Articulation between health services and “indigenous medicine”: Anthropological reflections on policies and reality in Brazil

Articulando conocimientos y prácticas frente al Covid-19: Acciones de enfermeros técnicos indígenas en salud intercultural

A partir de entrevistas y conversaciones a profundidad con cinco enfermeros técnicos de los pueblos Yine y Shipibo-Konibo que laboran en establecimientos de salud en la Amazonía de Ucayali en Perú, este estudio muestra que las prácticas desplegadas para atender a los enfermos con síntomas de Covid-19 hicieron uso de terapias y nociones biomédicas e indígenas. Dichas prácticas reflejaron su formación en salud intercultural y su capacidad para adecuar las normas establecidas por el Ministerio de Salud. En función de los síntomas observados en los pacientes, los enfermeros indígenas usaron una variedad de prácticas: vaporaciones, masajes, baños, infusiones y remedios. Las nociones de salud y enfermedad que los enfermeros técnicos indígenas comparten con sus pacientes fueron la base para interpretar el Covid-19 y estuvieron presentes en las atenciones brindadas. Esto se nutrió de la existencia de un sistema de cuidado familiar bastante articulado que fue tejiéndose y siendo negociado en función de los síntomas y las terapias aplicadas. Sus prácticas demuestran la creatividad en los pueblos indígenas. En ese sentido, el sector salud necesita repensar su mirada sobre la medicina indígena, a la que denomina "tradicional" y nos muestra la necesidad de repensar las ideas sobre adecuación de los servicios para la población indígena para colocar en el centro del debate el significado de interculturalidad en salud desde la perspectiva indígena.

Snakebites from the standpoint of an indigenous anthropologist from the Brazilian Amazon

Conflicting attempts between indigenous caregivers trying to exercise their healing practices in hospitals have been recorded in the Brazilian Amazon. In this work, we present an interview with the Baniwa indigenous anthropologist Francy Baniwa. In an external and colonial interpretation, it was previously stated that indigenous people attribute the origin of snakebites as supernatural and that indigenous medicine, when it saves a patient from complications and death, has symbolic efficacy. In this interview, we observed that this form of interpretation is asymmetric because, for indigenous people, their understanding of nature is broader than ours, with more possibilities of ways of existence, including non-human entities as well or ill-intentioned as humans. The interaction of humans with these identities produces a form of existence with its own clinical reality, which is full of symbolism. Effective communication between health agents and indigenous patients and caregivers must undergo this exercise of otherness and interculturality.

COVID-19 pandemic evolution in the Brazilian Indigenous population

INTRODUCTION

The COVID-19 pandemic has affected several neglected populations such as the Indigenous peoples, which have suffered a high impact from the pandemic.

OBJECTIVES

To analyze the impact on the health and disease process according to the COVID-19 evolution in the Brazilian Indigenous population.

METHODS

Data was collected from press releases by the Health Ministry and a descriptive analysis of the numbers of Indigenous individuals infected with the SARS-CoV-2 in Brazil was carried out.

RESULTS

In February 2021, there were 41,855 confirmed cases of Indigenous individuals infected by the SARS-CoV-2, including 4,387 active cases, 36,809 recovered cases, and 549 deaths. The Brazilian Indigenous population is distributed in over 300 ethnic groups and, due to the high number of deaths by the COVID-19, many of these groups are endangered. The elderly are the most affected age group, and they play a fundamental role among the Indigenous population for transmitting their customs mainly orally. Indigenous populations do not have proper access to transport to specialized health centers, since many areas are inaccessible and other cases require air or river transportation, which many times results in late assistance. When managing the COVID-19, it is important to emphasize the need for social isolation to prevent the virus from spreading among the Indigenous groups, mainly due to their contact with other ethnic groups represented by missionaries, hunters, and wood explorers, among others.

CONCLUSION

The adoption of practices that can reduce the virus transmission among the Indigenous population and provide them with better access to treatment, mainly for the elderly, must be prioritized in Brazil.

¿Qué es la medicina alternativa, complementaria e integrativa?

El concepto de medicina alternativa fue creado por la medicina occidental para identificar prácticas médicas diferentes a la medicina convencional, tales como la medicina tradicional china y acupuntura, homeopatía, terapia neural, medicina osteopática y quiropráctica, medicina ayurveda y la medicina tradicional indígena, que también tienen fundamentos filosóficos, científicos y terapéuticos. Desafortunadamente, con el tiempo se estableció la creencia de que la medicina alternativa comprende todas las prácticas médicas que no son parte de la medicina convencional, lo que ha causado muchas inexactitudes y controversias. La medicina surgió como necesidad de auto preservación del ser humano y que considera a la salud como bienestar completo y a la enfermedad, como pérdida de esta condición. A lo largo de su evolución han emergido diversas racionalidades y algunas de ellas se han convertido en sistemas médicos. La medicina convencional se estructuró en Occidente, fundamentada en racionalidades médicas existentes para la época y enfocada en modificar la enfermedad, lo que resultó en marcadas diferencias conceptuales con sistemas de tratamiento ya existentes que se centraban en el individuo y en modificar los procesos de la enfermedad. Todos los sistemas médicos han generado un impacto en diversos campos sociales. Asimismo, han surgido tendencias y estrategias de integración de la medicina convencional con otros sistemas médicos comoLa electroacupuntura de Voll, la homotoxicología, el balance polar electromagnético, la antroposofía, la sintergética y la biofotónica. Actualmente se considera que el objetivo de la medicina es integrar y complementar conocimientos de diferentes racionalidades médicas dentro del concepto de una sola medicina. Teniendo en cuenta lo anterior, el objetivo del presente artículo es clarificar los conceptos de las diferentes formas de medicina, plantear algunas definiciones al respecto, y proponer una definición de medicina alternativa, complementaria e integrativa.

Coping with Hypertension among Indigenous Peoples in Brazil and the Role of the Primary Care Nurse: A Critical Review from a Transcultural Perspective

Our objective is to critically review the literature addressing the strategic role of nurses in the daily primary care of arterial hypertension in Indigenous communities in Brazil. We selected studies based on an initial keyword search of major bibliographic indexing databases for the years 2000 to 2020 and manual search. Further selection was based on topical, methodological, and thematic relevance, as well as evaluation of scholarship quality and pertinence to our chosen narrative. The literature demonstrates Indigenous peoples do not receive health services that measure up to national standards in large part due to a marked lack of academic and employer preparation for nurses operating in transcultural settings. Inequities were apparent in recurrent reports of victim-blaming, deficient clinical communication with patients, clinical malpractice, devaluation of hypertension as a problem for Indigenous peoples, insufficient intercultural training for nurses, and discrimination against Indigenous students in nursing education programs. This systemic problem needs to be addressed by universities and the Indigenous Health Care Subsystem in Brazil.

Equity, intercultural approaches, and access to information on traditional, complementary, and integrative medicines in the Americas

Access to information and intercultural approaches in the field of health are essential for the elimination of inequities in health access and care. Intercultural models such as traditional, complementary, and integrative medicine (TCIM) are an important part of health care in most countries and often contribute to expanding access to primary health care. Despite legal recognition and policies to integrate TCIM into health systems, their contribution to health, well-being, and people-centered care to achieve universal health is still underestimated. This article presents the progress (2017-2020) achieved by the Virtual Health Library specialized in the TCIM (VHL TCIM Americas), an initiative created as a tool to reduce the gaps in the production and access to validated information on TCIM. Through collaborative network work, VHL TCIM Americas contributes to the democratization of health, access to verified scientific data, visibility of non-conventional knowledge, strengthening of research capacities, and exchange of experiences for informed decision-making.

Birthing, corporality and care among the Guarani-Mbyá of southern Brazil

Abstract In this paper I draw attention to the happening of childbirth among the Guarani-Mbyá women. I highlight the centrality of a care language in the act of birth and of being born supported by the production of human bodies and kin. From Yva deliveries’ stories I explore the connection between silences, bodies and human and non-human socialities by interweaving it with native modes of care and a critical analysis of the medicalization of birth derived from the relationship with the “Juruá (“white”) system”. I emphasize a non-reductive understanding of life and health in the translation of epistelomogies of care between indigenous and biomedical sociocosmologies. The data presented are results from a long-term ethnographic research carried out among guarani-mbyá collectives of the southern Brazil.

[Equity, intercultural approaches and access to information on traditional, complementary and integrative medicines in the AmericasEquidade, abordagens interculturais e acesso a informações sobre medicinas tradicionais, complementares e integrativas nas Américas]

El acceso a la información y los abordajes interculturales en el ámbito de la salud son esenciales para la eliminación de inequidades en el acceso a los servicios de salud y la atención sanitaria. Los modelos interculturales, como las medicinas tradicionales, complementarias e integrativas (MTCI) son una parte importante del cuidado de la salud en la mayoría de los países y frecuentemente contribuyen a ampliar el acceso a la atención primaria de salud. A pesar del reconocimiento legal y de la existencia de políticas para la integración de las MTCI en los sistemas de salud, aún se subestima su contribución a la salud, el bienestar y la atención de la salud centrada en las personas para alcanzar la salud universal. En este artículo se presentan los avances (2017-2020) alcanzados por la Biblioteca Virtual en Salud especializada en las MTCI (BVS MTCI Américas), iniciativa creada como herramienta para disminuir las brechas en la producción y el acceso a la información validada sobre las MTCI. Mediante el trabajo colaborativo en red, la BVS MTCI Américas contribuye a la democratización de la salud, el acceso a datos científicos verificados disponibles, la visibilización de conocimientos no convencionales, el fortalecimiento de capacidades de investigación y el intercambio de experiencias para la toma informada de decisiones.

Healthcare and Health Problems from the Perspective of Indigenous Population of the Peruvian Amazon: A Qualitative Study

Indigenous communities usually experience higher levels of mortality and poorer access to healthcare services compared to non-indigenous communities. This study aims to understand the most prevalent health problems and their treatment in the Asháninka indigenous communities of the Peruvian Amazon. We conducted an ethnographic study in order to explore the perceived health problems, the use of traditional medicine and the resources offered by the official Peruvian healthcare system. Field notes and semi-structured interviews were used. A total of 16 indigenous and four non-indigenous people were interviewed, and interpretative analysis was used to identify themes. The Asháninka community is an overlooked population, which, due to distance restrictions, misconceptions and ethnical disparities, is far away from an appropriate healthcare system and is subjected to acute medical conditions such as infections and gastrointestinal problems. This group tends to seek traditional medicine, mostly herbal medications and traditional healers. The use of a health professional is seen as a last resort. Although the official Peruvian health system incorporates community participation strategies to improve the healthcare of indigenous people, the shortage of material, human resources and cultural sensitivity makes this difficult. Healthcare strategies should be devised and implemented in order to minimize health inequality in this population.

Nursing care to address community health of the indigenous population in the Peruvian Amazon

The native community Shonori is made up of Ashaninka families of the Peruvian Amazon. This paper addresses community health through an assessment and nursing care plan based on the Purnell cultural competency model and the standardized nurse taxonomy (NANDA, NIC, NOC). The assessment is based on 12 domains related to inheritance and biocultural ecology, communication, roles and family organization, risk behaviours, nutrition, pregnancy, death and spirituality rituals, and health care providers and practices. A diagnosis of «Poor health of the community r /t insufficient resources m/b health problems suffered by the community» is detected. The expected results criteria in the care plan are: social competence, community health status and control of social risk related to communicable diseases. The interventions consist of promoting community health, analyzing and identifying the health situation and risks, and controlling and protecting from communicable diseases and environmental risks. Interventions of the public water supply network and subsidies for agricultural and housing support, allowed vectors to be reduced, costs of safe water supply to be covered, and food to be bought to improve child nutrition. The use of traditional medicine was enhanced and health and sexual education campaigns were carried out in coordination with the official health system. A follow-up was carried out for 40 days, corroborating the improvement of community health, and the need for a group approach with all actors.