Colombia Integrated Community Health Project Departments of Antioquia and Chocó, Colombia
About the Region • Since 1964, the country has been embroiled in a civil war that continues to date to cause the death and kidnapping of more than 3,000 people a year, most of whom are civilians and civilian leaders. • There are close to three million internally displaced people in Colombia, 74% of them are women and children (according to the United Nations High Commissioner for Refugees). • In the region where the project is located, known as the Atrato River Basin, there are approximately 180,000 people living in “forced confinement.” • Chocó is the poorest department of Colombia consisting of only two roads, and most communities are only accessible by boat or jungle path. As well, most roads and rivers in this department are controlled by the various armed forces who impose strict blockades of materials into the region, making it extremely difficult to supply the communities with medicines, food, and other essentials, and making travel a very dangerous activity. • 70% of the population is unable to feed itself with a daily, basic diet.* • 60% of the population lives in extreme poverty.* • Infant mortality is 94 for every 1,000 births, the highest in the country.* • 26.3% of the population is illiterate, the highest in the country.* • 75% of the houses have no sanitation systems (drainage sewers).* • 77% of the houses have no access to potable water.* (*Statistics compiled by the Claretian Priests of Chocó)
Curt Wands, Physician Assistant Julie Bourdoiseau, Social Worker & Educator Current Professional Team
Project Description • Health Training: basic and advanced health promoter training, including both curative care and also the most essential public health and sanitation measures; “When I think about it, our goal is very ambitious: we are starting with a bunch of adults, many of whom have none to three years of school, and we are teaching them anatomy, physiology, pathology, symptomatology, and treatment with the resources available to us. This is something that would freak out the average first year medical student.” -Cliff O’Callahan, M.D. (1996) • Women and Children: addressing the needs of children and women, including pregnancy and delivery, basic reproductive health care, domestic violence, and other human rights; • Access to Medicines: establishment of essential medicines and medical supply warehouse for health promoter support; • Community Organization: training local communities in organizational, administrative, and accounting skills and in the "formation" of viable community health and other service committees or organizations. This focus also includes the development of small income- generating projects as a means of sustaining the project.
Stories from the Field “I just returned from a visit “upriver” to a very poor community of internally displaced people attempting to re-settle their village. All that remains from their original village were three cinder blocks. Every simple wood-frame building with thatched roof (in other words, their homes and community buildings) had been destroyed. The families that just recently returned now live in the simplest of dwellings: just a thatch roof held up by poles, no floor but the ground, no walls. As we entered the community, they welcomed us with the words, ‘We welcome you in the name of the God of life.’ I accompanied the health promoter in examining the patients. He told me that the community is so committed to making health care a priority in their community that they plan to build a small clinic using cinder blocks, as a reminder that that was all that remained of their initial community and as a pledge to their children, their children’s children, and into future generations that they will never have to suffer from lack of decent health care.” ~ Curt Wands, PA (April 2005)
“A number of weeks ago I was hit by one of the more chilling moral/ethical issues that I have come across here. A mother approached me in Apartadó asking me for counsel on her 15-year-old daughter who has been diagnosed with HIV. The mother did not come asking for medications or alternative treatment. Her concern was for her other children she told me. I was prepared for her to ask me about how HIV might be transmissible to her other children through daily life at home, or perhaps on how to counsel her other children to avoid risk factors like using IV drugs or having unprotected sex. However this mother’s quandary was different. She explained that the paramilitary forces had heard that her daughter was HIV positive and that they were planning on coming to kill her daughter in the home. ‘Should I move my other children to sleep in another room, so that they might not be killed when the paramilitary come to kill my daughter at night?’ was what this distraught mother wanted to know. The harshness of her reality I find devastating. Imagining the terror of waiting for the nighttime stomping of boots, the brutal entry of armed men, hooded ‘or not’ to avoid later identification, the shots fired whether directed or indiscriminate, were all part of a nightmare she awaits with the certainty of a ticking clock. This is the vision of social cleansing that the paramilitary bring to Colombia. The paramilitary’s contradictory activity in growing, processing and smuggling tons of cocaine and heroin, is stunning in their lack of allowance for what they perceive as social deviance (including drug addiction!) Whether it is children sleeping on the streets, alcoholics, drug addicts or other societal burdens (one can read into this the journalist, priest, health worker or other social change agent), the paramilitary are the judge, jury and executioner.” ~ Curt Wands, PA (2004)
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