Colombia: the lower Caguán region is suffering from neglect

08-09-2011 Feature

This region of Caquetá is remembered for the peace talks held here in the past. Today, however, the people living along the banks of the Caguán river are enduring armed conflict and abandonment. Disease is rampant.

Jeison felt crippling pain when he was bitten by a snake. Jorge is suffering from old age, and his lungs hurt. Marta, five months pregnant, is having pain, and Gloria* might have cervical cancer.

However, this is not the main problem; they are all also suffering from a condition called neglect. They live in the villages and towns of the lower Caguán region (Peñas Rojas, El Guamo, Santo Domingo and Monserrate). Reaching them can take more than eight hours by boat from Cartagena del Chairá (Caquetá).

The health posts in these places have no supplies or staff. The people, most of whom earn a modest living from the land, have no money to pay for medicines. Travel by boat to the nearest hospital costs on average 120,000 pesos (64 US dollars, about one week's minimum wage) for a one-way trip. What do people in Caguán do when they fall sick? "Well, we use herbal remedies, and when it is very serious, we take up a collection. The truth is, though, that we almost always resign ourselves to it," say the inhabitants.

For now, they have access to health care mainly through the ICRC's mobile health units, which visit every four months. Four years ago, after health-care workers came under serious attack, doctors from the hospital in Cartagena del Chairá stopped travelling to lower and middle Caguán to treat patients.

Ideally, in the medium term, the medical team will return to the region to provide health care to the population. However, for this to happen, trust and acceptance must be built, the team's safety must be guaranteed, and the regional and national authorities must back the initiative.

The plight of the lower Caguán communities highlights the difficulties faced by civilians living in conflict-ridden areas in accessing health care and other basic services. The distances involved, prejudice against indigenous people, and the reluctance of medical personnel to visit such areas owing to past attacks on medical teams all play a role. In addition, the entire national health-care system is plagued by corruption and financial difficulties.

Jeison's pain

Jeison is 13 years old. He remembers clearly the day he was bitten by a snake. First there was excruciating pain, and then he lost all feeling in his left arm. He was with his father, hunting near the river, when he went to push aside a branch with his hand, and suddenly he was bitten by a palm snake, a "green snake with a yellow belly and three fangs."

Since there were no doctors that day, his father extracted the venom by squeezing his arm. Then he took him to see a "man who prays to animals," and he was treated with a traditional remedy made from fermented milk and honey. Several days later, Jeison went to the mobile health unit in Monserrate, the first town in lower Caguán, downstream from Cartagena del Chairá, to have his wound examined. Francisco, one of the doctors, explained to him that he had been very lucky, thanks to his father's swift action.

However, not everyone in the lower Caguán region has been as lucky as Jeison. In Remolinos, a town on the border between lower and middle Caguán, a community leader says that they have been asking the government for a long time for a water ambulance to transport the injured and sick. "People have died from snake bites; when something serious happens, we have to raise the money to rush to Cartagena," he says.

Chronic respiratory conditions

At 77, Jorge suffers from a "cough that never lets up, day or night. Apart from that, I was kicked by a mule, I have pain around my waist and my eyesight is going."

He made his way to the health check-up session from the El Convenio district, an hour from Monserrate town centre, after not seeing a doctor for a year. Pamela, the doctor who saw him at the run-down health post, diagnosed him with chronic obstructive pulmonary disease.

Jorge's case is an example of the type of ailment that most affects the population of the Caguán region – respiratory disease. In these winter months, it afflicts children and the elderly in particular.

Painful childbirth

Another major health problem which besets the Caguán region is pregnancy at a young age among women who do not receive prenatal care and who put themselves at major risk by giving birth with traditional midwives.

Marta is 32 and is already expecting her fifth child. "With my last child, I went into labour on a Saturday. The midwife barely arrived in time and the baby was born immediately. She cut the cord with a brand-new razor blade and tied it off." The baby she is expecting is due in November, and Marta is almost certain that she will give birth again with the help of the midwife.

Gloria, 49, has a more complicated story. She came to the health check-up session to collect the results of the smear test carried out four months ago. The news does not appear to be very encouraging. Pamela explains that Gloria has to go to Florencia because the smear test reveals an anomaly. "It shows us that there is a serious lesion on the uterine wall."

The ICRC is giving her money for travel and to cover expenses for three days, as well as helping her to arrange the medical appointment, but it cannot subsidize the rest of the treatment. It's difficult enough to be told you have cancer when you're in the city, with hospitals and doctors on hand, but hearing such news in Caguán leaves you speechless. Gloria, however, demonstrating the bravery that comes from a lifetime of struggle, simply replies: "Tears will not get you anywhere; you have to take things calmly."

Fortunately, Gloria, unlike most Caguán inhabitants, is registered with the national health service and will be able to get treatment in Florencia. The problem will be how to pay for a six-hour boat trip and three hours' overland travel each time she has to see the doctor. Without doubt, the most serious disease afflicting Caguán is neglect, as well as remoteness. It seems to belong to another country, a distant and uncharted territory for city dwellers, and a foreign land for most Colombians.

* Name changed.


The ICRC carries out humanitarian work in Colombia with people affected by conflict and other forms of violence. In 2010, it provided care to more than 180,000 people and documented 768 violations of international humanitarian law, including murder, threats, disappearance and seizure of civilian property. It also recorded 35 cases of mass displacement and provided care to 38,000 displaced persons. Another 700,000 people benefited indirectly from its work, by making use of the infrastructure built by the ICRC or through the first-aid training provided to community leaders.


El principal acceso a la salud que tienen las comunidades del bajo Caguán (Caquetá) son las Unidades Móviles de Salud (UMS) que cada cuatro meses realiza el CICR en la zona. En la imagen, la llegada de las lanchas al pueblo de Monserrate. 

Communities in the lower Caguán region (Caquetá) have access to health care mainly through the ICRC's mobile health units, which visit every four months. This picture shows the boats arriving in the town of Monserrate.
© ICRC / M.C. Rivera

Francisco, uno de los médicos del CICR, revisa a Jeison, el niño mordido por una culebra. 

Francisco, one of the ICRC doctors, examines Jeison, the boy bitten by a snake.
© ICRC / M.C. Rivera

Las jornadas de salud que realiza el CICR, aparte de cubrir las enfermedades crónicas de la población también incluyen la atenciónodontológica. 

The health check-up sessions run by the ICRC include dental care as well as treatment of chronic diseases.
© ICRC / M.C. Rivera

Gracias a estas jornadas de salud las mujeres embarazadas reciben sus controles prenatales. En la imagen, un examen de ecografía realizado a una paciente. 

Thanks to these check-ups, pregnant women receive prenatal care. This picture shows an ultrasound scan being carried out on a patient.
© ICRC / M.C. Rivera