ABSTRACT
The coronavirus disease 2019 (COVID-2019) pandemic struck Latin America in late February and is now beginning to spread across the rural indigenous communities in the region, home to 42 million people. Eighty percent of this highly marginalized population is concentrated in Bolivia, Guatemala, Mexico and Peru. Health care services for these ethnic groups face distinct challenges in view of their high levels of marginalization and cultural differences from the majority. Drawing on 30 years of work on the responses of health systems in the indigenous communities of Latin America, our group of researchers believes that countries in the region must be prepared to combat the epidemic in indigenous settings marked by deprivation and social disparity. We discuss four main challenges that need to be addressed by governments to guarantee the health and lives of those at the bottom of the social structure: the indigenous peoples in the region. More than an analysis, our work provides a practical guide for designing and implementing a response to COVID-19 in indigenous communities.
Subject(s)
Coronavirus Infections/epidemiology , Coronavirus , Health Services, Indigenous/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Population Groups , Rural Population , Betacoronavirus , COVID-19 , Ethnicity , Humans , Latin America , SARS-CoV-2ABSTRACT
El empacho, el mal de ojo, los aires, el susto o espanto, son las principales y más reconocidas enfermedades populares latinoamericanas. Sobre el empacho la información médica, histórica y etnográfica es extensa y profunda, pues existen documentos que la registran desde el siglo XVI hasta tiempos recientes (2014), y para el caso chileno lo encontramos desde 1674. Para esta revisión fueron consultadas 109 fuentes documentales procedentes de las principales bibliotecas del país e incluso foráneas. Se encontró que la enfermedad es conocida en todo el territorio. Se trata de un trastorno de vías digestivas ocasionado por excesos alimentarios y la ingesta de productos poco o nada digeribles que provocan alteraciones del tránsito gastrointestinal. Los datos clínicos sobresalientes son gastralgia, diarrea o estreñimiento, vómitos, fiebre y otros malestares. La enfermedad es tratada a nivel doméstico, y en caso necesario se emplean especialistas populares, con excepcional visita al médico académico. Los tratamientos son múltiples, complejos y combinados; abarcan desde productos herbolarios hasta elementos rituales, sin faltar la denominada «quebradura del empacho¼. Esta somera revisión del empacho en Chile permitirá al médico pediatra adentrarse al mundo de los saberes y prácticas populares con la finalidad de mejorar su atención a los pacientes infantes y sus acompañantes familiares, pero también inducir al estudio serio y sistemático sobre esta entidad nosológica que seguirá existiendo a través del tiempo.
«Empacho¼ (abdominal pain and bloating), «mal de ojo¼ (evil eye), «los aires¼ (illnesses said to be caught by catching draughts), «el susto¼ or «espanto¼ (fright or panic), are the principal and most well-known popular Latin American illnesses. As regards empacho, the medical, historical and ethnographic information is extensive and detailed, since there documents recording it from the 16th century until recent times (2014), and in the case of Chile since 1674. For this review, 109 source documents from libraries in Chile, including some foreign ones, were consulted. It was found that the illness is known all over the country. It is a digestive system disorder caused by over-eating and the ingestion of products difficult to digest or indigestible, which cause problems in gastrointestinal transit. The most significant clinical data are gastralgia, diarrhoea or constipation, vomiting, fever, and other discomforts. The illness is treated at home, and if necessary, popular specialists are employed, with a visit to a qualified doctor being exceptional. There are many complex and combined treatments, which go from herbal products to ritual elements, not forgetting the so-called «quebradura del empacho¼. This review summary of empacho in Chile should enable the paediatrician to enter the world of popular knowledge and practices with the aim of improving the care of child patients and their families. It should also lead to the serious and systematic study of this nosological condition that will continue to exist in the future.
Subject(s)
Humans , Child , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Abdominal Pain/etiology , Gastrointestinal Diseases/history , Medicine, Traditional/methods , Gastrointestinal Transit , Chile , Pediatricians/organization & administration , Gastrointestinal Diseases/physiopathology , Gastrointestinal Diseases/therapy , Medicine, Traditional/historyABSTRACT
"Empacho" (abdominal pain and bloating), "mal de ojo" (evil eye), "los aires" (illnesses said to be caught by catching draughts), "el susto" or "espanto" (fright or panic), are the principal and most well-known popular Latin American illnesses. As regards empacho, the medical, historical and ethnographic information is extensive and detailed, since there documents recording it from the 16th century until recent times (2014), and in the case of Chile since 1674. For this review, 109 source documents from libraries in Chile, including some foreign ones, were consulted. It was found that the illness is known all over the country. It is a digestive system disorder caused by over-eating and the ingestion of products difficult to digest or indigestible, which cause problems in gastrointestinal transit. The most significant clinical data are gastralgia, diarrhoea or constipation, vomiting, fever, and other discomforts. The illness is treated at home, and if necessary, popular specialists are employed, with a visit to a qualified doctor being exceptional. There are many complex and combined treatments, which go from herbal products to ritual elements, not forgetting the so-called "quebradura del empacho". This review summary of empacho in Chile should enable the paediatrician to enter the world of popular knowledge and practices with the aim of improving the care of child patients and their families. It should also lead to the serious and systematic study of this nosological condition that will continue to exist in the future.
Subject(s)
Abdominal Pain/etiology , Gastrointestinal Diseases/history , Medicine, Traditional/methods , Child , Chile , Gastrointestinal Diseases/physiopathology , Gastrointestinal Diseases/therapy , Gastrointestinal Transit , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Medicine, Traditional/history , Pediatricians/organization & administrationABSTRACT
The study of the health/disease/healthcare process from the socio-medical aspect is the field of the medical anthropology. In Mexico, this medical specialty had its origins at the end of the 19th century. Since then, many educational reforms occurred associated to the political processes and the recognition and better understanding of Mexican pluricultural society; allowing expansion, diversification and consolidation of medical anthropology as an specialty. This review presents the historical evolution of the academic courses on this field, the educators that influenced its consolidation, and the current situation of the available academic programs on medical anthropology. The diversity of specialties from those health sciences that are associated to medical anthropology is emphasized.
Subject(s)
Anthropology, Cultural/education , Cultural Competency , Cultural Diversity , Anthropology, Cultural/history , History, 20th Century , History, 21st Century , Humans , MexicoABSTRACT
El estudio del proceso salud/enfermedad/atención, abordado desde el punto de vista médico y social, es desarrolladode forma especializada por la Antropología Médica. En México esta especialidad tiene sus inicios a finales del siglo XIX. Desde entonces han existido muchas reformas educativas, relacionadas con los propios procesos políticos y el entendimiento y reconocimiento de la pluriculturalidad mexicana, lo que ha permitido ampliar, diversificar y consolidar esta especialidad. En la siguiente se hace una revisión de la evolución histórica de los cursos dedicados a esta materia, los docentes que influyeron en su consolidación, y una presentación sobre el estado actual de los programas académicos que se brindan, destacando la diversidad de otras especialidades en ciencias de la salud que se ven involucradas.
The study of the health/disease/healthcare process from the socio-medical aspect is the field of the medical anthropology.In Mexico, this medical specialty had its origins at the end of the 19th century. Since then, many educational reforms occurred associated to the political processes and the recognition and better understanding of Mexican pluricultural society; allowing expansion, diversification and consolidation of medical anthropology as an specialty. This review presents the historical evolution of the academic courses on this field, the educators that influenced its consolidation, and the current situation of the available academic programs on medical anthropology. The diversity of specialties from those health sciences that are associated to medical anthropology is emphasized.
Subject(s)
Humans , Anthropology, Cultural , Cultural Competency , Cultural Diversity , Education, MedicalABSTRACT
During the 19th century, empacho as a nosological entity prompted academic research by such renowned Mexican clinicians as Miguel F. Jiménez, Eduardo Liceaga, Fernando Altamirano, José Peon y Contreras, among others. Empacho is often the result of excessive eating or difficulty in digestion of certain foods, especially fruits with a peel (oranges, limes, grapefruits, apples, etc.) and legumes (beans, sweet pea, chick peas). Empacho has a greater effect on children under the age of two. It is clinically identified by diarrhea, abdominal pain, fever, restlessness, the presence of abdominal distension, abdominal dullness to percussion, nausea, vomiting, anorexia and meteorism. The most common treatments during the 19th century sought to evacuate gastrointestinal content immediately through vomiting or purgative medication. The general population often used medicinal plants to provoke gastrointestinal purges, while academic doctors most frequently used castor oil as a laxative and ipecacuanha to induce vomiting. This work presents a description and analysis of the general characteristics of the popular illness, empacho. The information comes from doctors, pharmacists, homeopaths, botanists and popular groups.
Subject(s)
Gastrointestinal Diseases/history , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , History, 19th Century , MexicoABSTRACT
La carrera profesional de un médico se inicia en los tiempos y espacios de la Escuela o Facultad de Medicina, cuando se empieza un largo proceso de formación teórico-conceptual que culmina con la práctica clínica y el ejercicio de la medicina en instituciones pública o privadas.
Subject(s)
Culture , Health of Indigenous Peoples , Latin AmericaABSTRACT
La llegada de los europeos a América a partir del siglo XVI tuvo repercusiones en aspectos muy relevantes pero también muy cotidianos de la población.
Subject(s)
Health of Indigenous Peoples/history , Health of Indigenous Peoples , Latin AmericaABSTRACT
El impacto es una categoría nosológica popular que se conoce en toda Iberoamérica. Es una enfermedad del aparato digestivo originada por la excesiva ingestión de alimentos e irregularidades en la digestión.
Subject(s)
Child , History , Medical Records , Natural History of DiseasesSubject(s)
Humans , Phytotherapy , Herbal Medicine , Medicine, Traditional , Naturopathy , Complementary Therapies , PeruABSTRACT
El joven alemán Albert Schweitzer (1875-1965) después de realizar promisorios estudios musicales en París (1899) y haber obtenido los doctorados en Filosofía y Teología en Berlín, decide a los 29 años iniciar la carrera de medicina en la Universidad de Estrasburgo. A pesar de su cómoda y asegurada vida profesional en las grandes ciudades europeas a partir de 1913, en forma por demás sorpresiva, decide ejercer la práctica médica en un remoto pueblo del Africa ecuatorial. Construye un hospital en Lambarené y durante poco más de 50 años dedica lo mejor de símismo al servicio de los pacientes de raza negra. En esta presentación hacemos una aproximación a los aspectos interculturales en la obra médica del doctor Albert Schweitzer, tomando como ejes analíticos algunos indicadores socioculturales en hospitales que atienden enfermos con características culturales diferentes al personal que organiza, administra y ejerce funciones curativas.
Albert Schweitzer (1875-1965) was a young and promising German who at age 29 decided to undertake the profession of Medical Doctor at the University of Strassburg after finishing a career in musical studies in Paris (1899) and obtaining in Berlin a doctoral degree in Philosophy and Theology. Surprisingly, Albert Schweitzer, despite his comfortable life in Europe, decided in 1913 to practice his medical career in a remote and small Equatorial African country. He devoted nearly 50 years of his life caring for the Black population at Lamaberene, where he built a hospital. In this paper, we attempt to develop some theoretical aspects related with interculturality in the medical practice of Dr. Albert Schweitzer. We begin by considering certain sociocultural variables in hospitals that give care to patients with cultural characteristics that are substantially different from those of the health care personnel who organize, administer, and execute medical functions.
Subject(s)
History, 19th Century , History, 20th Century , Cultural Diversity , Clinical Medicine/history , Gabon , GermanyABSTRACT
OBJECTIVE: To identify the changes brought about by various national and international factors in an intercultural hospital of the municipality of Cuetzalán, Puebla. MATERIAL AND METHODS: A case study was conducted during 2000 and 2001 in two Intercultural Hospitals of Mexico; the Cuetzalán Hospital in Puebla and the Jesús María Hospital in Nayarit State. Data were collected by means of 72 semi-structured interviews with allopathic therapists, indigenous therapists, and authorities of the different health care levels. Moreover, documental research was carried out on national policies for indigenous peoples as well as on indigenist policies. These policies were related with the five organizational stages of the hospital. State authorities gave their permission and interviewees signed informed consent. RESULTS: The hospital was created in 1958 by the Ministry of Health as a biomedical institution, in agreement with the integrationist indigenist policies going on at the time. It remained so during the beginning of the administration by the National Indigenist Institute. In 1990, the new participative indigenist policy trends and the creativity and sensitivity of some authorities, under the influence of international strategies, helped to transform the hospital into an Intercultural Hospital (offering both types of medicine, indigenous and allopathic) with regional coverage. In 2000, the devolution of the hospital to the State Ministry of Health, based on financial rather than socio-cultural considerations, caused the temporary loss of its intercultural character. The last stage as an Integral Hospital with Traditional Medicine (from 2003 onwards) was due to a combination of state official initiatives and the new political stance acquired by the Mexican indigenous movement. The hospital is now part of a regional project of five such hospitals officially denominated Integral Hospitals with Traditional Medicine, to be financed by the Puebla-Panama Plan of regional development. CONCLUSIONS: Our results confirmed that health organizations follow a historical process in which selected national and international forces open opportunities to promote intercultural health models that respond to the needs of indigenous populations. Despite the formerly held belief that traditional and scientific medicines were incompatible, this study demonstrates the viability of intercultural health care models that may become a real possibility in the country, based on new conventions to establish alternative and intercultural health services, thereby setting an example for other regions and countries. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
Subject(s)
Cultural Diversity , Health Policy , Health Services, Indigenous/organization & administration , Hospitals, Municipal/organization & administration , Indians, North American , Decision Making, Organizational , Health Services Research , Health Services, Indigenous/standards , Hospital Planning , Hospitals, Municipal/standards , Humans , Medicine, Traditional , MexicoABSTRACT
OBJETIVO: Identificar la evolución del hospital del municipio de Cuetzalan a partir de la influencia que diversos elementos del contexto nacional e internacional han tenido sobre ella. MATERIAL Y MÉTODOS: Estudio de caso, realizado en 2000 y 2001 sobre los Hospitales Mixtos en México -el de Cuetzalan, en el estado de Puebla, y el de Jesús María, en el estado de Nayarit-. Durante el trabajo de campo se obtuvo información a través de 72 entrevistas semiestructuradas con terapeutas alópatas e indígenas del hospital y con directivos de los diferentes niveles del sistema de salud. Además, se hizo una revisión documental, tanto de las políticas nacionales de salud para pueblos indígenas, como de las indigenistas, para relacionarlas con las cinco etapas organizacionales del hospital. Además de la autorización de los directivos estatales para el estudio, se pidió el consentimiento informado de los entrevistados. RESULTADOS: El hospital fue creado en 1958 por la Secretaría de Salud con carácter biomédico, acorde con el indigenismo integracionista de la época, y continuó con ese carácter durante la administración inicial del Instituto Nacional Indigenista. Pero las nuevas tendencias del indigenismo participativo y la sensibilidad y creatividad de algunos funcionarios del Instituto, sumadas a estrategias internacionales para lograr una mayor integración de las culturas indígenas, impulsaron su transformación, en 1990, en Hospital Mixto (que ofrecía las dos medicinas, la indígena y la alopática) con proyección regional. En la devolución del hospital a la Secretaría Estatal de Salud en 2000, que causó retrocesos temporales en el carácter mixto del hospital, primaron los criterios financieros sobre los socioculturales, mientras que en la actual versión del hospital como Hospital Integral con Medicina Tradicional influyeron, además de la iniciativa de funcionarios estatales, el reposicionamiento político de los indígenas en el país y la disponibilidad de recursos internacionales del Plan Puebla Panamá. CONCLUSIONES: El análisis ratifica el carácter histórico del desarrollo de las organizaciones de salud, y las oportunidades que las coyunturas y políticas nacionales e internacionales constituyen para impulsar modelos alternativos e interculturales de atención para la salud de los pueblos indígenas que respondan a sus necesidades. A pesar de que...
Subject(s)
Humans , Cultural Diversity , Health Policy , Health Services, Indigenous/organization & administration , Hospitals, Municipal/organization & administration , Indians, North American , Decision Making, Organizational , Health Services Research , Health Services, Indigenous/standards , Hospital Planning , Hospitals, Municipal/standards , Medicine, Traditional , MexicoABSTRACT
Se presentan los resultados de recientes investigaciones históricas y etnográficas sobre el tema del empacho en Cuba. En bibliotecas de La Habana, Santiago de Cuba y Ciudad de México se ha encontrado una abundante y rica información al respecto, en documentos de los siglos XIX y XX, así como terapias muy específicas que continúan realizándose en toda la Isla. La mayoría de los textos recopilados se limita a describir profesional y popularmente terapéuticas para eliminar el empacho, más que a brindar información referida a la causalidad, el cuadro clínico y la epidemiología de este trastorno. Cabe mencionar que aparecen tratamientos descritos por médicos -- en especial homeópatas --, botánicos, farmacéuticos, varios folcloristas y escritores, de donde se infiere que es cierta la existencia del empacho a partir de la documentación histórica y de las propias vivencias cotidianas del pueblo cubano
Subject(s)
Medicine, TraditionalABSTRACT
Se presentan los resultados de recientes investigaciones históricas y etnográficas sobre el tema del empacho en Cuba. En bibliotecas de La Habana, Santiago de Cuba y Ciudad de México se ha encontrado una abundante y rica información al respecto, en documentos de los siglos XIX y XX, así como terapias muy específicas que continúan realizándose en toda la Isla. La mayoría de los textos recopilados se limita a describir profesional y popularmente terapéuticas para eliminar el empacho, más que a brindar información referida a la causalidad, el cuadro clínico y la epidemiología de este trastorno. Cabe mencionar que aparecen tratamientos descritos por médicos -- en especial homeópatas --, botánicos, farmacéuticos, varios folcloristas y escritores, de donde se infiere que es cierta la existencia del empacho a partir de la documentación histórica y de las propias vivencias cotidianas del pueblo cubano(AU)