In 2019, an ambitious new effort to improve the lives of indigenous communities in central and Latin America began.
Called Prevention and Control of Diabetes in the Indigenous Populations in Bolivia, Guatemala and Nicaragua, it aimed to reach more than 400,000 people, and was the first large-scale intervention targeting indigenous communities to receive WDF support. The project was designed by the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean (FILAC), and it built on the learnings of a successful pilot project in Bolivia.
Its methods were tried and tested, resources were in place, and the need was huge. Then, just a few months after the project’s launch, COVID-19 arrived.
WDF checked in with Gabriel Muyuy, Technical Secretary at FILAC and a member of the Inga people of Colombia, to learn what happened next, and what others can learn from their experience.
Gabriel began by explaining why diabetes prevention and care is a priority for FILAC.
“In my childhood, our parents fed us with food produced on our land – corn and its by-products. Unfortunately, due to deforestation and climate change, in most indigenous lands the soil doesn’t yield crops as it did 30 years ago,” he said.
A flight from the countryside and the effects of globalisation have made matters worse.
“That is why it is so important that the pilot project that started in Bolivia has been given continuity not only there but also in Guatemala and Nicaragua.”
A patient screening event in 2018, organised by the Bolivian pilot project.
The project was not affected by the pandemic right away, he said. But in the second half of 2020, when authorities introduced measures to limit movement between different communities, Gabriel and his team knew they needed to act.
They quickly proposed a reallocation of project resources from seminars, meetings and travel – which were now impossible – to new needs such as personal protective equipment for more than 20 of the primary care facilities involved in the project.
“This situation made us re-schedule and make many adjustments, but thankfully they were approved,” he said.
Platform wins praise
FILAC responded to the pandemic in other ways as well. In a widely watched – and praised – move, FILAC joined with the Abya Yala Indigenous Forum to create the Plataforma Indígena Regional frente al COVID-19, Por la Vida y los Pueblos (the Regional Indigenous Platform against COVID-19) to record, analyse and report on the effects of COVID-19 on the continent’s indigenous peoples.
The platform has contributed to work on indigenous languages and intercultural approaches to health, as well as on the right to land and territory.
“In this way, the platform is contributing to better health practices and improved diets, both of which are very valuable to prevent diabetes,” Gabriel said. “This space we have created has been very useful, and we will continue building upon it in the hopes that it will also be helpful in the future.”
An asymmetrical rollout
The WDF-FILAC partnership has ambitious targets, including training for hundreds of doctors, nurses and traditional practitioners/healers, and screening and treatment for thousands of patients.
“Training is a key aspect of the project. There is no other way of making changes in deep-rooted habits,” Gabriel said. “Fortunately the project is moving in the right direction, and training plans are going well.”
Still, the roll-out has faced challenges. In Bolivia, both the pandemic and political issues have caused delays. Strong interest in the project has also led the project team to open certain meetings and activities to additional participants.
In Guatemala the rollout had a strong start, but work on site is now suspended because of an extremely high number of COVID19 cases and an overwhelmed health system. “It is simply not safe enough,” Gabriel said.
In Nicaragua, however, the project is moving according to plan. “In Nicaragua’s case we have a much stronger institutional cooperation with the government and health authorities. We have periodic meetings and an open dialogue. It is where we have the best communication and development of the project,” Gabriel explained.
Flexibility, interculturality, holistic action
Asked what he believed to be the most important lessons learned from FILAC’s pandemic rollout, Gabriel responded with three.
“First, it is crucial to have and act with flexibility,” he said. “When working with indigenous communities, you must be aware of timing, space, and communication, because there is a spirituality and cultural values that you may not be used to or expecting.”
“Second, interculturality is important. You must work with it and acknowledge it. Many actors and institutions at different levels are involved in the process, and they come from very different environments. The reality in Guatemala is a different one from Nicaragua, and again a different one is found in Bolivia.”
“Third, medium- and long-term holistic action is required when dealing with diabetes and health. There are myriad factors involved, like the right to territory and food production. These changes cannot happen overnight.”
Teamwork is critical, he added – and often overlooked.
“Everyone has a different point of view and something to contribute and having a team with an interdisciplinary nature has been very helpful.”
With WDF support, the project team recently added COVID19 as a variable in a planned diabetes prevalence study and extended the study’s scope to include socio-demographic data, information about family history and lifestyle behaviours.
The project is scheduled to conclude in 2023.