Protests highlight plight of Chile's Mapuche Indians
By Anastasia Moloney - 6 February 2010
Land disputes between the Chilean Government and Mapuche Indians have brought the health issues facing the nation's largest Indigenous group into sharp focus. Anastasia Moloney reports.
The recent government crackdown on protests by Chile's Mapuche Indians has exposed the plight of marginalised Mapuche communities who are struggling to preserve their traditional way of life amid allegations of increasing human-rights violations and political persecution.
Since the late 1990s, small groups of Mapuche activists have resorted to sporadic violent protests to demand the return of ancestral homelands, they say have been taken away from them by successive governments. Over the years, swathes of Mapuche territory have been converted into large-scale commercial pine and eucalyptus plantations owned by forest and timber companies.
During the latest wave of protests late last year, Mapuche activists occupied land, torched forests and farmhouses, and destroyed forestry equipment and trucks, in what was billed as Chile's worst security crisis in decades.
The heavy-handed police response has marred the otherwise positive human-rights record of the centre-left government of Michelle Bachelet and has sparked criticism over government methods to prosecute activists. Clashes with police have left several Mapuches dead and dozens have been detained and imprisoned under an anti-terrorist law that dates from the military dictatorship of General Augusto Pinochet (1973—90).
The controversial law is being applied in an indiscriminate way against the Mapuches, community leaders say. “In Chile, a new law is being systematically applied that violates the human, civil, and political rights of the Mapuche people”, said Andrea Marfil, from the Mapuche Human Rights Committee, in a statement to the UN Human Rights Council last March. International rights groups have also raised concerns about the law. “There's no justification and it's absolutely unacceptable that Mapuches are subject to draconian legislation with serious flaws and without real due process guaranteed”, said Jose Miguel Vivanco, the Americas director for Human Rights Watch.
The 700 000-strong Mapuche are Chile's largest Indigenous group and account for nearly 4% of Chile's population of 17 million. Some Mapuche communities have benefited from government programmes that have transferred some 650 000 hectares of land to Indigenous groups since 1994. But the loss of Mapuche territory is taking a heavy toll on the community. It is having a detrimental effect on their health, while it threatens farming livelihoods and the Mapuche traditional way of life.
For the Mapuche, their homelands form an integral part of their sense of identity and culture, including medicine and rituals. The practice of traditional medicine is becoming increasingly difficult as the plants, trees, and herbs used by Mapuche healers are becoming scarcer. “We've relied on the land for centuries for our traditional medicine. With deforestation, and our native lands, forests, wetlands taken away and reduced to small holdings, the herbs we use have all but disappeared”, said Doralisa Huenulen, a Mapuche leader and health coordinator.
The loss of Mapuche territory has brought on new types of health problems and left a marked psychological effect on Mapuche communities. “We're seeing more cases of mental health problems, depression, stress, and trauma caused by the loss of contact with our land, a sense of loss and identity and the lack of self-autonomy, which is made worse by poverty”, said Mapuche leader Huenulen.
Squeezed off their ever fragmenting homelands, growing numbers of Mapuches, along with other Indigenous groups, have settled in the shanty towns surrounding Santiago. Roughly 60% of Mapuches now live in urban areas, with many working as domestic servants. Urban migration among the Mapuche has given rise to increasing rates of obesity, diabetes, hypertension, and respiratory diseases. Nearly 20% of Mapuche are obese, according to a recent study by the University of Chile. “The Mapuche diet has changed for the worse”, said Huenulen. We're eating foods that aren't part of our traditional diet like coffee, tea, salt, sugar, and soft drinks.”
During the Bachelet administration, living standards across Chile have risen overall. But less progress has been made in reducing poverty in the country's southern rural Indigenous communities where the Mapuches live in impoverished enclaves. Poverty is higher among Indigenous groups, with 32% of Indigenous groups living in poverty compared with about 20% among Chile's non-Indigenous population. Although the gap between health and social indicators between non-Indigenous and Indigenous populations has narrowed in recent years, the scant research available shows that Indigenous groups still have less favourable health indicators than the rest of Chileans.
Death from bronchopneumonia in Indigenous children younger than 5 years is proportionally higher than in non-Indigenous children. The rates of tuberculosis, among some Indigenous groups, are double the national average, according to government data, whereas the same applies to child mortality rates in the late 1980s. And life expectancy rates are lower in Indigenous communities compared with non-Indigenous groups.
Under the Bachelet Government, health-care coverage has been extended and Chile's successful universal vaccination programme strengthened. Still, there are divergent opinions as to the extent this has improved access to health care among the Mapuche, particularly those living in remote rural communities and in areas plagued with land disputes. “In general terms, there's little discrimination and difference in terms of access to health services between Mapuche and non-Mapuche”, said Alejandro Herrera, director of the Institute of Indigenous Studies at the University of the Frontier in southern Chile. However, Mapuches do receive lower quality health care. “The overall quality of health services Mapuches receive is worse in comparison to non-Indigenous people. There is a gap”, said Herrera.
This gap stems from cultural barriers and a lack of awareness and sensitivity of Chile's Indigenous cultures among western doctors. “There's a lack of understanding between Mapuche patients and doctors trained in western medicine who have different concepts of illness”, added Herrera.
The Mapuche view of health and illness is related to notions of harmony. For Mapuches, being ill does not have a biological explanation but is caused by supernatural powers. This belief often makes it difficult for Mapuches to articulate their illness and symptoms to a doctor trained in western medicine. The difficulty is compounded by the language barrier. “Mapuches over 45-years-old, especially women, are less likely to speak Spanish, which is one of the main barriers in receiving good quality health care”, said Herrera. Improving the quality of health care to Mapuche communities means breaking down cultural barriers, bridging cultural gaps, and raising understanding of Mapuche culture and traditional medicine among conventional doctors.
Since 1996, following the creation of the ministry of health's special department on Indigenous health, government efforts have focused on promoting so-called intercultural health systems, allowing traditional medicine and practices to be offered as an equal and complementary alternative to western medicine in some hospitals and health centres in Chile.
Intercultural health systems also aim to strengthen and preserve Indigenous traditional practices, and promote the autonomy of Chile's Indigenous communities by giving them a choice in the type of health care they receive. A central premise of intercultural health systems is that Indigenous groups play a pivotal part in their design and implementation, while ensuring that indigenous communities can receive medical treatment in their own language.
After a 10-year-long consultation process between Mapuche leaders and state health providers, Chile's New Imperial Intercultural hospital opened in 2006 as part of a government pilot project in implementing intercultural health systems in the heart of Mapuche communities. The hospital, which receives roughly 80 Mapuche walk-in patients a day, has traditional Mapuche healers, natural remedies and herbs specialists, a bonesetter, a midwife, and intercultural health workers on hand, who work alongside western-trained doctors. Patients are assessed both by Mapuche staff and western-trained doctors, who usually have some training in Mapuche culture and medicine. “What we've achieved in this hospital is that state public health policy accepts that there are other ways of practising medicine, and ones that can co-exist alongside western medicine”, said Huenulen, a Mapuche leader and health coordinator at the hospital.
But such attitudes are the exception rather than the norm in Chile. The concept and practice of intercultural health systems is still in its initial stages. “The policy of intercultural health is not yet properly understood or incorporated into the public health service”, said Herrera from the University of the Frontier. Mapuche leaders are urging the government to increase the numbers of intercultural workers, ensure more medical graduates are trained in Indigenous medicine, and allow those doctors working in Indigenous regions to be chosen by a committee with Mapuche representatives.
Source: The Lancet
The Lancet, Volume 375, Issue 9713, Pages 449 - 450, 6 February 2010