The tragedy of the indigenous Miskito population of the Atlantic coasts of Nicaragua and Honduras makes clear the serious lack of sanitation faced by these people as they continue their underwater fishing for lobsters in deplorable conditions. This helps us deepen our understanding of the indigenous people of the Americas with the help of Rocío Rojas, regional adviser for the Health Program for the Indigenous People of the Americas of the Pan American Health Organization (PAHO), who has been working on this issue for more than 10 years. The program has just been moved from Washington to Ecuador as a reflection of the interest of PAHO Director Dr. Mirta Roses Periago in placing the organization closer to the real situation of the indigenous people and to better take care of their health needs.
"Never have I seen such neglect, sadness and loneliness at the mercy of the market forces"
Rocío Rojas, Regional Adviser on Health of the Indigenous People
By José A. Carnevali-OPS
For connoisseur diners from Chicago to Los Angeles, Madrid or Paris, lobsters are an irresistible delicacy. On both sides of the Atlantic, to dine on lobster is a symbol of social status and of purchasing power. Many Americans and Europeans pay high prices at restaurants serving this delicious meal of tender white meats from the red claws and covered by an almost impenetrable shell.
However, for the Miskitos of the Atlantic coasts of Nicaragua and Honduras, the story is anything but glamorous. Far from a luxury fit for a king, catching lobsters at a depth of 20 meters is for these divers -- without the proper diving gear -- a means of acquiring serious pathologies and, in many cases, a sure way toward their indiscernible but inevitable ethnic extinction. Few people know this better than Rocío Rojas, PAHO's regional adviser on Health of the Indigenous People.
She returned from a working visit to the Central American Atlantic coasts with clear and dramatic images of these courageous workers who make a subsistence living in that region. She and her team documented the suffering of the Miskitos during their three-day trip. The PAHO official summarized her experiences thus: "Never have I seen such neglect, sadness and loneliness at the mercy of the market forces."
Additional Information
PAHO Book: Crecer SanitosEstrategies, Methodology, and Instruments to Investigate and Understand Indigenous Children's Health (
in Spanish.)
(
PDF, 1.07MB)
Fact Sheet: Gender, Equity and Indigenous Women's Health in the Americas.
(
PDF, 31.6KB)
Rojas acknowledges there is negligence on the part of the captains and owners of the fishing boats for failing to provide divers the conditions and tools necessary to do their jobs properly. She noted as particularly distressing the lack of technical and sanitary equipment to prevent Acute Decompression Syndrome that many of these young divers suffer when they swim toward the surface of the water. Strong headaches and earaches, as well as progressive weakening of the arms and legs, are part of a pattern of circumstances and pathologies that eventually turn into paraplegia and hemiplegics. Many of them, including the president of the Miskito-Honduran Association of Disabled Divers, end up disabled for life. He lives confined to a bed, paralyzed below the waist.
Industry and dehumanization
In 2000, Nicaragua exported more than four million pounds of lobster, which meant profits of some US$21 million for the exporters. Even though there are no official statistics, it is estimated that some 9,000 divers are involved in this activity. Of those, 98% are Miskitos, 97% have suffered of some kind of syndrome and at least 4,200 Miskitos are totally or partially disabled due to the decompression syndrome.
A wide-ranging report from the Nicaraguan Attorney General's Office to the Defense of Human Rights group described as "hasty and unmanageable" the transition from the once-traditional lobster fishing to a large-scale industrial operation. "There is abundant domestic and international legislation regarding the protection of health and occupational safety of divers," the report says. "However, the role of the official agencies in charge of applying these rules is so passive that in most cases it becomes negligent."
Just the tip of the Iceberg
For the last 10 years Rojas has used the efforts of PAHO on behalf of the rights and the health of the indigenous people of Latin America and the Caribbean. When it comes to the deficiencies and problems of the indigenous people, Rojas has possibly witnessed everything that is to see about the Miskito and many others indigenous people of the Americas, the large limitations as well as the incredible survival strategies.
The PAHO expert noted the work on behalf of the Miskitos of the Health Ministry, PAHO's representative in Honduras, the Inter American Commission on Human Rights of the Organization of American States (OAS) and the National Human Rights Commission of Honduras. But for Rojas, what is happening along the Atlantic coasts of Central America is just the tip of the iceberg of the health and human rights problems which to varying degrees affect the indigenous populations. For example, so far this year, seven mothers have died in Ecuador's Cotopaxi Province, a region with a high percentage of indigenous people. "Even though some people are dying because of HIV/AIDS, in general, the indigenous people are dying from diarrhea, malaria, tuberculosis. And many mothers (are dying) for lack of access to health services," Rojas said. "This is happening not just in Ecuador but also in Panama, in Colombia..."
As a whole, the indigenous people make up about 10% of the population of Latin America and the Caribbean.
Raising one's voice
It is within this framework that PAHO has concentrated its comprehensive efforts to deal with a solution for the indigenous problems over the last decade. "PAHO's Dr. José Luis Di Fabio, manager of the Technical Area for the Health Program for the Indigenous People of the Americas, has given an invaluable momentum to the issue of indigenous health," said Rojas in the interview. "Before, there had been an indigenous initiative (within PAHO). Now, there is a program."
This change within PAHO has shown tangible results because, Rojas noted, of three circumstances which encourage PAHO's Health Program for the Indigenous People of the Americas. First, credit must be given to the indigenous people themselves who "are making gains in the area of representation and power thanks to their untiring struggle," Rojas said. "It is they, due to their leadership and capability, which have placed their demands on the agendas of the most important international conferences, with the objective of demanding all their rights, especially the right to life - in other words, those conditions that are the basis for health and welfare."
Rojas added that "a process of becoming more sensitive has been developed at all levels, and especially since 1992 and at the time of the Fifth Centennial of the arrival of Christopher Columbus in the Americas, an event which the indigenous people said was not a reason for celebration." These events triggered a series of unprecedented constitutional changes that recognized the indigenous cultural diversity as a part of the national and hemispheric reality of the Americas.
Finally, it is not unusual that when analyzing the inequity gaps in the Americas, there were direct ties between the indigenous people and extreme poverty and mortality rates. "What was really seen was an overlapping of pathologies and the need to adopt strategies and conventional actions to the socio-cultural context of the indigenous people," said Rojas.
A change of vision
The United Nations' vision for addressing the wealth and the needs of the indigenous people of the world included what is known as the International Decade of the World's Indigenous People, an initiative for the preferential approach, study and evaluation of these communities from 1995 to 2004.
"The indigenous people of the Americas told PAHO that too little was being done," Rojas said. The reality today is far from good. However, the outlook has made a substantial shift thanks to the constitutional reforms and decentralization efforts made so far. "That is of interest to PAHO's Director Dr. Mirta Roses. And it is because of this that the Regional Health Program of the Indigenous Peoples has been transferred from Washington to Quito - so that it can be closer to the real situation."
A great deal still needs to be done on behalf of the comprehensive action plan of the Health Program for the Indigenous People of the Americas, Rojas said, to meet the goals of the Millennium Development Goals (MDG). Even if one recognizes the steps already taken, Rojas said that in the assessment of the objectives that have been reached and the goals that have been conquered, it is imperative to deal with them by individual ethnicities because it makes no sense to present the successes in this matter in a more general fashion.
Other Documents (in Spanish)
Iniciativa Salud de los Pueblos IndígenasLineamientos estratégicos y plan de acción 2003-2007.
(
MS Word, 182KB)
Derechos humanos y discapacidad entre los pueblos indígenas.
(
MS Word, 1.55MB)
As is evident from the challenges faced by PAHO's strategy for the issue of indigenous health, the lack of vital statistics and services catalogued by ethnic groups, gender and differing groups make more difficult an adequate evaluation of the conditions of health, life and the health care of the indigenous population.
But Rojas goes even further. She says she is convinced that "the indigenous problem will be solved not only by emphasizing the health issue, but also incorporating an integral approach that must take into account all social determinants that make possible the enjoyment of a dignified life. This means that there can be no health if there is no access to good nutrition, to a culturally appropriate education, to safe working conditions, and to appropriate water and sanitary conditions, among other things."
Rojas is certain of the need to know and respect the indigenous health systems, used for a long time, for the prevention of diseases, and the recovery and maintenance of health. Many indigenous practices are based on a deep knowledge of plant life and the lifestyle based on spiritual and community-based beliefs that ensure the individual and collective well-being. Rojas believes that incorporating an intercultural approach to health opens the doors to the benefits that Western medicine can and must offer.
The important and the urgent
Rojas admits that she hasn't always felt an indigenous identity. "Everywhere there was a great deal of discrimination," she noted. However, her work with PAHO -- in addition to other personal experiences - has helped her overcome social stereotypes. Rojas today fully and proudly accepts and acknowledges her indigenous Ecuadorian Chichewa ancestry through her grandmother.
From Ecuador, the geographic center of the world, Rojas calls on all to join in the efforts to make a reality of the utopia of just and inclusive societies in which the indigenous people, and all people of the Americas, will turn our deepest aspirations into reality."
Buzos Miskito de Gracias a Dios, Honduras