Deo'ye paa'iye: Bridging traditional knowledge with modern telemedicine to enhance healthcare

The Siekopaai are an ancestral, Western Tukanoan indigenous nationality with unparalleled territorial management (Vickers, 1989). Their ecology is characterized by a sustained attunement between Amazonian patterns of growth, maturation, and regeneration and a rich symbolic tradition articulating and embodying these principles (Belaunde, 1994; 2019). This includes an intricate body of knowledge regarding the utility and treatment of medicinal plants which have served as their primary healthcare defense for centuries (Ceron et al., 2011).

From the outset of oil exploitation in their Ecuadorian territories, the Siekopaai people have been exposed to a series of negative impacts on their access and relation to health solutions. This is predominantly due to the emergence of new diseases and conditions tied to unsustainable energy and agricultural development carried out in their territories; ones which fall outside of their ancestral ecological context.

In the case of the Siekopaai, this has predominantly translated into three key problems.

Firstly, the onset of degenerative diseases associated with oil spills contaminating water sources and soils used for subsistence horticulture (Andrade and Proaño, 2011; San Sebástian and Hurting, 2001).

Secondly, agricultural and oil expansion, in addition to causing unprecedented deforestation in the Amazon, paved the way for processed foods alien to the traditional  Siekopaai diet. A diet which, until 50 years ago, was based on game meat, endemic Amazonian fruits, and tubers produced in their fields, now pivots towards the excessive consumption of carbohydrates and refined sugars linked to nutrition issues and anaemia amongst both children and adult populations – a health concern not exclusive to the Siekopaai and found across many Amazonian societies (Donders and Barriocanal, 2020; Marques et al., 2020).

Finally, the Siekopaai have undergone a series of drastic changes in their life expectations/conceptualizations which have had a direct effect on their mental health. Alcoholism, drug abuse, suicidal tendencies, and various 'afflictions of the soul' are becoming increasingly common, especially among the youth for whom cultural connections with ancestry and indigeneity have equally been severed (Cianconi et al., 2019).

 In their legitimate effort to seek out assistance in responding to such issues, the Siekopaai keep running into a contemporary healthcare system fundamentally incompatible with their lived reality. Difficulties in utilizing national healthcare arising from protracted access, limited transportation, and elevated financial costs are exacerbated by social incommensurability between the Siekopaai and their non-Indigenous counterparts. Contemporary socioeconomic changes adjacent to their territories – from extractive industry to crime and intergenerational disconnect – have not only diminished the reach of Siekopaai traditional medicine, but also actively contribute to a generalized lack of viable alternatives. There are no systematized records in place to streamline information regarding the threat of tropical disease, overall nutritional statuses, incidence of and treatment options for cancer, and genetic markers associated with auto-immune conditions.

If such problems are not promptly addressed, given the current context of agricultural frontier expansion and the systematic violation of Siekopaai territories by encroaching industries, these ancestral repositories of knowledge and their pathways for application will face endangerment of both cultural and environmental proportions. 

Our solution aims to address this problem via a multidimensional approach seeking the intersection between Siekopaai ancestral knowledge and technological solutions capable of amplifying informational reach to bridge the existing health gap in these Amazonian territories. We intend to bring healthcare services closer to communities using grassroots internet networks previously deployed in Siekopaai territory. This physical and digital infrastructure will serve as the base to deploy a pilot telemedicine program for three different Siekopaai communities across Peru and Ecuador.

Our solution will deploy a culturally tailored online healthcare service focused on:

1) Allowing the Siekopaai to collect data and establish a detailed information and record system on the incidence of cancerous diseases, DNA fragmentation (Paz y Miño et al., 2010), and toxicity exposure associated with both water and food contamination for evidence-based decisions, informing planning and adequate response to this ongoing health threat.

2) Enabling remote consultation services for basic medicine and other specialized services including electrocardiograms, breast lump self-examinations, evaluation and monitoring of risky pregnancies, continuous, supported triage, and pre-diagnostic counselling offering lab work necessity assessments.

3) Establishing a nutrition program and monitoring methodology grounded on the promotion of sound dietary practices through the revival of the traditional Siekopaai cultivation model, bolstered by additional agroforestry principles to improve overall crop yield, reduce dependency on foreign processed products, and foster food sovereignty in Siekopaai territory.

3) Establishing a pilot mental health program resting on the reconstruction of traditional elements responsible for strengthening cultural roots and an identity-based sense of belonging within the Siekopaai population generally, and the younger strata in particular.

Equitable Origins is currently designing the platform hosting this service so it can be easily accessible through available technologies in Siekopaai communities. The platform will incorporate web development technologies such as HTML, CSS, JavaScript for frontend development, and backend technologies such as Node.js or Django for server-side logic. Additionally, a database management system like MySQL or MongoDB will be employed to store patient data securely. For our data collection and analytics, we´ll use both Programming languages Python or R with simple visualization libraries such as Matplotlib or D3.js for generating insights for streamlined decision-making.

In addition, video conferencing technology, possibly utilizing WebRTC for real-time communication, will be integrated into the platform to facilitate doctor-patient interactions securely. This will also involve the development of a mobile application using cross-platform frameworks like React Native or Flutter, allowing community members to input dietary information, monitor agricultural activities conveniently, and generate alerts with the support of AI. Finally, the mental healthcare solution will consist of a meticulously crafted digital sanctuary, recognizing the deep-rooted, consequential connection between mental health and cultural identity. The focus of this approach is to complement the existing social roots among Siekopaai people with digital tools that will cultivate resilience and belonging.

By integrating these technical elements, the telemedicine pilot program offers a scalable and sustainable solution to bridge the healthcare gap in Siekopaai territory, empowering communities with access to essential healthcare services while preserving their cultural heritage and autonomy.

Our proposal is focused on the indigenous Siekopaai nationality. The Siekopaai currently inhabit areas of the modern-day border between Ecuador and Peru. Historically, however, the Siekopaai moved freely through a far larger territory, prior to the start of the armed conflict between Ecuador and Peru in 1941 which divided entire families overnight, imposing Ecuadorian or Peruvian nationality upon the Siekopaai. Since the peace treaties of 1998, the Siekopaai have begun a gradual retracing of their ancestral territory. In this process, they have faced multiple barriers, with the first being the delimitation of their territories within Ecuadorian political jurisdictions and ontological boundaries (García-Labrador and Ochoa, 2019).

 
Siekopaai communities are thus found within such imperfectly negotiated spaces, characterized primarily by incommensurable notions of ancestrality and governmental-territorial disposition. Access to healthcare facilities and other vital services is not only difficult for the Siekopaai (e.g., due to distances, associated costs, and available transportation methods) but also designed according to patterns which fail to take into account their particular livelihoods and relations with surrounding environments. In addition, a host of social obstacles further exacerbate this accessibility problem. Communication between health professionals and Siekopaai patients is not only mired by ill-approached language barriers, but also tends to be colored by racist undertones and a generalized underappreciation of the seriousness of presented health complications.
 
Our proposal is aimed at the specific needs of three separate Siekopaai communities; important cultural hubs in their own particular right. San Pablo de Katëtsiaya and Siekoya Remolino are found on the banks of the Aguarico River, in Ecuadorian Sucumbios, while Vencedor Wajoya is located in the Santa Maria River, a tributary of the Napo river in Peruvian territory. All three communities share familiar ties and important political roles for both Ecuadorian and Peruvian Siekopaai federation organizations. With varying degrees of intensity, physical access to hospitals, clinics, and pharmacies is limited and further complicated by elevated financial costs. Autochtonous, indigenous forms of medicine are still prevalent, albeit gradually declining due to external socioeconomic pressure and evangelical missionization. Overall trust in Western healthcare is threatened by this consorted host of complications, leading the Siekopaai, and these important communities in specific, to urgently require an alternative solution capable of generating a system wherein the local ethnobotany can be successfully combined with contemporary medical care.

Our solution intends to directly address this elaborate set of obstacles. Virtual medicine options would serve as an explicit means to introduce high-quality – and, indeed, culturally-tailored – speciality consultations into the daily lives of Siekopaai people devoid of the physical, financial, and social drainage peculiar to their present circumstances. Alongside this technical service, we aim to gradually develop better systems of community-level record-keeping/health history, simultaneously producing precautionary measures tied with community-wide screenings (e.g., for tropical disease detection, anaemia control, and comorbidity management). Culturally-informed consultations on mental health, nutritional balance, and overall well-being will equally play a decisive role in progressively remedying the relationship and history the Siekopaai currently share with healthcare treatment (see Shalash et al., 2022).   

Sources: https://docs.google.com/docume...

Equitable Origin’s (EO) team has over 30 years of experience working in the Ecuadorian and Peruvian Amazon, specifically with the indigenous Siekopaai nationality. This work reaches beyond a mere professional, technical interface; the relationship with this nationality rather represents a commitment, with bonds nurtured around the shared goal of strengthening Siekopaai culture and perpetuating its ancient territory. The team involved in generating this proposal has supported the Siekopaai in various legal struggles, not only opposing extractive industries but also against the Ecuadorian state for the recognition of their legal territorial tenure and rights.

Members of our team compiled environmental and social information on the effects of the operation carried out by the Texaco company in Siekopaai territory specifically, and throughout the wider region in the northern Amazon of Ecuador generally. Thanks to this research, EO has firsthand knowledge of the negative consequences of irresponsible prospection in indigenous territories.
Likewise, members of EO have contributed to the expansion of Siekopaai recognized territory both in Ecuador and Peru, through strategies and agreements developed alongside states to ensure the effective conservation of globally significant natural areas. Additionally, for the past 24 years, EO has been working in the Siekoya Remolino community on projects consecrated to Sustainable Autonomous Development; engaging in the support of various programs such as sustainable community tourism, community territory monitoring, training of local technicians (parabiologists and paralegals), development of environmental and cultural curricula within the Siekopaai nationality’s educational system, participatory scientific research, among others.
In light of years of interventions in Siekopaai communities, with an emphasis on Siekoya Remolino, our technicians directly witness emerging needs faced by the nationality as a whole. Years ago it would have been inconceivable to talk about food sovereignty, but we can explicitly discern that the intervention of various industrial activities in Siekopaai territory not only brings negative environmental ramifications, but also has a substantial capacity to meddle with "everyday" cultural processes. This promotes the abandonment of ancestral practices tied to natural resource management and thrusts these indigenous societies towards engaging in activities that are alien to their ancestral worldview.
Currently, EO is working on issues related to the defense of indigenous peoples' rights and the development of grassroots women's leadership in indigenous communities. History shows us that community-based research and direct collaboration with women-led associations strengthens indigenous governance; it sustains the development of activities in an organic, orderly manner, devoid of corruption. Working together under this new vision will help address the problem of chronic malnutrition – restoring cultivating practices and (re)planting native products in Siekopaai fields – widespread disease and its conjoined lack of precautionary structures, alongside mental health epidemics. Undoubtedly, improving on these issues will help revalue Siekopaai identity.

Despite our organization’s longstanding relationship with the involved communities, we have selected the Prototype stage as we are momentarily compiling initial feedback from community members to refine and tailor our approach to originally identified issues. So far, we have been able to support the implementation of a Community Internet Network, which is now actively operating in the Siekopaai community of Siekoya Remolino and serving around 60 individuals. This effort is focused on enhancing local connectivity and communication infrastructures, crucial for integrating our broader telemedicine objectives. The particularity of this community Network rests on it being managed entirely by “Keñao”, a grassroots Women's Indigenous Association with whom EO has been working hand in hand on a variety of development projects. The “Keñao” Women's Association is a pivotal group within the community dedicated to preserving Siekopaai culture and its natural environment. This association is actively working on sustainable practices and leveraging ancestral knowledge, integral to their cultural expression and profound philosophy of "Vivir Bien", “Deoye Paai’ye” or “Living Well”.

We are applying to Solve because we recognize it as an ideal platform in which to advance our initiative for the benefit of the Siekopaai people; by going beyond what is offered by traditional funding schemes and connecting us to critical resources and partnerships that are otherwise inaccessible. Solve's comprehensive 9-month virtual support program offers a valuable opportunity for the continuous development and refinement of our model. We also view Solve MIT’s support as an opportunity for accessing state-of-the-art technology and innovations which can be adapted for employment in resource-limited settings. Having the chance to potentially utilize and implement novel AI and software engineering solutions under the guidance of MIT, a global leader in these fields, is invaluable and sure to make a difference. Our technology solutions must not only be accepted but, indeed, embraced by the Siekopai nationality, a complex task contingent on culturally sensitive adaptation. Solve’s experience in facilitating culturally aware innovations would thus further assist our venture in refining its intercultural, translative, and intergenerational approach to ensure it aligns with and respects indigenous values and practices. We recognize this as a unique feature of Solve which is usually overlooked in extant opportunities. By taking part in Solve, we aim to bridge gaps in access and quality medical care for the Siekopaai, leveraging the support and network offered to not only advance our project, but to also set a precedent for how technology can be used responsibly and effectively in underserved settings with unique cultural circumstances and deep connections to the land.

Our solution is innovative in several key ways, distinguishing it from conventional approaches to healthcare and cultural preservation in indigenous communities. At the core of our solution is the fusion of modern telemedicine technologies with the Siekopai people's ancestral knowledge. This integration respects and utilizes their traditional healthcare practices, such as the use of medicinal plants, while introducing modern medical diagnostics and remote consultation capabilities. This not only preserves important cultural practices but also significantly improves healthcare access and quality for the Siekopai people. Unlike standard healthcare solutions that are often developed with a one-size-fits-all approach, our project is designed around the specific needs and circumstances of the Siekopai people. We engage directly with community members to ensure that the proposed technologies are culturally appropriate, accessible, and effectively meet their unique health and environmental challenges. By leveraging existing community internet networks within Siekopai territories, our telemedicine platform is both sustainable and scalable. This use of existing infrastructure reduces costs, enhances the speed of deployment, and can be replicated in other similar communities facing healthcare access issues. Beyond addressing physical health, our solution incorporates mental health and nutritional support, recognizing the interconnected nature of health, well-being, and cultural identity. The inclusion of mental health services and nutrition programs rooted in traditional practices can catalyze a more holistic approach to indigenous health and wellness programs globally. We consider that our approach could set a precedent for how healthcare is delivered in remote and indigenous communities worldwide. By demonstrating the effectiveness of integrating traditional and modern medical practices, we can influence other health initiatives to adopt similar culturally sensitive health solutions. By empowering communities with data about their health and environment, we shift the paradigm from reactive to proactive and informed healthcare management. This can lead to better health outcomes and more sustainable living practices. Our project showcases the viability of telemedicine in remote areas, potentially expanding the market for telemedicine providers and technology firms to consider these underserved areas as feasible markets. This could drive innovation and investment in similar contexts, expanding the reach and impact of healthcare technology.

In summary, our solution not only addresses immediate healthcare needs but also engages with broader social, cultural, and environmental factors, fostering a sustainable, empowered, and healthier community. This holistic approach redefines the landscape of healthcare and cultural preservation in indigenous settings, paving the way for similar communities to adopt and benefit from such innovations.

We intend to have a positive impact on the Siekopai community through our telemedicine project where the integration of technology and traditional knowledge leads to a sustainable health system that respects and preserves cultural practices while improving health. 

Activities:

• Deployment of Telemedicine Technology: We will install telemedicine infrastructure using existing community internet networks to deliver healthcare services.

• Integration of Traditional and Modern Healthcare Practices: By combining Siekopai ancestral knowledge with contemporary medical practices, we develop culturally adapted health solutions.

• Training and Capacity Building: Local health workers and community leaders will be trained to use the telemedicine platform, ensuring sustainability and community ownership.

• Data Collection and Analysis: Implement a system to collect health data, which will be used to monitor health trends and outcomes.

Outcomes:

• Improved Health Outcomes: With better access to healthcare and a combination of traditional and modern practices, we expect to see improved health metrics such as reduced incidence of preventable diseases.

• Empowered Community: As local providers and leaders manage the health system, the community gains autonomy over its health needs and solutions.

• Informed Health Decisions and Policies: The comprehensive data allows for informed decision-making, leading to targeted and effective health interventions.

Our impact goals focus on transforming healthcare for the Siekopai community through our integrated telemedicine project. Here’s a summary of our goals and the indicators we use to measure progress:

Enhance Access to Quality Healthcare for the Siekopai community within two years.

• Indicators: Number of telemedicine consultations, percentage of community with healthcare access.

Halve the prevalence of preventable diseases in five years.

• Indicators: Rates of preventable diseases, emergency health incidents.

Strengthen Community Health Management by training local health workers to independently manage health services by project end.

• Indicators: Number of trained health workers, capability assessment scores, community satisfaction.

Preserve and Integrate Cultural Practices in Healthcare by documenting and utilizing traditional medicinal practices.

• Indicators: Traditional practices documented, community feedback on integration.

Assessment tools: 

- Regular monitoring and evaluation of key performance indicators, such as the number of consultations conducted, patient demographics, and health outcomes.

- Community surveys and interviews gathering feedback on the effectiveness and cultural appropriateness of healthcare services. Community gatherings (or "mingas"), organized by EO and its grassroots partners, consecrated to community-wide open discussions on the progress of the solution, the current state of Siekopaai trust and interest in seeking out our solution's medical resources, and potential pathways for improvement.

- Longitudinal studies tracking changes in health conditions, disease prevalence, and overall well-being over time.

- Collaborative data collection and analysis with community members to ensure that indicators are pertinent, consequential, and in line with community priorities.

Our solution leverages a combination of modern telemedicine technology, artificial intelligence (AI), and traditional Siekopai knowledge to provide comprehensive healthcare services. Here’s a straightforward description of the core technologies we use:

• Telemedicine Platform: This is the backbone of our solution, enabling remote healthcare delivery. It includes a user-friendly interface accessible via web and mobile applications, which allows community members to engage in virtual consultations with healthcare providers. This platform supports video calls, messaging, and data sharing, ensuring that doctors can provide advice, perform virtual diagnostics, and follow up on treatments from a distance.

• Data Management System: We expect to use a secure AI-powered system to collect and analyze health data from the community. This AI component helps in predicting health trends and identifying outbreak patterns, making the system more proactive. It includes information on disease prevalence, treatment outcomes, and environmental health factors, supporting decision-making in healthcare provisioning.

• Training Modules: Leveraging both online and offline resources, we provide training for local health workers. These modules combine modern medical knowledge with traditional practices, ensuring that the care provided is both culturally appropriate and medically sound.

• Integration of Traditional Knowledge: A significant aspect of our technology involves documenting and integrating ancestral Siekopai practices with scientific healthcare services. This includes the use of medicinal plants and traditional healing techniques, which are cataloged and shared through our digital platforms, ensuring they are preserved and utilized alongside modern medical practices.

• Community Engagement Tools: Our solution includes AI-driven tools for community feedback and engagement, using both SMS and app-based interfaces to ensure wide accessibility. These tools analyze feedback and engagement patterns to improve health education sessions and adapt services to better meet community needs.

By combining these technologies, our solution not only addresses immediate healthcare needs but also respects and preserves the Siekopai’s rich cultural heritage. This dual approach ensures a sustainable, effective healthcare system that is deeply rooted in the community it serves.

Full-time staff: 3

Part-time staff: 4

Contractors: 2

3 years.

Our team prioritizes diversity, equity, and inclusion. We actively seek diverse candidates, employing structured interviews and diverse hiring panels to minimize bias and ensure equity in recruitment. Our workplace is built on sensitivity and inclusion training, robust policies, and a culture that promotes respect and understanding. We strive to make every team member feel valued and included. These practices ensure our team reflects the diversity of the communities we serve and fosters an environment where everyone can thrive and contribute effectively to our mission.

Our project will be primarily funded through grants and partnerships with NGOs and government bodies interested in improving healthcare access for indigenous populations. 

This model provides high value to the Siekopai by improving their health and well-being while respecting and preserving their cultural heritage. It also offers a sustainable approach to scaling and potentially replicating our services in other similar communities.

Our plan for achieving financial sustainability involves diversifying our funding sources and gradually introducing a scalable service model. Our project will be largely supported by grants from health-focused NGOs, international development agencies, and government health departments. We continuously seek new grants and maintain relationships with our current donors to secure ongoing funding. There is special interest in working with the Siekopai of this region because of their closeness to abandoned oil fields, gas burners, and other sources of pollution related to extractive industries. Due to mediatic cases such as the Chevron/Texaco case and the gas burner class action case in Lago Agrio, this region is under the public eye and people recognize that the high incidence of cancer in the population is tied to these activities. Organizations such as the Union of People Affected by Texaco (UDAPT) are constantly looking for ways to support these communities, and we plan on working hand-in-hand with them to keep procuring funding to sustain this initiative. We are also exploring the possibility of developing health products based on traditional Siekopai medicinal practices, such as herbal remedies or health supplements, which could be marketed to a broader audience.