‘You’ve done nothing!’

As the Covid-19 pandemic ripples through Peru’s Amazonian communities, Stephanie Boyd reports on sinister official neglect and the people’s desire for healthcare combining the best of traditional and Western medicine.

A woman at breaking point as she queues along with other relatives of Covid-19
patients to try to recharge oxygen tanks for their loved ones at the regional hospital in Iquitos,
the largest city in the Peruvian Amazon. CESAR VON BANCELS/AFP/GETTY

There’s a note of panic in Mari Luz’s voice when she calls. ‘Señorita, it’s arrived,’ she says. She doesn’t have to say more: Covid-19 has reached her small village on the Marañón River, in Peru’s northern Amazon region.

I feel an upwelling of panic myself as I think of her elderly parents who still bathe in the river at sunset every day, her aunt, the wise and ancient village midwife, and the children, our teachers, guides and companions during the many visits my husband and I have made over the past six years. Our home in Peru’s southern Andean mountains feels hopelessly far away.

But this is not the moment to fall apart. Mari Luz Canaquiri, who runs a volunteer group – the Kukama Women’s Federation – and has worked on campaigns to defend the Amazon’s rivers and indigenous territory for 20 years, has called to strategize: I must alert health authorities and help co-ordinate donations of medicine and supplies to the villages in her district.

It is mid-May and despite quick actions by Amazon leaders in March, closing their communities to outsiders, the virus has found a way in. A local mayor in a neighbouring district was reported to have spread the virus by delivering food aid to indigenous communities. In Mari Luz’s area, the doctor at the health centre was accused of breaking the quarantine to travel and returning with the virus.

In one of the most oxygen-rich zones of the planet, people were dying for lack of air

Public deficiencies

Peru enacted one of Latin America’s most stringent early lockdowns to prevent the spread of Covid-19, but was unable to contain the disease. By the end of August, the country had the second-highest number of cases in the region, after Brazil. Peru has also had one of the world’s highest excess death rates – the number of deaths above the average in previous years – suggesting that the government’s Covid-19 statistics are drastically underreported. How did one of South America’s rising-star economies and darling of World Bank economists go wrong?

The obvious answer is that the government failed to invest in public services, most notably healthcare. In the past five years Peru has only spent 3.4 per cent of its GDP on health. (The Organization for Economic Cooperation and Development recommends spending 10 per cent.) When funds are spent they are often lost to corruption. Currently 14 projects to build rural hospitals have been paralysed due to misuse of funds.

The list includes the new regional hospital in my home province of Cusco, which should have been completed in 2014. Instead, patients must withstand a makeshift ‘temporary’ hospital in portable buildings on the military’s soccer field. The former regional governor in charge of the project currently resides in prison serving a sentence for corruption.

A report on the pandemic by Peru’s Ombudsman’s Office found public-health services ‘deficient in infrastructure, equipment, security, supplies of oxygen and medicine, personnel and administration’. In a word: everything.

Emergency – no rush

The problem goes beyond one of public spending, however; the pandemic has laid bare Peru’s systemic neglect and mistreatment of its indigenous population. Decades of abuse, including contamination from oil exploration and illegal goldmining and a lack of healthcare services and potable water have left native communities especially vulnerable.

In urban areas, the lockdown forced indigenous people, who survive precariously on daily earnings, to either stay home and go hungry or risk Covid-19. Isolated villages have faced a different challenge. Most are hours from the nearest ill-equipped health centre and were already suffering a dengue epidemic.

Health officials in the province of Loreto, where Mari Luz lives, estimate that 60-80 per cent of the population in urban centres have had the virus, but the lack of tests makes it impossible to know.

Anyone with foresight could see the looming disaster back in March, but the government waited two months before passing an emergency law for indigenous communities. By this time health systems in Peru’s northern Amazon had collapsed. Hospitals lacked beds, oxygen and medicine, and at least 17 doctors had died of the virus. In one of the most oxygen-rich zones of the planet, people were dying for lack of air.

Peru’s Minister for Health, Pilar Mazzetti, admitted that there were ‘difficulties’ getting the health plan for indigenous communities passed and said she had made it her ‘own personal challenge’. Her face beaming with pride, and with no hint of irony, the minister said she had not only ensured the plan was enacted; she had also secured the funds to implement it.

But indigenous communities say they haven’t seen improvements in public healthcare since the plan came into effect. In June, Mari Luz and other Kukama leaders attended a virtual meeting with health officials to discuss the possibility of setting up measures that would, perhaps, lead to implementing the indigenous health plan. Someday. Maybe.

Mari Luz chastised the Minister for Health: ‘I said, “You say you want to help but it’s been three months and you’ve done nothing. You could send helicopters with oxygen and medicine if you wanted to.” I said that to her face – well, to her image on the big screen.’

Non-profit and church groups have tried to fill the gaps. The Kukama Women’s Federation raised enough funds to donate medicine, cleaning supplies and food to eight villages as well as indigenous people stranded by the quarantine in the city of Iquitos.

Lost in translation

Even then there was trouble from health authorities. The doctor in charge of the only health centre in Mari Luz’s district refused to distribute the donated Tylenol (paracetamol) and aspirin to indigenous health promoters, claiming they lacked training.

‘What kind of training do you need to give someone Tylenol?’ Mari Luz asked. ‘It’s over-the-counter medication.’

Health promoters are recognized under Peruvian law and include midwives and other health agents. The Catholic Church has been running the health promoter programme in Loreto for the past 13 years, providing training and supplies. Father Miguel Fuertes, who runs the Vicariate of Iquitos, has publicly criticized the government for failing to work with health promoters during the pandemic. He points to a cholera epidemic in the 1990s when promoters were essential for providing basic health and communicating vital information.

Even when the government’s messages about Covid-19 reach indigenous communities, he says they’re often not understood. ‘It’s not just translating,’ he explained. ‘There are also ways of transmitting information. For example, there are indigenous groups that will never use the name of the illness because that would attract it or call it upon them.’

Juan Carlos Ruiz, a lawyer at the Institute for Legal Defence in Lima, says indigenous health agents are protected by international conventions. ‘The International Labour Convention 169 says that health services for indigenous communities have to be co-ordinated with the communities, giving them leadership roles and substantial participation in providing the services.’

Armed with a letter from Ruiz – and her own feisty constitution – Mari Luz travelled 12 hours to reach the health centre. The doctor still refused to comply, so Mari Luz took the medication her federation had donated and gave it to the health promoters.

In the end nearly everyone in her village of about 200 people contracted the virus, including octogenarian elders, but no-one died. Mari Luz credits the use of traditional plant medicine with aspirin and Tylenol for their recovery.

When Peru’s lockdown began, Mari Luz was trapped in Iquitos, Peru’s largest jungle city. She caught the virus in late April, before it reached her village, and treated herself with a mix of medicinal plants, Tylenol and azithromycin, an antibiotic a doctor prescribed for her respiratory difficulties.

‘I couldn’t breathe,’ she said. ‘I thought I was going to die.’

As soon as Mari Luz recovered, she called the members of her women’s federation, and gave them a list of plant medications to prepare, including an immune-system booster with bee pollen and camu camu, a fruit with so much vitamin C an orange seems like dried toast in comparison.

Indigenous leaders have accused the government of attempted ethnocide: a policy of ignoring the pandemic to rid the Amazon of its forest guardians who oppose oil exploration and projects to open the region to more extractive industries

A place of healing

Many government health officials see traditional medicine as witchcraft or myth, a system that threatens Western medicine. Rather than allying with shamans, midwives and health promoters, the under-staffed government clinics cling jealously to their medical monopoly. They fail to understand that most Amazonian communities seek to combine the best of both systems.

In the Kukama language, the word for any healing centre, including hospitals, is the same: mutsanakatupaka, which literally means a place for curing. Whether traditional or Western medicine is used, the idea of healing takes precedence over the method. The word ‘cure’ refers to both a physical and spiritual cure.

Mateo Italiano, a Machiguenga healer from the southern Amazon, also believes in combining Western and traditional medicine. ‘There are illnesses that the shaman can cure, and there are others for the doctor,’ he says. When someone comes to him with a disease or infliction that he knows he cannot treat – like a broken or dislocated bone – he sends them to a medical doctor.

Plant medicine has helped a lot of villages survive the pandemic, says Leonardo Tello, director of Radio Ucamara, a community media outlet in Nauta. He says centuries of epidemics – from smallpox brought by the first explorers in the 1500s to later deadly waves of measles, influenza and cholera – have taught healers which plants to use.

‘Instead of encouraging indigenous people to keep using these plants, the government has forced them to go to health centres,’ says Tello. In order to receive a support payment of $30 per month, families must attend poorly equipped health posts, many of them without doctors or adequate medicine.

‘This pandemic has shown us that the government has abandoned indigenous communities,’ he says. ‘It’s vitally important that we return to our medicinal plants.’ Radio Ucamara now has a respected woman shaman hosting a regular programme about plant medicine.

Peru’s Ministry of Health insists that its work with indigenous communities is based on an intercultural health approach. Rolando Luque of Peru’s Ombudsman’s Office disagrees. ‘We can’t say we have an intercultural state that is concerned about indigenous people,’ he exclaims animatedly. ‘What we have is historic neglect.’

In one weekend in May the Catholic Church in Iquitos crowdfunded enough money to build an oxygen plant and within a week was supplying hospitals and clinics. Why was Peru’s government unable to provide such a life-saving service? Was it only inefficiency, or is there something darker behind the lacklustre response?

Indefatigable organizer: Mari Luz Canaquiri on the Marañón River. MIGUEL ARAOZ/QUISCA

Clashing for care

Indigenous leaders have accused the government of attempted ethnocide: a policy of ignoring the pandemic to rid the Amazon of its forest guardians who oppose oil exploration and projects to open the region to more extractive industries.

Four years ago communities affected by contamination from an oil pipeline spill near the village of Cuninico in the northern Amazon signed a landmark agreement with the government for healthcare and an environmental clean-up. Two years later the provisions had still not been met. The communities protested and after lengthy negotiations signed another landmark agreement that the government, again, failed to implement.

Now they are dealing with Covid-19 without safe drinking water or healthcare facilities.

In mid-August frustrated Kukama leaders shut down an oil installation on the Ucayali River owned by PetroTal, a Canadian company, to protest the government’s lack of support during the pandemic. Communities had tried to self-isolate but the oil and mining industries have been allowed to continue operations, bringing migrant workers into contact with villagers. Leaders were also angry about decades of oil spills from leaky pipelines.

The police responded with violence: three indigenous protesters were shot and killed, ten more were injured and six police officers reported injuries. The bodies of the deceased were sent for autopsies to Iquitos, the far-off jungle metropolis. Mari Luz had to fight with government officials to have them returned to their communities.

‘The government is treating them like criminals, but they’re victims who were peacefully defending their rights,’ said Mari Luz, adding that the protesters did not have guns. ‘The families even had to buy sheets and packing tape to cover the bodies,’ she said.

The government’s disgraceful treatment of the PetroTal victims is indicative of its actions throughout the pandemic. Rather than recognizing historic neglect and mistreatment of the country’s indigenous population, and seizing this opportunity to make amends, Peruvian officials are only making the wound deeper.

Against these odds, Peru’s indigenous population is surviving the epidemic, as they have survived centuries of foreign diseases: with a combination of traditional and modern medicine and strong, communal support networks. Times and methods have changed, but their desire for mutsanakatupaka, the place for healing, lives on.