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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. 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