Indigenous Medicine and Conceptions of Health in the Amazon

The Amazon basin is the largest tropical rainforest in the world, and its six to eight million square kilometers of land houses hundreds of indigenous groups and forest dependent peoples (Yale University, 2019). In the Americas, the Amazon is home to the majority of the most isolated groups in the region, and it is estimated that there are more than 50 indigenous societies in the Amazon that have very limited contact with the outside world (Fonseca et al, 2015; Walker, Sattenspiel, & Hill, 2015). These isolated groups are considered "virgin soil" populations, meaning that they have not been exposed to certain diseases and as such have little to no immunity to them (Walker et al, 2015). This isolation, combined with economic and social marginalization and cultural differences, makes indigenous populations highly vulnerable in most of South America. Scholarly interest in the health of indigenous populations in the Amazon centers on reasons for their vulnerability, cultural perceptions of health, the pharmaceutical benefits of traditional knowledge, and attempts to integrate indigenous peoples into national health systems.

Indigenous populations in the Amazon confront infectious diseases like malaria, diarrheal illnesses, and tuberculosis, but they also have some of the highest rates of cervical cancer in the world (Brierley, Suarez, Arora, & Graham, 2914; Fonseca et al, 2015). In addition, indigenous women in the Amazon often have higher rates of unwanted pregnancies and limited access to skilled delivery care (Goicolea, San Sebastián, & Wulff, 2008). This vulnerability is influenced by many factors, including the isolation of the populations, but also by prejudice, climate change, and deforestation. As well as a general concern about access to quality healthcare, there is also a growing concern for the susceptibility of "virgin soil" populations as their contact with the outside world increases (Brierley et al, 2014; Walker et al, 2015). If these populations are exposed to novel disease to which they have no immunity, the consequences could be catastrophic, as illustrated by the significant decrease in the indigenous population due to the introduction of new diseases to the Americas in the early 1500s. There is not a consensus on how much of the decrease in the indigenous population was due to diseases not endemic to the Americas, but some estimates are as high as 90 percent (Cueto & Palmer, 2015).

In addition to their isolation, indigenous populations are becoming more vulnerable as climate change worsens and as deforestation continues. In Peru, for example, new challenges associated with climate change—unprecedented flooding alternating with extremely low water levels—have even further isolated communities that primarily travel by canoe (Brierley et al, 2014). In addition, logging and other environmentally detrimental practices have recently been shown to negatively impact the physical health of indigenous populations (Bauch, Birkenbach, Pattanayak, & Sills, 2015). These impacts have been limited mostly to diarrheal diseases; however, there is also evidence of mental health impacts in certain areas caused by the influx of cultural outsiders into communities (Izquierdo, 2005).

Cultural differences in perceptions of health have been an important topic of research as they can both contribute to the vulnerability of indigenous populations and impact how public health interventions are received. On one hand, many view cultural preferences for traditional healing methods as preventing members of these populations from accessing effective treatment for diseases like tuberculosis (Brierley et al, 2014). On the other hand, the effectiveness of some herbal remedies is widely recognized, and it is not always a preference for traditional healing that prevents people from accessing biomedical care. Rather, other cultural differences frequently contribute to a rejection of biomedical care because it does not accommodate certain needs and preferences or because of alienation caused by the sterility and foreignness of the environment (Goicolea et al, 2008; Johnson, 2010).

In addition, some cultural differences lead to a rejection of biomedical care because communities have felt that such care has detrimentally affected their health. For example, biomedical indicators show that the physical health of the Matsigenka of Peru has significantly improved over the past 20-30 years. However, the Matsigenka—who link health to fundamental ideas about happiness, productivity, and goodness—perceive that their health has, in fact, declined during this period. The Matsigenka attribute this decrease in their health to sorcery and stressors imposed by outsiders who enter their community, like missionaries, school teachers, and health personnel. Public health interventions like hand washing campaigns and other sanitation efforts are seen to directly decrease the health of the community (Izquierdo, 2005).

Indigenous knowledge of herbal remedies has received a lot of scholarly and corporate interest because of the potential pharmaceutical benefits associated with some remedies and plants. Much of the scholarly work revolves around the historic exploitation of indigenous populations and lands for labor and natural resources. More recently, corporations have become interested in Amazonian biodiversity as a potential source for pharmaceutical development. In 1998, several companies predicted a gain of US$43 billion per year from sales of pharmaceuticals derived from natural plants. Companies have also begun to explore ways to use indigenous medical knowledge, with one company predicting a 40 percent decrease in research and development costs if indigenous knowledge was used (Addison Posey, 1998). This willingness to exploit indigenous knowledge and resources for corporate gain, generally called biopiracy, has continued to be problem into the 21st century, with many outside companies obtaining patents on specific Amazonian plants in the early 2000s. For example, Aveda, a North American company, has a patent on the copaiba tree, and The Body Shop, a British corporation, has one on the cupuacu fruit, both plants native to the Amazon. Many companies have used traditional knowledge to identify and access these plants, without providing any compensation to indigenous communities for their knowledge nor the exploitation of their environment. Brazil especially has filed cases against corporations for patents such as these, and there have been several international meetings and agreements on biopiracy (Danley, 2012).

The practice of biopiracy stems from a long history of dehumanization and marginalization in Latin America and other areas. Although frequently acknowledged as a harmful and unjust act, biopiracy is neither a tort nor a crime, meaning that many communities have little to no avenues of redress available to them in cases of biopiracy (Nagan, Mordujovich, Otvos, & Taylor, 2010). International attention was called to biopiracy in the early 1990s, and there has been a growth in efforts to both problematize biopiracy and address it as a serious issue in the Amazon. However, despite the developing international regulations surrounding biopiracy, large corporations have continued to find ways to exploit indigenous knowledge and biodiversity (Nagan, Mordujovich, Otvos, & Taylor, 2010; Danley, 2012).

In light of the vulnerability and marginalization of indigenous populations, there have been attempts made, particularly in Bolivia and Brazil, to integrate indigenous peoples into national health systems. On a broad scale, local public health physicians in certain urban areas of the Amazon have drawn on scientific plant knowledge to better understand and treat indigenous patients in clinical settings (Wayland, 2003). In Bolivia, use of malaria nets and mosquito repellants increased when they were made with plant-based materials and were locally produced. Not only were these methods of mosquito control more culturally acceptable, they were also more cost effective, which increased compliance among indigenous groups and other marginalized populations (Moore, Hill, Ruiz, & Cameron, 2007).

Bolivia also offers a more institutionalized example of a government that has attempted to integrate indigenous populations and their healing methods not only into society as a whole, but also into the medical system. This process began with the election of President Evo Morales in 2006, Bolivia’s first indigenous president and leader of the Movement Towards Socialism, which aims to address racism, colonialism, and human rights with a focus on cultural identity and indigeneity (Bernstein, 2017). With the creation of the Vice Ministry of Traditional Medicine and Interculturality and the development of training programs that emphasize the histories and cultures of indigenous peoples and their healing methods, Bolivia is working towards decolonizing medicine and providing quality care that remains culturally appropriate to all its citizens. As part of this effort, a number of indigenous students have received scholarships to study medicine at the Latin American School of Medicine in Cuba, with the idea that once they have received their education they will return to their communities to work as doctors (Johnson, 2010). However, even these efforts, which have been the most developed and institutionalized in Latin America, have fallen short of fully integrating indigenous peoples and medicine into Bolivia’s health system. The Vice Ministry has historically made little national headway, with most results being at a regional level, and the implementation of many programs have been particularly scarce in the Amazon region, demonstrating a lack of connection between theory and reality and a prioritization of highland indigenous groups (Johnson, 2010; Bernstein, 2017).

Brazil is another example of an Amazonian country that has significantly reformed its health system, though the extent to which the reforms have integrated indigenous populations into the health system remains to be seen. Civil society in Brazil has been the driving force behind such reforms, advocating for a restructuring of the health system with an emphasis on health as a human right that should be universally available. In the 1990s, Brazil developed the Unified Health System, which aims to provide comprehensive preventative and curative care to all sectors of the population (Paim, Travassos, Almeida, Bahia, & Macinko, 2011). Eventually, Brazil also implemented an Indigenous Health Subsystem that decentralized management of basic health services to 34 Special Indigenous Health Districts while maintaining national oversight and organization for more complex health issues. This approach has frequently led to more in-depth, community oriented health provision and highlights the importance of tailoring health services to the communities and cultures of the people they are treating, acknowledging that the indigenous populations of Brazil experience health and medicine in a different way than other, more represented groups (Coelho & Shankland, 2011). Despite this progress, the recently elected president, Jair Bolsonaro, has, as of 2019, decided to eliminate the Special Secretary for Indigenous Health, leaving healthcare provision responsibilities entirely in the hands of local councils and removing any national accountability or interest. Bolsonaro has also dismantled the National Foundation for the Indigenous, which was the government body responsible for protecting indigenous communities in Brazil. These decisions by Bolsonaro have provoked outrage from indigenous activists group, who have been protesting Bolsonaro’s demonstrated disregard for indigenous health rights amid increases in land grabs and violent attacks (Alberti, 2019).

The situations in both Bolivia and Brazil demonstrate that, although there have been attempts made to provide culturally appropriate, quality healthcare for indigenous populations in the Amazon, the fact remains that these populations face many barriers to access. These barriers can include physical isolation, marginalization, climate change, deforestation, and cultural differences. Physical isolation and cultural differences seem to be the most cited reasons for health disparities among indigenous populations, but it is important to acknowledge that many of these barriers are interconnected. In addition, the consequences of some, like climate change, deforestation, and biopiracy may not be fully understood until several more years or decades have passed.

As governments and organizations work to overcome these barriers to access and provide adequate healthcare, it is important that they consider the desire of most indigenous groups for political autonomy and control. While these aims are by no means mutually exclusive, it has been historically difficult for governments to provide indigenous groups with public services while respecting their right to and desire for political autonomy. In terms of health services, it certainly seems like Brazil approached an appropriate compromise with its Indigenous Health Subsystem that provided care and resources to indigenous groups while leaving management at a local level. With enough community involvement, this system would ideally allow indigenous groups to maintain most of their autonomy while still being supported by the state in the same way as the rest of its citizens. However, as is clear, this system did not last forever, and political power changes have had extremely detrimental effects on the progress that Brazil has made towards creating a health system that balances the rights of its indigenous citizens to healthcare with their rights to political autonomy. However, this system could still function as an example to other countries with large indigenous populations, especially Amazonian countries, as they consider the health of their indigenous populations.

Related Articles

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Additional Resources

Coimbra Jr., C.E.A., Santos, R.V., Welch, J.R., Cardoso, A.M., Carvalho de Souza, M., Garnelo, L., Rassi, E., Follér, M.-L., and Horta, B.L. (2013). The First National Survey of Indigenous People’s Health and Nutrition in Brazil: Rationale, methodology, and overview of results. BMC Public Health, 13(52).

Crosby, A.W. (1972). The Columbian Exchange: Biological and cultural consequences of 1492. Westport: Greenwood Publishing Group.

Lovell, W. G. (1992). “Heavy shadows and black night”: Disease and depopulation in colonial Spanish America. Annals of the Association of American Geographers, 82(3), 426-443.

Mann, C.C. (2005). 1491: New revelations of the Americas before Columbus. New York City: Alfred A. Knopf.

Pedrollo, C.T., Kinupp, V.F., Shepard Jr., G., and Heinrich, M. (2016). Medicinal Plants at Rio Jauaperi, Brazilian Amazon: Ethnobotanical survey and environmental conservation. Journal of Ethnopharmacology, 186, 111–124.

Williamson, J., Ramirez, R., and Wingfield, T. (2015). Health, Healthcare Access, and Use of Traditional Versus Modern Medicine in Remote Peruvian Amazon Communities: A descriptive study of knowledge, attitudes, and practices. The American Journal of Tropical Medicine and Hygiene, 92(4), 857–864.

References

Addison Posey, D. (1998). Biodiversity, Genetic Resources, and Indigenous Peoples in Amazonia: (Re)Discovering the wealth of traditional resources of native Amazonians. Prepared for ILAS’ 1998 conference AMAZONIA 2000: Development, Environment, and Geopolitics. London.

Alberti, M. (2019, April 26). Indigenous Groups in Brazil March for Land Rights. Al Jazeera. Retrieved from https://www.aljazeera.com/

Bauch, S.C., Birkenbach, A.M., Pattanayak, S.K., and Sills, E.O. (2015). Public Health Impacts of Ecosystem Change in the Brazilian Amazon. Proceedings of the National Academy of Sciences of the United States of America, 112(24), 7414–7419.

Bernstein, A. (2017). Personal and Political Histories in the Designing of Health Reform Policy in Bolivia. Social Science & Medicine, 177, 231–238.

Brierley, C.K., Suarez, N., Arora, G., and Graham, D. (2014). Healthcare Access and Health Beliefs of the Indigenous Peoples in Remote Amazonian Peru. The American Journal of Tropical Medicine and Hygiene, 90(1), 180–183.

Coelho, V. and Shankland, A. (2011). Making the Right to Health a Reality for Brazil’s Indigenous Peoples: Innovation, decentralization, and equity. MEDICC Review, 13(3), 50–53.

Cueto, M. and S. Palmer. (2015). Public Health in Latin America: A History. New York: Cambridge University Press.

Danley, V. (2012). Biopiracy in the Brazilian Amazon: Learning from international and comparative law successes and shortcomings to help promote biodiversity conservation in Brazil. Florida A&M University Law Review, 7(2), 291–327.

Fonesca, A.J., Taeko, D., Chaves, T.A., Amorim, L.D.d.C., Murari, R.S.W., Miranda, A.E., Chen, Z., Burk, R.D., and Ferreira, L.C.L. (2015). HPV Infection and Cervical Screening in Socially Isolated Indigenous Women Inhabitants of the Amazonian Rainforest. PLOS One, 10(7).

Goicolea, I., San Sebastián, M., and Wulff, M. (2008). Women’s Reproductive Rights in the Amazon Basin of Ecuador: Challenges for transforming policy into practice. Health and Human Rights, 10(2), 91–103.

Izquierdo, C. (2005). When “Health” Is Not Enough: Societal, individual and biomedical assessments of well-being among the Matsigenka of the Peruvian Amazon. Social Science & Medicine, 61, 767–783.

Johnson, B.B. (2010). Decolonization and Its Paradoxes: The (re)envisioning of health policy in Bolivia. Latin American Perspectives, 37(3), 139–159.

Moore, S.J., Hill, N., Ruiz, C., and Cameron, M.M. (2007). Field Evaluation of Traditionally Used Plant-Based Insect Repellents and Fumigants Against the Malaria Vector Anopheles darlingi in Riberalta, Bolivian Amazon. Journal of Medical Entomology, 44(4), 624–630.

Nagan, W.P., Mordujovich, E.J., Otvos, J.K., and Taylor, J. (2010). Misappropriation of Shuar Traditional Knowledge (TK) and Trade Secrets: A case study on biopiracy in the Amazon. Journal of Technology Law & Policy, 15, 9–64.

Paim, J., Travassos, C., Almeida, C., Bahia, L., and Macinko, J. (2011). The Brazilian Health System: History, advances, and challenges. The Lancet, 377(9779), 1778–1797.

The Amazon Basin Rainforest. (n.d.). Retrieved from https://globalforestatlas.yale.edu/region/amazon.

The Story of…Smallpox—and other Deadly Eurasian Germs. (n.d.). Retrieved from https://www.pbs.org/gunsgermssteel/variables/smallpox.html.

Walker, R.S., Sattenspiel, L., and Hill, K.R. (2015). Mortality from Contact-Related Epidemics Among Indigenous Populations in Greater Amazon. Scientific Reports, 5.

Wayland, C. (2003). Contextualizing the Politics of Knowledge: Physicians’ attitudes toward medicinal plants. Medical Anthropology Quarterly, 17(4), 483–500.