Download Alternative Medicine: Healing in Candomblé and its place within the

Alternative Medicine
Healing in Candomblé
and its place within the Brazilian health care system
Elizabeth Hong
Health in Brazil
Summer 2007
Health care in Brazil is not shockingly different from that in the United States, but
there exist subtle differences in approach and philosophy. Our technical visits to clinics
and hospitals in various cities in Brazil have revealed much of the same equipment and
techniques that are used in the United States, and while in some places there may be
fewer beds or more limited resources (the Santa Casa emergency room in Bom Despacho
had only two critical care beds, and the main hospital in Barbacena had only eight), it was
reiterated to us again and again by doctors and other professionals that the respectful and
holistic care of patients is of the utmost importance. While this is certainly a common
goal for health care workers the world over, the philosophy of concern for patients as
individuals with personal worth and a right to quality health care has manifested in
tangible programs in Brazil. One important program is the institution of family health
clinics in poorer areas, staffed with teams of physicians, nurses, and health workers who
actively go out into the community monthly to check in on the status of households in
their microregions. In a country of such racial, cultural, and economic diversity, it seems
a step in the right direction that the government’s attempts through SUS (the universal
health care system under development in Brazil) to provide considerate and competent
health care to the whole of the population.
Yet SUS is not without its problems, carrying the baggage of an older system, as
we were told in various presentations. The services it provides do not always meet the
high demands, and in bigger cities such as São Paulo, some hospitals emergency wings
have patients sleeping on the floor of the waiting room for days. Furthermore, SUS
services tend to be less adequate than those provided by private insurance plans, as
witnessed in the oncology department of a private hospital we visited in Ipatinga. While
private health care patients receive the most up-to-date cancer medication, SUS patients
must settle for older versions. The problem, Dr. Alfredo told us, is not a lack of revenue
via income tax collection, but rather inefficient distribution and government corruption.
Only 10% of the taxes collected in Ipatinga remain there to be dealt with by the
municipal government, while 90% must go through the state and national government for
distribution. The result is a need for SUS hospitals and clinics to make do with limited
resources – the words “cost-effective” were common on our visits. Often the cost is
alleviated by hospitals serving both private and SUS patients, such as in the Márcio
Cunha Hospital in Ipatinga, with the only difference in care being the luxury of a single
room for private health care in-patients. Facilities such as this one appeared efficient and
effective, hopefully a representation of the direction in which SUS is heading.
Yet to most Brasileiros, the system is still far from perfect. One host family gave
me a thumbs up at the mention of private health insurance and a double thumbs down at
the mention of SUS. Of course, they were wealthy enough to pay for private health care.
Most must still deal with being redirected to hospitals and specialists in neighboring
cities, even in cases of emergency visits in which a facility does not have the room or
equipment to take on a patient. It is at the very least an inconvenience, even though SUS
pays for the transportation, and in severe cases could be life-threatening. There is also
the possibility that requests for specific procedures – especially costly ones – may simply
be denied or ignored. It helped, we were repeatedly told, to know the right people in
government if you wanted your request to be approved. The majority of Brazilian citizens
do not have this luxury. And while family health clinics are expanding their programs,
they still do not have the resources to extend coverage to all those who are in need of
health care. This supply-demand inequality and the continuing distrust and fear of such
procedures as cervical cancer exams (rooted in lack of education or social taboos) raise
the question of whether there exist other outlets through which people can meet their
health care needs.
A possible answer to this is the healing practices found in Afro-Brazilian religions
such as Candomblé and Umbanda, whose influence we witnessed in as varied places as
musical groups in a cultural parade poster in Bom Despacho, murals of orixás (African
god / Roman Catholic saint amalgams) in a primary school in Barbacena, and numerous
booths devoted to both religions in the Central Market in Belo Horizonte. The prevalence
of Candomblé and Umbanda in Brazilian culture makes it interesting to examine their
origin, theory, and practice, particularly in the context of medicinal healing. While the
two religions have markedly different histories and slightly different theories, on the
whole they appear to occupy the same niche. Indeed there is little difference that can be
seen from observing their respective stands at the Central Market, even upon conversing
with the vendors (Jason acted as interpreter). Instead of elaborating in depth on their
differences, this paper will focus mostly on Candomblé, the older of the two religions,
with hopes that it will suffice in representing where Afro-Brazilian religions fit into
Brazilian culture and into the national health care system.
Candomblé is based predominantly in Bahia, a state northeast of Minas Gerais,
but its influence has extended throughout Brazil. Bahia had been the capital of Brazil
during the colonial era, largely due to its prosperity in sugar plantations and agriculture,
and thus had also been the center of the African slave trade from 1452 on into the 16th
and 17th centuries (Williams, 5-6). In the early 18th century, a mining boom in diamonds
and gold shifted the focus of the slave trade to Minas Gerais. Even after the decline of the
boom after 1750, the slave trade continued to thrive and even increased its activity,
providing a steady labor force for the cattle, coffee, commercial agriculture, textile
production, and continued mining of gold and diamonds in the south (Bergad, 68-69).
With these slaves came the importation of their native beliefs and practices, along with
the plants that played so integral a role in their religion and healing ceremonies. The
survival of these elements owed itself in part to the extremely high mortality rate of
slaves and virtually no reproduction to replenish their numbers, unlike those on North
American plantations. This created a constant demand for new labor, maintaining a
cultural link between Brazil and Africa (Voeks, “Sacred” 128). Also, even though Roman
Catholicism was the official state religion, the persecution of pagan religions was not so
strictly enforced in colonial Brazil. Just as landowners found that allowing slaves to
distill their own cachaça from sugar cane made for a more placated work force, so they
must have concluded in permitting them to practice their native religions. Thus
Candomblé was not displaced by Catholicism or marginalized to secular folklore or
quaint superstition detached from pertinent everyday life.
The majority of slaves that arrived in Bahia originated from the Yoruba region in
West Africa, and it is the religion of this area that is most strongly represented in
Candomblé (Voeks, “Sacred” 118). Commonly viewed as a syncretic religion between
African Yoruba religion and the Roman Catholicism of the Portuguese settlers,
Candomblé has mainly retained its African elements, with the superficial syncretism of
replacing the African names of its gods (orixás) with those of Roman Catholic saints
(Voeks, “Sacred” 130). For example, Oxossi, orixá of the hunt, was renamed St. George;
Yemanjá, goddess of the sea, became Our Lady of the Conception, and so on (Voekes,
“Sacred” 118). As we saw in the mural in Barbacena, the orixás are associated with the
natural elements – earth, air, fire, water – and since a major element of Candomblé
worship is healing, each orixá retains its own medicinal healing domain and associated
medicinal plants (Voeks, “African” 70). Presented below is a brief list of selected orixás,
their domains, and plants and/or parts of the body under their control (Voeks, “African”
71-2).
Name
Oshum
Domain
beauty/vanity
Obatalá
peace/tranquility
Yemayá
Babalu-Ayé
oceans
smallpox/disease
ironworks, hunting,
warriors, revolutionaries
Ogun
Exú/Elegua
crossroads, doorways
Osanyin
secretive god of the leaves
Plant/Body Part
aromatic leaves used in healing baths
white parts of body, head/thoughts/dreams,
leaves for blindness, paralysis
intestinal illness, TB
disorders of the skin
material health, happiness, pointed apices on
leaves (symbolize his sword)
messenger of orixás, must be propitiated
with offerings, animal sacrifices; can bring
happiness/good health if appeased, but easily
offended and can bring misfortune/illness;
barbed leaves, stingy spines
important figure in health/medicine in
general
Illness was viewed in Candomblé as being caused by an imbalance of the cosmic
equilibrium imposed by the spiritual realm, angering the spirits and inciting them to cause
disease. This imbalance may occur when a patient inadvertently strays from the imposed
order, when dead ancestors directly intervene with the equilibrium, or spirits are
manipulated by magicians or sorcerers (Voeks, “African” 69). The patient then goes to a
holy house, or terreiro, within which healing, devotional, and initiation ceremonies are
held, accompanied by drumming, chanting, dancing, animal sacrifice, divination, and
spirit possession. The chanting, singing, and dancing can be likened to those we
witnessed at the children’s capoeira demonstration in Barbacena – many of the same
instruments are used, such as drums and the berimbau, and the same African-inspired
rhythms that are found in these religious ceremonies can even be heard in the music of
the samba or in the chants at a Cruzeiro soccer match.
Ceremonies are coordinated by a head practitioner, or babalorixá, who can be of
either gender – a departure from the traditional African male-only babalorixás (Voeks,
“Sacred” 118). The babalorixá assumes a dual role: that of the babalawo, who mediates
human-orixá relations via divination, and that of the onisegun – the leaf doctor – who
treats physical and emotional illness with medicinal plants (Voeks, “Sacred” 119). The
role of these sacred plants is so essential to Candomblé ceremony that the babalorixás’
most important function is to collect, prepare, and administer consecrated plants, and are
forbidden to reveal their secrets.
The terreiro, however, is not a hospital or clinic in the traditional sense – that is,
the patient’s ailment is rarely directly treated within the holy house. Instead, the healing
ceremonies are more similar to the preliminary examination of a patient entering a
hospital, the process of determining the severity of the illness and what procedures to
take next. In the hospitals we visited, such examinations were carried out in rooms called
consultórios. Appropriately, the Candomblé and Umbanda healing ceremonies are
referred to as consultas. During the consulta, the babalorixá uses divination, trance, and
sometimes spirit possession to diagnose the patient’s ailment and discern to which orixá
the patient ought to appeal, whether to appease or to enlist assistance. The divination is
accomplished with a shell toss (jogo de buzios), the configuration of which reveals the
source of the problem and the solution (Voeks, “Sacred” 122). Cures are then prescribed
by the babalorixá, which could include votive offerings to ancestors or spirits, observance
of taboos, fasting and seclusion, trance, or the use of medicinal plants (Voeks, “African”
69). The properly prepared herbs may be purchased from a specialized herbalist and
applied in private by the patient. In the Central Market in Belo Horizonte, we saw at least
four or five herbalist booths offering a varied selection, from herbs for the liver
(alcachofia and boldo do Chile) to aphrodisiacs (catuaba and kit energía). Also offered
were herbs for pain – arnica, which is to be ingested in an herbal tea, and cânfora, which
is soaked in rubbing alcohol for an infusion for topical application. What was interesting
was that asking two different vendors for herbs targeted at the same problem would
nearly always result in two recommendations, thus the importance of obtaining a
prescription from a babalorixá before purchase.
The consultation ceremony is offered for a small fee, usually one that is flexible
and takes the economic standing of the patient into account. The importance of payment
is not one of monetary concern, but to ensure the effectiveness of the treatment. It is the
belief in Candomblé that ritual without payment is worthless, as if the rituals and herbs
would lose their power if not exchanged for something of worth (Williams, 160). It is
appropriate that such payment is never referred to as pagamento, but rather as troca
(exchange). This applies to payment for any rituals conducted within the terreiro and for
the medicinal plants purchased on prescription. It is interesting to note that family health
clinics, hospitals, and pharmacies run by SUS do not charge any fee, and so it can be
tentatively concluded that those turning to Candomblé are not doing so due to monetary
necessity. Reasons for turning to religious versus scientific healing may be ones of
personal belief, distrust of the latter, or because the condition the patient is suffering is
beyond the help of mainstream medicine. Even in the United States, those suffering from
terminal illnesses or even chronic back pain seek out alternative means of healing such as
acupuncture or hypnosis. Perhaps Candomblé is used as a last resort, perhaps it acts as a
supplement to SUS services. In areas where SUS care is inadequate, or coverage of the
population is incomplete, alternative medicine such as that found in Candomblé may be
the only alternative, though this is admittedly mere speculation.
The plants used in Candomblé healing may be collected in the field, fetish
gardens, and medicinal herb markets, many of which cater to local demands of
Candomblé followers and folk medicine practitioners. Spirit-possessed priests often roam
the forests, collecting hitherto unknown plants as directed by the orixá (Voeks, “African”
73). Babalorixás learn via oral tradition the knowledge of plants that migrated from
Yoruba to Brazil in the form of cantos (incantations). These contain the plants’
associations with particular orixás, uses for the plant, and its African name. The verses
are chanted to bring out the spiritual power latent within the plants, and it is essential for
a babalorixá to know the cantos in order to be considered a healer worthy of respect,
rather than an average folk medicinal healer (Voeks, “Sacred” 121). In fact, the power of
a plant prescription is often not considered as being due to the physiological effects
inherent in the plant, but rather as a reflection of the strength of the incantation (Voeks,
“Sacred” 127).
The taxonomy used in Candomblé to categorize medicinal plants is based more on
their effects on the senses than their phylogeny or physiological effects. Morphology and
geographic origin also play a role, but the sensory characteristics of a plant are
considered the most important. For example, all bitter tasting leaves would be associated
with a specific medical or spiritual disorder, and even distantly-related species with
similar sensory outputs would be used in the same way, and might even share the same
name (Voeks, “Sacred” 127).
This sense-based system of plant categorization lent itself well to the substitution
of native African species with those native to Brazil. The need for substitution arose not
out of dissimilar environments – indeed, both West Africa and Eastern Brazil comprise
wet and dry tropical forests, were connected before the Cretacious plate division, and
have undergone convergent evolution. Many plants can be found on both continents that
share the same family, sometimes even the same genus (Voeks, “Sacred” 127). Nor was
an inability to transport a sufficiently wide assortment of plants the problem, for not only
did species make the Atlantic crossing accidentally (as weeds mixed in bedding straw, for
instance), but active efforts were made by African freedmen, who are known to have
returned to Africa to study the Yoruba religion and subsequently return to Brazil, and by
Portuguese landowners, whose experimentations in planting Old World plants in New
World gardens served to transplant some of the African species which had reached
Europe by trade as spices or medicinal plants, but were still being used in Yoruba
ceremonies (Voeks, “Sacred” 124-6). The problem lay instead in the fastidious nature of
many tropical plants which resisted introduction to a new environment. The prevalence of
dioecious species, for which both male and female must be successfully transplanted,
recalcitrant seeds, and the need for host-specific pollinators were a few of the factors that
limited the successful cultivation of the original African medicinal plants (Voeks,
“Sacred” 125). Though each terreiro functions independently of the others, and no
cannon of plants exists, the plants known to be currently in use in Candomblé appear to
be half-and-half in African and Brazilian origins (Voeks, “Sacred” 124).
The lack of centralization or coordination among the terreiros makes for an evervarying degree of quality and accuracy of medicine. Yet all use the sacred plants in the
same general way: to extricate malevolent spirits, induce the presence of favorable orixás,
ward off black magic, and physically treat medical problems. The plants are most often
imbued in teas, which usually address bodily illnesses, or poured over the body in an
herbal bath, which usually deals with spiritual problems (Voeks, “Sacred” 122). Plants
crushed into powders are associated with dark magic, believed to be used by practitioners
to cause disease or bring disorder (Voeks, “Sacred” 123). All the plants we encountered
at the herbalist stands in Belo Horizonte were in their dried, relatively intact forms, in
clear packaging with only their names handwritten across the label. When questioned, the
herbalist gave general directions on how each herb should be applied.
Both the Candomblé and Umbanda stands we visited in the Central Market did
not sell medicinal herbs. Instead, their stock consisted mainly of statues of orixás (which
resembled those of Catholic saints), candles, perfumes, incense, and religious beads. At a
Candomblé stand, the vendor explained that the turquoise and white color scheme
represented the caboclos (Native Brazilian Indian spirits usually associated with a lessstudied branch of Candomblé, Candomblé Caboclo, rather than the most frequently
studied branch about which most of this paper is focused, Candomblé Nagô), and orange
and black were the colors of Exú, the messenger god. In both Candomblé and Umbanda,
caboclos and Exú act as intermediaries between humans and more powerful spirits, such
as those with the power to cure illnesses (Brown, 78). The beads would be used to invoke
these messenger gods, and the petitioner would ask them to take their prayer to the
appropriate higher deity. This resembles the prayer cards we encountered on one of our
hospital visits, such as the one titled “Santo Expedito – O Santo Das Causas Urgentes.”
We were told that family members of patients could read the prayer on the back of the
card to have the saint take their message to God, in hopes that He would intervene on
behalf of their loved one. Religion and healing are closely linked in Brazil, though
Roman Catholicism is obviously more readily accepted.
For all the cultural relevance of Afro-Brazilian religions, there are still signs of
stigma attached to their practice. Often when we would initially ask Candomblé or
Umbanda vendors to elaborate more on their religion, they would reply that they really
do not know much about it, but are simply working the stand. Yet upon further inquiry,
they would consent to talk about orixás and the relevance of the wares they were
marketing. And while no one feels it necessary to explain the presence of crucifixes and
other Catholic images in hospitals or schools, the teacher showing us the mural of orixás
in the Barbacena school made a point to stress that it was a cultural celebration only, with
no religious ties. Yet the abundance of religious booths in a well-populated market
suggest that not only are practitioners hardly in short supply, but they are not afraid to
advertise their adherence by openly buying religious wares. In fact, research shows that
particularly within Umbanda, members, leaders, and mediums are to be found in all
social strata – rich, poor, educated, illiterate – and in all major racial/ethnic groups
(Brown, 73). Yet this reality is not represented in the cultural stigma that is more
economic than racial – one white Brazilian is quoted as having said, “When a black man
puts on a tie and shoes and learns to read and write, he loses his interest in the
Candomblé (Brown, 76).”
This cultural ideal that economic status and practice of Afro-Brazilian religions is
incompatible is most strongly challenged by the political power gained by Umbanda,
particularly in Rio de Janeiro and the surrounding area. Umbanda is a comparatively new
religion, originating in Rio in the 1920s and 30s, which appealed to the industrial/urban
society (Brown, 74). The Umbanda Pura or Umbanda Branca branch has become more
accepted by the mainstream than other Afro-Brazilian religions, because its early leaders
sought to “whiten” their ceremonies by ridding them of animal sacrifice, associations
with black magic, evil, and immorality, and building their reputation on charitable white
magic (Brown, 80). Umbanda churches, called centros or terreiros, often offer social
welfare services such as childcare, dental/medical clinics, and cut-rate medicines (Brown,
78). There seems to be less emphasis placed on medicinal healing ceremonies and herbs,
focusing instead on the more accepted use of clinics and pharmacies associated with the
centro. The consultas largely resemble those in Candomblé, but tend to cover a wider
range, with the spirit-possessed mediums giving advice on problems such as
unemployment, family conflicts, as well as illness (Brown, 77).
The power to establish medical clinics and pharmacies is due in part to many
centros’ membership in Umbanda federations, the leaders of which have close association
with local politicians and the mass media (Brown, 79). Umbanda-influenced medicine
and healing is therefore more established and mainstream, in contrast to the largely
under-the-surface and individualized healing practices of Candomblé.
In the current climate of Brazilian health care, when the process of turning ideals
into a viable reality is still a work in progress fraught with obstacles, it is imperative to
refrain from losing sight of the reason behind the endeavor. It is for the benefit of the
Brazilian people that SUS was conceived, and meeting their needs ought to be the
priority of any health care system. The flaws in the current operation of both SUS and
private health care in Brazil are undeniable, but the prognosis is hopeful for
improvement. Perhaps Afro-Brazilian religions and their healing practices are a muchneeded alternative in this transitional period of insufficient resources, incomplete
coverage, or inadequate care, or perhaps they are simply a supplement, not replacing
mainstream medicine but rather providing another approach to the treatment of disease.
Whether their influence is on a personal level, like the private consultas in Candomblé, or
extends to clinics and pharmacies associated with Umbanda centros, they are a part of the
cultural and health care landscape of a diverse people. In the end, the reason that the idea
of SUS is so remarkable isn’t entirely because of its philosophy of universal health
coverage – indeed many nations have such programs already in place. Rather, it is
because that a nation that comprises such racial, ethnic, cultural, and economic diversity,
that was the last in the western hemisphere to abolish slavery, and that is still considered
to be a (albeit rapidly) developing country could conceive and initiate a system of health
care so completely indiscriminative and egalitarian. The boldness and heart of such an
endeavor is a lesson that we who call ourselves the most progressive nation in the world
can take home with us.
Bibliography
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Brown, Diana De G., Mario Bick. “Religion, Class, and Context: Continuities and
Discontinuities in Brazilian Umbanda.” American Ethnologist. Vol. 14, No.1,
Frontiers of Christian Evangelism (Feb., 1987), pp. 73-93.
Voeks, Robert. “African Medicine and Magic in the Americas.” Geographical Review,
Vol. 83, No. 1 (Jan., 1993), pp. 66-78.
Voeks, Robert. “Sacred Leaves of Brazilian Candomble.” Geographical Review, Vol. 80,
No. 2 (Apr., 1990), pp. 118-131.
Williams, Paul V.A. Primitive Religion and Healing. Cambridge: D.S. Brewer, 1979.