By Alexia Escóbar
Alexia Escóbar is the National Coordinator for FCI-Bolivia.
In April, I journeyed by boat along Bolivia’s Ichilo River to a remote community of the Yuracaré people. I hoped to better understand how pregnant women from these poor indigenous villages travel to the nearest health facility–located an hour and a half away—for the skilled care they need. During our trip to Tres Islas, colleagues from UNICEF Bolivia and I discovered that these women face not only transportation difficulties but also many other barriers in accessing culturally respectful, high-quality health care.
Since 2014, FCI has worked with Yuracaré leaders, authorities from the Indigenous Councils (Consejos Indígenas del Río Ichilo, CIRI), and Cochabamba regional health personnel to implement culturally sensitive health care standards in clinics. Through the project, Derecho a la Salud Intercultural para una Maternidad Segura (Right to Intercultural Health for Safe Motherhood), we work with the Ministry of Health to establish norms for maternity waiting homes near hospitals, providing safe spaces where pregnant women from isolated communities can stay while they wait to give birth. In some indigenous communities in Bolivia, the maternal mortality rate is up to four times higher than in non-indigenous areas.
As we began our journey to Tres Islas, we encountered the obstacle of obtaining fuel for the boats. Puerto Villarroel is a small municipality in Cochabamba, a notorious “red zone” for drug trafficking, so gasoline purchases are restricted because of its role in cocaine production. We ended up buying fuel on the “black market” for a much higher price than it would sell for in a gas station.
Accompanied by a Cacique (chief) from the Indigenous Councils, we set off in two wooden boats and one metal vessel lent by the Navy in case of emergency. We surveyed the peaceful Ichilo River, hoping to see river dolphins, a sign of good luck.
When we arrived at Tres Islas, near the mouth of the Chaparé River, we were confronted by so many logs blocking our way that the Cacique and the pilot had to remove them so we could reach the bank safely. We were pleasantly surprised by a welcome committee of Yuracaré children, ranging in age from six to eight years old and elegantly dressed in corocho clothing made of flexible tree bark. They took us each by the hand and introduced us around the community.
The first stop was the chapapa, a grill cooking our lunch of surubí and pacu, two types of river fish, valued by the townspeople for their lack of large bones, wrapped in plantain leaves. We then went to the primary school, where students performed a special dance to Yuracaré music.
After the performance, traditional midwives and women from the community gathered to share their perspectives on maternal health care. Tres Islas lacks electricity and running water. The community does not have a health center, and a nurse or doctor visits only about once per month. Women prefer not to travel all the way to Puerto Villarroel for health services, as the trip is uncomfortable and can take an hour and a half downriver and three hours to return. Traveling by boat is uncomfortable, and gas prices are prohibitively high. As a result, the traditional midwives in the community play a key role in providing prenatal care and assisting deliveries.
The traditional midwives explained the different childbirth positions, such as the vertical position, that women in their culture prefer, and noted that health facilities in Puerto Villarroel are not accommodating. The midwives emphasized that health services need to be more responsive to pregnant women’s other needs as well, such as the presence of a companion and the consumption of traditional foods during labor. Also, doctors should visit the communities more frequently in order to effectively look after the health of children, pregnant women, and older adults.
Hearing these perspectives reinforced my belief in the importance of the work we’ve been doing for many years to sensitize policy-makers to the demands of indigenous women, who feel marginalized by the health system. The Caciques, in turn, stressed the urgency of empowering the indigenous communities themselves to represent and articulate their own health needs, setting up free transportation to emergency care when it is needed, and making sure that qualified health workers understand and respect the culture of the Yuracaré villagers.
On our way back to Puerto Villarroel, we saw the river dolphins. Our trip had received the blessing of the river guardians, an affirmation of our commitment to ensure that Article 45 of the Bolivian Constitution – which states that ALL Bolivian citizens have a right to free, quality, culturally appropriate, respectful health care– becomes a reality for every Bolivian mother.