Evaluating emergency physicians' knowledge, attitudes, and experiences of FARC ex‐combatants: A pilot study of Colombia's emergency medicine teaching hospitals

Abstract

Objectives In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex‐combatants into the healthcare system. However, FARC ex‐combatants have faced significant challenges in receiving healthcare, and little is known about physicians’ abilities to address this population's healthcare needs. Methods An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians’ knowledge, attitudes, and experiences with the FARC ex‐combatant reincorporation process. Results Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two‐thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex‐combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty‐two participants (41.5%) had identified a patient as an ex‐combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex‐combatants (r = 0.356, n = 47, P = 0.014). Conclusion Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex‐combatants, and cared for these patients when they self‐identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex‐combatant healthcare reintegration.

Impact of the armed conflict in Colombia: consequences in the health system, response and challenges

“…In addition to these challenges, the current model of care, fragmentation, and the need for effective integration and coordination of care are also important [ 42 ]. It has been identified that the system of financial incentives distributed to multiple actors, which is related to high administrative decentralization, creates access barriers for users [ 29 , 42 , 43 ]; this adds to the problematic coordination and deficiencies in communication between primary care and specialized services [ 44 ].…”

How Should Health Systems Help Clinicians Manage Bias Against Ex-combatants?

“…One study found that 22.6% of Colombian physicians were affected by the FARC conflict and, like other clinicians, seemed to share experiences like CH's. 14 The Geneva Conventions and Colombian law affirm a universal right to health care, 15,16 so helping clinicians manage affective negative bias that could undermine what they think a patient deserves from them is ethically, clinically, and legally important and could determine whether and to what extent the health provisions of a peace agreement will succeed.…”