Integrating Traditional Indigenous and Western Medicine into Nicaragua’s Health Systems
M
yrna Cunningham is the first Miskitu doctor in Nicaragua. She is part of the Center for Autonomy and Development of Indigenous Peoples in Nicaragua and currently chairs the Fund for Development of Indigenous Peoples of Latin America and the Caribbean. Shaldon Ferris (Khoisan), Cultural Survival Indigenous Rights Radio producer, recently interviewed Cunningham.
Cultural Survival: You have helped build healthcare, judicial, and governance systems based on traditional Indigenous knowledge in the North Caribbean Coast Autonomous Region of Nicaragua. What do those look like? Myrna Cunningham: In Nicaragua and specifically in our
autonomous region, we have organized a family and communal-based model of a health system. In each area, a specific sector with a health facility is responsible for a certain number of families in a community. This health system is in our autonomous region, which recognizes collective rights of Indigenous Peoples, Afrodescendants, and ethnic communities. The autonomy law recognizes our Traditional medicine and the traditional health systems. There is coordination among
Myrna Cunningham
the Ministry of Health, our traditional health systems, the families, and communities. Traditional healers are part of this health system. There is also coordination between traditional and customary law in communities with the national legislation. Health, education, judicial administration, and land management are under the administration of the communities and in the customary law system. All of these areas coordinate with the rest of Nicaragua to try to have respectful arrangements. We have three levels of governance including a regional autonomous government composed of a regional council of 48 members elected by ethnicity. Under the regional parliament we have different secretaries responsible for health, education, production and development, and the environment. Our autonomous government coordinates with the national government, and we have our own legislative system. In our region, we have about 300 Indigenous communities. They have their own customary governance systems. They elect their own authorities and these authorities are recognized by their autonomous government. They have control of their territories and their natural resources; forestry, mining, and health are under their administration. Traditional medicine is recognized in our autonomous region, so the health system has the obligation to integrate it. Over the last several years, we have been working on a model of intercultural autonomous health systems where there is coordination between Traditional medicine and Western medicine. CS: Tell us about your journey toward becoming the first Miskitu doctor in Nicaragua. MC: I’m from a region that is very isolated on the border be-
tween Honduras and Nicaragua. We did not have a high school in my community, so I had to go to boarding school for my high school education. I worked as a teacher before I got a scholarship to go to medical school, which was on the other side of Nicaragua. After I graduated as a doctor I came back to work in my community, but I did not know much about Traditional medicine. I became the only doctor in a hospital that covered more than 300 Indigenous communities. It was then that I realized that there were diseases that I did not learn about at the university, and I realized that I had to coordinate with the traditional healers. That’s when my journey as a doctor respecting Traditional medicine started. My first [experience with this] was for patients who were bitten by snakes; I didn’t have any other treatment and they needed to be treated by traditional healers. I did my specialty in surgery but I realized that surgery was not enough to address traditional health issues, so I did more training in public health. Since then I have focused on how to build intercultural health
24 • www. cs. org
All photos by Teresita Orozco Mendoza.
