Ecuador is a multi-ethnic country with a wide cultural diversity, made up of 18 indigenous nationalities and 14 traditional and diverse indigenous villages, which are distributed in different geographical areas of the country. In many cases, there are no roads to these communities, and entry is only possible by river or small aircraft transportation. The remoteness of the locations, among other socioeconomic realities, makes it difficult for these indigenous communities to access health services, a fact that represented a greater challenge for the execution of response activities to the COVID-19 emergency.
From the beginning of the pandemic until 26 November of 2021, there were 710,027 confirmed cases of COVID-19 reported among indigenous people in 18 countries of the Americas, of which 16,860 died from complications related to this disease (including 6,560 cases and 226 deaths reported in indigenous people in Ecuador).
In Ecuador, PAHO/WHO engaged with the local civil society organization Fundación Pachamama (Foundation Pachamama) to jointly plan a comprehensive, community-based intervention in the Achuar and Shuar indigenous communities to mitigate the pandemic’s impact, showcasing ways to maintain the continuum of essential health services in remote communities through the empowerment and training of indigenous women as community health workers (health promoters).
Through this initiative Ecuador enabled local civil society organizations (CSOs) to empower indigenous Amazonian women in becoming “agents of change” and engaging their communities against COVID-19 and future emergencies.
According to Narcisa Maschiento, Health Promoter on Maternal Health and co-founder of the pre-existing Program Ikiami Nukuri of the Foundation Pachamama, they have been working for 10 years on the topic of empowerment for Achuar indigenous women and on maternal and child health. For several of the health promoters (also known as community health workers ) not only did the workshops train them as professional midwives to understand the early warnings in pregnant women, and equip them with lifesaving tools as a way to give back to their communities, but they also felt respected and serving a purpose.
Through the various training offered by Pachamama and with PAHO's technical support, participant indigenous women have been able to realize the importance of their involvement to make their communities more resilient.
This community-based intervention showcased a way to maintain the continuum of essential health services in remote communities through training local indigenous health promoters (CHWs) as trained midwives. The series of diverse workshops on COVID-19 awareness, risk reduction efforts, and health promotion trained a total of 223 indigenous women from Achuar and Shuar territories in the Amazonian territory in Ecuador. These workshops included the training of 20 indigenous women as midwives for safe deliveries and the prevention of maternal and neonatal deaths; community and field trips with 2 trained health promoters from the Shuar indigenous community to discuss maternal health with 5 neighboring indigenous communities, each with around 30 to 100 inhabitants. Accompanying these efforts, 400 childbirth kits were distributed to support safe and healthy childbirth.
"I come here to collaborate with the women, with the health promoters of this area, to train them in care and assistance in gestation, childbirth, postpartum, and breastfeeding of the women of the Shuar communities. It is extremely important that the health promoters are trained, and that there are sufficient funds so that these women can return to their communities empowered and with new knowledge. In those areas where access is really difficult, they become a become of light for their communities."
Carmen Sivaichahuma, Professional midwife.
As the workshops evolved, Shuar men were included in addressing domestic and gender-based violence. The news of local men becoming allies for women’s and family health was welcomed by all communities. This activity marked the first step in a long-term plan to work to dismantle the generational cycle of violence.
Dr. Adrián Diaz, Family and Community Health Advisor at PAHO, stated that the main focus of the work with Fundación Pachamama, within the framework of this project, was threefold. “First, training and advocacy for the prevention of domestic violence and gender-based violence. Another element was the training and development of culturally appropriate messages for the prevention of COVID-19 aimed at Amazonian populations. And a third element, in particular, had to do with soap production. In the first place, it’s for the communities to have access to this basic input for hand hygiene, but a second element is for the health promoters [community midwives] to regularly use soap in optimal conditions for clean childbirth delivery”.
This story reflects activities supported by WHO’s Global Pilot Initiative in engaging with Civil Society Organizations in response to COVID-19. For the region of the Americas, PAHO led the initiative in collaboration with 7 CSOs in 4 countries (Guyana, Panama, Ecuador, and Guatemala). With the financial assistance of the COVID-19 Solidarity Response Fund, WHO provided direct financial and technical support to 54 local CSO in 40 countries, serving over 80 million people in situations of vulnerability.
The aim of the WHO global initiative was to streamline and scale up the involvement of civil society and communities as equal and integral partners to the national pandemic responses and recovery, following a “whole-of-society” approach to the COVID-19 response. This initiative targeted mitigating the impact of the COVID-19 pandemic on the most vulnerable through connecting communities and systematic engagement of community stakeholders in COVID-19 response and beyond.