For the past 50 years, the Patrulla Aérea Civil Colombiana – the Colombian Civil Air Patrol, affectionately known as PAC – a fleet of volunteer pilots, has whisked doctors, nurses, and other health workers off to remote areas of Colombia, many of them only accessible by plane or boat.

There, those health workers have provided people living in these remote areas – many of them from indigenous groups – with everything from surgeries to eyeglasses – treating approximately 800 people over the course of a couple of days during a typical medical brigade.

An advocacy and health care group, Sinergias, has been working for the past decade with similar communities – rural, in many cases indigenous – to tackle ongoing issues like mental health and food security.

Then Covid-19 hit the country, and everything changed.

A New Threat

Because of Colombia’s lockdown measures and its wide swathes of mountain and rainforest, which make travel difficult, PAC was originally optimistic about these communities. Living so far from the general population that even a local health outpost staffed by a single doctor is a long way away, rural communities seemed relatively safe from widespread Covid-19.

“Most of the communities that we thought were going to be safe, they’re really not,” said Juan Carlos Lenz, a volunteer pilot and president of the organization’s board.

Covid-19 infections have been reported among a number of indigenous groups, many of which are already fighting malnutrition and other health concerns.

Although Colombia has universal health care, it’s not always easy for remote communities to access.

“People can take hours and even days to get to the closest hospital,” explained Pamela Estrada, PAC’s general manager. “Sometimes they reach the hospital, but the hospital is basic, and they have to go to a bigger city,” taking time and expense in the process.

This situation has been especially problematic during Covid-19, said Monaya González of the Organización Nacional de los Pueblos Indígenas de la Amazonia Colombiana (the National Organization for the Indigenous People of the Colombian Amazon, or OPIAC).

She explained that patients requiring intensive care have to be transported via air to an intensive care unit, and that many people have died as planes did not arrive on time, and people in these communities lacked access to ventilators and other equipment.

González said that indigenous communities are taking steps to protect themselves, including traditional medicine and self-isolation practices. Because elders in these communities are invaluable sources of information, people in these communities are also gathering as much knowledge and wisdom as they can from them, knowing they are at greater risk.

OPIAC has also taken steps to rally for greater protection for these vulnerable groups and distribute vital supplies, González said.

Taking additional measures to protect these communities and help them fight the disease more effectively, both PAC and Sinergias have pivoted, focusing on distributing PPE to rural and indigenous communities and providing them with culturally and linguistically tailored communications about Covid-19.

Difficult Landings

Covid-19 forced PAC to stop their medical brigades. A new sexual and reproductive health program was put on hold.

“We wanted to be very responsible not to bring in Covid to these remote places,” Estrada explained.

When Covid-19 first arrived, Estrada said, it arrived in Bogotá, Colombia’s capital city. Volunteers jumped into action, wanting to “bring PPEs to remote areas even before they have the virus in their territories,” Estrada said.

Volunteers have flown PPE, intended to be used at rural health outposts, to rural communities all over the country, including those so remote they can’t be reached any other way. The kits they distribute include N95 masks, surgical uniforms, hand sanitizer, and disinfectant. They are also distributing testing kits and offering conference calls to help local health care providers learn how to manage their limited supplies effectively.

Lenz, who has been flying for PAC for more than 20 years – he began as his father’s co-pilot – described distributing PPE to rural outposts all over Colombia.

“We are all volunteers, we all have our businesses or we work in companies, but…we have been flying a lot,” he said.

By and large, Lenz’s volunteer work involves short flights in complex conditions, and what he describes as “difficult” landings – often on a grass landing strip where he has to watch out for dogs and cattle, in low-visibility conditions in the western and southern parts of Colombia where the rainforest is located.

“I love that,” he said.

Where People Live

Working closely with indigenous and other marginalized groups is in Sinergias’s bones.

“We work hand-in-hand with communities and people to understand their views of the problems and the ways they think these problems should be solved,” said Dr. Pablo Montoya, founder and director of the NGO. “When we start, we start by asking people what are their priorities, what are their main issues, and we respond to those issues.”

Sometimes, the answers Dr. Montoya hears aren’t the ones he’s expecting. For one community, Sinergias planned to develop a maternal health project, only to learn that people in that community were actually particularly concerned about suicide. The organization ended up working on both issues.

Sinergias also works to promote health care access in remote communities by training local, indigenous health promoters, nurses, or similar professionals to provide home visits that integrate public health programs, such as maternal and child health care, infectious disease monitoring, and mental health interventions.

“You have to go where people live,” Dr. Montoya said.

But the pandemic required a new approach.

“In this situation of the pandemic, we had to reinvent our work because there are so many restrictions in order to move, to travel, and go to the communities,” Dr. Montoya said.

He was particularly concerned about getting information about Covid-19 out to remote communities. He explained that many of Colombia’s rural communities have very limited access to media. Many don’t have phones.

Sinergias worked with members of indigenous groups to develop what Dr. Montoya describes as “culturally adapted, culturally understandable” messages about Covid-19 containment, monitoring, and treatment to remote communities.

That involves video material, an illustrated pamphlet, and a multi-part radio series that covers everything from how the disease spreads to community surveillance techniques to the problems, like interruptions to food supply or a rise in mental health issues, that can appear during confinement.

González said that Sinergias has played a valuable role in reaching communities with limited knowledge of what Covid-19 is and how to prevent and treat it.

In addition, Sinergias is working to provide PPE and face coverings to medical personnel serving hard-to-reach communities.

“We work with any community, but our main interest is the indigenous communities, because we think that these are the most marginalized in the country,” Dr. Montoya said.

Even More

Direct Relief is providing grants to both PAC and Sinergias – for $64,000 and $50,000, respectively – to allow them to continue their vital work during the Covid-19 pandemic.

With the grant from Direct Relief, Estrada said, “we are going to reach even more remote places in Colombia.”

Sinergias’s grant will allow the organization to continue its work with education, outreach, and PPE distribution among remote communities.

“We’re interested in taking the program to other indigenous communities,” Dr. Montoya said. “It’s important to bring a message to them that’s coherent and that incorporates their voices.”

Cydney Justman contributed additional reporting to this story.