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out the activities related to health, disease, and care, whereas men are usually not involved in caregiving.

Sections 3 through 5 include a series of articles using empirical data gathered in the state of Jalisco, Mexico. Solis Matias, in an article on the relation be- tween the Mexican family and the labor market, shows that even when women are employed they fail to gain any decision-making power in the home. Instead they end up having a double role of producer and repro- ducer, decreasing their ability to give adequate atten- tion to their children (Gabayet). Other articles focus on the ways families deal with diabetes (Robles Silva and Mercado Martinez), the relationship between pat- terns of reproduction and infant mortality (Schlaepfer, Bobadilla), and the health of children, as related to migration and poor nutrition. Most of these studies are based on questionnaire data.

As in any book of essays, the diversity is great and the quality varies. For the most part the theoretical articles are interesting, although too many of them re- capitulate North American and European theoretical and empirical sources rather than develop theories and draw on empirical data derived from Mexican re- alities. What is most commendable and important about the volume is that each author attempts to tie together micro and macro processes in his or her analysis and that the articles focus on the family rather than the individual, reflecting a Mexican reality.

The book is recommended to Mexicanists as well as medical anthropologists and international health specialists interested in family, gender, and health is- sues in developing nations in general and Mexico in particular.

Precarious Dependencies: Gender, class, and Domestic Seruice in Bolivia. Lesley Gill. New York: Columbia Uni- versity Press, 1994.176 pp.

LINDA GREEN Columbia University

In Precarious Dependencies, Lesley Gill has writ- ten a richly textured account of domestic service work in La Paz, Bolivia. Gill describes the circumstances facing rural Aymara women who have chosen urban migration as a survival strategy when "traditional" eco- nomic options are no longer available to them and their families. Whether due to the closing of the tin mines or the loss of an adequate land base for subsis- tence agriculture, poor rural families have frequently sent their adolescent daughters to the city for wage work to bolster their household economy. Through the skillful use of historical analysis, Gill reveals how the social relations and meanings ascribed to domestic work for both the young servants and their employers

have changed significantly over the 50-year period since the 1930s. As such, the dynamic, heterogeneous nature of these relations is underscored. Through a deft interrogation of gender, class, and ethnic relations in the urban domestic service arena, Gill explores the contradictory ways in which social inequalities have operated in Bolivian society.

Gill contends that female domestic work has been crucial not only for the survival of poor Aymara women but also in reproducing upper-class privilege in the private domain, despite the vagaries of Bolivian political economy. Nonetheless, the alliance between the sefiora and her servants has not been an easy one. In the early part of the century, it had been based on patron-client relations, where obedience was ex- changed for long-term care and protection. Yet by the postrevolutionary 1950s, domestic service work had become temporary and contractual. Not surprisingly, this shift produced a number of paradoxes for both workers and employers as they struggled to accommo- date the changes.

While poor migrant women continued to flood the city in search of work, they entered domestic service as a foothold into the urban economy, not as a lifelong occupation. As the fortunes of many upper-class fami- lies were reversed, some bourgeois women were forced to enter the job market for the first time. Con- fronted with the double burden of employment and household responsibilities, their relations with their domestic help were necessarily renegotiated because of their new class position and a domestic labor short- age. Yet over the ensuing decades, employment of do- mestic servants by an expanding middle class and a reconstituted upper class did little to alter the ex- ploitative situation for indigenous women with few other available options.

In the final chapters, Gill examines how dominant ideologies in Bolivian society have served both to rein- force social inequalities and to provide a terrain for contestations in unpredictable ways. To illustrate her point, Gill notes the failure of the trade union move- ment to recognize the plight and potential of domestic workers because it interpreted paid domestic work as "women's work par excellence." In contrast, the con- servative Protestant Pentocostal churches, which seek to save individual souls, have unwittingly provided spaces where Aymara women can in part recapture control of their lives and reflect on their circum- stances, despite the churches' fire-and-brimstone rhetoric.

Perhaps the only shortcoming of this innovative study is that while Gill aptly demonstrates how ethnic inequality operates between whites, mestizos, and In- dians, we are given only a brief glimpse of the meaning ethnic identity may have for urban Aymara and how,

668 A M E R I C A N A N T H R O P O L O G I S T V O L . 98 , N o . 3 S E P T E M B E R 1996

torn from their social base, their cultural practices are being reworked under the constraints of modern life.

This singular critique aside, Gill has written a sen- sitive and nuanced portrait of the struggles of urban Aymara women, which highlights the contradictions embedded in gender, class, and ethnic relations that give shape to their lives. Precarious Dependencies is an important contribution to a growing literature that artfully integrates historical and anthropological analyses. 1

Saude e povos indigenas. hcardo V. Santos and Carlos E. A. Coimbra Jr., eds. Rio de Janeiro: Editora Fiocruz, 1994.251 pp.

EMILIO F. MORAN Indiana University

This is an excellent edited volume that not only fills a long-standing lacuna in the Portuguese-language literature on the health of indigenous peoples in Brazil but contributes significantly to medical anthropology in its own right. The book provides a series of case studies on indigenous health using a range of theoreti- cal approaches, including biological anthropology, ecological anthropology, medical anthropology, and interpretive anthropology. It is the editors’ contention that all these, and several other currents in anthropol- ogy, must be brought together to understand indige- nous health, a process too complex to yield to unifor- mitarian approaches. What brings these varied contributions together into an unusually well inte- grated edited volume is attention to process (the pro- cess of health and disease in societies experiencing rapid transformation) and to the complementarity of approaches (biology, culture, and society).

The first part of the book, “Health and Disease in Prehistory and the Contact Period,” discusses issues of paleopathology, the interface between epidemiol- ogy and demographic process, and the consequences of biological variability on the impact of infectious and parasitic diseases. Of special note is the chapter by the editors that examines the relationship between resi- dential mobility and the presence of domestic animals on the spread of Chagas’ disease in the Americas. It suggests that the public health community needs to be ready to address the spread of this disease in lowland South America in the years ahead as sedentarization and domestication of animals becomes a part of in- digenous communities. The essay by Francis Black cri- tiques the facile suggestion that the major reason for devastating mortality among indigenous people is the collapse of the food production system, providing con- trary evidence for their lesser capacity to respond im-

munologically to infection resulting from their genetic homogeneity at the population level.

The next section (“Belief Systems and Medical Practice”) focuses on questions of ethnomedicine. The authors focus on how health and disease, and their representation, become an area of intense negotiation about meaning and practice. The papers discuss power relations between indigenous and dominant sectors of society. They deal with a curious dsease that affects young men undergoing seclusion as part of their initiation into manhood in the Upper X i n ~ ; the narratives used by the Colombian Siona to interpret illness; the contrast between Western conceptions and Kulina conceptions of classification of illnesses; and the creation of dependency by Western medical practi- tioners of Wan native systems of knowledge about health and disease. The third and final section (“Changing Profiles of Health”) is perhaps the most interesting part of the book. An essay by Nancy Flow- ers deals with the changing demographic status of the Xavante throughout the period of contact. Santos and Coimbra carry out a comparative analysis of a number of Tupi-Mond6 populations in the southeastern part of Amazonia using historical, epidemiological, and envi- ronmental data. A final paper by Bom Meihy examines the motives behind the high rates of Guarani-Kaiowa suicide-a problem that has been observed also among Canadian, U.S., and Mexican indigenous popu- lations.

This volume is a model for how bringing together anthropological approaches can elucidate the human condition and suggest alternative ways to address hu- man needs. Health is one of the most basic human needs (and rights). Yet it is one of the aspects most neglected by governments whose function is said to be to care for the common good. Indigenous peoples in South America, as elsewhere, seem to experience un- even, and often absent, delivery of health services. When these services are delivered, they often fail to take into account the existing cultural system of mean- ings and practices that provide a robust understanding of a population’s health and disease. Moreover, this volume illustrates how the conditions of contact be- tween indigenous societies and national society often result in exposure to new pathogens and diseases, and to socioeconomic stratification that tends to lead to unequal access to food and medical care. This volume provides a balanced analysis of the prehistoric contact period and of contemporary interactions between na- tional society and indigenous communities. It inte- grates interpretive and biological approaches into a remarkably insightful examination of the health of lowland South American Indians.

The book was published in Portuguese to meet an urgent need for this kind of material in that language.