Medicina Cultural, Medicina Esencial: Plant-based Health Care among Dominican Women in Puerto Rico

Karla Claudio-Betancourt
July 24, 2020

Felicia de JesĂşs spends her quarantine days behind a sewing machine making reusable masks on the balcony of her home. She sells them for $3 dollars apiece, a price she considers affordable for her neighbors, and just enough to cover the cost of materials. She lives four blocks from the main square in RĂ­o Piedras, a working class, predominantly immigrant neighborhood located on the outskirts of San Juan.

I arrive at her home on a Sunday afternoon in June during Puerto Rico’s second month of quarantine. Metal grating envelops her balcony, supporting a canopy of thin bamboo shades that keep her workspace dark and cool. Colorful piles of fabrics adorn her sofa and work table. Tinino, her pet rooster, keeps her company while she sews, occasionally tugging at her skirt for food or affection. Felicia quietly works while I settle in. Her neighbor, Romelinda Grullón, sits across from her, helping to assemble the masks while the faint dialogue of a telenovela plays on a small monitor at the other end of the room, like a distant soundtrack ignored.

two women sewing

Felicia sews masks while Romelinda, in the back, prepares the side rubber bands.

Romelinda is the director of Centro de la Mujer Dominicana in Río Piedras, a safe recreational and educational space for survivors of domestic violence among the neighborhood’s immigrant communities. We spoke on the phone a few days before meeting at her house and I explained my intention to document herbal medicine traditions practiced by Dominican women both before and during the pandemic. I wanted to understand how these marginalized women use plant-based healing as an alternative to Western biomedicine, and how plants are in fact their allies when facing the classist and racist restrictions of Puerto Rico’s healthcare system. She recommended that I to speak with Felicia, who does not participate at the Center’s events, but is close with Romelinda and well-versed in herbal medicine.

Born and raised in Santo Domingo, Dominican Republic, Felicia came to Puerto Rico as an undocumented immigrant in 1992. She works as a seamstress at a laundromat in Guaynabo, which closed during the pandemic and reopened in early June when mounting pressure from the economic sector forced Governor Wanda Vázquez to announce Puerto Rico’s transition out of quarantine. Like many others on the island, Felicia feels that governor cowed to fiscal alarmists and re-opened prematurely. She has decided to stay at home, choosing instead to support herself by selling masks and working on commissions for private clients, some of them government employees and policemen from the nearby police station who ask her to tailor or mend their uniforms.

Felicia shows me the insulina plant (Costus igneus) that helps regulate her diabetes (bottom right).

After acquiring U.S. citizenship, Felicia enrolled in Puerto Rico’s government healthcare system Plan de Salud VITAL, which contracts private health insurance companies (Triple S, Medical Card Systems and Humana) to provide care rather than government-run hospitals and emergency rooms. Commonly referred to as La Reforma, its original name, by Puerto Ricans, the healthcare system receives funding from the local government and from Medicaid. However, it only gets one-third of the federal funding designated to other U.S. territories or states, even though Puerto Rican residents pay the same amount in taxes for Medicaid and Medicare. Free access to La Reforma is available to U.S. citizens who earn a monthly income of $800 or less—about half the income of the federal poverty threshold. As a result, many of the island’s most marginalized citizens are ineligible for affordable medical care. Even after acquiring legal status, Felicia didn’t qualify for La Reforma because she worked 40 hours a week. To make matters worse, the devastation of Hurricane María left Felicia unemployed; only then did she qualify for free healthcare through La Reforma.

The privatization of the healthcare system took place in 1993 under the administration of Pedro RosellĂł, the father of former governor Ricardo RosellĂł who resigned in 2019 amid mass protests stemming from Telegramgate. Prior to privatization, healthcare coverage for state-sponsored secondary and tertiary treatment could not be denied on the grounds of immigration status. Now, according to Law 72-1993, which created the Puerto Rico Health Insurance Administration (the public corporation that runs La Reforma), proof of U.S. citizenship or residency is required for eligibility. According to the 2016 Human Development Report in Puerto Rico published by the Puerto Rican Institute of Statistics, the population with the least access to medical services on the island are immigrants from Latin American countries without U.S. citizenship, more so than non-Latino immigrants without U.S. citizenship.

330 Clinic in Santurce, Puerto Rico.

Federally-funded 330 Clinic in Santurce, Puerto Rico.

Undocumented citizens in Puerto Rico have access to primary health care at Section 330 clinics across Puerto Rico. These clinics receive federal grants under the Public Health Service Act and don’t require proof of citizenship. But before becoming a naturalized citizen, it was cheaper for Felicia to fly to Santo Domingo for medical care than to pay for specialized treatments at secondary or tertiary healthcare facilities in San Juan.

Romelinda GrullĂłn says that primary healthcare services are insufficient for those with advanced or chronic illnesses. “When there is a need for a series of lab work, for example, it can be very expensive. Same as for hospitalization and X-rays…it’s not enough. There is the cost of medications. That’s why botanical [medicines] are important…they can substitute some of these [pharmaceutical] medications. It’s a way for the community to feel empowered and strengthen their immune system, which is so important right now. Many immigrants have compromised immune systems due to the anxiety they feel in the face of uncertainty, and poor or little nutrition.”

Felicia stands next to her cundeamor covered side-entrance gate.

Felicia uses her Reforma card to visit a general practitioner whose office is near her house. Diagnosed with diabetes, she is prescribed insulin treatments, but claims she doesn’t take them often, and instead uses plants from her backyard known as insulina (Costus igneus) and cundeamor (Momordica charantia) to control her blood sugar levels. She stresses that “doctors are not my friends” and prefers to take care of herself with herbal medicine because, she declares, “I don’t like to depend on the government.” Felicia raised five children and prepared botanical remedies when they got sick—only in very rare cases did she take them to the doctor. She cured her daughter’s asthma with guázuma bark (Guazuma ulmifolia) jarabe (syrup), a condition she notes to be more common in Puerto Rico than in Dominican Republic.

Throughout the pandemic, Felicia’s botanical allies have been “jengibre (ginger), limón, yerba buena y llantén.” She drinks decoctions of boiled ginger root and lime peel, along with mint and plantain leaves (Plantago major) from her backyard. Sometimes she adds orégano brujo (Plectranthus amboinicus) and cinnamon bark. Felicia drinks a different combination every seven days so that her body doesn’t get used to the same plants. She feels cared for by her plants: “God gave doctors science,” she says. “But God also gave you plants that grow in a small corner outside your house. You might not even know what it’s for or why it’s there, but it can probably heal you.”

Graciela in her frontyard medicinal garden.

Back in Santurce, where I live, I visit the home of Graciela Muñóz in Barrio Obrero. I was introduced to her through her daughter, Ana Castillo, whom I met while volunteering at a social dinner organized by Comedores Sociales and the Colectiva Feminista en Construcción this past May. Ana welcomes me at the front gate of her mother’s house, smiling with her eyes through her brightly patterned mask. We walk past a row of orchids lining the balcony that leads to her living room. I notice orégano chiquito, bright fuschia bugambilias and aloe vera growing in the narrow garden beds around the house. Once inside, Graciela invites me to sit down on the living room sofa. Although shy at first, a few minutes into our conversation she lets loose her funny, charming self.

Graciela was born and raised in the town of Hostos, a few hours outside Santo Domingo, and came to Puerto Rico in 1987 when she was 31. For the past 15 years she’s worked as a hotel maid at the Caribe Hilton, but, as a non-unionized employee, she was temporarily dismissed from the hotel a week after curfew was implemented in March. Unlike many other citizens right now, she was fortunate to have applied for unemployment and qualified right away. She has taken basic precautions during the pandemic, staying at home and receiving her unemployment benefits.

woman prepares herbal tea in kitches

Graciela prepared her daily decoction of lemongrass, lime peel, ginger root and plantain leaves.

Before becoming a citizen in 1998, Graciela was able to enroll in La Reforma during the system’s early years, when she only had U.S. residency status. The government eventually instituted a five-year waiting period for those who acquired permanent residency after August 22, 1996. “In Puerto Rico,” she observes with some dismay, “people don’t drink much (medicinal) tea. It’s very rare and more common among older adults. People here prefer pills.” She believes herbal infusions are more healthy, as well as growing the plants themselves. “It’s better because they’re organic, they have no chemicals,” she affirms. “It’s a real pleasure to grow and harvest [medicinal plants] for your own use.”

She grows culantro (Eryngium foetidum), rosemary, orégano chiquito (Origanum vulgare), orégano brujo, alcanfor (Plectranthus hadiensis) aloe vera, papaya and gandules (Cajanus cajan) in her garden. In order to strengthen her immune system during the pandemic, she drinks ginger root and lime peel decoctions, like Felicia, regularly. She also adds plantain, naranja agria (Citrus aurantium) and lemongrass leaves that she forages from around the neighborhood. While growing up in Dominican Republic, her mother and grandparents would prepare daily infusions and decoctions with fresh–not store bought–leaves. No one “taught her” how to do this, she explains. “I learned by looking at them every day.” After a captivating tour, she prepares her daily decoction in her kitchen and we enjoy the warm beverage while she shares stories about her childhood in el monte, the countryside.

Graciela and Ana pose together at home.

As residents of Puerto Rico find ways to support their health with or without medical insurance, herbal medicine has become an increasingly popular alternative to pharmaceutical treatment. The archipelago’s tropical climate is conducive for a wide variety of herbal medicine to be grown and harvested all year-long, so plant medicine is free if you have access to land or knowledge of foraging. In our journey to reconnect with these ancestral teachings, let us not forget that herbal medicine is not a new trend, but rather an age-old system of knowledge accumulated by black, brown and indigenous people–and now by those who can’t afford private medical treatment or expensive herbal products at health stores. It’s a tradition born out of collaboration with la tierra, the land, but also out of austerity. Racism, classism and economic deprivation have conspired to stigmatize herbal medicines for centuries; these long-standing societal inequities help explain why natural remedies are only now being embraced by capitalist ventures.

For Felicia and Graciela, decocting herbal medicine—or “cultural medicine,” as doted by Western biomedicine—will continue to be an essential daily practice. Recognizing its value does not mean we should ignore the urgency to demand equal access to affordable health care. Rather, we might consider how we can integrate these daily preventative rituals as a means to reclaim our medical sovereignty. How can we defend the communities that safeguard this knowledge? Although Felicia and Graciela would not recommend using plant treatment alone to treat COVID-19, they believe plant-based medicines are effective and inexpensive aides to recovery. Some contend that faith is responsible for the effectiveness of herbal remedies, but the survival of these practices over millennia might point to a deeper truth: if they’re still around, it’s because they work.

Author’s Note
This article is part of an ongoing investigation led by la recolecta, an arts and ethnobotany project in Puerto Rico that focuses on learning about the potential of wild plants for medicinal, culinary or craft use. To learn more about herbal medicine in Borikén, please download Yerba Mala Nunca Muere (2017), a Spanish-language zine created by la recolecta.


Karla Claudio-Betancourt

Karla Claudio-Betancourt

Karla Claudio-Betancourt is a visual artist living in Santurce, Puerto Rico working primarily with illustration, natural paints, text and video. Her creative practice is guided by ethnobotanical investigation, oral history and regenerative practices connected to land and food sovereignty.

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