An Outbreak of Yellow Fever in Colombia
An Outbreak of Yellow Fever in Colombia
Here is another crisis thrown into the daily national disorder. An emergency. The Uribe government has admitted that the 2004 outbreak of yellow fever has already killed 8 people in 25 days. The number who have contracted the illness this month has already exceeded the total for the previous year. In that year, there were as many cases as in the previous ten years. The country has fallen back 60 years in its ability to control yellow fever. There were insufficient vaccines to slow the epidemic, so Venezuela donated 500,000 and 1,250,000 doses came from Brazil.
Vice President Santos announced that they would work to exterminate the mosquito that transmits the illness. For 80 years they have believed this was possible: but in the tropics, in a country of tropical forests like Colombia, it is impossible. Trying to keep mosquitos out of the cities is difficult enough: attempting to eliminate them from the jungles is another story entirely. In the 1950s, the Aedes aegypti breed of mosquito, found in Cucuta and Catatumbo, became resistant to DDT. But scientists, including a Colombian, Osorno, showed that other jungle mosquitos, Haemogogus, Aedes, and Sabethes also transmited the fever through the primates of the jungles. Communities discovered that the harm done by the fevers was only surpassed by the harm done by DDT contamination to their water supply. The vector of disease was not eliminated and the permanence of the disease in the jungle was verified.
"Eradication" campaigns did not succeed in exterminating mosquitos, but with the arrival of vaccines, yellow fever was kept out of the cities. In Colombia, there has not been an urban epidemic since 1929. After this, there was success in reducing infections to an annual average of 2-4 cases, an improvement over the average of 1946, which was 80 cases. This relative victory could not have been complete, because these "campaigns" did not take socioeconomic, sociopolitical, and ecological realities into account.
The power of the latifundium to prevent an agrarian reform and impose periodic forced displacement on the campesinos has structurally imposed the colonization of the jungles as a social and economic outlet. The 'colono' (the poor peasant who colonizes a piece of the jungle) scratches the soil of the jungle again and again and encounters the jungle's fevers. The Malaria Eradication Service (SEM) follows the 'colono' and tries to stop the spread of epidemics. The difference between malaria and yellow fever is that one has a vaccine and the other does not. Malaria continues to register tens of thousands of cases. For every yellow fever death there are nearly a thousand deaths from malaria, a disease that can generally be cured - but the budget for doing so was never high enough to reach all those affected, nor high enough for substitute medicines when the microbe had increased its resistance.
Under pressure from neoliberal economics, eradication efforts have been disappeared, despite being proven to be one of the most successful rural programs in the 1960s when it was recognized as a model for other programs of prevention and primary care, as a program that did not wait for the sick but instead systematically extended preventive care to the population. Instead of increasing these kinds of services, they were weakened in favor of a model of 'care centres' in fixed locations that did not reach remote regions.
At the end of the 1980s the discourse of decentralization was used to undermine national-level services. The result was that only the strongest departments, like Antioquia, could keep up the momentum of the struggle against malaria and yellow fever.
The neoliberals gave the coup de grace to SEM at the beginning of the 1990s, privatizing the medical system and putting it in the hands of the EPS and IPS groups. These groups had never administered rural programs remotely comparable to those of the SEM. Meanwhile, the National Health Institute (INS), with a very limited budget, did what it could to try to reduce malaria and yellow fever. The situation is so bad that there are no reliable statistics on malaria: in many rural zones there is no one to count. But malaria could claim 3,000 victims a year: uncounted, they do not cause the same outcry as the yellow fever deaths. Malaria is curable, so it is mostly the very poor in the very remote areas who die. Yellow fever, by contrast, kills between 30-60% of those infected, even with medical attention.
Little by little in Colombia and other South American countries the conditions for new epidemics of yellow fever are being created. International organizations have recommended the vaccination of all children older than one year in order to prevent urban epidemics. Colombia is not among the few countries that have followed this advice. In Colombia, mass vaccination only occurs in municipalities where cases have occurred, and their neighbors.
The problem has exploded in Colombia under the Uribe government. That government did not listen to the National Health Service's alerts, that warned in 2000 that the annual average of infections (3-6) was increasing, and that conditions like those found before the epidemics of the 1990s in Peru and Bolivia were being replicated. In 2003 the number of cases was 5 times the average. The most affected department was Norte de Santander. Before the outbreak, the majority of cases had occurred in Guaviare, Meta, Caqueta, Vichada, and the Magdalena Medio. Before reaching Catatumbo in Norte de Santander, outbreaks occurred in Casanare.
The current epidemic, permitted by the structures of the latifundium and colonization, was prepared by the neoliberalism that liquidated the Malaria Eradication Service, closed hospitals and public health services, ruined agriculturalists and made coca the only possible subsistence crop in the colonization zones. It was triggered by the massive fumigation of illegal crops that has displaced thousands of campesinos in the areas where the outbreak has occurred and elsewhere, where mosquitos have spread to carry the disease to carriers yet unregistered. The mosquitos have also infected those who fled the fumigations by going deeper into the jungle to cultivate new fields and found the virus that never stopped living there.
In the Sierra Nevada of Santa Marta, in the outlying regions of the cities of Valledupar and Santa Marta, in the south of Guajira, even in Santander del Sur, the Aedes aegypti is proliferating. The National Health Service has warned of this. And still, when the epidemic exploded in 2003, only Norte de Santander was vaccinated. Health personnel warned that this was inadequate because of the high mobility of the population, principally coca cultivators, frequently expelled by fumigations. In Tibu they never stopped vaccinating for precisely this reason: they understood that the vaccinated would often leave and new people were constantly arriving.
Why did no one react? For the purposes of 'efficiency', Uribe had combined the Ministry of Health with the Ministry of Labor and Social Security. But how can a single ministry, no matter how efficient, simultaneously a) raise the retirement age and lower pension payments, b) implement a labor reform that takes $3 billion USD away from workers annually, c) destroy collective bargaining rights and deny the right of new unions to register, and still have time to prevent a yellow fever epidemic (and stop malaria?) If the Minister of Environment succumbed under the rule of an expert in the construction of housing for those wealthy enough to buy it, how could the Vice-Ministry of Health escape? It, too, succumbed, closing hospitals and privatizing clinics, in the hands of experts in the destruction of labor rights.
All of the forces marshalled by Uribe have joined to declare this epidemic. Fumigations, latifundismo, war expenditures, cuts to social expenditure and scorn for the environment, justice, health and work expressed in the fusion of the ministries. Yellow fever has been treated with the same disorder as the fiscal crisis, treated with monthly tax reforms and increasing indebtedness.
Ten indigenous who died in the Sierra were not included in the official statistics of yellow fever deaths, because no one went to see that they had died. Nor did some campesinos and day laborers who were not registered. A few of the monkeys who died had the honor of being recorded.
Tourists were alarmed. Assured of their protection from the insurgency under Colombia's 'Democratic Security' policy, they were at the mercy of the mosquito. Colombia has problems other than the guerrillas. Malaria kills more campesinos than the paramilitaries. Yellow fever could have far worse effects if vaccination is not immediately extended. In Valledupar, Santa Marta, and neighboring populations in the Sierra of la Guajira first. In Bucaramanga, in Barrancabermeja, in Magdalena Medioâ€¦
Still more serious than the epidemic is the whole style and project of Uribe, that causes crisis after crisis and faces them with band-aid solutions across the board, from the economy to politics, from the environment to the energy policy, from service fees to education to campesinos, debts, poverty, hunger, healthâ€¦ this is not just a passing fever. It is in the structure, the economic model, and the model of public health.
[translated by Justin Podur]