Militarization in the Special Indigenous Health District of Maranhao: from the "announced disaster" to the epicenter of the pandemic

This case study used a historiographical methodology to investigate the trajectory and performance of the Special Indigenous Health District of Maranhao, having as a parameter what the National Policy for Health Care for Indigenous Peoples, still officially in force in 2021, recommended. It has the general context of health policies in successive federal governments as background. The period analyzed and discussed ranges from 2010 to 2021, covering: the crisis in the management of the National Health Care Policy for Indigenous Peoples, implemented by the National Health Foundation;the subsequent creation of the Special Secretariat for Indigenous Health and the transfer, to its scope, of the role of manager of this policy, in 2010;the challenges faced by the Special Secretariat for Indigenous Health in its first years of management, in the context of the political crises that led to the impeachment of President Dilma Rousseff and the administration of Michel Temer;the administration of Jair Messias Bolsonaro, with the consequent systematic attack on principles and guidelines inscribed in the 1988 Brazilian Constitution and the dismantling and/or sabotage of the National Health Care Policy for Indigenous Peoples;the advent of the covid-19 pandemic in this context and its specific impacts on the indigenous population, in Brazil and Maranhao, until 2021.

The 2022 restructure of Aotearoa New Zealand's health system: Will it succeed in advancing equity where others have failed?

Aotearoa New Zealand has restructured its health system with the objective of addressing inequitable access to health services and inequitable health outcomes, particularly those affecting the indigenous Maori population. In July 2022, two new organisations were created to centralise planning, funding and provision responsibilities for publicly funded health services in Aotearoa New Zealand. Health New Zealand and the Maori Health Authority have been created to drive transformational change within the national health system and monitor and improve the health and wellbeing of Maori. At the local level, new Localities are to be formed with the aim of integrating services between government and non-government health and social services providers, while incorporating local Maori and local communities in co-design of services. These changes will be of interest to those in many other countries who are grappling with their own colonial histories and struggling to provide health services in ways that are equitable and contribute to positive health outcomes for their whole population. Although key aspects of the reforms are well supported within the health sector, the ambitious scope and timing of their introduction in the context of the COVID-19 pandemic and health workforce shortages can be expected to generate significant implementation challenges.

Indigenous Food Systems Changes and Resiliency: Protocol for a Scoping Review.

BACKGROUND: Indigenous food systems (IFS) consider the complex relationships and connections between land, animals, plants, water, and people. These food systems may differ between regions, Indigenous cultures, and history; however, given the similar colonial histories and policies influencing Indigenous groups in Canada, the United States, Australia, and Aotearoa (New Zealand), the IFS changes and responses in these regions may follow similar trends. Climate change and pollution continue to impact the environment in catastrophic ways, and this, in turn, impacts IFS. However, to date, there has been no review of the literature on IFS, how they are changing, and how communities are responding to these changes. OBJECTIVE: In this scoping review, we will summarize primary research in Canada, the United States, Australia, and Aotearoa related to IFS addressing the following questions: (1) What changes are IFS experiencing in the context of climate change and pollution? (2) What actions have been taken in response to IFS changes? (3) What are the characteristics of IFS research in peer-reviewed academic literature? METHODS: We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews and the Joanna Briggs Institute reviewer's manual to inform the review process. MEDLINE, SCOPUS, International Bibliography of the Social Sciences, Sociological Abstracts, and the Bibliography of Native North Americans are the databases included in this review search. All screening and extraction have been supported by Covidence software (Veritas Health Innovation) with 2 independent reviewers conducting the abstract and full-text screening. We will map concepts and themes related to the research questions to contribute to the understanding of IFS within the academic literature and provide a narrative review of the outcomes. RESULTS: The electronic database searches for this review were conducted in May 2021. Screening and full-text review were initially completed in the winter of 2022. We are currently in the process of compiling results and aim to share findings in 2023. CONCLUSIONS: This review will provide valuable insight into current IFS needs by summarizing the peer-reviewed literature on how IFS are changing because of climate change and pollution and how communities are responding to these changes. The results of this review will be shared with Indigenous communities, through academic publications, community conversations, and conference presentations. TRIAL REGISTRATION: OSF Registries osf.io/xrj87; https://osf.io/xrj87. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/41627.

Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing.

Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers' perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers' involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts.

Enacting Mana Maori Motuhake during COVID-19 in Aotearoa (New Zealand): "We Weren't Waiting to Be Told What to Do".

Maori, the Indigenous people of Aotearoa (New Zealand), were at the centre of their country's internationally praised COVID-19 response. This paper, which presents the results of qualitative research conducted with 27 Maori health leaders exploring issues impacting the effective delivery of primary health care services to Maori, reports this response. Against a backdrop of dominant system services closing their doors or reducing capacity, iwi, hapu and ropu Maori ('tribal' collectives and Maori groups) immediately collectivised, to deliver culturally embedded, comprehensive COVID-19 responses that served the entire community. The results show how the exceptional and unprecedented circumstances of COVID-19 provided a unique opportunity for iwi, hapu and ropu Maori to authentically activate mana motuhake; self-determination and control over one's destiny. Underpinned by foundational principles of transformative Kaupapa Maori theory, Maori-led COVID-19 responses tangibly demonstrated the outcomes able to be achieved for everyone in Aotearoa when the wider, dominant system was forced to step aside, to be replaced instead with self-determining, collective, Indigenous leadership.

The Power of Relationships During the Pandemic: A Community Health Center's Response to COVID-19

This report describes one community health center's response to COVID-19 by integrating Pacific Island (PI) values—which prioritize dignity, agency, and ancestral philosophies—within the context of deep relationship building. We share impacts and insights with the hope this work will resonate with other PI and Indigenous communities.

Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review.

BACKGROUND: Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. METHODS: We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? RESULTS: We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. DISCUSSION: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. CONCLUSION: These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.

The Health Impacts of Social Distancing Among Indigenous People in Ontario During the First Wave of COVID-19

Among Indigenous Peoples in Canada and around the world, the health impacts of COVID-19 have been measured largely through biological, social, and psychological impacts. Our study draws from a relational concept of health to examine two objectives: (1) how social distancing protocols have shaped Indigenous connections with self, family, wider community, and nature;and (2) what these changing relationships mean for perceptions of Indigenous health. Carried out by an Indigenous team of scholars, community activists, and students, this research draws from a decolonizing methodology and qualitative interviews (n = 16) with Indigenous health and social care providers in urban and reserve settings. Our results illustrate a considerable decline in interpersonal connections such as with family, community organizations, and larger social networks as a result of social distancing. Among those already vulnerable, underlying health, social, and economic inequities have been exacerbated. While the health impacts of COVID-19 have been overwhelmingly negative, participants noted the importance of this time for self-reflection and reconnection of human-kind with Mother Earth. This paper offers an alternative perspective to popularized views of Indigenous experiences of COVID-19 as they relate to vulnerability and resilience.

From autonomous monitoring to virtual collaborative research: partnership with the indigenous movement from the Northeast region during covid-19 pandemic as social control

In the first months of the covid-19 pandemic, in 2020, indigenous movements and organizations in the Northeast region of Brazil established an extensive network of support and partnerships with groups of researchers and civil society entities to organize campaigns of solidarity with the indigenous peoples. The production of general information and empirical data on how the disease reached indigenous territories and populations constituted one of the main strategies for action. This mobilization was the basis for establishing collaborative networks that investigated how the indigenous peoples faced the pandemic, from an anthropological bias and applying methods that we could define as virtual collaborative research. The article, thus, discusses the potential of this can constitute a kind of support for social control exercised by the communities.

"You Can't Replace That Feeling of Connection to Culture and Country": Aboriginal and Torres Strait Islander Parents' Experiences of the COVID-19 Pandemic.

This Aboriginal-led study explores Aboriginal and Torres Strait Islander parents' experiences of COVID-19. 110 Aboriginal and Torres Strait Islander parents were interviewed between October 2020 and March 2022. Participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory, Australia. Participants were predominantly female (89%) and based in Victoria (47%) or South Australia (45%). Inductive thematic analysis identified three themes: (1) Changes to daily living; (2) Impact on social and emotional wellbeing; and (3) Disconnection from family, community, and culture. COVID-19 impacted Aboriginal and Torres Strait Islander families. Disruption to cultural practice, and disconnection from country, family, and community was detrimental to wellbeing. These impacts aggravated pre-existing inequalities and may continue to have greater impact on Aboriginal and Torres Strait Islander parents and communities due to intergenerational trauma, stemming from colonisation, violence and dispossession and ongoing systemic racism. We advocate for the development of a framework that ensures an equitable approach to future public health responses for Aboriginal and Torres Strait Islander people.

Seeking to improve access to COVID-19 therapeutics in the remote Torres and Cape communities of Far North Queensland during the first COVID-19 omicron outbreak.

INTRODUCTION: The first outbreak of the omicron variant of COVID-19 in the Torres and Cape region of Far North Queensland in Australia was declared in late December 2021. A COVID-19 Care at Home program was created to support the health and non-health needs of people with COVID-19 and their families throughout the mandatory isolation periods and included centralising the coordination and delivery of COVID-19 therapeutics. The therapeutics available included one intravenous monoclonal antibody (sotrovimab) and two oral antiviral therapies: nirmatrelvir and ritonavir (Paxlovid®) and molnupiravir (Lagevrio®). This article describes the uptake and delivery of this therapeutics program. METHODS: COVID-19 cases were documented in a notification database, screened to determine eligibility for COVID-19 therapies and prioritised based on case age, vaccination status, immunosuppression status and existing comorbidities, in line with Queensland clinical guidelines. Eligible cases were individually contacted by phone to discuss treatment options, and administration of therapies were coordinated in partnership with local primary healthcare centres and hospitals. RESULTS: A total of 4744 cases were notified during the outbreak period, of which 217 (4.6%) were deemed eligible for treatment after medical review. Treatment was offered to 148/217 cases (68.2%), with 90/148 cases (60.8%) declining treatment and 53/148 cases (35.8%) receiving therapeutic treatment for COVID-19. Among these 53 cases, 29 received sotrovimab (54.7%), 20 received Paxlovid (37.7%) and four received Lagevrio (7.5%). First Nations people accounted for 48/53 cases (90.6%) who received treatment, and COVID-19 therapeutics were delivered to cases in 16 remote First Nations communities during the outbreak period. CONCLUSION: The COVID-19 Care at Home program demonstrated a novel, public health led approach to delivering time-critical medications to individuals across a large, remote and logistically complex region. The application of similar models to outbreaks and chronic conditions of public health importance offers potential to address many health access inequities experienced by remote Australian First Nations communities.

Still Thriving: A Case Illustrating How COVID-19 Affected Indigenous Health and Wellness

The myriad of social, financial, material health, and educational inequities that continue to plague Indigenous communities was exacerbated by COVID-19. In order to place on spotlight on them, this case follows Star, an Indigenous Student Success Coordinator. as she navigated the policies and practices couched in the rhetoric of supporting the success, health and wellness of students and families during a global pandemic. The case and teaching notes that follow illustrate the limitations that Westernized models of health and wellness create for Indigenous and non-Indigenous educators when it comes to maintaining their students' and own well-being. As an alternative to the dominant Westernized models, the teaching notes offer a more holistic and integrated model of Indigenous health and wellness. The elements of the model situate health and wellness as encompassing all aspects of an individual's life by connecting them relationally to their families and communities, nations, and the land.

A tangata whenua (people of the land) approach to conceptualising Maori health and wellbeing.

From a Maori (Indigenous to New Zealand) perspective, health is not confined to the treatment of illness but also includes the philosophical concepts, structures and cultural practices which reinforce health and wellbeing. The ill-health of Maori is often the focus of health initiatives, particularly if there is an equity approach that centres on disparities between ethnic groups. However, an Indigenous approach prioritises health and wellbeing aspirations through strengthening self-determination, identity and connection with the environment. This article synthesises knowledge from Indigenous and Maori rights, matauranga (Maori ways of knowing) expressed in purakau (epistemological narratives), tikanga (Maori principles), te reo (Maori language) and lived experience to reflect a shared understanding of Maori health and wellbeing. Consideration is given to the status of Maori pre-colonisation, the ongoing impacts of colonisation, and Maori led responses to contemporary health issues. It is proposed that health for Maori, like many Indigenous peoples, should be informed by an enhanced understanding of Indigenous rights, an Indigenous worldview and notions of wellbeing. We argue that a tangata whenua (people of the land) approach is integral to the effectiveness of health policies and initiatives aimed at improving Maori outcomes sustainably. We propose that the current reorganisation of Aotearoa New Zealand's health system, as well as the COVID-19 pandemic response, provide opportunities to emphasise and embed Maori health leadership and knowledge, as well as a tangata whenua conceptualisation of health and wellbeing.

Indigenous people of Paraná and Covid-19: 2020 overview

The coronavirus Covid-19 pandemic has caused an unprecedented global crisis. From the economic scenario until the Indigenous people’s lifestyle, including the typically capitalist society, has been significantly reshaped. As invisible characters in History, the Indigenous people of Paraná have been socially isolated and may be under non-measurable inequalities, misleading statistics, and limited support by the health institutions. This study aimed to analyze the vulnerabilities and resilience responses of the Indigenous people of Paraná to the Covid-19 pandemic and discuss the underreporting and inconsistency of data on confirmed cases and deaths by Covid-19 based on state and national health institutions. This research consists of descriptive and qualiquantitative analysis conducted online that lasted ten months in which: (i) data from two governmental health institutions responsible for monitoring Covid-19 among the Indigenous people of Paraná and two Indigenous were collected and compared;and (ii) perceptions from the Indigenous people of Paraná through interviews and responses to the considered problem at indigenous organizations. As non-conclusive results, it is mentioned: (a) the confirmed cases and deaths by Covid-19 among Indigenous people of Paraná were discrepant according to the considered health institutions;(b) the Indigenous people of Paraná have probably got limited access to health services, including the lack of Covid-19 testing that may be influencing on the underreporting data, and (c) the transparency of methods of data collection and publishing has been inadequate among the studied health institutions. © 2022 Universidade Federal do Parana. All rights reserved.

Wapekeka's COVID-19 Response: A Local Response to a Global Pandemic.

Two years after the onset of the COVID-19 pandemic, many nations and communities continue to grapple with waves of infection and social fallout from pandemic fatigue and frustration. While we are still years away from realizing the full impacts of COVID-19, reflecting on our collective responses has offered some insights into the impact that various public health policies and decisions had on nations' abilities to weather the multifaceted impacts of the pandemic. Widely believed to have the potential to be devastated by COVID-19, many Indigenous communities in Canada were extremely successful in managing outbreaks. This paper outlines one such example, Wapekeka First Nation, and the community's formidable response to the pandemic with a specific focus on food mobilization efforts. Built on over a decade of community-based participatory action research and informed by six interviews with key pandemic leaders in the community, this paper, co-led by two community hunters and band council members, emphasizes the various decisions and initiatives that led to Wapekeka's successful pandemic response. Proactive leadership, along with strong traditional harvesting and processing efforts, helped to take care of the community while they remained strictly isolated from virus exposure.

Migration and indigenous health during COVID-19.

Indigenous communities during the pandemic are a precarious group. While they rely on the epistemological formation of their own knowledge systems, an integrated concept of indigenous health must include cooperation with other institutions and organizations. Drawing from grounded insights, this article highlights the crucial applicability of this idea to migrant indigenous groups during the pandemic.

Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario.

OBJECTIVE: Our primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS. METHODS: We observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 - March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Abstract Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients' health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40. CONCLUSIONS: Our results indicate that IHSS positively influenced program completion but had no significant effect on health service use. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020.

THE PERCEPTION OF INDIGENOUS HEALTH PUBLIC POLICIES AND THE HEALTH-DISEASE RELATIONSHIP BY THE KAINGANG INDIGENOUS OF THE FOXA INDIGENOUS LAND DURING THE COVID-19 PANDEMIC

This study aims to address the way in which the Kaingang from the Foxa Indigenous Territory, in the municipality of Lajeado (RS), perceive Brazilian public policies on indigenous health and the health-disease relationship during the Covid-19 pandemic period. The methodology used lists the ethno-historical approach and the interdisciplinary character in the treatment of data from the Kaingang indigenous people. The research techniques used were qualitative, descriptive in nature, using a literature review built from documentary and oral sources on indigenous health, using field diaries and interviews in loco, with indigenous leaders Kaingang, from the Foxa indigenous land. The main results showed that despite the Brazilian legislation guaranteeing to indigenous peoples differentiated care, with respect to cultural-religious diversity, the acceptance of the demands of the investigated Kaingang indigenous peoples is not very effective, since health professionals tend not to understand the perspective in the health-disease relationship, which is more complex in times of pandemic. It was found that for the Kaingang of the Foxa Indigenous Territory, the health-disease relationship is linked to the (partial) break between man and nature, including its cycles. In view of this, public health policies do not adequately address aspects of nature in the same way as in the indigenous conception, distancing both cultures. © 2022 UNIVERSIDADE FEEVALE . All Rights Reserved.

Indigenous Border Migrants and (Im)Mobility Policies in Chile in Times of COVID-19.

The commodification of healthcare and the structural violence towards the migrant population in the Chilean system materialize in a series of structural barriers to accessing healthcare. In the face of this structural vulnerability, cross-border health mobility is one of the primary resources of indigenous border migrants living in the Tarapacá region (Chile). This involves crossing the border of both people (specialists/patients) and objects (such as ritual supplies or biomedicines), which play a crucial role as, in many cases, it is the only way to satisfy their healthcare needs. The security-orientated geopolitics of border closure (Plan Frontera Segura) has been reinforced by immobility policies linked to the COVID-19 pandemic. While doing so leaves people without the fundamental resource of healthcare mobility or obliges them to cross the border via unauthorized crossings, exposing them to criminalization and abuse by different agents of violence (the military, people smugglers, etc.). In this paper, we will offer a description of these processes of (im)mobility, analyzing their conformation both by the current policies of the Chilean State and by the notorious deficiency in indigenous and migrant rights, denouncing the material impact they have on the health/illness/care process of indigenous migrants.