Concientización : Education

Sensano educated peasants by trying to change their perceptions so that they felt that they could do something about their impoverished conditions. In Bolivia and elsewhere, peasants often have a fatalistic attitude that discourages them from trying to improve their conditions, which in most instances is borne out by a history of exploitation. In Chuquisaca, for example, some peasants refused to improve their houses for fear that the landowners would then charge them rent. They also thought that the supplies would be another form of debt peonage, with interest rates at 12 percent per month. Diseases, such as Chagas’ and tuberculosis, are facts of life for rural Bolivians; control over disease often is best initiated by means of rituals.

Concientización (consciousness‑raising education, or CRE) was popular in Latin America during the 1980s. It implies that community members recognize the relationship of material conditions to behavioral, economic, social, and cultural factors by means of investigation and analysis of actual concerns.[51]Concientización attempts to help instill in poor people the hope of improving their situation. Concientización has premises in concepts of Christian social justice that relate the cause of the disease within the political and economic contradictions of Bolivian society. Therefore it is useful for looking at the connections between local causes of infestation and broader social concerns.

Even though Sensano proposed to look at the connection between broader concerns and causes of disease, she used an approach that scared peasants more than it made them reflect upon the political economy. As she describes it:

…concientización was, and still is, the key to our success. We used shock methods to make them realize that the bites of vinchuca cause bulbosos [welts] and heart problems. We traveled from house to house, showed them feces that the vinchucas left after they had sucked human blood, then became so full that they left traces of mierday sangre [feces and blood] on the walls. We pointed out their eggs, hundreds of them, tiny white beads inside walls, mattresses, and clothing. The earth and straw of their houses were filled with vinchucas. Inside their straw roofs we showed them nests of sleeping vinchucas.

We showed them the damage vinchucas do. We made them afraid. If you don’t scare the campesino, he won’t do any work. We also showed them the parasites with microscopes and pictures of people with intestines stretched out. We made them hear the irregular heart beats of chagasic patients, 1231234121234, with a stethoscope. We showed them radiographs of a normal heart and some of a chagasic heart. We had a video made and showed them that. We told them that they have a responsibility to take care of their children and that it is their responsibility if children suffer from Chagas’ disease. Fathers and mothers cannot permit that their children die from vinchucas, it is just as necessary to get rid of vinchucas as it is to have their children learn to read and write. After educating and motivating them, they agreed to fix their houses (Sensano interview 6/17/91).

Concientización was used by Sensano to frighten people and instill in them a hate of vinchucas. Peasants now had another object to fear; a bug they once thought was a sign of fertility was now seen as a harbinger of death. Bolivians realized the connection between vinchucas and some people with chronic heart disease, but life expectancy is not a major concern for peasants subsisting from day to day. Making peasants aware of disease‑causing agents often is not enough to motivate them to do something. Disease and death are accepted facts of peasants’ lives; they have become long accustomed to the unhealthy environments of mines and factories and being subjected to revolutions, reprisals, and military repressions.

^{Figure 23.}

^{Education of children about housing hygiene is important to prevent Chagas’ disease. Traditionally children regard vinchucas as “toys” to play with.}

Preventative health measures modify behavior to the degree that these measures produce some immediate and desirable effects. With Chagas’ disease, once community members realized how nice their houses would be if they did not suffer from insect bites there and that they thus would have increased prestige, they were motivated to improve their houses. When I brought up the objection that peasants might revert to unhygienic conditions after the house was built, Sensano replied that this was not the case, because the women take pride in their new homes. They sweep them and put things away every day. Prestige is more motivational than is either injustice or economics.