Sitting at approximately 9000 feet above sea level at the feet of 4 volcanoes (3 inactive, one dormant) is the beautiful town of Otavalo, Ecuador. The beauty of Otavalo stems not just from the glorious surrounding but also from the warmth and smiles of the Quichua indígenas who make up a large proportion of the city’s population. They are known for their adherence to their traditional native clothes, foods, festivals, and customs and for their weaving (we cleaned up on everything Alpaca- sweaters, ponchos, socks). The market on Saturdays in Otavalo attracts thousands of people (both Ecuadorians and tourists) and is a must for anyone travelling to Ecuador.

For the month of September we are working at the Jambu Hausi clinic in Otavalo. Jambi Huasi, means “House of Health” in the native language Quichua, and was founded in 1984 to help indigenous people who for decades had been marginalized and discriminated against (by the majority mestizos)  because of their language and their cultural beliefs. Jambi Huasi is a primary care, pediatric, and Ob/Gyn clinic offering both traditional and western affordable medical care to the Ecuadorian people, especially the indigenous Quichua population. With a unique and integrated intercultural model of health, Jambi Huasi helps to eliminate health disparities. They work by a motto of “Un pueblo sano es un pueblo libre” (A healthy people is a free people).

At the clinic, the doctors and traditional midwives seamlessly mix traditional and western medicine. The traditional medicine operates on the idea of harmony: balance between mind, body, and espanto (spirit). The Quichua people believe in the positive and negative spirits, and further, the direct correlation between the spirits and physical health. The clinic has been run since the late 1990s by Darwin Aragon, a soft-spoken, caring man.  The clinic’s representative for Western medicine, Dr. Olga, trained as a general practitioner at an allopathic medical school, alternates between wearing scrubs and traditional dress. She spends her day treating acute disease (respiratory infection, etc) and chronic disease (diabetes, hypertension). She complains that these chronic illnesses are on rise since KFC and other fast food restaurants have come to Ecuador- though I’m not so sure that all of the traditional Ecuadorian dishes- roast pig, fried plantains, and fried potatoes are any healthier. Across the open courtyard, works an extremely friendly Andean doctor, Dr. Patricio, who was primarily trained in homeopathy and apitherapy (using products from bees: venom, propolis, royal jelly, etc).  He frequently prescribes homeopathic treatments that are commonly used in the U.S.- saw palmetto for benign prostatic hypertrophy, arnica, calendula, and traumeel for inflammatory conditions such as arthritis.  

Near the entrance to the clinic there is tri-fold door. When you walk into clinic for the first time, the smells coming from behind that door strikes you almost immediately. Behind this strange door, is Juan Perugachi, the yachac or shaman. Though he only infrequently sees the light of day, he is hard at work mixing up a pungent remedy from local herbs. Spread throughout the rest of the clinic, in a number of other smaller rooms, the parteras (midwives) carry out traditional healing methods.

Patients are mostly walk-ins, although many have been referred to the locally renowned partera, Mama Juanita, who has been at Jambi Huasi since its founding. She wears the indigenous Quichua dress: 50 or more strands of gold beads enveloping her neck, coral colored bracelets up to her elbows, a brightly embroidered shirt and a long wool skirt. Mama Juanita speaks Quichua, with very limited Spanish, and as the week progressed we saw many instances of communication without words. The patients trust Mama Juanita and her traditional knowledge, coming to her every few weeks throughout pregnancy and referring family members for her spiritual healings. Mama Juanita is also a fregador (medical masseuse) and she heals minor ailments using (very aggressive) massage and herbs, and diagnoses and treats more severe illness by cleansing the patient of mal aire (bad air or energy).

The two main cleansing methods are limpia huevo – cleansing with a raw egg and aromatic oil– and limpia cuy – cleansing using a live guinea-pig (cuy). The white and brown guinea-pig is used only for diagnosis, while a black one is used for healing as well (we haven’t seen this, yet). The Quichua believe that the guinea pig, which resembles a human internally, can absorb the mal aire from a patient. The initially alive cuy is rubbed over the patient’s whole body many times until it “stops moving.” The formerly alive cuy is then dissected, (definitely a shocking experience) and any pathology inside reflects the pathology in the patient. One patient, an incredibly fit man in his sixties, came to see Mama Juanita for right shoulder pain. From his description of the pain, Gail and I immediately suspected a torn rotator cuff. However, he also mentioned that he had been to a “regular doctor in Quito” – he showed us two bottles of homeopathic medicine- and had not gotten better. He was coming to see Mama Juanita because “he knew” that she could figure out the cause of his pain- something the doctor in Quito hadn’t been able to do. Mama performed the limpia cuy and low and behold she showed us two small masses in the cuy’s right shoulder. However, while she performed this rather lengthy process, she told the man that she too had had shoulder pain and she went to an orthopedic surgeon and had 6 injections and her shoulder was better- so if he didn’t better with her suggestions, he should probably do that too!  Not to be outdone, Gail and I couldn’t help ourselves so I ran to the clinic’s formulary and grabbed a handful of ibuprofen and handed it to him as he left with a smile. While we may scoff at this “cuy MRI” this story really does show the importance of Jambi Huasi: this man’s traditional beliefs were honored and he was offered traditional treatments BUT if he didn’t get better, he was encouraged to see a orthopedic surgeon. Time and again we saw this integration of traditional and Western beliefs: women would come to see Mama Jaunita for prenatal care (instead of measuring fundal height or listening to the fetal heart with a Doppler- she would always do external cephalic version- even at 20 weeks- because she and her patients believe that the pregnancy is only normal if the baby’s head is down) however, she always asks if the woman had her ultrasound and she inquires about the patient’s next appointment with an obstetrician. Mama Juanita will refer patients to local doctors and the hospital when she encounters a problem that she feels is beyond her realm of healing. Similarly, the Western doctors respect the traditional beliefs of their patients and will refer their patients to Yachak or Mama Juanita. In addition to observing, we have been put into service. As there isn’t currently a gynecologist assigned to Jambi Huasi, I have been enlisted to remove Implanon contraceptive devices and to insert IUDs. In addition, next week I will be giving a lecture (with Lena’s immeasurable help) to a large group of parteras about screening for complications during pregnancy. In addition, Gail’s derm skills are always very, very useful. We will give you more updates about our experiences as the month continues.