Curandero

A curandero (curandera if female) is a practitioner of the Hispanic folk medicine curanderismo. Like most folk and shamanistic medicines it uses diagnoses and treatments that were created hundreds or thousands of years before modern effective medicine was developed. Curanderos use a range of procedures from massage and herbal supplements to prayer, magic, and talk therapy to treat patients. The strong focus on talking to the patient and embracing often deeply held superstitious beliefs offers a fertile ground for the placebo effect, which accounts for curandero success in treating minor aliments such as headaches or allergies. However, curanderos also claim to be able to cure much more serious aliments such as asthma or cancer, and sometimes their procedures are not harmless, resulting in damage and loss of life through poisonings, or failure to seek out proper medical treatment.

Basic principles
The basic principle of curanderismo is that health is a product of a natural balance in a person between internal states, mind, nature and the supernatural world. The curanderos do not accept the germ theory of disease and instead explain illness as a state of imbalance with the universe. These imbalances can be caused by internal mental or emotional states, but are normally attributed to external sources: food and drug intake, social stress, curses, and evil spirits. Evil spirits and curses are the most common and favorite cited cause for disease by curanderos.

Treatment involves the use of herbs, ritual, magic, prayer, massage and exorcism, and are heavily influenced by both Catholic and Native American ideology and folk remedies. Some very dangerous medical practices are still commonly done by curanderos such as bloodletting and the use of heavy metals such as mercury. The key philosophical elements to curanderismo and its treatment methods are:
 * Disease or illness are associated with strong emotional states
 * Imbalance and lack of harmony with the universe cause illness
 * Most causes of illness are malicious things done to the patient such as curses or possession by evil spirits
 * The soul is a source of health and can become separated from the body and need to be reattached
 * The entire family must participate in the treatment process

Modern popularity
Curanderos likely represented the height of medical knowledge a thousand years ago, but their techniques and diagnoses have changed little into modern times. Various studies show that up to 75% of Hispanics have sought out folk treatment from curanderos; it is probably one of the most common sources of medical treatment in Mexico with particular hot spots in the US including Oregon, California, and New Mexico. One of the most often cited reasons for this popularity is the expense of modern medical care. With many Hispanics in these regions being unable to afford or qualify for health insurance, many turn to local curanderos. In addition to cost, the popularity of curanderos is also likely due to their techniques of talk therapy and empathy; these are common themes in most alternative medicine treatments and often offer a contrast to modern hospitals that rarely have the time to invest in individual patients to that degree. Other sources for their popularity can be traced to generally superstitious and religious beliefs, and a strong desire to preserve "tradition."

Training
The strong Catholic influence in the curandero system has led to the belief that healing power is a gift ordained from God to certain people, so curanderos are "chosen" not trained. Most curanderos are adults though there are cases of children being used. The training program pretty much consists of doing rather than learning. New curanderos work alongside a more established practitioner for a few months and then they go off on their own. However, some curanderos are starting to capitalize on a resurgence of interest in altie circles, and are starting expensive schools that offer certificates if you pay enough money and hang around for a year.

Favorite diseases and treatments
Curanderos claim to be able to cure a wide range of diseases. These range from alcoholism, asthma, headaches, impotence to even money problems. Most of these illnesses are attributed to evil spirits or curses. The most common treatment performed by curanderos amounts to an exorcism called a limpia ("cleaning"). These limpias combine various elements of influence from Catholicism and shamanistic beliefs, mixing herbs, magical ritual, prayer and calling ''Jesus' name to eliminate the evil spirits causing people to cough too much and spend money too quickly.

In addition to aliments most people are familiar with, curanderos also deal with a lot of diseases that originate from local superstitious beliefs. One of the most common is a diagnosis called empacho ("indigestion"). There is a common belief (though completely false) that old food gets stuck in the intestines and gets moldy and rotten and produces "bad energy" that makes people sick. The curandero "pushes" this bad food out with a massage and then gives the person laxatives to take over the course of a few days. Another popular diagnosis is mal de ojo ("evil eye"): this is the belief that when one person looks at another with attraction or admiration it can make the person being looked at sick. This is a common superstitious belief cross-culturally. In Hispanic tradition, attractive children are at particular risk when looked upon by adults. The treatment involves trying to boil a raw egg over the sick person's body, and then praying and sucking out the bad spirits. Once the egg stops boiling the person is cured.

Dangers: death, damage and destitution
Curanderos are completely unregulated by anyone. The general secrecy that surrounds them and the fear of western medicine and authority keeps them insulated and hidden. While curanderos treating minor aliments like headaches using complex placebo effects isn't really a problem, there are some significant dangers and risk associated with their popularity. The most common are scams. Curanderos can demand huge sums of money, often bankrupting their already-poor customers. One case in Oregon had a curandero demand a big screen television which would be used to see who had put a curse on the family. These frauds are often difficult to track down because of the secrecy that surrounds curanderos: even if they are turned in, they are often gone before they can be arrested.

Beyond the loss of thousands of dollars, seeking treatment from curanderos can be deadly. The most obvious cases are people who have serious medical conditions who fail to seek real treatment. The only effective element of curandero medicine lies in the placebo effect, and cancer is not cured by placebo. People who attempt to be cured of major illnesses by only the curandero are likely to die because of it. The popularity of the empacho diagnosis is particularly dangerous as people with pelvic inflammatory disease or appendicitis fail to get treatment and get much worse, or die while being treated with massage and laxatives.

Curanderos themselves can also be deadly. Since some of the treatment programs involve giving substances to their patients, the wrong thing to the wrong person can kill. One example is of a baby diagnosed with empacho who was given liquid mercury as a cure. The baby almost died.

All of this points to a simple message: there is no efficacy of curanderismo beyond placebo and many of the treatments (bloodletting, heavy metal ingestion) are deadly. To try and curb the numbers of people who are suffering and dying because they do not seek proper treatment, many people are advocating integrating curanderos as part of the normal health system. The idea is to allow them to treat minor aliments under an official sanction, and refer everything else to qualified doctors. Ultimately this only legitimizes the woo aspects of the practice and is unlikely to decrease harm since most people seek out curanderos because of a lack of affordable health care and the strong influence of tradition.

In the end, the best solution is increased awareness, education and outreach about the limitations of curanderismo, while at the same time opening up access to affordable health care to everyone.