21 minute read
Integrating Indigenous and Western Medicine
Inte grat ing Tradit ional I ndigenous and We ste rn Med icine int o Nicaragua’s He alt h Syste ms
Myrna 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.
I n 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 between 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
systems that do not prioritize Western medicine over Traditional medicine, but promote traditional intercultural health systems in which the two health systems can coordinate and use the strengths of one another to solve the problems in our community.
CS : How is Traditional medicine integrated into mainstream medicine?
MC : First, via the law. The national legislation of the Nicaraguan Health System has a chapter that addresses Traditional medicine and it calls for the Ministry of Health to ensure that it’s integrated. The second way is through the coordination and the organization of the family, community, and health system. This model establishes that the public health system exercises control over each one of the areas in our country, each family, each community. It requires that intersectional teams of health workers exercise their work in one area. We should have midwives, we should have traditional healers; they are part of this team. If a pregnant woman is identified by the team as being in need of being close to the hospital, she can travel and stay in a home that has been created in the different areas for pregnant women waiting to give birth, and she can attend that home with her midwife. If she goes to the hospital, she can give birth with the doctor and the midwife together.
Th e other way in which they coordinate is through epidemiological statistics. We have identified diseases that can only be cured by traditional healers, some of which have a very high epidemic rate. These go on a list of diseases that have to be supervised by the health system. We have a disease, blakira, that can affect a whole community with a collective hysteria. It does not have an explanation in Western concepts of biomedicine. Because it covers so many people and changes life in the community, it is under the epidemiological vigilance system. We have identified at least 35 traditional diseases that can only be cured through traditional healers. There is a fund in the national health system budget to cover the expenses that the traditional healers go through if they have to solve such problems. We have a traditional institute on Traditional medicine at the national level and in some of the regional areas. These institutes document traditional medicines and therapies. They support traditional healers so they can meet and exchange among themselves and sometimes with conventional doctors.
CS : At what point do traditional healers in Nicaragua engage with Western biomedicine, and vice versa?
MC : Traditional healers were very concerned when the first cases of HIV/AIDS appeared. This was a new disease and they did not have a traditional protocol to deal with it. They began to coordinate with Western medicine to see what the other system could do for these types of patients. These new diseases that we are facing are the ones in which I see traditional healers calling on the other health systems. In the cases of maternal health and maternal mortality, we have very strong midwife groups, but sometimes they face problems and call on the Western system, for example when a patient has to go through a caesarean section. These areas are complementary. If you have to strengthen the immune system, traditional healers have some treatments that they use to strengthen your immune system, but sometimes antibiotics are needed. In the example of blakira, psychiatrists, psychologists, or other Western health workers have come in and tried to solve the problem and realized they cannot. They have to call in the traditional healer to come and deal with the bad spirits that are causing that disruption in the community. For traditional healers, a holistic approach is very important. A traditional healer can bring a lot of experience in how to strengthen immune systems, how to gather the community and share the messages with the communities, how to explain what is happening. But, I don’t think traditional healers can work alone with new diseases. We have moved into a world in which the new epidemics that we are seeing require the participation of Traditional and Western medicine together. If we can do that, I think we can solve a lot of problems.
CS : What does the future of Indigenous health look like in your community? What needs to happen to optimize it, from the State as well as from the community itself?
MC : In my community, we need to continue strengthening this model of family and communal health systems rooted in Traditional and Western medicine. If we can really strengthen this, we can foresee or identify new diseases. For example, we have a lot of diabetes, so if we can change the food system, we can help that region decrease the amount of drugs that are used for diabetes. But this requires participation of both systems. We have started training the health workers to understand the two health systems. We have a school of medicine in the university here in the autonomous region that is training intercultural doctors. Nurses and specialists also need to receive an intercultural training. We have to improve the documentation and evidence that can prove that if these two systems work together, things are better. I give you the example of the coronavirus at this moment: in our region, and the whole of Nicaragua, we don’t have all of the technology that is needed to confront a threat of this type. We have to improve our coordination so we can ensure that communities are closed, and once we get a vaccine, they can receive it. If we do not coordinate, this will be impossible to face. We also need to have good reference systems between Traditional and Western medicines and good centers where we can move patients where they are needed; centers in which they will also respect the communities. These are some of the things that we need to strengthen.
Spirituality is an important part of Indigenous health and well being.
Restoring Balance with the Earth Eastern Woodlands Rematriation
Families harvesting reclaimed white flint corn in the Assabet region of Nipmuc homelands.
Photo by Kristen Wyman (Natick Nipmuc).
Now more than ever, centering Indigenous food systems and restoring kinship is necessary to save our planet and the most vulnerable communities from the devastating effects of climate change. To that end, Eastern Woodlands Rematriation (EWR) is working to sustain the spiritual foundation of our livelihoods through Indigenous food and agroecological systems. Our projects are rooted in the reclamation of healthy food, wild medicines, and traditional knowledge through exchange, mutual aid, and apprenticeship within Tribal territories of the Northeast. We focus on local infrastructure needs of their various food cultivation spaces with the goal of building capacity through trust and care to others.
L ed entirely by Indigenous womxn and Two-Spirits, EWR aims to be non-exploitative and regenerative. We believe the process of rematriation supports the expression of our power from within; this expression is reciprocal and in generosity to our relatives. Yet this balanced way of life has been violently tested, limited, and stripped away from our womxn, Two-Spirits, and youth. The trauma of surviving more than 400 years of colonization and genocide has manifested through lateral violence, partner abuse, and high rates of substance abuse and suicide in many of our communities. What we desperately need as womxn and Two-Spirits are spaces to heal, organize, and strategize on ways to escape the colonial systems that are designed to keep us oppressed, unhealthy, and disconnected from the earth and our way of life. In a matriarchal framework, power becomes transformative. Rematriation re-powers our people and allows us to remember that we have what it takes to live healthy, balanced lives. By centering Indigenous womxn and Two-Spirits as medicine people, midwives, and food producers, we are rematriating our food and economic systems in a way that’s more resilient and just.
Th e projects EWR carries out take place throughout New England. In the north, we work with the Maliseet, Mi’kmaq, Passamquoddy, and Penobscot Peoples and families; in the south, we work with Nipmuc, Wampanoag, Massachusett, Narragansett, and Mohegan Peoples and families, as well as urban, mobile, and displaced Native people. One of our primary projects is the Wabanaki Herbalism Apprenticeship Program, which aims to foster exchange, dialogue, and sharing of knowledge of Indigenous health practices with the long-term goal of developing a Tribal community apothecary and trained traditional birth and death practitioners who can serve local communities. By training and convening healers in our communities, we are building and reclaiming ancestral knowledge and making non-pharmaceutical health more accessible while reducing our reliance on pharmaceuticals. The apothecary is a space where we can deliberately assure the continuance of traditional healers.
Given that the apothecary plays such an essential role in the community, expanding the number of trained individuals who
understand Indigenous medicine through the Apprenticeship Program was the logical next step. In it, participants learned about plant identification and harvest, cultural relationships with plants, making medicines and clinical application, along with home first aid, maternal health, prevention, and recovery. Since receiving the Keepers of the Earth Fund grant, Eastern Woodlands Rematriation has trained 12 apprentices; our 1-year apprenticeship concluded at the beginning of May. Apprentices continue studying and gathering medicines to begin by first building their home apothecary, and second, a community apothecary to share among kin networks.
In addition, EWR has held multiple intensive sessions about food and land access grounded in spirituality and values of rematriation. These have included medicinal gatherings and teachings at our homes, reservation, and sites of cultural significance; the building of a home and community apothecaries; and a Roots and Barks Medicinal Session, which drew participation from prospective apprentices from southern New England. Members created an inter-Tribal herbal medicine donation list to address the needs of the communities we work with, which include resources for maternal health, anxiety/depression, culturally significant medicines, and prevention. We also share medicines for tea and salves with womxn of southern New England.
“What is most beautiful about how far we have come in this grant period is the interaction we are witnessing among womxn and Two-Spirits from different Tribal communities in the Northeast, and the ways members are building with each other and offering their own unique gifts and power for the betterment of EWR and all of our respective families, kin, and homelands,” says co-founder Kristen Wyman (Natick Nipmuc). “Many Tribes are conditioned to be siloed, to focus only on their community, or in the case of many fed Tribes, to focus only on other federally recognized Tribes. Oftentimes, this leaves out families and individuals who have relocated for various reasons and aren’t directly being serviced by their Tribal governments, are living in urban areas, and/or state recognized Tribes who hold important knowledge and continue defending land but are often left out of decision making and social political spaces. To see this level of grassroots organizing and exercise of self-determination among Indigenous womxn and Two-Spirits is really inspiring.” Co-founder Nia Holley (Nipmuc) adds, “Unfortunately with COVID-19, it’s more and more clear how the system we’re in does not acknowledge our humanity.”
Wyman explains that Eastern Woodlands Rematriation has developed programs to adapt to the current crisis, “given how COVID-19 has amplified the struggles Indigenous communities already face. Since mid-March we have been hosting weekly community care sessions offered to our member families and Indigenous kin networks. Each week is either focused on food as medicine or as a space for participants to speak about their experiences and find community.” The group is also strengthening their mutual aid response for Tribal families by surveying members and identifying their needs, as well as distributing seeds, seedlings, remedies, and produce from Maine to Massachusetts and parts of Connecticut and Rhode Island. This involvement on a regional level is critical; as cofounder Alivia Moore (Penobscot) says, “Our local struggles are also connected to regional struggles across our Tribal communities.”
Eastern Woodlands Rematriation plans to continue its apprenticeship program by formally offering two-year apprentice opportunities to members in southern New England. We will also be creating opportunities for youth to engage in apothecary development and herbalism as part of a substance abuse prevention program. Over the past year, we have succeeded in promoting a balanced approach toward medicine, healing, and food and economic systems. Despite the challenges COVID-19 poses to vulnerable communities, which include Indigenous Peoples, EWR is working hard to meet the many urgent needs of its members while continuing to plan our future work and progress toward enriching individuals, our kin networks, and our planet.
Medicines gathered by Wabanaki herbalism apprentices at Penobscot Nation.
Photo by June Sapiel (Penobscot).
Families harvesting wild blueberries in Nipmuc homelands of Western Massachusetts.
Photo by Marcy Hendricks (Mashpee Wampanoag).
Medicinal Plants of Santa María Tlahuitoltepec Estrella Jhonaí Gutiérrez Vásquez
The Indigenous Community Media Youth Fellowship, as part of the Community Media Grants Program, supports young Indigenous leaders between the ages of 16–26 who are eager to learn about technology, program development, journalism, community radio, media, and Indigenous Peoples’ rights advocacy. This is the third year of the Fellowship Program, which has awarded grants to 22 youth to date.
E strella Jhonaí Gutiérrez Vásquez (Mixe/ Ayüük), 17, is from Santa María Tlahuitoltepec, Oaxaca, Mexico. She has participated at her local community radio station, Radio Jënpoj, from a very young age. When she was 9, she learned audio editing with the help of her father and became a program editor by the time she was 15. Her fellowship project, entitled “Tyikyëë’nyëm Tyik’ä’jtsyëm Yë N’ääts Yë Nkukoj” (Taking Care and Feeding Our Roots to Make Them Bloom), aims to strengthen the Ayüük language, worldview, and ancestral knowledge by producing a series of radio programs in Ayüük and Spanish. She recently created a guide and radio program on medicinal plants found in Santa María Tlahuitoltepec and how to use them for prevention during the COVID-19 pandemic.
Tr aditional Medicines Recommended in COVI D-19 Prevention. Recipes and instructions contributed by Santa María T lahuitoltepec citizens.
1. W illow and mezcal bath to fight against fever, one of the symptoms of COVID. Preparation: Heat water, boil the willow, and add one liter of mezcal. Use: Bathe with the mixture. 2. Pumpkin bath to fight fever, one of the symptoms of
COVID. Preparation: Heat the pumpkin. Use: Take a pumpkin bath. 3. Ga rlic to alleviate cough, one of the symptoms of COVID.
Preparation: Peel the garlic so that it can be taken as a pill and chewed, crushed, and boiled in water, adding half a lemon. Use: Drink the boiled mixture to open constricted airways. 4. Ga rlic, onion, lemon, and honey to combat cough, one of the symptoms of COVID. Preparation: Boil the water adding ¼ onion, 2 cloves of garlic, 1/2 lemon, 2 teaspoons of honey. Use: Take as a tea. 5. E at healthily: quelites (edible greens), avocado leaf, a lot of garlic, and accompany meals with huaje. These foods have a high vitamin content so they help to keep our immune system healthy and strong. 6. Use some of the plants mentioned above to fight symptoms such as cough, fever, and headache; others are responsible for detoxifying the body.
Estafiate/ Mugwort treats digestive problems and regulates menstruation.
Epazote-putteety/wormseed has anthelmintic, antiinflammatory, and pain relieving properties.
Menta/Nëxu’uk/ Mint treats stomach disorders, clears the airways, and cools the body.
Ruda/Mëkku’ujts/Rue treats stomach, eye, and ear ailments; also eliminates lice.
Sauce/Tum’tsye’/ Willow relieves colic, regulates menstruation, helps with sleep, and combats fever.
Sabila/Mantexy/Aloe vera may be used as soap and aids in digestive issues.
Lengua de vaca/Jatsy Tyojts has anti-inflammatory and anti-bacterial properties. It is used in treatments for diabetes, arthritis, and sexually transmitted infections.
L-R: Beader Rosario Mendoza, painter Antonio Coche Mendoza, and painter Angelina Quic Ixtamer have been working with Guatemala Art and Culture Connection for many years.
Bazaar artist Promoting Indigenous Artists Guatemala Art and Culture Connection
Guatemala Art and Culture Connection works with Maya villages around Lake Atitlan, Guatemala, and collaborates with traditional Maya communities in order to bring their art and crafts to the wider international market. The paintings and crafts depict themes that are an integral part of their life and culture and often incorporate designs and figures that are based on centuries-old traditions. “Our vision is to utilize this art and the crafts as a means of connecting people across borders and cultures and supporting local initiatives in the communities we work with. We also seek to increase awareness of the economic, political, environmental and social issues impacting these Indigenous communities and to cultivate an appreciation of their rich art and culture while helping to support the artists and local economy through the fair trade sales of their art and crafts,” say founders Imre and Lorna Kepes.
The villages that work with Guatemala Art and Culture Connection represent three Maya communities and languages: Tz’utujil, Kaqchikel, and K’iche. San Juan La Laguna (Tz’utujil) is smaller and more traditional and has the highest concentration of cooperatives. San Pedro La Laguna (Tz’utujil) is larger and is the birthplace of the art naïf style. Santiago Atitlan, the largest town on the lake with a population of 50,000, is known for the atrocities it has suffered during Guatemala’s civil war, including massacres of civilians, but today it is also known for the spectacular beadwork and weaving its artists create.
Guatemala Art and Culture Connection represents more than 30 artists and artisans. The artists are known for their distinctive style and their works have been exhibited in places such as the Smithsonian in Washington, D.C. and galleries and shows internationally. One of the artists, Angelina Quic Ixtamer, born in San Juan, explains, “Most of the women in my village do fine embroideries and weaving, but I wanted to do something different.” Quic also says she initially faced “severe criticism from other women because they regarded painting as exclusive to men.” As the first female oil painter from her village, Quic has become renowned nationally and internationally.
Quic, along with her husband, Antonio Coche Mendoza (also Tz’utujil and born in San Juan), opened their own gallery in 2002. She hopes to travel internationally to exhibit and sell her work. “What I love most about what I do is that when I paint, I think back to the lives of our predecessors and the work they did on the field, which is deeply rooted in my country’s culture. I used to help with the coffee harvest and picked about 60 pounds a day. Now my husband and I are able to support ourselves with our art,” she says. Coche is represented in UNESCO’s 2001 book, Art Naïf: Contemporary Guatemalan Paintings. His career as an artist began early and evolved rapidly. “I was the first person in my family to start painting,” he says, but has since taught several of his siblings how to paint. Today “many of the residents of San Juan appreciate how we are depicting and valuing our culture through our art. Painting the culture and the traditions helps to preserve them, and in addition helps to validate them.”
With the help of Guatemala Art and Culture Connection, artists like Quic and Coche have been able to bring their work to an international audience, fostering worldwide respect for Indigenous artists. The Kepes say that now, during these challenging times, “the artists and artisans we work with tell us that they are struggling to sell their art and support their families. We are exploring new ways to market their work and plan to open up an online store by the end of June.” A percentage of sales will also go to help the local programs they support.
Please visit guatemalaartandcultureconnection.blogspot.com or the Facebook page, Guatemala Art and Culture Connection, for more information.
The 2020 Summer Bazaars in Newburyport and Tiverton in July are cancelled due to COVI D-19. Please stay tuned for online shopping opportunities and future dates and locations at bazaar.cs.org.
Cultural Survival Support Indigenous-Led COVID-19 Responses
International solidarity is vital for the survival of Indigenous Peoples and all our relations. We must support groundbreaking initiatives managed by Indigenous governments, local community organizations, women, and youth as we navigate through this pandemic emergency.
At Cultura l Surviva l we a re working to:
Arrange emergency funding via Keepers of the Earth Fund to make direct grants to their Indigenous partners to respond to the crisis in their local communities
Produce, distribute, and translate Public Service Announcements for preventative measures against COVID-19 into 100+ Indigenous languages to be broadcast through 1,000+ Indigenous radio stations globally Listen and share rights.cs.org/covid
Launch an Emergency Response Toolkit for Indigenous community radio stations translated into several Indigenous languages
Curate a global monitoring system for COVID-19 in Indigenous communities using Google Maps technology
