Venezuela: Pregnant and paddling for hours to reach care

Rivers serve as roads and the tropical rainforest stretches far to the horizon in Delta Amacuro state.

Here, in a vast and often inaccessible area of northeast Venezuela that borders the Atlantic Ocean, a large number of indigenous communities face significant challenges accessing healthcare.

Eighteen-year-old Adelia is 38 weeks pregnant. But, so far, she has had no antenatal check-ups. 

As a member of the Warao indigenous community, she had planned that when her labour started she would visit the wisirato – a spiritual healer and purveyor of traditional medicine who plays a significant role in her culture. 

However, when her labour did come, the pain was so strong that Adelia felt afraid.

One day earlier, Adelia had noticed two boats bearing flags with a red figure on a white background sailing down the Orinoco River. She recognised them as belonging to Médecins Sans Frontières / Doctors Without Borders (MSF) and realised they were on their way to the nearby community of Nabasanuka to provide medical care. 

She persuaded her mother to accompany her to an outpatient clinic there, and they set off to paddle the two-hour journey in a long and lightweight wooden boat called a curiara.

Now, in the delivery room at Nabasanuka clinic, Adelia feels almost overwhelmed by the heat and humidity. But, on the instructions of the medical team, she pushes hard and with determination. Because of her young age and the lack of medical care during her pregnancy, Adelia’s childbirth is seen as high-risk by the healthcare staff. 

Despite this, and the limitations of a basic healthcare centre, at 9.30 in the morning, Adelia hears the cry of her baby for the first time. Her son José Antonio. a strong and healthy boy.

Cut off from care

Since July 2022, MSF teams have been working alongside local authorities to bring basic healthcare to isolated communities across Delta Amacuro state. 

Access is a challenge in itself: the state covers more than 15,000 square miles and is heavily forested. Most indigenous communities live scattered along the banks of the Orinoco River, which is the region’s main highway. 

This means that to reach the clinics where they can provide medical care, our teams must travel by motorboat for at least six hours from the state capital, Tucupita, while patients often have to paddle their canoes for hours or even days to see a doctor.

The indigenous communities in this region suffer from a range of preventable diseases caused by the precarious conditions in which they live and the multiple obstacles they face in accessing healthcare. 

This includes waterborne diseases such as parasitosis and diarrhoea; diseases spread by mosquitoes and other insects, such as malaria; respiratory infections; skin conditions; and malnutrition. Meanwhile, an absence of antenatal and postnatal care increases the risks for pregnant women and their babies.

Local people’s difficulties accessing healthcare services are also aggravated by language barriers and cultural differences with visiting medical teams, as well as shortages of drugs and medical supplies across the region. 

"Difficulties in staffing these remote locations and the lack of supplies and medicines also contribute to people’s challenges in obtaining adequate and quality medical care," says Carlos Dominguez, MSF project coordinator in Delta Amacuro.

Mobile medical teams

Working with local authorities, MSF works in two outpatient clinics in the communities of San Francisco de Guayo and Nabasanuka, both in the east of the state. 

For three weeks every month, a multidisciplinary MSF team – made up of doctors, nurses, pharmacists, water and sanitation specialists, logisticians and health promoters – base themselves here, providing general medical care to around 70 patients a day. 

Health promotion is a particularly important aspect of MSF's work here. 

“By providing people with information, it is possible to raise awareness about healthy practices, proper hygiene and disease prevention, without neglecting the community's own traditions," says Carlos.

“Not only does this have a direct impact on people's health, but it also fosters community empowerment and a proactive approach to health.”

MSF also arranges hospital transfers for patients who need specialist care. 

This morning, our medical team contacted health authorities to request an ambulance boat from Tucupita for three-year-old Jesus who needs urgent treatment that is unavailable in Nabanasuka. 

Jesus’s parents paddled their canoe for four hours to bring him to the Nabanasuka clinic. It would take them seven days to paddle on to Tucupita, compared to a journey by ambulance of six hours. 

Yakera wito

MSF’s work in Delta Amacuro state is a testament to the importance of providing basic medical services to everyone, regardless of their geographic location or circumstances. 

It demonstrates MSF’s belief that healthcare is a fundamental right of every individual, which must be fulfilled in even the most remote and disadvantaged regions.

At the Nabansuka clinic, Adelia is now talking with a health promoter about the benefits of breastfeeding.

"Yakera wito," she says, with a big smile. This means “hello” in the Warao language but is also a way of expressing gratitude. 

The scene is witnessed by a Warao community leader who observes: "When a doctor is next to a village, the people feel calm and happy."

Adelia is now ready to make her way upriver and back home to introduce baby José Antonio to the rest of his community.