Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 7, Number 3, 2002

Electronic health map

Jenny García, a newly qualified Venezuelan doctor, with her medical post’s nurse. García sees local shamans as allies in providing health care to the remote indigenous communities she serves.

The process is still in its infancy, but Rivero hopes eventually to produce a file on each of Venezuela’s 32 indigenous communities, 19 of which are located in the Amazon. Each file would include disease and mortality statistics, relevant cultural and linguistic information, population estimates and details about community representatives and traditional medical practitioners. These fact-packs would then be provided to health workers posted to indigenous communities, including those in the rural doctors program.

The improved information also would allow the ministry to allocate health resources better, a key concern in the Amazon, where transporting medicines to outlying health posts can be extremely difficult and costly. For example, Amazonian indigenous groups who migrate during the year are affected more by certain illnesses at certain times. Medical staff working with those groups need to know, for example, that they will need more antimalaria treatments when these groups settle in an endemic malaria area, but more supplies of diarrhea treatments when they locate near a polluted river.

Upstream from Isla Ratón on the banks of the Orinoco River is Puerto Ayacucho, capital of the Venezuelan Amazon. The small city is home to the region’s only hospital and is the supply base and administrative center for the health authorities responsible for serving the scattered communities of the Amazon.

Puerto Ayacucho is also home to the powerful Regional Organization of Amazonian Indigenous Peoples, or ORPIA. The group’s headquarters was originally built as a small tourist resort before being taken over by the organization in the early 1990s. "We liberated it," ORPIA’s president, José Gregorio Diaz Miraval, says with a smile.

After years of struggle, during which the ORPIA offices were the target of arson attacks and thefts, the organization has won its battle for legal recognition of indigenous rights and has now set as a top priority the struggle for better health care.

Pedro Jaro, ORPIA’s health coordinator, says he is pleased with the Ministry of Health’s new emphasis on responding to communities’ specific needs, noting that ORPIA has been urging health authorities for some time to tailor programs to individual communities rather than try to implement a "one-size-fits-all" policy.

A Piaroa mother and her child in the entrance to their tatched hut home on Venezuela's Cataniapo River. The country's new constitution mandates respect for indigenous beliefs and cultural norms in the provision of health care services.

ORPIA is also concerned that despite the new constitutional and legal protection for indigenous medicine, much traditional knowledge is still at risk, particularly as communities begin to adopt Western habits and gradually abandon aspects of traditional culture. The organization sponsors an exchange program that brings shamans together to discuss their work and pool their knowledge. Rivero sees such programs as crucial to the survival of the body of indigenous knowledge and believes the ministry would likely provide financial support for the scheme.

Indeed, the ministry already sponsors a similar pilot project among the Wayuu of western Venezuela. Wayuu communities have created "intercultural homes" (casas interculturales) where mothers can leave their children in the care of community elders, who pass on their culture to the younger generation. The homes also provide meals, and shamans treat patients there and talk to the children. The project has proved a resounding success, and Rivero believes the scheme would work with other communities if it were adapted to their specific cultural needs.

As for Western-style health workers, Rivero says the efforts now under way to help them understand indigenous culture are critical and should significantly enhance their effectiveness in Amazonian communities. "Among the Yanomami it is taboo to name the dead, for example," she says. "And if we are going to talk about HIV/AIDS we need to know how each culture addresses sex. We have to be sensitive to what they want. It’s no longer a case of turning up with vaccines and telling everyone to form a line with their sleeves rolled up."

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