Indentured servitude: the Chinese in Cuba

Mass emigrations from China that occurred between the nineteenth and mid-twentieth centuries are known collectively as the Chinese diaspora. Many of these migrations to Spanish colonies were due to economic deprivation in China and the promise of a better life in new lands. From 1847 to 1873 more than 200,000 Chinese (primarily farmers from Canton) arrived in Cuba with promises of employment that would lead to fortunes; though in reality they faced indentured servitude (Delgado Garcia 1995). This particular chapter of the Chinese diaspora was a result of numerous international changes, including the Treaty of Nanking that ended the Opium Wars and resulted in the ‘creation of Hong Kong as an outpost of British imperialism’; facilitating access to labourers from South China (McKeown 1999: 313). The resulting increase in Chinese labour migration was often made via Hong Kong (Ibid.). Early nineteenth-century abolitionist campaigns in the United States and England that resulted in the restructuring of slave labour prepared the way for a new wave of Chinese migration and facilitated the Spanish colonists’ procurement of Chinese workers (Dabney 2006).

The Spanish colonists in Cuba already had experience with the Chinese, having worked alongside Chinese traders over several centuries in the Philippines (Dolan 1991). The Chinese who ultimately made their way to Cuba were predominantly poor peasants from Southeast China, who believed that labour on sugar or tobacco plantations would eventually bring them wealth (Dabney 2006). Although the Chinese contracts stated that they were wage labourers, their contracts were usually sold to plantation owners for the equivalent of US$60.36 (Ibid.). Subsequently, the Chinese workers were paid a minimal amount and, for the most part, treated as indentured servants (Ibid.).

The Chinese maintained their community in Cuba in an area called Sagua la Grande. This area eventually housed a Chinese theatre, and numerous service businesses including tailors, barbers, candy stores, gambling houses, opium shops, and Chinese physicians (Dabney 2006). The Spanish colonists were reported to have held the Chinese physicians in higher esteem than their own physicians, ‘whom nobody trusted’ (Ibid.: 178).

The embrace of modernity …at the expense of other ‘local’ practices

Along with Chinese medical practices, an abundance of plural ethnomedicines were practised throughout nineteenth century Cuba. However, just as Chinese medical practices were practised almost entirely within Chinese communities, the practices of the indigenous Guanahatabey and Ciboney, the Taino Indians, African slaves, and immigrants from other Caribbean islands were also not integrated into Cuban State healthcare of the nineteenth to mid-twentieth centuries (Volpato et al. 2009).

Similar to the trajectory of local and indigenous practices in China – which were initially dismissed by Mao Zedong and the Chinese Communist Party as ‘old medicine’ before being embraced by Mao as a ‘national treasure’, that could be used to redress rural health disparities – (Taylor 2005), Fidel Castro originally rejected all indigenous, non-biomedical practices as archaic (Rosenthal 1981; Cochetti 2008). Both Cuban and Chinese Communism embraced modernity and scientism while rejecting the past (Kadetz Chapter 42 in this volume). Modernisation was the discourse that fuelled the early Cuban communist State (Cochetti 2008).

Following the Cuban revolution (1953–1959), local healthcare practices, including religious practices, were actively discouraged. For example, beginning in 1961, Chinese pharmacies in Cuba were systematically closed until only one remained open (Stafford 2010). If biomedical practitioners used or referred patients for non-biomedical practices, they would receive sanctions from the Ministry of Public Health (Brotherton 2005). Hence, the State’s initial rejection of local non-biomedical healthcare was further supported by Fidel Castro’s renewed emphasis on the biomedical modernisation of Cuba, and the centrality of modern biomedicine to the communist State.

In Castro’s 1953 speech, La Historia me Absolverà (‘History will Absolve me’), the health of the population is proclaimed to be an important indicator of the success of governance. And in the 1975 Cuban constitution, health was incorporated as a right of Cuban citizens and the responsibility of the State (Official Gazette of the Republic of Cuba 2003: 3). As a result of this constitutional change, Castro’s government instituted the Ministry of Public Health along with ‘a national health system, the nationalization of private clinics and pharmaceutical companies and social and rural health care services at little or no cost’ (Stafford 2010: 42). The goal of these changes was to provide universal access to biomedicine.

Interestingly, though, it was during this early post-revolutionary period that acupuncture started being utilised in place of specific biomedical procedures, such as acupuncture analgesia during the mid-1970s. However, the teaching lineages of acupuncture in Cuba cannot be traced to the Chinese migrants living in Cuba, nor indeed to China specifically (Padron Caceres and Perez Vinas 2005). In 1962, after a seminar in Havana was hosted by a physician who founded the Medical Institute of Acupuncture in Argentina, Floreal Carballo, acupuncture was formally, albeit minimally, introduced into the Cuban healthcare system (Acosta Martínez 2000). Further acupuncture courses during the 1980s and 1990s employed American acupuncturists (Padron Caceres and Perez Vinas 2005). Despite its acceptance in certain circles, acupuncture would not be fully accepted by the Cuban government and medical community until 1988, when three consultants from military academies in North Korea, North Vietnam, and the PRC were invited by the Minister of Military Affairs of Cuba to organise a speciality of traditional military medicine (Ibid.). Acupuncture would then go on to become part of a medical speciality that was incorporated into the national healthcare system under the rubric of Medicina Tradicional y Natural (MTN).

MTN was formally integrated into the Cuban healthcare system in 1992 through a national mandate (Applebaum et al. 2006). By 1995, a State commission was formed by the Ministry of Health for the development of MTN throughout Cuba (Ibid.). In 1999, the National Program for MTN approved the use of acupuncture, homeopathy, chiropractic, and native medicinal plants into the national health system (Stafford 2010). But what can explain this marked departure from the State’s initial embrace of biomedical modernity and rejection of non-biomedical practices?

The mother of invention

The Cuban government’s reversal in its acceptance of acupuncture was largely an outcome of the constitutional commitment to universal healthcare that was severely challenged by the US embargo to Cuba. The United States has held an ongoing trade embargo against Cuba since 1961; the longest such embargo in modern history (Garfield and Santana 1997). However, the first three decades of the embargo had negligible effects on Cuba and Cuban healthcare, which were protected by maintaining 70% to 90% of international trade (which included pharmaceuticals and medical supplies) with Soviet bloc countries (Ibid.).

According to Garcìa (2002), the Cuban government was well aware that the blockade against Cuba could become global and, therefore, planned for self-sufficiency, particularly in terms of healthcare. In the late 1980s, Cuban military policy acted on the need for self-sufficiency and opened the Central Laboratory of Herbal Medicine at the Higher Institute of Military Medicine, thereby taking the first steps towards the formal integration of traditional medicine (MTN) into the Cuban healthcare system (Ibid.; Stafford 2010). The military’s preparatory steps towards the widespread use of MTN were unerringly prescient, for within a matter of years, Cuba’s protection from the ongoing US embargo vanished with the dissolution of the Soviet bloc.

Cuba had produced sugar for the Soviet Union, which paid higher than world market prices for Cuban exports, and exported Soviet goods in return (Garfield and Santana 1997). After the collapse of the Soviet bloc in 1989, Cuba lost 85% of its foreign trade; with an 80% reduction in Cuban exports and a 70% reduction in Soviet bloc exports to Cuba from 1989 to 1993 (Ibid.). Cuba’s Gross National Product ‘declined by 35%; and the value of imports from all sources declined from US$8 billion to $1.7 billion’ (Ibid.: 15). Even though the PRC became Cuba’s second largest trading partner (with an increase in Cuban imports from 4.3% in 1996 to 10.9% in 1991), with the dissolution of the Soviet Union, Cuba had not only lost its most important trading partner, but also its primary source for the raw materials for pharmaceutical production (Dominguez 2006: 10; Stafford 2010).

To add to Cuba’s plight, the United States, at this juncture, strategically exacerbated trade restrictions in its embargo against Cuba (Garfield and Santana 1997: 15). In 1992, the U.S. embargo was made even more punitive with the passage of the (ironically titled) ‘Cuban Democracy Act’, whereby all US subsidiary trade to Cuba, including trade in food and medicines, was prohibited (Stafford 2010). Furthermore, any ships docking in Cuba were prohibited from docking at U.S. ports for six months thereafter, even if their Cuban cargoes were solely humanitarian goods (Garfield and Santana 1997: 15). It could be argued that the perverted logic of the Cuban Democracy Act (ie., that democracy in Cuba would be promoted by completely isolating the island economically) was, in fact, a direct reversal of the logic of neoliberalism; namely, that democracy is only fully promoted through free markets (Friedman 2002), and moreover a complete rejection of the democratic principles of sovereignty and autonomy upon which the United States was founded.

Thereafter, the United States’ application of substantial pressure on other countries to cease both trading with, and providing humanitarian goods to Cuba, resulted in a near-global trade blockade against Cuba. In terms of biomedicine, the Cuba Diplomacy Act strictly prohibited trade of ‘medicines or medical devices with 10% or more of their components made by a US company or foreign subsidiary of a US corporation […] medical supplies for humanitarian aid can be sent to Cuba only after the Cuban government holds free and fair elections’ (Stafford 2010: 43).

Such restrictions created severe issues in accessing pharmaceuticals and the materials for the domestic production of pharmaceuticals in Cuba, particularly considering that the global pharmaceutical industry was predominantly controlled by U.S. transnational corporations. The dollar value of imports for health to Cuba fell from US$227 million in 1989 to US$67 million in 1993 (Garfield and Santana 1997: 18). Many of the hard-won benefits of the Cuban healthcare system were quickly reversed, despite the State’s organised targeting of limited resources to vulnerable populations, including the elderly, children, and women (Applebaum et al. 2006). Overall, the resulting shortage of pharmaceuticals was associated with a 67% increase in deaths due to infectious and parasitic diseases; a 77% increase in deaths due to influenza and pneumonia from 1989 to 1993; and a 48% increase in tuberculosis deaths from 1992 to 1993 (Garfield and Santana 1997: 17).

Hence, it was in this context that in 1992 the Cuban government completely reversed its position on the use of non-biomedical practices; reminiscent of Mao’s need to reverse his position disparaging the use of Chinese medical practices in order to redress access to rural healthcare more than twenty years earlier (Applebaum et al. 2006). Following specific orders from Fidel Castro, certain standardised non-biomedical healthcare practices ¹ were promoted as an important element of Cuban healthcare (Cooper, Kennelly, Ordunez-Garcia 2006). Suddenly, several non-biomedical practices, including acupuncture, that had hitherto been slowly and, at best, selectively and reservedly promoted or researched by the Cuban State could now scarcely be integrated into the national healthcare system quickly enough. ²

The migration of acupuncture to Cuba was, therefore, an outcome of a very specific political economic context, while the migration of acupuncture to Guatemala involved a quite different set of conditions.

Pre-colonial Mayan health practices

Contextualisation of pre-colonial Mayan health practices provides a basis for understanding current Mayan medical pluralism and the reception of acupuncture by indigenous Guatemalans. A marked disruption in Mesoamerican local order occurred with the Spanish conquests of the sixteenth century. After the conquests, indigenous practices, including local health practices, were markedly influenced by the Spanish colonists.

The lack of literature on indigenous health practices pre-dating the conquests presents challenges in disentangling Spanish influences from indigenous practices. Two works that may provide the most accurate depiction of pre-Columbian life are the Popul Vuh and the Chilam Balam. The Popul Vuh, written in the mid-sixteenth century, describes the early history of the Quiche’ people and is one of the earliest surviving documents regarding Mayan illness classification and therapies. The Chilam Balam, a grouping of disparate writings named for the particular town in which they were found, and containing historical, medical, and divinatory knowledge (Roys 1933; Kunow 2003: 33), was believed to have been written by indigenous authors immediately after the conquest (Garcia, Sierra, Balam 1999). The Chilam Balam contains such information as the proper days for bleeding and purging, practices that were also affiliated with contemporary European and Chinese medical practices; which raises the question of whether Mayan practices were merely examples of ‘travelling medicine’ or forms of transcreation and hybridisation (Lo and Yoeli-Tlalim 2018) or, rather, continuities resulting from simultaneous, yet discrete, creation (Roys 1933; Gubler and Bolles 2000: 5).

Similar to the logic of myriad local, non-biomedical healthcare practices across the globe, ancient Mayans framed health as an outcome ‘of living in harmony with social and natural laws; [whereas] disease is the result of transgressing these laws’ (Garcia, Sierra, Balam 1999: xxxv). Medical practices are both a part of, and a product of, a given group and their specific system of order. According to anthropologist Mary Douglas (1966) all ‘cultural’ groups order the world and phenomena in a way that is meaningful to that particular group and that facilitates a common group understanding. Similar to Chinese medical understandings of order, categorical affiliations existed in Mayan medical order between chronology, the winds, animals, the cardinal directions, and illness (Chapters 5 and 6 in this volume; Roys 1933). Illness was diagnosed in pre-colonial Mayan society using palpation, divination, and consultation with the patient, and was primarily treated with medicinal plants, prayer, and bleeding in an attempt to restore harmony between ‘the physical, social, and cosmological order and internal bodily processes’ (Huber and Sandstrom 2001: 109). In describing the pre-Columbian classification system of illness, Orellana (1987: 28) differentiates between two categories of aetiology; illness caused by non-human beings – or by human beings who possessed supernatural powers – and natural causes, such as accidents, deficiencies, or excesses. In summary, religion, medicine, and morality were closely interwoven in pre-colonial Mayan medical practices (Ibid.: 257).

The influence of Spanish colonisation on Mayan medical order

Colonisation resulted in myriad changes in Mayan health practices by virtue of colonial religion, colonial health practices, and colonial policy aimed at replacing indigenous understandings and practices with those of the Spanish colonial order. In the mid-sixteenth century, Dominican missionaries in Guatemala opened the Hospital de San Alexo, treating local Maya with European medicine (Huber and Sandstrom 2001). Catholicism was inextricably linked to colonial medicine in Guatemala. Priests, friars, and missionaries operated the Spanish hospitals and the clergy promulgated the concepts of Spanish medicine to Mayans hoping to replace Mayan medical beliefs with European beliefs, which included Catholicism (Ibid.). Colonial policy, that was enforced by a Protomedicato responsible for licensure of medical personnel, resulted in the standardisation and complete legal control of Mayan medical practices by the State (Ibid.).

A fundamental outcome of colonisation and the ensuing epidemics the Spanish brought, was the hybridisation of European humoral medicine into constructions of Mayan medical order (Huber and Sandstrom 2001). There is strong support in the literature, concerning the history of humoral medicines in Latin America, that the humoral system is not an indigenous system (Currier 1966; Orellana 1987; Foster 1994; Huber and Sandstrom 2001). For example, Trevino identifies that the Relacio’n de Tiripiti’o (written in 1579) mentions Mayan physicians discussing illnesses in terms of ‘the Galeno-Hippocratic humoral medicine that Spanish doctors practiced’ (Huber and Sandstrom 2001: 51). Concurrently, indigenous medicine was attacked by the Spanish protomedicos for not following ‘the doctrines of Hippocrates and Galen’ (Ibid.: 55). According to Baer, Singer and Susser (1997: 307), ‘humans universally have developed health care systems that reflect their living conditions and resources’. Hence, humoral medicine may not only have been a European system of order that was forced on the Mayans, but may also have been embraced by Mayans in order to survive the new infectious diseases the colonists introduced, against which the Maya were defenceless with their own interventions. Thereby, the Greco-Persian-Arabic humoral medicine of Hippocrates, Galen, and Avicenna may have been absorbed into Mayan medicine.

The centrality of the conception of equilibrium to Mayan cosmology may have provided a fertile ground for humoral theory (Orellana 1987: 260). In humoral theory, illness is believed to be caused by a disturbance resulting in an imbalance of hot and cold in the body, and remedied by hot and cold therapies that restore the imbalance (Wilson 1995; Adams and Hawkins 2007). However, in the Mayan adaptation of humoral medicine, hot and cold are not equivalent endpoints. Heat is considered more advantageous and positively associated with emotional support and affection (Wilson 1995). This meaning is illustrated in the hot classifications of fertility, pregnancy and menstruation, a powerful pulse, elders and ancestors, officials, and military officers (Ibid.). In contrast, cold is associated with factors that threaten one’s survival, including sterility, weakness, rejection, and withdrawal (Ibid.).

Given that the humoral model is structured by life stages, gender, interpersonal relationships, and social hierarchies, this model can be understood to serve as a symbolic system onto which social anxieties can be projected and from which social desires can be fulfilled (Currier 1966). However, it should be understood that the meanings of hot and cold systems throughout Mesoamerica ‘vary according to indigenous group and linguistic area’ (Wilson 1995: 131). Hence, it is unlikely that a single interpretation of humoral medicine was adopted. For example, there is relatively little agreement as to which foods are hot and which are cold, not only between geographical areas of Mesoamerica, but even among the members of a single community (Currier 1966).

In order to understand why only certain elements of medical theories and practices are translatable and adopted between one group and another, it is essential to know who mediated and controlled these translations.

Reflections or illusions: Chinese medicine and Mayan medicine

The goal of the dynamic dualisms of humoral medicine, embedded in the order of Mayan medicine, is harmony; a central tenet of both Mayan medicine and traditional Chinese medicine (TCM); though this concept is relative to each system and we should not imagine that they are simply interchangeable. For example, in TCM, harmony of both the nutritive elements of the body (or simplistically stated, the more feminine or yin elements) and the functional (or more masculine or yang elements) is sought for ideal health (Ni 1995). In Mayan understandings, women and children are considered weak, whereas men are strong. Men are believed to be hotter, women colder. Men are believed to have stronger blood than women. Hot blood is considered healthier and stronger than cold blood. Hence, the concept of harmony that provides ideal health in Mayan medicine actually places stronger emphasis on masculine associations.

Furthermore, the general hot/cold duality of the adopted Mayan humoral concept can be perceived as similar to the concepts of hot/cold; yin/yang and myriad other dynamic binaries in Chinese medical systems. For example, in Chinese medical theory if there is a deficiency of yin, yang predominates and deficient heat ensues. The same is true of lack of cold resulting from yang deficiency. As death follows from the separation of hot and cold in Mayan medicine, so too is it a consequence of the separation of Yin and Yang (Orellana 1987: 29; Ni 1995). Despite the healthier and stronger nature of masculine attributes in Mayan medicine, according to Adams and Hawkins, one elderly male Mayan informant identified: ‘If there was no cold we would die’ (Adams and Hawkins 2007: 77). Similarly, Tonalli, or life force in Mayan medicine, appears to resemble the Chinese concept of life force or qi; as both can result in illness or death if deficient or absent from the body (Orellana 1987: 29; Ni 1995).

Both medical systems echo tensions with Western pharmaceuticals. Modern biomedicines are usually considered dangerously hot by Mayas, and as consuming yin in TCM (Wilson 1995). According to Mayan logic ‘Vaccinations and strong medicines burn humans by creating excess amounts of heat damaging the body’ (Adams and Hawkins 2007: 77).

Parallels can be further identified between Mayan and Chinese cosmology, mythology, understandings of chronicity and health, aetiological explanations for illness, diagnostic methods, therapeutics, and management. Garcia, Sierra, and Balam (1999: xxxii) report ‘from the moment we began to introduce Asian techniques like acupuncture into our community health work, we were received quite differently than when we had presented ourselves as Western doctors’. They maintain that one reason for this reception may be that Mayan medicine had the most developed ‘autochthonous system of acupuncture in Mesoamerica’ (Ibid.: 109). Although, we can challenge whether what Mayans practised could actually be deemed an ‘autochthonous system of acupuncture’, Garcia et al. identify two indigenous variations of medical treatment utilising body piercings, that clearly resemble the manual techniques and body topology of Chinese acupuncture and the superficial surgical practices of waike (外科). Known as jup and tok, these practices have been located in Maya communities of the Yucatan peninsula.

Purportedly the first documentation of these therapies appear in a book of the late sixteenth century; The Ritual of the Bacabes, in which illness is treated by ‘ix hun pudjub kik (the needle which bleeds) and ix hun pudjub olom (the needle which frees the blood)’. The skin is punctured ‘with the spines and thorns of several varieties of plants and several animals’ (Garcia et al. 1999: 109). Jup is a technique in which discrete points on the body are pricked several times in rapid succession, but blood is not drawn (Ibid.). Jup is performed in two ways; the same point can be punctured three times at approximately 1 centimetre depth, or the same point on the body can be punctured repeatedly until a response of inflammation to the area is achieved (Ibid.). In Tok, a point on the body is punctured in order to draw blood (often facilitated with cupping over the point-another shared practice between the two medical systems) (Ibid.: 110).

Similar in practice to Jup, is the 1000-year-old Chinese practice of Plum Blossom Needle, named for the five needles bound together to resemble a plum blossom, in which the instrument is repeatedly struck over an acupuncture point or an area resulting in inflammation or micro-bleeding (Zhong 2007). Although in acupuncture, a needle is usually inserted in a specific point on the body and is typically retained for fifteen to twenty minutes, in the technique known as ci xue liao fa 刺穴疗法, bloodletting will occur (often with cupping) as practised in tok (Cheng 1996: 110).

In TCM, more than 350 acupuncture points are identified that can be utilised in treatment; a reflection of the original astromedical conception of the continuities between the number of days of the year of the macro world and the number of points on the body of the micro world (Cheng 1996). Garcia et al. (1999: 112) have identified fifty body points used in tok and jup, all of which they have correlated with the location of acupuncture points. For example, a common and important point on the body in both TCM (yintang 印堂) and Tok/jup (tok lu ni) is located midway between the eyebrows. The skin is lifted and pierced in both medical systems. In tok/jup it is both a point punctured in children to prevent future illness and in adults to stop ‘evil wind attacks’ that may cause headaches (Ibid.). Acupuncture at this same point location can be used for headaches, as well as for ‘clearing external wind-heat’ pathogens, pathology in the brain and nose, calming the spirit of the patient, and hypertension (Cheng 1996).

There are numerous instances of other correlations in both anatomical location and function between the two medical systems, even though these practices developed quite independently from one another. Yet, despite the differences in cosmology, understanding, meaning, and order, embedded in Chinese and Mayan medical systems, the similarities in the practice of these two distinct medical therapies may offer one explanation for the reception of acupuncture in some Mayan communities. But, there may also be other factors to help explain these ‘cultural migrations’ to both Mayan Guatemala and Cuba that can be best understood via a popular representation of acupuncture as a kind of revolutionary or ‘rebel medicine’; for acupuncture represents the medicine of a people who have never had any colonial history, but who have been associated with socialist revolutions in Latin America.