Two-part package of measures against Covid-19
In the catchment area of Istmina im Chocó, 130,000 people live under mostly simple circumstances: In Istmina there is a hospital with 23 regular beds without ventilation options. So far, the hospital can only treat simple emergencies and has no way of operating, isolating or even treating people in intensive care. There are no specialists, and there is not only a lack of medical protective equipment such as gloves or mouth and nose protection, but also of everyday medical items such as thermometers. But the impending pandemic is not the only current problem in Chocó. A nationwide curfew has been in effect in Colombia since the end of March. The failure of this everyday public life is driving the 40% single mothers in the Chocó into extreme poverty and is already leading to food shortages in their children. The longer this condition lasts, the more desperate the situation becomes.
Together with the local people, CASA HOGAR responds to the conditions in Chocó with a two-part package of measures:
Projekt Cabeza de Hogar
We try to absorb the life-threatening economic consequences in Chocó with a nutrition program. On the last weekend in March, for example, we began to distribute 260 food parcels together with the local authorities and voluntary private individuals, and we will continue to do so.
Together with Professor Dr. med. Laureano Quintero, the medical director of the Centro Medico Imbanaco and professor of trauma surgery at the Universidad del Valle in Cali, Colombia, our main partner of the diocese of Istmina-Tadó and the authorities in Istmina, we have drawn up a plan for medical support for Istmina and decided over Easter .
Two intensive care physicians and three paramedics experienced in intensive care are to be sent to Istmina together with medical equipment such as protective clothing, but also equipment such as defibrillators and ventilators. There you will meet a prepared team of 15 local doctors and nurses. The aim is that on the one hand the best possible health care is made available in Istmina during the pandemic, and on the other hand that the medical staff in Istmina emerge from the acute measure trained and thus an improvement of the medical care of Istmina and the surrounding area is guaranteed in the long term. For this purpose, a long-term telemedical accompaniment between Cali and Istmina is planned. At the beginning of the mission, Professor Quintero will get an idea of the situation in Chocó on site.
The administrative unit “Chocó” in Colombia is located on the west coast of the country on the Pacific – largely isolated and difficult to reach from the rest of Colombia. The Chocó is rich in rain, beautiful fauna in the rainforest, various traditions (83% Afro, 13% indigenous ethnic groups) and gold. However, the wealth does not bring any blessing to the approximately 500,000 inhabitants. The gold goes into the hands of others and the Chocó is sadly known for its three times higher poverty compared to the rest of Colombia: 83% of the Chocoanos have not met their basic needs. At the same time, gold gives the population illegal mines and the associated mercury-contaminated rivers – traditionally the basis for their food. After all, the beautiful rainforest is also a breeding ground for the “white gold” and the Pacific is its gateway to the whole wide world. Thus the many waterways that meander through the Chocó are bloodily contested drug routes by various illegal armed groups. The peace treaty of 2016 with the FARC and the current political developments have unfortunately not changed anything, but rather worsened the situation in Chocó. While the state looks on inactive, the population wishes for a peaceful coexistence in the midst of these circumstances and touches us again and again with their warmth, happiness and hope during our visits. (see our page Background information on the Chocó)
Despite the worst roads and a disastrous infrastructure, the approximately 500,000 inhabitants of Chocó move between the different villages. Quibdó, the capital of Chocó, is around 1 hour’s flight from Bogotá. The contrast between Bogotá and Quibdó couldn’t be greater, however. Quibdó has only 115,000 inhabitants and, with the many small moto-taxis, the people walking on the streets and the constant honking, gives a feeling of bustling life in the middle of the street. Quibdó, however, is just a stopover for many Chocoanos. From Quibdó it goes on roads, rivers or even the smallest airplanes to the more remote areas of Chocó. Everyone who wants to go from Quibdó to the south of the Chocó inevitably has to go via Istmina – the place where CASA HOGAR mainly operates. From Quibdó it is about 2 hours by car on bad roads to Istmina, the second largest “city” of Chocó. Despite its approx. 20,000 inhabitants, Istmina presents itself like a small village: everyone seems to know everyone, everyone greets everyone everywhere, you talk across entire streets and you know exactly what your neighbor is doing or not doing …
Istmina is located on the San Juan River and is therefore the starting point for all those who want to travel by land and water to the remote areas of the San Juan River or even further down the Baudó River (see our page Map of the Chocó). In general, the rivers in the Chocó often replace the roads. In total, there are around 3,000 travelers per week who move between the different regions in the vicinity of Istmina.
The world has been revolving around COVID-19 since February – and Colombia is also struggling with the harbingers and the consequences of the pandemic. Compared to Germany and Europe, Colombia is still at an earlier stage of the spread: on April 10, 2020, almost 2,500 confirmed cases of COVID-19 and 80 deaths were registered in Colombia. However, the figures should be treated with great caution, as tests cannot be carried out everywhere (see under 5. The health system in Chocó).
As a remedy against an uncontrolled outbreak, the Colombian government has ordered a nationwide quarantine since March 24, during which the population is only allowed to leave their homes for necessary purchases and visits to the doctor. Schools and other educational institutions are closed and religious celebrations have been canceled. At the beginning of April, the quarantine for the entire country was extended to April 27, and for people and third-generation people with pre-existing contamination even until the end of May. This measure, which is widespread almost worldwide, has an existential impact on the population in Chocó and poses the question of “hunger or infection” for many people.
Details in our blog article: Der Coronavirus hat Kolumbien erreicht.
In Colombia – and especially in rural areas like Chocó – the social structure is characterized by a macho attitude that structurally disadvantages women. Women in Chocó often have to endure (sexual) violence – be it in a domestic context or in the form of the ever-present violence between illegal armed groups that target the population and fight for drug routes and areas in the midst of bystanders. At the same time, 40% of women are single parents because their fathers have been kidnapped, recruited, murdered or because – as is unfortunately not uncommon – they have pulled themselves out of responsibility. In order to provide for their families, 70% of women in Chocó work on the informal labor market, that is, on the street selling, cooking, sewing, cleaning shoes or as cleaning and service personnel. The majority of them live from hand to mouth and cannot save up any reserves. Exactly this unregistered work is on the one hand not allowed in times of COVID-19 and on the other hand these people are excluded from state aid. So many women at Chocó are currently faced with a question that no one can answer. Should I defy government regulations, expose myself to infection and risk the spread of the virus in order to bring food to the table for my family? Or should I “reasonably” stay at home and starve my family? COVID-19 means a new additional – life-threatening – problem for the women in Chocó.
In the entire Chocó region with 500,000 inhabitants there is a single hospital with intensive care beds in the capital, Quibdó. However, these 40 intensive care beds are already fully utilized by the urban population themselves. However, given the poor infrastructure, the majority of the population would have little chance of making it from the remote regions over water and land to Quibdó in an emergency.
In Istmina – the second largest city in Chocó and about two hours by car from Quibdó via bad roads – there is a second hospital: the Eduardo Santos Hospital. This hospital is the contact point for the 20,000 inhabitants of Istmina as well as for all residents of the more or less close neighboring communities of Istminas such as Novita, Condoto, Medio San Juan, Río Iró, Sipi, Medio Baudó, which themselves have at most the smallest medical wards. In total, the hospital with its 23 beds has to care for 130,000 people. However, so far the hospital can only treat simple emergencies and has no way of operating, isolating or even treating people in intensive care. Not only is there a lack of material for the latter, but also trained personnel.
For the treatment of COVID-19, Istmina faces unimaginable challenges:
- You will find the current numbers of corona cases and tests for the 500,000 residents of Chocó on the Departmental Administration website. However, due to the completely inadequate test facilities in the region, it can be assumed that the actual number of infected people is significantly higher. Because tests have to get from Istmina to Quibdó via inadequate roads and flown from there to Medellín. It seems difficult that infections in Istmina and even more remote areas of the Chocó can currently be included in the official figures.
- For suspected cases, the method that is also common in Germany is used to send people into self-isolation and to have a doctor contact them daily by telephone. However, it should be remembered that people in Chocó and Istmina often live with many people in one room and isolation from the rest of the family is not possible. The virus will likely come into contact with the other family members, who in turn come into contact with other outside people. Self-isolation will not bring much success in Chocó.
- In addition, there is not yet enough protective material for medical staff and people with health problems in Istmina. However, the community is trying to get state funds to be able to provide at least minimal care for the medical staff.
- At the same time, the Eduardo Santos Hospital itself has neither the space nor the possibility to isolate patients. We are currently trying to convert and equip an empty building into a treatment and isolation center for 50 COVID-19 (suspected) cases. In doing so, Istmina reaches its financial limits.
- In addition, Istmina would theoretically have the capacity to convert 14 hospital beds into intensive care beds, but is faced with the dilemma of not having any intensive care staff on site.
An outbreak of the COVID-19 virus would have fatal consequences for the entire catchment area of this hospital in its current state.
The current situation of the curfew and the prospect of a COVID-19 outbreak in Chocó are devastating. We at CASA HOGAR Germany eV are in constant contact with the local people and not only with the local authorities, but also with the population themselves. Laura is still in Istmina on behalf of CASA HOGAR and so we get the many personal stories and the existential needs firsthand. In view of the life-threatening situation in Chocó, which is life-threatening in several respects, we cannot and will not just wait until it is all over! That is why CASA HOGAR is committed – despite the actual focus on empowering girls and women in Chocó through education – during this extraordinary time for acute, vital measures in Chocó. We use Facebook to report as soon as possible about the latest developments and events in and around Istmina.
In the area of prevention and education, we are in close contact with the local actors and have been involved in their campaign to sensitize the population to the need for quarantine.
In the area of food security, we are working together with local authorities, traders and private individuals to support those families who are no longer able to go about their daily work due to the precautions and consequences of Corona, have no savings or receive any state aid. This applies in particular to the 40% single mothers. With the help of food packages, these families should be able to really spend times of quarantine and isolation at home and not be faced with the decision of “hunger or infection”. The primary target group are single mothers who have to pay for their children and their parents’ generation. The families live in Istmina as well as in remote rural areas. In the countryside, the need is exacerbated because there is currently no public transport connection with the city and at the same time aid supplies rarely get there. The project is handled by our project partner Fundación CASA HOGAR Istmina – part of the Istmina-Tadó diocese – and carried out in close cooperation with local committed people and authorities. This ensures that the measures really reach those who cannot be reached in any other way. (Details on the Projekt page.)
In the area of medical care, we try to support Istmina and the surrounding area in preparing for an outbreak of COVID-19. The current medical care in Istmina is rudimentary and an outbreak of the COVID-19 virus would have fatal consequences – not only for the city of Istmina with its 20,000 inhabitants, but also for the approximately 130,000 inhabitants of the more or less nearby neighboring communities on the rivers San Juan and Baudó. So far, however, the hospital has only been able to provide basic care (e.g. vaccinations). There are no protective materials, test options, isolation options or even intensive treatment in view of the pandemic. Medical devices are not working. But not only is there a lack of material – the medical staff in Istmina know and know the limits of their medical services and their personnel capacities and know that they currently have no chance against COVID-19. CASA HOGAR therefore works together with the local actors in Istminas – under the leadership of Bishop Mario de Jesús of the diocese of Istmina-Tadó and with the help of Dr. Laureano Quintero – medical expert in disaster situations and medical director at the University Clinic del Valle in Cali, where Theodor Rüber got to know him personally as a student – for ensuring that the population of Istmina and the surrounding areas also get a chance against COVID-19. On the one hand, this involves the procurement of urgently needed medical material and, on the other hand, the personal support of the local medical staff, both by a team that will fly from Cali to Istmina and provide on-site support and training, as well as virtual support a medical team of experts stationed in Cali. This not only provides material support, but also works together in terms of content. We hope that Istmina will be able to provide better health care – in the best case even with intensive care medicine – not only in the short term, but in the long term! (Details on the Projekt page.)