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
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.”
By Imogen Foulkes
Imogen Foulkes is a correspondent for the BBC based in Geneva, Switzerland.
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.
easily controlled in
an urban setting
could be fatal along
the Caguan River.”
An ICRC delegate performs a check-up at a makeshift riverside
Photo: ©M.C. Rivera/ICRC