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BACKGROUND: Detailed qualitative information regarding Indigenous populations' health-seeking behaviours within Peru's plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru. METHODS: Community-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation. RESULTS: Shawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care. CONCLUSIONS: These findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes.

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Promoting and supporting Indigenous health includes ensuring health services reflect local concepts of health. There is, therefore, a need to better understand context-specific Indigenous understandings of health in order to design culturally appropriate health services. To this end, this study characterized two Shawi communities' understandings of what it means to be healthy. Using a community-based participatory research approach, 40 semi-structured interviews and a series of informal interviews were conducted and analysed thematically, using a constant comparative method. The Shawi definition of health extended beyond individual physical welfare and focused on emotional, collective, and environmental wellbeing. The primary factors underlying Shawi perceptions of health and wellbeing included providing for the family, ensuring the welfare of others, maintaining positive social relationships, preserving traditional values and practices, and living harmoniously with the natural environment. Conversely, Shawi classified illnesses according to their cause or treatment. These included illnesses caused by sorcery, those caused by spirits of the forest, and 'new diseases,' that first appeared in the communities when they were contacted by the Western civilization, for which no traditional remedies existed. Consequently, according to Shawi, sociocultural, environmental, and climatic changes are posing imminent health threats. This study highlights the differences between biomedical and Indigenous Shawi health understandings, and therefore emphasizes the importance of acknowledging and embracing Shawi culture and beliefs within the formal healthcare system.

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Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.

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Sustainable Development Goal 6 (SDG-6) addresses poor water quality, inadequate sanitation, and improper hygiene, all of which negatively impact health and disproportionately impact Indigenous Peoples' health. Understanding and responding to local contexts is critical to effectively improve water, sanitation, and hygiene (WASH); however, in-depth understanding of local knowledge, practices, and perceptions are often overlooked. As such, this study described the knowledge, practices, and perceptions of WASH held by residents of two Indigenous Shawi communities in the Peruvian Amazon. Quantitative data were collected via a cross-sectional survey and analyzed using descriptive statistics. Qualitative data were collected via interviews, PhotoVoice, focus group discussions, and participatory transect walks, and analyzed using a constant comparative approach to thematic analysis. Emergent themes included characterizing water sources, collection methods, and consumption patterns; knowledge, perceptions, and practices related to WASH; and knowledge and perceptions of health issues related to WASH. This study provides insight into the ongoing challenges related to WASH in Indigenous communities in the Peruvian Amazon and highlights the need to prioritize interventions that will advance WASH-related SDGs.

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Trypanosoma (Megatrypanum) shawi n. sp., is described in the capybara Hydrochaeris hydrochaeris, from Mato Grosso do Sul State, Brazil. This trypanosoma produces no visible pathological effects in the host, and the parasitaemias are extremely low. The trypanosome can be grown in culture.  

Trypanosoma (Megatrypanum) shawi, n.sp., é descrito em capivara, Hydrochaeris hydrochaeris, no estado de Mato Grosso do Sul, Brasil. Os animais examinados apresentavam aspecto saudável e as parasitemias eram extremamente baixas. O tripanosoma desenvolve em meio de cultura.    

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Trypanosoma (Megatrypanum) shawi n. sp., is described in the capybara Hydrochaeris hydrochaeris, from Mato Grosso do Sul State, Brazil. This trypanosoma produces no visible pathological effects in the host, and the parasitaemias are extremely low. The trypanosome can be grown in culture.

Trypanosoma (Megatrypanum) shawi, n.sp., é descrito em capivara, Hydrochaeris hydrochaeris, no estado de Mato Grosso do Sul, Brasil. Os animais examinados apresentavam aspecto saudável e as parasitemias eram extremamente baixas. O tripanosoma desenvolve em meio de cultura.