Vale do Javari - Brazil-Peru Border
Consultants: Conrado R. Octavio e Lucas I. Albertoni
Collaborator: Beatriz A. Matos
2022
GEOGRAPHIC REACH AND INDIGENOUS TERRITORIES
The study covers the binational hydrographic basin of the Javari River and adjacent areas with special relevance for protecting the health of highly vulnerable indigenous peoples in initial contact in this region. A preponderant aspect for the definition of this spatial cutout are the main flows that impact the health of indigenous peoples in the region.
In this sense, the priority focal area covers the following territories: the Vale do Javari Indigenous Land in Brazil; the Matsés Native Community, Fray Pedro Native Community, Nueva Esperanza Native Community, Yavarí Tapiche Indigenous Reserve, and the proposed Yavari Mirim Indigenous Reserve in Peru. In these territorial categories are located 83 villages and annexes (66 in Brazil and 17 in Peru).
Regarding the political-administrative units, cities or localities that have a relationship with the health situation of the indigenous peoples of the Javari Valley, the study covers the cities of Benjamin Constant, Tabatinga, Jutaí, São Paulo de Olivença, Eirunepé, Ipixuna, Guajará, and Cruzeiro do Sul, in Brazil; and those of Requena, Iquitos, and Caballococha, in Peru. Among the natural protected areas, the Cujubim Sustainable Development Reserve (a state conservation unit in Amazonas that borders the eastern sector of the Vale do Javari IT), the Matsés National Reserve, and the Sierra del Divisor National Park were considered.
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:
INDIGENOUS PEOPLES
The priority target population of the study is made up of the isolated indigenous peoples on both sides of the border and the Korubo, Tyohom Dyapá, Kanamari, Kulina Pano, Marubo, Matis, Matsés, in Brazil; and Matsés and Yagua in Peru. These people live in the Javari Valley and neighboring areas in Peru, especially in the Yaquerana district, where most of the people self-identify as native or Amazonian Indians – which basically corresponds to the Matsés people. The territory is considered to have the highest known concentration of records of the presence of isolated indigenous peoples in the world, mainly on the Brazilian side, but also on the Peruvian side.
As far as linguistic affiliation is concerned, the Kanamari and Tyohom Dyapá are part of the Katukina family; the Korubo, Kulina Pano, Marubo, Matis, and Matsés, of the Pano family; the Yagua, of the Peba-Yagua family. Although the language spoken by the different isolated indigenous groups in the region is still unknown, ethnographic data and information gathered to date by government agencies, civil society organizations, and researchers suggest that they also belong to the Pano and Katukina linguistic families.
Box 1: Indigenous peoples, linguistic affiliation, and general population by territorial category in the priority focus area of the report
|
Indigenous peoples, linguistic affiliation and general population by territorial category in the report's priority focal area
|
|||||
|---|---|---|---|---|---|
Box 2: Records of the presence of isolated indigenous people in the Javari valley (Brazil)
Sources: Population data: Sesai, 2019 (Kulina Pano, Marubo, Matis and Matsés at TI Vale do Javari); Sesai and CTI, 2019 (Kanamari); Oliveira, J., 2019 (Korubo); CTI, 2019 (Tyohom Dyapá); Cedia, 2020 (Matsés at CN Matsés); Instituto del Bien Común, 2018 (Matsés at CN Fray Pedro); Puertas, P. & Vela, A., 2018 (Yagua na CN Nueva Esperanza). The data presented in the table do not include the population of Cruzeirinho villages, belonging to the Matsés people, and Campinas, belonging to the Kulina Pano people, both in Brazil, outside the Vale do Javari IL. According to Sesai data, their population is 209 and 77 people, respectively. Legal status and area: Funai, 2021 (TI Vale do Javari); Instituto del Bien Común and Ministry of Culture (Native Communities and Indigenous Reserves). *The Supreme Decree 002-2018-MC, of March 15, 2018, recognized the indigenous people in isolation in the Yavarí Tapiche Indigenous Reserve as belonging to the Matsés, Remo (Isconahua), Marubo peoples and others whose ethnic belonging was not possible identify; and, in the proposal of RI Yavarí Mirim, as belonging to the Matsés, Matis, Korubo or Kulina Pano and Flecheiro (Takavina) peoples
|
Records of the presence of isolated indigenous people in the Javari Valley (Brazil)
|
||
|---|---|---|
Source: Funai, 2017
ANTHROPOLOGICAL CONTEXT
Health and illness among indigenous peoples in the Amazon
For any action in the field of health care among indigenous communities to be successful, it is necessary to take into consideration and respect the conceptions and practices linked to traditional systems of illness and healing.
Amazonian indigenous peoples’ conceptions of health and illness are closely related to those linked to the constitution of persons and of corporeality, which differ in many important aspects from non-Western indigenous biomedical conceptions. For example, for Amazonian indigenous peoples the person is always multiple: composed, in addition to his own body, of “souls,” “doubles,” or “spirits.” Not only human persons, but animals, plants, and other beings also possess or are “spirits,” and such spirits interact in many situations with the component spirits of human persons.
From this perspective, many dietary rules have these conceptions as a foundation, as does the use of plants to strengthen or heal the patient through the influence of the spirit of the plant on the spirit or spirits of the patient. Also, according to several Amazonian indigenous traditions, this evil that befalls the spirit or spirits of the person is the effective cause of almost all illnesses. It is up to the shaman or other specialists in interspecies or supernatural communication to recover the patient, through their techniques of manipulation, singing, trance, displacement of their own spirits or auxiliary spirits, to recover the alienated spirit of the patient, so that he or she can return to a healthy state.
It is important to emphasize that such conceptions about illness and healing do not annul the indigenous people’s own understanding that the illnesses with which they began to live after contact with non-indigenous people are caused by pathogens such as worms, viruses, bacteria, etc. Most of the time, there is a separation of the two domains on the part of the indigenous people, who usually classify some illnesses that affect them as “white people’s illnesses” and others as “indigenous people’s illnesses,” seeking medical treatment when they understand that they are white people’s illnesses, and shamanic treatment when they understand that they are illnesses caused by attacks by spirits. Thus, it is possible and of fundamental importance that non-indigenous health agents have a respectful and non-confrontational attitude toward such conceptions and practices. The role of indigenous specialists must be recognized and respected, so that health actions are carried out integrating and dialoguing with the traditional practices of the communities in question.
SOCIOECONOMIC OVERVIEW
Activities and surroundings of the indigenous territories
On the Brazilian side, Atalaia do Norte is the main city of reference and where most of the commercial exchanges carried out by the indigenous people of the Vale do Javari Indigenous Territory are concentrated. It is a space of fundamental socio-political importance for the indigenous peoples, due to the centrality it plays in their relations with the public authorities, the non-indigenous population, and several other agents and institutions. As in most Amazonian cities, Atalaia do Norte has great deficiencies in sanitation, which have a decisive impact on the quality of health of the majority of the indigenous population on the Brazilian side of the Javari basin, due to the large number of indigenous residents and the intense traffic between the villages and the town.
In Peru, the Javari River is the only river access to the Yaquerana district which has an airstrip and subsidized flights by the Peruvian Air Force (FAP) on a weekly basis from Iquitos. Currently there is illegal construction of a road in the region. Several institutions have warned about the impacts and risks of this road for the protection of indigenous peoples – including those in isolation – and for the integrity of their territories in the Javari basin. Migratory flows and transformations in the dynamics of occupation and land use resulting from the construction of this road are important aspects to be taken into account and monitored with regard to epidemiological surveillance in the region.
The district of Yavarí, in Peru, also assumes great importance in local socioeconomic processes. The district encompasses the stretch of the lower Peruvian Amazon on the Brazil-Colombia-Peru triple border, where the most densely populated stretch of the Javari basin is located, and also the most intense transit of people, boats, and goods. Regular river routes connect the district of Yavarí to an extensive commercial network that includes everything from Iquitos to Manaus. Land routes connect communities in the middle Javari to the city of Caballococha in the lower Amazon; and the international airports of Leticia and Tabatinga regularly connect the triple border to more distant spaces. This is an extremely porous and dynamic border area, which is the main entry point to the Javari basin and is of outstanding importance to several licit and illicit networks.
PRESSURES AND THREATS
And how they affect isolated indigenous peoples (PIACI)
One of the main territorial threats to the isolated indigenous peoples in the Javari Valley is the presence of groups of fishermen and hunters that have increased throughout the extension of the Vale do Javari Indigenous Land, including in places that have Funai bases, frequently accompanied by threats and even attacks on indigenous people, workers, and members of institutions that operate in the region. In the context of the covid-19 pandemic, this situation has worsened. In view of this scenario, the complexity of the relations of territorial sharing between isolated and contacted indigenous peoples, the recent contact processes that occurred in Vale do Javari, and the imminence of new contacts, the adoption of effective measures that safeguard the life and territorial integrity of the indigenous peoples of Vale do Javari becomes urgent.
In the region comprised by the upper course of the Jutaí and Jandiatuba rivers, their tributaries, and the areas of the Itaquaí river interfluve, where the largest number of confirmed isolated indigenous presence is located, besides the invasion of hunters coming from Eirunepé, intense pressure of miners is also registered. Gold dredges and rafts have been operating in the Jutaí basin for at least 20 years. Their operations are concentrated in the rivers Boia, Mutum and in the Jutaí itself – the first two are its tributaries. According to reports collected by Nascimento (2019), around 300 rafts operate in the region, with the largest concentrations on the Boia river and one of its tributaries, the Preto igarapé.
On the Peruvian side of the border, one of the main territorial pressures on isolated indigenous people in the Javari Valley is logging activity. There are records of numerous logging concessions in the region, as well as camps and the presence of groups of illegal loggers in areas where the presence of isolated indigenous groups is reported.
EPIDEMIOLOGICAL PROFILE
Prevalence of infectious and contagious diseases above the national average
The epidemiological profile in the region is marked by the high prevalence of infectious and contagious diseases in all age groups, but especially among children under 5 years of age. The infant mortality indicators in the Atalaia do Norte municipality and the districts of Yaquerana and Yavarí are higher than the national averages for Brazil and Peru, which is an important data about the quality of health in the region.
The main morbidities registered were diseases of the respiratory system, specifically upper respiratory tract diseases, mostly caused by viruses. Another pathology widely reported was malaria, mainly in its vivax form, with indicators at very high levels even for an endemic area such as Vale do Javari. In the group of children under 5 years of age, the morbidity indicators of acute diarrheal diseases also stand out, indicating a deficiency in sanitation in this region, since these pathologies are mostly waterborne. Another important indicator in the region is the presence of viral hepatitis types B and Delta, highlighting the high prevalence and low incidence of the disease, which may demonstrate an effective control of the pathology through immunization and prevention of vertical transmission in recent years.
The health actions aimed at this region should prioritize actions to control the transmission of infectious and contagious diseases through prevention, protection, and immunization. The control of the circulation of these diseases generates, consequently, a cordon sanitaire around these highly vulnerable people. It is important that this control considers broader factors such as territorial security, guaranteed access to clean water, control of deforestation, illegal mining, and the circulation of invaders in the territory, ensuring the effectiveness of the sanitaire fence.
HEALTH SYSTEMS
In Brazil, the peoples of the region are served by the Special Indigenous Health District (DSEI) Vale do Javari, of the Special Indigenous Health Secretariat (Sesai), an agency linked to the Ministry of Health. In Peru, the public health system is structured in different insurance modalities, and the indigenous population of the Vale do Javari region is mostly served by the Seguro Integral de Salud (SIS).
In both Peru and Brazil, the systems rely on local health agents: Indigenous Health Agents (AIS) and Indigenous Sanitation Agents (AISAN) in Brazil, and Health Promoters in Peru. The public health services of the two countries also have as a common strategy the performance of home and community visits – carried out by the Multidisciplinary Indigenous Health Teams (EMSI) of the DSEI in Brazil, and by the local health teams and the teams of Atención Integral de Salud a Poblaciones Excluídas y Dispersas (AISPED), as well as occasional health missions of the Navy, in Peru.
In Brazil, with the exception of the Hospital Municipal de Atalaia do Norte; the Emergency Care Unit (UPA) of Tabatinga, of medium complexity, and the Hospital de Guarnição de Tabatinga (HGuT), of medium-high complexity, the health facilities in the Vale do Javari region correspond to the first level of care. Therefore, they are establishments that develop health promotion, prevention, diagnosis, and low complexity treatment activities.
Within the Vale do Javari Indigenous Land, there are 8 territorial clusters under the responsibility of health teams, called Base Poles. When the Indians need treatment in the city, they are welcomed at a support home (CASAI) in Atalaia do Norte or in Tabatinga. Cases that require highly complex care are usually referred to the Hospital Pronto-Socorro (HPS) August 28, in Manaus, where they are also housed in a CASAI. Besides the establishments mentioned, eventual cases that require specific care can be referred to other reference units of the SUS network.
In Peru, the Matsés have as their reference the health center located in the Buenas Lomas annex, on the Choba River (CN Matsés), and the Angamos Health Center, both linked to the Angamos micro-network. The Yagua of Nueva Esperanza are referred to the Nueva Esperanza Health Post and the Iceland Health Center, both linked to the Islandia microregion. Cases that require more complex care are referred to the Loreto Regional Hospital in Iquitos.
Table 17: Health establishments of the reference network for indigenous peoples of Vale do Javari (Peru)
|
Health Facility Name
|
Location
|
Level of Complexity
|
Category
|
Microgrid
|
Grid
|
District
|
|---|---|---|---|---|---|---|
Source: MINSA, 2022
Table 18: Health establishments of the reference network for indigenous peoples of Vale do Javari (Brazil)
|
Health Facility Name
|
Type
|
River
|
City
|
Indigenous
|
|---|---|---|---|---|
Source: Consultant’s elaboration, 2022
COVID-19
The Vale do Javari IT presents high vulnerability, mainly due to the low availability of Intensive Care Units (ICUs), and the consequent long distance required to be traveled by patients in cases that require highly complex treatment. Besides this, the adversity of interethnic contact makes it difficult to face the epidemic process for the following reasons: (1) inequity in their living conditions and health situations; (2) infectious diseases introduced into indigenous groups tend to spread rapidly and reach a large part of these populations, with severe manifestations in children and the elderly; (3) high prevalence of different diseases and health problems in the indigenous population; (4) challenges to guarantee the isolation foreseen for suspected or confirmed cases in indigenous territories, whose dwellings often have a large number of residents.
Another fundamental aspect to be considered concerns the pressures and threats on the territories of isolated and recently contacted indigenous peoples, which intensify or even determine their vulnerabilities. In the cross-border context of Vale do Javari, several economic activities and also religious proselytism threaten and exert pressure on the territories and way of life of these peoples.
As a response to the effects of the Covid-19 pandemic in Brazil, the Special Secretariat of Indigenous Health (Sesai) released, in March 2020, the “National Contingency Plan for Human Infection by the Novel Coronavirus (Covid-19) in Indigenous Peoples” which was locally adapted according to the vulnerabilities and specificities of the region. In addition, human resources serving indigenous health were expanded to cope with the covid-19 pandemic. By the end of the study, Vale do Javari showed high adult vaccination coverage, approximately 75% of the indigenous people over 18 years old were vaccinated with two doses.
In Peru, the technical document “Plan de Intervención del Ministerio de Salud para Comunidades Indígenas y Centros Poblados frente a la Emergencia del COVID-19”, recognized the vulnerabilities of indigenous peoples, as they are a population with poverty indicators higher than the national average and where gaps in access to health services are evident. Due to these vulnerabilities, the plan proposed a transversal strategy that encouraged prevention, through a system of community surveillance and notification of suspected cases, and the increase in the resolutive capacity of health facilities at the first level of care. Among the prevention actions, the document highlighted: the preparation of health teams to enter the communities, dissemination of educational messages, organization and training of community leaders and health agents, active search for suspected cases of Covid-19 and respiratory symptoms, work safety for health teams, and increased capacity to access health facilities.
