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Social Science & Medicine 61 (2005) 767–783

www.elsevier.com/locate/socscimed

When ‘‘health’’ is not enough: societal, individual andbiomedical assessments of well-being among the

Matsigenka of the Peruvian Amazon

Carolina Izquierdo�

Sloan Center on Everyday Lives of Families, University of California, Los Angeles, 341 Haines Hall, Box 951553, Los Angeles,

CA 90095-1553, USA

Available online 26 November 2004

Abstract

Although biomedical indicators of health status show that physical health for the Matsigenka of the Peruvian

Amazon has significantly improved over the past 20–30 years, the Matsigenka perceive their health and well-being to

have severely declined during this period. This discrepancy between empirical measures and local perceptions of health

and well-being points to the central tension inherent in measuring and defining ‘‘health.’’ While biomedical parameters

of health are generally linked to notions of the body free of illness, measurable by physiological means, the Matsigenka

define physical health as only one component of what it means to be healthy and to experience well-being. For the

Matsigenka, notions of health and well-being are linked fundamentally to ideals about happiness, productivity and

goodness, in addition to biomedical health. The Matsigenka attribute the decrease in their well-being to newly instigated

sorcery and stressors resulting from outside influences and morality institutionalized by cultural ‘‘outsiders’’, such as

missionaries, school teachers, health personnel, oil company employees and government officials. This article explores

the relationships between biomedical, societal and personal assessments of health and well-being among the Matsigenka

as they seek to preserve their sense of wellness in spite of their rapidly changing social and economic environment. By

using longitudinal qualitative and quantitative ethnographic and health data, this paper shows that, for the Matsigenka,

increases in acculturation and permanent settlement result in an alarming decrease in their health and well-being.

r 2004 Elsevier Ltd. All rights reserved.

Keywords: Matsigenka; Peruvian Amazon; Well-being; Health measures; Biometrics

To be happy one must live in a place far away from

Mestizos and away from flus and smallpox. Before

we didn’t know how to wash dishes, we ate out of

pamocos [coconut shells or calabashes used as bowls],

we used monkey heads as spoons and we didn’t have

illnesses. We didn’t have to boil water and we lived in

peace. We were happy without having to wash our

hands all the timey now health personnel come and

e front matter r 2004 Elsevier Ltd. All rights reserved.

cscimed.2004.08.045

28 5417.

ess: cizquier@ucla.edu (C. Izquierdo).

say we have to wash our hands all the time, boil

water for everything, and make latrines to be happy,

but before we were happy (Amalia, a 25-year-old

Matsigenka woman).

Introduction

In a globalizing world, culturally sensitive concepts

of cross-cultural well-being will no doubt become

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783768

increasingly important. Many researchers have pointed

out how the value that people place on personal/

subjective well-being can differ across cultures (Klein-

man, 1978, 1980; Kroeger, 1983; Larson, 1991; Oishi,

2000; Suh, 2000). A common definition used by social

scientists is that of Evans and Stoddart (1994): ‘‘the

sense of life satisfaction of the individual’’. This

assessment is eminently subjective and changeable, as

well-being is how individuals themselves evaluate their

lives, both in terms of satisfaction, and of affective

reactions (Diener & Suh, 1996, p. 5). Individual concepts

of health and well-being can be said to be derived,

maintained and challenged by the cultural systems from

which they originate. Therefore the concept of well-

being in itself presents difficulties for researchers, in that

it can be very broadly defined, resulting in the use of

unclear methodologies and definitions, making it diffi-

cult to compare cross-culturally.

Even if we can agree that it is human nature to strive

for well-being in terms of general fulfillment, there is still

a problem in determining which ideals people are using

to evaluate their happiness, well-being and health. To

what extent is well-being thought of in individual terms,

and to what extent is it conceived of as a matter of

belonging to entities beyond the self? Is it more in terms

of spiritual fulfillment or material gain? Do people

examine their lives in comparison to ideals and values

from the past or more emergent values? Ultimately,

how central is ‘‘health’’ to perceptions and definitions of

well-being?

While biomedical parameters of well-being are gen-

erally linked to notions of the body free of illness,

longevity, the ability to procreate, physical capacity,

strength, and the absence of pain or fatigue, biometric

indicators are but one of the many indicators useful in

constructing a health assessment. These data, in isola-

tion, do not summarize people’s health and well-being,

nor can individuals’ assessments alone validly do so.

Although physical examinations of individuals, and

health indices of a society as a whole, provide insight

into physical health in a society, among a population

such as the Matsigenka, however, ‘‘health’’ encompasses

much more than physical status. The Matsigenka define

physical health as only one component of what it means

to be healthy and to experience well-being. For the

Matsigenka, these are holistic, interrelated concepts that

incorporate ideals about happiness, productivity and

goodness, in addition to biomedical health. They define

health and well-being in terms of balance and social

functioning, according to the family focused culture they

inhabit. Illness is understood as a break-down of the

body that signifies an existential crisis wherein the

individual and close kin search for a culturally coherent

explanation for their distress. Therefore, concepts of

health and well-being for the Matsigenka cover a

broader range of human functions and abilities. This

paper explores the relationship between societal, in-

dividual and biomedical assessments of health and well-

being being among the Matsigenka of the Peruvian

Amazon.

Findings indicate that despite biomedical indicators of

health status that show improvement in physical health

for the Matsigenka over the past 20–30 years, the

Matsigenka consider their health and well-being as

severely declining during this same time period. This

discrepancy between empirical measures and local and

historical perceptions of health and well-being points to

the central tension inherent in measuring and defining

‘‘health.’’

In this paper, cultural interpretations of meaning are

complemented by a longitudinal biomedical assessment

to determine physical health. The Matsigenka report

that their health and quality of life have ‘‘significantly’’

deteriorated in the past years, claiming that they now

suffer more physical, mental and emotional stress. They

are concerned with an increase in illnesses, which they

attribute to cultural integration pressures and social

strife associated with dense and permanent settlement.

Sorcery, resulting from outside influences and morality

institutionalized by cultural outsiders such as mission-

aries, school teachers, health personnel, oil company

employees and government officials, is the main stressor.

How the Matsigenka learn to adapt their culture and co-

exist within worlds where indigenous and non-indigen-

ous cultures collide is played out in every illness episode

(Izquierdo & Shepard, 2003). Matsigenka medical

beliefs and practices are an important aspect of their

identity and culture, as they seek to preserve their sense

of wellness in spite of their rapidly changing social and

economic environment.

Interestingly, part of a wider paradigm concerning the

dangers of modernization or permanent settlements, is

the general assumption that the health of Amazonian

populations deteriorates when people move into large,

centralized communities; i.e., that their physical health is

negatively impacted by permanent settlement. This

concept of settlement is posited on an assumption of

scarcity: that population growth and depletion of

resources, particularly fish and game, will endanger

local communities (Jelliffe, 1966; Dricot–D’ans &

Dricot, 1977; Strongin, 1982; Baksh, 1984; Bennett,

1991; Dufour, 1994). Although these threats are very

real, I argue that social conflict engendered by settlement

is much more of a threat to the health and well-being of

these communities than is competition for natural

resources such as fish and game. For the Matsigenka,

their physical health and their material world may be

relatively better than 30 years ago, but their subjective

evaluation of health and the fulfillment of their own

valued goals of family and community have declined.

This ethnographic research shows the importance

of attempting to disentangle physiological measures

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783 769

for defining health to include broader and more

culturally appropriate local conceptions of understand-

ing by taking as many variables and points of

view into consideration as possible, such as physiologi-

cal measures, personal accounts, observations of

behavior, and the use of previous ethnographies

when assessing a population’s health and their well-

being. Ultimately, this paper questions the universal

centrality of physical health in defining health and

well-being.

(footnote continued)

study, by Dricot and Dricot-D’ans (1977), found deterioration

of nutritional status in more acculturated villages. Their

anthropometric study (skin fold measurements, fat weight and

lean body weight, circumference of arms, forearm, calf and arm

muscle) of adult Matsigenka males in three communities

(Koribeni, Timpia, and Tayakome) found the more accultu-

rated community to have worse nutritional status than the less

Defining health and well-being

A variety of tools and research methods have been

developed to describe the health of populations. Health

status has been measured, for example, by using macro-

level indices such as nutritional status, crude birth, death

and fertility rates, distributions of acute infectious and

chronic diseases, and mortality/morbidity rates due to

specific conditions such as accidents and genetic

diseases. Associated indices include measures of health

service infrastructure (such as number of health posts,

hospitals or number of physicians per capita) and access

and utilization measures (e.g., service-based visits and

rates of hospitalization for preventable conditions)

(Jansen, 1981; McElroy & Townsend, 1985; McElroy,

1990). Indirect but related ways of describing health

rates and distributions are socioeconomic indicators

such as household income, levels of formal schooling,

employment and literacy. While many of these indica-

tors have been standardized for use in the developing

world, the accuracy of the data, the instruments and the

appropriateness of comparison standards make inter-

preting their results problematic (Larson, 1991; Turns &

Newby, 1983). Conversely, criticism is leveled at

researchers who provide little data and anecdotal

information to support the supposedly deleterious or

other effects of modernization on people’s lives,

particularly on health and well-being. They are criticized

for being overly qualitative in their approach and for not

specifying what data sources or measures they use in

reaching their conclusions about health status. For

example, a common problem in community assessments

of health in the Amazon is to equate deteriorating health

with permanent settlement or acculturation. Without

examining the dynamics and behavior of the population

in detail and not collecting physiological measures over

time, sweeping theories about urbanization and the

‘‘paradise lost’’ of indigenous groups infect research

designs and taint results accordingly1 (Hill & Hurtado,

1Only two studies have directly examined the effects of

acculturation on nutrition, diet and physical health. The first

study found no correlation between acculturation and nutri-

tional status and general health (Holmes, 1985). The second

1996)[(The fact still remains that the initial formation of

large settlements brought epidemics and disaster to

native populations resulting in a possible loss of up to

two-thirds of native populations (Gade, 1972; Steward

& Faron, 1959)].

Most importantly, biomedically oriented research that

aims to elucidate the health of communities, at times

reflects a peculiar disengagement with socio-cultural

factors affecting local populations. Researchers have

begun to address cultural constructions of health,

‘‘question the underlying ideological assumptions of

health’’ (Adelson, 1998: p. 6, 2000; Crawford, 1985,

1994). Their findings are broadening our understandings

and scope by introducing ideas about health that are

closely linked to concerns of cultural identity and

notions of power (Adelson, 2000; Lupton, 1997;

Crawford, 1994).

Studies have, for the most part, equated well-being

with judgements about life satisfaction as a ‘‘global

assessment of a person’s quality of life according to his

own chosen criteria’’ (Diener, 1996: p. 543). But as

Christopher (1999) points out ‘‘this approach is directly

linked to certain Western individualistic assumptions

and values—or moral visions (143).

The very notion of assessing a person’s health and

well-being assumes that well-being is not taken for

granted, that its fluctuations can be measured in some

way, and that these measurements have meaning. This

individualistic concept of assessment also implies that a

person is both capable of and adept at observing his or

her feelings; able to separate his or her state of mind

from the surrounding environment. Furthermore, if

well-being can be measured and assessed, it can also be

improved. Some sense of the production of well-being is

implied in cultures that stress individual agency where

the business of life is optimizing life satisfaction;

however, that may be measured. At the same time,

some degree of unproductiveness is associated with

those who do not achieve a sense of health and well-

being.

Although presently there are no standardized indica-

tors for measuring well-being, a comprehensive defini-

tion of well-being is that of Pollard and Rosenberg

acculturated community. This comparison failed to address

important ecological differences in terms of access to resources:

these villages are located in completely different environments.

Such different environments make for a poor comparative test

of health measured by nutritional status alone.

ARTICLE IN PRESS

2Reliance on retrospective accounts is problematic. There is a

tendency for people to romanticize the past and that recall

information is inaccurate half of the time (Bernard, Russell,

Killowrth, Kronenfield, & Sailer, 1984). The problem regarding

people’s recollections of illness episodes has been well

documented (Freeman & Romney, 1987). Studies indicate that

people adjust and distort their cognitive beliefs and perceptions

to make them consistent with their behaviors and previous

actions.

C. Izquierdo / Social Science & Medicine 61 (2005) 767–783770

(2003), which combines Weisner’s (1998) and the

Surgeon General’s:

Well-being is a state of successful performance

throughout the life course integrating physical,

cognitive, and social-emotional function that results

in productive activities deemed significant by one’s

cultural community, fulfilling social relationships,

and the ability to transcend moderate psychological

and environmental problems. Well-being also has a

subjective dimension in the sense of satisfaction

associated with fulfilling one’s potential.

Standardization of indicators and measures are

necessary to advance research, even if we can agree that

culture-free theories are not possible. Social context and

culture shape related values and behavior, which, in

turn, set parameters for ideals about health and

wellness. For example, in some cultural settings,

religious beliefs and practices are important drivers of

both collective and individual health, as they shape

values and behaviors, providing a lens through which

wellness and satisfaction in daily life are interpreted.

For others, economic indicators are powerful drivers.

Nevertheless, as Diener has observed, more wealth

does not necessarily translate into greater health, life

satisfaction or feelings of well-being in cultural contexts

as disparate as those in the United States or Japan

(1996).

One possible interpretation for culture’s role in

shaping well-being, which can often be dramatically at

odds with objective economic and health status predic-

tions or subjective assessments, is the extent to which a

culture defines health and well-being as a personal

project over which individuals have control. As Adelson

notes:

That obsession [with health], however, is not with a

universal, knowable entity but rather with a parti-

cular cultural ideal. The obsession with which those

in industrialized societies are most familiar is closely

linked to particular ideals of bodily fitness and

longevity. However, these two prominent character-

istics of ‘health’ may or may not have anything to do

with physiological wellness (2000, p. 4).

Questions of human well-being have fueled the

imagination of philosophers since time immemorial.

Although there are no categorical blueprints for

determining the universal nature of well-being and the

process is utterly complex, this paper, by integrating

physiological, individual and societal assessments, at-

tempts to deliver a more holistic understanding of what

it means to be well in a particular society, which can in

turn be used for cross-cultural comparison.

Research methods and time line

This study draws on ethnographic research gathered

between 1996 and 1999. Although I visited most

Matsigenka communities in the Lower Urubamba

region, this research was carried out mainly in the

Kamisea community located along the Urubamba

River. This community, very much like most other

Matsigenka communities in this region, has a total

population of 265 people, living in approximately

40 households (houses are easily and frequently dis-

mantled and rebuilt). During the course of my fieldwork,

I lived with a very generous and patient Matsigenka

family.

I also draw on previous research carried out among

the Matsigenka in the late 1960s, early 1970s and 1980s

in order to establish a longitudinal time line to draw a

comparison over time—thus I avoid relying solely on

people’s retrospective accounts.2 The primary methods I

used for data collection were participant observation, in-

depth semi-structured and open-ended interviews with

most members of the community to ascertain their

health assessment (the small setting provided me the

luxury of interviewing most people in this community).

Cognitive tasks, such as pile sorts and free listing, were

used in order to elucidate theories of health and illness. I

checked health post records, and physical medical

examinations were conducted by medical personnel

working in the area. Examinations include a general

physical, blood samples to test hemoglobin and protein

levels, and parasite tests from a total random sample of

104 people. Physical examinations were possible with the

help of the Peruvian Ministry of Health, Dr. Martin

Cabrera assigned to the medical health post in Kamisea,

and Dr. Mary Malca who, through Shell Oil, helped

transport and finance the protein samples procedures.

The goal of this part of the study was to compare

current physical health assessments to similar assess-

ments conducted by Jonathan Strongin in 1975 and

1977, Soto in 1977, Weiseke in 1965 and Jelliffe in 1966

(Strongin, 1982). The following sections explore the

relationship between objective/physical measures with

individual and societal indicators of health and well-

being.

ARTICLE IN PRESS

4Dutch Shell Oil restarted their gas operations in 1996.

C. Izquierdo / Social Science & Medicine 61 (2005) 767–783 771

Matsigenka cultural profile

The Matsigenka are an Arawakan speaking people

currently numbering between 10 and 12,000. They

inhabit the regions of the Urubamba River and its

tributaries, the Madre de Dios region, and Manu

National Park in Peru.3 The Matsigenka are a ‘‘family

level’’ society (Johnson, 2003) who, in the past, have

lived in scattered small nuclear family residences or

hamlets, subsisting on a combination of fishing, fora-

ging, and horticulture—primarily maize and manioc. In

recent decades, however, communities have been estab-

lished into permanent settlements under the direction of

the Summer Institute of Linguistics (Protestant mis-

sionaries), organized around government sponsored

bilingual schools and health posts. Currently, there are

approximately 20 Matsigenka communities in the Lower

Urubamba region.

The period before communities were settled was a

frightening one for the Matsigenka living in Urubamba

region. During the height of the slave trade that lasted

well into the 1950s, most fled with their families into the

headwaters of the Kamisea River and others into the

Picha and Parotori River. Still, many Matsigenka were

not so fortunate. Men and women were sold in exchange

for machetes and shotguns, while others, generally older

people, were killed mercilessly. The Matsigenka, who

have long had contact with missionaries, explorers and

rubber patrons, are now facing further change and

challenges as large international oil companies are

exploiting gas and oil reserves in the region. In the past

40 years, planned development, including the institutio-

nalization of Christianity, education and Western

healthcare, has introduced the Matsigenka to a wide

array of foreigners. Mestizos, government officials,

other indigenous groups and multinational corporate

personnel have all lived in their midst, challenging the

Matsigenka to reframe their expectations in regard to

their health and well-being in their present situation and

their future goals.

The pressure to change their culture and to ‘‘pro-

gress’’ as a group has provoked in the Matsigenka, a

legitimate fear about their future, identity and culture.

Developing a historical fear for outsiders, the Matsi-

genka have grown increasingly agitated about the chaos

and uncertainty that accompany the massive cultural

changes derived from new settlement patterns followed

by international development projects in their region.

Discussion by outsiders about the cultural conditions of

the Matsigenka is marked by little effort to facilitate an

authentic understanding or exchange with the indigen-

ous population. Rather, visitors, government personnel

and agents of the media promulgate a nearly universal

3For extensive research on the Matsigenka of Manu and

Madre de Dios region see Shepard (1998, 1999, 2002).

sentiment of disdain towards the nativos or ‘‘natives’’,

stressing the urgent need for cultural changes. The

cambio (change=progress) that settlers and government

representatives advocate is generally that of accultura-

tion, echoing similar notions expressed centuries earlier

by missionaries. The basic premise of acculturation is

outlined by Father Ferrero:

We are in Peru. We educate Peruvians. It is necessary

that all its members incorporate themselves through

uniformity in their ways and customs. If all Peruvians

were Machiguengas that go around wearing cusma

and painting themselves, us missionaries would not

take away their cusma or paint, or many other

things. But this is not what Peru is about, and these

are Peruvians, unless we want to have each tribe in

the jungle be an independent nation. What ever does

not fit well with the general spirit of the nation we are

obligated to substitute for that which is genuinely

Peruvian of the twentieth century not that of the first

century. Evangelization of these [tribes], imposes

upon us the obligation of also incorporating them

into the general population’s way of feeling, living,

work ethics and clothing of the entire Nation

(Ferrero, 1966, p. 203).

Although written 30 years ago, Ferrero’s ideas reflect

contemporary sentiments towards the Matsigenka. Edu-

cation is believed to be the answer to the social problems

of the Matsigenka, but cultural outsiders, in formulating

education for them have, instead, merely encapsulated

their own values about family size, work, and lifestyle.

Little exchange of values or culture seems likely for the

Matsigenka, who face strong pressure to comply with the

demands of economic development and the consequent

social, spiritual and cultural requirements.

Paradoxically, ongoing development, missionization

and ‘‘eco tours’’ require locals to re-frame, re-historicize

and, in many cases, sell cultural difference in order to

obtain financial and political assistance; simultaneously,

people are pushed to modernize, and thus, to relinquish

cultural difference. In such uni-directional global

economies, the Matsigenka are asked simultaneously

to develop a marketable collective, ‘‘traditional’’ self,

and be the victim of one’s self and one’s traditional

practices. Multinational corporations and state govern-

ments ask indigenous people to adopt ethnocentric First

World desires and empathy, while simultaneously

assuming their blame for a presumed inability or

unwillingness to develop (Izquierdo & Casey, 2004).

Today, multinational oil companies4 (Pluspetrol,

Argentina; Hunt Oil Company, USA; SK Corporation,

Currently Pluspetrol, Argentina; Hunt Oil Company, USA; SK

Corporation, Korea; Hidrocarburos Andinos, Argentina have

concession over the ‘‘Camisea Gas’’ project.

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783772

Korea; Hidrocarburos Andinos, Argentina) are carrying

out a multi-million dollar ‘‘Camisea Gas Project’’ in the

heart of Matsigenka territory. The impact of these

sudden changes has been directly felt in terms of

subsistence, demographics and social organization,

leading the Matsigenka to view many aspects of foreign

culture as having the potential to cause illness,

misfortune and social disruption. Local communities

export male laborers, leaving women and children

behind to manage gardens and to subsist on inadequate

supplies of fish and game.

Additionally, the Matsigenka of Kamisea5 find

themselves in an emerging pluralistic medical environ-

ment with new medical options at their disposal,

including Western health professionals and medicines

as well as traditional remedies and new types of healers.

The protestant evangelical church was instrumental in

stamping out the cultural influence of native shamans

through wholesale demonization of their practices.

Consequently, without shamans (seripigari) and with

accusations of sorcery (matsitagantsi) on the rise in

Kamisea, there are few alternatives for dealing with

illnesses (mantsigarintsi), illnesses which do not respond

(nor are they recognized) to the limited biomedical

treatment available; but the Matsigenka have found

creative, innovative remedies and spiritual symbols by

incorporating a new category of ‘‘curers’’ (itsimpokan-

tavagetira) into their ethnomedical system. Thus, a new

class of health professionals has emerged, one could

argue, to address this need for culturally informed illness

management: a social–spiritual expert, the curer. More

important perhaps is that curers provide the Matsigenka

with cultural validation of the idea that certain types of

distress are indeed quite serious and disabling. These

disturbances have to do both with an imbalance of the

body and societal disharmony and conflict. A clear

example of current social conflict is reflected in the fact

that in Matsigenka, culture sorcery was not prominent

before settlement, yet it has flourished in newly densely

settled communities as an expression of envy, especially

regarding newly introduced Western material goods and

a generalized fear of outsiders (for further discussion on

envy and sorcery, see Izquierdo & Johnson, 2004).

Violence and communal stress have also increased, as

discussed in the sections below.

Matsigenka physical health: a biomedical perspective

The health assessments discussed here include physi-

cal examinations, analyses of blood samples for

5This paper refers to the Matsigenka of the Lower Urubamba

Region. According to Shepard (1999, 2002), The Matsigenka of

Manu and Madre de Dios still rely on local seripigari or

shamans.

hemoglobin and serum proteins, and analyses of stool

samples in order to assess parasite burden.6 Medical

practitioners working in this area tested a random

sample of 104 individuals (out of the total population of

256 people). These data were then compared to a similar

study conducted 20 years previously with this commu-

nity by Strongin (1982) as well as to an even earlier

medical assessment conducted in 1968 (Weiseke, 1968;

Soto, 1982).

My 1998 census shows 45 households and 265

people living in Kamisea. In 1975, Strongin counted

23 households and 104 people. These figures show that

the Matsigenka are rapidly increasing in population

size, unlike other Amazonian societies that are heading

towards extinction. Significant change in family size

also occurred in 1975 from an average 5.4 individuals

per family as noted by Strongin to my 1998 census,

which shows average children per family as 5.1 children

per family (standard deviation 2.9) while the average

death rate was one person per family (standard

deviation 1.1). As shown in Table 5, for the years

1996–999 there were a total of eight deaths in Kamisea.

This figure does not take into account Matsigenka

coming from other communities who died (n ¼ 14)

while seeking treatment in Kamisea (Kamisea has the

only health post for four neighboring communities

(Izquierdo, 2001). Between 1997 and 1998 there were

17 births in Kamisea. I do not use mortality or

morbidity indices to describe the population, as there

is not reliable statistical data for the region. The health

post in Kamisea dates back only 3 years, clearly not long

enough to make claims about mortality rates over time

in such a way that a comparison would be possible, nor

do previous ethnographics offer a means of comparing

such data. I checked my statistics against numbers

reported by Kirigeti community (Kirigeti gathers

information from the rest of the communities and

submits it to the Ministry of Health) and found that

much of what had taken place in Kamisea went

unreported.

Tables 1–4 present the results of a biometric analysis

of the physical assessment of the Kamisea community,

see also Table 5 for a report on the deaths in Kamisea

Table 1 summarizes mean anthropometric data, Table 2

summarizes serum proteins and hemoglobin, Table 3

summarizes blood pressure, and Table 4 summarizes

parasite presence for 1968 and 1998. The changes in

mean values were then tested for statistical significance

according to t-test, p-values and w2: Fig. 1 provides a

visual representation summarizing the general trend for

this Matsigenka population.

6The values for females (height, weight, weight/height) in the

age category 0–4 is not available in the study by Strongin

(1982).

ARTICLE IN PRESS

Table 1

Statistical summary of anthropometric examinations by age groups in males and females

Measure age 1977 1999 T p

Women Men Women Men Women Men Women Men

Height

0–4 — 67.9 — 84.9 — 6.92 — 0.000***

5–14 121.4 114.1 122.6 119.0 0.32 1.53 0.751 0.144

15–19 147.0 148.8 143.8 151.6 �3.49 1.43 0.025* 0.227

20+ 145.4 157.2 145.3 151.4 �0.13 �3.21 0.901 0.004***

Weight

0–4 — 8.2 — 12.3 — 5.70 — 0.000***

5–14 26.2 22.4 26.3 24.6 0.03 1.44 0.978 0.166

15–19 51.9 47.4 45.6 50.7 �2.32 1.24 0.081 0.284

20+ 46.7 58.4 49.8 55.5 2.05 �1.86 0.051 0.077

Weight/height

0–4 — 0.12 — 0.14 — 5.02 — 0.001***

5–14 0.22 0.20 0.21 0.20 �0.80 0.48 0.433 0.641

15–19 0.35 0.31 0.32 0.33 �1.62 1.62 0.180 0.181

20+ 0.32 0.37 0.34 0.36 2.28 �0.56 0.032* 0.582

BMI

0–4 17.7 — 16.9 — �5.51 — 0.000*** —

5–14 17.2 17.8 17.1 16.9 �0.56 �1.29 0.582 0.214

15–19 21.4 24.0 22.0 22.1 0.72 �1.30 0.514 0.265

20+ 23.6 22.1 24.1 23.6 1.25 2.19 0.224 0.038*

7The installation of a well and faucets were the result of

negotiations between the Peruvian Ministry of Health and

Dutch Shell Oil, as compensation to Kamisea.8Although most researchers agree that protein intake among

Amazonian indigenous peoples is higher than minimum daily

requirements, childhood illnesses and parasites compromise

their nutritional status. Emilio Moran (1994) notes that no

C. Izquierdo / Social Science & Medicine 61 (2005) 767–783 773

Summary of physical examinations

Contrary to the Matsigenka’s reports of decreased

physical health, physical examinations show that in

1998, the population in Kamisea seemed to be in

significantly better physical health (according to biome-

dical standards only) than 20–30 years ago. For both

males and females, all proteins and the albumin to

globulin (AG) ratio were significantly higher in 1998

than in 1977. Hemoglobin was significantly higher in

1998 than in 1977, in 0–4-year-old and 5–14-year-old

females by about one point, moving them from low into

the normal range. Hemoglobin was also significantly

higher in 1988 than in 1977 for 0–4-year-old males by 1.2

points, moving them from low into the normal range.

Table 4 shows that people of all age combinations were

significantly less likely to have Trichuris trichiura,

Entamoeba histolytica and Strongyloides stercoralis in

1998 than in 1968.

These results appear to be due to better general

nutrition, fewer parasite infections, better hygiene, and

perhaps due to the introduction of Western care and

pharmaceuticals. Increased aerobic activity could also

help explain lower pulses for men in Kamisea in recent

years, which is congruent with men’s reports of having

to travel farther to hunt and cultivate gardens. Higher

levels of hemoglobin indicate better nutritional status.

We also see a significant decrease in parasites. One

reason for this may be that Kamisea has improved its

water supply, thanks to the installation of a large well 4

years ago, with faucets from which people now get their

drinking water.7 This is much better than previous

practices of drinking water from the contaminated

Urubamba River, which flows down from Cuzco. In

addition to the improved sanitation facilities, including

an expanded number of latrines and better management

of waste, the community has benefited from public

health education designed to prevent infectious and

parasitic disease in new settlements such as Kamisea.

Fewer parasites also result when there is better nutrition

accompanied with the appropriate medicines to treat

infections and parasites.

Earlier findings by Baksh in the Matsigenka commu-

nity of Camana show patterns similar to those in

Kamisea, i.e., children represent a population at risk for

malnutrition while adults, both female and male, are

significantly healthier, and at relative equal levels of

nutritional health (Baksh, 1984, 1985).8 These deficien-

ARTICLE IN PRESS

Table 2

Statistical summary of blood composition by age group in males and females

Measure 1977 1999 t p

Age Women Men Women Men Women Men Women Men

Hemoglobin

0–4 9.90 9.90 11.10 11.14 7.51 4.97 0.000*** 0.001***

5–14 11.20 11.00 12.20 11.42 4.81 1.56 0.000*** 0.135

15–19 12.60 12.80 12.20 12.66 �0.66 �0.20 0.547 0.849

20+ 12.60 13.90 12.00 13.80 1.63 �0.23 0.115 0.819

Protein

0–4 5.31 5.31 7.34 7.19 6.87 19.49 0.000*** 0.000***

5–14 5.76 5.67 7.58 7.63 12.90 15.40 0.000*** 0.000***

15–19 5.70 6.00 7.48 7.88 8.09 6.01 0.001*** 0.009***

20+ 6.15 6.30 7.38 7.42 11.85 9.75 0.000*** 0.000***

Albumin

0–4 2.21 2.21 4.99 4.69 11.22 32.89 0.000*** 0.000***

5–14 2.51 2.44 4.95 4.87 36.06 27.97 0.000*** 0.000***

15–19 2.46 2.59 4.88 4.75 20.91 11.15 0.000*** 0.002***

20+ 2.56 2.73 4.68 4.65 34.09 37.44 0.000*** 0.000***

Globulin

0–4 3.10 3.10 2.36 2.50 �3.99 �4.85 0.007*** 0.001***

5–14 3.25 3.23 2.61 2.76 �6.10 �6.51 0.000*** 0.000***

15–19 3.24 3.41 2.60 3.13 �4.05 �1.73 0.016** 0.183

20+ 3.59 3.57 2.70 2.77 �11.40 �9.62 0.000*** 0.000***

Albumin/Globulin

0–4 0.73 0.73 2.19 1.92 6.67 9.64 0.001*** 0.000***

5–14 0.80 0.82 1.94 1.78 16.10 21.02 0.000*** 0.000***

15–19 1.02 0.80 1.91 1.53 6.52 9.58 0.003*** 0.002***

20+ 0.78 0.78 1.77 1.70 18.20 21.24 0.000*** 0.000***

C. Izquierdo / Social Science & Medicine 61 (2005) 767–783774

cies were attributed mainly to permanent settlements

and culturally determined patterns of food distribution,

which placed women and children at risk for developing

protein–calorie malnutrition. Adults are generally heal-

thier, probably because they survive childhood illnesses

or are more robust; a less likely explanation is that

adults are consuming resources at the expense of the

children. Previous research in Kamisea also predicted

that population growth, permanence of settlement, and

the acquisition of shotguns for hunting, would put great

pressure on protein resources, and that the environment

would not provide adequate sources resulting in nutri-

tional deficiencies due to permanence and settlement

(Strongin, 1982).

(footnote continued)

survey has recorded signs of protein deficiencies among South

American Indians living in their native habitats. Researchers

find the nutritional status of Amazonian populations to be

generally good (Black et al., 1974; Chagnon & Hames, 1979;

Moran, 1981; Johnson & Behrens, 1982).

Historical and ethnographic sources from this region,

or of populations in similar situations, discuss the tragic

health consequences of initial contact with isolated

populations (Shepard, 1999; Lowenstein, 1971; Neel et

al., 1964; Jelliffe, Woodburn, Bennett, & Jelliffe,. 1962;

Steward & Faron, 1959). It is important to keep in mind

that while this current research reflects improvement of

Matsigenka physical health over the past 20–30 years,

these findings cannot be interpreted to mean that a

native population’s health improves with settlement, for

that would be an extremely dangerous extrapolation, as

there is no available data from which to reconstruct such

a hypothesis. Previous medical examinations were

conducted in Kamisea when this population was in the

process of settling into a community. Assuming that pre-

contact Matsigenka had arrived at some kind of

epidemiological state of balance, the introduction of

Western diseases and economics changed the scenario,

throwing equilibrium off and causing decimation and

weakness. We can therefore assume that when Strongin

conducted his study, this population was therefore

recovering from this demographic collapse and also

ARTICLE IN PRESS

Table 3

Statistical summary of blood pressure data by age group in males and females

Measure 1977 1999 t p

Age Women Men Women Men Women Men Women Men

Systolic

15–19* — 119.0 — 108.0 — �2.94 — 0.042*

20+ 118.9 117.6 98.1 102.7 �15.30 �9.93 0.000*** 0.000***

Diastolic

15–19 76.3 78.3 56.0 62.0 �8.29 �8.15 0.001*** 0.001***

20+ 76.3 78.1 59.6 61.8 �12.85 �10.42 0.000*** 0.000***

Pulse

15–19 80.0 81.0 72.8 85.2 �3.88 1.10 0.018** 0.334

20+ 79.0 74.0 72.5 69.9 �4.59 �2.50 0.000*** 0.021*

Table 4

Statistical summary of parasitological data by age group

Parasite Age (in yr) 1968 1998 w2 P-value

Etamoeba histolytica 1–5 9/31=29% 0/22=0% 7.69 .005 **

6–15 15/46= 32% 0/34=0% 13.65 .000 ***

16–45 28/74= 38% 0/36=0% 18.27 .000 ***

45+ 2/9=22% 0/9=0% 2.25 .13

Trichuris trichiura 1–5 22/31= 71% 2/22=9% 19.88 .000 ***

6–15 31/46= 67% 4/34=12% 24.58 .000 ***

16–45 32/74= 43% 3/36=8% 13.60 .000 ***

45+ 3/9=33% 3/9=33% .000 1.00

Strongyloides stercoralis 1–5 16/31=19% 0/22=0% 4.80 .028*

6–15 9/46=20% 0/34=0% 7.50 .006 **

16–45 9/74=72% 0/36=0% 4.77 .029 *

45+ 1/9=11% 0/9=0% 1.06 .304

Ascaris lumbricoides 1–5 21/31= 68% 15/22=68% .001 .973

6–15 29/46= 63% 18/34= 53% .823 .364

16–45 44/74= 59% 16/36= 44% 2.20 .138

45+ 6/9=67% 7/9=78% .277 .599

Table 5

Deaths in Kamisea 1996–1999

Name Age Biomedical diagnosis Matsigenka diagnosis

Rosita 2 Diarrhea; dehydration Weak baby

Ivan 7 Rabies Sorcery

Herlinda 8 Internal bleeding; fell from tree Fell from tree

Grimaldo 24 Complicated flu Flu

Humberto 31 Stomach infection; unknown Sorcery

Miguelina 52 Severe bronchitis Sorcery; family failed to care for her

Pedro 56 Internal bleeding; fell from roof Sorcery

Marina 58 Cancer Sorcery

C. Izquierdo / Social Science & Medicine 61 (2005) 767–783 775

ARTICLE IN PRESS

Fig. 1. Summary of changes in health and well-being over time.

C. Izquierdo / Social Science & Medicine 61 (2005) 767–783776

adapting to a new social setting and new kinds of

epidemiological stresses (Shepard, 1999, p. 288). In the

past thirty years, with changes in hygiene, cleaner water

and introduction of Western medicines, the population

has moved toward a new equilibrium in people’s

physical states.

Ironically, 20 years later, while basic resources and

food supply are not a threat to Matsigenka health and

well-being, the viability of their culture is clearly in

danger. This is reflected in significant individual and

social stressors, discussed in the section below.

Societal indicators of health and well-being

The Matsigenka define health and well-being differ-

ently compared to Western medical standards. The

Matsigenka have no word that directly translates into

English as ‘‘health’’, ‘‘well-being’’ or ‘‘wellness’’ or to the

equivalent in Spanish such as salud which directly

translates into health. For example, among the Matsi-

genka, to take care of one’s personal health is translated

as to ‘‘take care of one’s body’’ (aneginteigakerora

ashiegi avatsaegi), indicating the importance the Matsi-

genka give to cleanliness and purity of the body and the

home, which are themselves practices fundamental to

prevent illness and maintain health. The concept

shinetagantsi,9 which is most commonly translated as

happiness or becoming happy, embodies ideas and ideals

of what the Matsigenka consider the basic premise of a

good life, including what it means to be a healthy person

in a healthy society. According to Matsigenka values,

definitions of health and well-being are linked to ideals

9Shinetagantsi, an infinitive in the Matsigenka language, is

not used in ordinary speech but is accompanied by infix.

about happiness, which are, in themselves, embedded in

notions of productivity, goodness, and maintaining

harmony with their social, physical and spiritual

environment. The main themes underlying Matsigenka

perceptions of what it means to experience health and

well-being include having positive and nurturing inter-

personal social relations; providing for the family (being

skilled hunters, fishermen, weavers); sharing; controlling

anger, disputes and jealousy; being free of illness; and

great emphasis is placed on traditional ways and values

as symbols of goodness and happiness.

Societal stress is indexed by an overwhelming increase

in sorcery accusations (leading to extreme personal and

collective fear), increase in domestic violence and fear of

the future. Previous researchers working among the

Matsigenka of Kamisea, Camana, and Shimaa during

the 1970s and 1980s (Strongin, 1982; Baksh, 1984;

Johnson, 1978, 1982) concluded that sorcery hardly

existed a generation ago. Although Baksh mentions

some witchcraft incidences, such cases are for the most

part associated with a new schoolteacher in the

community, and he concludes that for the population

in Camana community, ‘‘witchcraft has not assumed a

role of social control through fear’’(1984, p. 393).

Sorcery and witchcraft accusation are absent from

Strongin’s description of Matsigenka cosmology and

illness etiology and diagnosis for the population of

Kamisea (1982). The Johnsons in the 1970s found that,

although people believed that sorcerers did exist, the

Matsigenka of Shimaa they did not refer to sorcery as an

explanation of illnesses and misfortune. Rather, they

explained such suffering as the result of encounters with

various forest spirits who inhabited the forest and rock

outcrops (Johnson, 2003).

Today, however, the Matsigenka say that sorcery is on

the rise and rapidly becoming a preoccupation. They

explain the rise in sorcery in terms of stress arising from

permanent settlement and untrustworthy outsiders. With

settlement came more outsiders, and they, in turn, brought

increased competition for resources (especially, Western

goods), and new and frightening diseases for which the

Matsigenka say there are no local cures, such as influenza,

measles and chicken pox. With sorcery accusations on the

rise, individuals and the community of Kamisea took

preventive measures, which essentially translated into

isolating the community from other Matsigenka commu-

nities. Kamisea used to enjoy celebratations (such as the

community’s anniversary or Peru’s independance) to

which other communities were invited for several days of

soccer and food. However, it has been decided that

Kamisea would celebrate it among themselves this time.

This, they argued in a public meeting, would minimize the

risk of anybody being hexed.10

10Several hexes had resulted from festivities in the previous

year (Izquierdo, 2001).

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783 777

During the course of my fieldwork, many stories

circulated in Kamisea predicting the end of the world.

These ‘‘end of the world stories’’ reflect increasing

uncertainty about cultural change and pressures. The

Matsigenka have grown increasingly agitated about the

chaos and uncertainty that accompany the massive

cultural changes they are experiencing, especially inter-

national development. Many of these apocalyptic

accounts reveal sentiments of doom and disaster and

were often linked to Biblical ‘proof’ that the end was

near and that the end of their way of life was, in fact, at

hand. (From my fieldnotes: 5–98) Monica (a 30-year-old

Matsigenka woman) told us that in other countries,

gigantic grasshoppers were eating the plants and the

people and that these grasshoppers could not be killed.

‘‘The wind will bring them here too and we will all die

and disappear,’’ she said. Then Luzmila (an older

Matsigenka woman) interjected that they had already

found a grasshopper in the vicinity of her house but they

were able to kill it. She went on to tell us that the

grasshoppers will ‘‘kill all our food and our people, this

is confirmed in the Bible’’. Soon after, Andres (a retired

Matsigenka school teacher) asked me if I could help him

learn English. Why? I asked. He explained that he had

heard news from down river that the ‘‘gringos’’ were

coming to kill anybody who didn’t speak English,

especially ‘‘old useless people like me’’. He had heard

that ‘‘the gringos would be more tolerant of young

women of reproductive age’’. Anxiety and uncertainty

lie at the heart of these thoughts. These fears encapsulate

realities of historical memory mixed with present day

realities that pose a serious threat for the Matsigenka

life-style, values, and well-being.

In addition to anxiety and fear of the future and these

stories reveal how the Matsigenka feel the sting of

imposed inferiority, being constantly reminded of their

need for ‘development’. It was striking to see the

Matsigenka adopt the language of progress, echoing

the acculturation sentiments of the settlers and visitors.

The pressure to change their culture and to progress as a

group provoked in the Matsigenka a legitimate fear

about their future, identity and culture. While the

benefits of economic ‘‘progress’’ are certainly evident

to the Matsigenka, many also recognized the high price

they would pay by becoming bedazzled by material

culture and their reliance upon it. Certain goods were

welcomed to facilitate their livelihood, such as clothing,

tools, machetes and shotguns. Other luxury items began

to flood their culture as well, including sunglasses and

cameras, and, no doubt, these quickly gained practical

importance. At the same time, such items differentiate

members of their society into prestige hierarchies that

have little connection to the former dynamics of social

status. In fact, community-based authority had histori-

cally been limited as family members operated autono-

mously and little formal leadership structure existed.

Now two parallel processes of settlement and develop-

ment create different markers of social status that are in

direct conflict. On the one hand, the official community

leaders grant authority to elected officials who devote

their efforts to managing and organizing labor for the

common good. On the other hand, some Matsigenka are

fast becoming wealthier than others, at least in their

display of prestige items and, more often, in the social

power they hold due to ownership of prized items such

as shotguns, power-tools, boats and generators.

As a group, the Matsigenka, living in relative isolation

with low population density, were able to survive

complete destruction in the past. They have been able

to offset the full impact of ideological and physical

violence endured in recent and previous times. They

described histories of knowledge that left spiritual,

emotional and physical ideas about themselves that

contrast sharply with mainstream Peruvian and mis-

sionary notions of identity, especially conflicting

identifications that result from new forms of religion.

The suffering and vulnerability that the Matsigenka

now experience may reflect a broader crisis of identity

and survival in the midst of sweeping social and

cultural changes brought on by regional development

and consequent settlement. Clearly, cultural changes

and pressures are disrupting Matsigenka feelings of

well-being and could, if not taken seriously, result in

the physical, emotional and spiritual decline of this

population.

Individual assessments of health and well-being: what

constitutes a good life?

We used to think it was good to have a nice, clean

house. We worked in the gardens, we made

thingsywe just livedylived. You lived with your

wife, without fighting, in peace. People came and

visited. Now it’s not enough. If a man wants a

woman he just tells her, ‘Look I have a watch’ or

‘look at my radio. I have all these things.’ But this is

deceit. When they live together, the man doesn’t even

give her good food. Before we didn’t deceive. We just

said, ‘Look, I’m a good hunter’ (Andres, an elderly

Matsigenka man).

During open-ended interviews, I asked questions such

as: ‘‘What kinds of things give you happiness, satisfac-

tion and enjoyment in your life? How does your present

situation compare to the past, and in turn, what is your

envisioned future like?’’ I wanted to understand the

goals that people had for themselves and their families in

order to contextualize what people were striving for and

to determine how satisfied they felt about their present

circumstances. My intent was to pose questions that

would elicit the Matsigenka’s ideal life course in the

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783778

present and the imagined future. I asked them how they

envisioned health and well-being in their bodies and

thoughts. In addition, I sought to explore how illness

threatened a person’s sense of ‘‘health’’, well-being and

happiness.

These questions, which I considered straightforward

enough, were quite the contrary for the Matsigenka.

While growing up in Chile and the US, I learned to

assess my own personal well-being and satisfaction

throughout my life as a matter of course. When I have

asked Americans questions such as: ‘‘What makes you

happy, gives your life meaning, or what sort of

experiences give you satisfaction?’’ people might ponder

for a moment but quickly give an answer, usually citing

personal activities (such as going to the gym, running,

getting massages, or taking baths), work-related activ-

ities, personal relationships, family, wealth and health.

The same questions when asked of the Matsigenka

elicited long blank stares. When I probed further with

the Matsigenka, I discovered that Matsigenka concepts

of happiness and well-being were, by and large, about

providing for their families, improving their skills in

order to become better hunters, fishermen and weavers,

and maintaining harmonious social relationships. Per-

sonal goals or activities were inconceivable.

When I insisted on getting their views on strictly

personal satisfaction, people mentioned playing soccer,

weaving, and making owiroki (manioc beer) as pleasur-

able activities. For example, Ramon, a 26-year-old

Matsigenka,11 told me that happiness for him was ‘‘to

plant in my garden, to support my family by fishing and

hunting.’’ Carlos, a 38-year-old man, said ‘‘I am happy

if my house is clean and I have clothes for my children.’’

They mentioned very specific needs, which would

enhance a sense of satisfaction for themselves and their

families. But ultimately, having a sense of well-being had

less to do with biological health and more to do with the

balance people sought to maintain with their physical

and spiritual environment, their families and community

in their daily lives.

The Matsigenka do not make a clear distinction in

their everyday practices between illnesses and states that

affect the body, the mind or their society: emotional,

social and physical well-being are all integral parts of

what constitutes a healthy life (Izquierdo, 2001; She-

pard, 1999). While the following sections explore

Matsigenka concepts of well-being and happiness as

separate themes, many of these ideas are only subsets of

one another and are highly interrelated. These themes

consist of interrelated issues mainly about keeping

harmonious interpersonal relations, keeping body and

society free of illness, and traditional views of produc-

tivity and happiness.

11All personal names have been kept confidential.

Keeping positive and nurturing interpersonal social

relations

Among the Matsigenka, one’s responsibility and

respect for family, and the maintenance of nurturing

relationships of support are central for achieving health

and well-being. In adulthood, the Matsigenka strive to

be good providers for their families, which includes

being skillful and hardworking (hunters, fishermen,

weavers), and maintaining clean bodies and clean

households. One must cultivate good family relations

by being social, by visiting and sharing (Johnson, 1978,

1980). An important condition for facilitating social

relationships lies in keeping a peaceful environment.

This is necessary so that each individual can practice

self-discipline and control his or her emotions, specifi-

cally aggressive emotions, which can lead to conflict and

violence. This way they benefit the group as a whole.

The Matsigenka will readily sacrifice their own personal

goals or stifle their own feelings for the sake of

appeasing family and community members.

A main concern for both men and women is their

ability to be productive and contribute to their house-

holds through productive labor. Eva, a 45-year-old

woman, recounted her worries since becoming ill:

Before, I was well. I was happy then, but I got sick in

my chest. Now I have to ask my children to work for

me, wash my clothes, and I wonder when I will be

able to wash my own clothes. Nobody washes my

blankets. My boys can’t wash them.12 When I am

well, I can work and I am happy with clean blankets

and clothes. I can help my children work. Also I can

make my owiroki [manioc beer]. To be well, you must

clean your house and keep your children clean also.

Among the Matsigenka, the immediate and extended

families offer the support necessary to experience well-

being. The Matsigenka believe that if they serve their

families and follow a strict code of behavior informed by

shared cultural values, as evidenced in personal sacrifices

in the everyday sharing of food and labor, then

happiness, health, and well-being will result.

Keeping body and society free of illness: outsiders bring

illness and conflict

About 40 years ago, the formation of communities

brought new social obligations and new social order, all

of which resulted in increased conflict, within the family

and among community members. Initially (after the

formation of the communities), members of other

indigenous groups such as Ashaninca and Piro were

the chief sources of sorcery accusations. In time,

12Washing clothes is a woman’s activity.

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783 779

however, the Matsigenka began accusing other Matsi-

genka from distant communities of being sorcerers

(matsikanari). More recently, sorcery accusations have

begun to occur within Matsigenka communities and

even within families (Izquierdo, 2001).

Amalia, a 28-year-old woman, recounted the follow-

ing events related to illnesses and the influence of

outsiders in the Kamisea region:

This year there are lots of illnesses. I spent lots of

time inside my house and didn’t go to my garden.

More illnesses are coming because Kashiriari [a Shell

gas plant] has gas and the air brings it to us. This year

we will not be happy. Suddenly we won’t live

anymore. So many people are dying. Before we lived

in peace. Before we didn’t have ‘‘la companıa’’ (Shell

Oil). Also their helicopter noise is bothersome. They

spill gas and the air then comes here with a bad smell.

Sometimes their workers come to Kamisea and get

drunk. They urinate and throw syphilis into our

community.

Although Amalia does not refer to the distant past,

she still has memories of a more peaceful life in

Kamisea. For Amalia, there are strong links between

climate, noise, pollution, Shell Oil, death and disease.

For these disturbances, particularly new illnesses, she

blames outsiders and oil companies. Ultimately, this

translated into a pervasive fear of external forces

threatening health and well-being within the community.

For Amalia, being happy and at peace were no longer

easily achieved because of the constant threat of new

and strange illnesses against which she felt powerless.

She felt a general deterioration of family values among

the younger generations. Eva, a woman in her 50’s, tells

of her fears for her family’s health and the vulnerability

she feels faced with unknown entities (sorcerers), current

vehicles for distrust and suffering. She states:

Now we have unknown illnesses like pain in the eyes

and it doesn’t go awayy maybe it’s coming from the

gas. Some kids have wounds and the gas penetrates in

there and in their bodies. Before we were healthier; now

there are many more illnesses. Sorcerers are coming

here and doing harm. Children drink and husbands

mistreat their wives. Before it wasn’t like that.

According to the Matsigenka, ideals of peaceful living

are now threatened. They report more households

experiencing violence between couples, more frequent

and intense drinking owiroki and hard liquor, a

deterioration of family discipline, laziness, more jealousy

and envy. At a personal and cultural level, sorcery

afflictions perpetuate blame and suspicion regarding the

intentions of outsiders and fellow Matsigenka. Biome-

dical definitions of health do not include the Matsigenka

concern with threats to health from outsiders. For the

Matsigenka, it is the social and individual context that

shape health-related values and behavior which, in turn,

set parameters for ideals about wellness. Historical,

ecological, cultural and economic forces embedded in

their particular environment determine illness and

health evaluations.

Traditional ways and values as symbols of goodness and

happiness

For the Matsigenka, questions about general health,

well-being and happiness usually evoked stories about

an idealized golden past. The ideals and quality of life

were recalled through the experience of much harsher

life circumstances. They remembered happier times

before slave raids and the pervasive outside influence

of missionaries, non-Matsigenka schoolteachers, and

outsiders in general; a time when illnesses were more

manageable and when shamans were available to treat

their suffering. Although older people remember the

days when they had to go into hiding from the slave

trade and life was uncertain and dangerous, they also

express new concerns—specifically that outsiders have

now brought new and more powerful illnesses for which

there is no local cure.

Carmelo is a lively and charismatic 50-year-old

Matsigenka man who wanted to hold on to his

traditional beliefs and practices but felt pressured by

outsiders to give up important Matsigenka values.

Carmelo told me of having to conceal his shamanic

training and eventually give it up because of missionary

pressure. He also described the negative influence of

schoolteachers on Matsigenka children in eroding

community values of goodness: obedience, hard work,

collaboration, trust and sharing: all basic premises for

the Matsigenka in order to experience of health and

well-being. According to Carmelo:

Before, we used to enjoy each other, not like the

parties they have now. The young people do these

parades and formal presentations [taught by school-

teachers]. They think of themselves as Mestizo. They

can’t even play drums. We used to get together,

dance and play drums and go to different houses

where they had owiroki, telling stories and laughing.

Children used to be obedient with their elders. Even

when boys were young, they had their gardens. They

weren’t lazy like they are now. People don’t even

want to collaborate in community work. Most

important of all, they do not know what it means

to share. Young men don’t want to learn how to use

a bow and arrow properly. They think they will be

able to buy shotguns.

The Matsigenka also express general confusion

regarding their cultural identity and their religious

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783780

identity in particular, due to missionary Christianization

and education. While missionaries and school officials

believed formal education to be the answer for the

Matsigenka, education was formulated by these out-

siders to encapsulate their own values about family size,

work, and lifestyle. As Carmelo adds:

When the missionaries came, they told us ‘now you

will repent before God’. I had no idea how to repent

so I just pretended to ask for forgiveness. They told

us that now that we were with God, we shouldn’t

drink owiroki or play drums or use our medicinal

plants. They told us not to sing. They said: ‘‘Your

songs are for the devil.’’

Carmelo’s views echo those of many other men and

women in Kamisea regarding the corrosive effects of

outsiders imparting a pervasive sense of shame in the

Matsigenka people. The Matsigenka described spiritual,

emotional and physical ideas about themselves that

contrasted sharply with mainstream Peruvian and

missionary notions of identity, especially conflicting

identifications that result from new forms of religion and

education.

Like Carmelo, Andres, an older Matsigenka man in

his 60’s, described the moral decline associated with

contact with white people:

When their wives get sick, the man should be there

caring for her, bringing her food, not like now. My

wife was sick and her sister didn’t even come and

visit. Before it was different. Now people go to the

cities and they want to be like city people and have

the things that they have. But if you don’t have a

good garden, how will you feed your wife? And if you

are a bad hunter, worse yet. Then your wife will ask

‘where is the turkey’? Because the woman can ask

for meat or her own manioc garden to make her

owiroki. Now there is a lot of sorcery from jealous

people that can make you sick. Before people weren’t

so jealous.

Both men and women emphasized behaviors that

contributed to peaceful living, like curbing anger and

encouraging autonomy. Men like Carmelo and Andres

spoke of tradition, respect, family support, the impor-

tance of sharing and curbing impulses such as fighting,

jealousy or stinginess, and the importance of providing

well for the family all fundamental elements necessary

for achieving some degree of well-being. The themes I

have discussed, maintaining harmonious interpersonal

relations, keeping the body and society free of illness,

and the importance of traditional views about happiness

and well-being are all interrelated notions and central to

Matsigenka conceptions of well-being.

Discussion and conclusions

This study examines foundational domains for the

research of well-being within a broad paradigm to

include physical, cognitive, emotional, social and

environmental dimensions. It is a multidimensional

model, with special attention paid to culturally sensitive

concepts of well-being. I argue that it is the environ-

mental/cultural contexts that influence expressions of all

components of well-being. However, if anthropologists,

under the banner of cultural relativism, seek to avoid the

issue of cross-cultural well-being, then we are effectively

ceding an important area of social scientific inquiry to

other disciplines such as psychology, medicine, and

public health. Anthropology, with its rich tradition of

ethnography and cultural comparison, may have some-

thing important to say about cross-cultural well-being,

in a way that can add to the discussions within other

social scientific disciplines.

This investigation represents a first step with a small

comparison sample that follows up a prior study

conducted in the same community soon after settlement

began. The research therefore provides a culturally

situated approach to understanding health and well-

being within families, across the life-cycle and as a

function of social and economic development. Matsi-

genka well-being is a holistic reflection of the biological,

environmental, social and psychological aspects of their

lives, in which culture plays an important role in shaping

expectations about future well-being and assessments of

threats to well-being.

Findings show that biomedical indicators of Matsi-

genka health status are but one of many useful

indicators in constructing a health assessment of the

Matsigenka. The different approaches to studying

‘‘health’’ used in this study provide the backdrop to

this paradoxical observation: objective/-etic indicators

of physical examinations and laboratory tests confirm

that Matsigenka physical health has significantly im-

proved during the past 20–30 years, yet subjective/-emic

and societal appraisals demonstrate a contradictory

picture, one that suggests that the Matsigenka feel sicker

and suffer more.

The Matsigenka are undergoing unprecedented cul-

ture change. They have moved from a scattered family-

based social organization to communities that integrate

outsiders and outside knowledge. The Matsigenka

report that their health and quality of life have

significantly deteriorated in the past years. They

attribute their sickness and suffering, by and large, to

sorcery. Formal education is further redefining notions

of cultural identity and aspirations for the Matsigenka.

As the opening quote for this paper reflects, the

Matsigenka feel that health personnel, schoolteachers

and missionaries all introduce new philosophies, beha-

viors and ideas which the Matsigenka are to incorporate

ARTICLE IN PRESSC. Izquierdo / Social Science & Medicine 61 (2005) 767–783 781

in their lives. The Matsigenka face strong pressure to

comply with the demands of economic development and

the consequent social and cultural requirements and are

of two minds about their identity and their allegiances.

Many of them have adopted religious Evangelical beliefs

and practices that contradict local theories of illness and

notions of religiosity. Taken together with other

concerns, distress and uncertainty over their present

and future well-being, reflects social fears and anxieties

over the nature of good and evil in the context of

cultural integration and sweeping changes in family roles

and values. They view these attitudes and behaviors as

evidence of cultural deterioration and as warnings that if

this trend continues, the Matsigenka will suffer even

more in the future.

Health is described as the ability to be physically

strong enough to work, hunt and fish, care for family

members, keep good social relations and maintain

malevolent spirits at bay. The pursuit of self-chosen

satisfactions or self-promotion is not a virtue that the

Matsigenka promote or cultivate. Individual desires are

subordinated to those of the larger collective in that

one’s responsibility and respect for family and the

maintenance of nurturing relationships is an essential

component of a good life. The immediate and extended

family offers fundamental support for the Matsigenka.

They believe that if they serve their families and follow a

strict code of behavior informed by shared cultural

values, then happiness and well-being will result. For the

Matsigenka, there is no historical experience of well-

being in isolation from family. Although difficult times

are constantly in their memories, nurturing of kin and

community ties had in the past always helped to restore

strength and to enhance health.

The Matsigenka are in the process of weaving cultural

and personal identities through practices that serve to

make sense of what is right and wrong, familiar and

strange, and what will serve the health and well-being of

their families and community. The current situation

threatens the Matsigenka’s social fabric and contributes

to fears about the ill intentions of others. It is these

experiences of change in psychosocial well-being,

encompassing the moral and spiritual realms of life,

that distress the Matsigenka today, and seem to

outweigh, in their views of life, any biomedical changes

during the same time period.

Acknowledgements

Generous funding from several institutions made this

research possible: Fulbright IIE; National Science

Foundation Dissertation Research Grant (SBR-

9707454) and the Anthropology Department at UCLA.

I am extremely thankful to Carole Browner, Arthur

Rubel, Allen, Orna Johnson, Thomas Weisner, Glenn

H. Shepard Jr., Linda Garro, Kevin Groark, Gery Ryan

and Amy Paugh for their helpful comments and

suggestions on earlier drafts. In Peru I am especially

thankful to Dr. Martin Cabrera, Dr. Mary Malca and

the Peruvian Ministry of Health. I wish to thank the

Matsigenka people for their generosity and friendship,

for treating me with unforgettable warmth and kindness.

I dedicate this paper to the memory of my advisor and

friend Arthur Rubel.

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