Article on Colombia should have been more objective

Editor—We Colombians must cope with clichés about drugs, violence, and underdevelopment. Although we have enormous problems, Veeken’s article on Colombia lacks objectivity and fairness. It is based on prejudices arising from personal experiences, which he extends to the whole country. The BMJ should adopt a scientific approach to articles on health in Colombia instead of publishing subjective generalisations.

According to a 1997 United Nations report, Colombia’s human development index (which measures personal income, life expectancy, health, and educational standards) ranks 51st among the indices of the 175 developed and underdeveloped nations.² Colombia’s index (0.848) is well above the average for developing countries and close to the average for industrialised ones (0.907). Life expectancy increased to 70.1 years in 1994 from 56.6 years in the 1960s. Infant mortality fell to 26/1000 live births in 1994 from 99/1000 in the 1960s. The fertility rate has fallen to 2.1 children per mother in 1994 from 4.1 in the 1970s.

By the mid-1990s, 81% of the population had access to healthcare services. Safe water and sanitation were accessible to 85% of the population. Public expenditure on health was 1.8% of gross domestic product in 1990, compared with 0.4% in the 1960s. In 1988-94 the population per doctor was 1650 versus the average of 1064 for countries with a high human development index.²

We have eliminated almost all diseases preventable through vaccination. Dr Manuel Elkin Patarroyo’s work on a malaria vaccine is worthy of mention. Furthermore, the Colombian authorities are engaged in important work to protect the environment. There has been universal acknowledgement of our efforts to conserve our forests and biodiversity—crucial to developing existing and future medicines for mankind.

A supposedly scientific view of the drugs issue does not bear much weight without an equally rigorous consideration of consumption and without recognition of the shared responsibility of producers and consumers. It is untrue that half of our economy depends on cocaine. Such a simplistic generalisation is contradicted by serious economic studies and is untenable since it fails to take into account Colombian exports, such as petroleum, coal, coffee, and flowers.

The distorted statements contained in this article are a lesser concern than their futility. If Veeken went to Colombia under the auspices of Médecins Sans Frontières to help our country it is clear that he wasted his time there.