Nambudripad (see Alternative Medicine, issue number 29, May/June 1999) ALTERNATIVE MEDICINE. MAY 2000. healthy self-image. This aspect of ESM, …
Alternative Medicine Use and the Impacts of Tourism in Quepos, Costa Rica Stephanie Dobbins INTRODUCTION The store is a fascinating place with a whirlwind of aromas that knock you down as you enter Cinnamon, curry, ginger, chili peppers, lemon grass, aloe, and other pungent unrecognizable smells welcome your nose into a world of sensory explorations It feels far removed from the roar of the road Here diesel fumes are a forgotten misery Surrounded by palms and varying types of small trees with flowers on the outside the store is a small teak and cedar, raised structure with instrumental music drifting out, the enticing aromas of spices and herbs begging to be used in your favorite family recipes The whole store is very open with ample space to browse around without feeling trapped With its clay jars, mortar and pestle, and woven reed baskets it has a very earthy and calming effect Fresh strips of cinnamon bark about a foot long sit by the entrance in the raised bowl of the mortar It is
easy to float away with the memories brought back by all your favorite smells drifting around the room This store caters to tourists and locals who want fresh spices and herbs but do not grow their own Is this an example of alternative medicine practice? I would point to this as an example of a type of alternative medicine However, there are many forms of medicine that are considered alternative by Western culture The exact definition of alternative medicine poses a problem It can mean so many different things for so many people For the purpose of the study I conducted in Costa Rica establishing a working definition of alternative medicine was necessary I defined alternative medicine as medicines or treatment not administered by or supervised by a doctor, physicians assistant, or nurse This leaves many avenues open as alternative forms of medicine It does not exclude suggestions by the medical profession to seek alternate forms of healing other than Western medicine I made the
definition very broad initially because I was unsure as to what people would say they used to heal themselves These forms of healing are not always physical administrations or treatments They can involve energy channeling, prayer, aromatherapy, or a broad spectrum of other forms The narrower definition of alternative medicine is included in the data section of the paper because it is a result of the research Many forms of alternative medicine are available in Quepos The purpose of my project in Quepos was to examine the availability and use of alternative healing methods, both in the public marketplace and in local homes With this information, I also was looking for how tourism had impacted the development of the field of alternative medicine The questions that need to be answered are where these services came from, why they are here, how long have they been here and when did they begin I wanted to look at and include the response of the Western medical community to the development of
the alternative medicine community I wanted to explore the disciplines of Western medicine, traditional herbal medicine, and alternative methods of healing These three are overlapping at some points, their interconnectedness is important to understand in order to study any one of them The identification and the examination of these points along with the history are fascinating
1
There has been research done at this site Quepos on medicinal plants, which I depended on for part of the information on alternative medicine The types of plants people used, the use of various plants for certain symptoms, and how they were obtained are important parts of herbal medicine Herbal medicine and the role it plays in society were mentioned in the context of the impacts by tourism This work was completed in Quepos by O Scott Taylor 1997 and Susanne Lynch 1998 METHODOLOGY The methodology employed during this study was participant observation I used convenience, judgmental and snowball sampling
Convenience sampling was employed initially because I spoke very little Spanish and had not taken many anthropology courses in my academic career This type of sampling is simply interviewing the people around you, or whoever is available In order to get started, I talked with my host mother and told her what I was studying She said she did not know anyone who did alternative medicine but she did know people that spoke a little English Since I was having trouble speaking Spanish I welcomed the help getting started Judgmental sampling is examining the characteristics of the person before you interview them I looked for characteristics that were important to my study and tried to decide who would offer the most information on each subject I wished to explore I divided my questions into three categories and modified each of the questions within the categories as each of the interviews progressed and topics of interest came up The three categories I used were trained medical personnel,
vendors or users of alternative medicine, and residents of Quepos The questions varied from category to category and were dependent on the persons expertise or perceived expertise Snowball sampling was used in conjunction with the other two types I always asked at the conclusion of every interview if they could think of any other people who would be willing to talk to me about alternative forms of healing I always got at least one name or suggestions of places to go I found this very helpful in finding other informants to speak with on alternative medicine In addition to the interviews I went and observed at the pharmacy farmacias and spoke with employees I observed at a local store that specializes in herbs and spices I visited peoples gardens and explored the herbs they grew and used I have taken medicinal plants courses and explored alternative methods of healing through the Western medical perspective I was both challenged and excited to learn through the perspective of a Costa
Rican the uses of their plants, food, and other methods of healing DATA The first problem I had to tackle was that of defining alternative medicine for the Quepos area I brought with me a U S perspective of alternative medicine The view that if it was not performed, prescribed, or used in a doctors office or other medical facility it was not medicine I discovered as I began interviewing that I said alternative medicine and they responded confused Alternative what? one informant said Medicine is medicine Whether you get it from your garden or you go to the pharmacy it is still medicine I found that several of the people I spoke with used exercise, karaoke, smiling or laughing, food, and reading as ways to heal them There seemed to be a gap between medicine and the treatment of symptoms and healing
2
This is not far from Chinese culture that uses food to heal They classify foods as either yin or yang, depending on the energy they create in the body Simonds 1999:42 If you are sick then
one of them is unbalanced To correct your problem, according to these Chinese beliefs, you should eat foods that are on the weaker side Acupuncture is another form of Chinese medicine These beliefs are thousands of years old, before there was an Eckerd or farmacia around to stop by for the remedy There are similar beliefs in Quepos going back many generations regarding healing herbs From my interviews with locals, medicine would be classified as something you do or take for symptoms There is a chemical or a treatment that is performed to correct the physical problem Healing, however, was distinguished from medicine and included practices done for emotional and mental health as well as physical health I had the opportunity to speak with a man who was trained in China in the art of acupuncture, massage, and chiropractic medicine After he arriving here, in Costa Rica he received training in homeopathic medicine The man speaks Chinese, Japanese, and Spanish On my way to town, I noticed a
newly painted sign white background and black with red detail writing The sign was hanging beneath an advertisement for roasted chicken The sign listed four services, each marked by a dash and listed one under the other as follows: Acupunctura, Masaje, Quiropractico, and Homeopatia Under this listing was the phrase: 250 MTS Norte Not sure how far that was, I thought about not turning down there I did and walked for I guess 250 meters I saw a small building about 10 by 15 unmarked but looking fairly new, like the sign I climbed over the metal scrap that crowded the driveway I set up an interview at noon with the man that emerged to greet me Language was a barrier but we were able to communicate somewhat I began by asking how long he had been here He said he had been practicing in Quepos for nine years, when I asked why he chose Quepos he said why not? This was a good city and there were good people He commented that not many tourists seek out his services I wondered to myself whether
this was due to location in a neighborhood off the path of the tourists He treats people of all ages including children I asked if he knew anyone here who offered similar services as him, he said no He said I should try in town In town I found a building where a doctor, dentist, and massage therapist/ chiropractic doctor were all sharing an office I was able to interview the massage therapist with the help of a translator He said he was trained by working at the National Social Security Institute He worked for 4 years in rehabilitation there and took a three month course on massage He chose to come to Quepos because there are so many tourists here He has been in Quepos practicing three months He studied in Spain for a while before coming here to Quepos He said he would recommend herbs only if he knows the person well Most of his patients are women and tourists He said that Tico culture believes that if you want to be a masseuse people think that you are gay or there is something wrong
with you, ie, you are a pervert He does occasionally recommend people see a doctor, if something looks abnormal to him, or if they have had surgery or been in an accident and are more sensitive to massage When I asked if he knew the other massage people, he said that he had heard of them but did not know them One was from America, one from Italy, one from China, one Canadian but she had left and most of these have not had official training
3
Massage is well received by the tourists and is in demand when the season is high It costs about 60 in the high season but in the low season there are fewer clients, so the price goes down to 35 In the low season hardly anyone comes in and it is hard to get by, and maintain the payments on the building and everything else He is thinking about going back to Spain In Spain people are more receptive to massage and the cost of living is more expensive here is Quepos He says he is not respected here as a professional trained massage therapist He
related a story about three male tourists who wanted a woman massage therapist He also had an opportunity to work at one of the hotels but after hearing it was implied that he would have to provide sexual services , too, he declined to take the jobs He said he was a trained massage therapist and that here in Quepos, they dont yet appreciate that When asked about how to change these body images of massage thereapy, he said that if local medical doctors would start recommending massage for people with stress related problems instead of drugs it would helpful He treats people who have had orthopedic surgery or had casts on and need help getting their range of motion back He said the pharmacist sometimes goes too far in trying to treat people This is tolerable in small rural communities where it is needed because there are no doctors or other trained medical professionals but in Quepos proper orthopedic medical personnel are available At the pharmacy, they just write a prescription for a
pill and you go on your way They are not trained to give them medical prescriptions He mentioned that there was a doctor that worked in the same building as he and he was trained in not only Western medicine but also acupuncture and homeopathy The patient can decide which form of treatment they want to receive I thought these two men represented an interesting contrast One had established himself in a Tico neighborhood while the other had chosen to work for a doctor downtown Due to the language barrier, I was unable to ask why he had established himself in a neighborhood versus downtown The one working with the doctor said he was invited to come down and work with him and he accepted I know that there are highs and lows in tourism, which makes it unsure but there is also more money The Ticos do not have nearly as much spending cash as the tourists do but because they are residents they will come back repeatedly There seemed to be different approaches on how to market the services they
offer I thought it was important to get the Western medical perspectives on the field of alternative medicine The healthcare system in Costa Rica follows the Western medical beliefs as to where disease comes from and the methods of treatment The healthcare system is socialized, so everyone gets care as long as they are a citizen It is very easy to get put onto someones card, one, person commented Although this is true many people choose to go to private physicians and physicians can maintain quite a practice on the side of their hospital duties Several of my informants told me those who can afford to usually visit private physicians several of my informants told me One informant said it is just safer for me to go here Quepos then to go out to the hospital I like my doctor and feel safe Another informant said that there was negligence on the part of the doctors out at the hospital, and that they are not trained very well Conditions that are usually easily diagnosed are missed they
said
4
I had the opportunity to speak with physicians in Quepos The physician I spoke with was very patient with my inability to communicate in Spanish and he tried to speak some English I was able to get some basic information on the system of care and the training of doctors I asked him where he was trained and he pointed to the wall were several diplomas hung He explained he had obtained his first general medicine degree from Universidad Autonoma de Centro America This took him five years and he went on for his specialty in internal medicine at the Universidad de Costa Rica He got his specialty in internal medicine after an additional three years I asked him why he practiced in Quepos He said he really liked it here in Quepos and the economic situation was very good in Quepos He has been practicing in Quepos for three and a half years Since his specialty is internal medicine almost all of his patients are adults, although since they only get a pediatrician every now and then he
sees children if there is some kind of problem with them His patients come from all over to see him Some come from Parrita, Paquita, and most from Quepos He sees tourists in his office and he also will go to the hotel He goes to the hotels if they are too sick to come to him He will see them and then call the pharmacy and the pharmacy will deliver the medicine he orders to the person at the hotel He said, service is the important part He works seven days a week and will go out at anytime to see people The hotels or his patients have his number to get a hold of him I noticed on the way in that the doctors numbers were on the outside of the building He said he thinks in certain situations that massage can be beneficial if it is a muscle problem and not inflammation, tendon, or ligament problem He said he does not recommend it for older people It can be more traumatic than helpful for them He does not work with or agree with acupuncture, homeopathic medicine, or herbal remedies If his
patients want it he says they can have it as long as they take all the medicine he gives them, he does not have a problem with it Another part of the medical system is the pharmacy The pharmacy plays a bigger role in health care in Cost Rica than it does in the US While people in the US occasionally ask the pharmacists advice on what medication to take, in Costa Rica it is different The pharmacist has the power to prescribe drugs without consulting a physician first In the US currently the pharmacists have been pushing to get more power to prescribe drugs, so far their efforts have been fruitless However with managed care pushing for lower prices, it would better for the companys profits if people could just go to the pharmacy and skip the doctors appointment that is more expensive Many drugs are available without even seeing a physician People just go in and tell the pharmacist their symptoms and he gives them medication based on this information This ease with which drugs can be
obtained is scary to many expatriates I spoke with on the subject One expatriate shared stories with me about various people who had become dependent on the drugs They were easily obtainable from any pharmacy Drugs such as codeine and other opiates do not require a prescription from a physician I had the opportunity to speak with a pharmacist He said he had been trained at the University of Costa Rica and had then come to Quepos to work The first question I had was if he diagnosed problems or treated symptoms He responded that he prescribed medicine that relieved symptoms The kinds of problems they see the most are lung or
5
respiratory problems, skin problems and allergies, fungal infections, nasal allergies, and asthma Most of these problems can be handled with a trip to the pharmacy He does not give out an exact diagnosis He treats the symptoms I asked if he ever had to suggest that people see a doctor He said he sometimes did, so that the doctor could give them a prescription or
a diagnosis Once they have this then he can give them the appropriate drugs When I asked if he ever suggested that people see an alternative practitioner, he said on certain occasions, such as muscle problems He thought that getting a massage could help relieve tension in sore or aching muscles His comments on alternative medicine were that it was interesting and good He thinks that those who practice alternative medicine help people a lot They are beneficial to the health of the patient He said he likes them a lot He has been practicing pharmacy for nine years but has been at this job for only a couple months Herbal medicine is another part of alternative medicine I found in Quepos A different area than either acupuncture and massage or Western medicine, herbal medicine utilizes chemicals from plants versus processed medication Many residents of Quepos did not see this practice as alternative medicine; it was a way of life for many Before the hospital came in and brought all the
doctors and other medical personnel with it, people had to find their own remedies for ailments One informant said his mother was dependent on medicinal plants as a child but as medicine became available many people went with it because it worked quicker This however does not translate into better The medicines administered were often harsher when isolated for the active ingredients The chemical makeup of a plant is what gives it the medicinal effect The chemistry of the plant is important because here is where the medicinal properties lie When medications are produced, the active ingredients are isolated and the rest is discarded The argument in herbal medicine has been, some of the inactive ingredients are necessary for the active ones to be effective There is evidence in some cases that certain chemicals that are isolated from plants would work better if they were administered by producing a tincture or a tea From several informants, I got information on what plants could be used
for what symptoms Through these interviews I learned some plants were used for different things then what we use in the US One informant volunteered that his mother went to have acupuncture and massage done by one of my other informants, and that she used herbs His mother could not find relief with conventional methods or herbs alone so she decided to try going for her back pain She used to go to San Jose but then she discovered the man in Quepos His mother had taught him how to find herbs and make teas with them He said he never went to the doctor He used teas for all his problems, since he was fairly young he probably had very few health problems He used tea for headaches and stomachaches His parents both used this type of medicine and he did not like the way Western medicine treated the person as a set of symptoms He said while older people tend to rely on medicinal plants the younger generations are leaning more towards Western medicine The treatment of people as a set of symptoms
and not looking at the bigger picture was a comment I heard from many of my informants They thought doctors wanted to just hand you a diagnosis and not explore why or what underlying problems lead you to
6
the diseased state The embracing of the entire person instead of just a set of symptoms is what appeals to many of those I talked with about alternative medicine There were several plants that I heard about from various sources Mint tea and lemon grass were suggested for colds when I visited a botanical store There were several other examples of herbs shown to me here There was a mixture labeled alcoholismo that is used for cleaning the blood of alcohol Allspice, beside it, I was told is used to lose weight, for diabetes, and high blood pressure She said horsetail was used for infections in the blood Una de gato is used for infections in the intestines and ulcers in the stomach Pepinillo is also used for diabetes Tilo is used for stress and nervioso a condition that is believed to
exist in Latin American cultures, causing hysteria and total shut down of the body On the shelves above these remedies were natural shampoos containing rosemary, another with chamomile Both are considered to be soothing to the skin and body Natural soaps were beside these containing chamomile, one with aloe vera, and another with oatmeal There were seaweed capsules and lecithin capsules on this shelf also There was cartilage of shark, which in the US is rumored to be good for cancer and arthritis or joint pain I was told that all the herbs were grown on an organic farm that was operated and owned by the same family that owned the store The store had been established seven years ago at the time we talked The natural shampoos and other products were shipped in from San Jose They came from an organic store there Another source of mine gave me several names of plants used by herself or others She mentioned herbal tea with cinnamon and leaves of lemon trees for a cold or the flu She also
mentioned herb tea with honey for a sore throat, and manzanilla in English chamomile for period pain Tilo is another herb she mentioned for nerves or nervousness She said her mother makes all sorts of brews and mixes of herbs for different ailments but she does not recall what is in them or how to make any of them because she has always had the doctors to go to She uses Western medicine rather than herbs because it is easier She said her mother takes a potato, skins it, grates it and juices it She then drinks the juice This juice is used for ulcers and upset stomachs This is usually administered prior to eating breakfast Another source for alternative medicine was a man who lived close to my home stay He grew several useful herbs in the backyard He called this preventive medicine He classified preventative medicine as smiling, having fun, and treating his body right by exercising and eating good foods He says he never goes to the doctor, because he is a healthy person He said he knows
many herbs to use to keep from going to the doctor because the chemicals that the doctors give you hurt your body and make you worse in the end He uses many different types of leaves to make the teas with For a cough he recommended, leaves of the mango tree with oregano and honey Lemon grass is often very good for colds he said Mixing the lemon grass with the above ingredients helps relieve congestion and coughing both Lemon grass is also good if you cannot sleep Tilo was mentioned here again and he recommended it like several others for nervousness He believes in teas you brew yourself, not in the ones in the bags If you have a good attitude or are happy on the inside then you are a healthy person If you think
7
happy, you will be healthy If you communicate with others and singing or dance, you will be happy Smiling is very important After our talk he took me to see the herbs growing around where he stays He lived right across the street from me in a boarding house or something He
showed me fresh oregano and we smelled it Then we found some lemon grass and he picked a stalk, it smelled like lemons and he repeated its use in tea for sleeplessness, with honey Juanilama is used for stomach problems, traveling fatigue and other such ailments with the digestive tract He next picked a fruit for me to try that was also used for stomach problems He called it, guyana It had the consistency and the outer coloring of a pear but the flesh of the fruit was pink in color and it was smaller than a plum It had small clusters of tiny seeds in the middle It was very interesting He showed me tilo next and about how much one would need to brew for a single dose It was about a handful of the herb We moved next to the mango tree and he said to make the tea for a cough you needed to get the red leaves from the tree and make sure the oregano was included He said he had many more herbs on his farm, about 120, he said He used them for all different kinds of things ANALYSIS AND
CONCLUSIONS Herbal medicine shares the ideal that if it is not soothing or comforting it should not be done There are few unpleasant teas and mixtures that taste horrible Part of the draw of herbal medicine for many people is that it is easier to swallow than medicine In Costa Rica, where almost everyone has a fruit tree of some sort, the idea of using nature to cure illness seems to be very appealing, not to mention easier It saves a trip to the doctor for minor problems that may be solved by using a plant out of your yard This art of herbal medicine had started to go lacking in the younger generations as they move toward a more Western approach to medicine Western medicine as a discipline used to be based entirely on herbal medicine; there was not a distinction As chemists isolated the active ingredients in plants and used them to produce concentrated forms, herbal medicine began to play a secondary role People forget that the drugs they are taking are most often plant derived, and
at times not the best way to ingest the chemicals due to the lack of inactive ingredients The idea that if the plant works for some ailment that the isolated active ingredient is the sole reason is too narrow a perspective Without knowing what role the inactive ingredients play in the chemistry, it is hard to determine if the effect is from a combination of all the ingredients or just the active ones Acupuncture, massage and homeopathy come at a little different angle then herbal or Western medicine Acupuncture believes that by stimulating certain nerves brings pain relief, improves organ function, and decreases ailments Massage is more narrow a discipline and focuses more on relaxation of muscle resulting in pain relief It does not claim to have any effect on the function of organs Homeopathy administers drugs in very minute amounts that cause the symptoms you have So if you have a runny nose you would be given an herb or other chemical that causes a runny nose but in a very minute
amount The practitioners of all three areas of medicine–alternative, herbal, and conventional–believe that reduction of stress and maintenance of the body is important
8
How they go about reaching this goal is not always very different Medical doctors often tell patients to reduce stress How the patient would go about this is rarely mentioned Sometimes exercise is recommended or taking time to oneself What you do in this time is up to you On rare occasion, I have heard alternative forms of medicine mentioned, such as get a massage, try yoga or meditating, and warm baths with aromatic oils All of this would help reduce stress, however, it is frowned upon in the medical community to suggest such treatments Alternative healing is often combined with herbal treatments After, before or during a massage treatment or acupuncture herbal teas or tinctures can be administered Herbal medicine and alternative medicine seem to be open to the idea of sharing and combining treatment than Western
medicine The end goal of all these practices is the happiness of the patient and relief of pain or malady In Costa Rica I found that people were more willing to go out and use alternative forms of healing then in the US In the US there is a growing interest in the benefits of alternative medicine and herbs Now the scientific community is redirecting its attention away from pharmaceutical companies and is investigating other forms of healing This has become necessary because so many people are finding that some of these treatments work where Western medicine has failed I think the biggest failure of Western medicine has been the lack of personal attention that is so needed when one is ailing, whether it is mental, emotional, or physical In the US, sadly, we have lost the common knowledge of plants, but in Costa Rica during my study I found many people the still use plants and have passed that knowledge on to their children Unfortunately, as their children grow up in society pressured by
the everpresent Western culture they shy away from the use of the herbs The conclusions of my study are that herbal medicine is widely used in Costa Rica although they do not consider it a form of alternative medicine like we do in the West I found that although alternative methods acupuncture, massage, and homeopathy of healing were not widely used, they were accepted far better then in the US As the West begins to explore these types of healing it is my prediction that other cultures with Western influences may also begin to profit from these treatments I think they will continue to use herbs as long as they are readily available for them and they are cost effective REFERENCES CITED Simonds, Nina1999 Healing Meals Journal for Holistic Living: New Age, May/June: 42-48 See Appendix 1 for a list of sources and informants
9
Appendix 1 List of Alternative Medicine/ Medical Practitioners in Quepos Masata- massage, acupuncture, homeopathy, and chiropractic medicine Located off the road
where La Botanica is sign for it; also sign on road to Manuel Antonio La Botanica- herbal store Maria- limited English, fairly good knowledge of herbs Daughter- excellent English, little knowledge of herbs Dr Serrano and Dr Novo- doctors located near bus station, both very friendly Dr Soto-Jimenz- doctor practice Western medicine, acupuncture, and homeopathy Located in Macrobiotica Building in downtown on same road as bus station Massage therapist- well trained and has years of experience located with doctor and dentist in Macrobiotica building Massage therapists are best contacted through hotels unfortunately Most were not available because they leave for the low season Some of the nicer hotels know who is there and who is not Ghislaine- provides spa and massage services, offering service at a salon or on site Located near Makanda and the Parador 394-0294 Oscar- has a farm with over 120 herbs, lives close to school If facing school he is in green house on far left, there is a car
repair place there He lives in the back He is willing to share herbs and teach anyone interested in learning Pretty good English
was not able to speak with, was not an informant
10
