1. Key Issues in Providing Health Services to Indigenous Communities Conference Report
(September 15 – 16, 2011 in Madre de Dios, Peru)
Prepared for the Bureau of Oceans and International Environmental and Scientific Affairs
Drafted by: Esteban Sandoval, Regional Environmental Specialist, South America Environment, Science, Technology, and
Health HUB Office, sandovalej@state.gov, 51-1-618-2417
I. Activity Summary
The REO HUB organized a two-day conference in key issues in providing health
services to indigenous communities as part of a global health funds grant from OES. The
conference included presentations from international visitors, local government institutions
and NGOs involved in health care delivery systems.
The following outlines the different aspects of the conference:
Background: In April 2011, OES sent STATE 033936 offering Economic Support Funds (ESF) to
four Regional Environment Hubs to develop activities in global health, one of four OES
priorities worldwide. The Peru project selected for this funding was the development of a
conference on indigenous healthcare delivery, implemented by the REO HUB with
guidance from USAID, NAMRU (Naval Medical Research Unit), as well as the Indian Health
Service stateside. The proposal was submitted to the Bureau of Oceans and International
Environmental and Scientific Affairs that provided a Fund Cite Cable (STATE 088638)
allocating funds to Lima for its implementation.
Purpose: Understand and share information and experiences that could be potentially
transferred to the local environment. USAID has been part of this conference from the onset
providing valuable support with health project expertise and guidance through their work in
the Amazon region and with indigenous communities.
Venue: The Conference took place in Puerto Maldonado, located in the Madre de
Dios region in Peru, from September 15 to September 16, 2011. Madre de Dios is located in
the Amazon region bordering Bolivia and Brazil.
Invitees: The conference included two U.S. Speakers and a number of Peruvian
experts. The two U.S. American Indian representatives presenting at the conference were
Dr. Gerald Greenway, member of the Cherokee Tribe and representative of the Rotary Club
and Rochelle Lacapa, member of the White Mountain Apache Tribe, from the Johns
Hopkins Center for American Indian Health. They provided presentations about the Health
System for American Indian and Alaska Natives, an overview of American Indian/Alaska
Natives and a description on how community health systems are managed in the U.S. Local
participants to the conference included representatives from the Pan-American Health
Organization(PAHO), USAID, Madre de Dios Regional Health Direction (DIRESA), the National
Peruvian Indigenous Federation (AIDESEP), National Institute for Health (INS – Peruvian

2. Ministry of Health), the Peruvian Medical College, the Regional Government of Madre de
Dios, Health NGO Prisma, National Indigenous Madre de Dios Federation (FENAMAD), and
recognized health consultants working on different projects. The congress also hosted 15
indigenous leaders from indigenous communities in the Madre de Dios region of Peru who
interacted and outlined their main health concerns in their respective communities.
Content: The conference included welcoming remarks from a USG officer and key
note speeches from two prominent U.S. Indian Health Services experts. It also incorporated
two roundtables, one in Community Health Problems and another one in Traditional Health
Practices and Medicinal Plants. Themes for discussion in these workshops included health
promoter training, nutrition, water quality/conservation, immigration impacts in community
health, medicinal plants use and traditional knowledge, and national health systems.
Funding: OES provided $9,950 in funding for this conference through a Global Health
ESTH HUBS Funds grant as described earlier. The REO HUB in Lima implemented this program.
II. Target Audience and Objectives
Target Audience: The Conference took place in the city of Madre de Dios, Peru, but its
implications go well beyond Peru. The Peruvian Amazon is home to at least 50 indigenous
ethnic groups, some of which spread over into bordering countries, such as Colombia,
Bolivia and Brazil.
Objectives:
- Invite Native American, and U.S. Indian Health Service experts to share their experiences in
managing community health systems.
- Share the value of forming and using the village health committee as a primary unit of
community health management.
- Provide examples of community health programs practiced currently by Native North
Americans.
- Raise awareness about knowledge transfer and the importance of learning about
Indigenous Health Issues.
- Teach groups to rapidly and independently assess the underlying causes of disease and
environmental problems.
- Strengthen the relationship between Native American communities, U.S. agencies and
institutions and host country indigenous communities and health institutions, to promote
cooperation, build local capacity, and promote sustainability of public health
improvements
- Promote ecosystem care and sustainable use of local natural resources while
championing economic development through small business development and potential
public/private partnerships.
III. Presentations Summary

3. The Conference was a two day event. The first day of the conference featured key note
presentations by the two prominent U.S. experts: Dr. Gerald Greenway and Rochelle
Lacapa. The second day of the conference provided a venue for Peruvian experts and
local indigenous community leaders to interact, presenting current initiatives and identifying
key issues related to health services to Indigenous Communities.
III.3 Presentation by Dr. Gerald Greenway
Health Care for American Indian in the United States
The first speech featured an on line presentation by Dr. Gerald Greenway, member of the
Cherokee Tribe and representative of the Rotary Club, who talked about Planning systems
for medical attention of north American tribe members. Dr. Greenway provided an
overview on how indigenous communities are defined in the U.S. There are currently 565
Tribes and 223 federally recognized Alaska Native Villages in the U.S. with over four million
American Indians/Alaska Natives. In 2001, 201 out of the 562 federally recognized tribes had
going operations with revenues of $14.5 billion. Even though the average income is close to
USD $30,000.00, more than half of the population live in poverty. Since 1793, The USG has
been mandated to provide health care to every federally recognized tribal member. Dr.
Greenway provided some of the lessons learned from the U.S. experience which included
closer work with leaders and community, outreach through indigenous representatives
using mobile units, incorporate indigenous culture and knowledge, and an emphasis on
primary care safeguarding resources.

4. III.3 Presentation by Rochelle Lacapa
Health Care Systems for American Indians/Alaska Natives in the United States
The second presentation featured Rochelle Lacapa, from the John Hopkins Center for
American Indian Health. Lacapa said that the Indian Health Service (IHS) in the U.S. is
complex and changing, it currently has 12 area offices and 163 tribally managed service
units. Most of the population receiving these services is located in the western part of the
U.S. Most of the funding received by IHS comes from the central government; in 2010 IHS
received $4.05 billion from the USG. There is still a wide gap in health expenditures for
American Indiana as per capital personal health care expenditures for the U.S. population is
more than 2.5 times higher ($6,909.00) than those for IHS Service population ($2,741.00).
Leading causes of death for American Indian and Alaska Native population are related to
heart disease, malignant neoplasm, and unintentional injuries (related to car accidents).
Lacapa said that over the last 30 years there has been a shift in mortality causes for
American Indians in the U.S. from infectious diseases to chronic long term illnesses (diabetes,
liver disease, cancers) which take longer to be treated. Lacapa highlighted the fact that
Native Americans have a very holistic approach to life (encompassing spiritual, mental,
physical, behavioral & social, and environmental processes) and approach mental health
in the same way. This approach, Lacapa said, conflicts with Western medicine approaches
that tend to individualize these interrelated treatment processes. She also provided some
keys to improve health quality services for American Indian and Alaska Natives which
include health care delivery according to cultural beliefs, strong partnerships and
collaboration between providers and tribes, the inclusion of American Indians in health
systems development and implementation, and the use of resources to fund prevention
practices among the American Indian and Alaska Natives communities.

5. III.3 Presentation by Local Peruvian experts and key stakeholders from Local Indigenous
Communities
The second day of the conference focused on the local contribution of the different health
experts from the Peruvian government, indigenous communities and civil society. The
Peruvian Ministry of Health, through its National Center for Indigenous Health mentioned the
work being done to promote the creation of a registry for traditional plants that could be
used by the different medical posts in the country. The Medical college of Peru, listed a
number of treatments and plants that are currently used for health services in Peru and the
Peruvian National Indigenous Federation (AIDESEP) showcased a project currently
underway to train and develop traditional medicine professionals from different indigenous
communities with the aim of integrating traditional and modern medicine practices to
provide improved health services in local indigenous communities in Peru. AIDESEP seeks to
replicate the best practices gathered from this project in the Madre de Dios Region. The
Regional Government of Madre de Dios acknowledged the lack of support and marginal
conditions for health support to local indigenous communities and committed support to
improve the reach and quality of health services working with the different stakeholders
attending this conference.

6. IV. Feedback from Local Indigenous Community Stakeholders
Perhaps the best feedback from both days of the conference came from the leaders of the
15 Peruvian Indigenous Communities attending the event. These are the most important
issues and challenges outlined by some of these communities:
Native Community of Santa Teresita
 Community does not have a medical post available.
 Train and provide a health technician from the same ethnia or community to
guarantee his/her constant availability for the community. They also feel that this
technician should be trained by the Regional Health Direction to avoid any issues in
other communities.
 The government should recognize indigenous people as priority for health service
provision.
Native Community of Boca Pariamano
 Community has only one medical post with limited medicines available.
Native Community of Kotsimba
 Medical post available does not have the medicines and infrastructure required by
the community.
 The community contributes with half of the salary of the medical technician who
earns S/.1,000.00 (Approximately $360.00) but still cannot guarantee her full
availability at the medical post.
 The community has also pressing needs for potable water and sewage services.

7. Native Community of Palma Real
 Community has need for medicines, doctors (technicians, nurses), emergency room,
delivery room, medical transportation, stretcher, wheelchair, and an expansion of
the medical post currently available. Both medicines and medical technicians are
viewed as priority for the community.
 The community feels that these are basic services required for proper medical
attention and to support a healthy lifestyle for them.
V. Summary Budget for expenses related to the Key Issues in Providing Health Services to
Indigenous Communities Conference
Budget Categories Amount USD $
1. Travel - local, hotel (2 nights) $900.00
- Local, airfare $3,869.08
- International (hotels, meals, M&I) $1,800.00
- Transportation to Infierno (field trip) $107.69
2. Supplies (photo display, banners, filming, folders) $428.69
3. Contractual- conference room, including equipment $538.46
- 2 coffee breaks $346.15

8. - Dinner $288.46
4. Other Direct Costs - Miscellaneous, including
- Indigenous leaders outreach and invitation $2,117.31
- Interpreter Costs $200.00
5. Total Cost of the Project $10,595.85
Annex I. Agenda for the Key Issues in Providing Health Services to Indigenous Communities
Conference
Aspectos relevantes de los servicios de salud para
comunidades indígenas.
Hotel Don Carlos - Puerto Maldonado, Madre de Dios
15 y 16 de setiembre de 2011
DÍA 1, 15 de setiembre de 2011
15:00
REGISTRO
15:30 APERTURA
Palabras de bienvenida y presentación de la conferencia por Indran Amirthanayagam,
Director Regional de la Oficina de Medioambiente de la Embajada de los Estados Unidos
16:00 Conferencia on-line: Planificación de la atención médica para indios norteamericanos
Dr. Greenway – Miembro de la Tribu Cherokee
Representante del Rotary Club
Preguntas y debate
17:00 Conferencia: Sistema del servicio de salud para indios norteamericanos y
nativos de Alaska
Dra. Rochelle Lacapa – Miembro de la Tribu Apache de Montaña Blanca
Coordinadora local para el John Hopkins Center for American Indian Health
Preguntas y debate
18:00 Mesa redonda sobre los servicios de salud para comunidades indígenas
Participación de expertos peruanos y líderes de las comunidades indígenas.
Preguntas y debate
19:00 Fin del programa del primer día.
DÍA 2, 16 de setiembre de 2011
VISITA A COMUNIDAD NATIVA DE INFIERNO
Presentación del Proyecto Ñape

9. 14:00
REGISTRO
14:30 Mesa redonda: Problemas de salud en las comunidades indígenas
Entrenamiento para promoción de la salud, nutrición, calidad del agua, impacto de la inmigración en la
salud de la comunidad
OPS, USAID, DIRESA, INS, Gobierno Regional de Madre de Dios,
ONG Prisma, FENAMAD, AIDESEP
Preguntas y debate
16:30 RECESO
17:00 Mesa redonda: Prácticas tradicionales de salud y plantas medicinales
Prácticas tradicionales, uso de plantas medicinales, invernaderos comunitarios
DIRESA, ESSALUD/COLEGIO MEDICO DEL PERU, CONSORCIO M-P ICAA/USAID, representantes comunitarios,
FODAM, ONG’s, INS
Preguntas y debate
19:00 FIN DE LA CONFERENCIA
19:30 CENA
Presentation cultural.
Annex II. List of Participants
Registro Conferencia Aspectos Relevantes de los Servicios de Salud para Comunidades Indígenas
PUERTO MALDONADO, JUEVES 15 Y VIERNES 16 DE SEPTIEMBRE DEL 2011
AUDITORIO DEL HOTEL DON CARLOS
NOMBRE INSTITUCION EMAIL
Maria Susana Sandoval Huertas CEDRO ssandoval@cedro.org.pe
Oscar Guadalupe Zevallos Asociacion Huarayo huarayo@terra.com
Reyna Meshi Comunidad Nativa Palma Real
Jose Sehua Comunidad Nativa San Jacinto
Comunidad Nativa Boca
Isabel Meshi Inambari
Auria Coyuri Alarcon Comunidad Nativa Kotsimba
Franklin Zavala Perez Comunidad Nativa Shiringayoc
Eddy Tucha Comunidad Nativa Sonene

10. Comunidad Nativa Boca
Juan Ynuma Pariamano
Maria Miroslava Frias Peralta PEMdD - GOREMAD miroslavaf16@yahoo.com
Julian Dionisio Maquis Morales Macking Producciones
Jesus David Alvarez Ruedas MINSA jalvarez20033@yahoo.es
Alicia Fernandez P. FENAMAD marialicia_21@hotmail.com
Elmer Fernandez P. Comunidad Nativa Puerto Azul tu_angel7_forever@hotmail.com
Karen Angelica Lopez Espinoza DIRESA - MdD karenht_l@hotmail.com
Juan Obesso Rojas ACCA jobesso@gmail.com
Armando Cotrina USAID acotrina@usaid.gov
Ruth Elizabeth Goldstein Universidad de California ruthegoldstein@berkeley.edu
Bruno Sanguinetti Consorcio MdD Pando cede@cede.ws
Miwa Bankova Asociacion Niños perumiwa@yahoo.com
Ilson Lopez Añez ComunidaNativa Belgica
Neptali Cueva Maza Universida Peruana Cayetano neptalicueva@hotmail.com
Marilu Chiang Echenique PRISMA mchiang@prisma.org.pe
Jaime Corisepa Neri FENAMAD jaime_135_@hotmail.com
Lila Guisela Huimpa Chapiama ComunidaNativa Pto Arturo
Amanda Valencia Chimo Defensoria del Pueblo a.valencia@gob.pe
Amancio Zumaeta Zumaeta Comunidad Nativa Sta Teresita
Maria Amalia Pesantes Fundacion Interamericana map128@pitt.edu
Isolina Valdez Felipe AIDESEP maisa660@hotmail.com
Rocio Santibañez Acosta CENSI - IS roxioxanti@yahoo.com
Hugo E. Malaspina Colegio Medico del Peru hmalaspina@gmail.com
Yeni Carrasco Poblete ACRE ycarrasco@acrepi.es
Mercedez Chimbo Vera Arazaire
Sonia Edith Condori Huarca DIRESA - MdD sonya1247@yahoo.es

11. Edgarel Sulle Paredes FENAMAD edgarsulle@gmail.com
A. Roxana Lescano Centro Medico Naval de EEUU roxana.lescano@med.navy.mil
Manuel Calloquispe La Cara del Pueblo mcalloquispe@yahoo.es
Antonio Fernandini Guerrero Coalition for the Amazon foramazonia@gmail.com
Ana Lucia Hurtado Abad Asociacion Huarayo huarayo-peru@hotmail.com
Julio Cusurichi Palacios GORE MdD jcpimpacto@yahoo.es
Edith Alarcon PAHO ealarcon@theunion.org
Cynthia Giovanna Cardenas Palacios AIDESEP cintiacardenas@gmail.com
Veronica Carrillo FENAMAD fenamad@fenamad.org.pe
Annex III. Supporting Invoices from Conference expenses (See Attached document)