Percepções e ações da equipe multiprofissional em saúde sobre a medicina tradicional indígena / Perceptions and actions of the multi-professional health team on traditional indigenous medicine / Percepciones y acciones del equipo multidisciplinario de salud sobre la medicina tradicional indígena

Objetivo: compreender as percepções e as ações de uma equipe multiprofissional em saúde quanto à prática da medicina tradicional indígena em uma Casa de Atenção à Saúde Indígena. Método: estudo qualitativo descritivo, realizado em uma de Casa de Apoio à Saúde Indígena em um município do Pará, que incluiu oito profissionais de uma equipe multiprofissional. A coleta de dados foi realizada no ano de 2018 e estes foram examinados pelo método da análise de conteúdo. Resultados: inserção e prática do cristianismo; ritos e lideranças xamânicas; e postura da equipe de multidisciplinar foram as categorias elencadas, que apontam os entendimentos e atuações da equipe multiprofissional e da organização espacial da Casa de Saúde do município. Considerações finais: há novos costumes e valores entre as etnias, em virtude da aproximação de grupos religiosos, cujas ações foram registradas e apreendidas pela equipe de trabalhadores em saúde.

Objective: understanding the perceptions and actions of a multi-professional health team regarding the practice of traditional indigenous medicine in an Indigenous Health Care Center. Method: this is a descriptive qualitative study carried out in an Indigenous Health Support Center in a municipality in the state of Pará, which included eight professionals from a multi-professional team. Data was collected in 2018 and examined using the content analysis method. Results: insertion and practice of Christianity; shamanic rites and leadership; and the attitude of the multidisciplinary team were the categories listed, which point to the understandings and actions of the multi-professional team and the spatial organization of the Health Center in the municipality. Final considerations: there are new customs and values among ethnic groups, due to the approach of religious groups, whose actions were recorded and apprehended by the team of health workers.

Objetivo: comprender las percepciones y acciones de un equipo multidisciplinario de salud sobre la práctica de la medicina tradicional indígena en una Casa de Atención para la Salud Indígena. Método: estudio descriptivo cualitativo, realizado en una Casa de Apoyo a la Salud Indígena de un municipio de Pará, que incluyó ocho profesionales de un equipo multidisciplinario. La recolección de datos se realizó en 2018 y los datos fueron sometidos al método de análisis de contenido. Resultados: inserción y práctica del cristianismo; ritos y líderes chamánicos; y actitud del equipo multidisciplinario fueron las categorías enumeradas, que indican la percepción y las acciones del equipo multidisciplinario y la organización espacial de la Casa de Salud del municipio. Consideraciones finales: existen nuevas costumbres y valores entre las etnias, debido a la presencia de grupos religiosos, el equipo de los trabajadores de la salud registró y aprendió las acciones de los indígenas.

[Hegemonies, subalternities, and possible counter-hegemonies: The case of traditional medicine of Indigenous peoples in Mexico]. / De hegemonías, subalternidades y posibles contrahegemonías: El caso de la medicina tradicional de los pueblos indígenas de México.

A whole series of processes lead to the decrease in the use of traditional medicine by the indigenous peoples of Mexico, including the reduction in the number of traditional healers and the direct and indirect expansion of biomedicine. This essay addresses the central role these processes play in the relations of hegemony/subalternity that occur in different fields of reality, and especially in the health-illness-care-prevention processes, given that counter-hegemonic processes are not generated, or those that do arise have been ineffective in confronting social hegemony in general and biomedical hegemony in particular.

Toda una serie de procesos conducen a la disminución del uso de la medicina tradicional por los pueblos indígenas de México, incluyendo la reducción del número de curadores tradicionales y la expansión directa e indirecta de la biomedicina. En este ensayo se aborda el papel nuclear que tienen estos procesos en las relaciones de hegemonía/subaltenidad que se dan en los diferentes campos de la realidad y, especialmente, en los procesos de salud-enfermedad-atención-prevención, dado que no se generan procesos contrahegemónicos o, los que surgen, han sido ineficaces para enfrentar la hegemonía social en general y biomédica en particular.

Psicologia decolonial, contracolonial, por vir? / Decolonial, countercolonial, yet to come Psychology?

Objetivo Pensar a Psicologia, enquanto campo de saber e prática de cuidado, ainda que com sua rica polifonia, diversidade e multiplicidade, sabendo que encontra-se vinculada originalmente ao dualismo, ao individualismo, ao subjetivismo, ao cientificismo, ao eurocentrismo e ao profissionalismo. Por outro lado, trazer as contribuições inegáveis dos povos indígenas brasileiros, em sua imensa etnosociobiodiversidade de mais de 300 povos ainda sobreviventes, que apresentam saberes e práticas de cuidado e saúde a partir de seus diversos mas convergentes referenciais cosmopolíticos, integrais, integrativos, relacionais, comunitários, coletivos, ritualísticos, sacralizados, ancestrais, intuitivos, recíprocos e indisciplinares, pois tanto não reconhecem a fragmentação dos saberes em disciplinas, quanto não se colocam a serviço da "disciplinarização da vida". Método Trata-se de uma revisão de escopo a partir da vasta produção realizada por pensadores indígenas brasileiros da atualidade, trazendo suas contribuições que, definitivamente, podem e devem ser reconhecidas pelo campo da psicologia como provenientes de grandes interlocutores nesse processo de fecundar e refundar o campo de uma psicologia que possa ser decolonial, anticolonial e por vir. Resultados Essas contribuições nos levaram a pensarmos em uma outra Psicologia a partir do referencial cosmopolítico dos povos originários do Brasil. Conclusão Vislumbrarmos uma virada do próprio campo psicológico, avançando desde uma Psicologia decolonial, contracolonial, até uma possível Psicologia por vir.

Objective Think about Psychology, as a field of knowledge and care practice, despite its rich polyphony, diversity, and multiplicity, kowing that it is originally linked to dualism, individualism, subjectivism, scientism, Eurocentrism, and professionalism. On the other hand, there are undeniable contributions of Brazilian indigenous peoples. With over three hundred surviving peoples, they offer a vast ethnosociobiodiversity. They bring forth knowledge and practices of care and health based on diverse yet convergent Cosmopolitical references, which are integral, integrative, relational, communal, collective, ritualistic, sacralized, ancestral, intuitive, reciprocal, and undisciplinary, as they do not recognize the fragmentation of knowledge into disciplines, nor do they serve the "disciplining of life". Method This is a scoping review based on the production of contemporary Brazilian indigenous thinkers, bringing their contributions that can and should be recognized by the field of psychology as significant interlocutors in the process of fertilizing and reframing the field towards a psychology that may be decolonial, anticolonial, and yet to come. Results These contributions to help us to think another psychology from the Cosmopolitical reference of Brazil's indigenous peoples. Conclusion We see a turning point, a shift within the psychological field itself, advancing from a decolonial Psychology, countercolonial Psychology, to a possible yet to come Psychology.

De hegemonías, subalternidades y posibles contrahegemonías: El caso de la medicina tradicional de los pueblos indígenas de México / Hegemonies, subalternities, and possible counter-hegemonies: The case of traditional medicine of Indigenous peoples in Mexico

RESUMEN Toda una serie de procesos conducen a la disminución del uso de la medicina tradicional por los pueblos indígenas de México, incluyendo la reducción del número de curadores tradicionales y la expansión directa e indirecta de la biomedicina. En este ensayo se aborda el papel nuclear que tienen estos procesos en las relaciones de hegemonía/subaltenidad que se dan en los diferentes campos de la realidad y, especialmente, en los procesos de salud-enfermedad-atención-prevención, dado que no se generan procesos contrahegemónicos o, los que surgen, han sido ineficaces para enfrentar la hegemonía social en general y biomédica en particular.

ABSTRACT A whole series of processes lead to the decrease in the use of traditional medicine by the indigenous peoples of Mexico, including the reduction in the number of traditional healers and the direct and indirect expansion of biomedicine. This essay addresses the central role these processes play in the relations of hegemony/subalternity that occur in different fields of reality, and especially in the health-illness-care-prevention processes, given that counter-hegemonic processes are not generated, or those that do arise have been ineffective in confronting social hegemony in general and biomedical hegemony in particular.

Teacher plants - Indigenous Peruvian-Amazonian dietary practices as a method for using psychoactives.

ETHNOPHARMACOLOGICAL RELEVANCE: Indigenous groups of the Amazon have developed intricate methods for the application of psychoactives, among which particularly the dieta or diet method of Peruvian-Amazonian traditional medicine stands out. It is a retreat-like intervention involving lengthy periods of social, behavioural, and alimentary restrictions, while ingesting specially prepared plant substances. The interplay of the dietary conditions and plants ingested sensitizes the dieter to receive healing, strength, guidance, and knowledge. From a clinical scientific point of view, the method has remained largely underexplored, but seems more pertinent than ever given the increasing interest in Amazonian psychoactive preparations including ayahuasca (Banisteriopsis caapi) and the burgeoning field of psychedelic-assisted therapies in general. AIM OF THE STUDY: This study offers a descriptive account and emic interpretation of the Peruvian-Amazonian dieta. More specifically we document in detail the procedure, its context and purpose of application, effects, modes of action, adverse effects, and risks, from the perspectives of a sample of Peruvian traditional healers. The Peruvian-Amazonian dieta is a multi-purpose method for making use of medicinal plants, many of which (but not all), are psychoactive; the current work especially focuses on its therapeutic applications in conjunction with psychoactives. METHODS: We interviewed 16 healers working in the Ucayali, San Martín, and Loreto provinces of Peru using a semi-structured interview approach. Interviews were audio-recorded and transcribed verbatim. The extensive data derived from these interviews were analysed by means of computer-assisted manifest qualitative content analysis using a theory-advancing approach. Over 500 coded text segments were categorized, resulting in 7 main theme clusters and corresponding sub-themes. RESULTS: The interviewed healers described a complex intervention with multifaceted applications (treatment, prevention, training) and effects in various domains (body, mind, spirit, energy). The process was portrayed as transformative, with benefits attributed to the effects of the so-called teacher plants in conjunction with the diet's conditions, along with the skill of the healer guiding the intervention. Further, a detailed risk assessment revealed sophisticated safety measures and tools designed to address adverse responses. The importance of adequate training of the healer that administers the diet was particularly highlighted in this context. CONCLUSIONS: The dieta is a central therapeutic concept and tool in Peruvian-Amazonian traditional medicine and a unique method for using psychoactive plants. Multidisciplinary health research that includes traditional treatment methods from Indigenous cultures, Amazonian and other, should not be neglected in the current global interest in psychedelic therapies; such research may in the long-term contribute to a more inclusive psychedelic research paradigm as well as healthcare practice in countries where rich traditional healing systems exist, and perhaps beyond. It may also contribute to the recognition of the Indigenous healers as not only historical forerunners, but also current leading experts in psychedelic medicine.

KAMBÔ: an Amazonian enigma.

The secretions of the Giant Monkey Frog Phyllomedusa bicolor are used by populations in the Amazon regions (mainly the indigenous Katukinas and Kaxinawás). The so-called "toad vaccine" or "kambô" is applied as a medication for infections and to prevent diseases, and also as physical and mental invigorator, and analgesic. Since the 1980s, researchers and companies have been interested in the composition of these secretions. Phyllomedusin, phyllokinin, caerulein and sauvagine are the polypeptides in these secretions that can cause intense effects on smooth muscles, vessels provoking, nausea and vomiting, arterial hypotension, flushing, palpitations, nausea, vomiting, bile secretion and angioedema. These actions are similar to bradykinin. However, the feeling of well-being and improvement of motor skills described by the users seems to be associated with dermorphine, caerulein or deltorphin - peptides with analgesic properties - and their affinity for the opiate receptor systems. Caerulein is a peptide that increases digestive secretions. Phyllomedusin and Phyllokinin lead to blood pressure and digestive effects. Sauvagine release corticotropin and mimics the physiological reactions of exposure to stress. Deltorphins and dermorphins have high affinity for the opiate receptor system and can lead to analgesia. The fame acquired by the therapy motivated the use by individuals from urban areas worldwide, without safety considerations. While in indigenous communities, there is an entire cultural tradition that provides relative safety to the application, however, the extension of use to individuals from urban areas worldwide is a problem, with reports of severe adverse effects and deaths. Undoubtedly, the skin secretions of the Phyllomedusa genus contain substances of intense pharmacological action and that can lead to research for therapeutic uses, but control over their application in rituals outside the forest is needed due the risks presented.

Estudo etnobotânico de plantas medicinais na Terra Indígena Kaxinawá de Nova Olinda, município de Feijó, Acre / Ethnobotanical study of medicinal plants in Nova Olinda Kaxinawá Indigenous Land, city of Feijó, Acre, Brazil / Estudio etnobotánico de plantas medicinales en la Tierra Indígena Kaxinawá de Nova Olinda, ciudad de Feijó, Acre, Brasil

As plantas medicinais constituem um domínio essencial na medicina e saúde indígena. As questões de saúde e doença na medicina indígena implicam conexões entre natureza, cultura, questões físicas e espirituais. Para os Kaxinawá, as doenças não possuem causas únicas, sendo produzidas por um conjunto de forças internas e externas, enquanto os desenvolvimentos físico, mental, emocional e espiritual estão relacionados entre si. Este trabalho busca compreender os elementos presentes na medicina Kaxinawá, apresentando características relacionadas à manipulação das plantas de uso medicinal em processos de saúde e doença. Assim, o objetivo geral desta pesquisa é realizar um levantamento etnobotânico das plantas medicinais utilizadas pelos Kaxinawá e, por meio de seu registro, contribuir para o fortalecimento da resiliência do sistema tradicional de saúde indígena envolvido. Esta pesquisa realiza-se com a participação das cinco comunidades da Terra Indígena Kaxinawá de Nova Olinda (TIKNO), no Alto Rio Envira, município de Feijó - AC, Brasil. A coleta dos dados foi realizada em quatro viagens de campo, por meio da observação participante e de 41 entrevistas semi-estruturadas para o levantamento das informações socioculturais dos/as participantes, e das plantas medicinais com a técnica da lista livre. A análise de dados foi quali-quantitativa. Foram utilizados parâmetros da etnobotânica quantitativa e a criação de categorias analíticas de agrupamento em função dos usos das plantas medicinais listadas. A alimentação está intimamente relacionada à saúde e foi percebida uma forte relação entre os usos das plantas e as figuras de animais que perfazem a caça consumida. As características dos alimentos e contextos individuais ou sociais podem determinar sintomas ou doenças e relacionam-se ao diagnóstico e à escolha do remédio utilizado. A partir de um primeiro olhar sobre os usos etnobotânicos das plantas medicinais na TIKNO, sua riqueza e abrangência, é possível perceber o reflexo da apropriação sociocultural da biodiversidade local e da cosmovisão Kaxinawá no entendimento de saúde e doença. As práticas para manutenção da saúde enfatizam a importância das plantas medicinais e do conhecimento tradicional dos Kaxinawá, o que também evidencia a relevância de seu registro.(AU)

Medicinal plants are a fundamental domain in Indigenous Medicine and health. Health and sickness matters in the Indigenous Medicine imply in connections among Nature, Culture, physical and spiritual subjects. For the Kaxinawá, diseases are not related to a single root, but are originated in a series of internal and external forces, as the physical, mental, emotional and spiritual developments are linked. The present study envoys to comprehend the elements present in the Kaxinawá Medicine, presenting characteristics related to the medicinal plants in health and sickness processes. Therefore, the objective of this study is to attain a ethnobotanical data collection regarding medicinal plants employed by the Kaxinawá and, through such record, to contribute to the strengthening of the related traditional indigenous health system resilience. This research was accomplished through the involvement of four communities from the Terra Indígena Kaxinauá de Nova Olinda (TIKNO), in the Alto Rio Envira, in the city of Feijó ­ AC, Brazil. Data collection was done through participating observation and 41 semi-structured interviews for the listing of sociocultural information of the participants, and for the medicinal plants the free listing technic was employed. Data analysis was quali-quantitative. Quantitative Ethnobotany parameters and the analytical categorization of grouping regarding employ functions of the listed medicinal plants were applied. Medicinal plants, for the Kaxinauá, are the equivalent for "Medicine". Eating is intimately related to health and a strong relation between plant usage and animal models that represent the consumed game animal was noticed. Food characteristics and individual or social contexts can determine symptoms or diseases and are related to the diagnosis and medicine choice. From a first glance on the ethnobotanic usage of medicinal plants in the TIKNO, their richness and coverage, the repercussion of the local biodiversity sociocultural appropriation and the Kaxinauá worldview on health and disease can be perceived. The practices for health maintenance stress the medicinal plants and the Kaxinawá traditional knowledge importance, as well as the relevance of such record.(AU)

Violencia cultural, colonialismo y reetnización; el sentido de las prácticas en salud desde el punto de vista indígena / Cultural violence, colonialism and re-indigenization; meaning health´s practices from the indigenous perspective

Se hace un análisis del efecto del colonialismo y su violencia cultural sobre los grupos étnicos indígenas y el papel del proceso de reetnización en la redefinición de sus elementos culturales, su salud y las prácticas culturales que les caracterizan actualmente; se ilustró con el ejemplo de la comunidad reetnizada indígena muisca de Cota.

In this paper, an analysis on the effect of colonialism and its cultural violence on the ethnic native groups is done taking into account the role of the re-indigenization process in the redefinition of their cultural elements, their health and the cultural practices that currently distinguish them. The re-indigenization of the Cota Muisca native community was set as an example.

Exploring pain in the Andes--learning from the Quichua (Inca) people experience.

There is a mounting recognition that culture profoundly shapes human pain experience. The 28 million indigenous people of the Andes in South America, mainly the Quichua (Inca) people, share a distinctive culture. However, little is known about their pain experience and suffering. The aim of the present study was to explore how Quichua adults perceive, describe, and cope with the pain. An exploratory qualitative/descriptive study was conducted with a convenience sample of 40 Quichua adults, including 15 women and 25 men, in the Northern Highlands of Ecuador. Data were collected through structured interviews of approximately 3 h, using a Quichua questionnaire called "The Nature of Pain" [Nanay Jahua Tapuicuna]. The interviews covered the notions of causation of pain, vulnerability to pain, responses to pain, aggravating factors, frequent locations of pain, types of pain, duration, characteristics of pain, control of pain, pathways to care, and preventive measures of pain. Basic descriptive analyses were performed. The Quichuas' pain experience is complex and their strategies to cope with it are sophisticated. According to the Quichuas, emotions, life events, co-morbid conditions, and spirits, among others factors play an important role in the origin, diagnosis, and treatment of pain. They strongly embrace biomedicine and physicians as well as Quichua traditional medicine and traditional healers. Family members and neighbors are also valuable sources of health care and pain control. The pathway to pain care that the Quichua people prefer is inclusive and pluralistic. The knowledge of the Quichua ethnographic "emic" details of their belief system and coping strategies to control pain are clinically useful not only for the health professional working in the Andes, some Quichua cultural characteristics related to pain could be useful to the culturally competent health practitioner who is making efforts to provide high-quality medical care in rural and multicultural societies around the world.

The role of civil society organizations in the institutionalization of indigenous medicine in Bolivia.

December 2013 marked a significant shift in Bolivia with the enactment of a law for the inclusion of indigenous doctors in the National Health System. This article traces the constellation of forces that led to the institutionalization of indigenous medicine in Bolivia. It identifies three factors contributing to this health policy change. The first factor is the crystallization of a strong indigenous movement fighting for the recognition of cultural rights through the foundation of civil society organizations. Second is the rise to power of Evo Morales, the first Latin American president of indigenous origin, who has promoted multicultural policies, formally supported through the promulgation of a new constitution. Lastly is the influence of the global acceptance of alternative medicine. Indigenous doctor organizations in Bolivia have been highly involved throughout the entire process of institutionalization and have played a crucial role in it. An analysis of the relationship between these civil society organizations and the Bolivian government reveals a strong partnership. This dynamic can be described in terms of Interdependence Theory, as each party relied on the other in the promotion and practice of the law to achieve the integration of indigenous medicine as part of the Bolivian Health System.

A emergência da medicina tradicional indígena no campo das políticas públicas / The emergence of traditional indigenous medicine in the public policy field

Trata o surgimento da medicina tradicional indígena como objeto de discurso no campo das políticas públicas de saúde indígena. Os sentidos que nesse campo informam a noção de medicina tradicional indígena são diversos e constantemente revisados e/ou criados em situações dialógicas concretas, o que lhes confere caráter emergente. Se os discursos oficiais usam o poder de nomear para conceituar as medicinas tradicionais, as falas indígenas remetem a saberes e a práticas de autoatenção inscritos em contextos locais particulares. As políticas públicas são apropriadas e indigenizadas pelos povos indígenas, adquirindo novos sentidos e influenciando a reorganização sociocultural do cuidado com a saúde.

The article explores the emergence of traditional indigenous medicine as an object of discourse within the field of public policy and indigenous health. There are a gamut of meanings that inform the notion of traditional indigenous medicine in this field and they are steadily being revised and/or created in concrete dialogical situations, which endows them with an emergent nature. If official discourses use the power of naming to conceptualize traditional medicine, indigenous discourse designates knowledge and practices of self-attention rooted in specific local contexts. Public policy is appropriated and indigenized by indigenous peoples, gaining new meanings and influencing the sociocultural re-organization of health care.

O desenvolvimento participativo da área de medicina tradicional indígena, Projeto Vigisus II/Funasa / The participant development in traditional indigenous medicine area, Project Vigisus II/Funasa

O artigo trata sobre o desenvolvimento participativo das ações da Área de Medicina Tradicional Indígena (AMT) do Projeto Vigisus II/FUNASA. A Área tem como objetivo a construção de estratégias para a articulação entre os sistemas médicos indígenas e o sistema oficial de saúde, conforme preconizado pela Política Nacional de Atenção a Saúde dos Povos Indígenas. As principais atividades executadas foram os projetos participativos de pesquisa-ação que podem ser classificados em três eixos transversais: sistemas tradicionais de parto indígenas; plantas medicinais; xamanismo e intermedicalidade. Os resultados qualitativos alcançados pelo eixo sistemas de parto indígenas são aqui apresentados de modo a demonstrar o quanto a articulação dos serviços de saúde com as medicinas tradicionais indígenas é condição fundamental para a efetivação do princípio da integralidade em um modelo diferenciado de atenção à saúde indígena.

Medicina indígena y salud mental / Indigenous medicine and mental health

Las diferentes alternativas médicas con que hoy cuenta la humanidad enriquecen tanto la profilaxis, como los diagnósticos y los tratamientos mismos de las enfermedades, cuando éstas se abordan desde un marco multicausal. El siguiente artículo hace una reflexión alrededor de dos alternativas: la medicina occidental y la medicina indígena. Se focaliza en la concepción de salud que manejan estas dos formas de conocimiento, se hace hincapié en la necesidad de revalorar la medicina indígena, y se plantea a grosso modo cómo desde la medicina indígena se ven las alteraciones en la salud mental. El autor resalta que para comprender la concepción de salud mental que puedan tener los pueblos indígenas, se hace necesario entender la cosmogonía y cosmología propia de esos pueblos.

The different medical alternatives used today by humanity enrich the prophylaxis as well as the diagnoses and the treatment of diseases when these are tackled within a multicausal framework. In this paper two of these alternatives are considered: Western medicine and indigenous medicine. It focuses on the concept of health developed by these two approaches, emphasizes the need to reassess indigenous medicine, and examines in general how mental health disorders are regarded from the point of view of indigenous medicine. The author stresses that in order to understand this conception it is necessary to get acquainted with the cosmogony and cosmology characteristics of indigenous people.