Interpreting Symptoms and Locating Causality

Jampiris and yachajs symbolically interpret symptoms of Chagas’ disease and refer to natural deities that have hidden power over our bodies (an apt image for T. cruzi ). They rarely refer to disease entities, instead referring mostly to symptoms, which they reinterpret for specific purposes such as to perform a ritual, redress a conflict, or produce a male offspring. Chagas’ disease lends itself to multiple interpretations because of its unclear and varied symptomology, being difficult to diagnose even clinically without laboratory tests by doctors.

After the Bolivian national Chagas’ campaign began in 1991, educational programs educated the rural peasantry concerning the danger of Chagas’ disease and its parasitic cycle relating to vinchuca bugs. Reeducation campaigns strongly push for the destruction of vinchucas by insecticides and housing improvement. Problems exist. Although not publicly endorsed, the insecticide DDT is used. Housing improvement generally is too expensive for poor peasants. Motivation also is low because the relationship of parasites to vectors and hosts is incomprehensible to many peasants, who find it difficult to connect Chagas’ disease to a bug bite years before. (On the other hand, malaria offers little problem in that regard, with its rapid attacks following infection.)

A concern of biomedical ethics is to what degree Western scientists should impose their medical paradigms upon natives and disrupt their cultural systems of dealing with infirmities. Western scientists claim a privileged sense of truth in regard to health questions, but Andeans prefer not to see Chagas’ disease in terms of “biological warfare” or “us versus them.” In the rich biota of the Andes and Amazon, insects play a vital role, and, as any camba (lowlander) will tell you, “the ant is the king of the jungle, and one has to respect them and learn to live with them.”

Jampiris and yachajs are little concerned with clinical definitions of Chagas’ disease, fearing that such classifications relegate the discourse to doctors. They recognize the loss of their patients to medical doctors, and only rarely do doctors refer patients to curanderos. Moreover, Jampiris and yachajs fear that doctors could prohibit their practices. Jampiris and yachajs also do not refer patients with Chagas’ disease to doctors, because doctors and drugs are expensive and they cannot cure Chagas’ chronic forms. Doctors, however, can learn from jampiris and yachajs how to better diagnose the symptoms of Chagas’ disease, something which has potential for the disease’s prevention (see Chapter 10).

Jampiris andyachajs always consult coca leaves to interpret the symptoms of Chagas’ disease. Some examples of how jampiris and yachajs interpret the symptoms of Chagas’ disease follow. An enlarged heart is particularly meaningful to them as chuyma usu (heart sickness), possibly caused by a death, unrequited love, slapping a mother‑in‑law, or indigestion. Kallawaya diviners throw and “read” coca leaves to uncover hidden causes for chuyma usu. A simple parasitic explanation does not satisfy Andeans’ desires for semiotically rich interpretations of ailments. Inability to swallow might refer to fears and anxieties over some bad deed or, as a worse scenario, that the sufferer told a devastating tale. For typhoid fever, as another example, the coca leaves once read that I was the cause because I had given sugar to a neighbor who was an enemy of the family with whom I lived (Bastien 1978).

Empacho has all sorts of possible explanations connected to cutting oneself off from the nutritive fluids or sustenance of the environment. It is corrected by sharing a meal with the earth shrinesfor example, burning coca, llama fat, and guinea‑pig blood in the sacred sites that are spread throughout the ayllu (community). The symptoms of Chagas’ disease, diffuse as they are, are read much as one would play a hand of cardsthat is, according to what is needed at the time.

Kallawaya herbalists recommend enemas and purgatives to cure empacho, fievre, and chuyma usu, which are symptoms of Chagas’ disease but which they understand as a malfunctioning of the body’s hydraulic system rather than the intrusion of a parasite. Kallawayas conceptualize the body as a skeletal‑muscular framework with openings, conduits, and processing organs. Fluids enter and are processed into other fluids. Poisons that develop from distillation must be periodically eliminated before they attain toxic levels. Illness is caused by obstructed tubes and accumulated fluids, gas, urine, feces, mucus, and sweat. Therapeutically, Kallawayas employ enemas, emetics, and sweat baths to cleanse the body of these fluids.

^{Figure 11.}

^{Kallawaya ethnophysiology.}

According to their ethnophysiology, megasyndromes of the esophagus, colon, and heart are interpreted by Bolivian peasants as caused by the accumulation of fluids and need to cured by emetics and purges. Megasyndromes are interpreted as the congestion of distillation processes of the chuyma the internal organs. Frequently, the only complaint of peasants stricken with T. cruzi is chuyma usu, “ my heart is sick,” quite literally, “I have a congested heart” (as well as other internal organs). The widespread practice of emetics and purges in Andean medicine for the last thousand years results from dealing with the congestions of Chagas’ disease (heart, colon, and esophageal blockages). For this reason, peasants most readily associate Chagas’ disease with empacho meaning their bodily fluids no longer circulate from within the body to the outside but are locked into a centripetal movement. In educating Andeans about Chagas’ disease, a comparison can be made with the parasitic relationship of T. cruzi to triatomines, animals, and humans in that this microorganism flows in and out of the body in what could be called centripetal and centrifugal motion.