Work, Reproduction, and Health in Two Andean Communities

By Anne Larme, 1993.

Chapter 6 - Ethnomedical Interpretations of Symptoms and Illness

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Causes related to mining almost solely affected men, and varied by location. In Ancoccala, the most frequently reported cause of symptoms was standing for hours at a time in the cold water of the cañu, often in the rain. This frequently results in reumatismo (Sp./Qu., rheumatism). Almost equal in importance are musculoskeletal complaints related to the strenuous movements of mining which include breaking down the walls of the cañus with heavy iron pikes, shoveling the gravelly soil into the rushing water of the cañu, and throwing large rocks to the side. Other causes of complaints include the walk to Ancoccala, the cambio de clima and cold temperatures of Ancoccala, the necessity of wearing heavy boots, and accidents with mining tools. One Puna Ayllu miner also reported residual effects from the years he had spent mining gold in the tropical climate of Madre de Dios.

Most day-to-day symptoms related to gold mining in the lowlands (both Madre de Dios and the yunka) were missed due to the Ura Ayllu men's lengthy migrations. Limited symptom data collected upon the men's return suggest that the strenuous physical movements of gold mining are, just as in Ancoccala, the principal hazards of mining in the lowlands. Causes unique to Madre de Dios and the yunka, however, include hap'iqasqa in distant mining zones and the cambio de clima upon the return trip. Lowland miners also must contend with the "hot" lowland sun and the "cold" water of cañus, the cold temperatures and roughness of the long truck ride to Madre de Dios, dietary changes, injuries (especially while clearing trees), cold and lack of sleep experienced during the all night rikch'asqa rituals performed prior to traveling, unexplained symptoms attributed to the general unhealthiness of the lowlands, the fatigue of long walks to their claims, anger with mining partners, and intestinal parasites. Ura Ayllu men reported symptoms caused by lowland gold mining for many months after their return.

Ethnographic data supplement the limited symptomatology data on Ura Ayllu miners. Sources include interviews with miners, stories about sick and dying miners in Madre de Dios that circulated in Cuyo Cuyo during the mining season, and data on 1987-88 deaths and illnesses attributed by Ura Ayllinos to lowland mining. These data reflect the real and imagined fears Cuyo Cuyeños have about lowland health hazards.

H1
H1 became seriously ill with fiebre amarilla (Sp., yellow fever) in February of 1987 while mining in Madre de Dios. He attributed his illness mainly to general debilidad, which started at age 21 when he lost a copious amount of blood from a nosebleed. The precipitating factor in Madre de Dios, however, was drinking a "cold" soft drink and not changing his sweaty clothes after playing soccer during the miners' regular Sunday gathering.

H1 was incapacitated and unable to work for one entire month. Initially he walked four hours to the nearest government health post where he received one treatment. Friends told him not to return, however, since "everyone that doctor saw died within three to four days."¹² He then treated himself by resting and taking herbal and patent remedies. A folk remedy administered by two hermanas Evangélicas (Sp., Evangelical Christian missionary

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"sisters") finally sacó el calor (Sp., removed the "heat"/fever) and cured him. By early April H1 was back at work, though still weak. It took him most of 1987 to regain his strength in Ura Ayllu, only to return again to Madre de Dios in January of 1988.

G3
G3, an unmarried man of 25 years of age, suffered a chronic illness throughout 1987. The symptoms were general weakness, lack of energy, sleepiness, loss of appetite, and pains and cramping in his stomach, legs, and other parts of his body. It was so debilitating that he had stayed home during the 1986-87 mining season. Between June and December of 1987 his illness was variously explained to be the result of laziness (Qu., qella onqoy¹³), due to the residual effects of a leg operation,¹⁴ the consequences of poor nutrition in Madre de Dios, as anemia, or as hap'iqasqa. In January of 1988, despite his health (and probably because of constant criticisms), he left again to mine gold in Madre de Dios.

Miguel, the A's Son-in-Law
Miguel returned to Ura Ayllu in May of 1987, suffering from fiebre amarilla, diagnosed by physicians at the health post in Madre de Dios. He did not bring medications home with him, saying that he could not afford them, so the A's treated him with aspirin and other patent remedies. At the end of July he died.

Nearly everyone I talked to in Ura Ayllu had been affected by the death, accident, or illness of a relative or friend, as a result of migration to Madre de Dios. E1's brother, for example, had died in a truck accident at the Walla Walla mountain pass. The brother of an Empresa official, who stayed home during the 1987-88 season due to anemia contracted in the previous year, died in early 1988.

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Unlike Puna Ayllu women, who occasionally assist in the lighter tasks of gold mining in Ancoccala, Ura Ayllu women rarely participate in gold mining. Some of the younger Ura Ayllinas, including E2 and I2, had traveled to Madre de Dios for a few years to cook and manage the camps of male relatives. Women are generally discouraged from migrating, however, due to fears about women's health in the hot lowland climate. Shortly before my fieldwork, D2's sister, defying community norms, had traveled to Madre de Dios and had died of anemia. Her case was frequently mentioned by women and men as an example of the consequences of female migration.

Ura Ayllu women's health is affected indirectly by migration to Madre de Dios, however. Worry, anger, and sadness felt by wives left behind caused many symptoms in Ura Ayllu women. They worry about their husbands' health on the dangerous trip to Madre de Dios and while they are mining; they worry about managing their overwhelming responsibilities alone, about their lack of money and whether or not they will receive the promised remittances from their husbands; and they worry about whether their husbands are living with other women in Madre de Dios, and about why their husbands are staying away for so long. They experience anger over being left with debts and no money to repay them, and over arguments with ayllu officials about their husbands' unfulfilled cargos. And, they are sometimes lonely, sad, and fearful about being left alone.

These negative emotions are magnified by the lack of communication between Madre de Dios and Cuyo Cuyo. There is no mail, telephone, or telegraph service in Cuyo Cuyo. The only means of communication are other miners who travel back and forth sporadically throughout the mining season, and occasional radio messages sent over highland radio stations. The stories about illnesses and deaths of Cuyo Cuyeños in Madre de Dios that circulate among Ura Ayllu women (and the few remaining men) throughout the mining season increase women's fears and worries about their husbands, brothers, and fathers. They have no way of verifying these rumors quickly since communication is nearly impossible.

Ruway

Health risks associated with herding and animal care include strenuous walking, climbing, and running to locate pastures and to chase after animals, the "heat" and "cold" of exposure to the elements while pasturing animals, and carrying heavy loads of icchu grass needed for guinea pig fodder. Ura Ayllinos are exposed to the special stresses of rayo and hap'iqasqa on the isolated cerros below Ura Ayllu where cows are kept.

Ninety-four percent of the symptom causes related to fuel collecting were reported by individuals from Ura Ayllu, reflecting the greater difficulty Ura Ayllinos have in obtaining cooking fuel. The principal source of symptoms is lifting and carrying heavy loads of wood, brush, grass, and dung. Other causes include "heat," "cold," and irregular meals while searching for fuel; frustration over the scarcity of dry fuel during the rainy season; and the jerking motion of pulling out icchu grass. For Ura Ayllinos there was the additional danger of contracting limbu wayra or hap'iqasqa while searching for fuel in isolated locations.

Meal preparation is a cause of symptoms primarily for women, reflecting their major responsibility for this task. The "heat" of the cooking fire was the most common complaint, followed by cuts and burns, back injuries from lifting heavy clay pots, and staying out late at night to bake bread in the community ovens. One Puna Ayllu man, who cooked for himself on visits to his home during the mining season, reported symptoms caused by inhaling kerosene fumes while cooking on a primus stove.

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Symptom causes related to laundry and housework ("personal hygiene" category in time allocation data) were reported only for women. Causes included coming into contact with "cold" water, repetitive movements, and rearranging sacks of stored produce.

Likewise, causes related to spinning and weaving were mentioned only for women. Puna Ayllu women had more complaints than Ura Ayllu women, reflecting the greater importance of herding, wool, and weaving in Puna Ayllu. Symptoms resulted from the strain of repetitive weaving movements on arms and shoulders and of bending over floor looms for long periods of time, as well as from the "heat" and "cold" of weaving in outdoor patios and in doorways.

Child care was primarily a source of symptoms for women (94.7% of reports). Anger, frustration, and worry over children's behavior and about their well-being were the primary complaints, followed by the physical strain of carrying babies. Other complaints related to breast-feeding. These included "frío" from getting up at night to breast-feed, and nipple bites.¹⁵

Symptoms related to house construction ("other home production" category) involved primarily the "frío" of working outdoors, especially in the rain, and strenuous work movements. Other complaints included injuries from tools and the sharp edges of slate used in house-building, worry over the successful sponsorship of an ayni house-raising, lost sleep at the rikch'asqa ritual, and machu wayra from encountering machu bones while digging the foundation. (See also symptoms related to ayni work below.)

Trabaju

Symptom causes related to wage labor, trading, and marketing were reported primarily for men (66.7%). This is consistent with time allocation data showing that men are the ones principally engaged in these activities. Puna Ayllinos reported more symptom causes than Ura Ayllinos (77.1%) although, as with time allocation data, this may reflect aspects of the non-random sample more than actual differences between the two communities. Many of the symptom causes in this category relate to travel, either walking to the cordillera commercial town of Oriental or riding by cargo truck to the cordillera, Juliaca, and Lima. The O's, who ran a food stall at the Oriental market during the mining season, traveled weekly to Oriental. This involved an arduous six to eight hour uphill trek carrying loads on their backs through all types of weather, or waiting for one or two days at the Puna Ayllu truck stop exposed to the elements. Exposure to wayras is another risk of travel to the cordillera. R1 made regular trips by truck to Lima to purchase goods for resale in Cuyo Cuyo. He became ill nearly every time he traveled, and it often took him days to recuperate after his return to Puna Ayllu. Truck travel is considered hazardous due to the rough ride which may cause organ displacement, temperature extremes and altitude

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changes (cambio de clima), lack of sleep, irregular and unhealthy meals, and the ever-present danger of accidents.

Other health problems related to wage labor and commercial activities were caused by the working conditions of the manual jobs available to Cuyo Cuyeños -- strenuous work movements, construction dust, injuries, working with wet, cold stucco, and long hours searching for jobs. Dietary changes and the truck travel involved in relocation to the city were other problems. For example, M1, an experienced health promoter and elementary school teacher in Puna Ayllu, gave a poignant litany of complaints one day when I encountered him dejected over his inability to find a professional level job in the city. His lower back and abdomen hurt from the frío and vibrations of frequent truck rides between Puna Ayllu and Juliaca necessary in his search for jobs; his shoulders ached from carrying bags of cement in a construction job; gases from a welding job caused his eyes to burn; wearing heavy shoes with heels¹⁶ and walking all over the city in search of work made his feet sore; and, he had mal de corazón (Sp./Qu., heart sickness) from worrying over his inability to find work and about family finances.

Community Work

Causes related to community band participation, mandatory meetings and fiesta participation, other ayni, faena, and cargo work, and compadrazgo obligations are included in this category.¹⁷ So important are these activities to Cuyo Cuyeños, that they often risk illness in order to fulfill their obligations to the community. Both men's and women's health is affected, reflecting the important roles of each in community work.

Men complained of symptoms resulting from playing instruments in the community bands for hours and days at a time, first practicing and then playing for the fiestas themselves. These included sore lips, sore arms from holding the instruments, and frío from staying out late in the cold night air. Beer and alcohol drinking during mandatory rituals, fiestas, and meetings caused Cuyo Cuyeños various problems, including stomach pains, falls, and injuries. Late night events in general caused "cold"-related problems. The heavy physical work of ayni and faena was a problem for both men and women (muscle pains and injuries), as was the frío experienced during this work. Problems mentioned only by women included "heat" from ayni cooking obligations, worry over cargo responsibilities, and lack of sleep during the Yanasi¹⁸ in Ura Ayllu.

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Other Work-Related Causes

Cuyo Cuyeños often talked about symptoms related to work in general terms, without linking them to specific work activities. Walking and climbing while performing daily activities accounts for most of these reports, followed by "hard work" in general (meaning hard, physical labor) and the lifting and carrying of heavy loads. Finally, symptoms were occasionally blamed on the opposite of strenuous work -- laziness and inactivity.

Non-Work-Related Causes

I now depart from the time allocation categories to discuss non-work-related causes of symptoms and illnesses that emerged from the symptomatology data.

Environmental -- General

Environmental factors not directly related to work tasks were mentioned a total of 180 times by Cuyo Cuyeños. Clearly environmental factors, especially "cold" and "heat," are catch-all categories of explanation in Cuyo Cuyo. "Cold" and "heat"-caused symptoms occurred, for example, when getting out of bed or washing in the early morning, while walking, or while sitting in one's patio at mid-day. Other environmental causes included getting wet (and therefore "cold"), the effects of wind and smoke blowing up from the lowlands, wayras in general, seasonal temperature changes, bright sunlight, and suru (Aym., snow blindness) when it snowed in Ancoccala.

Food, Drink, and Coca -- General

The ingestion of food, drink, and coca is of vital concern to Cuyo Cuyeños, as represented by symptom causes. Most complaints relate to qualities of foods: "hot" or "cold" (whether in temperature or intrinsic nature), spicy, greasy, dry, hard, dirty, or "old" (leftovers). Quantity (too much or too little) is another concern, as is the regularity of meal times, because proper meals prevent debilidad. Sweet mate and candy were blamed for caries and intestinal parasites. Coca chewing was cited as another cause of symptoms.¹⁹

Negative Emotions -- General

Causes related to negative emotions in general -- anger, worry and sadness²⁰ -- were reported more frequently for women (83%) than for men. Women's complaints in this category outnumber men's complaints even in Puna Ayllu, where most men were present for the entire year. Thus, symptomatology, ethnomedical, and ethnographic data

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concur that in Cuyo Cuyo women suffer more often than men from the health consequences of negative emotions.

Anger (cólera), usually with one's spouse but also with other relatives or comuneros, was the most frequent type of negative emotion. This was followed by worry (Sp.,/Qu., preocupación) about the death or behavior of family members and about family finances, among others. Symptoms were also caused by sadness (Sp., pena; Qu., llakikuy), especially over deaths and other problems in the family. Finally, one husband reported that his wife's symptoms were caused by her chronically unpleasant disposition.

Supernatural -- General

Included in this category are causes of hap'iqasqa, wayras, and dañu unrelated to work. Symptoms caused by hap'iqasqa, which usually occurs after a person becomes vulnerable through negative emotions, were reported primarily for women (12 reports compared with three for men). Wayra was cited in ten symptom reports. Six of these were caused by machu wayra, regarded to be a common hazard in the in Cuyo Cuyo area due to the large numbers of prehispanic graves. Finally, dañu was considered as a last resort explanation for three cases of illness.

Rituals/Fiestas -- General

According to symptom reports, attendance at fiestas and rituals is a health risk for Cuyo Cuyeños. The most common complaints related to the effects of drinking alcohol, either directly, through stomach upsets and headaches, or indirectly, through accidents, such as falls, and fights. Other symptom causes related to cold temperatures and lost sleep due to all-night fiestas and rituals.

Accidents/Injuries -- General

Causes in this category included truck accidents (resulting in injuries or uraña) and injuries resulting from activities such as bicycle-riding or soccer-playing.

Domestic violence was the most frequently mentioned cause of injuries in the symptomatology data. Wife-beating often, but not always, occurs after men have been drinking at fiestas or rituals. Two Ura Ayllu women blamed symptoms ranging from chronic backaches, to headaches and abdominal pains, on beatings they had received from their husbands. No Puna Ayllu women mentioned beatings as a source of symptoms during the year of data collection.

Health histories and other interviews with women in the sample, however, suggest that domestic violence is a more serious problem in Cuyo Cuyo than symptomatology data represent. According to these data, five women in the Ura Ayllu sample and one in the Puna Ayllu sample had experienced domestic violence at some point in their married lives. During 1987, stories also circulated in Cuyo Cuyo about men beating their wives to excess. Two women, one in Ura Ayllu and one in Puna Ayllu, were rumored to have been murdered by their husbands. These data complement the picture of domestic violence obtained through symptomatology data.

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Seferina²¹
Seferina's husband consistently beat her after he had been drinking, although recently it had not been as bad as earlier in the marriage. She joked about her husband's violence, yet complained that it had caused the miscarriage of her second pregnancy and her subsequent inability to bear children. In addition, she attributed the chronic headaches and backaches she reported throughout 1987-88 to previous incidents of wife-beating.

Edelmira
Edelmira's husband traveled to Madre de Dios for the 1987-88 mining season, leaving her with the responsibility of obtaining materials and hiring workers to finish the interior of their new house, as well as maintaining the chakras, and taking care of their small daughter. She was lonely and afraid living in her large new house, which was located on the cold, windy pampa, separate from the main community.

Her unmarried compadre began to live with her, which she explained to me as an exchange: She was afraid to live alone, and needed help with her work; he needed a place to live, as he was single and an orphan. As comuneros suspected, however, Edelmira and her compadre were having an affair, which could not be hidden after she became visibly pregnant. The compadre left the community in May of 1987, leaving Edelmira to contend with her husband alone.

Her husband did not return until August, when she was five months pregnant. Several months of violent arguments ensued. Edelmira suffered beatings from her husband, in addition to headaches, hap'iqasqa, and other problems caused by the emotional upheaval. By January of 1988 when the baby was born, Edelmira and her husband had reached a partial peace, and he again left for Madre de Dios.

Pedro
Pedro was one of the poorest comuneros in Ura Ayllu. He and his wife had little land, did not own their own home, although they had been married for more than ten years, and Pedro did not have a mining claim in Madre de Dios. In 1987-88, Pedro and his wife were under considerable economic strain because they were trying to amass materials to build a house. In addition, all of the goods Pedro had purchased in Juliaca on his return from the 1985-86 mining season had been stolen from the truck while he was waiting to travel at the marketplace truck stop. Before he left for Madre de Dios in November of 1986, he and his wife had a vehement argument over family finances, and he struck her. She was six months pregnant at the time.

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Sebastian
Sebastian had a history of wife-beating, with repeated offenses that neither marriage padrinos, nor relatives, nor civil authorities -- nor anthropologists²² -- could control. In July of 1987 he and his wife traveled to his chakras in the yunka. This was a rare occurence; married women in Ura Ayllu do not usually travel to the lowlands. In a few days, Sebastian returned, alone. He stated that his wife had died during a severe coughing fit,²³ and that he had had to bury her there because he was too far away to bring her body home for autopsy and burial. Rumors began to circulate that he had murdered her, but comuneros felt powerless to take action. One woman stated that even if he hadn't murdered her, she probably died from llakikuy due to all his beatings.

Fortunata
Although it was rumored that Fortunata's husband had beaten his first wife to death, she married him after she became a widow, and they combined their two families into one. Favoritism for his own children over hers, however, caused the couple considerable tension, in addition to his generally belligerent behavior after drinking.

When we conducted the health history interview with Fortunata in January of 1987, she was alone at her home in Ancoccala. She gave a teary description of her husband's constant beatings, and complained of chronic back pain and other health problems which she attributed to them. During the rest of the year she did not mention wife-beating, possibly because her husband was treating her well, or -- more likely -- because her husband was present during most of the interviews and she felt intimidated. In June of 1988, I and my research assistant became compadres of Fortunata and her husband at the birth their daughter. This move, in retrospect, might be interpreted as an attempt by Fortunata to protect herself from her husband.

By early 1988, relations between Fortunata and her husband had again reached a crisis. Fortunata was desperately publicizing her husband's brutality in any way she could, in order to obtain support and protect herself. She had enlisted her male relatives to reprimand him; she had placed a demanda (Sp., official complaint) against her husband with the Guardia Civil, using a handful of hair he had pulled out as evidence; she had had a hampikuq divine with coca that their ten year old daughter suffered from hap'iqasqa as punishment by the Pachamama for their constant

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arguments; and she had brazenly told my research assistant the details of her husband's violence in the presence of her husband.

Bernaldina
In July of 1987, a Puna Ayllu man claimed that his wife, Bernaldina, had accidentally fallen over a cliff and died on the way to Puna Ayllu from Ancoccala. The couple had a history of violence, and it was also rumored that Bernaldina's father-in-law had perpetrated incest with her. Comuneros had observed the couple arguing in Ancoccala earlier in the day. Bernaldina's relatives were positive that she had been murdered, and began to fight for vindication. They initially proposed a bargain to the man and his family: They would not press charges if the husband returned all of the lands that Bernaldina had brought to the marriage.²⁴ This proposal was not accepted. Bernaldina's family sought justice at the District level to no avail, and concluded that the District officials had been bribed. At the time of my departure nearly a year later, Bernaldina's family was seeking justice at the provincial level and expending large sums of money to do so, but still had not been vindicated.

These examples make it clear that many women in Cuyo Cuyo have reason to be afraid of their husbands. Tensions with husbands are also reflected in women's emotion-related illness symptoms. Marital problems and domestic violence are undoubtedly a source of considerable stress for women in Cuyo Cuyo. Violence against women is condoned to a certain extent; women have less physical strength than men and cannot physically defend themselves; and they are economically dependent upon husbands. Women find it difficult to separate from abusive husbands due to their family responsibilities, and because alternative economic and social roles are unavailable to them in present-day Peru. For these and other reasons, despite domestic violence, Cuyo Cuyo women tend to stay with their husbands.

Clothing -- General

Causes related to clothing were reported only in Ura Ayllu. Most complaints resulted from the "cold" experienced by Ura Ayllu women when they changed from typical Cuyo Cuyo dress to the short-skirted chola dress. Men reported discomfort to their feet from the rubbing of sandal straps and from going barefoot. The number of symptoms related to clothing reflects its importance as a means of adaptation to the cold mountain environment, as well as its social and cultural significance in Cuyo Cuyo.

Clothing-related symptoms in Ura Ayllu seem to be related to the stresses placed on Ura Ayllu women by intensified social and economic change, including male migration.

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Ura Ayllu women are sometimes encouraged by their miner husbands to change their dress, but they are generally reluctant, citing health reasons. Two Ura Ayllu women, B2 and I2, suffered symptoms when they changed to chola dress in 1987. Another woman, G2, reported that she had worn polleras for six years as a young married woman, but changed back to Cuyo Cuyo dress after she realized her health was being damaged. In 1987, nearly twenty years later, she suffered from chronic headaches which she attributed to the clothing change.

Other
Men in particular mentioned age as a factor in illness (90% of reports refer to men). They complained that age limited their abilities to work. When they attempted to work, unlike in their younger years, they frequently developed health problems, such as lower back pain. Age-related complaints in men refer to physical trauma and organ damage/displacement in the lower back region after years of hard physical labor. They also relate to the Andean concept of increasing debilidad as a man loses body fluids through years of sweat-producing work and sexual relations.

Dental caries are a bothersome problem in Cuyo Cuyo. Dental care is unavailable, so Cuyo Cuyeños endure toothaches until either their teeth decay and fall out or they can be pulled out by hand. This problem begins in childhood. Most elderly Cuyo Cuyeños have few remaining teeth.

Other miscellaneous causes of symptoms mentioned by respondents included lack of sleep, the residual effects of serious illnesses and operations, contagion, eye infections, and kerosene lamplight.

Pregnancy and Childbirth-Related Causes

Cuyo Cuyeños frequently attributed married women's symptoms to the short and long-term effects of pregnancy and childbirth. This category of causation, as I will demonstrate, overlaps both "work-related" and "non-work-related" symptoms. For this reason, and because Cuyo Cuyeños themselves place a special emphasis upon them, I have given reproduction-related causes a separate category in this analysis.

Short Term Effects of Pregnancy and Childbirth

Women generally did not volunteer information about reproductive events during my symptomatology interviews because, among other reasons, these physiological events are not medicalized in Cuyo Cuyo. Because I was interested in the effects of pregnancy and childbirth on women's health and work lives, however, whenever possible I included questions about them in my interviews. Three women in the Puna Ayllu sample and six in the Ura Ayllu sample experienced pregnancy and childbirth during the period of my research.²⁵

Pregnant women reported abdominal pain, fatigue, difficulty carrying loads and performing work movements, nausea, swelling and itching of feet and hands, and negative

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effects from breathing the fumes of kerosene wick-lamps.²⁶ After giving birth, complaints included soreness and bleeding. Most of the women in the sample who gave birth in 1987-88 had normal pregnancies and childbirths and were soon back to their normal functioning in household and community.

Pregnancy and childbirth in Cuyo Cuyo can sometimes be physically and emotionally traumatic, however. Thirteen out of the twenty women in the sample had had at least one abnormal experience. Excerpts from their reproductive histories, and accounts of problem pregnancies and births from symptomatology interview data, provide additional information about the experience of reproduction and its effects on Cuyo Cuyo women.

D2
D2 had a miscarriage three months into her second pregnancy. After this she was unable to bear more children.

E2
E2's first baby was born with larpa, which she described as a thick tongue, strange crying, and slow motor development. The larpa was caused when E2 saw a dead cat during her pregnancy. The baby eventually died at age one and one-half years from larpa, combined with diarrhea and scabies.

During E2's second childbirth, the placenta would not deliver, and they had to call the sanitario for help. In order to prevent larpa, E2 regularly bathed her second baby with special herbs. During E2's third childbirth, her labor was not progressing and they again called the sanitaria. By the time the sanitaria arrived, however, a healthy baby had been born.

F2
F2's second child, a boy, was born in the hills below Ura Ayllu when she went to check the cow and couldn't get home in time to give birth. She was alone and went inside a cave. The boy died at one month of age from uraña suffered "from the emptiness and isolation of the hills" (Qu., ch'usaq orqokunamanta).

F2's third child, a boy, was "born dead"²⁷ because the heat and fire from cooking had "cooked the child in her belly" (Qu., phutirqun wiksapi wawata) while she was pregnant. He was born black in color and "burning" with heat.

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In June of 1987, a three week old son died from machu wayra that had entered her body when she was three months pregnant. She and F1 had gone to Sikuya to cultivate corn, and on the way back it began to rain. They sought refuge in a cave, which happened to have some prehispanic mummy burials. A machu bone entered the fetus and eventually made it swell up and die three weeks after birth.

G2
G2 was all alone when her fourth child was born. Because no one was there to assist her, she said, the neonate died shortly after birth.

H2
H2 gave birth to fraternal twins in February of 1987. The female twin was "born dead."

J2
When J2's second to last son was born, the contractions started three weeks too early because she had been working too hard in the chakra that day. She walked to the health post in Cuyo Cuyo to get an injection from the sanitario to stop the contractions, but they only got worse. On the way back to Ura Ayllu from Cuyo Cuyo, she gave birth on the road, but everything turned out well.

L2
L2's second and fifth pregnancies resulted in miscarriages, she said, because she had been carrying heavy loads.

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M2
M2's first pregnancy caused a lot of pain because the fetus was in the wrong position. Her aunt, a Puna Ayllu midwife, was able to change the position with a massage and thus relieve the pressure. Her legs were also extremely swollen for the last three months of this pregnancy.

N2
N2 had had three miscarriages. Two were caused by carrying heavy loads of dung for fertilizer, and one was caused by a burro kicking her in the belly.

O2
O2 lost her balance and fell off of an agricultural terrace while working in the fields when she was nine months pregnant. The child, her only son, was born without complications, but the fall caused him to be retarded. The fall also caused her to become sterile.

Q2
One of Q2's sons was "born dead."

S2
When S2's first son was born, she was returning on her own from the family's herding hut in Awi Awi, where she had been caring for their llamas and alpacas. The contractions came so fast that she could not make it home, so he was born on the road near Muña Cruz. After recovering sufficiently, S2 picked him up and walked home, a distance of two to three kilometers. During both of S2's pregnancies her entire body swelled up and she was very uncomfortable.

T2
T2 bled a lot during the last three months of her 1987 pregnancy. Her brother, L1, said that T2 always had difficulty giving birth. The family expected her to die this time, especially since she was already 44 and too old to easily give birth. The May 1987 birth went smoothly, but the baby died of gripe (Sp., respiratory problems) within three weeks.

Long-Term Effects of Childbirth

By far the majority of causes blamed on reproduction, however, were considered to be a result of long-term residual effects of childbirth, due to improper care during and after giving birth. Eighteen out of twenty women in the sample, including several beyond reproductive age, reported such complaints. The number of reports was nearly equal in the two communities, 25 for Ura Ayllu and 26 for Puna Ayllu. Reproduction-related symptoms were grouped into a set of folk illnesses called madre onqoy, sobreparto, and sopla, terms that describe both the cause of the symptoms and the illnesses themselves.

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Curious about why so many women attributed health problems to childbirth, some as many as twenty or thirty years later, I posed this question one day to my female research assistant. She responded, "After giving birth, a woman's body is completely malogrado (Sp./Qu., spoiled, ruined, malfunctioning), just like after a truck accident." This blunt analogy aptly describes the physical stress and serious health risks Cuyo Cuyo women perceive pregnancy and childbirth to cause them.

But there is obviously more to the explanation. The emphasis women place on the long-term health effects of reproduction seems to far exceed the physiological effects of childbearing itself. This suggests that reproductive symptoms and illnesses express and embody broader issues in the lives of Cuyo Cuyo women.

To explore these issues, in Chapter 7 I return to the broader context of women's lives within Cuyo Cuyo's present social and economic transformation. This will enable a more detailed analysis of reproductive symptoms and illnesses in Chapter 8.