By Debbie K. Becht, Photographs by Peter McFarren
Isabel Sandoval spent the first month of her life in intensive care. At 3 months she weighed six pounds, nine ounces-half the normal weight for her age-and was fading fast. Doctors in La Paz, the capital of Bolivia, diagnosed hypertension, but the treatment wasn’t working. In desperation, her mother Jacquelinne sought the help of a kallawaya, a traditional holistic medicine man.
“He read her future with coca leaves, performed a ritual on her, and gave me various herbs to bathe her with,” said Jacquelinne. “He told me to be patient for the cure, and that she would grow up a healthy, happy girl.”
Kallawayas in Bolivia still heal the sick with traditional herbs and rituals that date back to pre-Incan times. Their holistic approach involves a lengthy discussion with the patient concerning the illness and an examination of the physical surroundings. A kallawaya is received with respect and an awareness that his knowledge is based on long years of training and that he acts according to a strict code of religious and moral values. Faith and patience are vital for a kallawaya cure to be effective.
At some point in their life, some 80 percent-or over 6 million-of all Bolivians have called on a natural healer, and according to the National Institute of Statistics, 40 percent of Bolivians practice only traditional medicine.
Holistic practices, such as aromatherapy and herbal treatments, have been used for thousands of years in India and China for the relief of a variety of physical and emotional disorders. Yet only during the past three decades has Western medicine gradually and reluctantly begun to grant validity to certain principles of traditional holistic medicine and allow greater tolerance for forms of health care other than those officially sanctioned by modern science and technology.
Bolivia, because of its high altitude, rugged landscape, isolated pockets of human settlement, and pervasive ethnological remnants of ancient civilizations, has been called the Tibet of the Americas. This unique topography and rich cultural legacy have conspired to make the country a veritable human laboratory in which modern and ancient medical wisdom do not so much collide as peacefully coexist.
“Everyone of us lives bound by nature,” says kallawaya Hilarión Suxo. “Modern medicine may seem to heal quicker, but I always say, la medicina natural cura con calmita-natural medicine is still the most pure; it heals slowly but lasts forever.”
Kallawayas, like most Bolivians of indigenous descent, are deeply in tune with nature and their physical surroundings. They live according to the Andean cosmovisión, an all-encompassing view of humankind and its place in the universe based on veneration of the Pachamama, or Mother Earth. They believe that every mountain has its own resident deity that protects those who live around it from any possible misfortune and that human beings should respect and live in harmony with their environment.
Like most of Bolivia’s middle class, Isabel’s mother Jacquelinne usually relies on university-trained physicians for her family’s health needs. But she was frustrated by her daughter’s lack of progress and questions that went unanswered. So she went to a kallawaya for advice. “I wanted to see if natural herbs could do more than the chemicals,” she said. “I reached the point where I would do anything they [the kallawaya and doctor] told me to see Isabel get better.”
Following her doctor’s advice, Jacquelline is giving Isabel vitamins, her own milk, whole milk, and soft foods in order to help her daughter gain weight. She supplements this with home remedies consisting of water with oatmeal, quinoa grain, or willkaparu (crushed corned). Isabel’s situation has not improved substantially, but her mother continues to hope that this combination will slowly nurse her daughter to good health.
Natural Wealth in a Poor Country
The province of Bautista Saavedra, just north of Lake Titicaca, is 975 square miles of kallawaya country. Here, the venerated healers live with their families in villages such as Curva, Chajaya, Chari, Inka, Huata Huata, and Pampablanca. From this lonely region high in the Andean ranges of northwestern Bolivia, kallawayas have ventured all over Bolivia and into parts of Peru, Argentina, Chile, Ecuador, and even as far as Panama. With their chuspa, a colorfully woven bag filled with herbs, and the blessing of the Aymara gods of pre-Incan times to protect them on their journey and provide for their safe return, they set off on ancient Inca trails traversing the bleak high plains and dipping into the tropical lowlands.
A Kallawaya Medical Primer
Some historical sources cite the kallawayas as the first to use the dried bark of the cinchona tree, the source of quinine, used for many years to prevent and control malaria and other tropical diseases. Similarly, the main alkaloid of the coca plant, cocaine, was one of the first effective topical anesthetics used by the kallawayas and later adopted by medical science. Among the other plants found in the Bautista Saavedra province and the illnesses they have been used to treat are:
- the kantuta, Bolivia’s national red, yellow, and green bell-shaped flower, which grows in the high valleys and Los Yungas. The leaves, fresh or dried, are boiled in water and then used as a poultice over an abscess or tumor. Also, after the fresh flowers are soaked in clear water for three or four hours, the liquid may be used to wash tired, inflamed eyes.
- the espino (Colletia spinosissima), a type of thistle bush that grows in the high valleys of the Charazani and Chajaya regions. The fresh stalks are ground with three other plants-copal from the tropical region of Caranavi, incienso (from the tropical burseaceae family of trees and shrubs, from which incense is derived), and wairuru from the Santa Cruz region-to make a plaster for immobilizing fractures and lesions. The boiled bark is used in the preparation of a sweat bath to alleviate rheumatic pain in the joints. When crushed and soaked in liquor, the bark is used as a tonic to help cope with anemia.
- the perlilla (Dalea weberbaueri), which grows in the high valleys of the Charazani and Cruzpata regions. The boiled leaves, fresh or dried, have been used against smallpox and measles. Finely crushed and mixed with pig grease without salt, they are used to burn warts.
- the dandelion, which grows in all humid areas of the high valleys. An infusion of the fresh leaves is used to cure heartburn. The fresh leaves, stems, and roots are used as a diuretic. The dry, scraped roots are applied to wounds to heal them.
Some kallawayas find a home in the major cities, where an urban clientele composed of people like Jacquelinne Sandoval calls on them. But most return to Bautista Saavedra. Today, about a hundred authentic kallawayas live here, a number that is dwindling as fewer sons of kallawayas learn their fathers’ skills.
Bautista Saavedra is one of the poorest areas in Bolivia-the second-poorest country in the Americas. Locals, including the kalla-wayas themselves, earn a meager living by growing potatoes, corn, wheat, and oca and raising sheep and llamas. The minimum monthly wage in Bolivia is US$ 45 per month, but farmers in Bautista Saavedra earn less than a quarter of that. Almost everything they grow and raise is for home consumption.
But the province is blessed with a rich variety of plant and herb species found on three ecological terrains: the tropics, mountain valleys, and highland plateaus. Plants are said to grow with greater aroma and purity in Bautista Saavedra’s pristine environment. And if a certain plant doesn’t grow there, it most likely grows in the subtropical Yungas, a six-to-eight-day walk to the east.
Living in this earthly Garden of Eden has allowed the kallawayas to amass an encyclopedic knowledge of wild plants and their therapeutic uses, and enticed them to travel to the four corners of the once-powerful Incan empire in search of many more.
High Prices, Poor Access
In remote areas throughout Bolivia, when a person becomes ill, he or she most likely will turn to traditional remedies. The reason is a practical one: traditional remedies are affordable, and the costs of modern health services often are not. For most subsistence farmers, paying a doctor’s fees or even purchasing aspirin is simply beyond their means. On the other hand, a typical kallawaya prescription may be the preparation of a tea infusion made from plants the farmer probably already has on hand. The most common compensation for a kallawaya’s treatment is the exchange of goods or other services.
But even more important than the cost issue is that of accessibility. In rural Bolivian villages, there often are no doctors, nurses or medical posts. Townspeople rarely have a choice-the only health interventions available are those offered by traditional healers.
“Public health services do not reach that far into the countryside,” says Dr. Carlos Linger, who heads Bolivia’s office of the Pan American Health Organization (PAHO) in La Paz. “The presence of the kallawayas and their medicine provides people with a feasible alternative.”
Alipio Barrera, a youthful kallawaya of 25, would agree. “Doctors really don’t go where we do. We set out several times a year, for one to four months at a time, trying to visit as many communities as we can. We almost never come across doctors in these places.”
The kallawayas continue to travel on foot, just as they did centuries ago, despite modern means of transportation. “The roads are getting better now,” says Suxo, “but when you’re out looking for people who might be sick, it is always better to go from place to place on foot.”
The sight of a kallawaya medicine man, wearing a brightly colored hand-woven poncho of vicuña and his lluchu (knit cap), wending his way along the crooked path with his walking stick, is a common one in the Bolivian highlands. “They spot our clothes from far away and know that the kallawayas are coming,” Barrera says.
“They welcome us and feel comfortable with our medicine,” he continues, highlighting a third reason why so many rural dwellers turn to kallawayas for health advice: the kallawayas share the same indigenous roots and traditional world view. Thus, even in rural areas where modern physicians and services are available, many Bolivians are wary of them, perceiving them as too clinical and foreign to their culture.
A Dynamic Mixture
“Western medicine focuses on the individual, giving much less importance to the family, community, and psychological and socioeconomic background as determinants of health,” says Dr. Jeannette Aguirre, a national health services consultant in PAHO’s La Paz office who works with indigenous groups. “Kallawaya practices are based on a profound knowledge of the patient within his or her natural environment, and on listening to the patient.”
Marco Villareal is an agronomist of Aymara descent who lives on the outskirts of La Paz in El Alto. The neighborhood is composed of numerous recent rural migrants, and potato fields sprout up next to thriving micro-businesses. This eclectic mix of the new and the old, the modern and the traditional, spills over into the people’s syncretic approach to health care, as well. When Villareal was diagnosed with rheumatism and high blood pressure, “I decided to be treated by a kallawaya, because it is an ancient custom and I’ve seen the work they do in rural areas. I have faith in them.”
But will faith and cultural traditions alone be enough to preserve the kallawayas’ ancient healing practices for the future? Fortunately, health professionals and traditional healers in Bolivia are taking steps to integrate the two approaches, with the goal of preserving traditional kallawaya medicine while enhancing the quality and cultural sensitivity of modern medicine.
“Modern medicine has attained a technological level that has proved useful in controlling many diseases,” says Aguirre. “However, it does not have many answers for some chronic diseases whose treatment might benefit from a more holistic approach. There are obvious advantages to capitalizing on what both perspectives have to offer us.”
“There is a growing emphasis [in the medical profession] on recuperating indigenous medical traditions, especially herbal treatments,” adds Linger. “Kallawaya medicine is deeply rooted in indigenous beliefs and customs, which in turn form an integral part of Bolivia’s cultural heritage.”
PAHO in Bolivia
Since as far back as the 1950s, PAHO has recognized the importance of collecting information on the customs and beliefs of people regarding illness and traditional therapeutic methods. In the 1970s it helped produce a seminal work on kallawaya medical techniques and practices, and in 1994 supported a research project in Cochabamba that studied the methods used by itinerant practitioners of traditional medicine. More recently, PAHO supported the compilation of a two-volume Encyclopedia of Traditional Aymara Medicine by Dr. Gregorio Loza Balsa, who has authored two other books on medicinal plants and Aymara medicine for PAHO.
Through its Health of Indigenous Peoples Initiative in Bolivia and the other countries of the Americas, PAHO works with local and international partners to improve the health and living conditions of this social group. Aware that large segments of the population in countries such as Bolivia, Ecuador, Guatemala, and Peru rely on traditional medicine for primary health care, PAHO works with the academic and scientific community as well as rural health promoters and holistic practitioners to study the potential usefulness of traditional medicine, including evaluation of practices and examination of the safety and efficacy of remedies, and to upgrade the knowledge of traditional and modern health practitioners.
At 390 per 100,000 live births, Bolivia’s rate of maternal mortality is the Region’s second-highest (Haiti’s is first). In a country where 60 percent of all births take place at home and the number of rural home deliveries is high, Linger feels that traditional birth midwives can play an unparalleled role in helping reduce both maternal and child mortality.
“We work with this group, teaching them what to do in situations of complicated deliveries,” says Linger. “Although traditional kallawaya medicine helps midwives in their work, they need more training in areas such as prenatal care and hygiene.”
Dr. Sandra Land, PAHO’s Regional Advisor on Local Health Services and focal point for the Health of Indigenous Peoples Initiative, believes encouraging more indigenous youth to pursue professional careers in health and providing opportunities for indigenous community leaders would help make public health services more culturally appropriate and acceptable to indigenous groups. “Every country has a different cultural reality,” says Land, “and community health services must respond to local circumstances and reflect diversity when that is the case.”
Preserving Holistic Traditions
Paulino Rasguido, Director of Bolivia’s Center for Comprehensive Training and Services for Development (CISED) is devoted to preserving the kallawayas’ oral traditions. The small, independent center documents the teachings of kallawayas like Suxo and Barrera, creating a permanent record of their holistic knowledge and practical applications of medicinal plants.
Kallawayas collaborating with CISED relay their wisdom to young residents of Bautista Saavedra through formal lessons and train them to be health promoters. Though economically limited, the Center also trains modern health practitioners because it believes that natural medicine can play an integral role in modern medical practice. “Bolivia has a rich natural plenitude that can greatly compliment modern medicine, especially at the primary health care level,” Rasguido says.
Young people in Bautista Saavedra have a privileged opportunity to grow up learning about medicinal plants and herbs, he explains, but what is really needed is a systematic teaching of their value and unique properties, one that preserves the elderly kallawayas’ experiences.
Kallawaya knowledge is passed from father to son by a secret language known only to the kallawayas. Barrera and Suxo are grateful for the skills their fathers taught them but are concerned that today’s generations do not regard traditional medicine with the same profound reverence as theirs did. “My sons aren’t really interested,” shrugs Suxo. Barrera shares Suxo’s conviction that kallawaya traditions are in danger of being lost if they are not shared with others.
The Old and the New
Young Barrera sees no quarrel with modern medicine. He says his blending of modern and traditional techniques has made him more useful to the villages that rely on his knowledge. “In delicate cases,” he says, “I need to know first aid, because natural medicine cures more slowly.”
Unlike Barrera, Suxo, who is older, no longer travels so extensively and instead spends most of his time teaching in Bautista Saavedra. He does, however, makes occasional trips along the old Inca trail to Cuzco, Peru, legendary capital of the former empire, and to visit other small groups interested in acquiring his holistic skills.
“They know very little,” says Suxo. “I teach them because I know when I die, my knowledge might not live on. I tell my students I leave them an important legacy, because there is no virtue in the kallawaya tradition becoming lost.”
Debbie K. Becht is a freelance journalist currently residing in La Paz, Bolivia.
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