Folk medicine comes with its ethical dilemmas

Moe Milstein
Vancouver Sun

Monday, October 03, 2005

In the high Andes of Peru, under the gaze of Ausangate the holy mountain, I came face to face with both an ethical dilemma and the real consequences of folk medicine.

It happened like this. We were trekking through the mountains at an altitude of 12,000 to 15,000 feet. Our guide, the late James Dirks, knew that we would be incapable of carrying a month's worth of supplies on our backs, and had hired a team of horses and burros to carry our gear.

The animals struggled up the steep trails, their sides heaving with the lack of oxygen and the heavy loads that were strapped to their backs. They worked hard and were driven hard by the arrieros who had to break and make camp for our group. After a week of this, the prospect of a day's rest for animals and people was welcome.

We camped in a high grassy bowl overlooking a steep valley and the horses and burros were left free to graze among the bulls that belonged to the people in the hamlet below.

The next morning, I awoke to shouts and the high-pitched whinny of a horse in distress. I ran over to the source of the commotion and saw the arrieros grappling with a dappled gray mare. On the ground nearby, I saw what appeared to be a horse's tail. By the time I got to the scene, the men had succeeded in wrestling the mare to the ground. Two of them were sitting on her neck and the others had tied ropes to her flailing legs. The head arriero, a proud and taciturn Quechua, held a large pair of chipped, rusty scissors in his hands.

That the horse was terrified at her confinement was not surprising. Next the arriero raised the scissors and plunged them into the mare's belly, between her back legs, where the udder was. The veins feeding the udder were engorged as if she were lactating and it was at these large veins that the man aimed his attack. He jabbed the area repeatedly until he drew blood. With each stab, the mare thrashed hysterically, her eyes big and dark, and the blood welled in dark pools beside her. After about a half dozen such sallies, the men released her. She staggered to her feet and ran off trailing blood and serum.

I asked James to explain the meaning of this for I could think of no medical reason for such an action. With not a little disdain the arriero explained that the mare had recently given birth but that her foal had died. She would continue to produce milk but with no foal to nurse, her mammary glands would fill and remain engorged. This was certainly true. But why the scissors? According to local wisdom, it was believed that the mare would develop an infection if she was not relieved of her burden of milk. The stabbing was to prevent this from happening. The tail amputation was done for the same reason.

From what I knew of equine medicine, if left alone, the mare would be uncomfortable for a few days and then, with no further demands on her, the milk production would subside and she would be fit to conceive again. Now, she would almost certainly acquire an infection, a self-fulfilling prophecy in effect.
I watched the mare the rest of that day and the following one until we had to break camp and leave. She was too weakened by the ordeal to accompany us. When I last saw her she was standing with her head down, drooling and looking miserable.

Throughout, I was torn between my duty as a veterinarian and my position as a foreigner, a stranger to the culture. I knew that their view of medicine was not a thing apart.

It was intimately woven with their religion and their view of the cosmos. I could not figure out a way to navigate the diplomatic difficulties and decided to keep my own council, not without some guilt.

I think of the mare when I hear people wax romantic about notions of folk medicine and its putative superiority to modern medicine, and I wonder what they would have done in this situation.
© The Vancouver Sun 2005