Background

Wintukwa IPSI is a health institution of the Arhuaco people. It was established to look after the health of the people of the Sierra Nevada de Santa Marta, according to the principles and ancestral values of its people. The institution would lead to a formation and implementation of a healthcare model of the Arhuaco people themselves which is intercultural and where the western medicine is complementary and the knowledge of ancestral practices of healing regains its importance within the communities. Through the establishment of network of Indigenous Healthcare Assistants Wintukwa could fulfill its objective set out in accordance to the guidance of the Arhuaco elders (Mamos and local authorities).

As these individuals would be trained and educated in both western and traditional medicine they would be able to provide information, treatment and guidance to their community to improve the overall healthcare of the population while reestablishing and respecting ancient traditions. Given that the resurgence of traditional healing is a priority for the local authorities and the spiritual leader, the health assistants can count with their full support and endorsement. Additionally, as each health assistant will be a local representative within their own community they can count with the respect and acknowledgement of the population which is vital for a proper communication and health education.

2. Objectives

2.1 General

Educate and train healthcare assistants in indigenous healthcare in such a way that will enable them to learn the elements that define and constitute the traditional indigenous medicine and its relation to western medicine. The aim is that the traditional medicine will be applied according to the indigenous law. Educate and train these healthcare assistants in Western medicine so they can complement their traditional practices.

2.2. Specifics

2.2.1 Train 1 person for each existing health center (Jewrwa, Nabusimake, Simonorwa and Sabana Crespo) which makes a total of 4 students.

2.2.2 Train 1 person representing each mayor indigenous community as follows:

  • For the region of Jewrwa which includes the communities of zikuta, seyumuke, morotwa and kurinna a total of 8 students.
  • For the region of Nabusimake which includes the communities of kurakata, ati kimake, la granja, trankameyna, el pantano, aviongaka, sirkario, ati arumake and mamankana train a total of 9 students.
  • For the region of Simonorwa which includes the communities of karwa, kwanimun, nuevo mundo, jimain, seykurin, businchama, mañakan, dunawa, mamarwa, gunchukwa, seyarukwingumu, bunjwageka, gunarinchukwa, monugaka, and pradera train a total of 15 students.
  • For the region of Sabana Crespo which includes the communities of birwa, umuriwa, seykun, seyumuke tamakal, arwamake, jwanoswi, sogrome, seinimin, chukwinchukwa, timaka, monochukwa, ikarwa, izrwa, jugaka, and gunkey train a total 15 students.

This would sum up to a total of 51 students.

2.2.3 Provide integral healthcare services with indigenous vision to the entire Arhuaco population, orientating all efforts and committments to the effective implementation of the “own” healthcare.

2.3 Results

Milestone 1. Training of 51 assistants in indigenous healthcare, equipped with the knowledge of traditional as well as western medicine, and duly certified by an accredited institution (SENA).

Milestone 2. Launching and implementing integral healthcare services from IPSI Wintukwa as part of the strengthening of the Indigenous System of the own and Intercultural Healthcare (SISPI).

Milestone 3. Establishing the cultivation of healing plants and herbs according to the traditional ways and norms using known techniques of sowing and use. (Botanical gardens, indigenous pharmacy).

3. Beneficiary population

As part of thee integral health assistance, and as per policy of the Arhuaco people of the Sierra; the practices of traditional medicine will be promoted and developed, within the territories as well as outside of them. Providing the Arhuaco authorities the instruments and methodologies to monitor, evaluate and control the health institution that is working in the territory. In this sense the beneficiaries of this project corresponds 100% to the Arhuaco population established both within as well as outside the ancestral territory, corresponding to 45.000 Arhuaco people according to the census managed by the organization of the Arhuaco people.

The training consists of the theorical and practical formation in nursery, odontology, management and usage of plants according to the ancestral and cultural knowledge. The training will be supervised by an accredited institution that will provide the certificates on one hand, and on the other hand this will be done by the authorities of the communities. The time needed for the training of 51 assistants in indigenous healthcare and hereby guarantying the effective implementation of healthcare services for the Arhuaco people will take a total of four years. After finishing the program the health assistants will work in strict coordination with the internal authorities and with the Mamos, offering the attention to health which is particular to their community.

4. Methodology

As the Arhuaco knowledge is transmitted from generation to generation it is necessary to set up a training plan consisting on one hand on the transfer of knowledge and the use of the native medicine including its practices while on the other hand this has to be complemented with the training on western medicine. The first part will be guided and led by the Mamos and the Arhuaco elderly who put their knowledge into practice. The second part would be led and guided by healthcare professionals from different branches presented under a holistic perspective of health.

After completing the training they will receive the title of Assistants in Indigenous Healthcare and will be assigned to work and care after their gunamus (Arhuaco family) when needed.

The training of western medicine will be given by experts of the diseases which are endemic to the region and those to which they are exposed to from an epidemiologic profile. This will be an important element to establish a preventive approach to healthcare. It is thus very important to take into consideration aspects such as: geography, economy, environment, culture or social when implementing the training plan.

The implementation of this project can be divided in a few basic phases, following the logical preparation of the activities as follows:

Phase 1: Enquiries and internal work to be done in each community to define the guidelines concerning the selection of the members who will enroll into the training.

This phase consists of activities such as internal reunions, consultations and analysis. Meeting with the Mamos and authorities of the different communities who are the ones to define the directions of work in each phase.

Phase 2: Development of guidelines by the internal authorities, and leaders of the traditional medicine as well as the Mamos for the orientation of the training.

In this phase every action and processes realized by the communities and leaders will be carried out. This will happen in collaboration with Wintukwa, as well as the search for alliances and agreements and the establishment of mechanisms for its execution.

This phase includes the creation of corresponding texts to the four modules which will be given to each student during the training. The materials will be created by an interdisciplinary group conformed by eight people with extensive knowledge about the themes they will address and whom will receive a monthly salary. These instructors are specialized in the following fields; one Mamo, a botanist, a midwife, a doctor, a nurse, a sociologist and an anthropologist in addition to the different authorities and elders of the communities that will also provide their input. Afterwards all the documentation will be combined and provided to the students.

Phase 3: Development of the training of the selected individuals by the leaders, working team and the community in general concerning the orientation and definition of the curriculum.

5. Viability

The community has a very important role when it comes to the knowledge of their own healthcare practices, considered as a human resource for the compliance of the objectives.

These human resources correspond to:

  • The Mamo especially, who is the health caretaker of the natural and social order
  • The Midwife with reknown trajectory in the profession
  • The reknown botanists experienced in medicinal plants
  • The assistants in indigenous health who are linked with Wintukwa IPSI
  • Wintukwa IPSI, the institution in charge of providing healthcare to the Arhuaco and with its mission to provide integral healthcare services with indigenous vision
  • Non-indigenous healthcare professionals (doctors, dentists, nurses, nutritionists, psychologists) and from other social areas who are working with the institution and are members of the community.

At the same time there are:

  • Four healthcare centers located in the regions with mayor concentration of the Arhuaco population (Jewrwa, Nabusimake, Simonorwa y Sabana Crespo). Healthcare is provided through Wintukwa IPSI.
  • Twelve healthcare houses located in smaller communities. These healthhouses depend on the healthcenters. All these healthcenters/houses belong to the community.

6. Stategies for action

  • Dialogues and agreements with the Mamos, authorities and members of other sectors and general communities about the support for the implementation of traditional practices in health
  • Promote the cultivation of traditional and medicinal plants according to the traditional norms and techniques cultural practices of treatment
  • Promote spaces to reflect, analyse and for desicionmaking concerning the traditional health and the cultural parctices of disease treatment
  • Strengthening and cultural revitalization in order to maintain the balance and harmony according to the law of origin of the Arhuaco people where aspects are included such as:
    • The cosmovision (law of origen)
    • Territory – right to self determination
    • Autonomy (strengthening of the traditional knowledge)
  • Establish a process for learning, formation and orientation focused on strengthening the dynamics of cultural transmission and health practices of the Arhuaco people
  • Establish compromises with the selected members (students) for the training, where the goodwill to make progress is respected and where there is the willingness to provide healthcare services in agreement with the law of origin.

7. Sustainability

According to the report of february 22nd 2005 and following the guidelines as stated by the assembly of the Arhuaco people, both the authorities of the Arhuaco communities as well as the director of the Wintukwa IPSI are working on the need to implement a scheme for intercultural healthcare assistance. After eight years of providing healthcare services to the communities, one can now clearly see the threat of the loss of the traditional knowledge, healing practices and others. The traditional knowledge need to be complemented with western medicine and it is therefore necessary that all students must be 100% indigenous, whom will be equipped with a broad knowledge in the field of intercultural healthcare.

7. Legal framework

As part of the Colombian Constitution of 1991, the ethnic and cultural diversity should be protected and the State has compromised itself to respect and defend that diversity. Their languages were acknowledged as official languages within their territories, their autonomy to determine their own ways to govern and organize were acknowledged within their territories. Their right to decide for their own priorities concerning development, where it affects their lives, beliefs, institutions and spiritual well-being should be respected.