Ethnomedical interactions: health and identity on Nicaragua's Atlantic coast

This paper describes contemporary and historical interactions of medical belief and practice among the six ethnic groups of Nicaragua's Atlantic Coast--Mestizo, Creole, Miskitu, Sumu, Garifuna and Rama. The expansion of preventive medicine and primary care under the Sandanista-led government during the 1980s is presented, along with brief descriptions of counter-revolutionary attacks on the health care system. Traditional uses of medicinal plants and various forms of spiritual healing are then juxtaposed with the sporadic introduction of European and North American biomedicine throughout history. Next, the results of a health care survey carried out in 1990 are used to: (1) demonstrate the widespread use of the official health care system; and (2) show that traditional practices--use of herbal medicine, visits to spiritual healers, and home birth--are more prevalent among specific ethnic and socioeconomic strata of Nicaraguan Atlantic Coast society. Finally, I use these descriptions and survey results to argue for an understanding of health care behavior based on personal identity. I argue that a number of identities--ethnic, historical, political, socioeconomic and spatial (village, city, region or nation)--both situate and influence health care behavior, and thus mediate between the psychological and spiritual realms of illness and healing. Each individual chooses, variably and often subconsciously, to identify with any of a number these 'imagined communities' as he or she makes health care choices. These identity-influenced decisions are then manifested as specific health-related behaviors, forming the real-world data on which this argument is premised.