Health Case Studies
The Cerrejón coal operation (BHP Billiton 33.3% ownership) is located within La Guajira Peninsular in northeast Colombia, South America. As part of an ongoing effort to improve the quality of life in the Indigenous and non-Indigenous communities, Cerrejón conducts an extensive health program that greatly benefits the 8500 people who reside within the operation's area of influence. The program has been maintained and expanded over more than 20 years.
La Guajira
La Guajira comprises three different zones. The upper (north) zone, where the coal port of Puerto Bolivar is located, is generally semi-desert with sparse vegetation. The middle zone is a mixture of desert and some forest. The south zone is less dry and more fertile, with agricultural and cattle-raising regions, and is the area where our coal mining operations are located.
The north is mostly populated by Wayuu people, the most numerous of Colombia's Indigenous groups. The centre and south are mostly populated by non-Indigenous and half-caste people. The Wayuu belong to some 23 clans and preserve their language, wayuunaiki, which is spoken by nearly 200 000 people.
For years, La Guajira has been burdened by poor health services, with health institutions lacking economic resources, medical personnel, equipment and coverage. In some instances, obstacles to progress have arisen because of difficult relationships between state institutions, compounded by the remoteness of communities.
The Cerrejón Health Program
- Health brigades in action
The health program is one of Cerrejón's major social management activities in the municipalities of Hatonuevo, Albania, Maicao, and Uribia (the Indigenous capital of Colombia). It is made possible through the joint participation of local hospitals and state health departments.
Health brigades are one of the key activities operating under the health program and a fundamental component of its prevention and promotion strategy. Their effectiveness is due to collaboration between mayoralties, state health departments and communities.
Regional health-related organisations and medical professionals volunteer to provide general and specialised attention in dentistry, vaccination, gynaecology and immunisation services. They offer their services to the Wayuu people on a monthly basis. The use of a medical/dental mobile unit allows the brigades to reach outlying rancherías (communities) where the Wayuu live, most of which are located along the 150-kilometre railway line that links the Cerrejón mine with Puerto Bolivar. Patients of the brigades are mainly children, pregnant women, older people and the handicapped.
- Health brigades in action
The level of vaccination coverage in La Guajira has increased 95 per cent since the inception of the health brigades, according to data provided by the departmental Board of Health. In Albania, the municipality closest to the mine, vaccination teams supported by Cerrejón attained coverage of 100 per cent during 2004.
The most representative and important health brigade program takes place in Albania, with 1500 patients receiving general and specialised medical care annually at no cost.
The Mayoress of Albania, Oneida Pinto, has stated that, 'Albania, being a town near Cerrejón, has been favored every year with a health brigade. This year we have already had our health brigade and the population participated actively because the program is well-known. The municipality has been benefited by the visits made by various physicians that form these health brigades. Through the program, Cerrejón can see the needs of the health sector in Albania and determine the health infrastructure required for those needing medical care. For this reason, Cerrejón built a functional emergency room that allows dynamic medical care. As well, Cerrejón not only contributes to the urban area but also aids the native communities who are part of the municipality. Cerrejón must continue with this significant activity, working hand in hand with municipal administrations in each zone of its area of influence '.
The Cerrejón health program and health brigades are effectively contributing to community development, reflected in people gradually changing from having a passive attitude about health subjects to being pro-active. Previously visiting the doctor only in extreme cases, they now ask for the brigades and, together with Cerrejón and the state health departments, help plan the schedules and services provided.
Prevention and Promotion
Through the health program, people are learning the benefits of remedial and preventative treatment and lifestyle habits.
In 2004, Cerrejón launched an education campaign to help prevent the spread of HIV/AIDS, developed with the state health departments of La Guajira and its municipalities. So far, the campaign has reached 25 000 people. Using the theme 'The Solution is Prevention – For a Healthy Guajira', the campaign has helped increase the level of HIV/AIDS diagnosis, with most people in La Guajira now acknowledging the importance of prevention. Rates of the disease in the region over the last decade had been increasing in line with national figures; however, in 2003/04 official data by the Social Protection Ministry and the state health department showed a slight decline in HIV-positive cases.
- HIV/AIDS prevention program
Cerrejón has also supported widespread vaccination against yellow fever in the communities of Albania, Barrancas and Hatonuevo, helping to prevent an epidemic in La Guajira last year. After the vaccination program, the state health departments, with the support of Cerrejón, conducted an educational campaign on risk factors and how to handle them. Subsequently, the risk of contracting yellow fever has moved from high to low in the communities covered.
With illnesses such as cancer, the health program has transformed the perception of the value of preventive medicine. The communities, especially Wayuu leaders, have asked for ongoing public education on the benefits of prevention, such as through cytology tests, which are important for early diagnosis and the opportune treatment of cancer cases.
Improving Local Health Facilities
While the Cerrejón health program is primarily based on prevention and promotion, hospital facilities and health centres have also been improved to ensure better service to the community. For example, support has been provided to the health centre at Media Luna, which caters to some 800 Indigenous people located near Puerto Bolívar. Cerrejón has facilitated the provision of physician and laboratory services and the delivery of medicines.
Cerrejón has also provided significant funding to assist the Ministry of Social Protection of Colombia in improving the emergency facilities of hospitals and health centres in Uribia and Albania. Hospital Nuestra Señora del Pilar in Barrancas is also being assisted to enable it to provide high-level medical services.
This infrastructure development program is designed to be sustainable. Training is being provided to the management and staff of the health centres, particularly the Barrancas hospital. Cerrejón is participating on management committees to strengthen management capacity and facilitate self-sufficiency in the long term.
A Program for the People
The health program works directly in improving people's living standards and quality of life within the framework of sustainable development, as required by the Cerrejón HSEC policy. An external public opinion study has shown a strong level of community acceptance and satisfaction with the program, particularly the health brigades.
The program is an example of positive interaction between a private company, government, institutions and, in particular, the community as an active agent of its own development. This effort is sustainable and has an organised structure with mechanisms for the participation of other health-related institutions. Considered best practice, the Cerrejón health program has been officially incorporated into regional and local government health programs.
