By Raquel Godos |
Pie de Pató (Colombia) (EFE).- In Pie de Pató, as so many other times, today there is no water. But the health center, the only one for the 28,000 inhabitants of Alto Baudó, in the Colombian department of Chocó (west), opens its doors with just four doctors and a handful of nurses.
The heat is crushing, there is 80% humidity and obviously unsanitary conditions, a perfect setting for the proliferation of malaria, lung diseases, dehydration and child malnutrition.
Preventive medicine is a chimera: 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 the president, Gustavo Petro , wants to correct.
Lack of resources
Jany García is a nurse at Pie de Pató and claims that the means they have are insufficient. Although they have a small laboratory, a dental area and five double rooms, their resources, including medicines, are very scarce and almost any emergency requires a hospital transfer.
They attend to a hundred patients a day and make several referrals to the only public hospital in the capital, Quibdó, that works properly; transfers of up to ten hours by boat, five by land and most of them assisted by Doctors Without Borders (MSF), which bears the cost.
Wartinson, the few-month-old baby of Romaña Rubiano, an Embera indigenous from Pavarandó, was admitted to the health center six days ago due to pulmonary complications, cough and diarrhea.
“MSF covers the 108,000 pesos (25 dollars) of gasoline for the boat, and later they hospitalized him, and there they give us 67,000 pesos (17 dollars) a day” to keep us here, he says. Hopefully his son is recovering.
beyond the town
In Chachajo, a hamlet of about 800 inhabitants 3 hours by river from Pie de Pató, they only have Miriam Palacios, a health promoter with no formal studies. The center that he frequents has 4 empty rooms and a stretcher.
“It is up to me to promote health and prevent disease. If a sick person arrives, take care of him, give him first aid”, explains Palacios. He also coordinates referrals to Pie de Pató.
It only has acetaminophen, ibuprofen, zinc sulfate and oral serum. The sutures are made with a needle and sewing thread. And the materials are stored in a disinfected soda bottle.
“That they at least give us a head nurse (…) There are many cases that a head nurse can solve for the community,” she argues.
What happens with rural health?
Petro’s proposal seeks more resources and control for rural health, even if it is the same private companies, health providers, that manage them. 24% of the Colombian population lives outside the cities, some 12 million inhabitants.
The current health system is mixed and complex, and depends on the Health Provider Companies (EPS), private or public-private, which guarantee and manage the services.
The EPS contract the Healthcare Provider Institutions (IPS); 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 Pató, in addition, they have canceled the contracting of the medicalized transport of patients to Quibdó due to non-payment of the IPS, and now they depend on regular transport without sanitary conditions.
“There is a problem at the structural level, of the central government, of the EPS and the IPS. (…) Many times the EPS hide behind saying that the IPS are not paying them and that is why they provide a poor quality of service”, explains the health coordinator of Pie de Pató, Tatiana Jaramillo.
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 its rejection by the opposition has the initiative in check.
In his approach, he intends that around 80% of state resources go directly into the hands of hospitals and IPS; that they have the necessary direct resources to care for patients.
Also that there is more control over suppliers and eliminate intermediaries. The EPS 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% 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 Baudó is not the same as being in Bogotá. Here we are still thinking about how to refer a patient”, insists Jaramillo.
