Health situation in the Amazon: Where we are and alternatives for moving forward

Today, we are going to talk about the health context in the Amazon: health management by indigenous communities, the health system in institutions, which is provided by the government and 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 Colombian Amazon covers approximately 42% of the national territory and includes the departments of Caquetá, Putumayo, Amazonas, Vaupés, Guainía, and Guaviare, as well as part of the departments of Meta, Vichada, Cauca, and Nariño, and that this region has the longest borders with neighboring countries.

About 75% of the Colombian Amazon is part of indigenous reserves, natural parks, or forest reserves. The parks and nature reserves are managed by the Special Administrative Unit of the National Natural Parks System.

It is important to mention that there are 62 distinct indigenous peoples in the Colombian Amazon, constituting 74% of the total indigenous population nationwide. 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 its own language and cultural characteristics. These peoples have cultural traits that unite them, identify them, and define their social order.

The issue of health in these indigenous territories requires our full attention and commitment, coordinating efforts with both public and private entities, always taking into account the territory as well as its water and mineral resources, fauna, and flora, which contain sacred sites of great symbolic importance to the communities. These sites require the constant care of a shaman and the respect of all. Proper care will ensure health and food for the population. These places mark the boundaries of their territory and generally do not coincide with the political-administrative division noted above, extending beyond municipal, departmental, and national boundaries. These territorial boundaries must be taken into account when designing and implementing public policies. For indigenous peoples, with their holistic view 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 a means of preserving health and maintaining ecological balance, because this is how it has been since their origins. Healings are framed within the traditional ecological calendar, taking into account variations in stellar cycles, rainfall, river levels, lunar cycles, annual shifts in the sun's vertical position, harvests, and abundance.

This health system uses preventive activities as its fundamental pillar; these are based on the shamans' communication with “the owners of nature” through “healings,” invocations, dreams, and spells that are intended to ask for permission and make the necessary payments to restore the energy balance of the ecosystem and, consequently, collective and individual well-being.

For these communities, illness has causes external to the body, such as: 1) revenge by hunted animals; 2) enmity from other people; 3) ill will from supernatural beings. The shamans' treatments act on the parts of the ecosystem that have been disturbed and also heal social dysfunctions. In several areas of the territory, the traditional health network is recognized, strong, and important, and remains the main source of health care.

With regard to 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 rules 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, are not provided when needed, and are of poor quality. The focus of services is mainly on care, programs are not adapted to local needs, and are not coordinated with traditional medicine.

This reflects to a certain extent that the General Social Security System for Health has not worked in the region, and for many years the crisis in the health sector in the Amazonian departments has been deepening, 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 incidence 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 sociocultural, demographic, political, economic, and geographic needs of indigenous and non-indigenous communities in the region. This model must take into account the principles of primary health care defined by the World Health Organization, such as universality, social justice, community participation in the definition and implementation of health agendas, and an effective health system response with the promotion, prevention, treatment, and rehabilitation services necessary to address priorities, among others, and apply the principles established in national health legislation.

To this end, it is essential to carry out extensive dialogue and consultation processes with all the key actors who must be involved in this process, thereby rebuilding trust in institutions. In indigenous groups, consultation must be carried out with legitimate representatives of the communities themselves.

There is no doubt that coordination between indigenous organizations and stakeholders is necessary to raise awareness of the situation and move forward in developing concrete solutions to this problem, thereby working to ensure the best health care for all indigenous communities, which will generate well-being and quality of life in our Amazon region.