Juan Reátegui Silva
Fellow Since 2001
This description of Juan Reátegui Silva's work was prepared when Juan Reátegui Silva was elected to the Ashoka Fellowship in 2001.
Juan Reátegui has transformed the difficult crossroads between modern and traditional medicine into a unique opportunity by bringing together experts to help communities establish permanent health councils, which he integrates with the existing social and political structures of the indigenous peoples of the Amazon Basin.
The New Idea
Juan has established intercultural health councils in Amazon communities across Peru, which serve to rebuild confidence in traditional health practices, offer training in appropriate techniques of Western medicine, and initiate new systems for decision-making and conflict resolution at the community level. The councils are operated cooperatively by a local shaman (traditional healer), a technically trained local health promoter, and a traditional midwife, with the support of the community leadership. This team works together to provide patients treatment within their own communities, as opposed to far-away hospitals. By combining traditional healing practices with modern technology, the team is able to treat illnesses appropriately. Juan has also designed an Institute of Intercultural Health that will both train medicine men and midwives in conventional medicine and reinforce traditional knowledge and skills. It is the intention of Juan's program not only to improve the health of the Amazonian communities but also to develop self-esteem in these indigenous communities by placing a high value on their health practices and technologies.
With the introduction of modern Western medicine to treat new illnesses in Peru's Amazonian indigenous population of four million people, traditional medicine and knowledge have come to be considered as witchcraft or voodoo, and has generated insecurity and a lack of confidence in local shamans and traditional midwives. The decreased importance of traditional medicine has often led to its abandonment and the loss of key treatments. At the same time, traditional healers are also wary of Western medicine and sometimes refer to it as diabolical, which is also problematic as diseases of European origin are generally more successfully treated with Western medicine. Typically, state-run health programs do not take into account, and worse, often dismiss traditional medicinal practices. They set up health centers in Amazon communities and insist on using Western treatment for all illnesses, entirely discounting traditional practices, which are often quicker and more effective. The state does not take into consideration that traditional customs require indigenous patients to relocate their entire families when they go to the city for treatment at a hospital, making it impossible to sustain themselves and forcing them to abandon the treatment to return to their more affordable life in the Amazon.
Through the Indigenous Health Program, which he established in 1995 within the Association of Interethnic Development of the Peruvian Jungle (AIDESEP), Juan sends teams of experts in both traditional and modern medicine to indigenous Amazonian communities to work with local populations and create intercultural health councils. Juan formed six teams composed of representatives of local indigenous organizations, traditional midwives, and professional nurses to visit the indigenous communities in the Amazon. He selects young professionals who truly have an interest in working in the communities, evidenced by their endurance of the grueling journey by boat and on foot. Upon arrival, the team looks into the cultural identity of the community, talking to the older community members and shamans and asking people what they see their needs to be. The midwife surveys the community for human resources and herbal remedies that will be useful to the health care of the village. The community leaders also receive training on the importance of maintaining and promoting traditional treatments. The teams also promote community trainings so that the older midwives and shamans can pass down their knowledge to younger community members who will be able to continue their work. The health promoters, who are chosen by a community assembly, are trained in both Western treatments through a contract with the Ministry of Health as well as in traditional techniques. All trainings are bilingual, in both Spanish and the different local languages. As of 2001, such councils are successfully functioning in 120 different Amazonian communities, covering a total population of 17,000. These councils are maintained by the community organizations whose members have communal lots that produce and sell bananas, yucca, rice, fish, beans, and wood products to finance the medical centers and keep them stocked with necessary medicines. Juan says that in the third year of the project 90 percent of the communities were able to maintain the functioning of their centers with proper amounts of medicine and equipment. The traveling teams return up to seven times per year to evaluate the progress of the local medical centers and health councils and provide additional advice. Overall, as a result of Juan's program, community members utilize traditional medicines, treatments, and plants much more than they previously did. State institutions have become more accepting and appreciative of traditional medicine and how they can better integrate it with Western medicine. Sanitation has improved, garbage is disposed of carefully, water wells have been built, and families have begun to produce the necessary medicinal plants in their own gardens. In the long term, Juan intends to continue to expand his model to all 1600 Amazonian indigenous communities in Peru and eventually to the other nine countries in the Amazon Basin, through the national organization AIDESEP and the Latin American organization COICA. In addition, Juan is now working with the Ministries of Health and Education to establish an Institute of Intercultural Medicine to institutionalize the methodology for training local healers in Western practices to complement their traditional knowledge and bring this experience back to their community health centers. Those who study at the institute will become health promoters not only in their own centers but also in a minimum of six other Amazonian communities, as they will be required to train others within the communities and establish their own health posts. The institute will also have its own pharmacy with traditional products, which they intend to patent and sell to generate income for its operations, as well as a research department and information center.
Juan was born in the Amazon to a Shuar father and Awajun mother. He is one of five surviving children from his mother's fourteen pregnancies. The deaths of his siblings motivated him to become a healer and prevent such unnecessary death. His father and grandfather were both spiritual leaders who worked with the healing properties of herbs, and he trained under one of his community's best healers. Initially, his parents were opposed to Juan becoming involved in traditional medicine because he would be labeled as a witch. His parents were both illiterate, as is common among Peru's indigenous population, and they did not expect him to advance beyond primary school. However, he finished first in his class and wanted to continue his education. In spite of his father's objection, Juan persisted, and his mother sold her chicken to pay for his bus fare to the state of Amazonas, where the nearest high school was located. After graduating second in his high school class at age 21, he went to Lima with practically no money to continue his education and gain skills to help his community. He studied nursing on scholarship at the University of San Martín. Upon graduation, he did postgraduate work in health services administration at the National School of Public Health. In 1998, he began Masters studies in Amazonian anthropology at the University of San Marcos but has not yet finished due to lack of funds. During his studies, he worked with various Amazon communities, learning about their specific health problems and observing the deterioration and devaluation of their traditional knowledge, despite the fact that almost no one could afford conventional health coverage. These observations led Juan to create new ways of dealing with health problems in these communities and to design what is now the Intercultural Health Program. He has also served as the Representative of Indigenous Groups of Peru in the Fund for Development of Indigenous Communities of Latin America and the Caribbean.