A WESTERN PERSPECTIVE

Even though the systematic information about indigenous health, morbidity, and mortality is sparse it is widely documented that most indigenous people around the world have low standards of health. This poor health is associated with malnutrition, poor hygiene, poverty, prevalent infections, overcrowding and environmental contamination. The situation is aggravated by the lack of health promotion, inadequate clinical care and poor disease prevention initiatives. Existing studies in Latin America suggest that indigenous people in the region have higher morbidity and mortality rates than their non-indigenous counterparts. Indigenous groups in Colombia face similar health problems as other groups across the region but due to a different geography and effects of colonization each indigenous group has its unique local circumstances. The health situation and problems mentioned below are made from direct observations and experiences with the Arhuaco communities of the Sierra Nevada de Santa Marta. There is an obvious selection bias as most observations were conducted in the community health posts where more than 95% of the consultations were either women or children.

CHILDREN HEALTH

Inadequate nutrition, and exposure to high rates of infection causes a heavy burden of disease in infants and children. These diseases are mainly diarrheal diseases, parasite infestations, upper- and lower respiratory tract infections, urinary tract infections, dental caries, skin infections, acute and chronic ear disease. In addition there are diseases prevalent to the area such as dengue, haemorrhagic fevers, amoebiasis, and TBC.

Many Arhuaco babies, especially in the more remote areas have a low birth weight and tend to be small-for-gestational age. Many households do not have access to a wide variety of traditional foods and their infants and children are often malnourished. This malnourishment is also consequence of an unbalanced diet, and aggravated by the large number of children in each household and the inadequate facilities in the home to securely store and keep food cool and uncontaminated. Substandard nutrition of infants and young children can also be associated with maternal ill-health and malnutrition, or both, which can negatively affect pregnancy and predispose to premature birth, low birth-weight, and intrauterine growth retardation. Most of the childhood diseases observed are linked to substandard hygiene, nutrition, and immune status, worsened by exposure to environmental microbial contamination such as contaminated water, food, utensils, or person-to person or animal-vector-spread diseases such as giardiasis. Infections are also associated with falling breastfeeding practices and contamination of nonhuman milks or other fluids.

Immunization has mostly been effective against vaccine-preventable childhood viral infections in the region. However, universal vaccination has often not been feasible in the entire Arhuaco population, especially in remote areas due to resistance from more traditional parents and communities.

MATERNAL HEALTH

Many Arhuaco mothers are ill prepared for pregnancy, being either very young or having had many pregnancies and are therefore at risk of complications to themselves and their infants. Many Arhuaco mothers have other risk factors such as an insufficient nutrition during pregnancy due to a deficiency in nutrients such as iron and vitamins, a necessity to do strenuous physical activities during pregnancy such as carrying crops and water daily up and down the mountain, and high rates of treatable urinary tract and vaginal infections. This is further complicated by a lack of information, preparation, and prenatal or postnatal clinical care due to scant access to trained healthcare workers, laboratory or clinical resources.

INDIGENOUS PERSPECTIVE

“Parting from the fact that our culture of health is fundamentally based on spiritual dimensions, territorials and on the principle of collectivity and integrality, contrary to the Occidental that is supported essentially on a ground of attention to the physic in the individuals. Therefore the activities that characterize our culture of health cannot be included in a mandatory healthcare plan, with the reason that the logic and the principles that guide our culture of health are incompatibles with the medicalization and merchandizing that characterize the Occidental system.

The projection towards a proper health model; parts from the action of each one of us in relevant aspects in the promotion and prevention of diseases. Likewise, the participation of the community constitutes an end and a mean to contribute and improve basic family and community practices in the care of life. To reach these objectives it is required that from the health services processes are developed that have as a starting point the knowledge and the understanding of the social reality of our communities, and the notion of health-disease, seen within that same context. For that reason, has to be enriched with the experience and existing resources within our communities, this way the activities to be evaluated correspond to our objectives. The dream of consolidating a National Health System that recognizes the cultural practices has always been isolated from the reality. Up until now the health of the indigenous people has had to adapt to the system of conventional medicine developed by the government. It is there that the actions put in place to defend and protect the human life of our people, has to be done from a posture of respect and recognition of the fundamental principles, in response to the problems that our community faces today in regards to the intercultural healthcare attention.”

HEALTH-DISEASE

Health is conceived according to the proper cosmogony, like a state of harmony and equilibrium that depends on the respect to the vital laws of nature, obeying the rituals of initiation and other practices that preserve the equilibrium, like managing the relations with others alike in the private and public sphere, deprecating the effects of an individual´s behavior not only on the individual but also on close relatives and the communitarian life in general.

Disease therefore is associated to states of imbalance and disharmony in the material and spiritual world of an individual and/or nucleus to which they belong, reason why the process of healing tends to involve the sick person, their family and their community in general.

TRADITIONAL HEALING

The practice of the “own medicine” takes into consideration the fact that the symptoms that a person presents are not only that: symptoms. It is related to a much deeper problem that affects that person as a whole. The idea of attacking the symptoms is contrary to the Arhuaco vision. It’s no use taking a drug for headache if you don’t tackle the cause of it.

The traditional vision is that the causes of disease are not just related to the organic sphere. The psychological, the affective and the environmental are the aspects that really influence the organic and give impulse to the imbalances in health.

In the integral vision of the Arhuaco, health is not something mechanic, the mere “absence of illness”. Being healthy is having the appropriate balance between the organic, the mental and the spiritual. If one of those aspects is missing, one cannot speak of good health, even though there exists no physical pains.