Project Amazonia: Solutions - Indigineous Health Care (OPNAH)
Project OPNAH: Organization for the Protection of Native Amazonian Health
Project Amazonia recommends setting up an experimental independent organization, backed by funds from both the government and other aid organizations, responsible for combating the problem through the following tasks:
The indigenous people of Brazilian Amazon Rainforest are an integral part of the region, having lived there for thousands of years. In addition to being an intrinsic characteristic of the forest itself, they also represent the greatest source of knowledge of the region. For example, many believe that indigenous people may have incredible knowledge about Amazonian vegetation, including possible medicinal properties that might, in fact, be so strong, that they contain the key to curing such diseases as cancer. Unfortunately, however, many Amazonian indigenous groups are at risk of extinction if the necessary attention is not provided. The people are afflicted with a variety of severe diseases including typhoid, dysentery, influenza, malaria, dengue, minimata, tuberculosis, yellow fever, and measles. Without proper treatment, many of these diseases have fatal consequences, and, much of the time, adequate treatment does not reach these groups. Brazil’s indigenous will eventually perish if the proper actions to protect them from disease are not administered.
(Courtesy of the Pan American Health Organization)
IV. Procedure: Project OPNAH
a) Presentation of OPNAH to the public (about 5 mo.): OPNAH representatives will present plans to representatives from various affiliated groups, including:
b) Initial Analysis for permanent clinic sites (about 5 mo): OPNAH representatives enter the Amazonian region and do extensive research and investigation into location sites of each of six clinics scattered throughout the Amazonian state of Amazonas, which has been chosen because of its large indigenous population and central location. Factors in choosing site locations for the clinics will include:
(a) These clinics will also act as supply centers to the region. Thus, accessibility to more modernized areas without disruption of the external environment is a must.
(b) An optimal region will provide easy access to as many needy indigenous groups as possible. *Note: This is a need-based plan. For those rare groups that have ready access to medical care, the service should not be necessary at such a strong level. *
2. Disruption: OPNAH representatives must analyze each region for possibilities of environmental disruption associated with construction.
3. Overall viability: OPNAH representative will analyze the practicality of putting a base station in each considered location. Also, the OPNAH will be responsible for determining a location that is near indigenous groups that actually want aid.
c) ALSO IN YEAR ONE: Recruitment and Remote Aid:
1. Representatives that are sent to interview indigenous groups as part of the Presentation aspect of the plan will also be doctors. They will come with enough supplies for approximately one year, and will supply remote aid to each group that they visit.
2. Recruitment: Approximately four doctors will be required for each of the main clinics, with as many additional volunteer medical workers and doctors as possible. Optimally, most doctors will be Brazilian, and have a firm background in any indigenous languages necessary. One doctor and one health volunteer will also be hired for six mobile clinics working out of each stationary clinic (outlined in more detail later). Volunteers can work over intervals of 2 months, 6 months, or 1 year. Some volunteers can work through programs similar to that in the United States, which gives free medical school tuition in return of service.
d) Construction: (approximately one year)
1. Two OPNAH clinics will be constructed in what is determined to be the most urgent of the six predetermined possible locations. Funding will potentially come from government funds already designated for indigenous health, and/or from funds from other organizations that have been contacted during Presentation.
e) Implementation: (approximately three years): OPNAH will provide services to afflicted tribes, working out of the predetermined clinics. A board of directors comprised of medical representatives from each clinic, who will collaborate at least once a month, to determine necessary changes to the project, and discuss other problems that arise, will oversee the program. OPNAH will provide the following optional services:
1. Basic health care provided at the clinic
2. “Ambulance service” provided by the clinic, with communication provided through the SIVAM network. This will consist of basic transport services for the following uses:
(a) Transport to the clinic, based upon determined need from representatives from the “mobile clinic”
(b) Transport to more strongly equipped health care facilities for severe cases
3. “Mobile clinic” made up of two to three people (at least one doctor and one health representative) sent to each group on a regular/ non-regular basis (depending upon the desires of the group), to provide the following services:
a) Basic medical care: for injuries and minor illnesses
b) Basic medical education: offered to both the indigenous people as a whole and specifically to traditional healers that can incorporate modern methods into traditional beliefs and methods
c) Hygienic improvements, such as a water filtration system, gradually installed at the request of the tribe (assuming proper funding is attained).
* Note: because all services are optional, each indigenous tribe can choose to receive as many or as few of these services provided *
f) Review Period: (approximately two months)
1. A review board, made up of representatives from both the OPNAH organization itself, and from affiliated groups (such as key donors, and the Brazilian government), will analyze the success of the first three years of the project. Modifications to the plan would be made, based upon problems or successes discovered.
2. Implementation continues.
g) Expansion: (approximately eight years—and beyond for future implementation in other states)
1. Assuming success of the review period, the OPNAH will enter into its second four year Construction/Implementation phase for two more clinics. This will be followed by another review period, and, hopefully, the third and final four-year phase and two month review. While the new projects are implemented, old ones will continue, and mature with changing needs.
2. Assuming success of the project in the state of Amazonas, the project can be expanded into other states, and ultimately become a rainforest-wide organization.
3. With increased credibility, OPNAH will begin to lobby for improved enforcement for health regulations on those entering the region.
h) Program Continues: (indefinite—until stability is reached)
1. A two month analysis of the OPNAH plan will continue every three years
i) Gradual Reduction of Funding will occur as self-sustainability is attained
1. As the indigenous population improves both in numbers and in stability of health, the demands for resources will gradually decrease and funding can be pulled back. With many years of health education provided, tribes will hopefully develop methods of self-sustainable health care and only need basic resources, such as vaccinations and medications. Also, with improved health, indigenous groups will be more able to support themselves in terms of nutrition and other basic necessities. Thus, to some extent, good health can be self-sustainable.
V. Tools and Requirements
1. Approximately 24 doctors—four per base station (at first, with subsequent review periods determining actual requirements)
2. At least thirty volunteer workers
1. Possible Sources of Funding Include: Current government finances directed towards indigenous health care (disease control funding was a reported $54 million US in 2001), OPAM, the World Bank, the Pan-American Health Organization, the UN, URIHI, and FUNAI (the National Indian Foundation of Brazil)
2. Projected costs:
(a) $600,000 for clinics ($100,000 per clinic)
(b) In first year (very rough estimates):
$ 200,000 -- for 2 clinics
$ 300,000 -- manpower
$1,500,000 -- supplies (medication, bandages, etc.)
$ 300,000 -- running clinics (energy costs, etc.)
$ 50,000 -- travel (initial analysis, remote region travel, etc.)
$2,350,000 -- estimated total cost
To later test the progress and success of the project, a survey group will initially investigate the actual status of the Amazonian region. This will incorporate two main facets. The first is detailed investigation into current information on the status of indigenous groups. Much of this has already been performed through the Mission plan. The second will be physical entry into the region, for purposes of further investigation. This second facet will incorporate interviews, surveys, and gathering of current statistical data. With this information, the OPNAH will then establish a baseline report on the status of indigenous health.
Future testing will then incorporate specific short term and long-term aspects. For short-term analysis, OPNAH will send review panels into each base station region to determine how health has improved, and what specific changes need to be made. These panels will also include members from other affiliated organizations, including, but not limited to, benefactors and indigenous tribe members. Long-term indicators of success include overall marked improved health of indigenous people, and a rising population of indigenous groups.
Specific tests to determine the efficacy will include:
a. Interviewing indigenous people to determine changing health concerns based on increasing and decreasing levels of complaint, and based on:
1. Their views on how the system helps
2. Their specific health concerns (which diseases seem to be more controlled, and which seem to be causing greater affliction)
3. Their views on problems with the system
b. Constant analysis of available government statistics on number of health and disease cases
c. Analysis of changing productivity levels of indigenous groups as the project proceeds
d. Analysis to determine if indigenous groups that initially refused aid begin to ask for it
e. Conducting regular statistical analysis of diseases present, diseases treated, live birth rates, illness-related deaths, and number of cases of serious illness
VII. Expected Results:
If the plan is successful, analysis will reveal a marked decrease in major diseases within the Amazon rainforest region. Based upon the results of past health care efforts (specifically the URIHI plan), a decrease of at least 50% in child mortality and adult death from local diseases would represent adequate improvement in health of the region, and general success of the OPNAH. Complete success would occur with complete eradication of the major local diseases, such as malaria and measles. Also, with complete success of the program, adequate hygiene devices would be provided to every community that wanted it. Finally, if this project is successful, within approximately 15 years, health will have improved to the point that funding to the plan can be safely decreased over time.
A major obstacle for this plan could be convincing the indigenous people that this aid is indeed useful. From previous analysis and research in the region, it has been determined that many tribes, despite their illnesses, simply wish to be left alone. Because the OPNAH program would be completely optional, it would not encroach upon these wishes. However, this also means that it might be difficult to provide widespread aid to the region.
Another obstacle within the region could be that of internal corruption. While a consistent review board would possibly be able to curb these trends, the possibility for corruption would still exist, and again, might provide an obstacle to program implementation.
4: Reeve, Mary-Elizabeth. Medical Anthropology Quarterly v. 14 no 1, Mar. 2000, p. 96-108
6: WorldHealth.org, p.1171