Health Article

Ensuring everyone gets an equal chance to protect themselves from Covid-19

Travelling up rivers and mountains to help indigenous communities in remote parts of Peru make informed decisions about vaccination against Covid-19.

A woman in the Puno altiplano region is immunized by local personnel from Peru’s Ministry of Health. (DM)

The American continent accounts for the largest overall number of deaths and cases of COVID-19 recorded since the beginning of the pandemic. Access to vaccination for the most vulnerable populations there is limited and uneven: some countries have reached 90 per cent of their population with a full vaccination programme, while in others, this figure is no more than 20 per cent, a fact which exacerbates the social and economic inequality already present in this part of the world.

Two years after the beginning of the pandemic, Peru is the world leader with a mortality rate of 636 deaths per one hundred thousand inhabitants. The country has recorded over 212 thousand associated deaths and more than three and a half million cases, yet only 40 per cent of Amazonian communities were vaccinated against COVID-19 by March 2022, according to the Ministry of Health (Minsa).

In hard-to-reach areas characterized by diverse geographical features such as the Amazonian tropical forest or the mountains, Peruvian indigenous communities live with limited access to health services or information.

Vaccination processes, which proceed with ease in the cities, contrast with the slowness of the arrival of vaccinations in communities living in the heart of the forests or mountains, a situation aggravated by the disinformation, fears and rumours that circulate.

1 – The Peruvian Red Cross (PRC) team getting ready to leave by boat at the crack of dawn. (SC)
2 – The transport team manoeuvres to get around natural obstacles during the river passage. (SC)

Under the leadership of the Peruvian Red Cross (PRC), the International Red Cross and Red Crescent Movement has joined forces with Minsa and the indigenous organizations to facilitate community dialogue, with an intercultural focus, on the joint design of interventions, the provision of information and promotion of vaccination against COVID-19, for the indigenous population living in these hard-to-reach areas.

Thanks to this, 2,756 people in 70 Amazonian communities in the Ucayali, Loreto and San Martín regions received at least one dose of the vaccination against COVID-19. In addition, 623 people in 26 rural communities in the Puno and Ancash regions received at least one dose of the vaccination against COVID-19.

“We did not know the COVID-19 virus existed,” said Mariano Quisto, Apu (leader) of the Urarina de Mangual Amazonian community after a recent visit by the team from Minsa and the Red Cross. “This is the first time we have heard about it”.

1- The refrigerated vaccines are carried in motorized river boats and then transferred to lighter canoes to reach the communities. (SC)
2- Red Cross personnel on the way to reach the indigenous communities. (SC)

Accessing hard-to-reach areas

The responsible personnel, made up of health personnel, PRC specialists with the support of the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC), have to travel for three days in a launch, through rain and fallen trees to reach the Mangual community, situated among the meanders of the Amazonian River Chambira, which has not been reached by health services for several years.

The vaccines are transported through the tributaries of the tropical forests, where the temperature ranges from 30 to 38 degrees Centigrade, refrigerated in dry ice.

In the Lake Imiría basin, in the region of Ucayali, the Red Cross river boats also bring medical and humanitarian personnel, information and vaccines. In these communities, the radio is still the principal means of communication and dissemination of messages.

As explained by Segundo Mozombite, who lives in the area, the Internet is coming slowly and progressively to some small villages, so information on COVID-19 comes via WhatsApp. “People form groups or call each other and say that the vaccine is ‘666’, the mark of the beast, and they stick a chip in you,” he said.

‘’What I do know is that COVID kills people. It has not happened yet in the community, but I have decided to get vaccinated so I don’t get sick, because traders come by river and can bring the disease’’.
A resident in the Santa Hermosa community in the Peruvian Amazon region.

Red Cross personnel make home visits to bring information about Covid-19. (SC)

Community dialogue, core of the intervention

On reaching the communities, the priority of the personnel is to understand their needs and concerns about the virus, assess their health and promote community dialogue. So far, this has involved 2,760 people in 75 community assemblies, to guarantee their right to information and vaccination, respect for their independence and representation.

According to Minsa, the low vaccination rates in indigenous populations are for reasons which include difficulty of access to administer the vaccines, and the fear of the population because of the disinformation that they have received about it.

‘’What I do know is that COVID kills people,” said one woman in the Santa Hermosa community. “It has not happened yet in the community, but I have decided to get vaccinated so I don’t get sick, because traders come by river and can bring the disease’’.

The concerns about inoculation are resolved in their original languages based on scientific knowledge. This goes hand in hand with communication by loudspeakers, megaphones, trailers and home visits to deliver leaflets and other biosecurity materials like soap, alcohol and masks.

1- Women in the Puno altiplano region resolve concerns with Red Cross personnel. (SC)
2- Indigenous children participate in community dialogue at a local school. (SC)

Communities informed and vaccinated by their own choice

“Just as I became convinced by the good explanations they gave, I would like other people who are not inclined to get vaccinated to do so for their own and their families’ welfare”, added José, who went to get his first dose when his doubts about the vaccine were resolved. The vaccination is done by Minsa and perception surveys are conducted to understand the population’s interest in having the first and second dose.

“I feel great satisfaction as a nurse to see that those who came to be vaccinated did so happily, knowing that they were going to be protected and will come back for their second dose,” said Myriam Ríos, a nurse in a health centre in the Ucayali region. “This fills us with joy and gives is the strength to carry on fighting his disease”.

Meanwhile, in the communities living in the high Andes, some of them more than 3,800 metres above sea level, access to vaccination has been uneven due to the topographical difficulties and disinformation.

There, the personnel on the ground talk with the communities in Quechua, their mother tongue, to resolve their doubts. Among their chief concerns, emphasized Julio Mendigure, executive of the division within Minsa that addresses the needs of indigenous peoples, are the story of the vaccine as a method of sterilization of women, the low sexual performance that it can cause in men, the possibility of dying in the near future and that the virus is a divine punishment. “We are institutionalizing intercultural dialogue for vaccination against Covid-19”, Mendigure added.

1- Health personnel go to the homes of older adults to administer their vaccination. (SC)
2- The personnel work even after nightfall, despite the lack of electricity. (SC)
3- Minsa personnel administer vaccination with the support of the Red Cross. (SC)

The daughter of Rufina Luque, an inhabitant of Puno, was infected asymptomatically with COVID-19, but was getting worse. Before she saw her daughter sick, María did not have much faith in the vaccine, but she thought about it when she was receiving her first dose: ‘’You must get vaccinated; it does not cure us, but it does protect us”, she said. 

As part of this process of listening and sharing knowledge, the Peruvian Red Cross is providing communities with all the information that the population requires. In this way, they can receive the vaccine and be sure that the process carried out by the State is implemented to protect the health of its citizens.

Back in the Amazonian region of Ucayali, Cecilia Brito recalled that before the arrival of the awareness-raising and vaccination teams, there was a great deal of false information. She is a representative of the indigenous Shipibo people of the Regional Organization Aidesep Ucayali (ORAU), which carried out a survey in May 2021, which showed that over half the indigenous population opposed to being inoculated. “In the face of this reality, the organizations collectively answered the population’s questions with transparent information. This allowed us to achieve the objective of vaccination”, explained Brito.

Myriam Ríos is a nurse at the Bella Flor Health Centre in Ucayali, and has been living and working with the communities in the area for 18 years. Initially, she was doubtful about the awareness-raising before vaccination, but when she saw the announcement and answered the questions that her own patients asked her, she became more convinced about the process.

“I was apprehensive, but with many positive expectations,” Rios recalled. “In the end, it was very successful, because there were people who said that they were not going to get inoculated, who believed some of the myths and disinformation, but after the awareness-raising talks, they were the first to be vaccinated”.

A couple in the community of Jochi San Francisco, in Puno, show their COVID-19 vaccination card after being immunized. (MA)

The oringinal story in Spanish can be found here.

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