After being caught up through my research on the causes for unnecessary maternal mortality here in Medellin (due to market forces and organization of the health care industry), it is crucial to stick my head above the beautiful Colombian clouds once in a while and learn about the larger international issues impeding pregnant women's access to health care in other countries.
Nicolas Kristof is a very illuminating Op-Ed columnist for the NYT (I might be slightly biased after hearing him speak at a foundation event in Atlanta and admiring his approach to saving Africa), and lately he has been writing a lot on the issue of maternal health care in West Africa. He takes an interesting look at the lack of medical (personnel) resources in rural clinics and how international aid plays into the picture in the article "This Mom Didn't Have to Die." Kristof delves deeper into the issue on his blog On the Ground, responding to the link between maternal mortality and female education and financial situation in the post "A 'P.S.' on Maternal Mortality and Abortion," and also looks at the larger issue of malnutrition affecting women's health in his most recent post "Malnutrition and the Economic Crisis."
I am relieved that in Medellin I have not found patients dying in childbirth on hospital tables, but knowing that there are women in so many other countries who need a voice to represent their need for improved maternal health care overwhelms me with the possibility of a life's work. As Kristof notes, a woman should not die because her life is considered less than that of a man.
Tuesday, May 26, 2009
Sunday, May 17, 2009
Coffee Talk
Colombia is coffee territory. A cup with breakfast, at 10:00 am, after lunch, at 3:00 pm, and then maybe after dinner, Colombians drink an impressive amount of coffee. Not just because it grows in their backyards or keeps them going through long work days, but also because coffee breaks perfectly compliment their social culture. Yes, working is important, but staying up-to-date with family and friends is more important and so the excuse of going downstairs to the cafeteria for 15 minutes is the perfect way to gossip and discuss whatever is on their mind. (Larger companies even have a female employee whose job description is to carry trays of tinto around through the office at one-hour intervals so that the workers can stay sufficiently caffeinated.)
Although I don't drink much coffee because I am very sensitive to caffeine (realizing that this is a sin while living in Colombia--shouldn't I make an exception for their exceptional coffee?), I do accompany my friends for the conversations. (Or maybe it is because otherwise I would be left alone in the office... ) Either way, my two favorite coffee partners are Gilma and Felipe, who have the most interesting banter over their cups of java. I think several of the topics covered recently warrant a brief description here because they have increased my insight into politicized opinions that you can't read in the newspaper.
Colombian World Travelers: After an arduous process to get his U.S. visa, Felipe boarded a plane on Thursday for Chicago to attend a public health qualitative research conference at the University of Illinois, Champagne. About one in 22 Colombians get their visas approved by the U.S embassy in Bogota, seemingly on a random basis. Once they do get it though, it means that obtaining a visa for any other country is almost guaranteed.
Listening to people's dismay about being denied a visa to visit a sick family member abroad or frustrated that they can't take their child to Disneyworld for their birthday makes me realize how lucky I am to be a U.S. citizen. It's not just because I can easily move through international borders by flashing my passport, but because I can travel to other countries without being automatically discriminated against because of my nationality.
I have heard appalling stories from my friends of them getting mistreated in a range of countries just because of the negative international perception of Colombians. A Colombian woman traveling to the Netherlands to meet her fiance's family being detained for five days in a holding cell without bathing along with a Nigerian man (people scoff to think that anyone would consider them as disgraceful as a dirty African man). One of the most respected professors at the university being tortured and almost raped by immigration official in Panama because she brought in unprocessed coca, eventually released only because her husband was a cousin of a foreign minister in the Colombian government.
It is obvious that 'Colombian' is most often synonymous with 'drug lord,' and it frustrates me to see time and time again that the world is still so uneducated as to judge people based on stereotypes. But I almost feel guilty when I tell my hosts how easy it was for me to go to the Colombian consulate for an hour and live in the country for a year when my own natal land would reject their visit without hesitation.
But what Gilma told me is that this negative international reception of her country(wo)men means that not very many Colombians have a desire to leave their country. Why spend so much money on travel just to be treated poorly when they can be shown the respect they deserve by driving to a city a few hours away? She would prefer to avoid humiliation and miss out on life experiences than be made to feel guilty for her nationality.
Saving in Colombia: Not only is it hard for a Colombian to be approved for a foreign visa, but it is extremely difficult for an honest, educated worker to save up enough money to leave the country. Professors and doctors make just enough money to live comfortably in Medellin; paying for an apartment and take holidays to the coast with their families. The people who buy cars on finance work their entire lives to pay it off--worth it just to cruise around town and impress the ladies. I have friends who borrow money and take out loans just to find the $10,000 needed to go to English classes in the UK for a year...imagine what they would do to attend a 4-year college in the U.S!?!
And yet, many of the Rotarians and people with whom I have become friends here come from families that can afford international travel, two cars, and a house. I don't ever question the way in which they reached their economic standing (hey, old money still keeps Colombian families going), but I have heard some crazy stories of people quickly building up an economic empire based on lucrative, illegal businesses. One of Gilma's nephews worked in the shop his grandma ran out of their house along with other family members. Pretty soon they had earned enough money to buy a bus, and then a few taxis, and then an entire transportation company, and then a dairy plant in another department, and so on. When other aunts and cousins started raising eyebrows, the grandma told them that they just needed to work harder and save money. But any Colombian knows that working two honest jobs does not allow anyone to save enough to run that many businesses. If it really is so hard, imagine how appealing it would be to get involved in money laundering!
Government Exploitation: In the last post I explained the Uribe's recent abuse of power to make money off of poor Colombians. Felipe explained to me one day how all developed countries achieved success by exploiting other people; the U.S. had African slaves, the Europeans had serfdom, and the Spaniards had indigenous people. But because the indigenous population in Colombia was fairly small, and the imported African slaves only live along the coast, in order to compete in the current world markets the Colombian government has has to exploit its own people. But although most Colombians live in poverty, they are too proud to admit that they are being used by the government to complain.
Both Gilma and Felipe claimed that Colombians don't live in as dire poverty as in most other countries where people are surviving off the same meager income. They bathe once or twice a day and so always smell nice, keep their houses from looking decrepit by painting them every Christmastime, turn a one-story shack into a two-story bungalow after working a few years, hang flowers from their eves, and value education. I think that this mostly has to do with the abundance of natural resources in Colombia; they get more rain than almost any other country, can grow their own food in a small plot next to their lean-to, and look at beautiful landscapes to ease their pain. But cultural pride could play a small part...
Anyway, as in a lot of countries that suffer from corruption, the people grow poorer as the politicians and people with power grow richer. In Colombia it has dangerous to consider how the government has abused the people's rights because of the precarious and polarized nature of Colombian politics. Anyone who starts questioning their situation and becomes a humanitarian sides with the liberal leftist cause, which is then automatically considered to be equivalent to a guerrilla sympathizer, which is then considered anti-Uribista and thus puts the person's life in danger. Although the country has become more democratic than it was at the height of the civil war, those who do not subscribe to dominant politics are still considered to be a social risk. Understandably, the country is still combating against various armed forces controlling the drug war, but when will Colombia guarantee its citizens their deserved human rights?
Although I don't drink much coffee because I am very sensitive to caffeine (realizing that this is a sin while living in Colombia--shouldn't I make an exception for their exceptional coffee?), I do accompany my friends for the conversations. (Or maybe it is because otherwise I would be left alone in the office... ) Either way, my two favorite coffee partners are Gilma and Felipe, who have the most interesting banter over their cups of java. I think several of the topics covered recently warrant a brief description here because they have increased my insight into politicized opinions that you can't read in the newspaper.
Colombian World Travelers: After an arduous process to get his U.S. visa, Felipe boarded a plane on Thursday for Chicago to attend a public health qualitative research conference at the University of Illinois, Champagne. About one in 22 Colombians get their visas approved by the U.S embassy in Bogota, seemingly on a random basis. Once they do get it though, it means that obtaining a visa for any other country is almost guaranteed.
Listening to people's dismay about being denied a visa to visit a sick family member abroad or frustrated that they can't take their child to Disneyworld for their birthday makes me realize how lucky I am to be a U.S. citizen. It's not just because I can easily move through international borders by flashing my passport, but because I can travel to other countries without being automatically discriminated against because of my nationality.
I have heard appalling stories from my friends of them getting mistreated in a range of countries just because of the negative international perception of Colombians. A Colombian woman traveling to the Netherlands to meet her fiance's family being detained for five days in a holding cell without bathing along with a Nigerian man (people scoff to think that anyone would consider them as disgraceful as a dirty African man). One of the most respected professors at the university being tortured and almost raped by immigration official in Panama because she brought in unprocessed coca, eventually released only because her husband was a cousin of a foreign minister in the Colombian government.
It is obvious that 'Colombian' is most often synonymous with 'drug lord,' and it frustrates me to see time and time again that the world is still so uneducated as to judge people based on stereotypes. But I almost feel guilty when I tell my hosts how easy it was for me to go to the Colombian consulate for an hour and live in the country for a year when my own natal land would reject their visit without hesitation.
But what Gilma told me is that this negative international reception of her country(wo)men means that not very many Colombians have a desire to leave their country. Why spend so much money on travel just to be treated poorly when they can be shown the respect they deserve by driving to a city a few hours away? She would prefer to avoid humiliation and miss out on life experiences than be made to feel guilty for her nationality.
Saving in Colombia: Not only is it hard for a Colombian to be approved for a foreign visa, but it is extremely difficult for an honest, educated worker to save up enough money to leave the country. Professors and doctors make just enough money to live comfortably in Medellin; paying for an apartment and take holidays to the coast with their families. The people who buy cars on finance work their entire lives to pay it off--worth it just to cruise around town and impress the ladies. I have friends who borrow money and take out loans just to find the $10,000 needed to go to English classes in the UK for a year...imagine what they would do to attend a 4-year college in the U.S!?!
And yet, many of the Rotarians and people with whom I have become friends here come from families that can afford international travel, two cars, and a house. I don't ever question the way in which they reached their economic standing (hey, old money still keeps Colombian families going), but I have heard some crazy stories of people quickly building up an economic empire based on lucrative, illegal businesses. One of Gilma's nephews worked in the shop his grandma ran out of their house along with other family members. Pretty soon they had earned enough money to buy a bus, and then a few taxis, and then an entire transportation company, and then a dairy plant in another department, and so on. When other aunts and cousins started raising eyebrows, the grandma told them that they just needed to work harder and save money. But any Colombian knows that working two honest jobs does not allow anyone to save enough to run that many businesses. If it really is so hard, imagine how appealing it would be to get involved in money laundering!
Government Exploitation: In the last post I explained the Uribe's recent abuse of power to make money off of poor Colombians. Felipe explained to me one day how all developed countries achieved success by exploiting other people; the U.S. had African slaves, the Europeans had serfdom, and the Spaniards had indigenous people. But because the indigenous population in Colombia was fairly small, and the imported African slaves only live along the coast, in order to compete in the current world markets the Colombian government has has to exploit its own people. But although most Colombians live in poverty, they are too proud to admit that they are being used by the government to complain.
Both Gilma and Felipe claimed that Colombians don't live in as dire poverty as in most other countries where people are surviving off the same meager income. They bathe once or twice a day and so always smell nice, keep their houses from looking decrepit by painting them every Christmastime, turn a one-story shack into a two-story bungalow after working a few years, hang flowers from their eves, and value education. I think that this mostly has to do with the abundance of natural resources in Colombia; they get more rain than almost any other country, can grow their own food in a small plot next to their lean-to, and look at beautiful landscapes to ease their pain. But cultural pride could play a small part...
Anyway, as in a lot of countries that suffer from corruption, the people grow poorer as the politicians and people with power grow richer. In Colombia it has dangerous to consider how the government has abused the people's rights because of the precarious and polarized nature of Colombian politics. Anyone who starts questioning their situation and becomes a humanitarian sides with the liberal leftist cause, which is then automatically considered to be equivalent to a guerrilla sympathizer, which is then considered anti-Uribista and thus puts the person's life in danger. Although the country has become more democratic than it was at the height of the civil war, those who do not subscribe to dominant politics are still considered to be a social risk. Understandably, the country is still combating against various armed forces controlling the drug war, but when will Colombia guarantee its citizens their deserved human rights?
City Recyclers
Do you ever throw something out that could still be useful to someone else and think about where it ends up? In any Colombian city you can find people called recicladores, or recyclers, whose profession is to sift through trash piles collecting anything that could possibly be recycled or reused. They are seen pulling heavy wooden carts piled high with their findings through the busy streets, often skinny older men who do not look to be in adequate physical condition for the strenuous nature of the job.
Contrary to what I first thought when arriving--that these people were unorganized individuals trying to make a few pesos off of everyone's old junk, the recicladores first created their own union/association in 1962 in Antioquia, now called the National Association of Recyclers, that monitors price controls for recyclable materials such as metal or glass, and also represents the rights of the workers. They even have their own website! It says that after WWII when the Colombia encountered a lack of containers, metal, and paper, people started looking through the trash, reusing what they found to make up for the deficiency. Some would specialize in glass bottle collection, others in pieces of scrap metal, selling their 'wares' to recycling companies that then turn trash into something new and useful. (Since there are also recycling companies in Medellin that pick up the recyclables that people separate in their houses, I wonder what sort of competition there is between these services and the recicladores). At first there was a stigmatization of these workers as being crazy or street beggars, and so the creation of the association gave them the national recognition necessary to dumpster dive without being hassled. Recycling is thus a legitimate profession falling somewhere in-between the formal and informal economies, and the income earned offers an attractive alternative to selling candies on buses. I have even met women in the displaced communities who come from a family that has been working in recycling for generations, and she goes out every morning with her sons to collect what they can.
In the past week these reclicladores have made national news: Uribe is trying to pass a national law to consolidate the companies that buy recycled material, thus creating a monopoly that sets a price cap on what the recicladores can earn. The Colombian president has realized how profitable this business is, and, like with many other industries, wants to (ab)use his power to buy his (large) share and make a few hundred million pesos off of the poor people. There have been fierce debates in the Senate where members question Uribe's interests in the new bill, but he has enough supporters (who probably also have a financial stake in the issue) that it looks like he will get the outcome he wants. As my Colombian friends say, this is just another example of how the government works hard to make the poor people poorer so that politicians and their friends can get richer. Do I smell corruption?
So sorry recicladores, it looks like your Colombian trash will not be worth as much as it used to.
Contrary to what I first thought when arriving--that these people were unorganized individuals trying to make a few pesos off of everyone's old junk, the recicladores first created their own union/association in 1962 in Antioquia, now called the National Association of Recyclers, that monitors price controls for recyclable materials such as metal or glass, and also represents the rights of the workers. They even have their own website! It says that after WWII when the Colombia encountered a lack of containers, metal, and paper, people started looking through the trash, reusing what they found to make up for the deficiency. Some would specialize in glass bottle collection, others in pieces of scrap metal, selling their 'wares' to recycling companies that then turn trash into something new and useful. (Since there are also recycling companies in Medellin that pick up the recyclables that people separate in their houses, I wonder what sort of competition there is between these services and the recicladores). At first there was a stigmatization of these workers as being crazy or street beggars, and so the creation of the association gave them the national recognition necessary to dumpster dive without being hassled. Recycling is thus a legitimate profession falling somewhere in-between the formal and informal economies, and the income earned offers an attractive alternative to selling candies on buses. I have even met women in the displaced communities who come from a family that has been working in recycling for generations, and she goes out every morning with her sons to collect what they can.
In the past week these reclicladores have made national news: Uribe is trying to pass a national law to consolidate the companies that buy recycled material, thus creating a monopoly that sets a price cap on what the recicladores can earn. The Colombian president has realized how profitable this business is, and, like with many other industries, wants to (ab)use his power to buy his (large) share and make a few hundred million pesos off of the poor people. There have been fierce debates in the Senate where members question Uribe's interests in the new bill, but he has enough supporters (who probably also have a financial stake in the issue) that it looks like he will get the outcome he wants. As my Colombian friends say, this is just another example of how the government works hard to make the poor people poorer so that politicians and their friends can get richer. Do I smell corruption?
So sorry recicladores, it looks like your Colombian trash will not be worth as much as it used to.
Wednesday, May 13, 2009
The Perfect Sunday: Fincas and Relativity
Since arriving in Colombia I have been waiting for a certain invitation. As you have read before, a typical weekend past-time for middle/upper-class Colombians is to spend time at their or a friend's finca. Luckily I know many such friends, who invite me for a relaxing weekend get-a-way out in the countryside. But until last Sunday, there was one finca I had never visited but had heard a lot about: that of my Rotarian counselor Waldemar and his wife, Lyda. Waldemar was always telling me about his love for his ganado (cattle), riding horses through the open pastures, and spending holidays with his family at his modest finca. But because of the prolonged rainy season, bad road conditions, and some health problems, they he and Lyda were not going to their finca as often as other parts during their lives.
Sunday was different. The GSE group is now in Medellin and my host club, Club Rotario Medellin, was in charge of their activities for the day. Being the director of the entire program for the district, Waldemar was also responsible for entertaining the four of them and so decided that a trip out to the finca was the perfect option of typical Colombian hospitality. And he invited me!
We met at 8:30 in the morning at Waldemar and Lyda's apartment, and then piled into rented luxurious SUVs with hired drivers to comfortably transport us the 2 hours past Fredonia into Colombian paradise. Despite being a successful orthodontist and community figure, Waldemar is one of the most humble people I have ever met. Thus I was not surprised when we pulled up to
a modest house situated on perhaps the most beautiful 100 acres of land in Antioquia. He has over 100 heads of cattle, and planned a "cultural experience" for us to watch three young calves be branded and their horns cauterized. Despite the bad smell and guttural sounds the calves made, it was actually quite a fascinating experience, much less traumatizing than I expected. The ranch-hands had horses ready for us to ride, so before lunch we took an exciting (to put the horses' lack of guidability nicely) romp through streams and high grass out to a gorgeous lookout point where one can see beyond 30 km of the Cauca Valley, Cauca river, and parcelled land below. We returned somewhat muddy but in high spirits to spend the rest of the afternoon lounging in the pool, eating the beautiful spread Lyda had prepared (she is a published chef) involving over 10 different dishes, and sitting in rocking chairs on the porch discussing politics and human evolution. I was even able to paint for an hour! By the time we lazily made the return journey back to Medellin everyone was slightly sunburnt, full, and successfully relaxed.(The most interesting lunchtime conversation topics involved how one of my good friends in the club is so wealthy that she asked her husband for a helicopter to transport an elephant to one of their 13 fincas, how her multi-million dollar jewelry collection was stolen by a mafioso who threatened her husband's life after he sent out a private detective to find them, and then how her husband was kidnapped by the guerrilla and played mind tricks on them to get whatever he wanted--like making them hunt down and eat an anaconda. Speaking of kidnappings, I learned that at least two Rotarians from my club had been kidnapped by the guerrillas and lived to tell about it...I always wondered if their riches and public positions ever endangered them.)
But as wonderful as these luxurious country events were, I came home that night with an insurmountable respect for my Rotarian hosts. After spending over four hours in the car with Lyda and another Rotarian, Carlos, (a jolly old man who is never once been quiet for more than three seconds when in anyone's presence), I felt like I had just read an entire Encyclopedia Britannica set. They discussed the history of British monarchy personalities, the Pope's recent visit to the Middle East (did he end up taking his shoes off when visiting the mosque in Jordan?), traveling to every continent, the technological advances of Brazilian telecommunications, the perks of being a Rotarian when in other countries (special treatment in airports, accidentally walking in on a meeting in Switzerland, sightseeing with Canadian Rotarians throughout Spain), the theory of Relativity, egg and dairy processing plants in Germany, and, of course, the usual catch-up on old acquaintances and family gossip.
Now these Colombians have access to many more privileges and opportunities than most of their fellow country(wo)men, but to me represent the definitive Colombian trait that differs them from other Latin Americans I have known: the thirst for knowledge of the world that transcends their existence beyond their national bubble. My admiration of their conversational skill, storytelling wit, and the ease with which they moved from one intellectual subject to another makes me want to dedicate my life to studying. And like many other times since arriving in Colombia, actually makes me look forward to being old. After living for so many years my hosts have accumulated a wealth of knowledge and experience, which combined with nimble memories, makes them some of the most interesting people I have ever encountered. Anyone who considers Colombians to be uncultured, uneducated, and living in the jungle like monkeys should think again; I honestly consider them to be perfect examples for the future of humanity.
A Day in the Life of a Researcher
When do I work?
It might appear that I spend all of my time traveling around the country or walking through the city without much aim besides exploring. Admittedly I have been 'out of the office' for quite a bit of time since December. This is possible because of the flexibility that being a contracted researcher for the Facultad Nacional de Salud Publica allows; I can do my work in spurts and make my own schedule. When I am in Medellin I have been known to walk into school at 9 in the morning and leave at 7 at night after coding interviews or organizing mental maps all day. Or, I hole myself up in my apartment correcting transcribed interviews and doing supplementary reading. But, since I am still involved in the data-collecting phases for both of my research projects, I am often running around the city to hospitals or displaced shelters (my fieldwork sites) to conduct interviews.
To give you an idea of what a normal field visit day might entail, read on.
On Wednesday morning at around 9:30 I walked into the office I share with other "investigators" and sat down to check my email at one of the work stations. A few minutes later Gilma, my research partner and important friend/aunt-like figure in my life here, struts in proudly (as only a woman shorter than myself can), announcing that she has arranged five interviews for us back-to-back during the day. (After being received with skepticism every time I have tried to call offices asking for an appointment with a nurse or administrator in my foreign accent, we decided that it was better for her to arrange our interviews). Gilma walks up to our desk, starts collecting the necessary consent forms and interview questions, tests the tape recorder, asks everyone in the office if they know where new batteries are, and then pronounces us ready to go.
Gilma is about the age of my parents but does not lead the lifestyle of a typical middle-aged Colombian woman. Originally trained in nursing administration, she worked for 20+ years in quality control overseeing hundreds of government health care employees. Because of her experience, she has traveled all over the country evaluating hospital operations or giving lectures on the new privatized health care system that is still causing national confusion after it switched over 16 years ago. (My project with her looks at how the relatively new market competition is affecting quality of and access to maternal health care in Medellin, evaluating the desired efficacy of the health care system.) She literally knows everyone everywhere, has never married, dedicates her free time at school to learning Arab dance and painting, is always late, hikes with a walking group on the weekends up the mountains surrounding the city, is fiercely independent, and has four daily coffee dates with friends which makes it very hard for us to work on a tight schedule. But out of all of the Colombians I have met, she has the most expansive view of how the country operates, and I absolutely love working with her because she is determined to teach me something new during every conversation.
Anyway, so we walk out of the Faculty and up the street to the headquarters of one of the biggest insurance companies in Antioquia, Comfama. The man we interview is one of her old friends, (of course), and has the most comprehensive understanding of the health care system than any of the professors teaching Social Security at school (Gilma included). We sit in his white office for almost an hour, being served tinto (piping hot Colombian coffee) in small plastic cups, and wowed by his organized, outlined explanation of the problems he notes with maternal health care throughout the city and proposed solutions.
When done, we hurry over to the Faculty of Medicine and interview a woman in charge of NACER, an academic initiative funded by the government to reduce maternal mortality in the city. The professor is another one of Gilma's old colleagues, and has a much different perspective on the subject. She lists off new figures on hospital noncompliance, stressing how every singe maternal death in the city over the past five years has been preventable--a perverted fact heavy with socio-political implications. She is extremely helpful in offering us bibliographical references and access to their data, of which we will surely take advantage once we start writing our article.
Then we head back out the the street and catch a taxi to Alpujarra, the government center of the city housed in squat twin towers. Gilma leads the way through the security guards, into a crowded elevator, and up to the 7th floor where all of the state's health sector resides. We barely find the other old friend we are supposed to interview because every two feet we have to stop for her to greet someone. She's like a superstar walking through the ministry halls saying "Chiu belleza," "Hola reina, tiempo que no nos hemos visto," "Avemaria, mira quien he encontrado aca!" hugging and exchanging picos (the mandatory cheek-kiss hello/goodbye), catching up on gossip and making more lunch dates than she can attend in a month. The interview is somewhat inconclusive since the woman has worked in the ministry for almost 30 years and is so burned out that it seems like she does not even want to remember the problems in maternal health care she has seen during her career. It doesn't help that she is a bit microphone-shy and prefers to talk to us off-record. When we are done it takes almost as long for us to leave the building as it did to come in, and I end up finding a chair to rest on while I wait for Gilma to make her round of good-byes.
Next, we walk six blocks up to the administrative office of another insurance company, Saludcoop, and interview a woman in charge of maternal health who almost makes us fall asleep with her boring comments. She literally speaks so slow that she forgets what she is talking about mid-sentence and we have to remind her of the useless fluff she's saying. Although this might seem like a waste of a half-hour of our time, it important for us to show how little the people directing maternal health programs in the city and companies providing health care services actually know about the subject, which might be why there are so many improvements needed.
Once done, we breath a sigh of relief as we push through the throng of workers heading to lunch as we make our way back toward the other government building. This interview should be a bit more tricky to carry out since we don't actually have a set appointment, but Gilma is convinced that we can interview the Secretary of Health because of her connections. The security guards initially don't let us in, so we go to a public phone and Gilma calls a random man working in the office telling him that he has to come down and approve our entrance. Although confused, she is so convincing that a few minutes later he talks to the gruff guards and we stroll into the building, toward the elevator, and up to the Secretary of Health offices. By this time I am not surprised by the entire floor comprised of a maze of cubicals, and I wonder how these people who have some of the best jobs in the city put up with such a compartmentalized workspace.
Luckily the woman we want to interview is sitting at her desk working, but she won't let us interview her until we get permission from the Secretary since anything she says directly represents the state government. Gilma marches past the bullet-proof glass of the Secretary's office and stands waiting for a woman sitting at the reception desk to wake up, but over the course of five minutes of us staring at her she only nods through her dreams. Heading back out to the main office area, Gilma asks some other random person for the Secretary's cell phone number, and borrows my airtime minutes to call her, while at lunch, to ask permission. Gilma passes the phone over to our interviewee who just stares at us with astonished deference. As the director of the maternal health program in the city, this woman has an incredible grasp of the situation citing specific patient examples up to paraphrasing parts of the law to explain the gamut of problems she is attempting to address. Without her interview, our research would lack the scope of analysis we wish to achieve by looking at every level involved in maternal health.
Again it takes over 15 minutes for us to leave, Gilma being approached by random people who noticed her presence in the office as they trickled back in after finishing lunch. When we finally make it back to the Faculty I am so overwhelmed by the whirlwind of events that just took place that I can barely remember everything we learned. Luckily it is all 'on record' and after the girl that helps finishes transcribing the hours of interviews, I can pore over everything in more detail as the research cycle continues. Now who still wonders if I actually do work?
It might appear that I spend all of my time traveling around the country or walking through the city without much aim besides exploring. Admittedly I have been 'out of the office' for quite a bit of time since December. This is possible because of the flexibility that being a contracted researcher for the Facultad Nacional de Salud Publica allows; I can do my work in spurts and make my own schedule. When I am in Medellin I have been known to walk into school at 9 in the morning and leave at 7 at night after coding interviews or organizing mental maps all day. Or, I hole myself up in my apartment correcting transcribed interviews and doing supplementary reading. But, since I am still involved in the data-collecting phases for both of my research projects, I am often running around the city to hospitals or displaced shelters (my fieldwork sites) to conduct interviews.
To give you an idea of what a normal field visit day might entail, read on.
On Wednesday morning at around 9:30 I walked into the office I share with other "investigators" and sat down to check my email at one of the work stations. A few minutes later Gilma, my research partner and important friend/aunt-like figure in my life here, struts in proudly (as only a woman shorter than myself can), announcing that she has arranged five interviews for us back-to-back during the day. (After being received with skepticism every time I have tried to call offices asking for an appointment with a nurse or administrator in my foreign accent, we decided that it was better for her to arrange our interviews). Gilma walks up to our desk, starts collecting the necessary consent forms and interview questions, tests the tape recorder, asks everyone in the office if they know where new batteries are, and then pronounces us ready to go.
Gilma is about the age of my parents but does not lead the lifestyle of a typical middle-aged Colombian woman. Originally trained in nursing administration, she worked for 20+ years in quality control overseeing hundreds of government health care employees. Because of her experience, she has traveled all over the country evaluating hospital operations or giving lectures on the new privatized health care system that is still causing national confusion after it switched over 16 years ago. (My project with her looks at how the relatively new market competition is affecting quality of and access to maternal health care in Medellin, evaluating the desired efficacy of the health care system.) She literally knows everyone everywhere, has never married, dedicates her free time at school to learning Arab dance and painting, is always late, hikes with a walking group on the weekends up the mountains surrounding the city, is fiercely independent, and has four daily coffee dates with friends which makes it very hard for us to work on a tight schedule. But out of all of the Colombians I have met, she has the most expansive view of how the country operates, and I absolutely love working with her because she is determined to teach me something new during every conversation.
Anyway, so we walk out of the Faculty and up the street to the headquarters of one of the biggest insurance companies in Antioquia, Comfama. The man we interview is one of her old friends, (of course), and has the most comprehensive understanding of the health care system than any of the professors teaching Social Security at school (Gilma included). We sit in his white office for almost an hour, being served tinto (piping hot Colombian coffee) in small plastic cups, and wowed by his organized, outlined explanation of the problems he notes with maternal health care throughout the city and proposed solutions.
When done, we hurry over to the Faculty of Medicine and interview a woman in charge of NACER, an academic initiative funded by the government to reduce maternal mortality in the city. The professor is another one of Gilma's old colleagues, and has a much different perspective on the subject. She lists off new figures on hospital noncompliance, stressing how every singe maternal death in the city over the past five years has been preventable--a perverted fact heavy with socio-political implications. She is extremely helpful in offering us bibliographical references and access to their data, of which we will surely take advantage once we start writing our article.
Then we head back out the the street and catch a taxi to Alpujarra, the government center of the city housed in squat twin towers. Gilma leads the way through the security guards, into a crowded elevator, and up to the 7th floor where all of the state's health sector resides. We barely find the other old friend we are supposed to interview because every two feet we have to stop for her to greet someone. She's like a superstar walking through the ministry halls saying "Chiu belleza," "Hola reina, tiempo que no nos hemos visto," "Avemaria, mira quien he encontrado aca!" hugging and exchanging picos (the mandatory cheek-kiss hello/goodbye), catching up on gossip and making more lunch dates than she can attend in a month. The interview is somewhat inconclusive since the woman has worked in the ministry for almost 30 years and is so burned out that it seems like she does not even want to remember the problems in maternal health care she has seen during her career. It doesn't help that she is a bit microphone-shy and prefers to talk to us off-record. When we are done it takes almost as long for us to leave the building as it did to come in, and I end up finding a chair to rest on while I wait for Gilma to make her round of good-byes.
Next, we walk six blocks up to the administrative office of another insurance company, Saludcoop, and interview a woman in charge of maternal health who almost makes us fall asleep with her boring comments. She literally speaks so slow that she forgets what she is talking about mid-sentence and we have to remind her of the useless fluff she's saying. Although this might seem like a waste of a half-hour of our time, it important for us to show how little the people directing maternal health programs in the city and companies providing health care services actually know about the subject, which might be why there are so many improvements needed.
Once done, we breath a sigh of relief as we push through the throng of workers heading to lunch as we make our way back toward the other government building. This interview should be a bit more tricky to carry out since we don't actually have a set appointment, but Gilma is convinced that we can interview the Secretary of Health because of her connections. The security guards initially don't let us in, so we go to a public phone and Gilma calls a random man working in the office telling him that he has to come down and approve our entrance. Although confused, she is so convincing that a few minutes later he talks to the gruff guards and we stroll into the building, toward the elevator, and up to the Secretary of Health offices. By this time I am not surprised by the entire floor comprised of a maze of cubicals, and I wonder how these people who have some of the best jobs in the city put up with such a compartmentalized workspace.
Luckily the woman we want to interview is sitting at her desk working, but she won't let us interview her until we get permission from the Secretary since anything she says directly represents the state government. Gilma marches past the bullet-proof glass of the Secretary's office and stands waiting for a woman sitting at the reception desk to wake up, but over the course of five minutes of us staring at her she only nods through her dreams. Heading back out to the main office area, Gilma asks some other random person for the Secretary's cell phone number, and borrows my airtime minutes to call her, while at lunch, to ask permission. Gilma passes the phone over to our interviewee who just stares at us with astonished deference. As the director of the maternal health program in the city, this woman has an incredible grasp of the situation citing specific patient examples up to paraphrasing parts of the law to explain the gamut of problems she is attempting to address. Without her interview, our research would lack the scope of analysis we wish to achieve by looking at every level involved in maternal health.
Again it takes over 15 minutes for us to leave, Gilma being approached by random people who noticed her presence in the office as they trickled back in after finishing lunch. When we finally make it back to the Faculty I am so overwhelmed by the whirlwind of events that just took place that I can barely remember everything we learned. Luckily it is all 'on record' and after the girl that helps finishes transcribing the hours of interviews, I can pore over everything in more detail as the research cycle continues. Now who still wonders if I actually do work?
Monday, May 11, 2009
Where the $$ Goes
I walked out of my apartment this morning and started along La 70, one of the most important commercial streets in the city only four perpendicular blocks from my doorstep. Instead of the usual traffic and street vendor sounds competing with the birds and business bustle, jarring, hacking, less than unpleasant noises of construction accompanied my morning stroll. Today was one of the first days of the new "renewal" project that the city will carry out over the next nine months, improving the road, making the sidewalks more consumer-friendly, and planting new breeds of trees. Now, I have always been fond of La 70 because it seems much better maintained (not to mention greener) than most of Medellin's other main avenues, and would never considered it in need of a face-lift. But according to a recent newspaper article a neighbor posted to my building's message board, the alcaldia seems to think that investing $10,500 million pesos, or $4,730,000 USD, along 14 blocks is a worthy project.
As a strange coincidence, later on this afternoon I was reviewing one of my recent interviews with a displaced couple living in the barrios populares (slums) creeping up the surrounding mountainsides, and they talked for a while about the frivolity of many of the city's recent public works. The new Parque Explora, an admittedly amazing interactive science museum that's free for people of strati 1,2 and 3; the five libraries located throughout the different comunas with public computer and internet access, and renovation of buildings in the centro were all mentioned. This couple was saying that although these places are all a great way to improve the culture of the city and poor populations, they feel like the city is overlooking the more basic needs of their people. Those who don't have access to the health care they need, are suffering within the high unemployment rate, and watch their children receive mediocre education in public schools see that those billions of pesos could be put to a better use. They ask themselves what good is a new, free museum and library if they can't even pay for the bus fare to get there?
Point taken.
I do see the social and economic benefits of investing in these projects (from the city's perspective); creating jobs, cultural opportunities, and a stimulus for further spending in depressed areas that would benefit from an influx of visitors. This is all part of one of the main social campaigns in Medellin to combat the rampant violence: trying to get people to take more pride in their surroundings. It has definitely worked. The daily homicide rate has gone down in the past 5 years, and people now feel safe to leave their houses at night or visit parts of the city that were previously literal war-zones. Paisas in general are committed to solidarity, so even slight public incentives to bolster respect for their mini-metropolis easily results in larger social changes.
But after living here for ten months and getting to see behind the city's closed doors, the beautiful new facades seem like band-aids over much bigger problems that the government is not addressing. Poverty, unemployment, hunger, and homelessness are still rampant throughout Medellin and have not been solved the progressive organizations dedicated to the people affected. I have found that the people here are apt to list off the ways in which they are working to combat structural issues without admitting the low impact they have on the overall population. At first I was awed by the work being done, now I am just wary of their optimistic enthusiasm. Walking through orange cones, stepping over holes in the sidewalk, and listening to jack hammers every day for the next year assuredly will not improve my disposition.
As a strange coincidence, later on this afternoon I was reviewing one of my recent interviews with a displaced couple living in the barrios populares (slums) creeping up the surrounding mountainsides, and they talked for a while about the frivolity of many of the city's recent public works. The new Parque Explora, an admittedly amazing interactive science museum that's free for people of strati 1,2 and 3; the five libraries located throughout the different comunas with public computer and internet access, and renovation of buildings in the centro were all mentioned. This couple was saying that although these places are all a great way to improve the culture of the city and poor populations, they feel like the city is overlooking the more basic needs of their people. Those who don't have access to the health care they need, are suffering within the high unemployment rate, and watch their children receive mediocre education in public schools see that those billions of pesos could be put to a better use. They ask themselves what good is a new, free museum and library if they can't even pay for the bus fare to get there?
Point taken.
I do see the social and economic benefits of investing in these projects (from the city's perspective); creating jobs, cultural opportunities, and a stimulus for further spending in depressed areas that would benefit from an influx of visitors. This is all part of one of the main social campaigns in Medellin to combat the rampant violence: trying to get people to take more pride in their surroundings. It has definitely worked. The daily homicide rate has gone down in the past 5 years, and people now feel safe to leave their houses at night or visit parts of the city that were previously literal war-zones. Paisas in general are committed to solidarity, so even slight public incentives to bolster respect for their mini-metropolis easily results in larger social changes.
But after living here for ten months and getting to see behind the city's closed doors, the beautiful new facades seem like band-aids over much bigger problems that the government is not addressing. Poverty, unemployment, hunger, and homelessness are still rampant throughout Medellin and have not been solved the progressive organizations dedicated to the people affected. I have found that the people here are apt to list off the ways in which they are working to combat structural issues without admitting the low impact they have on the overall population. At first I was awed by the work being done, now I am just wary of their optimistic enthusiasm. Walking through orange cones, stepping over holes in the sidewalk, and listening to jack hammers every day for the next year assuredly will not improve my disposition.
Monday, May 4, 2009
Rotary 4280 District Conference
My year culminated the weekend of April 30-May 2 in the annual District 4280 Conference. Rotarians from all around my host district gathered in Pereira for 3 days of meetings, parties, and planning the next year's focus.
We were greeted Thursday night by a presentation of each flag from the many states of which the district is comprised, followed by typical dances from different parts of the country. This was followed by a cocktail party with live music and lots of social warm-ups reconnecting with Rotarians I had not seen for several months.Friday was full of presentations by Interact, Rotaract, the GSE group, talks on leadership qualities, redistribution of districts in Colombia, and a pep rally talk given by the Rotary International president's representative from Merida, Mexico. In the afternoon they bussed us to a bull fight just for us and typical party
complete with two live bands and a delicious buffet dinne
r. Several of the macho Rotarians got into the bull ring to test their abilities, and each club dressed up in matching outfits typical to the region from where they came. There was even a dance competition where the winning parter was awarded a cash prize, during which the entire party stood on top of tables to cheer--admittedly one of the most fun nights I have enjoyed while in Colombia.
Everyone arrived late on Saturday morning to listen to an inspiring speech given by the leader of the Afro-Colombian movement and candidate for Senate presidency, reflections on district-wide projects helping children with congenital heart diseases and HIV/AIDS awareness. I also had the chance to make a speech urging clubs that I don't know to invite me to visit and thanking everyone for the opportunity to participate in their Rotary family. After the closing events I 
went out to lunch with several conference organizers and the couple from Mexico, learning about their different opinions of spousal involvement in Rotary between the US and Latin America. That night we put on our finest for a gala dinner which lasted until 5 in the morning (the Rotarians out-partied me since I got tired and returned home at 3), during which everyone let loose and danced like teenagers.
It was great to see so many familiar faces come together from my visits to clubs around the country, and they were so appreciative that I have been completely dedicated to getting to know them throughout the year. I admired how well they mixed business with pleasure--talking about project objectives and brainstorming over shots of aguardiente (the typical way to accomplish anything in Colombia). Being an ambassador in a country with which I have completely fallen in love is easy, especially when Rotarians have shown me so much hospitality and encouragement. I love my job.
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