Parasitic infections can have a severe impact on a child's development, and skin infections can be severely painful or disfiguring. These often go untreated because there is no doctor, nurse, health promoter, health education, or even medicine.
Reproductive health is also an important issue in these remote communities. MSF works in villages where as many as 82% of births take place at home, with the average age at first parity being 16.6 years. In the Norte de Santander communities where MSF works, 13% of the women of childbearing age coming for care told MSF that they had had a child less than five years of age die during their lifetime.
The extent to which infectious diseases such as tuberculosis (TB) and hiv/aids affect rural populations is simply unknown. MSF has detected TB cases, particularly among the rural indigenous population. Many of the critical risk factors associated with these diseases are present, but access to diagnosis, treatment and follow up is often not available. Malaria is endemic in certain parts of Colombia, both falcipirum and vivax. When a blood test is available, it is usually done for a fee, and in MSF's experience, a large percentage of the rural population cannot afford it so they simply self-diagnose, self-medicate, or suffer untreated.
For those suffering from cutaneous leishmaniasis, there is the additional problem of stigmatisation. Since this disease is confined to inaccessible rural areas, it is commonly perceived as affecting members of the guerrilla. Therefore, medicines needed for treatment are restricted and controlled by the Ministry of Social Protection. This means treatment is not available from private pharmacies, often the only source of medicines for many rural communities.
Present estimates of vaccination rates in some communities are as low as 1% against certain diseases such as polio, DPT or BCG. Very few children have age-appropriate vaccinations for the full range of childhood diseases.