COLOMBIA:
Malaria Winning the
Battle in Chocó
By Constanza Vieira and
Diana Cariboni*
QUIBDÓ, Colombia ,
(Tierramérica) - The
Atrato River is "full of
malaria", according to a
dozen men in rubber
boots, standing in the
water that has inundated
the village of Tanguí,
in Colombia's
north-western jungle.
It is the fifth flood
this year, and the rice
harvest is ruined. The
men stand in a
semi-circle with their
arms crossed to talk
with Tierramérica. The
120 families of Tanguí
live two and three
families in each of the
stilt houses.
We travel down the
street by canoe.
Children play happily in
the stagnant water.
There are no nurses: the
health brigades come
"every once in awhile"
and only because the
governor sends them:
"He's a friend of the
mayor," says one of the
men.
Quibdó, capital of the
department (province) of
Chocó, is a half-hour by
boat from Tanguí.
Situated in the heart of
this tropical
rainforest, it is ideal
for the mosquitoes that
carry malaria. Heavy
rainfall occurs nearly
every day. For the
people of the area, life
takes place along the
rivers.
In the context of the
decades-long Colombian
civil war, many who flee
the fighting in infested
areas carry malaria with
them.
According to the
non-governmental
Consultancy for Human
Rights and Displacement,
between 1999 and 2006,
nearly 70,000 people
were displaced in Chocó,
whose population is
about 800,000.
"Malaria hasn't
diminished. And we are
facing problems of small
outbreaks, including in
areas where it hadn't
presented in two or
three years," José
Dolores Palacios,
technician with the
Chocó Health
Secretariat's
transmissible disease
prevention programme,
told Tierramérica.
There are 58 cases in
communities along the
Bebará River, in the
municipality of Medio
Atrato; more than 90 in
Managrú, seat of Cantón
de San Pablo; and more
than 50 in Bellavista,
228 kilometres north of
Quibdó, where there was
an outbreak "just when
the president (Álvaro
Uribe) went there" to
inaugurate the new town
built by the government,
on Oct. 13.
As of September of this
year, 19,971 cases had
been reported in Chocó,
and in 2006 there were
12,441, but the 2007
increase is due to
previous
"under-reporting". The
highest numbers were in
1998, with 31,713, an in
2002, with just under
32,000, says Palacios.
Now data-gathering has
begun in rural areas,
entrusted to 13 experts
who diagnose the
disease, distribute
medications and conduct
quality-control of the
health posts, says the
Chocó health official.
Malaria, caused by
plasmodium parasites,
which are spread through
bites from infected
mosquitoes, is
preventable and curable.
But the disease kills
more than one million
people a year around the
world, mostly in Africa,
according to the World
Health Organisation
(WHO).
Fever, headache,
vomiting and shivering
are symptoms that can
occur 10 days to one
month after infection.
If it is not treated
immediately, it can
become deadly.
It can also be
incapacitating,
worsening poverty,
epidemiologist María
Victoria Valero, of the
National University's
internal medicine
department, told
Tierramérica in an
interview. In Chocó,
78.3 percent of the
population is poor.
One patient with
plasmodium falciparum,
the most virulent of the
four strains of malaria,
suffers fever every
three days, and so
cannot work, says doctor
Carlos Agudelo, director
of the National
University's Public
Health Institute.
"As long as the disease
lasts, the person can be
incapacitated 15 days
each month," he adds.
Depending on which type
of plasmodium parasite
is behind it, the
infection can last
years.
Individuals are infected
over and over again in
the areas where it is
endemic, and many grow
accustomed to working
with low fevers, says
Agudelo.
Malaria is endemic
across much of Colombian
territory. More than 25
million people of the
national population of
45 million live in
malaria zones, according
to official data. In
2004 there were 25
malaria deaths reported,
according to the
Ministry of Social
Protection, and 123,177
cases, more than 47
percent in the
western-Pacific region,
where Chocó is located.
Furthermore, "there are
many complicated cases
of plasmodium vivax
appearing," warns
epidemiologist Valero.
Malaria "is an important
cause of anaemia in
infants and pregnant
women, low birth-weight,
premature birth and
infant mortality,
according to the WHO's
World Malaria Report
2005.
In Valero's opinion,
malaria is spinning out
of control not only in
Chocó, but across
Colombia. Agudelo,
meanwhile, says the
disease increased a
great deal until five or
six years ago, and then
stabilised, with
occasional epidemic
outbreaks.
Both experts agree that
development is the only
effective remedy.
"Malaria is an economic,
social and cultural
problem" which only
disappears from areas
with industrialisation
and better
socio-economic
conditions, says Agudelo.
Colombia signed on to
the global campaign to
"Roll Back Malaria" by
half by 2010, but the
country doesn't seem to
be on the road to
achieve that goal.
The efforts by the
now-defunct National
Malaria Eradication
Service (SEM) were not
successful. Nor were the
schemes adopted
beginning in 1993, when
the country embarked on
a reform that
decentralised the health
system and shifted the
burden to the local
governments, according
to doctor Agudelo.
Created by decree in
1956, SEM's strategy was
centralised and
vertical. It had
technical and
administrative autonomy,
national jurisdiction
and its own budget.
But it was subjected to
a series of cuts, and
failed to adapt to the
new realities that
further spread malaria,
such as the colonisation
of the jungle, illegal
drug trafficking, and
rural violence,
according to the book
"The Pan-American Health
Organisation and the
Colombian State: 100
Years of History,
1902-2002".
Epidemiologist Valero
believes that with the
disappearance of SEM
"the country forgot
about actively looking
for cases and for the
contacts of each
infected person." In
Colombia, it takes "as
long as 15 days to
diagnose and treat a
case. In that time, a
sick person can infect
many people," she says.
The residents of Tanguí
continue to point to the
lack of health workers
and the floods. "The
solution is to find a
way to fill in the town
and channel the Atrato"
to the Caribbean Sea.
Twelve of the river's 14
mouths are blocked by
sediment -- the result
of deforestation. "It
must be channelled so
that the water doesn't
rise," says one
resident, stating the
obvious.
But the obvious doesn't
always determine
government services. The
only hospital in Quibdó,
a rundown place where
some patients have to
sleep on the floor due
to lack of beds, does
not always attend to
people who come from
distant communities for
treatment, charges the
Chocó People's Defender
(Ombudsman) Víctor Raúl
Mosquera.
"They have to go to
other clinics that have
been set up here, and
where they are also
denied service. Children
have died because of
this. They are forced
into a sort of 'tour of
death'," pushing a sick
person from one health
centre to another until
he or she dies, says
Mosquera.
|
