Failures in Colombia’s health system were highlighted this week after a young boy died from “completely preventable” complications from blood condition after going off treatment for two months.

Seven-year-old Kevin Acosta was rushed to hospital in Pitalito, Huila, on February 8 after falling off his bike and hitting his head, a situation complicated by his hemophilia.

According to his mother Katherine Pico, the boy required regular injections of clotting factors to prevent the genetic condition that can cause fatal bleeding if untreated.

But due to failings by his health insurer, Nueva EPS, Kevin had missed his regular injections for two months, and on the day of his accident he was denied emergency doses even while bleeding from his head in the hospital in Pitalito.

When the health insurer finally agreed to evacuate Kevin by air ambulance 24 hours later to Bogotá, where clotting factors were available, the blood loss was severe. Kevin died four day later in the Intensive Care Unit of the Hospital de la Misericordia in Bogotá.

Since then, Kevin’s death has caused huge indignation in Colombia both among medical experts who claim the death was preventable and critics of the current government’s political intervention in the health system which has left many users worse off.

Get off your bike

Adding to the furor, President Gustavo Petro waded into the debate blaming the mother for allowing Kevin to ride a bicycle.

“A hemophiliac child shouldn’t ride a bike; it’s a matter of prevention. We need to know if the doctor or the health system isn’t providing education, because mothers don’t learn about it, especially given the low educational levels in Colombia,” he said.

His own health minister, Guillermo Jaramillo, added: “Children with hemophilia should be restricted from activities that can generate violent trauma,” he said.

These comments were challenged by patient’s rights groups, who pointed out that cyclists with hemophilia have competed in the Tour de France, and medical experts who emphasized that in recent decades in Colombia prevention has been based on weekly or monthly injections of “clotting factors” which allowed hemophiliacs to lead normal lives.

Many medical experts concurred that children with regular prophylaxis to prevent excess bleeding could, and should, integrate in physical activities.  

“The child died from the accident, but the reason he died was because he didn’t have the medication,” Dr Sergio Robledo, president of the Colombian League of Hemophiliacs, told Blu Radio.  “Prevention in hemophilia means having the drugs, not locking the child up at home.”

“For more than 20 years in Colombia we have not had any [hemophilia] deaths specifically due to a lack of medicine,” Robledo continued.

Chaotic plan

Kevin’s case was symptomatic of problems in Colombia’s health system which had worsened under the Petro government, Denis Silva told the Bogotá Post this week.

Silva, spokesperson for Paciente Colombia, a coalition of 202 patients’ rights groups, said Kevin’s death was “100 per cent avoidable”.

“If Kevin had been given the prophylaxis or given the treatment when he went to the clinic to coagulate his blood, the situation would have been different”.

Kevin’s mother had been asking Nueva EPS for the life-saving medicines since December, he said, but they were never delivered because the EPS had “failed to pay the clinic” that administered the drug in Pitalito.

Blame for these errors should bounce back to the Petro government, said Silva. State entities had forcibly intervened in Nueva EPS in 2024, claiming fraud in the huge health insurer, and were thereafter legally responsible for managing the entity that covered 11 million Colombians.

Interventions in EPS insurers was not unusual in Colombia, he said. Previous governments had done the same to avoid a crisis for patients.

But were timely actions to “administrate, improve and, where necessary, rescue” the health insurers, though in some cases they were shuttered and patients moved to other companies. Petro’s current takeovers were more chaotic and linked to political overhaul of the health system, he said.

Health system in crisis

This agenda was heavily criticized in an opinion article ‘How Politics Destroyed Colombia’s Model Healthcare System’, by Colombian-based journalist Luke Taylor and published in the prestigious British Medical Journal in January.

Referring to President Petro’s “bungled reforms”, the story claimed that maternity wards and neonatal units were shutting their doors, emergency departments becoming overwhelmed, and training programs for specialist doctors being shut down.

It also quoted the Colombian president as stating that health companies were being “run by crooks”, even as the his government’s interventions triggered a slew of complaints by patients suddenly finding their health care a lot worse.

For patients with chronic ailments reliant on monthly checkups and regular medical supply, the decline was becoming an existential threat, said Colombia’s ombudsman, Iris Marín, this week.

Kevin Acosta was “yet another victim of the failures in the availability and access to medicines that thousands of Colombians face today, in order to access timely treatments that are crucial for their health”.

According to documents released by Nueva EPS, Pico had tried to transfer her son’s care from Huila to Santander department, then switched back to Huila, suggesting a paperwork logjam had delayed the treatment. In another statement, it denied suspending the prophylaxis.

Need for treatment

This was “a big lie” said Pico, talking to Semana, since even before the administrative switch the local clinic treating Kevin had told her in early January that Nueva EPS had ended its contract. Without payments from the EPS, the clinic was forced to suspend treatment.

“By January we had no medication, no appointments, nothing,” said Pico.

Her position was supported by the fact that, across the country, other chronic or rare disease sufferers – including hemophiliac suffers in Pico’s same family – were reporting the same shortages, in many cases linked to contractual or payment problems with health suppliers. 

ACHOP, the Colombian Association of Pediatric Hematology and Oncology, warned in a public communication that children and adolescents “were not receiving in a timely and continuous manner the essential medicines to preserve their lives in conditions of dignity”.

These shortages fell mostly on patients with the state-intervened Nueva EPS, confirmed hemophilia specialist Dr Jorge Peña, who said he regularly treated dozens of children with the condition.

Talking to Caracol Radio, Dr Peña said that children with other insurers were receiving their prophylaxis on time and were “happy, free from bleeding, and going to school as usual”.

“In comparison Nueva EPS patients are not getting the medicines, and I see them every day with bleeding. They can’t go to school.”

Leaked records

Meanwhile attempts by the government and President Petro to push back on Pico even while grieving her son’s death caused condemnation across the political spectrum, particularly since the state had taken over Nueva EPS.

“The responsibility is clear: when the state intervenes and controls, it is held accountable,” said Senator Jorge Robledo on X.

“The healthcare system already had problems, but under this government it’s worse. And meanwhile, more and more Colombians are suffering from illnesses that medicine knows how to treat.”

More criticism piled on President Petro after he leaked details from the Kevin Acosta’s medical records during a speech in La Guajira. Patient spokesperson Denis Silva called on the government to respect patient confidentiality

“These are confidential in Colombia,” said Silva. “By law the EPS insurer should guard the medical records, and no-one should access them without permission from the family”.

The leaks came even as the state agency overseeing the system, the Superintendency of Health (also known as Supersalud), announced an investigation into the Kevin’s care, including looking at “administrative barriers and the delivery of medication by Nueva EPS and the service provider”. This audit should clarify differences in accounts from the family and Nueva EPS.

But even with results pending, President Petro again doubled down in a speech claiming the family was primarily responsible for Kevin’s health outcomes.

“It’s the family that first of all cares for its children,” he said, “Not everything is the responsibility of the state, because the state can’t respond to everything, otherwise we lose our liberty”.  

Colombians living with hemophilia might want those liberties to include the right to life-saving drugs – and to ride a bike.

The post Young hemophilia patient dies after delay in life-saving medicines appeared first on The Bogotá Post.

Judges ordered the recapture this week of a Violeta Arango Ramírez, a prime suspect in the 2017 bombing of Bogotá’s Andino shopping mall, after she lost her legal protections as an ELN peace manager.

The Colombian attorney general’s office requested that Arango, thought to be active in the ranks of the ELN guerrillas, “be found immediately to comply with an order for prison detention” based on accusations she was a key participant in the attack that left three dead and 10 more injured.

Arango, a sociologist, was previously arrested in 2022, but then released from prison to assume the role of a gestora de paz (‘peace manager’) during peace talks between the ELN and the the Petro government.

The controversial release was criticised at the time by survivors and families of victims of the Andino attack as Arango remained a key suspect. By being nominated as a gestora de paz, Arango was allowed both her freedom and temporary avoidance of homicide and terrorism charges while whe was “collaborating with the peace process”.  

This week’s recapture order followed breakdowns in government talks with the ELN with the Justice Department officially removing many combatants’ designations as peace managers. The news gave a glimmer of hope for justice after nine years of uncertainty as to who was behind the attack.

Arango herself has always denied any involvement in the attack, pointing to a plot from within the state prosecutors’ office to frame left-wing activists during the political fallout from the 2016 FARC peace deal.

Pamphlet bombs

The Andino attack unfolded during the evening of Saturday, June 17, 2017, inside the crowded women’s restroom of the busy shopping mall at a peak hour. It was the eve of Father’s Day.

A bomb placed in a toilet cubicle exploded killing one French and two Colombian citizens and maimed at least eight more women in or around the restroom.

Police investigators quickly blamed the Movimiento Revolucionario del Pueblo or MRP, a left-wing group that had evolved in Bogotá’s public universities and was dedicated to mediatic events such as dangling flags from buildings and letting off weak explosives that launched political leaflets into the air.

Over the space of two years the MRP had targeted public spaces outside tax offices, health insurers and banks with messages such as: “Today in Colombia the peace process is a business plan”, and “Health in Colombia is a problem of democracy”.

In the months following the attack, a dozen suspects accused of being linked to the MRP were rounded up, detained over many months, then tried and released after none of the evidence against them could be proven in court.

Meanwhile an alternative theory emerged: that the Andino bombing was part of a right-wing plot carried out to destabilise the then-Santos government’s closeness to left-wing guerrilla groups in the wake of the historic 2016 peace process with the FARC, previously Colombia’s most powerful armed group.

False positives

In this narrative, the MRP, with its history of small-scale attacks and rumoured links to the larger ELN guerrilla group, made a convenient scape-goat.

Investigators claimed to have found similarities between the Andino bomb and the pamphlet explosives, but an analysis by news website Las2Orillas at the time pointed out that the attorney general’s office at the time “had a long history of fabricating evidence” to bring down left-wing political targets, partly as a distraction from their own implications in high profile corruption cases.

Violeta Arango, an activist with links to left-wing causes, found herself officially accused of being an MRP leader and coordinator with the much larger ELN guerrilla group.

She avoided capture and publicy declared herself the victim of a “falso positivo”, or false positive, referring to the practice by the Colombian military of murdering civilians and disguising their bodies as guerrilla combatants.

“This legal persecution I am suffering, along with my family who are being harassed and abused, is nothing more than a setup by the police and the attorney general’s office,” she wrote in an open letter, before fleeing Bogotá.

What happened next is subject to speculation. According to Arango herself, she escaped into the arms of the ELN (literally, as she became the romantic partner of a senior commander) fearing for her life in the face of “political persecution”.  

But her smooth transition into the ELN guerrilla’s Darío Ramírez Castro Front – active in the conflict zone of Sur de Bolívar – also seemed to vindicate the prosecution’s narrative of her links to urban terrorism.

Alias ‘Talibán’

Meanwhile in Bogotá, 10 other people were detained as suspected MRP members linked to the attack.

After searches of their homes, some were accused of carrying false IDs, carrying weapons, and, in some cases, having printed plans of the Andino shopping centre showing entrances and exits, and notes which appeared to show preparations for the bombing, and USB sticks with messages from the MRP.

But in many cases the police arrests and searches were themselves found to be illegal and without due process which, added to the flimsy evidence presented in court, lead to the the cases falling apart under legal scrutiny.

Some of these investigations were later examined in a documentary called Andino File: A Judicial Set-up? produced by journalism collective La Liga Contra el Silencio. One of the main accused, Iván Ramírez, described how the police produced CCTV used to identify him “scoping out the Andino”. This “evidence” later turned out to be video of a regular mall worker with a similar look.

In another twist, Ramírez described how the police themselves invented the aliases to which the suspects were presented as a “terrorist cell” to the media; for example, ‘El Calvo’, ‘Japo’, ‘Aleja’ and, in the case of the bearded sociologist, ‘Talibán’. The scary name stuck and Ramírez was thereafter referred to by Colombia media as ‘alias Talíban’.

He was also constantly described by prosecutors as the “explosives expert” of the MRP cell, a charge he consistently denied.

Ramírez was released from custody in 2021 after spending four years in pre-trial detention, during which time every case against him collapsed. But even after his release he continued to be “linked to the investigation”.

Peace managing

Then in June 2022, Violeta Arango, now in the ELN, was captured in the Sur de Bolívar in the same military operation that killed her partner, known as Pirry.

According to a post on X by the then minister of defence, Diego Molano, alias Pirry was “one of the top ELN commanders responsible for attacks on the civilian population, forced recruitment, and terrorism”.  

Arango was jailed for her guerrilla links even while the process continued against her for the Andino bombing.

That panorama changed when Petro Gustavo took the presidency in August 2022; with peace talks in the air, and after a visit from a Cuban and Norwegian delegation to her jail, Arango was released to her gestora de paz role in November that year. She resurfaced a month later in Caracas, Venezuela, as part of the ELN talks with the Petro government.

This appearance caused anger among the Andino victims. Pilar Molano, who lost a leg in the explosion, told Vorágine magazine that “it’s insane that they let her out and put her in the peace negotiations with the ELN”.

Six years after the Andino attack, in April 2023, the prosecutor’s office again filed charges against Arango based on evidence that prior to the bombing she had downloaded plans of the shopping mall from the Internet.

Cell structures

The indictment formally accused Arango of the “detailed planning” of the bomb attack. It further alleged that Arango was a senior member of the MRP “responible for attracting new members to the criminal organization in Bogotá and apparently participated in at least 21 terrorist attacks against EPS headquarters, public transport and infrastructure”.

With this week’s recapture order the case can move ahead – assuming she can be found.

Any trial could shed light on the who and why of the Andino bombing, and also the complex backstory of ‘Violeta’. But, given the shambolic history of the judicial process, it could also put the investigation back to square one.

In interviews in the intervening years leaders of MRP have repeatedly denied their groups involvement, as well as denying any links to the ELN, or any connections to the original suspects.

But the truth might be hard to find even within the two armed groups; both the ELN and the MRP are known to work in cell structures which plan autonomous actions often without the co-members or leaders aware.

Such was the case with the devastating car bomb that killed 20 young police recruits in Bogotá in 2019, initially denied by the ELN – their leadership claimed not to know of the plot – but eventually taking responsibility.

An unusual element of the Andino bombing is that no armed group or political movement has ever taken responsibility. And so far the prosecutors have not only failed to pin the attack on the MRP, but also ignored alternative lines of investigations such as a false flag operation by paramilitary or right-wing groups.

Lawyer for the Andino victims and survivors Franciso Bernate, said this week that “on behalf of the 11 female victims we hope Violeta is found so she can respond to these grave accusations”.

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