Overview of the Study of Mesoamerican Healers
Mesoamerican healers are captivating people to watch at work, assist, listen to, read about, and study. Anthropologists have been fascinated with them for well over fifty years. Many outstanding ethnographers (e.g., Bennett and Zingg 1986; Bunzel 1952; La Farge and Byers 1931; Nutini 1968; Oakes 1969; Redfield and Villa Rojas 1934; Vogt 1969b; Wagley 1949; Wisdom 1940) have provided important information about Mesoamerican healers as part of a more general discussion of the life cycle, occupational specialization, religion, or culture change. And a fairly large number of scholars have published books and articles that have as their main focus one or more kinds of Mesoamerican healers, for example, bonesetters, curers, midwives, nurses, pharmacists, phlebotomists, physicians, spiritualists, social workers, or surgeons.
Fortunately, several excellent bibliographies can be used to locate these works as well as others that discuss topics related to Mesoamerican healing and medicine, for example, Argueta and Zolla (1994), Cosminsky and Harrison (1984), Ramírez (1978), and Vargas Melgarejo (1994). There is also an outstanding two-volume encyclopedic dictionary of traditional Mexican medicine by Soledad Mata Pinzón et al. (1994) as well as the single best source for descriptive data on traditional Mexican healing, the three-volume, 977-page book by Virginia Mellado Campos et al. (1994). Other useful sources of general information are Adams and Rubel (1967); Freyermuth Enciso (1993); Lozoya Legorreta, Velazquez Díaz, and Flores Alvarado (1988); Mendelson (1965); Mendez Dominguez (1983); Vargas and Casillas (1989); and Wisdom (1952).
Some of the earliest publications that focused on Mesoamerican shamans were produced by Parsons (1931), Bower (1946), Gillin (1956), and Madsen (1955). William Madsen's comparative piece was very influential because it showed that shamanism was widespread in Mesoamerica and that the divine call of Mexican shamans was similar to that of shamans in other parts of the world. His work was followed by more detailed or problemoriented investigations. Scholars working with Guatemala shamans have produced exceptionally rich accounts. They include Campos (1983) and Carlsen and Prechtel (1994), and especially Colby and Colby (1981), Douglas (1969), Metzger and Williams (1972), and Tedlock (1992a). Barbara Tedlock's work is remarkable for a number of reasons, including her attention to detail, use of cross-cultural comparisons, and innovative research methods.
In Mexico, there is a large body of work on shamans, including Alvarado (199I), Álvarez Heydenreich (1992), Bonfil Batalla (1968), Dow (1986a), Fabrega and Silver (1970,1973), Farfán Morales (1988), Gallegos Deveze (1996), Hamburger (1963), Huber (1990a, 1990b), Huber and Anderson (1996), Incháustegui (1994), Kunow (1996), Larme (1985), Lipp (1991), Claudia Madsen (1968), William Madsen (1983), Myerhoff (1974), Nutini and Forbes de Nutini (1987), Ruz (1983, 1992), Sandstrom (1975, 1978, 1991) Sandstrom and Sandstrom (1986), Vogt (1966), and Zayas (1992).
Evon Vogt does a superb job of describing the organization of shamanism and the wide variety of rituals shamans perform in the Maya village of Zinacantan (Chiapas). Dow's work is noteworthy for its intimate, firsthand account of a respected Ñähñu (Otomí) shaman's power, practices, and code of ethics, and for his theory of symbolic healing. This theory is insightful and widely applicable (see also Dow 1986b). Lipp's (1991) work is a comprehensive and detailed ethnographic account of Mixe cosmology, ethnomedicine, and shamans. When Dow's and Lipp's work is compared to that of scholars who have worked in the Yucatan, Chiapas, and Guatemala, it is clear that there are similarities between Mixe, Ñähñu, and Maya shamans in terms of their recruitment, training, and initiation, but marked dissimilarities in terms of the use of cut paper figures, plant hallucinogens, divining bundles, and social organization, with Mayan shamans entering the religious hierarchy to a greater degree.
Mesoamerican midwives have received almost as much anthropological attention as shamans. León (1910), McKay (1933), and Kelly (1956) published pieces on Mesoamerican midwifery during the first half of the twentieth century. Their work was followed by a flurry of publications in the 1970s, when women entered anthropology in larger numbers. Some of the more notable publications during this decade are those by Harrison (1977) and McClain (1975), and especially those by Sheila Cosminsky (1976a, 1976C, 1977a, 1977b), Lois Paul (1975), Lois and Benjamin Paul (1975), and Brigitte Jordan (1993). In a series of articles that span twenty-five years, Cosminsky has detailed the various roles midwives undertake as well as how their roles, beliefs, and practices have changed over time. Lois and Benjamin Paul do an outstanding job of describing the recruitment of Maya midwives and of explaining their relatively high but ambiguous status. One of Brigitte Jordan's most important contributions is her development and application of the concept of "authoritative knowledge." The study of Mesoamerican midwives gained additional momentum in the 1980s and 1990s with the work of Bortin (1993); Day (1996); Faust (1988); Greene (1988); Guemez Pineda (1989, 1997); Hurtado (1984, 1997a, 1997b); Maust (1995, 1997); Mellado Campos, Zolla, and Castañeda (1989); O'Rourke (1995b), Parra (1989, 1991, 1993); and Sesia (1992).
Until recently, interest in Mesoamerican bonesetters has been minimal. This is unfortunate because bonesetters are widespread (Mellado Campos et al. 1994) and effective. Benjamin Paul (1976) wrote the first article dedicated entirely to the study of the Maya bonesetter. It remains the best and most interesting discussion of the bonesetter's recruitment and the empirical and spiritual aspects of bonesetting. Paul's article was followed by Robert Anderson's (1987) analysis of a Mexican bonesetter's treatments and their safety. Nearly twenty years after the appearance of Paul's article, Clancy McMahon completed a 260-page master's thesis on bonesetters from the same community that Paul has worked in since the early 1940s. McMahon's (1994) thesis is notable for his detailed firsthand account of a bonesetter reducing a fracture. McMahon's work was followed by an article on bonesetting in a Nahua community by Huber and Anderson (1996). Another work that contains substantial information on bonesetters, as well as curers, midwives, and spiritualists, is Perez's (1978) dissertation.
Very little is known about spiritualists in Guatemala. In Mexico, a number of scholars, such as Sylvia Ortiz Echániz (1977), Soledad Mata Pinzón et al. (1994), and Kaja Finkler (1994b), provide detailed discussions of Spiritualism as a religion. Isabel Lagarriga Attias (1975, 1978b) was among the first to have written extensively about the healing role of Spiritualists. Her work was followed by that of Kaja Finkler (1984, 1994b, 1994C), whose Spiritualist Healers in Mexico was first published in 1985. It is a remarkable book for many reasons, not the least of which is Finkler's assessment of the therapeutic effectiveness of Spiritualist healing. The works by Baytelman (1986), Kearney (1977), and Reyes Gómez (1992) also contain valuable information on Mexican Spiritualists.
Physicians have not been extensively studied in Guatemala. However, Eduardo Guerrero Espinel et al. (1992) provide a nice overview of Guatemala's health sector and include some basic data on various kinds of biomedical "human resources," including the spatial and organizational distribution of doctors in Guatemala. Wellington Amaya Abad (1994,1995) provides succinct biographical accounts of Guatemalan doctors, past and present, including those who specialize in ophthalmology (see also Granados Ortiz 1983). Enge and Harrison (1988) discuss Guatemalan doctors as maternal health care providers and Dolores Acevedo and Elena Hurtado (1997) evaluate in detail the relationship among doctors, nurses, and midwives. The latter article is noteworthy in that it shows the importance of class and ethnicity among healers in Guatemala's health care system.
Quite a bit more has been published about physicians in Mexico than in Guatemala. Collado Ardón and García Torres published a ground-breaking article on Mexican doctors in 1975. This was followed by the interesting work of Finkler (1991), Frenk and his colleagues (1985, 1990, 1991, 1995), Garduño-Espinosa (1995), Nigenda (1995), and Nigenda and Solorzano (1997). Margaret Harrison's work (1995, 1998) focuses on the personal and family circumstances of female physicians, their identification with place, the development of their careers, and migration and mobility through the lifecourse. In addition to this work, there is information on a successful group of elite healers from Tijuana who mix scientific knowledge with ancient curing techniques (Schroeder 1990), physicians working in rural Mexico (Módena 1992), Mexican epidemiologists (Ruiz-Matus et al. 1990) and psychologists (Duran-González et al. 1995), and the contributions of Spanish doctors who immigrated to Mexico in the late 1930s (Guarner Dalias 1993).
Compared to doctors, nurses and social workers working in Mexico and Guatemala have received less scholarly attention. Eduardo Guerrero Espinel et al. (1992) provide good basic data on Guatemalan nurses and Eva García Pastor de Domínguez et al. (1988) describe a self-tutorial system that has been used to train auxiliary nurses in Guatemala since 1978. Maria Matilde Martínez Benítez et al. (1993) analyze nursing in Mexico from a sociological perspective; Marilyn Douglas et al. (1996) examine auxiliary nurse stressors, satisfiers, and coping strategies. Margaret Harrison (1994) used questionnaires and interviews to understand how nurses (and female doctors and social workers) view their job and how their status is shaped by the structure of Mexico's public health care system, family and personal needs, and machismo. Her approach as a medical geographer is worthy of emulation by other social scientists.
Harrison (1994) and Schmid-Dolan (1995) provide some basic data on social workers and their training in Mexico. We are not aware of any books or articles that discuss social workers in Guatemala in any detail. However, there are a number of publications that describe other kinds of health workers (e.g., health promoters, rural health technicians, volunteer collaborators) who have been recruited from indigenous Guatemala communities (Cabrera 1995; Colburn 1981; Heggenhougen 1976; Long and Viau 1974; Ruebush and Godoy 1992) and from Tarahumara communities in Mexico (Hubbard 1990). There is also some information on pharmacists in Guatemala (De Valverde 1989) and in Mexico (Logan 1983).
Sandra L. Orellana's book, Indian Medicine in Highland Guatemala (1987) is the single best modern, secondary source of information on different kinds of indigenous Guatemalan healers during the pre-Hispanic and colonial periods. This book and those mentioned below have excellent bibliographies that readers can use to discover primary and secondary sources of information on Mesoamerican healers prior to the twentieth century. For pre-Hispanic and colonial Mexican healers, consult León (1910), Hobgood (1959), and Rodriguez Baciero et al. (1987), and especially the groundbreaking work of Aguirre Beltrán (1963), Anzures y Bolaños (1989), Hernández Sáenz (1997), López Austin (1967), Quezada (1989, 1991), Sepúlveda (1988), and Viesca Treviño (1984, 1990). Carlos Viesca Treviño's work is remarkable for its detailed treatment of Mexican medical specialties and their transformation during the colonial period. Luz María Hernández Sáenz's (1997) book is the most comprehensive publication on all major types of colonial Mexican healers at the time of independence. Both Hernández Sáenz and Viesca Trevino note the importance of race, class, and gender, and make meticulous use of primary archival documents.
George Foster's contributions to medical anthropology (e.g., 1953, 1987, 1994) are diverse and quite extensive. Like Benjamin Paul, he is the author of several very influential publications and has worked in the same community for more than fifty years. Foster's work helps us to better understand Mesoamerican healers because he clearly recognizes the important influence Spanish healers and their theory of humors had on Mesoamerican folk medicine. The well-documented example of the diffusion of humoral medicine to the New World is all the more remarkable because it was preceded by the centuries-long spread of Graeco-Persian-Arab humoral medicine to Spain.
Scope of the Book
Throughout this book, comparisons are made regarding the socioeconomic status of Mesoamerican healers (e.g., gender, age, family of origin), their recruitment and training, compensation and workload, diagnosis of illness, conceptual models, and their relationship to other types of medical practitioners and religious and political leaders. My use of the term "Mesoamerican" (literally, Middle American) needs to be clarified because it means different things to different people (see Carmack, Gasco, and Gossen 1996: 5-6). Those who think of Mesoamerica primarily in geographic terms may find the scope of this book more limited than the title suggests. As Table 1.1 and Figures 1.1 and 1.2 indicate, comparisons are made of healers from a relatively large number of indigenous groups, but only those from Mexico and Guatemala. Practical considerations preclude discussion of healers from Belize, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama. Considerations of length also meant some kinds of healers working in Mexico and Guatemala could not be examined (e.g., dermatologists, ophthalmologists, dentists, psychologists, radio doctors, epidemiologists, volunteer health promoters, acupuncturists, homeopaths, fortune tellers). In any case, there is relatively little written about these kinds of healers.
"Mesoamerican" is often used to refer to a particular historical tradition of aboriginal cultures. For readers who generally think of Mesoamerica in these terms, the scope of the book may be more inclusive than they anticipated. Healers who are mestizos or who view themselves as descendants of Spaniards are discussed in detail. Contributors look at healers from Native American groups in north Mexico as well. Many scholars would group them with the North American Southwest (e.g., Ortiz 1983). These groups and types of healers were included because the authors of the chapters wanted to highlight the historical and contemporary interrelationships among them.
In addition to the above limitations in scope, this book does not treat in great detail the use of medicinal plants by Mesoamerican healers. Interest in Mesoamerican medicinal plants has a long history and the literature on this topic is voluminous. A minimum of several hundred pages would be necessary to treat this topic in an appropriate manner. Some of the more important resources on medicinal plants and their use by healers in Mexico and Guatemala are mentioned below.
One of the best places to learn about medicinal plant use in Guatemala is Orellana's 1987 book. It also has a nice nineteen-page overview of historical and current botanical, ethnobotanical, and ethnographic sources on medicinal plant use in this country as well as in Mexico. Another source to consult to learn about medicinal plant use in Guatemala is Armando Cáceres's (1996) Plantas de uso medicinal en Guatemala. Julia Frances Morton's Atlas of Medicinal Plants of Middle America: Bahamas to Yucatan (1981) is one of the best single sources about medicinal plants in Mexico. Especially worthy of mention are two 1994 books whose six volumes collectively contain nearly 3,400 pages of information on medicinal plants in Mexico: (1) Emes Boronda, Ochurte Espinoza, Castañeda Silva, and Peralta González' Flora medicinal indígena de Mexico: Treinta y cinco monografías del Atlas de las plantas de la medicina tradicional mexicana; and (2) Argueta Villamar, Cano Asseleih, and Rodarte's Atlas de las plantas de la medicina tradicional mexicana. The latter has an extensive bibliography of sources that deal with anthropological, botanical, chemical, ecological, ethnobotanical, geographical, historical, pharmacological, and toxicological aspects of medicinal plants. Also worthy of special mention are Alcorn (1984); Berlin and Berlin (1996); Bye (1986); Bye and Linares Mazari (1987); Frei, Baltisberger, Sticher, and Heinrich (1998); Frei, Sticher, Viesca Treviño, and Heinrich (1998); Ortiz de Montellano (1975); and Weimann and Heinrich (1998).
The approach taken in Chapters 2 and 3 is ethnohistorical. The authors make extensive use of archival materials and supplement them with published, secondary sources. Physicians, surgeons, pharmacists, phlebotomists, nurses, midwives, and curanderos are compared to each other. The authors also make regional comparisons and show how a healer's role has changed over time.
The next eight chapters concern themselves with contemporary practitioners. They are examples of regional controlled comparisons of healers from neighboring, culturally similar groups. All of the authors have firsthand experience working with healers in one or more Mesoamerican communities and have conducted an extensive review of the literature. Several have worked with two or more kinds of healers. As Dow and Lipp note, comparisons present a number of problems, for example, lack of information and imprecise definitions of some healers. Nevertheless, they are worthwhile because they lead to an appreciation of the amount and kinds of variation that exist among different types of healers. Equally importantly, regional controlled comparisons stimulate the development of midlevel theories. Since healers come from groups that are similar in many respects, differences in a small number of variables often "form integrated clusters, or systemic variations, whose functional or causal interdependence [holds] explanatory power (Johnson 1991:4).
Although there is more cross-fertilization and overlap now than in the past, economists, historians, political scientists, medical anthropologists, geographers, psychologists, and sociologists traditionally focused on different kinds and aspects of medical practitioners. For example, medical anthropologists have looked extensively at midwives and magico-religious healers such as shamans, often in relatively small non-Western societies. Medical sociologists frequently studied doctor-patient interactions and the organization, educational experience, and socioeconomic status of doctors and nurses in Europe and North America. Medical geographers have often focused on the accessibility, utilization, and spatial distribution of medical personnel and facilities in nations throughout the world. Scholars from these disciplines also tended to employ different theories. Four theoretical perspectives and how they can be applied to Mesoamerican healers are discussed below.
Interpretive theories explore the meaning and "metaphors of health and illness and the symbolic uses of the human body in various cultures" (McElroy and Townsend 1996:64). Finkler uses an interpretive approach at times in her chapter on Spiritualist healers. For example, she discusses a patient with heart palpitations to illustrate the way Spiritualist symbols are transmitted from healers to patients. The patient's Spiritualist healer suggested her heart palpitations were like crystalline drops falling into an empty glass. The drops symbolized God's words and the empty glass represented the patient. After the patient recovered, she became a Spiritualist healer herself and often referred to this metaphor when she talked to other patients about illness. Finkler also suggests spirit possession trance allows Spiritualist healers to experience their bodies in a new and sacred way, and that this may be health promoting.
There are different and competing theories of feminism. Following Sherwin (1996:188-189), feminist theory is understood here as the recognition that women are oppressed by sexism, and that this oppression may involve one or more of the following conditions: exploitation, marginalization, powerlessness, cultural imperialism, and violence. Harrison's chapter is in part an application of this theory. She discusses the increasing number of women entering the medical profession in Mexico, an increase that took place when a shift occurred from physician scarcity to excess. In turn, there was a corresponding decrease in job security, pay, and status. Women physicians were affected more negatively by these changes than were male ones. They are more likely than male physicians to work part time in the public sector. In addition, the percentage of women physicians working in less desirable sectors of Mexico's health system is greater than the percentage of women working in more desirable sectors. Harrison also discusses the fact that women physicians are expected to fulfill the same family obligations they have in the past, and how this makes it difficult for female doctors to take annual renewal courses, especially when travel is necessary.
The authors of several other chapters note that gender and type of healing role are correlated in Mesoamerica. During the colonial period, physicians, surgeons, pharmacists, and phlebotomists were generally men, while midwives and nurses were overwhelmingly female (Hernández Sáenz and Foster). The contemporary period is similar in the sense that higher status, better remunerated medical occupations are undertaken by men while lower status, lower paid ones are filled by women (Harrison, and Hurtado and Sáenz de Tejada). Dow and Lipp note that both men and women can become shamans. However, only male shamans tend to combine healing with the higher status role of priest. Female shamans have relatively little to do with the public aspects of religion and politics in Mesoamerican communities.
The political economy perspective is often used to critically look at how the world economic system and broad social and political forces shape illness and healing (McElroy and Townsend 1996: 65-69). This theory helps scholars to appreciate the important role funding from foreign countries and nongovernmental organizations (NGOS) plays in Guatemala's health system, including the type and distribution of healers (see Hurtado and Sáenz de Tejada's chapter as well as Bossert 1987, Cardona and Campos 1995, Guerrero Espinel et al. 199Z, and La Forgia and Couttolenc 1993). The institutional violence directed toward some of Guatemala's medical practitioners during the late 1970S and 1980S can also be understood within a political economy perspective. The American Association for the Advancement of Science (1992), Cabrera Perez-Arminan (1995), and Liebman (1994) document cases in which rural and urban health promoters, nurses, doctors, and medical students had to drastically curtail their activities because of widespread violence and their presumed antigovernment sympathies. Some were imprisoned, disappeared, and killed.
Political economy is especially useful in understanding how power, social class, and ethnicity are determinants of medical practice, and of the social relations among healers. One of the main contributions of Hernandez Sáenz and Foster is to show how the organization and characteristics of colonial healers reflected the social, economic, and ethnic stratification of the society in which they practiced. At the top of the medical hierarchy were wealthy, university-trained "pure blooded" Spaniards and Creoles. At the bottom were poor, uneducated, "racially mixed" practitioners: phlebotomists, midwives, nurses, and curanderos. Numerous mechanisms of social control, secular and religious, formal and informal, regulated Mesoamerican healers and medical practices during the colonial period. The Royal Protomedicato was charged with licensing medical personnel and enforcing legislation. Medical faculty within a university were ranked below the faculty of canons, theology, and law. Rural missions had hospital annexes.
Medical ecological theory views the health of a group as a reflection of the quality and kind of relationships within the group, with neighboring groups, and with plants, animals, and nonbiotic features of the environment (McElroy and Townsend 1996:2, 12, 67). Paleopathologists, social epidemiologists, and medical anthropologists have successfully used this theory to understand links among birth, fertility, nutrition, stress, death, and illness on the one hand, and the enviromnent, subsistence patterns, and population size on the other. Although healers have not been extensively examined from a medical ecological perspective, the authors of two chapters suggest how this approach can be applied to them. Huber and Sandstrom found a moderately strong positive correlation between population size and the likelihood that midwives will be found in an indigenous group, degree of medical specialization, and presence of a traditional medical organization. Dow found that shamans from sparsely populated north Mexican groups use fewer ritual objects than those from the east, west, and central regions. Medical ecological theory continues to shows promise. We suspect it can be used to account for other aspects of Mesoamerican healers, such as the number and types of medicinal plants healers use, the kinds of conceptual models employed, and the degree of competition among healers.
The above four theories shed light on different aspects of Mesoamerican healers, and for that reason they will continue to be useful. Nevertheless, these theories have limitations and problems with which scholars are still struggling. For example, some ecological explanations in medical anthropology are justifiably viewed as reductionist, "leaving out too many cultural variables, and not giving adequate emphasis to the forces of politics, economics, and history" (McElroy and Townsend 1996:67). However, scholars are developing an approach—political ecology—that merges ecological theory and political economy (Baer, Singer, and Susser 1997; Brown 1988). We are encouraged by this synthesis. The medical ecological perspective can accommodate political ecological theory as well as feminist and interpretive analyses. Accommodation is more productive than the wholesale rejection of this theory. It is consistent with anthropology's holistic and multidisciplinary approach (see also Anderson 1996; Biersack 1999; Kottak 1999).
Organization of This Volume
This volume contains ten topical chapters. The first two offer ethnohistorical perspectives on Mesoamerican healers, emphasizing their indigenous, Hispanic, and African origins and influences. The next eight focus on contemporary healers: shamans, Spiritualists, midwives, bonesetters, physicians, nurses, and social workers. Many of the authors of these chapters are well known to Mesoamericanists. I am pleased that they contributed to this volume. Their chapters represent the state of the art in the study of Guatemalan and Mexican healers.
Hernández Sáenz and Foster's chapter provides the best documentary support yet for the theory that the humoral component of Spanish American folk medicine came from elite colonial healers—physicians, surgeons, pharmacists, phlebotomist-barbers, and missionary friars. Viesca shows how indigenous, mestizo, African, and "mixed-race" healers at the lowest levels of the medical hierarchy were increasingly denigrated and persecuted as the number of physicians and missionaries increased. For example, Maya curers during the early colonial period grew reluctant to practice for fear of being accused of witchcraft. The Inquisition condemned the use of peyote, which was much more widespread in the past than it is at the present time among indigenous healers. When hearing Indians confess, friars regularly included questions to determine if they had been going to indigenous healers or believed in predictions based on dreams or omens.
Opposition to indigenous healers continued in Mexico and Guatemala well into the nineteenth century, and, as Dow, Lipp, Cosminsky, and Hurtado and Sáenz de Tejada show, it continues in various forms up to the present time. Dow notes that some Mesoamerican groups have shamans who participate in public religious ceremonies while other groups have shamans who limit their work to healing illness. The latter are found among groups where Roman Catholic and evangelical Protestant influence has been comparatively long and sustained.
Lipp examines the various ways shamans organize themselves and how their organization is related to other aspects of a community's social organization, finding that shamans from many Maya groups are formally and publically recognized, ranked in a hierarchy, and come from societies with lineage-based social organizations. In contrast, Oaxacan shamans generally lack an ancestor-based vertical arrangement and come from groups with a bilateral and generational kinship pattern. Finkler explains why the majority of Spiritualist temple leaders, healers, and patients are women, taking into account the exclusion of most women from full participation in social and political affairs, the subjugation of women to men, and their husbands' acts of violence during drinking binges.
Huber and Sandstrom, Cosminsky, and Hurtado and Sáenz de Tejada look at different aspects of Mesoamerican midwives. Huber and Sandstrom found that midwifery is more varied in northern and central Mexico than in southern Mexico and Guatemala. In addition to finding that ecological and demographic factors are systematically related to midwifery organizations, training, and gender, these authors discovered that the way midwives are recruited (sacred or secular) predicts the likelihood that they uill cooperate with doctors and nurses. This is a finding with potential practical significance.
Cosminsky leaves no doubt that Maya midwives are still one of the most important types of healers working in Mexico and Guatemala today, delivering most births in most rural communities. They have also been the type of healer most subjected to medicalization. As a by-product of this process, their authoritative knowledge has been contested and their role has been increasingly secularized. In addition, they have been placed in a hierarchy in which they are subordinate to doctors and nurses, and in a dominant position with respect to their clients.
Hurtado and Sáenz de Tejada compare Guatemalan physicians and nurses to midwives working with Guatemala's Ministry of Health Services. This brings into sharp focus the importance of class, educational level, gender, and ethnicity. Physicians and nurses are mostly ladino, speak Spanish, and have a university or high school degree. Midwives are generally illiterate Mayan woman who live and work in impoverished rural communities. These authors find that control is exercised in a variety of ways such as requiring a license to practice, training at monthly health services meetings, scoldings and reprimands, denigration of their supposed abuse of liquor, and criticism of their alleged misuse of massages and sweat baths. As a result, midwives may resist licensing, practice in secret, and avoid referring pregnant women to health centers. Ethnic discrimination is deeply rooted in Guatemalan society, and discrimination against traditional healers is common. Nevertheless, Hurtado and Sáenz de Tejada provide considerable evidence that the situation is beginning to improve as doctors, nurses, and midwives learn more about each other, become more tolerant, and begin to work together to produce positive health outcomes.
Paul and McMahon undertake the considerable task of comparing various subgroups of bonesetters in Mexico and Guatemala. One of their most interesting findings is that supernaturally called bonesetters are found primarily in the Yucatan, Chiapas, and Guatemala. Their status in the community is higher than that of secular bonesetters even though they use fewer medicinal products and do not charge a fee for their services.
In the last topical chapter, Harrison compares contemporary, formally educated healers—physicians, nurses, and social workers—to each other and examines their distribution throughout Mexico. As in several other chapters in this volume, gender and class stand out as two very important variables. However, Harrison also analyzes the importance of place in understanding some of the problems Mexico is experiencing with respect to access to biomedical health care.