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O câncer de colo de útero é uma neoplasia comum e letal para mulheres no Brasil, com uma estimativa de 17 mil novos casos entre 2023 e 2025. A região Norte apresenta as maiores taxas de incidência e mortalidade, refletindo desigualdades no acesso a serviços de saúde. A detecção precoce e a vacinação são essenciais para a prevenção, mas a cobertura é insuficiente quando se trata de povos indígenas. Trata-se de um estudo descritivo que busca analisar a proporção de exames citopatológicos em mulheres indígenas de 25 a 64 anos, considerando dois triênios, de acordo com as recomendações da Organização Mundial de Saúde (OMS), com base nos dados do Sistema de Informação do Câncer. Os dados foram obtidos a partir de dados populacionais do Distrito Especial de Saúde Indígena do Amapá e Norte do Pará. No primeiro triênio (2018-2020), a proporção de exames foi de 3,37% no DSEI AMP e 0% em Pedra Branca do Amapari, município de referência do povo wajãpi. No segundo triênio (2021-2023), essas proporções aumentaram para 21,95% e 52,38%, respectivamente. A melhora significativa nos indicadores de realização de exames junto aos Wajãpi, é atribuída ao Projeto de Rastreamento de Câncer do Colo do Útero, realizado pelo Instituto de Pesquisa e Formação Indígena (Iepé) em cooperação com o DSEI AMP. Ainda que a colaboração entre as comunidades wajãpi, Iepé e DSEI AMP tenha produzido uma melhoria nos índices, os desafios permanecem, especialmente em relação à cobertura e à qualidade da assistência à saúde fornecida aos povos indígenas.

Cervical cancer is a common and lethal neoplasm for women in Brazil, with an estimated 17 thousand new cases between 2023 and 2025. The North region has the highest incidence and mortality rates, reflecting inequalities in access to health services . Early detection and vaccination are essential for prevention, but coverage is insufficient when it comes to indigenous peoples. This is a descriptive study that seeks to analyze the proportion of cytopathological exams in indigenous women aged 25 to 64 years, considering two three-year periods, in accordance with the recommendations of the World Health Organization (WHO), based on data from the Information System of Cancer. The data were obtained from population data from the Special Indigenous Health District of Amapá and Norte do Pará. In the first three years (2018-2020), the proportion of exams was 3.37% in DSEI AMP and 0% in Pedra Branca do Amapari, a reference municipality for the Wajãpi people. In the second three-year period (2021-2023), these proportions increased to 21.95% and 52.38%, respectively. The significant improvement in indicators for testing among the Wajãpi is attributed to the Cervical Cancer Tracking Project, carried out by the Institute of Indigenous Research and Training (Iepé) in cooperation with the DSEI AMP. Although the collaboration between the Wajãpi, Iepé and DSEI AMP communities has produced an improvement in rates, challenges remain, especially in relation to the coverage and quality of health care provided to indigenous peoples.

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Resumen El valor espiritual atribuido a la muerte, para los guardianes del corazón del mundo en la Sierra Nevada de Santa Marta, Colombia, como en otras culturas indígenas, integra una preparación social, física, ética, ecológica y emocional para hacer un acompañamiento saludable a la vida después de la muerte. Su importancia va mucho más allá de una visión relacionada con hechos espectaculares o la desmitificación de su cosmovisión como "pobre o vulnerable". A través de una reflexión situada de los procesos de salud, enfermedad y cuidado en el contexto indígena del final de la vida, proponemos considerar el sentido de las ocupaciones en la tríada vida - muerte - renacimiento, para garantizar el derecho a una muerte segura y culturalmente adecuada. La dimensión ocupacional, como agente de construcción e interpretación de los significados colectivos de las comunidades indígenas a través de la espiritugogía precedida por su ancestralidad, puede ofrecer otras perspectivas interculturales de cuidados paliativos milenarios y un seguimiento diferenciado y respetuoso por parte de los sistemas de salud.

Resumo O valor espiritual atribuído à morte, pelos guardiões do coração do mundo na Serra Nevada de Santa Marta, Colômbia, como em outras culturas indígenas, integra uma preparação social, física, ética, ecológica e emocional para fazer um acompanhamento saudável para a vida após a morte. Sua importância vai muito além de uma visão relacionada a eventos espetaculares ou a desmistificação de sua visão de mundo como "pobres ou vulneráveis". Por meio de uma reflexão situada dos processos de saúde, doença e cuidado no contexto indígena do final da vida, propomos considerar o significado das ocupações na tríade vida - morte - renascimento, para garantir o direito a uma morte segura e culturalmente apropriada. A dimensão ocupacional, como agente de criação e interpretação dos significados coletivos das comunidades indígenas por meio da espiritugogía precedida por sua ancestralidade, pode oferecer outras perspectivas interculturais de cuidados paliativos milenares e um acompanhamento diferenciado e respeitoso pelos sistemas de saúde.

Abstract The spiritual value attributed to death, by the guardians of the heart of the world in Sierra Nevada de Santa Marta, Colombia, as in other indigenous cultures, integrates a social, physical, ethical, ecological, and emotional preparation to make a healthy accompaniment to life after death. Its importance goes far beyond a vision related to spectacular events or the demystification of the indigenous worldview as being considered "poor or vulnerable". Through a situated reflection of the health, illness and care processes within an indigenous context at the end of life, we propose to consider the meaning of occupations in the triad of life - death - rebirth, to ensure a compliance with the right of one that alludes to the meaning of a safe and culturally appropriate death. The occupational dimension, as an agent for creating and interpreting the collective meanings of indigenous communities through the espiritugogía preceded by their ancestry, can offer other intercultural perspectives of ancient palliative care and differentiated and respectful support by health systems.

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Chile es un país culturalmente diverso cuya población debe enfrentar dificultades relacionadas con la salud. Este ensayo tiene por objetivo reflexionar en torno a las competencias interculturales desde un enfoque ético intercultural, en la formación inicial de profesionales en ciencias de la salud. Se constata una salud carente y descontextualizada de la realidad cultural en la formación inicial en ciencias de la salud. Para evolucionar en esta área, se requiere imperiosamente formar a los profesionales en competencias interculturales desde un enfoque ético intercultural. Ello contribuirá al reconocimiento y comprensión de la otredad desde su propia cultura, a partir de la relación e intercambio de experiencias, conocimientos, saberes, entre otros. Para ello se requiere del diálogo intercultural entre profesionales y expertos pertenecientes a distintos sistemas de salud, con el fin de coconstruir desde la salud y enfermedad, para responder de forma oportuna y adecuada a las demandas de salud, y brindar un cuidado en salud digno y de calidad. En efecto, mitigará las desigualdades e injusticias, a la vez que proporcionará una vida más plena a las personas que conviven en una sociedad culturalmente diversa.

Chile is a culturally diverse country, and this population must face difficulties related to health. This essay aims to reflect on intercultural competencies from an intercultural ethical approach, in the initial training of professionals in health sciences. The initial training in health sciences shows that health is lacking and decontextualized from the cultural reality. In order to evolve in this area, it is imperative to train professionals in intercultural competencies from an intercultural ethical approach. This will contribute to the recognition and understanding of otherness from their own culture, based on the relationship and exchange of experiences, knowledge, wisdom, among others. This requires intercultural dialogue between professionals and experts belonging to different health systems, in order to co-construct from health and disease. This will allow a timely and adequate response to health demands. It will also provide quality and dignified health care and attention. In effect, it will mitigate inequalities and injustices, while providing a fuller life to people living in a culturally diverse society.

O Chile é um país culturalmente diverso, essa população deve enfrentar dificuldades relacionadas à saúde. Este ensaio tem como objetivo refletir sobre as competências interculturais a partir de uma abordagem ética intercultural, na formação inicial de profissionais em ciências da saúde. A saúde carente e descontextualizada da realidade cultural é verificada na formação inicial em ciências da saúde. Para evoluir nesta área, é imperativo formar profissionais em competências interculturais a partir de uma abordagem ética intercultural. Isso contribuirá para o reconhecimento e compreensão da alteridade a partir da própria cultura, do relacionamento e troca de experiências, saberes, saberes, entre outros. Para isso, é necessário o diálogo intercultural entre profissionais e especialistas pertencentes a diferentes sistemas de saúde; a fim de co-construir a partir da saúde e da doença. Isso permitirá uma resposta oportuna e adequada às demandas de saúde. Da mesma forma, prestará cuidados e atenção à saúde dignos e de qualidade. Com efeito, atenuará as desigualdades e as injustiças, ao mesmo tempo que proporcionará uma vida mais plena às pessoas que vivem numa sociedade culturalmente diversa.

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In the Brazilian Amazon, deaths and disabilities from snakebite envenomations (SBEs) are a major and neglected problem for the indigenous population. However, minimal research has been conducted on how indigenous peoples access and utilize the health system for snakebite treatment. A qualitative study was conducted to understand the experiences of health care professionals (HCPs) who provide biomedical care to indigenous peoples with SBEs in the Brazilian Amazon. Focus group discussions (FGDs) were carried out in the context of a three-day training session for HCPs who work for the Indigenous Health Care Subsystem. A total of 56 HCPs participated, 27 in Boa Vista and 29 in Manaus. Thematic analysis resulted in three key findings: Indigenous peoples are amenable to receiving antivenom but not to leaving their villages for hospitals; HCPs require antivenom and additional resources to improve patient care; and HCPs strongly recommend a joint, bicultural approach to SBE treatment. Decentralizing antivenom to local health units addresses the central barriers identified in this study (e.g., resistance to hospitals, transportation). The vast diversity of ethnicities in the Brazilian Amazon will be a challenge, and additional studies should be conducted regarding preparing HCPs to work in intercultural contexts.

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This article will address the considerations that must be examined in the design of public policies and government programs to achieve an intercultural approach to the health of the Pu Mapuce Zomo (Mapuce women). In this sense, the proposed objective is to formulate three essential aspects that serve as a basis to promote adequate frameworks for public health policies oriented towards an intercultural approach. For this, methodologically, from a qualitative approach, the ethical, gender(s) and epistemic aspects that must be considered in the configuration of health programs that favor the health care of indigenous women will be investigated. With this purpose, it begins by delimiting the unavoidable ethical-normative and gender approach to highlight the basic needs of Mapuce women. This approach seeks to establish a parameter about the obligations that States have in relation to the development of human capabilities. Finally, three aspects will be presented that the State must replicate in its health proposals to guarantee the construction of an intercultural approach to health, appropriate to the basic needs of Mapuce women in Argentina.

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In the Brazilian Amazon, deaths and disabilities from snakebite envenomations (SBEs) are a major and neglected problem for the indigenous population. However, minimal research has been conducted on how indigenous peoples access and utilize the health system for snakebite treatment. A qualitative study was conducted to understand the experiences of health care professionals (HCPs) who provide biomedical care to indigenous peoples with SBEs in the Brazilian Amazon. Focus group discussions (FGDs) were carried out in the context of a three-day training session for HCPs who work for the Indigenous Health Care Subsystem. A total of 56 HCPs participated, 27 in Boa Vista and 29 in Manaus. Thematic analysis resulted in three key findings: Indigenous peoples are amenable to receiving antivenom but not to leaving their villages for hospitals; HCPs require antivenom and additional resources to improve patient care; and HCPs strongly recommend a joint, bicultural approach to SBE treatment. Decentralizing antivenom to local health units addresses the central barriers identified in this study (e.g., resistance to hospitals, transportation). The vast diversity of ethnicities in the Brazilian Amazon will be a challenge, and additional studies should be conducted regarding preparing HCPs to work in intercultural contexts.

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Peru's Ministry of Health promotes the provision of culturally competent and universal health care. To do so they have implemented policies aimed at addressing indigenous peoples' social, geographic, and financial barriers to health care as well as cultural gaps between them and (bio)medical providers. While scholars argued that these policies have fallen short, their explanations have ignored the role that medical providers' professional authority plays in implementing these policies. This study examined how medical providers aim to provide culturally competent care and facilitate patients' use of medical services while protecting their professional authority. This includes preserving control over their space of work and their capacity to legitimately diagnose, treat, and prognosticate medical problems. Ethnographic observations and 50 interviews conducted between May 2017 and February 2018 show that to facilitate the provision of culturally competent and universal health care, medical providers engaged in non-clinical tasks, trespassed bureaucratic rules, tolerated and integrated the use of traditional medicine, and expanded the time and place of their practice. To advance these strategies, medical providers sacrificed aspects of their social authority (e.g., their autonomy over their work) and their cultural authority (e.g., their ability to define treatment). However, providers also asserted aspects of their professional authority such as the ability to give patients instructions and advice and control over the use of traditional medicine. The latter had the potential of deterring some women from having institutional births, thus reproducing some of the constraints that indigenous people face in accessing health care.

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OBJECTIVE: Novel foods and dietary practices, a lack of available land, and displacement by armed conflict have affected the ancestral food traditions practiced by the Inga community in Aponte, in Nariño, Colombia. These factors have led to problems with food security and malnutrition, which have impacted the growth and development of children. Therefore, this study is aimed at identifying the changes in ancestral food practices reported by Inga grandmothers, and the possibility of recuperating them in order to improve children's health. METHOD: A qualitative study was conducted that included 24 mothers with children under five years old and 25 grandmothers in nine Inga communities. Participants were recruited using snowball sampling. Free listing was used to identify changes in food patterns, and semi-structured interviews were conducted with 20 grandmothers to delve deeper into the subject. A translator of the Inga language facilitated communication, and the Inga researcher validated the translation using audio recordings. Each interview was transcribed and categorized for the purpose of analysis, using the NVivo 12 software. RESULTS: Free lists showed changes from a corn-based to a rice-based diet and a wide variety of non-ancestral food products. According to the grandmothers, "tiendas" have replaced traditional foods with those that are easy to prepare, which are attractive to mothers as well as to the children because of their flavor. Ancestral practices such as grinding, peeling, and log cooking are being abandoned. Government programs and daycare have incorporated new food that compete with traditional ones, with no clear evidence of an intercultural approach. Added to this is the dismissal by young mothers of the knowledge held by their grandmothers, which hinders the continuation of traditions. CONCLUSIONS: The findings suggest that it is necessary to prevent the loss of the Inga food culture, and policies need to be created that promote and protect ancestral knowledge and that help to regain the value of the "chagra" farming system, with the support of elders, authorities who are recognized by the community, and government technicians, as recommended by the grandmothers who participated in this study.

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Resumen: La contaminación ambiental es un gran problema que afecta la Tierra. El territorio mapuche no es la excepción, dado que el modelo extractivista transgrede los espacios sagrados, explota los recursos naturales y contamina, afectando los modos de vida y de salud del mapuche. El objetivo del artículo es reflexionar acerca de los fundamentos éticos de la relación mapuche y naturaleza como aportes para la salud intercultural. Se aprecia que los fundamentos "Az-mapu", "küme mogen" y "ixofil mogen" influyen fuertemente en el comportamiento del mapuche frente a la naturaleza. El respeto, amor, cuidado, empatía y reciprocidad del mapuche hacia la naturaleza, a sí mismo y a las demás personas, le permite estar en armonía y equilibro desde lo físico y espiritual. Es relevante considerar estos fundamentos éticos para mejorar el servicio de salud desde una perspectiva intercultural, considerando para ello la complementariedad, sobre la base del diálogo, con la finalidad de bridar una salud humanizadora, diversa y, por tanto, de calidad, para transitar hacia un bienestar más pleno de sujetos pertenecientes a culturas distintas.

Abstract: Environmental pollution is a big problem that affects the earth. The Mapuche territory is no exception, given that the extractivist model violates sacred spaces, exploits natural resources, and pollutes, affecting the Mapuche's ways of life and health. The objective was proposed: reflect on the relevance of the ethical foundations that sustain the Mapuche and nature relationship as contributions to intercultural health. It is appreciated that the ethical foundations: "Az-mapu", "küme mogen" and "ixofil mogen", have a fundamental role in ethical behavior regarding the relationship between the Mapuche and nature, where respect, love, care, empathy and reciprocity of the Mapuche towards nature, himself and with other people, allows him to be in harmony and balance from the physical and spiritual. In this sense, it is relevant to consider these ethical foundations to improve the health service, from an intercultural perspective, considering complementarity based on dialogue, in order to provide a humanizing, diverse and, therefore, quality health to move towards a good to be more full of subjects belonging to different cultures.

Resumo: A contaminação ambiental é um grande problema que afeta a Terra. O território mapuche não é uma exceção, dado que o modelo extrativista transgride os espaços sagrados, explora os recursos naturais e contamina, afetando os modos de vida e de saúde do mapuche. O objetivo do artigo é refletir acerca dos fundamentos éticos da relação mapuche e natureza como contribuições para uma saúde intercultural. Se considera que os fundamentos "Az-mapu", "küme mogen" e "ixofil mogen" influem fortemente o comportamento do mapuche frente à natureza. O respeito, amor, cuidado, empatia e reciprocidade do mapuche para com a natureza, para consigo mesmo e para com as demais pessoas, lhe permite estar em harmonia e equilíbrio desde o físico ao espiritual. É relevante considerar estes fundamentos éticos para melhorar o serviço de saúde desde uma perspectiva intercultural, considerando para isso a complementariedade, tendo como base o diálogo, com a finalidade de fornecer uma saúde humanizadora, diversa e, portanto, de qualidade, para transitar a um bem estar mais pleno de sujeitos pertencentes a culturas distintas.

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The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could beexplored with experimental studies to determine their long-term effectiveness, safety and low cost.

La prevalencia, morbilidad y costos de atención del asma se ha incrementado en el mundo. Este estudio describe el efecto y la seguridad de un tratamiento médico ambulatorio con recursos de la medicina tradicional para el asma, mediante una serie de casos retrospectiva con pacientes admitidos a consulta externa de 1995 a 2015 en Cota, Colombia. Analizando 26 casos con diagnóstico clínico de asma, durante el tratamiento el 34,6% (9/26) no presentó episodios de asma no controlada y el 61,5% (16/26) fueron clasificados como asma controlada en su última consulta de control. El 88,4% (23/26) de los pacientes no reportó reacciones adversas y las tres reportadas fueron leves. Los resultados permiten generar hipótesis acerca de la efectividad y seguridad de un tratamiento ambulatorio basado en la incorporación de recursos de la medicina tradicional. Estas observaciones podrían ser exploradas con estudios experimentales, para determinar su efectividad, seguridad y bajo costo a largo plazo.

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