RESUMO
This article briefly traces the history of the colonisation of Guatemala, its impact on the indigenous Mayan communities, the Maya relationship to nature, and the effects of displacement on the psychological and mental health of indigenous communities. It includes three narrative accounts that describe indigenous experiences of mental health and the impact of different mental health interventions in Mayan communities in Guatemala.
Assuntos
Colonialismo , Indígenas Centro-Americanos/etnologia , Transtornos Mentais/etnologia , Saúde Mental/etnologia , Guatemala , Humanos , Transtornos Mentais/terapiaRESUMO
BACKGROUND: Data is needed about barriers to self-collection of Human Papillomavirus (HPV) samples and cytology among low-income, disadvantaged women living in rural areas of lower-income countries as these women are at increased risk of cervical cancer mortality. METHODS: Individual interviews (n = 29), focus groups (n = 7, 5-11 participants) and discussion groups (n = 2, 18-25 participants) were organized with women from three indigenous ethnic groups residing in rural areas in Mexico, after they were provided with free, self-sampled HPV tests. These groups are low-income, underserved by healthcare and have historically been on the receiving end of racism and social exclusion. Descriptive, qualitative content analysis was done, including two cycles of coding. RESULTS: Interview and focus/discussion group data indicate women had limited understanding of HPV's role in cervical cancer etiology. They identified HPV's existence, that cytology detects cervical cancer, the need for regular testing and that cervical cancer is sexually transmitted. Organizational barriers to clinic-based cytology included irregular supplies of disposable speculums, distance to clinics and lack of clear communication by healthcare personnel. Women considered self-collected HPV-testing easy, less embarrassing and less painful than cytology, an opportunity for self-care and most felt they understood how to take a self-sample after a 20-min explanation. Some women feared hurting themselves when taking the self-sample or that they would take the sample incorrectly, which they worried would make the test useless. Attending HPV-testing in groups facilitated use by allowing women to discuss their doubts and fears before doing self-collection of the sample or to ask other women who were the first to do the self-sampling what the experience had been like (whether it hurt and how easy it was). Lack of indoor bathrooms was a barrier to doing HPV self-sampling at home, when those homes were resource-poor (one-room dwellings). CONCLUSIONS: Low-income, indigenous Mexican women residing in rural, underserved areas identified their need for cervical cancer screening but encountered multiple barriers to cytology-based screening. They found a number of advantages of HPV self-sampled tests. Employing self-collected HPV-testing instead of cytology could resolve some but not all gender-related, organizational or technical quality-of-care issues within cervical cancer detection and control programs.
Assuntos
Indígenas Centro-Americanos , Papillomaviridae/isolamento & purificação , Pobreza/economia , População Rural , Autocuidado/economia , Esfregaço Vaginal/economia , Adulto , Técnicas Citológicas , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Feminino , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/normas , Humanos , Indígenas Centro-Americanos/etnologia , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , México/etnologia , Grupos Populacionais , Pobreza/etnologia , Pesquisa Qualitativa , Autocuidado/métodos , Autocuidado/normas , Manejo de Espécimes/economia , Manejo de Espécimes/métodos , Manejo de Espécimes/normas , Inquéritos e Questionários/economia , Inquéritos e Questionários/normas , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal/métodos , Esfregaço Vaginal/normas , Adulto JovemRESUMO
BACKGROUND: Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. METHODS: The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. RESULTS: The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. CONCLUSIONS: If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.
Assuntos
Diversidade Cultural , Atenção à Saúde/organização & administração , Medicina Tradicional , Assistência Centrada no Paciente/métodos , Cultura , Atenção à Saúde/métodos , Guatemala , Humanos , Indígenas Centro-Americanos/etnologia , Medicina Tradicional/métodos , Assistência Centrada no Paciente/organização & administraçãoRESUMO
BACKGROUND: Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. AIM: To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. METHODS: A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. RESULTS: Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. LIMITATIONS: Human papillomavirus typing was not done owing to a lack of facilities. CONCLUSIONS: There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.
Assuntos
Hiperplasia Epitelial Focal/diagnóstico , Hiperplasia Epitelial Focal/etnologia , Indígenas Centro-Americanos/etnologia , Vigilância da População , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , México/etnologia , Mucosa Bucal/patologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/etnologiaRESUMO
The present research investigates cultural variation in grounding principles for inferring agency in order to address an important theoretical debate: does cultural diversity in agency concepts reflect an animistic overextension of (universal) folkpsychology, as many have argued, or an alternative theory of folkcommunication based on relational principles? In two experiments, mind perception measures were adapted to assess beliefs concerning the agency of non-animal kinds (plants, abiotic kinds, complex artifacts) among Indigenous Ngöbe adults in Panama and US college students. Agency attributions varied systematically, with Ngöbe ascribing greater agency to non-animal natural kinds and US college participants ascribing greater agency to complex artifacts. Analysis of explanations revealed divergent interpretations of agency as a prototypically human capacity requiring consciousness (US), versus a relational capacity expressed in directed interactions (Ngöbe). Converging measures further illuminated the inferential principles underlying these agency attributions. (1) An experimental relational framing of agency probes facilitated Ngöbe but not US agency attributions. (2) Further analysis showed that three key dimensions of agency attribution (experience, cognition, animacy) are organized differently across cultures. (3) A Bayesian approach to cultural consensus modeling confirmed the presence of two distinct consensus models rather than variations on a single (universal) model. Together, these results indicate that conceptual frameworks for agency differ across US college and Ngöbe communities. We conclude that Ngöbe concepts of agency derive from a distinct theory of folkcommunication based on an ecocentric prototype rather than overextensions of an anthropocentric folkpsychology. These observations suggest that folkpsychology and mind perception represent culture specific frameworks for agency, with significant implications for domain-specificity theory and our understanding of cognitive diversity.
Assuntos
Comparação Transcultural , Pensamento , Adulto , Feminino , Humanos , Indígenas Centro-Americanos/etnologia , Masculino , Pessoa de Meia-Idade , Panamá/etnologia , Estados Unidos/etnologia , Adulto JovemRESUMO
BACKGROUND: Indigenous cultures are the result of their adaptation to the natural surroundings, in such a way that, amongst their main features is a set of knowledge, technologies and strategies for the appropriation of nature. In Cuetzalan del Progreso, Puebla, Mexico snakes represent 71.1% of the total local herpetofauna; and in addition to this, different groups of Nahuas have shown to have information of their use of various snake species in many ways. This study was conducted to investigate the traditional uses of snakes in this cultural group. METHODS: Formal and informal interviews were conducted with the inhabitants of the communities. During these interviews, 30 images of the different species of snakes present in the area were presented to the subjects, so that they would recognize them and reveal information about the knowledge they possess on them. A usage analysis was applied to each species considering the following categories: food purposes, medicinal, artisanal and magical-religious. Likewise, the frequency, the diversity and the value of use was estimated for these snakes. RESULTS: A total of 51 interviews were carried out. The individuals recognized 18 out of 30 images of snakes that were presented. The total of usage categories was five; we found that the magic-religious use was the most mentioned by 32 personas. Boa imperator and Antropoides nummifer were the species with the highest value of use. More than half of the interviewees mentioned killing snakes because they're poisonous and aggressive. In the magic-religious aspect the "Danza de los Negritos" is highlighted; this is a local festival, brought by Africans, and alludes to snakes. CONCLUSIONS: This study revealed that snakes are still very important for the culture in Cuetzalan del Progreso, finding that the magical-religious and the medicinal use stand out. On the other hand, the fear and misperception on the toxicity of snakes might represent a potential threat for their conservation. Therefore, it is necessary to carry out a long-term monitoring of the ethno-zoological activities, and develop a sustainable management plan compatible with the cultural characteristics of the natives of the region.
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Indígenas Centro-Americanos/etnologia , Medicina Tradicional , Serpentes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Atitude , Boidae , Cultura , Feminino , Humanos , Indígenas Centro-Americanos/psicologia , Entrevistas como Assunto , Masculino , México , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: The causes of variation in breastfeeding duration in humans are poorly understood, but life history factors related to maternal energetics drive much of the variation in lactation duration in nonhuman animals. With this in mind, we investigated whether four energy-related factors influence variation in breastfeeding duration in a non-industrial human population: (1) mortality risk during mother's development (assessed via mother's adult height), (2) reliance on nutrient-dense weaning foods, (3) access to and need for help with infant feeding and care ("allomaternal care"), and (4) maternal tradeoffs between current and future reproduction (measured via child's birth order). MATERIALS AND METHODS: The data pertain to 51 Kakchiquel-speaking Maya mothers and 283 children from a village in rural Guatemala. We developed a linear mixed model to evaluate the relationships between breastfeeding duration and the energy-related factors. RESULTS: Duration of breastfeeding was associated with two of the energy-related factors in the ways we predicted but not with the other two. Contrary to predictions, taller mothers breastfed for shorter periods and we found no evidence that weanling diet quality impacts breastfeeding duration. As predicted, women who had more help with infants breastfed for shorter periods, and later-born infants breastfed longer than earlier-born ones. DISCUSSION: The results regarding allomaternal care suggest that help reduces mothers' lactation demands. The energy saved may be redirected to increasing fecundity or investment in other children. The birth order result suggests that children born to mothers nearing reproductive senescence receive higher levels of investment, which likely impacts children's fitness.
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Aleitamento Materno/etnologia , Indígenas Centro-Americanos/etnologia , Desmame/etnologia , Antropologia Física , Estatura , Metabolismo Energético , Feminino , Guatemala/etnologia , Humanos , População Rural , Fatores de TempoRESUMO
OBJECTIVE: This study tests the hypothesis that natural selection is associated with type 2 diabetes (T2D)-associated mortality and fertility in a rural isolated Zapotec community in the Valley of Oaxaca, southern Mexico. PARTICIPANTS AND METHODS: Mortality data and related demographic and genealogic information were linked with data for fertility, prereproductive mortality and family history of mortality attributed to T2D. Physician verified T2D mortality (n = 27) between 1980 and 2009 and imputed T2D (n = 70) from cardiovascular mortality (68% random sample) and renal failure (44% random sample). Bootstrapping was used to obtain a robust variance estimate in survival analysis and multivariate analysis of variance. RESULTS: Estimated maximum natural selection by Crow's Index occurred circa 1930 and was relaxed after this time in the study population. Cox-regression survival analysis of T2D mortality with covariates (family history of T2D, cardiovascular disease, renal failure) indicated a significant hazard ratio (HR = 5.95, 95% CI: 1.38-25.67, p < .008) for the increase in T2D in 2000 to 2009. Survival analysis of imputed T2D resulted in a significant HR of 2.03 (95% CI: 1.08-3.85, p = .01) for the increase in T2D in the 2000 to 2009 cohort (reference group: 1980-1989). Mean number of live born offspring was lower among T2D (n = 27, 4.04 ± 3.85 SD) compared to non-T2D (n = 199, 5.30 ± 3.48) groups (p < .08). Mean number of live born offspring was lower (p = .003) among imputed T2D compared to non-T2D groups (4.10 ± 3.44 vs. 5.62 + 3.50). DISCUSSION: T2D-associated mortality increased in frequency as natural selection decreased, and favored offspring survival of non-T2D descedants. The results indicated statistically significant directional selection against T2D and imputed T2D to this population isolate.
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Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/mortalidade , Fertilidade/fisiologia , Indígenas Centro-Americanos/etnologia , Indígenas Centro-Americanos/estatística & dados numéricos , Seleção Genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , População Rural , Adulto JovemRESUMO
PURPOSE: To assess the role of temporal bone characteristics in transcranial Doppler (TCD) insonation failures in Amerindians living in rural Ecuador. METHODS: We evaluated thickness and texture of temporal bones in community-dwelling Amerindians ≥65 years old undergoing TCD. Using receiver operator characteristics curve analysis and generalized estimating equations, we investigated factors associated with insonation failures. RESULTS: Of 65 participants (mean age 74.7 ± 6.7 years, 60% women), 32 (49%) had uni- or bilateral insonation failure through temporal windows. Considering temporal bones independently, 57 of 130 (44%) had poor insonation. Mean thickness was higher (4.7 ± 1.2 versus 2.7 ± 0.9, p < 0.0001), and texture more often heterogeneous (93% versus 22%, p < 0.0001) in bones with poor acoustic windows. Thickness, better predicting poor insonation, was ≥3.6 mm if used alone, and ≥2.7 mm if used together with heterogeneous texture. For every millimeter of increase in thickness, subjects were 2.9 times more likely to have insonation failures. Per se, heterogeneous texture increased by 3.2 times the odds for poor insonation. In all models, being woman increased the odds for poor insonation by six to nine times. CONCLUSIONS: Temporal bone thickness and texture are independent predictors of TCD insonation failure in Amerindians.
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Densidade Óssea , Indígenas Centro-Americanos/etnologia , Osso Temporal/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Idoso , Idoso de 80 Anos ou mais , Equador/etnologia , Feminino , Humanos , Masculino , Curva ROC , Projetos de Pesquisa , Fatores Sexuais , Osso Temporal/químicaRESUMO
Traditional or indigenous healing is often assumed to involve rich forms of dialogical and symbolic communication between healer and patient that serve to explain its salience and efficacy. An ethnographic study of Q'eqchi Maya healing in Belize suggests, however, that communication in some forms of indigenous healing may also be minimal and peripheral to treatment and more akin to that of biomedicine than so-called traditional medicine. While communication may still involve symbolic, intercorporeal, and other forms of subtle intersubjective connection, anthropologists often overreach in an effort to portray such healing systems in contradistinction to biomedicine. It is argued here that Q'eqchi healing might best be thought of as a form of empirically based restorative medicine in which communication is purely instrumental to the healer's task of diagnosing and eliminating pathology and restoring the health of the patient.