'Shamanism' or ancestral medicine: controversy in Colombia over health care reform (2023)

When Martha arrives at the office, the first thing she does is water the plants: at night she dreams that they are thirsty. Before anyone can interrupt her and ask about the offerings at the Victim Support Center in Bossa, southwest of Bogotá, she greets the herbs. "I love them, I care about them, I talk to them," she says. Martha Renteria is a therapist and midwife. These words recently caused controversy in Colombia after it was revealed that several of his tribesMedicina ancestorswill be included in the proposed health policy reformGovernment of Gustavo Petros.

This was announced by outgoing Health Minister Carolina Corcho in response to a petition by Liberal Senator Alejandro Carlos Chacon. It was one of his last official acts: the difficulties of passing the reform he advocated eventually cost him his office. Six other ministers were removed from office during the yearsecond big shock for the Petro government, due to difficulties raised in Congress regarding the President's reform agenda.

References to "shamanismit angered some anti-reformers, inspired memes and fueled rumours. “Massage therapist instead of orthopedist for fracture or vet for open heart surgery. It's a madhouse,” said opposition senator María Fernanda Cabal, one of the most visible politicians allied with former president Álvaro Uribe's plan.

The debate is now public, but it is nothing new. In fact, according to experts, it is practically obsolete. When the World Health Organization published the Alma-Ata Declaration on Primary Health Care in 1978, the importance of integrating traditional indigenous knowledge into health systems became clear. These forms of knowledge, which have nothing to do with alternative medicine such as homeopathy, flower essences or bioenergy, were the main method of health care long before Western medicine spread to the world. Its professionals continue to care for populations in remote areas.

“It's a global call: it's already a constitutional requirement in the United States, Canada, Australia and New Zealand. I think that's missing in Colombia,” says Germán Zuluaga, a doctor at the University of Rosario whose career has combined modern Western medicine with ancient practices.

“The issue is discussed in a very basic way, starting from the superficial political description. "What is being attempted - and what every government, whether left or right - is trying to do is to promote multiculturalism in health care on the one hand and the 2014 decree that established mandatory recognition of traditional indigenous systems on the other," he said the Zuluaga. Today in Colombia, five indigenous health promotion companies (EPSI) are working with communities to develop a model of intercultural care.

Zuluaga says he too was once a skeptic. After graduating in Western Classical Medicine, he was sent to practice in Caquetá, the gateway to the Amazon rainforest. There he found a local healer and doctor. “It was a big surprise because, despite my doubts about his knowledge, I gradually realized that he is very knowledgeable about medicine. After a few years I gave in and understood and accepted that [traditional] medicine contains a lot of wisdom and deep knowledge."

This unexpected meeting shaped the rest of his professional life. He then led a research group at the University of Rosario that scientifically demonstrated the effectiveness of many traditional treatments. Now, he says, "traditional medicine works both in the prevention and treatment of many diseases."

Zuluaga's PhD thesis shows howPatients with asthmawho had been forced to use inhalers for years by Western medical techniques were cured in months by traditional medicine. For him, "Western medicine excels when it comes to major surgery, hip replacements, heart transplants and serious accidents." When it comes to treating chronic diseases, however, the options are very limited. Patients with chronic problems such as high blood pressure, diabetes or arthritis do not find good answers in Western medicine."

He notes that these patients are hospitalized with medications that they must take daily, leading to the serious public health problem of overmedication. According to the National Pharmacology Symposium, "An adult over the age of 50 takes an average of five different medications every day of their lives." And they all receive the same treatments.

But how, critics of the former ministers asked, how can the government regulate ancestral practices? How to distinguish a traditional doctor from a charlatan? Responding to the petition, the ministry emphasized that the interns "must be recognized and supported by the collective and organizational bodies of the area where the activities are carried out." However, he did not mention that the 2014 decree already sets the rules of the game with the creation of the Indigenous Intercultural Health System (SISPI).

Kilombos, the beginning of a hybrid model

Since 2014, an ancestral medicine model in Bogotá has provided insights into how traditional practices work within an institutional context. Regional Health Minister and doctor Alejandro Gómez says this symbiosis can only be achieved with respect and recognition. "Given the challenges we face, we cannot pretend that there is some kind of knowledge and that the only people who know about treatment are Western doctors."

Regarding certifications, Gómez explains that "a person who claims to be a community doctor must have the approval of their community and their authorities." We cannot claim an academic degree that does not exist. We met with traditional authorities. Only people who are recognized by the community as midwives, as doctors, can be part of such a county health care system,” she says. "Of course there is a risk of quackery, but so is Western medicine."

In that sense, he says, Bogotá has made great strides: "The region's public health system has 125 people from different ethnic groups – African-American, Indigenous, Raizal, Palenquera and Gypsies or Gypsy groups – working in the system." , 32 are resident doctors, 25 classified as midwives and 39 as community managers, in addition to 29 health technicians'.

Perhaps the most representative model of ancestral medicine in the city are the quilombos, centers where the population can receive treatments based on traditional Afro knowledge. The first to start business was Kilombo Niara Sharay, where Martha RenteríaWater your plants. She only rests when she notices that they give off a smell that tells her that "her daughters" are content.

A strong smell of chlorophyll greets visitors. Here Rentería prepares the ancestral oils, pills and concoctions he will prescribe. Pacific orchestral music plays in the background and the sound of the marimba prepares her patients to begin their healing process, which consists of "various forms of attention, all focused on listening."

'Shamanism' or ancestral medicine: controversy in Colombia over health care reform (1)

"Eighty to 85 percent of the people we serve here are victims of conflict," says Martha. “You can hear everything. Girls who have been rushed come to us and the first thing we do is dissection work [a kind of energy cleansing]. Then comes the physical body, an internal treatment with medicinal plants, with vaporizations, baths and also withMarinillos[a natural egg] to make her feel good inside because rape is very damaging inside her. These are traces that will never be erased."

“The good thing about this quilombo is that we are busy. For example, I look for the cause of illness. how to find it Through dialogue, touch and asking questions, and the person brings it out. That's where I find the origin, because every disease has an emotional origin," he says. These experiences led her to develop a new concept: the "Ethno-Psycho-Ancestor", a mixture of African medicine, plants and listening, with which she wants to offer her patients a holistic treatment. Psychology students from the Universidad Javeriana interning at the Quilombo have documented in their theses how the center has helped improve the lives ofvictims of the conflict.

"War makes you sick," says Martha. “Someone wants to listen and listen patiently to what my students are doing on Thursday and Friday. Then I cleanse it [with medicinal plants], let it discharge. He who listens also becomes sick, because there are terrible things: rape damages the body of the woman who suffers, but also of the one who listens.'

The woman is the central axis of Afromedicine. “Who looked after the ladies when they were enslaving the blacks? The women! In African-American ancestral medicine, the guardians are women,” she says. Everything she knows, she learned from her grandmother, Dolores Florinda Barreiro. “I have many family members who are healers [in Tumaco, on the Pacific coast of Colombia]. My grandmother was a midwife, very careful and responsible. We are all born at home. She was a very wise woman. They rubbed, he made creams for her. I learned it from her by watching her. Today, Martha's own granddaughter watches and imitates her massages.

Martha is not opposed to Western medicine. "When I take care of a pregnant woman in Bogotá, with my exercises, with love, attention, companionship, solidarity, I observe how the pregnancy progresses. If I see that it is not working properly, I have to send it for testing. It must have the attention and medical control of the Western woman."

However, he finds the relationship with the institutions difficult. The problem remains how to reconcile two very different universes: one focused on oral communication, the other on documentation. One is old, the other modern; One empirical, the other based on laboratory tests. one is associated with plants and the earth, the other withchemical and pharmaceutical industry.

The entry of patrimonial medicine into the more orthodox health care system implies that it is governed by the rules of the system in one way or another. "There's endless paperwork to fill out," says Martha. He also criticizes the prevalence of care "by a head nurse". When they are not around, the quilombo cannot take care of the patients, but when the midwife and the healer are not around, the quilombo continues to work with a manager who is not familiar with ancestral medicine.'

For Martha, integration into the public health system made the quilombo "more of the same," that is, "getting a certain number of subscriptions a day." That means you have to be in it with all your might, without the proper listening that is necessary for a healing process.” She decided to declare herself autonomous and outside the system. The word Quilombo refers to exactly this: it is one of the names of the free communities founded by Africans and their descendants who had escaped slavery.

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