Medical Pluralism and the INI’s Health Programs in the Chiapas Highlands, 1951–61

This paper considers the first decade of INI health programs at its pilot Coordinating Center in highland Chiapas (1951-61). Arguably, no task was more difficult for the INI than the introduction of Western medicine and modern hygiene practices to the Tzeltal and Tzotzil Maya, who associated illness with sin, moral lapses, or metaphysical aggression. Western medicine challenged the traditional, magic-religious worldview of the highland Maya and threatened to undermine traditional hierarchies. These were outcomes that the INI openly sought. However, the INI also wanted to tread lightly, hoping to avoid direct confrontations with traditional healers; in no other aspect of its development programs was negotiation more necessary. After a rough start, the INI shifted to preventative medicine and became quite adept at finessing its programs with elders, traditional healers, and the Tzeltal and Tzotzil population at large. It accepted the reality of a medically plural environment and reconfigured its clinics to allow relatives to stay with the sick; some doctors even worked side by side with traditional healers. In spite of the many factors that conspired against the Coordinating Center’s health campaigns, the INI’s approach to health care in Chiapas was moderately successful and produced lower infant mortality rates, fewer deaths by preventable diseases, and a greater life expectancy. Unfortunately, shortly after the INI figured out how to operate in this medically plural environment, severe budget cuts forced it to relegate its health programs back to Secretaría de Salubridad y Asistencia.