| Intercultural health conception |
A dialogue between cultures is recognized, identifying the need to learn about other cultures, in health care practices, horizontality and supplementarity with Mapuche medicine is emphasized. |
“interculturality is the relation between cultures that have a common work” (Man, Psychologist) |
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“I believe that interculturality has to do with the practical, focused on health care, (...) that deep down may we be tolerant and respectful towards all the arriving ethnicities and cultures (...) a framework of respect, tolerance, and finally not only of competence but complementation, that finally a hypertensive patient, for example, does not stop taking enalapril for meeting with the Machi or a Brazilian witch doctor, what do I know” (Woman, Matron) |
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“what I understand by intercultural health care is that it has to do a little with this field… it is more natural than Mapuche medicine and all, but also… in the way we are as actors and how we not only work with indigenous people, but also foreigners” (Woman, Social Worker) |
| Bonding experiences in promotion and prevention activities |
Productive work experiences are found, which allow to understand the Mapuche world view and improve practices in health prevention activities. |
“(...) we organized the vaccination campaign… we had the opportunity to get together and obviously talk about the theme (…) on that moment they explained to us what their vision was and it obviously had many of the typically known myths; that is a business, what do I know, but they also gave us some tips to encompass that population, and one of the things they commented is that they cared a lot about who got vaccinated, (...), to them, those who got vaccinated were really important because there is an energy subject attached to it, so… it was suggested that we show them the different vaccinated people so that they would finally see that subject and open us the doors (...)” (Woman, Nurse) |
| Bonding experiences in referral |
As referral to Mapuche medicine, some professionals refer to users who consider complex cases or did not respond to biomedicine. |
“(...) when we do family work and the family has a Mapuche surname and there is a situation because they do not want to come or have a reason behind and the family cannot articulate, we refer them, to matters more related to bonding, if working there is possible (in La Ruka) beyond that, and it works sometimes” (Woman, Social Worker) |
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“As a psychologist, I accompanied many patients when registering or making an appointment, but at the same time were referred with mental health doctors and according to the patient if they wanted to go or not, as it eventually happened” (Man, Psychologist) |
| Bonding barriers |
Lack of integration of the Mapuche healthcare workers as part of the PHC health team. To some, the professionals are not welcoming to other, the traditional Mapuche health workers are not available for integration. |
“they feel discriminated, so much so that they do not greet them, (...) they are shyer (...) and do not facilitate for them, and listen! but they are coworkers, and you facilitate things for your coworker (...) Therefore, not everyone feels that they belong [to the health team] and appreciates them, I believe there is a general respect for Mapuche culture but not any... appreciation” (Woman, Social Worker) |
| “(...) they do not integrate much, as an example of when it happened, when we did the pie de cueca on September 18, they gave us sopaipillas and came as the Kallfulikan community to present themselves on a stand (...) they have been opening up (...) due to the circumstances, but they are closed off” (Woman, Social Worker) |
| Controversy about the scientific validity of Mapuche medicine and lack of a regulatory framework to protect intercultural practice. |
“We are measured by the accreditation of health centers, and we all work to accredit clinics, but this is non-existent on a regulatory or legal level for health... supplementary medicine, so you can find many shysters in this field” (Woman, Matron) |
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“there is a weakness (...) that has to do with the legal framework, for example you, as a doctor, when referring to the Machi, who supports you legally? (...) the patient decompensated, it ended badly for them, if auditing or summarizing [make a summary or investigation] who referred them to the Machi, and why the Machi and not a cardiologist?” (Woman, Matron) |
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“But this is inviting them to be Westerners (...) meaning we interfere by our means, where is the dialogue in that? “please dress like doctors, put on a white suit, and work on an office with no smoke” then it is not Mapuche medicine” (Man, Psychologist) |
| Bonding barriers |
The Chilean healthcare system has inflexible guidelines or protocols of health that would limit incorporating intercultural practices daily. |
“(...) it has to with listening, taking your time with someone and... things we cannot do, because there can be employees or even patients knocking on your door if you are over your 15 minutes (...), they (Mapuche health) take their time and people know it and respect it, we also have our own time, with the minutes being counted” (Woman, Nurse) |
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“... if it is a low-risk diabetic they will go once to the doctor and then to a nurse or nutritionist, (...) however in La Ruka I believe you have the option to go talk, sit down and talk to everyone, maybe not because you have the Machi’s attention but they are a community, and I think that helps the patients a lot” (Woman, Preschool Teacher) |
