Listening to patients: learning from sobreparto

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Emilie Egger // Imagine calling to check up on a friend who has recently given birth. Five weeks postpartum, she tells you she barely has the energy to get out of bed to take care of her baby. Because her family had moved to a new city for work—away from her support system—her partner couldn’t take any time off after the birth and she’s the primary caregiver. She can’t explain what’s wrong, exactly, but her house is a mess, she has no groceries and is behind on errands. After weeks of experiencing fatigue, she’s developed a fever and chills and is stuck in bed. She feels lonely, depressed, and unable to care for herself or her baby. 

During a visit, her mother-in-law blames the cold weather. Your friend got sick, she says, because she doesn’t remember to wear socks in her cold house. The older woman advises drinking hot fluids and resting while she tends to the baby. 

Your friend’s doctor blames her health routine; she should have gotten in better shape before the pregnancy. He adds that what she’s feeling is pretty typical for new moms–it will pass. Maybe she could pay for in-home childcare help. 

The symptoms I described above are diffuse enough to escape easy categorization (and even count as “normal”) in the contemporary United States. How would you interpret your friend’s condition? Is she ill or just tired? Are her symptoms physical? Psychological? Both? Is she experiencing postpartum depression? Is there any truth to what her mother-in-law and doctor are telling her?

In the Andean nations of Bolivia, Ecuador, and Peru, however, someone with these symptoms might be diagnosed with a postpartum condition called sobreparto (Quechua: kutipa). The list of causes include exposure to cold, coming into contact with water, and eating the wrong foods during the puerperal period. Typical cures include herbal infusions and vigorous massages with animal fat (Kuberska 47, 62). While it is a common ailment, sobreparto has no biomedical explanation or treatment and only indigenous Andean women get it. Another distinction: some of these women die.

In the words of Carmen Beatriz Loza, director of the Instituto Boliviano de Medicina Tradicional Kallawaya, sobreparto is “categorically ignored” by Bolivian obstetrician-gynecologists, “lo cual ha obstaculizado su entendimiento, su prevención y cura” (“which has hindered understanding, prevention, and cure [of the condition]”). A Bolivian woman interviewed by medical anthropologist Karolina Kuberska adds, “…the doctors don’t know how to cure it. They give you anti-inflammatory pills, but they don’t work, but you’re suffering and suffering, as if you were to die… Sometimes women die…” (Kuberska 62). 

I was inspired to write about sobreparto after reading fellow-Synapsis writer Steve Server’s piece “In defense of humoralism,” in which he discusses the tensions between some of his patients’ ideas of health and the anatomo-clinical approach that guides most biomedicine. Server critiques the idea that patients who rely on humoral explanations of their wellness and illness are the only party limited by their ideologies for understanding their ailments. He uses the writing of philosopher of science Paul Feyerabend to illustrate the intellectual faith required by doctors to trust the scientific method, which “…often demands that we reject what we see/experience with our own eyes in the service of a prevailing belief-system.”

Despite the intellectual and ideological impasses between patients and providers regarding their symptoms and their causes, reproductive illnesses like sobreparto and the cancer Server treats require medical attention. Rather than dismissing their patient’s lack of knowledge (of the causes and symptoms of their conditions) as meaning their experiences are less real, doctors and researchers can start with a critical line of questioning, both of themselves and of their patients’ circumstances. 

Scholars of Andean medicine and Andean people have suggested frameworks—we could call these “belief systems”—and questions that could bring health providers closer to the  goals of mutual respect and better health outcomes.

Framing of curiosity: 

This kind of inquiry requires an analytical schema to understand how a condition functions and what its societal meanings are. In 2003, medical anthropologists observing sobreparto in the field suggested that instead of asking “what is sobreparto,” we  ask “why sobreparto?”—why does it occur? Who is afflicted? How do those people’s lives change? 

And then: Who doesn’t report these symptoms? What do people who avoid this condition have in common (Larme, Leatherman 194)?  

What follows are a set of questions placing the condition in context: 

What social circumstances should we consider? 

Kuberska studies sobreparto through the lens of loneliness. Focusing on Bolivian women who have migrated from the highlands to cities, she asks what it means that Andean social networks extend beyond the individual, even beyond the human, and what happens when those networks are disrupted during pregnancy and the postpartum period (Kuberska 47, 48). 

Larme and Leatherman ask if they experience domestic violence and if sobreparto could be related to the stresses of successive pregnancies (202).

What structural expectations fall on those who suffer? In the Andes, stereotypes of women include that they are “weaker” (“más debíl”) than men and therefore expected to experience illnesses during pregnancy and childbirth (Larme, Leatherman 202). 

With this in mind, scholars ask: what expectations are placed on women as mothers and child bearers and what, if any, authority do they gain when they become mothers? Do these roles give them some room to negotiate some care for themselves and their children when they experience a postpartum illness (Larme, Leatherman 203)?

In the words of  medical anthropologists Larme and Leatherman, where do we see “…the process of illness negotiation emerg[ing] from, and recreat[ing] relations of power within the present-day political economy of the Andean region”? (205). 

How is the condition understood structurally? 

Kuberska observes sobreparto in Bolivia, a state that has intentionally incorporated indigenous medicine into their national health care system. Treatment and results vary in neighboring Peru and Ecuador, where the healthcare structure is different (Kuberska 50). 

This discussion is not an effort to translate sobreparto into legible biomedical terms, nor to equate sobreparto with postpartum illnesses and maternal mortality in the United States. Rather, it is an example of adopting a posture of curiosity and consideration to reconcile two different experiences of the world. 

This conversation reminds us that biomedical impasses can be an opportunity to ask questions of conditions that appear in our own society that we have normalized, racialized, gendered, or been taught to ignore. As Server contends, lack of medical knowledge does not make symptoms or perceived causes less real from a patient’s perspective. Sobreparto offers ways to think about causes, symptoms, and outcomes for conditions of many kinds. 

Works Cited

Larme, Anne C. and Thomas Leatherman. “Why sobreparto?: Women’s Work, Health, and Reproduction in Two Districts in Southern Peru.” Medical Pluralism in the Andes, edited by Joan D. Koss-Chioino, et al., Routledge, 2003, pp. 191-208.

Kuberska, Karolina. “Sobreparto and the Lonely Childbirth: Postpartum Illness and Embodiment of Emotions among Andean Migrants in Santa Cruz de la Sierra, Bolivia.” Etnografia. Praktyki, Teorie, Doœwiadczenia, vol. 2, 2016, pp. 47-71.

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