Colombia. Medical Care for People Excluded From the Health System.

"Many patients don't say they are displaced until they come to our centers and trust us enough"

For more than three years Valentina Niebles, a Colombian doctor with MSF, has been serving people without access to health care through a project in Altos de Cazuc·, a neighborhood on the outskirts of Soacha where many people displaced by the conflict go. She has seen the number of patients served by MSF go down in the last months since the authorities started enforcing Regulation 006 in Bogot· and surrounding areas. The regulation requires medical care be provided to displaced people even if they have not been registered. Previously, medical attention could only be provided if the person's case was researched and he or she was officially registered.

They provide medical attention here to people who have been displaced as well as other people without access to health care. Do you provide services to one group more than the other?

The average number of patients who receive care varies according to the time of year. Now, in the winter, we provide services to approximately 20 patients a day. Today for example, most of the patients who came to the center are displaced persons. A whole family of seven people came. But in general, it's usually 50 percent of one group and 50 percent of the other.

Why do you also provide services to people who are not displaced in a neighborhood so close to Bogot·?

Well, the goal of the project is primarily to provide care to people who don't have access to any health services at all. Many of those people are displaced persons. Others are people excluded from the health care system. It helps us to reduce safety risks and stigmatization for displaced people. Many patients come to the center saying that they are poor, but once they are inside, in an atmosphere of confidentiality, they tell us they are displaced people.

I would think that there are no differences between the illnesses among both groups.

No the patients who live here have illnesses that are common to where and how they live. These are people who are living in overcrowded areas and lack sewage and potable water. They have diarrheic, respiratory and skin conditions. They also have illnesses related to mental health.

How has the situation in Altos de Cazuc· changed in the last three years?

In terms of safety, Altos de Cazuc· is a Colombia in miniature. You can see all the different factions of the armed conflict here, in different forms. There are times when it is very difficult. Health-wise, a few months ago the government implemented Regulation 006 and people who say they are displaced are getting medical care from the government. Now they don't have to wait to be officially registered to get health care. The number of patients we see has gone down compared to previous years (before we saw an average of 30 to 35 patients a day), ever since the state started to shoulder its responsibilities.

But when they come here, patients come with more than just their illnesses, isn't that so?

Most of the patients who come to our center tell us their life stories, especially the parts relating to their displacement. There are mothers fleeing with children who saw their fathers die and now the mothers have no way to feed them. And then they don't have anywhere to live or they're living someplace they can be kicked out of at any moment. It radically changes their lives, coming from the countryside where they had access to many more resources.

As a Colombian doctor, how do assess the situation of displaced people?

The illnesses haven't changed. What has changed is the medical care. I used to work for the state and the health care they received was very limited. They only treated specific illnesses, but no one addressed the humanitarian aspect, it simply did not exist. They didn't send patients to humanitarian aid organizations and they didn't give them mental health services. There is a huge difference between working for the state and working for a humanitarian organization and it is a huge difference for the patients as well.

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