520: Leishmaniasis in the context of the Colombian Armed conflict

Lina Pinto-Garcia. It was definitely one of my favorite episodes from, I think, 2021, if I'm not mistaken, where we discussed the spread of leishmaniasis in the context of the Colombian armed conflict. Now, I get all geeky about things like that, especially in epidemiology and how health services have to react, and especially in something like the conflict, the jungle conflict in Colombia. So Dr. Lina Pinto has done major investigations and research on this.

It's really quite special to hear about it. Leishmaniasis, as you know, is kind of a flesh-eating disease transmitted by a type of fly, and then it spreads out, kind of like a burn. Obviously, it can be cured, but it takes really, really body organism-damaging antibiotics to do so. And so it has been very important and very much an issue in the armed conflict in Colombia. So it's a real pleasure to be able to revisit this episode and once again listen to a true expert speaking about her field.

Now, I do know in confidence that there will be a book in the future on this topic. So watch this space because no doubt I'll have her back on the show discussing her book once it is out. I can't give you any release dates or anything like that, but I know that there's a book in the offing. Talking of books, my book, Colombia at a Crossroads, a historical and social biography, so it's kind of like a history and society book with a heartbeat. Very much, not a long list of facts, cold, dry facts.

It is available on Amazon as an e-book and as a paperback, and in, I think, about 10 days time it will be available here in Bogota in the Best Independent Bookstore. So it is an up-to-date book about Colombian politics in English. So check it out, Colombia at a Crossroads. Through my little editing company, editorial company, we've also published the book by Barry Max Wills, Better Than Cocaine, Learning to Grow Coffee and Live in Colombia. A charming, charming account of life in Colombia.

I would say it follows the sort of the lilting writing of Alexander McCall Smith, but it's a fantastic book and really still continuing to sell. well. You can find that again on Amazon, both editions, and, of course, here in Colombia in Hard Coffee. But if you'd like to buy it directly from me, just get in touch. Not expensive, and we'll ship for free within Colombia.

So that's the news for now. That's the news from me. We'll be going over to Matt DeSalvo, Matthew DeSalvo in Medellin. We'll be standing in for Emily Hart this week and doing the Colombia briefing. And then we'll be back with Dr.

Lina Pinto-Garcia talking about leishmaniasis in the context of the Colombian armed conflict. So thank you again for listening, and don't go away.

We are also sponsored by BNB Colombia Tours, which is a leading tour operator providing a wonderful range of exclusive small group shared tours for those over 50, along with customizable private tours to both popular and off-the-map destinations throughout this beautiful and diverse country. If you're interested in experiencing one of their unforgettable journeys through Colombia, be it a shared tour with like-minded travelers or creating a unique private package of your own, just complete the form on the Colombia Calling website, that's www.colombiacalling.co, or the BNB Colombia Tours website, that's www.bnbcolombia.com. And they'll be in touch within 24 hours to answer all of your questions and to start the planning of your exclusive Colombian adventure. So that's bnbcolombia.com and latinnews.com. Thank you for supporting our sponsors.

I'm Matthew DeSalvo, and these are your headlines from Colombia this week. Former President Alvaro Uribe was on Friday charged with witness tampering and bribery in a long-running investigation. The divisive and highly influential leader, who was president from 2002 to 2010,, is accused of offering money to witnesses. The case relates to an allegation made 10 years ago by opposition senator Ivan Zepeda, who said he had evidence of Uribe founding a paramilitary group, El Bloque Metro. Uribe accused Zepeda of slander and using false witnesses, but later, in 2018, the Supreme Court opened a case against the ex-president for alleged witness tampering.

Prosecutors now allege that Uribe tried to bribe members of a paramilitary group which had damaging information against him. Uribe has long been dogged by allegations tying him to right-wing paramilitary groups and drug traffickers, but he has never gone to trial and always maintained his innocence. He will now be the first former president to stand trial in Colombia. If found guilty, he faces up to 12 years in prison. The ex-president has continued to barbs with Colombia's current president on X, formerly known as Twitter.

The two politicians, who constantly use the platform to communicate with the outside world, clashed over the security situation in the department of Cauca. It started when ex-president Uribe said on Tuesday at a university event that the armed forces were not doing enough in the violence-ravaged department. A few tweets later, President Pedro followed up, alleging that Uribe had threatened him back in 2007 by the country's now-defunct secret service. Violence in the southwest of the country is getting worse. Last Monday, criminals from the FARC dissident group, Jairo May Martinez, set off a bomb in the town of Jamundí, Baja del Cauca, injuring 12 people, including two policemen and three children.

Later that day, in the neighboring department of Cauca, suspected FARC dissidents bombed a killing two officers. Last week, President Pedro visited the department. FARC dissident groups are made up of rebels that rejected the country's 2016 historic peace deal, and are now mostly involved in illicit economies such as drug trafficking and illegal mining. On Saturday, Colombia's government and the ELN guerrilla group signed the first agreement of their peace talks, which allows civil society to participate in the process. Talks with the illegal armed group began in late 2022 and resumed in early April this year in Venezuela.

Despite the stopping and starting of the talks, the group said in May that it would continue kidnapping as a way to raise funds. The National Liberation Army, the ELN, is Colombia's longest-living guerrilla group. Formed in 1964, it has been in peace talks with President Pedro's government since 2022 as part of the Colombian leader's total peace plan. The group made headlines across the world last year when it kidnapped the father of Liverpool footballer Luis Diaz, in the department of La Guajira. The group then released him 12 days later and admitted that the kidnapping had been a mistake.

Remittances being sent to Colombia are hitting new highs. In the first four months of this year, remittances hit $3.6 billion, a $13.6 billion increase compared to the same period last year, according to government figures. Most of the money sent back is coming from the U.S., followed by Spain. And this week, Colombia and the U.S. will hold talks in Bogota.

Deputy Secretary of State for Management and Resources, Richard Verma, will meet with the Minister of Foreign Affairs, Luis Gilberto Murillo. The two will talk about the country's continued commitments to address shared priorities, including environmental protection, counter-narcotics and security, migration management, human rights and economic development.

And we're back. This is episode 396 of the Colombia Calling podcast. Our very special guest this week is Dr. Lina Beatriz Pinto Garcia. She's a postdoctoral researcher at the CIDER.

That's a division at Los Andes, a research division at Los Andes University in Bogota. And well, Lina came to my attention through various people on Twitter and social media, saying, you should get this person on. She's got some really fascinating investigations. And the one that caught my attention, and she's in Jamundi, so close to Cali, in the southwest of Colombia right now. And what caught my attention is this.

It's called Diseased Landscapes. But before we get into that, Lina, thank you so much for coming on the Colombia Calling podcast. Thank you so much for the invitation. It's really a pleasure to be here. And it's really cool to be able to share a little bit of what I do and who I am with all of your listeners.

Now, thank you for the invitation. Yeah, and we are very lucky because Lina is about to have a baby in about two weeks, I think, or less. So everyone out there is sending you a positive vibes and everything's great. And it's an amazing experience. There's nothing else like it.

And we wish you all the best in this. And it's definitely a new phase in life, because nothing is the same. Thank you so much. You're most welcome. So, Lina, tell us a little bit, because you've been doing this Diseased Landscapes project.

And I know it's with universities here in Colombia and Oxford University in England. Just tell us a bit about it, because of course, it's all based on Colombia and leishmaniasis and tropical diseases and coca cultivations and everything that we need to hear about, you know, for those of us who are, I would say, Colombianists.

So I got into this project as a kind of something that started from my PhD research. Actually, during my PhD research, which I finished last year, already, during the pandemic, I did an investigation on an ethnographic investigation on the relationship between cutaneous leishmaniasis and the Colombian armed conflict. And as part of this research, I conducted it in Tumaco, which is located on the Colombian Pacific Coast, close to the very close, is actually the bordering municipality between Colombia and Ecuador.

And at this particular place, I realized that most of the cases of leishmaniasis that I was, yeah, I was having contact with, they were from people working in coca cultivation and coca crops and processing coca for transforming coca into cocaine. So that was something that I kind of pointed out during my dissertation, but it's something that I didn't have the time and the scope also to analyze further. So that's why I decided to get into this, this is landscapes projects, mostly relating environmental health, extract, like agrarian extractivism, in this case, of coca plantations and coca cultivation, and also coca eradication, and how it relates to health problems for humans and also non-humans.

So that's why we ended up thinking about this project, we put it together in collaboration with INCIS at Oxford University, which is the Institute for Science, Innovation and Society at Oxford, also with the Department of Global Health and Social Medicine at King's College London, and CIDER, which is the Interdisciplinary Center for Development Studies at Universidad de los Andes. So it's a very highly interdisciplinary project that, again, explores environmental and human health and how this relates to agrarian extractivism, in this case, coca cultivation, coca eradication, and also migration. because in this part, well, we are focusing on, this time in El Catatumbo, which is this region, again, close to the border, but this time between Colombia and Venezuela. And in this region, Venezuelans coming, coming like in large numbers to Colombia, are being, they have become, many of them, they have become workers in this coca fields. So they are very, very much suffering from this disease that we will, I guess, talk more about, because probably no one knows what it is.

Well, first and foremost, I will never be forgiven if I don't tell you that my wife is doing her Master's in Global Health at the University of London. So there you go. I'll never go away. And she's the most excited about this interview, because it's, for her, it's fascinating. And she's explained some of the situations to me.

But I want to know, I mean, you get into this, it's this agrarian extractivism, it's the, you know, the exploitation of these lands for coca. And then you've studied the area with Tumaco, right on the border with Ecuador, and the area of Catatumbo, which actually we talked about a couple of podcasts ago with Joshua Collins, who was up there as a journalist, visiting the coca fields. And so, of course, that's up on the Venezuelan border. So is this, this can't just be a border thing, but you've taken it into account on the borders, because I'm sure in southwest Cauca, and so on, there's Leishmaniasis, but it's not, it's not border. But you've got a particularly interesting perspective from the borders, from the migration.

And so it's Venezuelans coming through the Venezuelan border, but on the Ecuadorian border with Colombia, who are the people, the migrations there? Actually, in Tumaco, it's not, well, yeah, there's migration from, there's a longer history, probably, on that, because of the war on drugs and the spraying of glyphosate in areas such as Putumayo and Caquetá. Many, many, many populations, like mostly mestizo populations, they ended up migrating to the Pacific coast, where most of the coca plantation had moved to since the 2000s. So the population that we see, they're affected by Leishmaniasis, because they work in these coca plantations, are mostly mestizos, not black populations are, who are like, the, kind of like the inhabitants, for excellence, of the Pacific coast. But in this case, it is mostly mestizo populations, campesinos, who have, who are now working in these coca fields, who have been displaced because of the war on drugs in Putumayo and Caquetá, and now live for some time now in areas like Tumaco.

However,

Leishmaniasis is not necessarily a disease that is related only to migrants coming from one place to the other and settling there, it's mostly related, well, in Colombia, to the armed conflict in general, which also entails a lot of migration from combatants. And that's why they take the disease from one place to another.

But maybe it's a coincidence that I have been in these two places that are border places, although Leishmaniasis is mostly a disease that is related to jungle areas, to the selva. So that's why, although in many, many countries in Latin America face this health problem, in Colombia,

it is characteristic and particular that the disease has a strong, very strong attachment to the war. Because these jungles, the selvas, have been the main theater of war in Colombia, that's why combatants of the state, so soldiers, but also paramilitaries and guerrillas, they have been the populations most affected by this disease. So that was actually the focus of my earlier work, let's say. And now I related that to mostly to civilians working on coca cultivation, which is also, of course, very much entangled with the armed conflict, but from a little bit of a different perspective than combatants, right? Yeah, definitely.

But it's okay. We need to explain to my listeners, most of whom I believe will know, what Leishmaniasis is, but we need to explain it. Explain it. for me. It's about one of the few tropical diseases I haven't had, okay?

I'm not going to joke about it. I've had typhoid, dengue, hemorrhagic, dengue, malaria. I can't remember what else I've had. But anyway, tell us about Leishmaniasis. So Leishmaniasis is, well, there are two major forms of Leishmaniasis.

There's cutaneous Leishmaniasis and vitreous Leishmaniasis. In Colombia,

the most prevalent form of the disease, although we have both, the most prevalent form of the disease, so the 98% of Leishmaniasis cases in Colombia is cutaneous Leishmaniasis. So it's a disease that affects the skin once you have been bitten by a sunfly, which is a tiny, tiny insect that lives in the jungle. And this tiny insect transmits a microscopic parasite that is called Leishmania, the Leishmania parasite. And this parasite leads to the formation of ulcers on the skin, of lesions that start growing. And they are not that painful, but they bother you.

They look kind of very disgusting. And they, in certain cases, they expand. So they grow like into the depth of the skin and also, how to say it, like on the surface of the skin, forming this like circular lesions that don't heal. That's the problem with the disease. They resist healing.

So they don't form a scar very easily, and they do need pharmaceuticals. The other type of disease that I was telling you about, that is visceral Leishmaniasis, is not very common in Colombia. It's restricted to some very specific areas. And it's not like a major public health issue here. While it is a major issue in countries like Brazil and India, for example.

But not in Colombia. In Colombia, the disease I have been studying, and also the disease that is related to the conflict and to coca plantations, for example, is cutaneous Leishmania. So when I say Leishmania, I'm referring actually to the cutaneous form, which is the skin form of the disease. that is not deadly. While the visceral form can be deadly, the cutaneous form is not deadly.

So you don't, you never die from that. But it's very annoying to have it. And especially if you have like a lesion that never scars over. So you don't, you have it all the time raw and open. And sometimes like smelling badly because of additional infections, because of bacteria and fungi, then you start worrying about it and you feel you need desperately treatment to get this thing to heal.

So it looks like, from what I understand, and the pictures that I've seen, is just this open wound that just keeps on, kind of as if you were sort of burning the edges of paper and it was, you know, receding.

And then you remain horribly disfigured, right? I mean, is there a way? Like for some people, it can just be like a tiny circular thing that doesn't grow that much. For some others, it can grow a lot and then become super scary and something that worries you a lot in your daily life. For some other people, for example, the parasites can migrate to the mucosal membranes.

That's why they also talk about mucosal leishmaniasis, which is when the parasites move to the nose or the mouth. And then this can lead to the like mutilations, disfigurations of the face. But this also happens in very rare cases. It's like 4% in Colombia. Once, yeah, it was like very, very small percentage compared to the people who just have, like the skin, lesions, or usually in parts of the body that are always exposed, like the arms or the legs, where the sandflies have access to our skin to bite us.

But the fact that it can eventually maybe lead to these larger problems or more concerning problems, such as, like the migration of parasites to the mouth, nose, throat, then that worries a lot of people. And that information kind of makes part of our understanding of the disease in the country and also how we deal about it. And the cure is just incredibly strong antibiotics on a drip, a suero, or something like that? That is like a huge part of my research, because the treatment that is used to deal with leishmaniasis in Colombia, so what is called the first-line therapy, so the standard treatment that is used for that, it's called glucantime. It is a treatment that was developed in the 1940s, actually very long time ago in the context of the Second World War.

And glucantime, in particular, is produced by Sanofi, this large pharmaceutical company from France. And it's an extremely toxic medicine that can even lead to death, even though the disease is not deadly. So, as you can imagine, like one of the populations that are most affected by these diseases are soldiers of the Colombian military, and kind of. they have a very privileged access to this treatment compared to other populations in rural areas of Colombia, like guerrillas and civilians, they don't have easy access to this drug. And I can also explain why.

But the fact that soldiers get privileged access to this drug is also concerning, because it is such a toxic treatment that you get it so much into, like injected into your bodies, that soldiers also end up suffering from violence because of repetitive treatments with this drug.

that has been used for years by the army in order to put soldiers back over and over again and make them like part of this war machine that never stops.

So yeah, the treatment is a super concerning part of the issue. And also, according, for example, according to some people from the guerrillas, it's kind of like the link that holds together the armed conflict, is the treatment. And this is so, or they say so,

because, as I was saying, the Welcome Time, this injectable drug, is controlled 100% by the state and is not made available to the people in rural areas that actually need it. It's controlled in a way that those who have access to it are mostly soldiers of the Colombian army, while guerrillas and civilians have suffered almost insurmountable barriers to access this treatment. So it has been weaponized as a strategy to harm guerrillas. And, as is common in Colombia with the armed conflict, the ones who end up suffering most from this policies and practices and regulations are civilians. Because guerrillas, anyway, they are very powerful, or they have been, or they were very powerful actors in rural Colombia, and they managed to black market and smuggling to get access to the drug.

But civilians are just in a limbo there. Kind of collateral damage on this one. This is where the phrase you use in one of your essays, the pharmaceuticalization of the conflict in Colombia. And I can jump in with some anecdotes there. Because when I was in Medellin in hospital many, many years ago, being treated for,

I don't sell the drugs on, and it was, and it did say like to, you know, illegal groups and stuff. And, of course, I wasn't going to because I needed the drugs, but it did strike me as evil. You know, it almost. it's kind of biological warfare in that way. And then the other thing I wanted to mention is that I have a friend who studied with me on my, my, my doctorate is a captain in the army.

And he, he spent lots of time in the jungles in the south, Putumayo, Caquetá, I think he was in Norte Santander quite a bit, you know, someone who's been a career military officer. And he said there were times where the guerrillas were so good at getting through the jungle, so they would lead soldiers deliberately on fake paths and fake pathways into areas where they knew there were the sand flies that had leishmaniasis. Of course, the guerrillas would know they had their way out. But they would lead the soldiers into these areas, because a soldier gets leishmaniasis and you take him out of the conflict, the theatre, as you said, you know, and I found that that incredible, because again, it's another angle of this biological warfare, using nature in this in this way. And I've never forgotten it.

I mean, I forget a lot of things, but I've never forgotten that, because it really resonated with me. It's like, wow, look at this. And, and so I mean, I just find it. So it's so confusing, but so clear at the same time. And I don't know how I feel about the state controlling medicines.

I don't know how I feel about that. I'm sure I'll get jumped on by my trolls for saying that. But, and then you have another phrase referring to this. is, you know, it's referred to? leishmaniasis has been referred to as a subversive disease.

So of course, it's a disease that the guerrillas get, or the that people in illicit groups get because they spend their times in the jungles. But of course, it's not a subversive disease. It's a disease that affects everyone, but everyone who are, who is involved in these areas. And so your research, which is fascinating, when we look at the diseased landscapes, is not only putting the guerrillas, not only putting the soldiers, but when now, when you're talking about civilians working in the coca fields, so they are more exposed to it. I mean, what have been your findings?

Because of course, you've been down to Tumaco and you've been to Catatumbo for these things, as you said, it's ethnographic. What has been the experiences amongst these people? Have you seen people suffering from the leishmaniasis? Have you talked to them about their work, and so on?

Yeah, actually, well, I have, I was a lot in places like Tumaco, I have been less able to be to places to Catatumbo because of my pregnancy, but I have like, very nice co workers and colleagues doing the fieldwork for us. Juan Camilo Montoya and Alejandro Cañizares.

So they are part of our research team. And what we have found so far is that there is, there is a state discourse that, at least in Catatumbo, this is how this seems to be working, is that the state have, I mean, the public health institutions, they have difficulties to enter areas that are, and to work in areas that are very much affected by the conflict, still, and even worse now, in this quote unquote, post-conflict phase.

And at the same time, this leads to an invisibility of the relationship between leishmaniasis, for example, and coca plantations, because these are zones where it is hard to, so this is that in general is underreported. But especially like if you have a lot of conflict and violence going on, it's very hard for people to move to health centers, to hospitals, to get this, whatever they have, like the lesion check and see if it's leishmaniasis or not, and then get treatment. Also for Venezuelans, well, there's another level of complexity, because they are not covered by our healthcare system. They are only covered as long as they have a health problem that is considered an urgency or an emergency. So what happens in these areas is sometimes, for example, health workers help Venezuelans to pass a leishmaniasis lesion as an urgency, even if it's not, just for help them to get some access to diagnosis and treatment.

And what also happens is that the state is kind of, in a way, blind to the problem, and they mostly talk about how leishmaniasis is related, for example, to coca plantations in southern areas of the departamento of Norte de Santander, where there's no conflict and they have more access to the populations and to cases and so on. But that produces this kind of.

biased picture of the problem. that is not, that doesn't account for the ways in which conflict, coca, migrants come together and are entangled in this issue. In the case of, yeah, I also wanted to mention in relation to what you were saying before,

I know this has some, like, yeah, I think it's important to mention that the military and the guerrillas, they both think, or many of them think, that leishmaniasis was actually used as a biological weapon, that this was, for example, guerrillas, they think that the military released this disease into the jungle in order to harm them, and the military, they think it was guerrillas who somehow liberated the parasite into the jungle in order to affect them. The truth is that this disease has been in South America before the Spanish came here, so it's been a disease that has always been there. So there's no kind of a release of a parasite, as you would imagine in a biological war, for example, there's no, like, engineering of a parasite or of a pathogen in order to harm the other group. But that doesn't mean that it's not been, or that it hasn't been used in a strategic way in order to harm the other. So the most visible aspect of this is what I was mentioning earlier, like the control, the restrictive control and the treatment that ends up harming guerrillas and civilians, and dogs, we can also talk about that.

Yeah. But, as you said, I've also heard, for example, there was an article or like a written piece, I think it was from the 90s, like I found it. once, I read it, I thought it was fascinating, and then I lost it, and I have never been able to find it again. But it said something like that, how guerrillas used to lead troops of the Colombian military into certain areas where they knew there was a lot of time slice. And they just waited, you know, until, like without shooting, or using any gun, they just waited there.

And then the military started evacuating, one soldier after the other after the other, until the military weren't there anymore because of leishmaniasis, because the military considers this is a professional disease or an occupational disease. They are obligated, although they don't do it timely, but they are obligated to evacuate soldiers for them to access diagnosis and treatment in some other place far away from the jungle, right? So that was super interesting. And I also heard, for example, how they have done it with snakes, like they know certain areas where snakes are living, and they know that a lot of snake bites are going to happen in certain places. So they kind of make the army to concentrate in those areas, because they know like snakes are going to do the job for them.

So it's really, really interesting what is going on there. And also, like this, all these technological devices that kind of the military and guerrillas have come to in order to address the problem. That is also fascinating for me. I can talk more about it. But I mean, I didn't think about the snakes.

I mean, I guess there are areas that are, well, you know, more inhabited, populated by snakes. And therefore, you could send people, I never thought about that at all. I mean, leishmaniasis.

But so, I mean, I think we need to, we need to sort of get some other basics out there. It's the figures, then for leishmaniasis in Colombia. And you, you've been, you've mentioned, okay, so they talk about the leishmaniasis in the coffee cultivations, in sort of, let's say, lower or more southern regions of Norte Santander, and not in the coca regions. So therefore, the figures are inaccurate for cases of leishmaniasis, which of course, then allows the government to play a different game. And, I mean, do we have any figures of recent cases and percentages?

I mean, do we know how prevalent this is? Because, I mean, it's almost like a leishmaniasis, not to belittle it a bit, it's like a horror film, isn't it? I mean, this sort of thing. Well, it depends. actually, for some people, it's something you can live with for many years.

And it's so common in rural areas, and it has many different names in rural areas. So, for example, in the Pacific, they call it guaral. And in most of the country, they call it pito.

So it's, and that's also very confusing, because pito is also a way to call Chagas disease, which is a very different, also vector borne, but it's still, it's a very different disease. And there's a lot of confusion there that we can also talk about. But the figures, as I said, like there's a huge problem of underreporting in general in the world, because, as I was saying, like some people just live with that. And in some cases, it just heals, you know, you're like your immune system is able to fight the disease and lay in and lead to the healing process of the of the body, so you don't need any treatment. But in other cases, it can become very bad.

So the people who end up kind of approaching healthcare institutions, and those cases that get counted, or that that figure in the public health databases of the National Institutes of Health, are just a small portion of the real cases out there. Of course, for example, guerrillas at a certain point, especially.

when it became very tough for them to leave the cell by and go to see a doctor in a health center.

Like guerrilla cases, of course, are underreported, like they don't often go to health centers. They try to deal with, at least that was when the FARC was operating, they tried to deal with their own health problems within the organization, and they avoided a lot to leave the jungle. It would have to be a very extreme case when they allow people to leave the jungle in order to check what was going on with their health in a health center hospital somewhere outside the jungle. So there's also the other component that you were also talking about, because this disease is stigmatized as a guerrilla disease or as a subversive disease, people are very afraid in certain areas of the country to let others know that they have leishmaniasis. And this can be.

in some areas of the country, there's no stigmatization, very much working on, while in others, for example, where the FARC had an important presence, in those areas, the stigmatization works very hard. So they are super afraid to get in touch with medical professionals or with health workers, because they don't want them to think they are guerrillas. And this information, in some cases, ends up reaching the military, the police, and then they start being targeted as guerrilla members. Also, in some, which is very,

yeah, like, one of those things that you live in Colombia and that you don't believe about it, but it's in the midst of this violence that has become so everyday thing for us. In some of the testimonies that paramilitaries provided during their demobilization process, so in the scope of the La Ley de Justicia y Paz, there are some testimonies of paramilitaries saying that leishmaniasis marks on the body were one of the many criteria they used to decide if someone was a guerrilla member or not, and then to proceed practicing violence on this person, like killing them. So it's like leishmaniasis marks on the body have been actually used to kill people and to affect people and to harm people. And this is very paradoxical in the sense, again, that this is not even a deadly disease. So you end up dying, it's kind of like the social construction of a non-deadly disease into a deadly one, because of the stigma.

So again, the figures are super confusing, are not reliable, but people. for a very long time, they talked about 14,000 cases in Colombia every year. Then, in moments where the war was more intense, they talked about 20,000 cases a year.

And one of the records we have is that in the mid of the 2000s, we had a huge peak of leishmaniasis cases. This also talks about how the military strategy during Alvaro Uribe's government changed in dramatic ways, became like, the recruitment of soldiers increased by more than 30%. Soldiers were asked not just to enter the selva and leave it, but go to the selva and stay there for several months. And these were populations that many of them were kind of naive to leishmaniasis. So they had never had contact with the vector or the parasite.

So they became very easily vulnerable to the disease. And then the military had, like a peak of cases, a large epidemic in the mid 2000s. And that's why leishmaniasis at this point, especially in the history of our conflict, it was during Alvaro Uribe's government that leishmaniasis turned into a problem for the, a major problem for the military and a major problem for the state in order to keep going with this war. And they had to solve it somehow. So it's all, it became even more stigmatization on one side, more control of the treatment on the other side, more provision of treatment for soldiers in a very, I would say, non-responsible way.

And the problem in general became more acute and the numbers also higher. Amazing. And yet these numbers will be less than the actual numbers, won't they? I mean, that's the thing. You talk about, a spike at 20,000 or so, but it's going to be much higher because, of course, the people from those regions aren't included, the guerrillas aren't included.

It's amazing. And so can we conclude, and there's a dangerous word. I know in academic fields, but the conflict led to the extension of the conflict and the intensification of the Colombian conflict led to an increase in cases of leishmaniasis? We can safely say that. Okay, good.

And I think that's part of why my research shows that it was especially during this time in the mid-2000s that the problem became a major problem, became also, like, I talk about this, 14,000 cases, or 20,000 cases, when you compare that to other diseases, for example, malaria, that is another vector-borne disease that is very much prevalent in Colombia, the numbers of malaria are much higher. And because malaria, for example, is a deadly disease, the state has, like, a huge concern for malaria, and to do things like the malaria strategy is kind of bold in Colombia. Like there are, for example, community volunteers who are trained to diagnose malaria in very remote areas of the country and also they provide treatment to these people. While leishmaniasis is a disease that has most likely, the numbers, the figures are much more smaller, it's not a deadly thing. So kind of, as a public health worker told me, like the state can afford not to do anything.

You know, you don't have people dying from that, it's not like one of those things that turns on alarms in the international public health institutions. It's something that you can just don't care about and still harm a lot of people while doing that. So yeah, during the most acute years of the war, during the mid-2000s, it is remarkable how this became a thing for the state. So it was a thing before, but it was a minor thing. But then, when it created lots of problems for the army and for being able to ensure domination and presence in areas they have fought for and they were losing it because of leishmaniasis.

Like also, I remember an officer of the army telling me like, for example, you go to an area that is endemic for leishmaniasis and you enter there with a large like group of people, 200, something. And then, because of leishmaniasis, then in a couple of weeks you have 180 and then you have 150 and then you have 130 and then you don't have like a battalion anymore, and then you end up losing whatever you have fought for in the war. And that became a major thing during Uribe's time. So that's why they created, in 2005,.

the El Centro de Recuperación de la Leishmaniasis, which is the Center for Leishmaniasis Recovery, also called sometimes the Center for Leishmaniasis Rehabilitation, which is located within the Silva Plazas Battalion, that is located in Guitamén, Boyacá. And it is a clinic, basically, that is devoted to exclusively treat leishmaniasis in soldiers, in active soldiers of the army. So huge was the problem that they had to create infrastructures and procedures in order to deal with that. And there's no other disease or condition that received that exclusive and so elaborated attention within the army. For example, there's no Malaria Recovery Center or, right, like there's, like this thing that is called with a specific name of a disease and that the whole, and that's also part of what I did during my PhD research.

I was many months in this center looking at the experience of soldiers going through treatment of leishmaniasis and how they experienced that. You were there in the base in Duitama? Yeah, I was like for three, four months there in 2016,, 2017.. And that was amazing also because for the army, the center, which is called the CRL, the Leishmaniasis Recovery Center, it's a source of pride, you know, is one of those things that they think is kind of like, it's sometimes pictured as a good legacy of the war, like that. the leishmaniasis program within the military is exemplary for other countries.

It's exemplary in the ways they are organized and how they treat all these soldiers against this disease that is a neglected tropical issue and so on. And then, when I was there and I realized what I was telling you at the beginning, like how cruel it is that they put soldiers under repetitive cycles of treatment because they need soldiers to put them back into the jungle as soon as possible. So they treat them over and over and over with. I think soldiers themselves call poison.

So it's really, really worrying and sad and cruel. But an incredibly important piece of research, to have been in there and to have viewed it, perhaps not from a medical background, from an ethnographic one. I think that's, you know, because we can look at stats and we can look at the drug that's used, but to have been there amongst the soldiers and then amongst the campesinos or the coca growers, or the people, I guess, the raspachinas, the guys who pick the coca leaves for them. Wow, it's a really, it's an intense experience, this.

So what, you know, we have to wind this down, unfortunately, because I think we could talk for hours. I think the, you know, we're in a, in inverted commas, post-conflict situation with, well, you've got the ex-combatants from the FARC and then you've got dissident FARC, and then you've got the other illegal groups, and then you've got the sort of post-paramilitary groups or newly armed groups, or whatever they're called now, the Clan del Golfo and others. You've got Venezuelans in search, in desperate need of jobs. So they're ending up in these places and we've got more coca cultivation. Was it less coca cultivation than before, but more cocaine production, I think it is.

So, I mean, this isn't going away. Lisa Menezes is here to stay. What are your thoughts to sort of close this conversation? What are your thoughts for the future on this? Well, right now, in the scope of the project we are doing, we're asking ourselves the same question, how this would inform policymaking in a context of post-conflict, and how do we have to understand the relationship between health and conflict in order to come up with better solutions to the problem?

I think Lisma and I, even though, again, it's a minor, let's say a minor disease, it's an emblematic case to kind of disentangle what this relationship between war and health has been in Colombia. And it's an emblematic case, also very illustrative, to understand what kinds of problems there might be in rural areas of the country that need to be solved urgently in order to think about how we repurpose health care for peace building and how we organize health care and public health. Because part also of what I have shown with my research is that areas such as biomedical research, like what scientists do in labs and so on, and public health have participated in the production of violence through the case, Lesmaniasis is a case that shows how biomedical research and public health can have a participation in the production of violence in the context of an armed conflict like the Colombia one. And I think those are areas, for example, that people don't imagine us being participants in a warfare, or you don't think that scientists might be in a way participating in this whole issue, and they are, even from good intentions and from trying to do their best, but they end up entangled, as I say, enmarañados, which is a concept that I developed in my research, in this whole issue, even if you are not aware of that, or even if you don't want to, but they end up there. So what should be done, I think, well, in terms of Venezuelans, I think there are many people thinking about this right now, like how the work, for example, of Natalia Acevedo, she has been studying how healthcare professionals, they are key in order to make the access of healthcare services for Venezuelans happen in Colombia, even though they don't have access to them, according to regulations, only, as I said, if there are emergencies.

And what we are documenting now is that they have a great need of diagnosis and treatment for leishmaniasis, and other, many other diseases and health conditions, so that needs to change. Also,

the criminalization of people working in coca plantations has also led to not considering leishmaniasis as a professional disease or occupational disease, as it is considered in the army. And they are like these people in that suffering from these diseases, such as leishmaniasis, because of the work they are forced to do, because they live in very marginal, or in a very marginalized condition, and on their poverty, and they are forced to work in this coca field. And that's why they end up having the disease. So we need also to start thinking of leishmaniasis in ways that account for how it is related to certain occupations, and how we need to stop criminalizing those occupations that people engage with, because of the poverty they are facing, or the different problems they are facing. And, of course, we need to provide treatment for everyone who needs it, and question also our policy of treatment.

Like, as I said, the treatment is terribly.

harmful and toxic. So we need to reconsider what other alternatives we have in order to treat this disease. And there are some alternatives, but they are not made available. So we need to kind of rethink the whole public health strategy on leishmaniasis, and stop making it a pharmaceuticalized policy that is based strongly and only on glucagon time on this very toxic treatment. We need to move beyond that and provide other alternatives to the people suffering from this disease.

It's a more inclusive healthcare plan for these isolated, marginalized areas. I thank you so much for that. It was, I mean, I've been absolutely, you've informed me beyond what I possibly ever knew on leishmaniasis and the regions in Colombia. And I know, you know, it's not an easy time for you right now. And I'm so very appreciative for your time, because this has been totally fascinating.

I'm now going to go and repeat almost everything you've told me to my wife, and keep her informed, because it's, I mean, thank you so much for your time on this one. And I will, you know, point people in the direction of your academic articles and so on, because it is an important one, because it's, as you say, repurposing healthcare for peace building. And I think in that concept, it's all encompassing really. So let me take this moment to thank you, Dr. Elena Beatriz Pinto Garcia, for your time today and coming on the Columbia Calling podcast.

It's been a real pleasure. No, thank you so much again for the invitation. Like I can talk about this for hours and hours. So, and I love to do it and I love to share my work. And so thank you so much for the invitation.

And yeah, and I hope that more people get interested about these issues and how we can think of areas like health that do not seem to relate it to our violence problems, but they are. Totally related. So, well, thank you again, everyone for listening. This has been episode 396 of the Columbia Calling podcast. I've been Richard McCall talking to Dr.

Elena Pinto Garcia. Please always, you know, spread the word about the podcast, share it all over the place. We're trying to get word, news about Columbia out there that goes beyond what's just in the headlines here, you know, in our mainstream press. Thank you again. The Columbia Calling podcast is sponsored by Latin News, a leading source of political and economic analysis on Latin America and the Caribbean since 1967.

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