Fact Sheet: Primary Care in an Indigenous Community of Chorotes (Tartagal, Province of Salta, Argentina)
At the end of 2001, the Country Office of the Pan American Health Organization (PAHO/WHO) in the Republic of Argentina initiated a pilot project directed at improving the quality of life of the indigenous communities of the region of the Chaco. The idea emerged as one of the actions aimed at monitoring to the Training Project in Environmental Sanitation for the Native Communities of the American Chaco, carried out in Charagua, Bolivia. One of the activities of this project was a four-month training course in basic sanitation technologies, offered to 26 peoples indigenous to the American Chaco (10 Argentines, 4 Paraguayans and 12 Bolivians). The course was organized by the PAHO/WHO Country Office in Bolivia and conducted by experts from the Sumajhuasi Foundation for Healthy Housing, Bolivia.
For the development of this pilot project, the group chosen was the Chorote Community in Mission Lapacho Uno, a village inhabited by more than 300 people and located three kilometers from Tartagal, a city located in the northern part of Salta province, close to the Bolivian border. Criteria governing the selection of this particular community included its high prevalence of gastrointestinal diseases and respiratory infections, and its high risk of exposure to such vector-borne diseases as Chagas, malaria, dengue, and Hantavirus.
Among the possible determinants of its high prevalence of diarrheal diseases and respiratory infections, the following were observed (among others):
The people in the community in charge of the cooking (mostly women) cooked their food outside, using a handful of kindling and changing place according to the time of day, in search of a little shade.
In order to help improve their situation, and in consultation with the community, the decision was made that the project would encompass the 21 family groups that made up the total number of inhabitants in the community. The decision was made to construct the the following:
Each detached cinderblock kitchen would contain a water-storage tank and a faucet with running water, a wood-burning stove made of mud and sand, a wooden shelf for above-ground food storage, a table, two benches, dishes, pots, pans, and cooking utensils.
The UNICEF Office in Argentina joined the project, contributing building materials to construct the above-mentioned structures. Works started in November 2001, with the active participation of the ten Argentine students trained in the course held in Charagua, Bolivia. A factor of utmost importance was that the entire community unanimously supported the development of this project, especially as family groups who were very actively involved in the construction of their kitchen and outhouse.
In December 2001, Dr. Mirta Roses Periago, then Assistant Director of PAHO/WHO (and now Director) visited the Chorote Community and could observe firsthand their needs as well as progress made in the construction work. What she witnessed, coupled with a request by the community, led to PAHO extending its support to additional aspects of the construction, such that the project was expanded using a more integrated approach involving a primary-care strategy. Within this context, and with the support of the Ministry of Health of the Province of Salta, the women of the community were offered a sewing course in sewing and another on nutrition and cooking, which have enabled them to sew clothes for themselves and their family, in addition to cooking more nourishing food.
In September 2002, specialized staff from of the PAHO/WHO Pan American Institute for Food Protection and Zoonoses (INPPAZ) visited the community and designed safety materials for food preparation in the new kitchens—in particular concerning personal hygiene, food-handling, cooking time, and proper food storage, as well as avoiding the presence of domestic animals in the kitchen. In addition, they collaborated in preparing educational material on hygienic food-handling, adapting WHO's five keys elements for food safety to the uses and customs of the community, according to its eating habits and the environmental conditions in which they live. These educational materials were then handed over to the community's school for teaching and distribution. In addition, guides for the appropriate use of the outhouses were jointly prepared with the PAHO Sanitary Engineer in Argentina. These in particular were based on hygienic practices:
Plans for designing equipment to be used in the community are available through the PAHO/WHO Country Office in Argentina (by writing the contact person mentioned at the end of this summary).
On 18 December 2002, the community held an inauguration celebration to officially open the new buildings, in which the entire Chorote community participated, accompanied by Chiefs from other neighboring tribes. The Governor of the Province of Salta presided; visitors included local authorities from the city of Tartagal, representatives from the Ministry of Health and the Salta Provincial Indigenous Institute (INTA), PAHO/WHO, UNICEF, the Sumajhuasi Foundation (Bolivia), and the NGO Father Ernesto Martearena.
By virtue of its overwhelming community support and the multiplicity of actors involved, the Chorote Community Project constitutes a prime example of teamwork and on-site application of technical cooperation in public health: integrated, multi-sectoral, and aimed at indigenous populations. The unique project design made it possible for the Argentine participants in the Bolivian course to apply the technologies they learned, with the goal of improving the basic sanitary conditions and bettering the community's overall quality of life.
The vision that the indigenous participants from Argentina had in their mind when they attended the course in Bolivia, was to pass from a mere dream to a shared reality for the Chorote Community—as well as a model for other communities living in similar conditions, both in the country and throughout the Region. PAHO/INPPAZ will be conducting an evaluation of the projects using health and social indicators and social, for the purpose of validating this experience. Indicators will include the following (among others):
The qualitative and quantitative data from this evaluation will be the topic of a forthcoming article focusing on the changes that have been effected, comparing the baseline situation before the project started with the changed one after its completion.
For additional information, please contact Rosario Castro, Advisor on Health and Environment, PAHO/WHO-Argentina.
1 Advisor on Health and Environment, PAHO/WHO, Buenos Aires, Argentina.