To share a little about this beautiful profession and report experiences marked by many challenges, we followed the daily lives of five Indigenous Health Agents (AIS) in the Raposa Serra do Sol and Serra da Moça Indigenous Lands: Gilberto Mota Macuxi, Patrícia Lima Macuxi, Lucineide Lima Macuxi, Marina Silva Wapichana and Maria Rosália Wapichana are some of the true "doctors" of the indigenous communities of Roraima.
The routine of the Indigenous Health Agents (AIS) in the community begins early. In the morning, home visits begin, traveling along paths, streams, rivers and long distances, often on foot, by motorcycle or canoe. They are responsible for closely monitoring the health status of people and families in their communities, with special attention to pregnant women, children and the elderly.
In the Camará indigenous community, located in the Raposa Serra do Sol Indigenous Land, lives the leader, Gilberto Mota, of the Macuxi people, 52 years old, and performs the function of AIS. He said that he has been an agent for more than 20 years, carries the responsibility of caring for the well-being of his people. He works on the front line of basic care, combining traditional knowledge of his people and protocols of the non-indigenous public health system.
"Our job is to promote the health of indigenous peoples. We have gone through many situations in the community and this project has allowed us to reach a level of professionalization. We started with traditional medicine, then came the basic courses, until they were proven as AIS. Today, we follow what was planned by our leaders together with the CIR organization", he explained.
Gilberto recalled that the service has improved over time, but still faces challenges."Health is not one hundred percent, but we do what we can for our people. The government serves within what it can, and we do our part. Of course, there are diseases that exceed our limits. We are the basics, the gateway. We need to train more people, doctors, nurses, dentists, among others, to have more opportunities."
He recalled that before the opening of the road, access was precarious in the Camará indigenous community, contact was via radio, to call ambulances or aircraft to save lives."We have already lost many relatives. Today we have a road, not a good one, but it exists."
On a daily basis, Mr. Gilberto's work begins early, with the accompaniment of children and the elderly."We monitor the children to see and find out if they are well fed. We also monitor our elderly. We monitor their health to see if everything is okay."
Gilberto also highlighted the role of midwives and traditional medicine in the communities."We have a midwife who takes care of pregnant women and helps with childbirth. Traditional medicine is important and helps a lot, especially in winter, when children and the elderly suffer from respiratory diseases. When the disease is serious, we refer them to the doctor. My job is to guide, talk, see if the pregnant woman is having prenatal care, if the vaccines are up to date, if there is any fever or diarrhea in the children. I also refer them to the health center when I see that it is needed",
The lack of medicines at the base center is a recurring problem, because it is distributed in other communities in the region."We have many removals in the region, and there is a lack of medicines. And this makes it difficult to provide care here at the center."
Gilberto ended a little of his trajectory with the following reflection."Here we don't play with health. This is very serious. We always work with respect, within our culture and our land."
Marina Silva Ramiro, 48 years old, from the Wapichana people, was born and raised in the indigenous community and Serra da Moça Indigenous Land. She is an Indigenous Health Agent in her community. Her trajectory began after training offered by institutions focused on this category."Before we started to act effectively, we went through a whole year of preparation. In the beginning, our remuneration was a scholarship of only R$ 100.00, very different from the amount we receive today".
"I worked for about seven years as an AIS, then I left for two years and, in 2014, I returned to activities in my community, where I continue to this day. Currently, we are two Indigenous Health Agents. Our goal has always been to carry out routine work, in collaboration with the community. Among the main activities, we carry out home visits, actions with groups in vulnerable situations and closely monitor the elderly. We have 27 health programs to develop every month, and at the end of each period we need to prepare reports on everything that has been done. These reports are fundamental to show our production and continue the work."
Marina recalled the challenges she faced during the COVID-19 pandemic."Although we did not record deaths within the Serra da Moça community, the concern was great. In 2019, there were no medicines available, pharmacies were empty. Faced with this shortage, we resorted to our traditional knowledge, used natural remedies, and applied protective measures at the entrance to the community, such as sanitary barriers. "Our work is continuous, in partnership with the community."
The community, Serra do Truaru, was the most affected among the five communities in the region, explains Marina, in addition to others such as the Morcego, Anzol and Truarú da Cabeceira communities. But there was no loss of life."We closely monitored all cases. Even without Personal Protective Equipment (PPE), such as gloves and masks, we were not helpless. The women of the community organized themselves to sew fabric masks, since it was not possible to buy them. With unity, we overcame this difficult moment. Today, we remain firm, always attentive to the needs of our community and committed to ensuring health and well-being for all".
The origin of the profession
Indigenous peoples have always taken care of their health in their communities, both in the treatment and prevention of diseases. They have vast knowledge about different forms of cure, extracting the necessary resources from the land itself. However, with the arrival of external factors, such as the presence of outsiders and the activity of illegal mining, it has become necessary to seek new knowledge to face and combat diseases that were previously unknown.
The profession of Indigenous Health Agent (AIS) has its roots in the historical mobilization of indigenous peoples in Brazil for their rights, especially from the 1980s onwards. The creation of the AIS arose as a response to the specific needs of indigenous communities, who lived, and still live, different realities from non-indigenous people. In the 1990s, faced with the precariousness of care and linguistic and cultural barriers in the health system, indigenous peoples themselves began to demand a model of care that respected their ways of life, traditional knowledge and care practices.
It was in this context that the differentiated Indigenous Health Care model was structured, later consolidated with the creation of the National Health Care Policy for Indigenous Peoples (PNASPI). And, although the AIS had already been operating informally since the 90s, it was only with the creation of the Special Secretariat for Indigenous Health (SESAI), in 2010, that their work gained institutional support and officially became part of the Indigenous Health Care Subsystem (SASI), within the Unified Health System (SUS).
Jonelson Lima Mota Macuxi, second tuxaua of the Camará indigenous community, Raposa Serra do Sol Indigenous Land, which for a time already acted as an AIS, recalled with pride and emotion the trajectory of the Indigenous Health Agents (AIS) in the Baixo Cotingo region. According to him, it was a struggle that came from the concerns of the Tuxauas, and this achievement was the result of great mobilizations of the leaders, moved by concern about the outbreaks of diseases that affected the communities.
"We started this fight because, in the past, here in our region and in others, there was no health care. Children suffered from diarrhea, malaria, tuberculosis, and there was no one to attend quickly. This made leaders look for urgent alternatives to change this reality", he says.
The decision to fight for each community to have its own health agent was taken in regional assemblies and the general assembly of the CIR, where the leaders understood that it was essential that the agents were people from the community itself, with commitment and interest in taking care of their people."I was also part of this path. In 1994, we started the first introductory courses in our region, with the support of the Indigenous Council of Roraima, which sought important partnerships for this training. I, as a tuxaua, always make a point of remembering the importance of the CIR in this process", reported Jonelson.
He also recalled the difficulties faced by his grandparents and parents, who had to walk long distances to the São Camilo hospital, (existing at the time in the Surumu mission, in the Barro community, Surumu region) in search of care."It was because of these difficulties that we were able to win the presence of health agents. Today they are the first to arrive at our homes, providing first aid and guidance".
The tuxaua also defended the appreciation of traditional indigenous medicine, which coexists with pharmaceutical medicine in the communities."It is not yet 100%, but we continue to fight for our traditional medicine, with the knowledge of the shamans, to be respected and valued even more. We use both medicines, and this has helped a lot."
The existence of the Indigenous Health Agent (AIS) profession is an example of the self-determination of indigenous peoples, a principle that guarantees communities the right to decide their own paths, including in the area of health. This self-determination was, and continues to be, essential for building a care model that respects cultural diversity and traditional knowledge, and values language, customs, and unique healing methods.
The ongoing training and capacity building of Indigenous Health Agents (AIS) are conducted by public bodies such as the Special Secretariat for Indigenous Health (SESAI), involving the Special Indigenous Health Districts (DSEIs), indigenous organizations, and educational and health institutions. However, they still face difficulties in several regions due to the lack of ongoing training for health agents. Chief Jonelson, from the Camará community, warns about the lack of continuous training.
“Some communities have lost their health workers due to a lack of new training. I need to continue training new workers. Here in our region, we want to continue being treated by doctors, but the health workers are fundamental. They are the ones who arrive first, they are the ones who know our reality.”
Jonelson's statement reflects the concern of many indigenous communities, as the lack of regular training compromises not only the work of these professionals, but also continued and qualified access to basic health care in their territories.
Traditional medicine
Lucineide de Lima Macuxi, 47 years old, was born and raised in the Camará indigenous community, where she still lives today. She has the gaze of a strong woman, a life dedicated to indigenous health and traditional medicine, a legacy left by her ancestors. Upon receiving journalist Márcia Fernandes Wapichana and photojournalist Maciel Macuxi, she expressed her gratitude for their presence and the opportunity to tell her story, a story dedicated with much love.
Her journey in healthcare began on December 18, 1993, when she participated in a year-long training program at the Surumu Mission, with activities at the São Camilo Hospital. It was there that she took her first steps in community work.“At the time there wasn’t much support, so I went on a whim. I gained a lot of experience and learned a great deal from the teacher, Sister Teresa, who trained health workers from various regions. The goal was to bring the knowledge I had acquired back to our communities.”, he recalled.
Lucineide also participated in other courses, becoming a midwife, Indigenous health agent, and microscopist. Upon returning to Camará, she put what she had learned into practice, but it wasn't easy.“At that time, we didn’t have a nurse. The diocese supported us. Sister Augusta came every month to supervise and guide us, and I relied heavily on Mr. Gastão, who taught me how to work with patients using a microscope.”.
And once again, Lucineide remembers the Indigenous Council of Roraima for strengthening training and opening new avenues for the work of Indigenous Health Agents. It was in this context that these professionals faced malaria outbreaks and began to support other communities. Even before her training, she was already practicing traditional medicine, learning from Dona Iolanda Macuxi, a leading figure in Roraima.
“I place great value on this work. Our nature is rich in remedies. The knowledge I have acquired I pass on to the younger generations, because those who taught us are gone now. I am concerned with keeping the wisdom of our ancestors alive.”
Lucineide is also a midwife, a profession she learned from her grandparents."Today, after the healthcare team came in, we've lost some of our values regarding childbirth. I still work as a midwife and we receive the necessary kit, but I notice that traditional medicine is being somewhat sidelined in relation to childbirth."
With this in mind, she is deeply concerned with training more young people so that they can learn how to produce and use traditional medicines."It's important for young people to know and value our medicine, because it comes from a long time ago and is part of our identity; we cannot lose this rich tradition."
Patrícia Lima, 34 years old, from the Macuxi people, is an example of leadership characterized by resilience and persistence. Currently, she is the coordinator of the Camará Base Center, which serves 11 communities in the region.“I started at the center in 2018 with no experience, but I gradually learned. I've been in the coordination role for seven years now.”"However, the journey has been marked by difficulties that intensify during the winter period," he says.“During this time, many communities become isolated. The teams can't reach them. I've thought about giving up, but I've always been encouraged by my colleagues.”
Among the main problems faced, Patrícia highlighted the reduction in fuel supply for service vehicles, which directly compromises the teams' travel."Sometimes, the team goes out to a community and returns without fuel to continue providing services. As a result, other communities are left without assistance. And they suffer greatly because of this."
Another serious challenge is the lack of medication.“We send the orders, but the medicines take a long time to arrive. Only now, after two months, has something started to arrive here in Camará. But it's still not much.”"This is unacceptable," Patricia denounces. The coordinator also criticizes the actions of the Special Indigenous Health District (DSEI)."They demand a lot from our production, but they don't offer the necessary support for us to do our work with quality."
Despite the obstacles, Patricia highlighted the important role of traditional medicine in providing healthcare to community residents:"She helps a lot, especially in moments when the emergency teams can't reach the team."
In the community, the work of the Community Health Agents (AIS) is organized in conjunction with the multidisciplinary team.“We have a schedule that is created by a nurse from the health team. She passes it on to the AIS (Integrated Health Agents), and from that we put together our local schedule here at the base center.”"Patricia explains."
Currently, three Community Health Agents (AIS) work in the Camará community, with activities divided among families. This division facilitates the monitoring of needs and the dissemination of health guidelines."Each person is responsible for specific families, according to the organization we create together with the team.", complete.
Voices from the community:"They are the doctors of the territories"
In the Camará indigenous community, in the Baixo Cotingo region of the Raposa Serra do Sol Indigenous Territory, listening to the residents is to understand, in practice, the important role of the Indigenous Health Agents. Families proudly and confidently recounted the work of the Indigenous Health Agents, who closely monitor the growth of children, the health of pregnant women, and disease control in the region. Zildo de Oliveira Mota, from the Macuxi people and a resident of the community, shared his experience as a hypertension patient.
“I suffer from high blood pressure and I am seen every month by the Indigenous Health Agents. They come to my house and to other families' houses as well, bringing medication and providing follow-up care. Here in the community, we are well cared for by the Indigenous Health Agents. Whenever we need them, day or night, they are there to help. They are our “community doctors.”.But we also have our healers, who take care of us with traditional knowledge. That's how we live here, with both kinds of knowledge."
For six years, Maria Rosália has worked as an Indigenous Health Agent in the Serra da Moça Indigenous community, in the Murupú region of Wapichana. With strong ties to her land and people, she is one of those responsible for ensuring access to basic healthcare for hundreds of people in five communities: Anzol, Truarú da Cabeceira, Serra da Moça, Morcego, and Serra do Truarú, where the base of operations is located.
“We are the front line of our community. We, the Community Health Agents, are the ones who identify an inflamed tooth, who seek out a pregnant woman or an elderly person who needs care. The community comes directly to us at the health center, and we pass the requests on to the team.”, explains Rosália.
Rosalia reported that the community has two primary care teams. Team 1, considered permanent, consists of a doctor, dentist, vaccination professional, and nurse, and visits once a month to provide follow-up care. However, the Community Health Agents' work is ongoing."We work with programs focused on the health of women, men, the elderly, children, and adolescents. We monitor them all monthly."
Despite her dedication, Rosália reported constant difficulties, especially due to the lack of support from SESAI.“We are without support. Even so, we remain steadfast. We accompany patients to the CASAI (Specialized Care Center for Indigenous Health), to the hospital, and we have no set hours to stop. We work practically day and night.”
According to her, the structure of the health center in Serra da Moça is precarious."There aren't enough rooms. It's very difficult to provide care. There's a lack of cleaning supplies, and often we have to pay for them out of our own pockets. The population has grown and the workload has increased, but the support hasn't kept pace."
All of the AIS's work is recorded manually, in notebooks.“Our biggest challenge is transporting patients. We only have two vehicles for the entire Murupu region, and that's not enough. Many times, we have to improvise and help however we can.”
In some situations, the AIS even had to deliver babies.“I’ve helped women in labor because I didn’t have a car, I didn’t have a team. I delivered their babies, thank God everything went well. Then we sent them to the maternity ward. But we’re the ones who provide the initial care.”
Rosália also calls for more training.“We want more advanced courses, such as first aid, midwifery, and emergency care. We often encounter situations that require preparation, but we don't have it. We need more support from SESAI.”
Despite all the obstacles, what motivates Maria Rosália is her commitment to her community."It's tiring work, yes. But I'm committed. I can do the work because I know my community needs me."
Traditional healing knowledge
In indigenous communities, healthcare goes far beyond the services provided by the health team. Indigenous Health Agents work on the front lines, but traditional medicine, represented by shamans and healers, plays an important role in care, especially in cases where Western science does not provide an immediate answer.
Augustino Macuxi, a 72-year-old shaman from the Camará indigenous community, explained.“I have love for what I do. What the white doctor cures, I don’t cure, and what I cure, the white doctor doesn’t cure. We take care of patients when we are called upon.”
For many residents, this action is of great value. One patient, for example, said that she spent a month suffering from severe body pain without a clear diagnosis.“The medicine from the health center didn’t alleviate the pain. My husband went to the shaman, who was able to identify the problem. With the shaman’s care, I’m getting better. Now it only depends on me following his instructions and having a lot of faith. The shaman’s work is important; he guides me in everything regarding my health.”
This partnership, even if informal, shows how dialogue between Western and traditional medicine can broaden healing possibilities, respecting culture and strengthening the community's trust in its own knowledge.
Looking to the future: Regulation of the profession
The profession of Indigenous Health Agent is in the process of being regulated in Brazil. This regulation was authored by former congresswoman Joênia Wapichana and aims to recognize and grant labor rights to Indigenous Health Agents (AIS and AISAN). A bill (PL 3514/19) is currently being processed in the Chamber of Deputies with the objective of regulating these professions within the Indigenous Health Care Subsystem (SasiSUS).
According to the most recent data from the Ministry of Health (MS), there are currently 657 Indigenous Health Agents working in the states of Roraima and a small part of Amazonas. Of this total, 380 are linked to the Eastern Roraima Special Indigenous Health District (DSEI Leste de Roraima) and 277 to the Yanomami Special Indigenous Health District (DSEI Yanomami), highlighting the importance of these professionals on the front lines of indigenous health in the Northern region.
In conversations, the agents demand fair pay and recognition, stability, strengthening the dialogue between traditional medicine and the health system (non-indigenous medicine), preservation of ancestral knowledge, and improved transportation, energy, and communication in indigenous communities to support the work of these professionals.
The stories of Patrícia Lima, Gilberto Mota, Lucineide Lima, Marina Silva, Maria Rosália, and so many other Indigenous Health Agents (AIS) reveal not only the importance of these professionals in promoting well-being in their communities, but also the strength of work done with heart. Even in the face of numerous difficulties and scarce resources, what motivates these agents goes beyond any material limitation. Their work is sustained by empathy, courage, and, above all, a deep commitment to their people.
Text: Márcia Fernandes Wapichana - Journalist - ASCOM/CIR;
Photos: Maciel Macuxi - Photojournalist - ASCOM/CIR;