The coronavirus disease 2019 (COVID-2019) pandemic struck Latin America in late February and is now beginning to spread across the rural indigenous communities in the region, home to 42 million people. Eighty percent of this highly marginalized population is concentrated in Bolivia, Guatemala, Mexico and Peru. Health care services for these ethnic groups face distinct challenges in view of their high levels of marginalization and cultural differences from the majority. Drawing on 30 years of work on the responses of health systems in the indigenous communities of Latin America, our group of researchers believes that countries in the region must be prepared to combat the epidemic in indigenous settings marked by deprivation and social disparity. We discuss four main challenges that need to be addressed by governments to guarantee the health and lives of those at the bottom of the social structure: the indigenous peoples in the region. More than an analysis, our work provides a practical guide for designing and implementing a response to COVID-19 in indigenous communities. ResumenLa pandemia de coronavirus 2019 (COVID-19) golpeó a América Latina a fines de febrero y ahora está comenzando a extenderse por las comunidades indígenas y rurales de la región, hogar de 42 millones de personas. El 80% de esta población altamente marginada se concentra en Bolivia, Guatemala, México y Perú. Los servicios de atención médica para estos grupos étnicos enfrentan desafíos distintos en vista de sus altos niveles de marginación y diferencias culturales de la mayoría. Con más de 30 años de trabajo e investigación sobre las respuestas de los sistemas de salud dirigida a las comunidades indígenas de América Latina, consideramos que los países de la región deben estar preparados para combatir la epidemia en contextos indígenas marcados por la privación y la disparidad social. Discutimos cuatro desafíos principales que deben ser abordados por los gobiernos para garantizar la salud y la vida de los que se encuentran en la parte inferior de la estructura social: los pueblos indígenas de la región. Este análisis proporciona una guía práctica para diseñar e implementar una respuesta a COVID-19 en comunidades indígenas.

BackgroundMexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations.MethodsThis is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012.ResultsThe interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.).ConclusionsEvidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.

Use and understanding of the nutrition information panel of prepackaged foods in a sample of Mexican consumers.

From an ethno-gerontological perspective, new models are needed to fulfill the health needs of the indigenous older adult population in Mexico. In this paper we developed a comprehensive healthcare model, interculturally appropriate, designed to meet the needs of Mexican indigenous older adults. The model was constructed using a qualitative design with semi-structured interviews of older adults, health providers, and available health resources in three Mexican indigenous regions. An ethnographical review was carried out to contextually characterize these communities. At the same time, a comprehensive bibliographic revision was made to identify socio-demographic markers. Results pointed out that Mexican indigenous older adults are not covered by any type of social health insurance program. Their health problems tend in large part to be chronic in nature due to the lack of early diagnosis and treatment. There is a need for trained human resources in the field of gerontology encompassing the sociocultural context of the indigenous groups. The geographical location of these communities limits the permanent presence of healthcare givers and thus limits access to continuous care. Traditional healthcare givers, able to speak the native language, are a great asset allowing the invaluable possibility of direct verbal communication. Based upon the data gathered from indigenous older adults and service providers, in tandem with evidence from the literature, we identified key elements for successful intervention and designed an intervention model. We concluded that indigenous older adults are a more vulnerable group, given that aside from being elderly in a country where the health needs of these populations exceed the capacity of existing healthcare services, their ethnicity serves as an added barrier preventing their access to the limited available healthcare resources. To achieve uniformity in providing health care, today's health systems need to address intercultural and participative aspects of healthcare models.

Objetivo. Identificar diferencias en indicadores socioeconómicos,de condiciones de salud y uso de servicios entrela población indígena (PI) y no indígena (PNI) del país.Material y métodos. Estudio trasversal descriptivo coninformación de la Encuesta Nacional de Salud y Nutrición2018-19. Resultados. La mayoría de la PI se encuentra enel quintil socioeconómico más bajo y usa menos los serviciosde salud. Las mujeres indígenas reportaron un mayornúmero de hijos, así como atención del parto con parteras.La PI acude por atención médica a las instituciones parapoblación sin seguridad social como primera opción, peromanifiesta menor deseo de regresar a atenderse al mismolugar. Conclusiones. La PI utiliza menos los servicios desalud. Se configura un panorama epidemiológico de doblecarga e inequidad en indicadores de acceso que afecta a laPI. La salud reproductiva es el ámbito donde se observan lasmayores desigualdades.