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Bolivia promotes intercultural medicine

LA PAZ, Bolivia - The year-old Bolivian government of Evo Morales is attempting a monumental task - transforming more than 500 years of views about health.

''With the Incas, Bolivia was known as Kollasuyu,'' said Dr. Jaime Zalles, vice minister of Traditional Medicine and Interculturality. '''Kolla' means plant, and Kollasuyu was the land of medicinal plants. Now we are the lowest-ranking country in South America in health standards.

''Why? Because the elders, the healers, were called witches by the conquistador doctors, at the same time they were burning witches in Europe. And the traditional healer also profoundly rejected the Spanish doctors. So there was mutual exclusion.''

The Bolivian government, with support from health professionals and Native organizations, intends to change that by building an intercultural model that integrates traditional indigenous healing practices with Western medicine.

''After 514 years,'' Zalles said, ''we need to reverse the mutual exclusion and begin to work together.''

Bolivia has several different indigenous nations, each with its own traditional healing practices. In the Andean tradition, for example, the medical system has included jampiris, who are experts with coca leaves in determining the appropriate time for healing; aysiris, who balance the ''small spirit'' of the individual and his environment with the ''big spirit'' of the cosmos; layqa, who can perceive the good and bad the person is receiving from Mother Earth; qhaqojkunas, who work with massage and pressure points; yatiri, who teach the deeper philosophy of life; kallawayas, itinerant plant healers; and qpachhaqueras, who are in charge of caring for and preparing medicinal plants.

Each culture has held onto its traditions with varying degrees of success, Zalles said.

The introduction of packaged foods has also had an effect on the overall health of Bolivia's Native people. ''Now people want to eat 'white food,''' he said. ''White rice, white pasta, white flour, white sugar.

''We have to go back to the roots, eat what the grandfathers ate. They were stronger.''

Zalles' ministry, which was created last year by the Morales government, has several projects planned or already in operation: a census of traditional healers to find out who they are, where they are and how willing they are to work with Western doctors; a law that will protect and regulate traditional healers; training programs in traditional medicine; a CD of 100 medical plants and their uses; and a plan to abolish all childhood malnutrition by the year 2010.

Morales' government has also imported 700 Cuban doctors who hold a high reputation in South America for their expertise in Western medicine to provide free treatment to patients in 180 rural municipalities throughout Bolivia.

Last August, 300 traditional healers, Western health professionals and representatives from Native organizations and nongovernmental organizations met for three days to discuss how to implement Bolivia's new intercultural health model. Suggestions included an indigenous university, a Native-only Congress of Traditional Medicine, the creation of a National Council of Native Healers and the export of traditional plant medicines. Existing intercultural hospitals in Ecuador and Chile were examined as models to learn from.

Bringing two very different medical philosophies together is not without its challenges.

One representative asked, ''What kind of training do they want to give us? Each traditional healer has a gift; we can't all be traditional healers. Each healer receives the inheritance from their ancestors, through being struck by lightning. This gift is given to each person who is able to be a healer. As much knowledge as a person may get from studying plants, he won't have this gift. As far as accreditation, how can a traditional healer have accreditation? The accreditation of a traditional healer is achieved when he receives the gift of his ancestors.''

Another challenge involves the lack of camaraderie between traditional and Western doctors, Zalles said.

Patients who have told Western doctors they have been treated by traditional healers have sometimes been refused treatment. Some traditional healers will not treat a patient who has begun treatment with a Western doctor.

For Zalles, practitioners of the two systems need to develop mutual respect for one another and they need to be ''mutually independent.''

''If one can't treat you, you go to the other. What you can't do is mix them together. The language of each one is different; the relationship is different.''

Zalles compared the ideal relationship between one system of medical knowledge and the other to the relationship between the sexes.

''Each sex is different, but they have to have the same rights, the same opportunities. They can have a respectful relationship between them. Accepting ourselves as different, we can negotiate how to resolve health problems. That is interculturality.''