MORE than 50 leaders from Costa Rica’s 24 indigenousterritories traveled to San José last week to speakwith government officials on a topic they say has too longbeen forgotten – health issues in their communities.They came to participate in the First National Forumon the Health of Indigenous Communities, held at the capital’sNational Cultural Center Oct. 26-28. The forum’sgoal: to bring together representatives from governmental,non-governmental and international organizations to discussthe state of indigenous health in Costa Rica and comeup with some concrete plans for improvement.Public Health Ministry studies have shown that CostaRica’s indigenous communities suffer from more healthproblems than the rest of the country. For example, infantmortality rates in areas where indigenous populations areconcentrated, including the Caribbean and southern Pacificzones, were double those in the rest of the country from 1995to 1999. Higher rates of respiratory infections, deathscaused by infectious diseases, malnutrition and diarrhea arealso common in these areas. The causes include lack of running water, unsanitary living conditions and inadequate access to health servicesfor people in these communities, often faraway from roads (TT, Oct. 14).“WE have a lot of sickness in our community;health is a very important issue,”said Cabécar Association President FranciscoMorales Fernández, 26, who traveledfrom the southern Caribbean Talamancaarea to attend the forum. “We’ve got to lookfor unity and help from the government.”Building more clinics and emergencymedical units to serve the Cabécar communityis one of the initiatives he said hehoped to discuss.The forum’s organizers – the PublicHealth Ministry in conjunction with thePlanning Ministry and Pan-AmericanHealth Organization – aimed to bringtogether government officials who makedecisions affecting indigenous communities,from institutions such as the SocialSecurity System (Caja) and NationalWater and Sewer Institute (AyA), and askthem to make concrete plans, accordingto Romano González, Health Ministrynutritionist and member of the forum’splanning committee.The Health Ministry does not have abudget for indigenous health projects, andtherefore must seek funding from otherinstitutions.“At this time, we’re hoping for a bettercommitment from government institutions,better participation,” González said.TO encourage such commitments, theforum’s more than 200 participants wereassigned to “work tables” during the firsttwo days. Divided into groups by region,the teams were asked to discuss topics pertainingto health care – such as humanresources, legal framework, and the needsof children and adolescents – and come upwith a work plan for their communities.The groups presented their ideas at theforum’s closing ceremony. Training morehealth workers, improving communicationbetween conventional health and indigenoushealth sectors, and creating a nationalindigenous health network were amongthe proposals.THE next step will be putting theseplans into action, said Xinia Gómez, HealthMinistry director of health development.“Now we have the responsibility toconsider what to do with these plans wehave made,” Gómez said. “We have to sitdown in smaller (groups) to take the nextsteps and make concrete proposals, to seehow we are going to continue.”In the meantime, leaders from differentregions returned to their communities withnew ideas for improvement. Caja Central-Southern Regional Director María EugeniaVillalta said she plans to focus more onhuman resources in her area, whichincludes the Chirripó Indigenous Reserve,and train more indigenous people to behealth workers.“We’ve got to take into considerationthe participation of indigenous communities,and name them as officials,” saidVillalta. “We need to continue talking withthem to see what their needs are.”Indeed, the participation of indigenouspeople in decision-making was a theme that echoed throughout the forum’s discussions.“This is the first time that people fromthese communities have been here andinvolved in the implementation of plans,”National Indigenous Roundtable coordinatorDonald Rojas said. “It’s been very openand transparent.”ROJAS also remarked on a recentincreased national focus on indigenouscommunities, offering an explanation forwhy more attention is being paid to the subjectby the media, government and otherorganizations than in the past.Achieving the goals set for Costa Ricaby the United Nations MillenniumDeclaration, which establishes developmentobjectives to be achieved by 2015, hasput more pressure on the government toimprove health care in indigenous communities,Rojas said. In indigenous areas, severalof the Millennium Goals, includingreducing infant mortality rates to nine perevery 1,000 live births, are not being met.González agreed there has been morediscussion of indigenous communities lately,adding that the upcoming February presidentialelections are a factor.“There’s always the risk that with thechange of government, things will change,”said González. “We’re trying to get somecommitments made now.”IN addition to national leaders, peoplefrom indigenous communities throughoutLatin America including Nicaragua,Mexico, Peru, Chile, Brazil, Colombia andEcuador attended the forum and sharedexperiences with health care from theirrespective countries.The three-day event was funded both bynational institutions including the HealthMinistry, Caja, AyA, Planning Ministry andMinistry of Culture, Youth and Sports, andby international organizations includingUNICEF, the United Nations DevelopmentProgram, the International LaborOrganization, Green Cross Italy, the Pan-American Health Organization and SpanishAgency for International Cooperation.In addition to making the Forum anannual event, Health Ministry officials areplanning to hold more frequent nationalgatherings to discuss indigenous health andalso working on a Web page to provide furtherinformation on the subject.