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Pioneering an Intercultural Health Model to Fight Climate-Sensitive Diseases

A new project trains nurse technicians in both Western and traditional Indigenous medicine

Máximo Joinama, traditional leader and healer, shows the toasted and ground coca leaves that are a key part of his medicine kit. (Photo Credit Masha Hamilton)



When Máximo Joinama was 25 years old, his wife began to suffer from body pains and general despair. Joinama took her to healers, but no one could resolve the problem.

Determined to save her, Joinama started studying.

The two years that it took for his wife to get well changed the course of Joinama’s life.

He spent three years learning about medicinal plants and the power of prayers and incantations, and then another seven learning deeper secrets of traditional medicine.

Now 53, he is a healer himself within his Murui Muina Indigenous community in Puerto Leguizamo, Colombia, just across the Putumayo River from Peru, near Ecuador, and surrounded by the Amazon rainforest.

He treated more than 80 people in the first three months of 2024, and estimates in the thousands those he has helped cure of various complaints.

The Amazon rainforest has been called the world’s largest medicine cabinet, brimming with tens of thousands of plants used for centuries to treat both physical and psychological disorders.

In the Colombian Amazon, the Amazon Conservation Team is supporting healers to they can better meet climate change challenges by combining practices from both traditional Indigenous and Western medicine.

  • Boaters on Putamayo River, which here marks the border between Colombia and Peru (Photo Credit Masha Hamilton)
    Boaters on the Putamayo River, an Amazon River tributary which marks the border between Colombia and Peru. (Photo Credit Masha Hamilton)

But climate change is destabilizing the region’s health systems, making Joinama’s work more difficult.

  • An illustration of the calendar learned by Amazon traditional Indigenous healers to anticipate seasonal illnesses and available treatements.
    An illustration of the traditonal calendar envisioned by Amazon traditional Indigenous healers to anticipate seasonal illnesses and available treatments. (Photo Credit Masha Hamilton)

“From the time of our ancestors, we could predict specific disharmonies depending on the month. Now we can’t anymore,” he said, showing an ecological calendar which detailed the anticipated onset of temperature changes or migration of disease-carrying animals.

“That means we can’t prevent them; we can only treat them. I feel sad and angry. Nature is the mother. Everything was organized. We disorganized it.”

Nurse and project liaison Jimmy San Juan shows some posters he uses to offer simple explanations of the impact of medicinal herbs. (Photo Credit Masha Hamilton)

The answer?

Joinama has become a trainer in a collaborative effort to fuse Indigenous ancient wisdom with Western medical practices, pulling from the best of both to create a more powerful public health system.

The “Intercultural Health Model” is aimed at strengthening the ability of the Amazonian population to innovate and respond to environmentally sensitive health issues.

The project is overseen by the Amazon Conservation Team (ACT) in collaboration with Indigenous communities, health leaders, and government officials in the area.

“In this time of accelerated environmental change, and in a remote area often left out of public health reports, having a group of Indigenous People trained in the Intercultural Health Model builds collaborative solutions from the best that each medical knowledge system can offer,” said Paula Galeano, ACT’s coordinator for the Putumayo region. “What needs to be done, we need to do together—especially with the Indigenous who live in the Amazon.”

The Rockefeller Foundation is supporting this effort, as well as similar work in Brazil and Ecuador. Compiling learnings from these three countries will help inform future strengthening of health systems that considers Indigenous practices. Importantly, the involvement of healers like Joinama has laid the groundwork for Indigenous trust in a blended approach.

“If we want to advance health systems in the Amazon, we need to listen, learn, test, and incorporate best practices from both traditional and Western medicine. Building these bridges means we are strengthening the way the health sector works by bringing new knowledge and ideas to both sides,” said Emilia Carrera, Director, Health, The Rockefeller Foundation.

  • Climate change adaptation to protect and improve people’s health requires us to work across sectors and cultures.
    Emilia Carrera
    Director, Health
    The Rockefeller Foundation

The Urgency of Integrating Health Approaches

How urgent is this effort to create an Intercultural Health Model? Just ask Carlos Catuche, a project advisor who is with the Colombia Health Secretariat.

“It’s critical,” he says. “We can’t overstate that.”

  • Students practice drawing blood to test for malaria (Photo Courtesy of ACT)
    Students practice drawing blood to test for malaria. (Photo Courtesy of ACT)

More than 30 million people live in the Amazon region, speaking about 300 different languages. Key health concerns include mosquito-borne diseases such as malaria, dengue, and yellow fever, and health issues caused by industrial pollution and deforestation.

Catuche points to an emerging hardier breed of mosquito as an example of climate-linked health threats.

A 2023 study in the Putumayo region where Puerto Leguizamo is located showed the mosquito incubation period had shrunk from 15 to a mere five days, he said.


Additionally, mosquitos – considered by public health officials to be the “most dangerous animal on earth” because of the number of diseases they can carry – have grown resistant to pesticides.

On top of that, deforestation means they reside closer to the ground – and people, Catuche said. Breeding grounds also have increased due to trash tossed on the ground that collects rainwater. All this means mosquito-borne diseases are expanding their geographic reach and appearing more frequently in once-exempt areas.

  • Indigenous nursing technician trainees learn new methodologies to teach their own communities to identify disease-transmitting mosquitos. (Photo Courtesy of ACT)
    Indigenous trainees learn to capture and identify the mosquitos that carry malaria, which typically come out at night. (Photo Courtesy of ACT)

Embracing Agility

Putumayo was under a red alert for dengue and yellow fever in Spring 2024, and a yellow alert for malaria. Four people had died of yellow fever in March.

Carlos Catuche points to discarded trash that is collecting rainwater and increasing mosquito presence. (Photo Credit Masha Hamilton)

“This scares me,” Catuche said. “The period between outbreaks is getting shorter, and the diseases seem to be getting more virulent. Climate change is impacting public health right now.”

Forming collaborative networks between Indigenous and Western healers will ultimately benefit the patients, Catuche said.

“We have discovered, for instance, that Indigenous communities have developed plant-based treatments for complex diseases that Western doctors don’t always know how to treat.” As an example, he mentioned difficult cases of the vector-borne disease leishmaniasis, transmitted by an infected sandfly.

“We need to collaborate to become more efficient,” he said. “We need to be more nimble.”

Marrying Vaccines and “Bad Wind”

About 40 percent of the world’s pharmaceuticals are drawn from plants and from traditional knowledge, according to the World Health Organization. Back in 2008, WHO member states recognized the role of traditional medicine in improving public health, and supported its integration into national health systems.

Still, that integration remains slow. The marriage between Indigenous and Western medicine is not without its complications.

For example, some health issues treated by Joinama and others have no easy translation to Western medicine.

Consider “bad wind,” which can cause fever, headaches, and fear. Or “ice from the dead,” which often occurs to survivors of violence or natural disaster, and can cause chills, purple lips, and droopiness. Or “the bad hour,” when the soul separates from the body and the patient suffers from depression.

These conditions are widely recognized in Putumayo, but “Western medicine has no answer for these imbalances,” Catuche said.

Jimmy San Juan, a Western-trained public nurse, with some. of the plants he grows to support healing. (Photo Credit Masha Hamilton)
Jimmy San Juan, a Western-trained public nurse, with some of the plants he grows to support healing. (Photo Credit Masha Hamilton)

“You have to treat these or they could be deadly,” Joinama said. “But you can’t treat them with just a pill. It goes deeper than that.”

Indigenous healers also believe the plants are not enough on their own; the healer must be prepared through spiritual practices, in particular the ingestion of mambe, which is a powder made primarily of coca, and ashes from the dried leaves of a tree known locally as yarumo, with the scientific name Cecropia Peltata.

When the healer is prepared, healing comes through “a breath, a bath, or an infusion,” aided by the plants of the Amazon, said Joinama, who named coca, tobacco, and yucca as three key medicinal plants that are the basis of traditional medicine for the Murui Muina people and important to their cultural identity.

  • The Putamayo River that separates Colombia from Peru (Photo Credit Masha Hamilton)
    The Putamayo River that separates Colombia from Peru. (Photo Credit Masha Hamilton)

Climate Change and Disease

Some of Putumayo’s “disharmonies” –  the term favored by traditional healers – are due to practices that disrupt nature, Joinama and others say.

“Deforestation, for example, is both a spiritual offense and a situation that changes physical conditions on earth, allowing new illnesses to appear,” said Luis Aisama, health leader for Putumayo’s Emberá People and an Indigenous liaison for the Intercultural Health Model project.

“Before, our communities had clean air and clean water. The food they grew was very clean,” Aisama said. “Then companies arrived, using pesticides, cutting trees, contaminating the water and earth. And now we have disharmonies we never saw before.”

These new stressors point to why it’s so important that health leaders from both traditions combine their knowledge for improved diagnoses and cures. “Patients should be attended by both Indigenous and Western healers, starting with maternal health and childbirth,” Aisama said.

Luis Aisama. Embera Chamí health leader and a liasons in the ACT Indigenous health project. (Photo Credit Masha Hamilton)

An estimated 150-200 billion tons of carbon are stored in the Amazon’s forests and soil, making the region vital in fighting the rise of global temperatures. Deforestation, commercial large-scale agriculture, mining, and other industries and activities have impacted the Amazon – and the globe.

“Our waters are heating up, we are losing some medicinal plants, and the barriers of the forest are shrinking,” noted Jimmy San Juan, a Western-trained public nurse who now studies with Joinama and also serves as a project liaison.

“These losses create tensions in the community, so there are disharmonies. And the animals are forced out of the forest and then transmit diseases,” he said.

  • Indigenous nursing technicians go house-to-house in Puerto Nariño, two hours downriver from Puerto Leguizamo, to do sample testing for malaria
    Indigenous nursing technicians go house-to-house in Puerto Nariño, two hours downriver from Puerto Leguizamo, to do sample testing for malaria. (Photo Courtesy of ACT)

The Younger Generation Leads the Way

Twenty-seven apprentices from four Indigenous communities participated in a 22-month, 2,640-hour Colombia program. Encompassing both classroom and practical training, it included a specific module on climate change and mosquito-borne diseases so students could learn new tools to support their communities in climate change adaptation strategies.

In the small Amazonian community of La Quebradita, nursing trainee Benilda takes blood samples. (Photo Courtesy of ACT)

One of those is Carlos Guerra, 19, who became interested in healing after his grandmother, who had raised him, became ill and then passed. About to graduate, he plans to go on to become a doctor, and help his community with a combination of medical practices.

“This my life’s calling,” he said. Combining the two approaches “will improve the efficiency of our treatments,” he said. “And it will also reduce costs because plants are much cheaper than pills.”

“At first, my grandfather did not agree with me being part of this program. He didn’t believe anyone should take pills,” Guerra said. “But everyone must evolve, and bring new ideas. Otherwise, we are stuck.”

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