Co-building health with Amazonian indigenous communities in Colombia
The Amazon rainforest covers about 47% of South America —equivalent to 79% of the area of Europe— and is shared by 9 countries. The Colombian Amazon represents more than 40% of the continental area of the country, however, this region, despite being at the center of many current discourses, continues to be ignored in practice. The Amazon is often thought of as an untamed and barren jungle, the lungs of the world, devastated at dramatic rates by legal and illegal economic activities. However, for millennia, the region has been inhabited by indigenous peoples who coexist with all the dimensions they conceive of as territory, recognizing themselves as beings in this vast universe. These people have served as guardians of the forest, but their importance in the maintenance of these systems and their great ecological and cultural knowledge is generally ignored.
Vaupés is one of Colombia's six Amazonian Departments, and like the entire Amazon River basin, it is biologically and culturally diverse. Of its nearly 49,000 inhabitants, 82% are indigenous people belonging to 27 different peoples, bearers of knowledge and speakers of diverse linguistic families, several of which are at risk of physical and cultural extinction, most of whom live in dispersed rural communities.
The Colombian health sector has a limited and difficult-to-access network —concentrated in the municipal capitals—, a primarily assistance-based approach to services, programs that are not adapted to the socio-cultural context, and discontinuous over time. Many communities do not receive services for years. Maternal and infant morbidity and mortality rates are several times higher than national rates, and indicators of access to and use of services are among the lowest in the country. An intolerable situation.
Colombia has innumerable legal instruments aimed at guaranteeing the right to health for indigenous ethnic groups. However, operational advances to make these rights a reality are limited. These conditions are shared by dispersed rural areas throughout the country, where access to health services is fundamental to improving the wellbeing of communities and helping to build and sustain peace.
But what is health and wellbeing for these peoples? How are these concepts constructed in practice? What is needed for this? Who should do it? How are indigenous ancestral medicine and the institutional health system articulated? What services and how should they be provided in this context? When? What prevents people from being able to live in health?
In this context, and trying to answer these and other questions, since 2012 the purpose of improving access to primary health care services for various neglected diseases through an intercultural approach has been developed in 21 indigenous communities in the municipality of Mitú —capital of Vaupés—, this Exhibition portrays that journey. The co-authors of the process are approximately 2,400 indigenous people from 18 different peoples with whom an operational model of health care for the territory has been developed through participatory methods.
The process has required the building of trust with the communities through dialogue, coexistence and agreement on all the actions developed based on the priorities defined in the participation spaces. Likewise, it has been fundamental to generate alliances with local institutions to guarantee the articulation and complementariness of the work, avoid supplanting, and thus leverage the sustainability of these initiatives.
The model is based on 14 components, five of them cross-sectional. The first nine are: 1) Strengthening of local capacities, for communities, indigenous organizations and actors in the health system; 2) Family and community health; 3) Surveillance in epidemiological and community health; 4) Women's health; 5) Children’s health; 6) Mental health; 7) Chronic non-communicable diseases; 8) Neglected infectious diseases; and 9) Basic assistance. The cross-sectional ones: 1) Intercultural approach; 2) Food and nutritional sovereignty; 3) Communication in health; 4) Health information systems; and 5) Accompaniment, advice and supervision. The Exhibition will delve into each of them.
This Exhibition has been elaborated by Maria Camila Rodriguez, Adelia Prada, Maria José Montoya, Daniela Rangel Gil, Edilma Bastidas, Bayron Orrego, Juliana Bejarano, Juliana Jaimes, Yuli Rubio, Valentina Riveros, Rosa Gonzalez, Jeison Gutierrez, Felix Moreno, José Esteban Valencia, Marcela Botero, Gabriela Molina, Juliana Ángel, Wilber Caballero, Emilia Cárdenas, Ana Judith Blanco y Pablo Montoya from Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social (Synergies Strategic Alliances for Health and Social Development).
We would like to acknowledge all the people that have been part of the Sinergias team and helped develop the health model presented in this Exhibition, mainly Matha Bibiana Velasco, Pablo Martínez, José Francisco Osorio, Luis Hernando Rodríguez, Alfonso Martinez, Ramón Casas, Jair Baylón, Elmer Torres, Leonardo Rodríguez, Juan Rojas, Hugo Puerto, Naylin Mendoza, Valerin Saurith, Jorge Rodrígez, Marta Dallos, Danny Mahecha and Carlos Franky. We would also like to thank all the institutions that have been allies through this process like the local health hospital and the Health Directorates.
Our work would not be possible without the support of our funders: CIDA Canada, the Panamerican Health Organization, Fundación Éxito, FALCK, Próbitas, CLUA, NOUS CIMS, Internews and the Colombian Ministry of Health.
The interventions by Pablo Montoya, General Director and founder of Sinergias, at the VIII Conference of the Association for the Study of Human Ecology, held in Madrid in December 2022, can be seen in the link Indigenous peoples of the Amazon facing COVID-19: vulnerability and resilience.
Recommended readings
Martínez, P.A., Dallos, M.I., Prada, A.M., Rodríguez, M.C., Mendoza, N. (2020). Un modelo explicativo de la conducta suicida de los pueblos indígenas del departamento del Vaupés, Colombia. Revista Colombiana de Psiquiatría, 49(3), 170-177. Disponible en:
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social. (2021). Endulzando el corazón: Material de educación alimentaria y nutricional para gestantes y menores de 2 años.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social. (2021). Fortalecimiento de capacidades para la gobernanza territorial en salud.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social (2021). Cartilla Nomé phephiri: Sentimiento, pensamiento y poder de las mujeres.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social. (2020). GABAS: Guías Alimentarias Basadas en Alimentos. Adaptación al Vaupés.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social. (2020). Manual para facilitadores: guía del buen comer basada en calendarios ecológicos, saberes y sabores locales.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social (2020). Observatorio de Salud Amazónico.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social (2020). Programa radial El Canto del Tucán.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social, Universidad Nacional de Colombia e Instituto Colombiano de Bienestar Familiar (2020). Conducta suicida en niños, niñas, adolescentes y jóvenes indígenas de Pueblo Nuevo y Macaquiño, Vaupés: Orientaciones para la prevención y atención. Bogotá DC.
Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social, Universidad Nacional de Colombia, Instituto Colombiano de Bienestar Familiar (2020). Conducta suicida en niñas, niños, adolescentes y jóvenes indígenas de Nazareth, Amazonas: orientaciones para la prevención y atención. Bogotá DC.