How Health Care Really Works: The Case of an Andean Community in Southern Cusco, Peru

Abstract

Abstract: The author of this paper examines the type of health care delivered in Capacmarca--a peasant community of the southern Peruvian Andes. The study shows that the health-care system fails to serve the peasant population. Because of the political and cultural marginalization of the region, health professionals play an important role in the reproduction of structures of gamonal domination.Introduction(f.1)Peru is a developing country burdened by poverty and extreme socio-economic inequalities. In recent years, these conditions have been exacerbated by the crippling political turmoil of the 1980s (Poole and Renique 1992, Strong 1992). Infectious diseases, malnutrition, rates of infant mortality and premature deaths are serious issues for Andean peasants who are among the poorest in Latin America.(f.2) Starting in the 1960s, Peruvian governments have attempted to bring public health-care services to rural communities. However, their state agencies have failed to bring substantial delivery benefits to the highland population (Caballero 1980).In this paper, I would like to address the question of health-care delivery in the Andean region of Peru in terms of: (1) the political economy of health within the context of changing agricultural relations, and (2) the relationship between peasants and higher levels of local society--including the landed elite (gamonales, Sp.) and the formal authorities. By contextualizing the health-care system within structures of unequal distribution of power and privileges, I intend to demonstrate that the socio-political environment of agrarian transformations can negatively affect peasant health issues (Dewey 1989; Leatherman 1994; Luerssen 1994).Special attention will be given to the residents of the upland district of Capacmarca in the province of Chumbivilcas, Department of Cusco. This province belongs to the provincias altas (Sp.) or high provinces of southern Peru. Since consensus exists among scholars that the provincias altas represent an identifiable cultural and historical region, all parts of which face similar economic and ethnic obstacles (see Poole 1994), it is my hope that the argument presented here can provide a basis for understanding some of the challenges faced by other Andean communities in southern Peru. The data for this paper were collected during several periods of field work which I undertook in 1983, 1984 and 1986.Ethnographic Profile of CapacmarcaThe district of Capacmarca is made up of five recognized communities(f.3) and various settlements or anexos (Sp.).(f.4) It lies in a quebrada (Sp., Andean valley) at some 3000 metres above sea level and is surrounded by bleak and cold semi-desert punas. The district itself is thinly peopled with no more than 4350 inhabitants (OREC 1984:30). Although Capacmarca benefits from a mild climate and is considered by local residents to be among the most fertile valleys of the province, it is one of the least developed and most isolated districts of southern Peru (Boza Ricalde 1955; Monje 1985).In the southern Andes, survival is precarious and highly dependent on preserving the ecosystem. This vast and rugged territory of mountain ranges and upland plateaus, interspersed with fertile valleys, represents a formidable challenge to human occupation. For centuries, agropastoralism has been the Andean response to a set of environmental constraints (Alberti and Mayer 1974; Brush 1977; Guillet 1983; Watters 1994, among others). In Pre-Colombian times, when food security was a core principle of social organization, the Andes and their rich flora provided a more than adequate diet to their inhabitants. Some remnants of biodiversification could still be found in Capacmarca.(f.5) However, the current trend shows a loss of this abundant genetic diversity in the area.Environmental problems are symptomatic of the bleak economic and political situation of the district. First, the region is geographically isolated from provincial centres. …