Doctors, deities and ancestral spirits: immigrants from Latin America and the Caribbean rely on traditional healing. Is the medical world prepared to care for them?

Alfredo Alonso sat on the edge of the rumpled bed tucked in one corner of his Northern Manhattan apartment. He was facing the altar and wearing ceremonial garb: white cotton fabric swaddling his head, colorful beads around his neck. His silky white pants were cropped at the knee, revealing watermelon-size calves, riddled with lumps and purple welts.

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The priest--a wiry man with bulging, tattoo-covered biceps--dabbed cocoa butter onto Alonso's thumbnails, the crown of his head, his inner arm. Then he sprinkled Alonso with perfumed water, called Agua Florida, to shoo away unwanted visitors from the spirit realm. All the while, Alonso prayed. "Health and prosperity, open all my pathways," he pleaded, scrunching his eyes shut. "Cure my legs. Cure all my health problems."

The priest knelt in front of the altar--a squat pedestal holding a wooden tureen full of sacred herbs and stones. Before it lay dozens of offerings: corn meal bundled in banana leaves; 12 white roses; speckled pears heaped on a white plate. He drizzled wine and honey over three empty dishes before fetching a bone-white pigeon. Grabbing the bird by its talons, the priest swept it slowly over Alonso's body, then held it up to Alonso's face. Its beak, a sliver of translucent yellow, pressed against Alonso's lips. "Cure my legs," Alonso whispered tenderly to it. He said this again and again, even as the priest pulled the bird away, slashed its throat and dribbled its blood over the honey-filled dishes.

Alonso suffers from a host of diseases, but the one that worries him most is the lymphedema, sometimes called elephantitis. It attacks the lymphatic system that is designed to filter toxins out of the body. Lymph fluid, which normally circulates like blood, pools beneath the skin of his legs, making them grow bigger and bigger. Most days Alonso can barely walk because of the pain and swelling. Doctors say there's little they can do to ease his symptoms. So he relies increasingly on Santeria, an African-based religion and healing system. Believers curry favor with deities, called orishas, through chanting, music, dance and offerings. The pigeon sacrifice, performed by a priest of Candomble, the Brazilian equivalent of Santeria, was one of a series of rituals intended to heal him.

Alonso hasn't told his doctors that he practices the religion; he worries they'll think he's ignorant or superstitious. He's simply blended the two healing systems as he's seen fit, often disregarding doctors' advice when it conflicted with that of his priests. Like Alonso, a growing number of people are finding themselves caught between two systems of healing. More than half of the 1.5 million immigrants to the United States each year come from Latin America and the Caribbean, where spiritually-based healing traditions flourish. These include Santeria, which arrived in Alonso's homeland, Cuba, on 16th century slaves ships, as well as its Hatian cousin Voodoo; Puerto Rican Espiritismo; and Curanderismo, practiced primarily in Mexico. Statistics on these traditions are scant. But Santeria expert Migene Gonzales Whippler estimates that five million people in the United States practice it. And the number practicing all of these traditions is likely to keep growing. Yet, most health care providers know little about the herbs and rituals associated with them, and this can work to their patients' detriment. Some herbal remedies can interact dangerously with prescription medications. And believers who don't feel they can talk to their clinicians about their spiritual practices are likely to disregard doctors' advice when it conflicts with that of their healers.

There are signs of change on the horizon, though. The growing emphasis on "cultural competence" has led a number of universities to begin researching Latin American and Caribbean healing traditions and integrating information into their medical school curricula, even bringing Santerian and Voodoo priests to talk to students. A handful of doctors is also collaborating with healers from such traditions in treating patients.

Such programs are advancing under a veil of skepticism, though. "We're talking about changes that are more sensitive than those that came with the sexual revolution," said David Hufford, a Pennsylvania State University medical anthropologist. "It's hard for people to get over the notion that these practices are rare, perverse, the product of ignorance. But I think the time is coming when they'll have a different standing in the medical world and the world in general."

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Babalawo vs. Doctor

Alonso's dark hair is peppered with gray, and his plump cheeks are dusted with stubble. He has narrow eyes that sink into his face when he's tired or hurting. But they come alive when he's explaining his religion. Perhaps it reminds him of his life before lymphedema, when he taught world history at a high school in downtown Manhattan. He had to give up his job because of the disease. Now, at 41, he lives in a cramped one-bedroom apartment with his mother. Usually, he sports a T-shirt and cotton drawstring shorts and sits in a plastic-covered, pink armchair in one corner of the living room.

Born in Cuba, Alonso moved to the United States before his fourth birthday and was initiated into the Santeria religion at age ten. He has long relied on the herbs and rituals associated with it for his fragile health. He's had asthma since childhood and has developed a variety of other health problems over the years, many of them because of his weight; he weighs 475 pounds.

Alonso got more deeply involved with Santeria after a crippling 1995 accident. He was visiting an upstate New York church when a rotten porch board buckled under him. His leg jammed between two ends of the split board, and an inch-long splinter lodged in it. Almost immediately, his calf swelled up, and the skin covering it grew scorching hot. He went to his family doctor, Carlos Toledo, who diagnosed him with a bacterial infection and sent him to Mt. Sinai Hospital. He spent his first night on a gurney shoved in one corner of the emergency room, where he lay awake, a nauseating ammonia smell swirling in his nostrils.

The hospital staff ran a battery of tests but had difficulty diagnosing him. Like many Cubans in the United States, Alonso's father practiced Espiritismo alongside Santeria. When Alonso was sick, his father often took him to seances, during which spirits offered insight and advice through human mediums. The spirits were quick to name his illness--be it diabetes or chicken pox--and prescribe herbs, spiritual cleansing or a doctor's visit. Alonso, who was accustomed to healers' decisive approach to diagnosis, was puzzled by the dithering of Mt. Sinai doctors. But when, after three weeks, they finally labeled his illness, he felt worse. Apparently, the bacterial infection had invaded his lymphatic system, triggering lymphedema. He was already hobbling and now might never walk normally again.

Alonso's hospital room overlooked Central Park. Every day, he watched women with baby carriages ambling down paths and children tumbling in the grass, and it crushed him. The doctors and nurses tended his body but didn't help him cope with his grief. "I was just a number and a name," he grumbled.

For support, Alonso relied on his family and, increasingly, on his babalawo, or Santerian high priest. During his first week in the hospital, his priest sacrificed a chicken to the orisha Babalu Aye, protector of the ill and crippled, guardian of the gates between life and death. Afterward, the priest stuffed some blood and feathers in a burlap pouch, along with corn and dried beans, Babalu Aye's favorite foods. Then he drizzled rum over the concoction and tied it closed with a royal blue ribbon.

He brought the pouch to the hospital, where Alonso and his parents waited. Chanting, he moved it over Alonso's leg to draw out the illness. Before leaving, he put a string of consecrated beads, called an eleke, around Alonso's neck for spiritual protection. His encounters with doctors often left Alonso feeling gloomy. But when his babalawo visited, his pain abated, and he saw glimmers of hope. Alonso's not alone. Dr. Arthur Kleinman, a Harvard medical anthropologist, has found that many people get more relief from healers--who treat the emotional and spiritual as well as the physical--than they do from doctors.

Toward the end of his hospital stay, Alonso was awaiting the results of a scan to find out if he had blood clots in his legs, that could break loose, causing a stroke or heart attack. His babalawo brought in four pieces of coconut shell. When he tossed them, they all landed fleshy side up--a good sign. "You might not be healed completely," he said. "But you're clot free."