OSORNO, Chile (AP) — While in labor with her first child last month, Lucia Hernández Rumian danced around her hospital room while her husband played the kultrun, a ceremonial drum.
She refused painkillers from hospital staff to receive massage and oil lubrication instead from her cultural liaison, who had ritually cleansed the site according to Mapuche customs.
“It became my space,” Hernández said.
The largest public hospital in the southern Chilean city of Osorno is finding new ways to incorporate these and other indigenous health care practices. There is a special birthing room with indigenous images on the walls and bed, forms for doctors to approve herbal treatments from trusted traditional healers, and protocols for a ‘good death’ aware of spiritual beliefs.
The hospital’s efforts validate cultural practices at a time when Chile’s indigenous groups — particularly the largest, the Mapuche — are fighting for rights and reparations with unprecedented visibility as the country prepares to vote on a new constitution next month.
But they also restore a critical spiritual component to health care, according to health professionals and patients at the San José de Osorno Hospital Base.
“It has to be a guarantee – we take on the physical part, but without violating the spiritual dimension,” said Cristina Muñoz, the certified nurse-midwife who launched new birth protocols that indigenous pregnant women can adapt, believed to be the first in the country .
Cristina Aron, the patient who first inspired Muñoz more than a decade ago, has now become a cultural link to Hernández and two dozen other women from pregnancy to early motherhood.
“Childbirth is a spiritual energy event for the mother, the baby and the community,” Aron said.
She had hoped to deliver her daughter in the countryside with a traditional midwife. However, Chilean law requires health professionals to deliver babies because of high maternal mortality in the past.
So Aron turned to the hospital in Osorno and negotiated the terms of the birth with Muñoz, including the escort of a woman knowledgeable in Mapuche practices and the transfer of her placenta to be ritually buried on her ancestral lands.
The Mapuche people see the placenta as holding a twin spirit with that of the child. Its burial, often with a tree planted on top to grow like the newborn, is believed to create a lifelong connection between children and the natural elements of their family’s territory.
“It’s something very poetic and very revolutionary,” said Allen Colypan, whose son’s placenta was placed next to a river near his paternal grandmother’s home. “He will not feel this uprooting from his land.”
Colipan was 17 when she gave birth in Osorno’s cross-cultural delivery room, with a floor-to-ceiling photo on three walls of the rocky beach that houses Grandfather Huentellao, a guardian spirit worshiped by the Mapuche Huilliche, its Indigenous group area.
Colipan said her then-85-year-old midwife, Irma Rohe, who had never been in a hospital, was allowed to receive the infant “without gloves and other mandatory things” and to ritually cleanse him.
“We’re back to wanting to breed with people with ancestral knowledge,” Colipan said. “Even the way we were born dominated. We have to start releasing it.”
Chilean law now requires hospitals to give placentas to mothers if requested. For a decade it has also enforced cross-cultural care in places with significant indigenous populations. Mapuche people represent a third of Osorno’s residents and eight out of 10 in the neighboring province of San Juan de la Costa, said Angelica Levican, who has been in charge of indigenous relations for the hospital since 2016.
“Native health care has always existed. Then another system came along to nullify our system,” he said. “Our goal is for them to complement each other.”
It is not easy to participate in both types of medicine. Many indigenous people perceive public hospitals as yet another state institution that discriminates against their beliefs.
Mapuche medicine, based on spirituality, is also different from what doctors have been trained to do, said Jose Quindel Lincoleo, director of a center for Mapuche health care studies in Temuco, another populous southern town natives.
Mapuche healers seek to connect with a patient’s spirit to discover the “biological, social, psychological and spiritual root of the problem” that manifests as illness, Quidel added.
“It could be another past life, or some harm done to you, or a lack of self-awareness that causes us to violate our worldview,” he said.
But doctors and traditional healers say they can complement each other’s work by realizing that each specialist knows only a fraction of what’s possible, especially when battling new diseases like COVID-19.
“One understands that saving a body has to be compatible with beliefs,” said Dr. Cristóbal Oyarzun, rheumatologist and coordinator of internal medicine at the hospital of Osorno. “A patient with inner peace has a better chance of healing.”
This is difficult to achieve in the aseptic, isolated environment of a hospital, especially during a pandemic. Mapuche healers continued to pray and “spiritually accompany” patients from afar, said Cristóbal Tremigual Lemui, a healer from San Juan de la Costa who has long worked with Osorno’s hospital.
“For us this is necessary … so patients can get the energy they need,” he said.
Family members also flocked to the hospital’s prayer space — an outdoor circle of small sacred laurel and cinnamon trees with a fireplace next to the parking lot — to hold ceremonies for the dying, Levicán said.
Attendants and admitted patients who identify as Indigenous — an average of 50 a day — are welcomed and escorted by Erica Inalef, the hospital’s intercultural facilitator, so they “don’t feel so alone.”
When, as a teenager, she took her elderly father to a hospital, the doctors barely spoke to them and “body and spirit were separated.”
Now, doctors can see the enthusiasm with which patients welcome the arrival of consulting traditional healers, and this helps build mutual trust, Inalef said.
Trust can be demonstrated when a trauma surgeon signs a patient’s lawenko—a herbal tea whose exact composition healers keep secret—or in an obstetrician who allows a woman in labor to wear her munulongko, a headscarf believed to protects her.
The cultural clothing is a part of the labor plan developed by Muñoz five years ago, which can be adapted by pregnant women. She hopes more people will realize this option – only about 20 of the hospital’s 1,500 births each year are cross-cultural births.
“Indigenous women are doubly timid, discriminated against because they are women, indigenous, poor and rural,” Muñoz said. “We tell her, your body is the first area you’re going to recover.”
Reclaiming ancestral practices is what drew Angela Quintana Aucapan to have her baby — Namunküra, or “steady step” in Mapudungun — in the special birthing room recently, while relatives played traditional instruments.
“I could do it like my ancestors did,” he said. “With a ceremony while we waited for the new addition to the family, I felt supported as I received my baby.”
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