State of the World's Minorities and Indigenous Peoples 2013 - Ecuador

Although health services continue to improve, the access to mainstream health care by Ecuador's indigenous populations still presents challenges – especially for rural populations in the Andean and the Amazon regions. This includes lack of available health centres in or near indigenous communities, and inadequate access to medication. According to the Pan-American Health Organization (PAHO), Ecuador's health services are concentrated in urban centres while indigenous and Afro-Ecuadorian communities are often isolated and sometimes only accessible by boat or forest and mountain footpaths. This makes emergency care almost impossible.

Traditional medicine

Some indigenous Ecuadorians are unwilling to make use of the services that actually exist. According to researchers, indigenous Ecuadorians in the Andean region regard health in the context of harmony between body, mind and environment. Under these circumstances they are much more likely to place greater confidence in their communities' own traditional medical practitioners and use them as their first option.[3] According to WHO studies, during such consultations the traditional healer will usually determine whether the illness requires therapy by rituals and ceremony and traditional medicines or a visit to the 'hospital doctor'.

Traditional medicine practitioners in Ecuador are unregistered and there is no licensing procedure; however associations of indigenous practitioners exist at regional and local levels.

According to the WHO, up to the early 1990s, Ecuadorian law limited the practice of medicine only to persons holding qualifications from the University of Ecuador. Under the new more culturally inclusive Constitution, however, recognition and regulation of traditional indigenous medicine came into force in August 1998. Included are stipulations that the state acknowledge, respect and promote the development of traditional medicine, monitor its application and legally control the operation of traditional medical practitioners.

This includes the right to the protection of ritual and sacred places, plants, animals, minerals and ecosystems of interest from the point of view of traditional medicine.

Unlike other Andean countries, there are no specific programmes in Ecuador linking traditional with formal mainstream medicine. Nevertheless, the state has been focusing more attention on official linkages including conducting courses for indigenous traditional birth attendants.

Amazon headache

In Ecuador, health issues that affect indigenous peoples can sometimes be linked directly to the economic sector. This is no more evident than in zones with resource extraction in the Ecuadorian Amazon and in the long-running legal drama connected with the giant Chevron-Texaco oil spill.

After 19 years of litigation, in October 2012, the US Supreme Court rejected a bid by Chevron to reverse a negative appeals court decision earlier in the year. In January, the 2nd US Circuit Court of Appeals in New York had overturned an earlier ban on enforcement of an Ecuadorian decision against the company. Meanwhile, damages in the case were increased to US$19 billion by the Ecuadorian judiciary. The suit was originally filed nearly two decades ago on behalf of 30,000 indigenous and mestizo plaintiffs from some 80 Amazon communities.

Substantial evidence – including thousands of contamination samples taken by the company – prove that Texaco (which Chevron absorbed in 2001) was responsible for significant pollution and environmental devastation in the rainforest of north-eastern Ecuador (see SWM 2012 for more details of the case).

From the human perspective, this seriously affected the economic and cultural base of the local indigenous communities, and especially their immediate and long-term well-being and health. The levels of hydrocarbon concentrations in some streams was as much as 280 times higher than European Union permitted levels.

According to sworn statements filed by the plaintiffs, some residents contracted skin rashes while others experienced vomiting and fainting. They also claim children have died from unknowingly drinking contaminated river water.

Studies have detailed the impact of oil development on the health of people in the Ecuadorian Amazon. There is a higher risk of health problems developing among residents who live near oil fields. Based on national population characteristics, higher than expected cancer rates have been found in the oil-producing village of San Carlos.

In another study published in the International Journal of Occupational and Environmental Health, a connection was found between higher spontaneous abortion rates and living in the proximity of hydrocarbon-contaminated water streams.

In the original decision, the Ecuadorian judge allocated nearly US$1.4 billion for health care. In addition, US$800 million is to be used for establishing a long-term health fund, US$5.[4] billion is to be used for soil restoration and US$600 million for clean-up of groundwater. By year's end, the plaintiffs were seeking enforcement in jurisdictions where Chevron does business.

Meanwhile, with the case still not settled and the health problems ongoing, Amazon indigenous communities continued to see multinational hydrocarbon prospectors cut through their ancestral lands in search of the vast petroleum resources.

In December 2012, the Ecuadorian government launched an international bidding process for large-scale oil exploitation in Ecuador's south-east Amazon region. According to indigenous leaders, most of this lies within ancestral territories of Achuar, Shuar, Huaorani, Kichwa, Shiwiar and Záparo indigenous communities.

Notes

3. WHO, Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review, retrieved June 2013: http://apps.who.int/medicine docs/en/d/JTITLE943e/5.2html.

4. Hughes, J., Gender, Equity and Indigenous women's Health in the Americas, Washington, DC, PAHO, 2004, retrieved June 2013, http://new.paho.org/hq/dmdocuments/2011/GDR-Gender-Equity-and-Indigenous-Women-Health-Americas.pdf.