Figure 8. Fluvial Unit "Tsunki Nua" in the Morona River.

The province of Morona Santiago is perhaps the most remote and isolated of Ecuador. The roads that service the region are in poor condition. 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. Moreover, the only way of communication between these communities is by a fluvial system.

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

For these reasons we believe it necessary to organize a healthcare system in a fluvial unit (fig 8), 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 necessities.

Objectives:

General Objectives:

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 – Provide Primary Care in the basin of the Morona River and its effluents. "Kangaime", "Macuma" y "Wichimi".

2 – Perform intermittent surgical brigades.

3 – Conduct a study of the main healthcare problems of the region.

4 – Determine an adequate model for development of the region with the joint participation of local inhabitants and a multidisciplinary team.

Program Description

Primary Healthcare

A healthcare team integrated by 2 physicians, 1 dentist and 1 nurse will navigate the rivers "Macuma", "Kangaime" and "Morona" 3 weeks per month, from "Tukupi" to "uerto Morona". Depending on the river conditions the service could be extended to other regions, including a Peruvian zone for which contacts are being established.

The healthcare team will provide primary care according to the programs established by the Ministry of Health. The following are a list of the programs:

1 – Information: Registration and medical records will be instituted for all patients, as well as visits to the communities to have and accurate and up to date census of all the population the FMU will serve.

2 –Immunization: with the same parameters used by the Ministry of Health.

3 – Growth and development in children under 5 years of age with treatment of the malnourished.

4 – Integrated management of prevalent childhood illnesses (IMPCI).

5 – School Children Health: this will be performed periodically aiming for early detection and treatment of diseases.

6 – Sexual and Reproductive Health: will include prenatal and postnatal care, if possible labor and delivery, education to midwives, planned maternity and early detection of cancer.

7 – Youth programs: sports and recreation, prevention of drugs, alcohol and smoking addiction.

8 – Attention of elderly and handicapped.

9 – Oral health: preventive and curative programs.

10- Mental heath: preventive and curative programs

11- Attention of general pathology

12 – Traditional Medicine: Gathering of ancestral knowledge of medicinal plants and its applications to be incorporated into therapy if opportune

13 – Environmental health: to address the problems with basic sanitation.

Surgical Brigades

We will conduct 3-4 surgical brigades per year. The teams will be structure by 2 surgeons, 2 anesthesiologists, 1 internist, 1 nurse and 2 auxiliary personnel. The team will perform approximately 15 surgeries, conduct consultation, and help in data gathering and interpretation.

Research Of Local Health Problems

The data collected by the" INEC" in the 2002 census will serve as a baseline for the population to be served. For all patient encounters a family record will be established, and based on the information gathered a strategic plan will be created to address the main problems documented.

Human Development Program Design

During the surgical brigades we will also conduct visits to families and meetings with local leaders to inquire about interests of the community in regards to a human development plan.

We are aware that the Amazonian Region is a fragile zone. On one hand we believe its people have the right to take advantage of scientific and technologic advances of modern civilization, while on the other hand our biased point of view of development can cause harm to the indigenous population and break the fragile Amazonian ecosystem as experienced in the Northeastern oil rich area of Ecuador

It is imperative to keep all these factors in mind so that once the information is gathered with the aid of a multidisciplinary team integrated by healthcare personnel, anthropologists, sociologists, and other professionals in conjunction with the local communities discuss and elaborate a model of development for the region.

To facilitate the execution of the program communication via Telemedicine will be established to allow consultation with the CINTERANDES Foundation and Universidad del Azuay, and MITAC (Medical Informatics and Technology Applications Consortium) of Virginia Commonwealth University in the United States.

This project is a joint effort between the Ministry of Health, Petroecuador, the Provincial Council of Morona Santiago, the University of Azuay, the CINTERANDES Foundation and other institutions.

Currently the Ministry of Health with the sponsorship of Petroecuador has built a fluvial unit that is in the Morona River, it has been named "Tsunki Nua", which in the Shwar language means goddess of the river that delivers health. The final details are underway to initiate the program.