotional causes.

Most yerberas begin their careers healing members of their immediate family and their animals. As their skill grows, they begin offering their talents to their extended family and later, their neighborhood. Some yerberas acquire such fame that people travel great distances to be healed by them.

Yerberas conduct limpias or cleansings in which they clear negative energy by slapping bouquets of astringent herbs over the patient's body. They also use an egg to detect the presence of a curse, or the evil eye, on a patient. The yerbera passes the egg lightly over the patient's body while asking the saints to intercede. The egg is said to extract the negative energy in the body. When they break the egg open in a clear glass filled with water, the source of the malaise is often clarified: the shape of an eye present in the yolk or the white indicates the evil eye, whereas a black spot might indicate stagnant energy due to someone's envy or jealousy of the patient. Some herbalists also sprinkle holy water (blessed by a priest) in homes and new vehicles as a measure of protection. MDs like Dr. Claudia Meza prescribe similar kinds of rituals for patients with chronic ailments or depression.

True to the assertion that curanderismo is a remedy-based system, many herbalists in Chiapas are increasingly integrating pharmaceuticals, specifically antibiotics and painkillers, into the oral pharmacopoeia and prescribing them to patients.

Iloles/Videntes/Curanderas (Conjurers/Seers/Shamans/Healers)

Iloles are traditional Indian doctors and personal spiritual guides. They treat ailments that originate in the spirit and have physical manifestations. They can also help patients to let go of strong emotional states, such as envy and jealousy, that cause disease in the body. They diagnose largely through pulse, interviews and the interpretation of the patient's dreams. Some practitioners in Chiapas also consult an ancient Mayan oracle called simply "the box."

The tools of the ilol are copal incense, meditation and prayer, fragrant herbs and flowers, and the complicity of the person to be healed. Patients are active participants in the conjurer's ritual. They lay close to altars filled with sacred herbs while the seer visits the church and the sanctuaries in the caves and mountain tops. Then patients must buy the candles of many colors that will be arranged on the church floor at the time of the healing.

But the work of the iloles is not limited strictly on the spiritual plane. In the 1980s, a group of them created the Organization of Traditional Doctors of Chiapas, known as OMIECh, under the umbrella of the National Indian Institute, INI (Institute Nacional Indigenista). Their goal was to provide a mechanism whereby the oral tradition could be systematically recorded, scientifically tested and formally shared with doctors, health organizations and individuals wanting to learn the science of the ancestors. OMIECh became independent in the early 90s and has since conducted important pharmacological studies of herbs traditionally used to treat common infectious diseases. They have extensive photographic records of local plants and flowers and exhaustive records of their chemical components.

Hueseros (Bonesetters)

Hueseros are the most earth-based practitioners. They are part chiropractor, part physical therapist and even part psychologist. They set broken bones and realign sprained or dislocated joints using pressure, traction and resistance. They treat inflammation, bone pain and broken spirits. A huesero practices the techniques learned as an apprentice. While some practitioners were clearly born into the practice, others simply learned the skill from a close relative or family friend.

Some hueseros can even tell by pulsation whether a fracture, sprain or inflammation requires cold herbs or heating herbs to counteract it. They work with lotions or camphor- based ointments and some dispense herbal remedies as well. For setting bones, they use rolled newspapers, boards, popsicle sticks and whatever other tools are available. After childbirth, women visit a huesero to "close" the pelvis.

Parteras (Midwives)

Like the ilol, the midwife dreams her patient and how to care for her. The midwife is the gatekeeper between the spiritual and the physical world. She uses her hands to position the baby for birth. She welcomes the child into this world then bathes the new mother in sacred herbs gathered at sunrise. For 40 days, the woman is cared for by mother, sisters, neighbors.

But midwives might be becoming a thing of the past. Rosa Gonzalez, a midwife, weaver and mother of six living in the remote mountain enclave of Jolxic, explains one of the reasons:

"I am a midwife by training but I don't practice any more. In my life, I have helped many women with the births of their children. But now families are blaming midwives if the women or the babies die during labor. Right now there are two midwives in jail because the women died. But sometimes there is nothing they can do to save them."

In addition, many women have discovered that giving birth in hospitals is a viable alternative. And many women make the journey to San Cr?st?bal to give birth at a clinic if there isn't a midwife in their community.

At the same time, however, other women are organizing to preserve and promote their craft. The traditional midwives of OMIECh have been researching the oral history, techniques and herbs of midwifery. With other health-oriented non-profit organizations, they published a book of full-color photographs of local herbs used before, during and after labor.

Espiritistas (Channelers)

Channelers attend, almost exclusively, to ailments of the spirit: souls separated from their bodies and past life trauma.

After many journeys to Mexico City visiting neurologists and psychiatrists and suffering many disagreeable tests, Laura was finally diagnosed at age 19 with paranoid schizophrenia. But her bizarre and unpredictable behavior continued, despite the pharmaceutical medicine she was taking. As a last resort, her family decided to take her to the Centre Espiritista in Tuxtia, the capital of Chiapas.

At the Center, patients stay from one day to one week. Channelers conduct diagnostic rituals involving tarot cards, wax, or coffee grounds. They conduct limpias with bouquets of herbs and an egg. They recite chanted prayers to the saints and prescribe rituals that patients are to follow at home. "Every day after my sister came home, we had to sprinkle salt in the comers other room, then mop it with a brew of special herbs and other things I can't talk about," said Laura's sister, Mayra.

Espiritistas channel the patient's guides and spirits for information about the source of their illness. Espiritistas can know, then, whether or not the disease is caused by a spell? and who cast it. Espiritistas fall into two camps: those who tell their patients who cast the spell and those who do not, arguing that it only jeopardizes their patient's healing process.

Laura's practitioners would not tell her who cast the spell, but they confirmed that it was indeed the source other illness. She stayed at the Center for a week, experienced a course of treatment and when she returned home, felt (and behaved) "like before." Her condition improved and during the following year she was able to finish high school. She visited the Center weekly for a few months. But one day, she began hearing voices again. She had a relapse and was kept at home for some time. With the help of the channelers, Laura has once again been able to control her illness, though her future is uncertain.

Sobadoras (Massage therapists)

Sobadoras are the massage therapists of the community. All the sobadoras I've ever met are little old ladies with a special gift. They do their household chores all day, but will always take a moment to treat the children brought to them by worried mothers. Sobadoras use massage to treat empacho (saturation from overeating), constipation and diarrhea. They dab alcohol on the feet to bring down fever. Some give full body massages and still others are skilled in visceral manipulation. They may concoct and administer brews and work with lotions, oils and alcohol. Many sobadoras are also midwives or hueseras.

Health promoters

Health promoters are an important part of the system of the health care system in the highlands of Chiapas, but are not limited to that area. The health promoter model is used all over Mexico and in impoverished nations all over the world as a way of giving communities tools, resources and a referral sys- tem to manage health and disease with confidence.

The first Indian health promoters were trained in the early- 1960s by the National Indian Institute, INI (Institute Nacional Indigenista) to take Western medicine to people in remote rural communities, but they were not immediately accepted. In the 1970s, these first health promoters were also pioneers in the field of parallel medicine, which began exploring the ways in which traditional Indian medicine and Western medicine intersected in the panorama of health services in the region.

Indian health promoters became the bridge between traditional Indian medicine and Western medicine, between rural communities and health services in urban centers. Government health institutions and nascent health-oriented non-profit groups began training health promoters to provide the first level of service in their communities and refer people to the nearest clinic if their skills were insufficient or the condition too advanced. The existence of health promoters helped make up for the deficiencies in the health infrastructure that barely existed in Indian communities. Health promoters also offered people a measure of power in knowing about and choosing their options for healing.

I know of one nurse/health promoter who single-handedly provided health services to hundreds of families that had no access to a clinic. Antonio Santiz had an economically- strapped client base and neither government support nor organizational affiliations. But he had a skill, and his people were sick. He also had connections with doctors and clinics for people willing to leave their homes. And he had plenty of faith that God would continue to provide. People would pay him what they could: a chicken, a dozen eggs, a sack of beans. He found himself working 18-hour days and scratching out prescriptions on paper napkins he acquired at restaurants.

After working to improve access to health services for women and children for two years, K'inal Antsetik, together with several members of the weavers' cooperative, developed a health promoter training specifically for women. Most promoters in the communities, if there were any, were men. And, as we learned, women were willing to discuss issues of health, and particularly reproductive health, only with women. They were much more willing to seek health services when provided with information and accompaniment.

Between 1995 and 1997, 35 women and 5 men from 11 communities participated in K'inal Antsetik's Health Promoter Training Program. The curriculum was created and taught by RN Blanca Espinosa, who insists that it is not enough to tell people to wash their hands or to boil their water. "They have to see what's happening. In one of our first experiments, we collected dirty water and looked at it through the microscope. Once the women saw living organisms, it didn't take them long to realize why it's important to boil the water. And why it's important to wash your hands."

In the training program, health promoters learned to navigate the complex system of health services and to provide intervention and referrals in high-risk pregnancies and unforeseen emergencies. They studied anatomy, first aid and CPR, and learned how to administer injections and IVs. They gathered the women in their communities and gave talks about health-related subjects previously chosen by the group. Blanca integrated foot reflexology, acupuncture and relaxation techniques into the curriculum. She also stressed women's reproductive health and the importance of women understanding their own bodies.

Most health promoters were already herbalists to varying degrees and so incorporated this expertise into the range of services they could provide for their community members. They were also able to access the services provided by OMIECh, the organization of traditional doctors. Also, thanks to Blanca Espinosa, the relationship between K'inal health promoters and the Hospital de Campo in San Cr?st?bal was formalized in 1995. Blanca continues to be the bridge between the Health Promoters and the Clinics. She is constantly de-mystifying Western medical practice for Indian patients and traditional Indian medicine for the medical doctors who serve them.

Though the project is over, the health promoters continue to provide services in their communities and participate in more specialized training. Many Indian men and women in Chiapas have even learned acupuncture from a committed visitor. Every day, health promoters become better referral sources; since their circles usually include an eclectic mix of health ' practitioners, they are familiar with a wide range of healing modalities available for their patients.

Perhaps the story told to me by Yolanda Castro, a founder of K'inal Antsetik, best illustrates how health care works in the rural regions of Mexico. In Petrona's story, both practitioners of curanderismo and of Western medicine intersect in the life of one woman.

In a small, dark hut with a packed dirt floor, a shadowy Petrona lay sleeping in the bed, white as a clean sheet and with an I.V. in her arm. The silence was so total, that each drop of fluid could be heard. It was nightfall, and she was still hemorrhaging after a miscarriage in the morning. The midwife explained that Petrona had miscarried because she'd made a coraje?someone had made her very angry that morning.

An altar in the corner showed that the ilol had already been there. Incense burned steadily and the flickering candles on the floor cast ghostly shapes on the whitewashed walls. The silence was broken now and then by the whispered greetings of a woman shaking hands with all 15 women sitting in chairs along the perimeter of the room. As she took her place, another would rise and leave.

Again the silence was broken, this time by several women singing a prayer asking for the blood to stop. Petrona knew they were there and was thankful, but could not open her eyes. Women came bearing buckets of chicken soup, others a dozen eggs, and still others sacks of corn for Petrona and her family.

Soon Antonio Santiz, the lone community health promoter in the region, arrived with medicine he had found through a non-profit organization in San Cr?st?bal, an hour away by bus. Petrona was losing blood quickly and this medicine was certainly the last hope. As night wore on, the women continued to sit quietly beside Petrona, lighting candles for her and watching over her, reminding her wandering soul that her place was among them.

The next day, Dr. Barbara Cadenas visited Petrona to make sure the medicine was helping her improve. She had already arranged emergency transportation to the Regional Hospital in the capital, four hours away, in case Petrona's condition had worsened during the night. Fortunately, it had not, so she was able to stay at home.

The women never left her side. When Petrona stood up five days later to go to San Cr?st?bal for an ultrasound and to pray at seven churches with her ilol, they saw her off.

Curanderismo as a system is the expression of a culture desiring to find balance in an unpredictable and often unkind world. When we see curanderismo as a system of healing modalities and practitioners, it's clear that Western medicine fits neatly into the scheme. Latinos are willing to integrate new modalities and practitioners into their network of health care providers. They do, however, have to become familiar with the process and feel comfortable in the environment in which it unfolds. Most importantly, they have to have faith in the practitioner. Herein lies the task of the health care provider: to make Western medicine accessible, comprehensible and worthy of faith for Latino patients.

Many Indian women I met in Chiapas wouldn't set foot in a clinic because "no one comes out of there alive." However, once they entered and met the secretary, the dentist, the ob/ gyn, the social workers and the nurses, their fear was replaced by curiosity. Finally, they were comfortable enough to ask questions and to consider that perhaps those who didn't come out alive had postponed coming until it really was too late.

Many times, Latinos are too shy to ask questions, lest they seem to question the doctor's authority. But as Western doctors begin to ask questions themselves, the barriers that exist between the culture of their Latino patients and the technological world of the MD will begin to come down. Latinos will more comfortably integrate Western medicine and doctors into their constellation of healing modalities and healers. And Western doctors will become much more knowledgeable about healing Latinos, and take their place as respected and trusted healers in the community.

Reprinted with permission of the author. Discovering Curanderismo was first published in Healing Latinos: realidad y fantas?a, the art of cultural competence in medicine. Hayes-Bautista, David E. and Chiprut, Roberto eds. Cedars-Sinai Health System: Center for the Study of Latino Health, UCLA, 1998 ISBN 0-9670100-0-4.

Cristina Orc? Fern?ndez spent most other youth in Mexico City. She has a BA in French Literature from Pomona College. After college, she worked with the L.A. Commission on Assaults Against Women and became a self-defense instructor. From 1992-1997, Orc? FERN?NDEZ lived and worked in Chiapas, Mexico, with K'inal Antsetik, a non-profit organization dedicated to improving the lives of Indian women. She is now a copywriter with La Agencia de Orc?, a Los Angeles-based advertising agency.

While working with battered women through the L.A. Commission on Assaults Against Women, Cristina Orc? Fern?ndez (Discovering Curanderismo) discovered that there is much more to healing than physical recovery. Her involvement in health lead her to become a self-defense instructor, a Hellerwork Structural Integration practitioner, and an expert on curanderismo. Despite growing up as a first-generation Mexican-American with a grandmother who brewed herbal remedies, Orc? FERN?NDEZ says that curanderismo was a mystery to her until she began studying it in Chiapas, a Mexican state renowned for its richness, beauty and political unrest. Here, she found a wide variety of healers, and began consulting them, as well as the local physicians, in an attempt to improve health care in the area. "It was a joyful discovery," Orc? FERN?NDEZ writes. "This incredible network (of my own making!) of healers who have such different approaches but in the end, take care of the whole person."

In her article, Orc? FERN?NDEZ details the kinds of healers involved in curanderismo and tells of the development of the health promoters system which brings medical services to rural areas all over the world. Orc? Fern?ndez? work with K'inal Antsetik, a non-profit group dedicated to improving the health of Indian women in the Chiapas highlands, showed her how traditional medicine and Western medicine can coexist and enrich each other?both in Mexico and in Latino communities here in the U.S.