Intercultural Health and the Mapuche: Perceptions and Practice in Santiago, Chile
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Intercultural Health and the Mapuche: Perceptions and Practice in Santiago, Chile Item Type text; Electronic Thesis Authors Moretz, Hayley Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 03/10/2021 16:24:35 Link to Item http://hdl.handle.net/10150/630135 INTERCULTURAL HEALTH AND THE MAPUCHE: PERCEPTIONS AND PRACTICE IN SANTIAGO, CHILE By Hayley Moretz ________________________________ Copyright © Hayley Moretz 2018 A Thesis Submitted to the Faculty of the CENTER FOR LATIN AMERICAN STUDIES In Partial Fulfillment of the Requirements For the Degree of MASTER OF ARTS In the Graduate College THE UNIVERSITY OF ARIZONA 2018 1 2 TABLE OF CONTENTS Tables and Figures……..…………………………………………………………………….… 5 Abstract…..……………………………………………………………………………….……. 6 Chapter 1: Introduction………………………………………………………………………… 7 1.1 Background……………………………………………………..………………...... 7 1.2 Theoretical Framework…………………………………………………………….. 11 1.3 Methodology………………………………………………………….…................. 16 Chapter 2: Defining Intercultural Health…..……………………………………………………21 2.1 Intercultural Health ……………………………………………………………....... 21 2.2 Interculturality in Chilean Policy ..…………....…………………………………… 24 2.3 Mapuche Medicine ………..…………………………………………………….........25 Chapter 3: A Brief History of Mapuche-Chilean Relations………...………………………...... 28 3.1 Historical Context of Mapuche-Chilean Relations………………………………….28 3.2 Urban Mapuche/Mapuche-Warriache………………………………………………..39 Chapter 4: IH from Macro to Micro Level…………………………………………………….. 44 4.1 History of PESPI…………………………………………………………………….44 4.2 History of CESFAM Los Castaños and CRSM “La Ruka”……………………….. 45 4.3 Dimensions of Intercultural Health at the Local Level…………………………….. 47 Chapter 5: Perceptions and Practice…………………………………………………………… 49 5.1 Issues with Design ………..……………………………………………………….. 49 5.2 Issues with Access………………………………………………….……………… 50 5.3 Cultural Relevance ………………………………………………………………... 52 5.4 Politics and Policies ……………………………………………………………….. 52 Chapter 6: ¿Quién contamina más?...………………………………………………………….. 54 Chapter 7: Recommendations & Conclusions ………………………………………………… 62 APPENDIX ...………………………………………………………………………………….. 67 A-1 IRB Approval Letter…………………………………………………………….… 67 A-2 Sample Interview Questions Guide………………………………………….……. 68 B-1 Map of Municipalities of Santiago Metropolitan Region………………..……….. 70 B-2 Infographic of CESFAM in Servicio de Salud Metropolitano Sur Oriente ………..71 3 B-3 CRSM La Ruka Referral Form…………………………………………………….. 72 REFERENCES…………………………………………………………………………………. 73 4 TABLES & FIGURES Table 1. Summary Information of Intercultural Health in each Case Study………………………. 24 Table 2. Obesity and metabolic conditions in aboriginal and Caucasian populations in Chile according to gender and rural/urban condition…………………………………………………….. 42 Figure 1. The Social Ecological Model …………………………………………………………… 10 Figure 2. Classification of kutran………………………………………………………………….. 26 Figure 3. Distribution of the Mapuche Population in Santiago……………………………………. 40 Figure 4. Organizational Structure of the Servicios de Salud de Santiago that implement PESPI: intercultural health pilot……………………………………………………………………………. 45 5 ABSTRACT Background: Intercultural health (IH), defined as the integration of western and indigenous medicine, is a public health approach that aims to reduce the divide between indigenous and biomedical health systems based on mutual respect and equal recognition of both knowledge systems. In Chile, IH has become a national strategy of indigenous health improvement through the Programa Especial de Salud y Pueblos Indígenas. With increasing Mapuche populations in urban centers, it is important to understand how these initiatives are conceptualized in urban settings. Methods: Through a qualitative assessment consisting of 10 in-depth, semi-structured interviews, this project sought to understand how IH is implemented in the La Florida municipality of the Metropolitan Region. Results: Results revealed that the current IH model is inadequate to meet the needs of the urban indigenous population. Constitutional recognition of the Mapuche people and culture was considered a prerequisite to restructure the IH model. Issues such as lack of funding, political favoritism, and a fundamental misunderstanding of Mapuche culture were seen as challenges to improving IH programs and indigenous health outcomes. Conclusion: Efforts to improve IH must take into account the indigenous concept of health and healthcare without forcing it into a biomedical model. A more comprehensive curriculum of indigenous healthcare and culture in general and medical education is critical to improve cross- cultural collaboration. An evaluation framework for funding mechanisms of IH at the regional level is needed to improve transparency and accountability among the Servicios de Salud, or Regional Health Departments, and indigenous associations. More research should be conducted in other urban areas with high indigenous populations to gather more representative data on IH implementation in the Metropolitan Region. 6 CHAPTER 1: INTRODUCTION 1.1 BACKGROUND The state of Chile has experienced some dramatic sociopolitical shifts in the last century, which have created substantial challenges and opportunities for the country’s indigenous populations. As is the case for many indigenous peoples around the world, the Mapuche have suffered a long history of discrimination, marginalization and resistance. Prior to the “pacification” of the Mapuche from 1860-1883, the Mapuche people resisted centuries of conflict and conquest attempts by Inca, Spanish and Chilean powers (Carruthers & Rodriguez, 2009). Over the years, the Mapuche have been subjected to the reservation system and assimilationist policies that have further reduced the Mapuche territory and status within the political and economic sphere. Although land reforms and recognition of indigenous rights were promoted in the 1960s and 1970s, this progress was abruptly halted by the military coup of 1973 and subsequent dictatorship. Post-dictatorship Chile continues to operate under neoliberal ideals while promoting multiculturalism, a political philosophy that advocates for the coexistence and tolerance of various cultures in a society (Cavieres Sepúlveda, 2006; Garcia, 2012). These shifts have important implications for the health and wellbeing of Chile’s indigenous communities, as representation and recognition of rights continue to be a point of contention. Policies directed towards indigenous peoples added several important elements to the concept of multiculturalism that produced the more integrative, dynamic notion of “interculturality” (Cavieres Sepúlveda, 2006). Interculturality acknowledges that distinct 7 cultures can not only coexist, but also interact, exchange and learn from one another in a constructive way (Cavieres Sepúlveda, 2006). Incorporating an intercultural component into public policy became the acceptable administrative response to the political mobilization of Mapuche demands for greater representation (Lucic, 2005). Some argue that these intercultural policies are just an extension of the neoliberal agenda that privilege economic gains over indigenous rights (Lucic, 2005; Richards, 2010) Others contend that these policies can simultaneously work against and for the reforms and changes that the Mapuche and other indigenous communities are fighting for Garcia, 2012). These apparent contradictions become more visible through the lens of public health and health promotion. Intercultural health is a public health approach that aims to reduce the divide between indigenous and western health systems on the basis of mutual respect and equal recognition of both knowledge systems (Torri, 2011). These types of programs can theoretically mitigate the social and cultural marginalization of indigenous populations, and can take shape in a variety of implementation strategies. It is also, however, a matter of political power and economic interest; and in Chile, has developed within unique neoliberal constraints (Garcia, 2012). A critical analysis of the formation of intercultural health programming and its effects in Chile is important not only for the emerging field of intercultural health but also for the reconciliation of the Mapuche struggles for rights and recognition. Thus, this analysis explores the social and political forces that shaped the development of Chilean intercultural health policies and the implications of these initiatives on the Mapuche people with the following underlying question in mind: Is the push for intercultural health 8 programming simply rhetoric or do Chile’s intercultural health policies foster true partnership? To answer this question, and add to the literature on intercultural health in Chile, my research focused on the unique challenges of intercultural health in a localized area in the capital city of Santiago. Most of the current literature regarding intercultural health in Chile focuses on programs in the southern portion of the country in La Araucanía, the ancestral territory of the indigenous Mapuche people; particularly the Makewe Hospital in Temuco and other health centers in this southern region. This thesis project sought to understand how Intercultural Health (IH) was conceptualized