Madidi - Bolívia - Peru Border
Consultant: Rodrigo Tarquino
Collaborator: Fritz Villasante
2022
The prioritized area of this study is located in the heart of the Madidi National Park and Natural Integrated Management Area in Bolivia, in the department of La Paz and on the binational border with Peru, department of Madre de Dios. In the central focus is the territory of the Indigenous People in a Situation of Isolation called Toromona and its surrounding areas.
In Bolivia, the areas colliding with the Toromona are the so-called Terras Comunitarias de Origen (TCOs) of the native indigenous peoples that in the region make up the territories of 7 original peoples: Tacana, Leco, Tsimane – Moseten, Ese Ejja, San José de Uchupiamonas and Araona. In Peru, in the Region of Madre de Dios, the study focuses on the Ese Eja people, in the communities of Sonene, Palma Real and Infierno.
MAPA INTERATIVO
Observe no mapa interativo do Módulo Povos Indígenas, onde se localizam os territórios indígenas na região amazônica e observe as regiões fronteiriças estudadas pelos consultores da OTCA:
ANTHROPOLOGICAL CONTEXT
Mobility, resistance and sedentarization of the peoples of the upper Rio Solimões
Ethnobotanical knowledge and the communities’ relationship with plants play a fundamental role in the healing processes, although the sustainability of this knowledge, which is passed on through oral communication, is more fragile due to the loss of language and the acquisition of other self-care habits.
Most of the Ese Eja communities in this Amazon region interpret illnesses as evils caused by “spirits” that enter the bodies via the eyes, and for this reason they also call them “mal de olho”. Generally, the containment of the evils caused by these spirits is done by restricting the consumption of certain plants and animals. When taken over by a “spirit”, the victim will feel ill, but this phenomenon is not necessarily considered an illness.
However, the medicinal use of plants is also used to treat bodily ailments and is the product of a historical process of relationship between ancestral and foreign knowledge. Due to the precarious access to health facilities, the medicinal use of plants is still widely used, as occurred in the COVID-19 pandemic when communities accessed ethnobotanical knowledge even before any government action.
ANTHROPIC THREATS AND TERRITORIAL PRESSURES
Activities and surroundings of indigenous territories
The study area is influenced by human territorial actions, with direct and indirect economic development projects that have great importance, especially in the municipality of Ixiamas in Bolivia. One of the main economic activities is forest exploitation. Part of this activity is legal, but the illegal activity usually comes from protected areas and indigenous territories in the region. The most common forest exploitation activities are hunting, plant gathering, expansion of the agricultural and livestock frontier, and logging.
In addition, there is the presence of activities related to drug trafficking in the communities surrounding the conservation unit, which undermines governance in the region due to the amount of resources and logistics that drug trafficking mobilizes. Furthermore, mining is an activity present in the region, which generates environmental liabilities and does not contribute with taxes.
EPIDEMIOLOGICAL PROFILE
Persistence of infectious diseases and social conditions of the population
The epidemiological profile in the region is related to the environmental characteristics and living conditions of the indigenous people in Peru and Bolivia. The main health problems identified in the region were Acute Respiratory Infections (ARIs) that generate recurrent episodes of outbreaks and epidemics in the region, in addition to requiring a greater presence of conventional medicine through medications provided by health centers. As for the Acute Diarrheal Diseases (ADDs), also quite present, the treatment with traditional medicines and local control has been more effective for these pathologies.
It was also verified that malnutrition affects mothers and children permanently; data suggests that mothers suffer from physiological anemia during pregnancy due to poor nutrition and end up transmitting it to their babies. Nutritional vulnerability is exacerbated by the changing economic and production matrix of many indigenous peoples that forces them to reduce hunting and fishing activities, increasing food insecurity. In addition, the high rates and frequency of reproduction prevent mothers from breastfeeding their newborns for more than 6 months. As a consequence, children as young as 5 years old presented symptoms of iron deficiency anemia, due to the lack of animal protein intake. It can be inferred that performance in schools is affected by malnutrition.
The adult population presented a frequency of diagnoses due to joint injuries and traumas, multiple osteoarthritis (traumatic osteoarthritis) due to their environmental exposure and way of life. We also highlight the high frequency of parasitic infections, very common throughout the population and age groups, which is related to the lack of basic sanitation services and hygiene habits. Parasites are more present at the extremes of the age groups, in children and the elderly.
HEALTH SYSTEMS
Health infrastructure in the region
In Bolivia the health system is organized on three levels: the first level is centers located in the communities, serving basic conditions and frequent illnesses. The centers have the capacity to resolve up to 80% of the illnesses suffered by the population. The second level is the hospital level, with specialized care, physical therapy and rehabilitation. At the third level are the high-resolution hospitals that have all medical specialties, including psychology services, tomography, milk bank, and cancer treatment. In the study area, most health services are concentrated in the first level, and only a few in the second level.
The health infrastructure in both countries is heterogeneous. In Peru there are several health facilities per district and a network connecting them. In Bolivia there are fewer health establishments, some in indigenous territories, but many lack the necessary personnel and equipment to attend to complex cases, and there is no connection between health establishments and administrative centers. In the community of Toromona, for example, when supplies run out, they have to travel more than 1,100 kilometers to Ixiamas (the capital of the municipality), the road is difficult to travel and is covered in two to three days, which makes access to health one of the most recurring problems in the region. On the other hand, the lack of access promotes the sharing of traditional knowledge about medicinal plants for the treatment of diseases.
In Peru, the Health Service is mixed, public and private. In the department of Madre de Dios most of the health establishments are basic level health centers. There are two establishments of greater complexity: the Hospital San Martin de Porres in the Iberian Peninsula and the Hospital Santa Rosa in Puerto Maldonado.
COVID-19
During the pandemic of COVID-19, between 2020 and 2021, the Amazonian indigenous communities of Bolivia and Peru shared their traditional knowledge among themselves and with the general population. During the first year of the pandemic, medicinal plants were widely used and fundamental for the treatment of symptoms. In addition, many communities developed control and prevention protocols in their communities, and adopted measures to restrict circulation. In the second year of the pandemic, with the arrival of the first conventional medicines and vaccines, the population resorted to conventional medicine. Bolivia, however, at the time of the study had not achieved good coverage of the vaccinated population.
The COVID-19 pandemic exposed institutional deficiencies in both countries, especially regarding communication with the indigenous communities, which was not very fluid and effective. Inaccurate information caused communities and residents to refuse, for example, vaccination. In addition, institutionalized and accurate data for decision-making at the community and municipal level was lacking. For example, it was not possible to obtain accurate information from indigenous communities, which hampered a better view of COVID-19’s development at the local level.
Another aggravating factor is related to the precarious living conditions of the indigenous communities in the region. Due to insufficient basic drinking water supply and sewage services, prophylactic measures for coping with COVID-19, such as cleaning the environment and washing hands, were hampered. In organizational and political terms, many of the decisions taken were centralized, and also without considering the heterogeneity of the population’s educational levels and access to health services. Due to the great social inequality that exists, the messages and decisions taken at the central level have not generated effective responses.
