River Health Project

Background

The province of Morona Santiago is perhaps the most remote and isolated of Ecuador. The roads serving the province have been improved substantially, but access from the southern Andes leaves much to be desired (image 1).

The area east of the “Cutucú Cordillera” practically lacks roads, and the only means to access the rural communities is by small aircrafts that utilize clearings in the jungle as rudimentary runways (image 2). Moreover, the only way of communication between these communities is by river.

Isolation is only one of the aspects of underdevelopment in this area. Overall healthcare is precarious. There are serious problems of malnutrition, parasitism, tuberculosis, malaria, and other diseases.

For these reasons we believed it was necessary to organize a healthcare system in a fluvial unit and integrate it with the fixed healthcare posts to deal with the current health problems, and additionally provide a human development program created in conjunction with the inhabitants of the region to address their needs.

Objectives

General Objectives

To create a Healthcare and Human development program in the basin of the Morona River, utilizing a Fluvial Medical Unit (FMU) in coordination with existing land healthcare posts.

Specific Objectives

1. To provide Primary Care in the basin of the Morona River and its effluents, Kangaime, Macuma and Wichimi.
2. To perform intermittent surgical brigades.
3. To conduct a study of the main healthcare problems of the region.
4. To determine an adequate model for development of the region with the joint participation of local inhabitants and a multidisciplinary team.

Program Description

The Ministry of Health ordered the construction of a Fluvial Medical Unit in a shipyard at the Ecuadorian Pacific Coast. The unit was transported by crossing the two ranges of the Andean Mountains to the Morona River, where it was baptized with the Shwar name of Tsunki Nua, which means “Goddess of the River”. Tsunki Nua was the base of the River Health Program (image 3).

Integral Family Health and Primary Care

The working area was divided in three zones along the main tributary rivers of the Morona. Three doctors and a community assistant rotated for ten days at a time, serving the Shwar communities situated along the rivers, gathering information about all families and taking care of the health problems according to the Family Health Program.

Surgical Program

Four surgical missions were organized. The health group was integrated by two surgeons, two anesthesiologists, one internist, a surgical technician and two multiple assistants. The surgical group took care of patients referred by the family doctors while the internist did medical consultations.

Investigation of Health Problems

All information obtained was recorded and analyzed in order to elaborate a baseline to have as a reference for evaluation of results.

Development Program

During the surgical missions we had meetings with the community and their leaders in order to find out their needs and interests as an input for a program in Human Development.

We understand that the Amazon region is a very fragile ecological system and any development program has to be carefully elaborated respecting the delicate nature equilibrium. In order to accomplish this purpose, we contacted sociologists, anthropologists and biologists of the University of Azuay, that were ready to participate in the program.

Program Results

During the first year of work the following information was obtained:

Consultations for promotion of health and treatment of pathology were as follows:

Consultations During 2006 and 2007:

We had four surgical missions and performed twenty surgical operations (image 19).

Unfortunately, some of the participating organizations did not fulfill their responsibilities for political reasons. The boat has deteriorated and the program has had to be suspended. We hope someday soon to restart the program.