When an Embera boy or girl gets sick from malaria in the Santa María de Condoto reservation, located in the rural area of Alto Baudó, in Chocóit is almost impossible to find treatment or help from a health professional to prevent possible complications.
Caused by four species of the parasite Plasmodium, Malaria is transmitted by the bite of Anopheles mosquitoes., with a wide presence in the department. If it is not treated promptly, it can be fatal.
The symptoms are well known by communities: fever, muscle pain, headache and vomiting. And, although the majority of cases reported in the subregion are vivax type malaria, which does not usually become complicated; There is also one of the most serious, falciparum malaria, which causes stronger symptoms and must be treated immediately to avoid fatal complications, mainly in children under 5 years of age.
The problem is that, in that reservation, as in most of the Baudó riverside communities, there are no health personnel to perform the test, confirm the diagnosis and provide treatment to children or adults. Everything is centralized in the municipal capitals of Alto and Medio Baudó, and second level care is in the capital of the department, Quibdó, Colombia.
But going to these centers requires from five hours to two days between river and road trips, which must be paid for by the communities themselves even though they do not have a fixed source of income. Although the subregion has more than 100 thousand inhabitants, there are no ambulance boats and there is only one land vehicle that makes the trip Medio Baudó – Quibdó in four hours.
All this without taking into account two more conditions: that the presence of armed groups in the area may restrict their movement (most boatmen avoid moving from 6 pm to 6 am out of fear). And then, if the patient travels and is lucky, they will be given the necessary treatment in the city. But there are other limitations, such as delays of up to two weeks for treatment to be authorizedthe historical discrimination against indigenous populations due to their beliefs around health, as well as the lack of Embera interpreters in health structures.
Community health is key
From April 2022, from Doctors Without Borders (MSF) We work in the Alto and Medio Baudó subregion with Afro-descendant and indigenous Embera communities that have multiple barriers to accessing health.
The armed conflict is one of them. According to figures from the Colombian Ombudsman’s Office, during 2023 there were 124 events of forced confinement in Chocó that affected more than 40 thousand people. It is also the second department with the highest number of massive displacements. The Humanitarian Assessment carried out by the International Committee of the Red Cross shows that, in addition to the effects on mobility, there is the constant threat of anti-personnel mines and unexploded ordnance, forced disappearances and violent acts against health care. Furthermore, the communities do not have a fixed economic source that allows them to mobilize and the region’s health scheme is not effective.
Since 2022, at MSF we have trained community agents and promoters in prevention and detection of warning signs, and we support referrals to health centers when necessary. It was thanks to them that we highlighted the gaps in malaria care, one of the main reasons for consultation and complications they received, although it is fully preventable. Between January 2023 and April 2024, agents attended to 608 cases and referred 363 to health centers.
Starting in February 2024, we began to develop a strategy to bring diagnosis and timely treatment closer. We identified nine communities that are easily accessible to others. There our community agents receive a training in malaria detection with rapid tests and microscope, which is more sustainable and free. They also raise awareness among their neighbors about the importance of taking the complete treatment, which is very simple and from the first dose relieves symptoms and avoids complications.
Although the strategy is just beginning, we have noticed that referrals to health centers are decongested and the route to follow to access treatments against the disease is also clarified. Furthermore, in the last week of March, 57% of the malaria records in the official epidemiological report of the municipality of Alto Baudó came from MSF agents. Detection and treatment of malaria in this type of context must be community-based.
Prevention is added to all this. To talk about malaria and other diseases transmitted by mosquitoes in these regions, it is not enough to mention the shortage of medicines or treatments, but it is necessary to broaden our view of what life is like in the communities. This has allowed us to develop strategies to promote the use of mosquito nets, fumigation and water collection systems that we donate; but also the correct disposal of garbage, avoiding mosquito breeding sites, among other factors that may be influencing the spread of malaria and other diseases.
The prevention It is also done from the communities, and not only contributes to reduce the spread of malariabut from different ailments that our community agents encounter recurrently, such as diarrhea, respiratory diseases, skin conditions, among others.
On World Malaria Day, our call is to listen to communities in dispersed rural areas that today are in the midst of armed conflicts and that do not have timely health care or effective diagnostic and treatment tools. Health in regions with these conditions must be community-based.
