Nine Years Since the Colombian Peace Process Began: Amputations, Landmines, and NGOs

For decades Colombia has been a country that international organizations were hesitant to invest in, and there was little tourism due to conflicts between guerrillas, paramilitaries, cartels, and the government. The use of conventional and homemade bombs and anti-personnel (AP) mines was high and has contributed to many traumatic amputations. Explosives are indiscriminate in nature and many of the victims were children whose curiosity and tendency to wander put them in contact with these devices. There was little chance for modern prosthetic care in conflict zones. Even today it is difficult to receive modern care because of the cost of transportation and housing in order to be seen in a city hospital. In small, self-reliant farming communities, it is not uncommon to see homemade limbs of wood, tire tread, PVC, bamboo, or other common materials. Between 2000 and 2002, Colombia held discussions that resulted in a demilitarized zone where the army and the government left five villages to the Revolutionary Armed Forces of Colombia/Fuerzas Armadas Revolucionarias de Colombia (FARC) guerrillas. However, even though there was a place set aside for discussion, FARC was at this time preparing for war and attempting to seize more power and reportedly received training in the use of AP mines. From this period on there was an increase in incidents and victims of AP mines. It wasn't until 2012 that true peace talks began between the FARC and the government. The peace treaty was signed by both parties and ratified by congress in November 2016, making partnerships between international organizations and government and local humanitarian organizations easier. These are the stories of some of those organizations.

United for Colombia United For Colombia is a nonprofit organization founded in 2003 that has helped hundreds of people injured during the armed conflicts get physical and psychological support. Their mission is "to fund an all-inclusive medical care and comprehensive rehabilitative program for Colombian civilians and servicemen who have been severely wounded in the fight against drugs and terrorism." That includes almost $30 million in orthopedic and reconstructive surgeries, counseling and psychological care, and rehabilitation since they started. Over 350 people have benefited from the programs. United For Colombia partners with local nongovernmental organizations (NGOs) to provide beneficiaries with ancillary programs such as education, vocational training, job opportunities, and social assistance.

At its core, United For Colombia promotes sport as a form of recovery, both physical and psychological. I was invited to photograph the Bogota Marathon by the executive director, Catalina Alvarez. There were 35 participants with physical disabilities in the marathon, many with prosthetic limbs, some using wheelchairs, and some using specialized hand bicycles. In the Medellin Marathon, where Alvarez is based, 100 individuals with disabilities competed with their organization.

Outside of encouraging physical competition through marathons and sport, United For Colombia has four other programs. A Step To Hope works with children who are maimed, usually from stepping on a landmine or picking up an explosive device that was decorated as a toy to attract them. Most of the children come from rural villages that lack the medical specialists needed to respond to their injuries. This means that before any assistive devices are used, or rehabilitation can be done, the children might need revision surgeries. Over 60 children have finished the rehabilitation program and are provided prostheses and yearly orthopedic care until they are grown. United For Colombia partners with others for incidental costs such as housing during medical visits, and educational and transportation costs.

A New Beginning works with servicemembers who are injured in the line of duty. United For Colombia partners with Ottobock to provide high-end prosthetic limbs and with other organizations for educational training and employment opportunities to help servicemembers reintegrate into society after their discharge. Also working with Colombian servicemembers, the American Solidarity program brings the most severely wounded soldiers to the United States to receive care at Baylor Medical Center in Dallas, and the Mayo Clinic in Rochester, Minnesota. Many physicians and medical staff have donated their services to provide $25 million in surgeries. The servicemembers are encouraged to take up sports as a part of rehabilitation, and United For Colombia has a number of their beneficiaries that are part of the Colombian Paralympic team. Some of them have also traveled to the Miami Marathon and competed with prosthetic limbs and hand bikes.

In its newest program, Medical Training, United For Colombia sponsors Colombian orthopedic physicians to observe at the Mayo clinic and bring the surgical practices back to Colombia. Over 50 physicians have completed the program.

Hughes International Clinics Jim Hughes is a well-known name in American prosthetics, having been involved in industry organizations and running a successful prosthetics business in Georgia for many years. He dedicated his retirement to working in countries with high prosthetic needs by fitting people with prostheses and working to improve their prosthetic treatments through education. He is currently working in Mexico and Colombia.

After volunteering in Vietnam in 1994, Hughes decided that if he ever got the opportunity he would travel and volunteer his professional skills full time to countries in need. After Hughes sold his O&P company in 2014, he met Lina Herrera at Fundación CIREC and discussed the unmet need for prosthetic devices in Colombia. He coordinates multiple trips to Colombia and Mexico each year, where he leads volunteer groups to fit people needing prosthetic care. In Colombia, Hughes focuses on treating people with traumatic amputations from the conflict, a large percentage of whom are victims of AP mines, often homemade. Both CIREC and United For Colombia identify, evaluate, and refer amputees who have acquired their injuries from the conflict and do not have access to other prosthetic care and would not have access to quality prostheses without Hughes' clinics. The U.S. Embassy helps with transportation and housing during the patient's stay in Bogota for casting, fabrication, and itting. Hughes International also travels with a physical therapist during these clinics to work with amputees and train local therapists. About 30 patients are seen and fitted with prostheses during each clinic.

Hughes said what drives his work in Colombia is "the Colombian people's desire and willpower to be independent, functional members of society, regardless of their disabilities. The patients work hard because most of them have to provide for their families. All of the patients are grateful for the help we provide and many pray for us, which is the ultimate payment in my eyes."

Fundación CIREC Fundación CIREC is a nonprofit that works with people with disabilities throughout Colombia. Based in Bogota, it also brings a community-based rehabilitation model to communities throughout Colombia. Once reliant on international donations and grants, CIREC has been developing a more sustainable local model, including contacting municipal governments to offer its services through traveling rehabilitation brigades. CIREC partners with these local government leaders to budget government funds to provide rehabilitation and assistive technology treatments needed locally.

Initially, one person goes to a town to ask the local authorities in charge of health services what services are needed. If the municipality wants to proceed, on the second visit an orthopedic physician or physiatrist, the brigade manager, psychologist, physical therapist, social worker, and a CPO who does all the prosthetic castings and measurements as well as wheelchairs and other assistive devices, also visit. The brigades see about 60 to 80 patients over a two-day period, some of whom receive several devices. Prescriptions for all devices are created during this visit, and all patients get services or devices equal or better than they have had. All parts for prostheses are ordered to arrive before manufacturing, which can take more than a month since there is no manufacturer or supplier in Colombia. CPOs then make a third visit where trial fittings of O&P devices take place. As most of the patients want cosmetic covers, all devices, including wheelchairs and crutches, are delivered at the fourth visit. A physical therapist goes on this visit as well to work with patients when the devices are delivered.

Perigeo It is estimated that in all of Colombia around 220,000 AP mines have been destroyed, and new ones are still found every day. Perigeo is an Italian NGO contracted with the government to handle demining operations in the Nariño Department of Colombia, which has the third highest number of AP mine victims of the geographic departments. Perigeo receives funding from the Italian government as part of an aid package. Previously, the Colombian government started training a special unit in the army to disarm 35 military bases that were protected by conventional mines when the Ottawa Treaty compelled the government to remove all AP mines. Colombia signed this treaty in 1997 and when the removal exceeded the capacity of the state, non-profit organizations like Perigo were contracted for the purpose of removing the mines and helping the victims of AP mines.

The Nariño Department produces more coca, which is refined to produce cocaine, than Peru and Ecuador combined. Its location on the Pacific coast and the border with Ecuador make it a crossroads for drug trafficking, which increases the dangers of landmine removal work. In the Nariño Department there have been 34 victims of AP mines so far this year. 90 percent of those were those were near coca plantations. The threat of armed groups and drug traffickers is always there because, as Perigeo states, "they think that our goal is to eliminate the mines so the army can take down their coca plantations, but that is not our mission." In other departments there have been cases of worker's cars being set on fire and blocking them from doing work. Because of this, Perigeo focuses on areas that are less dangerous.

Perigeo works by recruiting people from the community and training them to do the work—80 percent are locals and most of them are single mothers. Without involving the community, work like this is much less successful. While many of the AP mines are old, there are new ones being installed all the time.

Perigeo employees use top-of-the-line metal detectors and protective clothing in the removal process. They work with the local leaders, and when they receive potential locations of AP mines, they discuss this information with the community to help target the exact location. Their local employees are certified by the Organization of American States. Perigeo also helps retired servicemembers who were injured by providing jobs through an arrangement with the Dirección Centro de Rehabilitación Inclusiva, the military organization responsible for transitioning infantry and caring for injured retired military members. The NGO also provides risk education for local communities through school educational programs.

While AP mine removal is the first objective, the second is helping provide communities with alternatives to coca production as there is a clear relationship between the use of AP mines and coca production. Perigeo conducted a study showing it is cheaper and more effective to help communities transition from coca production than to work to eradicate all coca plantations. This is because without an alternative income people quickly return to planting coca. While the ideological war is less active, the drug war remains. As a member of Perigeo told me, "once you are in their communities you see that these are people in poverty with deep financial problems looking to support their families, and they are the ones that are getting the least from all this. That is why it is so important to us to get them involved, to help them by creating opportunity areas and jobs for them so they can transition."

While this is only a portion of the NGOs working in Colombia, it shows that to be effective they have to work with each other and local communities. No one with experience in nonprofit work ever said it was simple or easy.

Jason Rovig, CPO, is from the Pacific Northwest and has been on a sabbatical traveling Latin America working on projects with O&P organizations, refugee centers, humanitarian groups, and art galleries. He is currently working on humanitarian campaigns using art as activism through his art collective www.artforimpact.org . Unless otherwise noted, photographs by Jason Rovig. Hughes would like to increase the number of people he fits each year and needs both monetary and parts donations and experienced CPs and CPOs willing to volunteer. For more information about Hughes International Clinics, visit http://hicsga.com .

Nine Years Since the Colombian Peace Process Began: Amputations, Landmines, and NGOs

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BOC Announces New Award Recognizing Certificant Achievements

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CPO Joins R.J. Rosenberg Orthopedic Lab

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