Residents are attended to at the Pie de Pató health center on May 4, 2023, in the department of Chocó (Colombia). EFE/JUAN DIEGO LOPEZ

Four doctors for 28,000 people: the reality of healthcare in rural Colombia

By Raquel Godos

Pie de Pato, Colombia, June 17 (EFE).- In Pie de Pato, as so many other times, today there is no water.

But the health center, the only one for the 28,000 inhabitants of Alto Baudo, in the Colombian department of Choco, opens its doors with just four doctors and a handful of nurses.

Homes in the town of Pie de Pató, in the department of Chocó (Colombia), on May 4, 2023.

The heat is crushing, the humidity 80 percent and conditions are unsanitary: the perfect setting for the proliferation of malaria, lung disease, dehydration and child malnutrition.

Preventive medicine is rare: there are hardly any elderly on the streets.

The situation is a reflection of rural health in Colombia, aggravated in this area of the Pacific by the presence of armed groups and a complex orography, but with a clear abandonment by the state that the health reform promoted by President Gustavo Petro wants to correct.

Jany Garcia is a nurse at Pie de Pato and claims that the means they have are insufficient. Though they have a small laboratory, a dental area and five double rooms, their resources – including medicine – are very scarce, and almost any emergency requires a hospital transfer.

They tend to 100 patients a day and make several referrals to the only public hospital in the capital, Quibdo, that works properly; transfers of up to 10 hours by boat, five by land, and most of them assisted by Doctors Without Borders, which bears the cost.

People wait at the Pie de Pató health center on May 4, 2023, in the department of Chocó (Colombia).

Wartinson, the few-month-old baby of Romana Rubiano, an Embera indigenous from Pavarando, was admitted to the health center six days ago due to pulmonary complications, cough and diarrhea.

“Doctors Without Borders covers the COP108,000 ($25) of gasoline for the boat, and then they hospitalized him, and there they give us COP67,000 pesos a day” to keep us here, she says. Hopefully her son is recovering.

In Chachajo, a hamlet of about 800 inhabitants three hours by river from Pie de Pato, they only have Miriam Palacios, a health promoter with no formal studies. The center that she frequents has four empty rooms and a stretcher.

“It is up to me to promote health and prevent diseases. If a sick person arrives, attend to him, give him first aid,” said Palacios. She also coordinates referrals to Pie de Pato.

It only has acetaminophen, ibuprofen, zinc sulfate and oral serum. The sutures are made with a needle and sewing thread. And the materials she keeps in a sanitized soda bottle.

Inhabitants wash clothes on the banks of the Baudó river on May 4, 2023, in the town of Pie de Pató, department of Chocó (Colombia).

“They should at least give us a head nurse (…) There are many cases that a head nurse can solve for the community,” she said.

Petro’s proposal seeks more resources and control for rural health, even if it is the same private companies, health providers, that manage them. Twenty-four percent of Colombia lives outside cities, some 12 million inhabitants.

The current health system is mixed and complex, and depends on the private or public-private Health Provider Companies, which guarantee and manage the services.

These companies contract the Healthcare Provider Institutions; They allocate funds based on how many people they have affiliated and they are the ones who directly care for patients, in a tertiarization that ends up creating inequalities in access in remote and rural areas.

In Pie de Pato, the contracting of the medicalized transport of patients to Quibdó has been canceled due to non-payment of the institutions, and now they depend on regular transport without sanitary conditions.

“There is a problem at the structural level, of the central government, of the (companies) and the (institutions.) (…) Many times the (companies) hide saying that the (institutions) are not paying them and that is why they provide a poor quality of service,” said Tatiana Jaramillo, health coordinator of Pie de Pato.

Petro’s health reform has not been exempt from criticism and turbulence – the author of the text, Carolina Corcho, is no longer even the minister – and her rejection by the opposition has the initiative in check.

In her approach, she intends for about 80 percent of state resources to go directly into the hands of hospitals and institutions; so that they have the necessary direct resources to care for patients.

There is also more control over suppliers and eliminating intermediaries. The companies would not disappear, and would become the administrative managers of the affiliates.

But despite the desire to expand primary and preventive care, it is not clear how to finance it in a country where only 4.5 percent of the population contributes.

“If the government were to look at these complex rural areas, both in terms of geographic and population access (…) it would be different. Being in Alto Baudo is not the same as being in Bogota,” Jaramillo said. “Here we are still thinking about how to refer a patient.” EFE