Last week I visited an indigenous tribe along with a group of doctors. This has to have been one of the most incredible experiences of my life and I feel exceptionally lucky to have been invited to take part.
The group of 17 Brazilian GPs went along to learn about the health needs of the ‘Xukuru’ people and what they might be able to do to improve the health of indigenous people in Brazil.
Our visit was timed to coincide with a large annual meeting of the Xukuru people. This annual meeting commemorates the death of a leader, ‘Chicão’, who was particularly successful in uniting their community and fighting for their rights, but was assassinated in 1998. The meeting is also a chance for them to celebrate their culture and hold discussions about what they can do to improve the wellbeing of their community, as this is exactly the sort of thing Chicão would have wanted. We were also joined by other indigenous tribes around Brazil, as well as a few anthropologists and sociologists.
Brazil’s indigenous people
Brazil is home to 305 groups of indigenous people (around 897,000 people in total) who speak 274 different languages. The cultural diversity these people bring to Brazil is one of the country’s real treasures, but the history of indigenous people in Brazil has been marked by exploitation. Despite the inclusion of their rights in the constitution and the creation of a specific government body to protect them, the challenges they face have not relented.
Illegal deforestation is destroying much of their homelands, while authorities turn a blind eye. Another recent threat to indians in Brazil is the construction of hydroelectric dams, which are flooding large areas of their territory, often without the indians having any say in the matter.
As if the destruction of their territory wasn’t enough, violent attacks on indigenous people by wealthy landowners have sadly become a regular occurance. In this month alone, there have been massacres of indigenous people in Mato Grosso, in which timber merchants paid hitmen to storm through a village, slaughtering all they found, as well as Marranhão state, where angry farmers attacked a village, hacking off their victims arms and legs with machetes.
The Xukuru comprise an estimated 10,500 people, spread across 26 villages in the Orurubá mountains of Northeast Brazil. Their territory is a 3-hour drive inland from the coastal city of Recife and is bordered by the town of Pesqueira, with which they have frequent contact. Many sell their produce in Pesqueira’s markets and some even live in the nearby town.
They speak solely Portuguese; their original language having been made extinct after colonialists prohibited its use. Only a few individual words of “Kirirí” are still known, mainly the ones that have been incorporated into the tribe’s rituals and folklore.
The majority of the population still live off the land in small-scale family-run farms, however they do produce a surplus for trade with the local town. Increasingly, they are looking at other ways to expand their income, such as selling artisan goods at the market in Pesqueira. Interestingly, these projects to heard additional income are mainly driven by the women of the community.
The tribe is by no means isolated and they have embraced quite a bit of the modern lifestyle. They have mopeds, smart-phones (although lack internet connection in most of their territory) and even drones (more on the drones later).
What do the Xukuru have in terms of access to healthcare?
The Xukuru people are served by the Brazilian ‘Family Health Strategy’, in which primary care doctors (GPs) work with small teams of ‘community health agents’. There are three GPs (all of whom have been contracted by the Brazilian government from Cuba) for the population of just over 10,000 people. Each of these doctors is linked with several community health agents, who are Xukuru people themselves and look out for the health needs of the people from the village in which they live.
These health agents work really well and are a vital link between the GPs and the community. As they are indigenous people themselves, they really understand the Xukuru’s beliefs and ways of thinking, which allows them to tailor their health promotion messages. Whether they are delivering vaccines, taking blood pressures or explaining the importance of a healthy diet and taking medications regularly, they are more likely to be listened to and respected than an ‘outsider’ who may be seen to be ‘imposing’ Western medicine and ways of living that clash with their culture.
Interestingly, the Xukuru people seem to have better access to healthcare than the majority of non-indigenous people in the nearby town of Pesqueira.
This is partly because they are served well by a sub-system of the Brazilian Naitonal Health Service (SÚS), which is dedicated specifically to looking after Brazil’s indigenous groups. The Xukuru people I spoke to told me they thought this sub-system of the SUS serves them particularly well and they get more easily and swiftly referred to nearby hospitals or specialist treatment centres than the townspeople of Pesqueira.
They also praised their Cuban GPs for being particularly attentive and treating them with a human touch that they felt was lacking from their previous experiences with Brazilian doctors.
On the last morning, I set off on my own to walk up the hill to forest clearing where they were due to have a ceremony. On my way, I got chatting to a local man, the same age as me, who was also walking to the ceremony. We discussed politics, the various challenges facing the Xukuru community and his experiences with the Brazilian healthcare system. He told me: “my Cuban doctor looks me in the eye and really listens to what I’m saying when I talk with her”. A perfect reminder to me that empathy, listening skills and a patient-centred approach are greatly appreciated no matter who you’re treating and no matter where you are in the world!
Next up, I’ll be writing about what I learned from the experience, both in terms of what we can do to support the health of the Xukuru and some lessons we could learn from them.