Sheila Cosminsky

Medical pluralism on a Guatemalan plantation

Resources and treatments from different medical and religious traditions were found to be utilized by a mixed population of workers on a coffee and sugar plantation in coastal lowland Guatemala. Observation and interviews with 35 households representing a range of nutrition and health status and with the health practitioners consulted by them revealed a pluralistic orientation among both users and providers of care. This article analyzes the elements of Mayan Indian, folk Ladino, spiritist and cosmopolitan medical practice incorporated in home remedies and in the behavior of curanderos, herbalists, midwives, spiritists, shamans, injectionists, pharmacists, physicians, clinics and hospitals. 3 case studies illustrate common patterns of health seeking behavior in which sequential or simultaneous multiple usage characterizes families with varying economic resources. The pluralistic medical structure of the plantation provides flexibility and fills different needs of the population, but may lead to inappropriate use of cosmopolitan medicines, especially antibiotics and vitamin injections.

Women and health care on a Guatemalan plantation

Women on a Guatemala plantation are responsible for the health care of their families and are the primary therapeutic decision makers. This study focuses on women as lay health care providers. They provide medical care directly through home treatment and indirectly through strategies which increase their access to resources which enable them to utilize various illness treatment options.

Changing food and medical beliefs and practices in a Guatemalan community

This study examines the relationship between food and illness as part of the interaction between indigenous and Western medicine in a highland Quiche‐speaking community in Guatemala. It is suggested that certain concepts such as alimento (nutritious food) and fresco (fresh or cool) are being used to incorporate modern nutritional and medicinal information into specific health contexts. These concepts involve different ideas of causation and treatment that are neither wholly traditional nor modern, yet have elements of both. The mechanism of syncretism is used to understand the dynamics involved in such changes that occur as a result of this interaction.

The impact of methods on the analysis of illness concepts in a Guatemalan community

Abstract Survey and case study methods were used to obtain information about illness concepts and behavior in a Guatemalan Maya community. The different methods, with their concomminant questions, and type of informant (lay vs shaman) elicited different patterns of responses concerning the problems of native concepts of illness causation, the nature of illnesses reported, and treatment utilized. Analysis of the data generated by each method reveals differences in (1) the levels of illness causation and explanatory orders in the folk medical system, (2) chronicity of the reported illnesses, and (3) the frequency and sequence of medical resource utilization. The paper concludes by examining the methodological and theoretical implications of these differences.

Ethnicity and Mating Patterns in Punta Gorda, Belize

The town of Punta Gorda in southern Belize is composed of people from a variety of backgrounds. The majority (approximately 70%) are Garifuna (Black Caribs); the next largest group are Creoles (18%); the remainder includes Spaniards, East Indians, Chinese, Mayans, and others. Carr and Thorpe (1961) report that little interethnic friction exists and that intermarriage among the various peoples is common in Punta Gorda. On the other hand, Taylor (1951, p. 38) reports that the Garifuna rarely intermarry or have any social dealings with the non-Garifuna communities. The validity of these claims will be investigated in terms of data obtained in Punta Gorda. If intermarriage is common, how are ethnic boundaries maintained? If there is little friction, how is interaction structured among these ethnic groups to allow for their persistence without conflict?

Childbirth as a Lens of Medicalization on a Guatemalan Plantation

This chapter provides a longitudinal perspective of the continuity and changes that have occurred in local childbirth practices and biomedical practices on a Guatemalan plantation (finca) and a highland village in Guatemala over a period of 40 years. These include midwives’ incorporation of biomedical practices through addition or substitution, as well as their resistance to or rejection of such practices. During this period, changes have also occurred in the biomedical system. In this chapter, the author analyzes the problems produced by these changes through a series of illustrative examples. These include beliefs and practices of traditional Maya midwives and mothers that have changed, been modified, or persisted over the 40-year period of research on a finca in Guatemala and in the highland aldeas (hamlets or settlements) of Chuchexic and El Novillero of Santa Lucia Utatlan. We will look at how these changes have been either addressed or ignored in the government midwifery training programs, which are in turn influenced by international organizations, such as WHO, PAHO, and USAID and their health policies. We also examine the response of the midwives and mothers to these changes. In the process of medicalization of traditional births in Guatemala, midwives may have changed some of their former indigenous practices; ironically, these same traditional practices are now recommended by biomedicine and acknowledged as beneficial.

Wellness Beyond Words: Maya Compositions of Speech and Silence in Medical Care by T. S. Harvey (review)

Wellness Beyond Words is a creative and innovative analysis of communication in Maya medical encounters in highland Guatemala, both within the Maya group and in crosscultural dimensions. Harvey uses the device of a musical “polyphonic” score applied to recordings of two different types of consultation. He compares a patient-doctor encounter during a biomedical interview in a health center and a consultation in a dispensary, located on the grounds of the Catholic church in the town of Nima’ (pseudonym) and staffed by a therapeutic practitioner (or theurgical herbalist) who is both a Maya healer (in K’iche’, ajkun) and a certified nurse, and her Maya assistant. Their treatment is a syncretistic combination of sacred and secular approaches. Harvey is able to map out both the simultaneous and sequential interplay of multiple players, as well as the communicative roles of both speaking and silence during medical encounters, which a traditional linear transcript cannot show.

Ideology and reality in community health in central America

Morgan, Lynn. Community Participation in Health: The Politics of Primary Care in Costa Rica. Cambridge: Cambridge University Press. 1993. xiii + 181 pp. including references and index.

Child feeding practices in a rural area of Zimbabwe

49.95 cloth. Luecke, Richard. A New Dawn in Guatemala: Toward a Worldwide Health Vision. Prospects Heights, Illinois: Waveland Press, Inc. 1993. xx + 264 pp. including bibliographies, resources, and contributors.

Part four: Childbirth and Midwifery on a Guatemalan Finca

11.95 paper.