Experience and expectation: conflict and change in traditional family health care among the Quichua of Saraguro.

Quichua Indian mothers have traditionally served as primary health caretakers for the families of Saraguro in highland Ecuador. A hospital has recently opened, providing biomedical health care and programs in preventive medicine for local indigenous commmunities. Opposition to the new facility has arisen, however, as families express dissatisfaction with hospital policies. Surveys and in-depth interviews, conducted with Saraguro families ad hospital staff between 1977 and 1982 have outlined problems encountered i the introduction and administration of biomedical care. The hospital is seen by some residents as a threat to Quichua women's authority as herbalists and family curers. More importantly, however, Saraguro families view the facility as a disappointment, as it provided services inconsistent with traditional health values, practices and felt needs, and it fails to fulfill residents' expectations of hospital care. Conflicts between traditional and hospital health care experiences and between expectations and reality, have bred hostility between the health facility and the community it serves. Inability to negotiate with hospital staff for greater flexibility in policies has intensified community frustration. The impact of cultural health values, expectations, and program flexibility are discussed with potential implications for planning and administration of biomedical delivery services.