Out of sight out of mind: intercultural health technicians in the Peruvian Amazon\ud

This dissertation assesses the complexity inherent in the use of the concept of interculturalidad to implement projects and policies for indigenous people. The research is based on a case study of a grassroots initiative in intercultural health promoted by AIDESEP, an organization that represents indigenous communities from the Peruvian Amazon. The findings demonstrate the limitations of the strategies of both the indigenous organizations and the state around intercultural health and the creativity that, despite these limitations, a group of indigenous nurse technicians use to provide intercultural health care. \ud Interculturalidad does not have a single static meaning; rather, its meaning is specific to the context and actor using it. Two different meanings of interculturalidad are discussed in this dissertation, Critical and Functional interculturalidad. Critical interculturalidad is the one usually used by indigenous organizations which aim to effect changes to policy-making processes that have historically marginalized indigenous people and their knowledge. On the other hand, the state’s use of interculturalidad is often limited to a superficial acknowledgement of cultural difference without questioning root causes of discrimination against indigenous people during policy-making. This is known as Functional interculturalidad and, in contrast with Critical interculturalidad, does not aim to make radical changes in indigenous peoples’ social \ud position. In this dissertation I show that beyond discussions about the meaning of interculturalidad, intercultural policies require flexibility from bureaucratic state structures, and openness for negotiation on behalf of indigenous organizations.\ud Through the analysis of the approaches used by the Peruvian state and AIDESEP to provide intercultural health in Peru, this research shows that without structural changes in the state’s support and promotion of indigenous medicine, intercultural health will only produce superficial changes. Furthermore, this dissertation shows that without active political support from indigenous organizations, changes in healthcare delivery for indigenous people will remain limited. In the context of health services for indigenous communities in the Peruvian Amazon interculturalidad remains a well-intentioned idea, yet its implementation in health care by indigenous organizations and the state falls short of delivering the transformation it seeks to promote.\u