The concept "people" refers to the set of features that characterize a human group in terms of their territory, history, culture, and ethnicity from which they builds a sense of identity (1,2,3,4,5,6). Indigenous peoples of Latin America are recognized as the direct descendants of the inhabitants of this region before the arrival of Europeans in the 15th century. These peoples have their own culture, language, and customs that differentiate them from the Creole way of life (the term “creole” refers to those who are not indigenous) (6).

With the western expansion at different times in history, many indigenous peoples suffered from sociocultural, economic, and political transformations (7). It is estimated there are between 45 and 50 million people of more than indigenous 600 groups living in 24 countries in America (the term “America” here refers to the whole continent from Alaska to Patagonia). The existence of these peoples constitutes the basis on which the plurality of multicultural, multiethnic, and multilingual societies in the region is built (8).

Based on the latest round of censuses available in Latin America, it is estimated that indigenous inhabitants in the region are 38 million, which represents around 7 % of the total population. Mexico, Guatemala, Peru, and Bolivia have the largest indigenous populations in absolute and percentage terms, concentrating more than 80 % of the total indigenous population (30 million). On the other side, Argentina, Venezuela, Paraguay, Costa Rica, El Salvador, and Brazil have the lowest percentage of indigenous populations, with El Salvador and Costa Rica being the countries with the lowest indigenous populations in absolute terms (13,310 and 10,143 inhabitants, respectively) (9).

In Venezuela, according to the 2011 census, 725.148 people declared to belong to one of the 51 ethnic groups that inhabit the country. Some of the most numerous are: Wayúu, Warao, Kariña, Pemón, Guahibo (Jivi), Kumanagoto, Añú, and Wótjüja (Piaroa) (4). These groups are concentrated in three regions: south (states of Amazonas, Apure, and Bolívar), east (states of Sucre, Delta Amacuro, and Bolívar), and west (state of Zulia).

The Guahibo/Guajibo people are originally from the Venezuelan and Colombian plains. Currently, it is a heterogeneous population that is scattered both in the southeast of the national territory and in the east of Colombia (5). In the state of Amazonas in Venezuela, they are located particularly in the municipalities of Atures, Autana, Atabapo, and Manapiare. Guahibos are established in the basins of the Sipapo, Autana, Cuao, Guayapo, Samariapo, Cataniapo, Paria, Parguaza, Ventuari, and Manapiare rivers; the road axes that connect Puerto Ayacucho, capital of the state of Amazonas, with the port of Samariapo to the south, the middle Cataniapo basin to the east, and the states of Apure and Bolívar to the north (4). In the state of Apure, Guahibos are located in the municipalities of Achaguas, Biruaca, Páez, and Pedro Camejo. In the state of Bolívar, most of the group resides in the municipalities of Cedeño, Gran Sabana, Raúl Leoni, and Sucre, on the banks of the Vichada and Orinoco rivers (from the Guaviare to the Meta river mouths), Tomo, Tuparro, Meseta, Bita, and Alto Capanaparo. In addition, they occupy some smaller channels of these rivers due to their fertility, in contrast to the open plain whose soils are poor in nutrients (2).

The Guahibo society is of the extended matrilocal type, that is, when a man marries, he moves in with his in-laws until he forms his own household. Preferential marriage occurs between cross-cousins (the male preferably marries the mother's brother's daughter), being prohibited between parallel cousins (the male cannot marry the mother's sister's daughter). Marriage is carried out by agreement between the parents of the two young people, with the male having to present a pre- and post-marital service to the father-in-law. In the communities with more contact with the Creole world, especially families living in Puerto Ayacucho, the trend is to adopt Western marriage rules (2).

In Guahibo communities there is no formal political structure. However, there are community chiefs whose functions include maintaining community unity, organizing community work, and serving as liaison with the Creoles. Currently, in each Guahibo community in Autana, Amazonas state, there is a captain and a commissioner. The former is appointed by members of the community and the latter is appointed by the regional government based in Puerto Ayacucho. Community control generally occurs informally, with the family being the nucleus of reference (2).

Traditionally, the cure for most illnesses is provided by the shaman, one of the most important figures within the Guahibo organization. In addition to providing care in cases of disease, shamans participate in divination and interpretation of dreams and in mediation with higher entities (5).

Health is one of the main problems for the indigenous population of Venezuela (4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27). Access to health services to receive conventional treatments has been affected by discriminatory national health policies and the state of isolation in which they live (28). Some consider their popular health care practices have allowed this population to survive over time (2,11). For years, they have had a limited access to health care, generating high prevalence of preventable diseases, which is higher than the rest of the population, with high rates of morbidity and mortality.

In addition to the limited access to health services, there is a lack of knowledge of Guahibo’s culture and language by the health personnel. This has created communication and attention barriers. Therefore, it is necessary the health professional acts in balance between knowledge, beliefs, and cultural practices indigenous people have about health, disease, life, and death. This could start with a fluid communication, a process in which the knowledge of the indigenous language is key (12).

The Guahibos do not escape this reality. Being immersed in a political, economic, and social system that is alien to their cultural essence, like most of the indigenous peoples of America, they are at a great disadvantage. Many of them do not speak Spanish, or do not know the political and legal order of the Creole society. Likewise, they are discriminated and isolated within the same system in which they are almost involuntarily immersed (5,28).

The health-disease-care process is understood as a universal fact that is carried out differently in each society. Each culture develops models of care from which it seeks to understand and face the disease and, if possible, recover health (13). This process can be affected by the geographical characteristics of indigenous settlements (14).

There have been some studies on the health of indigenous peoples in Latin America. Among others, the nutritional health of the indigenous population in Peru was studied (15). In Chile, an analysis of inter-culturalization and competencies in health practices with the indigenous population resulted in the improvement of health centers (16). The factors associated with dental caries and periodontal disease in indigenous peoples of Brazil have been investigated (17,18). In Ecuador, studies looked at the prevalence of caries in indigenous children (19).

In Venezuela, there have been publications on indigenous peoples’ health. A study on the chronology and sequence of permanent teeth eruption in Wayúu schoolchildren identified health protective factors related to cultural practices, such as a low rate of premature extractions, prolonged breastfeeding, and consumption of solid foods at an early age (20). Temporomandibular joint dysfunction (TMD) and the chronology and sequence of eruption of permanent teeth of members of Wayúu communities were also studied (21). Another investigation in this indigenous group found a high prevalence of caries, dental fluorosis, periodontal disease, and TMD (22). Another study described communication problems between dentists and indigenous people (23).

Investigations in the dental field have also been reported in Pemón communities (24), as well as in Sanema and Ye'kuana people established in the state of Bolívar (25). In the state of Mérida, the use of medicinal plants for oral health was studied in the indigenous communities of Lagunillas (26). In Delta Amacuro, a study looked at the cultural knowledge on prevention and treatment of oral diseases in the Warao community of Delta Orinoco (10). In the state of Amazonas, analyses have included cultural knowledge on the prevention and treatment of oral diseases in the Wótjüja people of Autana. Those studies have concluded that the knowledge of indigenous peoples is composed of a syncretic practice that contemplates their empirical wisdom through the use of medicinal plants, mineral products, animal products and religious rites, together with conventional dental practices (27).

Health intervention mechanisms are influenced by people's perceptions, which may arise as a syncretism as a consequence of the influence of Western health practices (27). The perceptual process is the highly complex sensory-cognitive mechanism by which the human being feels, selects, organizes and interprets stimuli, in order to better adapt them to their understanding and allows them to subjectively form a coherent and meaningful picture of the real physical world of which they are a part. Thus, it identifies, retrieves, and responds to the information received through the senses (29).

Regarding the health-disease process in the dental field, the perception people have can influence preventive and curative care practices and determine, somehow, its success (10,26,27). The literature reviewed shows the general and oral health conditions of indigenous Venezuelans are precarious (20,21,22,23,24,25). In addition, in Venezuela there have been no studies on the oral health of the Guahibo people, particularly, their perception of oral health. Therefore, the present study aimed to analyze the oral health perception of members of the Guahibo community in the municipality of Autana, Amazonas state, Venezuela.

A qualitative descriptive study with a phenomenological design was carried out. It used observation techniques and interviews with indigenous informants (30). The study sought to characterize a concrete situation indicating peculiar features and distinctive characteristics, from the perspective of the Guahibo community. It reflects, as much as possible, people’s reality, their world vision, and situation. We used some ethnographic tools to describe and interpret events or situations in the natural contexts where they occur, in this case, some Guahibo communities of the municipality of Autana, state of Amazonas, Venezuela.

The study group consisted of 44 people of the Guahibo ethnic group from Isla del Carmen de Ratón, Autana municipality, Amazonas state, Venezuela. They were women, men, older adults, shamans, heads of family and representatives of the ethnicity. The number of participants was sufficient to qualitatively study the perception of oral health in the Guahibo community.

For data collection, ethnographic interview techniques (semi-structured, unstructured, and informal), participant observation, and extensive field notes were used. All interviews and conversations were conducted in Spanish. In the cases in which informants did not speak Spanish, an interpreter helped. The Guahibo language has been classified as independent since it does not have the characteristics of any other native languages of Venezuela (5) (figure 1).

FIGURE 1 FIGURE 1 Questions Used in the Interviews Source: the authors.

The data collection instrument was the transcription book of the recorded interviews. For the interviews/conversations, interviewers first asked broad questions in Spanish, which sometimes were translated into Guahibo, to identify interviewees’ perceptions of oral health. Then, more specific questions were asked to help the interviewer get an idea of interviewees’ viewpoints in terms of risk factors, methods to prevent diseases, treatments used, and expectations or care needs, depending on the responses, until the conversation was limited to more precise content. There was not a standardized questionnaire and questions varied from one interviewee to another.

Other resources used during the interviews included a camera, a voice recorder, a laptop, a notebook, clinical records, a pencil and, occasionally, an interpreter.

44 members of the Guahibo ethnic group participated in this study. They belonged to the communities of Isla del Carmen de Ratón, Autana municipality, Amazonas state. 24 participants were males, of whom 21 were farmers and fishermen and 3 community leaders or representatives of the ethnicity. The other 20 participants were women; 2 of them were household heads or representatives of the ethnic group and 18 did housework. Their ages ranged from 15 to 65 years.

Up next we present the findings obtained in the field work. They are organized taking into consideration the categories on the perceptions generated from the analysis: prevention and treatment of oral diseases, recognition of oral diseases, and need for dental care.

The most commonly used method preventive oral health in the Guahibo community of Autana is toothbrushing or, lacking it, rinsing the mouth with water, which is the common denominator in terms of preventive measures.

Guahibo people, on the prevention and treatment of oral diseases, combines Western with the ancestral practices, using religious rites, plants, and mineral products.

The presence of disease is determined by the existence of pain.

The most commonly used treatments include plants and religious rites.

For future qualitative studies with the Guahibo community, it is necessary to spend more time collecting data to achieve ethnographic depth, including a period of immersion to become more accepted by the community members and more meaningful findings.

Moreover, the researcher ideally should have knowledge of the Guahibo language or, at least, have an interpreter who is a member of the community.

Due to the oral health care needs of the Guahibo community, it is necessary to design permanent medical and oral health care programs, to contribute to improve their quality of life.

Because of the difficulty to commute by dental personnel to the community and/or Guahibos to attend dental health care centers, we recommend training some members of the community as oral health care promoters.

Prevention and primary oral health care practices directed at the Guahibo people should respect their worldviews. Educational and therapeutic practices should harmoniously and respectfully link both perspectives, Western and indigenous.