Stratified Classes

Beltrán highlights the problem of stratified classes to health projects. Chagas’ projects bring together people from different social classes who have to communicate with one another to combat Chagas’ disease. They often fail to achieve this goal because they perceive lower‑class people as incompetent and inferior, thereby hindering community participation. The social dynamics of classes are important considerations for the success of any project.

Rural peasants generally are considered the lowest class. Since 1953 it has been against the law to refer to peasants as Indiansthe accepted word is campesino. Campesinos have equal voting rights with all other classes. Campesinos traditionally speak Andean languages, follow an agricultural calendar, and, as of 1994, have their own political organization. Vecinos, or residentes, are the people who live in the city. They include the salaried workers, and most of them are not much better off than the peasants. Already mentioned, only 2,000 salaried workers make over U.S. $10,000 annually (Presencia 1 997). The upper class, sometimes called gente decente (civilized people), is composed of distinguished families and wealthy people. These are broad distinctions; there are many finer class strata in each of these groups, such as the cholo and mestizo classes, already discussed. Race, as defined by skin color, is not as important a marker in Bolivia as is social stratum, which is determined by one’s dress, behavior, family, and wealth. Consequently, such cultural markers as language, dress, and food habits are readily discarded to strip oneself from the lower peasant class. There is a tendency in peasants who have ascended to professional levels (doctors, nurses, and project personnel) to act out their perceived class superiority in dealing with peasants.

On the other hand, peasants have their own hierarchies, with certain members more distinguished than others; but this is based on completion of adult responsibilities within the community. Especially peasants from the Andean free communities (those that were not tied to haciendas) maintain a cooperative and communal spirit in their work. They help each other plow, seed, and harvest. If there is a fiesta, they all participate. If a project is to be completed, all members participate. When project personnel interact with such community members using class‑stratified manners, they project upon the community political and social relationships that are offensive and counterproductive. Community participation in such groups is predicated on respect of differences and equality of participation; it is not based on paternalism, maternalism, classism, or racism.

José Beltrán’s suggestions for better communication between doctors, nurses, technicians, and peasants include the fact that it is necessary that health professionals think in terms of cross‑cultural communication and sharing of knowledge rather than having a superior form of knowledge. Doctors also have to internalize the reality of peasant culture and become motivated to work with these people as partners. This may necessitate spending several years in rural areas after medical school. It also involves learning native languages, colloquialisms, ethnomedicine, values, and economics.

At the conclusion of our last interview in 1997, José Beltrán sang a song that he had taught children concerning Chagas’ disease. The tone is that of a cueca (popular dance of Chile), and the children dress like vinchucas and dance the cueca when they sing it.

Gracias a Dios que mi casa esta limpiay me curada.

Revocando las paredes combatimos las vinchucas.

Ordenaday revocada no hay mas bichos.

Thanks to God that my house is clean and I am healthy.

Plastering the walls we combat vinchucas.

Neat and plastered there are no bugs.