Indigenous Peoples Face Research Articles

Impact of low back pain and care-seeking behavior in an Indigenous community in Suriname: a qualitative approach.

Low back pain is a significant global public health issue affecting over half a billion people and contributing to disability worldwide. The impact of disability related to low back pain is growing, particularly in low- and middle-income countries. In contrast with previous research, current evidence shows Indigenous Peoples also experience low back pain's disabling effects. A clinical ethnographic can contribute by attempting to understand the data through the perspective of Indigenous Peoples. A clinical ethnographic study was conducted in Galibi, a Kalinya rural Indigenous village in Suriname, with support of the local traditional authority. The main objective was to explore the impact of low back pain and care-seeking behavior from the perspective of Indigenous Peoples with low back pain. The findings were that low back pain had a significant physical and emotional impact. Despite aggravating their low back pain, participants continued many of their activities of daily life since these were essential for their (economic) survival. Furthermore, participants expressed anxiousness, financial worries, and concerns about the cause and future of their low back pain. To address their low back pain, the Kalinya Indigenous Peoples used both western and traditional care. Visits to western healthcare practitioners were limited due to logistical challenges and travel costs, and the experience was often negative. The study highlights the experiences of Kalinya Indigenous Peoples dealing with low back pain. Low back pain is a burden within Indigenous Peoples of Galibi but accepted as an integral part of their life. When in pain, Indigenous Peoples face many barriers to access western health care and visits to healthcare practitioners were often unhelpful. This contributed to a long-lasting negative impact on the Indigenous people with low back pain. Further research is needed to develop strategies that improve health outcomes related to low back pain while reducing its associated disability in Indigenous Peoples.

Nahu Sanamang in the Tradition of Tulehu Indigenous People: A Study of Reciprocity in Maluku

This research explores the Nahu Sanamang tradition in Negeri Tulehu, Maluku, as a form of reciprocity in indigenous communities. Nahu Sanamang is a practice of gotong-royong that involves financial and social contributions to various celebrations, such as weddings, aqiqah, and other religious events. Through an ethnographic approach, this research reveals how this tradition functions in maintaining solidarity, identity, and social structure amidst changing times. Data were collected through interviews, participatory observation, and documentation. The results show that Nahu Sanamang plays a key role in maintaining communal and spiritual values in Negeri Tulehu, as well as helping Indigenous people face the challenges of modernization. The tradition reflects a form of balanced reciprocity that strengthens social cohesion and demonstrates cultural adaptation in the face of globalization dynamics.

Settler Midwifery: A Colonial Tool in Canada's Reproductive Healthcare System.

The land we call Canada is a settler colonial country where reproductive healthcare is used as a mechanism to control, subjugate, and erase Indigenous people and to advance the White settler state. Healthcare providers play an integral role in the healthcare system and contribute to Canada's colonization. In this piece, we critically analyze how settler midwifery is complicit with colonialism in reproductive healthcare by exploring the history of midwifery in Canada, midwifery education, and contemporary settler midwifery. European settlers omitted the history of Indigenous midwifery in Canada and to justify their erasure, they conceptualized Indigenous Peoples as uncivilized and their birthing practices as substandard. To establish a colonial healthcare system, settler midwives replaced traditional Indigenous birth attendants. When midwifery became regulated, midwives were required to train in formal post-secondary institutions that sustain colonial logics, systems, and practices. Midwifery education programs maintain colonialism by reinforcing medicalized Western practices and sustaining barriers to the growth of Indigenous midwifery. As a result, Western birthing practices are widespread among settler midwives and Indigenous Peoples face barriers to comprehensive and culturally sensitive care. To decolonize Canadian midwifery, we must dismantle stereotypes about Indigenous Peoples and their birthing practices in historical narratives, implement an anti-colonial approach to midwifery education, support Indigenous midwives in returning birth home, and improve the provision of culturally sensitive care. Settler midwifery in Canada is complicit in colonialism; building anti-colonial alliances can help support Indigenous midwives in leading a decolonial future for reproduction and birthing.

Assessing Indigenous Community Radio as Two-Way Communications Infrastructure: Communal Engagement and Political Mobilization in Ecuador

Because Indigenous peoples face unique challenges to their autonomy and lifeways from dominant media influences, Indigenous radio has been used to facilitate intra-community engagement among these groups. A small but long-standing literature reveals both strengths and vulnerabilities of Indigenous radio, though the rapidly changing communications landscape suggests new possibilities for these media sources. Our research was a community–academic collaboration that employed exploratory and mixed (survey, interview, and observational) methods across two Indigenous communities in the Central and Southern Amazon of Ecuador. The Indigenous radio station, La Voz de la CONFENIAE (Confederación de las Nacionalidades Indígenas de la Amazonía Ecuatoriana), sought to perform an impact assessment that would measure both the character and extent of the impact of radio programming with sensitivity to the priorities of listeners as to the purpose, function, and appropriate impact metrics for an Indigenous radio station. A total of 92 surveys and 30 interviews across two communities were conducted in July and August of 2022. Our findings reveal (a) the informational function of this radio for the Indigenous communities in its listening reach; (b) that radio programming conveys family, community, and cultural knowledge bi-directionally both from and to its listening audience; and (c) that members of the audience were, in turn, prompted to action and engagement. In our discussion, we identify opportunities to improve the assessment of community-owned radio as a bidirectional resource for communities. Our work also advances a model of self-determined and stakeholder-driven evaluation for Indigenous community radio, with particular attention to the material (e.g., behavioral) impacts of radio messages and potential for radio to support communal and collective engagements desired by the communities it serves.

EFFORTS TO CONSERVE THE WEHOR WATER RESOURCES CHANGES AND CHALLENGES

The issue of how the efforts to preserve the Wehor water resources carried out by indigenous peoples face environmental changes, as well as their challenges. The purpose of this study is to discuss the challenges of indigenous peoples in managing water resources. This study uses qualitative methods, data collection techniques through observation and interviews. The results of the study indicate the need for synergy and integration between regions, between sectors, between generations to anticipate the challenges of environmental change wisely and measurably.

El acceso a la justicia de las poblaciones indígenas. Una necesidad desde el lenguaje

Indigenous peoples face limitations in understanding the justice system due to linguistic and cultural barriers; therefore, the use of clear and accessible language is essential for them to exercise their rights and participate effectively in judicial processes. Through a documentary review of the problems faced by indigenous peoples in accessing justice, the strategies developed by the Peruvian judiciary are described. It is stated that, despite the existence of regulations and policies that guarantee access to translators and interpreters in the judicial sphere, the actions are limited and need to be strengthened. There is a need for strategies that are sustained over time, and that allow their impact to be measured in order to evaluate their relevance and effectiveness. It is concluded that there is a need to develop a language policy focused on justice, which includes incentives —in the training of indigenous lawyers— as a mechanism for the preservation of indigenous languages. It also highlights the importance of language planning in the administration of justice in order to have native language-speaking operators in each judicial district, speciality and instance.

Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico

ABSTRACT Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people’s uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Indigenous women, forest, and the battle for livelihood rights of Dayak Benawan in Indonesia

This research delves into the pressing issue of indigenous peoples' livelihoods in West Kalimantan, Indonesia, highlighting the imminent threat they face. The study underscores the urgent need for government intervention to safeguard the rights of indigenous communities, which are consistently eroded in the name of development. This erosion stems from government-sanctioned land concessions, biased policies, and the involvement of capital interests, all of which disproportionately affect indigenous groups. Employing an ethnographic approach, the research aims to elucidate the intricate dynamics at the nexus of gender, indigenous identity, and environmental justice. Through extensive interviews and observations, the study examines the distinct roles played by indigenous women in forest conservation and community sustainability. It challenges stereotypes portraying indigenous communities as underdeveloped or backward, emphasizing their agency and rejecting their characterization as mere beneficiaries of development. Consequently, indigenous peoples face dwindling access to resources, shrinking livelihood options, and the erosion of traditional knowledge, all while their rights remain largely unrecognized. The findings contribute significantly to the discourse on indigenous rights, particularly highlighting the indispensable role of women in environmental preservation. The research advocates for a more inclusive and equitable approach to natural resource management in Indonesia, emphasizing the need for policies that respect and uphold indigenous rights.

Unequal Land: Towards Full Recognition of Indigenous People’s Religious Rights

Indigenous people face disparate treatment regarding religious free-exercise claims in the United States court system. Specifically, courts misconstrue native religious practices and hold native religious practitioners to a higher standard of proof than practitioners of mainstream religions in their free-exercise claims. This Article analyzes the history of oppression of indigenous people in the United States and the congressional intent to remedy such oppression through legislation. Further, this Article argues that despite Congress’s efforts to remedy the oppression of indigenous peoples, courts still utilize a problematic analysis of indigenous free-exercise claims. To resolve the inconsistent treatment between native and mainstream religious practitioners, this Article argues that courts should do three things when analyzing an indigenous free-exercise claim: (1) presume indigenous peoples suffer subjective harm from the government action at issue; (2) apply the law through an anti-subordination lens; and (3) broadly construe the Religious Freedom Restoration Act.

What do we know about Indigenous Peoples with low back pain around the world? A topical review.

Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.

Indigenous peoples at the heritage–climate change nexus: Examining the effectiveness of UNESCO and the IPCC’s boundary work

Abstract There is increasing recognition that Indigenous knowledges have considerable potential to enhance collective understandings of and improve responses to complex ecological threats, such as those to cultural heritage from climate change. At the same time, it appears that Indigenous peoples face structural barriers to participation in international organisations that advance knowledge about those problems. Using the conceptual framework of boundary organisations (BOs) theory and case studies of the Intergovernmental Panel on Climate Change (IPCC) and UNESCO, I argue that the lack of meaningful Indigenous engagement in international knowledge institutions is not just an ethical problem; it also undermines the effectiveness of their assessments. The future success of their boundary work partly depends on further engagement with Indigenous stakeholders. At least at the heritage–climate change nexus, the salience, legitimacy, and credibility of IPCC and UNESCO assessments require substantive Indigenous representation alongside other state/non-state parties. Successful experiences in biodiversity governance indicate that incorporating the principles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) would enhance Indigenous engagement in UNESCO and the IPCC.

Utilizing cost-effective portable equipment to enhance COVID-19 variant tracking both on-site and at a large scale.

Despite optimistic predictions on the eventual end of COVID-19 (Coronavirus Disease 2019), caution is necessary regarding the emergence of new variants to sustain a positive outlook and effectively address any potential future outbreaks. However, ongoing efforts to track COVID-19 variants are concentrated in developed countries and unique social practices and remote habitats of indigenous peoples present additional challenges. By combining small-sized equipment that is easily accessible and inexpensive, we performed SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) whole genome sequencing and measured the sample-to-answer time and accuracy of this portable variant tracking tool. Our portable design determined the variant of SARS-CoV-2 in an infected individual within 9 hours and 15 minutes without external power or internet connection, surpassing the speed of previous portable tools. It took only 16 minutes to complete sequencing run, whole genome assembly, and lineage determination using a single standalone laptop. We then demonstrated the capability to produce 289 SARS-CoV-2 whole genome sequences in a single portable sequencing run, representing a significant improvement over an existing throughput of 96 sequences per run. We verified the accuracy of portable sequencing by comparison with two other independent sequencing methods. We showed that our high-throughput data consistently represented the circulating variants in Los Angeles, United States, when compared with publicly available sequences. Our scheme is designed to be flexible, rapid, and accurate, making it a valuable tool for large-scale surveillance operations in low- and middle-income countries as well as targeted surveys for vulnerable populations in remote locations.IMPORTANCEThere have been significant efforts to track COVID-19 (Coronavirus Disease 2019) variants, accumulating over 15 million SARS-CoV-2 sequences as of 2023. However, the distribution of global survey data is highly skewed, with nearly half of all countries having inadequate or low levels of genomic surveillance. In addition, indigenous peoples face more severe threats from COVID-19, due to their generally remote residence and unique social practices. Cost-effective portable sequencing tools have been used to investigate Ebola and Zika outbreaks. However, these tools have a sample-to-answer time of around 24 hours and require an internet connection for data transfer to an off-site cloud server. In our study, we rapidly determined COVID-19 variants using only small and inexpensive equipment, with a completion time of 9 hours and 15 minutes. Furthermore, we produced 289 near-full-length SARS-CoV-2 genome sequences from a single portable Nanopore sequencing run, representing a threefold increase in throughput compared with existing Nanopore sequencing methods.

Collaboration with Indigenous communities in an integrated care learning health system in Ontario, Canada: a case study of the Frontenac, Lennox & Addington Ontario Health Team

Context: Health systems in the province of Ontario in Canada have been restructured into Ontario Health Teams (OHTs). OHTs seek to provide integrated care through improving patient experience, improving care provider experience, improving population health outcomes, reducing costs, and addressing health equity - per the Quintuple Aim framework. The Frontenac, Lennox & Addington (FLA) OHT was created in bringing together numerous clinical and community partners, including local Indigenous health groups. Indigenous peoples face health inequities driven by colonization and systematic racism; improving accessibility, cultural appropriateness, and cultural safety of health systems are essential. To ensure that unique needs of Indigenous peoples are met, there should be a collaborative, participatory approach to planning and executing Indigenous-specific evaluation activities, with Indigenous-specific performance indicators.
 Objectives: 1) To co-design, implement, and evaluate a governance process for collaboration with Indigenous communities, for Indigenous-focussed evaluation of FLA OHT activities. 2) To nest the above into a case study of the FLA OHT, examining processes for centering Indigenous perspectives and priorities in systems evaluation. 
 Study Design: Case study method involving community-based participatory research (CBPR), and using principles of Ownership, Control, Access, Possession (OCAP) in ethical Indigenous health research. The research team involves Indigenous members of FLA OHT working groups and tables, other partners and stakeholders from the broader Indigenous communities of the region, Queen’s University (Kingston, Ontario) researchers on the FLA OHT’s evaluation support structure, and other FLA OHT team members. Data used for the case study include focus groups and interviews with Indigenous members, analysis of meeting minutes and other relevant organizational documents, and surveys on team function and Indigenous-specific evaluation activities. Indigenous-specific indicators have been identified through rapid literature reviews and are being incorporated into logic models for evaluation of FLA OHT projects.
 Expected Outcomes: 1) A framework to operationalize collaboration between Indigenous stakeholders and mainstream health systems, in the co-design and co-execution of health system evaluation approaches that reflect Indigenous perspectives and priorities. 2) Incorporation of Indigenous-specific evaluation activities for FLA OHT projects.
 Results: Work in progress at time of abstract submission.
 Conclusions: The framework produced will serve as a practical, operationalized guide to other mainstream health systems and Indigenous groups seeking to collaborate together. The Indigenous-specific evaluation activities will enable thoughtful and rigorous consideration of whether the needs of Indigenous patients and communities are met, and allow for modification of programs and services – per the “learning health system” goal of iterative knowledge production and action to drive continuous improvement. Additionally, this project will strengthen relationships between the region’s mainstream service organizations, policymakers, Queen’s University academic researchers, and local Indigenous peoples. Strengthened relationships will facilitate current and future collaborative work to improve systems, as a step towards addressing health inequities facing Indigenous peoples.

Racial and ethnic inequities in stillbirth in the US: Looking upstream to close the gap: Seminars in Perinatology

Though stillbirth rates in the United States improved over the previous decades, inequities in stillbirth by race and ethnicity have persisted nearly unchanged since data collection began. Black and Indigenous pregnant people face a two-fold greater risk of experiencing the devastating consequences of stillbirth compared to their White counterparts. Because race is a social rather than biological construct, inequities in stillbirth rates are a downstream consequence of structural, institutional, and interpersonal racism which shape a landscape of differential access to opportunities for health. These downstream consequences can include differences in the prevalence of chronic health conditions as well as structural differences in the quality of health care or healthy neighborhood conditions, each of which likely plays a role in racial and ethnic inequities in stillbirth. Research and intervention approaches that utilize an equity lens may identify ways to close gaps in stillbirth incidence or in responding to the health and socioemotional consequences of stillbirth. A community-engaged approach that incorporates experiential wisdom will be necessary to create a full picture of the causes and consequences of inequity in stillbirth outcomes. Investigators working in tandem with community partners, utilizing a combination of qualitative, quantitative, and implementation science approaches, may more fully elucidate the underpinnings of racial and ethnic inequities in stillbirth outcomes.

Intergenerational Affect, Language Trauma, and Pride: Young Māori Men’s Emotional Experiences of Te Reo Māori

ABSTRACT Indigenous peoples face specific challenges to the revitalisation of our heritage languages. I explore the role of emotions and socio-cultural contexts in shaping how young Māori men engage with te reo Māori (the Māori language). Through engaging in poetic analysis of semi-structured interviews with 16 young Māori men, I demonstrate how emotions about te reo Māori can inform our understanding about heritage language learning for Indigenous peoples. I discuss how repertoires of sadness, grief, loss, joy, and gratitude reflect wider settler colonial impacts and how they are differentially navigated by Māori families. Intergenerational trauma generated by colonisation, and the resistance and resilience of different families are highlighted as important factors in supporting young Māori men to engage with te reo Māori. To conclude, I discuss the important place of engaging with emotions and history for Indigenous peoples as a foundation from which to engage with our varied heritage languages.

Colonial legacies and the barriers to educational justice for Indigenous peoples in Taiwan

ABSTRACT Whilst in the past three decades Taiwan has developed a powerful policy and legal framework to protect and support Indigenous rights and development, culminating in the establishment of the Historical Justice and Transitional Justice Committee, Indigenous peoples are still the most disadvantaged, marginalised, and vulnerable group in the country. This article draws on 24 in-depth semi-structured and unstructured interviews with Indigenous educators, leaders, and academics. Drawing on postcolonial and de-colonial lenses the analysis demonstrates how the legacies of colonialism prevent efforts to address and redress the inequities and injustices Indigenous peoples face. I argue that for transitional and historical justice processes to be successful in supporting Indigenous justice, decolonisation of education needs to become a central purpose.

A240 "MY FEELINGS AND MY THOUGHTS ARE MY LIVED EXPERIENCE, NOT THE NUMBERS THEY SHOW ME ON A PIECE OF PAPER”: INDIGENOUS EXPERIENCES OF LIVER TRANSPLANTATION IN BRITISH COLUMBIA, CANADA

Abstract Background Indigenous peoples in Canada face inequities in healthcare access due to historic and ongoing colonial systems and structures of oppression. Indigenous peoples face greater health challenges including acute/chronic disease and may require consideration for transplantation including liver, kidney, heart, and lung. In a renal transplant study, Indigenous patients were less likely to undergo transplantation compared to non-Indigenous patients on dialysis; the reasons for this disparity are not known. The experiences of Indigenous patients during the liver transplant process in British Columbia, and how transplant professionals perceive challenges faced by Indigenous people, has not been studied. Purpose The purpose of this study is to explore experiences of Indigenous patients during the liver transplant process in British Columbia, and how transplant professionals perceive challenges faced by Indigenous people. This work will provide foundational evidence for improving Indigenous patient care in the transplant process in British Columbia, in response to recommendations made to address systemic and interpersonal racism documented in the In Plain Sight report in 2020. Method Thirteen semi-structured qualitative interviews were conducted with Indigenous patients (n=7) and transplant care providers (n=6) across British Columbia, Canada. Interpretive description identified themes to inform clinical approaches and transplant care planning. Themes and related recommendations were validated by Indigenous health experts prior to contextualization. Result(s) Interviews were conducted via Zoom from April 2021-May 2022. Among liver transplant patient participants: transplants had occurred between 1992-2020; all were women; and the median age at the time of their interview was 58 years. Among transplant care provider participants, roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: 1) Indigenous transplant patient participants had strong familial, cultural, and financial supports that were essential to accessing liver transplantation; 2) colonialism has created and perpetuated structural barriers preventing many more Indigenous peoples from being considered eligible for liver transplant; 3) anti-Indigenous racism and a lack of cultural safety and humility are barriers for Indigenous peoples who require timely care for liver disease and for establishing trusting relationships with care providers. Conclusion(s) To our knowledge, this study is the first to explore experiences of Indigenous liver transplant recipients and transplant care providers’ understanding of inequities uniquely experienced by Indigenous peoples. Addressing structural barriers to early linkage to care is needed and training for transplant clinicians on Indigenous histories, complex and intergenerational trauma, and cultural safety is strongly recommended. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Malaria Illness and Accessing Healthcare in an African Indigenous Population: A Qualitative Study of the Lived Experiences of Uganda’s Batwa in Kanungu District

Purpose: Malaria continues to be a public health threat, especially in sub-Saharan Africa, including Uganda. While Batwa Indigenous People (IPs) face a higher burden of malaria, there is limited understanding of their malaria-lived experiences. We assessed and characterized malaria illness and accessing healthcare lived experiences of the Batwa in Kanungu district to inform contextually and culturally appropriate public health interventions. Methods: An exploratory qualitative study was conducted in 5 Batwa settlements where 5 Focus Group Discussions (n = 36) and 13 Key Informant Interviews (n = 13) were held. Data were collected using printed guides and voice recorders in April 2018. Transcripts from the data that captured the lived experiences of the symptoms, prevention, treatment and barriers to accessing formal healthcare services were applied to Atlas.ti a qualitative data analysis software and condensed into codes, categories, and themes. Results: Many Batwa have experienced malaria in their households, and they know its causes and risk factors, like not sleeping under insecticide-treated mosquito nets (ITNs), living near water bodies, prevention measures like the use of ITNs, and vector management. The lived experiences demonstrate malaria management by an Indigenous population in a rural setting and comprised detecting malaria symptoms, use of herbs as first line of treatment, buying medicines from drug shops, and village health teams (VHTs) treatment. For many Batwa accessing formal healthcare is normally a second option. Barriers for malaria treatment included: long distances to health facilities, geographically difficult terrain, economic constraints, irregular health outreaches, and stockouts of malaria medicines at health facilities. Conclusion: This study characterized Batwa’s malaria illness lived experiences and access to healthcare in rural remote settings. These experiences are essential in appreciating the ways in which Indigenous populations understand and manage common illnesses and how appropriate policies and interventions can be developed.

Facing the blue Anthropocene in Patagonia by empowering indigenous peoples’ action networks

Chilean Patagonia is a globally significant ecosystem for biodiversity, and simultaneously a global center for the aquaculture industry. Environmental crises have accelerated over the last decades with the installation of salmon farms, increasing impacts on indigenous livelihoods and the habitats of marine species. Indigenous Marine Areas (IMA) have confronted the effects of the blue Anthropocene in Chilean Patagonia, causing diverse indigenous communities to evolve mechanisms to enhance ocean health and sustainability. Based on an analysis of the main socio-spatial trends of IMA in Patagonia and their action networks in the Los Lagos Region, this study demonstrates the importance of a multiple agent network to mobilize the implementation of IMA. The study shows how indigenous people face the challenges of the UN Ocean Decade, enhancing the sustainability pathways of blue Patagonia.

Providing culturally competent and universal health care in the Peruvian Amazon: The role of medical authority

Peru's Ministry of Health promotes the provision of culturally competent and universal health care. To do so they have implemented policies aimed at addressing indigenous peoples' social, geographic, and financial barriers to health care as well as cultural gaps between them and (bio)medical providers. While scholars argued that these policies have fallen short, their explanations have ignored the role that medical providers' professional authority plays in implementing these policies. This study examined how medical providers aim to provide culturally competent care and facilitate patients' use of medical services while protecting their professional authority. This includes preserving control over their space of work and their capacity to legitimately diagnose, treat, and prognosticate medical problems. Ethnographic observations and 50 interviews conducted between May 2017 and February 2018 show that to facilitate the provision of culturally competent and universal health care, medical providers engaged in non-clinical tasks, trespassed bureaucratic rules, tolerated and integrated the use of traditional medicine, and expanded the time and place of their practice. To advance these strategies, medical providers sacrificed aspects of their social authority (e.g., their autonomy over their work) and their cultural authority (e.g., their ability to define treatment). However, providers also asserted aspects of their professional authority such as the ability to give patients instructions and advice and control over the use of traditional medicine. The latter had the potential of deterring some women from having institutional births, thus reproducing some of the constraints that indigenous people face in accessing health care.