Mobility and Health in the Amazon.... An update...
2007-10-20
IFRTD member, Diogenes Ampan and his team members are collaboratively working on a research study on the role of river transport in accessing conventional and traditional health services in the rural rainforest of Peru. A big part of their methodology consists of organising participatory workshops with indigenous communities to sensitise them on the relationship between rural access and overall health care and assess how they can overcome some of these challenges. During the first workshop held in January Ana Bravo, IFRTD's regional coordinator for Latin America participated and when the second workshop was held in March Diogenes invited IFRTD's Executive Secretary, Marinke van Riet to attend during her visit to Peru.
It took the team three days of travelling to the area one of which was spent on a motor boat, also called a chalupa. Most Awajun communities in the Cenepa area, bordering Ecuador, are dependent on water transport on dug out canoes or peke peke's (long tail boats). The two-day workshop was attended by representatives from youth groups, local authorities, health posts, traditional leaders, elderly, traditional healers, women's associations, in order to get a full picture from society. Some of the representatives had to travel far, even up to a whole day in roder to reach the community centre in Mamayaque in time. As part of the workshop participants worked in small groups and then had to be present their findings to the other members of the group. It was interesting to note that many women actively participated, in fact almost 50% of the participants were female and especially young women made thair voices heard. In addition to the workshop the team made visits to the various health posts in the areas and talked to the extension workers who were willing to share their experiences as well.
Although the research is only half way and final results will only be published early next year some of the preliminary findings are already worth sharing. In the Cenepa area the main problems with transport and health is lack of access to fuel for emergency transport to health clinics. Many people do have access to boats but fuel for the motors is scarce and expensive. This applies to the extension workers of the various health posts as well as the remote communities. This means that quite a few people are dependent on dugout canoes for their journey to the posts, significantly delaying their journey as well as increasing the risk of drowning on the treacherous river rapids.
Also in this area the three delay model as explained in the literature review can be applied. The first delay is the cultural and socio-economic conditions, the second is the accessiblity to the facility and the third delay lies in the quality of the care. Fortunately in the Cenepa area these delays have not resulted in huge maternal mortality figures due to obstructed labour and transport. This is thanks to a strong system of traditional health systems in which mothers assist their daughters during pregnancy and deliver, passing on this knowledge from generation to generation. Traditional health systems and healers are consulted by the majority of the population no matter their socio-economic background, before seeking advice from a western-educated health physician.
Other health problems were infections, arthritis, bronchitis and snake bites. For these health issues it was discussed whether an emergency fueld fund would be an appropriate local solution, although a final decision has not yet been agreed. This solution will surely come up during the next and final workshop as well as during household surveys yet to be carried out by the research team. The final case study will be published on this web site and will also be presented during the international symposium on Mobility and Health to be scheduled for the end of October.
