Health situation in the Amazon: Where we are and alternative ways forward

Today, we are going to talk to you about the context of health in the Amazon: the management of health by the indigenous communities, the health system in the institutions, the one provided by the government and by private institutions, and some of the determining factors for health problems, the situation of diseases and the need to find alternatives to overcome many of the problems that we are going to show you.

Let us remember that the extension of the Colombian Amazon corresponds to approximately 42% of the national surface and includes the departments of Caquetá, Putumayo, Amazonas, Vaupés, Guainía and Guaviare and part of the departments of Meta, Vichada, Cauca and Nariño and that this region has the largest borders with neighboring countries.

About 75% of the Colombian Amazon is part of indigenous reserves, natural parks or forest reserves. The parks and natural reserves are administered by the Special Administrative Unit of the National Natural Parks System (Unidad Administrativa Especial del Sistema de Parques Nacionales Naturales).

It is important to mention that in the Colombian Amazon there are 62 distinct indigenous peoples that constitute 74% of the total number of indigenous peoples at the national level. These groups represent approximately 13.3% of the regional population, although in departments such as Vaupés and Guainía they represent more than 60%. Each group has a particular language and cultural characteristics. These peoples have cultural traits that unite, identify and define their social order and are recorded in the narratives of myths.

The issue of health in these indigenous territories requires our full attention and commitment, articulating efforts with both public and private entities, always taking into account the territory as well as water resources, minerals, fauna and flora that contain sacred places of great symbolic importance for the communities, which require the permanent care of a shaman and the respect of all. Their proper care will ensure health and food for the population. These places mark the limits of the territory for them and generally do not coincide with the political-administrative division previously noted, surpassing municipal, departmental and national boundaries. These territorial limits must be taken into account when designing and implementing public policies. For the indigenous people, with their integral vision of the cosmos, health, culture, environment, self-government and education go hand in hand and are inseparable. The shaman is the protector and administrator of natural resources. Most tribes use “healings” or “prayers” as an instrument of health preservation and maintenance of the ecological balance, because that is how it was arranged from its origin. The healings are framed in the traditional ecological calendar, taking into account the variations of the stellar cycles, rains, river levels, lunar cycles, annual displacements of the vertical of the sun, harvests and abundances.

This health system uses preventive activities as a fundamental pillar; these are based on the communication of shamans with “the owners of nature” through “healings”, invocations, dreams and incantations that have the purpose of asking for permissions and making the necessary payments to restore the energetic balance of the ecosystem and therefore the collective and individual wellbeing.

Illness for the communities has causes external to the body such as: 1) revenge by hunting animals; 2) the enmity of other people; 3) the ill will of supernatural beings. The treatments of the shamans act on the parts of the ecosystem that have been disturbed and also cure social dysfunctions.

In several areas of the territory, the traditional health network is recognized, is strong and important and remains the main source of health care. Regarding the institutional health system, there is relevant legislation that commits the State to the health of the general population and indigenous peoples, but as in many cases, there is a gap between what the regulations stipulate and what happens in reality; for example, in most of the Amazonian territory, the health network is insufficient, health services are difficult to access, they are not provided when they are needed and their quality is poor. The focus of the services is mainly on assistance, the programs are not adapted to local needs, and they are not articulated with traditional medicine.

This reflects to some extent that the General System of Social Security in Health has not worked in the territory and for many years the health sector crisis has been deepening in the Amazonian departments, as evidenced by the high rates of infant mortality in children under 1 and 5 years of age and maternal mortality, with figures that often exceed the national average by more than double. These territories also have the highest incidences of tuberculosis and, if not given the required attention, probably also of HIV-AIDS. Therefore, it is essential to develop a health model that responds to the socio-cultural, demographic, political, economic and geographic needs of indigenous and non-indigenous communities in the region. This model should contemplate the principles of primary health care as defined by the World Health Organization such as universality, social justice, community participation in the definition and implementation of health agendas and effective response of the health system with promotion, prevention, treatment and rehabilitation services necessary to solve priorities, among others, and apply the principles established in the national health legislation.

To this end, it is essential to carry out extensive processes of dialogue and consultation with all the key actors who should be involved in this process and thus generate confidence in the institutions once again. In the case of indigenous groups, there must be consultation with legitimate representatives of the communities themselves.

Undoubtedly, it is necessary an articulation between the indigenous organizations and the interested actors generating awareness about the mentioned situation and advancing in the construction of concrete solutions to this problem and in this way working to guarantee the best health care to all the indigenous communities, which will generate well-being and quality of life in our Amazonia.