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Presentation by E. Jean Langdon and Julio Portocarrero to the dossier dedicated to medical and health anthropology Presentación de E. Jean Langdon y Julio Portocarrero al dossier dedicado a la antropología médica y de la salud.

Este artículo, resultado de décadas de trabajo de campo, explora las reconfiguraciones del chamanismo siona como un género performativo y como performance cultural que expresa la diferenciación étnica frente a la violencia colonial y postcolonial. Desde el siglo xvii, los ciclos de epidemias, las actividades misioneras, las industrias extractivas y el conflicto armado provocaron cambios en el rol social del chamán. El líder ceremonial del período precolonial se reconfiguró como el líder político-sagrado (cacique-curaca) de las comunidades siona. Las fuerzas exógenas del siglo xx causaron la extinción de este rol social y el cese de las actividades chamánicas en la segunda mitad de dicho siglo. Los cambios constitucionales, el reconocimiento de los derechos indígenas y la demanda neochamánica de tomas de yajé contribuyeron a una importante revitalización del chamanismo siona en la última década del siglo xx. Las performances chamánicas han surgido como una estrategia clave para promover la diferenciación étnica, en el complejo campo de las negociaciones entre comunidades indígenas, organizaciones gubernamentales y no gubernamentales, industrias extractivas y grupos neochamánicos.

English abstract:In 1990, the Brazilian Unified Health System institutionalized new relationships between the government and society. In recognition of the inequalities and inequities inflicted upon Indigenous Peoples, the Indigenous Health Subsystem was established in 1999. Roles were created for the democratic exercise of Indigenous participation and prominence in three border spaces: Indigenous health agents as members of health teams; Indigenous representatives on health councils; and Indigenous organizations as primary care providers. This article explores these spaces based on ethnographic research from southern Brazil. It concludes that the roles created for Indigenous participation and governance are ambiguous and contradictory. When participating in new opportunities created by the government, Indigenous actors are subjected to a centralized and bureaucratized system that offers little possibility of autonomous decision- making or action.Spanish abstract:En 1990, el Sistema Único de Salud institucionalizó nuevas relaciones entre el gobierno y la sociedad, estableciendo en 1999 el Subsistema de Salud Indígena. Se crearon nuevos roles para el ejercicio democrático de la participación indígena con prominencia en tres espacios de frontera: agentes indígenas de salud como miembros de los equipos de salud; representantes indígenas en los consejos de salud; y organizaciones indígenas como proveedores de atención primaria. Este artículo explora estos espacios basado en investigación etnográfi ca del sur de Brasil. Se concluye que los roles creados para la participación y gobernanza indígena son ambiguos y contradictorios. Cuando se participa en nuevas oportunidades creadas por el gobierno, los actores indígenas son sometidos a un sistema que ofrece poca posibilidad de tomar decisiones autónomas o actuar.French abstract:1990 le système unique de santé brésilien, le SUS (Sistema Único de Saúde) institutionnalisait de nouvelles relations entre le gouvernement et la société en donnant aux usagers un rôle central et en leur att ribuant une large participation dans tous les secteurs des soins. En reconnaissance des inégalités et iniquités historiques infl igées aux peuples indigènes, le sous-système de soin indigène fut établi en 1999. De nouveaux rôles furent créés pour l’exercice démocratique de la participation indigène et sa reconnaissance dans trois zones d’action et de communication délimitées. Cet article explore ces espaces sur la base de recherches ethnographiques réalisées au Sud du Brésil et conclut que les rôles créés pour la participation indigène et la notion associée de gouvernance sont souvent ambigus et contradictoires.

This article outlines the transformations of yaje shamanism among the Siona Indians of the Northwest Amazon Basin of Colombia. The shaman's role and the political and sacred use of yaje rituals have changed since colonial times and can be seen as a result of adaptive strategies for survival. This study examines the factors that have contributed to the current revitalization due to state and popular representations of the ecological and wise Indian. Although Gow and Taussig argue that ayahuasca shamanism in Peru and folk healing in Colombia rose out of colonial domination and proletarian concerns, Siona shamanic practices are best understood as a transfiguration and result of their particular response to outside forces. Their contemporary use of yaje reflects this past and the discourse, aesthetics, expectations, and demands of the larger society.

Protests to claim rights are a common practice among Indigenous peoples of the world, especially when their interests conflict with those of nation states and/or multinational corporations regarding the use of their lands and resources. Drawing on a case study of the National Indigenous Mobilization held in Brasilia, Brazil in May 2014, this paper describes how Indigenous protests and strategic actions (e.g., blockades, sit-ins, rallies, marches, and publicity campaigns) are arguably legitimate tactics for Indigenous peoples to seek the attention of a broader audience, establish dialogue with authorities and companies, and to achieve respect for their individual and collective human rights. These forms of community mobilization often occur in contexts where good faith processes (i.e., based on the principle of free, prior and informed consent, FPIC) were not properly implemented. We analyse the use of social media and the role of the mass media in giving visibility to the protests and in assigning or withdrawing broader social legitimacy. Using anthropological performance theory, we consider the political and social context of the Mobilization. Although negative Indigenisms (i.e., akin to Said's concept of Orientalism) are propagated in the media, a key finding is that symbolic actions and/or performative actions (a theatricality of resistance) are essential dimensions of Indigenous protest to achieve objectives. We conclude that Indigenous mobilizations are legitimate and necessary ways for Indigenous peoples to gain respect for their right to self-determination and other individual and collective human rights. Protests can also help in building social capital and ultimately have positive outcomes for the environment and community health and wellbeing. (C) 2015 Elsevier Ltd. All rights reserved.

In Brazil, the right to health claimed by indigenous peoples interacts with various regulatory milestones, including the Alma-Ata Declaration, which proposes and highlights primary health care (PHC) as a means to increase access and minimize health inequalities. As part of the Brazilian Unified Health System (SUS), an indigenous health subsystem (SASI) was established, along with a National Policy for the Care of Indigenous Peoples (PNASPI), as a strategy to ensure health care access for these populations. PNASPI aims to provide differentiated health care to indigenous populations, considering the sociocultural diversity and the epidemiological and logistic peculiarities associated with the care of these peoples and focusing on the provision of comprehensive care. The present article discusses the implementation of PNASPI, highlighting achievements and challenges faced during this process. Despite the growing financial resources made available for the implementation of the indigenous health subsystem, the initiatives developed thus far have had little impact on health indicators, which reflect historical inequalities in relation to other population segments. Indigenous social control is still fragile, and the discussions in this arena show the dissatisfaction of users toward the system. The discontinuity of care, added to the shortage of and high turnover of health care workers and the need to establish intercultural dialogues that promote articulation with traditional knowledges, challenge the effectiveness of PNASPI. Care is still centered on palliative and emergency measures, usually based on relocation of patients for treatment, which is associated with high cost. To overcome these challenges, PHC must be strengthened and recognized as a regulatory milestone by the PNASPI organizational model.En Brasil, el derecho a la salud reclamado por los pueblos indígenas interactúa con varios marcos regulatorios, incluida la Declaración de Alma-Ata, que propone y destaca la atención primaria de salud (APS) como un medio para aumentar el acceso a la salud y minimizar las desigualdades en materia de salud. Como parte del Sistema Único de Salud de Brasil (SUS), se crearon el subsistema de salud indígena (SASI)y la Política Nacional de Atención de Salud de los Pueblos Indígenas (PNASPI), como estrategias para garantizar el acceso a la atención médica de estas poblaciones. La Política tiene como objetivo brindar atención de salud diferenciada a las poblaciones indígenas, considerando la diversidad sociocultural y las peculiaridades epidemiológicas y logísticas asociadas con la atención de estos pueblos y centrándose en dispensar una atención integral basada en la APS. En este artículo se discute la implementación de la Política, y se destacan los logros y desafíos enfrentados durante este proceso. A pesar de los crecientes recursos financieros disponibles para la implementación del subsistema de salud indígena, las iniciativas desarrolladas hasta ahora han tenido escaso impacto en los indicadores de salud, que reflejan desigualdades históricas en relación con otros segmentos de la población. La participación social aún es débil, y las discusiones en este campo revelan la insatisfacción de los usuarios con el sistema. La falta de continuidad de la atención, sumada a la escasez y alta rotación de los trabajadores de la salud, así como la necesidad de establecer diálogos interculturales que promuevan la articulación con los conocimientos tradicionales, cuestionan la efectividad de la Política. La atención aún se centra en prácticas paliativas y de emergencia, generalmente basadas en la reubicación de los pacientes para tratamiento, lo que se asocia con un alto costo. La superación de estos desafíos depende del fortalecimiento de la APS y de su reconocimiento como marco regulador importante del modelo organizativo de la Política.

Alors que le chamanisme a ete considere en anthropologie comme un phenomene specifiquement primitif et indigene, l’augmentation des rituels chamaniques pratiques dans les zones urbaines a travers le monde nous force a reconsiderer nos modeles analytiques. La diffusion du chamanisme parmi des cultures non indigenes fait partie d’un contexte plus large d’interaction entre le local et le global, qui est au centre des questionnements actuels de la recherche anthropologique sur les notions de culture, tradition, continuite, lieu et praxis. Cet article defend qu’il est preferable aujourd’hui de considerer le chamanisme comme un phenomene dialogique, plutot que comme une categorie analytique susceptible de diriger le regard anthropologique. A travers la comparaison de deux etudes de cas, l’une colombienne et l’autre bresilienne, cet article montre le chamanisme comme une pratique dialogique qui emerge des attentes des differents acteurs impliques, qu’ils soient indigenes ou pas. Le chamanisme ne peut etre considere comme une philosophie isolee ou comme une logique separee du contexte social, politique et historique qui accueille sa pratique.

Among the Siona indians, shamanic flights and encounters in the invisible world are recreated through oral performance. With the objective of exploring the relation between narrative performance, the creation of extraordinary experience and shamanic perspective, the article analyzes a narrative that tells of the visit to the house of the jaguars by a young apprentice and his master-shaman. This trip to the hidden side doesn't occur during the ritual and under the influence of yaje, but in the following morning, when the novice is returning to his home. The analysis points out at the strategies of contextualization in narrative performance that work to create experience, transmit shamanic knowledge and reflect upon change of perspective and shamanic power.

Entendendo o xamanismo como um modo performático, este texto explora o seu papel entre os índios Siona da Colômbia como expressão de especificidade cultural perante a violência colonial e pós-colonial. A história oral reconta como o papel xamânico transformou-se no papel do poderoso cacique curaca, em resposta adaptativa às atividades missionárias. Após a quase extinção dos xamãs praticantes no século XX, suas performances surgiram nas duas últimas décadas como uma estratégia-chave na fomentação das especificidades étnicas e nas lutas contemporâneas pelos direitos indígenas. Tanto a constituição colombiana de 1991 quanto as redes urbanas neoxamânicas associam o xamanismo à preservação ecológica, à medicina tradicional, à identidade étnica e ao bem-estar da comunidade. Em Putumayo, região caracterizada como “zona de guerra”, as performances xamânicas são uma estratégia fundamental no campo complexo das negociações entre comunidades indígenas, organizações governamentais e não governamentais, indústrias extrativas e diversos grupos armados.Tradução: Elisa Nazarian This paper explores the role of shamanism as a performance mode among the Siona Indians of Colombia as an expression of cultural distinctiveness in the face of Colonial and post-Colonial violence. Oral history recounts how the shamanic role transformed to that of the powerful cacique curaca as an adaptive response to missionary activities. After near extinction of practicing shamans in the 20th Century, their performances emerged in the last two decades as a key strategy in promoting ethnic distinctiveness in contemporary struggles for Indigenous rights. Both the Constitution of 1991 and urban neo-shamanic networks associate shamanism with ecological preservation, traditional medicine, ethnic identity and community well-being. In the Putumayo, a region characterized as a “war zone”, shamanic performances are a central strategy in the complex field of negotiations between Indigenous communities, governmental and non-governmental organizations, extractive industries and diverse armed groups.

No intuito de examinar o desenvolvimento dos paradigmas antropológicos e seu diálogo com a medicina, a discussão está organizada segundo dois eixos gerais, porém não exclusivos: o que enfoca a saúde e a doença como experiência e construção sociocultural, e o que examina a saúde a partir de uma perspectiva interacional e política. No primeiro eixo, privilegio as teorias estadunidenses e francesas que encontram reflexo no diálogo antropológico no Brasil. Para o último eixo, o da política, a discussão parte do diálogo entre antropólogos na América Latina que vêm desenvolvendo modelos para contribuir com a interdisciplinaridade necessária para as políticas e a intervenção na saúde. Os conceitos de práticas de autoatenção, intermedicalidade, entre outros, são explorados por causa de sua contribuição na antropologia para as políticas públicas em saúde. Estes antropólogos vêm argumentando que as práticas de saúde precisam ser entendidas através das noções de autonomia, coletividade, agência e práxis, em oposição à perspectiva biomédica caracterizada como universalista, biologista, individualista e a-histórica. In order to examine the development of anthropological paradigms and their dialogue with medicine, I divide the discussion into two general, but non-exclusive, approaches: one that focuses on health and disease as social and cultural experience and construction, and another that examines health from an interactional and political perspective. For the first approach, I focus on North American and French theories that find resonance in the anthropological dialogue in Brazil. For the second political approach, the discussion originates in the dialogue among anthropologists in Latin America who have been developing models to contribute to an interdisciplinary approach necessary for health policies and intervention in health. The concepts of practices in self-care and intermedicality, among others, are explored due to their contribution in anthropology to public policies in health. These anthropologists have argued that health practices should be understood through the notions of autonomy, collectivity, agency and praxis, as opposed to the notions of the biomedical perspective characterized as being universalist, biological, individualist and a-historical.

This paper is a reflection on the ritual incorporation of ayahuasca, an Amazonian psychoactive ritual substance, by members of a Guarani Indian village on the Atlantic coast of the state of Santa Catarina, Brazil. Their shamanic leaders have adapted the use of this beverage into their ritual practices and recognize it as part of their culture and tradition. This process of appropriation is a result of the formation of a network that involves various actors, among them the Guarani Indians, members of Sacred Fire of Itzachilatlan, followers of the Brazilian ayahuasca religion Santo Daime, and a health team employed to provide primary attention to Indian communities. Based on this case study, we demonstrate that shamanisms today emerge out of specific political and historic contexts. If the concept of shamanism is useful as an analytical paradigm, it must be thought of as a dialogical category constructed through interaction between actors with diverse origins, discourses, and interests.

This article traces the development of anthropological research on health in Brazil in light of discussions on modernity/coloniality and world anthropologies. Originating in the 1970s, stimulated by external and internal pressures for scientific production and along with the expansion of graduate programs, a network of anthropologists has consolidated and multiplied in Brazil. We describe the development of research groups, meetings, and publications in order to characterize Brazilian anthropology of health as a research program that distinguishes itself from North Atlantic medical anthropology. We examine the visibility and circulation of references in academic publications to explore the participation of Brazilians in the global discourse and, more specifically, in the North-South dialogue. From a comparative perspective, we argue that anthropological investigations of health reflect a perspective and ethos distinctive to Brazil and its historical and political processes.

OBJETIVOS: Comparar a percepção da depressão, incluindo a percepção dos sintomas e dos tratamentos considerados apropriados, pelos membros de três grupos étnicos (descendentes de açorianos, italianos e alemães residentes em Santa Catarina, Estado da Região Sul do Brasil), assim como a expressão de depressão por meio do Inventário Beck de Depressão nestes grupos. METÓDO: Em um estudo transversal, com uma parte quantitativa e uma qualitativa, foram avaliados 60 indivíduos, sendo 20 de cada uma das comunidades étnicas escolhidas: açoriana, italiana e alemã. Realizou-se uma entrevista semi-aberta, tendo como questões orientadoras: Para você, o que é depressão?; O que pessoas deprimidas devem fazer?; e Qual atividade de lazer você mais gosta de fazer? Depois, foi aplicado o Inventário Beck de Depressão (BDI). Os escores do BDI (subescalas: cognitiva-afetiva e somática) foram comparados entre os diferentes grupos por meio do método ANOVA. No estudo qualitativo, verificaram-se as percepções compartilhadas no discurso dos indivíduos de cada grupo, quanto à depressão e seu tratamento. RESULTADOS: Os principais sintomas relatados por descendência foram: irritabilidade (açorianos), autopunição (italianos) e falta de energia (alemães). Não houve diferença estatisticamente significativa quanto à freqüência de sintomas cognitivos e somáticos nas diferentes comunidades. O padrão de percepção da depressão caracterizou-se nos descendentes de açorianos por isolamento ("... a gente não quer ver ninguém"). Nos italianos, a depressão esteve relacionada a afastamento da família ("Depressão é vontade até de deixar o filho, o marido"), sendo esta vista como a responsável por ajudar na melhora. Já entre os alemães, a depressão esteve relacionada à dificuldade no trabalho ("Depressão é... não ter mais vontade de trabalhar") e este foi relatado como a solução. CONCLUSÃO: De acordo com o grupo étnico, a expressão, a percepção e a busca de tratamento para a depressão relacionou-se: à comunidade (açoriana), à família (italiana) e ao trabalho (alemã). OBJECTIVES: To compare perceptions of the symptoms of depression and its management between members of three ethnic communities (descendants of Azoreans, Italians and Germans in Santa Catarina, which is a State in the South of Brazil) and to compare the expression of depressive symptoms via the Beck Depression Inventory. METHODS: In a cross-sectional study, with both a quantitative and a qualitative design, 60 individuals (20 of each of the above ethnicities) were interviewed. A semi-structured interview was conducted, oriented by the following questions: In your opinion, what is depression?; How should persons cope with depression? and What is your preferred leisure time activity? After that, the subjects completed the Beck Depression Inventory (BDI). The BDI scores (subscales: cognitive/affective and somatic) were compared among the three groups using ANOVA. In the qualitative study, patterns of perceptions concerning depression were identified analyzing the responses of the individuals to the semi-structured interviews. RESULTS: The most frequent self-reported symptoms according to each ethnicity were: irritability (Azoreans), self-punishment (Italians) and low energy (Germans). There were no statistically significant differences between cognitive or somatic scores among the groups. The Azorean descendants suspected depression if the individuals evidenced social withdrawal ("... we don't want to see anybody"). For the Italian descendants, the family was cited as important in detecting ("Depression is feeling like leaving your son, your husband") and managing depression. The German descendants attributed depression to difficulty with work ("Depression is... not wanting to work") and work was also seen as the solution. CONCLUSIONS: According to ethnicity, the detection, expression of symptoms and search for treatment was related to: the community (Azoreans); the family (Italians) and work (Germans).

In democratic societies, protest is a legitimate and necessary way for communities to seek redress for issues that are ignored by decision-makers. In the wake of large projects, communities often find they need to mobilize to achieve respect for their rights and to influence the decision-making processes affecting their lives. Protest action can take many forms (e.g. blockades, rallies, boycotts) constituting a repertoire of contention, which is subject to continuous innovation. With new information and communication technologies (ICTs), digital repertoires of contention are also being enacted (social media, online petitions, digital sit-ins, twittering). This paper integrates the fields of performance theory, social movements, and impact assessment to conceptualize social protest. We identify over 200 forms of protest and related terms and provide a conceptual model to comprehend the contemporary role of protest. We consider that protest is part of the broader unfolding of social dramas, and is a mechanism to seek redressive action in contentious situations, especially between impacted communities and project proponents. Companies and governments that respect the principle of Free, Prior and Informed Consent (FPIC) and meaningfully engage with local people are less likely to experience protest and are more successful in establishing a social licence to operate.

Transformations in the Indigenous Health Care: Tensions and Negotiations in a Brazilian Indigenous Context Abstract In Latin America countries, programs and public policies aimed at indigenous health have impacted on new roles and border spaces. By addressing indigenous participation in primary healthcare, we analyze the tensions and negotiations before and after the implementation of the Indigenous Healthcare Subsystem in Brazil, providing as an example the indigenous land Kaingáng (TIK) located in the south of the country. Prior to the implementation of the Subsystem, the definition and execution of the services in this TIK were characterized by the strong presence of indigenous people linked to the indigenous political leader and the weak presence of institutions. Since 2000, the subsystem started covering various public and private segments. In the TIK, the role of a Kaingáng organization was full of ambiguities and paradoxes, because while it was an opportunity for getting a greater role in the negotiation spaces created by the State, it was also subject to the priorities defined in outer spaces to the ethnic group.

A performance das narrativas entre os índios Siona manifestam a função estética, apontada por Richard Bauman e outros, por meio da recriação da experiência das viagens xamânicas e da transformação de perspectiva que faz parte dos ritos com o uso do enteógeno yajé (ayahuasca). Nestas viagens, a perspectiva cotidiana é substituída por uma outra, que permite à plateia conhecer os seres que habitam o mundo invisível revelado nas visões. Ademais, as performances têm o importante papel de transmitir o conhecimento xamânico. A literatura oral dramatiza experiências de encontros ou viagens no mundo invisível, sejam estas ligadas ou não ao uso de enteógenos e aos sonhos. Através dos mecanismos poéticos, essas narrativas transmitem conhecimento ao indexar as relações entre o cotidiano e as regiões ocultas. Assim, elas criam expectativas na plateia a respeito das experiências extraordinárias com os espíritos e dão pistas de como entender e preparar-se para a mudança de perspectiva que caracteriza os encontros com o lado oculto. No intuito de explorar a relação entre a experiência extraordinária, performance e perspectiva, este trabalho analisa uma narrativa relatada por vários Siona sobre a época de sua juventude e aprendizagem xamânica – “A viagem à Casa das Onças”. Nesta, o jovem é convidado pelo mestre-xamã para visitar a casa das onças, onde elas aparecem na forma de humanos, em festas onde elas convidam o jovem para descansar numa rede nova, enquanto o mestre-xamã orienta o que o jovem está vendo. Esta viagem ao lado oculto não acontece durante o ritual sob a influência do yajé, mas na manhã seguinte, quando o novato está de volta à aldeia. A análise aponta para as estratégias que permitem à narrativa em performance criar experiências, transmitindo conhecimento xamânico e informando sobre a troca de perspectivas e o poder xamânico.