Caquetá: The enormous difficulties of reaching victims of the conflict.

Serge Le Duc, MSF project coordinator in Florencia in Caquetá department, in the south of Colombia, believes that MSF's mental health care program is very important in the town. Additionally, being in Florencia allows the teams to stay close to the rural parts of the department to once again hold primary health care brigades for people trapped there by the conflict and for those who are difficult to reach.

What is the scope of the mental health care MSF offers in Caquetá?

Right now, we have a well-equipped clinic in the town hall in Florencia, the capital of the department of Caquetá, where there is a very high proportion of people displaced by the conflict. We also hold mental health brigades every two weeks in some towns in the department. Unlike previous projects in Caquetá, MSF chose to work in towns in the department and not in rural areas for this mental health project.

Why not in rural areas?

Up until now we couldn't get there. Three years ago one of our teams was kidnapped for a week. They were holding a brigade at the wrong place and time. After that we had to stop the brigades. Later we decided to start this mental health project in urban areas to treat displaced people and victims of the conflict and provide a service that didn't exist before in the department. Until June 2006 we held trainings for educators on primary health care in towns in the department so they could keep helping in rural areas where the conflict is worse and people more isolated.

Do you expect to return to the rural areas?

Well, in fact, after the project with primary health care brigades was closed in 2004, we kept analyzing and closely following the humanitarian and health situation in rural areas with the hope of restarting health brigades for the people most affected and isolated by the conflict. And I can tell you that I believe we will start again soon, because now there are more possibilities.

Why is it so hard to reach people in rural areas?

The problem is that we didn't have permission from the armed groups to go into the rural areas. With Plan Colombia and the Patriot Plan that goes along with it, military operations have multiplied in the department. With the increase in tension, the armed groups had less confidence in our teams. They also say they refuse permission for our own safety so we don't find ourselves in the middle of a fight and that it's the government and hospitals' responsibility to hold brigades.

So paradoxically, today it is the public hospitals that hold brigades in some rural areas while a few years back they had to go with MSF teams in order to work in rural areas. It's important to note that there are areas that don't have any health services at all because they are forbidden to everyone and because the hospitals can't cover such a wide area with such a dispersed population by themselves.

Why is the mental health care MSF offers here necessary?

I believe it is one of the largest gaps that exist. The government provides some primary health care services, but mental health care is almost nonexistent. In Florencia, and in all of Caquetá in general, the conflict has had an enormous effect on mental health, not only for displaced people, but for everyone. Almost every family has lost at least one person to violence. There is definitely a need for MSF's services.

How do other health organizations and the medical community in Colombia view our involvement?

Generally they are grateful for the health care we provide because they know there is a huge gap. They serve the same people we do. After coming to our mental health center, patients generally feel better, and that makes subsequent treatment and follow-up easier. The majority of displaced people in Caquetá are here in Florencia. It is estimated that there are between 20,000 and 40,000 people (it's difficult to calculate because not everyone registers) out of a population of 120,000 people. This is a large percentage of the people in the city.

Why do they come here?

Because, although it's small, Florencia is a big city for many people from rural areas. The more threatened a person feels, the farther they will go. If they feel very threatened, they go to Bogotá and even further.

Do the towns in the interior of the country feel the effects of the conflict more strongly?

Yes, in the towns we've served, San Vicente and Cartagena, they feel the conflict more. You could say it's more obvious, closer. That's why we go there.

How have the patients responded?

It's been tremendous. We can tell you that by offering our services, we discovered a huge demand. There are serious problems. Our psychiatrist says that you should go to a psychologist at least once in your life. If you live in Caquetá, you have to go more often.

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