Brazil - After more than six years of challenges and successes, MSF closed its Javari Valley project operations at the end of December 2000. Originally set up in response to cholera and malaria epidemics that threatened some of the world's most isolated indigenous groups with extinction, the Javari Valley project created a network of indigenous health workers and microscopists.

The health workers, some of whom encountered western culture for the first time less than 15 years ago, succeeded in dramatically reducing the rates of morbidity and mortality in the region.

MSF felt ready to leave following the establishment of a government health initiative creating special indigenous health districts. The government proposal is based in part on the model of community health workers and microscopists (who provide malaria diagnosis and treatment) implemented by MSF in Javari and other indigenous areas in Northern Brazil.

A local indigenous NGO, who has worked in partnership with MSF since the onset of the project in 1996, is now responsible for the management of the Javari health district. With the establishment of the special indigenous health districts, MSF's primary objective of ensuring access to health services for Brazil's indigenous population appears to have been met.

However, there are concerns regarding the government health initiative, especially regarding its marginalisation of traditional medicines and cultures. As the Brazil programme looks towards eventual closure, it will increase active assessment of the medical-humanitarian situation among the country's indigenous population.

The year 2001 foresees continuation of the MSF project in Tefe, building supervision, administrative and advocacy skills among local health workers, as well as collaboration with a regional indigenous NGO in preparation for Brazil's Third National Indigenous Health Conference in May.