The town of Otavalo, just two hours from Quito, is a place where Ecuador’s indigenous Andean population has thrived for thousands of years. The Quichua indígenas (indigenous people) in Otavalo make up a large proportion of the city’s population and although many still live in poverty, the socio-economic status of the community is high compared with that of other indigenous groups. They are known for their weaving and crafts and the market in Otavalo attracts streams of tourists at weekends.
One of the biggest challenges for indigenous groups in Ecuador is healthcare: the government system is not only limited but ignores the needs of a community who have their own complex and ancient medical system. Founded in 1994, the Jambi Huasi Clinic in Otavalo has pioneered a new wave of attempts to integrate western and traditional medicine. The Quichua system operates on the idea of harmony: balance between mind and body, hot and cold, and the self and the environment. The clinic offers a range of options: upstairs is a young western doctor, Dr Nadia Montero, fresh from medical school in Quito. Next door an Andean doctor, Dr Patricio, primarily trained in Quichua medicine and who now incorporates western knowledge into his practice. And in a number of other smaller rooms, the parteras (midwives) carry out traditional healing methods. Finally, in a darkened room on the ground floor behind a door that looks much the same as the others, is Juan Perugachi, the yachac or shaman.
The two main cleansing methods
involve a raw egg and a live guinea-pig.
Señora Angelita, an indigenous woman in her 60s, is one of the parteras. She sees patients in a clean, bare room upstairs in the clinic. Here, using a mixture of indigenous and western medicine, she monitors pregnancies and assists with deliveries. She even performs what is known in western medical terms as external cephalic version (ECV), the practice of turning a baby around inside the mother’s womb. ECV is performed when a term baby is positioned bottom rather than head-first and would in a matter of days result in a breech delivery. Turning the baby is dangerous even with the assistance of modern medical technology as the baby’s umbilical cord can get tangled. But the parteras are well trained. Jambi Huasi clinic is unique in this way, with its parteras trained in both western and indigenous medicine. A course is run in a local town called Cotacachi and it was there that señora Angelita completed her training eight years ago.
As well as training in western obstetrics Angelita learnt how to perform Quichua diagnoses and treatments. Now, in between managing pregnancies, she heals minor ailments using massages and herbs, and diagnoses and treats more severe illness by cleansing the patient of mal aire (bad air or energy). The two main cleansing methods are limpia huevo – cleansing with a raw egg – and limpia cuy – cleansing using a live guinea-pig.
The white and brown guinea-pig is used only for diagnosis, while a black one is used for healing as well. The Quichua believe that the guinea pig, which resembles a human internally, can absorb the mal aire from a patient. The point at which it absorbs the energy is the point at which it dies. Once open, any pathology inside reflects the pathology in the patient. “The cuy can even diagnose cancer,” Señora Angelita tells me. “It can tell how long someone with a terminal illness will live.”
At a certain point it was clear to me
that the guinea-pig had died.
On my second morning at the clinic another partera, Juana Perugachi, let me sit in on one of these sessions. Perugachi wears the indigenous Quichua dress: a green panama, swathes of gold beads enveloping her breast, a large white shirt and a long skirt made of a complicated system of linen and wool sheets. The language she speaks is Quichua (or Kichwa), descended, like the Quichua people, from the more southern Quechua populations of Peru and Bolivia.
Her patient, a young girl of fifteen brought in by her mother, was also Quichua but was dressed in jeans and a sweater. She had had a fever and headache for eight days straight. They entered the room and her mother handed over a squealing guinea-pig. Juana Perugachi told the girl to take off her sweater in order to carry out the cleansing. Holding the guinea-pig around the neck she began to shake it all over the young girl’s body. The girl stood with her shoulders hunched, disgust on her face as the screaming guinea pig was rubbed over her head, shoulders, back and stomach. At a certain point it was clear to me that the guinea-pig had died. The squealing stopped first, but it was still alive, and then its eyes appeared wide and black. Soft western sensibilities took hold and I felt just as unsettled as the teenage girl in front of me.
Juana Perugachi left the dead guinea-pig on the floor next to a metal bowl, and picked up two eggs for the limpia huevo. She shook the eggs in the same manner over the girl, chanting incantations and then cracked them into a metal dish. We peered over her shoulder as she pointed out the signs of mal aire in the white and yolk. They looked to me like two very normal eggs.
She turned back to the guinea-pig, lying discarded on the floor. Squatting down she held it over the metal bowl, and made a small incision under its chin. Then, as if peeling a banana, she unzipped it down the middle and slid the pelt from the body. Taking each foot in turn she detached the skin with her knife and, after examining it for mal aire, laid the coat in the bowl with the fur upwards like a luxurious bed. The guinea pig was surprisingly small without its coat, and quite rat-like apart from a bulging iridescent belly. It looked like a skeleton covered in a shiny purple-grey skin, pregnant with intestines.
The guts poured out onto the royal bed of fur,
and I started to feel a bit sick.
Slicing open the guts, they poured out onto the royal bed of fur, and I started to feel a bit sick. Then she ran a knife down the sternum and opened the chest to reveal the heart, a small red anemone. The mother and the partera examined the chest cavity, then the liver and kidneys, then turned to the grey wormy guts in the bowl. Nothing there. They examined its small pink testicles. Still nothing. Then the mother pointed out mal aire on the guinea-pig’s knees. “No, those are just knees” replied Perugachi.
The head was examined, followed by the neck. She found blood. “Do you have pain there?” “Yes” said the mother, “yes” from the daughter. I stayed quiet, thinking of the partera’s grip as she shook the animal. Perugachi gave some advice in Quichua; it seemed little could be concluded about the girl’s illness. The eggs appeared to be more helpful.
The last few years have seen a steep rise in Western interest in the Jambi Huasi clinic. Some, like myself, have been volunteers interested in the cultural phenomena from hopefully quite an objective perspective. Others come here seeking serious alternatives to western medicine: during my time here, a number of American tourists have come to have a guinea-pig cleanse themselves.
One American woman arrived at the clinic heavily pregnant. She had come to Ecuador for a natural birth delivered solely by the indigenous midwives. The medical team were left with a dilemma: under normal circumstances they would have carried out prenatal medical tests and prepared drugs and equipment in case of emergency. But the woman refused western intervention of any sort. The doctors were faced with delivering a baby in developing world conditions to a patient with western standards of medical duty of care. They were at a loss as to how to proceed. The birth ultimately went ahead without problems, but only after the doctors had coaxed her into agreeing to accept emergency care should she need it.
The rise in western interest in traditional medicine puts doctors and healers in a difficult position. What rules apply? If a patient refuses the recommended treatment, who is responsible if it all goes wrong? Such patients bring unforeseen new challenges to the Jambi Huasi clinic.