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Colombia: Isolated and Forgotten
By Olga Ruiz MSF Regional Information Officer, South America
November 11, 2003
"One day we treated 400 people who hadn't seen a doctor for three years," said Vikki Stienen, MSF Head of Mission in Colombia. She had just returned from a one-week health campaign in an area controlled by an armed group in Cundinamarca, an area surrounding the capital Bogota. "We are here to provide primary health assistance regardless of who controls the territory."
The four international volunteers and eight national staff that travelled for five hours into the Colombia countryside with the mobile clinic - a task the team repeats every week in coordination with the local hospital. On this trip, they visited four villages in four days.
Every week, MSF has eight mobile clinics providing basic health care in ten of Colombia's 32 administrative areas, or about one third of Colombia's expansive territory. Teams are on the road for up to five days to reach impoverished and excluded people.
Teams are on the road for up to five days per week bringing health assistance to impoverished and excluded populations. On occasion, teams from MSF reach distant villages by boat or even on horseback.
In NariÃ±o, a province on the Pacific Coast, the MSF team takes a boat every Monday up river to deliver primary health care to communities along the river's banks. MSF has also rehabilitated two health facilities along the route this year.
The MSF clinic is often little more than a doctor working in whatever free space is available - sometimes in a school, sometimes a playground. Throughout the day, entire families arrive on foot or by horse from homes often several hours away.
During this visit to Cundinamarca, more than 400 people came for treatment on the first day. Another 200 came each of the following days, half of them children.
MSF offers treatment to an estimated 250,000 people per year, mostly for malaria, leishmaniasis, parasitosis, chronic malnutrition and hypertension.
Daily battles for land between different armed groups dictates that people in rural and isolated areas effectively have no right to get sick. Guerrillas, paramilitary forces or the army controls roads in Colombia, and health care facilities are often several hours away by foot in areas controlled by different groups.
Crossing checkpoints is often too dangerous for residents. Various armed groups may suspect them of supporting other factions, and threats against local hospitals make it difficult for doctors and nurses to organize medical teams.
On occasion, the MSF mobile teams are stopped at checkpoints by the same armed forces that prevent people from visiting hospitals and the teams are turned back.
In a general context of daily oppression, threats, displacement, bomb attacks, extortion, minefields and kidnappings that particularly affects rural residents, MSF mobile clinics are of special relevance in Cundinamarca, Tolima, Caquetá, NariÃ±o, Sucre, Bolivar, Cordoba and Norte de Santander - all areas where access is extremely limited.
Health care in Colombia is just another victim of the ongoing conflict that dominates the country. It is exacerbated by structural inequities that exclude the poorest and the displaced from registration in the administrative areas - effectively denying them access to health care
"MSF is bringing health services to victims of direct violence but also to victims of structural violence that excludes the most vulnerable", stated Antonio da Silva, MSF Head of Mission in Cali.
In reception areas for displaced people, like Soacha on the outskirts of Bogota or northern QuibdÃ³ in the Pacific Coast's ChocÃ³ district, MSF is not only providing primary health assistance but also helping the municipal governments include vulnerable people in the social system. One example is how more than 7,000 people in QuibdÃ³, one of the poorest areas of the country, have been registered for inclusion in the public health system since MSF began working there in April 2003.
"MSF tries to help people that the government seems to forget exist," Vikki Stienen said. "Like displaced people or peasants living in isolated areas - by providing medical assistance, clarifying their status and even informing medical staff about their rights in conflict."
Nearly 40 international volunteers and 126 national staff work in Colombia trying to improve access to health care, which is hindered by the ongoing conflict in rural areas. MSF also provides medical attention for displaced and vulnerable people in urban areas like Soacha while helping them access the public social system. MSF also treats people for the physical and psychological consequences of urban violence in Cali. MSF has been present in Colombia since 1985.