Patricia Junge is a medical anthropologist currently working as a lecturer and researcher in the Faculty of Medicine of the Universidad de Chile. Yarrow Global recently sat down with her over Zoom to talk about her dissertation: “We Are the System! Affective memories and the political history of healthcare in Chile,” which details her field research at two alternative healthcare and integrative medicine sites in Chile. The country has a complex political history, which continues to influence the healthcare system to this day. Salvador Allende, a socialist physician committed to public health since the 1920s, was the president of Chile from 1970 until 1973 until he was killed in a coup. The Pinochet dictatorship that followed, from 1973 to 1990 was marked by violent political repression, torture, and sexual violence, especially against women.
Patricia lives in Viña del Mar, Chile with her beautiful children, Clio and Noah, as well her surly cat, Helga.
This interview has been edited for clarity.
YG: So tell us, how did you become interested in healthcare and healthcare systems in general?
P: If I go back very far, early in my childhood, I was engaged with the healthcare system because my mother was a dietician and my father was a chemical engineer researching food. It was part of my upbringing to be engaged with nourishment and how important it is for everybody in our society to have access to nourishing food. One of the main preventive health care policies in the 60’s and early 70’s in Chile was providing good food for the children at public schools. Both my parents were researchers, studying how to improve the formulas on the food and cookies delivered for children at school.
Later during dictatorship my mother was working in the healthcare system, which was very underfunded because of the neoliberal reforms under the dictatorship. They wanted the public health care network to be bad so the people would prefer to go to the private system. My mother was working in the public one and I spent a lot of time sitting in the waiting areas of these public clinics. I was just watching how people came there and stayed there for hours waiting for an appointment, the mothers with their children doing homework there, the children having their meals there.
And since I was sitting there for so long, people started to talk to me. I remember a lady telling me, “I have four children. We are poor. I need contraceptive medicine. They say they will give it to me, but when I go to the pharmacy, they say ‘ we only have 10 contraceptive pills for you’ even though you need twenty five. So there is nothing I can do to just get pregnant and go on with life.” From such experiences and conversations I started getting interested in the role of health in society, as something important in everybody’s life, and how unequal it can be.
YG: Can you break down what complementary alternative medicine means and looks like and how it evolved in Chile?
P: First of all you have to understand the diversity expressed in the differences between health care in the cities and healthcare in the rural areas. For generations until the 1960s or so, people living in rural areas had no access to biomedical healthcare because there was no polyclinic there or because the roads were bad or not usable in the winter. So people were using popular medicine as a first line option. In the south of the country, you also had the traditional ethnic medicine of the Mapuche, (an indigenous Chilean people) because most of the peasants were also Mapuche.
During the 60s and 70s, Chilean healthcare policy was focused on primary health care even before the Alma Ata declaration from 1978 (a Milestone WHO declaration that identified primary health care as the key to attaining the ‘Health for All’ goal). They were focusing on primary healthcare and community health care. And this meant working with the community to produce healthcare and also to prevent disease, so the healthcare teams were very open to lay knowledge about healthcare, which included, besides biomedicine, both popular and traditional-ethnic medicines. These were also present in the cities, due to the rural-urban migrations. They worked with that, not against that.
In the 90’s, after the dictatorship, the new democratic governments produced a lot of policies and programs to repair the damage of the dictatorship, including recognizing and fostering diversity. They opened in healthcare a big program for traditional native or ethnic medicines. So there was an acknowledgement of diversity that was also focused on acknowledging and repairing the violence against natives.
And on the other side you have what I found in my dissertation, which is another type of diversity. This is represented by complementary and alternative medicines or therapies that came to Chile as part of the counter-cultural movement resisting authoritarianism in the 1980’s and later making up for the deficiencies of official reparation programs from the 1990’s on. What is known elsewhere as the ‘new-age’ alternative and complementary healing practices, was for some politically committed practitioners a cultural resistance practice. Here the subject was not a standardized individual carrying disease, but a person, a subject of life and of disease, of work, of gender, of violence.
Alternative medicine was a complex model to address this complex subject. Even today, people can be sent to get acupuncture, to the energy healer, to a doctor using Bach Flowers, or to a shaman, for example – it all depends on his/her needs.
Since it addresses the person as a situated person, that is a person composed not only by his or her body and what happens to the body, but also his or her position in society and history and culture, this kind of integrative medical practice forces you to look critically at the context of this person. It also forces you to look at how this person is engaging with that context. This way, it becomes a political practice.
YG: The old San José hospital in Santiago, which is one of your field sites for your dissertation, had the slogan, “solidarity, integrative and humanized medicine.” It seems to stand in contrast to the type of medical care that most people are perhaps used to getting. Can you explain those three words?
P: Sure. Solidarity here is the opposite of charity because in charity you get help from somebody in a different status in the social hierarchy. In a charity model, those who have more help those who are poor. But solidarity is different. The way it’s framed here has a long history in Chile where people resolve the problems they had on their own. So when you say solidarity, you mean help among equals. And this idea gained strength during the early 20th century because there was no state helping anybody, instead it was the work of the poor and the laborers who started to organize mutual help to provide care and security to their people.
For example, there was a global organization of workers – the I.W.W.- whose chapter here produced these healthcare newsletters for the people in the beginning of the 20th century. Obviously, they got help from physicians to explain things like reproductive health, to explain how to deal with the infectious diseases, etc. When the physicians came to help there, they engaged with practicing solidarity with the workers. This influenced generations of nurses and physicians, including the socialist physician Allende who worked in the 20th century as a public health physician before he became president.
Even today, soup kitchens are very important in Chile: the solidarity kitchens have been fundamental since the social protests in October 2019 and during the COVID-19 pandemic, for instance in neighborhoods where most people have lost their jobs. Everybody brings something to contribute, and the self-organized kitchen redistributes. This is the opposite of politicians taking pictures of themselves giving boxes of food to the poor and calling it solidarity – that’s nothing but charity. In the old San José physicians, nurses and therapists recall solidarity in their practicing model; they do not only provide low-cost healthcare but also foster mutual help among neighbors in forms of art, therapy and community work.
So then “humanized” has to do with the background of the community healthcare of the 60s and early 70s. It means to take the human being as the center of the health care process, rather than the disease. Those physicians working in primary health care, in the Old San José, are reproducing this community healthcare, and have this humanizing focus in the sense of healthcare not only as preventing disease and promoting health, but also promoting well-being.
The fact that the community healthcare center was placed in the facilities of the Old San José -a 19th century public hospital from the TBC and smallpox epidemics era- was very stimulating for those recalling solidarity well-being as part of their social identity.
And finally, “integrative” relates with this humanizing, this integrality or wholeness of the human, but also the diversity of humans. It means they also respect and accept that people may have different ideas or different needs regarding a health issue. And this may be related to their different backgrounds as well. As one physician told me, they learned that diversity is an opportunity and not a threat.
This is what allows, for example, to have a native shaman, a “sacred-smoke” lady and a physician-drummer, guiding a thanksgiving ritual in the yards of the Old San José hospital together where therapists, biomedical healthcare professionals, neighbors, students -and an anthropologists- take part.
YG: Do you see a division between, you know, more traditional kinds of Western private health care systems? How are the politics entwined in these different systems?
P: Something I learned with my research is that the health system policy has this tension all the time between the hospital focus and the primary healthcare focus. And when resources are limited, they turn more to hospital, to curative, to bring correct curative healthcare, because the priority is basically to stop people dying, even if they live in a very bad way. And when they have enough resources to promote healthcare, they turn to primary healthcare, to interdisciplinary health care teams, not just to physicians, but all the other professionals of healthcare and social workers and even anthropologists.
The influence of dictatorship in the healthcare system was seen in the impacts of limited resources over years. I mean, the budget was cut every year during almost two decades . So even today there is still work to do from that time. Even the super socialist progressive physicians have to make this prioritization and they say, “OK, fine, but we need to build hospitals. We need to buy more vaccines, we need to hire more physicians to cover the needs of the population, etc. All this community work. It’s super nice, super fine, But we can’t put this as a priority now.”
So in this logic, they are willing to demolish the 19th century facility of the Old San José hospital, the place where I conducted research, which is now focused on alternative medicine and community health. Because they need to build a new cancer hospital…
YG: I’m curious if you had any observations of how gender plays itself out in these complementary alternative medical systems, if it’s something that people explicitly pay attention to at all?
P: Generally speaking, in the alternative healthcare market there is little gender bias – you can find male and female therapists and it’s very diverse. With the kind of integrative medicine I studied, I found in this case it is produced and reproduced mainly by physicians and nurses with a strong political background. They are the ones who got tortured and raped [during the dictatorship]. While the sexual violence against women during the dictatorship is more well known, there are plenty of testimonies of men who faced this kind of torture and rape as well. These practicioners are the ones who embodied the political and structural violence. Bringing this focus on violence to today, in some ways, this kind of integrative medicine is more of a female integrative medicine.
If you take the big picture, I mean, there is a gender bias and how you suffer structural violence. Here in Chile, it’s very clear how women got paid less and their health insurance costs are higher. There is no consistent social security here.. So basically female health was and is dependent on other females having to care for them. Solidarity appears as mutual help here, again. You see lots of grandmothers taking care of the grandchildren so the mother can go and work because the husband may not be there. This could be because he left or during dictatorship, because he was disappeared, or is spending his money on alcohol or on himself, which is always prevalent in this kind of machista society. I mean, men and women may work the same, but men work and live more for themselves, and women work and live for others. The mothers have all the caring responsibilities inside of families. This is still extremely strongly reproduced here. So women are more exposed, more vulnerable to structural violence of this society.
So this is where the patients I see in these places clash with these other women who started as politically committed physicians and nurses working in community health care; who got persecuted, exiled, tortured during dictatorship; who had to reinvent themselves and got open to this diversity of ways of addressing healthcare because bio-medicine was not good enough to address this affective dimension of humanity damaged by violence. This is how this female experience – the suffering and caring at the same time – meet in this kind of integrative medicine. And this is where the solidarity issue makes sense, because they are equals in their gendered way of experiencing violence. Equal in the way they are dealing with violence.
YG: What have you learned about medicine and the healthcare system in studying it now for so long?
P: I think what I learned from this is: how important resilience and well-being and well, living is as part of health. And this is something that cannot be done within an individualistic standardized healthcare model. It has to be done with community affective healthcare models, so that living together improves the reproduction of good life instead of reproducing suffering. I mean, the politics of equality or health are not only related to official policing but also to what concrete subjects in concrete situations expect and do together regarding diversity, violence, trust. This part of the healthcare systems is mostly neglected; well, I am still learning how fundamental it is.