SANTIAGO, Chile — Like conventional medicine, the diagnosis starts with a urine exam. In this case, however, no lab equipment is involved.

Don Manuel Lincovil swirls a small glass jar of urine, holding it up to the light to detect patterns in the swirling sediment. From this observation, he determines whether the pain the patient is suffering from has a physical, psychological or supernatural origin.

Don Manuel is a machi, or Mapuche healer, practicing in Santiago, far from his homeland in the south. Increasingly machis and yatiris (Aymara healers, from the north) are being incorporated into Chile's health care system.

The Ministry of Health hopes this resurgence of traditional medicine — where medicine men with drums practice alongside physicians in lab coats and where new pharmacy chains tout ancestral remedies — will improve health care for the disadvantaged Mapuche and other indigenous groups.

From a ruka (a thatched, dirt-floored hut) behind a conventional clinic, Don Manuel uses invocations and herbal infusions, music, trance and techniques similar to reflexology and aromatherapy. He treats lifestyle ills, such as obesity, diabetes, hypertension and respiratory illness, that increasingly affect urban Mapuches.

“By coming to the city, the Mapuche migrant brings his malaise with him: uprootedness and longing,” said Samuel Melinao, the “intercultural facilitator” at Los Castanos health clinic in La Florida, on the outskirts of Santiago.

“People consult the machi for depression and trauma from loss of contact with our land, loss of identity and a lack of self-autonomy made worse by poverty, discrimination, exclusion and not being valued for what we are,” Melinao said.

The uneasy fusion of cultures has brought coexistence and conflict. Long-simmering disputes over land recently erupted in an 82-day hunger strike by 34 jailed Mapuche leaders protesting the government's use of anti-terrorism laws to quell attempts to recover ancestral lands.

Health statistics indicate there is an “equity gap” between the Mapuche and non-indigenous populations, with differing leading causes of mortality and higher rates of infant death, said Margarita Saez of the Ministry of Health’s Program for Health and Indigenous Peoples. This reflects the conditions of poverty, overcrowding and job instability that characterize urban life for many Mapuches.

With a population of some 900,000, the Mapuche is Chile's largest indigenous group, accounting for nearly 5 percent of the country's 17 million people. Pushed off their ever-fragmenting lands, some 60 percent of Mapuches now live in urban areas. Many have migrated to poorer neighborhoods on the periphery of Santiago, working as maids and unskilled laborers.

“When somebody’s son is a drug addict or alcoholic or violent husband, his mother will no doubt have headaches, insomnia and emotional instability,” said Lincovil, the machi at Los Castanos. “For us, these symptoms denote spiritual disease.”

Lincovil also came to Santiago as a young man to work, eventually assuming the mantle he inherited from his aunt, maternal grandfather, great-grandfather and great-great-grandmother — all machis.

Dreams, visions, experiences and the spirits of their ancestors give machis their knowledge. In the Mapuche cosmovision, health and illness are linked to harmony. Illness occurs when a person feels fear or when the soul comes into contact with evil spirits. The machi’s role is to reestablish balance between the body, mind and spirit.

Two days a week, patients at Los Castanos gather outside the traditional Mapuche hut set up behind the clinic. A small garden of canelo, laurel, maqui and copihue reproduces the sacred plants traditionally found outside the machi’s home.

Carolina Vidal rests from her twice-weekly walk to the ruka to pick up two liters of the brown infusion she drinks three times a day. After losing an eye to facial paralysis, traditional doctors in the clinic next door referred her to the machi.

Victoria Valdes sought relief from depression when three different kinds of pills taken simultaneously "didn't do anything for me anymore." She credits the machi with putting her life back on track.

Neither Vidal nor Valdes identify themselves as Mapuche, although, like most Chileans, they embrace their mestizo heritage. In the La Florida ruka, the mix is mix is 50/50 between Mapuches and "winkas" (the Mapudungun word for Chilean/foreigner, literally “thief, usurper”).

“We aren’t here to cater exclusively to the Mapuche community,” Melinao said. “Our mission is to bring our tradition of healing to anyone who seeks it.”

One-third of greater Santiago’s 37 districts host intercultural health centers with a machi in attendance. The program began in 1996 to meet the needs of the Mapuche, who make up 85 percent of Chile’s indigenous population. In 2006, the country’s first Mapuche hospital opened its doors in Nueva Imperial, a small town in the heart of the Araucania region, some 700 kilometers south of the capital.

The program also incorporates a handful of healers from among the eight other recognized indigenous groups, including an Aymara medicine man in a clinic in the center of Santiago. Some clinics are run by the government; others by NGOs and Mapuche organizations.

Program success is measured not by conventional indicators of patients cured, but by satisfaction with the service. The La Florida ruka, which attends 260 patients a year, is booked to capacity. Treatments last from three months to several years.

The system is not without critics. Some disparage the trend as neo-shamanism. They point to the explosion of new Mapuche-inspired remedies and drugstores. At Farmacia Makelawen, with branches in several major Chilean cities, a top-selling item is palwen, the Mapuche Viagra.

But Ana Maria Oyarce, an anthropologist working with the United Nations Latin American and Caribbean Demographic Center, describes the intercultural health program as an “ethical imperative to provide care to vulnerable groups.”

“The motive is not simply to improve the health of indigenous people but to respect their rights,” she said. Intercultural health “is not a benefit, but a collective right — the right to be visible as a people.”

Provision of traditional medicine must not supplant the possibility of opting for more conventional alternatives. “What’s the right prescription?” she asked. “Anywhere from machi to scanner.”

