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Editorial
Healthcare of Indigenous Amazonian Peoples in response to COVID-19: marginality, discrimination and revaluation of ancestral knowledge in Ucayali, Peru
  1. Doreen Montag1,
  2. Marco Barboza2,
  3. Lizardo Cauper3,
  4. Ivan Brehaut4,
  5. Isaac Alva5,
  6. Aoife Bennett6,
  7. José Sanchez-Choy7,
  8. Juan Pablo Sarmiento Barletti8,
  9. Pilar Valenzuela9,
  10. José Manuyama10,
  11. Italo García Murayari11,
  12. Miguel Guimaraes Vásquez12,
  13. Celso Aguirre Panduro13,
  14. Angela Giattino14,
  15. Edwin Julio Palomino Cadenas15,
  16. Rodrigo Lazo16,
  17. Carlos A Delgado17,18,
  18. Alfonso Nino19,
  19. Elaine C. Flores1,20,
  20. Maria Amalia Pesantes21,22,
  21. Juan Pablo Murillo23,
  22. Luisa Elvira Belaunde24,
  23. Sergio Recuenco2,
  24. Robert Chuquimbalqui2,
  25. Carol Zavaleta-Cortijo19
  1. 1Centre for Global Public Health, Queen Mary University of London, London, UK
  2. 2Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales - CITBM, Universidad Nacional Mayor de San Marcos, Lima, Peru
  3. 3Asociación Interétnica de Desarrollo de la Amazonia (AIDESEP), Lima, Peru
  4. 4ProPurus, Pucallpa, Peru
  5. 5Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
  6. 6Vicepresidencia de Investigación, Universidad Nacional Intercultural de la Amazonia, Pucallpa, Peru
  7. 7Departamento Agroforestal Agrícola, Universidad Nacional Intercultural de la Amazonia, Pucallpa, Peru
  8. 8SHARE Amazónica, Pucallpa, Peru
  9. 9Department of World Languages and Cultures, Chapman University, Organge, California, USA
  10. 10Comité de Defensa del Agua, Iquitos, Loreto, Peru
  11. 11Red de Comunicadores Indígenas del Perú-Ucayali (REDCIP-U), Pucallpa, Peru
  12. 12Federación de Comunidades Nativas de Ucayali (FECONAU), Pucallpa, Peru
  13. 13Escuela de Sociologia, Facultad de Ciencias Sociales, Universidad Nacional Mayor de San Marcos, Lima, Peru
  14. 14Department of Anthropology, The London School of Economics and Political Science, London, UK
  15. 15Facultad de Ciencias del Ambiente, Universidad Nacional Santiago Antúnez de Mayolo, Huaraz, Peru
  16. 16Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
  17. 17Research Group Neonatology, Department of Pediatrics, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
  18. 18Department of Medicine, Neonatal Unit, Instituto Nacional de Salud del Niño, Lima, Peru
  19. 19Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
  20. 20Instituto de Investigación, Universidad Católica de Los Ángeles de Chimbote, Chimbote, Peru
  21. 21CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
  22. 22Dickinson College, Carlisle, Pennsylvania, USA
  23. 23Departamento de Medicina Preventica y Salud Pública, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
  24. 24Escuela Académico Profesional de Antropología, Universidad Nacional Mayor de San Marcos, Lima, Peru
  1. Correspondence to Dr Doreen Montag; d.montag{at}qmul.ac.uk

https://doi.org/10.1136/bmjgh-2020-004479

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    Systematic and persistent discrimination against Indigenous Peoples translates into differential health outcomes when analysed through ethnicity and/or mother tongue.1 In Peru, morbidity and mortality rates among Indigenous Peoples for COVID-19 appear to confirm this.2 The COVID-19 pandemic has highlighted the historical structural violence against Indigenous Peoples that currently takes a disproportionate toll in the Peruvian Amazon. This equally applies to Indigenous Andean Peoples and Afro Peruvians. Indigenous Peoples in voluntary isolation and those in initial contact are at highest health risk in this pandemic as they have no previous immunity against common infectious diseases, and lack access to public healthcare services. The Peruvian government introduced a state of emergency early on, but it did not work as theoretically expected because of the deeply rooted inequalities in Peru.

    Public policies focused on reducing health inequities affecting Indigenous Peoples in peri-urban Amazonian contexts are urgently needed.3 Essentially, Indigenous Peoples (through their legitimate representatives) ought to be incorporated in the planning, monitoring, implementation and evaluation of those public policies to ensure sustainability, equity and inclusion in the short, medium and long run. It is also urgently necessary to rethink Peru’s health system to ensure it has an intercultural approach, designed for and with Indigenous Peoples in terms of prevention, treatment and access during and beyond the pandemic. An intercultural approach to healthcare implies that health services not only respects indigenous medical practices but promotes and enables joint and complementary interactions between biomedical and indigenous medical approaches to prevent and treat healthcare problems.4 In the last 15 years, Peru has produced more than 10 official documents on intercultural health, but very little of this has turned into practice. The problem is not the lack of an approach, as such, but the incapacity to turn it into practice.

    Transforming the current …

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