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The Medical Plight of AmerIndians in the Interior of Guyana

The Medical Plight of AmerIndians in the Interior of Guyana. By Raywat Deonandan , PhD Assistant Professor, University of Ottawa Caribbean Studies Association 2009 June 2,2009. Where Is it?. Geography. Bartica. Georgetown. Mt Roraima.

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The Medical Plight of AmerIndians in the Interior of Guyana

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  1. The Medical Plight of AmerIndians in the Interior of Guyana By RaywatDeonandan, PhD Assistant Professor, University of Ottawa Caribbean Studies Association 2009 June 2,2009

  2. Where Is it?

  3. Geography Bartica Georgetown Mt Roraima

  4. Most of the 700k-800k population resides along the coast, but the vast interior is home to a few AmerIndian tribes

  5. Guyana’s Health Status • High HIV/AIDS rate (2-4%) • Low life expectancy (~65) • High infant mortality (31 deaths/1000 births) • High maternal mortality (126/100K popn) • Exploding diabetes epidemic (50K cases acknowledged) • Child malnutrition, unevenly distributed • Malaria endemic, but decreasing • TB endemic

  6. Major Donors& Intervenors • USAID • Global Fund • WHO • CIDA • Clinton Foundation • Gates Foundation • Smaller NGOs and religious groups

  7. History of Public Health Funding • 2002-2007: CIDA spends CDN$5 million on HIV/AIDS, STIs and TB • 2004: Global Fund awards US$2 million for Malaria • 2006: newspapers announce Guyana will tap US$63million from Global Fund for TB, Malaria and HIV/AIDS • 2004-2009: >$US100million from PEPFAR for HIV/AIDS

  8. Needs Assessments • In AmerIndian regions, usually consists of: • Assessing indicators (which are often unavailable) • Speaking to city-based bureaucrats • Speaking to community leaders

  9. Needs Assessments • Rarely involve direct contact with main stakeholder group • Rarely involve liaison with immediate, local health care provider • Might be tainted by a desire to conform to donor priorities

  10. This Study • The Toronto-based philanthropic group Vea’havta received funding to conduct maternal health development sessions within Mazaruni area of Guyana • Needs assessment was conducted to determine what services within the funding mandate could be provided

  11. This Study • In Nov, 2008, a team of 2 doctors, 2 nurses, 1 logistician, 1 programme manager and 1 epidemiologist visited a series of sites in the Mazaruni • Remote village of Kamarang (within forest) • Remote village of Waramadong (within forest) • Town of Bartica • 3 river-based villages within short travel distance of Bartica

  12. This Study • While medical services were provided, health literacy presentations were made to those waiting for clinical care • Presentations were also made to local schools • At each location, a hat was passed and villagers were invited to submit anonymous questions about health, which were then addressed by the team

  13. Implications • The submitted anonymous questions serve as a parallel, grassroots needs assessment that suggest an undercurrent of health need that is not being addressed by the mainstream programmes

  14. The Locations Kamarang public school - about 25 students, equal gender split, aged 11-15 Waramadong high school - about 100 students, equal gender split, aged 14-16 Waramadong high school - about 200 students, equal gender split, aged 11-13 Waramadong high school - 35 teachers and mentors, equal gender split, all adult Waramadong clinic - 22 adults, only 4 men

  15. The Locations ) Bartica antenatal clinic - 31 adult women Bartica diabetes/hypertension clinic - 44 adults, only 8 men Bartica vaccination clinic - 50 adult women Kartabo village - 17 adult women

  16. Kamarang • About 500 people • Mining town • Well resourced • Prominent feature is mile long landing strip • You will likely stay in your own house, across the “street” from the health centre • May have to share with a peace corps student

  17. Waramadong • 2 hour boat ride from Kamarang • Residential high school with 300 students • Very Christian • You will likely stay in the health centre

  18. The Results • 137 questions were submitted anonymously • They can be divided into five themes: • 1) requests for further personal contact with the presenters; • (2) desire for knowledge of self-care regarding diabetes and proper nutrition; • (3) questions regarding infertility; • (4) questions regarding safe sex and general healthy sexuality; • (5) miscellaneous questions about body functions.

  19. Examples of Questions Asked

  20. self care (nutrition and diabetes) "If we stop exercising, what can happen" (age 11-13) "What is the proper diet for our body" (age 11-13) "If I have diabetes what must I do" (adult) "Why do diabetics get amputations" (adult) "What causes low blood pressure" (adult) "Do we need to boil well water" (adult) "Is it okay to toast bread" (adult) "Why does diabetes cause swelling" (adult) "Is brown bread and rice as bad as white bread and rice" (adult)

  21. infertility "When am I most fertile" (adult) "I want to have sex but I am unable. What is wrong" (adult) "[My wife] does not produce children" (adult)

  22. sexuality, STIs and HIV "Can the baby still be [hiv] negative when the parents are positive" (age 14-16) "Why you have to use a condom" (age 14-16) "Why young people want to have sex? Give reasons." (age 14-16) "Can you get AIDS from kissing" (age 11-13) "Can you test a fetus for hiv" (adult) "Can the [contraceptive] pill cause cancer" (adult) "What happens if you take depo [DMPA contraceptive] while pregnant" (adult)

  23. miscellaneous (including body functions) "Why is alcohol dangerous to health" (age 14-16) "What is a pancreas" (age 14-16) "How does a woman get twins?" (age 14-16) "Why do girls sometimes get the menstruation two time in one month" (age 14-16) "Is milk good or bad" (adult) "How can we preserve our traditional medical knowledge" (adult)

  24. Observations • Interests expressed by villagers are not always in line with mandate of donors • When clinical care is provided, there is still a gap in clinical understanding (health literacy)

  25. Recommendations • While these populations are saturated with competing interventions focused on preventing HIV/AIDs and STIs, there remains pervasive ignorance about the nature of HIV transmission. More thorough health literacy initiatives must be considered. • While government and NGOs are alert to the new epidemic of diabetes, and pharmaceutical and clinical programmes are being introduced, there remains a profound lack of knowledge about the causes of diabetes and the number of self-care options available to sufferers.

  26. Recommendations • The demand for effective contraception is great, but more education is needed around the types of contraceptive options, limitations of contraception and contraindications for specific contraceptive interventions. • Public health interventions are stressing protection against infectious diseases, but there is a growing demand for ergonometric and physiotherapeutic literacy, care and capacity development.

  27. Recommendations • Future needs assessments can benefit from including similar anonymous comments and not relying solely upon clinical indicators and the opinions of local leaders.

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