Knowledge Dialogues
A fundamental element to guarantee the implementation of the intercultural approach in health plans, programs and services is the generation of horizontal intercultural dialogues based on respect and mutual understanding between the health systems and models of indigenous, Afro-descendant, Roma and other ethnic populations and the national health model (allopathic/Western) of the countries.
Intercultural dialogue implies recognition of cultural diversity, of the other without barriers or social distinctions (1); it is understood as a dialogue in search of consensus between different cultures and their medical practices (2); it seeks recognition and respect for the differences existing between cultures in the field of health and disease (3).
In some countries of the Americas region, intercultural dialogues have become meeting spaces between representatives of ethnic communities and institutional health services personnel -usually with the support of a facilitator- in order to: generate intercultural health models that incorporate elements of traditional medicines (Panama) (4), reduce cultural barriers and discrimination against traditional therapists (Guatemala) (5), regain the confidence of ethnic populations to communicate their knowledge (Argentina) (6), reach agreements and enable mutual learning (Peru) (7).
Also, in some countries, such as Peru, intercultural dialogue, as a methodological tool, is not exclusive to the health sector, since it implies an “…open and respectful exchange of opinions between people and groups with different ethnic, cultural, religious and linguistic traditions and origins, in a spirit of mutual understanding and respect”. (8).
According to the Pan American Health Organization PAHO/WHO, “dialogues of knowledge, also called intercultural dialogues, are processes of communication and exchange between persons, groups or communities coming from different origins or cultures. In the case of the health sector, exchanges take place between certain groups or individuals and trained health personnel. Their objective is, among others, to improve access to health services and to build intercultural health, with emphasis on the resolution of previously posed problems and their causes, mutual understanding and the creation of solid links” (9).
For this reason, within the framework of the Policy on Ethnicity and Health, PAHO recommends that the countries of the Americas, in the priority line of recognition of ancestral knowledge and traditional and complementary medicine, promote the dialogue of knowledge as a useful tool for the institutions and entities of the health sector to plan joint actions with indigenous, Afro-descendant, Roma and other ethnic populations, develop intercultural health policies, implement intercultural health models or advance sociocultural adaptations in health services (10).
To advance these dialogues, the officials of the health institutions of the countries of the region and those who become the facilitators of these dialogues must be willing to recognize and respect the existing cultural differences, as well as the different conceptions and logics of the health systems of these populations and enable the participation in them, not only of the people designated by these populations for the dialogue, but also of their own health personnel (such as physicians or traditional therapists, midwives, health promoters, intercultural facilitators, among others) (11).
Since 2021, PAHO has been conducting, among others, dialogues of knowledge with midwives and birth attendants in Bolivia, Colombia, Ecuador, Honduras and Peru on topics related to family planning, prenatal control, identification of danger signs and childbirth care, showing how the combination of traditional medicine and Western medicine can help solve health problems and improve the living conditions of the population.
More information on the methodology to carry out these dialogues of knowledge can be found in the following documents published by PAHO: Methodology of the Dialogues of Knowledge and Methodology of the Dialogues of Knowledge. Manual for facilitators.
On the other hand, in the Andean Intercultural Health Policy of ORAS CONHU and as a strategic line of its action plan, the importance of carrying out these intercultural dialogues is highlighted in order to advance, in a participatory manner with ethnic populations, actions for mainstreaming the intercultural approach in health plans and programs (12).
Thus, the ORAS, on October 28, 2021, in the framework of the Andean Plan and the Andean Intercultural Health Policy and the Andean Policy of Intercultural Health and the Andean Health Plan of the Andean Community (13).
Thus, on October 28, 2021, within the framework of the Andean Plan and the Andean Intercultural Health Policy and the PAHO Policy and Plan of Action on Ethnicity and Health, ORAS held a webinar on the topic of dialogues of knowledge with the participation of PAHO and experts from the Ministries of Health of Bolivia, Ecuador and Peru, highlighting the contribution of traditional medicines to improving the quality of life of ethnic populations.
References.
1. Agudelo Ortiz, Diana Marcela. Salud intercultural. Encrucijadas del vivir bien y el sumak kawsay en Bolivia y Ecuador. Tesis Maestría En Estudios de la Cultura, Mención en Políticas Culturales. 2014. [Internet] 108 pp. Disponible en: https://repositorio.uasb.edu.ec/handle/10644/4268
2. Campos Navarro, Roberto. “Experiencias sobre salud intercultural en América Latina”, en Salud e Interculturalidad en América Latina. Antropología de la Salud y Crítica Intercultural”. [Internet] 2004 Abya-Yala/UCLM/AECI/FCSICIII/JCCM, p. 129-151:129. Disponible en: https://dialnet.unirioja.es/servlet/libro?codigo=559818
3. Oyarce, Ana Maria. “Política intercultural en salud: elementos de una propuesta”, Primer Encuentro Nacional Salud y Pueblos Indígenas, Saavedra, región de la Araucanía (Chile). 1996. Disponible en:
4. Ministerio de Salud de Panamá. Guía de diálogo intercultural, salud reproductiva. En el marco del Programa de Mejoramiento de la Equidad y Fortalecimiento de los Servicios de Salud (BID 2563/OC-PN) y la Iniciativa Salud Mesoamérica. [Internet] 2015 (BID GRT/HE-13116-PN). Disponible en: https://www.saludmesoamerica.org/sites/default/files/2018-05/1.%20Guia%20Dialogo%20Intercultural.pdf
5. Ministerio de Salud Pública y Asistencia Social de Guatemala. Metodología de Diálogos Interculturales. [Internet] 2019. 28 pp. Disponible en: http://bvs.gt/eblueinfo/GP/GP_003.pdf
6. Ceriani, Sara Victoria (2015). La relevancia del dialogo intercultural en la accesibilidad al sistema de salud en comunidades de pueblos originarios de Formosa. VII Congreso Internacional de Investigación y Práctica Profesional en Psicología XXII Jornadas de Investigación XI Encuentro de Investigadores en Psicología del MERCOSUR. Disponible en: https://www.aacademica.org/000-015/584
7. Ministerio de Salud. Diálogo intercultural en salud: documento técnico, elaborado por Dionisio Astuhuamán, Doris Irene; Portocarrero Gutiérrez, Julio; Salaverry García, Oswaldo. [Internet] 2014. 41 p. Disponible en: https://repositorio.ins.gob.pe/handle/20.500.14196/549
8. Ministerio de Cultura. Diálogo Intercultural. Pautas para un mejor diálogo en contextos de diversidad intercultural. [Internet] Primera edición, abril 2015. Pp46. Disponible en: https://centroderecursos.cultura.pe/es/registrobibliografico/di%C3%A1logo-intercultural-pautas-para-un-mejor-di%C3%A1logo-en-contextos-de-diversidad
9. Organización Panamericana de la Salud. Diálogos de saberes. Página web: https://www.paho.org/es/dialogos-saberes
10. Metodología de los diálogos de saberes. Washington, D.C.: Organización Panamericana de la Salud; [Internet] 2021. Licencia: CC BY-NC-SA 3.0 IGO. https://doi.org/10.37774/9789275324707.
11. Metodología de los diálogos de saberes. Manual para facilitadores. Washington, D.C.: Organización Panamericana de la Salud; [Internet] 2022. Licencia: CC BY-NC-SA 3.0 IGO. https://doi.org/10.37774/9789275324707.
12. Organismo Andino de Salud – Convenio Hipólito Unanue. Política Andina de Salud Intercultural. [Internet] 2019. 2ª edición. 26 pp. Disponible en: https://www.orasconhu.org/es/content/pol%C3%ADtica-andina-de-salud-intercultural