On the Ground in Colombia: Q&A with Dr. Atilio
Our country representative in Colombia, Dr. Atilio Rivera-Vasquez, shares his experience of the Venezuela crisis and the greatest health challenges he’s seeing as more and more refugees and migrants arrive to Colombian hospitals in need of urgent care.
Dr. Atilio Rivera-Vasquez has spent the last nine months on the ground in Colombia overseeing our health sector activities and responding to health needs — on the front lines of a situation that worsens each day as thousands of Venezuelans continue to cross the border seeking lifesaving support.
Over the course of his decades-long career, Dr. Atilio has responded to many humanitarian crises — from Kenya, Angola, Guinea and Mozambique to Indonesia, DRC, Cameroon and Syria — and describes the situation in Venezuela as the worst he’s ever seen. He reports a dire shortage of assistance and media coverage, and calls for expanding the response to meet the unprecedented scale of the crisis. Read on to learn more.
Q: You have worked in many different conflict zones and many different humanitarian crises throughout your career. Can you tell us what’s the same and what’s different about the situation here in Colombia?
A: They were all so completely different, but here in Colombia is the worst I’ve ever seen. Why? Because in other countries there was a lot of media coverage and many NGOs working, planning and donors interested in investing money in health, shelter and food security to alleviate the dire needs of the vulnerable population.
There is not so much [media] attention being given to the very vulnerable migrants from Venezuela coming in to Colombia, who are in total dire need of support for health, shelter, nutrition, and water and sanitation.
This is the very first time Latin America is facing a displacement crisis as massive as it is now. For host countries like Colombia, Ecuador or Peru, this is their first contact with migrants and they don’t have a clue about their needs. In any other country we can say exactly what the needs are among “the big five” — shelter, health, nutrition, food security and water and sanitation — but not here. And because there’s a belief that Venezuelans are more educated, there is also some discrimination and fear about job security. There’s a mix of what countries can broadly offer them, but also a lot of discrimination and fear.
Colombia, Ecuador and Peru all have strong, well-coordinated ministries of health, and we need to make sure we’re meeting their standards; it’s important that our work is addressing what they see as the most urgent needs.
Q: Can you describe the migration movement? We know some 5,000 people are leaving Venezuela every day. What does that look like?
A: There are three types of migration happening – three types of vulnerable Venezuelans coming into Colombia, Peru and Ecuador. One is called pendular migration – “penduláres” who come for just one or two days specifically looking for food, health care or some small product to take back to Venezuela to survive. The second type of migrant comes to establish here in the departments in the border region between Venezuela and Colombia. The third group includes those who are coming through Colombia, through Cúcuta, to go down to rejoin parents or friends in Ecuador, Peru or Chile.
Q: How have response efforts been organized to meet the needs of these populations, and what have been your greatest challenges?
A: We organize ourselves using the four W’s: who is working where, doing what, until when. And the trend that we’ve seen on the map in Colombia is that we’re clustered – we’re aggregated more or less in Cúcuta. In other parts of the Norte de Santander Department and other departments bordering Venezuela, there is limited access to health and nutrition or food assistance.
Q: It sounds important to go beyond Cúcuta to other parts of Colombia. What specific gap does Project HOPE want to fill?
A: Two gaps. First of all, the first line of health care support: primary health care. That means immediate care for malaria, diarrhea, respiratory infections and measles epidemics in small peripheral clinics. And secondly, we want to be able to attend to more complicated patients at hospital levels. That’s what we do, and we’d love to expand this intervention strategy and get out of Cúcuta to other border areas in Norte de Santander or in other departments like La Guajira that are receiving many more refugees and displaced people.
Q: What health challenges are most common among these populations?
A: We report weekly to the Ministry of Health and our technical staff on the most common diseases with epidemic potential. We see four main health problems: the reappearance of malaria and dengue, high malnutrition (most prevalent in children under five), cases of gender-based violence (GBV) — because so many women are crossing at unofficial crossings – and complicated pregnancies, which impacts the maternal mortality rate among these migrant populations.
In October 2018, all vaccination activities stopped in Venezuela. This means people were not protected from diseases like measles, hepatitis B or A or whooping cough. The number of children here who’ve developed measles or other such diseases has been alarming.
Prenatal care for women is also nearly nonexistent. Many medical staff – some say as many as 22,000 doctors – have left the country [Venezuela] searching for other job opportunities. Almost none of the expecting mothers we see have received any prenatal care. Practically 85% of pregnancies are at risk and all need specific surgical procedures, like Caesarian sections.
Lack of medicines for HIV and tuberculosis patients is also a real problem. We’re facing a very, very serious issue here. This is the first time in my extensive clinical life that I’ve seen – in just five months – four cases of multi-drug resistant tuberculosis. Additionally, as the HIV-positive patients have stopped receiving antiretroviral therapy, we have seen several cases of AIDS-related diseases, rarely seen in South America. All the diabetic and hypertensive patients and chronic diseases have placed immense strain on clinics and hospitals as well.
Q: Can you tell us a little about the personal circumstances and health challenges we’ve seen with the Venezuelan patients that Project HOPE is caring for?
A: HOPE is supporting two levels of health care: primary health care, and secondary and tertiary care at the hospital. At the primary health care level, we’re seeing a lot of terrible cases of malaria and dengue. People come in with fever and chills. There have been several cases of falciparum malaria, which I haven’t ever seen in Latin America – only in Africa and in Southeast Asia. Because they don’t have proper or timely treatment [in Venezuela] these diseases become totally life-threatening.
We’re also seeing many victims of gender-based violence. People are passing through unofficial crossings, where women are sometimes accosted and forced to either pay to cross or face sexual violence. It’s estimated that less than half of these victims are reporting it. And because of this violence, the number of pregnancies has increased, as has the number of newborns with syphilis. I haven’t seen newborns with syphilis in over 20 years. There’s also been an alarming number of teen pregnancies; girls under 16 make up 48 to 52% of pregnancies.
Q: Among the patients you’ve seen in these last few months, are there any cases in particular that have touched your heart and stuck with you?
A: Yes, Baby Ema. A tiny three-month-old baby girl with Down syndrome, who came to us totally malnourished, with skin like leather, and a cardiac problem. Because her condition wasn’t life-threatening, nobody seemed to care about her. It was a touching story for all of us.
Fortunately, the support of a private donor gave us the flexibility to help her. We took her to the cardiologist and the nutrition specialist, and now she’s improved. We’ve successfully connected her with a cardiac foundation in Bogotá, so she will be receive the treatment she needs – and hopefully be cured.
Q: You said the situation is worse here than in many other places you’ve worked because there’s not enough media attention or financial support from donors. Can you articulate what’s needed in terms of scaling the response, and how resources can be used most effectively should people decide to respond?
A: We need help to expand our services to other districts within Norte de Santander and to other departments to which migrants are traveling. We need to expand not only geographically, but also programmatically. We need to do more integrated programming: for example, combining health activities with GBV holistic management and income-generating activities. We would love to see private donors or corporate donors help us, the NGOs, understand more deeply the needs, particularly around maternal health and gender-based violence; expand access to secondary health care, specifically for complicated pregnancies and Caesarian sections; and improve access to nutrition services. But we also do need to expand geographically, following the pathway of the migrants.
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