Key Issues in Providing Health Services to Indigenous Communities Conference Report
Key Issues in Providing Health Services to Indigenous Communities Conference Report (September 15 – 16, 2011 in Madre de Dios, Peru)Prepared for the Bureau of Oceans and International Environmental and Scientific AffairsDrafted by: Esteban Sandoval, Regional Environmental Specialist, South America Environment, Science, Technology, andHealth HUB Office, email@example.com, 51-1-618-2417I. Activity Summary The REO HUB organized a two-day conference in key issues in providing healthservices to indigenous communities as part of a global health funds grant from OES. Theconference included presentations from international visitors, local government institutionsand NGOs involved in health care delivery systems.The following outlines the different aspects of the conference:Background: In April 2011, OES sent STATE 033936 offering Economic Support Funds (ESF) tofour Regional Environment Hubs to develop activities in global health, one of four OESpriorities worldwide. The Peru project selected for this funding was the development of aconference on indigenous healthcare delivery, implemented by the REO HUB withguidance from USAID, NAMRU (Naval Medical Research Unit), as well as the Indian HealthService stateside. The proposal was submitted to the Bureau of Oceans and InternationalEnvironmental and Scientific Affairs that provided a Fund Cite Cable (STATE 088638)allocating funds to Lima for its implementation.Purpose: Understand and share information and experiences that could be potentiallytransferred to the local environment. USAID has been part of this conference from the onsetproviding valuable support with health project expertise and guidance through their work inthe Amazon region and with indigenous communities.Venue: The Conference took place in Puerto Maldonado, located in the Madre deDios region in Peru, from September 15 to September 16, 2011. Madre de Dios is located inthe Amazon region bordering Bolivia and Brazil.Invitees: The conference included two U.S. Speakers and a number of Peruvianexperts. The two U.S. American Indian representatives presenting at the conference wereDr. Gerald Greenway, member of the Cherokee Tribe and representative of the Rotary Cluband Rochelle Lacapa, member of the White Mountain Apache Tribe, from the JohnsHopkins Center for American Indian Health. They provided presentations about the HealthSystem for American Indian and Alaska Natives, an overview of American Indian/AlaskaNatives and a description on how community health systems are managed in the U.S. Localparticipants to the conference included representatives from the Pan-American HealthOrganization(PAHO), USAID, Madre de Dios Regional Health Direction (DIRESA), the NationalPeruvian Indigenous Federation (AIDESEP), National Institute for Health (INS – Peruvian
Ministry of Health), the Peruvian Medical College, the Regional Government of Madre deDios, Health NGO Prisma, National Indigenous Madre de Dios Federation (FENAMAD), andrecognized health consultants working on different projects. The congress also hosted 15indigenous leaders from indigenous communities in the Madre de Dios region of Peru whointeracted and outlined their main health concerns in their respective communities.Content: The conference included welcoming remarks from a USG officer and keynote speeches from two prominent U.S. Indian Health Services experts. It also incorporatedtwo roundtables, one in Community Health Problems and another one in Traditional HealthPractices and Medicinal Plants. Themes for discussion in these workshops included healthpromoter training, nutrition, water quality/conservation, immigration impacts in communityhealth, medicinal plants use and traditional knowledge, and national health systems.Funding: OES provided $9,950 in funding for this conference through a Global HealthESTH HUBS Funds grant as described earlier. The REO HUB in Lima implemented this program.II. Target Audience and ObjectivesTarget Audience: The Conference took place in the city of Madre de Dios, Peru, but itsimplications go well beyond Peru. The Peruvian Amazon is home to at least 50 indigenousethnic groups, some of which spread over into bordering countries, such as Colombia,Bolivia and Brazil.Objectives:- Invite Native American, and U.S. Indian Health Service experts to share their experiences in managing community health systems.- Share the value of forming and using the village health committee as a primary unit of community health management.- Provide examples of community health programs practiced currently by Native North Americans.- Raise awareness about knowledge transfer and the importance of learning about Indigenous Health Issues.- Teach groups to rapidly and independently assess the underlying causes of disease and environmental problems.- Strengthen the relationship between Native American communities, U.S. agencies and institutions and host country indigenous communities and health institutions, to promote cooperation, build local capacity, and promote sustainability of public health improvements- Promote ecosystem care and sustainable use of local natural resources while championing economic development through small business development and potential public/private partnerships.III. Presentations Summary
The Conference was a two day event. The first day of the conference featured key notepresentations by the two prominent U.S. experts: Dr. Gerald Greenway and RochelleLacapa. The second day of the conference provided a venue for Peruvian experts andlocal indigenous community leaders to interact, presenting current initiatives and identifyingkey issues related to health services to Indigenous Communities.III.3 Presentation by Dr. Gerald GreenwayHealth Care for American Indian in the United StatesThe first speech featured an on line presentation by Dr. Gerald Greenway, member of theCherokee Tribe and representative of the Rotary Club, who talked about Planning systemsfor medical attention of north American tribe members. Dr. Greenway provided anoverview on how indigenous communities are defined in the U.S. There are currently 565Tribes and 223 federally recognized Alaska Native Villages in the U.S. with over four millionAmerican Indians/Alaska Natives. In 2001, 201 out of the 562 federally recognized tribes hadgoing operations with revenues of $14.5 billion. Even though the average income is close toUSD $30,000.00, more than half of the population live in poverty. Since 1793, The USG hasbeen mandated to provide health care to every federally recognized tribal member. Dr.Greenway provided some of the lessons learned from the U.S. experience which includedcloser work with leaders and community, outreach through indigenous representativesusing mobile units, incorporate indigenous culture and knowledge, and an emphasis onprimary care safeguarding resources.
III.3 Presentation by Rochelle LacapaHealth Care Systems for American Indians/Alaska Natives in the United StatesThe second presentation featured Rochelle Lacapa, from the John Hopkins Center forAmerican Indian Health. Lacapa said that the Indian Health Service (IHS) in the U.S. iscomplex and changing, it currently has 12 area offices and 163 tribally managed serviceunits. Most of the population receiving these services is located in the western part of theU.S. Most of the funding received by IHS comes from the central government; in 2010 IHSreceived $4.05 billion from the USG. There is still a wide gap in health expenditures forAmerican Indiana as per capital personal health care expenditures for the U.S. population ismore than 2.5 times higher ($6,909.00) than those for IHS Service population ($2,741.00).Leading causes of death for American Indian and Alaska Native population are related toheart disease, malignant neoplasm, and unintentional injuries (related to car accidents).Lacapa said that over the last 30 years there has been a shift in mortality causes forAmerican Indians in the U.S. from infectious diseases to chronic long term illnesses (diabetes,liver disease, cancers) which take longer to be treated. Lacapa highlighted the fact thatNative Americans have a very holistic approach to life (encompassing spiritual, mental,physical, behavioral & social, and environmental processes) and approach mental healthin the same way. This approach, Lacapa said, conflicts with Western medicine approachesthat tend to individualize these interrelated treatment processes. She also provided somekeys to improve health quality services for American Indian and Alaska Natives whichinclude health care delivery according to cultural beliefs, strong partnerships andcollaboration between providers and tribes, the inclusion of American Indians in healthsystems development and implementation, and the use of resources to fund preventionpractices among the American Indian and Alaska Natives communities.
III.3 Presentation by Local Peruvian experts and key stakeholders from Local Indigenous CommunitiesThe second day of the conference focused on the local contribution of the different healthexperts from the Peruvian government, indigenous communities and civil society. ThePeruvian Ministry of Health, through its National Center for Indigenous Health mentioned thework being done to promote the creation of a registry for traditional plants that could beused by the different medical posts in the country. The Medical college of Peru, listed anumber of treatments and plants that are currently used for health services in Peru and thePeruvian National Indigenous Federation (AIDESEP) showcased a project currentlyunderway to train and develop traditional medicine professionals from different indigenouscommunities with the aim of integrating traditional and modern medicine practices toprovide improved health services in local indigenous communities in Peru. AIDESEP seeks toreplicate the best practices gathered from this project in the Madre de Dios Region. TheRegional Government of Madre de Dios acknowledged the lack of support and marginalconditions for health support to local indigenous communities and committed support toimprove the reach and quality of health services working with the different stakeholdersattending this conference.
IV. Feedback from Local Indigenous Community StakeholdersPerhaps the best feedback from both days of the conference came from the leaders of the15 Peruvian Indigenous Communities attending the event. These are the most importantissues and challenges outlined by some of these communities:Native Community of Santa Teresita Community does not have a medical post available. Train and provide a health technician from the same ethnia or community to guarantee his/her constant availability for the community. They also feel that this technician should be trained by the Regional Health Direction to avoid any issues in other communities. The government should recognize indigenous people as priority for health service provision.Native Community of Boca Pariamano Community has only one medical post with limited medicines available.Native Community of Kotsimba Medical post available does not have the medicines and infrastructure required by the community. The community contributes with half of the salary of the medical technician who earns S/.1,000.00 (Approximately $360.00) but still cannot guarantee her full availability at the medical post. The community has also pressing needs for potable water and sewage services.
Native Community of Palma Real Community has need for medicines, doctors (technicians, nurses), emergency room, delivery room, medical transportation, stretcher, wheelchair, and an expansion of the medical post currently available. Both medicines and medical technicians are viewed as priority for the community. The community feels that these are basic services required for proper medical attention and to support a healthy lifestyle for them.V. Summary Budget for expenses related to the Key Issues in Providing Health Services to Indigenous Communities Conference Budget Categories Amount USD $ 1. Travel - local, hotel (2 nights) $900.00 - Local, airfare $3,869.08 - International (hotels, meals, M&I) $1,800.00 - Transportation to Infierno (field trip) $107.69 2. Supplies (photo display, banners, filming, folders) $428.69 3. Contractual- conference room, including equipment $538.46 - 2 coffee breaks $346.15
- Dinner $288.46 4. Other Direct Costs - Miscellaneous, including - Indigenous leaders outreach and invitation $2,117.31 - Interpreter Costs $200.00 5. Total Cost of the Project $10,595.85 Annex I. Agenda for the Key Issues in Providing Health Services to Indigenous Communities Conference Aspectos relevantes de los servicios de salud para comunidades indígenas. Hotel Don Carlos - Puerto Maldonado, Madre de Dios 15 y 16 de setiembre de 2011 DÍA 1, 15 de setiembre de 201115:00 REGISTRO15:30 APERTURA Palabras de bienvenida y presentación de la conferencia por Indran Amirthanayagam, Director Regional de la Oficina de Medioambiente de la Embajada de los Estados Unidos16:00 Conferencia on-line: Planificación de la atención médica para indios norteamericanos Dr. Greenway – Miembro de la Tribu Cherokee Representante del Rotary Club Preguntas y debate17:00 Conferencia: Sistema del servicio de salud para indios norteamericanos y nativos de Alaska Dra. Rochelle Lacapa – Miembro de la Tribu Apache de Montaña Blanca Coordinadora local para el John Hopkins Center for American Indian Health Preguntas y debate18:00 Mesa redonda sobre los servicios de salud para comunidades indígenas Participación de expertos peruanos y líderes de las comunidades indígenas. Preguntas y debate19:00 Fin del programa del primer día. DÍA 2, 16 de setiembre de 2011 VISITA A COMUNIDAD NATIVA DE INFIERNO Presentación del Proyecto Ñape
14:00 REGISTRO14:30 Mesa redonda: Problemas de salud en las comunidades indígenas Entrenamiento para promoción de la salud, nutrición, calidad del agua, impacto de la inmigración en la salud de la comunidad OPS, USAID, DIRESA, INS, Gobierno Regional de Madre de Dios, ONG Prisma, FENAMAD, AIDESEP Preguntas y debate16:30 RECESO17:00 Mesa redonda: Prácticas tradicionales de salud y plantas medicinales Prácticas tradicionales, uso de plantas medicinales, invernaderos comunitarios DIRESA, ESSALUD/COLEGIO MEDICO DEL PERU, CONSORCIO M-P ICAA/USAID, representantes comunitarios, FODAM, ONG’s, INS Preguntas y debate19:00 FIN DE LA CONFERENCIA19:30 CENA Presentation cultural. Annex II. List of Participants Registro Conferencia Aspectos Relevantes de los Servicios de Salud para Comunidades Indígenas PUERTO MALDONADO, JUEVES 15 Y VIERNES 16 DE SEPTIEMBRE DEL 2011 AUDITORIO DEL HOTEL DON CARLOS NOMBRE INSTITUCION EMAIL Maria Susana Sandoval Huertas CEDRO firstname.lastname@example.org Oscar Guadalupe Zevallos Asociacion Huarayo email@example.com Reyna Meshi Comunidad Nativa Palma Real Jose Sehua Comunidad Nativa San Jacinto Comunidad Nativa Boca Isabel Meshi Inambari Auria Coyuri Alarcon Comunidad Nativa Kotsimba Franklin Zavala Perez Comunidad Nativa Shiringayoc Eddy Tucha Comunidad Nativa Sonene
Comunidad Nativa BocaJuan Ynuma PariamanoMaria Miroslava Frias Peralta PEMdD - GOREMAD firstname.lastname@example.orgJulian Dionisio Maquis Morales Macking ProduccionesJesus David Alvarez Ruedas MINSA email@example.comAlicia Fernandez P. FENAMAD firstname.lastname@example.orgElmer Fernandez P. Comunidad Nativa Puerto Azul email@example.comKaren Angelica Lopez Espinoza DIRESA - MdD firstname.lastname@example.orgJuan Obesso Rojas ACCA email@example.comArmando Cotrina USAID firstname.lastname@example.orgRuth Elizabeth Goldstein Universidad de California email@example.comBruno Sanguinetti Consorcio MdD Pando firstname.lastname@example.orgMiwa Bankova Asociacion Niños email@example.comIlson Lopez Añez ComunidaNativa BelgicaNeptali Cueva Maza Universida Peruana Cayetano firstname.lastname@example.orgMarilu Chiang Echenique PRISMA email@example.comJaime Corisepa Neri FENAMAD firstname.lastname@example.orgLila Guisela Huimpa Chapiama ComunidaNativa Pto ArturoAmanda Valencia Chimo Defensoria del Pueblo email@example.comAmancio Zumaeta Zumaeta Comunidad Nativa Sta TeresitaMaria Amalia Pesantes Fundacion Interamericana firstname.lastname@example.orgIsolina Valdez Felipe AIDESEP email@example.comRocio Santibañez Acosta CENSI - IS firstname.lastname@example.orgHugo E. Malaspina Colegio Medico del Peru email@example.comYeni Carrasco Poblete ACRE firstname.lastname@example.orgMercedez Chimbo Vera ArazaireSonia Edith Condori Huarca DIRESA - MdD email@example.com
Edgarel Sulle Paredes FENAMAD firstname.lastname@example.orgA. Roxana Lescano Centro Medico Naval de EEUU email@example.comManuel Calloquispe La Cara del Pueblo firstname.lastname@example.orgAntonio Fernandini Guerrero Coalition for the Amazon email@example.comAna Lucia Hurtado Abad Asociacion Huarayo firstname.lastname@example.orgJulio Cusurichi Palacios GORE MdD email@example.comEdith Alarcon PAHO firstname.lastname@example.orgCynthia Giovanna Cardenas Palacios AIDESEP email@example.comVeronica Carrillo FENAMAD firstname.lastname@example.orgAnnex III. Supporting Invoices from Conference expenses (See Attached document)