Simplified medicine auxiliaries among indigenous people in Amazonas, Venezuela : their role in a shifting context
Background: Auxiliares de Medicina Simplificada (AMS) is a community health worker programme of the Venezuelan Ministry of Health launched in the 1960's. AMS remains the most permanent and direct presence of the Amazonas Health System in rural indigenous communities. Recent political and legal changes have occurred in the country in relation to health and indigenous people's rights thus affecting the role of the AMS. Aim: To examine the role of Auxiliaries in Primary Health Care among indigenous populations in Amazonas, their relationship with the regional health system and their potential contribution to the health of indigenous people in the light of the current legislation. Methods: A descriptive study was carried out using a qualitative approach and ethnographic methods including in depth interviews, participant observation in selected health posts in Amazonas state, and documentary analysis. Thematic analysis explored self-identification of Auxiliaries as health workers and as indigenous, the ideal and actual roles they play, and their relationship with the regional health system. Findings: Auxiliaries developed a strong biomedical professional identity mainly shaped by their curative tasks. Values attached to "The Manual" of the programme were highly illustrative of this identity and the influence of the health system. AMS also identified themselves as Indigenous of Amazonas, and their professional and ethnic identities were not mutually exclusive or conflicting. Promotion and Abstract prevention appeared in their normative discourse as very important but what they most valued were their curative tasks and access to and use of drugs. The study showed that AMS play an important intermediary role between traditional and biomedical medicine systems, and between the indigenous communities and the health system. This intermediary role has been neglected in the training process and in the guidelines. Support from the regional health system has decreased during the last decade and the political decentralisation process was identified as crucial to the weakening of the program and perhaps of the entire primary care level in Amazonas. Current reforms implemented nation-wide have altered the role of the indigenous AMS. Conclusion: In the current Venezuelan legal framework of health, health care and indigenous rights, the role and space that the AMS have as intermediaries between traditional medicine and biomedicine, and between the indigenous communities and the health system provide the greatest opportunities for improving the health of indigenous people in Amazonas. Recommendations: To integrate the AMS programme into the current PHC policies being implemented by up-dating the programme, extending the training course and redefining their role as health promoters in line with the constitutional rights to health for indigenous people.