During her first birth, Lucía Hernández Rumián danced in her hospital room while her husband played the kultrún, a drum used in the ritual ceremonies of their culture.
She declined to take pain medication and instead received massages and scrubs applied by an “intercultural companion” who had purified the space following Mapuche traditions.
“I appropriated my space,” Hernandez said.
The main high-complexity public hospital in Osorno, a city in southern Chile, is finding new ways to incorporate these and other indigenous medicinal practices. It features a special delivery room with pictures of the original peoples on the walls and on the bed, as well as forms for doctors to approve herbal treatments delivered by trusted traditional healers (machis). It also has protocols for a “good death” that respect the spiritual beliefs of the indigenous people.
The hospital is working to validate these indigenous practices at a time when Chile’s original peoples –and in particular the most numerous, the Mapuches– are waging an intense campaign to assert their rights and demand restitution ahead of a vote on a new constitution, scheduled for the month of September.
They also seek to restore a crucial spiritual component in medical care, according to health professionals and patients at Hospital Base San José de Osorno.
“It has to be a guarantee. We take care of the physical part without transgressing the spiritual part”, declared Cristina Muñoz, the midwife who promoted the new protocols for births of indigenous women, which are believed to be the first implanted in the country.
Cristina Aron, the patient who first inspired Muñoz more than a decade ago, is today Hernández’s “intercultural companion” and the two dozen women she treats from the time they become pregnant until after childbirth.
“Childbirth is an energetic spiritual event for the mother, the baby and the community,” Aron said.
She hoped to give birth to her daughter in the countryside, with a traditional birth attendant. But Chilean law requires births to be attended by professionals due to high maternal mortality rates in the past.
It was thus that Aron went to the Osorno hospital and negotiated the conditions of the delivery with Muñoz, including the presence of a companion steeped in Mapuche practices. Later he took the placenta to plant it in ancestral lands.
The Mapuche believe that the placenta preserves a twin spirit of the baby. That their burial –generally accompanied by a tree that is planted in the same place, so that it grows along with the child– creates a lifelong connection between the little ones and the natural elements of the family’s territory.
“It’s something very poetic and very revolutionary,” said Alen Colipán, mother of a child whose placenta was planted next to a river, near the paternal grandmother’s house. “He will not feel the uprooting of his land.”
Colipan was 17 years old when she gave birth in Osorno’s intercultural delivery room. Three walls are covered with a photo of this rocky beach where Taito Huentellao lives, a protective spirit revered by the Huilliche Mapuches of the region.
He said that his midwife, Irma Rohe, was 85 years old and had never been admitted to a hospital, but she was allowed to receive the little boy “without gloves or other imposed things” and clean him according to indigenous rituals.
“We again want to give birth to people with ancestral knowledge,” said Colipan. “Even our way of being born was dominated. We have to start freeing ourselves.”
Chilean law now requires hospitals to deliver the placenta to the mother if she so requests. For a decade, it has allowed intercultural care in places with a significant indigenous population. The Mapuche represent a third of the inhabitants of Osorno and in the adjacent province of San Juan de la Costa they are 80%, according to Angélica Levicán, who has been in charge of the hospital’s relations with the indigenous people since 2016.
“The health of the original people always existed. Then another system came to invalidate ours,” said Levicán. “Our intention is that they complement each other.”
The coexistence of both medicines is not easy. Many indigenous people believe that public hospitals are another state institution that discriminates against them for their beliefs.
Mapuche medicine is based on spirituality and is very different from what doctors are taught, said José Quindel Lincoleo, director of a Mapuche medical care study center (Ta Iñ Xemotuam Center for Health Studies) in Temuco, another southern city with a large indigenous population.
Mapuche healers try to connect with the spirit of patients to learn “the origin of the biological, social, psychological and spiritual problem,” which manifests itself as an illness, Quidel said.
“It could be from a previous life or a damage they did to you. Or a self-ignorance that leads us to transgress our worldview, ”she added.
Traditional doctors and healers say they can complement each other, admitting that each expert knows only part of what is possible, especially in treating new diseases like COVID-19.
“It is understood that the salvation of the body has to be compatible with beliefs,” said Dr. Cristóbal Oyarzún, rheumatologist and head of the Osorno hospital’s medicine responsibility center. “The patient with inner peace has better chances of healing.”
That is difficult to achieve in the aseptic, isolated environment of a hospital, especially during the pandemic. Mapuche healers continued to pray and “spiritually accompany” patients from a distance, said Cristóbal Tremigual Lemuy, a machi (healer) from San Juan de la Costa who has long collaborated with the Osorno hospital.
“For us that is essential… to receive the energy that a patient needs,” said the healer.
Family members have access to a circular outdoor space, surrounded by laurel and cinnamon trees, where they can pray and perform ceremonies for those who are dying, Levicán said.
The hospital admits walk-in patients who identify themselves as indigenous — about 50 a day — who are greeted and accompanied by Erica Inalef, an intercultural liaison at the hospital, “so they don’t feel so lonely,” he said.
When, as a teenager, he took his elderly father to a hospital, the doctors hardly spoke to him and “body and spirit were separated,” he said.
Doctors now see the enthusiasm of patients when traditional healers arrive, and that helps build trust, Inalef said.
That trust may lead an orthopedic surgeon to recommend a lawenko — a herbal water whose exact composition healers do not reveal — or an obstetrician to allow a woman about to give birth to wear a munulongko, a headscarf believed to be the protects.
The “clothing of culture” is one of the aspects of the birth plan that Muñoz prepared five years ago. Muñoz hopes that patients will be more informed about this option. Only about twenty of the 1,500 deliveries that the hospital attends each year are intercultural.
“The women of the original peoples are twice as shy, discriminated against for being women, indigenous, poor and rural,” said Muñoz. “We tell them: Your body is the first territory that is going to be recovered.”
The recovery of ancestral practices is what led Ángela Quitana Aucapan to have her baby in a special hospital room, while her relatives played traditional instruments.
“I was able to do it like my ancestors did,” he said. “With a ceremony to wait for the new member of the family, feeling accompanied to receive my baby.”
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