BackgroundThis article explores how people in the Andes incorporate beliefs from both biomedical and ethnomedical systems in treating folk illnesses that often involve spiritual beings. The article focuses on the kharisiri—one who is believed to steal fat and blood from unsuspecting humans to make exchanges with the devil. The kharisiri in turn is rewarded with good fortune. Victims of kharisiris, however, fall ill and may die if untreated. Historically, kharisiri victims relied on ethnomedicine for treatment, but it appears biomedical pills are now perceived by some as an effective treatment. By drawing on participants’ attitudes towards biomedicine, and how people in the Andes conceptualize health, this article theorizes as to why biomedical pills are sought to treat kharisiri attacks but not for other folk illnesses.MethodsFieldwork was conducted in Arequipa and Yunguyo among market vendors, who make up a significant portion of Peru’s working population. This type of work increases the risk of different illnesses due to work conditions like exposure to extreme temperatures, long-distance travel, and social dynamics. Biomedical and ethnomedical products are often sold in and around marketplaces, making vendors a compelling group for exploring issues relating to treatment systems. Qualitative data was collected in 2011 with a follow-up visit in 2013. Participant observation, informal conversations, and unstructured interviews with 29 participants informed the study.ResultsParticipants unanimously reported that biomedical pills are not capable of treating folk illnesses such as susto and mal de ojo. Several participants reported that pharmaceutical pills can cure kharisiri victims.ConclusionsIn comparison to other folk illnesses that involve spiritual beings, those who fall ill from a kharisiri attack lose physical elements (fat and blood) rather than their soul (ánimo) or becoming ill due to a misbalance in reciprocal relations—either with humans or non-human beings such as Pachamama. Because the kharisiri is typically a stranger to the victim, the Andean concept of reciprocity appears to be irrelevant in terms of preventing and treating attacks. The association between kharisiris, biomedicine, and exploitation may also play a role in the use of biomedical pills.

With a growing percentage of the world's population living in urban areas, many people in cities are increasingly participating in economic activities on the margins of the formal economy. Many such workers generate income by vending goods on a small-scale level in and around traditional open-aired marketplaces. As a setting for health, marketplaces have been studied largely in the interest of consumer safety but less in terms of occupational health. This study explores the health of market vendors with a health promotion lens. It assumes health to be a holistic concept that considers the physical and psychosocial affects that vendors experience as a result of their work. Situated in the Andes, I describe how traditional concepts of health and well-being related to social reciprocity and ritual payments to the natural surroundings inform vendors' everyday health practices in a market located in the city of Arequipa, in the southern Andes of Peru. Data interpreted through socio-economic frameworks describes how one's social status, inside and outside the market, as well as social networks, affect health and rationale of treatment choices, largely in terms of biomedical and traditional methods. It was found that the nature of vendor's work represents a challenge to maintaining health in relation to both biomedical and traditional health practices. Findings suggest that treatment decisions may be motivated by demands of work, but also made as a means to re-enforce social relationships that go on to support one's economic well-being.