Taken from Doctors Without Borders.
We call on the entities in charge to strengthen mental health services in health structures and to do so from an intercultural approach.
We have documented 10 suicide attempts and 4 completed in Alto Baudó between October 2022 and February 2023.
Two psychologists are in charge of the mental health of the almost 30,000 inhabitants scattered between the rivers and the 1,500-kilometer territory of Alto Baudó (Chocó). The municipality is located four hours by trail and two more by river from Quibdó, where the San Francisco de Asís Hospital is located: the only second level hospital in the department and from which more than 20 specialists have resigned in the last month due to lack of pay.
Limitations for mental health in Alto Baudó, Chocó
If accessing physical health care is difficult, the limitations for mental health are multiplied. It is to this hospital that the most complex cases are referred, despite the fact that there are only two psychologists with constant service.
The effects on mental health, however, are multiple and are mainly due to the persistence of the armed conflict in the territory. In 2022, the Ombudsman’s Office issued an early warning for Bajo, Medio and Alto Baudó in which it refers to the disputes between armed groups that have been occurring and the risks for the civilian population associated with the use of antipersonnel mines, recruitment of children, girls and adolescents and, especially, restrictions on the mobility of Afro-descendant and indigenous communities.
That same entity launched an urgent message last April for 22 completed suicides and 50 attempts in the Emberá community of Chocó during 2023. Our organization has documented 10 suicide attempts and 4 completed in Alto Baudó between October 2022 and February 2023.
According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), during 2022 there were some 23,904 people confined in Alto Baudó due to the confrontation between armed groups. In 2023 the conflict has not ceased. Despite this, the two psychologists from Alto Baudó are located in Pie de Pató, the urban area of the municipality, which can be one or five hours by river from the communities, one of the reasons why care rarely arrives.
Added to all these difficulties is the cultural clash between Western medicine and the traditions of indigenous and Afro-descendant peoples, who have been disproportionately affected by violence. The Emberá, for example, do not have a specific word to name suicide or psychology.
The Doctors Without Borders project in Chocó
Within this framework, since March 2022, we have developed a decentralized health project in Alto Baudó in which we train health agents and promoters belonging to the communities, among others, in the detection of signs and symptoms in mental health and in providing first psychological aid.
90% of the suicide attempts we documented were committed by women. Also 90% are indigenous. This knowing that underreporting is high: neither the community nor the Departmental Health Secretariat are clear about the process for notifying or registering suicides before the Institute of Legal Medicine.
According to Laura Garzón, our mental health manager in Chocó, in addition to the high risk of suicide, “the team has identified in the community reactions of acute and chronic stress, sadness and despair regarding the future, reactions of fear and terror that persist due to the presence of armed groups in the area. All of this has led to psychosomatic reactions such as headaches and gastric illnesses”.
Faced with this reality, we call on the entities in charge to strengthen mental health services in health structures and to do so from an intercultural approach. The efforts made by the State from an exclusively Western medical perspective have not been able to reduce suicide rates among the indigenous population, so mental and psychosocial health care must be framed from the sovereignty of ethnic peoples.