The Vital Connection between Health and Land Use Policy in Paraguay

Emma Mitchell

By Charlie Feigenoff (Ph.D., English '83)
Emma Mitchell

Emma Mitchell
Photo by Tom Cogill

When Emma Mitchell, a nurse and graduate student in the School of Nursing, held a clinic last January in the Enxet village of Xamok Kasek in Paraguay, she realized that she was literally applying a Band-Aid to a complex social and political problem. Despite constitutional protections, the indigenous Enxet were displaced when the Paraguayan government opened their homeland in the Gran Chaco region to foreign cattle ranchers. The Enxet now live in remote villages or in communities that stretch alongside roads without access to potable water or protection for their harvests from grazing livestock.

“I was struck that the health and nutrition issues that the Enxet face are symptoms of a larger, systemic problem,” Mitchell observes. “I decided to study this connection.”

In collaboration with Tierraviva, a Paraguayan human rights organization, Mitchell and fellow student Julie Schexnayder returned to the Chaco last May to do just that. Their trip was supported in part by a Nursing Alumni Council International Scholarship.

While there, Mitchell and Schexnayder assessed the health status of three Enxet communities using the “community as partner” model—an approach they learned in a public health nursing course taught by Associate Professor Pamela Kulbok. This model helps researchers develop a detailed and comprehensive overview that incorporates such factors as demographics, belief systems, access to transportation, and educational opportunities, in addition to medical information.
Because the nutritional status of children in a community is an indicator of overall community health, Mitchell and Schexnayder measured the height, weight, and upper-arm circumference of children ages 2 to 18 years in each community to look for signs of chronic stunting. They supplemented these measurements by interviewing Enxet leaders to identify sources of nutrition and visiting a hospital for indigenous people in Limpio, the nearest city. “Because of finances, this hospital was open only in the morning and offered just the most basic services,” Mitchell notes.

Mitchell’s goal was not simply to document the health conditions the Enxet face and offer recommendations to improve it, but to provide evidence that Tierraviva could use in its cases before the Inter-American Court and Commission of Human Rights. Tierraviva maintains that Paraguayan land use policies are undermining the health of the Enxet. “We did find what appeared to be signs of stunting and malnutrition,” says Mitchell. “Tierraviva is submitting the report as evidence to the commission, and hopes to receive a favorable decision.”

Mitchell had the opportunity to present this research when she attended the annual doctoral nursing student forum at the 2007 Universitas 21 meeting in Hong Kong. Universitas 21 is an international network of 21 leading research-intensive universities in thirteen countries that includes U.Va. Her experience in Paraguay also confirmed Mitchell’s decision to focus on global health research for her doctorate. “I would like to study health interventions that local communities can more easily sustain over the long term,” she says.