With Health in our Hands

By: Wambra Medio Digital Comunitario @wambraec

  In partnership with Belen Febres-Cordero and the women who participated in the creation of this series

English Version Published on December 13, 2021

Reading time: 14 minutes​

Without knowing each other, Rosa P. and Delia Paillacho have something in common: they both feel they hold health in their hands, even if they do so at opposite stages of life: Rosa at the beginning, and Delia at the end.

Rosa was born in a rural area of Ecuador, but she ran away from her home as a child and arrived in Quito more than 40 years ago. Despite the discrimination she experienced for speaking the Kichwa language and wearing her traditional clothing, one of her happiest phases in life was working as a nursing assistant at a local maternity hospital.

With sparks in her eyes, Rosa describes how much she enjoyed using her hands to transmit energy and love to newborns she cared for there. “From the deep love that emanated from my heart, I used to run my hands over their tiny faces and say: ‘You are going to be a great doctor someday’,‘you are going to be a great lawyer’, and if a baby screamed a lot, I would say: ‘I know what you are going to grow up to be: A singer!’” recalls Rosa, and she laughs. “Even the doctors who worked with me used to tell me that I transmitted them the desire to pamper, caress, and snuggle the children,” she adds with a smile.

In contrast, as a palliative specialist, Delia accompanies people at their final stages of life. “Human beings have an avid need to be cared for and emotionally caressed, even if it’s not through physical contact,” she says, as she emphasizes that she loves her profession deeply because it allows her to support others at the most fragile moments of their human existence.

Just like Rosa, Delia feels that she transmits health through her hands. “I was unaware of this attribute, but people have made me realize that I have some sort of energy that connects me with others. It has something to do with my hands. I can be in the middle of the coldest winter, but my hands always remain warm.”

She uses this power to support her patients. She explains that, as they die, many people experience anxiety, despair, frustration, or anguish. “To calm them down, I approach them, I rub my hands and I place them slowly over their face while whispering into their ears: ‘It’s OK Juanita, calm down. Everything is going to be all right in here. You have permission to go. You have lived your life, and now you can rest in peace.’ Then, I put my hands over their eyes and close them gently. Often, people pass away at that very moment.”

The subtle and affectionate way of caring that Rosa and Delia describe has not always been valued by modern Western medicine, also known as the biomedical paradigm. This paradigm defines health as the absence of disease and considers medicine to be purely based on objectivity and reason.

In the book, Biomedicine Examined, the medical anthropologist, Deborah R. Gordon, explains that the biomedical paradigm accepts the division between mind, spirit, and body that was marked back in Ancient Greece and reinforced during the Renaissance Period. Considering that the body functions exclusively through verifiable, objective, and universal operating rules, doctors trained in this paradigm focus, above all, on the physical bodies of their patients. They generally prefer not to get too involved with the mental and affective aspects of others or themselves, since they tend to think that these interfere with reason and the objectivity they seek to maintain.

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Broadening the Perspective

Although the biomedical paradigm has become dominant, there are other ways of understanding and approaching health that also offer important contributions. Margarita de la Torre – a Kichwa Otavalo warrior woman, ancestral healer, and independent consultant – invites us to broaden the horizon towards different knowledge, much of which is born from Indigenous wisdom and practices.

Research carried out in different parts of the world supports Margarita’s words. For example, the study titled “Achieving Healthy Societies: Ideas and Learning from Diverse Regions for Shared Futures” explains that, although the biomedical paradigm has become the predominant approach worldwide, there are other ways of addressing health from different settings that are equally relevant.  The Sumak Kawsay / Living Well proposal is one of them.

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Sumak Kawsay /Living Well as an Alternative of Health and Life

The Sumak Kawsay / Living Well is a proposal offered by the Runa / Indigenous Peoples in Ecuador. In “Beyond Development,” Floresmilo Simbaña explains that this proposal offers a critique and an alternative to development. Instead of conceiving people as individual beings, it sees them as collective subjects. As such, it centres life around the community and promotes complementarity, reciprocity, and a harmonious relationship with all the elements of our surroundings.

Illustration by Andrea Venturini inspired in Leonor Bravo’s mandala

José Yánez del Pozo, author of the book “Allikai: Health and Disease from the Indigenous Perspective,” argues that proposals such as the Sumak Kawsay/ Living Well open the path towards novel ways of approaching health because our understandings of this term relate to broader philosophical questions that these proposals address. Some of these interrogations are: What is the origin and basis of humanity? Why are we here? What determines if we are healthy or ill? What do we need to achieve a healthy and wholesome life?

Rasu Paza Guanolema, a teacher of the Kichwa language, explains that the health view that emerges from the answers that the Sumak Kawsay/Living Well proposal gives to these questions is not individual. Instead, this proposal approaches health as a relational and collective experience.

Rasu adds that all beings have a space, time, and mission to fulfil, since we are all a part of the whole that complements each other. Therefore, our actions affect ourselves, and our families, communities, and surroundings. Under this premise, health is understood as a harmonious relationship with oneself, the community, ancestors, and the environment /nature /Pachamama /cosmos /spiritual world.

Rasu clarifies that harmony, in this case, is not understood only as maintaining balance but also as a complete acceptance and integration of all aspects of life, emotions, and experiences, including those that might be considered as negative or uncomfortable. Harmony is also understood as reciprocity, or “giving first to receive later,” and as taking responsibility for one’s actions.

Rasu also describes that, according to Sumak Kawsay/ Living Well, disease is not something that happens only to our physical body. Instead, it is an aya /person /entity that visits us to make us realize that one or more aspects of our lives might be out of balance or lacking harmony and reciprocity.

José adds that, unlike the biomedical paradigm, the Indigenous/Runa philosophy of Abya-Yala considers that medicine should be preventive, not curative. Therefore, it seeks to understand the roots of each disease. Margarita explains that to find these roots, ancestral medicine focuses not only on the physical realm, but also on the mental and spiritual aspects of people’s lives. “Often, what makes us sick is the pain that we carry inside us. This pain may come from violence, resentments, and frustrations. It is these human and social pains that we must also heal,” she argues.

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The Contributions of Afro-Ecuadorian Ancestral Wisdom

María Eugenia Quiñónez Castillo, Afro-Ecuadorian leader and ancestral healer at Centro Médico Ancestral la Fe , technologist in Ancestral Sciences, and teacher at Instituto Superior Tecnológico los Andes de Estudios Sociales (ILADES).

“When we talk about traditional medicine in Ecuador, we tend to think of the Indigenous/Runa perspective, which is crucial, but we must not forget about the knowledges and practices of Afro-Ecuadorian Peoples,” says María Eugenia Quiñónez Castillo. «We also have medicine in our hands, we are also healers, harmony, joy, and we are sisters and brothers of the same essence,» she adds, and explains that much of this traditional medicine is based on plants, as nature is wise and has what we need to heal.

Likewise, Yenny Nazareno Porozo, an Afro-Ecuadorian poet and teacher, explains that for the Afro-Ecuadorian Peoples, food is another crucial component of ancestral medicine. “We cook with the herbs and produce that we find in our environment, which are the same that we use to cure people. Hence, we both heal and nurture our bodies with them.” 

Irma Bautista Nazareno from the Coordinadora Nacional de Organizaciones de Mujeres Negras (CONAMUNE) organization, clarifies that certain medicinal herbs are common to several ancestral practices, but the preparation processes followed, as well as the diagnosis, prognosis, and treatment, are unique to each of them. “Afro-Ecuadorian ancestral medicine makes great use of language, words, faith, and spirituality,” she adds.

Thus, Afro-Ecuadorian medicine goes beyond the physical and cognitive spheres.  “This is why I love the word ‘intangible’, because not only material bodies offer insights,» says Yenny. Like her, María Eugenia believes that medicine must keep in mind that people are also made of what she calls a ‘sublime matter’, and that it is there – in what cannot be touched, nor fully understood – where wisdom also resides. She adds that healing occurs when people have not yet lost the ability to understand, listen, and give importance to these immaterial elements, for «there is where our secret lies.»

In this way, medicine based on Afro-Ecuadorian ancestral knowledge expands the understandings of health proposed by the biomedical paradigm, as it not only includes reason and science, but also faith, spirituality, and the intangible. Furthermore, it suggests that health is not only found in hospitals or medical centres, but also in our everyday lives, nature, medicinal plants, and food.

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Exchange of Knowledge

Yenny Nazareno Porozo explains that to truly benefit from all the contributions of different understandings and approaches to health, we must share and integrate diverse practices and perspectives. To this end, she invites us to reconsider which alternatives we accept as valid and why, and how we exchange knowledge.

Yenny highly values the expertise of older women, such as her own mother, who is an 82-year-old midwife. “To heal ourselves and others, we rely on all the teachings transmitted to us by our mothers and other women whose life cycles are coming to an end. We have always been sheltered by all their experience and the vast wealth of their knowledge. But now our elders are dying, and it is painful to think that all this wisdom will die with them.”

To prevent this from happening, Yenny considers that it is essential to create meaningful meeting spaces for knowledge to be shared. She is convinced that the first step to take towards this goal is to instil in people a love for their own history, practices, and skills.

Irma Bautista Nazareno agrees, as she views the process of learning to love her own history as transformative. Irma clearly remembers that when she was a little girl, at school she was told: “You and your people have no culture because you are the descendants of slaves brought from Africa to America, and that left you with nothing of your own.” However, later in life, a priest told her something that she had never been taught before. He talked to her about the history, contributions, and value of the Afro-Ecuadorian Peoples. «Thanks to that, I was able to understand many things and to finally accept my Black identity in all its depth. We reclaimed the ‘Black’ word – once used to insult us – to such an extent that we began to feel a sense of pleasure every time that we heard and pronounced it. It is from this profound love for the Afro-descendant Peoples awoken in me that I address everything I do,” she says.

Both Irma and Yenny feel that classrooms and formal education do not always offer enough space for the exchange of ancestral knowledge, and they consider that encounters more in accordance with their worldviews and practices should be generated. For instance, Yenny has created interactive learning spaces where she has asked each participant to bring two plants: one with medicinal properties and another to be consumed as food. Then, each person explains the use of both while everyone else plants them.

María Eugenia Quiñónez also believes that academic knowledge is usually considered as the only valid one, and she reminds us that this is far from true, as ancestral Peoples have other ways of obtaining and sharing information that are also relevant. «Western and ancestral medicine belong to two different schools, but both are equally valid. Our school is based on practice, life’s mission, and spiritual gifts. God gave each one of us a spiritual gift. Some were given the gift of teaching; others, the gift of words; and yet others (like me) were given the gift of healing. We can combine our own spiritual gifts with those of others to put everything we are, know, and do in service of humanity,” she says. 

María Eugenia learned and experienced this at an early age: “My mom does not know how to read or write, but she is a great healer because she had the wisdom to put her gifts and talents in service of others. My dad did the same. This is why I always say that they are my first and best teachers. I got into academics later in life, but no one has ever taught me what my parents were able to transmit to me.”

María Eugenia adds that this wisdom should be widely shared. For her, doctors trained in modern Western medicine should be interested in the practices and knowledge of ancestral healers, and vice versa. However, she feels that there is no such openness. She believes that part of this rejection is due to the misconception that people are seeking to replace one approach with the other, and she clarifies that this is not the case. For instance, she accepts Western medicine for ailments that require a quick cure, such as a fracture, while she goes to ancestral medicine to look for the multiple origins that a disease may have. «They are two different competencies, but we could bring science and spirituality closer together to achieve a more comprehensive approach to health,” she says.

For Martha Arotingo, a Kichwa Cotacachi woman and traditional midwife, this convergence of knowledges should not only occur between Western and ancestral practices, but also among the different traditional medicines. For example, she thinks that Afro-Ecuadorian and Indigenous/Runa midwifery could strengthen each other, and she would like a national network of midwives to exist for them to support and learn from each other.

Martha started practising midwifery from an early age, and she deeply values the knowledge that her mother transmitted to her since childhood. «When I was just a little girl, I used to go with my mother to the births where she assisted as a midwife. This experience, together with what she used to tell me, made me want to follow her footsteps,» she says.

One of her mother’s stories that influenced Martha the most was that she was the midwife of her own births; during the births of five of her six children, she was either alone or accompanied only by her babies’ father. «These shocking anecdotes marked me and touched me deeply. I am very moved when I feel her words,” says Martha, and adds that her mother would have liked to have the support of a midwife. Unfortunately, not many people practised midwifery in her community at the time, so she only had a midwife during the birth of her first child, during which she learned from her. Then, she continued with this practice both in her own births and in the ones of other women in her community. «I thank my mother for having handed this knowledge to us so that other women do not have to give birth alone as she did. I also thank her for the strength she has given me to continue on this path,» she adds.

Martha is saddened that midwifery and ancestral medicine more broadly are not widely recognized. She feels that both the State and other health institutions often consider midwifery a risky and illegal competition while they are actually on the same side.

She believes that the existing rejection towards her practice may stem from a lack of understanding of the multiple contributions of midwifery and ancestral medicine. «Our way of attending people is more familiar, affectionate, and spiritual. We follow a community-based approach that is born from an ancestral knowledge that is being lost and that we need to rescue.”

Xavier Maldonado, a medical professor at Central University of Ecuador and the coordinator of the Latin American Association of Social Medicine in Ecuador (ALAMES), highly values midwifery and ancestral medicine. He explains that midwives in the country play a crucial social role in the lives of the people they attend: “Midwives are with women during pregnancy. They also move to women’s houses a few days before they give birth, and they accompany them during labour and postpartum. They share the space, cook, chat, and discuss important life matters together. They even continue offering support with upbringing and education as children grow up,” he explains.

Considering these important functions that midwifery and other ancestral practices can play in society, Xavier advocates for an integration of different types of medicine, which, for him, should emerge from a profound understanding of the contributions of each approach. «The role of the midwife goes far beyond attending a birth at a hospital. To not understand and deeply respect this is to kill midwifery,” he says.

To achieve this amalgamation of knowledges, María Eugenia invites everyone to learn more about diverse ancestral practices. “There is a lot of ignorance and misconceptions about what we do, and that is why people get scared of us, because they don’t understand our approach. But if we are going to be afraid of the Bogeyman, let’s at least get to know him first, don’t you think?,” she says with her characteristic smile.

Like this – each from their own space and practice – Martha, Yenny, Irma, María Eugenia, and Xavier agree that with humility, respect, and collaboration, we can join hands and efforts to move towards new and more comprehensive ways of understanding, seeking, and experiencing health and life.