Primary Health Care in the Peruvian Amazon during COVID-19: perspectives from Indigenous nurse technicians

Abstract

IntroductionIndigenous peoples of the Amazon basin, in Peru and elsewhere, suffered disproportionately from the impacts of the COVID-19 pandemic. In part, this was due to an initial lack of support by the Ministry of Health, who did not prioritize their care despite their vulnerable situation. Consequently, during the first wave of the pandemic, health professionals in public health facilities in Amazonian Indigenous communities had to handle the disease with limited information and resources. This article analyzes the actions carried out by Indigenous nurse technicians during the first wave of the pandemic. MethodsRecurrent semi-structured interviews with six Indigenous nurse technicians focusing on their measures toward disease prevention and caring during the first wave of the COVID-19 pandemic in the Atalaya province, Ucayali region, in the Peruvian Amazon.ResultsNurse technicians worked closely with local authorities and volunteer health promotors. The limited resources they had at the health facilities, coupled with no training about how to treat COVID-19 symptoms led them to resort to their knowledge of traditional Indigenous medicine in combination with biomedical approaches, and support from Indigenous healers. Our analyses shows that this approach proved essential to alleviate symptoms and prevent complications and new infections.ConclusionsThe actions implemented by the Indigenous nurse technicians strongly contributed to the management of COVID-19 in their Indigenous communities, being both effective and culturally appropriate. Our data is in support of a health provision concept that bridges medical knowledge systems in contexts of diversity, avoiding a view on Indigenous health practices as antagonistic or in competition with biomedical practices provided by public health services.

Consultas médicas per cápita en el sistema de salud del Perú, 2019. Hacia una nueva descripción del sistema de salud peruano

“…Ello implica la convergencia de todos los recursos y programas del estado para transformar el espacio territorial de un foco de enfermedades y exclusión, a ecosistemas que generan salud y calidad de vida (42) , sumadas a diversas estrategias orientadas a los problemas y características de cada territorio. Eso implica un sistema de salud de geometría variable adaptado a la realidad local, donde puedan desplegarse las mejores prácticas disponibles en nuestro medio, orientadas a la complejidad de los escenarios locales: despliegue de equipos móviles de atención (43) , fortalecimiento de articulaciones comunitarias (44) , recuperación de saberes tradicionales (45) , tecnologías de apoyo a las intervenciones de salud pública en los territorios (46,47) , poner en valor intervenciones como los Comités Locales de Administración en Salud (CLAS) (48) , un ejemplo de varias estrategias de participación y empoderamiento ciudadano en salud (49) , etc. Todas estas iniciativas pueden traducirse como lo plantea Andy Stirling, en una creciente cartera de innovaciones dirigida a transformar la acción del estado en salud a partir de un nuevo modelo de construcción y gestión del territorio (50,51) orientado al desarrollo sostenible y al bienestar, lo que implica la generación de nuevas capacidades de innovación en el diseño y gestión de las políticas públicas en el estado peruano (52,53) .…”