Shuar People’s Healing Practices in the Ecuadorian Amazon as a Guide to State Interculturality: An Epistemic Case for Indigenous Institutions

Abstract

What do we understand by the principle of state interculturality? What would be the full implications of making Latin American states culturally representative, rather than agents of modernisation on the European model? Could the state reflect the distinctive local cultures within the various particular regions of its sovereign territory? This project takes the example of state healthcare in Ecuador, an ‘intercultural state’ according to its 2008 constitution, as a point of entry to answering these questions. By presenting an epistemological critique of biomedicine as culturally specific and historically contingent, it argues for intercultural health as a break with taking western knowledge systems as the universal arbiters for social policy. Instead, it proposes that the health-seeking preferences of indigenous minority groups–working with the example of the Shuar nationality in the south-eastern Amazonian province of Zamora-Chinchipe–become the basis for culturally representative state healthcare within their territory. I argue that this is a question of indigenous justice, in light of the evident dramatic disconnects in meaning and disappointed expectations of many Shuar people in their engagement with clinical healthcare. However for non-indigenous society, too, intercultural health would lead to the further development of health practices founded on distinct epistemological and ontological assumptions from those of western biomedicine, thereby bringing a new diversity of approaches with which intercultural societies could address universal social problems. Yet the effort to put forward a medical ethnographic representation of Shuar culture understood as a set of present-day practices and preferences, rather than a body of essentialised tradition, raises the question of how meaningful it is today to speak of cultural groups, when these are inevitably cross-cut by transnational economic, religious and political-discursive forces to different extents in different locations. The thesis thus concludes with a suggestion for what we mean when we say we value cultural diversity.