La hegemonía del modelo biomédico desde las representaciones del personal de salud en el contexto de un modelo de atención en salud con enfoque intercultural en Chugchilán, Ecuador / The Hegemony of the Biomedical Model from the representations of health care worker in the context of a health care model with an intercultural approach in Chugchilán, Ecuador

Resumen Este artículo pretende conocer cómo se pone en práctica el enfoque intercultural en el contexto del Modelo de Atención Integral de Salud con enfoque Familiar, Comunitario e Intercultural en Chugchilán (Ecuador), mediante los conocimientos, percepciones y prácticas que aplica el equipo de salud en la atención materno-infantil. Estudio etnográfico, en que participaron 21 profesionales sanitarios entre profesionales indígenas -técnicos de atención primaria de salud- y no indígenas del Centro de Salud. Las técnicas llevadas a cabo fueron observación participante y entrevistas en profundidad. Los datos generados se analizaron mediante análisis del contenido temático. El análisis de los datos evidenció que la hegemonía del modelo biomédico operante podría constituir una limitación en el desarrollo del enfoque intercultural, sin embargo, el personal de salud indígena, desde su rol ambiguo y contrario al modelo biomédico, emerge como un elemento contrahegemónico y articulador real entre los saberes biomédicos e indígenas en contextos interculturales de atención-autoatención.

Abstract This article aims to discover the intercultural practical approach in the context of the Comprehensive Healthcare Model within family, community, and interculturality in Chugchilán, Ecuador, via the recognition of knowledge, perceptions, and practices applied by the health team in maternal and child care. In this ethnographic study 21 health professionals, both Indigenous and non-indigenous from Chugchilán Health Center have participated, among the Indigenous health care workers were the primary health care technicians. The techniques applied were participant observation and in-depth interviews. The observed scenarios were the Health Center and excursion with community to record their daily life experiences. The generated data were examined using thematic content analysis. It showed that the operating biomedical hegemonic model could constitute one of the main limitations in the development of the intercultural approach. Even though Indigenous healthcare team holds an ambiguous and sometimes contrary role to the biomedical model, it has emerged as a counter-hegemonic element and real conciliator between biomedical and indigenous knowledge in intercultural contexts of care-self-care.

Interculturalidad e infancia rural: trabajo y cuidado en La Araucanía, Chile / Interculturality and rural childhood: work and care in La Araucanía, Chile

(analítico) Desde una mirada intercultural, se exploraron los significados de infancia en la agricultura familiar campesina, así como sus implicaciones en términos de trabajo y provisión de cuidados a niños y niñas. A partir de la tensión entre los significados universales de infancia basados en un enfoque de derechos y el trabajo en el campo del cual participan las personas desde temprana edad, se realizó un estudio cualitativo con diseño de teoría fundamentada y aplicación de entrevistas a mujeres cuidadoras y profesionales de programas de desarrollo rural en Chile. Se evidenció que a medida que la infancia aumenta en actoría social, disminuyen las prácticas de trabajo y se profundizan las de cuidado. Los resultados alientan a pensar en la proyección de una ontología de la niñez rural.

(analytical) Using an intercultural perspective, this study explores the meanings of childhood in the rural peasant population, as well as the implications of these meanings on the allocation of tasks and providing care to boys and girls. Taking into account the tension between universal meanings of childhood that draw on rights-based perspectives and the traditional practice of children working in agriculture, we conducted a qualitative study using a grounded theory methodology. Interviews were conducted with women caregivers and staff who work in rural development programs in Chile. The study's results show that as childhood has had an increasing value with children becoming more and more recognized as social actors, traditional child work practices in agriculture have decreased and care practices have been strengthened. The author concludes that the results of the research have consequences when thinking about an ontology for rural children.

(analítico) A partir de uma perspectiva intercultural, exploramos os significados da infância entre famílias voltadas para agricultura familiar camponesa, bem como suas implicações em termos de trabalho e prestação de cuidados às meninos e meninas. Considerando a tensão existente entre os significados universais da infância a partir de uma abordagem de direitos e o trabalho no campo, no qual as pessoas se engajam desde muito cedo, realizamos um estudo qualitativo, com base na teoria fundamentada, onde realizamos entrevistas com mulheres cuidadoras e profissionais dos programas de desenvolvimento rural no Chile. Evidenciamos que à medida que a infância adquiriu um valor ao nível da atuação social, as práticas de trabalho diminuíram e as práticas de cuidado se aprofundaram. Conclui-se sobre as consequências dos resultados para pensar uma ontologia da infância rural.

Formación de profesionales de la salud que incorpora la competencia intercultural: una necesidad actual / The Training of Health Professionals Including Intercultural Competence: A Current Necessity

Introducción: Hoy en día, dadas las transformaciones de la sociedad, existe una necesidad de generar una formación de profesionales de la salud con nuevas competencias, por lo que se les entrega otras herramientas para la atención en salud, que incluye, especialmente, la perspectiva basada en la interculturalidad. Esta representación se hace imprescindible debido a la configuración de sociedades más heterogéneas, marcadas por los procesos migratorios y la visibilización de grupos que, hasta hace pocos años, estaban al margen del sistema de salud. Objetivo: Analizar los referentes teóricos de interculturalidad, interculturalidad en salud, competencia intercultural y la competencia interculturalidad en la formación de los profesionales de salud. Métodos: Se realizó una revisión narrativa. Desarrollo: Se abordaron los conceptos de interculturalidad, interculturalidad en salud, competencia cultural/competencia intercultural, y cómo estos conceptos y atributos se pueden enseñar en la formación de las nuevas generaciones de profesionales de la salud. Conclusiones: Es necesario que el futuro profesional observe, escuche, pregunte aquello que desconoce de la cultura. Hay que evitar los estereotipos, garantizar el respeto y comprender sin juzgar; además, desarrollar el autoconocimiento, antes de llegar a la aplicación integral de la competencia intercultural. Se ha de conseguir realizar un encuentro intercultural adecuado para garantizar una asistencia de calidad a los usuarios(AU)

Introduction: Nowadays, given the transformations in society, there is a need to train health professionals with new competences; therefore, they are provided with other tools for health care, which includes, especially, the perspective based on interculturality. This representation is essential due to the configuration of more heterogeneous societies, marked by migratory processes and the visibility of groups that, until a few years ago, were on the margins of health systems. Objective: To analyze the theoretical references of interculturality, interculturality in health, intercultural competence and the competence of interculturality itself in the training of health professionals. Methods: A narrative review was conducted. Development: The concepts of interculturality, interculturality in health and cultural competence/intercultural competence were addressed, together with how such concepts and attributes can be taught in the training of new generations of health professionals. Conclusions: It is necessary for future professionals to observe, listen to and ask what they do not know about culture. It is necessary to avoid stereotypes, to guarantee respect and to understand without judging; in addition, to develop self-knowledge, before reaching the comprehensive application of intercultural competence. Adequate intercultural encounters must be achieved in order to guarantee quality healthcare provision for the users(AU)

Vulnerability assessment of debris flow in the central Peruvian rainforest - An intercultural approach.

For several decades, calamitous debris flows have inflicted profound negative impact on Peruvian rainforest society, encompassing both economic losses and human casualties. To address this concern, this study proposes a methodological tool to assess vulnerability while focusing on intercultural nuances. The contextual analysis of the incident reports identifies La Merced (Junín, Perú) as a severely affected locality, thereby justifying its selection for a detailed case study on the Pampa del Carmen sector. The study conducted a thorough systematic review of parameters such as diglossia, poverty, and origin that are crucial for vulnerability assessment. Moreover, these parameters aided in developing a structured digital survey. The integration of survey data into the analytic hierarchy process revealed high levels of vulnerability in the sector, emphasizing the imminent need for targeted interventions. The intercultural approach is significant as it facilitates future risk mitigation strategies based on effective integration and genuine acknowledgment of social dynamics and individual freedoms within the region for devising impactful risk management policies and plans.

Snakebites from the standpoint of an indigenous anthropologist from the Brazilian Amazon.

Conflicting attempts between indigenous caregivers trying to exercise their healing practices in hospitals have been recorded in the Brazilian Amazon. In this work, we present an interview with the Baniwa indigenous anthropologist Francy Baniwa. In an external and colonial interpretation, it was previously stated that indigenous people attribute the origin of snakebites as supernatural and that indigenous medicine, when it saves a patient from complications and death, has symbolic efficacy. In this interview, we observed that this form of interpretation is asymmetric because, for indigenous people, their understanding of nature is broader than ours, with more possibilities of ways of existence, including non-human entities as well or ill-intentioned as humans. The interaction of humans with these identities produces a form of existence with its own clinical reality, which is full of symbolism. Effective communication between health agents and indigenous patients and caregivers must undergo this exercise of otherness and interculturality.

Relatos en torno a la lactancia materna de las mujeres-madres-migrantes haitianas en Chile / Stories About Breastfeeding by Haitian Migrant Mothers in Chile

Introducción: Desde hace ya una década, Haití se ha ubicado como uno de los principales países emisores de migración hacia Chile, dada la estabilidad económica y política del país. Esta migración, con fuerte tendencia a la feminización, significa un aumento de los nacimientos de hijos de madre haitiana en Chile. Desde ese lugar, las madres haitianas enfrentan un desencuentro cultural al desplegar sus prácticas de crianza que involucran a la lactancia materna, en un Chile que promueve políticas homogeneizadoras de crianza infantil que, además, construye un discurso estereotipado respecto a las madres haitianas como madres indiferentes e ignorantes. Objetivo: Describir las experiencias y significados atribuidos a la lactancia materna por un grupo de madres haitianas residentes en la ciudad de Santiago de Chile. Métodos: Se realizó un estudio cualitativo, con enfoque interseccional, que describe las relaciones asimétricas entre la sociedad chilena y las mujeres madres haitianas con ocasión de la crianza de sus hijos en Chile, producto de las características de clase, género, etnia/raza que en ellas se encarnan. Resultados: Se obtuvieron tres categorías de análisis: las experiencias de amamantamiento, el significado atribuido a la lactancia materna y las formas de socialización a través de las cuales las madres haitianas han aprendido a amamantar. Conclusiones: En cuanto a la lactancia materna, las mujeres haitianas entrevistadas atraviesan diversas experiencias y atribuyen un sentido positivo a la leche materna como alimento vital para el fortalecimiento de sus hijos, y en cuya práctica despliegan conocimientos propios y también los aprendidos del sistema de salud chileno en una especie de mixtura. Si bien estos hallazgos no difieren de los resultados obtenidos en investigaciones con otros grupos de madres de origen no haitiano, el esencialismo hacia las prácticas de lactancia materna de las madres haitianas estaría basado en su etnia/raza y su pertenencia a grupos sociales vulnerables que las ubican en una posición social de subalternidad y, por tanto, factible de ser desvalorizado y gobernado(AU)

Introduction: For a decade now, Haiti has been one of the main countries sending migration to Chile, given the country's economic and political stability. This migration, with a strong tendency towards feminization, means an increase in the births of children to Haitian mothers in Chile. From that place, Haitian mothers face a cultural disparity when deploying their parenting practices that involve breastfeeding, in Chile that promotes homogenizing child rearing policies that, in addition, constructs a stereotyped discourse regarding Haitian mothers as indifferent and ignorant mothers. Objective: To describe the experiences and meanings attributed to breastfeeding by a group of Haitian mothers residing in the city of Santiago de Chile. Methods: A qualitative study was carried out, with an intersectional approach, which describes the asymmetric relationships between Chilean society and Haitian mothers dedicated to raising their children in Chile in terms of the characteristics of class, gender, ethnicity/race that in these women incarnate. Results: Three categories of analysis were obtained: breastfeeding experiences, the meaning attributed to breastfeeding and the forms of socialization through which Haitian mothers have learned to breastfeed. Conclusions: Regarding breastfeeding, the Haitian women interviewed go through various experiences and attribute positive meaning to breast milk as a vital food for the strengthening of their children, and in whose practice, they deploy their own knowledge and also the knowledge learned from the Chilean health system, in a kind of mixture. Although these findings do not differ from the results obtained in research with other groups of mothers of non-Haitian origin, the essentiality towards the breastfeeding practices of Haitian mothers would be based on their ethnicity/race and their belonging to vulnerable social groups placing them in a social position of subalternity and, therefore, likely to be devalued and governed(AU)

Bioética, biopolítica e interculturalidad en salud pública: estudio de caso del Hospital Mama Dominga

Propósito/Contexto. Este artículo da cuenta de los resultados de un proyecto de investigación, cuyo objetivo fue la propuesta de un aporte desde la Bioética y la Biopolítica para la reformulación de un modelo de salud pertinente con las necesidades del contexto sociocultural de la población atendida por el Hospital Mama Dominga en Silvia, Cauca, Colombia. Metodología/Enfoque. El estudio siguió un corte fundamentalmente cualitativo, se privilegiaron las fuentes documentales y de sondeo, así como las observaciones propias del investigador. Resultados/Hallazgos. Los resultados ofrecen un acercamiento a la apreciación del pueblo Misak sobre la salud y su sistema de atención y resaltan la necesidad de apertura de diálogos realmente horizontales en ámbitos de ciencia y cultura, en pro del mejoramiento del bienestar de las comunidades tradicionales en el país. Discusión/Conclusiones/Contribuciones. A partir de la lectura de referentes teóricos y su correlación contextual con el desarrollo histórico de la salud en el Cauca, especialmente en el resguardo de Guambía con la comunidad Misak, se estableció una línea de análisis sobre la pertinencia de los modelos de atención en salud en contextos rurales o tradicionales y las oportunidades de transformación desde experiencias, historia y conocimientos propios de la población.

Purpose/Background. This article presents the results of a research project which objective was to propose a contribution, from bioethics and biopolitics, for the reformulation of a health attention model according with the needs of the community attended by Mama Dominga Hospital in Silvia, Cauca (Colombia) in their own sociocultural context. Methodology/Approach. The study fundamentally followed a qualitative approach, favouring documentary sources, polls, interviews and observations from the researcher. Results/Findings. The results offer an approach to the Misak conception about health and its attention system, and highlight the importance of promoting truly horizontal dialogues in science and culture spaces, in favor of the wellbeing improvement of traditional communities across the country. Discussion/Conclusions/Contributions. Parting from theoretical references and their contextual correlation with the historical development of health policies in Cauca -specially the Guambía Reservation with Misak people-, it was possible to set an analysis line about health attention models and their pertinence in rural and/or traditional contexts, and their adjustment opportunities by listening to experiences, history and knowledge that come from the own community.

Objetivo/Contexto. Este artigo relata os resultados de um projeto de pesquisa cujo objetivo foi propor uma contribuição da Bioética e da Biopolítica para a reformulação de um modelo de saúde relevante para as necessidades do contexto sociocultural da população atendida pelo Hospital Mama Dominga em Silvia, Cauca, Colômbia. Metodologia/Abordagem. O estudo seguiu uma abordagem fundamentalmente qualitativa, dando prioridade a fontes documentais e de pesquisa, bem como às observações do próprio pesquisador. Resultados/Descobertas. Os resultados oferecem uma abordagem da apreciação do povo Misak sobre a saúde e seu sistema de saúde e destacam a necessidade de abrir diálogos verdadeiramente horizontais nos campos da ciência e da cultura, a fim de melhorar o bem-estar das comunidades tradicionais do país. Discussão/Conclusões/Contribuições. Com base na leitura de referências teóricas e sua correlação contextual com o desenvolvimento histórico da saúde no Cauca, especialmente na reserva de Guambía com a comunidade Misak, foi estabelecida uma linha de análise sobre a pertinência dos modelos de atenção à saúde em contextos rurais ou tradicionais e as oportunidades de transformação com base nas experiências, na história e no conhecimento da população.

Epidemiologia e emancipação humana: uma revisita aos princípios da justiça / Epidemiology and human emancipation: revisiting the principles of justice

RESUMO A epidemiologia, apesar de suas origens sócio-históricas, tornou-se hegemonicamente individual, linear, com clivagens entre os hemisférios norte e sul, entre método e teoria crítica, de onde emerge a necessidade de uma epidemiologia voltada à emancipação humana. O objetivo deste artigo é avaliar de que forma a epidemiologia contra-hegemônica tem contribuído para práticas efetivas de emancipação humana na saúde pública nos diferentes níveis de justiça. Realizou-se revisão integrativa, com busca nas bases de dados PubMed, BVS, Assia, Embase e SA e análise temática e cross-case. Diante de lentes ajustadas à epidemiologia crítica, reconstituímos os tensionamentos entre as diferentes formas de emancipações política e humana, nos níveis de justiça cognitiva, socioambiental e de saúde. O primeiro nível, cognitivo, é atravessado pela razão de mundo e pelo pensamento abissal e envolve os demais. O nível socioambiental foi ancorado no metabolismo socionatural-histórico e o de saúde, angustia-se entre o bem viver e as lutas fragmentadas pelos direitos à saúde universal, frente à espoliação do setor. No enfrentamento ao modelo de acumulação de capital, devemos valorizar a interculturalidade e a subjetividade. Evidenciou-se que a 'Epistemologia do Sul' remete a um pensamento descolonizador, orientando metodologias capazes de potencializar descobertas bem como desmistificar as relações sociais.

ABSTRACT Epidemiology, despite its socio-historical origins, has become hegemonically individual and linear, with the north-southern hemispheres divide, methodology and critical theory, which calls for a human emancipation oriented epidemiology. The aim of this article is to assess how critical epidemiology has contributed to effective human emancipation practices in public health, at different justice levels. An Integrative review was performed, with searches in PubMed, VHL, ASSIA, EMBASE and SA databases and thematic and cross-case analysis. Elaborating through critical counter-hegemonic epidemiology adjusted lens, we reconstitute the tension between different modes of human and political emancipations, at the levels of cognitive, socio-environmental and health justice. The cognitive level is crossed by the 'way of the world' and the 'abyssal' thinking and involves the other levels. The socio-environmental level was anchored in the historical socio-natural metabolism and that of health, anguishes between well-being and the fragmented struggles for universal health rights, as opposed to the spoliation of the sector. In confronting the capital accumulation model, it's essential to value interculturality and subjectivity We found evidence that the 'Epistemology of the South' points out to a decolonizing thought-oriented methodology, capable of enhancing discoveries and demystifying social relations.

Diseño del Programa de Educación Intercultural a distancia, mención salud, de la Universidad Indígena de Venezuela / Design of the distance Intercultural Education Program, health mention, of the indigenous University of Venezuela

A pesar de la puesta en práctica de la Ley de Educación Intercultural Bilingüe para los Pueblos indígenas en América Latina, son pocos los países en los que se consideraron elementos de sus costumbres para construir una verdadera educación intercultural. Reconocer las características propias de cada Pueblo, admite abordar las culturas bajo una educación que incida de manera certera en cada individuo. Las culturas se identifican a través de códigos estructurados en años de historia, dando identidad a cada Pueblo. Construir la educación a través de esos códigos, permitirá bajo el espacio que los representa, diseñarlos en términos que identifican su etnicidad. Las poblaciones indígenas se encuentran esparcidas a través del territorio nacional, dificultando en gran medida el alcance de la educación para todos. La Universidad Indígena de Venezuela no escapa a esa realidad. Por tanto, se pretende con este trabajo realizar un modelo de educación a distancia utilizando los códigos que le dan identidad, diseñando el espacio que los representa, a través del aula virtual bajo el programa de formación de licenciados en salud intercultural(AU)

Despite the implementation of the Law on Intercultural Bilingual Education for Indigenous Peoples in Latin America, few countries have considered elements of their customs to build a true education in terms of interculturality. Recognizing the characteristics of each People, admits to approach the cultures under an education that affects in an accurate way in each individual. Each culture is identified through codes structured in years of history, giving identity to each People. Building education through these codes will allow under the space that represents them, to design it in terms that identify their ethnicity. Rural and indigenous populations in particular are scattered throughout the national territory, which greatly hinders the scope of education for all, and the Indigenous University of Venezuela does not escape that reality. Therefore, it is intended with this work to make a model of distance education using the codes that give it identity, designing the space that represents them, through the virtual classroom under the training program for graduates in intercultural health(AU)

Salvajes, indígenas, cojas, inválidas: Epistemologías anticapacitistas del Sur / Selvagem, indígena, coxo, inválido: epistemologias anticapacitistas do Sul / Wild, Indigenous, Lame, Invalid: Anti-Ableist Epistemologies of the South

Resumen El objetivo del manuscrito es presentar una primera aproximación a una propuesta epistemológica que reflexione y se ocupe de la construcción y legitimación de conocimientos generados desde corporeidades abyectas, anormales o tullidas geopolíticamente ubicadas al Sur. Pone especial atención al sistema sexo-género-capacidad en la organización social y epistemológica del saber. En ese devenir, identificamos una posicionalidad y riqueza desperdiciada para el análisis y transformación social regional como resultado de un ordenamiento moderno colonial. De ahí que esta propuesta se inscriba dentro del pensamiento crítico latinoamericano para reflexionar sobre esos lugares otros de enunciación abyecta.

Resumo O objetivo deste artigo é apresentar uma abordagem inicial de uma proposta epistemológica que reflita e lide com a construção e a legitimação do conhecimento gerado a partir de corporeidades abjetas, anormais ou inválidas, geopoliticamente localizadas no Sul. Dá atenção especial ao sistema de sexo-gênero-capacidade na organização social e epistemológica do saber. No processo, identificamos uma posição e uma riqueza desperdiçadas para a análise e transformação social regional como resultado de uma ordem colonial moderna. Por isso, esta proposta se inscreve no pensamento crítico latino-americano para refletir sobre esses outros lugares de enunciação abjeta.

Abstract The aim of the article was to present a first approach to an epistemological proposal that reflects on and deals with the construction and legitimation of knowledge generated from abject, abnormal, or crippled corporeities geopolitically located in the South. It pays special attention to the sex-gender-ability system in the social and epistemological organization of knowledge. In this development, we identify a positionality and wasted wealth for regional social analysis and transformation as a result of a modern colonial order. Hence, this proposal is inscribed within the Latin American critical thinking to reflect on those other places of abject enunciation.

Práticas corporais na Amazônia: contribuições para o currículo cultural na escola / Body practices in the Amazon: contributions to the cultural curriculum at school / Prácticas corporales en la Amazonia: aportes al currículum cultural en la escuela

O processo de escolarização brasileiro, alicerçado pelo prisma da modernidade, fortaleceu no cotidiano escolar a predominância de práticas pedagógicas homogêneas e monoculturais que não dialogam com a diversidade cultural presente na escola. Argumentamos que esse cenário traz implicações para o processo educativo e para a formação do sujeito, além de provocar tensões ou conformidade diante da (in)adequação frente à cultura dominante. Diante disso, o presente artigo analisa as interseções entre cultura, escola e práticas corporais desenvolvidas na Amazônia para a valorização dos sujeitos e significação do processo de aprendizagens à luz da interculturalidade crítica e da educação física cultural. O diálogo com o campo teórico opõe-se aos modelos vigentes de pensar e construir a educação e tensiona em favor do reconhecimento dos diferentes conhecimentos, da valorização e do respeito à diversidade de sujeitos e culturas para a construção de uma sociedade mais democrática, plural e humana. (AU)

The Brazilian schooling process, based on the prism of modernity, has strengthened in everyday schools the predominance of homogeneous and monocultural pedagogical practices that do not dialogue with the cultural diversity present in schools. It is argued that this scenario has implications for the educational process and the formation of the subject, besides causing tensions or conformity in the face of (in)adequacy to the dominant culture. Therefore, this article analyzes the intersections between culture, school and body practices developed in the Amazon towards the valorization of subjects and the significance of the learning process in the light of critical interculturality and cultural physical education. The dialogue with the theoretical field opposes the current models of thinking and building education and tenses in favor of recognizing different knowledge, valuing and respecting the diversity of subjects and cultures for the construction of a more democratic, plural and human society. (AU)

El proceso de escolarización brasileño, basado en el prisma de la modernidad, fortaleció en el cotidiano escolar el predominio de prácticas pedagógicas homogéneas y monoculturales que no dialogan con la diversidad cultural presente en la escuela. Se argumenta que este escenario tiene implicaciones para el proceso educativo y para la formación del sujeto, además de provocar tensiones o conformismo delante de la (in)adecuación frente a la cultura dominante. Por lo tanto, este artículo analiza las intersecciones entre cultura, escuela y prácticas corporales desarrolladas en la Amazonía para la apreciación de los sujetos y el sentido del proceso de aprendizaje a la luz de la interculturalidad crítica y la educación física cultural. El diálogo con el campo teórico se contrapone a los modelos vigentes de pensar y construir la educación y se incide a favor del reconocimiento de los saberes diferentes, la valoración y el respeto a la diversidad de sujetos y culturas para la construcción de una sociedad más democrática, plural y humana. (AU)

Health professionals and Amerindian patients: representations and practices in French Guiana / Professionnels de santé et patients amérindiens : représentations et pratiques en Guyane française

CONTEXT: In French Guiana, Amerindian populations find themselves in a health system whose therapeutic itinerary revolves around their traditional medicine and modern medicine provided by health professionals mostly from hexagonal France. The latter intervene in a “complexity of intercultural contact” which influences the caregiver-patient relationship and affects therapeutic adherence. METHOD: To better understand the practices and representations of the health system in an intercultural context, qualitative research was carried out in the field between 2018 and 2019 with seventeen health professionals working in health centers located in the municipalities of the Interior of French Guiana. Semi-structured individual interviews were conducted in order to explore the representations, the difficulties encountered, and the tools used by these caregivers in their daily practice. These interviews were crossed with participant observations and bibliographical research in the medical and anthropological fields. RESULTS: The caregiver-patient encounter was asymmetrical, unequal and was part of a power relationship. The caregivers remained marked by ethnocentric representations -inherent to each culture- far removed from those of the populations and this divergence impacted the practice. DISCUSSION: It would be advisable to shift the focus in order to « penetrate » the frame of reference of the Other and rebalance relationships. The exploration of popular knowledge and skills and the application of proven teaching methods would encourage therapeutic adherence. « Homethnic workers » and intercultural training could help promote community health.

Contexte: En Guyane française, les populations amérindiennes se retrouvent dans un système de santé dont l'itinéraire thérapeutique s'articule autour de leur médecine traditionnelle et d'une médecine moderne prodiguée par des professionnels de santé originaires, pour la plupart, de la France hexagonale. Ces derniers interviennent dans une « complexité de contact interculturel ¼ qui influence la relation soignant soigné et affecte l'adhésion thérapeutique. Méthode: Pour mieux comprendre les représentations et pratiques du système de santé en contexte interculturel, une recherche qualitative a été menée sur le terrain, en 2018 et 2019, auprès de dix-sept professionnels de santé exerçant dans les centres de santé situés dans les communes de l'Intérieur de la Guyane. Des entretiens individuels semi-structurés ont été menés afin d'explorer les représentations, les difficultés rencontrées et les outils mobilisés par ces soignants dans leur pratique courante. Ces entretiens ont été croisés avec des observations participantes et des recherches bibliographiques dans les champs médicaux et anthropologiques. Résultats: La rencontre soignant soigné était asymétrique, inégale et s'inscrivait dans un rapport de pouvoir. Les soignants restaient marqués de représentations ethnocentriques - inhérentes à chaque culture - éloignées de celles des populations amérindiennes, et cette divergence impactait la pratique. Discussion: Il conviendrait de se décentrer, pour « pénétrer ¼ dans le cadre de référence de l'Autre et rééquilibrer les rapports. L'exploration des savoirs et savoir-faire populaires et l'application de méthodes éprouvées d'enseignement encourageraient l'adhésion thérapeutique. Les « intervenants homethniques ¼ et une formation à l'interculturalité pourraient favoriser la promotion de la santé communautaire.

A Relevant Debate in the Post-pandemic Sustainability or Sustainable Development of the Territory? / Un debate pertinente en la pospandemia. ¿sostenibilidad o sustentabilidad del desarrollo territorial?

RESUMEN En este artículo Se identifican las diferencias a propósito de conceptos asociados al desarrollo como lo son sostenibilidad o sustentabilidad ambiental. Se da cuenta del debate entre las concepciones sobre el crecimiento económico de los enfoques económicos-políticos neoclásicos, y las críticas a estos enfoques por parte de Georgescu-Roegen, Rene Passet, Enrique Leff, Manfred Mc Neef y Philippe Smith, al igual que las consideraciones de Edgar Morin sobre las lecciones de la pandemia. Y se Toma, como corolario, estas reflexiones en debate para abordar el tema de la sustentabilidad del desarrollo territorial, asignándole a la dimensión ambiental y a las estrategias de la educación intercultural un papel preponderante.

ABSTRACT This article identifies the differences regarding concepts associated with development, such as sustainability or sustainable environmental development. accounts for the debate between the conceptions of economic growth of the neoclassical economic-political approaches, and the criticisms of these approaches by Georgescu-Roegen, Rene Passet, Enrique Leff, Manfred Mc Neef, and Philippe Smith, as well as Edgar Morin's considerations on the lessons of the pandemic. These reflections are taken as a corollary to address the issue of sustainable territorial development, assigning a preponderant role to the environmental dimension and to the strategies of intercultural education.

Meanings and Practices in Intercultural Health for International Migrants.

In this article, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the city of Antofagasta in northern Chile. METHODOLOGY: The methodology was qualitative with a phenomenological descriptive design, through which discourses from health personnel in the public primary and secondary care system were explored (n = 23). Next, meanings and practices in intercultural health for international migrants in health establishments are described from the perspective of health personnel in the northern Chilean city of Antofagasta. RESULTS: The participants presented trees of thematic categories. There were three thematic categories overall: (1) The meaning of interculturality included features of understanding of the concept, with respect for culture being the transversal axis in all discourses. (2) Practices in health care, where voluntariness, references, and the adequacy or non-technicality of the language are fundamental axes. (3) Training in the intercultural approach, where there is often self-knowledge and lack of supply in the health system. CONCLUSIONS: The findings show essential elements to consider in the care of international migrants, including the training and awareness of staff about the intercultural approach through strategies following the local reality in which each health establishment exists.

Ideological assumptions of Chile's international migrant healthcare policy: A critical discourse analysis.

In the current historical moment of rewriting the Chilean Constitution, there are new hopes for producing a different socio-legal, political-economic and public health order. The Chilean case holds important implications for global health practitioners, researchers and policy-makers because it clearly shows both the impacts of neoliberal processes on a worldwide scale and neoliberal policy responses. This article contributes to the field of global health policy critical analysis by offering scrutiny of Chile's international migrant healthcare policy from the perspective of its ideological assumptions. We apply Fairclough's analytical perspective to the Chilean migrant healthcare policy, identifying its components, argumentative premises and ideological assumptions that contribute to the reproduction of the processes of social determination. It allows us to identify bias mobilisation, exclusion, and subordinate inclusion processes that systematically lead to the omission of structural processes in the social determination of migrants' healthcare, contributing to their reproduction. We conclude by problematising the place of academia in said reproduction to the extent that the concepts and premises they use remain in the ideological territory of exclusion of the structural defined by the policy, disconnecting reflection and action in the health field from collective demands.

Interculturality: a place to experience multiplicity.

The mobility of people around the world is nothing new and brings with it different impacts on interpersonal relationships. In this paper we will reflect on this subject starting from certain questions: what dialogues can be had from those who bring new ideas from their travels with the keepers of traditions in their communities? Is it possible to entertain the image of a pluralistic and globalized world? We begin by tracing the movement of peoples through the centuries, the two major ways in life which developed: nomadism and sedentarism - and how the differences generated conflicts and discrimination. Finally, we reflect on the attributes of the god Hermes from which there is the possibility of creating space to live out our intercultural encounters with reciprocity and generosity within the hospitality ritual of 'giving and receiving'.

La mobilité des personnes dans le monde entier n'a rien de nouveau et amène avec elle différents impacts sur les relations interpersonnelles. Dans cet article nous réfléchirons sur le sujet en partant de certaines questions: quels dialogues peuvent se produire nourris par ceux qui amènent de nouvelles idées de leurs voyages avec ceux qui sont les gardiens des traditions dans leurs communautés? Est-il possible de concevoir l'image d'un monde pluraliste et globalisé? Nous commençons par retracer le mouvement des peuples au travers des siècles, et les deux principales manières de vivre qui se sont développées: le nomadisme et la sédentarité - et comment les différences ont généré des conflits et de la discrimination. Finalement, nous attirons l'attention sur quelques épitaphes du dieu Hermès, qui nous donnent la possibilité de créer de l'espace pour vivre les rencontres interculturelles avec réciprocité et générosité au sein du rituel d'hospitalité: 'donner et recevoir'.

La movilidad de las personas alrededor del mundo no es algo nuevo y trae consigo impactos diferentes en las relaciones interpersonales. En el presente trabajo reflexionamos sobre este tema comenzando con algunas preguntas: ¿Cuáles son los diálogos posibles con quienes brindan nuevas ideas a partir de sus viajes con los cuidadores de la tradición en sus comunidades? ¿Es posible considerar la imagen de un mundo globalizado y plural? Comenzamos por trazar los movimientos de las personas a través de los siglos, los dos modos principales de vida que se han desarrollado: nomadismo y sedentarismo - y cómo las diferencias han generado conflictos y discriminación. Finalmente, ponemos de manifiesto algunos epitafios del dios Hermes, desde lo cual es posible crear espacio para vivir encuentros interculturales con reciprocidad y generosidad al interior del ritual de la hospitalidad del 'dar y recibir'.

A mobilidade de pessoas em todo o mundo não é novidade e traz consigo diferentes impactos nas relações interpessoais. Neste artigo, refletiremos sobre esse assunto a partir de certas perguntas: Quais diálogos podem ser tidos daqueles que trazem novas ideias de suas viagens com os guardiões das tradições em suas comunidades? É possível entreter a imagem de um mundo pluralista e globalizado? Começamos traçando o movimento dos povos ao longo dos séculos, os dois principais modos de vida que se desenvolveram: nomadismo e sedentarismo - e como as diferenças geraram conflitos e discriminação. Finalmente, trazemos à luz alguns epitáfios do deus Hermes, dos quais há a possibilidade de criar espaço para viver os encontros interculturais com reciprocidade e generosidade dentro do ritual de hospitalidade de "dar e receber".

Estrategia educativa intercultural para la prevención del cáncer de cuello cérvico uterino en el resguardo de Paujil, Amazonia Colombiana / Intercultural educational strategy for the prevention of cervical cancer in Paujil Resguardo Amazonía colombiana

RESUMEN Los pueblos indígenas siguen sufriendo inequidades, a pesar de los avances relacionados con la protección de la diversidad étnica y cultural, siendo las mujeres uno de los grupos de mayor riesgo, sobre todo, en lo referente a la salud sexual y reproductiva, situación contemplada como un compromiso de acción en los objetivos de desarrollo sostenible. En ese contexto, esta investigación acción participativa buscó construir una estrategia educativa intercultural, sostenible y segura culturalmente que, a propósito de la prevención del cáncer de cuello uterino, aportará al empoderamiento y la conservación de la salud de las mujeres habitantes del resguardo de Paujil -Colombia. La iniciativa surgió de mujeres indígenas preocupadas por mejorar la salud de sus congéneres y un grupo de investigadores. La construcción de una estrategia educativa intercultural representa un reto, pues la pedagogía occidental no necesariamente corresponde a las concepciones de enseñanza aprendizaje de las indígenas del resguardo. Hay dificultades lingüísticas, pues cada etnia tiene su propia lengua. Las indígenas lideresas se convirtieron en las facilitadoras del proceso que se centró más en el uso de la oralidad y encuentros entre mujeres, que se conocen entre sí. Las mujeres prefieren estrategias didácticas basadas en compartir experiencias y el uso de cartillas y videos. El trabajo permitió concluir que cualquier estrategia educativa intercultural que se proponga debe ser específica y acorde a las necesidades de las comunidades.

ABSTRACT Despite the advances related to the protection of ethnic and cultural diversity, indigenous people continue to suffer inequities, with women being one of the groups most at risk, especially concerning sexual and reproductive health, a situation considered as a problem, a commitment to action in the sustainable development goals. In this context, this Participatory action research searched to build an intercultural educational strategy, sustainable and culturally safe, which, concerning the prevention of cervical cancer, would contribute to the empowerment and conservation of the health of the women who live in the Paujil reservation-Colombia. The initiative arose from indigenous women concerned about improving the health of their peers, and a group of researchers. The construction of an intercultural educational strategy represents a challenge since western pedagogy does not necessarily correspond to the teaching-learning conceptions of the indigenous people of the reservation. There are linguistic difficulties because each ethnic group has its language. The indigenous leaders became the facilitators of the process that focused more on the use of orality and meetings between women who know each other. Women prefer a didactic strategy based on sharing experiences, and the use of primers, and videos. The work allowed to conclude that any proposed of intercultural educational strategy must be specific and according to the needs of the communities.

Reflexiones y experiencias sobre la interculturalidad y la ética en el abordaje del paciente / Reflections and experiences on interculturality and ethics in the patient approach / Reflexões e experiências sobre interculturalidade e ética na abordagem ao paciente

El concepto de interculturalidad es utilizado extensa y recurrentemente en reuniones y publicaciones científcas tanto extranjeras como nacionales. Es importante valorar conceptos que se entrelazan con el ámbito de la salud. Ante ello reflexionamos y analizamos que el Perú es un país pluricultural, con poblaciones que pertenecen a diferentes grupos étnico-culturales y hablan diferentes lenguas. Al mismo tiempo, los servicios públicos se orientan a satisfacer las necesidades de todos los peruanos y peruanas, por lo cual deben considerar la diversidad étnica y cultural de la población. Entonces, los servicios públicos que no incorporan perspectivas culturales de la población generan brechas que desaniman a la población a acudir a los mismos servicios

The concept of interculturality is used extensively and recurrently in both foreign and national meetings and scientific publications, both foreign and national. It is important to value concepts that are intertwined with the field of health. health. In this regard, we reflect and analyze the fact that Peru is a pluricultural country, with populations that belong to country, with populations that belong to different ethnic- cultural groups and speak different different ethnic-cultural groups and speak different languages. At the same time, public at the same time, public services are oriented to satisfy the needs of all Peruvians. Peruvians, which is why they must take into account the ethnic and cultural diversity of the population. and cultural diversity of the population. Therefore, public services that do not incorporate cultural perspectives of the population generate gaps that discourage people that discourage the population from seeking the same services.

O conceito de interculturalidade é ampla e recurrentemente utilizado na ciência estrangeira e nacional. reuniões e publicações científicas, tanto no país como no exterior. É importante valorizar conceitos que estão entrelaçados com o campo de saúde. A este respeito, nós reflect e analisamos o fato de que o Peru é um país pluricultural, com populações que pertencem ao seguinte país, com populações pertencentes a diferentes grupos étnico-culturais e falando diferente grupos etno-culturais e falam idiomas diferentes. Ao mesmo tempo, o público ao mesmo tempo, os serviços públicos são orientados para satisfazer as necessidades de todos os peruanos. Os peruanos, por isso, devem levar em conta a diversidade étnica e cultural da população. e diversidade cultural da população. Portanto, os serviços públicos que não incorporam as perspectivas culturais da população geram lacunas que desencorajam as pessoas que desencorajam a população de utilizar os mesmos serviços.