By Edward de Burgh
MONTERIA, Colombia, Oct 11 (AlertNet) - Steadying himself with practiced ease, Colombian peasant Jose removes his prosthetic leg and an audible shock ripples through the students taking in the scars that are evidence of surgeries gone wrong.
For the Colombian surgeons studying proper amputation techniques, the tattered leg before them serves as a stark reminder of the challenges they face treating victims of landmines scattered in the country's waning guerrilla war.
Jose, 25, lost his right foot seven years ago. After a crude first amputation, and then a botched second one he became one of the growing number of victims struggling with the country's lack of specialist expertise in amputating limbs lost in conflict.
"I agreed to the second amputation because a proper prosthesis seemed the only way I would be able to walk better," says Jose, whose name cannot be used because he once served time in jail as a former member of an armed group.
"After the operation I was a bit traumatised; the stump could have been longer."
Colombia's war is ebbing with leftist FARC rebels under pressure from a U.S.-backed security campaign and driven back in remote rural areas where they use the cocaine trade to finance their four-decade-old insurgency against the state.
But the country's armed groups still use ambushes and make-shift landmines to harry troops. Home-made explosives litter rural areas putting the civilian population at risk of injuries that often end in emergency amputations.
"Home-made devices are made with a lot of organic material including biological contaminants," explains Dr Julio Vidal, a Red Cross surgeon and expert in war wounds. "The wounds are very difficult to treat; they need to be managed correctly to avoid infection."
According to the International Committee of the Red Cross, many Colombian doctors are not adequately trained to manage the complicated conflict wounds requiring amputation. The spread of infection starts the moment the injury occurs.
"There is a very small group of specialists in Colombia that know how to effectively treat this type of trauma and most of those are in the military and police hospitals," said David Gutierrez, a senior surgeon in Colombia's remote Amazon region and participant in the workshop explains.
RURAL COMMUNITIES STRUGGLE
Communities plagued by explosive devices are often located deep in the Colombian countryside, far from professional medical help and even too remote for an ambulance.
Landmine victims usually have to endure a grueling journey to reach the first stop that is often a remote health centre, which is neither staffed nor equipped to deal with conflict casualties.
When the casualties arrive at the next level of hospital with surgical facilities, life-saving amputations are carried out by well meaning, but not always well trained, surgeons, medical experts say.
In rural clinics, protocols for dealing with conflict casualties are not consistent, a factor worsened by a lack of understanding of rehabilitation.
"After the surgery, it is not always clear who to pass the patient onto and the patients themselves receive little guidance," Gutierrez said.
According to official figures there have been 5,529 reported injuries caused by explosive artifacts in Colombia since 2002 - civilian casualties make up 33 percent of this figure. Many cases are not reported because of fear of reprisals and isolation of victims.
No reliable statistics exist about how many amputees or re-amputees there are. But the Red Cross estimates that 50 percent of amputee cases they manage are in fact, re-amputees, and the ratio is rising.
Colombian officials are increasingly worried about the problem.
"We have reached the point where it is necessary to analyse this, dedicating resources to it," said Luis Fernando Correa, an emergency services coordinator at the Colombian Ministry of Social Protection.
The government, Red Cross and Bogota's National University recently began a series of workshops, such as the Monteria class, to train doctors in proper amputation, often working on pig legs to practice.
But the courses are only the first step.
"The workshop is designed to enhance initial diagnosis," said Tatiana Florez, a Red Cross delegate in Colombia. "Our goal for 2011 is that all medical faculties include in their curriculum a module on surgical and medical management of war wounds."
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