Reflection on indigenous health and current challenges in dialogue with the dissertation ‘It has to be our way’: participation and protagonism of the indigenous movement in the construction of the health policy in Brazil

Ailton Krenak About the author

Abstract

This essay presents the speech given by Ailton Krenak on March 25, 2020, at the PhD thesis’ defense of Nayara Scalco, advisee of Professor Marília Louvison, in the Graduate Program in Public Health, School of Public Health, University of São Paulo, plus excerpts from the lecture given at the International Seminar: Indigenous Health and Ecology of Knowledges in Facing Current Challenges: “It has to be our way”11The International Seminar: Indigenous Health and Ecology of Knowledges in Facing Current Challenges: “It has to be our way,” held on March 26, 2020, is available at <https://bit.ly/3povjUR> and <https://bit.ly/3aspLoi>., on March 26, 2020. In this context, it highlights the importance of a dialogue between different knowledges and how the Indigenous Health Care Subsystem is constituted. Focusing on the debate about the relationship between the Brazilian State and indigenous peoples since colonial times, based on the production of Epistemologies of the South that guides the discussion of the dissertation, it proposes rethinking health and care beyond biomedical knowledge.

Keywords:
Indigenous Health; Indigenous Health Care Subsystem; Public Policies; Epistemologies of the South

It is a great joy to be here with you all on this occasion. It is a great pleasure to participate in this table, in a situation that we know is not very common. I do not know how many times an indigenous person has actually been admitted in a position to evaluate a thesis or dissertation in our universities. It is not very common for subjects that live on that other side of the abyssal line (Santos; Meneses, 2009SANTOS, B. S.; MENESES, M. P. (Org.). Epistemologias do sul. Coimbra: Almedina, 2009.) to be called upon to speak on this side - perhaps this reflects the so-called internal colonialism (Casanova, 2006CASANOVA, P. G. Colonialismo interno (uma redefinición). In: BORON, A. A.; AMADEO, J.; GONZÁLEZ, S. (Org.). La teoria marxista hoy: problemas y perspectivas. Buenos Aires: Consejo Latinoamericano de Ciencias Sociales, 2006. p. 409-434. ). It is a real example of the internal colonialism that permeates us.

I tried to do the possible readings of this thesis (Vieira, 2019VIEIRA, N. B. S. “Tem que ser do nosso jeito”: participação e protagonismo do movimento indígena na construção da política de saúde no Brasil. 2019. Tese (Doutorado em Ciências) - Universidade de São Paulo, São Paulo, 2019.) and I am very grateful for this opportunity, which coincides with the fact that we are here experiencing this friction between the arrogant knowledge, as professor João Arriscado Nunes put it, and the ecology of knowledges (Santos, 2010SANTOS, B. S. Ecologia de saberes. In: SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo: Cortez, 2010. p. 137-178.). What this image suggests is exactly the historical situation of these peoples, who are the pretext of this conversation about the Indigenous Health Subsystem. The Indigenous Health Subsystem only has meaning between these clashes: between that ecology of knowledges and that arrogant knowledge. We live a history shrouded in colonialism, in which the State that promotes public policies is our enemy.

We cannot trust that the State under capitalism will promote care for anyone; on the contrary, It will devour people just as it devours landscapes. We are a pro-capitalism extractive platform. Our mountains, our rivers, our forests and our bodies undergo the same market logic as the economies, which encompasses the entire planet, and this is a problem not only in Brazil. Capital’s way of treating health and the healthcare field as a commodity is increasingly in dispute, and of a growing trend everywhere in the world. It works a ticket: they sell you a ticket for survival, which is the health package.

So, this thesis (Vieira, 2019VIEIRA, N. B. S. “Tem que ser do nosso jeito”: participação e protagonismo do movimento indígena na construção da política de saúde no Brasil. 2019. Tese (Doutorado em Ciências) - Universidade de São Paulo, São Paulo, 2019.) sought support in constructions of the Epistemologies of the South (Santos; Meneses, 2009SANTOS, B. S.; MENESES, M. P. (Org.). Epistemologias do sul. Coimbra: Almedina, 2009.) and the tools of the ecology of knowledges to address this issue and try to unravel some of these occultations that form our coexistence. These occultations are the places of silencing, the negation of the subject. This whole trajectory of our colonial relations affects us to this day because we left the colony and started a republic. The text reflects well this crossing, and how coloniality scatters itself and traverses time with the same virality.

In colonial times, we were harshly persecuted by the attempts to use our bodies as slave labor. Our non-submission to the condition of slave labor marked us as hostile Indians, and we suffered from violence and wars. So, this process of estrangement between those who lived here and those who arrived to conquer this territory never saw a truce, even when the State policies sought to somewhat reflect strategic changes regarding these peoples, like the Indian Protection Service’s and the National Indian Foundation’s “morde e assopra” (popular Brazilian expression that means “to bite and then blow on it to soften the pain”, regarding, in this context, the forward and backward movement of policies that directly affect indigenous peoples). All these policies only foiled the colonial mode of annihilation, which in the text “It has to be our way”: participation and protagonism of the indigenous movement in constructing health policies in Brazil is achieved by using the ecology of knowledges (Vieira, 2019VIEIRA, N. B. S. “Tem que ser do nosso jeito”: participação e protagonismo do movimento indígena na construção da política de saúde no Brasil. 2019. Tese (Doutorado em Ciências) - Universidade de São Paulo, São Paulo, 2019.).

This set of tools that Professor Boaventura and his colleagues (Santos; Meneses, 2009SANTOS, B. S.; MENESES, M. P. (Org.). Epistemologias do sul. Coimbra: Almedina, 2009.) have been structuring expands the protest apparatus to the fury of this capitalism that devours the planet - and we are not specially chosen; capitalism devours everyone. We are all being eaten: our mountains, our rivers and our subjectivities.

Within this field of subjectivities, it would be interesting to reflect on the contact of what we call care, health, and not be prisoners of these predetermined notions of what health, disease, well-being is; these crystallized ideas about the body, a body that does not constitute itself, a body that is imposed. Having the courage to be a body that constitutes itself, a critical body, would allow us to ask another more radical question: would Indians not survive without the white man’s medicine? These are the questions that emerge from reading this interesting document, because to the extent that it opens a fissure in the system’s logic, which is colonialist, capitalist and predatory, it reserves a small part to discuss a little thing called health.

Why is it a little thing? Because within capitalism, within the imperial logic, the last thing that matters is life. We are, all of us, matter to burn. Our colonial history burned, turned people into coal. Well over thousands and millions of people supplied the demand of colonialism in the boilers: coal-people. I consider that this idea of coal-people is the most coherent in the criticism of colonialism: when it takes other bodies as a matter that it can manipulate, can turn into a labor force for sugarcane, for working mills, for building power plants, for building roads, for building farms, for growing coffee. You need people to do this, and in Brazil they were implemented with slave labor.

In Brazil, it was black people who planted coffee, black people who planted sugarcane, and black and indigenous people who produced sugar. At the end of the 19th century, with the arrival of Italian immigrants, they stopped using slave labor because they had a more trained and docile work force to plant coffee. The Italians came to replace slave labor, but not in much better conditions than the slaves. It was cheaper to bring in freed Italians who would willingly work, and often only in exchange for food and a place to stay, than to watch runaway Indians and provide for blacks in the slave quarters. This is how our colonial history was formed, until it configured the complex society that we are, which almost annihilated the Indians.

If this were one of those ancient myths, we would say: it was written that one of the three founding subjects of the myth had to disappear, but for some reason, by some apparatus, this subject, the Indian, erupted. And he appeared in Brazil’s political history scene only at the end of the 20th century, because until the 1950s and 1960s this subject was completely buried. So much so that Darcy Ribeiro (1977RIBEIRO, D. Os índios e a civilização. Petrópolis: Vozes, 1977.), on a section of the book The Indians and civilization, writes that the peoples Krenak, Aimoré, and Tremembé were extinct. During the entire colonial period we were left with that ambiguity, and I do not think wiping out the Indians was even a priority at that time. When the Republic was established, all the bandeirantes, Indian hunters, came into the Republic and created the Indian Protection Service. Despite all the worship that is given to the memory of Marshal Rondon,22Cândido Mariano da Silva Rondon, known as Marshal Rondon (Santo Antônio de Leverger, 1865 - Rio de Janeiro, 1958): Brazilian military engineer and sertanista. He was the first director of the Indian Protection Service and encouraged the creation of the Xingu National Park. they were precisely the ones who brought the Indians to the state of extinction. By the 1930s, 1940s, 1950s, virtually all the literature produced in Brazil already declared the Indians extinct.

The countless peoples we see today protesting in Brasilia, throwing rocks at the Palace’s windows, were once extinct. So it is almost a fantastic tale, and not even Gabriel García Márquez (1977MÁRQUEZ, G. G. Cem anos de solidão. Rio de Janeiro: Record, 1977.) would understand how this crowd of people who were already dead showed up to mess up things, occupy the Paulista avenue, pester Alckmin,33Geraldo José Rodrigues Alckmin Filho (Pindamonhangaba, 1952): Governor of the state of São Paulo from 2001 to 2006 and from 2011 to 2018. heckle Temer,44Michel Miguel Elias Temer (Tietê, 1940): President of Brazil from August 31, 2016, instated after impeachment of the incumbent, Dilma Rousseff, to January 1, 2019. and eventually also protest against Dilma55Dilma Vana Rousseff (Belo Horizonte, 1947): President of Brazil from January 1, 2011 until her removal by an impeachment process in 2016. and Lula66Luiz Inácio Lula da Silva (Caetés, 1945): President of Brazil from January 1, 2003 to January 1, 2011., when they did not understand and tried to build Belo Monte. In fact, the Indians warned: “do not do this, it will go wrong.” And it did!

But the Indians have not yet earned the mantle of prophets, they are at most shamans, which is what puts Indian medicine right in that place attributed by biomedicine, by the field specialists, which is “knowledge.” You see, the Indians have some knowledge, but this knowledge needs to be proven. A friend of mine from the Federal University of Ouro Preto asked me to collaborate on a document he was writing to “prove the rationality of the Indian’s system of healing practices, to prove the rationality of indigenous medicine.” He was picking the wrong guy, because I would have convinced him that there is no rationality in this, nor in your medicine. That your medicine is a fiction, that you invent diseases, and then you invent medicine, and the labs make a lot of money.

Well, considering that these practices have markedly distinct origins and paths, at what point is it possible to intersect the idea of integrality and equity when the whole complex itself has no equity, and even when it seeks integrality it does so in a manipulated way and with the objective of control? The health system of the West is control, as Foucault (1987FOUCAULT, M. Vigiar e punir: história da violência nas prisões. Petrópolis: Vozes, 1987.) put it, the high of the West is to discipline and punish. So it only keeps alive those it can use in its service and lets die those it does not want alive. Why would the Brazilian State support a complex program of integrality and equity in health care for the enemies of the State, which are us? Or are you confusing us with someone we are not? The indigenous people will not give the State any respite.

If the State wants to care for the Indians, the State needs to know who we are. When Pierre Clastres (2003CLASTRES, P. A sociedade contra o Estado: pesquisas de antropologia política. São Paulo: Cosac Naify, 2003.) wrote that these societies, in their way of life, contradict the configuration of the state apparatus, he was not provoking any crisis in the knowledge system of sociology, anthropology, and social sciences. Clastres (2003) lived among the Mbyá, the Guarani Paí Tavyterã, the Yanomami. These relatives, with their worldviews, have never let the state overrule them, they have always escaped this control. Clastres saw people who had a potency, an autonomy to be in the world that fascinated him so to the point of stating that the State has nothing to say to these people; these indigenous peoples in their constitution do not conceive a thing above them, they are sovereign; they may be few, but they are sovereign over any domain.

Reason why the Portuguese colonial Brazilian state, or updated to the new terms, is unable to establish communication with these peoples with equity. The relationship will always be unequal. I have never looked for a match between this apparatus and who we are or what we think. I have always dealt with the State as a threat. This apparatus is a threat to our bodies, and it is a threat to our ways of being in the world with its capture of the whole symbolic world.

Our medicines have nothing to do with what non-Indians call medicine; the very ideas of body, of person, are distinct. And this is definitely not a particularity of the Kamaiurá, the Yawalapiti, or those who have stayed, say, hidden in some remote area of Brazil. This is also in the minds of the Pankararu who live in the favelas of Morumbi (in Real Parque), the Truká, the Fulni-ô, the Kiriri, the Kariri-Xocó, people who have lived on the São Francisco River, fighting for 300 years. They disappear, submerge, emerge.

The cleavage system of the West said: there is white people, there is black people, and there is indigenous people, and defined what each one is. Time passes and they decide to get rid of the Indians. When these people reappear, the West asks: “but is that not the Indian? Isn’t the Indian who disappeared the one who appeared?” Well, do you know other people who disappeared and appeared again? It is a transfiguration, they disappeared and appeared. And you want to have their picture, of the missing person, to find them? No, they are someone new now, man! They are another people, another person. Not even this the State can understand, because they want an anthropological report, an inventory dating back to the 17th, 18th century to prove that those Tupinambá that Florestan Fernandes (1970FERNANDES, F. A função social da guerra na sociedade Tupinambá. 2. ed. São Paulo: Pioneira, 1970.) said lived in the Atlantic forest are the same Tupinambá from Olivença, who live in Bahia. Because after all, the Tupinambá are over.

Florestan (Fernandes, 1970FERNANDES, F. A função social da guerra na sociedade Tupinambá. 2. ed. São Paulo: Pioneira, 1970.) also said that the Tupinambá are societies that reproduce themselves as war, that it is their motto. By waging wars, this society reconstitutes and reshapes itself. You go out, you hunt someone, wage war, and that society goes on celebrating rites, making ceremonies, reproducing itself. One good thing that Florestan Fernandes left us was this. We are all Tupinambá, we do not live without war, we are consistently waging war to reproduce this colonial system, which arrived here waging a war of extermination, which continues to reproduce itself in our practices.

The policy that the State takes against us all, Indians, blacks and whites, is a policy of extermination. Some non-Indians might think that the State is hunting down the Indians, but It is hunting down everyone-the Indians, the whites and the blacks. They are hunting down everybody that has any potential to rise up against an abstract order that wants everyone dominated.

I was at the beginning of the 8th National Health Conference, and by chance, maybe not by chance, but due to a historical situation, I was the one who forwarded a resolution proposing that the 1st National Conference on Indigenous Health be held. This resolution was approved, and we had the 1st National Conference on Indigenous Health, which produced over this political history some instruments, and what today configures the health policy exercised within this conduit, which is the Indigenous Health Subsystem. I have co-responsibility for the existence of this experience. A continuous experience, without ceasing, every year, every conference, every regional articulation. It was an intense process until we got to this situation where the Brazilian State seems no longer interested, for one thing, in the continued existence of this instrument. This denounces the absence of the rule of law and democracy.

We do not live in a democracy, and we also do not live in a context where the rights that have been won, the rights constituted in processes of mobilization and social struggle, are being respected. So if we have a situation in which citizenship achievements can be called into question, we need to be able to discuss the recent history in a more critical and less appreciative tone.

We need to understand that we are facing an attack. We are under a more general framework in which we will not have many possibilities to resort to other forums other than that of our own capacity to resist and fight, to fight for our rights, here in this country that we share, with so many inequalities that become outrageous when we discuss the reality of indigenous peoples.

***

Considering the broad reality that we are living in, the demands, the struggles on the agenda are those of the peoples connected to the land. When the indigenous people say that “land is health,” is not only a slogan, a campaign motto. They are saying: “we will die for this, we will not change our strategy, we will die if we have to.”

The other movements connected with the demand for land do not have the land as their only place of existence. The land, for these, is also a commodity. For all other groups, except for the Indians and quilombolas, land is a commodity. And so, it is a dispute that fits very well within the capitalist logic and within an authoritarian and manipulative state. This is why even in a dictatorship, you can have an agrarian reform program. It is production, it will put people to produce for the market, it will integrate these people into the market. Now, what is inadmissible, what contradicts the relations within the organized capitalist State and its capitalist economy, is to respect the autonomies of peoples who occupy territories - besides land, territories - and who have identity, and who establish governance in these territories from their own perspectives. They do not take ownership over tracts of land to produce for the market. That is the actual issue. And what makes this relationship most unfeasible is the fact that it will be a communal ownership of the territory. Ownership and use are communal, peoples sharing the use of a territory that informs how they think about themselves. It is different from a lot of people taking over a tract of land so they can grow flowers or potatoes and enter the market economy. The crisis starts when you have people who want to live, and not enter the production line.

In Latin America, we have recurrently seen an issue become a power of mobilization, of articulation, before an authoritarian state situation. In Argentina, the Mapuche leadership drew a large protest movement from one region of the provinces, which became a national mobilization of workers from all categories, around a spark. So if the indigenous movement creates a spark that can mobilize populations that are beyond this land agenda, in urban centers, with workers, this may even happen.

If the urban population is feeling good, fine, then they do not need to worry about turning this into a banner that will interest everyone. Now, if they are feeling uneasy, if they are truly realizing that climate change, that lack of water, that the urban quality of life is bad, then start taking actions to change it. Because I do not believe that living in the city is everyone’s destiny, and certainly not the Indians’ final destiny. This context of indigenous peoples living in transit, in urban regions, is the result of a constant war we have been suffering for a long time.

We have never been at peace. This machine has always been waging war against someone, in here. One minute it is against the Indians, another against the blacks, and another against the poor in general. And so we cannot be so naïve, so alienated as to think we are on an island. We are not on an island; we are standing in a stormy sea. No indigenous people think they are at peace, they all know they are at war.

The fact that the history of Brazil was unable to integrate the indigenous people within its way of operating and constituting itself as a society created this grotesque situation where, when talking about indigenous people, they speak as if talking about either totally incapable people or people who are always on the verge of a crisis in their relationship with Brazilian society. Since Brazil has never decided whether or not to kill the Indians, they created a first aid kit to keep applying bandages while they decide whether or not to annihilate them. In history, the census is always surprised by the reappearance of peoples who were declared extinct in other times, and with the emergence of peoples who had never been sighted in the different locations of the country where they appear.

And we keep reappearing in different contexts. Reappearing in the urban context, reappearing in the middle of forests that are neither recognized nor demarcated, reappearing in places already recognized and demarcated, as if constantly questioning the idea of a Nation and of a State. We should consider that any public policy can only happen conditionally, that it is being made for a people that until now the State does not know whether to let stay alive or kill. So, let us not entertain any illusions about the Brazilian State, under any circumstances, even in an experience more or less promoting inclusion in other policies, which may have inspired a good part of the Indigenous Health Subsystem design. It was a certain willingness to promote inclusion and public policy that led to the creation of a new category of health workers, the Indigenous health specialists. And my question, again, is: would Indians die if there were no Indigenous health specialists?

That is all. Thank you very much.

References

  • CASANOVA, P. G. Colonialismo interno (uma redefinición). In: BORON, A. A.; AMADEO, J.; GONZÁLEZ, S. (Org.). La teoria marxista hoy: problemas y perspectivas. Buenos Aires: Consejo Latinoamericano de Ciencias Sociales, 2006. p. 409-434.
  • CLASTRES, P. A sociedade contra o Estado: pesquisas de antropologia política. São Paulo: Cosac Naify, 2003.
  • FERNANDES, F. A função social da guerra na sociedade Tupinambá. 2. ed. São Paulo: Pioneira, 1970.
  • FOUCAULT, M. Vigiar e punir: história da violência nas prisões. Petrópolis: Vozes, 1987.
  • MÁRQUEZ, G. G. Cem anos de solidão. Rio de Janeiro: Record, 1977.
  • RIBEIRO, D. Os índios e a civilização. Petrópolis: Vozes, 1977.
  • SANTOS, B. S. Ecologia de saberes. In: SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo: Cortez, 2010. p. 137-178.
  • SANTOS, B. S.; MENESES, M. P. (Org.). Epistemologias do sul. Coimbra: Almedina, 2009.
  • VIEIRA, N. B. S. “Tem que ser do nosso jeito”: participação e protagonismo do movimento indígena na construção da política de saúde no Brasil. 2019. Tese (Doutorado em Ciências) - Universidade de São Paulo, São Paulo, 2019.

  • 2
    Cândido Mariano da Silva Rondon, known as Marshal Rondon (Santo Antônio de Leverger, 1865 - Rio de Janeiro, 1958): Brazilian military engineer and sertanista. He was the first director of the Indian Protection Service and encouraged the creation of the Xingu National Park.
  • 3
    Geraldo José Rodrigues Alckmin Filho (Pindamonhangaba, 1952): Governor of the state of São Paulo from 2001 to 2006 and from 2011 to 2018.
  • 4
    Michel Miguel Elias Temer (Tietê, 1940): President of Brazil from August 31, 2016, instated after impeachment of the incumbent, Dilma Rousseff, to January 1, 2019.
  • 5
    Dilma Vana Rousseff (Belo Horizonte, 1947): President of Brazil from January 1, 2011 until her removal by an impeachment process in 2016.
  • 6
    Luiz Inácio Lula da Silva (Caetés, 1945): President of Brazil from January 1, 2003 to January 1, 2011.

  • 1
    The International Seminar: Indigenous Health and Ecology of Knowledges in Facing Current Challenges: “It has to be our way,” held on March 26, 2020, is available at <https://bit.ly/3povjUR> and <https://bit.ly/3aspLoi>.

Publication Dates

  • Publication in this collection
    12 Mar 2021
  • Date of issue
    2020

History

  • Received
    04 Aug 2020
  • Reviewed
    09 Jan 2021
  • Accepted
    10 Jan 2021
Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. SP - Brazil
E-mail: saudesoc@usp.br