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Letters from the field

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More from Colombia

A Month in Focus: November 2013

A short monthly update on the medical humanitarian activities that Médecins Sans Frontières teams are conducting around the world.

 

Buenaventura’s Tuberculosis Trail

In the port city of Buenaventura on the Colombian Pacific coast, TB cases are three times higher than in the rest of Colombia. The failures of the health system impede access to appropriate care and once obtained, the drugs side...

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Logistician from Adelaide supports TB project in Colombia

Colombia / 28.07.11

Rachel Creek

Rachel and the architect during the construction of the TB centre.

At the end of December 2010, Médecins Sans Frontières began to support the national tuberculosis (TB) control program in Buenaventura, Colombia. The team is providing assistance to improve diagnosis and treatment for regular tuberculosis as well as the multi-drug resistant form of the disease. Since the project’s opening, Rachel Creek, from Adelaide, has been working in logistics and administration. This is Rachel’s first field placement. In this letter, she describes the challenges and successes of working in such a setting.

As I read letters from Médecins Sans Frontières colleagues in other parts of the world I begin to think about my experience and the health status of the population here in Buenaventura, where I am currently working on my first field placement. Wearing both hats as a logistician and administrator, I have had the fortune to be placed in a new project, focusing on improving the treatment of regular and multi-drug resistant TB in the community.

Buenaventura is located on the Pacific coast and serves as the largest shipping port in the country. It is also home to around 70,000 displaced people who are here due to years of internal conflict in the region. The fast growth of the shanty suburbs or ‘barrios’ in Buenaventura has meant the city is full of poor infrastructure and a lack of vital services that support it, like a clean and ample water supply and access to state health and social services.

Cramped conditions and limited or no access to second line treatment options for drug-resistant patients, has resulted in the population of Buenaventura suffering rates of TB and multi-drug resistant TB four times higher than the national average. The treatment for TB is lengthy and relies on a stable supply of treatment drugs. As is often the case in Buenaventura, patients begin treatment but due to lack of appropriate medication and/or institutional support, they are unable to continue their treatment, which often results in more drug resistant cases presenting in the community.

In order to better deliver the required treatment and follow-up of these patients, Médecins Sans Frontières has constructed a purpose built TB centre which includes a diagnostic laboratory. The location of the centre in the barrio area will enable easier access to TB services for the patients themselves and will serve as a hub for all municipal TB activities. Centralising all of the TB cases in the Médecins Sans Frontières TB centre will allow for better follow up of existing cases and identification of new regular and multi-drug resistant cases in the community.

As the project’s logistician, I have been responsible for supervising the construction of the clinic and procuring all necessary equipment for its use. The Médecins Sans Frontières team is working alongside state staff members in the facility in order to support Colombia’s existing National Program for the Control of Tuberculosis. In ensuring timely diagnosis and appropriate treatment of these regular and multi-drug resistant patients, we hope to lower the prevalence of the disease whilst strengthening the state’s medical capacity to treat the disease and raise awareness amongst health providers in the private sector.

As the administrator of the project, I am also responsible for accounting for how our project money is spent. Sometimes Colombian accountancy bureaucracy can be trying, but so far with perseverance, it seems most can be achieved, even if it is within far different timeframes than I am accustomed to at home. I am unsure if I have become more or less patient in my time here, but I know that my frustrations are nothing compared to those of our beneficiaries, who are often denied access to their medications due to administrative obstacles.

Working in Colombia has been an extremely enriching and eye-opening experience for me. The population here has suffered crises of conflict in the past, and continues to suffer the effects of inadequate access to healthcare today. The politics of resourcing in the health sector is a difficult theme in Colombia, and often diseases requiring long-term treatment such as multi-drug resistant TB are not prioritised. Luckily, Médecins Sans Frontières saw the need to combat this latent emergency and provide its ongoing support.

It is not always easy to work in partnership with other actors, and it is definitely the most difficult thing about this project, but I also think it is the most worthwhile. I am pleased to be a part of this project in its infancy and help create the structures that will be used in the long-term. Time goes so quickly here and I never feel as if I can achieve all that I want to in a day. Patience and perseverance certainly do go a long way here.

It is interesting that ‘Buenaventura’ actually translates as “good adventure” in English, something I can definitely say that I have had during the past six months working with Médecins Sans Frontières in Colombia.

Rachel and the architect working in the TB centre during construction.
  

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