The Colombian Civil Air Patrol (PAC) is an organization that has been providing free medical and surgical care for over 55 years to populations living in poverty, social exclusion, remote areas, or those affected by disasters. We spoke with Pamela Estrada Ocampo, the general director of PAC, about the organization's operations, funding sources, and projections and challenges for 2023.
What services does PAC offer?
It functions as a mobile hospital. We have all the equipment, supplies, and medications needed for various services. We offer gynecology, ophthalmology, urology, dentistry, and dermatology. In terms of surgical services, we provide ambulatory surgeries that would otherwise be inaccessible to people in the areas we serve, where specialized medical services, let alone surgical services, are scarce.
We also conduct ultrasounds, which were previously mainly focused on pregnant women but have now been expanded to include men. We have several special programs. For instance, in a child nutrition program for children under 5, we provide a special therapeutic food.
We conduct rapid tests for anemia in pregnant women. We also have cancer screenings; currently, we offer screenings for skin cancer, which is prevalent in Colombia, and cervical cancer.
All of this is accompanied by pharmaceutical services. We have a pharmacy that supplies surgical rooms and a public pharmacy where we dispense medications prescribed by our specialists to our patients.
Who is the target population for PAC's services?
From a socioeconomic standpoint, we prioritize people covered by the subsidized health insurance regime, assuming that those covered by the Contributory Regime have better access to healthcare. In municipalities, we prioritize people living in rural areas over those in urban areas for the same reason.
Since we have special programs, some services benefit specific populations more. We offer a full range of gynecological services aimed at women, including family planning implant insertions, especially for young women.
Cataract surgeries and dental prostheses are geared towards older adults who have lost some or all of their teeth. This not only affects their self-esteem but also their nutrition, making it a beautiful program focused on the elderly.
What is PAC's coverage?
Until the pandemic began, we conducted eleven brigades per year. Last year, we started conducting special brigades for Venezuelan migrants in Colombia who still lack access to the healthcare system, increasing the frequency to two brigades per month.
We expanded from solely visiting the most remote areas of Colombia, which was PAC's original mission, to maintaining those brigades in remote areas while also conducting brigades for migrants in capital cities. The criterion here isn't geographical isolation but rather the fact that these people, despite being in capital cities with the best healthcare infrastructure, lack access.
Last year, we reached 10 departments and 17 municipalities, aiming for coverage in different regions. We frequently visit the Pacific and Orinoquia regions, and last year, we returned to La Guajira after a long absence.
How many people received care in 2022?
Last year, we conducted 21 brigades, 15 medical and six medical-surgical. In total, we attended to 15,796 patients and provided 23,222 services, with the number of services being higher because one patient can receive multiple services. These services include 16,254 specialized medical consultations, 419 surgical procedures in general surgery, ophthalmology, gynecology, dermatology, 1,600 surgical support procedures, and 4,949 non-surgical procedures.
We provided 9,327 medical treatments last year, and in optometry, we also provided glasses with the exact prescription for each person. When a patient comes for a consultation, we print out the prescription, offer a variety of frames for them to choose from, and then package the chosen frame with the exact prescription in a bag. We bring it back to Bogotá, process it, and then send it out. While we could use pre-formulated lenses, we prefer to do it properly. We provided 5,351 lenses, 1,568 family planning implants, and 31 dental prostheses.
How is the organization of a brigade? How long do they stay in the area?
The organization of the brigade depends on the location. If it's a place we've never been to or haven't visited in a long time, we do a pre-visit about two or three months before.
The logistics director and the medical director go to the municipality. During the visit, we check that the hospital has infrastructure that, despite being basic because we go to first-level hospitals, the spaces are suitable for setting up the surgery areas. Sometimes we find that minor adjustments are needed, or sometimes we see that the space definitely doesn't suffice, and instead of conducting three surgical specialties, we can only do two, or that the hospital is definitely not suitable.
Additionally, we visit a school in the municipality, where we set up the entire external consultation, and there we inform the local actors about how the brigade works, and if they agree, we proceed. We always do everything in coordination with the Mayor's Office, the Health Secretariat, and the hospital management. If these three actors do not agree with the brigade, then it cannot be carried out because we need their support on the ground.
Preparation starts two months before. We inform the municipality about the services we will provide and the quotas we have in each specialty, and the process of dissemination and patient registration begins. During the previous week, in the surgical brigades, they review the patients who are registered for surgery and determine if these patients are suitable or not.
The entire pharmacy purchasing process is also part of it, as well as computer equipment because we carry digital medical records. We take about 35 computers, servers; in each place we go, we set up a local network because our medical records system doesn't work with the Internet in the places we go. All of this happens before the brigade; Thursday and Friday are for setup, Friday and Saturday for providing care, and on Sunday, we return. The bulk of the brigade really takes place over two days.
How is the PAC team composed?
We are a team of 17 people. But for this to happen, there is a volunteer recruitment process. There are volunteers who have been with the patrol for 25 years, others who have been here for a month. In recent years, we have tried to democratize volunteering.
On the patrol's website, people can see the requirements, upcoming brigades, and profiles of volunteers we take to each one. The profiles we mostly need are healthcare professionals, and additionally, system engineers. Also, as the aerial patrol is an association of pilots, we also recruit pilots who are the ones that allow us to transport the team of healthcare professionals to the brigade location.
How many airplanes do you have?
Actually, the patrol doesn't own any airplanes; the patrol has associates who own their airplanes and put them at the service of the patrol. So at the moment, we have 70 associated pilots and around 30 small airplanes with four to six passengers, thanks to which we manage to reach all these places.
How much does it cost and how is a brigade financed?
We rely 100% on donations, receiving resources from different allied actors, mostly Colombian private companies or those with a presence in Colombia.
If we were to monetize everything, a brigade could cost around $600 million, if we had to pay for the rental of planes, pilot flight hours, which are things we don't pay for. The co-financing we request depends on the brigade, some allies contribute to all brigade services, there are a few that donate in-kind, but what we receive the most are cash donations, and with that, we buy everything.
What are the main partnerships?
Terpel is an ally that provides fuel for the planes for all brigades of the year.
Colmédica has been an ally of the patrol since 2014. They decided to change their 25th anniversary celebration for a brigade, and at that time there was an alert of infant mortality due to malnutrition in Riosucio, Chocó, and Colmédica said, "Instead of spending a lot of money on a party, I want to do something that really changes lives," and they decided, together with the patrol, to sponsor this municipality.
With Colmédica, we develop special brigades focused on pediatrics and nutrition for children under 5 years old. In addition to Riosucio, Colmédica decided to sponsor another municipality that had the same type of needs: Cumaribo, Vichada. Last year we started going with Colmédica to Chimichagua, Cesar, a place where many children arrive with infant malnutrition.
So, Colmédica, in summary, finances two brigades a year focused on pediatrics and nutrition. They are a great ally of ours, in addition to financing, they support us at the strategic level.
With Cardioinfantil, we made an alliance to promote the volunteering of pediatricians in particular, and for example, if one day we find a child with a heart condition, the idea is to be able to refer them and that they can take care of it. It is a very recent alliance that is just beginning to walk.
What are the expectations for 2023?
For this year, we plan to conduct 22 health brigades, 13 medical and nine medical-surgical ones, which means understanding roughly about 15,000 patients, making close to 24,000 appointments.
We want to focus much more on cancer detection, start doing prostate cancer detection, and upper digestive tract screening, and breast cancer screening. We also want to start reviewing other services, for example, otolaryngology, which we included many years ago and have not done since.
Those are some challenges we have for this year, as well as having a new headquarters and growing in partnerships.
