Exploring the integration of Indigenous traditional birth attendants into the western healthcare system: A qualitative case study from the Amazon of Ecuador

Main Article Content

Eline Hallor
Erika Arteaga
Miguel San Sebastián

Abstract

Background: Indigenous populations in Latin America are often at the crossroads of traditional and Western healthcare systems. Despite the cultural significance of traditional medicine, integration into Western healthcare practices remains challenging. Ecuador has been at the forefront of embracing intercultural health, aiming to merge these distinct medical paradigms effectively. This study sought to systematize the experience of integrating Indigenous traditional birth attendants (TBAs) into the Western healthcare system in the Amazon region of Ecuador, identifying the enabling factors and challenges of such an integration to enhance healthcare access and quality for Indigenous communities.


Methods: Employing a qualitative case study design, the research involved conducting key informant interviews with 15 participants, comprising TBAs and midwives, in the province of Orellana, Ecuador. Thematic analysis was utilized to interpret the data, focusing on the participants' experiences, perceptions, and the operational dynamics of the integration process.


Results: The study revealed initial scepticism towards integration, which was gradually overcome through mutual learning and adaptation processes, highlighting the importance of cultural sensitivity and bidirectional knowledge exchange. Integration seemed to have facilitated healthcare access, with TBAs playing a pivotal role in bridging cultural and linguistic gaps, thus enhancing Indigenous women's comfort and trust in healthcare services. Despite these advances, TBAs faced significant challenges, including financial constraints and logistical difficulties, underscoring the need for continued support and sustainable integration strategies.


Conclusion: Integrating TBAs into the Western healthcare system in the Ecuadorian Amazon has shown promise in improving healthcare access for Indigenous women by fostering an environment of mutual respect and cultural sensitivity. However, to ensure the sustainability and effectiveness of such integrative health models, it is imperative to address the identified challenges and support the continuous development of TBAs and healthcare professionals alike. Future research should aim to quantitatively evaluate the health outcomes of this integration and explore its scalability to other regions.

Article Details

How to Cite
1.
Hallor E, Arteaga E, San Sebastián M. Exploring the integration of Indigenous traditional birth attendants into the western healthcare system: A qualitative case study from the Amazon of Ecuador. J Community Syst Health [Internet]. 2024 Oct. 1 [cited 2024 Oct. 3];1(1). Available from: https://journals.ub.umu.se/index.php/jcsh/article/view/1051
Section
Original research
Author Biography

Miguel San Sebastián, Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden

I am a medical doctor with a MSc degree in control of infectious diseases and a Ph.D. degree in environmental epidemiology from the London School of Hygiene and Tropical Medicine. I practiced public health during 12 years among Indigenous communities of the Amazon basin of Ecuador. Currently working as Professor in Public Health at the Department of Epidemiology and Global Health, Umeå university, teaching different courses (public health, epidemiology, social epidemiology) at Master and PhD level. My current research is focused on strengthening health systems in low-income countries and social inequalities in health in the Swedish context. I am also part of the Norrland´s Observatory for Equity in Health and Health Care (NOEHHC) and Lávvuo: Research and Education for Sámi Health.

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