This is a remarkable account of the use and coexistence of seemingly contradictory strategies for health care in a town of about a thousand in the Bolivian Altiplano. The medical systems include medicinas caseras, a form of self-medication usually dispensed by women in the home; Western medicine, administered mainly at the Methodist hospital; and divination through coca leaves, conducted by Aymara healers called Yatiris. The third is a simplified folk version of the system of the Aymara Kallawayas, who practice a sophisticated form of herbal medicine throughout the Andes. Mestizos, Aymara campesinos, and Aymara Methodists, the three main groups in this rural town, use more than one system at the same time, accommodating their beliefs and decisions to their religious, ethnic, economic, and sociopolitical relationships. Their choices suggest that they use medicine as a primary resource through which people gain access to secondary resources such as power, prestige, and upward social mobility. One of the most suggestive aspects of this book is the author’s analysis of how debate and negotiation between different perceptions of health and disease reinforce or restructure collective and individual ethnic identity.
This fascinating book reads like a collection of short stories, following the biographies and medical vicissitudes of a number of residents of the town and the cross-cultural experiences of the author doing her research there. The anecdotes in these stories are framed by a theoretical discussion that encompasses the major works on medical pluralism from Bolivia, Mexico, Peru, and Africa. The work also includes, in different sections, a very disorganized narrative of political developments in Bolivia, especially since the revolution of 1952, which is taken as a turning point in terms of interethnic relations and social mobility. Unfortunately, very little is said about the disease profile of the town and even less about the history of medicine or the history of diseases in Bolivia. The work is partly based on individual interviews with 38 people, who provide a variety of responses about the causes, symptoms, and cures for more than one hundred diseases. The results of these interviews, however, are presented in tables in an appendix. I wonder if the inclusion of these materials would not have improved earlier sections of the main text. Nevertheless, the book should appeal to those interested in the social history of medicine and to historians who find in anthropological studies of ethnicity suggestions for their own work.