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International Activity Report 2011
Colombia
MSF in Colombia, 2011
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Conflict in Colombia has taken a severe toll on the population, and medical assistance is often scarce for people living in zones affected by fighting. Guerrilla groups continue to fight government forces, while paramilitary groups have re-emerged in many areas. The strife has displaced an estimated three million people, many of whom live in poverty on the outskirts of the bigger cities, while large parts of the countryside remain unsafe.
Assisting rural communities
In the southern departments of Caquetá, Nariño, Putumayo and Cauca, Doctors Without Borders/Médecins Sans Frontières (MSF) set up additional permanent or semi-permanent clinics in order to improve the quality of care available to people living in conflict areas. Teams provided basic health services, reproductive healthcare, check-ups and vaccinations for children, an emergency referral system and dentistry. Dentists perform essential work – such as extractions – which has a considerable impact on patients’ health and wellbeing.
As part of its antenatal programme, MSF began offering counseling and testing for HIV. There is still significant stigma attached to HIV, but the testing service has been well received by pregnant women. Those women who test positive for the virus are offered prevention of mother-to-child transmission services.
More than 54,200 patients attended consultations at rural clinics in 53 locations across the four departments. Over 1,600 people traumatized by conflict also received mental healthcare at MSF programs in municipal hospitals in Cauca and Caquetá.
Cristóbal *
9 years old
Cristóbal arrived in Florencia * two years ago and is still trying to adapt. He misses the river that ran near his old house. He misses riding his horse through the woods. He misses the milk, cheese and good food. He misses his teacher and his friends and the games he used to play with them in the afternoon. He weeps when he talks about the armed group that killed his father two years ago a few steps from his house, after accusing him of supporting another armed group.
Cristóbal is receiving care in an MSF psychological program, but, like many other boys and girls from Caquetá and other parts of Colombia, he is in unfamiliar surroundings and traumatized, trying to recover from unspeakable tragedy.
* The patient’s name, and place names, have been changed.
Over the course of the year, MSF provided medical and psychological assistance, as well as water and sanitation services, to 4,800 people during 19 emergency interventions. Most of them were suffering from conditions caused by conflict and forced displacement. When widespread flooding hit Cauca, MSF delivered washing kits, blankets and mosquito nets to 4,430 people. However, MSF teams were still unable to reach 16 locations because of security problems.
In Turbaco, Bolívar, and Tierralta, Córdoba, MSF offered basic healthcare and psychological assistance to people also suffering the direct consequences of conflict. Teams conducted more than 780 individual mental health consultations and 53 group counseling sessions. Mobile teams conducted another 9,000 medical consultations. In November, the program was closed due to a relatively low number of patients.
Through its report Access to Health is Access to Life: 977 Voices, MSF gave medical evidence of the barriers that Colombians have to overcome in order to access decent healthcare. People living in rural zones have greater difficulty obtaining medical assistance than people living elsewhere in the country. The report exposed the necessity of extending health services, both qualitatively and quantitatively, making them free of charge for more people, and increasing the availability of essential medicines in health facilities. It also highlighted the intrinsic relationship between conflict and the lack of access to medical care.
MSF was invited to present this report and its 2010 report Three Times Victims: Victims of Violence, Silence and Neglect, Armed Conflict and Mental Health in the Department of Caquetá to the Colombian parliament.
Assistance to victims of sexual violence
At its clinic in the town of Riosucio, in Chocó department, MSF provides mental and reproductive healthcare, and assists victims of sexual violence. Staff carried out more than 3,900 consultations over the year, as well as training and outreach activities with teachers, health staff and primary school students to raise awareness about sexual abuse and sexual violence.
Healthcare in Buenaventura
A great many people displaced by violence in the Pacific coast area seek shelter in the city of Buenaventura. But the ratio of health workers in Buenaventura is three times below the national average. In 2011, MSF opened a second clinic in the city and conducted more than 33,200 consultations. Staff provided a range of services, including emergency assistance, medical and psychological care for victims of sexual violence, basic healthcare, ante- and postnatal care, family planning, vaccination and treatment for acute malnutrition. Some 360 tuberculosis (TB) patients, including 42 with multidrug-resistant TB, began treatment. Teams also carried out health promotion activities and vaccinations in around 15 neighbourhoods. In several areas, MSF helped residents to set up safe water supplies.
Offering treatment for Chagas disease
Chagas disease is an endemic parasitic disease that causes chronic health problems over many years, and if untreated, usually leads to fatal heart disease. It goes largely untreated in Colombia. In collaboration with the Ministry of Health, MSF has developed treatment protocols for Chagas. Mobile teams in Norte de Santander and in the Tame municipality of Arauca provided screening and treatment, reaching more than 2,000 children aged between nine months and 18 years in 2011: 41 patients in Tame began treatment and the two children in Norte de Santander who tested positive will start treatment in 2012. The program was closed in November, given the relatively low number of patients found to have Chagas.
At the end of 2011, MSF had 361 staff in Colombia. MSF has been working in the country since 1985.
