UC San Diego

Along both sides of the Bolivian-Chilean border, the indigenous Aymara suffer from tuberculosis at much higher rates than white-mestizos. They also experience the illness differently. In this comparative and multi-sited study, I use qualitative methods to highlight these differences and demonstrate that they emerge from processes of structural violence, in particular institutional racism and precarity. I show that in Chile, while the Aymara face economic instability and political exclusion due to the state's neoliberal multicultural approach, they are also highly medicalized. In Bolivia, they benefit from an ongoing process of sociopolitical transformation towards decolonization which values their political membership, yet the state is structurally constrained from fully delivering biomedical antituberculosis treatment to Aymara communities. This produces contrasting ways of interpreting and signifying pain associated with tuberculosis. In Chile, patients engage with the biomedical treatment while in Bolivia, I argue that Aymara patients are able to contest treatment and resist medicalization by integrating the indigenous concept of suma qamaña (to live well) to their everyday struggles for achieving prosperity and health.Considering ethnopsychological theorization of emotions, I underline the role of both emotions and cultural conceptions of health in shaping the illness experience. I analyze Aymara notions of salir adelante (to come through) and prosperidad (prosperity) in relation to notions of health, economic prosperity, and emotional well-being. I discuss the particular associations that Aymara make between the individual illness experience and indigenous identity in both countries by looking at the traditional hydraulic- topographic model of the body, and the importance of wari (fat) in relation to samaña (breath), and ch'ama (physical energy), sweat, and work as key features of the framing of ujuk usu. I argue that renegar (bitterness/sadness) and compartir (community engagement) are linked to larger indigenous discourses of suma qamaña, which are currently decoded and enforced through decolonization policies in Bolivia and neoliberal multiculturalism in Chile. This dissertation advances the political dimension of the medicalization process and its relevance in understanding the embodiment of structural inequalities that transcend national borders