Pneumonia, anemia, malaria, whooping cough, HIV, and chronic malnutrition are among the most common diseases of patients arriving at the health center in San Lorenzo, one of the key locations in the Peruvian Amazon, where more than 70% of its inhabitants belong to indigenous peoples.
In this city of the Loreto department, the largest region in Peru, about 60,000 people live, with a very young population: at least half are under 18 years old. Therefore, most of those who go to this public health establishment are children and adolescents.
However, the limitations of the center prevent covering many medical needs, forcing the sick to be referred to other urban centers. But the enormous distances and the scarce connectivity that Amazonian communities have faced for decades complicate these transfers and cause some families to give up seeking help.
The nearest reference for complex cases is Yurimaguas, 45 minutes by plane or about twelve hours of river travel from San Lorenzo, a journey that seriously endangers the lives of patients. Furthermore, the hospital in Yurimaguas does not have a Pediatric Intensive Care Unit (ICU) despite serving a predominantly young population.
"If Yurimaguas does not give us (a) solution, we have to coordinate with Iquitos," says Liseth Durand, head of health promotion in San Lorenzo, in statements to Europa Press. The referral to Iquitos further complicates the situation, as there are only two flights per week from San Lorenzo, while travel to Yurimaguas is possible daily.
In practice, a minor who cannot be treated either in San Lorenzo or in Yurimaguas may be forced to travel almost 850 kilometers to receive adequate treatment. This is described by Carlos Albrecht, health and nutrition officer of the United Nations Children's Fund (UNICEF) in Peru: "Let’s imagine that a child with pneumonia from Andoas, ten hours from San Lorenzo, arrives here (at the medical center) ten hours later and cannot be treated. He needs to go to Yurimaguas. If there are no small planes, it’s another ten or twelve hours until he is finally assisted, in case they accept him. If not, he would have to go to Iquitos."
To face this reality, the UN agency collaborates with indigenous organizations, Peruvian authorities, and funding from the European Union in strengthening early warning systems. The goal is for communities to be able to detect risks and activate rapid responses to emergencies not only health-related but also in the face of fires, floods, or gender-based violence.
Indigenous brigades and community committees in the face of emergencies
In this framework, community emergency and disaster committees are created, organized indigenous brigades, formed and equipped by entities such as UNICEF and Acción Contra el Hambre (ACH). These groups have first aid kits, stretchers, a computer to request support from local authorities, and megaphones to alert and inform the population when it is necessary to evacuate or react to an imminent risk.
At least five indigenous communities in the Datem del Marañón province already have these committees, including Trueno Cocha and Puerto Industrial, located five and 15 hours respectively from San Lorenzo by chalupa, a small motorboat. These risk management and emergency response teams provide a certain, although still limited, autonomy to more than 1,600 people living in these communities.
Vaccination campaigns and cold chain challenges
The UNICEF program includes immunization campaigns through "integral care brigades of ten, 15, or 20 constant days" that move to some of the most isolated points in the jungle, explains the person in charge of San Lorenzo. However, she emphasizes that bringing the vaccines in optimal conditions to the last settlements is a permanent challenge.
"We have the vaccines but the cold chain is very important. If we do not ensure the cold chain, we cannot reach the last village because we do not guarantee a safe vaccine. (....) Sometimes there are no points to feed back the chain and prevent it from breaking or they do not have the conditions for it," she points out.
When questioned about the local population's perception of vaccination, Durand acknowledges that cultural factors come into play. In the area, at least seven indigenous peoples coexist —awajún, wampís, kichwa, candoshi (kandozi), achuar, shawi, and chapra— in addition to mestizo population, each with their own worldviews.
"They have their culture, their way of thinking. Moreover, Christian groups have a bit of rejection. Some refuse because they say that the vaccine kills," he points out. In recent decades, evangelical churches —especially the Adventists— have gained influence among indigenous peoples, although there is also a presence of the Catholic Church.
Religious leaders and intercultural approach to save lives
In this context, awareness-raising actions are fundamental. The UNICEF team works with health personnel and community leaders to strengthen their communication capacities and provide clear information about the benefits of vaccines, as well as about nutrition and basic hygiene practices such as handwashing.
"We have also approached evangelical pastors to involve them in all these community mobilization activities in Datem del Marañón. We consider them very important for the dissemination of life-saving practices such as vaccination," says Ysabel Limache, social and behavior change officer at UNICEF.
At this point, the intercultural approach becomes particularly important, based on "knowing and understanding" the populations to which the intervention is directed, so that the strategies adapt to their sociocultural reality. For Limache, the key is "that people can feel that these activities are added to their daily lives, that they do not (...) generate any kind of questioning," which favors the continuity of projects over time.
Thus, users who visit health centers find informational materials in the indigenous languages of the area, as well as in Spanish. Likewise, women are allowed to give birth through vertical delivery, a traditional practice in which the pregnant woman gives birth standing, which reduces pain and facilitates the expulsion of the baby.
"This is reflected in the work we do with the apu -leader- of each indigenous community. We recognize who they are, how they are, what they think, the level of influence over families, over the decisions families make in health, in education (...) Because if you choose to strengthen what already exists in the community, you are creating conditions for those activities to remain over time once the institutions leave the territory," he explains.
Beyond the supply of equipment and materials, UNICEF emphasizes that the "integral perspective" and "social listening" are what allow communities to strengthen and organize themselves in an isolated environment, marked by decades of absence of the State.