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La Macarena: A precarious healthcare system

La Macarena is part of the Special Management Area of the Macarena, a territorial and environmental zoning region that includes 16 municipalities of the Province of Meta and 3 of the Province of Guaviare, established through Decree-Law 1989 of 1989 to govern human activities that could impact the ecological structure of the territory.
 

Read more: La Macarena: the battle for the land (in Spanish.)


Although it has an area of approximately 1,123,100 hectares (4,337 sq. miles) for agricultural activities, only 758,935 hectares (2,930 sq. miles) may be allotted, as the rest is forest reserve areas, forming part of national parks such as the Serranía de La Macarena, the Tinigüa National Park, and the Cordillera de los Picachos.
 

A part of area faces the growing internal and external pressure of extensive cattle ranching, cocaine crops, palm oil cropping and production, and mining and oil exploration and production, incentivizing deforestation that the government has tried to stop by militarizing the territory, through a military operation known as Operación Artemisa.
 

It has also been part of border litigation between the provinces of Meta, Guaviare, and Caquetá, and for the creation of park areas, forest reserves, and integrated districts, after the settlement of peasant and Indian populations.
 

All the preceding, along with the neoliberal rationality of the General Healthcare Social Security System  (SGSSS, for its Spanish acronym) and other public and social policies, have hindered defining and establishing the responsibilities of the government concerning the organization and operation of the local healthcare system, basic sanitation, food sovereignty and security, public utilities, project building, execution of communitarian projects and in general, warranting the efficient means for the well-being of communities, through social, economic, and cultural improvement in conditions of preservation and conservation of the environment.
 

Read more: The dispute for the land, the fuse that spurs the conflict in the Macarena region (in Spanish.)
 

In this sense, the municipality of La Macarena suffers the typical unconstitutional state of affairs in the Colombian rural system.
 

The healthcare situation is worsened due to the social conditions


The healthcare system is considered as precarious, being infectious and chronic diseases, malnutrition, domestic violence, and homicides the most recurring issues.


People hardly use the healthcare system and on the contrary recur to home remedies and self-medication due to the geographic barriers, transportation, economic and administrative issues to access healthcare services–despite the majority being affiliated to the SGSSS– and the weakening of traditional medicine of the ancestral and peasant communities.
 

The failure to guarantee the effective enjoyment of the right to healthcare in a framework of interculturality is especially due to the lack of funds and inadequate planning of activities from the Offices of the Governor and the Mayor, also to the lack of appropriate regulations of the service contracts between insurers and contractors, and in general to the privatized SGSSS, where the insurers and the public and private contractors do not consider sustainable or profitable to invest in these rural territories.
 

The healthcare situation is worsened due to the living conditions of the communities which have low access to basic or higher technical education. Also, for the scarce coverage of the sewage systems, garbage disposal, and ironically for the deficient access to freshwater in a territory with great water wealth.


Despite the productive activity of the majority of the population is based on the peasant economy of subsistence, work, and employment; there is a lack the appropriate protection against labor accidents and occupational diseases.
 

“Health without borders”, a proposal


To endure the violence and displacement, build dignified conditions, and advocate for the right to the territory, close to 10,000 of the 12,000 families have established organizations, 8,000 of which are in the territory of the Losada–Guayabero Environmental Peasant Association. Along with this association, there are other women groups, town councils, Indian communities, and former FARC guerrilla combatants located at the Espacio Territorial de Capacitación y Reincorporación Urías Rendón.


Read more: When peace is not a synonym of tranquility, but fear (in Spanish).


As an alternative from the ejection from the parks, forest reserves, and integrated districts, since 2011 they are supporting building the Losada Guayabero Peasant Reserve Zone and other environmentally sustainable peasant production initiatives.
 

Also, with the support of professors and students of several universities including UNal, the Universidad Javeriana, and the Universidad de la Salle, have proposed including the Rural Healthcare Communitarian Plan named “Healthcare without Borders” in the National Rural Healthcare Plan and the Municipal Development Plan.
 

The initiative is targeted to building a local and state system for universal healthcare access; the territorialization of healthcare according to communitarian socioeconomic and cultural organizational traditions; implementing a care model based on Health Prime Care; rescue, restoration and protection of ancestral and environmental knowledge and practices; and the communitarian participation based on independence and self-management.
 

To seek an escape from the escalating conflict with the recent military incursions, they presented the government an ample agenda for socio-environmental conflict solution derived from the use and management of area protected and other figures coming from Law 2 and Decree-Law of 1989. Along with this agenda, they developed activities for establishing the Development Plan of the municipality and designing a Territorial Healthcare Plan.
 

The rules and plans between these organizations and the government began only after peasant protests and mobilizations that obligated the presence of government officials in San Juan de Losada –between the provinces of Meta and Caquetá–, in March of last year.
 

Due to the official measures for social distancing because of the pandemic, the peasant organizations stopped the protests and blocking of roads hoping for dialogue with the government to reach an agreement to solve the environmental conflict, access to the land, for dignified living conditions and the harmonious coexistence with nature in the territory.

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