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Postscript : Colombia's Cholera Points Up Health Plight of Indians : * The tribes in the southwestern part of the country are vulnerable to a variety of medical problems.


LA SIERPE, Colombia — This and other Indian villages on the banks of the Saija River in southwestern Colombia stand as dark omens of what cholera, the deadly bacteria breeding in human waste, holds in store for Indians living all along the country's Pacific Coast.

Three months ago, cholera attacked La Sierpe and other isolated river communities, producing what was then the highest fatality rate from the disease in Colombia. Many Indians belonging to the Embera tribe died from dehydration caused by uncontrolled diarrhea, cholera's main symptom.

Though Colombian authorities have succeeded in slowing cholera's progress in the southwest, the bacteria has underscored the vulnerability of the country's estimated 400,000 Indians, not just to cholera, but to a wide range of health problems.

Doctors agree that the government reacted quickly to the disease, educating people about its treatment and supplying affected areas with antibiotics and rehydrating solution. But critics say that chronic problems of sanitation and health care remain unaddressed, especially in the isolated Indian villages like La Sierpe dotting southwestern inlets and rivers.

Cholera continues to ravage several such villages, where the fatality rate remains among the nation's highest. The reason, doctors say, is that the Indians' tribal customs, combined with their isolation, make timely medical treatment difficult.

The residents of La Sierpe say the tragedy is just another case of the Colombian state's neglect of the health of the country's indigenous people.

"We have a medical station here that's an empty shack without medicine and without a (permanent) doctor," said Florin Chiripua, the leader of La Sierpe, sitting with other Embera men in a communal house raised on stilts beside the brown river. "Before cholera came, we hadn't seen a doctor in months."

As he spoke of the village's health problems, an emergency team of two doctors and two nurses treated some of the sick. The team and an administrator were on a 15-day mission to the zone's Indian villages as part of a $14,000 project financed with public funds from a Cauca state development corporation. The project was initiated after cholera swept through the region in April and May.

"The problems with cholera opened the way for these people to receive temporary medical treatment that they have lacked for years," said Adolfo Orosco, a 28-year-old doctor working on the project. "The problem is that once we leave, they will be left totally unprotected once again." People are dying, Orosco said, "not only of cholera but of abandonment" by the authorities.

La Sierpe is not unique. The medical project's administrator, Grace Gallego, said her team had not found a single doctor or nurse in their tour of the region's river communities. Nor do any of the villages have sewage disposal systems or aqueducts to provide fresh water.

"These villages use the rivers as their bathrooms and as their sources of drinking water," she said. The practice opens the way for cholera infections when people come in contact with waste containing the bacteria.

Officially, 23 of the 511 inhabitants stricken with cholera in the region have died from the illness. The majority were Indians either unable or unwilling to receive treatment at a medical center. Unofficially the number of deaths is much higher, health workers say.

"Hospital statistics do not reflect reality because many Indians who die without ever making it to a health station do not appear in the official count," Gallego said. "We'll never know how many people in Saija the disease has killed."

Transportation problems hamper efforts to aid the Indians. Some of the region's rivers rise and fall along with the ocean tides, and many of them dry up when the heavy rains on the coast diminish for even brief periods.

"The difficulties of transport along the Saija River are tremendous," said Cecilo Gongora, the owner of a small boat at Puerto Saija, about five miles down river from La Sierpe. "Even if people have a canoe, they usually have to drag it across the dry parts. If a person has cholera, it's almost impossible to get him down river."

It took the medical team four days of rowing and hiking to reach several isolated Embera villages up-river. There they found not only cholera but also cases of malaria, amoebic dysentery and pneumonia. At least seven Indians were near death, Orosco said.

When cholera first struck the region in late April, many Embera, faced with daunting transportation problems, chose treatment by their village's traditional doctor or jaibana (literally, a "man of the spirits").

A jaibana treats sick patients by drinking pilde , a fermented beverage, falling into a trance and communicating with spirits that he believes tell him the nature of the illness and how to cure it. Plants and other natural medicines commonly used are worthless in the treatment of cholera.

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