Facing a double burden of inequity: A qualitative participatory study of the experiences of a remote Indigenous population in Andean Peru during the COVID-19 pandemic

The COVID-19 pandemic profoundly impacted Indigenous populations worldwide, extending far beyond the biomedical outcomes of disease and mortality. This study explores the experiences of a Quechua-speaking Indigenous community on Amantaní Island, Peru, through a critical medical anthropology lens. Employing a participatory approach, we engaged with community members to explore the multifaceted impacts of COVID-19 on their health and wellbeing. Local facilitators used participatory methods to collect qualitative data from 10 men and 8 women during 2-day gender-segregated workshops within a larger four-year research study. The data were analysed thematically. Our findings reveal that COVID-19 intensified economic instability, social isolation, and educational disparities in Amantaní, with significant impacts on wellbeing. The interruption of tourism, a primary income source, caused severe financial hardship, while lockdowns disrupted social cohesion and access to services. Despite these challenges, the Amantaní communities implemented autonomous coping strategies: reviving ancestral practices such as bartering, developing new income-generating activities, and leveraging social networks for support. This study underscores the importance of addressing the structural determinants of health and integrating Indigenous knowledge systems into public health strategies. By highlighting pre-existing systemic inequities and community strengths, we advocate for equity-driven pandemic preparedness and response, emphasising the need for culturally competent healthcare and inclusive policymaking.