Intercultural Health Processes in the Colombian Amazon

Amazonian indigenous peoples understand and manage health as a vital expression ofthe way in which human beings and the rainforest environment interact. Health is a cross-cutting theme of social life that is closely related to the cultural dynamics of family and community life, the ecological relations between local settlements and the surrounding natural ecosystems, and the way people conceive and relate to non-human forms of life. This near fusion of the social and natural worlds is an essential quality of indigenous traditional medicine, and reminds us of the etymology of “health,” which goes back to the Germanic root –kailo, meaning whole, wholesome, and even holy. Other terms such as “well-being” or “wellness” help convey the indigenous concept of health, which is most clearly embodied in the work of shamans as mediators between human society and the world of spirits (between local community and environment or territory), in their everyday life endeavor to restore the archetypal equilibrium among living things.

During my fieldwork among the Tanimuka, Letuama, Matapí and Yukuna of the Mirití-paraná River and the Uitoto, Andoke, Muinane, Nonuya and Bora of the Middle Caquetá River (Colombian Amazon), I witnessed an interdependen ce between these cultural patterns of environmental management in the Amazon rainforest and issues of human health.

Eco-Social Wellness

Indigenous peoples have inhabited the Amazon rainforests for over 10,000 years, a span of time during which they have co-existed with immense ethnic and biological diversity, and developed complex systems of ecological knowledge and management that underlie their subsistence economy, social organization structures, and diverse cultural practices. Health and education, work and leisure, everyday and ritual/mythical time, as well as material production and spiritual relations, are understood to be interrelated in an integrated system of life; all parts of social life are interconnected, and none can be understood in isolation from the others.

Many of the Amazon’s indigenous peoples have lived in their territories since ancient times, managing natural resources and ecosystems through social and ecological relations that aim to maintain a healthy way of life for all beings in their community. In the traditional worldview of these indigenous peoples, humans are part of the forest environment, along with plants, animals, and spirits. All living organisms, as well as soil and mineral structures, are understood to be key parts of the world system, each having vital energy and governing spiritual power of their own. This holism views the forest as an extended social system, in which social relations include not only humans, but also the other living beings such as minerals, plants, animals, and spirits.

Absence of a radical dichotomy between nature and society has strong implications for the discussion of health issues in the context of Amazonian cultures. Health, conceived and practiced as a dynamic process of eco-social well-being, emanates from the balance attained in social relations among humans as well as between humans and all other living beings in the forest. Holistic worldviews tend to integrate various dimensions and relations of social existence in a complex matrix of eco-social equilibrium, which is constantly moving in complementary patterns of rupture and restoration.

Each ethnic group has different ways of integrating the units and relations that make up the eco-social system. For example, specific dietary restrictions and associated shamanistic recitations constitute important elements of ethnic identity and differentiation, and are practical ways of avoiding the feared effects of disturbing the ecological balance, which is conceived as an agreement between the human community and the spirits that govern the natural communities of the forest. While the Tanimuka often eat the flesh of ant-eater bears, neighbouring Yukuna never do; likewise, the Yukuna eat alligator meat quite frequently, whereas Tanimuka cultural norms strictly prohibit eating this reptile’s flesh. These cultural norms are highly effective strategies of social control over the use of natural resources.

Power of Ritual

Since mythical episodes, each tribe and its clans have identified with specific ancestors from the flora and fauna realms. The underlying principles of these ancestral worldviews are systematized in mythological narratives, chants, recitations, and “words of counsel,” which are actualized and reproduced in the ritual cycles of dance festivals, initiation ceremonies and other healing practices that work as coherent systems geared toward the everyday attainment and longer-term maintenance of eco-social health.

In order to live well, tribes believe they need to take energy from other beings and from wild spaces: hunting, fishing, gathering, and shifting cultivation are carried out in different parts of the territory and along different seasons of the annual cycle. Through their everyday use of natural resources and places, humans exert pressure upon the local ecosystems, resulting in alterations of the natural balance. Each being’s or place’s energetic integrity must be honored in order to regain balance. For most indigenous societies, rituals function as effective means of social cohesion and collective therapy, and maintain a balanced ecosystem by re-establishing the delicate ecological equilibrium between people (family, community, ethnic group) and the governing spiritual powers of the forest. Whether individual or collective processes, curative or preventive treatments, simple recitations or festive dance ceremonies, rituals are always healing practices that involve complex interactions with the forest spirits.

Among the groups I worked with, rituals are always prepared and managed by shamans, whose mediation focuses on negotiating the energy that is taken by humans in the form of offspring or fruit and must be given back to the forest spirits. The shaman’s jurisdiction is not only the immediate surrounding territory used directly by the community, but also the wider environment which is the ancestral territory, and understood to be a web of sacred sites inhabited by many guardian spirits. These spirits must be greeted and gratified in order to avoid their sending illness as they reclaim the energy taken from them.


The drive for good health relies on a two-fold strategy that combines prevention and healing. Prevention is based on the avoidance of the multiple causes for the rupture of well-being through illness, epidemics, accidents, fights, or many kinds of social malaise or disorder. Harm is generally avoided by performing ritual acts of offering that attempt to keep the spirits calm or away. Once the ruptures have been generated—an occurrence that is absolutely normal in the day-to-day unfolding of social life—shamans must devote their powers to curative or restorative healing, which involves paying for the damage inflicted upon the spirits’ interests, thus cleansing the debt or imbalance created by human transgression of cultural-natural norms.

A web of fine lines unites the individual and collective, physical and mental, and human and non-human dimensions where the game of health is played. This is a serious game framed by life and death, where the need to be well is acknowledged for all the components and entities that exist in nature.

Impacts of Globalization

Like most rainforest ecosystems, the Colombian Amazon region has been under growing pressure by external agents who have imposed Western models of land use and natural resource extraction, coupled with the vision of nature as an unproductive realm to be conquered, colonized, and exploited. The penetration by this economic rationality of accumulation—first through the slave trade and rubber-tapping booms and later through other extractive cycles of furs, timber, and gold stimulated by international markets—generated significant social and cultural impacts among the indigenous communities of the region. These impacts were intensified through the ideological pressure exerted by other Western agents such as religious missionaries, politicians, and civilian and military state officials. As a result, many ethnic groups moved away or were displaced from their ancestral territories and forced to adopt an alien way of life. In the process of relocation, whether voluntary or obliged, considerable changes in the social and demographic structure took place.

Since the mid-19th century, the indigenous population in the Amazon has been decimated by abductions, massacres, and epidemics; many ethnic subunits and even entire tribes have disappeared. The surviving groups have had to reorganize themselves, confronting the influx of new ailments such as influenza, smallpox, tuberculosis, and venereal diseases, for which their genetic constitution and traditional medicine were not prepared.

This experience of contact has generated a growing dependency vis à vis Western medical technology, which Indians consider effective in curing certain Western illnesses. Local health posts have been established in communities to facilitate their access to basic Western medicines, and also as new institutional spaces where local health needs might be handled through the efforts of Western doctors or nurses fulfilling civil service, indigenous health promoters with basic training, and traditional healers, medicine men, and practitioners. But pharmaceutical drugs have come coupled with the overspecialized medical rationality that separates the organism from its social and environmental milieu, and further compartmentalizes the human body into isolated subsystems or organs, much different from the traditional holistic concept of well-being. Local health posts are seldom spaces for intercultural dialogue or cooperation, and rather became strongholds of the Western medical system within the communities.

Although indigenous people continue to rely mostly on their traditional holistic medicinal systems, the Western conception and management of health have been imposed by Westerners in Amazonian territories as though they are universally valid. Positive results in certain aspects of this system of public health have been used to justify the need for technology transferal and investment in Western medical infrastructure, institutions, and programs. Notwithstanding the legal recognition of indigenous peoples’ rights to design and manage their own health programs in accordance with their cultural principles and practices, Native communities and their experts are seldom consulted or their cultures taken into account by the government with regard to policy design or implementation. Marginal efforts by some indigenous organizations, non-governmental organizations (NGOs), and individual doctors or government officials have created examples of how intercultural health programs could be structured and applied on the basis of respect toward the particular needs and full participation of indigenous peoples.

Recent external pressures have been exerted upon indigenous peoples and their territories in the Colombian Amazon region by the expanding armed conflict between guerrilla and military troops, illegal drug traffic, and gold-mining activities. These pressures tend to impact not only the current situation of indigenous communities’ health and human rights, but the entire context of endogenous organizational processes that strive to strengthen self-governance and diversity as basic elements of cultural and ecological sustainability. Despite individual cases of involvement, indigenous communities and authorities have generally responded to these exogenous pressures by reaffirming their formal rights to territorial autonomy and by insisting on maintaining themselves outside of the conflict and exploitation of natural resources.

Despite the changes brought about by contact with “whites” in recent history, on the whole indigenous peoples have managed to maintain their cultural dynamics and social structure, reshaping what they need to find new ways and preserving the diversity of the rainforest as the basis of their well-being. This potential has been recognized and supported by grassroots indigenous and civil society organizations that are working together to preserve cultural and biological diversity by empowering indigenous peoples to self-govern their territories, in a respectful articulation with national and regional state institutions.

Empowering Indigenous Worldviews

The Colombian Amazon rainforest has been relatively well-preserved, partly due to its historical isolation from the colonizing drives of Latin American nation states, and more recently due to the special protection allowed by the resguardo, a form of communal land-tenure that recognizes indigenous peoples’ collective ownership of the land as well as relative autonomy in their territories. As a response to the need for concrete implementation of the legal framework of the Amazonian resguardos, several Colombian NGOs created the COAMA (Consolidation of the Amazon Region) Programme in the late 1980s. This network has assisted the Amazonian indigenous peoples in strengthening their autonomy, decision-making, and administrative capacities for territorial management, based on their cultural heritage and particular views on development.

The Colombian constitutional reform in 1991 enshrined the multiethnic and pluri-cultural reality of the nation, and consequently granted indigenous peoples the right to govern themselves and their territories according to their ways of life and cultural systems. Indigenous territories were elevated to the rank of autonomous political-administrative entities, and organizations composed of traditional indigenous authorities are now acknowledged as public state authorities. Further legislation protects the rights of indigenous peoples to participate in the design and management of their own health, education, and development programs.

But it is the ancestral worldviews and their concomitant cultural practices, the intimacy experienced by indigenous peoples in their coexistence as an integral part of the rainforest, that have produced an organic model with the power to inspire contemporary alternative approaches to development and forest management. This “model” is imbued with the holistic conception and practice of health as eco-social well-being that may well inspire Western institutions to adapt public health policy design and implementation to acknowledge cultural and biological diversity.

After a decade of intense fieldwork by COAMA, concentrated on grassroots initiatives developed by indigenous communities and associations, several local and regional processes have arisen with a clear focus on health issues. Much effort has gone into defining intercultural health protocols, so that information is collected and processed by indigenous promoters and leaders in ways that respond to internal demands and realities. These initiatives are oriented to strengthen indigenous medicinal systems and to articulate an intercultural health service system where the proposals are generated at the grassroots level of communities and community-based organizations, and coordinated directly with the regional governments’ health department. This process would ensure legitimacy from the bottom-up and funnel official funds through transparent and decentralized mechanisms.

This intercultural vision seeks to allow health promoters and shamans to intervene coherently, according to their capacities and understandings of the cultural context, addressing each particular case in mutual and respectful recognition of each other’s place in the indigenous health system. Such cooperation would be a contemporary strategy to maintain the fundamental eco-social equilibrium between all the living beings and systems of the Amazon rainforest.

Nicolás Bermúdez-Vélez is a Colombian sociologist who has lived with various indigenous communities in the Amazon rainforest since 1985. With his wife and children, he has been active in the emergence of grassroots initiatives and participatory processes in the Amazon and other regions. As a member of the Gaia Foundation and together with other local NGOs, he has coordinated several projects aiming to help strengthen indigenous peoples’ identity, autonomy, and territorial management, as a practical way of enabling the protection of biological and cultural diversity. He is currently a private consultant to various community-based organizations and civil society networks in Latin America, Africa, and Europe.

References and further reading

Reichel-Dolmatoff, G. (1997). Rainforest Shamans: Essays on the Tukano Indians of the Northwest Amazon. Devon, U.K.: Green Books.

Reichel-Dolmatoff, G. (1996). The forest within: The Worldview of the Tukano Amazonian Indians. Devon, U.K.: Green Books.

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