Medellin, Colombia.--Teenage Boy Scouts and Girl Scouts in blood-stained uniforms met the taxis that pulled in, with horns blaring, to the small lot in front of the emergency entrance of the hospital to unload the wounded and dying.
It was a Saturday night at the San Vicente de Paul hospital, known in Medellin as La Policlinica, where on weekends the emergency room averages about 150 gunshot victims a night. Because the hospital has no money to pay for orderlies, troops of Boy Scouts and Girl Scouts volunteer to work 12-hour shifts to unload the wounded. Ambulances are scarce, so most patients have to pay for a taxi. The bleak concrete building has no waiting room, so relatives, barred by an iron gate, wait outdoors.
`The first time I did this, I cried and everything,' said Girl Scout Sandra Patricia Pulgarin, 16 as she removed her rubber gloves and wiped fresh blood from her uniform after taking one more patient to the emergency ward. `Now I just do it.'
While drug-related terrorism has declined sharply in Medellin since leaders of the city's infamous cocaine cartel surrendered to the government earlier this year, human rights and medical workers say the violence has not declined. And La Policlinica, with few resources, is fighting for survival in one of the most violent cities in the world.
A hospital study released last month said that in Medellin there are 320 homicides a year per 100,000 inhabitants--about 6,000. In the United States, the national figure is 12 homicides per 100,000 people, and Washington, with 483 homicides last year, has about 80 per 100,000.
Most of those who arrive at the hospital here are men between 15 and 30 years old from comunas, the poor neighborhoods that ring the city. Gang fights, skirmishes with the police, drunken brawls and fights over drugs and women all contribute to the flow of patients.
By 1 a.m. on the recent Saturday night, patients waiting to be treated had filled the stretchers, so new arrivals were carried on whatever the volunteers could find.
Following the arrival of `another package,' as the bodies are called, Pulgarin disappeared behind the iron gate that keeps visitors from entering the emergency room and emerged a moment later, carrying 2-year-old Catarina, whose mother had been shot in the chest by her father.
The child had refused to let go of her mother's hand in the taxi, and Pulgarin pried her loose and hugged the trembling girl in the parking lot, eventually coaxing her to drink a cola and eat some chips. Relatives arrived about an hour later to take her away.
The dimly lit parking lot was splattered with dried blood. Relatives and friends waiting for word on the fate of loved ones sat on the ground or whatever surface they could find.
Vendors sold coffee, snacks and cigarettes, while late-night hangers-on, morticians hustling business and morgue workers lounged against the wall. Occasionally, the murmurs were interrupted by the sharp cries of those being informed of a death or by chatter of patients being discharged.
A long hearse-like vehicle was backed up to the morgue doors, and three bodies were loaded. Four more were inside awaiting identification.
Asked if the night was unusually gruesome, a morgue worker replied: `No, this is Saturday. Seven, 10, 15, 20 dead is normal here.'
After discharging their passengers, taxi drivers are often unable to collect the fares, and they stay for a while, cleaning the blood off the back seats. The single policeman on duty asks each driver who arrives with a gunshot victim for the location and circumstances of how the body was found. Most give the shortest possible answer to avoid involvement, then head back into the night.
A young intern working the 36-hour weekend shift said that Saturday, when more than two dozen wounded arrived between 10 p.m. and 1 a.m., was actually relatively quiet but that he was one of only a handful of doctors the hospital could afford to have on duty.
`We have no resources to do this work,' the doctor said as he slumped in a chair in a small cafe, smoking and drinking a cola during one of the few breaks he would grab. `I can only operate on maybe three or four people a night, the same as the other physicians. The rest have to wait, and, I am sorry to say, many die while waiting.'
Orlando Londono Ospina, director general of the hospital, asked last month that the city build a new `war hospital' to deal with the overwhelming flood of emergency victims so that La Policlinica could concentrate on important non-emergency treatments.
`The congestion is such that with only 40 beds in the emergency ward, only the most extreme cases are placed there,' Londono said at a press conference. `Regular patients get a mattress in the hall, and those with wounds that are not too serious get treated as they lie on the floor on a blanket.'
The intern put out his cigarette and prepared to go back to work. `We lack everything here that you can imagine,' he said. `We all do the best we can, but as you can see, sometimes that is not enough.'