Manuel Núñez Butrón: A Peruvian symbol for primary health care

“The government pays a titled doctor to combat the epidemics that show up in his jurisdiction. But what can he do, no matter how much a scientist he may be, if his mission is to cover thousands of residents distributed over hundreds of kilometers? What does a young doctor do, recently graduated from the Faculty, if he has but a thermometer and prescription pad? A thermometer that doesn’t last long and a pad to prescribe remedies that arrive a number of days after the death of the patient” (Butrón, 1944, Cueto & Palmer, 2014).

In many rural parts of Latin America, health care has been inaccessible to many marginalized communities. Take Peru as an example, with an indigenous population of approximately 45 percent (“Peru”, n.d.). Despite this significant portion of the total population, Peru, as with many Latin American countries, has historically done a poor job in addressing the needs and disparities present in the indigenous communities, especially when it pertains to health care. Prior to the 1930s, there was an abundance of physicians in large cities, such as Lima and Arequipa (Arroyo-Hernández, 2013). However as one travelled more into the rural highlands of Peru, it was common to find just one or two physicians that served thousands of residents spanning a large area (Cueto & Palmer, 2014). As a result, indigenous people were not receiving the proper care that their less marginalized neighbors were, resulting in unnecessary deaths and an overall lack of understanding of disease prevention (Flores, 2014). Public health icon Manuel Núñez Butrón began to change that.

Manuel Núñez Butrón was born and raised in Puno, an arid and cold city in Peru hugging Lake Titicaca. Puno in particular was unfortunately one of the most isolated and underdeveloped cities in Peru, with a large indigenous population (Flores, 2014). Despite his strong indigenous roots and the general lack of opportunities for said communities, Núñez Butrón decided to become a medical doctor. He received most of his schooling in Puno and finished his training in The University of Barcelona in Spain where he experienced constant discrimination because of his ancestral roots (Flores, 2014). Instead of taking a more prestigious and well-paying job after graduation in a larger city such as Lima, he decided to work as a state physician back in Puno. Núñez Butrón was shocked to find how disadvantaged his city truly was, with the majority of the indigenous population suffering from smallpox and typhus (Cueto & Palmer, 2014). He acknowledged that the state had essentially abandoned his people, and that he had the power and knowledge to combat this vast inequality.

Núñez Butrón initially drew inspiration from Seventh Day Adventist missionaries from the U.S. and Argentina. They not only advocated for better corporal hygiene, but they also believed in the benefits of having a bilingual education (Cueto & Palmer, 2014). It was also around that time in the late 1920s that indigenista ideology began to resurface in Peru. The indigenista movement sought to ignore the disparities present in indigenous communities and instead uplift the culture and aesthetics that dated back to the Incas. It was a nationalist movement of sorts for those with native ancestry to reclaim their power (Cueto, 1991). Inspired by this movement, Núñez Butrón and other social activists formed a group of sanitary brigades where they referred to themselves as rijcharys, meaning “awake” in Quechua (Flores, 2014). These motley brigades consisted of Adventists, community leaders, bilingual teachers, and ex-soldiers (Cueto & Palmer, 2014). Núñez Butrón made it his life’s mission to educate marginalized indigenous communities by teaching them basic yet essential hygiene habits. This lead to his creation of “El Rijcharismo”, a revolutionary fusion of both western and traditional medicine aimed to better reach the native community (Flores, 2014). This was impactful considering much of the indigenous population who had never encountered western medicine were being exposed to it in a more familiar context.

Adopting the name Hatun Rijchary, or Great Rijchary, Núñez Butrón along with the other rijcharys left a positive impact on various indigenous communities. Few of the many services the rijcharys provided were advocacy for vaccination of smallpox, combating the flea that transmits typhus, and always offering education about corporal hygiene (Cueto & Palmer, 2014). Moreover, in 1935 Núñez Butrón created the first issue of his magazine “Runa Soncco” which literally translates to “heart of an indian” (Arroyo-Hernández, 2013). This magazine contained information over the diseases typhus and smallpox, including tips on how to best prevent them. What made this magazine truly encompassing was its inclusion of indigenous culture by adding sections of social news from the indigenous community. The magazine was even printed in Spanish, Quechua, and Aymara. Since a significant amount of the indigenous population were illiterate, rijcharys themselves would read the magazine out loud in public to make the information as accessible as possible (Arroyo-Hernández, 2013).

Indigenous population’s access to healthcare has generally been poor, affecting thousands of indigenous lives. Having one doctor care for hundreds of patients spanning a wide range of land led to these abysmal conditions. Luckily, Manuel Núñez Butrón noticed this inequality and actively attempted to change these conditions. With the creation of the rijcharys, Núñez Butrón was able to successfully educate the surrounding indigenous population over disease prevention while integrating their traditional medicine with western medicine. It was ultimately Núñez Butrón's emphasis on accessibility for all truly allowed this marginalized population to reclaim not only their health, but also their power.

References

Arroyo-Hernández, C. Hugo. (2013). Runa soncco: Manuel Núñez Butron y su proyecto de educación sanitaria. Revista Peruana de Medicina Experimental y Salud Publica, 30(2), 336-339.

Cueto, Marcos. (1991). "Indigenismo" and Rural Medicine in Peru: The Indian Sanitary Brigade and Manuel Nunez Butrón. Bulletin of the history of medicine. 65. 22-41.

Cueto, M., & Palmer, S. (2014). Medical Innovation in the Twentieth Century. In Medicine and Public Health in Latin America: A History (New Approaches to the Americas, pp. 157-203). Cambridge: Cambridge University Press.

Moncada, Samuel. “Manuel Núñez Butrón, Héroe De La Salud Pública En El Perú.” Consejo Regional III Lima, 21 Sept. 2018, cmplima.org.pe/manuel-nunez-butron-heroe-de-la-salud-publica-en-el-peru/.

Núñez Butrón, Manuel. “Qué es el Rijcharismo?” Medicina Social, 1944: 9-10.

“Peru.” World Directory of Minorities and Indigenous Peoples, Minority Rights Group International, minorityrights.org/country/peru/.

Salinas Flores, David. (2014). Manuel Núñez Butrón: Pionero de la Atención Primaria en el Mundo. Revista médica de Chile, 142(12), 1612-1613.