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Culture can be defined and described as the underlying beliefs, perceptions, norms and values that are held in common by a group, and that serve as a foundation for social, economic and environmental interactions. The experience of disease and illness are given meaning by culture. Every culture conceptualizes disease and illness differently. The treatment people seek is influenced by their beliefs and perceptions of what caused their illness. These beliefs and perceptions endure because they have meaning for the members of the group.

Different cultures have unique systems for classifying illness and diseases based on perceived symptoms. Symptom is any subjective evidence of organic change or changes in some bodily or mental state. Symptoms can be warning signs that organic change (illness) is occurring. The term "disease" generally signifies any organic illness. Rene Dubos defined disease as “any departure from the state of health,” and health as “a state of normalcy free from disease or pain" (1965: 348). Disease can be measured to determine pathological condition of the body. In contrast, illness is more subjective, a feeling of not being in balance or healthy. Illness may, in fact, be due to a disease.

Beliefs and perceptions of symptoms and illness are related to culture, while disease usually is not. For example, in the study region illness is believed to occur when one's system is out of balance. Thus, within Dominican society there exist unique and personal ways of formulating an etiology of illness, which contrasts with conventional medical data, as well as the beliefs and perceptions of other cultures.

Different cultures embody strategies for coping with and healing illness and disease (e.g., Spiritualism, Voodoo, Santeria, Herbalism, and Humoral Medicine (Tables 7.1, 7.2). Interpreting the cultural text of symptoms and illness requires understanding cultural beliefs and perceptions, and meanings that underlie a social system. Culture influences how people communicate to others what they feel and how they cope with illness (Helman, 2000). Symptoms and illnesses are painful experiences in themselves, but they become more painful when the sufferer is unable to communicate how he or she feels. Helman writes that “the process of ‘becoming ill’ involves "…both subjective experiences of physical or emotional changes and, except in the very isolated, the confirmation of these changes by other people” (2000:85).

Culture also influences the type of treatment sought (Strathern and Stewart 1999; Cartwright 1998; Helman 2000). Cultural beliefs and perceptions when combined with mistrust and fear often serve to deter the poor from seeking conventional health services, and receiving appropriate treatment for illnesses that are curable in their early stages. In the study region, economic impoverishment and the absence of an efficient public health system in pesticide-exposed communities, forces many community members to seek alternative treatments that are consistent with cultural beliefs and perceptions. Traditional or folk medical beliefs and practices have been identified as potentially important aspects of symptom, illness, and disease identification (Helman, 2000, 1991; Cartwright 1998; Strathern and Stewart 1999; Brady et al. 2001).

The research argues for the use of cultural beliefs and perceptions in identifying the cause or causes of self-reported symptoms and illnesses. It examines: (1) the linkages between cultural beliefs / perceptions about illness and pesticide exposure; (2) the role folk healing or traditional medicine plays in helping community members cope with symptoms and illness; and (3) the relationship between illness attributed to “supernatural” causes and pesticide exposure; and (4) how folk medicine can contribute in the diagnosis and treatment of illnesses thought to be “supernatural” in origin but that exhibit a definite pesticide poisoning etiology. These folk medicine traditions, whether they have been transmitted from one generation to the next, for spiritual, quackery, or profit-making reasons, deserve closer examination.

What Causes Illness

Many community members believe that their illnesses are caused by a supernatural intervention of the demoniac sphere - a consequence of guilt or of exposure to potent negative action (spell, evil eye, sorcery, charm, etc.). The therapeutic intervention comes from the world of beneficial influences. As soon as the person feels better and his organism functions properly, they have conquered the malevolent forces unleashed by enemies. One of the main principles of my research was never to forget that the symptoms and illnesses reported by community members were real in their minds and that the possibility existed that there was a cause and effect for them.

Although community members are aware of the offers of conventional medical treatment for their self-reported symptoms and illnesses, many opt for selecting non-western treatment to obtain better health. It must also be noted that many of the symptoms and illnesses they suffer from are thought to be caused by agents other than pesticides. Many seek help at the local curandero, yerbero or espiritista, who prescribes herbs and incantations to heal an illness thought to be caused by breaking culturally defined health taboos.

These can occur because of a dysfunction in the relationship with the sacred or unknown (castigo divino or divine punishment), or in the interaction between group members that have quarreled (brujo or curse, mal de ojo or evil eye), or when cultural forms of behavior and instructions are not respected (tomar sereno, empacharse, pasmarse, susto, ataque de nervios). Interestingly when offered the choice between the various medical approaches, community members chose the one closest to their cultural beliefs.

In the study area, Parkinson’s disease, linked to pesticide exposure, is considered a spiritual evil, a malefic and threatening destiny that the diseased person must endure unless he exorcises the evil. It is not the sick person’s destiny, which is important as much as determining what induced the spiritual world to hit that person, through illness. Was it a “behavioral” offence that he/she committed? These spiritual attacks recall the rules governing relations between members of a community and between men and supernatural beings. Rules that, if violated, unleash punitive attacks: illness, which must be correctly interpreted for the appropriate therapy to be found, and for equilibrium to be achieved.

The research underlines the difference between organic or serious illness characterized by an inability of the person to function mentally or physically; and non-serious illness or a "culture-bound" syndrome, that is a syndrome that is unique to Dominican-Caribbean culture. Some psychosomatic diseases such as susto, pasmo, sereno, ataque de nervios, malignant anxiety, etc characterize this type of illness. All of these illnesses have symptoms similar to pesticide exposure, such as nervousness, hyperventilation, and dizziness. To get a clearer picture of the respondent’s knowledge about illnesses caused by pesticide poisoning, they were asked to give the name of the illness or illnesses they believe to be suffering from.

Symptoms and illnesses associated with pesticide exposure involve the whole community in a reflection on the causes, organic or involuntary, committed by divinities or supernatural beings, neighbor’s spell, or breaking health taboos. The health questionnaire sampled the broader community, giving them the opportunity to recall folk medicinal remedies, rules of health behavior, and cultural traditions dealing with spiritual offences. The health questionnaire had its effects on some of the respondents, who for years thought they were being punished or cursed with an illnesses for upsetting God, a neighbor or committing a behavioral offence. The process involved in administering the health questionnaire help dispel health taboos and in the process demystified their symptoms and illnesses.

The first step in administering the health questionnaire was to impregnate the whole process with a sense of community sharing. The community was sharing information on illnesses that for many were caused by a neighbor’s evil eye or ill intentions. Dispelling these notions helped bring community members together to discuss the causes of their symptoms and illnesses.

The same attention was given to time, scheduling the questionnaire during times when the largest number of community members were free to participate as a group. Sufficient time was given to listen to the narrations of all those who were suffering, including evaluation of their disease, thus including in the process the patient’s cultural leanings, perception of disease and experience of health.

Hot / Cold Imbalance

The hot/cold theory of diseases survives in the study region (Observations on multiple case studies conducted in 1998, 2000 and 2002). This hot/cold theory traces its roots to the Aristotelian system of humors, which were hot or cold, wet or dry. Internal organs, illness, foods, and liquids are classified as being "hot" or "cold," and good health depends on maintaining a balance or equilibrium of hot and cold (Helman, 2002; Brady, 2001; Strathern and Stewart, 1999). A "cold" ailment calls for "hot" herbs and foods to restore the balance, and vice versa (See Tables 1, 2). Temperature is not the key factor in the classification scheme; ice is "hot" because it can burn, and tea, such as tilo, though served hot, is "cold" and is often used by locals to treat "hot" ailments.

Table 1 Humoral Pathology

Bodily substances	Normal "Complexion" Substance Hot Cold Wet Dry
Humor Fluid
Blood	X		X
Phlegm		X	X
Black Bile		X		X
Yellow Bile	X			X
Internal Organ
Heart		X		X
Brain		X	X
Liver	X		X

Source: http://anthro.palomar.edu/medical/humoral_pathology.htm

Table 2 BioMedical versus Traditional Folk Medicine

BIOMEDICINE	TRADITIONAL FOLK MEDICINE
Looks at isolated disease agents, which it attempts to change and control.	Holistic, treats the person rather than the disease.
Separate physical illness from emotional and psychological illness.	Mind and emotions are one.
Starts with the symptom and then searches for the underlying mechanism - a precise cause for the disease.	Treats "patterns of disharmony" that describe a situation of imbalance in the patient.
Heavily dependent on quantifiable methods such as x-rays scans to make a diagnosis.	Uses both a clinician as well as the subjective symptoms reported by the patient to heal.
Uses diagnostic tools to come up with a quantifiable description of the illness.	Looks at relationships more than causes.

Sources: Jones and Polk, 2001: Brady 2002l Adler 1999, 2000, 2001

“Supernatural” Illness

The health survey (2002) tried to capture how community members explain what I believe to be illness and treatment; who they turn to when faced with illness or intoxication and how their beliefs, behavior and activities relate to biological, psychological, and social changes occurring at the household and community level. Cultural beliefs and perception cannot explain the causes for “supernatural” symptoms, illnesses or disease. On the other hand, human behavior and activities can help uncover the linkages between these and the organic causes.

There are striking similarities between symptoms reported by respondents, which have a possible link to pesticide exposure, and “supernatural” illnesses caused by evil spells, evil eye, sorcery, charm, and other supernatural interventions. Having a clear understanding and description of the symptoms reported by respondents, allowed for the classification of illnesses strongly associated with pesticide exposure and those with “supernatural” origins.

The classification of illness based on symptoms was an important phase considering that many respondents who suffer from severe pesticide exposure had been self misdiagnosed. The respondent suffering from the illness usually attributes his/her illness to forces outside his/her control. Feeling that his/her illness is out of their control, causes complacency and no action is taken to treat or cure the illness. The respondent is often times incorrectly diagnosed by the local health care provider, who attribute the illness to mental problems or other causes, rather than pesticide exposure.

Symptom and illness prevalence studies have a number of limitations and shortcomings that were taken into consideration, in particular, recall. Recall bias can be a problem because a persons’ memory of health problems and related events can be faulty.

Susto

This is a “supernatural” ailment in which a startling, frightening or shocking experience causes some level of sickness or dislodging of the soul from its harmonious position in the body. Humoral medicine theories are evident throughout Latin American societies, and are based on achieving a balance or equilibrium via the even distribution of ´hot´ and 'cold' humors.

Disturbing the equilibrium between hot and cold is avoided. Disturbance can occur with: (1) the wandering or displacement of the soul; (2) sudden onset of heat, cold or moisture; (3) sudden or powerful emotions that prevent the body to re-equilibrate on its own, and (4) accumulation of normal or diseased body fluids, preventing self-cleansing. Symptoms include insomnia, fatigue, irritability, anxiety, lack of interest in personal hygiene and appearance and other more pronounced symptoms such as vomiting diarrhea and headaches (Landy 1977; Bauwens 1978; Cartwright 1998; Strathern and Stewart 1999; Brady 2001; Helman 2002).

Treatment for “susto” usually begins at home. This starts by restoring the person’s equilibrium (hot and cold humors) of the body with herbal tea. In more serious cases, a curandera or traditional healer, must be brought in to restore the equilibrium through a ritual process .The most common of these rituals is called a “limpieza” (a cleaning) which utilizes cigar smoke, coconuts, color candles and incantations to remove the harmful being causing the "susto".

Ataque de Nervios (Nervous Attack)

Generally, there are two different medical reasons for the occurrence of "ataque de nervios". The first one is psychological and is attributed to stress. The second is a biological one, where the symptoms of "ataque de nervios" are actually caused by an identified illness or infection.

The stress levels associated with “ataque de nervios”, is of a greater intensity for women community members. They are much more restricted in their behavior than are men. Women must care for the home, children and husband, act like a dama (proper lady) in public; they must never show their anger, and most of all be submissive to their husbands, just to name a few. Men are allowed much more leeway in their responsibilities and expectations they are supposed to fulfill.

In the study region, women experienced the greatest stress in the process of meeting obligations as wife and mother, thus making them more vulnerable to ataques de nervios and susto. Women in pesticide-exposed communities had a slightly higher frequency level of "ataque de nervios " incidents than women in non-exposed communities (Health Survey 2002).

Mal de Ojo (Evil Eye)

Mal de Ojo means "strong glance" or "evil eye". Young children are most vulnerable but all ages may suffer from mal de ojo. The mal de ojo occurs when a person with a "powerful" gaze glances or looks admiringly at someone without touching him or her. The symptoms include sudden onset of high fever, vomiting, headache, fainting, and sometimes convulsions (Landy 1977; Bauwens 1978; Brady 2001; Helman 2002). Babies and small children are most vulnerable from mal de ojo. Parents are watchful for excessive praising and compliments that may bring illness and even death upon their children. Childless women are watched with suspicion and fear when near babies and small children. They are thought to be revengeful and jealous for not being able to give birth and will curse children.

Sereno and Pasmo

Sereno is night air or dew. Colds and flu are attributed to sereno. Community members, when leaving their homes at night, always cover their heads, since sereno starts in the head area. Symptoms include: fever, chills, and difficulty breathing and sweating. Leaving a hot environment and entering a very cold one cause Pasmo. There are two forms-childhood (causes ear ache) and adult (muscular spasms or facial paralysis). Symptoms include: swelling or bloating of exposed areas, swollen eyes and chills.

Embrujado (Bewitchment)

A socially accepted psychological disease (in contrast to being considered "mad"); embrujado may be manifested through physical or psychological illness, depending on the intent of the bewitcher (who is always female). Locals say that a man that is embrujado is being punished by a wife or significant other for his infidelity. Symptoms include: depression, loss of appetite, mental confusion, and vomiting. The embrujado is unable to erase the image of the bewitcher from his mind, a constant torment day and night (Landy 1977; Bauwens 1978; Strathern and Stewart 1999; Helman 2002; Brady 2001).

Empacho and Bilis

Empacho is a “pseudo-illness or folk illness” affecting cultures of Hispanic/Latin America. It usually presents itself as an ailment of the digestive or intestinal tract. Some of the attributing characteristics include: abdominal pain, vomiting, constipation, anorexia, gas and bloating. These symptoms are also associated with other illnesses, such as those linked to pesticide exposure.

Empacho, as an illness, is not accepted in the medical profession (Brady, 2001). Symptoms that arise from such an illness are often diagnosed as something as simple as an upset stomach. At other times, they are dismissed as being totally psychological manifestations. Individuals that suffer from this disease told me that their condition was far worse than an upset stomach or constipation. In Dominican rural society, usually the women bear the responsibility of staying home and taking care of the family. This is why mothers and grandmothers are usually the first to help treat the family member that is suffering from an illness such as empacho.

The most widely sought person to treat empacho is usually found within the home. The mother or grandmother will notice the infliction and take it upon herself to cure the family member. There are several remedies available with easy reachable herbs and teas, usually found within the home. This is another reason that empacho is usually treated at home first. In Dominican rural society, usually the women bear the responsibility of staying home and taking care of the family. This is why mothers and grandmothers are usually the first to help treat the family member that is suffering from an illness such as empacho.

Bilis is an illness similar to empacho. It is believed to be caused by strong emotions that result in an imbalance of bile, which "boils over" into the bloodstream. Symptoms include vomiting, diarrhea, headaches, dizziness, and/or migraine headaches.

Gripe or Flu

The gripe or flu has been found to be the cause of many of illnesses and deaths, as it leaves the afflicted body susceptible to secondary infections. In addition, it has almost the exact same set of symptoms as pesticide poisoning and, therefore, many are not properly diagnosed.

Folk Medicine Providers

This section discusses the treatments or remedies sought by community members who believe they are suffering from a “supernatural” illness. Remedies are sought in various places, starting first inside the home, then the immediate family, followed by traditional folk healers outside the home. When a person complains of ataque de nervios, empacho, susto, or sereno, the first to come to their aid are immediate family members, usually the grandmother. If the grandmother is not available, others will be summoned, usually the mother or aunt. If the mother or aunt cannot be reached, any female in the community that has knowledge about folk cures is summoned.

Women are consulted more than men in folk-illnesses and in the matters of curing, the reason being is that women are the prime sources of healing. This is not to imply that men are never consulted in these matters, it is more common to hear that a woman cured fulano (so and so) of a terrible illness.

Santeria

Santeria is one of the Spanish Antilles synergetic belief systems "whose external manifestations is the parallelism created between the diverse images drawn from the Catholic cult and the representational deities of an African group, known to ethnologists as the Yoruba" (Dalmau 1978: 6). There is strong relationship between the Catholic Church and Santeria in the syncretism between the different Santeria Gods and the Catholic saints, in which Jesus Christ, Santa Barbara, Saint Anthony, and Virgin Mary represent the African deities of Olofi, Chango, Elegua, and Yemaya, respectively (Dalmau 1978). Although the local Catholic Church is vehemently against the practice of Santeria, most who attend Sunday mass to pray and worship also venerate the Yoruba deities.

According to the Santeria religion, every petition or request must go through one of the orishas. It is believed that invoking the wrong orisha or requesting that a petty problem be solved, angers them in such a way that they will make the person suffer more. Oloddumare is above all the orishas; he has always existed. For this reason he is not considered an orisha but God the creator. Any problem can be solved no matter how difficult it is. Problems with love, money, and spells can be solved through the orishas, which have power and authority to change any condition or situation.

Most of the people that go to see a santero have personal problems that they describe as “bad luck”, “love problems”, “bewitched”, “cursed”, “money problems”, and “haunting.” Many community members interviewed said they went for a consultation with the santero to find a solution for their illness or symptoms. They believed that their illness was caused by a spirit that was following them, a spirit sent by an enemy.

Some of the community members that visited a santero were given special “magical” herbs to use, candles, and prayers for a specific saint. Others were given cleansing baths to take out the negative vibrations that were perturbing them. Animals, mostly chickens and goats are sacrificed and their blood offered to the deities. Sahumerios are incenses that are burnt in the house to chase evil spirits away. The smoke is dispersed to all corners of the house to ensure that the evil spirit has no place to hide, to cleanse their house of evil forces.

Cleansing the house of evil forces is also done by sprinkling holy water, essences or oils in the interior and exterior corners of the house. Candles with the figures of the Yoruba deities (Chango, Elegua, Yemalla, Obatlla and Ogun) are lighted and placed throughout the house. Banos or baths are made of plants boiled in water and sprinkled or poured over the person that is afflicted. Sometimes this can be done without going to see a santero. Some people, familiar with herbs and their use, purchase them at the botanica and prepare their own baths.

Botanicas are the stores where Santeros purchase their ritual items and supplies such as special candles, magical powders, herbs, lucky charms, statues, and potions. The local cemetery is visited to dig for bones and solicit the help of “tormented spirits” to assist in the ritual. These muertos or un-evolved spirits are summoned during the ritual. Depending on the nature of the problem, muertos can either be sent out to torment an enemy or help the person with a problem. After the session with the Santero, the person is instructed to go to a botanica to purchase the items needed to complete the cure.

Espiritismo

Espiritismo is the Spanish Antilles synthesis of Spanish, African and Taino folk systems that combines ancient spiritual beliefs with quasi-religious healing techniques. Based on a theory of visible and invisible worlds, journeying entities, sometimes in human form, pass through different stages of perfection toward their ultimate goal of unity with God. When they err from their path, due to desires of previous lives, they often cause trouble for people through dreams or actual possession manifested in psycho-somatic complaints, stress, anxieties and nervous conditions.

“Espiritistas" (mediums) are called upon for symptomatic relief, often complementing non-folk medicine, to improve mental health conditions and distressed relationships. Empowered to draw on their inner resources, believers are encouraged to change their thoughts and attitudes. During a “consulta” the medium, possessed by and communicating for the spirit, is consulted regarding the characteristics of a specific illness. To protect the participants from further anguish, the entity is then severely criticized and urged to resume their original mission.

Vudu Haitiano

Vudu, known in the study area as vudu haitaino (Haitian Voodoo) or brujeria africana (African witchcraft) comes from the Yoruba word for "spirit". Vudu's roots go back to the West African Yoruba people who lived in 18th and 19th century Dahomey. Slaves brought their religion with them when they were forcibly shipped to Haiti and other islands in the West Indies (Simpson 1971).

The purpose of vudu rituals is to make contact with the Gods and Goddesses (Simpson 1971. They are used to gain their favor by offering them animal sacrifices and gifts, to obtain help in the form of more abundant food, higher standard of living, and improved health. Human and Loa (deities), depend upon each other; humans provide food and other materials; the Loa provide health, protection from evil spirits and good fortune. Rituals are held to celebrate lucky events, to attempt to escape a run of bad fortune, to celebrate a seasonal day of celebration associated with a Loa, for healing, at birth, marriage and death (Simpson 1971).

Haitian vudu is greatly feared in the Dominican Republic for its purported association with “devil worshipping”. The presence of large numbers of Haitian farm workers in Tireo have some community members worried that they are using vudu against them. In a Colmado in Tireo, a fight between Haitians and locals broke out one night; the result of a dispute over a “brujo” or curse that the locals believed was the work of the Haitians. Threats were made on both parts, the Haitians, outnumbered and unarmed, were assaulted. Such arguments and threats were taken seriously. A few months before my last field survey in February 2002, three Haitians were brutally killed by an enraged group of Dominicans who believed they were possessed by demons sent by Haitians.

Haitians use Vudu as a means of protection from abuse as well. In Tireo Abajo, I observed a group of Haitians threatening locals with vudu curses if they caused them any harm. The Haitians told locals that the vudu gods would seek them out and make them sick. One of the Haitians pulled out a red powder wrapped in a handkerchief to show the locals. Enraged and fearful some of the locals ran into their homes after seeing the red powder (Observation made in Tireo Community, 2002).

Curandero(a)

A practitioner is either a curandero (male) or a curandera (female), and may be a member of the patient’s nuclear or extended family. Sometimes the curandera is a señora or older woman who has developed a reputation for success in treating friends and family. Sometimes the curandera is an espiritista.

Curanderos practice Curanderismo, a system of healing derived from a mixture of Taino, Spanish, African spiritualistic, homeopathic, and modern medicine. Curanderismo is used to treat physical, psychological, and social illnesses. It is more popular in the Cibao region than in the rest of the Dominican Republic. My contact with curanderos in the study area was limited. However, community members in Tireo, who frequently visit curanderos, informed me that the two most popular and solicited curanderos live in Bonao and Jarabacoa. Curanderismo shares many scientific concepts and procedures with modern scientific medicine, and many community members attribute their health to the remedies prepared by the curandero. Although, SESPAS health officials and local doctors dismiss it as "quackery," curanderismo plays a major role in the community’s health beliefs and practices, that hospitals and clinics in the region are unable to fulfill.

Partera (Mid-Wife)

A partera helps a woman give birth and delivers babies. A partera is always a woman because women are believed to have a better understanding of the female reproductive system than men, including "scientific" physicians.

However, a partera is usually not summoned, unless the person is a pregnant woman. The goal of the partera is to support women physically and emotionally during the birthing process. Parteras facilitate the normal, non-traumatic birth of healthy newborns. While interviewing in the community of Tireo, a partera, by the name of Antonia, was summoned to a nearby wooden shack that served as a home for a woman and her five children. The pregnant woman was in pain and sweating profusely. The partera arrived with all her “birthing” paraphenalia.

The partera with quick motions and experience as her guide began massaging the woman to assist the birthing. The massage continued for a few minutes. She then rubbed an oily substance on the pregnant woman’s abdomen and began telling her to breathe through her mouth. Soon after, the baby’s head began appearing. The partera, after cutting and tying the umbilical cord, wrapped the baby in blankets and placed him beside the mother. Sanitary conditions during and after the birthing were deplorable, but hundreds of babies are delivered in this manner and the infant death rate is lower in rural communities than the larger cities and towns (Dr. Rodriguez, 2000, personal interview).

The “Supernatural” Illness-Pesticide Connection

Supernatural illnesses form part of a syndrome of a particular disease or illness. In the health survey, not all persons suffering from the same disease or illness had the exact same pattern of symptoms. The symptoms, in many cases, differed in severity, duration and intensity. It was observed that many of these symptoms and illnesses had more to do with the person’s mental well-being and cultural beliefs than their physical well being. The health survey took into consideration this fact, and that some of the so-called “pesticide exposure symptoms” might be caused by psychosomatic” illnesses. in view of the fact that these diseases present themselves in many different forms, the health survey was unable to accurately pinpoint the symptoms, therefore, in these cases no explanations of probable causes were given.

The study contends that community members who are exposed to pesticides often are not diagnosed, because so few health care providers take the time to do a thorough medical check up, including patient history (Observations made at local health clinics and hospital, and interviews with health care providers in Constanza, 1998, 2000, 2002). In addition, many health providers are unaware of the symptoms associated with long-term pesticide poisoning. Many had been wrongly diagnosed with illnesses such as: asthma, heart irregularities, bronchitis, the flu (gripe), and even mental illness. Although the cause or medical attention received is not recorded by health care providers, symptoms of poisoning from organophosphate pesticides such as headaches, dizziness, muscle twitching, tremors, nausea, mental confusion, abdominal cramps, diarrhea, sweating, blurred vision, and tightness in chest, are identical to the symptoms that respondents attribute to supernatural causes.

However, farm workers and other pesticide-exposed community members are not aware of the possible relationship between their symptoms and where they work, live, and play. Commonly they do not associate their symptoms of cough, chest tightness, irritation of the skin, or shortness of breath with their work or near-home-school exposures.

The survey collected detailed self-reported medical history of each respondent, including an accurate and detailed occupational history. In this way, the survey categorized symptoms, which were typical of pesticide poisoning and those attributed to “supernatural” causes. The final diagnosis, however, should be made based on biological studies to include, when indicated, cholinesterase testing, liver panel, and urine analysis (Personal Interview with Medical Staff, Santo Domingo, 2001).

Conclusion

The research supports the conclusion that folk healing or traditional medicine is a significant coping mechanism for many community members suffering from symptoms and illnesses that are possibly linked to pesticide exposure, but which are attributed to “supernatural” causes.

Accordingly, survey participants’ medical history also included their cultural beliefs and perceptions regarding symptoms, illnesses and disease. The study also shows that engaging in folk healing may result in a heightened sense of control over symptoms and illnesses associated with pesticide exposure. Much of the knowledge gained during the health survey can be attributed to what was observed in the field and not from narratives, which possessed a tremendous capacity for helping to evaluate pesticide exposure in the study region.

The narratives became medical stories that spoke of the emotional and physical suffering of the health survey participants. In essence, narratives proved to be a valuable tool of the health survey, by becoming a window into the participant’s physical, emotional and spiritual self. For many participants, talking about and sharing their beliefs and perceptions, regarding their symptoms and illness, became a healing experience in itself. This is part of the healing process, listening to the inner self, sharing the experience no matter how “unnatural” it may sound.

References

Bauwens, Eleanor E., editor. 1978. The Anthropology of Health. St. Louis: C. V. Mosby.

Brady, Ericka, editor. 2001. Healing Logics Culture and Medicine in Modern Health Belief Systems. Utah State University Press.

Cartwright, Elizabeth. 1998. Malignant Emotions: Indigenous Perceptions of Environmental, Social and Bodily Dangers in Mexico. University of Arizona (Ph.D. Dissertation).

Dalmau, Felipe. 1978. Obatalá, Changó y Ochún: Elementos Espirituales de la Santería. New York, NY: Colección Destino.

Dubos, R. 1965. Man Adapting. New Haven: Yale University Press.

Helman. C. 2000. Culture, health and illness. Oxford; Boston: Butterworth-Heinemann.

Landy, David. 1977. “Role Adaptation: Traditional Curers under the Impact of western Medicine.” In Culture, Disease and Healing. Editor: David Landy. Pp. 468-480.

Simpson, G. E. 1971. “The Belief System of Haitian Vodun.” In Peoples and cultures of the Caribbean: an anthropological reader. Edited and with an introduction by Michael Horowitz. Garden City, NJ: Natural History Press.

Strathern, Andrew and Pamela J. Stewart. 1999. Curing and Healing: Medical Anthropology in Global Perspective. Durham: Carolina Academic Press.