Table 3 An ecosystem approach to anti-microbial resistance (CIHR funded)
Conceptualization, research and praxis | Accomplishments and challenges | |
|---|---|---|
Bio-security | Antibiotic resistance is now rampant due to many processes: short-term profit-seeking behaviour on the part of Big Pharma and food production industries; inadequacies in healthcare provision which lead to self-medication due to inaccessible medical attention or needed medication; and especially the social disparities related to infectious diseases and their transmission due to inadequate sanitation, clean water, proper housing and nutrition. | We collaboratively developed an educational guidebook for community health promoters that not only provided them with information on differences between viruses and bacteria, when antibiotics are not needed and how to manage common upper respiratory tract infection or gastrointestinal disease likely of viral origins, but also addressed the social drivers of antimicrobial resistance. Unfortunately, our research fell short of designing, implementing and rigorously evaluating the impact of using our educational tools in interventions in communities. This was partly because of the absence of surveillance systems for antimicrobial use, let alone antimicrobial resistance – precluding objective evidence of impact, and partly because changes in personnel at the Health Ministry hindered the implementation of a well-designed intervention study. |
- Health justice | ||
Sustainability | All organisms have a role in the complex ecosystems of our planet, and all life should be respected. The Ecuadorian constitution provides protection to nature independently of property rights. | Our discourse emphasizes the important role of microbes in the universe. Our collaborative Ecuadorian-Canadian team has been working to promote a “re-imaging of resistance” raising awareness that destruction of ecological integrity constitutes a threat to human health. We would have liked to contribute rigorous empirical evidence linking animal husbandry practices to increased antimicrobial resistance but were unable to do so. |
- Ecological justice | ||
Solidarity | Combatting antimicrobial resistance, embracing a social determination of health approach, requires promoting grassroots mobilization to demand changes to the drivers of antimicrobial resistance, including not only changes in policies regarding drug use, but also equal access to clean water, safe food and healthcare services. | We conducted several workshops with community health promoters as well as provided a certificate program for health professionals that required their conducting projects in their communities, thereby building local capacity to address the immediate as well as more structural determination of antimicrobial resistance. However, we have not been able to rigorously evaluate our efforts to date. |
- Social justice | ||
- Agency | ||
Sovereignty | Respect for indigenous beliefs and values is essential in promoting wellness and combatting the symptoms of minor infections. Ancestral knowledge, including the appropriate use of medicinal plants is to be encouraged. | We learned that merely incorporating information on how to use medicinal plants was a superficial way of trying to respect indigenous concepts of wellbeing, yet in order to maintain institutional support from experts who maintained that ancestral knowledge lacked an evidence-base, we could not give full appreciation to indigenous cosmology. |
- Epistemological justice | ||
- Interculturality | ||
- Respect for local expertise |