C C P Y - Comissão Pró-Yanomami

NGO SET UP TO INCREASE HEALTH CARE FOR YANOMAMI

FUNASA (National Health Foundation) is decentralizing health care in the 37 regions of the Yanomami Indigenous Area, on the Brazilian-Venezuelan frontier. Twelve of the regions will now be under the responsibility of URIHI-Saude Yanomami, a non-governmental organisation especially set up to provide health care for the Yanomami, and funded by the Ministry of Health to the tune of R$6.5 million.

The funding agreement will last for 15 months and is renewable. The new organisation will provide health care for 6,159 indians (almost half the Yanomami population in Brazil). Health care for the other regions will be provided either by other organisations (NGOs, religious missions) or directly by FUNASA. URIHI-Saude Yanomami was set up by members of the CCPY (Pro-Yanomami Commission) which has been carrying out projects with the Yanomami for over 20 years.

For the last six the CCPY, funded by the FNS (now FUNASA) had been running three health posts (Demini, Toototobi, and Parawau)within the Yanomami area. It was this positive experience that led the Ministry of Health to invite the CCPY to extend its health care to other regions and led to the creation of the new organisation. URIHI -Saude Yanomami is a Brazilian NGO completely independent in politically or administrative terms of any other organisation in Brazil or abroad.

It has taken over the running of another nine regions (Catrimani, Aajarani, Homoxi, Xitei, Surucucu, Xiriana, Parafuri, Tukuxim and Auaris). The government's initiative is part of a process of creating DSEIs (Special Indigenous Health Districts) aimed at changing the worrying situation of indigenous health care in the country. In the Yanomami area especially, the health situation has been very serious for some years. A report published in July 1999 by FUNASA's Epidemiology Service in Roraima showed that 70.4% of the deaths in the area were due to the lack of medical assistance. It also stresses that if there had been adequate vaccination in the indigenous area, half of these deaths would not have happened.

URIHI-Saude Yanomami has already received R$1.5 million of the total due, and with this money it is reorganizing the health structure in the regions under its responsibility. Fifteen out of the 92 health professionals hired previously have been offered fixed work contracts and another 70 have been selected to fill the posts of doctors, dentists, nurses and auxiliaries within the indigenous area. Priority was given to candidates from Roraima.

After a three month transition period during which the new health staff were chosen and trained and a new logistical/administrative structure was put in place, on 15th December 1999 URIHI began to provide direct health care to 12 regions. Under the contract, Yanomami health agents are also to be trained. Three Yanomami from Demini, Toototobi and Parawau (Joseca Yanomami, Pipiu Yanomami and Abraao Yanomami) had already been trained by the CCPY and obtained the FUNASA certificate for microscopists working with malaria, and now work in the indigenous area. More Yanomami will be trained in the other nine regions now under URIHI administration.

YANOMAMI MORTALITY IN 1999 WAS TWICE AS HIGH AS IN THE REST OF BRAZIL

A report by FUNASA's Epidemiololgy Service in Roraima, released on 25th July 1999 revealed that only 20.6% of the Yanomami who died the year before had received any medical assistance.

The report which covered the health conditions of 30,000 indians in the state of Roraima, covering all the local ethnic groups, showed that the incidence of diseases like TB, malaria, pneumonia and whooping cough was very high. The infant mortality rate among the Yanomami was also alarming: 141 deaths per 1000, ten times higher than the rates in the poorest areas of the general population where the Catholic Church's Pastoral da Crianca (Children's Pastoral) is active, which is 13.7 per 1000 (source: WHO Report 1996).

URIHI-Saude Yanomami data from July 1999 show that in terms of general mortality, the Yanomami rate was 2.4 times higher than the Brazilian average. For the Yanomami it was 14.4 per 1000, as against 6.0 for the general population. In 1998 the situation was especially serious, rising to 20.4 per 1000, equal to countries like Angola, Uganda and Afghanistan (source: WHO Report 1996). These numbers reveal the failure of the previous health care programme for the Yanomami, when it was all state-run and health responsibility was passed from FUNAI to the FNS. Bureacracy and corruption caused many problems, while health and demographic statistics failed to improve (source: Jornal Brasil Norte 20/08/99).

Better results have been achieved through partnerships with NGOs. One example was the agreement signed between CCPY and FUNASA (ex-FNS) to cover the period 1995-1999, under which the CCPY team provided permanent healthcare in the Demini, Toototobi and Parawau regions, funded by FUNASA. The results of this partnership were to reduce malaria and infant and general mortality rates, while there was an accumulated population growth of 22% over the six years. 93% were covered by vaccination. These results led FUNASA to invite CCPY to take over health care in a further nine regions, making a total of twelve. The organisation URIHI was then created to take on this new responsibility.

For further information, URIHI Saude-Yanomami's email is: urihi@technet.com.br

In just six months the partnership between URIHI and FUNASA has raised the quality of the health care supplied to the indians.

URIHI - Saude Yanomami, the NGO responsible for healthcare in 136 communities of the Yanomami Health District (DSY) announced this week that in the first six months of this year (2000), mortality in these communities fell by 52.2%, compared to the projected rate based on previous numbers. The projected rate was based on the deaths registered in the last nine years in the same area now being covered by the agreement. URIHI data showed that between January and June 2000, thirtytwo indians died, instead of the projected number of 68: "Half the deaths where the cause is known were from malaria and pneumonia, each responsible for 25% of the total". For URIHI, this drop is even more significant when it is remembered that many deaths before the year 2000 were not notified because of the lack of medical assistance.

The Yanomami Indigenous Area covers an area of 9.664.975 hectares in the extreme north of the Brazilian Amazon, in the states of Roraima and Amazonas. About 10,000 indians live in this area, in different stages of contact with governmental and non-governmental agencies.

According to URIHI, the difficulty, or even impossibility, of access to health posts by those who live in the forest helps to maintain death rates in some of the communities high. The agreement between FUNASA and URIHI was signed in September 1999 and work in the field began three months later. In this period staff were selected, hired and trained and the necessary equipment was acquired.

There are now 194 qualified staff, 161 of them working predominately in Yanomami villages. About 6,800 indians in 136 communities are covered by the health contract. (ISA-DF, 18/08/00)

Marco Antonio Gonçalves
Programa Brasil Socioambiental
Instituto Socioambiental
marco@socioambiental.org
http://www.socioambiental.org

Once more the Yanomami are under threat, this time because of a possible interruption to their health care. A proposed cut of 33% in government funding for Yanomami health programmes in 2001 is causing great concern to the various organisations that run them.

Background: The Yanomami have a history of high rates of infectious and contagious diseases, which were introduced by the relatively recent contact with our society, and to which their natural immunological resistance is low. The measles epidemics of the 1960s and 70s and the malaria outbreaks of the 1980s and 90s in particular led to a large number of deaths. During the Roraima goldrush at the end of the 1980s, the introduction of malaria caused the death of approximately 15% of the population. In the 1990s the health situation worsened, putting the very survival of the Yanomami people at risk. In this decade, their health indicators were comparable to the worst in the world, with extremely high rates of general and infant mortality and very high death rates from malaria, TB, acute respiratory infections and diarrheas. At the same time, the health care on offer to most of the Yanomami population was extremely precarious, due to government restrictions on hiring personnel and the use of public funds.

In 2000 special indigenous health districts (DSEI) began to be introduced by the federal government's FUNASA (National Health Foundation) in partnership with non-governmental organisations and state and municipal administrations. In the already existing Yanomami Health District (DSY) NGOs with a good track record in health assistance in some of the Yanomami regions were contracted while FUNASA remained responsible for the health care of 6% of the total population. The total budget for the year 2000 for all the health care in the DSY was approximately R$12 million (approx. US$7 > million). This new policy permitted the organisation of a health system that for the first time could provide quality healthy care to all the Yanomami, even those living in the most remote areas where access was difficult. Thanks to investments in infrastructure, the hiring of an adequate number of qualified staff and the development of suitable operational and logistical schemes adapted to the difficult conditions of the Yanomami area, there were impressive results. In just 10 months general mortality was reduced by 50%, malaria by 60% and vaccination cover was cosiderably extended. The infrastructure included the opening of new airstrips in the forest and the building of health posts equipped with medical and hospital material. The training of indigenous health agents had been started, so that the Yanomami themselves would one day be able to take over their own health care. However there is still much to do to ensure the health of the Yanomami and remove the risk to their survival. They are still dependent on the health teams for the treatment of the illnesses that have been introduced among them; the population is very dispersed: in some regions the infrastructure is still very precarious; and goldminers and others continue to invade their territory, permanently re-introducing various diseases. All this means that the Yanomami remain extremely vulnerable.

Recently FUNASA announced that the DSY budget for 2001 would be R$8 million, a reduction of 33% compared to the amount for 2000. The organisations providing health care in the field calculate that it will be impossible to maintain the minimum of activities needed for the proper functioning of the present health system, making the renewal of the existing contracts with FUNASA for next year unfeasible. Unfortunately FUNASA does not have its own means, especially the human resources, which would enable it to take over again the direct provision of health care, even on the previous precarious basis. Unless the budget is kept at the year 2000 level, from January 2001 health care will be profoundly affected, and once more Brazil's Yanomami population will be at risk.

Letter sent to Indigenous Health during a discussion on the ethics of intercultural relations.

" As we know, the anthropologist Chagnon caused a lot of harm to the Yanomami, both directly and indirectly, with his sociobiological practices and theories. Maybe the Yanomami ought to sue him, demanding some type of compensation. In the same way, although on an even bigger scale, goldminers in Brazil continue to cause grave problems to the Yanomami population. During all of last year and up until the present moment, we have been registering incidents involving goldminers and indians in the Parafuri, Surucucu and Paapiu regions.

The distribution of weapons and ammunition to the indians, the looting of their gardens, the supplying of material goods as a means of co-opting the villages, the prostitution of the women and the encouragement of conflicts between communities and against the URIHI health teams have all been amply documented and sent to FUNAI and made available to public opinion. Only last week, one of our teams found armed goldminers on a trail between communities in the Parafuri region. These garimpeiros demanded medecines and food which had to be handed over by the health professionals.

This same team was then treated with hostility by some of the Yanomami in a village allied to the garimpeiros. The indians alleged that, according to the garimpeiros, URIHI was trying to get them expelled from the area, and this would mean that they, the indians, would no longer receive weapons, ammunition and other goods. At the end of 2000 FUNAI announced that it was about to begin an operation to remove the garimpeiros.

About 30 federal police agents then arrived in Boa Vista, but most of them ended up staying in the city because of lack of funds to hire planes and helicopters to take them to the goldmining areas in Yanomami territory. We hope that at the beginning of 2001 the federal government will transfer the necessary funds to FUNAI for this urgent operation and that some form of permanent surveillance will be put in place to stop new invasions. It is sad to note that, with the aim of manipulating the Yanomami to their own benefit, Chagnon and thousands of goldminers have introduced such similar problems into Yanomami society.

The most dramatic aspect is that this continues to happen right up until today. Besides demanding a definitive solution to this problem, it would only be fair if the Yanomami took their case to court to demand reparations for the consequences of the government's omission during so many years".

For further information on Yanomami health in Brasil contact:
urihi@technet.com.br