Care along the Caguan

An ICRC team navigates Colombia’s Caguan River to bring medical care to a region caught in conflict.

IN a little village on the banks of Colombia’s Caguan River, people are standing in line outside a derelict building. It is in fact an abandoned medical centre, one of many up and down the river.

Inside the building, a makeshift clinic has been set up and, in 100 per cent humidity, as the generator roars outside, an ICRC medical team is working. At the end of a 14-hour day, the physician, Francisco Ortiz, has treated almost 100 patients. Tomorrow, after a 05:00 start, he and his colleagues will move on to the next village, where many more patients are waiting.

To explain why an ICRC medical team is out here in the Amazon basin, working in conditions that many health-care professionals in the developed world would dismiss as impossible, you need to go back up the Caguan River, to the start of the team’s journey, the little town of Cartagena del Chaira. For that is where regular health care along the river ends.

Cartagena does have a hospital, though it is tiny and underequipped. Doctors and nurses there work long days in difficult conditions, but although they know the communities down river desperately need health care, health staff have been very reluctant to travel to those isolated areas.

Frightened to come
The reasons are linked to Colombia’s long internal armed conflict, a decades-long struggle involving armed groups, drug cartels and the Colombian military. Increasingly in recent years, medical workers have faced various types of interference in carrying out field work and medical workers have been affected by a string of incidents. This comes on top of serious weaknesses in the health system in Colombia, particularly in remote, rural areas.

“We are in a conflict zone,” explains ICRC delegate Abdi Ismail, “and this has had an impact on the presence of the government, [so there is] no health care.”

Ortiz does go down the river, but his presence is only possible, he believes, because he works for the ICRC. “Colombian public medical staff are frightened to come here,” he says. “And then often the army doesn’t trust the medical teams — thinking that they are gathering information for the enemy.”

It was the absence of any national or local medical care along the Caguan that led the ICRC to begin medical missions in the region. One doctor was recently appointed to work along the river, which is 200 kilometres (125 miles) long, from a health post in Remolino. The ICRC team, after long and complicated negotiations with the armed group in the area, manages to go down the Caguan just once every two months to different areas along the river. Nevertheless, it makes a big difference to the local people.

Although the ICRC team has regularly visited this area in recent years, access cannot be taken for granted. As in any armed conflict, it is important to maintain a regular dialogue with all armed actors. Even then, it can happen that access may be restricted in some areas during certain periods.

A few weeks before the mission begins, villages are informed of which days the medical mission will visit and, as the ICRC boats set off down river, people are waiting all along the banks. Some have immediate needs: a pregnant woman with pre-eclampsia or a 17-year-old boy who has sliced open his foot on an old oil can — the two huge cuts need dozens of stitches. His only good fortune is the fact that the accident happened on the day of the ICRC team’s visit.

What becomes very clear, as the medical team begins to treat patients, is that although the very young and the very old are especially vulnerable, everyone along this river lives in fear of illness or accident.

“Nothing I could do”
Sandra and Ovidio are a case in point. This young couple has walked for more than an hour through the jungle, carrying their 7-month-old sick baby, but leaving their other two children at home.

“I worry all the time about the children getting ill,” says Sandra. “We have absolutely nothing in our village, no clinic, no doctor, no nurse.”

“The government doesn’t care about us,” adds Ovidio. “If I had an accident, there would be nothing I could do — I would just have to ask God for protection.”

Their baby has diarrhoea and a cough — minor ailments in theory but, as physician Francisco Ortiz knows, potentially fatal without proper treatment.

“A disease that is easily controlled in an urban setting could be fatal along the Caguan River,” he says. “I really worry a lot about the people here. It’s so difficult for them to see a doctor, they only see one when we come. And so many of them have conditions that are preventable or that we could treat if we saw them in time.”

Another example is Mercedes, the mother of four children. The last time the Red Cross team visited she was given a routine test for cervical cancer. Now, she is told it is positive. The ICRC provides her with money for the long boat trip up the river so she can have the hospital treatment she urgently needs, but it may not be in time.

“People here tell me they feel as if they have no right to get sick,” says Ismail. “It’s not considered an option. And yet people are still living here, and still smiling at you and offering you a cup of tea when you visit.”

Waterways are often the most effective way to travel into Colombia’s interior, where armed conflict has made health care inaccessible in many areas. Here, an ICRC medical convoy motors down the Caguan River in southern Colombia. Photo: ©M.C. Rivera/ICRC

“A disease that is
easily controlled in
an urban setting
could be fatal along
the Caguan River.”
Francisco Ortiz,
ICRC doctor

An ICRC delegate performs a check-up at a makeshift riverside clinic. Photo: ©M.C. Rivera/ICRC