Hernán learned to see health and sickness through the eyes and language of the people he had come to teach and has developed a health education program that builds upon rather than destroys indigenous culture.
The New Idea
In talking to campesinos, indigenous people, and urban dwellers, Hernán realized that many Mexicans have a vision of the world that explains sickness and health in very different terms from western medicine.Millions of Mexicans might seem to respond to the language of the local clinic, but Hernán has found that they also hold on to a second "channel" that needs to be understood by health educators if they are to obtain results that are not superficial or contradictory. This second channel provides a vision of the world in which man is closely connected with the supernatural. In simple terms, it is a world divided in two parts: above ground is male-dominated by warmth and light, vitality; beneath is the earth which is female-cool, dark and fertile. A malady which would be diagnosed in one way by western-trained doctor is often explained by traditional medicine in terms of the balance between hot and cold. This balance can be affected by climate, diet, human relations, and the will of the gods. Hernán is doing research on traditional healing techniques and is incorporating this knowledge into health-education programs to make them more culturally sensitive and thus, more effective. His work is a bridge between ancient knowledge and modern science, and he is working to see that it is taken up as a model by other health educators.
Since traditional medicine was dismissed first by the Spanish conquerors and later by western science, there is virtually no published work which can help health educators understand how rural communities think and feel. "Most available data on traditional medicine is folkloric, unconnected and chaotic," Hernán says.
"To understand the breadth of the indigenous world is a real headache," Hernán adds, "so it has been easier to forget about it and believe that the people we work with can understand us completely."
But Hernán says that, more and more, the serious health educators who analyze their work are facing up to the reality that millions of Mexicans are, as Hernán says, "simultaneously connected to two channels," and that academic works normally attend to only one.
The implications are serious. Hernán points out that health workers who appreciate the beliefs of a community are more likely to be trusted and accepted. This trust and acceptance is critical to success, where much of the population is indigenous especially in a country like Mexico. Often the initiatives of the medical schools and health institutions fail because they do not incorporate any element of cultural sensitivity in their educational campaigns.
For example, many peasants, Indians, and slum dwellers do not grasp the concept of microbiological diseases. They attribute diseases to the winds, which are part of their cosmos, mysterious and inexplicable. The impatience of traditional health educators with what they dismiss as "superstition" has made their task of explaining such things as bacteria more difficult. They must first understand traditional ways of thinking, and then figure out what the best approach to education is.
Hernán has designed a health education strategy that builds out from the world vision of the people he hopes to reach. In two regions of Campeche in southern Mexico, he is encouraging traditional healers to organize into groups to increase their impact. He is also forming teams of area health promoters who can resolve local health problems in a way that respects their own conception of what those problems are.
Since 1989, Hernán has been working in the Mayan communities of Camino Real and Chenes, studying local theories which explain how illness is caused, how it can be diagnosed, and how the body functions. In addition, he is documenting interpersonal relationships as well as relationships between people and animals, plants, objects and the cosmos in general. In his research, he hopes to gain a broad understanding of indigenous culture and its attitudes and beliefs about health.
"I don't know of any other public health project that bases its education methods on a thorough knowledge of indigenous culture," Hernán says, "Mostly they focus on technical and social questions and, and if they decide to confront the question of culture, they lack the tools for analysis and handle it in a very superficial way."
Through workshops with local healers, Hernán is finding ways for two very different medical systems to complement each other. For example, he has found that rheumatism is treated more effectively through Maya acupuncture than through western medical remedies. Since the two systems are no longer exclusive, people can go to the clinic for certain ailments and to their healer for others.
In the absence of documentary information about traditional medicine, Hernán Chinese medicine has become useful because it is similar to Mayan thought. Mayans share like explanations for disease and how it can enter and leave the body, the supernatural causes of sickness, and the division of the world into two parts.
In addition to helping him approach a health system so alien from his own, the parallels that Hernán finds between Chinese and Mayan medicine help to bring credibility to Mayan medicine amongst the scientific community. Whereas traditional medicine in Mexico has been dismissed and discredited since the arrival of the Spanish conquerors, Chinese medicine has earned international respect. Hernán is now using traditional medicine to prepare a basic diagnosis of the health situation in the two communities where he is working. He hopes that by showing his work to other professionals, he can make them realize that health education in Mexico must take traditional medicine into account so that the work can be more effective.
Hernán plans to spend two more years in Campeche, building on his work with healers and health promoters and documenting traditional medicine with the help of references from Chinese culture. He then plans to work in a rural community in a different part of Mexico where he will be able to test his hypothesis that the system he has successfully established in Campeche is relevant for indigenous communities throughout the country.
"The idea is to help healers and health promoters interact with each other, organize themselves, and fight together for their culture to be more highly valued," Hernán says. "In this way indigenous people can strengthen their own way of thinking rather than taking part in the fight against it."
Hernán was 15 years old when he began working with street children and prostitutes in working class neighborhoods of Mexico City and in indigenous communities.
On leaving school, Hernán became the first member of his family to study medicine. Specializing in public health, Hernán met students with a similar interest in the need to develop health education programs and together they worked in indigenous communities in Hidalgo state during breaks from the university.
Working as a health educator in Veracruz, Hernán began to realize the error of imposing western science on communities who see the world in other terms. Although the job did not allow him to change the focus of health education, Hernán was developing a theory that he began to put into practice when he moved to Campeche in 1989.
Hernán, helped by his wife (who is an anthropologist) and another colleague who has specialized in Chinese medicine, is beginning to focus especially on spreading the results of his work on to professionals who need to be made aware of a more culturally sensitive approach to medicine.
Educe supports the recognition of traditional indigenous medicine as a comprehensive healthcare system by making its contribution known to the people and to medical services, where traditional doctors are the key players. They recognize and value the contribution of traditional midwives, with whom they have shaped the model of pregnancy, childbirth and postpartum care with a humanizing, intercultural and safe focus, for all women. This model also takes into account national standards, scientific evidence and human rights.