I'm woken up at 5:30 am by drums and trumpets. Undeterred by the heavy flooding, the marching band have taken to boats. In any other context this might be unusual but I'm in the aptly named Riosucio (dirty river) where the unusual is an everyday occurrence. Nobody is marching anywhere in Riosucio at the moment. The flooding means everybody negotiates their way precariously over planks of wood suspended above water level. These "puentes" connect all the wood and tin houses in this small town. Everyone is hovering in Riosucio; my feet haven't touched the ground for three weeks now. The puentes can be as thin as balancing beams and sprung like diving boards. But you don't want to dive into the dirty river if you can help it. The entire population uses the river as a toilet. Photo : April Baller, MSF. People walk on planks suspended above flood waters and raw sewage. Riosucio, Colombia. This is Chocó, the poorest department in Colombia. In this country of "have lots" and "have nots," Chocó tops all the rankings for severe poverty, infant mortality, conflict and most pertinently, rainfall. The predominantly Afro-Colombian population gets rained on a lot, up to ten meters of rainfall per year. It is one of the wettest places on earth and the humidity sometimes makes reading a book a struggle. The dirty river floods every couple of years and sometimes the water level doesn't go down for months. This year it is particularly bad and MSF is assessing the emergency and providing aid to the most affected families, a large proportion of which are internally displaced people. Mainly women and children, they have fled the internal conflict in the surrounding communities. Many have lost husbands, fathers and brothers, killed by the paramilitaries or guerillas. They live in the worst conditions and have the least money to prepare for the flooding. I've been in nearly a hundred flooded houses now. People continue to live in houses inundated with up to two meters of stagnant, contaminated flood water. Families perch above the water, living close to their roofs on top of whatever wood they have found. The flies are always a problem. Since the flood there are a lot more mosquitoes and this will get worse when the river level sinks. Photo : April Baller, MSF. MSF conducts home visits in Riosucio, Colombia. In one house, five indigenous families are living together. Twenty-three people share four mattresses and live in the only room of the house that is raised above the water level. They aren't going to evacuate their house. They have nowhere to go and no means to get there. I enter one house and ask its only occupant how he is. "I'm dying," he nonchalantly replies. I knew the answer to my question before I asked it. He is skin on skeleton, living alone, on top of a number of planks he'd assembled. "Have you been to the hospital?" He finds this question amusing. That's when I realize he probably has been to Riosucio's hospital, a place that would make you laugh to avoid crying. Fourteen people live in the next house; it is the worst I have seen all day. They don't have a floor. They just have a few planks on which to walk. They sit above the flood water, which is full of excrement and rubbish. I ask them what we can do to help them. "We don't like the snakes," they reply. "Which snakes?" "The snakes in the water." I struggle to write "there are snakes in the water!" because sweat is pouring down my face onto the paper; it's soaked and I have to rip it up. It's hot under this tin roof. Really hot! I'm crouching on a thin piece of wood trying not to think about the snakes, the smell, and the excrement in the water. I ask the family what they need from us. "We're fine" is the response. At this point, I begin to think that my tenuous ability to communicate in Spanish has abandoned me altogether. I decide not to explain that they can't possibly be fine, as these are the worst living conditions I have seen in my life. I bang my head entering the next house. I've been doing this all day. Even though I have to crawl under the top of the door frame to enter some houses I still can't seem to resist the urge to stand up once inside. After I've finished clutching my head and whimpering I manage to ask the people inside what they are going to do if the river keeps rising. They tell me they will move next door. When one house goes under, the inhabitants move in with neighbours or friends. More people to share hovering space and damp mattresses. Displaced again. We distribute food, planks of wood, mattresses and mosquito nets to the most affected families and we make sure there is enough anti-venom and medicines. Our doctors work around the clock supporting the local health post. Our intervention is well received by the community. They aren't used to receiving promised aid. Chocó receives huge amounts of investment, but none of it seems to filter down to the people. It tends to filter off in other directions. I sometimes wonder why the hell a psychologist was included in our team. This is especially worrying as I am the psychologist. The problem with this disaster is that few here regard it as a disaster. Even some of the most affected families shrug in the face of this inundation. I've lost count of the people telling me this is normal for Riosucio. I don't know whether it's stoicism or resignation. The dirty river continues rising and the band in the boat keeps on playing.