Lisa Richardson is very scared by the second wave of covid-19. The indigenous health expert from the University of Toronto (Canada) stresses that it is necessary to improve infrastructure, access to water and tighten controls in local communities. Despite these needs, the management of the region’s indigenous populations (First Nations, Inuit and Métis) in the face of COVID was exemplary in the first wave, when the cold was not yet lurking. They have had four times fewer infections than the general population, three times less mortality and a 30% greater recovery, according to Richardson in a article published in the scientific journal Canadian Medical Association Journal.
How have they managed to handle the beginning of the SARS-CoV-2 pandemic so well that has already claimed the lives of more than a million people?
Learning from the past was the first strategy. The region has suffered from many different waves of infectious diseases since the arrival of Europeans more than 500 years ago. The experience with influenza A (H1N1) was the most recent and traumatic, and that is why the scientific community feared that the pattern would be repeated. But, to his surprise, it was not the case. The 2009-2010 epidemic left its mark on the memory of these populations and, in a way, they already knew what to do. “Everything is fresh in their heads,” says Richardson. “Public health in these areas is very scarce and is heir to a colonial past, which has complicated everything. It is necessary to take into account the historical question and understand its influence in the handling of these crises, “adds his partner Allison Crawford by video call. When they look back at the current global situation, the two experts think the same thing: “They have gone 10 steps ahead of all of us.”
Prevention and reaction
Local communities reacted quickly and effectively. In the blink of an eye, the borders of the reserves were sealed. No one could enter or leave and they did not let the members who had gone to study or work abroad return. The decision was made for an obvious reason: if the virus entered the community, it could lead to devastating consequences. Richardson points out that it was an aggressive, but necessary method: “The socioeconomic conditions are so vulnerable, the access to drinking water so scarce and the distance from health centers so wide, that had it not taken measures, it could have been a drama” . This restriction was also added to quarantines within their lands and isolation of the sick in temporary infrastructures that were being created to prevent the spread of the disease.
Dialogue with the Government and access to information
Although they resorted to their own protocols without waiting for the decisions from above, the Government provided financial aid as well as devices for necessary evacuations, medicines or tracking materials, tests and protection. Another important point, key to the success in managing the first wave among Canadian indigenous people, was communication and dialogue between the State and local populations, even the most remote. The two specialists say that the communities know better than anyone what they need and their initiatives were recognized, respected and, above all, listened to. “Having a person on a respirator is complicated, that’s why they bet more on evacuation. They were aware that they needed experts, doctors and more knowledge to take care of their people, and the government helped them with that, ”explains Richardson.
The scale that the campaigns against covid-19 took in the North American country were also essential. The institutions translated into indigenous languages the knowledge necessary to handle the pandemic, respect the protocols, and facilitated access to such information.
Thinking in community
If they have done so well, what can be learned from these peoples to face the second wave? “What stands out is their conception of the community,” Crawford answers. It must be clear that health goes far beyond the strictly clinical and medicinal. For them, health includes both relationships with each other and with nature, such as being in the middle of the field and having access to their culture. “That we would have to learn. And more now ”, stresses Richardson. They think together and not alone, and they have a different way of being in the world that helped them get through the first months of the pandemic.
The arrival of winter is restless. There is already an alarming spike in cases in recent weeks, as warned by the Canadian government and the indigenous communities will need, now more than ever, help from the authorities. “The priority will be the urgent construction of infrastructures and a strict control at the entrance and exit of the lands. They will have to do much faster and more efficient tests to control the spread. You have to continue to be very careful, ”Richardson suggests.
As of November 3, the country has about 1,655 cumulative cases of covid-19 in First Nations, with 535 of them active and 15 deaths. In Latin America, the data corroborate that the situation is worse, since there are already at least 100,000 infected indigenous people. It is one of the figures that reflects the third and last report of the Regional Indigenous Platform. In rural communities, an estimated 63,000 people were infected at the beginning of August, a number eight times higher than that registered in June. The analysis also indicates that at least 276 Indigenous peoples have outbreaks of covid-19. The Fund for the Development of Indigenous Peoples of Latin America and the Caribbean (FILAC) it places the mortality rate at 23% and specifies that it is twice as high as in the rest of the population; a scenario contrary to that of Canada, where communities have three times fewer deaths.
Latin America: same initiatives without support or listening
In Latin America creating community, closing borders and taking the reins was not enough, because they also need support from their governments due to their lack of resources. “It is true that infection and mortality rates are very high,” begins Alejandro Parellada, Argentine advisor to the International Working Group for Indigenous Affairs (IWGIA) that has been working with these communities for more than 30 years. Before the health crisis broke out, the United Nations already warned that it is the region of the world with the highest proportion of indigenous people living in extreme poverty. Furthermore, “the health system of the countries in the region is already deficient and it is true that they have not provided the necessary help to the communities. It is the great difference with Canada ”, warns the anthropologist.
Latin America is the region of the world with the highest proportion of indigenous people living in poverty, according to the UN
Parellada highlights the positive points that coincide with those of Canada. In Latin America, local populations also reacted quickly and implemented their own protocols, as well as the tracking and follow-up of cases, and rigorous traffic control. “They did not wait for the government’s decisions either and that was what surprised me the most. Isolation is nothing new for them ”, he adds. The IWGIA advisor also believes that something can be learned from his way of life: decision-making. “The populations have internally agreed on common strategies, when in the West it is seen that we do not agree on what to do,” he says before referring to what happened in Madrid a few weeks ago. In short, the indigenous people have created a common front of struggle, when in other places people were talking more about politics than about the pandemic.
Now, although the communities knew what to do and managed to mitigate the damage, something stopped them: government inaction. “The material and the medicines are completely non-existent. Those communities are the most underserved in this pandemic. There is a clear inaction, lack of understanding and general inability of some States to handle this, “says the anthropologist. And it does not seem that things will change from one day to the next in places like Brazil, for example. “The covid is not even taken seriously, well imagine the local populations,” he confirms.
The incidence of infections is accentuated by the presence of other diseases such as dengue, malaria and respiratory ailments that are aggravated with the arrival of the covid
There are more complications. The incidence of infections is accentuated in the region by the presence of other diseases such as dengue, malaria and respiratory ailments that are aggravated with the arrival of covid-19. Then health care and access to a health center leave much to be desired. “In Brazil there was a specific health program for this, but Bolsonaro is reducing its funding. These are structural issues that go against any type of care for these communities, ”concludes Parellada.
From Toronto, Crawford assures that in Canada the Government has the obligation to provide the same quality to all its citizens and it should be the same throughout the world. For her, if there is no national response plan, it is impossible to allow local strategies. “In a country where the incidence of the virus and respect for human rights are even in question, it is a perfect formula for chaos,” he concludes.
A nun and a doctor in remote areas
Amaya González understands about local strategies on the ground, who arrived in Santa María de Wónken (Venezuela), which almost borders Brazil, in 1983 as a nun and stayed with the Pemons for 34 years. When it arrived, the disease that affected the population the most was tuberculosis. Little by little, with an increase in services and an improvement in food, they managed to eradicate it in some villages. At that time there was always a doctor, the Government helped and facilitated evacuations in case of emergency. “We could talk to them by radio and some organization would attend to you. Now it’s a disaster, “he says by phone. “They are starving and the government does not support them at all. There are no longer any doctors in the area, ”he adds. Although the contagion rate is not high, the woman assures that the Pemons have suffered deaths and have had to resort to medicines made with jungle plants to treat the disease. “They don’t have access to anything. They are not given medicine, nor are communication or travel facilitated. Now if you get sick, you die in there, ”González denounces.
Carlos Chaccour, researcher and doctor at the Barcelona Institute of Global Health and the Tropical Health Institute of the University of Navarra, worked in that region and confirms that access to health care must be done by plane and even by helicopter depending on the context. Chaccour was the only doctor in the area, with between 3,000 and 5,000 dependents, for three years. “There is usually a toilet provided by the Ministry, but it is true that people are reluctant to spend a few years in isolation,” he argues. Although he has not had to live the current crisis, he has treated diseases such as malaria, many skin problems and malnutrition; and the high vulnerability of these populations is not removed from his head. “Few concrete actions can be taken. There are no resources and no knowledge. There is a cultural barrier and they do not have access to information ”, he details. “It is a system thinking to the extreme and when a pandemic arrives in there, it is chaos,” he concludes. What will happen to the second wave? No one has a clear answer, but everyone cares.