Covid-19 pandemic and the motivations for demanding health service in indigenous villages.

OBJECTIVE: To discuss the fundamental aspects in the establishment of preventive measures to tackle covid-19 among indigenous people in view of the motivations for seeking health care in villages of the Terra Indígena Buriti, Mato Grosso do Sul, Brazil. METHODS: Theoretical-reflective study based on assumptions of the National Health System and previous ethnographic research that enabled the identification of the motivations to seek health care in Buriti villages. RESULTS: Indigenous people seek health centers for health care programs assistance, treatment of cases they cannot resolve and to chat. Such motivations were the basis for discussing the indigenization process in the confrontation of the new coronavirus pandemic in indigenous lands. FINAL CONSIDERATIONS: The motivations for seeking health care show the physical and social vulnerability of the Terena ethnicity. The effectiveness of the social isolation measure in the villages depends on the dialogue with indigenous leaders, professional engagement and intersectoral actions.

Metaphors and cultural narratives on adaptive responses to severe adversity: A field study among the Indigenous Pitaguary community in Brazil.

The expressions resilience and posttraumatic growth represent metaphorical concepts that are typically found in Euro-American contexts. Metaphors of severe adversity or trauma and the expressions of overcoming it vary across cultures-a lacuna, which has not been given much attention in the literature so far. This study aimed to explore the metaphorical concepts that the Indigenous Pitaguary community in Brazil uses to talk about adaptive and positive responses to severe adversity and to relate them to their socio-cultural context. We carried out 14 semi-structured interviews during field research over a one-month period of fieldwork. The data were explored with systematic metaphor analysis. The core metaphors included images of battle, unity, spirituality, journeys, balance, time, sight, transformation, and development. These metaphors were related to context-specific cultural narratives that underlie the Pitaguary ontological perspective on collectivity, nature, and cosmology. The results suggest that metaphors and cultural narratives can reveal important aspects of a culture's collective mindset. To have a contextualized understanding of expressive nuances is an essential asset to adapt interventions to specific cultures and promote culture-specific healing and recovery processes.

Culturally shared metaphors expand contemporary concepts of resilience and post-traumatic growth: contrasting an indigenous Brazilian community and a Swiss rural community.

The metaphorical concepts resilience and post-traumatic growth (PTG) reflect the contemporary Western understanding of overcoming highly challenging life events. However, it is known that across different cultures, a broad range of metaphorical idioms for describing adaptive responses to severe adversity exists. This study aimed to explore and contrast two distinct cultural groups' culturally shared metaphors for overcoming severe adversities. Fieldwork was conducted in two rural communities: an indigenous Brazilian community that has experienced severe collective adversity and a mountain village in Switzerland that has survived a natural disaster. We carried out separate qualitative metaphor analyses of semistructured interview data from each community. There were some similarities in the metaphorical narratives of the two cultural groups, for example, in metaphors of balance, changed perspective, collective cohesion and life as a journey The main variations were found in metaphors of magical thinking, equilibrium and organic transformation used by the Brazilian group and metaphors of work, order and material transformation used by the Swiss group. Results from this study suggest that the Western-devised concepts of resilience and PTG can be further expanded, which is highlighted by the variety of culturally shared metaphors. Metaphorical idioms for overcoming severe adversity may be determined by the type of trauma as well as by the sociocultural and historical context. Our findings indicate potential approaches to the cultural adaptation of psychological interventions.

"It Is Not Natural Anymore": Nutrition, Urbanization, and Indigenous Identity on Bolivia's Andean Plateau.

The objective of this article was to characterize how urbanization and indigenous identity shape nutrition attitudes and practices in El Alto, a rapidly urbanizing and predominantly indigenous (Aymara) community on Bolivia's Andean plateau. We took a qualitative ethnographic approach, interviewing health care providers ( n = 11) and conducting focus groups with mothers of young children ( n = 4 focus groups with 25 mothers total [age = 18-43 years, 60% Aymara]). Participants generally described their urban environment as being problematic for nutrition, a place where unhealthy "junk foods" and "chemicals" have supplanted healthy, "natural," "indigenous" foods from the countryside. Placing nutrition in El Alto within a broader context of cultural identity and a struggle to harmonize different lifestyles and worldviews, we propose how an intercultural framework for nutrition can harmonize Western scientific perspectives with rural and indigenous food culture.

Localizing Global Medicine: Challenges and Opportunities in Cervical Screening in an Indigenous Community in Ecuador.

This participatory research study examines the tensions and opportunities in accessing allopathic medicine, or biomedicine, in the context of a cervical cancer screening program in a rural indigenous community of Northern Ecuador. Focusing on the influence of social networks, the article extends research on "re-appropriation" of biomedicine. It does so by recognizing two competing tensions expressed through social interactions: suspicion of allopathic medicine and the desire to maximize one's health. Semistructured individual interviews and focus groups were conducted with 28 women who had previously participated in a government-sponsored cervical screening program. From inductive thematic analysis, the article traces these women's active agency in navigating coherent paths of health. Despite drawing on social networks to overcome formidable challenges, the participants faced enduring system obstacles-the organizational effects of the networks of allopathic medicine. Such obstacles need to be understood to reconcile competing knowledge systems and improve health care access in underresourced communities.

Meanings of 'Tuberculosis' in Rural Indigenous Communities from a Municipality in the Colombian Amazon.

OBJECTIVES: The purpose herein was to describe the meanings on tuberculosis (TB) in rural indigenous communities from a municipality in the Colombian Amazon. METHODS: This was an ethnographic study with theoretical reference of dialectical hermeneutics, which created focus groups, one for each rural community of Puerto Nariño, for a total of 15 focus groups. The participants were community leaders and health referents. RESULTS: Seventy-nine subjects participated, mostly midwives, kurakas, traditional physicians, and shamans. The analysis yielded four categories: knowledge of TB, attitudes regarding TB, community practices of TB, and the intervention proposal on TB by the participants. It was found that community leaders recognize TB as a disease that can cause death, but which can be cured if timely care is secured. The study also identified the need to conjugate western medicine with traditional medicine. CONCLUSIONS: It is recognized that meanings may impact upon knowledge, attitudes, and practices that affect early detection and treatment of the disease. In addition, this work corroborates the need to strengthen and develop educational programs on tuberculosis supported by the real needs of the communities to enhance their knowledge, attitudes, and practices on the disease.

Indifference to dissonance in native Amazonians reveals cultural variation in music perception.

by biology remains debated. One widely discussed phenomenon is that some combinations of notes are perceived by Westerners as pleasant, or consonant, whereas others are perceived as unpleasant,or dissonant. The contrast between consonance and dissonance is central to Western music and its origins have fascinated scholars since the ancient Greeks. Aesthetic responses to consonance are commonly assumed by scientists to have biological roots, and thus to be universally present in humans. Ethnomusicologists and composers, in contrast, have argued that consonance is a creation of Western musical culture. The issue has remained unresolved, partly because little is known about the extent of cross-cultural variation in consonance preferences. Here we report experiments with the Tsimane'--a native Amazonian society with minimal exposure to Western culture--and comparison populations in Bolivia and the United States that varied in exposure to Western music. Participants rated the pleasantness of sounds. Despite exhibiting Western-like discrimination abilities and Western-like aesthetic responses to familiar sounds and acoustic roughness, the Tsimane' rated consonant and dissonant chords and vocal harmonies as equally pleasant. By contrast, Bolivian city- and town-dwellers exhibited significant preferences for consonance,albeit to a lesser degree than US residents. The results indicate that consonance preferences can be absent in cultures sufficiently isolated from Western music, and are thus unlikely to reflect innate biases or exposure to harmonic natural sounds. The observed variation in preferences is presumably determined by exposure to musical harmony, suggesting that culture has a dominant role in shaping aesthetic responses to music.

[Is disease merely illness?: Biomedicine, "parallel" forms of care and power]. / Las enfermedades ¿son solo padecimientos?: biomedicina, formas de atención "paralelas" y proyectos de poder.

Following Giovanni Berlinguer's proposal that health/disease processes are one of the primary spies into the contradictions of a system, this article describes cases that occurred in central and peripheral capitalist contexts as well as in the so-called "real socialist" States that allow such a role to be seen. Secondly, we observe the processes and above all the interpretations developed in Latin America and especially Mexico regarding the role attributed to traditional medicine in the identity and sense of belonging of indigenous peoples, which emphasize the incompatibility of indigenous worldviews with biomedicine. To do so we analyze projects that were carried out under the notion of intercultural health, which in large part resulted in failure both in health and political terms. The almost entirely ideological content and perspective of these projects is highlighted, as is the scant relationship they hold with the reality of indigenous people. Lastly, the impact and role that the advance of these conceptualizations and health programs might have had in the disengagement experienced over the last nearly ten years in the ethnic movements of Latin America is considered.

Exploring pain in the Andes--learning from the Quichua (Inca) people experience.

There is a mounting recognition that culture profoundly shapes human pain experience. The 28 million indigenous people of the Andes in South America, mainly the Quichua (Inca) people, share a distinctive culture. However, little is known about their pain experience and suffering. The aim of the present study was to explore how Quichua adults perceive, describe, and cope with the pain. An exploratory qualitative/descriptive study was conducted with a convenience sample of 40 Quichua adults, including 15 women and 25 men, in the Northern Highlands of Ecuador. Data were collected through structured interviews of approximately 3 h, using a Quichua questionnaire called "The Nature of Pain" [Nanay Jahua Tapuicuna]. The interviews covered the notions of causation of pain, vulnerability to pain, responses to pain, aggravating factors, frequent locations of pain, types of pain, duration, characteristics of pain, control of pain, pathways to care, and preventive measures of pain. Basic descriptive analyses were performed. The Quichuas' pain experience is complex and their strategies to cope with it are sophisticated. According to the Quichuas, emotions, life events, co-morbid conditions, and spirits, among others factors play an important role in the origin, diagnosis, and treatment of pain. They strongly embrace biomedicine and physicians as well as Quichua traditional medicine and traditional healers. Family members and neighbors are also valuable sources of health care and pain control. The pathway to pain care that the Quichua people prefer is inclusive and pluralistic. The knowledge of the Quichua ethnographic "emic" details of their belief system and coping strategies to control pain are clinically useful not only for the health professional working in the Andes, some Quichua cultural characteristics related to pain could be useful to the culturally competent health practitioner who is making efforts to provide high-quality medical care in rural and multicultural societies around the world.

Dimensiones y significados que adquiere el proceso salud/enfermedad/atención en usuarios mapuche ­ williche con diabetes mellitus e hipertensión arterial / Dimensions and meaning surrounding the health-disease-care process for mapuche-williche patients with diabetes and hypertension

Las enfermedades cardiovasculares representan la primera causa de muerte en población adulta en Chile. En el caso de la población indígena, los resultados de estudios epidemiológicos comparativos muestran un peso relativo mayor de estas enfermedades en la población indígena que en la no indígena. OBJETIVO: Describir las concepciones y prácticas terapéuticas tradicionales que convergen en los procesos de sanación de usuarios mapuche­williche diabéticos e hipertensos que consultan en los establecimientos de salud, ubicados en la jurisdicción del cacicado de Riachuelo, Río Negro. MATERIAL Y MÉTODO: Estudio exploratorio-descriptivo de carácter socio-antropológico que se inscribe en el paradigma interpretativista que articula el proceso salud/enfermedad/atención que desarrollan los pueblos originarios y las lógicas positivistas de la biomedicina. El muestreo fue no probabilístico. Se realizó estudio de caso y entrevista en profundidad. Para el análisis de los datos se utilizó el análisis categorial aplicado a las entrevistas, construyendo interpretaciones desde los sentidos y significados que los propios actores transparentan en sus discursos y prácticas culturales.RESULTADOS: El sistema cultural de salud mapuche-williche es relevado por los usuarios en un itinerario terapéutico que los lleva a complementar, alternar o sustituir la medicina occidental por la medicina mapuche para el tratamiento de la diabetes mellitus e hipertensión arterial. CONCLUSIONES: Las enfermedades cardiovasculares conceptualizadas por el modelo médico oficial hegemónico no son parte de la matriz cultural mapuche-williche, constatándose dificultades en la adherencia al tratamiento impuesto por la biomedicina en usuarios que viven en territorios con alta concentración de población indígena.

Cardiovascular diseases are the leading cause of death in adults in Chile. Comparative epidemiological studies show a relatively greater burden of these diseases amongst the indigenous population compared to the non-indigenous population. OBJECTIIVE: To describe the concepts and traditional healing practices that converge in the healing process of mapuche-williche diabetic and hypertensive patients, treated in health facilities located in the jurisdiction of cacicado of Riachuelo, Río Negro. MATERIAL AND METHODS: exploratory-descriptive study, socioanthropological in character, part of the interpretive paradigm that articulates the health/disease/care developed by indigenous peoples, and logical positivist biomedicine. Sampling was not probabilistic. Case study and in-depth interviews were conducted. An examination of the interview categories was performed to construct interpretations from the sense and meaning that the subjects showed through their discourse and cultural practices. RESULTS: The mapuche-williche cultural health system is revealed by patients: we see a therapeutic journey that leads them to complement, switch or replace Western medicine with mapuche medicine for the treatment of diabetes mellitus and hypertension.CONCLUSIONS: Cardiovascular diseases conceptualized by the hegemonic medical model are not part of the cultural mapuche-williche matrix, confirming the difficulties in following biome-dical treatment for patients coming from areas with a dense indigenous population.

The influence of Christian conversion in Mapuche traditional medicine in Temuco, Chile: toward a cultural syncretism or a form of ideological assimilation?

The Mapuche communities living in the urban areas of Chile have undergone radical cultural changes due to Christian conversion. This article analyzes the influence of these changes on the Mapuche ideas and practices of the traditional healers (machi) and patients in Temuco (IX Region), Chile, and the changes and adaptations in the perceptions of healing practices and rituals by the patients. The paper shows how, despite some evident challenges, the encounter with the religion of Christianity can create a process of cultural and spiritual syncretism and push traditional medicine toward an increased specialization in the therapeutic practices.

Mobilização social em saúde e saneamento em processo de pesquisa-ação em uma comunidade indígena no noroeste amazônico / Social mobilization in health and sanitation in an action research process in an indigenous community in northwestern amazon

As condições de vida dos habitantes de Iauaretê, área indígena no município de São Gabriel da Cachoeira, AM, têm sido afetadas negativamente devido à concentração populacional, ao precário saneamento e à manutenção de práticas sanitárias incompatíveis com essa realidade, sendo desejável, para melhoria da qualidade de vida da população, a implantação de sistemas de saneamento adequados às características socioculturais locais e a utilização de processos educativos com ênfase na mobilização social e no fortalecimento comunitário (empoderamento). O objetivo deste texto é relatar e discutir um curso de formação em saúde e saneamento, utilizando como estratégia a pesquisa-ação, voltada para a mobilização dos indígenas de Iauaretê, visando subsidiar outros estudos dessa natureza. Nos encontros foram abordados temas relacionados à saúde ambiental, construiu-se um Jornal Comunitário, os participantes do curso aplicaram entrevistas e elaboraram documentos reivindicatórios. Essa experiência propiciou aos participantes maior compreensão da problemática local e da importância da mobilização social para a interlocução com instituições governamentais responsáveis pela oferta de serviços de saneamento e para a busca de melhores condições de vida; aos pesquisadores e docentes do curso, a construção de um saber coletivo resultante da interação com os sujeitos da situação investigada, bem como pelo reconhecimento e ressignificação das representações destes, atendendo premissa fundamental da pesquisa-ação.

Health and indigenous people: intercultural health as a new paradigm toward the reduction of cultural and social marginalization?

The precarious socio-economic and health conditions of indigenous populations legitimize claims of marginalization and attest to the inherent inequality that indigenous groups suffer. In the last few years, advocates have urged the use of traditional indigenous health practices as more culturally fitting for most indigenous populations. An intercultural health program can reduce the conditions of social and cultural marginalization in an indigenous population. However, accepting and integrating indigenous medicine into a westernized health system presents a major challenge to intercultural healthcare in Latin America. The objective of this paper is to analyze the case of Makewe hospital, one of the first and few examples of intercultural health initiatives in Chile. The paper will examine the implementation of this initiative and the main challenges in creating an effective intercultural health program.

Llaki and ñakary: idioms of distress and suffering among the highland Quechua in the Peruvian Andes.

This article examines some of the long-term health outcomes of extreme adversities and the ways in which social inequalities and idioms of distress are historically and socially produced in the Peruvian context. We describe how the highland Quechua of northern Ayacucho construct and experience expressions of distress and suffering such as pinsamientuwan (worrying thoughts, worries), ñakary (suffering) and llaki (sorrow, sadness), in a context of persistent social inequalities, social exclusion and a recent history of political violence. It is concluded that the multiple expressions of distress and suffering are closely related to past and current events, shaped by beliefs, core values and cultural norms and, in this process, transformed, recreated and invested with new meanings and attributions.

Marcos Zapata's "Last Supper": a feast of European religion and Andean culture.

In Marcos Zapata's 1753 painting of the Last Supper in Cuzco, Peru, Christian symbolism is filtered through Andean cultural tradition. Zapata was a late member of the Cuzco School of Painting, a group comprised of few European immigrants and handfuls of mestizo and Indian artists. The painters in Cuzco learned mostly from prints of European paintings, and their style tends to blend local culture into the traditional painting of their conquistadors. Imagery was the most successful tool used by the Spaniards in their quest to Christianize the Andean population. By teaching locals to paint Christian subjects, they were able to infuse Christianity into Andean traditions. Zapata's rendering of the Last Supper utilizes this cultural blending while staying true to the Christian symbolism within the subject. Instead of the traditional lamb, Zapata's Last Supper features a platter of cuy, or guinea pig, an Andean delicacy stocked with protein as well as cultural significance. Cuy was traditionally a sacrificial animal at Inca agricultural festivals and in this way it offers poignant parallel to the lamb, as a traditional Christian sacrificial animal.

Desire, envy and punishment: a Matsigenka emotion schema in illness narratives and folk stories.

Accumulating evidence suggests that folktales in some societies are characterized by a culturally constructed underlying emotional structure, or Cultural Emotion Schema. In this paper we argue that Matsigenka illness narratives and folk stories share an underlying emotion schema, in which death and suffering result from conflicts between strong-willed individuals prompting anger and aggression. Analysis of illness narratives collected by Izquierdo in the Matsigenka community of Kamisea in the Peruvian Amazon between 1996 and 1999 reveals a common pattern in which envy and frustration lead to the belief in sorcery as the main cause of illness and death. This pattern contrasts with the typical stories of a previous generation collected by the Johnsons among the Matsigenka of Shimaa and other Matsigenka researchers, where sorcery beliefs were virtually absent. Our argument is that important changes in ecology, community, politics, and religion have led to a systematic rise in feelings of envy and frustration, and that these have increased the likelihood that sorcery accusations will occur. We explore the likelihood that such beliefs increase as egalitarian peoples become more crowded into settlements where they are likely to experience greater inequality, more competition for resources and increased societal and personal stress.

An anthropological study about epilepsy in native tribes from Central and South America.

PURPOSE: Epilepsy was a well-recognized disease in pre-Columbian cultures. However, anthropological studies about epilepsy in native cultures living at the present time are scarce. The objective of this paper was to study native perception and myths about epilepsy, their magic-religious healing rites and ceremonies, and the natural treatments that archaic cultures used. METHODS: An anthropological fieldwork was performed in Central and South America with Tzeltal Maya (Chiapas, Mexico, 1995), Kamayurá (Matto Grosso, Brazil, 1999) and Uru-Chipaya people (Bolivian Andes, 2004). We collected information from shamans and medicine men about epilepsy beliefs and the use of traditional treatments. RESULTS: Epilepsy is called tub tub ikal by Tzeltal people. It is caused by an attack suffered by the animal spirit who accompanies the person, after a fight between the spirits who serve the forces of good and evil. People with chronic epilepsy are considered witches. Epilepsy is called teawarup by Kamayurá, and is caused by the revenge of the spirit (mama'e) of the armadillo killed by a huntsman. It is treated with two roots, tsimó and wewurú, kneaded and diluted in water. Epilepsy is called tukuri by the Chipaya people, and is originated by a witchcraft that enters into the nose and the head, as a wind. Tukuri is treated with a ritual animal sacrifice called willancha, and by taking several dried insect infusions and bird's blood. CONCLUSION: These American native cultures have developed a system of orally transmitted knowledge about epilepsy based on magic-religious traditions.