Paper short abstract:

This paper compares the role of indigenous health workers in Western Amazonia as cultural mediators between shamanic popular medicine and health services in the 1980s and now. The rise of both indigenous movements and shamanism in Latin America call for consideration of this cultural mediation in the new health goals for integrated primary health care.

Paper long abstract:

In this paper I review the involvement of Amazonian indigenous health workers in shamanic popular medicine in two surveys conducted in the Peruvian Upper Amazon in the early 1980s and in 2013-4. In the first survey, as sons or nephews of shamans, health workers mediated conflicting views of health and illness and helped patients negotiate parallel quests for therapy. Three decades later, the rise of both indigeneity and shamanism and the prevailing hospital model of health care in Amazonia have produced a superficial integration of health services yet a deeper cultural divide. Analyzing the changing modalities of “delivering health care” in the two periods, I show that indigenous health workers are more actively and explicitly engaged in cultural translation and the production of difference. As popular shamanic medicine, now re-claimed as ‘indigenous’, continues to spread in the sprawling urban shanties of Amazonia, rich and poor alike practice extensive ‘healer shopping’ across the hospital-shaman divide. Traditional midwives however are still excluded in a binary system of care as they were thirty years ago in Peru, while in the Ecuadorian and Bolivian Amazon, their role is acknowledged in health services. Regardless of the concept of medical pluralism having fallen into academic disrepute, I argue that medical anthropological studies of the indigenous health workers’ role as cultural mediation can throw light on the new policies of participatory engagement of local healers in the delivery of primary care for all. Notions of covert or overt agency, tacit or explicit knowledge need to be addressed.