INDIGENOUS HEALTH AND

ADAPTATION TO CLIMATE CHANGE

Peruvian Amazon

Status Report

By:

César Cárcamo

Irene Hofmeijer

Alejandro Llanos

Carol Zavaleta

Peruvian

Amazon

www.lib.utexas.edu/maps/americas/peru_veg_1970.jpg

Peruvian

Amazon

Ethnic Groups

• Loreto:

–Shawi

• Ucayali:

–Shipibo-Konibo

Region: Loreto

Province: Alto Amazonas

District: Balsapuerto

Communities:

1. Nuevo Progreso

2. Puerto Porvenir

Region: Ucayali Province: Coronel Portillo Districts: Calleria;

Iparia

Communities: 1. Panaillo 2. Puerto Consuelo

Source: Esderas Silvano Source: Google Maps

Community

Characteristics

SHIPIBO SHAWI

Community PanailloPuerto

Consuelo

Nuevo

Progreso

Puerto

Porvenir

Population 250 300 350 500

Access

5hr by boat

(Dec – June)

2hr by car

(July – Nov)

3hr by boat1hr motocar

+ 1hr walking

1hr motocar

+ 5hr walking

Western

InfluenceHigh Moderate Moderate Low

Project Management

• Administrative lead: – Cayetano Heredia Foundation (CHF)

• Dr. Alejandro Llanos

• Dr. Cesar Carcamo

• Management:– Indigenous Health unit (CHF)

• Dra. Carol Zavaleta

• Dr. Isaac Alva

• Connie Fernandez (Biologist)

• Associates: – Global Health Unit (CHF)

• Dra. Patricia Garcia

– Faculty of Public Health – Epidemiology department (UPCH)• Dra. Magaly Blas

• Angela Bayer (Sociologist)

– Tropical Medicine Institute (UPCH)• Dr. Eduardo Gotuzzo

Partner Organizations

• AIDESEP - Interethnic Association for the Development of the Peruvian Amazon

NATIONAL

• CORPI-SL – Regional Coordinator of the Indigenous Peoples of San Lorenzo

• ORAU – Regional Organization AIDSEP Ucayali

REGIONAL

• FECONACHA – Federation of Native Communities of Chayahuitas

LOCAL

• Indigenous Groups:

Partner Organizations

• Ministries of Health:

– Loreto

• DIRESA Loreto

• Red de Salud Alto Amazonas

– Connie Fernandez

– Ucayali

• DIRESA Ucayali

– Epidemiology department

» Dr. Cayo

– Environmental health unit

» Ing. Saenz

Partner Organizations

• Others:

– Peruvian Amazon Research Institute (IIAP)

• Virginia Montoya (Anthropologist)

• Elsa Rengifo (Biologist)

• Manuel Saudre (Agronomist)

• Jose Choy (Agronomist)

– National Meteorology and Hydrology

Services (SENAMHI) – Loreto Branch

• Marco Paredes (Engineer)

Collaborators

• International Labour Office

– PRO 169

• Liliam Landeo (regional coordinator)

• www.pro169.org

• Instituto del Bien Comun

– Ucayali

• Carlos Arana (regional coordinator)

• Mario Osorio (in charge of SICNA)

• www.ibcperu.org

Objectives• Primary Objective:

– Estimate incidence in indigenous

communities of:

• Water / airborne disease:– common diarrheal infection; intestinal parasitic diseases; cyclosporidium;

leptospirosis

– respiratory infections ( flu, bronchitis, etc.); neumonia

• Vector-borne disease: – malaria; dengue; leishmaniasis; yellow fever; arbovirus

• Skin diseases: – Scabies; miasis; bacterial and fungal diseases

• Sexually transmitted infections

• Food-quality

• Secondary Objective:

– Identify individual / behavioural /

environmental risk factors associated to

Cohort Study

• Implement community based

prospective cohort study:

– Size: 1,000 approx

– Length: 3 years

– Frequency:

• Baseline study start of year 1

• Additional study end of year1, 2, and 3

• Every three months for water/airborne diseases

– Will allow to determine seasonal variations

Methods

• Standardized questionnaire:

– Socio-demographic characteristics

– Health-related knowledge and behaviours

– Perceived health status

– Recent Illness

– Use of health care

Methods

• Clinical evaluation:

– Assess nutritional status

– General health status

• Including hypertension

– Skin lesions

• Traces of leishmaniasis

– Febriles

Methods

• Anthropometrics:

– Height and weight

• Laboratory tests:

– Malaria thick smears

– Leishmaniasis skin test

– Yellow fever and Dengue IgG,

– Glucose test

– Syphilis treponemic test and hematocrit.

– Ova and parasites stool analysis

Methods

• Entomological surveillance:

– To be carried out by MoH at study sites

• Water quality:

– With support from MoH

– Experience and tools to locally test for:

• Fecal coliforms

• Turbidity / conductivity

• pH

• parasitology

– Heavy metal testing must be done in

Lima

Ethical Considerations

• Community approval:

– Already obtained from community leaders

– Approval must be reconfirmed

– Could result in modification to methodologies

• Local indigenous coordinator:

– To help communicate the process before, during, and after the development of each research protocol

Ethical Considerations

• Treatments:

– Provided by MoH national programs:

• Malaria

• Leishmaniasis

– Provided by IHACC:

• Antibiotics

• Anemia

• Parasites

• Syphilis

Ethical Considerations

• Team members with experience

working with indigenous groups:

– Dr. Alejandro Llanos

– Dr. Patty Garcia

– Dr. César Cárcamo

– Dr. Isaac Alva

– Dr. Carol Zavaleta

Results Dissemination

• Annual coordination meetings with:

– Community representatives:

• Chief and project coordinator

– Indigenous leaders:

• National, regional, and local indigenous

organizations

– National authorities:

• Regional government and local municipality

– Ministry of health representative

– Other local collaborators

Thank you