Saving Lives While Listening in the Amazon Basin

The death threat was real, and José Irumenga, 27, took it seriously.

It came not long after he began talking to his tiny Indigenous community in the Ecuadorean Amazon about using Western medicine, including vaccines, to fight a disease born on a distant shore.

His distrustful neighbors warned that if harm befell a single one of them, they would kill him. Irumenga, concerned, considered abandoning his mission to help support a full-throated and equitable response to Covid-19 in the Amazon basin.

“But then I told myself I’m coming with truth,” said Irumenga, who was trained to be a health promoter by the Hivos Foundation, supported by a grant from The Rockefeller Foundation.

He fought his fear and persisted. Today, his entire community of 845 people is fully vaccinated, and he is overseeing booster shots, thanks to the work of Hivos, which worked with Indigenous organizations in Ecuador, Brazil and Peru to establish the Amazon Indigenous Health Route.

Bridging Indigenous Organizations To National/Local Healthcare Systems

This innovative model of creating an integrated healthcare network underpinned with intercultural communication and centering the rights of Indigenous peoples has reached some 340,000 individuals in the Amazon, says María Moreno de los Ríos, an international nonprofit founded in 1968 that provides support to civil society organizations in Latin America as well as Africa, Asia and the Middle East.

Image is of José Irumenga and a young boy receiving a vaccine in the Amazon.

In all, Hivos and its partner organizations trained 134 healthcare promoters in three countries, developed 18 route maps to improve access to healthcare, created culturally relevant Covid material and developed an epidemiological surveillance app, that is community based and will provide data to Indigenous leaders, hence strengthening the information sovereignty of the communities. Also, in Ecuador, the leader of the Covid strategy in HIVOS provided technical assessment to the Ministry of Health to develop the specific guidelines for indigenous population in the vaccination national program.

Attending to such a high number of people, in areas of such difficult access, would not have been possible without the leadership of the Confederation of Indigenous Nationalities of the Ecuadorian Amazon (CONFENIAE) and the close work with the Ministry of Health. Having generated a reliable bridge between indigenous organizations and the National and local Health Systems is one of the greatest recognitions made to our work” – says Moreno de los Ríos

“Here we have an example of a trusted messenger: someone who really understands people’s lives, listens to their community’s perspectives, and builds a space that allows them to bring new ideas to the table,” said Emilia Carrera, a Rockefeller Health Initiative Manager. “This work reminds us of lessons we have heard throughout the Covid-19 pandemic: it takes more than just accurate information and lowering barriers to access. It’s about trust. We believe lessons from Amazon Indigenous Health Route will help us create a model that can be adapted to other communities.”

Image is of José Irumenga and members in the community.

An Opportunity Hidden in a Challenge

When Covid-19 hit, Hivos chose to regard it as an opportunity as much as a challenge. “We decided to take actions that would contribute not only to immediate needs, but to structural changes, so the system could help with more routine healthcare as well as the Covid-19 pandemic,” said María.

On-the-ground listening highlighted cultural value differences and the Indigenous communities’ emphasis on coexistence with nature and connection to the land.

Even when these communities decided to seek Western medical intervention, they faced several practical issues that stood in the way of a broad and successful response to Covid-19: medical centers that were difficult to reach due to the complex geographical reality of the Amazon, issues of distrust stemming from interacting with medical staff untrained in an intercultural approach, and disorganization that resulted in patients being sent long distances to a facility unequipped to handle their particular issue.

Hivos and its partner organizations decided the best approach would be to strengthen the capacity of community indigenous health promoters so they could serve as a bridge for their communities between ancestral knowledge and Western medicine, and to help them implement a community contact tracing system with cultural sensitivity.

“This has been a two-way process. As a medical doctor, I have learned a lot with the health promoters. We must value the wisdom they possess; and work with these two subsystems of knowledge that are not opposed but complementary”, said Patricia Granja, senior health expert and Leader of the Covid-19 strategy at Hivos.

Prioritizing Understanding each Community’s Culture

Convincing the communities to allow this was key, but before developing its messaging and prevention and care strategies around vaccines, the Amazon Indigenous Health Route conducted dialogues to understand indigenous perspectives—regarding not only Covid-19, but healthcare more broadly.

Image is of José Irumenga and members of the community in the Amazon.

“We do not try to convince people; this was a process of listening, of understanding their doubts, and discussing them, to be able to understand their approach and for them to understand ours. In this horizontal dialogue, in which we did not always agree, we were able to find common goals”, said Granja.

Irumenga agrees. Indigenous peoples have been living in the Amazon for thousands of years, slowly accumulating detailed knowledge of the rainforest, native plants and animals, and how to survive and thrive in that environment. His community is 75 miles from the nearest hospital, so self-reliance is key. They also revere the forest that, Irumenga says, has given them everything they need.

Although he is grateful for the role vaccinations have played in his community, he still deeply believes in the power of ancestral medicine, and nurses his own high blood pressure with a mixture of cat’s claw, mountain water, nettle, mountain herbs and menthol.

“We should treat ourselves with a mixture of ancestral medicine and Western medicine,” he says. “It’s not one or the other. The jungle and Mother Earth have much of what we need to keep ourselves safe. Western doctors won’t understand this until they open their minds.”

Image is of José Irumenga and and a woman from the Amazon.

In One Family, Healthcare Providers Over the Generations

Indira Vargas, 30, is another health promoter trained by the program who lives in Pastaza Province, central Ecuador. She comes to her work naturally; her grandparents were healers who believed the supernatural could also impact one’s soul and health.

Her grandmother also served as the community’s midwife, using plants to calm the aches of pregnancy and help women give birth. They did not believe in the efficacy of Western medicine.

When she contracted a serious case of Covid and had to travel many miles to be hospitalized for several days, “my mother and my aunts were very frightened. They said ‘You can’t go to the hospital; they will kill you there.’”

When she returned, she could share from first-hand experience how Western medicine had helped.

“We do believe that the health route has contributed to mitigating the impact of the disease in the communities. Still, it has also generated a reflection on the determinants of health and the pressures in the territories. We need this kind of initiative that gives way to models where interculturality ceases to be a mere discourse.” Granja said.

“When the pandemic started, my community felt the government didn’t prioritize their needs. They felt left out and ignored. Thanks to this work, they now feel included in the worldwide struggle,” Indira says. By the beginning of 2022, everyone in her community except children is fully vaccinated.

“I do believe the work of the Amazon Indigenous Health Route has saved lives,” she concludes.

She has not rejected her grandparents’ beliefs in ancestral medicine, but is working to broaden perspectives so that her neighbors’ approach to health can include Western practices.

“Things are changing generationally. I’m a feminist, working as a health promoter, and my husband is forward-thinking also,” she says. “Our daughter is going to grow up with a wider vision of life.”