Isolated or forgotten, MSF mobile clinicsreach remote populations in Colombia

Health care in Colombia is just another victim of the ongoing conflict that dominates the country. It is worsened by structural inequities that exclude the poorest and the displaced from registration in the administrative areas - effectively denying them access to health care.

"In only one day we reached 400 people who hadn't seen a doctor for three years," said Vikki Stienen, MSF Head of Mission in Bogota who had just returned from a one-week health campaign developed in an area controlled by an armed group in the Cundinamarca department. "We are here to provide primary health assistance regardless of who controls the territory."

This team of four expats and eight national staff members that made up this MSF mobile clinic had travelled five hours into the Colombia countryside - repeating a task the team undertakes every week. In this trip, they visited four villages in four days. The visits are done in coordination with the local hospital, which is responsible for announcing MSF's arrival in the previous days - an effective technique that allows MSF to cover large parts of the region.

MSF has eight separate mobile clinics operating each week, providing basic health care in ten of Colombia's 32 administrative areas - about one third of Colombia's expansive territory.

Teams are on the road for up to five days per week bringing health assistance to impoverished and excluded populations. But on occasion, the MSF staff reach the distant villages by boat or even on horseback.

In the Nariño department, on the Pacific Coast, the MSF team jump in a boat every Monday and travel up the river offering primary health care to the communities along the riverside. This year, MSF has also rehabilitated two health facilities along the river that are now run autonomously.

Although exact numbers are not available, in these mobile clinics MSF offers treatment to over 250,000 people per year - and virtually all treatment is to people who, otherwise, would have no access to health care. Treatment is mostly for malaria, leishmaniasis, parasitosis, chronic malnutrition and hypertension.

The MSF clinic is often little more than a doctor working in a classroom. The doctor works in whatever free space is available - sometimes in a school, sometimes in a playground or wherever the community has free space. Throughout the day, entire families arrive on foot or by horse from homes often several hours away.

During this visit to Cundinamarca, over 400 people came for treatment on the first day. Another 200 came each of the following days, half of them children.

Although exact numbers are not available, in these mobile clinics MSF offers treatment to over 250,000 people per year - and virtually all treatment is to people who, otherwise, would have no access to health care. Treatment is mostly for malaria, leishmaniasis, parasitosis, chronic malnutrition and hypertension.

Daily war for land between the different armed groups dictates that people in rural and isolated areas effectively have no right to become ill. Colombian roads are controlled by guerrillas, paramilitary forces or the army - and health facilities could be several hours away by foot and in armed held areas.

Crossing checkpoints is too often difficult for locals. The armed groups may suspect them to be supporters of other factions. Also, threats to local hospitals make it difficult for the hospitals to organise medical teams.

On occasion, the MSF mobile teams are stopped at checkpoints by the same armed forces that prevent the local population from visiting the hospitals in the region and the teams are turned back.

The aim for MSF is to support local health facilities with international presence during their work with the mobile clinics. In a general context of daily oppression, threats, displacement, bomb attacks, extortion, minefields and kidnappings that affects most of the rural population, MSF mobile clinics are of special relevance in areas of difficult access in Cundinamarca, Tolima, CaquetÃ?¡, NariÃ?±o, Sucre, Bolivar, Cordoba and Norte de Santander.

Health care in Colombia is just another victim of the ongoing conflict that dominates the country. It is worsened by structural inequities that exclude the poorest and the displaced from registration in the administrative areas - effectively denying them access to health care.

"MSF is bringing health assistance to victims of direct violence but also (to victims of) structural violence that excludes the most vulnerable", stated Antonio da Silva, MSF Head of Mission in Cali. Displaced and poor people have enormous difficulties in being included in the public health system. The process is so complicated, and so far behind the social-economical reality of the country, that the most vulnerable almost certainly have no access.

In displaced reception areas, like Soacha, in the outskirts of Bogota or northern QuibdÃ?³ (ChocÃ?³ department, in the Pacific Coast), MSF is not only providing primary health assistance but also helping the municipality with the inclusion of vulnerable people in the social system - an essential step is to enforce the right to be treated in public hospitals. However access to care requires registration - which often never happens. Since MSF has started assisting this vulnerable population, more than 7,000 people have been registered since early April in Quibda, one of the poorest zones of the country.

"MSF tries to help people that the government seems to forget exist - like displaced people or peasants living in isolated areas - by providing medical assistance, clarifying their status and even informing medical staff about their rights in conflict", Stienen said.

Almost 40 international volunteers are working in Colombia, the most MSF staff in any Latin American country. MSF is is trying to improve access to health care, which is hindered by the ongoing conflict in rural areas. MSF also provides medical attention for displaced and vulnerable people in urban areas like Soacha while helping them to be included in the public social system. MSF also deals with physical and psychological consequences of urban violence in Cali.