RESUMO
BACKGROUND: Detailed qualitative information regarding Indigenous populations' health-seeking behaviours within Peru's plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru. METHODS: Community-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation. RESULTS: Shawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care. CONCLUSIONS: These findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes.
Assuntos
Atenção à Saúde , Política de Saúde , Hispânico ou Latino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Peru , Pesquisa QualitativaRESUMO
Promoting and supporting Indigenous health includes ensuring health services reflect local concepts of health. There is, therefore, a need to better understand context-specific Indigenous understandings of health in order to design culturally appropriate health services. To this end, this study characterized two Shawi communities' understandings of what it means to be healthy. Using a community-based participatory research approach, 40 semi-structured interviews and a series of informal interviews were conducted and analysed thematically, using a constant comparative method. The Shawi definition of health extended beyond individual physical welfare and focused on emotional, collective, and environmental wellbeing. The primary factors underlying Shawi perceptions of health and wellbeing included providing for the family, ensuring the welfare of others, maintaining positive social relationships, preserving traditional values and practices, and living harmoniously with the natural environment. Conversely, Shawi classified illnesses according to their cause or treatment. These included illnesses caused by sorcery, those caused by spirits of the forest, and 'new diseases,' that first appeared in the communities when they were contacted by the Western civilization, for which no traditional remedies existed. Consequently, according to Shawi, sociocultural, environmental, and climatic changes are posing imminent health threats. This study highlights the differences between biomedical and Indigenous Shawi health understandings, and therefore emphasizes the importance of acknowledging and embracing Shawi culture and beliefs within the formal healthcare system.
Assuntos
Serviços de Saúde do Indígena , Nível de Saúde , Pesquisa Participativa Baseada na Comunidade , Atenção à Saúde , Humanos , PeruRESUMO
Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.
Assuntos
Bebidas Alcoólicas/microbiologia , Carga Bacteriana , Enterobacteriaceae/isolamento & purificação , Povos Indígenas , BrasilRESUMO
Land use change (LUC) is a main cause of global environmental change, and is an important activity to be studied. Our research aims to examine the current state of evidence on the link between LUC and human health in the Amazon region. We conducted a scoping review of literature in two research databases, resulting in 14 papers for analysis. Our analysis demonstrated a lack of clear definitions for LUC, a wide variety of negative health effects from LUC, the lack of qualitative articles, a lack of studies exploring the potential positive health effects of LUC, and the predominance of studies coming from the Brazilian Amazon. Our study validated the prevailing idea that LUC can lead to negative health consequences, if not managed properly.