Este artículo presenta y analiza las principales características de la propuesta de interculturalidad desarrollada por una organización indígena amazónica del Perú en la formación de jóvenes indígenas como enfermeros técnicos en salud intercultural. A través de este programa de formación, mostramos cómo la Asociación Interétnica de Desarrollo de la Selva Peruana (Aidesep) se apropia del concepto de interculturalidad, lo resignifica y reconstruye en la práctica. A partir de documentos internos, publicaciones institucionales, testimonios de egresados, dirigentes y miembros del equipo técnico del Programa de Salud Indígena de Aidesep, analizamos la construcción e implementación del concepto de interculturalidad. Este artículo muestra la forma en que una organización indígena se vuelve un actor proponente de la interculturalidad, construyendo una respuesta indígena para la formación de profesionales técnicos, preparados para brindar atención en salud culturalmente apropiada a la población indígena. La propuesta de formación de enfermeros técnicos en salud intercultural demuestra que es posible que la interculturalidad crítica pase del discurso a la práctica cuando los pueblos indígenas construyen propuestas interculturales propias. / This article examines the main characteristics of the proposal on interculturality developed by an indigenous Amazonian organization of Peru for the training of indigenous youth as nurse technicians in intercultural health. It shows how the Interethnic Association for the Development of the Peruvian Jungle (Aidesep) appropriates the concept of interculturality, reconfigures and reconstructs it. Based on internal documents, institutional publications, testimonies of graduates of the intercultural health program, leaders and members of the technical team of the Indigenous Health Program of AIDESEP, we analyze the construction and implementation of the concept of interculturality. We also examin the way in which an indigenous organization becomes a proponent of interculturality, building an indigenous response for the training of health professionals prepared to provide culturally appropriate health services to the indigenous population. The proposal for the training of nurse technicians in intercultural health shows that it is possible for critical interculturality to move from discourse to practice when indigenous peoples develop their own intercultural proposals.

Background In remote areas of the Peruvian Amazon there is a high burden of communicable diseases, limited access to health care and a low distribution of registered nurses. Registered nurses are working with indigenous patients in the area, where traditional medicine and practice is common. In order to strengthen the relation between western and traditional practices, intercultural health has been implemented within the public health care. Aim The aim was to describe registered nurses’ experiences of working with indigenous patients in remote health care settings in Loreto region, Peruvian Amazon. Method A qualitative field study with semi-structured interviews was conducted at four health clinics in Maynas and Mariscal Ramón Castilla province. A qualitative content analysis was used when analyzing the data. Findings Three categories were identified in the analysis; Working environment in a remote area, Providing health care for indigenous patients and Including intercultural health in nursing practice. The participants’ daily work with few colleagues and high demand in remote clinics was described. Experiences of working with intercultural health, as well as opportunities and challenges of working with indigenous patients was found. Conclusion The registered nurses work in an area with a high workload, limited resources and geographic isolation. Intercultural implementations were shown to improve intercultural relations, autonomy and health. Challenges between registered nurses and indigenous patients related to communication and different cultures were described. In order to improve the situation and reach the UN Sustainable Development Goals, infrastructural and socio-economic improvements, more resources and health professionals are necessary.

BACKGROUND: All human societies have developed ways of maintaining health, dealing with illness and injury in ways that conform to their culture and environment. People worldwide draw upon a variety of healing systems, therapeutic methods, practices, and products, often referred to as Traditional and Complementary Medicine (T&CM). The World Health Organization (WHO) has encouraged member states to develop national policies that advance the integration of T&CM in national healthcare systems to harness their potential contribution to health, wellness, and people-centered health care. Yet, no global guidelines have been developed for assisting countries in structuring and developing such policies, and little is known about the characteristics of existing T&CM policies in Latin America and their level of implementation. METHODS: A qualitative research design was used to conduct a landscape analysis characterizing existing therapeutic pluralism policies in Latin American countries through a comprehensive literature review, a policy focused qualitative content analysis, key informant interviews and a case study analyzing the formulation process of Brazil's National Policy for Integrative and Complementary Health Practices (PNPICS). A technical cooperation tool to guide T&CM policy development and revision for Latin American countries was refined through face validation and an expert consensus method (Delphi process). Data categorization and analysis were performed in MS Excel and NVivo, using deductive and inductive coding. RESULTS: A total of 74 T&CM policy documents from the 16 Latin American countries were identified and characterized according to policy mechanisms. A typology of Latin American policy approaches identified policies as: health services-centered, model of care-based, participatory, and indigenous people-focused. Selection of T&CM practices for policy inclusion vary across countries; criteria change over time in Brazil might have compromised PNPICS’ political status. Lack of PNPICS financing jeopardized its implementation. A technical cooperation tool for T&CM policy development was structured on the policy cycle: national situation analysis, policy formulation, policy implementation, policy monitoring and evaluation, and policy re-formulation, re-prioritization for incremental policy developments. CONCLUSION: With a few exceptions, therapeutic pluralism policy implementation in Latin America seems to be a real challenge, often reducing policies to cultural and political symbols. Continued research is needed on assessing the various stages of the policy process in T&CM. / 2023-09-10T00:00:00Z

The research questioned the efficacy of standard biomedical information sharing and communication processes in ensuring rapid and reliable behavioural changes in the control of epidemics, especially in high-context cultures. Information processing arousals and behaviour change motivations are subject to the level of interactions in the extrinsic and intrinsic elements of an information. Following, epidemic control can only be successful if relevant elements of a system’s values, norms, beliefs and practices for information processing are superimposed on scientific communication to create shared meanings. An empirical research approach in grounded theory underscore the data collection of this research with the data analogy utilising the MAXQDA Analytics Pro software. Ebola behavioural changes were identified to be enabled by the functional properties of community mobilisation as a structure and process for meaning making and behavioural motivation. A contextual health communication model dubbed the ecological collegial communication model has been modelled for epidemiological control as the output of the research. Specific to the methodology, a systematic qualitative and data analysis process in grounded theory was adopted for conducting the research and the dissertation writing. Commencing the process was the identification and analysis of the problem from the perspectives of the challenges to the Ebola communication management. This was comprehensively identified from the fundamentals of the process of communication to the communication itself and was assessed from the motivational factors underlying the behaviours within which the rationality of the behaviours could be understood for their inflexibility to change or their insensitivity to the Ebola messages. The mediations of the behavioural motivators in the cognitive processes to information processing were considered for their intrinsic and extrinsic values to arouse information processing and persuade change. To explore the interface between communication and culture in cognitive processes of information processing and decision making, literatures on behavioural theories, including anthropological theories from which the processes and determinants of behavioural enactment are predicted were reviewed in chapters two to four. Intention (also used interchangeably in this dissertation as motivation) was unanimously construed as proximal in determining behaviours in the literatures. However, intention was also construed to have linkages with other factors in the determination of behaviours.:Dedication ii Declaration iii Acknowledgements iv Table of contents v List of figures vi List of photos vii List of matrices vii List of tables vii List of appendices viii Abbreviations ix 1 Communication and culture of the 2014/2015 West Africa Ebola outbreak 1 1.1 Introduction 1 1.2 Conceptualisation of the research problem – the key factors of the Ebola outbreak 4 1.2.1 Structural violence 7 1.2.2 Communication deficiency 10 1.2.3 Cultural models (values and practices 20 1.2.3a Death and funerals 21 1.2.3b Caregiving 26 1.2.3c Reliance on traditional healers 31 1.3 Research objectives 37 1.4 Definitions 38 1.5 Questions formulation and research questions 42 1.6 Justification 52 1.7 Conclusion 58 2 Theoretical frameworks consistent with the 2014/2015 Ebola outbreak health communication approaches – A discourse 59 2.1 Introduction 59 2.2 Psychological/behaviour science models 60 2.2.1 Health belief model 61 2.2.2 Protection motivation theory 64 2.2.3 Theory of planned behavior /reasoned action 71 2.2.4 Social cognitive theory / social learning theory 76 2.3 Summary 79 3 Information processing/communication theories 81 3.1Introduction 81 3.2 Elaboration likelihood model 81 3.3 Activation model 86 3.4 Narrative theory and entertainment education 88 3.5 Summary 95 4 Ecological theories / framework 97 4.1 Introduction 97 4.2 The PEN-3 Model 98 4.2.1 Health education (cultural identity)100 4.2.2 Cultural appropriateness of health behavior (cultural empowerment) 101 4.3 Bioecological theory 103 4.4 Developmental process of Bronfenbrenner’s model in the framework of the 2014/2015 Ebola outbreak 108 4.5 Theoretical framework of this dissertation 119 5 Research process and methodologies 125 5.1 Introduction 125 5.2 Justification of the research methodology 128 5.3 Overview of Monteserrado County 134 5.4 Techniques/procedures 137 5.4.1 Archival materials/documents 138 5.4.2 Ethnographic/observations 139 5.4.3 Key informants/in-depth interviews 142 5.4.4 Focus group discussions 143 5.5 Data analysis 146 5.5.1 Codes 147 5.5.2 Qualitative analysis employed in the research 152 5.6 Role of the researcher 153 5.6.1 Origins of the project 153 5.6.2 The discourse - philosophical worldview 156 5.6.3 Concluding thoughts 157 6 Data analysis: cultural practices, health and communication in the Liberian context 160 6.1 Introduction 160 6.2 Ethnicity and religion 162 6.3 Social organization 171 6.4 Aspects of death and burial practices 179 6.5 Concept of health and health care 186 6.6 Communication and information sharing approach in Liberia 193 6.6.1Traditional communication and the town crier in Liberia 195 6.6.2 Contribution of Crusaders for Peace 201 6.6.3 Development of overarching Ebola communication messages 206 6.7 Conclusion 210 7 Data analysis: Socio-cultural patterns in Ebola perceptions, content of messages and behavioural outcomes 212 7.1 Introduction 212 7.2 Parent codes – summative description and discussions 214 7.3 Understanding the socio-cultural patterns in Ebola knowledge and behaviours: Perceptions of Ebola transmissions 226 7.4 Content and nature of Ebola messages in perceptions and behaviours 237 7.5 Conclusion 276 8 Data analysis: Understanding the motivators of Ebola behaviours – an analytical interrelationships model perspective 278 8.1 Introduction 278 8.2 Patterns of Ebola behaviours 279 8.3 Conclusion 317 9 Decoding: the interface between culture and communication in the Ebola communication management 319 9.1 Introduction 319 9.2 Contextual elements of effective communication – the interface 321 9.3 Cognitive heuristics to “…protect yourself…” 336 9.4 Processes of moderations of “protect yourself” in cognitions 339 9.5 Conclusion 343 10 Theoretical and conceptual inferences from empirical data and framework for a culturally appropriate communication 344 10.1 Introduction 344 10.2 Research questions 344 10.3 Epidemic control: The cultural model framework to persuasive communication for epidemic management 359 10.3.1 The composite conceptual analytical elements of the model 364 10.3.1a Model definition and assumptions 365 10.3.1b The ECCM – the interactive elements of a system 367 10.3.1c Pattern of communication in the ECCM 371 10.3.2 Summary 374 10.4 Processes of how to apply the ECCM 375 10.5 Limitations of the model 382 10.6 Conclusion 383 11 Conclusions and recommendations 385 11.1 Introduction 385 11.2 Key conclusions 385 11.3 Implications 387 11.3.1 Policy framework implications 387 11.3.2 Theoretical implications 390 11.4 Further research 393 11.4.1 Approach to communication 393 11.4.2 Cultural dynamics 396 11.4.3 Health perceptions 398 11.4.4 Ebola orphans and victims 398 11. 5 Research limitations 399 References 401

This research thesis explores how healers in the Peruvian Upper Amazon experience and negotiate their roles and knowledge systems at the interface of Amazonian, Western scientific and other medical knowledge systems at the confluence of community and environmental health. Experiences of identity, practice and place feature in this research among selected healers in the region of San Martín, Peru. Relationships with nature have sustained Indigenous populations in this region, and economic pursuits of natural resources have attracted many populations to the Upper Peruvian Amazon, making it an interesting site for the analysis of healers’ experiences at the interface of different knowledge systems. An emergent objective of this thesis has been to provide what healers in the region expressed to me as a need for an experiential approach to research on local medical knowledge systems. The resulting thesis is an ethnography of my experiences learning from healers and plant teachers about intercultural health initiatives on a regional level in Peru.

This research thesis explores how healers in the Peruvian Upper Amazon experience and negotiate their roles and knowledge systems at the interface of Amazonian, Western scientific and other medical knowledge systems at the confluence of community and environmental health. Experiences of identity, practice and place feature in this research among selected healers in the region of San Martín, Peru. Relationships with nature have sustained Indigenous populations in this region, and economic pursuits of natural resources have attracted many populations to the Upper Peruvian Amazon, making it an interesting site for the analysis of healers’ experiences at the interface of different knowledge systems. An emergent objective of this thesis has been to provide what healers in the region expressed to me as a need for an experiential approach to research on local medical knowledge systems. The resulting thesis is an ethnography of my experiences learning from healers and plant teachers about intercultural health initiatives on a regional level in Peru.