[National health policies and local decisions in Mexico: the case of an intercultural hospital in Cuetzalan, Puebla].
OBJECTIVE
To identify the changes brought about by various national and international factors in an intercultural hospital of the municipality of Cuetzalán, Puebla.


METHODS
A case study was conducted during 2000 and 2001 in two Intercultural Hospitals of Mexico; the Cuetzalán Hospital in Puebla and the Jesús María Hospital in Nayarit State. Data were collected by means of 72 semi-structured interviews with allopathic therapists, indigenous therapists, and authorities of the different health care levels. Moreover, documental research was carried out on national policies for indigenous peoples as well as on indigenist policies. These policies were related with the five organizational stages of the hospital. State authorities gave their permission and interviewees signed informed consent.


RESULTS
The hospital was created in 1958 by the Ministry of Health as a biomedical institution, in agreement with the integrationist indigenist policies going on at the time. It remained so during the beginning of the administration by the National Indigenist Institute. In 1990, the new participative indigenist policy trends and the creativity and sensitivity of some authorities, under the influence of international strategies, helped to transform the hospital into an Intercultural Hospital (offering both types of medicine, indigenous and allopathic) with regional coverage. In 2000, the devolution of the hospital to the State Ministry of Health, based on financial rather than socio-cultural considerations, caused the temporary loss of its intercultural character. The last stage as an Integral Hospital with Traditional Medicine (from 2003 onwards) was due to a combination of state official initiatives and the new political stance acquired by the Mexican indigenous movement. The hospital is now part of a regional project of five such hospitals officially denominated Integral Hospitals with Traditional Medicine, to be financed by the Puebla-Panama Plan of regional development.


CONCLUSIONS
Our results confirmed that health organizations follow a historical process in which selected national and international forces open opportunities to promote intercultural health models that respond to the needs of indigenous populations. Despite the formerly held belief that traditional and scientific medicines were incompatible, this study demonstrates the viability of intercultural health care models that may become a real possibility in the country, based on new conventions to establish alternative and intercultural health services, thereby setting an example for other regions and countries. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
Duarte-Gómez
María Beatriz
MB
Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. maria_beatriz_duarte@hotmail.com
Brachet-Márquez
Viviane
V
Campos-Navarro
Roberto
R
Nigenda
Gustavo
G
D018864:Cultural Diversity; D003659:Decision Making, Organizational; D006291:Health Policy; D006302:Health Services Research; D006303:Health Services, Indigenous / Q000458:organization & administration* / Q000592:standards; D006752:Hospital Planning; D006773:Hospitals, Municipal / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007198:Indians, North American; D008519:Medicine, Traditional; D008800:Mexico