Work, Reproduction, and Health in Two Andean Communities

By Anne Larme, 1993.

Chapter 6 - Ethnomedical Interpretations of Symptoms and Illness

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As I began my year of illness follow-up visits with Cuyo Cuyo families, I soon realized there was a fundamental difference in the way my research subjects and I thought about symptoms and illnesses. Cuyo Cuyeños attributed identical respiratory symptoms to causes ranging from abrupt changes in temperature (such as a change in weather or altitude, or when the hot, sweaty body of a gold miner came into contact with the cold water of the cañu), to culturally-interpreted illnesses such as rayo (Sp./Qu., lightning sickness, caused by lightning in the yunka), or hap'iqasqa (Qu., soul capture). What superficially appeared to be the same symptoms were explained and categorized differently, depending upon their particular cause. Cuyo Cuyo medical treatments followed this same rationale. Respiratory symptoms thought to be caused by a temperature change, for example, would simply be treated with patent cold remedies purchased at a local store and dissolved in a hot mug of eucalyptus tea. Rayo or hap'iqasqa, however, would need an expensive ritual cure by a hampikuq.

Gradually it became clear to me why most Cuyo Cuyeños generally ignored the government clinic. It was not because of its cost. A cure by a hampikuq might cost ten times more than the government-subsidized cost of a consultation with a nurse or sanitario. Cuyo Cuyeños ignored the Puesto Sanitario because, while Western biomedicine was regarded to be effective in treating certain symptoms, its treatments were considered to be superficial and temporary. To Cuyo Cuyeños, only by dealing with the root cause of an illness can it truly be cured.

In this chapter I present ethnomedical interpretations of symptoms and illness in Cuyo Cuyo. I begin by briefly describing Cuyo Cuyo ethnomedical concepts. I then discuss Andean etiological categories as represented in Cuyo Cuyo illness follow-up data. Symptom causes are closely related to the types of work Cuyo Cuyeños perform, the Andean environment, and other aspects of life in Cuyo Cuyo, reflecting a concern for the human body in relation to its physical, social, and supernatural environments. The same seems to apply to a category of illnesses experienced only by women, reproductive illnesses. I demonstrate how the special emphasis placed on childbirth as a source of women's symptoms in Cuyo Cuyo is only partially explained by the physiological effects of childbirth.

Cuyo Cuyo Ethnomedicine

I have divided this discussion of Cuyo Cuyo ethnomedicine into sections for ease of comprehension. Yet ultimately I wish to convey the sense of interconnection and wholism between Andean ethnomedicine and its sociocultural and material contexts, as I observed it in everyday practice.

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The Centrality of Causation

The causes of illness, rather than their symptoms, are the central features of Cuyo Cuyo ethnomedicine. This is not to say that symptoms are unimportant. Andeans and Americans alike perceive and can communicate about headaches, muscle strain, and abdominal pain. My interview format, where I asked questions about symptoms based upon various body parts and organ systems, turned out to be an effective, systematic way to elicit information on causes in Cuyo Cuyo.

I was initially fairly ineffective at getting these symptoms and causes translated into Andean illness categories, however. I did not know the range of causes to ask about, and Cuyo Cuyeños were reluctant to share their "backward" ethnomedical beliefs with me. As field work progressed, however, I was gradually able to redirect my focus from Western categories to Andean ones and begin to understand Cuyo Cuyo symptoms on their own terms. As I did so, I added questions about Andean body concepts and causes to my list of follow-up questions, moving toward an emphasis on causation that became more apparent as the research progressed.

In Cuyo Cuyo, as the example in the beginning of this chapter represents, symptoms may be clues to illness causation. But there is considerable flexibility in determining cause and in grouping symptoms into illnesses, especially if symptoms persist. From experience, for example, Cuyo Cuyeños know that swellings are usually caused by wayras, and that rashes in women who have given birth are related to exposure to "heat" and "cold"¹ after childbirth. Yet, a symptom that might initially be interpreted as a simple gripe (Sp., cold, influenza) caused by exposure to cold temperatures may eventually be attributed to hap'iqasqa if the symptoms worsen or persist. Depending upon the course of an illness, symptoms may actually be superfluous to the meaning of the illness to Cuyo Cuyeños.

Curing in Cuyo Cuyo reflects this same rationale. Decisions about whether to treat at home or with a specialist are based upon the determined cause, as ascertained by family members. Cause varies according to type and persistence of symptoms and circumstances surrounding the initial illness episode. Mothers and wives generally treat illnesses determined to be of natural origin; a hampikuq treats illnesses of supernatural origin. Hampikuqs are also required if no cause can be determined by family members.

The initial visit to a hampikuq consists of a divination, usually with coca leaves. Using the position and appearance of the coca leaves as a guide, and according to information skillfully elicited from his client, a hampikuq determines the cause of the symptoms. This may have occurred as recently as a week prior to the visit, or forty years ago in the patient's childhood.

Cuyo Cuyeños also pay attention to the relief of immediate symptoms in their treatments. They often combine Andean treatments, patent remedies, pharmaceuticals, and treatments by hampikuqs and biomedical practitioners in their attempts to cure. In this way, they address a range of causes and symptoms. Andean remedies are thought to deal effectively with cause and some symptoms; biomedical treatments are considered to be effective for certain symptoms, but rarely root causes.

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Wayras: The Essence of Andean Ethnomedicine

Wayras (Qu., illness-bearing wind or air; mal viento in Spanish), comprise a category of illnesses that embody holistic notions of illness in the Andes. There are twelve to sixteen different types of wayras in Cuyo Cuyo, some only known to specialists. (They are described in detail in Appendix III.) Although I did not realize it until late in my field work, by studying the various wayras, one can quickly learn most of the key concepts of Cuyo Cuyo ethnomedicine. They represent the essence of Cuyo Cuyo ethnomedical knowledge about the physical, social, and cosmological environments, and about the relationship of humans, in both corporeal and spiritual terms, to these environments.

Wayras are thought to emanate from natural and supernatural elements in the Andean environment, such as rain, whirlwinds, rainbows, vapors, machu bones, and corpses. They travel about in the air, entering humans who allow themselves to become débil (Sp./Qu., weak, vulnerable) through experiencing hunger, cold, or negative emotions, or through being in the wrong place at the wrong time of day. Once inside the human body, these wayras create illnesses of varying symptoms. Cuyo Cuyeños mentioned specific wayras relatively infrequently in their symptom reports. However, it is clear that the strong focus on symptoms caused by "cold," "heat," wind, odors, smoke from clearing fields in the yunka, kerosene fumes, and other air or wind-borne causes of illness relates to implicit cultural knowledge about wayras. Wayras, intrinsic to the Cuyo Cuyo environment, are the principal cause of illness in Cuyo Cuyo.

Below I have grouped the various wayras according to specific cause. The importance of these causes will become evident later in my discussion of illness follow-up data.

Supernatural Forces -- machu wayra, limbu wayra, wich'u wayra, phaña wayra, chikchi wayra

"Cold," especially after a sudden temperature change or when combined with moisture -- sulla wayra, hupha wayra, ch'uñuq wayra

Other Weather Features such as rain, whirlwinds, rainbows, and vapors -- sulla wayra, muyu muyu wayra, k'uychi wayra, pasma wayra

Feared Locations -- machu wayra, limbu wayra

Times of the Day -- machu wayra, limbu wayra

Emotions -- muyu muyu wayra, mal de corazón wayra

Irregular Meal Times or Leftovers -- machu wayra, limbu wayra, muyu muyu wayra, hupha wayra, chukchu wayra, pilima wayra

Sleeping too much -- wich'u wayra

Contagion -- muyu muyu wayra, kuti kuti wayra

Illegitimate Pregnancy -- limbu wayra

Childbirth -- sulla wayra, ch'uñuq wayra

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Wayras also provide important information about Andean body concepts. For example, wayras enter the body through vulnerable openings such as the mouth, nose, vagina, and anus, especially if a person's body is in an unprotected state from being improperly dressed, hungry, asleep, angry, sad, fearful, cold, wet, or postpartum. In wayras, illness is conceived as either a natural force in the environment or as a willful entity. Both travel about the body and create symptoms by lodging in different body parts. Women seem more susceptible to wayras than men because they experience more negative emotions, have more orifices, and because they bear children.

In sum, through wayras we learn that the ultimate causes of illness in Cuyo Cuyo are thought to be forces in the natural and supernatural environments. These are seen to be closely intertwined and alternately nurturing and threatening to humans. Proximate causes of symptoms, however, are certain behaviors that make one débil, as well as the intrinsic debilidad (Sp./Qu., weakness, vulnerability) of some individuals.²

With this basic introduction to Cuyo Cuyo ethnomedicine through this key group of illnesses, I move on to discuss specific causes of illness in Cuyo Cuyo.

Causes Related to the Natural Environment

It is not surprising that "frío" (Sp., "cold") and "calor" (Sp., "heat"), the most immediate sensory features of the Andean environment, are used as the principal explanations for illness symptoms in Cuyo Cuyo. Daily, from morning to evening, Cuyo Cuyeños experience extreme temperature fluctuations in their unheated homes, as well as en route between their homes and worksites, and at their worksites. These include below-freezing temperatures, the heat of solar radiation and cooking fires, frequent rain, cold winds, fog, and cold water. Although Andeans are somewhat physiologically adapted to cold temperatures, temperature extremes cause them considerable discomfort, as represented by Andean ethnomedical beliefs. Their discomfort is magnified and embodied as Cuyo Cuyeños begin to worry about the deleterious effects of temperature extremes on their health.

"Heat" and "cold" are thought to enter parts of the body left unprotected by proper clothing, or, for example, if a person carelessly allows him or herself to get wet (by rain or sweat), and then cold. The "cold" or "heat" creates illness by traveling through the body and lodging in a specific body part. People are particularly susceptible to illness when subjected to sudden temperature changes, such as those caused by rapid changes of weather, by the sun disappearing behind a mountain ridge or cloud, by cold air hitting a warm body while riding on a truck, or by jumping out of a warm bed into the cold morning air.

Altitude and Perceived Health Risks

Altitudinal differences are conceived not in terms of actual altitude, but in terms of cambio de clima (Sp., climate/weather change). This is Cuyo Cuyeños' way of expressing the acclimatization to high altitude and cold they must undergo after long sojourns in the

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lowlands, or after any type of travel up and down (but primarily up) the mountain slopes. Travel to and from Ancoccala, the yunka, Madre de Dios, and Lima is therefore a frequent source of illness symptoms.

Health risks are also associated with these destinations, and with other altitudinal zones in which Cuyo Cuyeños carry out their work. Perceived risks in various work environments are illustrated in interview data from Puna Ayllu and Ura Ayllu adults. Puna Ayllinos stated that for reasons of climate, lifestyle, and economics, it was advantageous to live in both Puna Ayllu and Ancoccala. Puna Ayllu's major advantages were proximity to crops and healthy food, and because it was "home," that is, where they celebrated fiestas, had their permanent houses and most of their possessions, and where their children went to school. Puna Ayllu's major disadvantages were stated to be the "contaminated" air blowing up from the unhealthy lowlands and channeled through the narrow Cuyo Cuyo valley, and its lack of commercial opportunities.

Ancoccala's advantages included wide open spaces and pure healthy air, gold and commercial activities, and -- an observation mentioned by all the women -- the easy availability of dung for cooking fuel. The major disadvantage of Ancoccala was the distance from food crops. Several women also mentioned the cambio de clima involved in the move from Puna Ayllu to Ancoccala. They thought this made childbirth more dangerous, infant survival more tenuous, and older children more prone to illness, especially if they normally lived in Puna Ayllu.

The nearly equal advantages of Puna Ayllu and Ancoccala in Puna Ayllinos' perceptions reflects, perhaps, their historical roots in the high altitude puna. It is interesting to note that Puna Ayllinos initially participated in the Madre de Dios gold rush in the 1970s. But by the 1980s the majority had returned to their traditional gold mining site in Ancoccala (see Recharte 1990). Such was the case of six out of eight adult male heads of household interviewed in the Puna Ayllu sample. The reasons given were the health risks of the lowlands,³ the dangerous truck ride, the lack of healthy foods in Madre de Dios, the high costs of travel and subsistence in Madre de Dios, the long separations from their families, and the fact that Puna Ayllinos already had access to mines -- albeit less profitable ones -- in Ancoccala. Puna Ayllinos felt that the health and other advantages of Ancoccala far outweighed the risks of working in Madre de Dios, even though by working there they earned less money.

I asked Ura Ayllu men to compare life and health in Ura Ayllu, the yunka, and Madre de Dios. Some men had worked in all three sites during their lifetimes. Ura Ayllu was preferred by all because of its healthy climate, healthy foods, and because it was "home," despite what they perceived to be a lack of economic opportunities. The yunka was regarded to be generally unhealthy because of the hot climate, which interestingly did not prevent them from experiencing it as "cold." "Cold" was common in the yunka because it rained frequently, there were many rivers to cross, they had to stand in "cold" water to mine gold, and they sweated more due to the heat, which made them more susceptible to "cold" entering their bodies. The "cold" foods of the lowlands (fruits, vegetables, beans, fish) were perceived to clash with the "hot" climate and make them sick. They were also considered to be less nourishing than the chakra foods of Ura Ayllu. Other lowland hazards included insects, snakes, heavy vegetation that had to be cleared away with sharp machetes, and frequent, violent rainstorms that caused slippery trails and

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rayo. Finally, Ura Ayllinos had to contend with symptoms and illness caused by the cambio de clima upon their return to Ura Ayllu.

Ura Ayllu men were in unanimous agreement that Madre de Dios was unhealthy, but stated that they had to migrate there for economic reasons. The health hazards they listed were many: the dangerous truck ride; lack of nutritious foods; "heat" and "cold" as in the yunka; insects, snakes, and blood-sucking bats; tree clearing; assaults by robbers⁴; the frequency of serious illnesses, such as malaria, yellow fever, and anemia⁵ and illnesses caused by the cambio de clima upon their return.⁶ Nevertheless, there were ways to prevent these hazards, especially by eating well. Also, there were many places to get health care, including pharmacies and government clinics. And, unlike in Ura Ayllu, where they are constantly short of cash, in Madre de Dios they had the money to buy medications.

Women are thought to be more susceptible to illness in the lowlands than are men, and married women are thought to be more susceptible than unmarried women. Health reasons, in addition to economic and family reasons, in effect bar most married women from travel to the yunka and to Madre de Dios.

Perceptions of health and life in the lowlands will be explored in greater detail in Chapter 7.

Causes Related to The Supernatural Environment

Supernatural forces, both positive and negative, are another important cause of illness in Cuyo Cuyo. The Pachamama may "grab" and impound the soul or life force of a person (hap'iqasqa). This is a danger if a person displeases her by showing negative emotions, or if she has not been "paid" sufficiently, especially in distant agricultural or mining work sites. A person without the protection or strength of a soul is then d‚bil and susceptible to illness. Evil spirits are especially blamed for illness. This may happen directly, for example, as in machu wayra and limbu wayra when the evil spirits invade one's body. Or evil beings such as condenadus or saqra (represented by toads and snakes) may facilitate hap'iqasqa by frightening the soul out of a human, which may then be "grabbed" by the Pachamama. Evil spirits are especially dangerous when encountered at night or during the liminal hours of dusk and dawn when the world of the machus is appearing or disappearing, or when a person is far from home. When Cuyo Cuyeños travel to Madre de Dios they pray to local apus, in addition to the apus whose "jurisdictions" they will be entering in their travels and work. It is important for example,

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for miners to pray to the Apu Walla Walla, the highest peak on the way to Madre de Dios, to ensure their health and safety on the trip, and their health and success while mining gold.

Cuyo Cuyeños attempt to maintain reciprocal relations with the supernatural beings and to maintain harmony in their families and community in order to avoid being punished with bad health. Rituals to "pay" the spirits are performed both to prevent illness, and to assist in a cure if, despite their efforts, they become ill. But illness is seen as only one of a series of misfortunes that may befall persons who fail to maintain reciprocal relations with the supernatural beings, who displease them by unacceptable behaviors, or who are simply "careless" or débil, allowing the spirits to take advantage and sequester their souls.

Cuyo Cuyeños experience the natural/supernatural mountain environment as capricious. They understand themselves to be constantly vulnerable to illness and other misfortunes, including failures in agriculture and mining due to lack of rain. The malevolent attraction of spirits to human souls and the human vulnerability expressed by Andean ethnomedical concepts is interesting in light of the fragility of human life at high altitude.

Causes Related to the Social Environment

Harmonious relations within and among households are also essential to health in Cuyo Cuyo. This means cooperation and reciprocity in communal work, rituals, and fiestas, avoiding fights and wife-beating, and generally avoiding negative emotions. The social and supernatural realms are intertwined in Cuyo Cuyo illness etiology. The Pachamama is angered by social disharmony and the resulting negative emotions and may "grab" people as punishment. Crying, sighing, and gasping when sad, angry, or fearful, opens the body to wayras. In extreme cases, Cuyo Cuye¤os also blame sorcery -- evil spirits sent by other comuneros to harm them -- for illness. This is an additional reason to maintain harmonious relations with fellow comuneros. Other health problems resulting from social disharmony include injuries from fiesta fighting and from wife-beating. Anger might also cause a physical reaction, colerina (Sp./Qu., anger sickness, from the Spanish cólera, anger) which is caused when anger releases hayaqen (Qu., bile) into the body, creating stomachaches and headaches.

Illness and the Body

Despite multiple threats to individual health from the natural, supernatural, and social environments, illness is not inevitable. An extensive system of preventive behaviors in Cuyo Cuyo helps individuals to avoid illness by making themselves invulnerable to illness.

Debilidad: Ethnoanatomy and Vulnerability

Individuals in Cuyo Cuyo consider themselves to have both physical bodies and a soul or life force, called animu (Sp./Qu.). To be healthy, a person must have a physically healthy body with a strong, intact life force. Without the life force, a person may live for several years, but will slowly weaken and die. A healthy, intact life force is represented principally by a good supply of body fluids, including blood and semen, and by fat (see

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Bastien 1987). Conversely, a loss of these substances weakens a person's life force, making a person débil and sickly. For example, individuals who have lost blood through nosebleeds, accidents, menstruation, or childbirth are considered weaker and more vulnerable to illness than others. Drinking bat's blood or, more recently, injecting suero (Sp., intravenous solution, available even in Cuyo Cuyo's small dry goods stores), are methods Cuyo Cuyeños use to replace lost blood and strengthen the body. It is acknowledged, however, that the replacement "blood" will never be as strong as the original.

The value of fat in preventing debilidad is demonstrated by an emphasis on fat in diet, rituals, and personal appearance. Meat and fat, two of the nutritional elements most lacking in the Cuyo Cuyo diet, are considered to be nutritionally equivalent, and are regarded to be essential to a healthy diet. Cuyo Cuyeños recognize their importance by prescribing a diet of meat to cure certain illnesses and to restore women's strength after childbirth. Llama fat is added to potato soups for proper nutrition, and is offered to the apus and the Pachamama in the sirvisqa ritual. A fat woman is considered healthy, fertile, strong, and capable of hard work. A thin person of either gender is considered to be weak and sickly.⁷

The importance of body fluids is represented by other ethnomedical beliefs. Sexual intercourse is thought to weaken a man because he loses semen, an irreplaceable body fluid, each time he has intercourse. Children must not be allowed to cry, for, in addition to the danger of soul loss (uraña), they lose essential body fluids, which will make them débil as adults. Likewise, women are thought to be more débil than men because they cry more. Consumption of hot liquids, such as soups prepared with salt, and mates, helps to replace body fluids. These are essential to maintain human health. They are especially needed to balance the consumption of "dry" foods, such as rice and noodles, that are served as second courses (Sp., segundos) in Cuyo Cuyo. Without a proper balance, a person can become ill.⁸

Abundant body fluids and a strong life force mean that a person has a strong connection between his or her physical body and animu. The strength of this connection is thought to change over a lifetime. Some humans, despite their behaviors, are intrinsically weaker than others. For example, infants have a weak connection between body and soul. Their souls are easily dislodged with loud noises, bright lights, or brusque movements, following which they often sicken and die from uraña. Women also have a weak connection because they regularly lose blood. They are easily frightened and frequently become worried and sad. These emotions, along with crying, make them more susceptible to hap'iqasqa. Strength and vitality in both men and women peak just before marriage, after which hard work, childbirth, and sexual relations gradually weaken all adults. With age, humans become increasingly susceptible to illness as their life force weakens and they eventually die. Even the frugal and careful must in the course of everyday living deplete these vital fluids.

Food, drink, and coca of the proper qualities, and ingested at the proper times of day, also prevent debilidad and maintain health. For example, fruits, which are "cold,"

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must only be eaten at mid-day on sunny, warm days. Leftovers, even if they are only several hours old, are risky because they are "cold," possibly malogrado (Sp./Qu., spoiled), or because malevolent spirits may have entered them for a meal of their own. Hot liquids, as previously mentioned, are especially important to provide essential fluids to the body and to balance "dry" foods ingested with them. Meals and coca must be taken at regular intervals, both to provide fuerza (Sp., strength), and to protect oneself from hunger. This reduces the likelihood of either hap'iqasqa or wayras. Alcohol drinking, coca chewing, and cigarette smoking are essential components of ritual offerings to the supernatural beings. They help to maintain goodwill and reciprocity with the spirit world. Also, because these substances are considered to be "hot," they help to ward off "cold" when traveling or working in "cold" environments.

Certain activity schedules, in addition to regular meal times and coca breaks, are also essential for health maintenance. People ideally should be home from their subsistence work by dusk in order to avoid evil night spirits and wayras, and it is best not to leave the comunidad until the sun has risen over the valley rim, signaling that the human world has overtaken the night-time world of the machus. Exceptions are made during fiestas, rituals, night meetings, and the early morning qaray (Qu. or Aym.) work period, when comuneros are out in force. With proper precautions in these limited cases of exposure, illness can be prevented. A proper amount of sleep, meaning eight to ten hours, is also essential to maintain health. Losing sleep through fiestas, rituals, late night meetings, and truck rides can be risky. Balance is essential, however. People should not sleep too much, nor should they sleep during the daytime -- even when sick -- or they will become débil and vulnerable to attacks by malevolent forces.

An understanding of certain other body concepts is essential to understand how Cuyo Cuyeños prevent debilidad and vulnerability, and therefore maintain their health. These body concepts are: vulnerable "openings" in the body; the movement of illness within the body; organ displacement; and the physiological connection of mothers and infants.

Vulnerable Openings

Cuyo Cuyeños are careful to protect certain vulnerable openings in their bodies so that "cold," "heat," evil spirits, and wayras cannot enter. These include the nose, mouth, ears, and the head in general, the vagina, anus, and the lower back region in general, and the feet. Ch'ullus, felt hats, monteras, and chukus should be worn at all times, and blankets should be pulled over the head when sleeping at night. Warm clothing should cover the back and lower body, and care should be taken never to expose the lower body, even when bathing little children. Sandals and phulqus (Aym., hand-made llama-hide slippers) protect the soles of the feet; rubber boots protect the feet of Ancoccala miners. A full stomach prevents wayras from entering through the nose and mouth, especially in the dangerous pre-sunrise hours, and prevents hap'iqasqa when distant from home. Women are especially vulnerable to illness-causing forces entering their bodies because they must squat to urinate, and they have vaginas, an extra opening that men do not have. They are especially "open" to these dangerous forces during childbirth.

Movement of Illness Throughout the Body

Illness-bearing forces that enter the body through these openings move throughout the body by various means. "Cold," "heat," and some wayras move throughout the body by "hydraulic" forces (see Bastien 1987). Malevolent spirits and other wayras move

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through it by willfulness and spite. In both cases the forces situate themselves in various organs or areas of the body, creating the symptoms of illness. There is a limited time during which it is possible to cure illness by expelling these forces. Once the illness has moved deep inside to the intestinos (Sp., intestines, the word Quechua speakers use to describe deep inside the body), the illness becomes iritasqa (etymology uncertain) meaning deep-seated, chronic, and impossible to cure. In the early stages of this process, illnesses and impurities can be expelled from the body by working hard and sweating on a regular basis, which help to cleanse the body and maintain health. A proper balance is essential, however. Sweating can have negative effects if the wet garments are left on the body and allow "cold" to enter it. Because women generally perform less strenuous work and sweat less than men, they are thought to be more susceptible to illness, especially in unhealthy lowland climates.

Llucha: Organ Displacement

Another cause of illness is llucha (Qu., organ displacement), which damages organs or causes them to malfunction by pushing them out of their proper positions. Llucha occurs through abrupt movements or vibrations, such as a child jumping up and down, a woman jerking icchu grass out of the ground, work movements, or rough truck rides. Women seem to be more susceptible to llucha than men because of their inherent debilidad and because pregnancy and childbirth have loosened and damaged organs in their lower bodies.

In all cases where organs are affected -- by "cold" or "heat," by evil spirits lodging themselves in an organ, or by organ displacement -- illness symptoms may superficially disappear for a time, but might reappear months, or even years, later. This explains why the trauma of childbirth (the damaging of organs and the entrance of "cold" and "heat" into a woman's body after childbirth) might create symptoms in a woman years after parturition, and why symptoms related to organ displacement or a disconnection of body and soul that occurred early in life can reappear later in life. In other words, illness can lie "dormant" in the body for years, making it difficult to be sure that it has ever truly been cured. "Dormancy" thus becomes a handy causal explanation for chronic or recurring illness. These cases can only be divined and cured by a hampikuq.

Physiological Connection of Mothers and Infants

A final important concept in Cuyo Cuyo ethnoanatomy is the perceived physiological connection of mothers and infants. Because of this connection, guarding the health of fetuses, infants, and small children is a special responsibility of mothers that begins at conception and lasts through at least the age of seven. Mothers are blamed for larpa and uraña, for example, two illnesses of infants that can begin in the womb. Larpa (Aym.), a sickness that causes a baby to lose weight and die, originates when a pregnant woman sees a dead animal or human corpse. The causes of uraña, which has symptoms of diarrhea, fever, and crying, include loud noises experienced while in the womb, or the trauma of being born.

The symbiosis of mother and infant continues through weaning at 18 to 24 months. Mothers can pass larpa to babies through breast milk if they are larpa ñuñuyuq (Aym./Qu., breasts characterized by larpa), meaning that larpa is intrinsic to their breast milk. They can also pass frío (and therefore illness) to their babies through breast milk if they do not dress warmly enough or if they eat "cold" foods. To further illustrate this

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concept of symbiosis, one woman told me she treated her son's diarrhea by taking Terramycin herself, which was then passed to her infant as he nursed.

Infants and small children must be protected from uraña and "frío" by mothers and caretakers such as older siblings and grandmothers. They must not be handled roughly, disciplined harshly, nor allowed to cry, or they risk losing their souls and essential body fluids, factors that will make them débil as adults. They must also be protected from "frío" by clothing them in wool, by changing their wet rags and clothing without exposing them to cold temperatures, and by bathing them with sun-warmed water on sunny days, in a place shielded from the wind. Mothers often blame themselves or are blamed by others for causing their children's illnesses and deaths. This responsibility causes adult women considerable anxiety. Worry is heightened if the child is a son, if he or she is the only boy or only girl in the family, or if the father is away to Madre de Dios and cannot observe the circumstances of the illness and the genuine attempts to cure it. These special responsibilities gradually lessen until a child reaches the age of seven years. By this time a child's body and soul are perceived to be tightly connected. The child is finally fully "human" and able to function more independently.⁹

Summary of Ethnomedical Concepts

To summarize, the ethnomedical system of Cuyo Cuyo focuses on causation rather than symptoms. Causes center on the natural, supernatural, and social worlds, which in the Andes are closely intertwined. These ultimate causes of illness pose health risks to Cuyo Cuyeños in their daily lives and in their travels and work in various altitudinal zones where they grow crops, herd animals, and mine gold.

Illness is not inevitable, however, despite multiple environmental threats. Cuyo Cuyeños have an extensive preventive system aimed at mediating health risks by preventing debilidad. Another key to health, evident in both prevention and curing, is the maintenance of balance. The same element or behavior that is healthy -- whether it be food, sleep, work, sweating, or alcohol-drinking -- can become unhealthy if done to excess. Balance must also be maintained in the social and supernatural worlds through the maintenance of proper social relations, communal activities, and rituals, in order to avoid illness.

Despite their extensive attempts to prevent debilidad, and maintain balance and harmony in the universe, Cuyo Cuyeños are not always successful. And some individuals, especially women, young children, and the elderly, are intrinsically débil, and therefore are less successful at resisting illness-causing forces. Debilidad and the risk of illness also increase when Cuyo Cuyeños travel and work far from their homes. These factors are especially important in the health of Ura Ayllinos, who range farther from home than Puna Ayllinos to carry out their subsistence and mining work.

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Debilidad and lack of harmony and balance result in bodily symptoms and illness, the subject of the following section.

Cuyo Cuyo Symptomatology Data

Table 6.1 and Table 6.2 group the raw data from symptom reports by Cuyo Cuyo adults aged twenty and above into categories of perceived cause. I have restricted the sample to adults in this portion of my analysis to provide a more evenly matched sample between Ura Ayllu and Puna Ayllu. This, in addition to the use of time allocation activity categories, facilitates a comparison with time allocation data.¹⁰

Causes are tabulated according to number of times each cause was mentioned during data collection. If, for example, one symptom was reported to have three different causes, all three reports are listed on the table. Also, causes are listed per symptom report. The table includes repeated mentions, when a symptom persisted and the same causes were given in several different interviews. In cases where the informant said he/she did not know the cause, I have reconstructed the cause whenever possible from other data in the interview, such as the symptom or illness label, treatment, or prevention mode, using my knowledge of Cuyo Cuyo ethnomedicine. The category "Don't Know"/Por Sí No Más" (Sp., "for no reason at all," the way Cuyo Cuyeños express unknown cause) includes the cases where it was impossible to reconstruct the cause. Finally, there were a few cases (less than 5% of symptom reports) where causation data were not recorded. These have been omitted from the tables altogether.

The interviews from which symptomatology data are drawn are not strictly matched in terms of gender, age, community, season, and interview frequency. Due to migration, for example, fewer symptom reports were obtained for men than for women, and there are fewer data for Puna Ayllu than Ura Ayllu because visits were less frequent and because one Puna Ayllu family (K) had to be dropped from the study. Thus, comparisons between men and women and between Ura Ayllu and Puna must be made with caution. When I have made such comparisons, I have been careful to back my assertions with time allocation and ethnographic data. Symptomatology data, within the context of time allocation and ethnographic data, thus indicate the range of illnesses and their attributable causes in Cuyo Cuyo, whom they primarily affect, and their relative importance in the lives of Cuyo Cuyeños.

There is another facet to these data, however. In asking about symptoms in various body parts, I unwittingly but fortuitously ended up with more information than I expected. I not only learned about symptoms and illnesses in Cuyo Cuyo. I learned about the phenomenological experience of being a Cuyo Cuyo peasant, of daily performing strenuous agricultural and mining work and living in intimate relation to the Andean environment. The result is more than an account of illness. It embodies the experience of being a peasant in Cuyo Cuyo.

In the following section I discuss symptom causes in Cuyo Cuyo according to work-related causes, non-work-related causes, and causes related to pregnancy and childbirth, which, in the Cuyo Cuyo context, span the first two categories. This category

(pages 103-106: Table 6.1)

(page 107)

was created due to the unusual emphasis placed upon reproduction as a source of symptoms for women in Cuyo Cuyo.

Work-Related Causes

Cuyo Cuyeños perceive close linkages between the symptoms they experience and their work activities within the vertical Andean ecology. Causes of symptoms for men and women closely parallel the types and locations of the different work activities they perform. Like the work activities themselves, there is considerable overlap between genders and between the two communities. Other causes relate more specifically to men or to women, and to Ura Ayllu or Puna Ayllu.

Llank'ay

Symptoms related to agriculture illustrate the heavy toll the work of food production and processing takes on Cuyo Cuyeños' bodies. Consistent with time allocation and ethnographic data, 70.2% of these symptom causes were reported for women, reflecting their greater responsibility for agricultural tasks.

The most frequently reported complaints result from the carrying of heavy loads of seed, dung, and harvested produce. These are followed by aches and pains associated with long hours of repetitive movements with rawk'ana and wiri, and symptoms related to "heat" and "cold" in agricultural worksites. Most of these reports relate to "cold," not surprisingly, given the temperature and moisture extremes of Cuyo Cuyo's lands. Cuyo Cuyeños do not stay home or stop working when the weather changes. They proceed to work, simply taking off layers of clothing when they get hot, or donning bright sheets of green and blue plastic when it rains. Food processing by women in the windy, cold months is thought to create illness through exposure to the cold water of the ch'uñu- and qhaya-making processes.¹¹

Other symptoms related to agricultural work occur during travel to worksites, or are caused by wayras (especially machu wayra, caused by accidentally digging up machu bones in the chakra), injuries, hap'iqasqa brought on by anger and worry (especially in isolated worksites), by negative emotions (including worry over completing the work and quarrels over land ownership and with laborers), by wind, eating cold foods for lunch, smoke, dust, and by the smell of dung.

Unique to Ura Ayllu were complaints related to work in the yunka. These include the clash of the "hot" yunka climate with the "cold" yunka foods, insect bites and plant allergies, rayo, and the generic lowland health risk, anemia. Other complaints mentioned in relation to yunka work include walking long distances while carrying heavy loads, the danger of falling on muddy, slippery yunka trails, the strenuous movements necessary to clear jungle vegetation from worksites, the "hot" sun and frequent "cold" rains in the lowlands, and hap'iqasqa in isolated yunka lands.

(pages 108-110: Table 6.2)