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Section 6 Present Day Health Conditions Among the Camisea Nanti In this section we discuss the health conditions in the Nanti settlements of Montetoni and Malanksiá. First we provide a description of the general state of health in both communities, including diet and hygiene practices, and the effects that changes in community location and size have had on Nanti health. We then focus on the commonest and gravest illnesses that effect these communities, discuss their sources, and suggest effective responses to these problems. We then discuss the attitude, practices and responses of the Nanti toward both sickness in general and toward introduced illnesses. Next, we discuss the actions of the Machiguenga teacher, Silverio Araña; the Machiguenga promotor de salud, José Arisha; and the authors of this report with respect to the health of the Camisea Nanti. We conclude with a discussion of the effects that enforcing the boundaries of the Reserva de Kugapacori y Nahua would have on the health conditions of the Camisea Nanti. 6.1 General Health Conditions Among the Camisea Nanti, Including Diet and Hygiene Practices In general, the Nanti exhibit excellent health. Most individuals, from the oldest to the youngest, and even women in advanced pregnancy, are active and energetic. The children, especially between the ages of 2 and 12, are tireless in their play. Most males possess substantial strength and endurance. Most Nanti have an impressively high tolerance for pain, and recover rapidly from minor illnesses and injuries. The authors observed a lower level of general health, including all of the above areas, in Malanksiá than in Montetoni, perhaps due to the less adequate diet available in Malanksiá. The residents of Montetoni have a varied and ample diet. Their staple food is yuca, which is grown in enormous quantities in their chacras. They also cultivate and regularly consume many varieties of plantain, both green and sweet, peanuts, corn, tsanaro (a starchy root vegetable) and wild potatoes. They gather various fruits and seeds from the jungle. They prepare and consume substantial quantities of owiroki (fermented yuca mash); besides owiroki, the Nanti drink only water1. They consume a wide variety of game, including many species of monkey, birds, peccary, and large rodents, and various types of fish. Because the village of Malanksiá is relatively new, the Nantis' chacras there are also new, and do not yet produce much (as of December 1997); therefore food is somewhat scarce. The men of Malanksiá also hunt and fish less often than the men of Montetoni, so their families rely heavily on yuca and plantains for sustenance. In particular, some of the children of Malanksiá display such symptoms of malnutrition as thinness, greatly distended bellies and unhealthy hair, conditions that are very rare in Montetoni. We understand that the Nanti typically form couples at the age of 18 to 20 for males, and about 16 for females. Most couples form long-term relationships, including cases in which one man has two wives. Children are spaced 2 to 3 years apart, and older siblings as well as fathers provide much care for the younger children, particularly when the mother has an infant. We noticed, however, that there are presently numerous young girls with infants in Malanksiá; some of these girls have a young "spouse", but several do not, and live with their own parents. The Nanti adults were hesitant to discuss fatherhood in these cases. Most Nanti adults, especially in Montetoni, expressed concern and even disapproval that couples are forming and reproducing at such a young age in Malanksiá. Infant mortality is fairly high among the Nanti, and most women seem to lose a child during its infancy at some point in their lives. Life expectancy appears to be 55 to 60 years, and even the oldest Nanti presently living are remarkably healthy. Children are breastfed on demand by Nanti mothers. The infants begin to consume owiroki and premasticated foods at about 4 - 6 months, and are weaned at about 12 - 18 months of age. Slightly bloated bellies from intestinal parasites are common among Nanti children, but in most cases, the children do not appear to suffer much from this condition, and after about the age of ten, distended bellies are a rare sight. Some Nanti adults complain of having worms, and we saw evidence of Ascaris worms in some cases. These worms seem to be a nuisance to the Nanti, but do not pose a serious threat to their overall health in almost all cases. Conjunctivitis is a persistent problem for the Nanti, especially in children and young adults. We saw many mild cases, and a few serious ones; all responded well to treatment with optical antibiotics. A discussion of other more serious health problems will follow below, on a case by case basis; please refer to Section 6.7 for a discussion of the health care provided to the Nanti by the authors of this report. The Nanti are now living in settlements much larger than those to which they were accustomed prior to their contact with Silverio Araña. They are now in daily contact with a much larger number of people, and with outsiders and new illnesses. Unfortunately, up to this point they have not adopted any new practices of sanitation or hygiene in response to these new factors. No one has yet taught them of the new health risks that result from their new village size. In both Montetoni and Malanksiá, all Nanti defecate on the beaches along the river and leave their feces uncovered, just downriver from the village sites, and a very short way from the places where they draw drinking water, bathe and wash their food and garments. There is not, and never has been, a latrine in either community. The Nanti do not yet know to boil their water before consumption, to wash their hands before eating, or how to avoid contamination of their food and water with feces. As we discuss below, these unhygienic conditions can, and sometimes do, lead to serious health crises. The illnesses that present the gravest threats to the health of the Nanti fall into three broad categories: gastrointestinal illnesses, respiratory illnesses, and malaria. We shall treat each of these illnesses separately, and provide specific strategies for managing each problem. 6.2 Gastrointestinal Illnesses Gastrointestinal illnesses are responsible for the greatest number of deaths among the Camisea Nanti. The majority of these deaths are of children less than two years of age, and are due to simple dehydration from severe diarrhea. These cases of severe diarrhea come in sudden, brief epidemics, and can be linked to the introduction of pathogens into the communities by people who have arrived in the communities from further downriver. These epidemics last roughly two weeks, and kill between 2 and 7 children per incident, based on those epidemics for which we have reliable information. We know of only two adult deaths due to diarrhea since the founding of Montetoni in 1991, and in both cases the victims were elderly. In the same time period, it is likely that the number of deaths of infants and small children due to diarrhea lies between 20 and 30. We have reliable information on epidemics of gastrointestinal illness in June of 1995, one in late 1996, and a recent one in November of 1997. Interviews carried out in Montetoni suggest other epidemics, but our information on these other incidents is incomplete. We examine two of these epidemics below. The June 1995 epidemic began roughly one week before our own arrival in Montetoni during our 1995 visit. The epidemic began soon after the return of José Arisha, the recently appointed Machiguenga promotor de salud (Health Promoter), from a trip downriver. Ironically, he appears to have brought the pathogens back to Montetoni on his return from a trip to the Dominican Mission medical facility in Kirigueti to receive training for his new position. We arrived on June 1st, and by that point, two children had already died. Upon our arrival we found five children with severe diarrhea, all displaying symptoms of severe dehydration. We began to administer fluids to these children immediately, and to the most severely ill, we also administered a course of oral antibiotics. Over the next ten days that we spent in Montetoni, we encouraged the mothers of the sick children to give them lots of liquids, in order to rehydrate them and prevent more deaths. They were reluctant to do so, however, as the Nanti believe that withholding fluids reduces the quantity of diarrhea produced. While strictly true, of course, this tactic only heightens the risk of death by dehydration. One evening, however, we were approached by a group of Nanti women who brought us a baby so close to death by dehydration that we believed that it would die right in front of us. Nevertheless, we began spoon-feeding it water and continued to do so for several hours. Finally we left the infant with the women, with instructions to continue giving it water throughout the night. They did so, and we were surprised and relieved to find the baby much-improved in the morning. This incident had a great impact on the Nanti mothers, and from that point on, they actively cooperated in our efforts to rehydrate their ill babies. Unfortunately, two more of the sick babies died, but several other lives were saved by little more than the use of water. By the time that we left Montetoni, on June 11th, there was almost no diarrhea in the community. The information we have on the epidemic that recently took place in November of 1997 is similar in many respects to the previous account of the epidemic in June of 1995. We ourselves were not present in Montetoni or Malanksiá at the time, but have obtained our information from Dr. Martin Cabrera, the doctor at the Boca Camisea medical post, and Angel Diaz, a Machiguenga evangelist who was in Malanksiá for much of the epidemic. Angel Diaz arrived in Malanksiá in late October, finding an outbreak of severe diarrhea and malaria in full swing. He radioed downriver, and Dr. Cabrera and nurses from the Boca Camisea medical post were brought to Malanksiá by a Shell Company helicopter. In the last days of September, Silverio left for Quillabamba in the company of three young Nanti men who attend the school run by Silverio. They returned in mid-October, after an absence of a little over two weeks. Soon after their arrival, diarrhea spread throughout the population of Malanksiá, and a week later, spread to the upriver community of Montetoni. All of those who died were children of about one year of age or less. Four children died in the downriver community of Malanksiá and three died in Montetoni. The outbreak of diarrhea lasted 2 to 3 weeks, and Dr. Cabrera predicted that even without medical intervention, it would have likely run its course and disappeared. There are a number of points to be noted from the above accounts. In both cases the epidemic began suddenly, spread rapidly throughout the community, and disappeared after approximately two weeks. Similarly, the onset of the epidemics was coincident with the return of a resident of one of the communities from a downriver journey. The sudden onset and short duration of the disease, coupled with the correlation with the return of a village resident from a downriver journey, strongly suggest that it was the traveling individual(s) who brought the disease back to the Nanti communities. In addition, we know of no epidemic of diarrhea correlated with the arrival of a short-term visitor. This suggests that substantial contact must occur between the carrier of the pathogens and members of the community. Most likely, someone preparing food must come into contact with the feces of the infected person, who then transmits it to the community at large. It is also noteworthy that these epidemics may pass without the use of modern medicine, which suggest that deaths could be avoided simply by the use of fluids to rehydrate at-risk children. These observations suggest a number of possible courses of action to reduce the incidence of these epidemics, and the number of fatalities associated with them:
6.3 Respiratory Illnesses The Nanti are surprisingly resistant to respiratory illnesses. It is a well known fact that many recently-contacted groups are very susceptible to respiratory infections. The Yabashta (Nahua), for example, who share the Reserva de Kugapacori y Nahua with the Nanti, were decimated by respiratory illnesses during their first years of contact with the outside world. Happily, the Camisea Nanti do not appear to be in the same situation. The most common respiratory illness among the Camisea Nanti is chronic bronchitis, exclusively among the elder members of the group. Ministry of Health workers from Boca Camisea have administered courses of treatment for some of the worst afflicted, but this treatment has had a modest and temporary effect. Occasionally bronchitis will flare up into pneumonia, and we know of one death, in 1996, of an elderly man who died of pneumonia. Otherwise, the bronchitis only seems to cause discomfort to those afflicted. Perhaps the greatest threat posed by the chronic respiratory illnesses of the elder adults is that it serves as a reservoir for respiratory infections that can spread to infants. We have information indicating that one or two small children die from pneumonia every year, and these deaths do not appear correlated with the arrival of visitors. This suggests that they contracted their illnesses from pathogens already present in the community. The most serious respiratory illness in Montetoni and Malanksiá is a condition which may be tuberculosis. The symptoms of this illness are consistent with tuberculosis -- severe and intermittent cough with great amounts of mucus, extreme physical exhaustion, and severe weight loss -- but the bacteriological testing that has been done is ambiguous. In 1995, a Nanti man and Nanti woman were taken to Kirigueti for bacteriologically confirmed cases of tuberculosis, and in 1996 another Nanti woman was also treated in Kirigueti for confirmed tuberculosis. However, tuberculosis tests carried out in July of 1997 on some of the more severe cases in Malanksiá came out negative. In addition, a Nanti man is presently (as of January 1998) in treatment for tuberculosis at Boca Camisea, despite testing negative for tuberculosis. Prior to beginning the treatment, his exhaustion and cough were so severe that he could not hunt, and only was able to fish and farm his chacra with difficulty. However, after a few months of treatment he has gained a great deal of lost weight and has regained his energy. Despite the ambiguous nature of the evidence on the present state of affairs, it must not be forgotten that there have been some confirmed cases of tuberculosis among the Camisea Nanti. It is implausible to suppose that a highly contagious disease spread by saliva would not be easily transmitted in a cultural setting where spitting is common, and one of the primary beverages, owiroki [Spanish: masaato], is made by allowing masticated yuca to ferment. Regardless of the precise nature of this illness, however, it is the cause of roughly one adult death per year, typically in the 20 - 30 year age group. A disproportionate number of the deaths are male. During our 1997 visit to Montetoni and Malanksiá, three adults displayed severe symptoms of the illness in Montetoni, and two did in Malanksiá. It is probable that without treatment, these adults will die in the next several years. Interestingly, our investigations indicate that this illness has been present in the Nanti population for at least 20 years. The Nanti related stories to us of a great number of deaths from an illness whose symptoms are very similar to those of tuberculosis, while they still lived on the Timpia. This suggests that tuberculosis, or an illness with very similar symptoms, was introduced during their contact with outsiders on the Timpia during the 1970s; please see Section 4 for historical information. Since the respiratory illnesses present in the Nanti populations of Montetoni and Malanksiá are mostly chronic, only widespread testing, and long-term administration of medicine by competent medical personnel resident in the communities is likely to be effective. As this is unlikely to occur at any time in the near future, we can expect the present state of affairs to persist for the foreseeable future. 6.4 Malaria In late October of 1997 an outbreak of malaria occurred in Malanksiá, the first such incident since contact was made with the Nanti on the Camisea. As the outbreak occurred after our departure from the upper Camisea at the end of September, we have relied on the reports of medical personnel at the medical post at Boca Camisea, especially Dr. Martin Cabrera, and Angel Diaz, a Machiguenga evangelist present in Malanksiá at the time of the outbreak. The outbreak began in the downriver community of Malanksiá in late November, and by chance, Angel Diaz had brought a two-way radio with him, with which he notified the medical personnel at Boca Camisea. Dr. Martin Cabrera was transported to Malanksiá by a Shell helicopter, and upon an examination of the patients, diagnosed them as having malaria. A total of ten individuals were afflicted at this time of Dr. Cabrera's visit, but we have no information if others fell ill after his departure. No deaths have been attributed to this outbreak of malaria. The outbreak began roughly two weeks after the return of Silverio Araña and three young Nanti men he had brought with him from a visit to Quillabamba. Given that they were the only people to have arrived in Malanksiá from the outside since a visit by nurses from Boca Camisea in early September, it is natural to assume that one (or more) of the four of the group was the malaria carrier. At the time of Dr. Cabrera's visit, the malaria epidemic had not spread to Montetoni, so he instituted a quarantine, instructing the villagers of Montetoni and Malanksiá to refrain from visiting each others' villages. Dr. Cabrera hoped, in this way, to prevent the disease from spreading to the larger upriver community. Malaria is easily treated by a combined regimen of chloroquine and primaquine, meaning that with even modest medical attention, the illness can be arrested and cured. Unfortunately, the highly contagious nature of the illness means that it can rapidly spread through concentrated populations, like those of Malanksiá or Montetoni. This outbreak of malaria highlights two main points. It underscores once again the significant role of Silverio Araña as a vector for disease introduction into the Nanti communities of the upper Camisea. Also, malaria is a disease that could easily be transmitted by a casual visitor, suggesting that more stringent control of entry into the Reserve would be recommendable. 6.5 Nanti Medicinal Traditions and the Response of the Camisea Nanti to Introduced Illnesses A natural question arises in discussing the health situation among the Camisea Nanti: what are the traditional medicinal practices of the Nanti, and how have these been applied to the introduced illnesses they are now facing? The answer to this question is very surprising: The Nanti possessed very limited traditional medicinal practices prior to the arrival of Silverio Araña, and he has suppressed even these limited practices. At the moment, therefore, the Nanti are entirely dependent on modern medicines for whatever medical care they receive. According to our informants, their sole form of traditional healing or medicinal practice involved the ritualistic consumption of saaro (Datura Arborea), a powerful hallucinogen. In this ritual, a person knowledgeable in the use of saaro, and sometimes the ill person as well, consumed a quantity of the drug, and chanted for many hours. No other drug or medicine was involved in this ritual, and the efficacy of the ritual apparently had much to do with the content of the chants. All the adult males we spoke to in Montetoni had apparently consumed saaro with regularity, but one man was singled out as particularly knowledgeable about its use, Samwero [Spanish: Samuel]. Unfortunately, Samwero died in 1996, before we were able to talk to him about these practices. The saaro ritual is no longer performed among the Camisea Nanti. Silverio strongly disapproves of the use of hallucinogenic drugs, and put a stop to its use soon after arriving among the Nanti. The Nanti now say that although they used to consume saaro, they no longer do since they learned that it is bad: "saaro tea onkametite, maika tea nogsemparo" -- that is, "Saaro is not good, now we do not consume it." Our questions about medicinal specialists were also unproductive -- our Nanti informants said that they had heard that the Machiguenga had individuals knowledgeable in the use of medicinal plants, but that they themselves never had any such person. It is interesting to note that Silverio, despite his disapproval of saaro, generally thinks very highly of traditional Machiguenga herbal medicine. Like many Machiguenga, he believes that herbal medicines are in many cases more effective than modern medicines, and he is proud of his own limited knowledge of traditional Machiguenga medicine. During both our 1995 and 1997 visits, he expressed his amazement at Nanti ignorance about herbal medicines, and contrasted their ignorance with the vast knowledge the Machiguenga have about such matters. Given his generally high opinion of herbal medicine, it does not seem probable that Silverio would have much motive for suppressing traditional medicine among the Nanti, save the use of saaro. When we asked the Nanti what they did when someone became ill, they responded that in the absence of external medical intervention, they simply waited for the person to recover, or die, as the case might be. Their responses to questions about the sources or causes of illness were similarly unilluminating -- "tea nongote" -- "I do not know." All the evidence we have been able to gather suggests that the now abandoned saaro ritual formed the totality of Nanti medicinal practice, and that Nanti theories of illness and medicine are very unelaborated. While this means that the introduction of modern medicine does not threaten an already extant medicinal practice, it unfortunately also means that the Nanti are presently unable to exploit the medicinal resources present in their environment, increasing their dependence on the outside world in this crucial area. On each of our visits to the Nanti communities, the Nanti expressed concern for their ill, and interest in receiving help from us in treating them. In 1993 and 1995, their exposure to modern medical practices was as yet minimal. As a result, the Nanti were unfamiliar with either the methods of modern medicine, or the success rate those methods bring. They were attentive, however, to the treatments we provided, and very receptive to the positive effects of the treatments. Because of their positive experiences with us in 1993 and 1995, as well as the dramatic recovery made by several seriously ill Nanti after our 1995 visit, the Nanti expressed great interest in receiving health care from us during our 1997 visit. Because the Nanti have not yet received any thorough education in sanitation, hygiene or disease prevention, they are still very passive in the face of illness, and do little to prevent or cure sickness. As recently as October of 1997, during the diarrhea outbreak in Malanksiá, the health care providers from the Government health post in Camisea observed and commented on the passivity of the Nanti in responding to illness. But we wish to stress that so far, the Nanti have only received interventionist health care from outsiders, such as ourselves, the doctor and nurses from Boca Camisea and Angel Diaz; except for a small amount of education provided by the authors of this report during our stay in 1997 and other temporary visitors to their communities, the Nanti have not yet been taught how they themselves can protect and maintain their health and well-being. 6.6 Actions of Silverio Araña and José Arisha with Respect to Health and Illness among the Camisea Nanti The most likely person to provide the Nanti with basic health care and education would be the Machiguenga school teacher resident among them, Silverio Araña. However, he does not have any interest in doing this work with the Nanti. He expresses fear of modern medicines, and the possibility of mis-administering them. He believes that latrines are dirty and attract flies, and therefore refuses to build them in the Nanti communities. He expresses nothing more than factual awareness when there are sick villagers; it appears that it has never crossed his mind to attend to the ill, or to help the villagers prevent the spread of disease. It is clear to the authors of this report, based on extensive conversations with Silverio, that he has no understanding of germs, the vectors of disease transmission or the mechanisms of modern medicine. He is in no way involved in health care or disease prevention among the Nanti. José Arisha arrived among the Nanti in February of 1995. He came to Montetoni to live, in the capacity of promotor de salud (Health Promoter), at the invitation of his friend, Silverio Araña. These two men are both from Chokoriari, a Machiguenga community on the Rio Urubamba. The position of promotor de salud is voluntary but recognized by the Peruvian Ministry of Health, which provides training courses for the promotores at intervals throughout the year. The authors of this report met José in May of 1995 just prior to our arrival in Montetoni. José had returned to the village about 10 days before from his first training as promotor; he told us that he had had no medical training or health care experience prior to his volunteering as promotor for Montetoni. During our ten days in Montetoni, we endeavored to work with José as we cared for the sick Nanti. It was clear that he knew very little, and understood almost nothing, about modern medicine, so we attempted to explain and clarify everything we could for him. We discovered that his interest in providing health care was limited and his attention span was very short, but he repeatedly professed a desire to learn more. When we left, we provided him with a basic Health Care Manual written in Spanish, that is published by the SIL, since he had no written materials whatsoever, but did possess some medical supplies given to him by the Ministry of Health and by us. We encouraged him to attend as many training courses as he could, in order to be able to perform as promotor. When we returned to the Nanti in 1997, we expected to find a better-informed and better-trained promotor in José, and were looking forward to working with him in combating the basic illnesses in the community. José had moved to Malanksiá, and had built a posta, or health post hut, for the community, in which were stored a few basic medicines. However, our very first conversation with José revealed that while he had been to numerous training sessions, he understood little more than he did when we had met him in 1995 -- he did not, for example, know what Ampicillin is, or what it can be used to treat; and that he spent very little of his time working as promotor. He had cleared and planted several large gardens in the intervening two years, and spent almost all of his time working in them; his time spent living in the village and among the Nanti was minimal. The reports of the villagers and of Silverio corroborated our observations that José was not in reality a promotor, but a small-scale commercial farmer. The presence of José among the Nanti is unfortunate for a number of reasons. Firstly, he has used the title of promotor de salud to justify his living in their community, and using their kindness and labor in his profit-making activities. Several of the Nanti commented to us that for a long time they fed and housed José when he first arrived among them, but now that he has many chacra and money, he is not generous with them. Secondly, because José claims to be a legitimate promotor, the Ministry of Health workers in the area consider the Nanti to be cared for to a certain degree by him. That is, the Nanti are believed to have a level of health care immediately available to them that they do not. For example, many Nanti children have died of simple dehydration in the last two years, deaths which could have been easily prevented by the intervention of a competent promotor. However, when we questioned José and the Nanti about José's role in these deaths, we discovered that he was either away from the village at one of his chacras, or took no action to intervene. It would seem that José's lack of intervention was mostly a matter of ignorance, because in our conversations with him in 1997 he revealed to us his lack of knowledge about dehydration, rehydration, or the use of ORS (Oral Rehydration Salts). Yet José has attended trainings by the Ministry of Health about these matters, and there were at the time ORS in the posta. Thirdly, José is a primary vector for disease into the Nanti communities. Ironically, it has been his return from promotor trainings that has immediately preceded at least two outbreaks of illness: the diarrhea outbreak in May and June 1995 that claimed the lives of four children, and the cold or flu virus that circulated through Malanksiá in July of 1997. The authors of this report were informed by Angel Diaz in December of 1997 that he believed José had renounced his position as promotor de salud, and was no longer living in Malanksiá, but had moved to the Machiguenga settlement at Rio Kuria. It is unclear to us if this is a permanent move on José's part, since he has a house and a substantial chacra in Malanksiá. 6.7 Our Health Care Activities Among the Camisea Nanti Each of the visits made by the authors of this report to the Nanti communities on the Camisea have involved some level of health care. In this section, we wish to discuss exactly what we have done in terms of providing health care for the Nanti. As we discuss previously in this section, the main health problems that are afflicting the Nanti are simple ones, with simple solutions. While in some cases the use of modern medicines such as antibiotics is desirable, the majority of instances of illness can be alleviated with little intervention. As we discuss in Section 6.2, the authors of this report arrived in Montetoni in 1995 to find many Nanti children gravely ill with diarrhea. Our response to this was to begin immediately rehydrating the sick children with water, and administering oral antibiotics (Ampicillin or Megacillin) to the sickest. We instructed and encouraged the mothers to continue feeding, and/or breastfeeding, their children frequently, to help them get over the diarrhea, to which they responded well. Several adult Nanti also came to us with severe respiratory illnesses, and we treated them as well with oral antibiotics (Megacillin). We treated a number of children with extremely distended abdomens for intestinal parasites using Mebendazol. One adult woman, Elena, we found unconscious, nearly dead from starvation, dehydration, severe diarrhea, respiratory illness and intestinal parasites. We treated her with water, food, oral antibiotics (tetracycline) and Mebendazol. After ten days of care, she was well enough to sit up, and she agreed to make the trip downriver to the mission hospital at Kirigueti with us. When we left the community, we took her and her husband Juan with us, and left them at Kirigueti, where they were both treated for tuberculosis. Upon arriving in Malanksiá in 1997, we found both Elena and Juan alive and well there; many of the Nanti commented to us that we had saved Elena's life by taking her downriver. Because of our experiences in 1995, we returned to the Nanti in June of 1997 with basic medical supplies to give to the community. As we discuss in Section 6.6, we expected that José Arisha, as promotor de salud, would be in a position to use these medical supplies, both while we were among the Nanti, and after our departure. Unfortunately, the inability of José to understand modern medicine, as well as his apparent departure from his post in October of 1997, means that all the medical supplies we brought will now only be used by the doctor and nurses from the Boca Camisea health post on their intermittent visits to the Nanti communities. While in both the villages of Malanksiá and Montetoni, many Nanti came to us to request health care for themselves or their children. Their complaints, and our treatments, are detailed below: Topical Injuries and Infections: Many Nanti came to us with injuries from machetes, bamboo spines, burns, falls, infected insect bites, etc. We treated them by cleaning the wounds, treating them topically with disinfectants or topical antibiotics, and oral antibiotics if the injury was serious enough to warrant them. A number of children also suffered from mild skin irritations or infections. These we treated with gentian violet, aloe vera gel, talcum powder, or topical antibiotics, as the case warranted. Eye Infections: Many Nanti, especially children, suffer from highly contagious conjunctivitis. We treated them by cleaning the eyes, and administering optical antibiotics. Fortunately, the treatment was very effective, and all cases responded within a few days. By monitoring the families of the infected person, we were able to drastically reduce the amount of conjunctivitis in the communities. Unfortunately, we believe this infection will regularly recur in the future. Diarrhea: There were a number of cases of diarrhea among the Nanti children while we were among them; fortunately, these cases were isolated and easily treated. Our main treatment of the children was to observe them and hydrate them, to keep them out of danger. We encouraged the mothers to provide generous amounts of liquid and/or breast milk, and most of the cases cleared up in a few days to a week. Only in a few cases of severe diarrhea did we administer oral antibiotics, and these children then made rapid recoveries. Intestinal Parasites: We found clear evidence of intestinal parasites among the Nanti, especially Ascaris worms. We treated many adults and children with Mebendazol to kill the worms. Unfortunately, only with the use of latrines in the future will this chronic problem be significantly reduced. We were unable to dig and build latrines in either community during 1997 due to opposition by Silverio Araña, the school teacher. It is our intention to prioritize this project upon our next return to the Nanti villages. Respiratory infections: Many Nanti of all ages came to us complaining of coughs, chest pain, and/or substantial amounts of phlegm in their chests and noses. While some individuals were clearly suffering simply from common colds that passed on their own, a number of Nanti adults exhibited symptoms of chronic bronchitis, or even possibly tuberculosis; see Section 6.3 for further discussion of respiratory illness among the Nanti. When it seemed appropriate, we administered Vitamin C powder, or oral antibiotics (Ampicillin or Megacillin). Similarly, over the course of our stay, four infants exhibited unmistakable symptoms of pneumonia, which we promptly treated with Ampicillin; all made excellent recoveries. When Dr. Martin Cabrera from the Boca Camisea health post visited Malanksiá in early July, he prescribed courses of treatment to several sick adults and infants, which we administered to those patients in the following days. Other incidental illnesses: A few unique cases warrant mention. One little boy suffered from a severely abscessed tooth; the infection and his inability to eat because of it nearly killed him. Several weeks of antibiotics, then vitamins and continuous eating, brought him back to health. Two other little boys suffered serious burns; treatment with both topical and oral antibiotics provided each with a full recovery. Other minor complaints, such as fevers, muscle aches, joint pains, and headaches, we treated with aspirin, paracetamol, or nothing, as the individual case warranted. We wish to reiterate that the Nanti, especially in Montetoni, were very interested in our help in caring for their health, and were generally very responsive to our suggestions and treatments. We are confident that with patient and thorough instruction, the Nanti will soon be able to contribute quite a bit to their own health protection and maintenance, and disease prevention. 6.8 Integrity of the Reserva Kugapacori y Nahua and the Health of the Camisea Nanti The Nanti live within the Reserva de Kugapacori y Nahua, a reserve created to protect the Nanti, among others, from some of the harmful effects of the early stages of contact with the modern world. As we discuss in Section 5, however, the regulations that govern the entry of non-Nanti into the reserve have been rarely, if ever, enforced. One of the effects of the lax enforcement of the park boundaries is the poor health conditions found among the Camisea Nanti. The Nanti are presently in an unfortunate position: They are in sufficient contact with the modern world that they are regularly exposed to illnesses to which they have little resistance, and yet they are sufficiently isolated that the medical care they receive is sporadic and intermittent. To a large degree, the first part part of this problem could be remedied by conscientious enforcement of the already extant regulations that govern the park. The vast majority of the illnesses that the Nanti face are due to the entry into the park of people carrying diseases to which the Nanti are susceptible -- especially Silverio Araña and José Arisha, who live among the Nanti and therefore are that much more likely to transmit illnesses to them. Rigorous enforcement of the park boundaries would therefore be largely beneficial to the health of the Camisea Nanti. It should be noted, however, that merely excluding short-term visitors, such as tourists, woodcutters, and traders, would not have a great impact on the health situation in Malanksiá and Montetoni. Although the potential exists for short-term visitors to bring illnesses to the Nanti, it is the Machiguenga residents among the Nanti that have been the primary vector for introduced illnesses. From the health perspective, then, closure of the Reserve boundaries would likely only be meaningful if it meant either the expulsion of Silverio Araña and José Arisha, or severe restrictions on their travel in and out of the Reserve.
1 Owiroki production was introduced to the Nanti by Silverio Araña in 1991. Prior to this innovation, the Nanti only drank water. |