Health interventions and local values

What impact do local traditions have on health indicators? How can modern approaches be paired with indigenous customs to improve the health of communities? These are some of the questions that our network of correspondents based in Nairobi, Jakarta, Mumbai, Rio de Janeiro, and Mexico City set out to answer on URB.im, the network for just and inclusive cities.

 

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Katy Fentress, Nairobi Community ManagerDisabled children in Nairobi's informal settlements

Katy Fentress, Nairobi Community Manager

Mothers of disabled children growing up in under-served informal settlements are faced with a daily uphill struggle to feed, nurture, and appropriately take care of their children.

Nairobi's slums are awash with stories of women who have no choice but to tie their physically disabled progeny to the bed for many hours on end while they go out to earn their daily wage and the other siblings are in school. It is also not uncommon to hear of women who hide their disabled child, for fear that their neighbors will think that it is the manifestation of a curse put on the family and give them a wide berth.

To exacerbate the issue, there is a higher incidence of disabled children living in slums than in the rest of the city. This is mainly due to inadequate healthcare women may receive during pregnancies and childbirth and to curable diseases like meningitis — which, if not caught in time, may result in permanent brain damage.

According to World Friends, an Italian NGO that runs Neema Hospital, situated in Nairobi's eastern periphery: "Ten percent of children living in slums under the age of 15 are disabled and live in conditions of severe marginalization."

Small, privately run health centres that take care of disabled children can be found in informal settlements around the city. Yet these centres are few and far between and are mostly staffed by well-meaning caregivers — who do not, however, have the training, funds, or facilities necessary to provide anything beyond the most basic supervision to their wards. Children are left strapped to chairs or lying on urine-stained mattresses for most of the day, and there are few guidelines that caregivers can follow regarding what kind of treatment works best for individual disabilities.

As part of a World Friends initiative to "improve the quality of life for disabled children in the shanty towns of North East Nairobi," a project was launched in 2010 in Baba Dogo with the aim of helping mothers of disabled children overcome the hurdles they face. The project was kick-started by a local NGO called African Cultural Research and Education Foundation (ACREF), run by World Friends and staffed by doctors from Neema Hospital, in nearby Ruaraka.

"It all started a few years back when a few of us from ACREF went to visit a lady whom I knew and discovered that she was hiding a disabled child in her home," Ramdhan Obiero, one of the ACREF coordinators, tells us. "I asked her what kind of problems she was facing and she told me that her husband had left her when he had realized their son was disabled and that since then, she had struggled to be able to balance caring for her child and earning money for them both."

Realizing how common the problem was, Obiero and his colleagues tried to find out if there was any way they could provide support to mothers in this situation.

"We began going door to door to talk to mothers and try to identify families with disabled children," Obiero tells us. "We realized that we needed to raise awareness in the community that disabled children should not be left to live on the edges of our society."

One of the problems that the ACREF team identified was that many children did not engage in any kind of physical activity and were in need of physiotherapy to help them develop basic mobility in their limbs.

Using some of the space available in the ACREF community centre, World Friends helped build a theatre space that could be used for physiotherapy sessions and community performances, debates, and meetings. According to Obiero, the idea was to bring the care the children needed to a place that was easily accessible to mothers in the area.

There are currently two different physiotherapy sessions that take place at the ACREF centre every week. Obiero explains that they "put mothers with children who have similar disabilities together so that they can find solutions that work for them... Beyond the outreach work with the hospital, a lot of what we do is about involving the women in exploring options together regarding how best to care for their children. This is basically how we work at ACREF: to come up with possible solutions and then get people to debate it within the community."

Before starting their treatment, children are referred to Neema Hospital in order for them to undergo a thorough needs assessment. Through the assessment, a physiotherapy course for the mothers and outreach doctors is prescribed, along with some guidelines with regard to nutrition.

Information on how best to manage a disabled child's food allergies and intolerances can make life much easier for a family living without running water or sanitary facilities. "You'd be surprised how different kinds of food can have different reactions on children's behaviour." says Nicola Griffiths, a playworker who has been involved for a number of years in social inclusion and outreach projects for young people with disabilities and their families. "For example, children on the autistic spectrum react very strongly to products with wheat or dairy in them, and children with ADHD will react to sugar, becoming hyperactive or unmanageable."

Although ACREF's main mission is to run arts and culture initiatives aimed at creating employment opportunities for Baba Dogo's talented youth, Obiero says they are still looking to scale up the disability program and train local staff to visit affected families and give them additional in-house support.

"We are trying to expand the program, involve more ACREF members," Obiero concludes. "Personally, I would like to spend more time teaching children to play musical instruments... we are still at an early stage but I'll let you know when we're ready to perform!"

Carlin Carr, Mumbai Community ManagerImproving safety, honoring tradition: women and birth in South Asia

Carlin Carr, Mumbai Community Manager

India's slums are a tightly woven fabric of tradition and customs from all over the country. Migrants to the urban areas bring with them long-standing practices from village life, visible in their houses, work, food, and languages. These customs also often extend to childbirth practices. For example, women traditionally deliver at home and choose this practice over hospitals, despite the availability of healthcare facilities in the cities. Economic circumstances also limit their choices. The home births are often unattended by trained professionals, and the risk to newborns can be fatal.

In fact, India's urban poor newborns have some of the lowest survival rates in the world. There are more than 52,000 babies born to urban poor families every week in India, and that number is expected to double by the end of this decade. Each year, nearly 1.2 million newborns in India die within their first four weeks. The shockingly high number amounts to a quarter of all neonatal deaths worldwide. These newborns face grave risks to survival given the complex circumstances into which they are born. Poor nutrition, inadequate housing, and unsafe water are among the myriad issues that reduce life expectancy and make healthcare solutions more than just medical interventions. In addition, there are customs that have been passed down for generations that pose additional threats, such as giving infants cows' milk instead of breastfeeding.

According to the World Health Organization, breastfeeding is crucial in the first six months and should continue for up to two years along with regular food. Yet across the world, only one in three children is breastfed during this period. "Breast milk contains nutrients that are vital for the infant in the first few months. Research has demonstrated that mothers require active support for establishing and sustaining appropriate breastfeeding practices," says an article, "The Importance of Breastfeeding."

While an international focus on reducing the under-five mortality rate has proven increasingly successful, high neonatal mortality rates persist. However, a number of low-cost and simple solutions have emerged that work to improve birthing practices, educate mothers on ante-natal care, and broaden access to affordable hospital deliveries. The solutions honor the traditional practices while bringing greater safety, higher-quality care, and a broader range of options to mothers and their newborns.

Homebirths and community health workers

Most female slum dwellers who deliver at home live in small shacks with many people living together. The women have little privacy and the setting is often unhygienic. Home births in these conditions, especially without the presence of a trained attendant, put both the mother and child at risk. A study in the urban slums of Lucknow, in northern India, found that half of the women surveyed delivered at home. Other studies have found the home birth rates in urban poor areas of India to be even higher. Since a mix of traditional and financial barriers lead to a majority of the urban poor having home births, a highly cost-effective intervention would be to develop strategies for safe home deliveries.

"Many of the life-threatening conditions could be prevented or treated with low technology, improved labor and delivery care, and attention to the physiological needs of the newborn. The causes of neonatal mortality, the organization and coverage of delivery care, resuscitation, low birth weight, hypothermia, low technology warming, reducing infection, etc. are some important areas that have to be addressed," said the study.

In Mumbai, the Society for Nutrition, Education and Health Action (SNEHA) works in slum communities such as Dharavi to train community health volunteers around maternal and neonatal care. The volunteers work out of one of 30 health posts in the city's slums that seek to strengthen maternal and neonatal care at the local level. The community volunteers educate pregnant women to have safe deliveries and make them aware of the signs that something could be wrong. The health posts also offer ante-natal care services and provide tetanus inoculations, calcium, folic acid and iron supplements — all necessary for the health and well-being of their children.

Birthing huts

SNEHA also works with new mothers to discuss traditional customs and what practices are best for the baby. For example, while the majority of the mothers in the Lucknow study believed that the newborn should be bathed with warm water and dried with a clean cloth, only 36 percent initiated breastfeeding within one hour of birth, and 30 percent initiated it after one day. The major reason was attributed to custom. In an article by a Dhaka doctor investigating birthing practices in the slums of Dhaka, Bangladesh, he reported that many of the same customs and behaviors existed there. He writes, "We have lots of traditional practices; some are good and some are not. We need to change or modify unhealthy practices and appreciate and incorporate the best practices."

The doctor was investigating a unique option for Dhaka's pregnant women in the slums: birthing huts that offer trained attendants and more hygienic conditions. The BRAC program, called Maternal, Neonatal and Child Health Initiative (MANOSHI), aims to change people's attitudes and behaviors concerning neonatal health and nutrition issues and to improve the quality of related health services. The centers also offer quick diagnosis and referral in case of birth emergencies. Each delivery center has two birth attendants who serve about 2,000 households (about 10,000 people). Community midwives are also available to provide skilled service during delivery.

"The MANOSHI Birthing Hut, it seems to me, is a good initiative undertaken by BRAC and brings hope to me in the care of maternal health," writes the investigating doctor. "They are using largely traditional birth attendants in a professional manner that enables them to use their skills and experience to provide a healthy and normal delivery."

Low-cost Maternal and Neonatal Care Hospitals

While many women prefer home births, there is a growing interest among the poor in affordable hospital delivery services. LifeSpring Hospitals, a joint venture by Acumen Fund and Hindustan Latex, offer natural births and caesarian sections, often at costs 30 to 50 percent lower than local rates. The for-profit chain of maternal and neonatal care facilities in urban slum areas of India pre-screens patients to identify high-risk pregnancies for referral to emergency care centers. The focus on low-risk procedures reduces the need for more advanced technology and infrastructure, and has allowed the company to standardize processes and procedures to reduce costs, improve focus-area training for doctors and nurses, and increase the potential for expansion.

LifeSpring has become "the largest chain of maternity hospitals in South India," according to Acumen Fund, "treating more than 70,000 patients and delivering more than 7,000 healthy babies." The 25-30 bed facilities operate with a cluster head that manages all associated hospitals to reduce overhead within the network. Further, the cluster shares ambulances, vendors and doctors, and is strategically situated in close proximity to neonatal emergency care centers, as well as blood banks. Each hospital has one high-end incubator, a basic lab and a partner pharmacy inside, which offer lower, negotiated rates to LifeSpring customers.

"We operate with basic facilities to keep our costs low," explains Priya Pingali, an assistant manager of monitoring and evaluation at LifeSpring. "But we don't believe quality and price conflict."

The company, which targets working poor families — rickshaw drivers, tailors, street vendors, housekeepers — has also devised a number of different schemes to create a trusted brand name in the areas they operate, thus driving demand in a market accustomed to home births. Women from the community are hired to go door-to-door on a daily basis to talk about LifeSpring — to mothers-to-be and non-mothers alike — and invite them to attend a free clinic in areas such as nutrition and breastfeeding and also receive a regular check-up. More than 50 percent of women who deliver their first child at LifeSpring return for the next child as well.

Education and awareness

Two of the most important aspects for influencing behavior-change practices and improving on pre- and post-natal care are education and awareness. Trained community health workers can provide new and expectant mothers who deliver at home with the knowledge they need to provide safe conditions for their child and learn simple practices to detect when something is wrong. For example, a study has found that human touch is an easy way to detect hypothermia, which is a sign of neonatal sickness. If women are trained to feel for hypothermia, then it is more likely the child will quickly get the needed care. Early recognition and prompt management are crucial to reducing further risk related to hypothermia: "Human touch is one simple, programmatically feasible method to detect neonatal hypothermia." Training local community health workers to work with new mothers on these simple techniques is an essential part of a program to improve neonatal care in the home.

While modern health practices have advanced rapidly in recent decades, many countries around the world still have very traditional customs when it comes to medical care. Maternal and neonatal care is one of those areas. "It is critical that all government, non-government stakeholders, and academia acknowledge this reality and work towards a phased approach to make these deliveries safer than the present situation and gradually work towards deliveries in hospitals," says a report by India's Urban Health Resource Centre, which has done groundbreaking work with slum communities on maternal and neonatal care. If India is to reduce its infant mortality rate, these gradual steps need to be taken, but with a very strategic introduction of simple and safe practices through raising awareness and making alternative care — be it birthing huts or specialty hospitals — more widely available and affordable. Only then will India's urban poor children have options for a healthy life that can positively impact the entire country.

Julisa Tambunan, Jakarta Community ManagerAtasi malnutrisi di Jakarta dengan kelompok pendukung ibu

Julisa Tambunan, Jakarta Community Manager

Angka malnutrisi anak di ibukota Jakarta sungguh memprihatinkan. Di sejumlah perkampungan kumuh, akibat kondisi hidup yang tak layak, hampir sekitar 50% anak mengalami malnutrisi yang ditandai dengan berat badan jauh dari ideal. Jika tak diatasi segera, akibatnya bisa fatal. Kerusakan fisik dan kognitif yang permanen mengancam anak-anak ini. Padahal solusinya ternyata tak sulit dan tak mahal, modalnya hanya budaya lokal. Masih banyak harapan untuk warga miskin Jakarta.

Lingkaran kemiskinan

Tak perlu terkejut melihat tingginya angka malnutrisi di perkampungan miskin yang kumuh dan padat di Jakarta. Kota dengan seribu wajah ini tak ramah bagi warga miskinnya. Buruknya kondisi air dan sanitasi, hunian tak layak, dan kurangnya wawasan tentang gizi membuat warga tak punya banyak pilihan. Malnutrisi pada bayi dan anak-anak disebabkan oleh pemberian makan yang tak memadai dan penyakit infeksi akibat lingkungan yang buruk. Jka tak diatasi dini, malnutrisi dapat mengakibatkan terhambatnya perkembangan anak dan menimbulkan kerusakan fisik dan kognitif yang permanen. Dengan generasi penerus yang mengalami malnutrisi, makin sulitlah bagi warga miskin untuk keluar dari jebakan dan lingkaran kemiskinan.

Padahal, mencegah malnutrisi tak butuh peralatan mewah apa pun. Pemberian Air Susu Ibu (ASI) secara eksklusif dalam 6 bulan pertama dijamin dapat mengurangi angka malnutrisi secara drastis. Sebab, bayi akan membangun sistem kekebalan tubuh yang membuatnya lebih tahan terhadap ancaman eksternal seperti pencemaran air dan udara. Ditambah lagi, kandungan nutrisi di dalam ASI aka memaksimalkan perkembangan fisik dan otak bayi. Belum lagi, ASI jauh lebih higienis dibandingkan dengan susu botol yang, apalagi mengingat kondisi air yang tak baik di perkampungan kumuh. Mennyusui: paket lengkap dan hemat. Sederhana saja.

Kalimat yang diucapkan oleh James P. Grant, mantan Executive Director dari UNICEF, pun menyatakan hal tersebut, "Menyusui adalah jaringan pengaman pertama melawan kemiskinan. (Menyusui) seperti memberikan kesempatan bagi bayi untuk keluar dari kemiskinan yang dialami keluarganya dalam bulan-bulan pertama, memberinya awal yang adil yang bisa mengkompensasikan ketidakadilan yang ia alami ketika ia lahir."

Namun, ketika menyusuri gang-gang kecil di perkampungan kumuh Jakarta, kebanyakan bayi, alih-alih menyusui malah meminum susu formula dari dot-nya, atau diberi makan makanan padat seperti pisang. Sungguh mengejutkan, mengingat perliaku menyusui merupakan hal alamiah dan merupakan praktek tradisional yang dilakukan oleh para ibu di Indonesia sejak dulu. Alasan mengapa para ibu di sana tak menyusui adalah kombinasi dari faktor internal (merasa ASI tak cukup) dan eksternal (tekanan keluarga dan pengaruh pemasaran susu formula).

Budaya lokal jawabannya

Masa dua tahun pertama kehidupan manusia merupakan masa kritis untuk membentuk pondasi pertumbuhan, perkembangan dan kesehatan yang optimal dalam jangka panjang. Oleh karena itu, penting untuk memastikan bahwa anak usia 0-2 tahun mendapatkan asuhan gizi yang optimal. Upaya untuk memberikan asuhan gizi optimal usia 0-2 tahun berati memberdayakan para ibu untuk dapat melaksanakan inisiasi menyusu dini (IMD), pemberian asi eksklusif selama 6 bulan dan meneruskan pemberian ASI hingga anak berusia 2 tahun atau lebih. Inilah pesan yang disampaikan melalui program Kelompok Pendukung Ibu (KP Ibu).

KP Ibu adalah istilah bagi kelompok teman sebaya atau peer support yang secara khusus diselenggarakan untuk para ibu yang ingin berhasil melaksanakan pemberian air susu ibu (ASI) secara optimal. KP Ibu ini dirintis oleh organisasi nirlaba Mercy Corps, awalnya sebagai bagian dari program Child Survival – Healthy Start yang didanai oleh USAID. Kini, program ini diadopsi penuh oleh pemerintah kota Jakarta, dan direplikasi oleh pemerintah Indonesia di seluruh wilayah negeri dan pelaksanaannya pun dipimpin oleh pemerintah.

Prinsip dari KP Ibu sungguh sederhana, karena mengadaptasi budaya lokal di perkampungan di mana para ibu akan berkumpul dan bercengkerama di sela-sela tugas domestik yang mereka lakukan sabagai ibu rumah tangga. Seperti disebutkan sebelumnya, salah satu kendala mengapa para Ibu tidak menyusui adalah kurangnya dukungan dari lingkungan. Dengan menciptakan kelompok yang saling memotivasi, saling mendukung, dan bertemu secara rutin, para Ibu akan merasa aman dan percaya diri untuk menyusui bayinya.

KP Ibu umumnya terdiri dari 10 sampai 15 ibu hamil dan ibu yang memiliki anak di bawah 6 bulan. Pertemuan rutin dilakukan sebanyak 2 minggu sekali atau setidaknya sebulan sekali termasuk kunjungan rumah untuk saling bertukar pengalaman, berdiskusi dan saling memberi dukungan terkait kesehatan ibu dan anak. Topik obrolan biasanya adalah seputar kehamilan, menyusui dan gizi, serta dipandu atau difasilitasi oleh motivator yang telah dilatih oleh Dinas Kesehatan Jakarta. Satu sesi KP Ibu dilaksanakan sekitar 1 jam. Dengan adanya pembatasan waktu sekitar satu jam diharapkan kegiatan ini tidak mengganggu tugas para anggota sebagai istri dan ibu di keluarganya, tidak menimbulkan kelelahan dan kebosanan peserta.

Kunci keberhasilan: tak mengubah kebiasaan

Ketika proyek percontohan KP Ibu dilakukan oleh Mercy Corps selama 4 tahun di sejumlah kelurahan di Jakarta Utara, sejak tahun 2006 sampai 2010, angka menyusui meningkat secara drastis. Hasil evaluasi dari program tersebut dinilai sangat menggembirakan. Setelah implementasi, persentase bayi yang mendapatkan ASI satu jam setelah lahir meningkat dari 18 persen menjadi 65 persen di wilayah intervensi. Persentase bayi 0-6 bulan yang mendapatkan ASI eksklusif dalam kurun waktu 24 jam meningkat dari 29 persen menjadi 36 persen. Persentase balita usia 0-24 bulan yang mendapatkan makanan atau cairan tambahan selain ASI setelah tiga hari kelahiran menurun dari 64 persen menjadi 35 persen.

Salah satu keberhasilan KP Ibu terletak pada pendekatannya. Karena merupakan adaptasi dari kebiasaan sehari-hari para ibu di perkampungan, begitu mudahnya program ini diadopsi oleh masyarakat tanpa ada resistensi sedikit pun. Sebab, tak perlu ada perubahan perilaku. Hanya konten dari obrolan saja yang diperkaya.

Karena dinilai berhasil dan sangat sesuai dengan tradisi masyarakat, program ini kemudian direplikasi oleh pemerintah provinsi DKI Jakarta bekerja sama dengan PKK (Pemberdayaan dan Kesejahteraan Keluarga) di seluruh kotamadya di Jakarta. Kini, program ini direplikasi ole pemerintah nasional di berbagai daerah di Indonesia.

María Fernanda Carvallo, Mexico City Community ManagerMedicina tradicional indígena, inclusión cultural y salud ante la pobreza

María Fernanda Carvallo, Mexico City Community Manager

La Organización Panamericana de la Salud (OPS) afirma que cada año mueren 400 mil niños menores de cinco años, provenientes de pueblos indígenas en la Región de las Américas por enfermedades prevenibles. En este sentido, las variables de pobreza y etnicidad son un binomio que va de la mano e incide directamente en la salud de la población; los indicadores de salud como la mortalidad materna, los partos hospitalarios y la cobertura de vacunas son más negativos en este grupo de la población, que se ha considerado históricamente como un grupo minoritario, por lo que es altamente vulnerable.

Así mismo, las costumbres sociales arraigadas en la población obstaculizan el uso de los servicios de salud de la medicina "moderna"; como es el caso de las mujeres durante el parto, pues bien, la tradición incorpora elementos de la cosmovisión indígena en donde mujeres parteras son quiénes ayudan a las embarazadas a dar a luz, poniendo en riesgo la salud del recién nacido y de las madres al no contar con los elementos necesarios ante complicaciones en el parto. En este sentido, es necesario incorporar los elementos de las costumbres locales en un esquema de intervención de las estrategias de salud, de manera que la población tenga acceso a la salud con inclusión cultural y social, como lo es la Medicina Tradicional (MT).

Correa, en su artículo "Protección Y Promoción De La Medicina Tradicional, Consecuencias Para La Salud Pública En Los Países En Desarrollo" afirma que esta práctica es de utilidad para los países en desarrollo ya que responde a las necesidades de salud de la gran mayoría de la población que no tiene acceso a la atención médica "moderna" por factores económicos y culturales; por lo que la MT con frecuencia es el único tratamiento al que puede acceder las poblaciones pobres y comunidades remotas que viven en un contexto de marginalidad.

Contexto: Incorporación de las costumbres en los sistemas de salud en México

En México, sexenalmente se elabora un Plan Nacional de Desarrollo para delinear los ejes de acción que se han de seguir en materia de desarrollo social. El Plan Nacional de Desarrollo 2007–2012, además del objetivo de sistematizar las metas y estrategias para lograr el desarrollo integral a nivel nacional, tiene como fin alcanzar el desarrollo humano sustentable, entendido éste como el conjunto de políticas públicas que permitan a la sociedad alcanzar, con base en la propia capacidad individual, un nivel de desarrollo que no comprometa el bienestar de futuras generaciones.

En el rubro de salud y acceso a servicios sanitarios, el Plan Nacional de Desarrollo tiene como vertiente, además de ampliar la cobertura de servicios, el fortalecimiento y desarrollo de la medicina tradicional mexicana y su relación intercultural con la medicina institucional. Así, el Gobierno Federal reconoce a la medicina tradicional como una alternativa sanitaria, sobre todo para las comunidades indígenas y comunidades marginadas, y su incorporación formal al Programa Nacional de Salud y Nutrición, creando así un nuevo panorama que permita fortalecer acciones coordinadas con las instituciones de salud del Estado.

Es importante señalar que la integración de la medicina tradicional al Plan Nacional de Salud y Nutrición dio lugar a que también se estableciera la Dirección de Medicina Tradicional y Desarrollo Intercultural dentro de la Secretaría de Salud Federal. La Dirección integra a miembros de la sociedad civil e instituciones académicas con el fin de hacerla una instancia plural y participativa que pueda fortalecer el ejercicio de la medicina tradicional para beneficio de quienes es el único servicio de salud al que tienen acceso.

De acuerdo a la Dirección de Medicina Tradicional, la MT se define como un conjunto de sistemas médicos basado en los conocimientos sobre salud y enfermedades que los grupos indígenas del país han acumulado a través del tiempo que utiliza procedimientos terapéuticos que incluyen la herbolaria, el uso de productos animales y minerales, masajes, punciones y aplicación de terapias térmicas. Está sustentada en una comprensión del universo como totalidad interconectada donde cuerpo y mente deben formar una sola entidad y en una concepción de la salud y enfermedad como estados de equilibrio y desequilibrio entre distintos factores sociales, ambientales y espirituales.

Medicina tradicional: estrategia de intervención de salud en el Distrito Federal

En el marco del Programa Nacional de Salud y Nutrición, las prácticas de la medicina tradicional se han adoptado en la Ciudad de México; considerando que estas prácticas son el primer, y en muchas ocasiones el único medio de muchas personas para atender cualquier enfermedad, ha habido esfuerzos para acercar estos métodos de curación a zonas igualmente marginadas pero que no tienen una usanza arraigada de medicina tradicional.

El Distrito Federal presenta una alta concentración de comunidades en condición de pobreza con acceso limitado a los servicios de salud, por lo que se han implementado estrategias para acercar a la población al uso y aplicación de la medicina tradicional, al tiempo que se rompen estereotipos sobre su origen y aplicación. Muestra de ello es la Feria de Población Indígena y Medicina Tradicional que anualmente se lleva a cabo en la explanada principal de la Delegación Iztapalapa, cuyo objetivo es fortalecer los usos y costumbres de los pueblos indígenas y vincularlas a las prácticas de la medicina moderna.

En conjunto con el gobierno delegacional, la Feria es organizada por la Secretaría de Desarrollo Rural y Equidad para las Comunidades Indígenas para que cumpla con algunos lineamientos básicos que permitan entender la aplicación de la medicina tradicional en la vida diaria de quienes no están acostumbrados a ella. Así, tiene entre sus principales ejes de acción:

  • Ayudar a médicos tradicionales para habilitar espacios y práctica de la medicina tradicional en zonas marginadas del Distrito Federal.
  • Fomentar, difundir y promocionar las lenguas y cultura indígenas en las ferias que se realicen de forma anual.
  • Apoyar, ya sea con dinero en efectivo o en especie, a grupos que lleven a cabo proyectos productivos que contribuyan al desarrollo de las comunidades indígenas.
  • Promover el acceso equitativo a programas y servicios públicos de salud para la población indígena.
  • Implementar dentro de la Secretaría de Salud del Distrito Federal, un programa de recuperación de la medicina tradicional y uso de la herbolaria.
  • Apoyar la implementación de cursos, diplomados y seminarios que promuevan el entendimiento de la medicina tradicional y la herbolaria.

Quien acude a la feria tiene la oportunidad de aprender las prácticas más usadas dentro de la disciplina, directamente de sanadores, hierberos y otros especialistas de la medicina tradicional. Por un lado, se realizan juegos educativos relacionados con la salud para que los asistentes puedan entender el sustento de las mismas, y por otro se realizan baños de temascal, aplicación de hierbas sobre el cuerpo, masajes, entre otros, para resaltar la importancia del manejo de plantas medicinales y su importancia para el cuidado de la salud.

Por parte de la sociedad civil, el Instituto Mexicano de Medicinas Tradicionales Tlahuilli A.C., es una ONG cuyo propósito es la "investigación, promoción, educación y capacitación en medicinas tradicionales y alternativas para establecer servicios de salud en comunidades urbanas y rurales marginadas desde la propia concepción comunitaria del proceso salud enfermedad y con sus propios recursos (humanos, materiales y de conocimiento) reduciendo cualquier dependencia externa y transformando a las comunidades de objetos a sujetos de los programas de salud". El Instituto implementa sus acciones en el Distrito Federal, así como en estados con presencia indígena por pueblos originarios o debido a la migración a las ciudades. A través de su labor, el Instituto ha logrado generar una red de promotores comunitarios de salud desde la perspectiva socio-cultural, por medio del desarrollo de programas de salud que incorporan conocimiento teórico-práctico indispensable para la atención con impacto en la salud comunitaria.

Retos

A través de la participación del Gobierno Federal, local y sociedad civil, se busca el fortalecimiento de las aportaciones de las culturas indígenas y se favorezca la vinculación entre los médicos de la medicina moderna y los practicantes de la medicina tradicional para beneficio de quien busque servicios de salud alternativos. Así mismo, se acerca a la población a los cuidados de la salud ante la carencia el acceso y de servicios de salud de calidad que atiendan la demanda de la población marginada. Sin embargo aún queda el reto pendiente de la incorporación de prácticas de medicina tradicional por parte de los médicos en las clínicas de salud de la Ciudad de México. Un estudio de la Fundación Mexicana para la Salud y el Instituto de Salud Pública muestra que las zonas marginadas de Tláhuac, Xochimilco y Milpa Alta, aunque no es exclusivo el uso de la medicina tradicional, tienen a demandar estos servicios a las instituciones de salud, y utilizan prácticas en casa, como la herbolaria. De los médicos entrevistados en este estudio, se concluye que la incorporación de la MT en las unidades de salud traería beneficios a los usuarios de estos servicios en cuanto a economía y opciones para la salud, así como un mejor control y un seguimiento más cercano de la práctica médica alternativa, lo cual contribuiría a un servicio de mejor calidad. Así mismo, afirman que habría un mayor conocimiento sobre que padecimientos pueden atenderse a través de este método, de los alcances terapéuticos y los puntos por reforzar para fortalecer el actual sistema de salud en la Ciudad.

Catalina Gomez, Rio de Janeiro Community ManagerFavela Orgânica: Bringing healthy food habits to low-income communities

Catalina Gomez, Rio de Janeiro Community Manager

Favela Orgânica ("Organic Favela") is an initiative launched in late 2011 by Regina Tchelly, who had been a cook for several years when she decided to share her love of cooking while contributing to improved nutrition and sustainable food practices among favela residents in Rio de Janeiro. Her specialty: the use of natural ingredients that people generally discard, such as banana, watermelon, and passion fruit peels, carrot leaves, and cauliflower and broccoli stalks.

With a small budget of about R$140 (US$70) — an amount that she pulled together from her own income as a maid, combined with other contributions — Tchelly created Favela Orgânica in the Rio de Janeiro neighborhood where she has lived for several years: Morro da Babilônia, a low-income community located in Leme, in the southern part of the city.

Once a week, at 7:00 p.m., Tchelly gathers people in a small venue in front of the Babilônia Residents Association, where she teaches cooking classes. There, participants can enjoy her tasty, healthy recipes for about R$10 (US$5). The importance of this initiative, beyond the cooking classes themselves and the community engagement they engender, lies in the practical skills and techniques she is teaching to local residents to help them improve nutrition and avoid wasting food — extremely important for people who generally live within very tight budgets.

Tchelly is becoming the ambassador of "aproveitamento total" ("making the most of everything") when it comes to preparing meals. In several of her workshops, she has explained that she comes from a poor family in Paraíba, in Brazil's northeast, and learned to make the most out of every possible ingredient in order to avoid wasting food. In addition, she explains that because many people don't know about the nutritional values and uses of certain foods, they mistakenly discard them. For example, it is said that many peels, especially from citrus, have more vitamin C than the juice itself. Many citrus peels and vegetable stalks also have substantial amounts of fiber and other healthy nutrients.

Favela Orgânica celebrated its first year of activity on 30 September 2012 with a food festival in Morro da Babilonia. Tchelly and her fellow contributors have much to celebrate. The initiative has become widely recognized in the community in a very short time. In addition, there are about 18 women working on the project who are expanding its activities into other communities throughout the city, such as the Complexo do Alemão in Rio's North Zone. The weekly workshops vary in their topics and the skills involved; while most are about cooking, others deal with such topics as implementing sustainable urban agriculture and composting practices. Their target audiences also vary: although women are often the focus of Favela Orgânica's activities, men and children have demonstrated their interest in healthy cooking as well.

Some examples of the magnificent recipes prepared by Tchelly include watermelon peel risotto, broccoli stalk quiche, and colorful rice with pumpkin peel and cauliflower and carrot leaves. And as Cariocas, like all good Brazilians, love their sweets — and in large amounts — Tchelly has introduced healthy dessert recipes, such as banana and passion fruit peel cake, passion fruit peel marmalade, and everybody’s favorite: chocolate made out of banana skins. To learn how these foods are prepared, visit Favela Orgânica's blog and Facebook page, where you will find many creative recipes and ideas, as well as links to other local healthy lifestyle projects.

The importance of initiatives like Favela Orgânica lies in their effectiveness in engaging people in Rio de Janeiro's low-income neighborhoods — addressing good nutrition, love of food, and sustainable lifestyles while reminding us that these issues are no longer associated exclusively with elites, but are active concerns for many residents of Rio's favelas. The more people there are like Tchelly, and the more contributors she has, the more knowledge and positive change will grow at the community level.


 

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