Palizada, Loreto (Amazon region)

Palizada, a native hamlet of the Kukama Kukamiria ethnic group in the Amazonian region of
Loreto, on territory bordered by the Marañón River, faces significant challenges in accessing
public health care amid widespread social indifference.

Ninety percent of the population is indigenous, and they must contend daily with the deep gaps
that expose long-standing disparities in the national health system. Electricity, running water,
and a sewage system do not exist in this forested region that is shaped by the river’s water cycle,
specifically its rising and falling floods.

Nothing happens here—no movement, no voices, not even the sound of the breeze. It is as if this
location has been forgotten even by time itself.

Grimaldo Chujutalli is one of the elders who, despite his difficult circumstances, finds hope in
reading. He usually sits in his hammock and pulls up his old Bible to read the declaration of
faith from the Book of Job. He has read the passage multiple times and intends to continue
reading it till his eyes fail. “My wife can’t read. I called for God to grant me sight, and he did. I
asked him for the intelligence to read, and he gave it to me because I failed to attend school.”

Peruvian neurologist Maritza Pintado traveled more than six hours to reach this remote
community to conduct a descriptive study assessing the cognitive status of its population — a
task made more challenging by the area’s limited access to healthcare and diagnostic resources.
Her goal is to identify signs and symptoms of cognitive decline or dementia in 30 adults over the
age of 60, who represent 26% of the evaluated population.

Clotilde Canariquiri, 65, moved to Loreto from Yurimaguas 21 years ago. Since then, she has
rarely left Palizada. She works her cassava and corn plot in the mornings while caring for her
four granddaughters, who play in a cot with clothes and toys scattered around. A plywood wall
serves as a blackboard.

She never attended school and has no siblings. “My mom died when I was three months old.
“My relatives raised me in the same way that a mother raises her children,” she explains.

According to Elena Tsoy, clinical neuropsychologist and assistant professor at the Edward and
Pearl Fein Memory and Aging Center at the University of California, San Francisco, “Cognitive
testing is a critical part of detecting dementia early and getting people the care they need. But
if the tests don’t match the culture and background of the people taking them, a lot can go
wrong.”

Conducting this kind of cognitive testing in rural communities like Palizada is rather
challenging. Nobody is concerned about the state of their memory or whether they are aging
with dignity. There is a widespread perception that aging is an irreversible process of decline.
Most people are simply thinking about what they will eat the next day.

During this visit, Dr. Pintado learns that there are health issues that must be addressed: 40%
have mild visual impairments, but not to the point of blindness, and 20% suffer from hearing
problems. Heart and neurological disorders, cases of advanced cancer, and other illnesses
they’re unaware of are also being revealed. Some individuals are not aware they have
Parkinson’s disease.