One morning in mid-2015, I walked around the medicinal plant greenhouse of a Bolivian public hospital with a traditional healer named Reynaldo. As we spoke, he wondered out loud whether biomedical practitioners working in the hospital had been ripping leaves off the plants for their own use. Some of the plants had sparse leaves, while others were wilting or surrounded by buzzing white insects.

An Indigenous Aymara naturista (natural healer or naturopath), Reynaldo had been working for nearly a decade in the small hospital of a rural but rapidly urbanizing Andean highland town. During the presidency of Evo Morales (2006-2019), Ministry of Health officials enacted a series of policies to descolonizar (decolonize) the health care system, including by expanding mechanisms for Indigenous traditional healers to work in hospitals. To support these state programs at the local level, a transnationally funded NGO had also built a greenhouse in the hospital, with the idea that healers would be able to grow and harvest plants for medicinal purposes. 

Yet as Reynaldo and I continued our conversation, it became clear that his concerns were linked to a broader host of frustrations. Reynaldo described the lack of material support for the four traditional healers working in the hospital, noting the deteriorated state of greenhouse and exam room. Moreover, as he explained, healers did not receive a salary for their work in the hospital. As I came to better understand, decimated medicinal plants were not only a marker of unequal dynamics between paid and unpaid medical workers in the hospital. They also pointed to concerns about a lack of material sustenance and relations required to nourish patient well-being.

In Bolivia, the practice of traditional medicine was legally recognized and decriminalized in 1984 (Loza and Álvarez Quispe 2014)—and so, for at least some healers, participating (even with no pay) in institutions that had been historically off limits to them was an important means to establish their legitimacy. Moreover, healers expressed a renewed sense of hope as the Morales administration invoked promises of decolonization. In 2013, the administration enacted a long-awaited Law of Traditional and Ancestral Medicine that promoted medical pluralism and the formal credentialing of traditional healers. Healers I interviewed hoped that their continued participation in the hospital might eventually translate into salaried pay and material support—as well as greater legitimation of their expertise.

Yet as Reynaldo’s frustrations revealed, promises made in the passing of new legislation did not always translate to substantial transformations on the ground. Even before Evo Morales was elected president, Bolivian and global health policymakers positioned healers as a form of low-cost labor who could do the work of cultural brokerage in a public health care system that largely served Indigenous patients. As the Morales administration sought to solidify the status of healers in the name of decolonizing medicine, many bureaucrats I interviewed agreed that, in principle, healers should receive a salary for their work in public clinics. However, faced with an under-resourced biomedical system, state and local health officials often gave low priority to the question of support and compensation for Indigenous healers. Over the course of my research in Bolivia in 2014-2015, only one municipality out of twelve I visited had managed to put healers on the payroll.

In my forthcoming book, Decolonizing Medicine: Indigenous Politics and the Practice of Care in Bolivia, I describe how many healers simultaneously desired to work for state-run institutions while also criticizing ongoing lack of material support as an extractive practice. Even before coming to work for hospitals, healers had long positioned extraction as a central cause of illness: it was a violation of moral norms of reciprocity that also had ontological effects on the body itself (Canessa 2012). In turn, healers historically addressed many ailments by cultivating ties among human and nonhuman beings. Reynaldo and others’ speculations about the ripping up of plants reflected growing anxieties among healers that institutional norms were decimating the very relations and substances at the core of healing practice.

Aymara healers articulated expectations geared toward pulling the state and adjacent nonprofit and medical institutions into relations that might nourish well-being. For example, they requested that institutions replant the dying sections of the garden with coca, a plant central to sustaining social and healing relationships. In this and other cases, healers situated institutions within relations that could either sustain or impede patient well-being; they demanded material investment in salaries, supplies, and maintenance to foster relations essential to healing. As scholars writing about moral economies in the Andes have noted, powerful institutions and individuals are often expected to provide material goods as a fulfillment of moral obligations—an expectation that many also came to articulate with regards to the Morales administration (Winchell 2022). Building on this work, I suggest that such expectations were also inseparable from the relational ontologies that came to materially bear on the body and that made healing efficacious. 

Yet what constituted nourishment or what constituted extraction was also contested. A representative from the NGO ultimately refused to plant coca because she was worried it would extract too many nutrients from the soil. In turn, some town residents also worried that healers themselves had become too extractive in a context of rural urbanization. As healers since the 1980s increasingly sought to commodify their practice, townsfolk expressed concern that healers—especially those practicing newer specialties like naturismo that partially displaced older forms of ritual healing—had become too alienated from the very relations that sustained their practice. 

In contrast to these narratives, however, healers often insisted that they were retaining ancestral ties, even as they were reinventing them in new, more commodified and institutionalized forms. The problem, they explained, was not that they were rupturing with relations. Rather, state and medical institutions were the ones disrupting the ethical relations at the core of healing practice by engaging in extraction. Healers’ demands for support sought to problematize the idea that institutionalization had ruptured their care practice and instead shift the onus for care back onto their employers. They positioned institutional investments as fundamentally imbricated in embodied relations in a rapidly changing, more-than-human world.  

Dried medicinal plants gathered for display by the traditional healers working in the hospital. Photograph by Gabriela Elisa Morales. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.