Home Institution

University of Colorado at Boulder

Publication Date

Spring 2009

Program Name

Chile: Public Health and Community Welfare

Abstract

Background: Explanations for disparities in health between groups of people are complex, and based in differences in genetics, environment, access to medical care, socioeconomic, educational, and cultural factors. In short a person’s lifestyle is inextricably related to a person’s health and their propensity to contract disease. Members of the indigenous group Aymara who live in Arica, Chile have 6 times the rate of morbidity from Tuberculosis (TB) as non-Aymara and 9 times the rate of mortality from the disease. This study examined if there was a link between the rate of TB amongst the Aymaran people and the way Aymarans lead their lives.

Methods: 11 patients undergoing treatment for TB were recruited from the 15 patients currently being treated for the disease at the Clinic Victor Bertín Soto in Arica, Chile. All of the people currently being treated for TB at the clinic were of the ethnicity Aymara. Data were collected through in-depth interviews with the 11 participants about their lives before they contracted the disease, seeking information about their homes, their jobs, what they ate, and their feelings toward Aymaran culture.

Results: The 11 participants had an average 9.6 years of school, the majority were under 50 years of age, and 88% of those with jobs made less then the Chilean minimum wage. An average of 5.3 people lived in the houses of the participants and each house had an average of 3.5 bedrooms and 3.9 beds. 5 of the 11 participants did not believe their homes were of sufficient size for the number of people who lived in them. The participants unanimously preferred windows of a medium to large size. 6 of the 11 participants lived with someone who had TB. Nutrition was poor amongst the group with a mode of 1-2 fruits and vegetables being eaten less than 7 days a week. 8 of the 11 participants were employed and the two most common types of jobs held within the group were in the areas of agriculture and food sales. 9 of the 11 participants felt like they were of the ethnicity Aymara and 7 had used traditional medicine at least once. 10 of the 11 patients consulted a clinic or hospital before seeking traditional cures and none of the participants spoke the Aymaran language.

Discussion: The 9.6 years of schooling the participants averaged was 1 year less than the 10.6 years averaged by non-Aymarans in Arica. The salaries and overcrowding of homes amongst the participants suggests they come from a low socioeconomic status. The areas of work of the participants were physically and emotionally demanding and the majority had poor nutritional practices. During the interviews, the majority of participants lacked basic knowledge of the causes of TB and methods that could be employed to prevent the disease. More than three quarters of the participants either lived with someone who had TB in the passed or worked in an environment with large numbers of people. Delayed access to care due to primary consultation with traditional medicine was not a problem amongst the participants.

Conclusion: The TB risk factors of overcrowding, poor nutrition, excessive work, and proximity to people with the disease were clearly present in the lives of the participants. However, these conditions were most strongly related to socioeconomic factors and limited knowledge of TB shared by the participants rather than the influence of Aymaran culture. Based upon the results, the TB disparity between Aymarans and non-Aymarans can be best dealt with by addressing economic disparities within Arica and developing culturally relevant health education.

Disciplines

Community Health and Preventive Medicine | Epidemiology | Social Welfare

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