Development & Aid, Environment, Tierramerica

Malaria Winning in Chocó

QUIBDÓ, Colombia, Oct 30 2007 (IPS) - Malaria has taken hold in the Colombian department of Chocó and across almost the entire country, which will not meet the international goal of halving the disease by 2010.

The flooded villages along the Atrato River are breeding grounds for malaria mosquitoes. - Jesús Abad Colorado

The flooded villages along the Atrato River are breeding grounds for malaria mosquitoes. - Jesús Abad Colorado

The Atrato River is “full of malaria”, according to a dozen men in rubber boots, standing in the water that inundates the village of Tanguí, in Colombia's northwestern jungle.

It is the fifth flood this year, and the rice harvest is ruined. The men, with their arms crossed, stand in a semi-circle to talk with Tierramérica. The 120 families of Tanguí live two and three families in each of the stilt houses.

We travel down the street by canoe. Children play happily in the stagnant water. There are no nurses: the health brigades come “every once in awhile” and because the governor sends them, because “he's a friend of the mayor,” says one of the men.

Quibdó, capital of the department (province) of Chocó, is a half-hour by boat from Tanguí. It's at the heart of this tropical rainforest, ideal for the mosquitoes that carry malaria. Heavy rainfall occurs nearly every day. For the people of the area, life takes place along the rivers.

In the context of the decades-long Colombian civil war, many who flee the fighting in infested areas carry malaria with them.

According to the non-governmental Consultancy for Human Rights and Displacement, between 1999 and 2006, nearly 70,000 people were displaced in Chocó, whose population is about 800,000.

“Malaria hasn't diminished. And we are facing problems of small outbreaks, including in areas where it hadn't presented in two or three years,” José Dolores Palacios, technician with the Chocó Health Secretariat's transmissible disease prevention program, told Tierramérica.

There are 58 cases in communities along the Bebará River, in the municipality of Medio Atrato; more than 90 in Managrú, seat of Cantón de San Pablo; and more than 50 in Bellavista, 228 kilometers north of Quibdó, where there was an outbreak “just when the president (Álvaro Uribe) went there” to inaugurate the new town built by the government, on Oct. 13.

As of September of this year, 19,971 cases had been reported in Chocó, and in 2006 there were 12,441, but the 2007 increase is due to previous “under-reporting”. The highest numbers were in 1998, with 31,713, an in 2002, with just under 32,000, says Palacios.

Now data-gathering has begun in rural areas, entrusted to 13 experts who diagnose the disease, distribute medications and conduct quality-control of the health posts, says the Chocó health official.

Malaria, caused by plasmodium parasites, which are spread through bites from infected mosquitoes, is preventable and curable. But the disease kills more than one million people a year around the world, mostly in Africa, according to the World Health Organization (WHO).

Fever, headache, vomiting and shivering are symptoms that can occur 10 days to one month after infection. If it is not treated immediately, it can become deadly.

It can also be incapacitating, worsening poverty, epidemiologist María Victoria Valero, of the National University's internal medicine department, told Tierramérica in an interview. In Chocó, 78.3 percent of the population is poor.

One patient with plasmodium falciparum, the most virulent of the four strains of malaria, suffers fever every three days, and so cannot work, says doctor Carlos Agudelo, director of the National University's Public Health Institute.

“As long as the disease lasts, the person can be incapacitated 15 days each month,” he adds. Depending on which type of plasmodium parasite is behind it, the infection can last years.

Individuals are infected over and over again in the areas where it is endemic, and many grow accustomed to working with low fevers, says Agudelo.

Malaria is endemic across much of Colombian territory. More than 25 million people of the national population of 45 million live in malaria zones, according to official data. In 2004 there were 25 malaria deaths reported, according to the Ministry of Social Protection, and 123,177 cases, more than 47 percent in the western-Pacific region, where Chocó is. Furthermore, “there are many complicated cases of plasmodium vivax appearing,” warns epidemiologist Valero.

Malaria “is an important cause of anemia in infants and pregnant women, low birth-weight, premature birth and infant mortality, according to the WHO's World Malaria Report 2005.

In Valero's opinion, malaria is spinning out of control not only in Chocó, but across Colombia. Agudelo, meanwhile, says the disease increased a great deal until five or six years ago, and then stabilized, with occasional epidemic outbreaks.

Both experts agree that development is the only effective remedy. “Malaria is an economic, social and cultural problem” which only disappears from areas with industrialization and better socio-economic conditions, says Agudelo.

Colombia signed on to the global campaign to “Roll Back Malaria” by half by 2010, but the country doesn't seem to be on the road to achieve that goal.

The efforts by the now-defunct National Malaria Eradication Service (SEM) were not successful. Nor were the schemes adopted beginning in 1993, when the country embarked on a reform that decentralized the health system and shifted the burden to the local governments, according to doctor Agudelo.

Created by decree in 1956, SEM's strategy was centralized and vertical. It had technical and administrative autonomy, national jurisdiction and its own budget.

But it was subjected to a series of cuts, and failed to adapt to the new realities that further spread malaria, such as the colonization of the jungle, illegal drug trafficking, and rural violence, according to the book “The Pan-American Health Organization and the Colombian State: 100 Years of History, 1902-2002”.

Epidemiologist Valero believes that with the disappearance of SEM “the country forgot about actively looking for cases and for the contacts of each infected person.” In Colombia, it takes “as long as 15 days to diagnose and treat a case. In that time, a sick person can infect many people,” she says.

The residents of Tanguí continue to point to the lack of health workers and the floods. “The solution is to find a way to fill in the town and channel the Atrato” to the Caribbean Sea. Twelve of the river's 14 mouths are blocked by sediment — the result of deforestation. “It must be channeled so that the water doesn't rise,” says one resident, stating the obvious.

But the obvious doesn't always determine government services. The only hospital in Quibdó, a rundown place where some patients have to sleep on the floor due to lack of beds, does not always attend to people who come from distant communities for treatment, charges the Chocó People's Defender (Ombudsman) Víctor Raúl Mosquera.

“They have to go to other clinics that have been set up here, and where they are also denied service. Children have died because of this. They are forced into a sort of 'tour of death',” pushing a sick person from one health center to another until he or she dies, says Mosquera.

This article is part of a series about the Millennium Development Goals in Chocó. The project that gave rise to this effort was the winner of the AVINA Investigative Journalism scholarship. The AVINA Foundation is not responsible for the ideas, opinions or other aspects of the content.
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