On a Sunday early in March, Briana fell ill. By dawn the following morning, the condition of the six-year-old – one of five siblings and member of the Misión La Loma Wichi indigenous community in Embarcación, Salta Province – had worsened and Eugenia, the girl’s mother, decided she needed to see a doctor. The two set off for the only public health centre in the region, San Roque Hospital, soon after. It was about four kilometres away, a half-hour walk at a good pace.
Briana was weak and she struggled to walk, but they made it. After a long wait in the emergency room, the young girl was seen by a nurse and given an antipyretic to bring down her fever. The family were told to make another appointment and come back later in the week, but they were designated on a first-come, first-serve basis, only the day of the appointment. They would have to come back in the morning and queue.
A follow-up appointment was eventually obtained, but only after a neighbour and friend of the family spent successive mornings waiting in line outside the clinic. And so, on Thursday, once again, Briana and her mother set out for the state hospital. The youngster couldn’t walk, she collapsed halfway there and had to be carried the rest of the way in the arms of her mother.
Later that day, Briana would later lose her life in the hospital waiting-room. Other patients who witnessed the tragedy insisted that a paediatrician see and treat the child, but by the time they did, it was already too late. Doctors tried in vain to revive her. The cause of her death remains unknown. The medical part of her death certificate read “septic shock and possible meningitis.” Another doctor said that it was pneumonia, another that she had died of cardiac arrest. There were no studies to explain what happened.
Across Argentina, are hundreds of Brianas. Thousands of children are at risk, do not receive proper medical attention, live in poverty or have their defences lowered by malnutrition.
If Briana had received attention in time, perhaps her life could’ve been saved. If the community had clean drinking water, perhaps it would not have ended this way. If medical appointments at public hospitals were accessible, not illegally put up for sale as happens in more than one inland province, perhaps she would still be alive. If the family had the money to pay for an appointment and if there were no discrimination when assigning them, perhaps the worst would not have happened.
But it did. Briana, remembered as a happy girl who enjoyed going to school, is gone. Her mum is without her little one. Eugenia still struggles to understand what happened. In the days immediately following the tragedy, she was left in a state of shock, unable to speak. The family had to make a big effort to put the impact of the tragedy aside and organise a funeral for the young girl, who was buried in the local community cemetery.
Far from being an isolated tragedy, the death of children of indigenous communities across Argentina has been going on for some time. Some deaths are known, but others are not reported. Many are a product of the failure by successive governments to guarantee rights such as healthcare, drinking water, correct food and decent housing to all Argentina’s citizens.
“We are grief-stricken … she was only six. I was very accustomed to Briana’s joy. I know other cases like this but they never come to light – people stay quiet for fear of worse treatment for the rest of the family,” said Mirco Neuenschwander, the girl’s uncle and a spokesman of the Salta Wichi community.
In the last three full calendar years at least 217 children have died in Salta: 108 in 2020, 64 in 2021 and 45 in 2022. The provinces with the highest child mortality, according to a 2021 Health Ministry report, were Formosa, Corrientes, La Rioja and Jujuy.
If the reason for Briana’s death was meningitis, it would be one more case joining one of the main causes of child mortality: parasitic and infectious diseases. Ailments related to water are commonly provoked by bacteria or parasites with a relationship between drinking contaminated water and the illness likely. Among the bacteria which might cause meningitis is Escherichia coli, detected in the water of Salta.
Early this year residents of the Grand Bourg neighbourhood in Salta commissioned a private investigation to analyse the local water. In the “drinking” water they found salmonella and the bacteria in question. Although most variants of Escherichia are inoffensive, some can have fatal consequences.
“There are 18 indigenous communities with very seriously difficult access to water,” reads a report from the Asociación Civil por la Igualdad y la Justicia (ACIJ) civil rights association, affecting 4,000 people, among them 400 kids.
The investigation details: “None of the nine [indigenous] communities visited had water mains. There is a project to bring the infrastructure to only three of them and the communities pointed out that the water had high levels of arsenic and salt with its consumption producing illnesses.”
“Since the 2010 Census the state has the relevant information to tackle the problem,” affirms the ACIJ. The national survey revealed that 10 percent of indigenous people used rainwater or water from rivers or creeks against a provincial average of one percent. The use of natural water becomes the only alternative when there is no running water.
“The lack of access to healthcare continues to be seen as an isolated misfortune of those who ‘do not integrate’ into society or live far from urban centres, instead of perceiving it for what it really is – a direct consequence of inaction and state abandonment,” concluded the ACIJ in its report.
Less than half of indigenous homes have access to water from mains, as against a provincial average of 76 percent. Transport by cistern is the method for 6.2 percent of households while that percentage in Salta as a whole is 0.3 percent.
ACIJ states that there are at least 7,543 children at risk of malnutrition. In 2021 the association found that milk deliveries were blocked in some Wichi communities. Access to DNI identity documents was also found to be difficult, thus making it impossible for many to receive social welfare benefits and pensions.
In 2020, the Inter-American Court of Human Rights notably ruled in favour of Salta indigenous communities in the case of Lhaka Honhat versus Argentina, with a sentence reading: “The court has determined that the state has violated ... the rights to a cultural identity (including the right to participate in cultural life), a healthy environment, a proper diet of food and water.”
An avoidable problem
The lack of professionals, precarious hospitals and the absence of an intercultural approach are just some of the problems faced by the Salta healthcare system. And as the numbers demonstrate, Briana was not the only one affected by the shortcomings.
In 2021 a Wichi baby died in the Salta city of Orán from respiratory insufficiency after a delayed caesarean section. While the mother was in labour, she had to be taken to another health centre because the high-complexity medical apparatus was lacking where she was, only for the lack of specialists to cause her to be transferred to a third centre at which her baby died.
“Children living in precarious conditions surely have some degree of malnutrition. The defences are not the same as an infant in ideal conditions. They have more risk of contracting infections while a child in better conditions has an immune system more suited to fighting infections and would not end up getting meningitis,” explained Dr Nicolás Lázaro in an interview.
“When a child arrives at the emergency ward with fever, they must be examined to see if they require an antibiotic and not be told to go home. If nothing is found, the family must pay attention to no other symptom presenting itself with the possibility of an immediate return to the emergency ward. The fever not going down – as happened with Briana – is an alarm-bell. You cannot wait three days because what did happen might happen; there could be complications. It might have been a case evolving faster than normal,” points out Lázaro.
ACIJ lawyer Nahuel Arias Camacho, says that the girl did not receive attention when she went to the hospital the first time because there were no doctors at the emergency ward.
“This frequently happens in many inland hospitals. Doctors only attend outpatients if there is an emergency according to their criteria or if there are so many people in the ward that the nurses cannot take care of them. The nurse gave her an antipyretic, told her it was not urgent and made no record of the mother having been to the hospital,” says the lawyer.
“The doctor only comes out if somebody is trying. When Briana was treated she was already in serious condition,” recalls Mirko.
“This case became notorious because the community demonstrated [in response to the tragedy] but the truth is that child mortality is a constant among indigenous peoples, of whom some 60 percent have no prepaid health scheme, depending on the attention of the public system,” indicated the lawyer.
Public health is free but this does not seem to be the case nationwide.
“The system is completely outside. Appointments are sold off instead of being made in conditions of equality. Certain people have access to all of them and then sell them off to those in need,” affirms the ACIJ.
“To get an appointment the next day you have to be there at 5pm and then spend the whole night queuing because the appointments are allotted at 5am. However long you wait, there are only 10 with five already sold in advance and magically disappearing,” relates Briana’s uncle.
“There are many people participating in the sale of appointments. This is a widely practised and well-known situation. An appointment costs between 1,500 and 2,000 pesos. Even if this is not a huge sum – although it should be free – for Briana’s family, with a woman bringing up five children by herself, asking this of her was an unbearable effort, ” recounts Camacho.
Reality is so harsh that a little girl dies in a morass of irregularities and impoverishment in a family so needy that it could not raise 1,500 pesos to save its daughter via a corrupt system of selling appointments.
“Nobody knows who owns the appointments – there are many people participating in this,” indicates the lawyer. On its Facebook page the hospital published a photo with the text: “(...) Due to the daily inconveniences from the sale of appointments by people alien to this hospital, there will be information on the assignment of appointments next week (...)”.
“The indigenous communities must wait for hours for the appointments and even obtaining them, they are subject to discrimination by health personnel, who are judgmental about their lifestyle,” declares the ACIJ.
“The question is complicated by the [huge area] the hospitals have to cover – some come from distant places hours of travel away because they have no closer centre,” reveals Camacho.
To this must be added the difficulties of reaching the clinics – often on foot via bad roads walking distances of up to 100 kilometres.
The ACIJ has called on the state to comply with provincial law N° 7,856 on intercultural health, which purports to guarantee proper medical attention to indigenous communities, via the creation of a support network including intercultural facilitators who are much more than translators. Almost 10 years after its approval, the ACIJ lawyer affirms that this law is not being heeded.
In 2020 a DNU emergency decree declared a state of socio-medical emergency in the Salta departments of San Martín, Orán and Rivadavia. Three years on, little has changed. It’s time to act – how many more Brianas will there be?