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Indigenous researchers reveal preventive medicine in which well-being depends on preservation of the environment

Scholars from different ethnic groups discuss healthcare from the perspectives of different peoples

Jaider Esbell, O Pajé Curando Com Tabaco, 2020 © Jaider Esbell Contemporary Indigenous Art GalleryIn 2009, 12-year-old Luciane, the niece of anthropologist João Paulo Lima Barreto, a member of the Tukano indigenous people, was bitten by a poisonous snake in her community deep in the Amazon. She was initially treated with traditional indigenous remedies, including herbal medicine, to manage the pain and swelling in her foot. At the suggestion of the local indigenous health agent, she was taken to a health clinic in Pari-Cachoeira, in the municipality of São Gabriel da Cachoeira, to continue her treatment. “There, she was attended to by a nurse who happened to be menstruating, as my family later discovered when questioning the medical team. In our culture, a person who has been bitten by a poisonous snake cannot have any contact with menstruating women,” recalls Barreto. “This worsened Luciane’s condition.”

The girl was then transferred to a hospital in Manaus, where the medical team suggested amputating her left foot. The family, however, were against it. “My father and two uncles were adamant that amputation was unnecessary. They believed that a combination of indigenous practices and allopathic medicine would suffice. Unfortunately, the doctors at the hospital were less than receptive,” Barreto recounts. With the support of the Federal Public Prosecutor’s Office, Luciane was moved to another healthcare facility where she received treatment from a medical team willing to collaborate with indigenous specialists. “The treatment was successful. Luciane is now doing well, although she does have some minor lingering effects, such as reduced mobility in her foot,” says Barreto.

This incident inspired Barreto to research the subject for his doctoral dissertation in anthropology, which he defended in 2021 at the Federal University of Amazonas (UFAM). In his dissertation, titled “Kumuã na kahtiroti-ukuse: Uma ‘teoria’ sobre o corpo e o conhecimento prático dos especialistas indígenas do alto rio Negro” (Kumuã na kahtiroti-ukuse: A ‘theory’ on the body and the practical knowledge of indigenous specialists in the Upper Negro River region), Barreto challenges prevailing notions in public health and anthropology, calling for their reevaluation. He also advocates for the use of classifications and terms borrowed directly from indigenous languages. Last year, his paper was selected as the best thesis in archaeology and anthropology by the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES), and was published as a book by the Brazilian International Institute of Education (IEB).

One commonly used term that Barreto addresses is pajé. “The pajé is often portrayed as an elderly person with the ability to commune with the gods, the deceased, animals, plants, or minerals to acquire supernatural powers. This is an overly exotic depiction that the media, textbooks, and even the scientific community often portray to nonindigenous society,” he wrote in a 2017 article. According to Barreto, even in the Tupi-Guarani language, the word pajé fails to capture the diversity of roles performed by indigenous health specialists. “Among the Tukano, there are three different types: yai, kumu, and baya,” he told Pesquisa FAPESP. “They all share the same core training, but each has their own healing specialty. In broad terms, a yai is responsible for diagnosis, while a kumu administers treatments. A baya, in addition to being a master of ceremonies and dances, is also a kumu.” Barreto also believes the translations of indigenous terms need to be decolonized from their religious connotations. “Concepts such as “sacred,” “faith,” “spirits,” “prayer,” “healer,” “good,” and “evil” are imported from a Christian and colonizing theological model. The health and healing practices of indigenous peoples are not within the realm of religion or theology; the kumuã, the plural form of kumu, are not religious.”

Barreto’s father, Ovídio Lemos Barreto, and two of his paternal uncles, Manoel Lima and Durvalino Moura Fernandes, are kumuã and co-supervised his thesis alongside anthropologist Gilton Mendes dos Santos at UFAM. “The kumuã are recognized as custodians of indigenous knowledge in the Upper Negro River area. Barreto, Fernandes, and Lima each made a valuable contribution to João Paulo’s research, his investigations, discoveries, and formulations,” explains Santos. Their inclusion as co-supervisors, he explains, was Barreto’s decision and was never formally approved by the program or the university, which “unfortunately, like other institutions, has not provided enough space for these individuals and their knowledge within its academic settings.”

Another concept Barreto explores in this paper is bahsese—“a therapeutic resource and a means of communication with the waimahsã. According to our cosmology, when the world was made, a group of waimahsã was chosen to be transformed into humans, while the others, who were rejected, came to inhabit the water, land, and air. They continue to seek revenge for their exclusion by bringing diseases to humans,” explains Barreto, who cofounded the Bahserikowi Indigenous Medicine Center in Manaus, where he previously conducted ethnographic research. “I believe the word “benzedero” (“healer”), with its Christian connotation, is insufficient to express the epistemological meaning of the term as understood by the Tukano.”

Barreto uses the term “indigenous medicine” rather than conventional expressions like “ancestral knowledge” and “traditional knowledge.” “These labels need to be challenged because they give the impression that indigenous people possess a less legitimate and inferior form of knowledge simply because it is not scientific. Barreto’s work demonstrates that there are alternative forms of knowledge that should be respected as such,” notes João Pacheco de Oliveira, a professor of anthropology at UFAM and at the National Museum of the Federal University of Rio de Janeiro (UFRJ).

Sanitation expert Sofia Mendonça concurs. “I believe the term “indigenous medicines,” in the plural form, is more appropriate as it better reflects the diverse and sophisticated systems and the wide range of preventive and healing practices among different indigenous ethnic groups. The terminology also varies across groups; the word pajé, for example, may hold significance and be utilized by certain indigenous groups, such as those in Xingu,” says Mendonça, who is the coordinator of a university extension program called Projeto Xingu at the São Paulo Medical School of the Federal University of São Paulo (UNIFESP). “Whatever the terminology used, what’s important is that we harness and embrace this knowledge to expand our understanding of disease processes.”

Indigenous researchers face significant barriers to publishing their work and attending health conferences, says Machado

“Neither biomedicine nor indigenous medicine holds supremacy over the other; both have their limitations. The ideal approach is to integrate them together,” adds Rubens Belfort Junior, a professor of dentistry at UNIFESP. This was the original idea behind Projeto Xingu, established in 1965 by Roberto Geraldo Baruzzi (1929–2016), a professor at the same university, and explorer Orlando Villas-Boas (1914–2002), then the director of the Xingu Indigenous Park in Brazil’s Midwest. “Physicians practicing Western medicine and indigenous medicine specialists can learn from one another,” says Belfort Junior, who joined the Xingu Project in the 1970s and has provided eye care to indigenous peoples and other local communities in northern Brazil since the 1980s.

The discussion is not a recent one. In 1906, in a thesis titled “O exercício da medicina entre os indígenas da América” (The practice of medicine among indigenous people in America), completed at the then School of Medicine of Rio de Janeiro (now run by UFRJ), the Brazilian anthropologist, physician, and radio host Edgard Roquette-Pinto (1884–1954) wrote that indigenous societies possessed valuable knowledge about diseases that should be investigated and incorporated into nonindigenous society. “He noted that there were even indigenous techniques for dealing with psychological illnesses, at a time when psychoanalysis was just making its debut,” says Oliveira, one of the pioneers in postcolonial studies in Brazil.

“Unfortunately, health professionals are still reluctant to incorporate indigenous knowledge into both practice and academia,” laments Douglas Rodrigues, the director of UNIFESP’s Indigenous Outpatient Clinic. “Breaking this ethnocentric view that underestimates other forms of knowledge, such as indigenous knowledge, is difficult. It is worth noting, however, that while a doctor practicing Western medicine typically undergoes six years of undergraduate studies and four years of residency, the training of a pajé in the Upper Xingu can take up to two decades,” he adds.

Rodrigues highlights that, within the field of anthropology, there has been extensive discussion in the past two decades toward the integration of diverse medical traditions. Concepts like “intermedicality,” first developed in the 1990s by American anthropologist Shane Greene, have played a role in this discourse. Greene argues that this integration often leads to biomedicine exerting dominance over indigenous medicine. “We must push these discussions further within the field of biomedicine and other healthcare disciplines,” he suggests. In her chapter of the anthology Vozes indígenas na produção do conhecimento: Para um diálogo com a saúde coletiva (Indigenous voices in knowledge production: Towards a dialog with public health; Hucitec, 2022), Diádiney Helena de Almeida, a historian from the Pataxó ethnicity, writes that “since colonial times, non-European healing practices have been associated with witchcraft and voodoo, marginalizing them as mere expressions of indigenous and African cultures.

“During the nineteenth century, there was a prevailing view among physicians that medical practices and systems outside the scientific realm were not effective in treating illnesses. However, this view was mainly rhetorical since in practice, doctors observed and even experimented with folk healing practices, especially herbal medicine.”

The anthology was produced in a collaboration between the Oswaldo Cruz Foundation’s National School of Health Policy (ENSP-FIOCRUZ) and a group of indigenous researchers from different regions of Brazil. “Despite the growing number of indigenous students in Brazilian higher education since the early twenty-first century, they still encounter significant barriers to publishing their work and participating in health conferences,” notes sociologist Felipe Rangel de Souza Machado, a researcher at the school and one of the organizers of the initiative. “They not only face prejudice, but some encounter difficulties due to Portuguese being their second language, and the lack of indigenous bibliographic references.”

The editorial board for the book consisted entirely of indigenous researchers, including Barreto himself. In addition, each of the 21 articles in the book is lead authored by indigenous researchers from diverse ethnic groups across Brazil. “The book includes discussions on education and territory, for example, recognizing that health is a comprehensive concept from an indigenous standpoint. It is a form of medicine in which human well-being is inherently connected to the land and the respectful interaction with the environment,” Machado explains.

“Indigenous peoples are now actively advocating for the right to healthcare that respects their cultures,” notes Almeida, who has a PhD in the history of science and health from FIOCRUZ and serves as professor at the State University of Santa Cruz (UESC) in Bahia. One related initiative is the book Hitupmâ’ax: Curar (Hitupmâ’ax: Cure), produced by students from the Maxacali ethnic group as part of the Intercultural Training Program for Indigenous Educators at the Federal University of Minas Gerais (FIEI-UFMG). “The book was written as a manual for healthcare professionals who are sent to Maxacali reservations. Among other recommendations, it addresses the negative impact of constant turnover of medical teams on the quality of care provided,” says Almeida. The book was launched in 2008 by Núcleo Literaterras, at UFMG’s School of Languages and Literature. “These ideas offer an immensely valuable intercultural experience and should be incorporated as mandatory reading in training programs for healthcare professionals,” he concludes.

Scientific article
BARRETO, J. P. L. Bahserikowi – Centro de Medicina Indígena da Amazônia: Concepções e práticas de saúde indígena. Amazônica – Revista de Antropologia. Vol. 9, no. 2, pp. 594–612. 2017.