Saturday, July 26, 2014

Post Conflict but not Post Consequences

This week, Larissa and I went to the hospital to talk to one of the nurses there.  I was interested to hear her impression of the young girls in La Merced and their knowledge of reproductive health, as well as her experience with women and what sort of resources the hospital had to offer them.  At the time, I had no knowledge of the unexpected direction that this interview would take.  I was told that Jenny was the head nurse and that she would be the person to talk to.  We met her at the hospital in the morning, and to my surprise she was a younger girl.  As “head nurse”, I was expecting to meet a woman who had been working at the hospital for decades.  Jenny has worked at the hospital in La Merced for the past 6 months.  Apparently, there is a national policy in Colombia, which requires all doctors, nurses, and dentists to do one year of social work as part of their degree programs.  Jenny had been assigned to La Merced for her year of rural medical work, and has 6 more months of work in La Merced ahead of her.  After talking with her for a few minutes, we learned that her role as head nurse was somewhat by default, since she is the only certified nurse working in the hospital.  There are 7 nurse assistants who have not received the same training that she has, and don’t perform the same tasks that a full time nurse would.  Needless to say, Jenny has been very busy for the past 6 months.  She also told us that until recently, there were 3 doctors working in the hospital.  Last week, one of them decided to quit due to “political reasons.”  The two doctors that remain are actually students in the same program as Jenny.  Not only do these doctors have minimal experience, but also they will only be working at the hospital for the next year, before moving back to a larger hospital in the city.  From what she has learned during her time here, she says that this is the normal cycle of staffing at the hospital.  Mostly, the nurses and doctors are working there as a part of this degree program and leave each year, while new interns arrive.  So there is never really a seasoned staff of doctors or nurses to treat the people of La Merced. 

When we asked Jenny why she thought that it was so difficult to keep the hospital sufficiently staffed, she told us about a meeting she had recently attended.  There was discussion about the paramilitary history of La Merced.  La Merced became a center for paramilitary training in the 1990s and early 2000s, and the municipality was strongly controlled by a paramilitary group.  The severe loss of population in La Merced is largely due to this history of conflict that has left its mark on the town.  Jenny told us that up until about 10 years ago, while the paramilitary group was occupying the town, they placed officers in the hospital.  These officers monitored who was coming in for treatment, and told the doctors which patients they were allowed to treat, and which ones they needed to turn away.  After hearing this story, it became clear why it was so difficult for the hospital to maintain a sufficient and capable staff.  Her jarring story reminded us of the very real violence and darkness that the town had been put through.  La Merced’s history is something that we have all been aware of even before coming here.  It’s something that sits in the back of my mind every time I learn something new about the town, or hear another person’s story.  But it’s not something that has ever been out in the open.  It’s not often that you hear people referring to it directly, so it’s easy for the stories and facts that we’ve read to remain intangible notions in my mind.  These facts take on a whole new meaning when they are brought into reality, which is what happened for me that day at the hospital.  The conflict may be over, but there are still very visible consequences that the town endures. 

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