(courtesy of http://www.proyanomami.org.br/action.asp?cat=12)
1. SIVAM: System for the Vigilance of the Amazon-- project instituted primarily by the Raytheon corporation in 1990 and announced to world leaders at a conference in Rio in 1992. The Raytheon group is specifically developing aircraft and other surveillance data that, according to the group are set to achieve the following goals: "environmental protection, control of land occupation and usage, economical and ecological zoning, updating of maps, prevention and control of epidemics, protection of the indigenous populations, surveillance and control of the borders, monitoring of river navigation and forest fires, identification of illegal activities, air traffic control, and surveillance for cooperative and non-cooperative aircraft. " (Raytheon Group Report, "Raytheon Plays a Key Role in the Government of Brazil's System for the Vigilance of the Amazon (SIVAM).
-----my notes: while it seems that this project could be promising, in terms of sharing data, or even combining forces for the Mission Project, it will be necessary to further investigate the actual progress of SIVAM. According to data published by American Univeristy (http://www.american.edu/TED/SIVAM.HTM ), the major focus of the project seems to actually be geared towards drug enforcement, rather than analysis for preservation. However, the project is intriguing,
-----see the Raytheon website, at www.raytheon.com, for more information
2. SIPAM: Systerm for the Protection of the Amazon (SIPAM)-- According to a translated version of the official SIPAM site, "The SIPAM represents the beginning of a new process of discovery and occupation of the Amazônia, that if bases on the integration of information and knowledge, with sights to the sustainable development and the preservation of the region for the future generations. " This government-led preservation project declares its goal to be that of "sustainable development" of the Amazon region. It seems to be an umbrella plan, encompassing many projects, including SIVAM. The Portugese site for the project is located at http://www.sipam.gov.br/.
-----my notes: This project seems to be much more interesting, and most likely much more relevant to the Mission Plan. Any plan that we institute will require us to take current actions into consideration, so that we are sure that our plan is actually productive, and not repetitive of other projects.
---I have now been assigned to "group i" with the task
of developing a heatlhcare plan for the indigenous people of
the Brazillian Amazon.
--I discovered a very interesting case study on Amazonian
Health. It is an article by Mary Elizabeth Reed, in the
Medical Anthropology Quarterly (sited below).
Reed visited a specific tribe in the sothern Amazon, and interviewed
vaious members about specific health concerns
that they faced. This article seems to indicate that the biggest
issue for Amazonian indigenous groups is
not necessarily availability of health-related services, but instead
accessiblility of these services. Thus,
I am working on a plan that will be geared mostly towards providing
acessible care to the region. Hopefully,
I will also be able to formulate a plan that provides the least disruption
of
the Amazonian ecology.
--I have found a few sites that indicate that the government
is actually strongly involved in attempting to solve
indigenous health issues. Information is rather
confusing, because control over specifically health care has shifted
hands many times. However, from what I can gather,
indigenous health care, which was formerly under control
of the group FUNAI (www.funai.gov.br/),
is now under the auspices of the main government health branch, known
as the Ministry of Health.
--I've been busy =) --- here's my plan:
Nina's* Healthcare plan [*first four paragraphs of background
courtesy of Christina Huang-- the rest is mine =) ]
Project OPNAH: Organization for the Protection of Native
Amazonian Health
I. Problems:
a. Serious
diseases and illnesses afflict indigenous groups of the Amazon.
b. Many Amazonian
Indigenous groups lack affordable health care.
c. Some indigenous
people lack adequate modern health care education.
d. Indigenous
people often lack access to basic health care supplies.
e. The actual
health status of indigenous groups in many areas of the Amazon is undefined.
f . Known
indigenous groups are currently at varying levels in terms of healthcare
needs.
g. Current
aid programs are helpful, but for the most part, not widespread, and rather
disjointed.
II. Plan: Mission 2006 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:
a. Setting
up accessible humanitarian healthcare and health education
b. Sending
task forces into indigenous territories to investigate need on a case-by-case
basis.
c. Collaborating
with the many current aid projects/ organizations currently situated in
the region, in an attempt
to create a more cohesive method of aid.
III. Background:
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.
There are multiple causes for the indigenous health crisis. The diseases were first introduced to the indigenous people through the influx of foreigners from Europe and Africa in the 1500s when Brazil was “discovered.” As intrusion into the forest has continued, logging practices have also contributed to the propagation of disease. Minimata disease, for example, affects the nervous system causing uncontrollable shaking, muscle wasting and birth defects. The disease is produced by methyl mercury poisoning, a toxic substance used to separate gold and ore. In a recently performed study, thirty percent of small-scale Brazilian gold miners, referred to as “garimperos” had mercury levels in their body above the World Organization’s standards. Mining processes have produced other health risks as well. In addition to methyl mercury, cyanide released by large-scale mining companies also serves as health risks to indigenous groups. The seriousness of the issue can be demonstrated by the1980s discovery of gold in the northern Brazilian state of Roraima. According to Survival International, a London?based indigenous support group, within seven years of contact, 20% of the Yanomani population of the Roraima died from contact-related illness and disease.
More indirect health problems have also resulted from contact with outsiders: particularly missionaries, rubber extractors, gold miners and logging companies. When these foreigners exchanged goods for cheap labor, the indigenous habituated to the commodities they supplied. As this reliance developed, it proved harmful to cultural practices, and, in turn, to the health status of afflicted tribes. The Katukina tribe, who inhabit the flood land area of the upper Amazonian region, for example, succumbed to high levels of malnutrition, anemia and vitamin deficiencies as males began to work away from the villages to attain these industrialized supplies. As a result, malaria, measles, and influenza outbreaks have afflicted the Katukina tribe.
The indigenous people are especially vulnerable to disease because of their aboriginal tendencies. According to the Pan American Health Organization, the tuberculosis rate was ten times Brazil’s national average. In 1996, malaria was determined to be the main cause of death, and infant mortality rates were three times the national average. The situation is not irreversible. Within one year of intensive prevention and treatment programs, child mortality dropped by sixty percent and deaths from diseases (malaria and TB) diminished by half. However, as displayed in the following map, based on data collected in 2002, the risk of malarial infection is still high, and there is still work to be done:Health care thus continues to be extremely valuable in saving many from suffering. 
(Courtesy of the Pan American Health Organization)
Basic health care in most regions of the Amazon is performed within the tribes themselves. Societies typically rely on the traditional medical practices of each individual tribe as their prime source of care. This is partly due to the fact that many of these communities, such as that in the Ilhas de Abaetetuba region of the Amazon estuary, suffer from the effects of a “boombust economy.” In this situation, a large influx of immigration is followed by a slow or even stalled economy, in which health resources frequently become scarce and expensive (3, Reeve). The second, and perhaps more distinctive problem, seems to be the fact that effective healthcare is often too distant. In Reeve’s study, out of 80 individuals interviewed from the Illhas de Abaetetua region, the most common response to the question of seeking medical exams in clinics was that this method of healthcare was only used as a last resort. (5) Another common sentiment among those interviewed was the fact that traditional treatment worked better because of the faith that the natives are able to have in its powers. Thus, in creating any health care plan to aid in indigenous life, it is incredibly important to integrate traditional beliefs and practices with any western treatment.
The current key players in providing additional healthcare to the region are the government funded, non-profit organizations, the Brazilian government itself, and other non-affiliated humanitarian groups. One notable government-funded group is URIHI, a non-profit group set up to provide health services to remote Yanomani communities (the term means “forest” in the Yanomani language). According to a report in OneWorld US, by Alison Raphael, the group was successful after it’s first year, with child mortality dropping by 60% and adult death from local diseases dropping by half (http://forests.org/articles/reader.asp?linkid=7117). This smaller scale effort geared towards the Yanomani people seems to indicate that a large scale, widespread, and sustained effort at disease eradication would indeed prove successful.
The Brazilian government also has its own indigenous health policy. While formerly controlled by the National Health Foundation (Funasa), as of early 2002, the policy came under the direction of The Indigenous Health system and the Federal Agency for Disease Prevention and Control (APEC) (http://www.brazzil.com/p07mar02.htm). In the past, the Brazilian government has stepped up efforts to control the spread of serious diseases in the Amazon region. According to a report by the World Health Organization, as of 2001, Brazil increased funding for national disease control in the Amazon to $54 million US dollars. That year, the number of cases of malaria in the Brazilian Amazon dropped 43%, from 420,000 in the first eight months to 237,0000 (1171, World Health org). Again, this example seems to support the correlation between humanitarian aid and widespread health improvement. However, Brazilian government funding for indigenous groups still seems to be disproportionate to that of the rest of the population. According to a report by the United Nations Association for Great Britain and Northern Ireland (UNA-UK), the annual amount spent by the Brazilian government on indigenous health care is about R$22 per capita, versus the R$100 per capita Brazilian average (http://www.una-uk.org/brazil2.html).
A major humanitarian organization that works with various indigenous concerns, including health care, is Operação Amazônia Nativa (OPAN). This organization was founded in 1969 and works in the northern and central-western areas of Brazil (http://www.una-uk.org/brazil2.html). The organization sends groups of four specialized individuals, one of which oversees health concerns, into a region or society to work on small projects. They are currently working on five projects in the Amazon, and former material and health aid seems to have provided success for individual tribes involved. However, while the organization does seem to be a valuable asset to health care concerns, its major focus seems to be more on general indigenous rights than on specific health problems. Thus, the project seems to be a good starting point for health issues, but does not represent a comprehensive health plan for the Amazonian indigenous groups.
The major problems associated with these formerly instituted plans seem to be first, in a lack of sustained dedication to the effort and second, in a scope that is too narrow for substantial health recovery. The Mission 2006 Plan aims to amend these problems, while still maintaining the successful aspects of the current health plans.
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:
1. Brazilian government
2. Brazilian organizations: including OPAM and URIHI
3. Other organizations: including the World Bank, the UN, the Pan-American
Health Organization,
and other health oriented groups (This includes visiting small aid groups
already in the region for additional
input.)
4. Indigenous groups of the Amazon: This involves entry into the region
to speak with indigenous people about
resources that will be offered through the plan. *Note: all services offered
will be completely optional and will
be provided on a case by case basis depending upon both need and desire
for aid* Groups will be asked for input
on other possible needs. Indigenous groups can include, but are not limited
to the Guarni, Caingang, Ticuna,
Terena, Guajajara, Xavante, Yanomami, Macuxi, Potiguara, Xacriaba, Fulni-o,
Canipuna, Pata xo, Macuxi,
Kuikuru, Baniwa, Mekranoti Kapo, Txu Kahamae, Arapaco, Wari, and Uru-Eu-Wau-Wau
tribes.
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:
1. Accessibility:
(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:
a. Manpower:
1. Approximately
24 doctors—four per base station (at first, with
subsequent review periods determining actual requirements)
2. At least
thirty volunteer workers
b. Funding
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
VI. Testing
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.
VIII. Externalities:
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.
By Nina DeBenedictis =)
Non-website source:
Reeve, Mary-Elizabeth. Medical Anthropology Quarterly
v. 14 no 1, Mar. 2000, p. 96-108
Alston, Lee J., Gary D. Livecap, and Bernardo Mueller. Titles, Conflict, and Land Use. The University of Michigan Press. Ann Arbor, MI, 1999.
Barham,
Bradford L. and Oliver T. Coomes. Prosperity's Promise: The Amazon Rubber
Boom and Distorted Economic Development. Westview Press.
Boulder, Colorado. 1996.
Blaikie, Piers and Harold Brookfield. Land Degradation and Society. Methuen & Co. Ltd. New York. 1987.
Healy,
Kevin. Llamas, Weavings, and Organic Chocolate: Multicultural Grassroots
Development in the Andes and Amazon of Bolivia. University of
Notre Dame Press. Notre Dame, Indiana. 2001.
Hemming, John. Change in the Amazon Basin Volume I: Man's Impact on Forests and Rivers. Manchester University Press. Dover, New Hampshire. 1985.
Hemming,
John. Change in the Amazon Basin Volume II: The Frontier After a Decade
of Colonisation. Manchester University Press. Dover, New
Hampshire. 1985.
Smith, T. Lynn. Brazil: People and Institutions. 4th ed. Louisiana State University Press. Baton Rouge Louisiana. 1972.