The research team, led by Yesika Natali Fernández-Ortiz of the Institute of Public Health at Pontificia Universidad Javeriana in Bogotá, used a concurrent mixed-methods design that combined a structured household survey with ethnographic fieldwork. In 2022, six surveyors recruited from within the community, selected by traditional authorities and trained by the researchers, administered questionnaires to 819 individuals across 161 households, a participation rate of 78.1 percent of the total population of 1,049. Because internet connectivity in the region is limited, the surveyors used mobile devices equipped with offline software and GPS devices to record household locations. Interviews were conducted in Spanish and, where necessary, in Tikuna, the community’s own language. The team also carried out two field stays during 2022, one in the rainy season and one in the dry season, conducting fourteen semi-structured interviews with healers, midwives, community leaders, teachers, and health professionals, alongside participant observation and a social cartography workshop.

The technical findings reveal a health system that exists mostly on paper for the Arara. Although 97.9 percent of respondents were formally affiliated with Colombia’s General System of Social Security in Health, actual use of Western services was low. The nearest hospital with primary care capacity lies in Leticia, roughly 20 kilometers away by boat, and 97.3 percent of respondents who did receive institutional care had to travel there to get it. Departmental data show that Amazonas has 12 service sites, 137 beds, and just two mobile units for a vast, river-dispersed territory, with no public ambulances recorded in the dataset and a workforce skewed toward generalists rather than specialists. Sixteen percent of respondents said they would not seek Western care even for serious health problems, and only 10.6 percent attended routine medical appointments or check-ups.

What the numbers describe, the qualitative accounts explain. Traditional healers in Arara do far more than treat symptoms; they maintain what the community understands as balance between territory, spirits, and people. Their treatments include medicinal plant infusions and baths, prayers, smoke rituals, dietary restrictions, spiritual dances, and cleansing of the surrounding environment. Illness itself is categorized differently than in biomedicine. Alongside headaches, which 35.3 percent of respondents reported, and respiratory infections at 19.8 percent, the community recognizes conditions with spiritual origins, including spiritual harm or bewitchment, a condition called pecho abierto or open chest, and pérdida del cigarrillo, the loss of a baby’s spiritual protection after a fall or shock. A former Curaca, a traditional Magüta authority, told the researchers that the elders’ remedy was always found within the community, not in the city.

The survey also mapped the social architecture of traditional medicine, and it turned out to be gendered in unexpected ways. Among respondents aged 14 and older, 94 percent attributed importance to traditional healers and midwives, with no statistically significant difference between women and men. But participation in the traditional system followed distinct gendered patterns: 12.1 percent of women identified as midwives compared with 2.1 percent of men, and women were also more likely to be apprentice midwives, while men predominated as prayer healers and showed a non-significant tendency toward bonesetting. Education mattered too. Individuals with higher educational attainment were more likely to resort to pharmacies or self-care, whereas use of both health institutions and traditional healers was more frequent among those with lower educational levels, a counterintuitive pattern that suggests Western schooling does not simply displace traditional health beliefs.

Then came COVID-19, and the community’s response became a natural experiment in medical pluralism. Traditional healers interpreted the virus’s arrival through dreams, receiving a vision that the virus was destined mainly for whites or settlers and would not seriously affect Indigenous peoples, a reading that shaped early perceptions of the threat. Yet the community did not reject biomedical prevention outright. Among residents aged 12 and over, 76.9 percent wore face masks in public, 63.5 percent practiced regular hand washing, and 47.8 percent followed quarantine measures. These were layered with traditional practices: 23.5 percent used herbal remedies, 19.7 percent used vapor treatments with medicinal plants, and 14.9 percent observed community diets, collective restrictions that suspended dances and football matches and closed the community to outsiders. One traditional medical leader described the settlement filled with incense smoke that protected those inside it.

Treatment patterns during the pandemic confirmed where trust lay. Of the 223 people who reported having contracted COVID-19, 80.3 percent identified the illness through symptoms alone, without laboratory testing, and about 80 percent refused diagnostic tests when health workers went house to house, with some believing the tests themselves could transmit the virus. Among the infected, 40.8 percent relied exclusively on traditional healers, 36.8 percent combined traditional medicine with support from family and friends, and only 5.4 percent used treatments based solely on Western medicine. Hospitals were perceived as places of death rather than healing, with one community leader stating bluntly that intubation was what killed patients. Vaccination revealed a more negotiated picture: 87.2 percent of the population received at least one vaccine dose, but only 70.8 percent completed the full schedule, as fears circulated on WhatsApp that the vaccine contained a chip or could transform people into animals, and traditional authorities recommended limiting the number of doses.

The researchers are careful about what these findings do and do not show. They document meanings, preferences, and constraints rather than a fully developed service-level integration between the two systems. High formal affiliation with the Colombian health system, they conclude, does not translate into trust or routine use of biomedical services. The authors trace this mistrust to a longer colonial and postcolonial history in which official systems privileged biomedicine as modern and scientific while Indigenous knowledge was stigmatized as backward. Colombian law, including Law 21 of 1991 ratifying ILO Convention 169, formally recognizes Indigenous medical practices, and initiatives such as the Indigenous and Intercultural Health System, SISPI, aim to articulate them with the national system, but structural barriers, institutional racism, and mutual distrust have kept these efforts largely normative rather than operational.

What emerges instead is what medical anthropologists call intermedicality: a selective, negotiated, community-mediated relationship between therapeutic systems rather than a binary choice. The Arara did not treat biomedical care, home remedies, and ritual practice as mutually exclusive; they combined them according to the meaning of the illness, the perceived appropriate response, and the practical conditions of access and trust. Crucially, Indigenous authorities acted as gatekeepers and mediators, determining when public health measures became acceptable and when vaccination teams could enter the community. This suggests that vaccine hesitancy in Indigenous settings cannot be reduced to misinformation alone; it is also bound up with cultural autonomy, historical grievances, and the legitimacy of outside intervention.

The study’s implications are direct. The authors argue that intercultural health must be understood not as an abstract principle but as a lived practice grounded in respect, negotiation, and genuine recognition of Indigenous knowledge. That would mean health services that are not only geographically accessible but capable of engaging with local understandings of illness and community authority, stronger local primary care capacity, better communication between traditional leaders and health institutions, and training that prepares health professionals to work respectfully within Indigenous realities. The researchers also acknowledge limitations: the survey instrument was adapted from tools designed for a mestizo-Western population, the qualitative component relied on a small number of interviews, and the study captured community perspectives far more deeply than those of health providers. Even so, the Arara case delivers a clear message to global public health: in Indigenous territories, formal coverage on paper means little without trust, and trust is built through the community’s own authorities, not around them.

Subject of Research: The interaction and coexistence of traditional and Western medicine in an Indigenous Tikuna community in the Colombian Amazon, including health-seeking behavior and responses to COVID-19.

Article Title: Integration of traditional and Western medicine in the Arara community, Colombian Amazon

Article References: Fernández-Ortiz, Y. N., Amaya-Lara, J. L., Ariza-Ruiz, L. K., Barrera-Aguilera, D. C., Vivas-Sánchez, P., & Mejía-Rocha, M. M. (2026). Integration of traditional and Western medicine in the Arara community, Colombian Amazon. Discover Social Science and Health, 6(1), Article 96. https://doi.org/10.1007/s44155-026-00428-0

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00428-0

Keywords: traditional medicine, Western medicine, Indigenous health, Colombian Amazon, Tikuna, COVID-19, vaccination, intercultural health, medical pluralism, health-seeking behavior, medical anthropology, public health policy