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date: 22 March 2019

The Politics and Culture of Medicine and Disease in Central America

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Latin American History. Please check back later for the full article.

With its diverse ecological zones that vary by vegetation type, altitudes (ranging from tropical to high-altitude zones), and annual and diurnal temperature and rainfall ranges, Central America was a challenging place to practice health care. Faced with diverse public health threats that ranged from lowland epidemic to highland endemic diseases, the region contains challenging landscapes in which to conduct health campaigns. In addition to affording an opportunity to explore how topography and geography influence disease and healing, Central America is a useful site for examining how race and class relations influence the dynamic, contested, and negotiated process of health care in developing countries. Adversarial relations between indigenous people and the state marked the regions’ pasts. Throughout the colonial period, Spaniards extracted land and labor from indigenous communities, which laid the groundwork for racist structures that favored Hispanic citizens over indigenous people and perpetuated elite paternalism. Although most countries assumed that adopting Hispanic customs would improve the lives of indigenous people, many elites felt indigenous peoples’ health was important only insofar as it did not impede their ability to labor. Often with the assistance of multinational companies and nongovernmental organizations, governments deployed biomedicine and public health campaigns to undergird assimilationist projects. Based on assumptions that indigenous medicine was impotent and indigenous people were vectors of disease, public health campaigns often discounted, rejected, or persecuted indigenous healing practices. When authorities embraced rather than problematized the confluences of race and health, they enjoyed some success. Yet neither authoritarian nor democratic governments could establish a medical monopoly

Characterized by holistic approaches to health that took into account psychological, emotional, and physical well-being, indigenous healing practices flourished even after states embraced the fields of bacteriology and parasitology in the late 19th and early 20th centuries. Primarily served by curanderos, midwives, bonesetters, and other traditional healers for generations, many remote rural communities were isolated from scientific medicine and its practitioners. In other rural communities and cities, hybrid health care offered patients palatable and efficacious healing options