Access to health care - Colombia's cycle of violence

The man was found wandering around town. He said he was feeling bad, but he could not explain what was wrong. He kept talking and crying... tears went down his cheeks and when we asked him why he was crying, he said, "Am I crying?" and he cleaned his face, started crying again, and kept repeating he did not feel well. He was disoriented, confused, with mental blackouts, he could not remember what had happened. In this war you get to see beyond the dead, there is another face to violence. — Community leader, rural area
Colombia is a large country and vast parts of its territory are covered by thick jungle that makes travel extremely difficult. Most health professionals are based in the large cities. Beyond the shortages of human and financial resources common to many of the countries in the region, the conflict in Colombia plays a major role in preventing government medical staff from reaching remote areas. Despite these constraints, there are many rural medical staff that assume exceptional levels of personal risk to provide medical attention. They frequently recount stories of armed groups exerting pressure and control over their movements or work. One doctor described a one-month term of practice in a heavily controlled village: "The paramilitary would make all the decisions in the health post and were informed about everything. They drove the ambulance, managed trade and prostitution in town, they knew how many sex workers were in each bar. A total of 76 sex workers came for STD [sexually transmitted diseases]check-ups each week, so they would stamp it and allow them to work. "I knew that the paramilitary killed those women who were sick, so they would not infect their clients. So we agreed with the bacteriologist that nothing was to be reported officially in the notebook, nothing was to be written on the individual tests. Then, when the women came in, I would take them aside, give the real results to those who were sick, and advise them to leave everything behind, find an excuse, and leave town at once." — Former doctor, rural community Not all conflict regions suffer from these extremes of control, but many MSF patients have expressed reluctance to seek medical help out of fear of who may be involved, how they may be treated, and where their medical records might end up.