Food, Floods, and Farming An Ecosystem Approach to Human Health on the Peruvian Amazon Frontier

DAVID WALTNER-TOEWS JAMES J. KAY NINA-MARIE E. LlSTER

EDITORS'

T ECOSYPP OACH

Complexity, Uncertainty, and Managingfor Sustainability

Columbia University PressPublishers Since 1893New York Chichester, West Sussex

Copyright © 2008Columbia University PressAll rights reserved

Library of Congress Cataloging-in-Publication Data

'The ecosystem approach : complexity, uncertainty, and managing for sustainability /David Waltner-Toews, [ames J. Kay, and Nina-Marie Listar, editors

p. cm. - (Complexity in ecological systems series)Includes bibliographical references and index.

ISBN978-0-231-13250-3(cloth: alk. paper) / ISBN978-0-231-13251-0(pbk.: alk. paper)ISBN978-0-231-50720-2(ebook)

1. Ecological integrity 2. Ecosystem management 1.Waltner-Toews, David,1948- n. Kay,James J. III. Lister, Nina-Marie E. IV.Title V Series.

QH541.15.E245E382008333.72-dc22

2008014964

Columbia University Press books are printed on permanent and durable acid-free paper.This book is printed on paper with recycled content.Printed in the United States of America

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Contents

A PrefaceDavid Waltner-Toews, Nina-Marie E. Lister, and Stephen Bocking

IX

Part I Some Theoretical Bases for aNew Ecosystem Approach 1

1 An Introduction to Systems Thinking[ames]. Kay

2 Framing the Situation: Developing a System Description[ames]. Kay

3 Scale and Type: A Requirement for Addressing Complexitywith Dynamical QualityT. F. H. Al/en

4 Self-Organizing, Holarchic, Open Systems (SOHOs)[ames]. Kay and Michel/e Boyle

5 So, What Changes in a Complex World?[ames]. Kay

6 Bridging Science and Values: The Challenge ofBiodiversity ConservationNina-Marie E. Lister

3

15

37

51

79

83

7 The Cultural Basis for an Ecosystem Approach: SharingAcross Systems of Knowledge 109Fikret Berkes and lain Davidson-Hunt

vi Contents

8 ,A Family ofOrigin for an Ecosystem Approach to.Managing for 5ustainabilityMartin Bunch, Dan McCarthy, and DavidWaltner-Toews

125

Part 11 Case Studies: Learning by Doing 139

9 Linking Hard and Soft 5ystems in Local DevelopmentReg Noble, Ricardo Ramlrez, and C1ive Lightfoot

10 Human Activity and the Ecosystem Approach:The Contribution ofSoft Systems Methodology toManagement and Rehabilitation ofthe Cooum River in

Chennai, IndiaMartin Bunch

141

157

11 Landscape Perspectives on Agroecosystem Healthin the Great Lakes BasinDominique Charron and David Waltner-Toews

175

12 An Agroecosystem Health Case 5tudy in theCentral Highlands of KenyaThomas Gitau, David Waltner-Toews, and john McDermott

191

13 Food, Floods, and Farming: An Ecosystem Approach toHuman Health on the Peruvian Amazon FrontierTamsyn P. Murray, David Waltner-Toews, josé Sanchez-Choy,and Felix Sanchez-Zavala

213

Part 111 Managing for Sustainability:Meeting the Challenges 237

14 Implementing the Ecosystem Approach: The Diamond,AMESH, and Their SiblingsDavid Waltner-Toews and james]. Kay

1S Return to Kathmandu: A Post Hoc ApplicationofAMESHR. Cynthia Neudoer{fer, David Waltner-Toews, and james]. Kay

16. Tools for Learning: Monitoring Design andIndicator DevelopmentMiche/le Boyle and [ames j. Kay

239

257

289

Contents vii

Part IV Where to from Here? SomeChallenges for a New Sciencein an Uncertain World

47 Beyond Complex Systems: Emergent Complexity andSocial SolidaritySi/vio Funtowicz and Jerry Ravetz

8 Third World Inequity, Critical Political Economy,and the Ecosystem ApproachErnesto F. Ráez-Luna

19 An Ecosystem Approach for Sustaining EcologicalIntegrity-But Which Ecological Integrity?David Manuel-Navarrete, Dan Dolderman, and james ]. Kay

20 The Water or the Wave? Toward an EcosystemApproach for Cross-Cultural Dialogue on theWhanganui River, New ZealandCharlotte He/en Sunde

A Tribute tojames]. KayDavid Wa/tner- Toews et al.

Appendix: Hierarchy and HolonocracyHenry Regier

Contrib utors

/ndex

307

309

323

335

345

363

367

369

373

13Food, Floods, and Farming

An Ecosystem Approach toHuman Health on the

Peruvian Amazon FrontierTamsyn P. Murray, David Waltner-Toews,

José Sanchez-Choy, and Felix Sanchez-Zavala

IntroductionBeginning at about the same time as the Kenyan project described in the previouschapter, a team ofCanadian and Peruvian researchers began working on an ecosys-tem approach to understanding agriculturally altered landscapes in the neotropicsof South America. We began by developing a research process and conceptualframework that brought together the most recent understanding of ecosystems ascomplex systems with secondary data and exploratory field work in the Ucayaliregion of Peru (Rowley et al. 1997).Equipped with this process and framework,we revisited the region to specifically investigate the key determinants of, andlinkages between, ecosystem and human health. The actual process followed wasmodified to fit the context, while retaining its essential features (fig. 13.1).

The Ucayali region is populated by 370,000people and spans 100,000squarekilometers. In the 1940sa road connecting Pucallpa on the Ucayali River, a majorAmazon tributary, with Lima, hastened settlement from the coast and the Andes.By the late 1990s, about 80 percent of its population lived either in Pucallpa oron the Lima road, creating agricultural production and food security challenges.Despite the natural diversity and fertility of this region, remote rural communi-ties struggled to meet their basic needs and face a range of nutritional and healthproblems (Instituto Nacional de Estadisticas y Informaticas 1997).As a result ofslash-and-burn agriculture, deforestation steadily increased and logging activitiescontinued unregulated and with unknown ecological ramifications. The relation-ship between household production, income levels, and health in the Ucayali re-gion was complex and poorly understood. Exploitation of local resources resultedindiverse seasonal combinations of farming, fishing, logging,and hunting andgathering activities. It was not known, at the time we started this study, how thesedifferent resource strategies affected household health or whether health and earn-ings were related-problems that have important implications for agricultural andtechnology development in the region. Ucayali therefore presented our research

214 Case Studies: Learning by Doing

e«)~

Interven~ionstrategíes

Monitoring &

,~'lu,tiOnU

The Presenting Situation

-Analysis of the Presenting Situation

Description of System, Dynamicsand Key Relationships

The Research Agenda

Establishteam

dAnalyses and

diagnoses

Figure 13.1 An ecosystem approach to health in the western Peruvian Amazon.

team with a very complex and dynamic set of interconnected issues. In addition,Ucayali was a benchmark site for the Consultative Group on International Agri-cultural Research's (CGIAR)Eco-Regional Program and the focus of coordinatedresearch efforts whose findings would have potential application to other forestmargins areas in the tropics. Therefore it provided a valuable challenge to deter-mine whether the ecosystem approach was developing could synthesize differenyet interdependent dimensions within the same region.

The Presenting IssuesWhen researchers or development workers enter a problema tic situation such asthat in Ucayali, both the opportunities to intervene and the way the problems areframed are based on how issues are presented to them. In the early 1970s, inter-national and national research centers in Ucayali focused their efforts on livestockfarming and deforestation. On the basis of their analysis of the system, deforesta-tion was the result of declining land productivity and soil degradation that forcedfarmers to expand into forested areas. Research was directed toward technologie

Food, Floods, and Farming 215

that would increase farm productivity and extend theeconomic life of the land.Cattle production on improved pastures was selected as the most efficient systemto adopt. Because scientists confined their studies to the farm level and includedonly agricultural researchers, they failed to take into account important sociocul-tural and political issues at regional and nationallevels that affected farmers landuse decisions. After twenty years, only a handful of farmers had adopted the tech-nologies. Moreover, lack of access to credit meant that few farmers were able topurchase cattle and the resulting overabundance of bracchiaria, the improved pas-ture grass promoted by the researchers, has created a serious fue hazard duringthe dry season.

In the 1990s, the response to the presenting issue of deforestation was moreexpansive. Researchers recognized that farmers engaged in a multitude of natu-ral resource activities including annual crops and agroforestry. However, effortscontinued to focus at the farm level and overlooked sociopolitical issues as well asother resource sectors such as fishing and forestry.

Between 1996 and 1998,Canadian and Peruvian researchers gathered all ex-isting data on Ucayali and developed a rich and detailed history of the regíon,including all ecological, social, and political dimensions at the farm, community,regional, and national levels·.On the basis of the overall picture that emerged,we were able to identify relationships between sectors, key regional, and nationalconstraints and information gaps that needed to be addressed. From this, in turn,emerged a consensus that human health was an integrating concern behind a vari-ety of other presenting issues. Using an ecosystem approach to health allowed usto tease apart those key forces driving the system and therefore determine moreeffective methods of intervention than previously selected.

Issues and Actors: From Cattle to Complex EcosystemsThe evolution of understanding of this frontier region of the Peruvian Amazondemonstrates how the nature of the research approach influences the way in whichissues and actors are identified and ultimately how the goals of the system and de-sired interventions are determined.

As described above, between the 1970s and 1990s, the key issues of concernin Ucayali have expanded from a narrow focus on cattle and pastures to naturalresource management and ultimately to human health. Tohighlight the differencebetween past disciplinary approaches and the ecosystem approach, the issues, ac-tors, and overall system descriptions are outlined in table 13.l.

The identification of issues and actors and the way the systern was describedwere very different using the ecosystem approach from that used in previous re-search. Our understanding of the human activities within the ecosystem approachwas predicated on three key principies, which, in turn, reflected our understand-ing of complex systems: (1) methodological pluralism and interdisciplinarity,(2) multilevel investigation, and (3) local participation and action research. Withrespect to actors and issues, this translated into a deliberate effort to ensure that all


Ecosystem ApproachDisciplinary andTraditional Approaches

TABlE 13.1 Comparing Disciplinary and Ecosystem Approaches in Pucallpa, Peru

Presentingissue

Increasing deforestation Increasing human health problems

Actors Intemational and nationalresearch organizationsRegionallevel Ministry ofAgriculture

• Intemational and national researchorganizations

• Regionallevel Ministry of Agricul-ture, Ministry of Health, Ministry ofFisheries and Ministry of Education

• Regional University• Nongovemmental groups (includes

women and native groups)• Comrnunity groups (Village-level

Mothers Club and AgriculturalComrnittees)

• School teachers

Beneficiaries The main beneficiaries of researchand development are cattle farmssituated in the upland terracesalong the Lima-Pucallpa roadwith easy access to markets. Theyinclude a relatively homogenousgroup of comrnercial farms fullyengaged in the cash economy,owned and managed by male,Spanish-speaking mestizos, whohave migrated from other partsof Peru. They have land titles andtherefore access to governmentcredit programs

Beneficiaries of the research on healthinclude remote rural comrnunitiesliving in the floodplain and uplands,with special focus on the higher riskgroups that include children andwomen of reproductive age. This is avery heterogeneous group that includesfamilies and comrnunities with differ-ent land use strategies, varying degreesof involvement in the market economyand settlements age ranging from 5to 100 years. The majority of familiesbarely surpass subsistence levels. Veryfew families have land titles. The groupincludes indigenous populations whohave been living in the area for thou-sands of years.

interests were represented and the all the social, ecological, and political dimen-sions of issues, were also addressed. In contrast, in the 1970sand 1980s,the proj-ects that focused on cattle production involved only a small set of actors, namely,agricultural scientists, the Ministry ofAgriculture, and approximately forty to fiftylarge cattle farmers situated along the road to Lima. These farmers were unlikethe majority of farmers in the region. They had land titles and year-round accessto markets and derived little income from other resource sectors and off-farmsources. At the organizatíonal level, there was no cornmunity-level involvement;relationships were set up between researchers and individual farmers. There were


no women's groups, native groups, or other groups reflecting the diverse com-munities of this region included. Because the stakeholder group was so narrowlydefined, issues raised were similarly narrow and confined to the interests of thissmall group. The issues they raised were mainly technical and economic in nature.They included market access, price variations, weed invasion, land degradation,and pest invasions.

Multiple Actors-Multiple InterestsAs the authors in this book attest, the ecosystem approach demands a variety offorms of inquiry and multiple sources of evidence. Different methods are neededto address different forms of complexity and to answer different kinds of ques-tions (Checkland and Scholes 1990;Midgley 1992;Holling 1995;Waltner-Toewsand Wall 1997).In order to represent these different perspectives in Ucayali, weestablished a multidisciplinary team with expertise in nutrition, health, anthropol-ogy, agronomy, natural resources management, fisheries, forestry, ecology, ruralplanning, and economics. More importantly, the team included stakeholders fromthe region, local cornmunity leaders, as well as governrnent professionals. The in-volvement of these key actors ensured that our efforts maintained their relevancyto local needs an"dultimately that the information gathered was owned and usedby local organizations.

The process of selecting researchers was instrumental in developing not onlya competent team, but one that was representative of the different interests withinUcayali. The positions available were advertised through our partners, and wemet personally with leaders of these organizations seeking their advice and sug-gestions. We included local representatives of these organizations in the projectteam. They had first-hand knowledge of the project and, more importantly, hadinput into its focus and direction. Because we selected eight communities thatdiffered greatly in ecological, social, and economic factors, these representativesgained a significantly broader view of the diversity of problems in their regionthrough their involvement in the fieldwork. This knowledge was then fed backinto their organizations, thereby increasing their understanding of people's needsand the effectiveness of their programs.

Once health had been identified as an integrative presenting issue in the re-gion, all our research questions were based on issues identified by local stake-holders. This entire phase of determining the project direction was done in closecollaboration with our local partners. Notably, this phase was augmented withseveral focus group meetings with the only women's organization, Asociación deMujeres Campesinas de Ucayali (AMUCAU), the main indigenous organization,Asociación Interétnica de Desarrollo de la Selva Peruana (AIDESEP), and key in-fo.rmant interviews with leaders of other local organizations. Figures 13.2and 13.3show the different factors that the team identified as being critical to understand-ing child health: one set mediated through food intake (which identifies socioeco-nomic variables) and the other on food utilization (which focuses on biological


Nutritional statusof child

t Intra-householdHousehold Food íntake I food allocationfood íntake -¡ of child

~~'-----~ I.~--~+,, 1--------' Cultural beliefsHousehold food surróundíng food

production Family size -+-+- 1 . & ..Breastfeedíng se ectíon restnctiont

Livelihood strategies -L,• farmíng, fishíng Timeallocation

• hunting & gatheríng ofwoment Pood purchases

Nutrition and healthknowledge Income and resource

controloffamilymembers

Dietarystructure Pood

classification$ocioeconomicvariables

Market access . Food pricesPood

availability

Income

LIncome generated fromhousehold production

Other incomesources

Expenditure onnon-food iterns Income control

of famíly members

Figure 13,2 A web of causal influence on the nutritional status of children in Ucayali,Peru, mediated through food intake.

variables). There are clearly overlaps between the two. From there we were able todetermine how each of these variables was to be measured. In addition, togetherwe determined the selection criteria for the project sites, identified the eight com-munities that represented the diversity within the region and decided on the tim-ing 'ofvisits necessary to capture seasonal fluctuations.

Once we had a rough plan that identified the communities and the main is-sues we were to address, we went back to the community groups and govern-ment agencies to ask for their comments and stiggestions. In order to ensure thatall the issues important to the individual communities themselves were included,we used a variety of participatory action research (PAR)methods. They includedcommunity mapping, seasonal calendars, focus groups, time line, life histories,pile sorting, and key informant interviews. At the community level,the researchteam adapted their investigation to meet priorities identified by the community.During the process of data collection, the team and the community began to assessdifferent options for intervention. As results became available, they were used toguide local initiatives and provide feedback for ministry programs. Characteristicof multimethodological studies in general, and specific to systems:-based research,there was an iterative cycle between research and action. We developed actionplans that were then evaluated and the results were used to refine our hypothesesand future research agenda. The issues were not static; they evolved as we learned


Nutritional statusofchild

-i,

Bíologícal utilizationoffood

tNutrient

bioavailabilityAbsorption of

nutrients ~ Interaetion between-l, micronutrient deficiencies

tMorbidity ~e.g. malaria

Health statusofchiIdFood

quality

TIme allocationofwomen

~ Para sitie infections •

Water sourees ~tionalHygiene chiId care

H"¡~Wk"," II TIme alloeation

ofwomenWater protection

IUtilization of

health servicesFood processing &

preparation

t Digestibility

Waste managernent

Housing

Tune allocationl ofwomen

Figure 13.3 A web of causal influence on the nutritional status of children in Ucayali,Peru, mediated through biological utilization of food.

more and were better able to focus our efforts. There was not the usual lengthydelay between research, analysis, and intervention often carried out by differentsets of actors.

The research was conducted in eight different cornmunities spread acrossthe region of Ucayali. From a methodological perspective, it was important toinclude sites that differentiated those factors affecting human health. To capturethe region's heterogeneity, the following criteria guided the community selectionprocess: (1) ecosystem type (floodplain versus upland forests), (2) ethnicity (na-tive versus colonist), (3) access to markets and involvement in market economy,(4)time of settlement (early versus old frontier), and (5)dominant land use strategy(slash and burn agriculture, fishing, cattle ranching, and oil palm plantations).

Multiple-Issue-Multiple-Level HierarchyOne of the basic principIes of the ecosystem approach is that ecosystems ex-ist within nested hierarchies (Allen and Hoekstra 1992;Checkland and Scholes1990).They are comprised of smaller systems while at the same time being part

-220 Case Studies: Learning by Doing

of a larger whole. A household is therefore part of a cornmunity, while sinu-lady being made up of different individuals. Recognizing that often the deter-minants of individual human health may occur at levels higher within the ec~system hierarchy, we investigated variables at four spatial scales: the individua'family, community, and region/landscape. Figure 13.4 demonstrates the mul -level nature of the issues facing Ucayali as well as the different actors at theselevels. All issues are linked to and have consequence for others higher and lowerwithin the nested hierarchy. The ecosystem approach focuses investigation onthe cross-scale interactions of key variables that explain the complexity and mul-tidimensionality of health. For example, landscape spatial mapping determinedthe extent to which families depended on an area larger than their farm or com-munity for food and income. The temporal scale was seasonally determinedwith three field visits that captured the driest period, the start of the rains andthe height of wet season. Data on seasonal flooding levels were correlated withwater quality and parasitic infections to investiga te links between the hydrologí-cal cycle and disease periodicity.

Actors Key Issues

• Priorities for health aid programsdetermined intemationally

• Uttle baseline data and follow-upto evaluate national interventions

• PAHO, CARE andUNICEF-Intemational International Cornrnunityaid organizations

• CIAT,ICRAF and CIFOR-Int.Research Organizations

·INIA-Nat. research org. Nation• Natibnallevel Ministries ofHealth and Agriculture

• Centralized health policy• Unregulated cornmercial extraction

• AMUCAU (women's group)• AIDESEP (native group)• UNU Regional University Region/Landscape• Regionallevel Ministries of Health,Education, Agriculture and Fisheries

• Floodíng cycles aHect livelihoodsystems

• Sectoral approaches that fail to takeinto account linkages between healthand the environrnent

• Conflicts over cornrnon-pool resources• Absence of state and resource useregulation on the frontier

• Mothers Club ,• Agricultural Corrunittee• Health Promoters Cornrnunity• School teachers

• Poor water quality• Little social capacity

• Farnilies-colonist and native Household

• Food insecurity• Poor hygiene and sanitation• Diverse seasonallivelihood strategies• Intra-household food allocation• Gender dynarnics

• Men, women, and children Individual"'"

• Malnutrition• Gastrointestinal infections

Figure 13.4 Nested hierarchy of the key issues and actors in Ucayali, Peru.

Pood, Floods, and Farming 221

Multiple Decision Makers-Multiple Constraints

Understanding the governance structures in Ucayali was key to understandinghow the situation could be changed. Centralized policy making at the nationallevel severely undermined the ability of the regional ministries to respond appra-priately to local prablems. Moreover, powerful commercial interests that dictateresource use in Ucayali are based and regulated in Lima. Therefore all regionallevel efforts must take into account the constraints of these political and institu-tional dynamics.

Multiple Methods-Multiple DisciplinesMethodologically, we combined several quantitative and qualitative methods, im-plemented at four levels within the ecosystem: individual, family, community, andlandscape or region. Tables 13.2 and 13.3 outline these methods. For data on healthand nutritional status, we complemented medical diagnostic tests,household sur-veys, anthropometry, and food recall with ethnographic and participatory meth-ods exploring local diagnoses and understanding of health. For data on ecosystemdynamics and natural resources management, we complemented landscape-Ievelgeographic information systems (GIS), spatial mapping, and soil tests with in-depth household surveys and community-Ievel participatory methods detailingthe livelihood systems of families. In this way, we were able to compare the resultsfrom the methods designed and driven by r~searchers with those that wereled bythe community members themselves.

Methods were complementary in their ability to verify results. The sequenceof methods used allowed us to compensate for weaknesses in individual meth-ods and to build knowledge systematically. For example, participatory techniques(tables 13.2 and 13.3) pravided insight into local priorities and needs, yet exten-sive household surveys determined the extent to which these issues were commonamong all community members and which graups were most at risk. In addition,different methods were used to include different actors. For example, surveys in-volved the Ministry of Health, while mapping, timelines, and other participatoryresearch techniques involved other members of the community. The data derivedfrom each method were specifically targeted to the different end-users or decisionmakers. For example, GIS and the regional maps generated were directed to theregional government, medical testing results to the community health workers,and maps and drawings from PARwere used in community meetings to furtherdiscussion of the community action plans.

System Dynamics: Building an UnderstandingThe natural and human ecosystems of this Amazon region are in a state of con-stant change. These changes are the result of the annual 8-12 meter rise in riverlevels that occurs during the rainy season. Such annual floods affect every aspectof the local ecology as well as human settlement. Understanding of the dynamicsof the rivers and its effects on the changing configuration of the floodplain and


TABLE 13.2 Data Collection for the Household Surveys and Field Tests

Round 1 Round 2 Round 3LeveI Indicators Variables Jun-Jul Oct-Nov Mar-Apr Methods

1999 1999 2000

Landscape Ecosystem Soil fertili ty X X Soil testsproductivity Existing

informationCornrnunity Access to food Food prices X X X Observe

Food X X X Observeavailability

Access to Education X X X Intervieweducation facilities with lead-

available ers andteachers

Access to hea1th Health X X X Interviewservices services with hea1th

available worker

Household Socioeconornic Wealth index X Recallstatus Nonfood X Recall

expendituresNutritional Energyand X X X 24hourstatus nutrient recallFood Security intakeDietary Quality Nutrient X X X Food

intake frequencyrecall

Dietary diversity Food sources X X X RecallIncome level; Income by X X X Recalldiversity sourceProduction Production X X X Recalllevels; diversity and extrae-

tion outputsFood security Crop storage X X RecallWater access; Water quality X X X Watercontamination samples

E. coli,pH,andturbidity

Environrnental Hygienehealth practices X Recall

Child Growthand Anthropo- X X X Actualdevelopment metric mea- measure-

surements ment

Nutritional Energy and X X X Recallstatus nutrient

intake

(con tin ued)


TABLE 13.2 Data Collection for the Household Surveys and Field Tests (contínued)

Round 1 Round 2 Round 3Level Indicators Variables Jun-Jul Oct-Nov Mar-Apr Methods

1999 1999 2000

Health status Breastfeeding X Recall byhistory mother

Diarrhea X X X Recall byincidence and motherpatterns

Incidence X X X Recall byand pattems motherof respiratoryinfections

Morbidity X X Recall bypattems mother

Mortality X Recall bymother

Iron status X X Measure-mentofhemoglobin

Parasitic X X Stoolinfection samples

Women Nutritional Energy and X X X Recallstatus nutrient

intakeFemale fertility Reproductive X Recall

historyHealth status Morbidity X Recall

patternsLabor demand Time X X X Recall

allocationMen Nutritional Energyand X X X Recall

status nutrientintake

Health Status Morbidity X Recallpatterns

Labor demand Time X X X Recallallocation

surrounding envirorunent provided insight into the patterns of resource use offamilies and therefore ultimately, the determinants of health, food security, andnutrition. Figure 13.5provides a basic understanding of the relationship betweenflooding and human health.


TABLE 13.3 Data Collection for Spatial Mapping and Ethnographic andParticipatory Health Assessment

Level Variables Methods

Landscape Spatial mapping of GPS/GISecological di versity; lakes,swamps, forests, rivers,palm forests etc.

Spatial mapping ofresource use activities;farrning, físhíng. huntíng,gathering and logging

GPS/GIS

Participants "

Farmers/ fishermen/hunters and gatherers

Farmers / fishermen/hunters and gatherers

Community Sources of information Community leaders,teachers, students

Community organization

Community facilities andresources

Hygiene and sanitation

Disease periodicity

Historical information

Observe/key infor-mant interviews

Observe/key infor-mant interviews

Community mappingWealth ranking

Observation,Community mappingand health walk

Seasonal calendar(focus group)

Timeline (focusgroups)

Community leaders,teachers

Two groups of malecomm. members approx.20 people

Two groups of femalecomm. members approx.20 people

Two groups of femalecomm. members approx.20 people

Groups of 6-9 people• Elderly (1)• Fishermen (2)• Hunters (2)• Farmers (2)• Women(3)

Individual Diarrhea management

Nutritional ethnography(local classification)

Key informant inter-views / case historiesand decision models

Pile sort/ food attri-butes/ attribute rating

Interviews with:8-10 people knowledge-able of health issues10 women with childrenwith a recent diarrheaepisode

Small groups of 2-3people include:• women with children• < 5 years (5)• women > 45 years (5)• men (2)• adolescents (2)• teachers (2)

(continued)


Participants*

TABLE 13.3 Data Collection for Spatial Mapping and Ethnographic andPa.rticipatory Health Assessment (continued)•......_--

Level Variables Methods

Health ethnography Focus groupsBody and sexualitymapping

Fertility (pregnancy,prenatal care, birth, diet,contraception etc.)

Interviews

Risk Management(identification of risks,frequency, predictabilityand coping strategíes)

Focus groupsLife histories

Focus groups include:women with children• < S years (2)• women > 4S years (2)• men (1)• adolescents (1)

Interviews with 10women of different ages

Groups of 6-9 people• Elderly (1)• Fishermen (2)• Hunters (2)• Farmers (2)• Women(3)

"Number in brackets indicates the number of groups.

In the natural ecosystem, changes in river levels dictate migratory patternsof fish and wild animals and the seasonal availability of forest foods. During thetimes of low water, the commercially important seed and fruit eating fish inhabitthe river channels and lakes, fasting, yet avoiding predators. Once rivers rise,these fish disperse into the flooded forest seeking food and the protective cover of

¿/FlOOding~

Adaptive livelihood Availability ofstrategies < > ecological resources,/

Migration

Food production <"--====>& extraction ,- Income generation

Water quality Vedor habitats

DDynamics of disease transmissíon

Nutrition and food "",,"ty~ ~l_ticlood;ng

Human HealthFigure 13.5 Relationships between human health and ecosystem in Ucayali, Peru.


the trees. This general pattern of fish migration results in periods of abundance,in the dry months, followed by scarcity,when the rains come and fish are difficultto catch. Terrestrial animals exhibit complementary migratory patterns. Duringthe rainy season, they move into the floodplain to feed on the abundant supply offruits, seeds, and nuts available in the forests. At this time, hunting is facilitated asthe animals tend to concentrate on the higher "restingas" or levees.

In terms of the human ecosystem, all natural resource use decisions are die-tated by the dynamics of the changing floodplain. The Ucayali riverbanks shift100 meters each year and large floods every 7-10 years can change the river'sentire course, wiping out communities and flooding arable land. Agriculturalproduction cycles follow the rise and fall of the rivers and precipitation levels.During the dry season, as the river recedes, fertile alluvial banks are available forannual cropping, in particular rice, maize and plantain. Naturallevees are acrossthe floodplain, the rernnants of ancient river channels that have changed course.These areas provide valuable agriculturalland that is inundated only during thelarger, less frequent floods.

Moving from the floodplain to the upland forests, the river's impact is reducedand less directoIn these uplands, the driving force is the construction of roads andthe ensuing access to natural resources as well as markets. As logging roads enterthe frontier regions, colonists soon follow,building homes and clearing a couple ofhectares for such crops as corn, rice, and cassava. These crops are then transportedout to the markets in Pucallpa. Often farmers with existing farms along an olderroad will clear land near a logging road, taking advantage of the untouched and,at least temporarily, more fertile soils.

Rivers and Roads as Nexus ofOrganizationIn complex systems terms, the river can be seen as a nexus around which a wholerange of other activities and variables self-organize in the floodplain, resulting inthe formation of a particular attractor; roads serve a similar function in the uplands.There are a number of important system variables that are part of the river-cen-tered attractor. First, changes in food availability that result from flooding create asituation of annual yet predictable food insecurity. Second, health status exhibits asimilar cyclical pattern. Disease and sanitary conditions change with the floods asrising water levels alter animal and insect habitats and affect water quality, vectorincidence, and disease outbreak. At certain times of the year the combination ofthese two factors, malnutrition and ill health, result in a critical situation wheresome form of intervention is needed

Ecosystem Dynamics and MigrationHuman migration is the result of the interaction between the river- and road-cen-tered attractors. Human migration, similar to that seen in fish and animals, is cy-clical and widespread. The rural population is constantly moving, synchronizedto the changing rivers and lakes and the migratory paths of fish and animals. Thiscontinuous flow of people and resources sustains their livelihoods, as rarely can


the area inunediately surrounding them provide adequately for their needs. Fami-lies and individuals may leave their conununities for several weeks at a time, en-gaging in a number of different activities in other parts of the region. As rivers riseand riverine villages are flooded, people travel to the uplands, using the roads toaccess markets as well as other farms in need of labor. The difference in agricul-tural cycles in the floodplain versus the upland areas allows for the labor pool tobe shared between these different ecosystems. As labor shortage is one of the mainconstraints for farmers, this movement of farmers is critical to agriculture is theentire region.

Ecosystem Dynamics and Human HealthDetermining the issues facing conununities of the Amazon through an under-standing of the dynamics of their ecosystem led to the discovery of a much largerset of complex interconnected problems that until this point had been overlooked.These new insights gained are as follows:

1. Pattems of natural resource use can only be understood at a fairly large, re-gional spatial scale, and using a variety of criteria [as defined by Allen and Hoek-stra (1992)],particularly landscape and ecosystem. On-farm activities as well asthose in the close surroundings do not capture the family livelihood strategies.Families make use of a great diversity of ecological resources located in differentbiotypes and parts of the region. We discovered that this large and diverse set ofresource use activities interacts with each other. Often income from one resourceuse, for example, logging in the wet months, is used to pay for land preparationfor crops in the subsequent dry months. Surplus harvest income is later used forequipment purchase and maintenance for logging and fishing. Thus resource usesare inextricably intertwined and interdependent and cannot be meaningfully ana-lyzed separately.

2. Pattems of natural resource use can only be understood if examined at dif-ferent times of the year. Seasonal resource use is determined by the flooding cyclesthat dictate the availability of arable land, wild foods, fish and animal migrations,and access to valuable forest resources. Figures 13.6 and 13.7 portray the differ-ent cycles of disease, food availability, and income level as perceived by the com-munity members. The numbers indicate relative values: 1 is low, 3 is high, and 2is medium. This information was gathered during a conununity meeting wherethe group, using colored markers, drew the graph on a large piece of paper. Thefigures demonstrate the difference between the cycles of the upland forests versusthe floodplain. For example, in the floodplain, disease (in this case, diarrheal infec-tion) is most prevalent in the dry months (June-August) when the water quality isat its worst. In the uplands, there are similar problems in the summer, though theyalso facemalarial outbreaks in the wet season. In the floodplain, fish and wild ani-mals provide sources of protein rich foods during the sununer and winter monthsrespectively. InJanuary,little food is available as the flooded lands inhibit farming,hunting, gathering, and fish have dispersed into the flooded forests. In the up-lands, food shortages occur in the winter months when fish prices are high and the

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MonthsFigures 13.6 Cycles of disease, food availability and income level as perceived by thecommunity members in the Ucayali floodplain (5) and upland forest (6). Numbers indi-cate relative values; 1 is low, 3 is high and2 is medium.

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MonthsFigure 13.7 Same as fig. 13.6, but for upland forest.


agricultural harvest is still months away. Lastly, income in the floodplain is linked,first, to the sale of timber, usually sold in April when it has all been harvested andcarried along the flooded rivers, and, second, to the sale of the agricultural harvestin September. In contrast, in the uplands, income is highest in [anuary andFebru-ary when their crops reach maturity and are sold in the Pucallpa market. There arefew other sources of income.

3. Individual and family nutritional status can only be understood at a regionalscale using landscape and ecosystem criteria. As food security and nutrition aredetermined primarily by the family's ability to produce, gather, or purchase foodfrom a diversity of resources that extend across the landscape, an understandingof when and why there is low nutrient intake must take into account landscape

. level variables.4. Individual health c?ll only be understood if linked to seasonal change. Pat-

terns of disease periodicity are linked to the environmental changes that occurwith flooding. This affects vector habitats, dynamics of disease transmission, andwater quality. Health is dynamic and therefore cannot be understood at only onepoint in time.

5. Population health can only be understood if linked to both national andinternational health policies and programs. All regional policies are designed inLima and then implemented by the regional Ministry. Programs are not often ap-propriate, as they are not adapted to local conditions, nor are there baseline datato allow for an impact assessment. Health priorities are often influenced by theavailability of resources from international aid agencies. Thus critical health issuesfacing communities in the Amazon are not effectively identified and addressed.

Development of a Common VisionIn any complex system, there are always multiple system goals and therefore deci-sion choices that need to be negotiated among the actors or stakeholders, some ofwhich are trade-offs. Emphasized by other case studies in this book, research intosuch complex systems requires legitimate involvement of the local communitieswho are most directly affected by decision choices and trade-offs. The affectedcommunities may include government agencies, women's groups, nongovern-mental organizations, or individual citizens. Together, professional researchersand local stakeholders define the problems to be examined, generate knowledge,analyze the findings, and take action. Identifying a common vision or goal is acritical step in the process from research to action.

In this project, there were two levels of goal-settíng, or visioning. First, theresearch team developed a common vision. This vision evolved over the courseof the project on the basis of input from our partners as well as our experiences inthe field. Our vision dealt principally with issues and solutions at a regionallevel,bringing together information gathered in the different communities. This vision,


developed in collaboration with the Ministry of Health, included two key aspects:(1)we recognized that, because the health problems of rural communities were sopoorly understood, the Ministry's programs were not appropriate and thereforenot effective; and (2)we highlighted the key role ecological factors play in deter-mining health. For the first time, the Ministry considered the environment as asource of, as well as a solution to, health problems.

Second, we worked with communities to develop their own visions. In com-munity meetings, as well as with smaller groups of women, men, and children, weasked people how they imagined their future and what, if anything, they wouldlike to change. Then, in each community we developed an overall idea of whattype of community people wanted to live in and how they thought they might ar-rive there. It would be overly optimistic to assert that each community had a com-mon vision. However, the process of identifying goals allowed the communities tosee where their common ground lay.

I nterventionsHistorically, interventions based on the narrow focus of cattle and deforestationwere confined to improved plant varieties and animal species and more effectivefarm management strategies that extended the economic life of the land such asimproved fallows and agroforestry systems. These programs were unsuccessfulas farmers failed to adopt the proposed technologies. Such technologies were de-veloped by researchers on research stations, using evaluation criteria developedin isolation from the affected communities. Simple issues, such as the fact thatmost farmers were without a land title and therefore ineligible for governmentcredit schemes to purchase cattle meant that most technologies, in reality, heldlittle promise for the majority of farmers.

Our intervention strategies were guided by the communities themselves aswell as by the regional Ministry of Health. Although our focus was the family,our efforts were directed at the community and regionallevel. On the basis of ourunderstanding of the system's dynamics these were determined to be the most ef-fective channels for improving human health.

Regional-LevellnterventionAt the regionallevel, our intervention strategies included policy evaluation, devel-opment, and training. On the basis of our experiences in the field and the results ofour research, we worked with the Ministry in modifying their existing programsas well as exploring ways by which they could begin to incorporate the issues thatlinked flooding and ecosystem dynamics with human health.

There were several areas of intervention. These included thefollowing:1.Water quality and environmental healthThe environmental health data collected by the project included parasite prev-

alence and re-infection rates, seasonal changes in water quality, basic hygiene con-ditions, and sanitation infrastructure. The Ministry of Health had an antiparasite


program that contained neither baseline data nor impact analysis. The Depart-ment of Environment Health had several models of wells and latrines that areneither monitored nor maintained. There was DO water quality testing in ruralcommunities.

All the data on water quality and parasite levels in children were shared withthe Deparhnent of Environment Health. This gave them substantial evidence ofthe severe water quality issues in rural communities. The project helped supportfurther monitoring of these rural communities by donating over 1000filters to De-partamento de Salud Ambiental (DESA).Weprovided DESAwith information onappropriate water treatment technologies for upland and floodplain ecosystems(solar and sand filters).

2. NutritionOur main data sets included nutrient deficiencies (micronutrients), seasonal

food security, nutritional status (anthropometry), anemia levels, and diversity offoods consumed. As the above information had not been collected by the Ministryof Health in the rural communities, our results provided critical information thatfed directly into the evaluation and design of their rural nutrition programs andthe training of their health workers.

Using these data, we have begun to develop food composition tables appropri-ate for the Peruvian Amazon. The Peruvian food tables do not contain nutritional.information on the majority of foods unique to the Amazon region. We also de-veloped dietary guidelines based on our results of key nutrient deficiencies (e.g.,vitamin A deficiencies) and sources of nutrients in regional foods that are beingpromoted through the Ministry's nutrition programs ..

Through the World Health Organization (WHO), we were able to acquireseveral thousand field anemia test kits for the Ministry's Micronutrient ProgramoWith these tests, the Ministry was able to monitor the impact of their new region-wide program in iron supplementation. This test is also be used by the Ministry'sMalaria Program to monitor the recovery of malaria patients. Before this was im-plemented, we set up region-wide program to train all rural health workers in theuse of the WHO anemia test.

3. Health: Training manual for community health promotersAlthough most rural communities have ahealth outpost, with a nurse or health

technician, these people are away from the community for as much as 30percent ofthe time. During these times, communities are left with no means to treat illnesses.The Ministry of Health has a three-month training program available to commu-nity members who would like to become health promoters. As this training can begiven by any of the Ministry ofHealth' s professionals, the quality of the course hasvaried considerably. In addition, several key areas, such as environmental health,nutrition, and links between diet and natural resources management are missing,and the protocol needed to be adapted to the two main ecosystems: the uplandsand the floodplain. Our project has modified and adapted the training protocol forhealth promoters on the basis of findings from the research. This has resulted inan extensive training manual now being used by the Ministry. In five of the eight


cornmunities the two nurses who are members of the researcher team spent oneyear working in the health outposts with the community health promoters. Usingthe new training manual, they ran several workshops with the health promoters,specifically targeting the health issues that were linked to ecosystem dynamics.

4.Nutrition, food security, and natural resources management strategies: Link-ing health and agricultural policy

The project team worked with professionals from Ministry of Health identify-ing areas where there needed to be coordination with Ministry of Agriculture. Onthe basis of the project's evidence of the linkages between natural resources man-agement strategies and food security, it became clear that a link is needed betweenagricultural programs that increase food production with those health programsthat address food insecurity and malnutrition. In each cornmunity we facilitatedlinkages with Ministry of Agriculture's extension agents and other groups work-ing in agriculture that can integrate nutrition and food security goals with produc-tion and income generation. One of the team members is now working part-timefor the Ministry's of Health food aid programs. Using our research findings, hehas helped to direct their efforts at the specific times of year when seasonal foodinsecurity is at its greatest.

Community-Based InterventionsIntervention at the cornmunity level was confined mainly to education and somesmall initiatives based on the data collected on water quality and parasite levels.Each cornmunity was different in terms of the issues they faced and their availableresources.

Although most interventions occurred after the research phase was complete,there were several key initiatives that took place in conjunction with our researchactivities. In all the cornmunities we asked the women to identify areas of healthand nutrition that were of most concern to them. Once we understood these is-sues, we set up small workshops where the women could learn some of the basichealth and nutrition principIes and ask questions. This provided us with a valu-able opportunity to check the relevance of our work as well as providing the com-munity with something in return for their time. Our experience demonstrated thatvariables such as water quality and parasite loading provided a very good start-ing point from which to link analysis and action. The cornmunity gained a betterunderstanding of the significance of the research results and was, in turn, able toincorporate these results into their understanding. For example, stool and watertesting initiated action in cleaning and controlling defecation along stream banksand reducing contamination of wells. In addition, two of our health workers pre-sented a talk on hygiene practices. With the villagers as partners we identifiedcommon areas where hygiene could be improved.

Once the research phase was complete, we organized a series of educationalworkshops in five of the eight cornmunities, emphasizing areas of water qual-ity, parasites, hygiene, nutrition and basic health prevention measures. These oc-curred over a one-year period and drew upon the results from our research. The

Pood, Ploods, and Farming 233

project formed the basis for a general assessment of health care delivery in Peruand how it might be improved (Goy and Waltner-Toews 2005).

Monitoring and Adaptive ManagementAlthough the official research project has ended, continuing impacts are mediatedprimarily through the Ministry of Health's professionals who were involved firsthand in our activities and through several of the project's researchers who nowhold positions within the Ministry and other nongovernmental organizations.

The monitoring of basic health indicators set up by the project in remote ruralcommunities continues through the Ministry of Health. This includes anemia andparasitic infections. Monitoring was made possible by the donation of resourcesfrom WHO and the University of Western Sydney.

Unfortunately, the highly centralized policy-making structures made it nextto impossible to set up organizational structures for adaptive management at aregional scale, which underlines a major challenge for locally based, "bottom-up"initiatives such as this and the need for multiscale initiatives. Raez-Luna (chapter18) addresses some of the challenges in doing this kind of work in parts of theworld where there marked disparities in econornic and political power.

RefiectionsAs expected, there were both successful and unsuccessful aspects to the project.Webelieve that the project's greatest success was with the Ministry of Health. Wewere able to bring a new, systernic perspective to the Ministry and the profession-als with whom we worked. They have now incorporated many of our findingsinto their programs. We have drawn their attention to the links between healthand ecology, and, as a result, they have redistributed their resources so that mea-sures such as parasite infections and water quality are now being monitored. Fur-ther, the Ministry was able to adopt some of the methods used on the project. Forexample, two Ministry professionals were on the research team and therefore hadfirst-hand experience with our methods and the skills to use them and train othersin their application.

The inclusion of Ministry professionals on the research team also meant thatthe Ministry had a sense of ownership of the information. We worked with themin the initial analysis of the results, which were then immediately included in theirreports. Byincluding Ministry officials on the research team, we managed to avoidthe perception that the research was conducted by outsiders and therefore notof particular relevance. All too often, when outsiders gather data, analyze it, andreport their findings in isolation, the resulting information lies unused on govern-ment shelves, having little or no impact on decision making.

Our project helped to develop baseline data on remote rural communities that• ere previously beyond the Ministry's scope of impact, owing largely to theirresource constraints. Our work provided critical information on the health and

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234 CaseStudies:Learningby Doing

nutritional status of these cornmunities and therefore on the nature and extent oftheir need for assistance.

Furthermore, the project linked members of the cornmunity with professionalsin the Ministry of Health and the local university. Access to these decision makerswas essential to providing cornmunity leaders with an avenue to voice their con-cerns. We helped them improve their understanding of the governance structuresand how best to cornmunicate their needs to policy makers.

The impact of the project on local cornmunity groups carne largely from theirdirect involvement in the research activities. They received valuable training, andbecause of the large scope of the project, were exposed to many different parts ofthe region. As a result, they were able to return to their respective organizationswith a greater understanding of the range of problems facing their members, andthey were able to talk about these problems from first-hand experience. In addi-tion, the training achieved during the project afforded these individuals importantanalytical and cornmunicative skills that will continue to empower them in theircapacity as cornmunity leaders.

With respect to the research team, the researchers gained a valuable andunique experience in working with different disciplines. Wewere all better able tosee the limitations of the sectoral approaches taken by the government and otherresearch organizations. Many members of the team are now working in other proj-ects where they are able to apply the knowledge gained during this project.

The single most limiting aspect of the project was the short duration. Once theresearch was completed, there remained less than ayear to implement the actionplans. On the basis of our experience, we would recommend nothing less than afive-year period for projects using the ecosystem approach. This is especially truein a region where there is so little institutional capacity and social capital, whichare seen to be essential for the implementation of the approach. Indeed, our ex-periences resonate with those of other authors in this book, and many share ourconclusions. In particular, that "deep" or meaningful participation by, effectivecollaboration among, and fundamental empowerment of diverse constituencies,are essential achievements to navigating the complex cultural-natural ecologies inwhich we dwell. The work in Nepal, for instance (see chapter 15),unfolded over aperiod of ten years. There is no quick fix,no panacea: an ecosystem approach takestime, but the results are lasting.

References

Allen,T.H. F.and T.W.Hoekstra.1992. Toward a Unified Ecology. NewYork:ColumbiaUniversityPress.

Checkland,P.and P.Scholes.1990. 50ft 5ystems Methodology in Action. NewYork:Wiley.Goy,J. -and D.Waltner-Toews.2005. Improvinghealth in Ucayali,Peru:Amulti-sectorand

multi-levelanalysis.EcoHealth 2:47-57.Holling,C.S.1995. Whatbarriers?Whatbridges? In Barriers and Bridges to the Renewal

of Ecosystems and Institutions, eds.L.H. Gundersonand C.S.Light,pp. 3-34. NewYork:ColumbiaUniversityPress.


Instituto Nacional de Estadisticas y Informaticas. 1997. Población. Muher y Salud. Resultadosde la Encuesta Demografica y de Salud Familiar. Lima, Peru.

Midgely, G. 1992. Pluralism and legitimation of systems science. Systems Practice 5(2):147-172.

Rowley, T., G. Callopin, D. Waltner-Toews and E. Raez-Luna. 1997. Developing an inte-grated conceptual frarnework to guide research on agricultural sustainability fortropical agroecosystem: Centro Internacional de Agricultura Tropical-Universityof Guelph Project. Ecosystem Health 3:154-161.

Waltner-Toews, D. and E. Wall. 1997. Emergent perplexity: In search of post-normalquestions for cornmunity and agroecosystem health. Social Science and Medicine45:1741-1749.

Food, Floods, and Farming An Ecosystem Approach to Human Health on the Peruvian Amazon Frontier

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