Monday, March 14, 2016

Risk in Colombia

Mosquitoes and other dangerous characters

This year's trip added the Zika wrinkle.  In the weeks leading up to my departure, there were lots of articles and TV and radio broadcasts that suggested we were entering a major health crisis.  The biggest concern has been the possible link between Zika and microcephaly in infants.  What perplexed me was that all the medical experts I heard on the radio insisted that the link was hypothetical and that more study was needed to confirm any connection.  In spite of that caveat, my favorite NPR station reported all through January and February that "Zika was linked to microcephaly".  Then there were the travel advisories: use lots of mosquito repellent containing DEET, and sleep under a mosquito net or in a room with mosquito-proof windows or AC.  In my mind I kept picturing a house like the one pictured below.  Windows are irrelevant when your roof doesn't touch the top of the wall, and you need it that way for ventilation. Mosquitoes are going to get into your house.

Travel by pregnant women from the US or Canada to Central or South America was discouraged.  Most bizarrely and impossibly, women from these heavily conservative religious areas from those southern regions were encouraged not to get pregnant even though their churches discourage or forbid birth control and abortion. 

So, now that I've been down here in mosquito central for a couple weeks, I thought I should update you on some interesting Zika data I've found.  First, how many of you knew that this "new" virus was first identified in Uganda in 1947 and later spread to Asia?  Zika has been around almost 60 years. [1] Then I read that Brazilian Pediatric cardiologist Dr. Sandra Mattos realized that congenital heart disease data she had collected on newborn infants in northeast Brazil included head size, which is a primary symptom of microcephaly.  Looking back she found a significant rise in newborns with smaller head size at least as early as 2012, two years before Zika was introduced to the South American continent.  [2]  Also consider that Lavinia Schüler-Faccini, a geneticist who specializes in birth defects at the Federal University of Rio Grande do Sul, Brazil has pointed out that Brazil's reporting of 147 cases of microcephaly for 2014 is unusually low.  She says that given the size of its population, Brazil should have expected to see 300-600 microcephaly cases a year.  It looks as though Brazil had been under-reporting cases of microcephaly until an unusually high rate started to appear in a small northeastern Brazilian province.  This regional surge suggests that although Zika is present, it probably is not a causal link. [3]  Brazil has around 70,000 cases of Zika. The fact that Colombia has reported over 43,000 cases of Zika with 7,000 plus being pregnant women and has yet to confirm a microcephaly case in any birth so far is another obvious sign that perhaps Brazil is looking in the wrong place for it's microcephaly crisis.  

Here is the saddest part, though.  It is ludicrous to have Latin American governments focusing on Zika, when the risk it represents pales in comparison to other women and infants health issues that have been around for years.  This is where I get so frustrated by the idea of risk, how we perceive it, and how we react to it.  For a thorough and extremely well-written article that addresses Zika and women's health see the following Washington Post article

Another question of risk presented itself in our Christian Peacemaker Teams office yesterday in Barrancabermeja.  I had just returned from 5 days in the campo, returning in the morning to help host a delegation of 12 persons from a university in the Netherlands.  CPT delegations are learning tours that start by giving a background of the conflict(s) where we are involved in a particular country.  Colombian delegations end by spending few days visiting one of the communities we are accompanying, hearing their stories first person, staying in their homes, eating their food, etc.  These campo experiences are extremely powerful, in part because one is so far out of the cultural comfort zone. They can be life-changing experiences.

With this particular group there had been a change of plans.  They were to have visited the community of Garzal where I had just visited.  The consensus in the community was that the unknown armed men were trying to find the community leader Salvador Alcantara who happened to be out of the area visiting family.  The organization handling travel arrangements for the Dutch students advised the two professors in charge that it was probably too dangerous to travel to Garzal.  They arranged to come to our office in Barrancabermeja instead and have folks from the campo come into the city, in doing so, deleting the campo experience.

The professors totally understood that they were missing something special.  What they were surprised to hear from me is that their big city travel advisors from Bogota had warped sense of risk.  A tiny town in the countryside where everyone knows everyone else is a much safer place than a city of 300,000 where gangs infiltrate neighborhoods and armed robbery is part of the daily routine.  The armed intruders in Garzal have a specific goal political goal, to get the president of the community killed or relocated by force.  Harming an international delegation would be very bad for their cause.  Yes, Colombia led the world in deaths of human rights activists in 2015 with 54, but the slain were Colombians not Dutch or US citizens.

It is when CPT and others go to the rural areas that are under pressure that violence can diminish for those who are really at risk.

1 comment:

temporary said...

Hello Phil
I stumbled across you Blog by wife is from Puerto Coca, Colombia and I was researching her town because she still owns land there. I was quite surprised to see that a white guy like me was visiting there!! Haha You have a great blog and I enjoyed reading some of it. It looks like you are doing wonderful work down there. Keep up the good work....they really need all the support they can get. I'd definitely would be interested to know if there's any way that I can support your work there. I may be in the area in August of 2017.