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This paper describes efforts by public health practitioners to address a health crisis caused by economic development policies that are unrestrained by either environmental, public health, or human rights mandates. Economic development projects funded by international funding institutions like the Inter-American Development Bank that reduce poverty when measured in terms of Gross Domestic Product (GDP) per capita in the transborder region between Suriname and French Guiana harm minority populations where commercial activities destroy, alter, and remove the resources upon which local communities depend. In this study, the structural causes of a community health crisis affecting Indigenous people in the transborder region between Suriname and French Guiana was addressed by seeking gatekeepers in government who have access to policy-making processes. We found that deeply rooted economic development policies structured social, economic, and political alliances and made them resistant to feedback and reform. We concluded that work must be focused beyond the simple exchange of public health information. Public health practitioners must become politically active to create new policy commitments and new patterns of governance that advance development as well as improve health outcomes. Failure to do so may result in public health practitioners becoming 'engaged followers' that are complicit in the inhumanity that springs from their acquiescence to the authority of government officials when their policies are the cause of preventable death, disease, and disability.

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BACKGROUND: Previous studies found that while internationally financed economic development projects reduced poverty when measured in terms of per capita GDP, they also caused indigenous people to become disassociated, impoverished and alienated minorities whose health status has declined to unacceptable lows when measured in terms of mercury poisoning and the burgeoning rate of suicide. In this study, we developed a needs assessment and a policy-oriented causal diagram to determine whether the impaired health of the people in this region was at least partially due to the role the country has played within the global economy. Specifically, could the health and well-being of indigenous people in Suriname be understood in terms of the foreign investment programs and economic development policies traceable to the Inter-American Development Bank's Suriname Land Management Project. METHODS: Interviews took place from 2004 through 2015 involving stakeholders with an interest in public health and economic development. A policy-oriented causal diagram was created to model a complex community health system and weave together a wide range of ideas and views captured during the interview process. RESULTS: Converting land and resources held by indigenous people into private ownership has created an active market for land, increased investment and productivity, and reduced poverty when measured in terms of per capita GDP. However, it has also caused indigenous people to become disassociated, impoverished and alienated minorities whose health status has declined to unacceptable lows. While the effects of economic development programs on the health of vulnerable indigenous communities are clear, the governance response is not. The governance response appeared to be determined less by the urgency of the public health issue or by the compelling logic of an appropriate response, and more by competing economic interests and the exercise of power. CONCLUSION: The health and well-being of the indigenous Wayana in Suriname's interior region is at least partially due to the role the country has played within the global economy. Specifically, the health and well-being of indigenous people in Suriname can be understood to be a result of foreign development bank-funded projects that drive the government of Suriname to trade land and natural resources on the global market to manage their country's balance of payments.

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This paper addresses the merits of public health activism that advocates for social change in which health is the outcome of interest. We acknowledge that while efforts at the individual level are important, social network models consider the underlying mechanisms that lie outside the public health sector. This paper considers the inequitable health of Indigenous people who bear a disproportionate share of the negative health consequences due to economic development programs that follow an assimilation model. This paper discusses a combination of theoretical constructs to understand and solve the problems at hand. It concludes that while the attention paid to technological and behavioral solutions at the individual level yields important health outcomes, attention should also be paid to structural causes that address social, political and economic barriers to prevent disease, disability and premature death.

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The indigenous Wayana community of Puleowime (Apetina) in Suriname is susceptible to the effects of mercury because they consume large amounts of fish compared to mainstream communities. Small-scale and artisanal gold mining activities occur at numerous sites in eastern and southeastern Suriname placing the Wayana at risk from exposure to mercury released into the environment. A previous community-led risk assessment study showed that the Wayana were at a high lifetime risk of adverse effects from exposure to mercury. Subsequent to this earlier study, the residents of Puleowime requested assistance in a community-led follow-up research project to determine for themselves whether there were health impacts associated with exposure to mercury contamination. Neurotoxic effects consistent with methylmercury exposure were documented in an exposed population through a battery of neurological tests. Although the specific motor and cognitive batteries were not exactly the same, similar associations were observed between neurologic impairment and hair mercury concentrations compared to other studies in the Amazonia region where mean hair mercury levels were in the subacute range.

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This study was a collaboration between Western public health researchers and Suriname indigenous communities. The question asked was "how can Western researchers effectively engage traditional indigenous communities in Suriname, South America, in public health research". The approach used a combination of Participatory Action Research methods in which "Western" researchers became participating observers in an indigenous-led research initiative. The Wayana communities of Puleowime (Apetina) and Kawemhakan (Anapayke) defined a single objective: determine for themselves whether they are at risk from exposure to mercury (Hg) contamination. Community members collected hair samples for analysis. Hair samples were analyzed using a portable Hg analyzer. Individual, community and hazard quotient indices were used to quantify risk. Results showed the Wayana were at a high lifetime risk of adverse effects from exposure to Hg. This study showed that the community-led approach is an effective way Westerners can engage indigenous communities and address serious public health threats. While factors that appealed to indigenous communities were identified, obstacles inherent to Western research methodology were also encountered.

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OBJECTIVES: The overarching objective of this project was to support the indigenous people in Kwakoegron, Suriname, in self-diagnosis of public and environmental health problems. The specific objectives, defined by the people of Kwakoegron were: (1) to determine for themselves if they are at risk of exposure to mercury (Hg) contamination, (2) to measure the extent of the Hg contamination problem, and (3) to initiate an intervention plan. METHODS: Field work was conducted from June 2005 to April 2006. Community members were trained to collect hair samples for analysis using methods designed to maximize sample quality and consistency and minimize cross-contamination. Each hair sample, of approximately 20 mg, was weighed, added to the sample boat, and analyzed immediately without preservation or storage. Technicians educated in analytical chemistry and trained in the operation of the portable Lumex Zeeman Hg analyzer measured the total Hg (THg) for each hair sample. Confidential meetings were held with each person sampled and any questions were answered. Afterwards, a community meeting was held to reflect on the process, outcome, and future needs. RESULTS: Hair samples from 16 of the 22 participants had Hg levels of 2.2-20.2 microg/g THg, exceeding normal THg levels for hair (2 microg/g THg). During the confidential, individual meetings and the followup community meeting, information was shared regarding the Hg levels found, what the numbers meant scientifically, what the potential health effects could be, and how exposure levels might be brought down. At the conclusion of the followup meeting, the Kwakoegron community proposed an intervention plan that had three principle parts: (1) routine analysis of Hg exposure to monitor trends and track the effects of exposure-reduction efforts; (2) routine health assessments to determine the effects of Hg exposure, particularly in children less than 5 years of age; and (3) fish advisories based on fish biology and trophic level or on the specific measurement of Hg levels in various fish species from various locations and different times throughout the year. CONCLUSIONS: This project showed that a democratic approach to science does not automatically compromise the orderly search for answers. Specifically, our experience in Kwakoegron suggests that the collaborative relationship that emerges by empowering an indigenous community to initiate its own research projects, and address the needs it identifies, can contribute positively to the risk assessment process. This project showed that when Kwakoegron was acknowledged as an equal partner, the risk assessment process led to an open exchange of information and an intervention plan that was both pragmatic and acceptable in the context of the community's unique social and cultural needs.

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OBJECTIVES: The overarching objective of this project was to support the indigenous people in Kwakoegron, Suriname, in self-diagnosis of public and environmental health problems. The specific objectives, defined by the people of Kwakoegron were: (1) to determine for themselves if they are at risk of exposure to mercury (Hg) contamination, (2) to measure the extent of the Hg contamination problem, and (3) to initiate an intervention plan. METHODS: Field work was conducted from June 2005 to April 2006. Community members were trained to collect hair samples for analysis using methods designed to maximize sample quality and consistency and minimize cross-contamination. Each hair sample, of approximately 20 mg, was weighed, added to the sample boat, and analyzed immediately without preservation or storage. Technicians educated in analytical chemistry and trained in the operation of the portable Lumex Zeeman Hg analyzer measured the total Hg (THg) for each hair sample. Confidential meetings were held with each person sampled and any questions were answered. Afterwards, a community meeting was held to reflect on the process, outcome, and future needs. RESULTS: Hair samples from 16 of the 22 participants had Hg levels of 2.2-20.2 µg/g THg, exceeding normal THg levels for hair (2 µg/g THg). During the confidential, individual meetings and the followup community meeting, information was shared regarding the Hg levels found, what the numbers meant scientifically, what the potential health effects could be, and how exposure levels might be brought down. At the conclusion of the followup meeting, the Kwakoegron community proposed an intervention plan that had three principle parts: (1) routine analysis of Hg exposure to monitor trends and track the effects of exposure-reduction efforts; (2) routine health assessments to determine the effects of Hg exposure, particularly in children less than 5 years of age; and (3) fish advisories based on fish biology...

OBJETIVOS: El objetivo central de este proyecto fue apoyar al pueblo indígena de Kwakoegron, Suriname, a hacer su propio diagnóstico de los problemas de salud pública y ambiental. Los objetivos específicos, definidos por la población de Kwakoegron fueron: 1) determinar por sí mismos si están en riesgo de exposición a la contaminación por mercurio (Hg), 2) medir la magnitud del problema de la contaminación con Hg, y 3) comenzar un plan de intervención. MÉTODOS: El trabajo de campo se realizó entre junio de 2005 y abril de 2006. Se entrenó a miembros de la comunidad para tomar muestras de pelo para el análisis mediante métodos diseñados para optimizar la calidad y la consistencia de la muestra y minimizar la contaminación cruzada. Cada muestra de pelo, de aproximadamente 20 mg, se pesó, se colocó en el bote de muestras y se analizó inmediatamente sin conservar o almacenar. Un técnico en química analítica entrenado en la operación del analizador portátil de Hg de Lumex Zeeman midió el Hg total (THg) de cada muestra de pelo. Se realizaron conversaciones confidenciales con cada persona muestreada y se respondieron sus dudas. Luego se realizó una reunión con la comunidad para exponer el proceso, los resultados y las necesidades futuras. RESULTADOS: Las muestras de 16 de los 22 participantes tenían niveles de THg de 2,2-20,2 mg/g, superiores a los niveles normales de THg en pelo (2 mg/g). En las conversaciones confidenciales individuales y en la reunión de seguimiento con la comunidad, se informó sobre los niveles de Hg encontrados, su significado desde el punto de vista científico, los posibles efectos para la salud y cómo se pueden reducir los niveles de exposición. En las conclusiones de la reunión de seguimiento, la comunidad de Kwakoegron propuso un plan de intervención que contaba con tres partes principales: 1) análisis periódicos de la exposición al Hg para monitorear la tendencia y los esfuerzos hechos para reducir la exposición; 2)...

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