The Kallawaya healers of the Andes

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The Kallawaya healers of the AndesStanley Krippner a & Earl Scott Glenney ba The Saybrook Institute , #300, 450 Pacific Avenue, San Francisco, California, 94133b Trinity College , ConnecticutPublished online: 13 Aug 2010.

To cite this article: Stanley Krippner & Earl Scott Glenney (1997) The Kallawaya healers of the Andes, The HumanisticPsychologist, 25:2, 212-229, DOI: 10.1080/08873267.1997.9986882

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The Kallawaya Healersof the Andes

Stanley Krippner and Earl Scott GlenneyThe Saybrook Institute and Trinity College

ABSTRACT: In 1996, we interviewed several Kallawaya healersin La Paz, Bolivia. The Kallawaya tradition is several hundredyears old and interweaves the maintenance of health, the treatmentof sickness, the fostering of spirituality, and the facilitation ofsocial and environmental relationships. Using a 12-facet model forour interviews, we concluded that the goal of the Kallawaya modelis to live in harmony with nature, one's community, and oneself.Sickness is conceptualized as dissonance with this relationship.Treatment, both herbal and spiritual, is conducted in ways torestore this balance.

According to the United Nations World Health Organization (WHO),over 70% of the world's population relies on non-allopathic systems ofhealing. Determined to insure that medical care was available to all thepeople of the earth by the beginning of the 21 st century, WHO realized thatthis goal was beyond the scope of personnel trained in Western medicine.As a result, WHO initiated a program to prepare native healing practitionersto serve as health auxiliaries. Halfdan Mahler (1977), when he was theDirector-General of WHO, pointed out that "WHO has proposed that thegreat numbers of traditional healers who practice today in virtually everycountry of the world should not be overlooked... Such traditional healersand local midwives can, at a very moderate expense, be trained to the levelwhere they can provide adequate and acceptable health care under suitablesupervision... The age-old arts of the herbalists too must be tapped. Manyof the plants familiar to the 'wise-woman' or the 'witch-doctor' really dohave the healing powers that tradition attaches to them....Let us not be in

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Stanley Krippner and Eari Scott Glenney 213

any doubt: modern medicine has a great deal still to learn from the collectorof herbs." Mahler concluded that the utilization of native health careproviders "may seem very disagreeable to some policy makers, but if thesolution is the right one to help people, we should have the courage to insistthat this is the best policy in the long run" (p. 3).

In 1972, WHO held a conference to stimulate the training and employ-ment of midwives and, in 1977, adopted a resolution urging governmentsto give adequate importance to the utilization of their traditional systemsof medicine. Perhaps as a result of WHO's increasing support for nativehealth practitioners, as well as the extraordinary cost of health care in theUnited States, the American Medical Association, in 1980, revised its codeof ethics and gave physicians permission to consult with, take referralsfrom, and make referrals to practitioners without orthodox medical training.This move opened the way for physicians to cooperate with shamans,herbalists, spiritists, homeopaths, chiropractors, and other non-allopathicphysicians. Also in 1980, Lancet, the world's most influential medicaljournal, stated, in an editorial, "Even where modern medical care isavailable the people may still prefer to consult their traditional practitionersfor certain troubles. This decision maybe quite reasonable, because systemsof traditional medicine have a holistic approach to illness, in which thepatient is seen in relation to the environment, ecological and social" (Prosand Cons, 1980, p. 964).

In general, anthropologists have enthusiastically endorsed the WHOdeclarations and the conferences, even though they have been criticized forpromoting the maintenance of cultural diversity in ethnomedicine for itsown sake. In response, Bastien (1992) suggests that ethnomedicine shouldbe viewed as a logical alternative and adaptive strategy that is readilyavailable and accessible for peoples throughout the developing world. Hewrites, "The use of ethnomedicine should not be seen as a substitute forbiomedicine in solving the problems of insufficient health-care coverage"(p. 6). There are several reasons for the successes of both ethnomedicineand Western biomedicine, e.g., physical causality, psychosocial effects. Butboth ethnomedicine and biomedicine can be ineffective, and both can bemishandled by incompetent practitioners.

Nevertheless, many indigenous treatment procedures have been re-markably effective. For example, Native American practitioners lancedboils, removed tumors, treated fractures and dislocations, and cleanedwounds in ways that were more hygienic than those of the Europeaninvaders (Sigerist, 1951, p. 207). The Hurons used evergreen needles, richin vitamin C, to treat scurvy; the Shoshone used stoneseed to produce

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214 The Humanistic Psychologist, 25, Summer 1997

spontaneous abortions; several tribes utilized the bark of willow or poplartrees, whose active ingredient, salicin, resembles today's aspirin. Of theherbs used by the Rappahannock tribe, 60% have been found to haveunquestioned medicinal value, a record somewhat higher than the medi-cines brought by the Europeans to America (Stein, 1942). The first U.S.pharmacopoeia, published in 1820, listed 296 substances, 130 of themoriginally used by Native Americans (Vogel, 1970, p. ix).

For several decades, social and behavioral scientists have been col-lecting data that reflect the wide variety of human kind's healing systems.Sicknesses and injuries are universal experiences, but each social groupimplicitly or explicitly classifies them as to cause and cure. Ultimately, eachperson has a belief system that provides an explanation of how he or shecan maintain health and overcome disease or illness. A "disease" is markedby a pattern of symptoms and signs fairly common across cultures(Maltzman, 1994, p. 15). An "illness "typically has culture-specific symp-toms because, to a large extent, it is constructed by a society. Hence virtuallyall cultures manifest such "diseases" as measles, influenza, and cancer, butnot all cultures have "moth craziness" or illnesses generated by the "evileye." Therefore, we would conceptualize "disease" as a mechanicaldifficulty of the body resulting from injury, infection, or imbalance, anddeviating from a culture's standard of health. "Illness," however, is abroader term implying dysfunctional behavior, mood disorders, or inappro-priate thoughts and feelings. These behaviors, moods, thoughts, and feel-ings can accompany an injury, infection, or imbalance—or can existwithout them. Thus one can speak of a "diseased brain" rather than an "illbrain," but of "mental illness" rather than of "mental disease."

Jerome Frank (1973) conjectured that the first healing model was builtaround the prehistoric belief that the etiology of illness was either super-natural (e.g., possession by a malevolent spirit) or magical (e.g., the resultof a sorcerer's curse). Treatment consisted of appropriate rituals thatsupposedly undid or neutralized the cause. These rituals typically requiredthe active participation not only of the sufferer but also family and commu-nity members. Spirits were felt to facilitate the healing process. David Levinand George Solomon (1990) have described seven models of the body, eachof which characterizes a different approach to medicine. They are therational, sacred, and universal body that replicates the larger cosmology;the anatomical body of organs and humours; the physiological body-ma-chine whose structures are seen as mechanisms; the biochemical body ofcells and molecules; the psychosomatic body which admits to the influenceof "mind"; the psychoneuroimmunological body in which "body" and

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"mind" are one; the body of experienced meaning in which "body/mind"and "environment/society" are one.

Kallawaya Practitioners in the Andes

Claude Levi-Strauss (1955) has proposed that the kind of logic devel-oped by indigenous people is as rigorous and complete as that of modernscience. It is not the quality of the intellectual process that differs but themode of expression and application. For example, the cultural myths ofpre-Columbian Mexican and Central American societies not only werecomprehensive guides to daily conduct but also provided an explanationfor the mysteries of the universe. Each mythic episode can be interpretedin several ways according to the context and the listener's understanding.The symbols used are manipulated with such economy that each serves awide range of philosophical and religious ideas. Quetzalcoatl was the"feathered serpent" who symbolized the transformation of matter intospirit, as well as the god of the winds, the Lord of Dawn, the spirit of thesacred ocelot (a fierce jungle cat), the last king of the Toltecs, and (followingthe Spanish conquest)Jesus Christ. Similar evaluations have been made byother scientists. In assessing Pima Indian shamanism, Fontana ( 1974) statedthat it is "a non-Western theory of disease which is as subtle and assophisticated as any other such theory" (p. x).

In January 1996, we spent five days in La Paz, Bolivia, and vicinityinterviewing practitioners of another sophisticated form of ethnomedicine,the Andean Kallawaya system. We interviewed four noted practitioners:Walter Alvarez, Gualberto Chambilla, Mario Vargas, and Juan Villa. Wealso interviewed Victor Morales, a psychologist who uses Kallawayaprinciples but is not a healer himself, and Luisa Aeschbacher and LuisaBalderrama, two eclectic healers who work in the La Paz area. At the timeof our interviews, Alvarez was president of Sociedade Boliviano deMedicina Tradicional, i.e., the Bolivian Society of Traditional Medicine,and Chambilla was president of the Asociación de Yatiris Tradicionales deLa Paz, i.e., the La Paz Association of Traditional Spiritual KallawayaPractitioners. The former group has thousands of members (about half ofthem women) while the latter is an affiliated group. About one quarter ofKallawaya men are herbalists but only a few hundred are regarded aswell-trained practitioners. Almost all of the latter live in Bolivia.

While the men are away from home on herbal trips, women take careof the animals and crops, usually during the nonproductive part of theagricultural year. Children herd sheep and work in the fields shortly after

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they learn how to walk. Kallawaya herbalists claim to trace their traditionback to the legendary Tiahuanaco cultures of 400-1145 A.D., continuingthrough the eras of other pre-Inca cultures, the Inca Empire, and the Spanishconquest, to present times. Kallawaya practitioners often travel to parts ofArgentina, Chile, and Peru, but always in small groups rather than alone(Bastien, 1981).

The Kallawaya healers are members of the Kallawaya ethnic groupthat speaks Aymara, Quechua, and/or Spanish. Chambilla told us that boththe earlier Aymara and the later Quechua cultures had Kallawaya healers.Today, these practitioners employ a secret language, machctj-juyai or "thelanguage of colleagues," thought to consist of about 12,000 words and,according to Alvarez, dates back to Inca times. Machaj-juyai is a hybridlanguage formed from a lexicon primarily of Puquina words and a Quechuagrammar (Bastien, 1992). Practitioners speak machaj-juyai among them-selves and in their healing rituals, primarily to protect their knowledge frombeing appropriated by outsiders. Most Kallawaya practitioners are males,but talented females are admitted to the profession as well.

The approximately 13,000 Kallawaya are farmers and herders. Theylive in Bautista Saavedra Province (of the Department of La Paz) whichborders on Peru and is about the size of the U.S. state of Delaware. Waterfrom Lake Titicaca and glaciers in the Apolobamba Mountains feed the RioCharazani and Rio Calaya which flow east to join the Mapiri and Benirivers, tributaries of the Amazon. The Charazani and Calaya form a systemof high and medium valleys where the Kallawaya live at elevations between2,700 and 5,000 meters above the rain forest of the Yungas area and belowthe regions of permafrost. Their proximity to high mountains and tropicalecological zones provides access to the many plants, animals, and mineralsused in their healers' ethnomedical treatments. Alvarez pointed out thatswamps are distinctive ecological areas because they consist of both"good" and "bad" water, symbolizing the paradoxical nature of humanlife. He also mentioned that the source of Kallawaya power is Achamani,a secret and sacred mountain where healers go to become "illuminated."

Morales told us that in ancient times, people saw no division betweenthemselves and their environment However, rivers and valleys creatednatural boundaries for ayllus, ecological and cultural units of Kallawayasociety. Kallawaya healers were once identified with ayllus referred to asQollahuaya, "place of the herbs." According to Bastien (1992), "Kal-lawaya" is an alternative spelling of "Qollahuaya," but Chambilla told usthat it is a term from Aymara culture meaning "people who carry medicineon their backs," halla meaning "picked up" and waya meaning "medi-

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cine." Tributaries flowing into the Charazabi and Calaya rivers formtriangulated land masses with various ecological levels: low, central, andhigh. The Kallawaya distinguish their communities according to the moun-tain on which each settlement is located but the 1954 Bolivian AgrarianReform Act diminished the importance of the qyllu system.in favor ofnational political units.

Even after they were downgraded, each ayllu was still known for itscharacteristic crops. The communities in the lower slopes (3,200 to 3,500meters above sea level) grow barley, beans, corn (or maize), peas, andwheat. Those in the central communities cultivate oca (i.e., oxalis crassi-caulis) and many varieties of potatoes on rotated fields that are 3,500 to4,300 meters high. Those of the highland communities (4,300 to 5,000meters) herd alpacas, llamas, and sheep. Traditionally, qyllu members fromthe three levels exchange produce and provide each other with the necessaryfoods to maintain a healthy and balanced subsistence. Morales identifiedamaranth, a native grain, as providing nutritional as well as spiritualsustenance.

Each qyllu carries a metaphorical meaning; the Kallawaya believe thatthe mountain levels are three resource and community areas that resemblehuman beings. The low, central, and high levels are analogous to the legs,trunk, and head of the human body, and it is this bodily metaphor thatregulates daily life in the ctyllus. The unity of the human body and nature,represented by the three levels of the mountains, represents a harmoniousrelationship between the person, the community, and the environmentSickness is conceptualized as the result of dissonance in this relationship;the ailing person has fallen out of balance with his or her community,environment, or both.

Alvarez noted that traditional Kallawaya follow three injunctions:amaswa, do not steal; ama Hulla, do not lie; amakhella, do not be slothful.Kallawaya also believe in a principle of nature they refer to as the "boo-merang law": if you harm others, malevolent acts will return to you. Livingby these precepts is felt to be fundamental in establishing and maintainingharmony within the community. Alvarez told us that a life of moderation,peace, and harmony is in accord with the Kallawaya maxims, and a dynamicequilibrium is needed to produce a healthy balance.

There are special spiritual times of the year during which the com-munion between human beings and nature is acknowledged. Ch'alla is athree-day celebration during February in which thanks is given toPachamama (Mother of the Cosmos); it is highlighted by prayers andofferings. The entire month of August, "the time of winds," is also

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dedicated to Pachamama. The winds are the vehicle of the spirits; highwinds are associated with hostile spirits and prayers are offered for protec-tion. During November, the dead are welcomed back to the earthly dimen-sion. Special meals of their favorite foods are prepared for deceasedrelatives and set out with a container of water to welcome them. Steps ofbread are constructed to allow these spirits to walk into the early dimensionfor 24-hours. The deceased are asked for assistance, especially regardinggood health and favorable weather. These are the only times of the yearwhen ordinary community members can make contact with the spirit world,especially the opus, or "old ones," who are said to live in the mountainsand do their best to protect human beings.

Kallawaya healers mediate between the ill person's body and theenvironment, attempting to restore the balance that has been lost. Thesepractitioners are not shamans, even though several shamanic traditions existin Bolivia and other parts of the Andes. Unlike shamans, who alter theirconsciousness to obtain power and knowledge to help and to heal theirclients (Krippner and Welch, 1992), Kallawaya practitioners are herbalistsand ritualists. They recognize the importance of faith in their procedures,as well as the superiority of natural methods; artificial fertilizers andpharmaceutical drugs are seen as inconsistent with the indigenous relation-ship between persons and their environment.

The Kallawaya Healing Model

Because of its sophistication, the Kallawaya system of healing lendsitself to analysis in terms of a 12-faceted model proposed by Miriam Sieglerand Humphry Osmond (1974). In the social and behavioral sciences, a"model" is an explicit or implicit explanatory structure that underlies a setof organized group behaviors. Their use in science attempts to improveunderstanding of the process they represent (Suppes, Pavel, & Falmagne,1994). Models have been constructed to describe human conflict, compe-tition, and cooperation. Models have been proposed to explain mentalillness, personality dynamics, and family interactions. We have modifiedthe Siegler/Osmond model, making it applicable to both "physical" and"mental" disorders, although non-Western traditions usually do not differ-entiate between the two. In addition, we have eliminated some terms thatsuggest a Western bias, substituting terms that lend themselves to a moreuseful cross-cultural comparison.

1. Among the Kallawaya, diagnosis is as important as treatment. Apatient's body is seen as the microcosm of the natural environment. It is the

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Stanley Krippner and Earl Scott Glenney 219

task of the healer to make an accurate diagnosis, and our interviews revealedseveral different methods. An initial decision must be made as to whetheror not the patient should be referred to an allopathic physician; a finaldecision involves whether the sickness is treatable by the person doing thediagnosis or if another Kallawaya healer should be consulted. After makingthe first decision, and before making the second decision, the practitionermust determine the problem. A common diagnostic tool is the "casting"of coca leaves in which the healer holds several leaves high above his orher head, dropping them on to the ground or a ceremonial mesa (i.e., a cloththat purportedly has spiritual powers, and on which various objects aredisplayed). Each aspect of the leaf is instructive, e.g., the side of the leafexposed, the orientation of the leaf, its resemblance to the Christian cross,its relative location to other leaves. For example, Villa explained that if theclear side of the leaf is exposed it is a positive sign, while the dark side isa negative sign.

We were fortunate to witness a "casting" and noticed that the healerchewed coca leaves to attain "unity" with the plant, allowing the informa-tion to "flow" from the diagnostic leaves to the healer. Two of thepractitioners we interviewed did not use this form of diagnosis, but Cham-billa told us that "casting" had been his only method of diagnosis duringhis entire practice. They all mentioned that coca leaves are instructive onlyon Wednesdays, Thursdays, and Saturdays.

Vargas told us that he takes his patients' pulse (at the heart, left arm,and right arm) and blood pressure, and makes direct observations of thetongue, eyes, breath, urine, and feces. Irregular pulse is an immediate signof disharmony. The color of the tongue and iris are observed carefully aswell as the dilation of the patient's pupil.

According to Alvarez, a common folk method of diagnosis utilizes aguinea pig. The procedure begins with tying the guinea pig to the patient'sstomach or kidney area. A coca leaf preparation is placed over the head ofthe patient followed by a joint prayer affirming belief in the procedure. Theguinea pig is removed and cut open so that its internal organs can beobserved. Any anomaly of these internal organs is regarded as a repre-sentation of the patient's illness. A small lesion in the animal's lung is mostserious as it indicates a terminal illness on the part of the patient. Thisprocedure did not originate with the Kallawaya, but is used by somepractitioners.

Alvarez informed us of another folk tradition that is taken seriouslyby some Kallawaya healers who examine the patient's side for small scarsthat resemble puncture marks. These marks, in combination with certain

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behavioral symptoms, indicate an invasive illness, marked by high tem-peratures, brought on by sorcery or kharisiri. The marks indicate that evilspirits have entered the patients' body, usually near the liver, to steal theirfatty tissue. These malevolent spirits can take the form of human beingsreferred to as karikari; they live on fat and usually strike when their victimsare not fully aware, such as when they are intoxicated (Bastien, 1992, p.71). Alvarez told us that sorcery is quite rare, and that some of it is relatedto the malignancy of the Spanish invaders.

Morales told us that he uses patients' dreams for diagnostic purposesbecause they represent one's own spirit communicating with the body. Avoyage may be postponed due to negative signs in a dream; nightmaresmay predict serious health problems; an important decision might be madeon the basis of a positive dream. One person's dreams might even be anomen of things to come for the entire community.

Regardless of the diagnosis, it is important that the practitioner andpatient come to an agreement. Family members often are present when thediagnosis is announced and are often given tasks to perform. The patientsand their families are fully informed and are advised to share the diagnosiswith the entire community—except in the case of kharisiri which thepractitioner might treat privately so as to not alarm the patient. In general,liver, stomach, and respiratory problems are the most commonly diagnosedsicknesses, but Kallawaya healers also diagnose and treat most of theconditions, both physical and psychological, familiar to allopathic medi-cinein addition, they work with spiritual problems such as susto, the lossof one's haio or ajqyu (spirit), often conceptualized as a vital fluid thatanimates each human being. We were told that each person has a major anda minor spirit, and maintaining harmony between them is a crucial life task.

2. Etiology, or cause of the illness, is seen as a disintegration ofharmony between the patients and their community and/or natural environ-ment, except in cases where there is a direct supernatural intervention (asin kharisiri). Thunder is perceived as capable of bringing affliction to bothhumans and animals. According to Alvarez, susto has several possibleetiologies, e.g., sorcery, traumas or shocks, an inclement wind that capturesa baby's spirit (which is why the birth process occurs indoors). Sometimesit is the major haio that is lost, and sometime the minor haio; in eitherinstance, the individual is thrown out of balance.

.3. The patient's behavior provides important clues for diagnosis andtreatment. Alvarez assumes that, in general, a calm patient is healthy; cryingand screaming may be signs of spirit loss. The symptoms of susto vary, butinclude depression, anxiety, laziness, loss of appetite, shaking, fever,

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nausea, hearing noises in the ears, and passing gas. Folk tradition in theAndes defines being sick operationally, as someone who is unable to work.

4. Treatment is highly individualized but the importance of a balanceddiet to prevent sickness was emphasized by Morales. Alvarez advises hispatients to "eat food from the area and during its season"; some fruits maybe eaten before they are fully ripe for medicinal purposes. The Kallawayahealers employ more than one thousand medicinal plants, about one thirdof which have demonstrated their effectiveness by Western biomédicalstandards, and another third of which have been judged to be "likely"effective (Bastien, 1992, p. 47). These plants are divided according to thethree distinct "weathers" which Pachamama and Tataente (Father Sun)have given to their ayllu, namely hot, mild, and cold.

When a guinea pig is dissected for diagnostic purposes, a plaster madeof copal incense is placed on the lesioned area of the animal; this is thoughtto lead to the healing of the patient's internal problem. Another procedureis to tie a guinea pig to the dysfunctional area of the patient, e.g., near akidney; the animal is thought to "rescue" the patient's organ by "absorb-ing" the illness. Our informants said that few Kallawaya practitioners usedthese folk procedures.

Coca plays a major role in many of the healing procedures; accordingto Morales, the plant grows between the world of human beings and worldof the spirits. A coca and quinine mixture has been used to treat malaria—most notably, as Kallawaya healers tell the story, during the digging of thePanama Canal, a triumph that brought them to world-wide attention. Thefungus of corn or bananas produces a substance similar to penicillin that isused for local infections. More serious infections are treated by a prepara-tion similar to tetramycin yielded by fermented soil; this preparation is alsoused for ulcerated skin and chronic illnesses.

Morales told us that Kallawaya medicine generally is accompanied byrituals involving prayers, amulets, and mesas—a ceremonial fabric onwhich objects are arranged, generally in a left-to-right manner that symbol-izes the journey from sickness to health. Llama fetuses are commonly usedin the preparation oí mesas because the llama is a sacred animal. Amuletsare placed on the mesa or worn around the patient's neck, giving him or herconfidence and spiritual power, especially when a patient complains ofsome type of deprivation. Different amulets represent health, love, wealth,or equilibrium with Pachamama and Tataente. Mesas are often used toprevent sickness or imbalance, often for the entire community; when theyrepresent offerings to the spirit world, they are burned after their utilization.The so-called Pachamama Mesa can be burned on any day of the week,

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often for a wedding or when crops are planted. According to Villa, the MesaGloria or Mesa Blanca is composed of 12 pieces of cotton on a whitebackground and is burned on a Wednesday night in response to a thunder-storm. Sets of four figurines are placed on the mesa, e.g., four figures ofhorseshoes, houses, and llamas, four dice made of sugar, four pieces of St.Nicholas bread.

The Awicha Mesa or Chulpas Mesa is burned on Tuesdays or Fridaysin honor of deceased members of the community to console their spiritsand is related to the chulpas, the preparation of corpses for traditionalfunerals. Villa mentioned that people who stroll through areas whilefunerals are being arranged sometimes fall sick. He also itemized theobjects he frequently uses for his mesas—coca leaves, religious figurines,"gold" or "silver" bread (pan de oro orpan de plato), alcohol, eggs, whiteflowers, and llama fetuses, fat, and wool. A suyo is a call to the llama fetusfor its healing power. If a llama fetus is not available, he may use a pig orsheep fetus.

Herbal preparations usually are ingested but occasionally are used inconjunction with a "steam box"; the naked patient enters the receptaclewhich is filled with steam created from the medicinal mixture. The activeingredients of the herbs enter the pores of the patient at the same time asthe sweat cleanses the toxins. We observed a patient in one of these steamboxes in the Tambillo Hospital we visited on the outskirts of La Paz. Inaddition to the steam boxes and their cleansing therapy, the hospital wasreplete with hundreds of Kallawaya herbal preparations, all carefullyprescribed, measured, and given to patients with explanatory procedures.

There is an armamentarium of procedures that do not involve herbs,for example, healing songs, especially for treating insomnia, and dances,particularly to renew the patient's supply of energy.

5. Prognosis, or anticipated outcome, is dependent on a number offactors: the sickness itself, its severity, and the cooperation of patients andtheir families. The confidence and the faith of the patient are key factorsbecause herbal treatment is a slow process that requires a great deal ofpatience. Belief is felt to activate the self-healing mechanisms that arefundamental to recovery.

6. If the treatment does not work, or if the patient's condition can notbe successfully treated, premature death or suicide may result. There arefew suicides among the Kallawaya, as this would bring dishonor to thefamily. Death at the end of one's life, however, is a natural process that canbe prepared for and confronted with valor. After death, one or both of one's

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spirits rejoins Pachamama. Some practitioners think that reincarnation ispossible, but others are skeptical.

7. The institutional setting depends on the patient's mobility; if thepatient can not go to the healer, the healer will go to the patient. However,female Kallawaya practitioners typically do not leave their homes, thustheir patients must come to them. In La Paz, there are clinics where patientscan visit a Kallawaya practitioner. The function of the institution is fordiagnosis and treatment regardless of its location but the patient's prefer-ence usually is home visitation, far from the influence of hostile spirits andunfamiliar surroundings and near to familiar animals, plants, and land.Hospitals are dreaded, in part because the color white is associated with thedeath and burial of infants.

8. The institutional personnel involved among the Kallawaya repre-sent various skills and functions. Herbolarios collect plants; yerbaterosprepare plants; curanderos apply the herbs and other medicines; yatiris(also known as amautas) are spiritual healers;partidas are midwives. Overtime, Kallawaya practitioners began to perform more than one function,hence many of these traditional divisions have become less rigid. Never-theless, all practitioners mediate between the environment and the patient(and, in some cases, the community-at-large). If a Kallawaya healer can nothelp a patient, there may be a referral to a medical doctor, especially ifsurgery is needed; in La Paz we were told it was a common practice forreferrals to go in both directions as some physicians would send patients toKallawaya healers. Alvarez told us that fees per visit may vary from 50cents (U.S.) in the countryside to $20.00 (U.S.) in suburban areas; if patientshave no money, they trade and baiter for their treatments.

9. In the Kallawaya system, the patient's first priority is that oftreatment, and they assume the role of cooperating with the practitioner.They have the right to receive effective treatment, the right to receive analternative treatment if the first one is not effective, and the responsibilityto prevent sickness. The patient is fully informed with the exception of casesinvolving kharisiri, and has the responsibility to inform the community ofhis or her diagnosis.

10. The majorpriority of the patient's family is to obtain diagnosis andtreatment for its indisposed family members. The parents take on the roleof providing emotional support for the patient, maintaining his or her faith,as well as practical assistance, e.g., giving patients their medicinal herbs.The family has the right to receive an accurate and honest diagnosis (withthe exception of instances of sorcery). Family members are informed of the

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patient's progress or deterioration, as would be the case if the condition isincurable, e.g., AIDS-related conditions, terminal cancer.

11. The Kallawaya society has the right to maintain a balancedenvironment that exists in harmony with nature. Morales stressed preven-tion as an important goal of the Kallawaya system; any disequilibriumdeserves immediate attention. In rare cases, the community has the right toexpel members who endanger the balance. A social responsibility is tosupport patients by bringing them food, money, music, and anything elsethat will maintain their faith and theirmotivation to recover, this communityprocess is referred to as qyni. A festive ceremony for offering groupassistance is referred to as apreste and is frequently used to treat susto.Morales discussed qyni at some length, telling how it is employed for peoplewith chronic problems, demonstrating community support. Susto is treatedin a number of ways; Vargas mentioned asking Tataente "Am I allowed tohealth is condition?" then burning incense, using the Christian rosary, andmaking offerings in the four directions of the compass.

Society places a high priority on the availability of healing practitio-ners for its members. There is a vigorous attempt to train students to becomeeffective practitioners. According to Bastien (1992), it is the duty of theeldest son of a healer to become a healer himself, and the boy will spendsome 14 years in preparation before he will be allowed to assist his mentor.However, some of our informants told us that all male children are obligatedto study Kallawaya healing practices, and many girls are admitted to thetraining programs as well. They must first learn how to plant, irrigate, andharvest medicinal plants. They are taught to identify herbs by their sightand smell. Animals, such as llamas, must be cared for as well. When ahealerreturns from a professional excursion, his or her family assumes theresponsibility of having more medicinal plants ready; when in training, theeldest son has most of the responsibility for this collection and preparation.Once the aspiring practitioner has completed the 14 years of preparation,he or she will assume the position of apprentice, often traveling with his orher mentor to assist in healing rituals. As he or she turns 23, he or she isconsidered of age to become a healer; several Kallawaya practitionersgather to examine their students' fund of knowledge and skills with oralquestions. Only those who demonstrate adequate proficiency will be sanc-tioned by the community as healers and allowed to practice. Candidateswho lack the required discipline, depth of understanding, and aptitude areturned down; being too reserved or subdued during the examination worksagainst the candidate.

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Kallawaya society also plays the role of obeying traditional spirituallaws so that its people will maintain balance, and will be protected fromplagues and epidemics. They have the right to evaluate practitionersaccording to how well they perform the role expected of them based onavailability, accessibility, dependability, and effectiveness. As a result, thecommunity recognizes various ranks of herbal skills, and frugal peasantsdepend upon word-of-mouth to discover which healers are superior.

12. The goal of the Kallawaya model is to maintain and restore theharmonious relationship of community members, the community as awhole, and the natural environment. The Kallawaya practitioner needs toassure the availability of medicinal plants and proficient healers who areconversant with health, sickness, the natural realm, and the world of spirits.Prevention involves the practice of moderation in daily life, and of themaintenance of trust among members of the community.

The Allopathic Medical Model

The allopathic medical model stands in sharp contrast to the Kal-lawaya model. Diagnosis is usually made by the physician. It followslogical procedures that may be carried out with or without input from thepatient; it rarely asks for extensive input from the family, and almost neverinvolves input from the patient's community. Etiology is considered to benatural rather than supernatural.

The patient's behavior is connected to the diagnosis through symp-toms (the patient's reported experiences) and signs(the results of examina-tions of the patient's body). The treatment of symptoms and signs some-times proceeds in the absence of a known etiology. For example, a physicianwill often prescribe medication to lower a patient's fever before identifyingthe cause of the fever.

Treatment is usually medicinal or surgical. It is specific for eachdisease, but when a diagnosis is unclear, it may proceed by trial and error.Treatment is oriented toward specific objectives and is adjusted to theresponse of the patient.

Prognosis (the physician's perspective on the course of one's disease)is based on diagnosis. The physician will discuss such matters as thechances of recovery, the probable length of time needed for recovery, andthe chances of a relapse. The physician offers hope but often can notpromise a cure. Death is seen as a failure of the diagnostic and treatmentsystem, or simply as the inevitable result of aging or of a serious disease

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that is unresponsive to the best treatment currently available. Suicidetypically is seen as an extreme outcome of a psychiatric disturbance.

The function of the institution, whether it is the physician's office ora hospital, is to provide care for patients. Some physicians are based at ahospital while others may work at an office. Personnel in the allopathicmedical system include physicians (who treat the patients), nurses (whoassist physicians in caring for the patients), and various rehabilitationists(who teach patients how to regain lost or damaged bodily functions). Thesepersonnel are subject to formal regulative and licensure procedures tomaintain standards of quality.

The allopathic medical model holds that patients have the right toassume the "sick role." While assuming this role, they can receive care andare not expected to assume their ordinary responsibilities. Patients have theresponsibility to obey their physician, nurse, and/or rehabilitationist. Thehave the right to be protected against incompetent practitioners.

The patient's family has the priority to seek help. Family membersalso have the right to sympathy and to receive information about thepatient's condition and progress. Their role is to cooperate with the medicalpersonnel in carrying out the treatment. The patient's society has a highpriority to be protected from ill people who are a danger to others. Its roleis to provide medical care in one form or another.

The goal of this model is to treat patients for illness. Allopaths attemptto restore patients to the greatest degree of functioning possible, and if not,to prevent the illness from getting worse. A secondary goal is the accumu-lation of medical knowledge so that more diseases can be cured and so thattreatment can become increasingly effective.

DiscussionPeasants in the Andes, as well as those in other parts of the developing

world, recognize the advantages of allopathic medicine. Yet they are oftenwary of how biomedicine can be used as a political instrument to discrimi-nate against ethnic groups and socioeconomic classes, and to create depend-ency relations with the industrialized countries who supply (and profitfrom) allopathic medicines and implements. In this way, our contrast of theKallawaya model with that of allopathic biomedicine enters what has beencalled the postmodern dialogue (White, 1991). Alvarez contrasted "offi-cial" medicine (i.e., biomedicine) with "traditional" medicine (i.e., herbalpreparations), noting that the latter has had to struggle for legitimacy againstpowerful forces. Kallawaya practitioners, according to our informants,

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attempt to preserve the "Andean way of thinking" with its emphasis onbalance, harmony, and the notion that "people are the fruit of what theyeat."

Biomédical technology often determines what is to be taken as authori-tative knowledge and, in turn, establishes a particular domain of power.Biomedicine typically extends this privileged position to economics, poli-tics, and class relationships. Its power is jealously guarded by legislation,medical schools, licensing, and medicinal terminology. It is no wonder thatordinary people frequently view biomedicine as serving powerful groupsin their country while they struggle for a vestige of power over their ownlives (Bastien, 1992, p. 17).

Bastien (1987,1992) describes how in the 1950s and 1960s, Bolivianpharmacists and physicians successfully curtailed the influence of Kal-lawaya practitioners by public humiliation, restrictive laws (and imprison-ment for their violation), and denial of licenses. Even though some Kal-lawaya practitioners incorporated various aspects of biomedicine into theirprocedures (pp. 25-32), physicians and politicians portrayed the healers, atbest, as members of an antiquated tradition and, at worst, as charlatans. Thesuccess of Kallawaya treatment and the increasing surplus of allopathicphysicians in Bolivia and other parts of the Andes exacerbated the situation.Mounting a counterattack, many Kallawaya healers stereotyped physiciansas kharisris, mythic figures who steal fatty tissue, the source of force andenergy in folk tradition. As a result, those Kallawaya practitioners who hadadopted a few biomédical practices often lost clients (pp. 17-18).

In the 1980s, most Bolivian physicians and nurses discontinued effortsat integrating ethnomedicine because their superiors did not promote it(Bastien, 1992, p. 38). At the same time, there was a resurgence inKallawaya practice as the value of medical plants was touted by Westernresearch, and because Bolivian peasants could not afford biomédicaltreatments; in 1984 the cost of a penicillin injection was about $ 10.00 U.S.,several days wages for peasants (pp. 54-55). In the 1990s, communicationbetween physicians and herbalists in Bolivia has improved because of theinterest in ethnomedicine; the two groups collaborated on several confer-ences and even jointly staffed a few clinics. Walter Alvarez, a gynecologistand surgeon as well as a Kallawaya healer, was instrumental in helping theKallawaya of one ayllu obtain a clinic staffed by both a physician and aherbalist. Once again, biomédical techniques are finding their way intoKallawaya practice without a loss of the tradition's unique identity.

In April, 1995, the Office of Alternative Medicine, U.S. NationalHealth Institute, convened a panel to discuss methodology in defining and

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evaluating complementary and alternative healing procedures (O'Connor,Calabrese, Cárdena, Eisenberg, Fincher, Hufford, Jonas, Kaptchuk, Martin,Scott, Zhang, 1997). The panel provided a useful definition: "Complemen-tary and alternative medicine (CAM) is a broad domain of healing resourcesthat encompasses all health systems, modalities, and practices and theiraccompanying theories and beliefs, other than those intrinsic to the politi-cally dominant health system of a particular society or culture in a givenhistorical period. CAM includes all such practices and ideas self-definedby their users as preventing or treating illness or promoting health andwell-being. Boundaries within CAM and between the CAM domain andthe domain of the dominant system are not always sharp and fixed....In theUnited States in the 20th century, the dominant health care system is, forwant of a better term, biomedicine"(pp. 50-51). This statement is in accordwith our observation of how ethnomedical practice and allopathic medicinesometimes coexist, sometimes conflict, and sometimes cooperate within agiven geographic area.

The value of ethnomedical practitioners and their incorporation intobiomédical systems has become widely heralded since their advocacy byWHO, butthe high cost of training folkhealers, the reluctance of the medicalbureaucracy to accept them, and the decline of ethnomedicine in many partsof the world have discouraged such incorporation. The objective of avail-able medical care for all people of the earth by the beginning of the 21stcentury depends upon granting folk healers professional autonomy as wellas to educate them in abandoning worthless (and sometimes harmful)practices, and to teach them and their communities about effective publichealth measures (Bastien, 1992, p. 27). Many ethnomedical practitionersuse adaptive strategies that are living and dynamic systems, subject tochange in response to the community and the environment. Bastien pointsout that "Bolivian as well as other Andean medical systems provide amyriad of adaptive strategies to some of the most variable environmentalzones of the world" (p. 27).

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Frank, J.D. (1973). Persuasion and healing (rev. ed.). Baltimore: Johns HopkinsUniversity Press.

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An earlier version of this paper was presented at the International Confer-ence on the Study of Shamanism and Alternate Modes of Healing, SanRafael, California, September, 1996, and is included in the proceedings ofthat conference. Stanley Krippner is a professor of Psychology at theSaybrook Institute. He is also a former president of the Division ofHumanistic Psychology of the American Psychological Association. Cor-respondence can be addressed to: Stanley Krippner, Saybrook GraduateSchool, #300, 450 Pacific Avenue, San Francisco, California, 94133. EarlScott Glenney is a student at Trinity College in Connecticut.

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Documents

The Kallawaya healers of the Andes