Communities in the Amazon band together to save pregnant women

Dr. José Luis Palma Vélez aboard the "Health Canoe," a water ambulance that transports pregnant women to the nearest health centre. © UNFPA/Jose Antonio Guayasamin
  • 14 November 2016

SUCUMBÍOS, Ecuador – Margarita Mamallacta’s village, in a remote Ecuadorian district on the edge of the Amazon rainforest, was not always a safe place for mothers.

Pregnant women in the indigenous communities here, in the Putumayo Canton, had little access to quality health care. Distance, lack of transportation and the absence of communication equipment left them isolated from hospitals and clinics.

Health promoters like Margarita Mamallacta are making pregnancy and childbirth safer for women. © UNFPA/Jose Antonio Guayasamin

The majority of women gave birth at home, without skilled care. When complications arose, little could be done.

If the women did, eventually, reach a health facility, language and cultural barriers could prevent them from receiving the assistance they needed.

But locals like Ms. Mamallacta, 45, took it upon themselves to change things.

For 15 years, she has served as a “health promoter” – a community member who helps locals travel the two to three hours by boat or ambulance to reach the nearest health centre.

When she accompanies pregnant women to the clinic, she also translates for them and helps them request culturally sensitive forms of care, such as traditional medicines and birthing positions.

“The role played by health promoters is really important, because they are the ones that foster the relationship between the community and the health system,” Ms. Mamallacta said.

A woman just hours before giving birth at the Puerto El Carmen Health Center. © UNFPA/Jose Antonio Guayasamin

The “Health Canoe”

Health promoters have greatly expanded indigenous women’s access to care. Their efforts are now supported by the Ministry of Public Health and UNFPA, which have provided training.

“Thanks to a series of training courses, we have learned how to identify the main signs of danger during pregnancy and what must be done,” Ms. Mamallacta explained. 

They also worked with UNFPA to purchase a dilapidated old boat, which they retrofitted into a water ambulance. Called “Jambi Killa” – meaning “Health Canoe” – the boat is used to transport women to the Puerto El Carmen Health Centre via the Putumayo River.

Radio equipment was also purchased by UNFPA to enable the promoters to communicate directly with health facilities, helping them arrange travel and coordinate care. District Mayor Genny Ron Bustos provided access to a repeating station to increase radio coverage.

“Equipping health units and improving the care they provide were two of the objectives sought by the Ministry of Public Health” to reduce maternal mortality, health minister Margarita Guevara told UNFPA.

Equipment is available to help women give birth in the position of their choice, including squatting, standing or kneeling. Women can also wear traditional clothes and consume medicinal teas. © UNFPA/Jose Antonio Guayasamin

Offering model care

Through its work with the health promoters, the Puerto El Carmen Health Centre has become a model of culturally sensitive care. 

The centre’s delivery room has been adapted to accommodate the traditions of the community. “Here, women decide how they want to give birth. We respect their right to have a free position childbirth,” said Dr. José Luis Palma Vélez.

Women are able to wear traditional clothes, consume teas made with medicinal plants, give birth in a family environment, and use traditional birthing positions, such as squatting, kneeling or standing.

“Our care model guarantees a safe childbirth with respect for their traditions,” emphasized Dr. Palma Vélez.

The promoters also help the clinic keep personalized and up-to-date records of all pregnant women in each community. “If a woman misses a prenatal care appointment, it is easy to find her and give her the right support so she can get the medical care she needs,” he added.

Radio equipment is helping to bridge the divide between remote villages and the nearest health centres. © UNFPA/Jose Antonio Guayasamin

A legacy of life-saving

Today, Ms. Mamallacta is a rarity in her community: a woman leader. She is the president of the local association of indigenous health promoters. “This position had always been held by men,” she proudly told UNFPA.

She hopes her work sets an example for other health workers and community members.

“I would like my legacy to be that of educating people so they can save lives,” she said. “The real achievement is the projects that benefit communities and give them more opportunities to access health care. But that will only be possible if we all work together.”

– Guadalupe Valdes

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