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Ultima is a curandera, what we might think of as a natural healer. She also serves as midwife on the llano. While Antonio's family, particularly his mother, respects and reveres her, others in the town do not. She is thought by some to be a witch, and rumors are heard of this throughout the book. This is left ambiguous in the showdown scene, where she steps through a door with an iron cross above it, yet the cross itself is broken on the ground after her passing. Antonio eventually chooses to follow her as a curandera, thus resolving his own inner conflict.
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