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Health care

A focus on traditional knowledge

by Barbara Kühlen

In depth

“Natural medicines are inexpensive, and maintaining a sustainable supply is easy”.

“Natural medicines are inexpensive, and maintaining a sustainable supply is easy”.

In the highlands of Ecuador, health promoters are improving basic medical services for the indigenous community, using medicinal plants and applying traditional methods. [ By Barbara Kühlen ]

The jeep judders slowly up the mountain road, bumping over potholes and past a herd of sheep. For a long time, not an automobile is to be seen. At nearly 4,000 metres altitude the air turns thin. Thick fog snakes its way across the fields. Not very much grows up here. It is a two-hour drive from Riobamba, the capital of Chimborazo province, to Totoras Llulín, where Manuel, Delfina and Maria Elena live. They are health promoters who were trained with the help of action medeor. They take care of emergencies, but they are also responsible for preventive care and providing basic services for around 85 families.

“Previously we had to hike for several hours if someone got sick,” says Manuel. “And then the state-run health centre would treat us poorly.” Now there is medical advice and medicine in the village itself. One father says he is relieved that assistance is now easily available. It is no longer necessary to make the expensive – and in an emergency often too long – drive to the city if, for example, a child falls ill.

Plenty of villages like Totoras Llulín dot Chimborazo province. They are small, cut off from the world and under-serviced. Most of the people are subsistence farmers, and live below the poverty line. The children are under- and malnourished, at risk of preventable disease.

The new government of President Rafael Correa wants to improve health care, expanding social services for those people who are particularly disadvantaged. Nonetheless, action medeor’s project partners doubt the health infrastructure will improve permanently in remote villages. There is just too much need across the entire country, and not enough funds available.

The few state institutions that exist are far away. Most are under-equipped and in lack of staff. Nonetheless, they are often beyond the reach of those without money. Young doctors prefer working in towns. Discrimination against the indigenous people is an everyday occurrence; the language barrier and cultural differences make communication even more difficult. “When they see us in our ponchos they don’t want to treat us,” one health promoter says.

Health promoters set up small outposts in their communities. In the last five years, more than 160 of them were trained. Currently, the ground is being laid for 15 larger outposts. The village communities provide land and building materials, and do the work. All in all, some 100 small and seven larger outposts exist already.

The health promoters study a combination of traditional and scientific medicine during their three years of training. Doctors and healers first impart basic knowledge of scientific, natural and dental medicine; and they also teach sexual and reproductive health. But there is a lot more than meets the eye. “A good health promoter has to take people seriously, to motivate and convince them,” says Gerardo Chacón, the project manager of the Yachachic organisation, action medeor’s partner.

People who manufacture and use natural healing methods receive support from the Alternative Andean hospital in Riobamba and the renowned Instituo Misael Acosta. The institute very quickly caught on to the potential of alternative medicine. A health promoters’ handbook displays disease patterns, diagnoses and cures, and also details the correct way to use medicinal plants.

Health promoters carry out community social work. But they usually do so out of solidarity. They rarely take any money, and are given eggs, some flour or a chicken instead. “It takes us back to who we really are,” Manuel says. Prevention and information take centre stage. Doctors stage regular campaigns to help sensitise patients in the villages towards health hazards. Promoters give talks in schools on prevention and proper nutrition. Radio spots air in Spanish and Quechua, featuring interviews on the project. The programmes give information on symptoms, and report on how to prevent and cure illnesses. Germany’s Ministry for Economic Cooperation and Development (BMZ) supports the project.

Andean medicine is gaining more and more respect, not only because of otherwise insufficient health services in remote regions. The Ecuadorian health ministry has a department for indigenous healing methods. Medicinal plants, natural medicine and natural sanitary products are in high demand; and ways to market and export the products are being developed.

The health ministry officially recognises the health-promoter training. Once graduates are equipped with an ID, they can sell medicinal plants and natural medicines. They produce medicines from plants grown in gardens. These medicines are inexpensive, and maintaining a sustainable supply is easy. Furthermore, reviving traditional cures strengthens indigenous peoples’ cultural identity and self-confidence. That, too, is a reason for success.

And success is palpable. Many families eat healthier; and sanitation has improved. Prevention is taken seriously; illnesses are recognised and treated sooner. When the Tungurahua volcano, located near the provincial capital Riobamba, erupted recently, villagers were able to seek shelter in the health outpost of La Palestina – it was the only building with a concrete roof.

But occasionally different worldviews collide. Gerardo Chacón, the project manager in Yachachic, describes how surprised many of the villagers are when promoters tell them to wash their hands after working in the fields as well as before meals. “How can Mother Earth be 'dirty' or even dangerous, since we're a part of her, we emerge from her and we return to her fold?” they ask. Pachamama, the earth, is the fertility goddess of the Quechua.

The written word is largely unknown in the promoters’ mother tongue so it is difficult to maintain patient records. Patients are also generally mistrustful and unwillingly reveal information about themselves. That dates all the way back to colonial times when the Spanish asked many questions, and then used that information to tax the people.

One perhaps somewhat questionable sign of success is that other organisations regularly lure away well-trained health promoters. While these people then no longer provide help to their villages, they nonetheless serve as multipliers elsewhere, probably reaching even more people. Since two promoters receive training in each village in Chimborazo, it has, so far, not been difficult to cope with the brain drain.