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Understanding Mapuche-Williche Conceptions of Diabetes Mellitus and Arterial Hypertension from the Perspective of Intercultural Health

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Understanding Mapuche-Williche Conceptions of Diabetes Mellitus and Arterial Hypertension from the Perspective of Intercultural Health ORIGINAL RESEARCH Understanding Mapuche-Williche Conceptions of Diabetes Mellitus and Arterial Hypertension from the Perspective of Intercultural Health Sergio Hernán Bermedo Muñoz, SW Abstract themselves saw in their understandings and prac- Background: In order to create a culturally tice. relevant health model, we examined how users Results: As explained by our patients, the Ma- from the Mapuche-Williche community, Chile's puche-Williche cultural system involves a thera- largest indigenous population, understood the peutic process during which traditional Ma- causes of Diabetes Mellitus and hypertension. puche-Williche medicine may complement, al- Objective: To describe both popular concep- ternate with, or substitute for traditional Allopa- tions and traditional therapeutic practices used thic Medicine. by Mapuche-Williche patients with diabetes and Conclusions: Diabetes mellitus and hyperten- hypertension. sion are not recognized illnesses within tradi- Setting: Health clinics located in the Cacicado tional Mapuche-Williche medicine. This creates de Riachuelo Jurisdiction of Rio Negro. difficulties in terms of adherence to biomedical Materials and Methods: This is an explora- treatment. Patients substitute traditional healing tory/descriptive study using the techniques of for biomedicine. These considerations suggest Social Anthropology to incorporate elements of the need to develop an intercultural health model indigenous health concepts into the positivist within the commune of Rio Negro. logic of biomedicine. Recruitment was non-ran- Introduction dom. We employed both case studies and in- Both official reports and a variety of studies depth interviews. Interviews were analyzed by on morbidity and mortality demonstrate that the constructing categories which described the health status and life expectancy of indigenous meanings and significance that the interviewees peoples are lower than that of the general popu- Corresponding Author: Sergio Hernán Bermedo lation. (WHO / PAHO, 1998, IWGIA, 2006, Muñoz, Social Worker and Faculty at the Nursing FID, (2013) This reflects a structural inequality School of the Universidad de Los Lagos, Osorno, which has persisted despite governmental efforts Chile. Address: Departamento de Salud. Municipalidad de Río Negro. Av. Buchmann No. 84. Comuna de Río to improve access to and quality of healthcare Negro. Chile. 64-2362240. Email: [email protected] services. Submitted: February 17, 2016 During the past few decades in Chile, there Revised: July 30, 2016 have been important initiatives to investigate and Accepted: August 7, 2016 Conflict of interest: None more fully understand the epidemiological pro- Peer-reviewed: Yes file of indigenous Chileans. It is clear that their Funding: Programa de Salud y Pueblos patterns of disease and death are different (infe- Indígenas(PESPI), Departamento de Salud. Municipalidad Río Negro,Chile rior) to those of non-indigenous populations. In Social Medicine (www.socialmedicine.info) - 83 - Volume 10, Number 3, September 2016 the Chilean province of Osorno, Mapuche-Willi- to the land, etc. Ibacache, McFall and Quidel che health status has the following characteris- (2002:15) note that "within Mapuche medicine, tics: the maintenance of Mapuche identity is an im- Mortality: The Mapuche-Williche population portant health indicator. As individuals become of Osorno has a higher overall mortality rate than more integrated into Chilean society (a process the non-Mapuche population; this is typical for known as wigkawün*) they become susceptible indigenous populations in Chile. However, mor- to diseases hitherto unknown within traditional tality of the Mapuche in Osornio is the highest Mapuche medicine.” recorded among indigenous communities. (Pedrero, 2012: 76) Figure'1:'Adjusted'mortality'rates'from'' circulatory'diseases'per'100,000'in'Mapuche'and'' Cardiovascular Diseases: Based on survey non'Mapuche'popula<ons'based'on'residence'(2004A2006)' data, the Osorio Mapuche population has a 60% 300$ 248$ higher risk of dying from cardiovascular disease 250$ when compared to non-Mapuches. Mapuches 200$ living in the capital have double the risk of those 150$ 114$ 114$ 95$ who live in rural areas. (Figure 1) 100$ The leading causes of death among the Ma- 50$ puche are Cerebrovascular disease, Coronary ar- 0$ tery disease, and Hypertension. Death rates in the Urban$ Rural$ Mapuche population for these conditions are Mapuche$ Non$Mapuche$ higher than in non-Mapuches. Compared to non- Source: Pedrero, 2012 Mapuches, the Mapuche-Williche have a 80% increased risk of death from cerebrovascular dis- Epidemiological studies of Chile's indigenous eases and a 30% increased risk of death from populations have clarified the differing epidemi- Cardiac ischemia and Hypertension. ological profiles of these groups when compared 34.3% of Mapuches die of cerebrovascular to non-indigenous Chileans. They also shed light disease in comparison to only 29.9% of non-Ma- on the sanitary conditions within the specific ge- puches. This would suggest that non-Mapuches ographical areas served by various governmental have a better understanding of these conditions health services. Epidemiological studies per- and are more adherent to allopathic treatments. formed by the health authorities in Bio Bio, Ar- Pedreros (2012: 53) argues that higher mor- auco, Araucanía North, Araucanía South, Valdi- tality from vascular diseases may be explained via, Osorno, Chiloé, and Reloncaví, demonstrate by "the loss of specific protective factors found that mortality rates are higher in the Mapuche in Mapuche culture and the harmful way that the population than in the non-Mapuche. Osorno had Mapuches have been integrated into modern so- the third highest overall mortality rates. (Figure ciety." Protective factors might include cultural 2) aspects of Mapuche identity such as their tradi- The UN Report on the Health Status of the tional lifestyle, the existence and acceptance of World's Indigenous Populations drew attention traditional authorities and healers, participation to "alarming rates of diabetes. Worldwide over in spiritual events, access to sacred spaces, ties * Wigkawün: refers to a person who has adopted a life- style that alienates him or her from Mapuche society. Social Medicine (www.socialmedicine.info) - 84 - Volume 10, Number 3, September 2016 half of indigenous adults over 35 have type II di- Materials and methods abetes. These numbers are expected to increase. Based on the June 2012 monthly census†, In some indigenous communities diabetes has there were 320 diabetic and hypertensive pa- reached epidemic proportions and has threat- tients enrolled in the Cardiovascular Health Pro- ened the very existence of the community. (p. gram and thus eligible for the study. 164). The International Diabetes Federation Inclusion and Exclusion Criteria: All patients notes that while diabetes is present throughout who had either diabetes and/or hypertension the world, indigenous peoples have a greater dis- were eligible irregardless of their level of con- ease burden than other populations. trol. They needed to be enrolled in the SIGGES database in conformity with Law No. 19.966.‡ Figure'2:'Adjusted'overall'mortality'rates'per'100,000'in'Mapuche'and' They needed to have at least one Mapuche sur- non=Mapuche'popula>ons'Selected'Health'Services.'(2004'to'2006)' 16$ name and/or be registered as an indigenous per- 14.3$ 14$ son by the CONADI. 12$ 12.3$ 12$ This was a descriptive study and we used a 10.3$ 10$ convenience sample. Data was collected through 8.7$ 8.4$ 7.5$ 8$ 7$ 6.6$ structured surveys and semi-structured in-depth 5.6$ 5.7$ 5.6$ 6$ Mapuche$ 6$ 5.2$ interviews. As noted by Rodriguez et al.: "Inter- Non$Mapuche$ 3.6$ 4$ 3.1$ views allow one to access the knowledge, be- 2$ liefs, and rituals of a society or culture in the lan- 0$ guage of the subject." (Rodríguez, Gil and Gar- Chiloe$ Bio$Bio$ Arauco$ Valdivia$ Osorno$ Reloncavi$ cía, 1999:168). Araucania$North$Araucania$South$ Source: Data drawn from the Epidemiological Profiles Table: Distribution of the research Series of the Mapuche Population (2016) subjects based on their pathology DM& Total We undertook this descriptive, exploratory Sector DM HTN HTN study to better understand how Mapuche-Willi- Riachuelo 5 54 17 76 che patients with diabetes and hypertension un- derstood their illnesses and how they integrated Millantue 0 4 2 6 concepts from traditional Mapuche medicine Costa into their therapeutic itinerary. Our patients were Blanco drawn from the Cardiovascular Health Program River 1 10 4 15 (PsCV), provided by the Family Health Commu- Total 6 68 23 97 nity Center (CECOSF) in Riachuelo and from the Rural Medical stations (EMR) in Millantue 57.3% of the subjects were women. In addi- and Costa Rio Blanco. These were all primary tion to these 97 subjects we also interviewed 3 care centers located in the territory of Cacical de Lawenche and 2 Lawentuchefe. Lawenche are in- Riachuelo. dividuals who have knowledge of traditional remedies but do not prepare them. Lawentuchefe are individuals who are not Machi (traditional † Monthly Statistical Review, Series P-4, June 2012. ‡ [SIGGES stands for the Sistema de Información para la Gestión de Garantías de Salud, the Database to Manage Guaranteed Health Services] Social Medicine (www.socialmedicine.info) - 85 - Volume 10, Number 3, September 2016 healers) but know how to prepare and administer based on rankings obtained from the Social Pro- traditional remedies. They have training in Ma- tection Classification
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