Bringing Western Health Care to the Peruvian Amazon
The Achuar Indians live on the upper Pastaza River in the Peruvian Amazon near the Ecuadorian border. They are one of the four tribes of the Jivaroan family that inhabit the vast regions of northeastern Peru and southern Ecuador.
I initially went to the Peruvian Amazon to work on a wildlife project, and then became a forest guide. I started the U.S.-based Rainforest Health Project (RHP) with three other people because of the desperate needs of the people in the villages near where I was working. RHP, a small non-governmental all-volunteer medical relief organization, helps the Peruvian Ministry of Health cover areas it cannot reach because of cost, access, and environmental risks. We are licensed by the Ministry of Health to provide medical care in remote mestizo and indigenous villages, and provide the ministry with detailed reports after each medical intervention. We also have a Peruvian medical care provider on every trip. While our work uses Western medical techniques to treat an array of diseases, we also utilize (or try to recover) traditional medicine techniques in our clinics. In areas that show an interest we try to provide that information to local individuals.
RHP began its work with the Achuar in the Pastaza in August 1997 after receiving repeated requests from a couple of Achuar men from that region who were living in a mestizo area in which RHP was working. For the approximately 1,600 people we serve in the Pastaza area, RHP is the only organization that provides a form of continuing care, but we are also only able to make it to the region two or three times a year for 12 days at a time. Demand is high and we only work in villages that have requested our assistance. Achuar leaders are constantly contacting us to find out when we’ll be back.
Improving health is especially difficult to achieve in these areas because of language barriers and the fact that men do all the talking. Getting information from the women can be difficult to say the least. We start by doing the simplest of things, like giving bars of soap and rehydration salts to all the families we see, and constantly reiterating the basic rules of hygiene. Just this seemingly simple act can make a big difference. It takes many trips to villages to get the message across as to how to take medications, and during each trip patients receive information first from the RHP volunteer doctor or nurse who is treating them, and then from the pharmacist in both written and illustrated instructions (for those who don’t read).
Shamanism’s Changing Roles
In the last 30 years missionary and oil company influences have lured the Achuar out of the forest with the promise of manufactured goods, and into villages along the riverbanks where they can be more easily controlled by both groups. Up until the early 1970s, the Achuar successfully resisted hundreds of years of colonial and missionary subjugation. They were the last of the Jivaroan tribes to succumb.
Achuar often blame a shaman from another village or tribe for sickness or death. There is a great distinction between regarding a shaman as a healing shaman, or tsuakratin, and regarding them as uwishin who does harm to others. Shamanism among the Achuar is a jealous and competetive profession with each side going to great lengths to blame the other and have them “taken out.” Because missionary influence teaches that any type of spiritual healer is doing the devil’s work, since the 1970s most shamans, good or bad, have gone into hiding or been murdered by other Achuar. But people still use shamanic services where they exist. Broaching the subject of who might or might not be a healer is a touchy subject that makes people uneasy and suspicious.
Men’s dominance in Achuar society affects traditional beliefs surrounding health. Women disappear into the forest to give birth alone, and whether or not they return with a newborn baby, they are expected to continue life as normal, tending to the needs of their house, garden, and husband. Meanwhile, Achuar beliefs prohibit fathers of newborns from doing any type of hard labor. Last year, a week after holding clinic a newborn baby died. RHP workers were blamed, not because of an ingis (white person) disease or our medicines, but because we had allowed the father to carry our supply boxes out of the forest.
Some of the effects of these traditional beliefs on women’s health have become apparent during our work in remote villages. Among the Achuar, after giving birth, women may return from the forest with infections. Doing a pelvic exam is unheard of except in cases where the woman is actually likely to die. Even then the husband may not allow it and our medical team is forced to walk away.
Traditional Treatments and Medicine
Traditionally, Achuar women were expert gardeners taking great pride in their knowledge of food crops and medicinal plants. But knowledge or frequent use of medicinal plants is no longer a natural part of life because Evangelical missionaries have taught that they are part of the devil’s work. This knowledge has been forgotten, or secretly tucked away and mostly only used by the few elderly Achuar who are still alive. RHP has begun to collect some medicinal plant information from those elders for other villagers and local health care workers who come to our clinic and want plant information. By boiling water to prepare some of these traditional medicinal teas, patients are helping to combat parasite infestations. They are also drinking more water, which helps to prevent dehydration.
One of the most powerful customs of the Achuar is the drinking of manioc beer, or jiamanch. The mainstay of the Achuar diet, jiamanch is made from boiled manioc roots that are chewed and spit into a large ceramic pot where it is left to ferment. It is then mixed with water and drunk every day all day long. While this important cultural practice allows people to work all day without needing food, many of those we worked with grew up with stomach maladies like gastritis and bloating. After spending the day drinking jiamanch, Achuar boil up the leaves of the Wayus plant, and drink the tea to provoke vomiting to clean out their stomachs.
New Health Strategies
The Achuar remain deeply set in their traditional ways, but are inevitably influenced by the powerful outside world. Up until the Franciscan missionaries arrived at the turn of the 20th century, none of the indigenous people in the Amazon had ever seen a pill. Today, Achuar travel to Lima and meet with government officials to procure access to government programs. Some have even traveled out of the country.
The introduction of Western medicine has been necessary for the Achuar as contact has exposed them to infectious diseases for which traditional medicine offers little in the way of remedies. They are suffering from diseases that need immediate care and prefer pills to plants because the pills work faster. Prior to RHP’s first medical intervention with the Achuar in 1997, there were no records of any full-scale medical visits (other than sporadic government vaccination programs) in the region. Once the initial missionary groups had successfully finished their campaigns of religious conversion, they left the Achuar to fend for themselves in their new world without plants or pills. Villagers tell us that missionary groups still arrive via float planes on rare occasions but charge for their medicines.
Some Achuar who live closer to the Plus Petrol oil base reluctantly take patients with more severe problems to the company clinic, but most refuse to go. In the last two years government-sponsored “medical brigades” have shown up sporadically; villagers complain that these small teams only stay an hour at best and do not have adequate medicines.
With the arrival of the oil companies also came the formation of a small town that has brought the outside world and all its vices to the Achuar. Andoas was founded about 25 years ago and is a rough and tumble town of mestizo patrones, displaced indigenous people, and even a family from the highlands.
In Andoas, the Achuar have encountered prostitution, along with several new diseases. In May 2003, the local ministry of health medical post reported a rise in HIV-positive testing. In places where RHP visits, many of the children suffer malnutrition and inadequate hygiene. The latter is a cause of diarrhea, high rates of parasitic infections, and chronic skin disorders such as bacterial dermatitis, mycosis (fungal infections), scabies, and infected wounds.
Deforestation by the oil companies has also increased the amount of standing water near Achuar settlements, harboring malaria-carrying mosquitos. Most Achuar have suffered the effects of repeated bouts of malaria and its complications, many made worse by chronic malnutrition. The Peruvian Ministry of Health offers free treatment for both malaria and leishmanias, a protozoan infection transmitted by certain biting sandflies that causes a chronic growing sore on the skin or in mucous membranes that can be disfiguring. But local government-run medical posts are usually out of the medications for these diseases, so many people go untreated.
The Oil Company Dilemma
At RHP, we have only just begun to understand the Achuar culture. They are living in a time of confusion. Their customs are deeply rooted, but they confront a bombardment of inevitable changes that they have not yet been able to control or fully understand. The government continues to give concessions to the oil companies, and so it appears that the companies will always be there and continue to drill in new areas. An intertribal war is now brewing over whether or not a new base should be allowed on the pristine Huasaga tributary, about a two-day trip downriver from Andoas. Whereas one group of Achuar sees benefits that the company may bring—including possible employment, a place to sell their farm produce, payment for use of their lands, and company-paid education for their children—another group is more concerned about contamination and the destruction of their lifeforce, the jungle.
Just exactly how much disease can be attributed to petroleum contamination from oil spills is unknown, but it is an inescapable reality that fish and water are not consumable on a couple of rivers.
Plus Petrol, which took over the Andoas base from the Occidental Petroleum Corporation in late 1999 provides emergency care for anyone who makes it to its on-base employee clinic. They have also flown patients with life-threatening problems to Lima and Iquitos for treatment. The company also provides seats on its airplanes for village leaders who need to get into Iquitos or Lima, and give boats, motors, and monthly gasoline stipends to villages in the areas in which it works. Plus Petrol has worked with some villages to build schools and wells.
Plus Petrol also provides seats for RHP medical teams, gas for our boats, land transportation between rivers when needed, and housing for our first and last nights’ stays in the Pastaza region. Without the aid from Plus Petrol, we would not be able to reach these faraway villages.
Working Toward Good Health
Indigenous advocacy groups have recently begun educating the Achuar about their rights and on what they can request from oil companies, such as money for college educations, wells and schools, cash settlements, and cattle and fish farms. Such education is a start, but it is also important that the Achuar are well-represented in government so that they can derive the most advantage from the wealth generated from their land.
When I was on the Pastaza last September delivering first aid packages, every chief and health promoter I met requested help with training, saying education was one of their most urgent needs. In 2004 RHP will be restructured into a new U.S.-based NGO that will support the work of our local Peruvian nonprofit Proyecto de Expediciones Medicales. This new organization, along with the help of Plus Petrol and the Ministry of Health, will offer training courses for health promoters in Achuar communities. We will teach basic first aid, hygiene, how to recognize and treat common illnesses, and how to recognize when a patient needs to be taken to the nearest health facility. We hope to eventually offer scholarships for health promoters to further their studies in Iquitos or Lima, and provide the necessary equipment and medicines they will need in their villages. With this support, Achuar communities will be better equipped to handle many of their own health needs.
Patricia M. Webster (firstname.lastname@example.org) is a founder of the Rainforest Health Project USA, and founder and president of Proyecto de Expediciones Medicales Peru.