Indigenous Women’s Politics of Care: Human and medicinal plants vital connections in the Caititu Land, Brazilian Amazon

This project explores yarning as a methodology for understanding health and wellness from an indigenous woman's perspective. Previous research exploring indigenous Australian women's perspectives have used traditional Western methodologies and have often been felt by the women themselves to be inappropriate and ineffective in gathering information and promoting discussion. This research arose from the indigenous women themselves, and resulted in the exploration of using yarning as a methodology. Yarning is a conversational process that involves the sharing of stories and the development of knowledge. It prioritizes indigenous ways of communicating, in that it is culturally prescribed, cooperative, and respectful. The authors identify different types of yarning that are relevant throughout their research, and explain two types of yarning—family yarning and cross-cultural yarning—which have not been previously identified in research literature. This project found that yarning as a research method is appropriate for community-based health research with indigenous Australian women. This may be an important finding for health professionals and researchers to consider when working and researching with indigenous women from other countries.

In pursuing progress and economic growth, the Bolivian state led by President Evo Morales replicated the colonial division of labor through a development model known as neo-extractivism. Rooted tensions between indigenous communities and the state emerged due to the latter’s zealous economic bond with the extractivist sector. While the political economy of neo-extractivism has been considerably studied, how such tensions affect socio-political relations at the intersections of class, race, and gender remains underexplored and undertheorized. To address this research gap, this qualitative study posed the following research questions: How does neo-extractivism create gendered forms of accumulation by dispossession? And what forms of resistance emerge to challenge the impact of neo-extractivism among indigenous communities? By analyzing processes of social reproduction in Oruro, Bolivia, this study shows that neo-extractivism leads to the dispossession of indigenous lands and indigenous ways of life mainly through the contamination of water. Because indigenous peasant women are subsistence producers and social reproducers whose activities are water centric, the dispossession of water has a direr and gendered effect on them. Indigenous women and their communities, however, are not idle. Resistances against neo-extractivism have emerged. In parallel, the daily responsibilities of social reproduction within the context of subsistence agriculture, which are embedded in Andean epistemes of reciprocity, have allowed indigenous peasant women to build solidarity networks that keep the social fabric within and between communities alive. These solidarity networks provide important socio-political resources that are sites of everyday resistances that represent an ongoing threat and an alternative to capitalist, colonial, and patriarchal mandates.

Within the vast majority of qualitative health research involving Indigenous populations, Indigenous people have been marginalised from research conceptualisation and conduct. This reflects a lack of regard for Indigenous ways of knowing, being, and doing, has served to perpetuate deficit narratives of Indigenous peoples’ health and wellbeing, and contributes to failure in addressing inequities as a result of ongoing colonisation and institutionalised oppression and racism. There is a need to place Indigenous voices and ways of doing at the centre of research by working in intercultural partnership, bringing together Indigenous and Western knowledges. This paper explores how such an approach can be applied, demonstrating a reflective process of conceptualisation and conduct that brings together Indigenous ways of working with grounded theory with Aboriginal communities in Australia. Furthermore, it supported a non-Indigenous researcher to learn ways of working respectfully, guided by community protocols. A six-stage research process was developed, overseen by an Aboriginal Women’s Advisory Group. Research conceptualisation and conduct centred on three principles: bringing together Aboriginal ways of working with Western research methodology; using women’s own voices to develop a narrative of cardiovascular health and wellbeing; and ensuring that tangible outcomes were delivered to women and communities in the spirit of partnership and reciprocity. This approach, guided at all steps by Indigenous women, demonstrates a way of adapting qualitative Western methodology to ensure values and principles of ethical guidelines of conduct are upheld to unravel constructs of colonisation, redress past wrongdoing, and reverse deficit narratives.

The gender-agenda is borderless. Arguably, legal justice for Indigenous girls and women survivors of violence is unfair, inequitable, and sometimes arbitrary. Systematic violence against girls and women pervades cultures and societies; operates at three main levels: institution and state, structural and cultural, and community and individual; and manifests in myriad shapes, forms and categories. Systematic violence in this research comprises historical, colonial and contemporary aspects of violence and its impact on Indigenous girls and women. Unlike comparative studies, this research is founded on heuristic arguments derived from validating the formation, establishment and continuity of the voices of Indigenous peoples in Liberia and Australia. While many studies isolate ‘gender-based violence’ and the ‘rule of law’ in separate contexts, none has explored the extent to which the Western concept of the rule of law impacts systematic violence against Indigenous girls and women in Australia and post-war Liberia. The research assesses the efficacy of the ‘rule of law’ in dispensing justice to Indigenous girls and women who have suffered systematic gender-based violence. The scope of the research demands a comprehensive and complex systematic empirical approach that draws on the principles of phenomenology, community-based participatory research, and feminist and Indigenous methods. The study adopts an interdisciplinary mixed-methods approach informed by theories of decolonization, feminist jurisprudence, intersectionality, critical legal/race studies, and social determinants of health. Data is drawn from case law, secondary data, empirical evidence, textual/content analysis, electronic mailing and informal participant observation. Over a period of two years, a survey of 231 social service providers working with Indigenous girls and women; in-depth interviews with 29 Indigenous Women Advocates; and 22 informal email exchanges with male colleagues were conducted in both Australia and Liberia. Statistical analyses were carried out on records of 127 708 convicts to Australia; 14 996 former slave returnees to Liberia; 2701 sexual and gender-based violence cases reported to the Ministry of Gender, Children and Social Protection in Liberia; seven case files from the Sexual and Gender-based Crimes Unit in Liberia; and 1200 interview entries from the Longitudinal Study of Indigenous Children in Australia. This analysis of historical documents, jurisprudence and case studies triangulates a philosophical inquiry intended to migrate issues of violence against Indigenous girls and women from the margins of complex socio-legal structures towards the core of Western-centric perspectives, such as the rule of law. Situated between dominant academic conventions and resistance, the research provokes readers to consider ontological, epistemological and ethical arguments regarding access to justice outcomes for Indigenous girls and women. Contrary to the research hypothesis and despite socioeconomic differences between Australia and Liberia, findings show that: although the principle of the rule of law is an emancipatory tool for justice and redress generally, it can also be an apparatus for persistent systematic violence against Indigenous girls and women. Furthermore, the intersection of colonial history, race, gender, class and social status exacerbates the ongoing perpetration of institutional/state, structural/cultural and interpersonal/community violence against Indigenous girls and women. In conclusion, the research recommends adopting a holistic approach to educating girls and women and encouraging boys and men to participate equally in the gender justice agenda, to ensure justice for Indigenous girls and women. The research also suggests incorporating diverse and comprehensive conceptual and methodological frameworks into further research. Finally, throughout the work, this dissertation attempts to give agency to Indigenous ways of being, knowing and doing justice.

Bothrops atrox Snakebite: How a Bad Decision May Lead to a Chronic Disability: A Case Report

This article presents the life stories of six indigenous women from the Amazonian region, who coordinate local women processes through indigenous organizations and networks. Since the political and legal visibility of violence against indigenous women in Colombia is weak and limited, we aim to analyze their experiences from an intersectional perspective. For this purpose, we employed multiple methodologies, including body mapping and social cartography. Thus, by reconstructing their experiences and attempts to make visible violence against them, we could perceive some of its multiple modalities, which are quickly captured by the great category.

Multiple ulcerated lesions in a patient from Amazon, Brazil

Background: Breast cancer prognosis depends on stage at diagnosis and varies by intrinsic tumor subtype. In the US, the distribution of intrinsic subtypes has been shown to differ between racial/ethnic groups with African American and Hispanic/Latina women more likely to be diagnosed with the more aggressive triple-negative breast cancer (TNBC) lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), compared to non-Hispanic/Latino White women. Hispanics/Latinos in the US are a heterogeneous group originating from different countries with different cultures and ancestral backgrounds. Information about the distribution of tumor subtypes in Latin American regions is lacking. Methods: Data for these analyses come from the Instituto Nacional de Enfermedades Neoplásicas (the Peruvian National Cancer Institute), which diagnoses and treats ~20% of all breast cancers diagnosed in Peru. We have abstracted data from clinical records for 303 patients diagnosed with breast cancer between 2010 and 2015 and who are members of Indigenous American communities from the Andean Mountain region (N=232) or the Amazonian region (N=71). We compared tumor characteristics and survival between the two groups. Comparisons between the two regions were conducted using chi-squared tests, as well as a t-test for age at diagnosis. Breast cancer subtype was defined as luminal A (ER/PR+/HER2-), luminal B (ER+/HER2+), HER2 overexpressing (ER/PR- HER2+), and triple-negative (ER/PR- HER2-) based on immunohistochemistry. Survival analyses were conducted using a Cox proportional hazards model and included region, age at diagnosis, stage, and tumor subtype as predictors. Results: Overall, tumors from the 303 Indigenous American women from Peru included in the present study were 37% luminal A, 20% luminal B, 23% HER2 overexpressing, and 19% triple-negative. Our analyses showed that women from the Amazonian region were diagnosed at a younger age (50 vs. 55 mean age at diagnosis, P value =0.001), later stage (61% vs. 48% stage III or IV, P value=0.06), and more frequently with triple-negative tumors compared to women from the Mountain region (31% vs. 17%, P value =0.013). Women from the Amazonian region had a 70% higher mortality hazard than the women from the Mountain region in a model adjusted by age at diagnosis (hazard ratio 1.73, 95%CI 1.06-2.86, p=0.027). In the full model including stage and tumor subtype, the difference in the mortality hazard was no longer statistically significant (HR 1.20, 95%CI 0.71-2.03, p=0.493). Conclusion: Differences in tumor characteristics and survival between Indigenous American women from the Amazonian and Mountain Range regions in Peru could be due to variation in genetic predisposition to particular subtypes of the disease, variation in environmental exposures, as well as to differences in cancer awareness and access to care between the different groups. The more we learn by analyzing diverse populations and subpopulations and revealing heterogeneity within Latin American women, the better equipped we will be to provide adequate care for all women. Citation Format: Lizeth I. Tamayo, Tatiana Vidaurre, Jeannie Navarro Vasquez, Sandro Casavilca, Jessica Ivonne Aramburu Palomino, Monica Calderon, Garth H. Rauscher, Laura Fejerman. Breast cancer characteristics and survival among Indigenous American women from Peru [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B79.

The human populations of the Brazilian Amazon were formed by interethnic crosses between Europeans, Africans, and Amerindians. The relative contribution of men and women of different ethnic groups was not homogeneous, since the social policies of the first three centuries of Brazilian colonization encouraged mating between European men and indigenous women and, later on, African women. In order to test this model based on historical data, we compared the relative contribution of the Y-DNA and mtDNA of Amerindian and non-Amerindian populations to the formation of the urban population of the town of Belém, in the Amazon region, on the basis of a C-->T mutation at locus DYS199 present in 90% of the Amerindian Y-DNA and of five markers that define 99% of the mitochondrial sequences of Amerindians. The contribution of indigenous men to the formation of this population was less than 5%, whereas the contribution of indigenous women was estimated at more than 50% of the mitochondrial sequences of the same population. Thus, the present results demonstrate that the contribution of indigenous women to the formation of the Belém population was 10 times higher than the contribution of indigenous men, a genetic consequence of social behavior and attitudes of the past; our results also help clarify the process of integration of indigenous communities into the urban societies in Brazil and possibly in other countries.

In this article, I reflect on my experiences as an Indigenous woman researcher coming to grips with colonialism through a post‐colonialism lens. I also discuss a study which examines the leadership journey of a group of Indigenous Australian women. The research, which includes an auto‐ethnographic approach, was guided by an Indigenous worldview and Indigenous research methodologies, and aimed to honour cultural dimensions such as Indigenous knowledge systems and ways of being. Indigenous women today are attempting to make better lives for themselves, their families and communities by becoming educated and developing their careers and leadership; however, they are thwarted in their endeavours by barriers such as racism, sexism, socio‐economic and educational disadvantage, which are the direct result of colonization. These obstructions continue to shape and control the daily lives and futures of Indigenous people in contemporary Australian society.

Background: Breast cancer prognosis depends on stage at diagnosis and varies by intrinsic tumor subtype. In the US, the distribution of intrinsic subtypes has been shown to differ between racial/ethnic groups, with African American and Hispanic/Latina women more likely to be diagnosed with the more aggressive “triple negative” breast cancer (TNBC), lacking expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2), compared to Non-Hispanic/Latina White women. Hispanics/Latinos in the US are a heterogeneous group originating from different countries with different cultures and ancestral backgrounds. Information about the distribution of tumor subtypes in Latin American regions is lacking. Methods: Data for these analyses come from the Instituto Nacional de Enfermedades Neoplásicas (the Peruvian National Cancer Institute), which diagnoses and treats 20% of all breast cancers diagnosed in Peru. We have abstracted data from clinical records for 303 patients diagnosed with breast cancer between 2010 and 2015 and who self-reported as members of an Indigenous American community from the Andean Mountain region (indigenous subgroups: Quechuas, Aimaras, N=232) or the Amazonian region (indigenous subgroups: Shipibo-Konibo, Awajún, Ashaninka, Kichua, Ese Eja, Harakbut, Amahuaca, Shawi, Yanesha, Kakataibo, Nomatsigenga, N=71). We compared the distribution of age at diagnosis and tumor characteristics by region. Comparisons between the two regions were conducted using chi-squared tests, as well as a t-test for age at diagnosis. Breast cancer subtype was defined as luminal A (ER/PR+/HER2-), luminal B (ER+/HER2+), HER2 overexpressing (ER/PR- HER2+) and triple negative (ER/PR- HER2-) based on immunohistochemistry. Results: Overall, tumors from the 303 Indigenous American women from Peru included in the present study were 37% luminal A, 20% luminal B, 23% HER2 overexpressing and 19% triple negative. Our analyses showed that women from the Amazonian region were diagnosed at a younger age (50 vs. 55 mean age at diagnosis, P value =0.001), later stage (53.0% vs. 41.7% stage III or IV, P value=0.107) and more frequently with triple-negative tumors compared to women from the Mountain Region (30% vs. 16%, P value =0.115). Conclusion: Differences between Indigenous American women from the Amazonian and Mountain Range regions in Peru could be due to variation in genetic predisposition to particular subtypes of the disease, variation in environmental exposures, as well as to differences in cancer awareness and access to care between the different groups. The more we learn by analyzing diverse populations, subpopulations and revealing heterogeneity within Latin American women, the better equipped we will be to provide adequate care for all women. Citation Format: Lizeth I. Tamayo, Tatiana Vidaurre, Jeannie N. Vásquez, Sandro Casavilca, Jessica I. Palomino, Monica Calderon, Garth H. Rauscher, Laura Fejerman. Breast cancer characteristics among Indigenous American women from Peru [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5275. doi:10.1158/1538-7445.AM2017-5275

To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio-economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015. Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate. Positive associations of overall malaria (β=0.100 [CI=0.032, 0.168], P=0.004), P.vivax malaria (β=0.115 [CI=0.036, 0.195], P=0.005), and P.falciparum malaria (β=0.389 [CI=-0.0124, 0.791], P=0.057) with TB rates were found, regardless of the sociodemographic factors included in the study. In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co-infections also occur in this region, regardless of the HIV status.

The records of blooms and cyanotoxins in the Brazilian Legal Amazon are scarce and do not represent the reality observed in recent years when there was an increase in notifications and studies carried out in this region. In this article, we carefully analyzed 48 studies to identify the locations where the blooms occurred, the most frequent species, and the tests performed to detect cyanotoxins within the territory of the Brazilian Legal Amazon. The analyzed studies identified approximately 145 taxa of cyanobacteria, and the most frequent species belong to the genera Microcystis and Planktothrix. The most frequently detected cyanotoxin was microcystin, and, in some locations, even with a low cell density, there was the production of toxins. In most cases, Microcystis and Dolichospermum were the major genera associated with blooms and toxin production. The state of Pará had the highest number of records of toxin-producing cyanobacteria, including records of seasonal events, while Acre had no records. This work contributes to our knowledge of the geographic distribution and occurrence of cyanobacteria and cyanotoxins in the Brazilian Amazon and proposes new strategies for improving the monitoring of cyanotoxins in the Amazon region.

As one of the last agricultural frontiers of the humid tropics, Amazonia is the largest area of the world currently undergoing frontier settlement. Although the earliest intrusions of foreign populations into Amazonia date from pre-Hispanic times, the large-scale entrance of peasant colonists into the vast region is a recent phenomenon. Much of this movement represents the spontaneous migration of peoples, but governments in the region have also become increasingly interested in opening up and integrating Amazonia to national and international economies. These actions are frequently seen as potential solutions to a number of national problems, including the need to increase agricultural production, correct spatial imbalances in the distribution of population, exploit frontier lands for reasons of national security, and defuse potentially serious political problems resulting from the existing agrarian structure, landlessness, and unemployment. The upper basin of the Amazon in Ecuador, bordering on the eastern slopes of the Andes, is one such area of frontier settlement. Recent decades have witnessed the rapid conversion of these Amazonian forests to agricultural uses through a series of schemes bearing such labels as land development and colonization. Most forest intervention in the region has come at the hands of colonist farmers attempting to establish land claims along transport routes originally constructed to aid in petroleum exploration and exploitation. These are farmers who formerly have made a living in long-established farmlands and who, for various reasons (population pressures, pervasive poverty, maldistribution of farmland, lack of inputs for intensive cultivation, lack of nonagrarian livelihood opportunities, and generally inadequate rural development) have been increasingly squeezed out of their homelands. A marginal person by virtue of his low socioeconomic and political status, the farmer often perceives

Due to historical and contextual factors, cervical cancer is typically detected at a later stage in Indigenous women, and so has higher morbidity and mortality. Increasing participation in cervical cancer screening (CCS) could ameliorate this health inequity by detecting cancer when it is more easily treatable. To understand the perspectives, preferences, and experiences of Indigenous women related to participation in CCS, we conducted a systematic review and meta-synthesis of nine qualitative research studies. To advance decolonised qualitative evidence synthesis approaches, we use a modified version of the Two Row Wampum-Covenant Chain Tradition, a Haudenosaunee two-eyed seeing analytic approach that integrates Western approaches with Indigenous worldviews. Using the metaphor of a network of forest plants, we illustrate the systemic and topical barriers and facilitators to CCS, as reported by Indigenous women. We use this metaphor to reiterate the importance of all levels of change to improve CCS experiences for Indigenous women.