Berkley Center

What do you get when you put a couple dozen public health officials and indigenous community leaders in the same room for a day? This is essentially what Ecuador is doing with a new program in which various actors are working together to create yearly and 10-year health plans, to be implemented as joint responsibilities of the communities, government, and nonprofit organizations. The answer is that you get very interesting discussions on health, identity, and self-governance.

A month ago I visited the community of Colta, near the city of Riobamba in the central highlands, to observe a meeting in which the participants established their yearly priorities. This community is roughly three-fourths indigenous and largely rural, despite its proximity to the city.

Health challenges here are numerous; the community faces traditional problems such as water-borne and contagious diseases, parasites and other gastrointestinal problems, difficult childbirth, malnutrition, and respiratory illnesses. At the same time, people are threatened by modern problems like cancer as a result of pesticides in agriculture, traffic accidents, and degenerative diseases of old age.

The goal of this program is to address the most prevalent causes of morbidity and mortality through an equitable partnership with the people themselves. This allows solutions to account for cultural and medicinal traditions and other indigenous priorities. As such, important actors in this initiative include a yachak, an elder with responsibilities that include reverence toward ancestors, the overall well-being of the community, and care for parteras (midwives). These leaders work closely with an intercultural health official from the Ministry of Health.

One innovative project involves creating space in Western-style hospitals for parteras so that indigenous women can give birth a hospital. This allows them to be in a safe, sterile environment where modern medical help can be provided if necessary, while also fostering the use of traditional health services that make women feel comfortable and valued. At the same time, it protects the work of parteras and recognizes their importance in the communities by placing them side-by-side with doctors.

Another program is directed toward promoting the raymis, festivals that occur four times a year on the solstices and equinoxes. These festivals, especially the summer Inti Raymi, are considered necessary to the welfare and cultural vitality of indigenous communities. But these pueblos often face financial difficulties, so the Ministry of Health is providing small amounts of funding and technical assistance to assist in the continuation of the ramyis. Some may ask why the health agency and not the Ministry of Culture is involved in this effort. How can a festival solve pressing modern health problems?

I believe this effort is important for the success of the whole intercultural project. One point brought up during the meeting was the fact that the information provided on health problems is almost entirely from a Western perspective. We often have a very limited notion of health that tends to focus on physical illness, rather than a broader conception of preventative health, mental and spiritual health, and well-being. For example, if the doctors say that the biggest problem in an area is respiratory illnesses caused by the lack of ventilated stoves in dwellings, but the community has determined their biggest problem is the lack of access to suitable land for agriculture, we won’t get anywhere without acknowledging the importance of both issues.

For many indigenous peoples in Ecuador, the raymis are an essential component of the community’s welfare. It is not the government’s right to tell such a large portion of the country’s population that their priorities do not merit any support.