Traditional medicines in emergencies and disasters
Vivian Camacho, Hernán Garcia, Giancarlo Biaggi
The indigenous peoples of the Region of the Americas have historically been subjected to conditions of discrimination and exclusion, and are now facing manifest health inequities in the context of the COVID-19 pandemic.
Indigenous peoples, as living and resilient cultures, rely on traditional ancestral medicine for health care in their territories, as part of their cultural identity and as a strength to live and coexist as a community.
They coexist in multiple territories with institutional conventional medicine and continue to use their ancestral knowledge to heal themselves. For this reason, it is necessary to make visible the points of encounter and dialogue between the two medicines. Within the respect and complementarity of the knowledge that both contribute to the communities.
In the face of the COVID19 pandemic, “it is urgent to know and learn from viable experiences that dialogue and care for the community; strengthening our knowledge and our identity to promote health from the territories, as an integral view of the care of community life, water sources, ecosystems and the human community” 1.
Reference
Camacho, Vivian. Ancestral Traditional Medicine in the intercultural approach to COVID-19. Conference. International Symposium on the contributions of Traditional, Complementary and Integrative Medicines (TCIM) in the context of the Covid-19 pandemic. VHL TCIM Americas, July 2020.
Background
There are commitments from the 2030 Agenda for Sustainable Development so that no one is left behind, the Strategy for Universal Access to Health of the Pan American Health Organization is one of them; within the Policy on Ethnicity and Health of the 29th Pan American Health Conference, intercultural dialogue and the recognition of ancestral knowledge and traditional and complementary medicine are promoted.
The Declaration of Alma Ata (1978) supports the inclusion of traditional medicine to meet the health needs of the community; the Report of the High-Level Commission 40 years after Alma Ata (2019) makes recommendations to guarantee Universal Health as a Human Right, from an approach that takes into account interculturality and ethnicity in health.
Article 24 of the United Nations Declaration on the Rights of Indigenous Peoples states the protection of the right to the highest attainable standard of physical and mental health and guarantees the right of indigenous peoples to access their traditional medicines and maintain their health practices.
The International Labor Organization’s Convention 169 on Indigenous and Tribal Peoples establishes that health services should be organized in cooperation with the peoples concerned, taking into account their healing practices and medicines.
The International Convention on the Elimination of All Forms of Racial Discrimination guarantees the right to public health and medical care without distinction as to ethnic origin.
Indigenous peoples and the gap to be bridged
Indigenous peoples are located in all regions of the world and represent more than 6% of the world’s population. And despite international commitments and agreements signed by Member States to care for and protect them, there is still a huge gap to be filled. Considering factors such as high rates of extreme poverty, social exclusion, high prevalence of communicable and non-communicable diseases, and limited and in some cases no access to health, both in terms of infrastructure, health personnel and lack of culturally appropriate and quality health services to adequately address their ailments (5). This underscores the social and health inequalities that put these populations at risk and that require urgent attention (6). Nevertheless, indigenous peoples possess a wealth of knowledge, traditional practices, natural and cultural resources, and forms of collectivist social organization that provide community resilience in the face of adversity.
In Latin America and the Caribbean, indigenous and Afro-descendant peoples represent 10% and 21% of the population, respectively. Nearly 53 million people belong to more than 700 indigenous peoples in the region. According to census data available for each country and collected up to 2011, Bolivia (62%), Guatemala (41%), Peru (24%), Mexico (15.3%), and Panama (12.3%) are the countries with the highest percentage of indigenous people in relation to the rest of the population (7). Despite this high representation in many Latin American countries, adverse conditions continue to threaten the health of these peoples. These conditions have worsened during the COVID-19 pandemic, making it a real challenge to address this public health problem where, in many cases, there has been no structured plan to deal with this type of circumstance in these populations.
COVID-19 in the indigenous populations of Latin America and the Caribbean
Currently, the COVID-19 pandemic poses a high risk to indigenous peoples, both those living in urban areas and those living in remote or isolated settlements. They are disproportionately affected and constitute a vulnerable population due to pre-existing risk factors such as malnutrition, poverty levels, susceptibility to disease, poor health status, access to social protection and health services, and access to safe drinking water and basic sanitation. These factors may be associated with high morbidity and mortality from COVID-19 (8).
In Latin America, the number of COVID-19 infections in indigenous populations (many of which do not reflect the reality, with underreporting of cases) has increased at an alarming rate. Among the countries with the highest number of confirmed cases in indigenous populations are Brazil (7,946 cases), Mexico (4,092 cases), and Colombia (1,534 cases) (9).
In Peru, the majority of the indigenous Amazon population is affected. Nine indigenous tribes, located mainly in the departments of Loreto, Ucayali and Amazonas in the northern Amazon region of Peru, account for an alarming 90% of the infected indigenous population. There are 3,467 confirmed cases, representing 12.7% of the total number of confirmed cases in these three regions of the Peruvian Amazon. This is particularly serious because they represent a small population (approximately 480,000) compared to the inhabitants of large cities (10).
Nevertheless, it has been observed how indigenous communities have generated intercultural initiatives of considerable importance to face this threat. Protective health mechanisms are evident, knowing how to use their community tools for collective reorganization, as well as the natural/cultural resources available in their geographic context, which has allowed them to ensure the health of their members during the pandemic. This action begins as a social and community empowerment response to a limited health system that does not meet the needs of the population and that, since the beginning of the pandemic, has shown an absence or lack of trained personnel to care for these populations.
It has also been observed that indigenous peoples, by virtue of their socio-cultural organization and their collectivist and naturopathic paradigm, have self-regulatory factors that can ensure community support. This has been demonstrated by the use of numerous medicinal plants and herbal preparations with promising empirical results. This experience, in which we find ourselves, helps us to permeate and begin to look for other sources of health that we have not recognized and that could be of great help to the current health system, in addition to promoting the articulation or interrelationship of both conventional and traditional medical systems, and which can be enhanced in a bidirectional and synergistic way.
Governmental Responses Traditional Ancestral Medicine in the Region of the Americas during the Covid Pandemic19
Most governments’ initial responses focused on implementing health strategies based on foreign models and applied to urban areas, left minority groups, especially indigenous Amazonians, isolated and with little or no information about what was happening. This was due to the limited reach of the health services provided by the state during the pandemic, in addition to a highly complex geography, limited connectivity and a dispersed population organization with low demographic density.
In the case of Peru, 56 days after the beginning of the state of emergency and largely due to protests by indigenous leaders demanding a policy of care for indigenous peoples, “Legislative Decree No. 1489” was approved, which establishes measures for the protection of indigenous peoples within the framework of the public health emergency declared by COVID-19. The purpose of this decree is to establish extraordinary and urgent measures for the care of indigenous peoples in the context of the pandemic. Its purpose is to guarantee the right to quality health care with criteria of cultural relevance and appropriateness. That they can promote health services in the mother tongue, taking into account the specific needs and conditions of indigenous women and men, as well as the geographical, social, cultural and environmental characteristics, taking into account the cosmovisions, as well as the concepts of development, gender, health and well-being of the population. And this can ensure intersectoral articulation mechanisms that allocate services for the care of the indigenous population (11).
In turn, the Peruvian Ministry of Health issued a ministerial resolution at the end of May this year. It authorizes the implementation of the “INTERVENTION PLAN OF THE MINISTRY OF HEALTH FOR INDIGENOUS COMMUNITIES AND RURAL VILLAGES OF THE PERUVIAN AMAZON IN THE EMERGENCY OF COVID-19”, which aims to contribute to the reduction of the adverse effects in the communities and to limit the health, social and economic consequences of the COVID-19 pandemic in the indigenous communities of the Amazon. The main strategy to be used and made available to the indigenous peoples is prevention, in order to avoid the spread of the virus in their localities. This will allow the development of more effective prevention and mobility restriction strategies, with the active participation of the community organization, strengthening the articulation between the health sector and the organized population, respecting their social and intercultural dynamics (12).
Community responses
Among the community responses that stand out for their rapid action and organization is the so-called “Comando Matico”, based in Yarinacochas, department of Ucayali, located in the Peruvian Amazon. This intercultural health initiative of the Shipibo-Conibo indigenous people was born as a community response and empowerment in response to the difficulties of access to health care presented by the indigenous peoples of the Amazon during the Covid-19 pandemic. It serves as a model for the work and implementation of an intercultural health system based on the use of community natural resources and ancestral/ritual practices of traditional medicine combined with the use of Western medications, seeking a coherent relationship that synergistically enhances the action of both types of medicine, and where spiritual and psychological care is also included as an integral part and of great importance for recovery from the disease caused by COVID-19. This model is currently being structured and formalized.
The coordinator of the “Comando Matico” and representative of the Amazonian Shipibo-Conibo community, Jorge Soria, tells us: “We Shipibos are a community based on relationships of union with everything, both with people and with nature and the spirits. When the virus came, we began to see our people falling ill because of the lack of response from the state, so we did not want to wait any longer and decided to follow the principles that are part of our life: reciprocity and solidarity among our brothers, because we are brothers of the same people. We began to talk to the grandparents and the healers of the different communities who kept the knowledge, and we began to understand the virus as a being that has a spirit, so we also performed cleansing rituals and ayahuasca ceremonies to better understand this evil and what it wanted”(13).
The interest of the “Comando Matico” proposal lies not only in the coherent articulation of traditional medicine with conventional medicine, which has served the recovery of more than 600 patients, using the leaves of matico and eucalyptus, onion, ginger, garlic, among others, along with common medicines such as paracetamol or ibuprofen. It has also served as a model and example for other communities to begin to see in their ancestral knowledge, safeguarded by the community elders, the values of their traditional practices and the need to continue developing them as an important part of strengthening their identity as a community, health prevention and managing their own autonomy as a community.
References
- PAHO/WHO 29th Pan American Sanitary Conference/ Policy on Ethnicity and Health https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=29-es-9250&alias=42298-csp29-r3-s-298&Itemid=270&lang=es
- OPS/WHO – FILAC. Health Plan for the Indigenous Youth of Latin America and the Caribbean https://www.paho.org/es/documentos/plan-salud-para-juventud-indigena-america-latina-caribe
- PAHO/WHO Declaration of Alma At https://www.paho.org/hq/dmdocuments/2012/Alma-Ata-1978Declaracion.pdf
- PAHO/WHO Universal Health in the 21st Century: 40 years of Alma-Ata”. Report of the High Level Commission https://iris.paho.org/handle/10665.2/50960
- (Implementation of ILO Indigenous and Tribal Peoples Convention No. 169: Towards an Inclusive, Sustainable and Just Future, p. 21.)
- (COVID-19 and Human Rights. United Nations. April 2020).
- (La salud de los pueblos indígenas y afrodescendientes en América Latina | PAHO Statistical Bulletin 2013).
- (REPORT: THE IMPACT OF COVID-19 IN LATIN AMERICA AND THE UN CARIBBEAN)
- (Pan American Health Organization / World Health Organization. Epidemiological Alert: COVID-19 in indigenous peoples of the Americas, July 15, 2020, Washington, D.C.PAHO/WHO. 2020).
- Alert from official figures: 3,467 covid-19 cases of indigenous peoples located in Loreto, Ucayali and Amazonas. Marlene Castillo Fernández Lima, 23 June 2020. https://caminando.lamula.pe/2020/06/23/alerta-desde-las-cifras-oficiales-3467-casos-covid-19-de-pueblos-indigenas-ubicados-en-loreto-ucayali-y-amazonas/marleamanecer/.
- (LEGISLATIVE DECREE N°1489 – CONGRESS OF THE REPUBLIC OF PERU)
- (Intervention Plan of the Ministry of Health for indigenous communities and rural population centers of the Peruvian Amazon facing the COVID-19 emergency (Ministerial Resolution No. 308-2020-MINSA) – May 2020.
- Excerpt from the interview with Jorge Soria, coordinator of the Comando Mático, during the conference “Dialogues of ancestral knowledge” organized by the Subcommittee of Traditional Medicine and Interculturalism of the Peruvian Medical Association.
Relevant links
Title: Epidemiological Update: COVID-19 in Indigenous Peoples in the Americas – August 5, 2020
Responsible/ Responsible Institution: Pan American Health Organization- PAHO
Title: Indigenous Peoples and the COVID-19 Pandemic: Considerations
Responsible/Institution: Department of Economic and Social Affairs – Indigenous Peoples – United Nations – UN
URL: https://www.un.org/development/desa/indigenous-peoples-es/covid-19.html
Title: Indigenous Peoples and COVID-19
Responsible/ Responsible Institution: United Nations-UNO
URL: https://www.un.org/development/desa/indigenous-peoples-es/covid-19.html
Title: First regional report. Indigenous Peoples facing the COVID-19 pandemic. Observatorio Regional de Derechos de los Pueblos Indígenas Plataforma Indígena Regional frente al COVID-19.
Responsible/Institution in charge: FILAC and FIAY
URL: https://indigenascovid19.red/monitoreo/
Title: Second regional report. Indigenous Peoples facing the COVID-19 pandemic. Communities at Risk and Good Practices. Regional Observatory for the Rights of Indigenous Peoples Regional Indigenous Platform in the face of COVID-19.
Responsible/Institution in charge: FILAC and FIAY
URL: https://indigenascovid19.red/monitoreo/
Title: Memory Virtual Seminar on monitoring experiences in indigenous territories in times of pandemic.
Responsible/Institution in charge: FILAC and FIAY
Title: Actions by COVID-19 and Indigenous Peoples in Latin America
Responsible party/ Institution: CLACSO Working Group Indigenous peoples and extractive projects
URL: https://www.clacso.org/medidas-por-el-covid-19-y-pueblos-indigenas-en-america-latina/
Title: Remedios del monte: Amazonian Indians of Bolivia launch a recipe book of ancestral medicines
Responsible party/ Institution: Fátima Monasterio Mercado
Description: The indigenous vademecum compiles 38 traditional medicines to raise defenses, cure coughs and colds. Through traditional medicines they seek to avoid going to a health post in the city of San Ignacio de Moxos, where there are already two contagions and dozens of suspected cases. The people of Bosque de Chimanes nurture their strategies for the defense of life and make it clear that they will continue to demand that the State fulfill their rights.
URL: https://www.iwgia.org/es/noticias-alerta/noticias-covid-19/3699-debatesindigenas-remedios.html
Title: Coronavirus (Covid-19) from a natural medicine perspective
Responsible persons/ Institution: Fernando Cabal, Mandala ediciones.
Description: Selection of articles on coronavirus from natural medicine and alternative therapies.
Title: The COVID-19 coronavirus from the Traditional Chinese Medicine (TCM) perspective
Responsible persons/ Institution: Fernando Cabal. Mandala ediciones
Description: Selection of articles and papers on the prevention and treatment of coronavirus (COVID-19) from Acupuncture and Traditional Chinese Medicine (TCM).
Title: Medicinal plants of the Mayan people in COVID-19 times.
Responsible/ Responsible Institution: Mayan Communities
Description: The organization Ka’ Kuxtal A.C. from Los Chenes, Campeche, share with us a valuable manual on the use of medicinal plants of the Mayan People to take care of the respiratory system and strengthen the immune system.
URL: https://desinformemonos.org/plantas-medicinales-del-pueblo-maya-en-tiempos-del-covid-19/
Title: Voluntary collective isolation as a better response to COVID-19 for indigenous populations? A case study and protocol from the Bolivian Amazon.
Principal Investigators/ Responsible Institution: Hillard S Kaplan, PhD, Benjamin C Trumble, PhD, Jonathan Stieglitz, PhD, Roberta Mendez Mamany, Maguin Gutierrez Cayuba, Leonardina Maito Moye, Lic.
URL: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31104-1/fulltext
Title: National Action Protocol for COVID-19
Responsible party/ Responsible institution: Ministry of Public Health