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HEALTH-ARGENTINA: Women’s Care Blossoms at the Desert’s Edge

Marcela Valente

ABRA PAMPA, Argentina, Jun 7 2006 (IPS) - The village bumps up abruptly against the plateau, framed by a halo of ochre peaks. In this last outpost before the freezing desert in northwestern Argentina, “perseverant women” are working hard to foster development that does not compromise community identities.

To reach the Warmi Sayajsunqo Foundation (the name translates from the indigenous Quechua language as “perseverant women”), travellers from the south must first pass through Abra Pampa, considered the capital of the Puna region, in the northern part of the province of Jujuy. Beyond this point is a landscape of adobe houses, dusty roads and half-buried train tracks, now into their 15th year of disuse.

A decade ago, the Foundation comprised only a handful of indigenous Kolla women. Now, membership is 3,600 strong, with representatives in Abra Pampa and 79 other communities throughout the Puna region. Local doctors have been less than enthusiastic about the women’s efforts, as they believe the Foundation’s work and access to foreign funding undermines the area’s only hospital.

“They call us a parallel institution, and ask us what they are there for, but we remind them that the area has no gynaecologist, so why should we stop people who want to come from other countries and help us?” said Rosario Andrada, the organisation’s founder.

In this region, women over 50 years old tend to wear traditional Kolla dress: full skirts, colourful ponchos, canvas and rope shoes, braids and wide-brimmed felt hats. But the younger women favour modern attire, although they still use the hats and continue to carry their children on their backs in what is known as a quepi.

La Puna, a sprawling Andean plateau region, has an average altitude of 3,500 metres. It is Jujuy’s largest but least populated district – no more than 40,000 residents are scattered throughout the territory’s 35,500 square kilometres, just six percent of the provincial population.

“La Warmi,” as the Puna women’s group is commonly called, tries to reach everyone. The organisation was founded in the 1980s when several of the area’s mines were closed, leaving the men unemployed. Six or seven women initially came together to weave and produce crafts.

By the 1990s, the women’s work became a matter of survival, Andrada told IPS. A Kolla woman born in Puna, Andrada had to drop out of school, because her childhood duties as a shepherd came first. Later she married a miner, had seven children and adopted three more when her aunt died of cervical cancer.

Her aunt’s death was a catalyst for Andrada. While there are more women than men among Abra Pampa’s 13,000 residents, no gynaecologist – or any other specialists, for that matter – serves the town.

Uterine cancer rates in Argentina’s northeast and northwest regions are much higher than in the rest of the country, explained the director of Jujuy’s Cancer Programme, Alicia Campanera. In some provinces, the rates are double the national average, and triple that of central or southern regions.

In 1998, Jujuy had the second highest uterine cancer rate among the country’s 24 districts, after Formosa. In 2003, it fell to fourth place, and neighbouring Chaco and Salta moved to the number two and three places. But while it is moving down the list, Jujuy’s rates are still several times higher than other provinces.

In 1993, Andrada was able to speak to a gynaecologist from the capital, who was in the area for a visit. She asked if he would come once a week “to give the girls checkups.”

Jorge Gronda agreed, and every Saturday for two years he provided free exams to dozens of women, who waited in long queues for a chance to see him. Most had never heard of a Papanicolaou or “Pap smear,” a tool for early detection of cervical cancer. Many came from rural communities, beyond the limits of the ochre desert.

In addition to his prevention work, the doctor identified ectopic (outside the uterus) pregnancies, fibromas and advanced uterine and cervical tumours. The pap smears were sent to a lab in San Salvador de Jujuy, the provincial capital, 220 km to the south, and results took up to a year.

When Gronda detected advanced cancer in one 24-year-old woman, the local women organised activities to raise money to transfer her to the capital for an operation.

Andrada’s community leadership was eventually recognised by the national government. The Foundation was created, and funds for health services began to trickle in. With the resources, the town was able to build and equip gynaecological surgery offices.

It also paid to train 30 Foundation members as health promoters, and provide them with health equipment and disposable supplies.

As time went on, “La Warmi” was able to bring in visiting doctors from Buenos Aires, the United States and Cuba to provide services in Abra Pampa. Some came with equipment to detect vision problems and furnished glasses on the spot. Others brought medicine and birth control.

“Can you imagine what that was like for us? The very moment vision problems were diagnosed, we were given glasses!” exclaimed Andrada. However, the Argentine medical bureaucracy – particularly professional associations – made it extremely difficult for foreign doctors to enter the country.

So the activist had to appeal directly to the provincial governor. “I had an opportunity when he was here for a political event. I played the ignorant Kolla and told him I didn’t know what was going on with the doctors who weren’t showing up. So he promised he would immediately take steps to resolve the issue,” she recalled with a smile.

A major break came in 2003, when the Warmi Sayajsunqo Foundation received resources to fund a project called “Improving Healthcare Access for Women and Children in Puna Jujeña.” The initiative was co-sponsored by the European Union, the Doctors of the World organisation and the government of Jujuy. In total, the programme received 420,000 euros (almost 540,000 dollars).

The goal was to “improve health access for the rural Puna population by strengthening linkages between local health institutions and the community; focusing on prevention; promoting maternal and child health, sexual and reproductive health and family planning; and encouraging early detection of genital or breast cancer in women of child-bearing age.”

“It was very difficult. It’s a three-year plan and we’ve just got it running smoothly, in the final year,” said Mirta Andrada, Rosario’s sister. However, it has paid off. “Eventually, women started coming in on their own to get checked, and some left with birth control,” she said.

Health promoters had difficulty convincing women that it was necessary to space the births of their children, but faced even more resistance from the men.

“[The men] were telling them that if they got an IUD (intrauterine device) their personality would change and they’d become nasty,” said Mirta Andrada. Some women also had misgivings about the Pap test. “A few believed that the doctor’s examination would trigger cancer,” she remembered.

When one woman was diagnosed with cervical cancer, her husband told her “Now Rosario better cure you,” as if the Foundation’s president were responsible for the disease.

Through the project, “La Warmi” was able to fund a maternity ward and clinic for newborns, which is being built in the Abra Pampa hospital. The facilities will have ultrasound equipment and will allow gynaecologists to treat pathologies.

The Foundation also helped acquire an ambulance, and built a home for pregnant women from the Puna region, who are encouraged to come to town 15 days before their due date to give birth in the hospital.

“The hospital tells them to go to a relative’s home, but we take them in and feed them,” Florinda Condorí, another Foundation member, told IPS, referring to the “Home for Mothers and Children,” next to the Foundation’s headquarters.

The programme also provided training for screeners – technicians who do a preliminary analysis of the Pap smears. These experts, trained at the nearby University of Tucumán, decide what samples require a more detailed lab study.

“If the screener sees that everything is OK, the woman just needs to come back the following year,” explained Rosario. If not, the sample is sent to the University lab, which has signed an agreement to return results within 15 days.

The new technicians work within the hospital, and accompany doctors to rural zones to take cell samples, which are later analysed in the hospital’s new cytology lab, also provided by the Foundation.

Cervical cancer is mainly caused by a sexually transmitted virus known as HPV. When caught early enough, the chances for complete remission are high. Hence the importance of regular Pap smears.

“Cervical cancer is related to several social factors, such as early initiation of sexual relations, lack of condom use, multiple partners, early motherhood,” explained Dr. Campanera.

The doctor believes that “La Warmi” goes a long way towards educating women in the prevention of this disease, but notes the importance of ongoing efforts from the hospital, which must take samples and conduct early-detection procedures.

“We all have to work together to get definitive results. Doctors cannot do it on their own, and neither can the women,” said Campanera. She admits that to do so, the protagonists must overcome many prejudices and cultural differences that currently relegate “La Warmi” to the periphery of Abra Pampa, where the freezing desert begins.