From Mothers of the River to Ikara: Increasing Knowledge in Indigenous, Amazonian, and Rural Health

Indigenous communities face the greatest gaps in access to healthcare and social protection, especially in rural and remote areas of the Amazon. Since 2015, I have led the Mamás del Río (Mothers of the River) program, which initially focused on improving maternal and child health by empowering Community Health Workers (CHWs) with information and communication technologies. Currently, the program has evolved into a platform called Ikara, which means "indigenous healing song." This platform seeks to increase knowledge in Indigenous, rural, and Amazonian health in diverse areas such as mental health, sexual and reproductive health, community empowerment, climate change, and environmental pollution.

To design Mothers of the River, we conducted research to understand the cultural practices surrounding pregnancy, childbirth, and newborn care among the Kukama-Kukamiria women of Loreto. We found that home births are extremely common, that women value and prefer home births because they are intimate, familiar, and affordable, and that they also face cultural and structural barriers to accessing prenatal care and childbirth in health facilities. This research helped design culturally relevant educational content adapted to the needs and realities of the communities.

This study was complemented by additional research that demonstrated the feasibility of using cell phones to collect health information by indigenous CHWs in Loreto. These studies laid the foundation for the structure of the Mamás del Río program, which is based on home visits conducted by CHWs using digital tablets.

Then, the Our Stories project developed an innovative educational strategy in which the communities themselves developed digital stories that reflected their life lessons, addressing sensitive issues such as the risks of failing to recognize maternal danger signs, lack of access to health facilities, the effects of teenage pregnancy, and domestic violence. Some of these stories were entered into tablets and shared by the CHWs during their home visits, achieving great acceptance among the population.

During the implementation of Mamás del Río (Mothers of the River), the COVID-19 pandemic occurred, and the CHWs exemplified resilience, expanding their roles and leading local responses with limited resources. The Hear My Voice project provided them with participatory tools such as Photovoice, which helped them document challenges and solutions through the use of photography. This allowed the CHWs to raise their voices in front of public policymakers.

Finally, in a study evaluating the impact of the Mamás del Río program in Loreto, we analyzed how the program impacted essential newborn care practices during home births. We observed that almost all key indicators related to thermal care of the baby, breastfeeding, and umbilical cord care improved significantly, and these gains were maintained even during the COVID-19 pandemic. Furthermore, more women began choosing to give birth in health facilities.

We saw Mamás del Río grow and expand to the border with Colombia, with the Mamás de la Frontera (Mothers of the Board) program operating in 38 communities in four districts on the Colombian-Peruvian border along the Putumayo River. In this program, the CHWs work to promote not only health but also social protection for the communities. The CHWs improve maternal and child health, vaccination, access to contraception, national identity documents, and government social programs such as JUNTOS. They also promote the population's health-seeking efforts at fixed health facilities and mobile social action platforms, which are boats from the Ministry of Development and Social Inclusion that transport various Peruvian government services. At Ikara, we have generated new lines of work that allow us to identify the most effective strategies to prevent teenage pregnancy, understand the mental health of indigenous women, and empower communities. Through these interventions, we seek not only to reduce health inequities, but also to strengthen local capacities and promote a more inclusive and culturally adapted care model.