In Ecuador, COVID-19 Trainings Connect Indigenous Groups to Care

In Ecuador, there are approximately two doctors for every 1,000 people. That makes community health workers a critical lifeline nationwide, but especially in geographically isolated indigenous communities who often have limited access to public health services.

COVID-19 has exacerbated these inequities, leaving those outside urban centers without access to the health care they need. Often without fully outfitted hospitals, pharmacies, or cold chains, these communities have been hit hard by COVID-19, leading to a disproportional death rate in Ecuador’s indigenous populations.

“In Ecuador, there is a great difference between health care in urban and rural areas, where the majority of the indigenous population lives,” says Ramiro Proaño, Project HOPE’s team lead in Ecuador. “For example, hospitals are located in cities, while in rural areas there are only medical centers that do not have hospitalization or intensive care units, only external care. Access to the farthest areas in the Amazon is very difficult — the only way to enter those remote areas is by helicopter, small planes, and through the river, which can take up to 14 hours by canoe.”

Project HOPE is helping bridge that gap, thanks to an innovative program designed by the Universidad Católica de Cuenca. In partnership with Project HOPE, hundreds of newly trained health workers are delivering accurate information about how to stop the spread of COVID-19 in the native languages of Kichwa and Shuar, the indigenous languages most widely spoken in rural areas.

The program focuses on health promotion and disease prevention with an emphasis on stopping the spread of COVID-19, and all the training materials have been specifically produced for easy downloading and printing — key in areas with low internet bandwidth. The training features simultaneous audio translations so participants from indigenous communities can immediately receive the training in Kichwa or Shuar, in addition to Spanish.

The program is the only training and prevention project done in native languages that has been validated by the Ministry of Public Health, Proaño says.

“This translation is necessary because many of the rural population, especially the elderly, do not speak Spanish,” he says. “Another characteristic is that the translators are natives of these areas, which means that it translates into the context and culture of each locality and there is greater acceptance of participation by the people in the rural area.”

As Ecuador became an early epicenter for the pandemic in South America, hospitals were overwhelmed with COVID-19 patients, and fear of infection spread. The pandemic also disrupted the flow of health information, at a time when simple, clear information about mask wearing, social distancing, hand washing, and isolating those with symptoms could save lives.

Now, thanks to the partnership between Project HOPE and Universidad Católica de Cuenca, more than 400 community health workers have completed thousands of hours of training, empowering them to pass on crucial health information to more than 5,000 people in indigenous communities.

“This project is crucial for the rural communities of my province of Cañar since it allows us to carry a clear message in our native language,” says Rosalina Guamán, a student who worked on the curriculum and is a member of the Kañari People of the Kichwa Nationality of Ecuador. “This is one of the most critical aspects of the program.”

The newly trained health brigades can also address other health issues affecting rural communities that existed before the pandemic and will be there when the pandemic is over. Ecuador’s community health outreach workers typically care for patients through educational talks, workshops, health fairs, and home visits, developing trusted relationships with the community and creating a critical linkage to existing health services.

Beyond addressing hygiene and getting out good information about COVID-19, the health brigades hold the potential to help administer standard childhood vaccines, conduct prenatal consultations with mothers, and provide treatment for common ailments, much of which has been placed on hold during the pandemic lockdowns. Additionally, the training platform will be exported to two other countries where Project HOPE works, Honduras and the Dominican Republic.

“I feel very honored to participate in this project,” says Runa, a training participant who is from an indigenous community. “Now we can bring to each of my fellow Kichwas this message concerning the COVID-19 pandemic, to educate, and, above all, create awareness by conviction but not by obligation. There is nothing more gratifying than helping human beings as health professionals, and even more so to do it in their native language without violating their rights.”

Carmen del Rocío Parra Pérez, a nursing graduate working on a master’s degree in health management for local development at the university, is one of the more than 800 participants enrolled in the program now. The pandemic has made her feel a sense of urgency, she says, to create more resilient communities that have traditionally been locked out of care.

“We must strengthen the first level of medical care to prevent more people from becoming infected and dying, and to prevent the high demands on the hospitals so they do not collapse,” she says. “With this platform, we will get to train more people, especially in more remote communities, to prevent disease and promote healthy lifestyles.”

This story is adapted from an article that originally appeared on protectingglobalgains.org, a website showcasing models of adapting healthcare systems during COVID-19.