Summary

With its diverse ecological zones and varied public health threats that ranged from lowland epidemic to highland endemic diseases, Central America is a challenging place to practice healthcare. In addition to topography and geography, social relations have also influenced the dynamic, contested, and negotiated process of healthcare in developing countries. Adversarial relations among indigenous people, African immigrants and slaves, and the state marked the region’s pasts. After the Spanish conquest established racist structures that favored Hispanic citizens by instituting forced labor mechanisms and limiting access to political, economic, and social power, colonists extracted land and labor from indigenous communities. Although most countries assumed that adopting Hispanic customs would improve the lives of indigenous and Afro-Central Americans, many elites felt such workers’ health was important only insofar as it did not impede their ability to labor.

Characterized by holistic approaches to health that took into account psychological, emotional, and physical well-being, indigenous and other traditional 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, some remote rural communities were isolated from schooled medicine and its practitioners. In other rural communities and cities, hybrid healthcare offered patients palatable and efficacious healing options.

As doctors became politicians and states embraced science to modernize their nations, politics and public health became inextricably linked. Often with the assistance of multinational companies and nongovernmental organizations, governments deployed scientific medicine and public health campaigns to undergird assimilationist projects. Based on assumptions that traditional medicine was impotent and indigenous people and African descendants were vectors of disease, public health campaigns often discounted, rejected, or persecuted the healing practices of such peoples. 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.