IN THE FIELD

We just returned from our ten day trip through the eastern side of the Arhuaco indigenous reserve where we visited a regional healthcare center and two health houses in three different communities. Our first stop was at the regional healthcare center located in the indigenous community of Gun Aruwun (Sabana Crespo) which is a 2 hour off-road ride from Valledupar and the last community reachable by a motored vehicle on this side of the Sierra. We hitched a ride in a 4x4 that was on its way to Gun Aruwun to pick up a patient that had been referred to the hospital in Valledupar for specialized care.

 

Tour of the Gun Aruwun healthcare center with Dr Pierre Angely, July 2014

 

After a rough hour and a half and a few kilometers before reaching Gun Aruwun we were stopped by a jeep heading the opposite direction which was carrying the elderly patient and his family who had been waiting all morning for their transfer. They were moved to our jeep and ended up going back to restart their trip, which added another hour to their journey. We later learned that in Gun Aruwun there are no vehicles immediately available to transport patients to the city and as there is also no telephone signal it takes about an hour just to call for a transfer which means it takes at least three hours before a patient can be picked up for a transfer.
We were dropped off at the healthcare center where we spoke to the staff and received a guided tour from the physician Dr. Pierre-Angely Mejía. The center includes a medical office for general consultations and emergencies, a dental office, a lab facility, a dorm for the non-native staff and a recovery center.  Currently the medical consultations are being attended by a health assistant because the assigned physician left a few months ago and Dr. Mejía would only be consulted for emergencies as she is dedicated full time to the recovery center. The dental office seemed fully equipped and staffed with a dentist and a dental assistant while the lab was quite empty with no equipment and was only used to take samples once in a while when a lab assistant came over from the city.
Dr. Mejía then took us to the adjacent recovery center which was created and is operated in cooperation with the ICBF (Colombian Institution of Family Well-being) to manage infant malnutrition which is one of the main health care issues of the region. In the recovery center, babies up to 2 and 3 years old are admitted for a nutritional recovery program that takes them in for two months but according to Dr. Mejía some babies were kept for almost six months. At the moment there were 13 babies admitted into the program and most came in with clear signs of malnutrition.
Besides attending the thousand plus inhabitants of this community this healthcare center is the referral center for the surroundings and the rest of the eastern reserve which includes our next stop, Sogromin.

Inside the Health House in Sogromin, July 2014

View of the Sogromin Health House, July 2014

After a 7 hour hike uphill we reached the community of Sogromin which is the last and most secluded community on the eastern side of the reserve. There we encountered a slightly abandoned health post as the healthcare assistant had left a few months ago and the center was being looked after by a student, Beto Chaparro, who would become our guide, translator and assistant during our stay in Sogromin. The last time a physician visited the village was more than two years ago, so over the next few days more than a hundred patients consulted for various type of illnesses but mostly gastritis, respiratory tract infections, acute diarrhea and headaches.  Including the two boxes of various medicines we brought from Valledupar the pharmacy was properly stocked but the rest of the center was quite empty except for a few pieces of furniture including a small bed which we used for evaluating the patients. It was immediately apparent that the most important need for the center and community was the presence of a full time health care worker, preferably a native speaker. It is the hope that this void can be filled in the future by Beto who impressed us with his dedication, willingness and knowledge of the community and basic illnesses but that will take a few more years. For now the only option is for the patients to travel down to the health post in the adjacent community of Donachui where there is a full time Health Assistant on call. This would also be our next stop.

Patients waiting in the Health House of Sogromin, July 2014

After a one hour hike downhill we arrived at the community of Donachui which is slightly larger than Sogromin and has a better resourced health post, including the health assistant Lucia. Our time in Donachui also coincided with a traditional meeting of the women from the region which clearly impacted the number and type of patients that consulted at the health post over the next few days. Lucia would screen and select the patients to be evaluated which made the consultation better organized and in contrast to Sogromin included many cases of pre-natal and neonatal care. Most of the women evaluated have had multiple pregnancies and in average were in their 5th or 6th pregnancy, the most extreme case was a 38 year old whom was in her 11th pregnancy. The short interval between pregnancies is clearly an added factor behind the cause of extensive malnutrition in babies besides the limited diet and repetitive gastrointestinal infections. Most of the babies evaluated were in the lower percentile for weight, height and head circumference according to the WHO growth charts. Another issue that became evident in Donachui was the refusal of parents to vaccinate their babies because of traditional believes.

Inside the Health House at Donachui, July 2014

With some patients in Donachui, July 2014

With some patients in Donachui, July 2014

Our visit to the eastern region of the Arhuaco reserve was a very insightful and interesting experience. We got a first-hand look at the main healthcare problems that affect these communities and understand how the healthcare coverage is organized. The main challenges and barriers that we encountered to improve healthcare in this region are the remoteness; the language; the traditional culture and believes. Some of the patients evaluated at Sogromin lived about a 2-3 hour hike away, so they lived about 10 hours away by foot or mule from the closest physician (Gun Aruwun) and another 5 hours away from the first hospital. From the 200 plus patients that were seen during this trip less than 10% spoke Spanish well enough to provide the requested information for a proper medical history. Besides the refusal to vaccinations other traditions and believes such as the chewing of Ayu; the long fasting periods during the day and “traditional work”; their diet and their tradition of having many children all have a clear association to the pathologies seen and impact the efficacy of any measure or program put in place to improve the overall healthcare of the communities.