The Association of Communitarian Health Services (ASECSA) and the Role of Religion and Health in Central America
The Association of Communitarian Health Services (ASECSA) is a transnational, religiously influenced health program in Central America created during the Cold War. ASECSA was founded in 1978 by a small group of international health professionals with ties to programs started by Catholic and Protestant clergy and laity in Guatemala’s western highlands in the 1960s. It introduced a model of healthcare in which Maya health promoters and midwives became partners in healing rather than objects to be cured. Support for the health programs and ASECSA came from secular and religious international agencies, including the United States Agency for International Development (USAID), German Misereor, Catholic Relief Services, and the World Council of Churches. ASECSA was founded to disseminate knowledge of popular health education strategies used by health promoters and midwives to provide preventive and curative medical services to their communities. The education methods grew from Paulo Freire’s Pedagogy of the Oppressed and its use by religious agents influenced by liberation theology. Although it was founded in Guatemala, ASECSA’s publications and meetings attracted participation by health professionals and paraprofessionals from Mexico, Central America, and even the Caribbean. Ecumenical religious centers affiliated with liberation theology in the 1960s and 1970s facilitated the development of popular health programs that played a defining role in the region.
David Carey Jr.
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