In Iquitos, when a poor person becomes ill and believes he is suffering from a disease caused by the malice of another, a visit to an ayahuasca healer may be suggested by a relative or friend. In Belen, Wils found that over 25% of the people he questioned preferred empiricos (folk healers) to doctors (1967: 131). My own impressions are that this is a conservative figure. Certainly, residents of Belen tend to seek assistance in times of crises rather than at the first sign of trouble or for preventative reasons.

The process of getting oneself healed may be a slow one if the sick person shops around for a healer who is reputed to have cured many people, who is wise in the use of the purge, and who knows which herbs will heal. Several people may be seen before the sick person settles upon a healer who can give some promise of being able to help him. The selection of a healer is matched by a similar sifting of patients, since the ayahuasquero, too, is careful to accept only those with whom he believes he may have some measure of success. A healer will refer patients to hospital or private medical facilities if he thinks the illness is a simple one which needs medication or X-rays. He will often reject patients who are psychotic--whose disease is in effect a total flight from reality and who consequently may not be reachable under the effects of the drug. The healer will also accept some patients to whom he will not administer ayahuasca. Their illness may have been chronic in nature, leaving them weak after a period of long physical suffering. Vomiting and diarrhea, continually reported in the wake of the initial hallucinogenic experience, may be too much for such a person. In many cases, the healer himself will prescribe pharmaceutical medicines, which in most South American countries require no prescription and are available to anyone who can pay the price.

The process of referring patients to medical personnel in cases of simple organic disease has its counterpart in the frequent referrals of patients to the drug healers by medical doctors attached to the city hospital and in private practice. Formal psychiatric facilities in jungle cities are relatively rare', and university training in underdeveloped countries, as in the United States, generally prepares the doctor for a focus on organic rather than psychological illness. For these latter illnesses, the folk healer is probably better prepared, as his general expectations are that a patient will suffer from socially precipitated illnesses which have resulted from stress, conflicts, tensions and the like. To the healer, interpersonal referents are as important, if not more so, than organic symptoms.

Rarely does a sick person go to a healing session by himself. The drug's effects are such that someone often must see him home afterwards. Weakness and debility generally follow the three of four hours of strong dizziness produced by the drink. Moreover, the presence of a loved one such as a spouse, parent, or brother may be necessary to reassure the patient when his visions fill with frightening and fearsome jungle beasts or monsters of his own imagination. Interestingly enough, feelings of camaraderie are often generated during the course of a drug session, even among men and women who may not be known to one another. On some occasions, however, groups of individuals may be attending several sessions together, if their illness requires several weeks or longer to heal. But generally, groups of total strangers sit around in a circle, taking ayahuasca along with the maestro, as he is called. If one were to visit such a group merely to observe, it would be difficult to know those present were strangers, since people seem to care so much about one another. By the time the full effects of the drug are experienced by participants, and especially if the experience is a good one with a well-prepared potion, the warmth, concern, friendship, and care radiating within the group stand out as an obvious characteristic of the session.

'In fact, in Peru as Seguin points out (1970: 175), there are about 100 psychiatrists in practice, 90 of them in Lima, the capital. Of the total of 2010 psychiatric beds in the nation, 95% are in Lima. The rest of the country, which has 83.4% of the population of Peru, has only 93 psychiatric beds.

Most drug healing in Iquitos today takes place in a jungle setting on the outskirts of the city. Several evenings a week, a healer and his assistants or wife assemble a group of patients ranging from three or four in number to larger groups of twenty or thirty. About six or seven o'clock at night, a healer may leave his home with his bottled preparation in a small sack, along with his schacapa, a rattle made from tying together a bunch of dried leaves that is used to accompany songs and whistling. He will collect some of his patients as he goes toward the place that has been decided upon for the session. Many times, patients will meet at the healer's home, as he may be busy there curing people during late afternoons. All of them may go by bus to the farthest point on the line, and then walk for an hour or two to their destination. Other times, they may take a motor-powered canoe or they may paddle for a few hours to some secluded place. Such settings are chosen because people who take ayahuasca, as with other hallucinogens, can be hypersensitive to sound. The frequent motorcycles that roam through the city can be disturbing to a patient if a session is held in a houseyard near a noisy city street.

As the city has grown, the jungle has receded further and further away, making transportation to it difficult. Today almost no virgin jungle is found less than half an hour away by motor boat. Healers say that the jungle is a better place to "work" not only because there is less noise, but also because the songs the ayahuasquero sings are penetrating and there is sometimes the fear that he may be reported to the police if overheard. Some city doctors are jealous of the success of their ayahuasca rivals and are reputed to be quick to make formal complaints. Interestingly enough, it is not against Peruvian law to take natural substances like ayahuasca to alter states of consciousness. It is against the law, however, to practice medicine without a license. City noises, too, can cause visions to disappear quickly, or become distorted, which could cause the patient to have a bad trip, especially in those cases where additional psychedelics such as Datura suaveolens may make the drug experience difficult for the patient under the best of circumstances. Should time be lacking to reach a forest clearing, a closed balsa house in Belen can serve as the place where healing takes place. If it rains, a wall-less shelter in the open forest with a thatched roof, called a tambo, may be used.

Patients bring small gifts of mapacho cigarettes or perfumed water to the session. These gifts may be used by healer and patient alike. If love incantations are to be performed, a client may bring something with him which belongs to his beloved. Many carry plastic drop cloths to sit on since the jungle floor is damp and sessions may last until three or four in the morning. As the healer and his patients arrive at the chosen spot, a light banter often is heard. People settle down around a circle, something which many healers believe is necessary precaution to keep the evil spirits of the jungle or those sent by other jealous healers or witches at bay. At about 10 P.M., the healer will take out a communal cup in which the ayahuasca drink will be distributed. Reciting an oration and whistling a special spell as protection for each person who drinks, the healer passes the cup around the circle. The amount of the potion will be varied in accordance with many factors, including what the healer assessed the body weight and physical strength of the person taking the purge to be. This will be one determinant of whether a patient receives a little or a lot. Is it the first or seventh time the person has had ayahuasca? From what illness is he suffering? The optimal dose found by Rios Reategui seems to be 7 mgm. per kilogram of body weight.' My impression from the various sessions I attended is that the healer will give a larger dosage to a person whose complaint is psychosomatic-illness with physical symptomatology but whose origin is believed by both to be due to some kind of magical harm.

Typically, the last one to drink is the healer. Some, in fact, prefer that no patient follow after him, so that those present can reach a climax in their visions as close together as possible. Needless to say, this enables the healer to be most effective in communicating with all his patients simultaneously. As long as half an hour may be necessary for the effects of ayahuasca to be felt, although reaching the height of visions may take longer for some individuals. People will sit around smoking and chatting. At times, someone may get up to vomit or defecate off to the side. The sounds made are not hidden from those present, and the healer may use the opportunity to talk to the rest of the group about what is happening. He may stress how effective the purge is and how important it is that each person try to keep it down in their stomachs for a long as possible, so that their visions will be both good and strong. If a patient has had no effects from the drug (which does happen on occasion), another portion may be meted out by the healer. Rarely, it may take as many as six or seven consecutive drinks until someone's visions begin.

In these instances, the fault may be with the healer, especially if he does not have his own fields to cultivate the vine. Thus, he may have to pay others to bring him ayahuasca for preparation and he may not be sure about the potency of the various ayahuasca species that are available in the region. The plant he receives may be dried out, or too small a quantity for everyone who plans to take a share.

With the growth of the city in recent years, it has become more and more difficult to obtain the quantity of ayahuasca that was formerly possible. The price of the vine has risen, and although some healers try to maintain their own psychedelic gardens, others must make frequent trips back and forth from their farms in order to bring the materials back to the city. Others pay people to travel to outlying hamlets for the liana, and such healers must have cash on hand to pay for their cuttings. Ayahuasca in the vicinity of Iquitos has long since been drunk up.

Healers use a good deal of Quechua (the highland language of the Andean region) in their songs during the ceremony. Whistling, too, often is part of the session and is interspersed throughout the evening's activities. As the hours pass, the healer moves around the circle contacting each person in turn, accompanied by his ever-present schacapa rattle which gives forth a rustling, rattling noise. During the curing ceremony, the healer will blow mapacho cigarette smoke over the body of a sick person, and if his patient is suffering pain in a particular part of his body, the healer will suck the dolorous area, often bringing forth a spine or thistle which those present believe was magically introduced by an enemy or evil spirit. Throughout the session, each patient receives counseling and is ritually exorcised by the healer.

Finally, at two or three in the morning, after some four or five hours of strong drug intoxication, the patient either returns to his home, or elects to spend the night in a nearby tambo. Dietary prescriptions are an integral part of ayahuasca healing because of a belief that the vine possesses a jealous guardian spirit. To propitiate this spirit, patients refrain from eating salt, lard, or sweets for at least twenty-four hours preceding and following the use of the purge. In addition, special diets may be prescribed by healers for particular patients, or sexual abstinence prior to a session may be demanded.

One interesting session took place near the edge of the city, close by one of the small river inlets leading to the Amazon. Don Luis, the healer, four of his patients, two assistants, and I met at the healer's house in Venecia. We walked several miles past open countryside to a clearing where we spread our plastic mats on the ground in a circle. Luis, whom I had met in Belen, was born in a small hamlet a few hours by boat from Iquitos. The fifth son of a small farmer, he left home when he was eighteen to serve in the army. Sent to a distant outpost near the Colombian border for two years, he eventually decided to live in Iquitos, where he was apprenticed to a carpenter. A distant uncle of his was an ayahuasquero and through his influence, Luis became interested in healing with the plant. For several years he worked with his relative, learning the ayahuasca songs and taking the potion at frequent intervals to assist his uncle in treating patients. Each August, he and his teacher would go by boat to an uninhabited part of the rain forest, where they would literally renew themselves and learn from the drug, as well as to strengthen themselves against the dangerous envy of witches. Such malice was thought to be an ever present threat to their healing successes. In these retreats, Luis experimented with various combinations of drug plants which his uncle taught him to prepare. He also spoke at great length with his teacher about the patients he had treated, their symptoms, and the remedies he prepared for them.

One day, while under the effects of ayahuasca, Luis had a vision which indicated to him that he was now ready to take patients on his own. Although he still practiced his trade of carpentry in Iquitos, he spent many hours receiving and treating patients, both at home and in drug sessions that he usually held two or three times a week, depending on the number of patients he thought should take the drug. After I was introduced to Luis and visited him several times in his home, watching him treat patients who came for counseling and exorcism of evil spirits, I was invited to attend an ayahuasca session. Twice the session had to be postponed because rain was imminent, apparently something which happened with regularity to healing sessions in Iquitos. That Tuesday night, however, the skies seemed reasonably clear and we reached our destination some three of four miles outside of Iquitos with little difficulty. I walked alongside two young women, one of whom was a patient. Her sister was there to see her home later that night. When we spread our mats in a circle, the atmosphere was informal. Several people smoked cigarettes throughout the session.

Luis whistled some special incantations over the cup he used to distribute the potion and in turn handed it to each man and woman. As usual, although the rest of the group were unknown to one another, they wished the person taking the purge good health as it was drunk. The amount of the drink was varied by the maestro for each person, and he was the last to drink. Some twenty-five minutes passed while Luis waited for the effects of ayahuasca to be felt. Chatting with each person in turn, he walked around the circle to talk to patients and to ask them if they were feeling any dizziness. He continued to whistle and moved his foot steadily to keep pace with the music. At times, he shook his schacapa. At this point in the session, after an hour or so of observing and listening, I felt a state of ease and tranquility even though I had not taken ayahuasca. The quality of the singing was quite soothing in its effects. As in many sessions I attended that year, several people were afflicted with heavy vomiting, a common side effect of the potion, although they didn't seem visibly upset by this. The healer continued whistling and singing, occasionally counseling patients and remarking, "Joven (young man), you've had this sickness a long time, I will cure you," etc.
My sense of well-being lasted for about an hour and a half until it began to rain. Then we took shelter under a nearby tambo. By the time we were resettled under the shelter, most of the people who had taken ayahuasca that night were at the height of their visions. The general mood of the group was easygoing and friendly, which contrasted enormously to the formal treatment one person accorded another at the beginning of the evening, when strangers who were known only to the healer met for the first time.

At this point, one man began to cry and said to no one in particular that his chest was full of tears. Another man patted his back to console him, advising him not to cry for any woman. During this period which lasted for about an hour, the healer counseled each patient openly in front of the rest. One older woman, dona Manuela, complained that she felt she was dying. Don Luis listened to her, but did not reply. This feeling of death and rebirth occurs frequently in sessions and is related no doubt to the feelings of loss of self at the height of entering an altered state of consciousness (see Ludwig, 1969: 16).

The healer went on to speak to me about an older man who was at the session but who was not taking ayahuasca. This patient, he said, had cancer and was told at the city hospital that they could do nothing for him. Nonetheless, Luis was certain he would be able to cure him by means of a special diet which he was prescribing. He spoke about another patient who had suffered the same illness and was now cured. The healer was full of boasts about the people he had helped. At the same time, he deprecated the performance of other healers who he said were jealous of his success and who did not know how to heal. "They only know how to whistle and suck at affected parts of the body," he said. Although Luis did not use the latter technique in healing, it is found quite commonly among all types of regional healers; a patient for example, who might have a pain in a particular part of the body would stretch out so the healer could such at the effected area, often removing a thorn or worm which he would claim he extracted from the painful area. I observed this procedure several times during both ayahuasca and non-ayahuasca sessions and was on occasion permitted to examine the slimy creature that was extracted from the healer's mouth before he spit it out with vehemence. Many among the urban poor maintain the traditional Indian belief that such thorns and worms are sent to their patient as part of magical harm--introduced into their body by a malign spirit to cause illness. The only radical cure for such an illness is to suck out this chonta. That a healer might introduce a foreign object into his mouth secretly before beginning the sucking procedure doesn't seem to occur to many patients.

At this particular session, Luis had two assistants with him. A woman, the dona Manuela mentioned earlier, once had her child cured by Luis a long time ago. She often returns to drink ayahuasca and to sing the healing songs along with him. Another man, Eduardo, who also felt gratitude toward Luis for curing a relative, frequently worked with him. In the past, he had been apprenticed to another healer, but claimed that his original teacher was jealous of his visions. That man's envy inhibited Eduardo's ayahuasca visions, so that he felt he had no choice but to terminate his training. He is now working with Luis, whom he believes to be a morally superior person and more effective curer. The session ended about 2 A.M., and the patients began their long walk home. I accompanied the two girls to their home, but found the ayahuasca patient very uncommunicative about her experience. She never came to Luis' session again. Many of the other patients had to cover distances of five or six miles, although a few who felt weakened by the purge slept at the tambo. At dawn, when they felt stronger, they made the journey back.