Today we visited the Nelson Mandela Displaced Persons Settlement in Cartagena. Colombia has the dubious distinction of having, after the Sudan, the greatest number of displaced persons. These are refugees from the endemic violence that has wracked this country for years. In Cartagena, a city of a million, there are about 65-70,000 refugees, mostly in two main settlements. The Nelson Mandela settlement has dirt roads, steep hills, jerry-built huts, little electricity, no running water and no sewage system.

A nun founded a community center, a series of cinder block buildings that serve as a soup kitchen, meeting hall and ad hoc health center. Because this nun understood the needs of the women of this community, she invited Profamilia to come in. Today, the Profamilia mobile health brigade, after advance work for several weeks, came to provide pediatric and Women’s health care services. The waiting room was jammed with mothers and babies, many of whom had traveled miles, carrying their babies. There was also one father holding his baby. While many of the women were refugees, not all were, and natives to Cartagena came from surrounding areas as well to get services.

Most of the mothers I talked to gave birth as teens. Nationwide, the incidence of teen pregnancy is one in five. Here it is one in three. Malnutrition is more common in the settlements than in the rural areas these refugees came from, since they cannot harvest their own food in the city. Jobs are hard to come by too since the refugees’ farming and fishing skills are not transferable to an urban setting. Only one woman I spoke to worked, and she was doing odd jobs as a cleaner. The men scavenged. As a result, children are often exploited in the sex trade. These are the poorest of the poor, and they came to take care of their babies. Interestingly, over 80% give birth in hospitals, so the health care system is not entirely hopeless, but family planning and pediatrics are harder to come by, given the bureaucracy and limited resources of the system. Profamilia fills this gap and brings the services to the people with a grant from USAID, which is expiring this year. Profamilia does not know how it will continue this program of its mobile health brigades reaching these desperate women and children. They literally have no where else to go.

The stories women told ranged from 1) a refugee woman in her ’30s with seven children was thinking about a tubal ligation, 2) an 18 year old’ whose husband was in prison for 36 years for murder; she visits him every Sunday with the baby, 3) a 34 year old had never used birth control, had 4 children and just had a tubal ligation. All came with their latest baby for pediatric care.

We next walked through a nearby settlement built on a garbage dump. Open streams of sewage ran through the camp. Buildings were built from scavenged materials. The children said they were in school (in Colombia there are not enough schools and the schools run two shifts, morning and afternoon). As always, children gathered around and wanted their pictures taken. Few wore shoes. One seven year old latched onto our photographer and shadowed her every move. As we were leaving, the girl asked if she could come with her to live. This girl, and others living in this settlement, was ripe for exploitation by the unsavory elements of society and could be easily lured or trapped into the sex trade.