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Colombia: doctors in the jungle

08-10-2010 Article

A humanitarian mission escorted by the International Committee of the Red Cross (ICRC) tries to relieve the isolation in which settlers and indigenous people live. An account of a day spent delivering medical care on the extreme periphery of Arauca department. Excerpts from an article by José Alejandro Castaño, published in the 25 September 2010 issue of the journal Semana.

David, a small boy belonging to the Macaguaje people, clenches his fists and digs his heels into the canvas cot when Marciano de la Hoz yanks out the fifth molar that he has removed from him this morning. It all takes place under a tree, in the jungles of the Orinoco delta on the Venezuelan border, amid insects swarming in the air and tiny lizards lapping at the moist earth. Some dentist's office!

The journey from Arauca takes ten hours, at first by car as far as Bocas, a hamlet on the banks of the Ele river, and then by canoe, until you reach a channel crossing in a place where the water goes above the treetops because of the floods at this time of year.

( …) The Arauca municipal council, which has to offer humanitarian services to the families scattered over this area at the centre of the armed conflict, a zone of dense forests, jungles and foothills of the Cordillera Oriental, is responsible for sending the medical team. Two doctors, a dentist, a nurse, four assistants and a pharmacist are coming, wearing waterproof coats to protect them from the rain. Three ICRC delegates accompany them, in order to ensure that the guerrilla groups allow them to pass through the territory and tend to the 50 or so families who have settled there, as well as to the Macaguaje people and 460 indigenous people of the Hitnu ethnic group.

(…) Alberto Vescance, the pharmacist, lays out on a table an assortment of medicines for the patients. Some of them, having been told about the team's visit, have been walking through the mountains for the past two days. With few exceptions, the Hitnu indigenous people do not speak Spanish, and so they touch the parts of the body where they feel ill. The doctor s manage to understand the sign language. “You can't give them medicine to take with them, because they will take it all at once, " warns Leydi Meléndez, placing her stethoscope on the chest of a pregnant woman.

(…) The doctors, to their surprise, discover that the woman is about to give birth. And there is a complication: the baby is upside down, nearly horizontal. If they want to save both lives, they must perform a Caesarean section immediately, but that is impossible here, with no resources, amid the heat and humidity of the jungle. They decide to send the woman to the Arauca hospital, so many hours downstream. Will she make it?

 Four noses  

At midday, in a clearing of the jungle where the team has improvised a kind of clinic, the settlers and indigenous people squeeze together under the shade of two palm-thatched huts. Marciano, the dentist, goes on pulling molars, those that he cannot anchor with glue. In other circumstances, many teeth could be saved, but the team will not visit again for five or six months, and the unbearable pain of people with cavities offers little hope. On this day, the team provides care to a total of 63 adults and 23 children, vaccinating them against diphtheria, tetanus, whooping cough, hepatitis, meningitis, yellow fever, measles, rubella and poliomyelitis.

Although he tries to lessen the pain of the injections with sweets, Marco Tulio Vargas is the other most feared member of the medical team. Sometimes when he comes back to administer the second doses, some of the children have already died of malnutrition, or have drowned or been bitten by a " four noses " pit viper, the most dreaded snake in these remote places, capable of bringing down a jaguar, a capybara, or any animal unlucky enough to step on it.

Fearing that the army will follow on the heels of th e medical team, the guerrilla groups restrict the periodic vaccination visits. On other occasions, Marco Tulio has had to return home with his cooler of doses preserved in ice after hours of walking fruitlessly through the jungle. Today, luckily, the ICRC is here to make sure that does not happen, and Marco Tulio's satisfaction is mirrored by the weeping of the children who are about to receive injections.

 At the end, a dolphin  

(…) In Romanos and La Conquista, two districts at the edge of the Ele river, two health centres are rotting and overgrown with tree roots. One of them is equipped with cots and furniture, and, although it is hard to believe, it also has a dentist's office with a chair, a lamp and surgical instruments. The members of the medical team clutch their heads in frustration at such a waste of resources.

If both health centres were functioning, there would be 95 per cent fewer deaths. That is what Juan Pablo Pineda, the other doctor aboard the canoe, thinks. Five days after navigating channels and streams, the team finds that the number of patients treated totals 417 – a figure that justifies the effort, the mosquito bites and the lack of payment, for nearly four months now. The doctors rejoice.

The news continues to be good: the indigenous woman sent urgently downstream the other day managed to get there alive – no one can explain how – and gave birth to two babies, a boy and a girl. “The obstinacy of life,” says Parientico, the canoe operator, before starting to sing and declaring for the umpteenth time that he wishes things would always turn out so well in Arauca.

On the embankment, under a sign in which a politician, now a government official, promises the same as the others do, three Hitnu girls sniff glue, just as other children do on any street in Medellín, Bogotá, Barranqui lla or Cali. And just as in those cities, for a 10,000-peso note, anybody can buy them for a while. Meanwhile, the river continues its course. It sometimes happens that, among the river's eddies, in the orangish light of the late afternoon, someone spots the blue skin of an Amazon river dolphin. And meanwhile, the doctors return home.




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