The Colombian Department with More Malaria Cases from Abroad

The porous border has loaded the inhabitants of the Colombian Amazon with the cases of its Venezuelan neighbors. Shortage and indifference has led patients to seek treatment even in Bogotá. Meanwhile in San Fernando de Atabapo, the transmitting mosquito has folded people back into their homes. But "God exists." So says a mural that receives visitors at the port.

13 February 2017

Following the Guaviare River from San Fernando de Atabapo and at one hour's sailing is Puerto Inírida, capital of the Guainía department and its most populated city. A town founded 205 years after San Fernando de Atabapo, and that many say was developed with Venezuelan gold.

The only bleached in this place anchored in the middle of the jungle is a green Santa Claus painted on the concrete stairs that you must climb to enter the town. Everything looks clean and tidy. The first businesses have signs announcing the purchase of scrap, gold, silver, copper, bronze and aluminum, and of course, the purchase and sale of pesos and bolivars, transfers to different banks in Venezuela. Three wheeler cars circulate along the asphalted streets and you can see lots of stores, restaurants and even an acoustic shell in the avenues.

READ THE FIRST RELEASE HERE: "Malaria Spreads through the Remote Amazon"

In Guainía the department, the highest number of malaria cases is concentrated in the municipal capital of Inírida, followed by cases from Venezuela, Vichada and Barracominas. Venezuela and Vichada import 15 and 6 percent of the cases, respectively, which implies an additional burden on this Colombian department in number of cases, efforts to control the vector, treatment of patients, economic burden, decrease in the quality of life, risk of mortality from malaria, and finally in the epidemiological indicators locally.

As a result, Guainía, in the Colombia department, has the most malaria cases from abroad, mostly from Venezuela. By week 48 (November 27-December 3), the epidemiological bulletin of the National Institute of Health - Directorate of Monitoring and Risk Analysis in Public Health reported that Guainía had an accumulated of 2,043 cases of uncomplicated malaria, 366 of which were from Venezuela. By week 52, the Department Secretariat of Guainía indicated that this department closed with 3,159 cases of malaria.

Tatiana Córdoba, coordinator of the Program for Vector-Borne Diseases (VBDs) of the Health Secretariat of Guainía, assures that 19 out of the 366 cases registered up to week 48 are from San Fernando de Atabapo and the rest come from the gold mines in Venezuela. The statistics turn dismal because they do not identify the communities, they only record the country and if the patients come from the mines. "In 2015, Venezuela was going through the most serious epidemic in its history and it ended up affecting us. The fact that you do not have medication makes people cross the river, and go where they can get a total solution."

Carlos Eric Azcarate, public health monitoring coordinator in the Health Secretariat of Guainía, says that there have been many cases of complicated malaria in children, pregnant women and the elderly, because they take the treatments without knowing if they have the disease. In the end, a problem that occurs in a rural area in Venezuela becomes urban in this department.

Another problem that hospital "Manuel Elkin Patarroyo" of Puerto Inírida is facing is the provision of health services to Venezuelan cases for other diseases. People even arrived for car accidents. Nelson Evelio Palomar, Departmental Health Secretary, indicates that patients from San Fernando de Atabapo and Puerto Ayacucho are referred by doctors from Venezuela. "We cannot take care of them because the health system here is different. The person must have a social security for Colombia or else pay, unless it is an emergency. The big problem is that many patients from Venezuela arrive in critical condition. It is necessary to send them to Bogotá or Villavicencio and we do not have resources. We have a child hospitalized for two months in Bogotá; we are giving shelter and food to the child’s companion. All the patients that we refer have identification problems. They are received due to the emergency, but it is a complication when they are discharged and we have had to give them one more month of shelter and food. It has reached to a point where the patients are brought virtually in secret and they pray that they are received there. Attempts have been made with the consul and the Ministry of Foreign Affairs with no success." 

International Cooperation

An electrical antenna that emerges from the Guaviare River can be seen from San Fernando de Atabapo as a promise of the Electric Power Interchange Agreement between Corporación Eléctrica Nacional (Corpoelec), the national power company in Venezuela, and the Institute of Planning and Promotion of Energetic Solutions (IPSE) for non-interconnected areas in Colombia. The agreement was signed in 2011 by Presidents Hugo Chávez and Juan Manuel Santos, and consisted of a construction project of a 34.5 kV electric interconnection line between San Fernando de Atabapo (Venezuela) and Inírida, Guainía department (Colombia). The idea was to bring energy with an optimal and low cost service to the jungle and peripheral populations of both countries. Today, this antenna only provides electricity to the 15 houses in Amanaven.

"San Fernando de Atabapo has been the backyard of Puerto Inírida. People travel there to stock up. I have not seen people having a December with light," says Cristóbal Colón Suárez, vice consul of Colombia in San Fernando de Atabapo, who practically does not leave the official residence because "to see Macondo, I rather read about it."

Magda Magris, director of research and coordinator of Caicet's Malaria research unit, recalls that there used to be binational meetings between Colombia and Venezuela to carry out epidemiological surveillance at the border. In fact, they had binational agreements for borders and joint projects for vaccination, but not for malaria.

Conversely, Tatiana Parra insists that if in Puerto Inírida they knew about the actions taken in Venezuela, they could work together to solve the malaria problem: "You are the coordinator of malaria there and I am here. We say 'let's make a brigade' and leave at the same time to search for patients of the mosquito and provide some personal protection elements such as mosquito nets, repellents and educational campaigns. We do it at the same time, you take this side and I the other. It is useless for me to take actions if you wait until next year, because your people is coming and infecting my people. If you do not have medicine I'll lend you and then you'll give me back. We need mutual help between countries, but it does not exist."

This is the border, porous, and while expecting actions that break some parts of this cycle of infection to stop malaria, the runway at the San Fernando de Atabapo airport struggles to not to be swallowed by the weed; homes resist the humidity of the Amazonian climate; puddles and grass grow disproportionately; the locals from Atabapo wait for the light poles to work; and the Colombian, Brazilian, and Venezuelan miners walk in this no man's land.

Afternoon falls and darkness takes over saved for the 1st Company of Border Detachment No. 94 and a naval post, which do have electricity, and the Atabapo river illuminated by the lights of Amanaven. The curfew imposed by the mosquito that transmits the parasite that produces malaria forces people into their homes. But, in San Fernando de Atabapo, "God exists." So says a mural that receives visitors at the port.

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