RESUMO
Central America science production on biodiversity topics is important in planning future adaptive and conservation policies in a climate-related risk region that is considered a biodiversity hotspot but has the lowest Human Development Index of Latin America. Science production on biodiversity is related to geo-referenced species occurrence records, but the accessibility depends on political frameworks and science funding. This paper aims at foregrounding how the democratic shifts throughout the years have had an impact on science production on biodiversity research, and species records. For this exploration we developed a novel systematic scientometric analysis of science production on biodiversity topics, we used Bio-Dem (open-source software of biodiversity records and socio-political variables) and briefly analyzed the history-from 1980 to 2020-of Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama. With a data set of 16,304 documents, our analysis shows the significant discrepancies between the low science production of Central American Northern countries (Guatemala, El Salvador, Honduras, and Nicaragua), the prolific production from the Southern (Costa Rica and Panama), and how this relates to democratic stability. Scientific production tends to be more abundant when democratic conditions are guaranteed. The state capture phenomenon and colonial-rooted interactions worldwide have an effect on the conditions under which science is being produced in Central America. Democracy, science production, funding, and conservation are core elements that go hand in hand, and that need to be nourished in a region that struggles with the protection of life and extractive activities in a climate change scenario.
RESUMO
BACKGROUND: Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. METHODS: The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. RESULTS: The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. CONCLUSIONS: If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.
