This article is an edited version of the original published by Minerva Vitti in the Gumilla Center's SIC magazine.
The first time when Jan Costa traveled to the Orinoco Delta was on 14 April 2014, the same month when he turned 24. He studied medicine at the José María Vargas School of the Central University of Venezuela and he was going to do his two-month internship in the town of San Francisco de Guayo , in Delta Amacuro State , in the eastern part of the country.
When Jan saw the precarious health situation in the Delta, he decided to come back and carry out his rural internship for one year. This was how he came to the Nabasanuka community, where he worked with the Warao  indigenous people, about an hour boat ride from San Francisco de Guayo .
It was during this second stay when the young doctor learned the native language better and discovered the wisiratu, or the “master of pain.” As it is often said, no matter how much the Warao people have culturally adapted to western ways, they strongly believe in the wisiratu.
Medicine and health in the Warao culture
In the Warao culture, diseases are treated by three types of shamans: bajanarotu, joarotu and wisiratu. They act as intermediaries between mystical entities and human beings. The wisiratu is the shaman who serves as a mediator between their people and the jebu (evil spirit).
The wisiratu holds the power of the gods of the North, East and South, and from the moment of their initiation, they carry in their body six children of these cardinal deities, which act as guardians.
Throughout their life, the wisiratu is reminded to keep the vows they took during his initiation, and provide tobacco smoke and sago from moriche palm  for the gods and their court. In return, the gods reduce the number of children's deaths and endow the wisiratu with the power to cure diseases.
Apart from their role as healer, the wisiratu also provides psychological counseling and reinforces moral norms within the group. The highest ranking wisiratu is known as the Guardian of the Sacred Stone, who plays a dual role: they are an incarnation of one of the deities, while at the same time they serve as the deity’s main source of protection.
The wisiratu and western medicine
Jan recalled that he thought of the idea of bringing wisiratu to the hospital in Nabasanuka, where Warao people who were bitten by the poisonous mapanare snake  went for treatment. Patients, desperate after seeing their symptoms getting worse, asked the doctor for the intervention of the wisiratu:
Me decían ꞌdoctor me quiero ir al wisiratu’. Yo me preguntaba ¿cómo controlo esto para que no empeoren los síntomas, para que no les dé una hemorragia, si se van del hospital? Entonces se me ocurrió que si tenía a los wisiratu en la comunidad podía meterlos en el hospital, así el paciente no se va, tiene su wisiratu; es feliz y yo soy feliz.
They told me, ‘Doctor, I want to go to the wisiratu’. I wondered how I could respond to this request, so that their symptoms do not get worse and cause hemorrhage if the patients leave the hospital. Then, it occurred to me that if I had the wisiratu in the community I could bring them to the hospital, so the patients do not leave, but they still have access to their wisiratu. They are happy, and I am happy.
Pastora, a wisiratu, dedicated herself to helping the doctor cure the children who had pneumonia or diarrhea and, of course, the victims of mapanare snake bites. She is a wisiratu who sings  and gives massages. Through these practices the spirits of the mapanare snake, of diarrhea, and of pneumonia are removed. Jan said:
Un día [cuenta Jan] por curiosidad le pregunté a Pastora cómo era el canto de la serpiente. Ellos consideran eso secreto, pero básicamente lo que expresa el canto es una petición al veneno de la serpiente para que dejara de causar dolor y para que se saliera.
One day out of curiosity I asked Pastora about the song of the snake. The wisiratu healers consider this a secret, but basically what the song expresses is a request to the snake venom that causes pain to stop and to leave.
Joa warayaja (espíritu sanador de dolores)
Iaeee emm, soy espíritu enviado para curar. ¿Quién quiere hacerle daño a esta persona?, ¿cuál es su mal? Aquí están los que sacan el daño en lo profundo de su ser, aquí están también los que chupan los malos espíritus. Yo mismo soy el [que curará] a este nieto pequeño. Revisaré su cabeza, su estómago. Vine a curar su dolor. Colocaré y limpiaré su espíritu. Si está mal o débil, si está dañado con sangre mala o tiene un mal espíritu de muertos, devolveré su espíritu a su cuerpo, yo curaré su cuerpo dañado.
[…] Yo soy el que sacará el espíritu de muerto que ha poseído este cuerpo, curaré su mal […] Yo soy el que cura el cuerpo dañado […]. Yo sí limpiaré este cuerpo enfermo y dañado por malos espíritus y enfermedades extrañas, soy el que te curará […]
Yo sí, este cuerpo poseído por algún espíritu de muerto [mi poder] cesará su dolor […]. Ahora sí nieto, te sentirás mejor. Tu cabeza, yo así tocando y echando todo mal te curaré […] conmigo también están mis hijos que te cuidarán, sanarás, […].
Joa warayaja (healing spirit of pains)
Iaeee emm, I am the spirit sent to heal. Who wants to hurt this person? What is his illness? Here there are those who take the harm from the depths of his being, here there are those who suck away the evil spirits. I myself am the one who [will heal] this little child. I will examine your head, your stomach. I came to cure your pain. I will find and cleanse your spirit. If it is sick or weak, if it is damaged with bad blood or has a bad spirit of the dead, I will return his spirit to his body, I will heal your damaged body.
[…] I am the one who will bring the spirit of the dead who has owned this body, I will heal their illness […] I am the one who heals the sick body […]. I cleanse this sick body damaged by evil spirits and strange diseases, I'm the one who will heal you […]
If this body is possessed by some spirit of the dead [my power] will cease its pain […]. Now, child, you'll feel better. By touching your head and throwing away all sickness, I will heal you […] with me there are also my children to look after you, you will heal […].
Pastora's presence helped the Warao patients remain in the hospital. According to Jan:
[Los warao se sentían más tranquilos] porque tenían como dos medicinas: la del hombre blanco y la del warao. Disminuyó el índice de indígenas que se iban del hospital. Aunque igual, siempre te presionan para irse rápido, así tengan al wisiratu, e incluso con este tampoco es que se queden mucho tiempo […] Ellos piensan que el hospital está lleno de espíritus, duendes y fantasmas de los que murieron en el hospital. Especialmente cuando no hay luz, ellos dicen que comienzan a escuchar cosas, monstruos, escuchan sonidos de niños llorando.
[The Warao patients felt calmer] because they had two doctors: that of the white man and the one of the Warao people. This decreased the rate in which the indigenous peoples were leaving the hospital. But equally, they always put pressure on you so they can leave fast, and even with the presence of a wisiratu, they will not stay a long time […] They think the hospital is full of spirits, of ‘duendes’ (sprites) and of ghosts of those who died in the hospital. Especially when there is no light, they say they begin to hear things, monsters, sounds of children crying.
In a broken healthcare system, doctors and healers struggle alike
The main hospital problems are the shortages of medical supplies, of river ambulance and of electricity. Nabasanuka has two power plants, one for the hospital and another for the community. The oil that runs both electric generators is brought by the barges, which in theory should stop by once a month and leave more than 10 barrels at the hospital and more than 30 at the community, but this is not enough:
Dejan cinco o cuatro tambores al hospital y quince o dieciséis a la comunidad. Eso no dura ni un mes y siempre quedamos con un déficit de siete días sin luz. El peor de los casos fue dieciséis días sin luz. Esto ocurrió en octubre.
They leave five or four barrels at the hospital and 15 or 16 in the community. That does not last even a month and we are always left with seven days without light. The worst was 16 days without light. This happened in October.
Jan is very sure it was that month because he counted all the days. They had to attend to births at night with flashlights, and there was also the problem of not having ambulances and any way to get patients to Nabasanuka:
Había veces [en que] yo tenía que ver cómo se morían varios pacientes [por no haber] ambulancia fluvial, y si se conseguía era pidiéndole favores a la comunidad: Con uno conseguía el motor, otro warao me prestaba la embarcación, otro me daba el aceite, otro me daba la gasolina…
There were times [that] I had to see many patients dying [because of the lack of] a river ambulance, and if anything was achieved was by asking favors to the community: one got the engine, other Warao man lent me the boat, another gave me oil, another provided the gasoline…
One of the toughest cases that this young doctor remembered was of a pregnant Warao woman who came to the hospital with serious complications from childbirth. In the remote Warao communities the women prefer to give birth at home, because they do not have the means to travel to Nabasanuka. They only go to hospital when there are complications with the labor. This woman had tried to give birth in her community; when she arrived at the hospital she had been with complications for two days and the child was dead inside her.
As Jan struggled to arrange for boat, motor, fuel and oil, 30 minutes passed. They arrived in Puerto Volcán at seven in the evening. From there they called the ambulance. They had been unable to notify earlier because there was no electricity in Nabasanuka. Twenty minutes later the ambulance arrived, but the mother died in the operating room that midnight. Jan then had to find a solution for the overnight stay and for the next day return to Nabasanuka.
The Regional Health Authority did not provide any support.