The Tsachila Indian Nation (2,500 people) in Santo Domingo, Ecuador, for which the province is named, has had a remarkable history like many tribal nations confronted with modernization. They were granted territorial lands on the edge of town more than 50 years ago. They maintained significant isolation from western culture for hundreds of years prior to that, but are now confronted with issues of language, deforestation and environmental contamination, a rapidly evolving western diet, educational challenges, and of course new health considerations.
AHD’s medical model is family physician-based with local Ecuadorian doctors. As we have discussed before, understanding patients within their cultural context drives our approach to diagnosis and treatment. This has been particularly attractive to the Tsachila nation, who faces illnesses of modernization that challenges the limits of their traditional medical model managed by their healers (shaman). They came to us asking for an assessment of their nation by our AHD physicians. We plan to publish a monograph with our findings for them to use in discussions with the Ecuadorian government.
It requires a special skill to gain the confidence of that diabetic or hypertensive patient with a vastly different worldview on the road to kidney failure to negotiate a treatment plan to prevent the need for dialysis. Or to explain to a patient with rheumatoid arthritis who blamed her condition on a curse (which it still might be, right?) that new therapies exist that can minimize the risk of severely deformed hands?
Of course our focus is not exclusively on this tribe, but on the larger community. That said, most people have a certain degree of this old-fashioned, pre-modern view of our health for which the contextualization is vitally important. By the way, so do we – whether we recognize it or not! Why else is the bowl of chicken soup still the universal remedy?
David Gaus, M.D., MPH/TM
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