viernes, 21 de mayo de 2010

The US Navy and too much T.P

These are some observations from my second week in Bogotá…funny to read them now the night before my departure!

The Supermarket:

When you pay for your groceries in Bogotá, the cashier asks you: “En cuantas quotas se lo quiere pagar?” This is the moment my raised eyebrows reveal I am a gringa. Oh! People pay groceries in quotas…when people go shopping, they are not expected to necessarily be able to pay for everything at once. How practical and thoughtful.

By the cash register, two police guards with guns stand by (I wish I could say which kind for dramatic effect, but I don’t know the terms…one big gun and one little gun each). It’s funny because they are standing in front of the toilet paper as if protecting it from thieves seeking treasure. I happen to grab a pack; only to realize that it comes with 24 rolls…I can’t help but feel everyone staring at me walking down the street with 24 rolls of TP. In my head I’m hoping they are thinking that I’m bringing it to some foundation or something. While traveling, one gets so much more self-conscious about this kind of thing!

Cash Machines:

Cash machines have little mirrors on each side of the screen so that you can see behind you when you take your money out. Just to be safe.


As in the DR and surely other Latin American countries, there are some names here that are borrowed from American or British cultural references or are the product of U.S presence in Colombia.

Some great examples are:

“Usnavi” (U.S Navy)

“Jon F. Kennedy Gomez”

“Miladis” (My lady)

“Yurladis” (Your ladies)

“Lady Diana”

“Lady Princessa Diana”

Slang (some Bogotano, some from the coast):

-Jeta=mouth...colgando jeta=gaping, practically drooling

-tienes afan?=are you in a hurry?

-voy pa esa=I’m there


-gusano=girlfriend stealer

-gonorrea!= insult, gross thing

-bareta=joint, blunt


-emputar=to get angry

so many more…


There are SO many kinds of fruit here that I had never seen or tried in my life.

-Maracuja: passion fruit. In the DR it’s called chinola, maracuja is also passion fruit in Portuguese

-Grenadilla: like passion fruit in texture, but sweet instead of tart. Orange on the outside.

-Pitaya: looks a bit like a yellow hand grenade. Inside, melon-type texture, sweet, clear and watery. Don’t eat too many of these!

-Feijoa: Kind of like a kiwi, a bit grape like, nutty, RICO.

-Lulu: Orange and sour, but tastes kind of like grape juice (we made lulitos…better than a mojito).

-Guanabana: Big, spikey and green on the outside…I think this is dragon fruit in English. Fleshy and white and sweet on the inside.

-Mangostina: like sweet cotton balls.


-arepa: flattened corn bread patty stuffed with cheese (or meat or egg). a staple

-tamale: corn meal roll stuffed with veggies or meat (I had one with tofu…muy rico)

-ajiaco: delicious soup of potatoes, cream, capers, corn…served with avacado and rice. perfect for rainy season

-fritanga: plate of fried yucca, maize and a plethora of meat- chuchullo (intestines), blood sausage, ribs etc.

-bandeja paisa: have to try this…

viernes, 7 de mayo de 2010

La Mona

Yesterday I went to a conference led by the Universidad Nacional’s research group “Antropologia Medica Critca.” Anthropologists, doctors (both in “Western” and traditional medicine), social workers, lawyers, health insurance representatives, and students all attended. The conference focused on intercultural interactions within the health system at various levels. We discussed ‘interculturalism’ amongst health workers (e.g. doctor to nurse interactions), within doctor to patient relationships (e.g. indigenous patients with Westernized doctors), and between health workers and the capitalist system they are subjected to that influences protocols. Specifically, we focused on the problem of language and understanding with medical interpreters and the ethical/problematic implications of administering “Westernized” health care to people with different interpretations of disease or different concepts of how to confront health issues.

The most interesting part of the conference was questioning the role and responsibility of the Anthropologist who conducts ethnography within the health/medical context. One of the key note speakers, an Anthropologist who conducted fieldwork in Laeticia with an indigenous group of people living with HIV, commented: “You have to ask yourself, what is the purpose of this ethnography? If I interview someone and hear that they are having difficulty receiving care, is it ok just to sit and listen and transcribe the interview? I say no. Ethnography within the health field is political, it should be approached as Participation Action Research, or participant observation. In other words, the Anthropologist has the responsibility of acting based on the information he/she collects.” I really enjoyed this point because it gives Anthropology a significant role in its capability to produce change. I have been asking myself this question as I interview street people about their experiences in access to health. When they tell me, for example, that a doctor has refused to operate on them because the operation is costly for the hospital and the patient is entitled to free service based on their socioeconomic condition, what do I do to help them? I think that multidisciplinary teams could work miracles in these cases. If I could work with a conscientious lawyer and doctor, we could see to that the operation had to occur based on the constitution’s definition of the right to health. I am actually referring to a true story, based on an interview I conducted today with a sex worker. I’ll call her Mona because that’s her nickname (it refers to her lightish skin, and hair, people call blonds ‘monas’). Here is her story:

Last April of 2009, Mona was thrown off the third story of an apartment building. She woke up in the hospital of San Jose with a fractured pelvis, broken leg, and disfigured face, not remembering anything from the day before. Mona was held there 6 days and when she was told that she would have to pay more than 1 million pesos (over $500) for her stay, she shouted at the doctors to release her as she could not pay the fee. The doctors agreed to her leaving provided that she pay eventually, but Mona left immediately, forgoing the payment and still in critical condition. Mona arrived home in a taxi unable to move for two months. She did not want to go to another Dr. after her treatment in San Jose and was afraid that she would have to pay more fees. Then, a friend of hers came to visit and told her about Dr. T from the Parche of the Procrear foundation. Mona agreed to seeing Dr. T and received her for home visits.

Dr. T discovered that the fees Mona was required to pay were due to her pending SISBEN (System for the Selection of Beneficiaries of Social Programs) situation that did not correlate with her current economic situation. The San Jose hospital had not attempted to understand this problem despite the fact that Mona told them that she was a sex worker living in a lower class neighborhood. Mona was still declared status 3 (middle class, required to pay 30% of fees for medical visits. Note there are 6 statuses, with 0 as the lowest) under her mother’s affiliation in Medellin.[1] How was Mona supposed to return to Medellin to change her SISBEN status when she could not even walk? Luckily, Dr. T helped write a letter declaring her incapacitated so that her aunt could disaffiliate her there. Finally, Mona was able to receive a “special populations card” declaring her incapacitated and a street person so that she could receive free medical care. As a result, Mona was finally well attended to in the hospital San Permendoza and Santa Clara. Until, it came to repairing her face.

Even though Mona had x-rays proving fractures along her jaw on both sides of her face, and that she could no longer smell or taste, the doctor refused to offer facial reparative surgery for her type of medical coverage. He simply installed some new false teeth and told her that was all he could do. She could try a private doctor, but it would not be reimbursed by the health system. It hurt her to laugh and swallow. It affected her work, because her former clients could no longer look at her face. Today, she no longer works and is still pining for the day when her face might return to normal and she might enjoy her food again.

One might ask, well what about her family? Couldn’t they help her pay for the operation if she needed it? Why did she leave Medellin and how did she fall into prostitution after belonging to a middle class family? In Medellin, Mona ran a micro industry, selling empanadas on the street with her husband. She was quite successful and had no troubles getting by with her two kids. Then one day her husband borrowed a large sum of money to be able to pay for his father’s health bills, only to realize that he could not pay it all back. He started stealing from Mona’s mother. Mona’s mother’s landlord happened to be affiliated with the paramilitary and caught on to Mona’s husband’s stealing and subsequent drug trafficking for revenue. He called upon security forces to siege Mona’s house. Her husband grabbed her and told her that they MUST leave the city. So Mona was dragged to Bogotá, leaving her comfortable lifestyle at home. She began to do drugs with her husband and drifted in to the prostitution business. And then, after sniffing many pots of glue, Mona got into a fight with another prostitute and was pushed out the window, to end up broken on the sidewalk.

During Mona’s interview, she showed my fellow researcher and I a photo of her with her smiling family from a few years back. She held the photo with trembling fingers and said, “Look at my face there. I am unrecognizable now. I don’t think my family could even point me out on the street.” Then she tilted her head down and sobbed. In addition to lamenting her disfigurement, she seemed to mourn the death of her former happy family life. Although her husband beats her, she told us that she didn’t dare going back home for the fear of paramilitaries and embarrassment from her husband’s actions. Her current situation is a product of relationship abuse and structural violence (e.g. the hospital’s negligence). Mona deserves a face, but what can be done? Beyond publishing her story in some academic journal that might stir some, but will eventually accumulate dust, how can I turn my participatory research into action? I have phoned a doctor I know in the hospital Tunal who is very supportive and proactive in sex worker health, so hopefully this case will receive the attention necessary to incite legal action and compel the hospital to pay for her reconstructive surgery.

[1] Ironically, one of the greatest barriers in access to healthcare is the SISBEN. If someone moves, they must return to their original location and disaffiliate themselves with the SISBEN there, in order to receive a new one in the new location. This process can take months.

lunes, 3 de mayo de 2010

Carolina the hairdresser

“Ay that’s Carolina…isn’t she beautiful?” He touched the paper copy of the photo on the wall, his fingers lingering on her smiling face. “Who is she?” I asked him. “Who WAS she…she was killed 6 months ago right in front of the Procrear office, just a few blocks from here. You see how she’s cutting hair in this photo? I taught her how, when we were in prison together. You see, in prison, our sentences where shortened because we cut people’s hair, we worked. And she had 8 years, which turned to 4 and I had 6 years which turned to 2.” He took a bite of his granola bar and chewed slowly with his few remaining teeth. “Why were you sent to prison? And she?” He swallowed and continued. “Well, I cut someone’s face with a knife. And when you aim for the face, you get more time in prison. She did too, but she was defending herself because someone was robbing her. And then I got out and she did later on. And one day, she was all dolled up, with her long hair, painted nails, everything. And she was standing out side the Procrear office, on the street, and some band of guys stabbed her, repeatedly. For a while, no one came to claim her body, but eventually her family came and buried her on her land.” He placed his hand on the photo, then on his heart. Then he walked to the closet, picked up a broom and swept the trash and dust off the sidewalk.

Like Wanda, Carolina is another transvestite who was killed in broad daylight, just standing on the street. Carolina would come to the Parche and cut street people’s hair every Thursday. Now a new trans girl cuts and the street people leave happily groomed. To how many more will this happen? And how does the news treat these kind of incidences? It would be interesting compare news reports over the years of these kind of hate crimes to see if they have changed at all. In Wanda’s case, the news blamed the violence on street culture, rather than on hate/exclusion against transgenders. Carolina’s murder seems to be another incidence of social cleansing…

sábado, 1 de mayo de 2010

Street Love

Wrote this before hopping off to Tayrona and Cabo de la Vela, where I traveled all last week:

I walked back to the Candalaria watching the pink clouds swirl into the gray sky. What is this city? It is a constant mixture of beauty and ugliness. Earlier today, at the Parche, I met a street couple. This is the first pair of street people that I have seen completely in love. The girl was eighteen, tiny, and hyper active. All morning she sat writing love lyrics to Harrison, her 38 year-old partner. “Harry!” she would call him, “Ven aca! Tengo que mostrarte algo…” Then she would show him the lyrics, stare deeply at him and give him a big kiss. Harrison, a poet, told me of his travels to Israel and of his favorite writers, like the Argentine Julio Cortázar. He wrote a poem for the Parche before leaving today. It used metaphors to explain how he would always support his lover. He told me, “You see, there is a big difference in age between the two of us, but my girl is young and motivated and eager to learn. I am older so I can protect her and share my experiences with her. We keep each other going.” The girl kept coughing all morning and I asked Dr. T if I could give her a cough drop. She said I could, but that she probably had tuberculosis, so it probably wouldn’t do much.

I met a one legged man who had been in a motorbike accident. He spent two years in the hospital during which he developed gangrene and was amputated. Today he came in with some kind of polipo (polyp) growing between his toes on his last remaining leg. Other street people came in with gashes from recycling wounds. Recycling is actually one of the main causes of wounds/infections in street people. A T.V screen or broken bottles are just some examples of the objects that had shattered on them and caused severe infections.

I spoke with another woman (who I would like to interview) who kept going to the doctor for chest pain, but the medications they prescribed to her were NonPOS, and she didn’t have the money to pay for them. POS is the “Plan Obligatorio de Salud,” it qualifies treatments as refundable by the government. NonPOS means that this lady’s medications were not reimbursable by the state, or not considered ‘obligatory.’ She told me that she still suffered of chest pain and didn’t know what to do. I learned that if a doctor prescribes a medication that is categorized as NonPOS, but thinks that the patient really needs it and shouldn’t have to pay for it because of his/her economic status, the doctor can send in a request to the ‘junta medica,’ a review board, to override the NonPOS status. I wonder if the doctor considered doing this and if this lady knows that the doctor is obligated to do this if he think the treatment is really necessary…

To conclude the day, we did street outreach in the prostitution zone right by the Parche. Most of these prostitutes are quite hideous. Many are obese and look over 40 years-old. They stand behind these cage-like windows, tapping their acrylic nails on the walls. Their swollen breasts ooze out of their tank tops. We handed out condoms and told them about the Parche, where they could receive free medical consults, hair cuts, condoms etc. Most of them seemed enthusiastic and happy to know there was a support center right near by them.

Next week I’m hoping to hand out lubricant and conduct a small teach-in about how it can increase their control during sexual encounters and decrease pain and irritation. Timothy told me that these teach-ins must be intimate. You have to let them feel the lubricant and rub it on their fingers as if their fingers were a penis. Wow! That sounds a bit intense, but apparently it makes the girls laugh and shows them that they can really stimulate a client to the point where he will spend a lot less time inside them and will thus diminish the pain/irritation/unpleasantness. We shall see how this will go…

martes, 20 de abril de 2010

Medical Consult Day

Every Wednesday is medical consult day at the Parche. Last week, I saw three different patients, all street people. The first one complained of ulcerous pains and of coughing up blood. At the end of the consult, Dr. T offered the man some medicine and asked if he could pay anything at all for the medicine. He took out 200 centavos (ten cents) from his jeans pocket and said he would give it instead of buying bazuko (type of crack). This system of asking the patient whether he can pay anything encourages the patient to take his health under his own control. It also demonstrates a shift in the patient’s self-value.

The next man we had seen last week for a consult. Last time he came in because he had hemorrhaging in his left eye after being punched in the face. This time he came in with a stab wound on his side. He told us that around 1 am, when he was sleeping, a few men high on glue stabbed him and stole his shoes. He said that he didn’t bleed much, but the area around his lungs hurt him a lot. After examining him, Dr. T thought that the stab could have pierced one of his lungs. He was having some trouble breathing and his heart rate was very fast. Dr. T told him that he should go to the main hospital to check up on his lungs and get some x-rays. Immediately, the patient shook his head and said he would wait and see how he felt tomorrow. Dr. T told him that she couldn’t force him to do anything, but that his wound could cause serious complications if he didn’t make closely survey it. For some reason, this man really didn’t want to go to the hospital. He told Dr. T he would hang out in the Parche and see how he felt in a couple of hours. I thought this would be a perfect thing to ask him about. What is it about the hospital that made him not want to go, despite his serious condition?

The third case was a 49 year old who looked about 70. He was a complicated case, because he had developed some kind of dementia and was fairly incoherent. He had a long knife cut scar along his cheek. He came complaining that he was going blind in his right eye and had a lot of liquid coming out of it. Dr. T inspected it and thought he had a cataract and potentially something else that was causing dimentia and chronic headaches. We asked him if he was on any medication and he showed us: flucanozole, iron vitamins and antibiotics. She asked him if he could read, and he said not very well since he had stopped school in the third grade. This was a crucial question to ask, because he clearly was confused about which medications he had and when he should take them. After he had left, Dr. T told me that this was an odd combination of medication and that perhaps he had HIV. He had told us that the family he lived with were all drug users, so they couldn’t come with him to his medical visits, this further complicated the case because there was no one we could ask about his medical history.

After the consultation, Dr. T looked over some of the histories of past patients and gave me eight different cases where patients had experienced some kind of barrier that prevented them from receiving or seeking appropriate care. Dr T. is going to contact these patients via phone or through house visits together so we can see if they wouldn’t mind being interviewed.

Dr. T also gave me some great ideas for other potential research topics. One was researching sex workers’ myths and practices to avoid pregnancy and deal with menstruation while working. Some of the myths to avoid pregnancy are the following: drinking alka seltzer, standing on your head. To keep working during a period, some prostitutes stick sponges up their vagina before intercourse and then pull it out and reuse it for the next customer (infections!!). Another research idea was to knock on doors of the inquilinos (dingy tenements around the Parche) and ask about recetas caseras. The goal would be to produce a whole cookbook of home remedies that people use to cure themselves in these settings. It would be interesting to see the effectiveness of these home remedies and if people use these instead of seeking care in hospitals if the sickness is serious. There is so much that could be researched here. I think a major project should be conducted by public health specialists on housing and its effects on child development…I know this has been done in East Harlem, but I’m not sure about here.

One thing I’ve noticed is that a lot of the students here are extremely motivated and concerned with the conditions perpetuating poverty and conflict within the country. The elections, for example, are a hot topic…although it is debatable how much a new president can change the current situation. An article in the Washington Post evaluated the current state of poverty in Colombia despite massive financial aid. Instead of investing money in the war on drugs, perhaps the U.S should give more money to research involved in discovering, deconstructing and dismantling those structures that perpetuate poverty and fuel drug production/selling/consumption. Is poverty a major cause of the drug war? I know that it is much more complicated that that, but if so, could solutions to poverty (i.e reformed health care system, less taxes for the war more taxes for public services etc.) be offered before increasing military/police action (bottom up)? I obviously feel way too uninformed to offer a complete opinion, but these ideas have been floating around mainly due to listening to student conversations and spending so much time with street people.

sábado, 17 de abril de 2010

I don’t mean to paint an ugly picture…Colombia is a mosaic!

Looking over my blogs thus far, I notice that they all seem pretty gloomy. In reality, I have had a wonderful time in Colombia these past 3 weeks. I feel more motivated to write about my work here, which is difficult and somewhat depressing…I seem to write when I am particularly moved by an experience. But why are we moved by extremes? I guess this is why I admire Hemmingway’s writing, because he writes so simply and clearly about potentially mundane events, while saying so much...(I am referring to A Moveable Feast , but this could be said about others too).

Besides wandering around prostitution zones and hanging out with street people, I have participated in lots of other activities. I went to this extreme sport place in sugarcane-covered mountains where I went rappelling in a cascade with two Canadians and my lovely Brit colleague Rosie ($20 for a whole day of rappelling and horse riding without a single safety training course to deal with!), went hiking in cloud forest at Chicaque National Park, saw Macbeth in the park during the Festival Iberoamericano de teatro, took this drunken party bus to the kitschest-hip club in Bogotá, and shared a massive plate of fritanga (intestines, blood sausage, ribs, fried yucca the works) with a group of gringas frustrated with teaching English to wild children, to name a few. I hate writing in lists, but this is sort of how I remember these events…like a shopping list of delicacies that I can linger on and taste, but don’t need to flesh out.

I mainly wanted to write this to express how much my perception of Colombia has changed since I have been here. Although the media reports many true events that occur in Colombia, it only focuses on the drugs, the hostages, the misery. Why did so many people think that I was CRAZY for coming here? I have experienced so much more than that and have been floored by the affection and warmth with which I have been welcomed by Colombians. This might sound obvious to some, but I thought it was worth sharing.

martes, 13 de abril de 2010

La Calle

When I walked into the Parche today, Willie* hailed me over to help translate a song into English. He had written down a verse that he liked on a big sheet of paper and on top of the verse he wrote, “La Calle.” It read:

“Esta es la historia de un caminante Judio errante

Andante que su ego va en busca de un por venir

Errante andariego que va en busca de un por venir

Acabo de la espada para sobrevivir”

Well, first, you need to explain this to me, I told him, because I don’t know if I fully understand. Willie tilted his head and answered, “It’s the street. It’s about walking and wandering and searching.” “It’s about a street person’s understanding of the future,” Carlos chimed in. “We walk looking for our future. Our future is what lies around the next street corner. We walk and create this future. Survival is the future we know.” Willie flipped the sheet over and drew a picture. He drew a tall mountain with a house on top of it with a banner reading “La Calle.” Then, he drew a long, winding, path from the bottom of the mountain that reached the house. He explained, “You walk along this path and the street lies at the end…the street is the future.”

Slowly we translated verse by verse, them teaching me more than I could teach them. Some times we would just laugh because we would look at each other dumbly, unable to get the perfect translation. We came up with this:

“This is the story of a wandering walker (or runaway)

A walker with an ego searching for a future

Wandering restlessness searching for a feature

To the tip of the spear to survive”

I translated Judio as Jewish at the time, but this doesn’t really make sense in retrospect. After doing a bit of reseach I found that Judio in Spanish can also refer to someone who won’t give up their own ways for Catholicism. In other words, it is a non-conformer to the system. When he finished copying out the English version, Willie started to tell me about his life. He flipped over another paper and began making diagrams. Here is the story he told me (unfortunately I didn’t have a tape recorder, so I am remembering to my best ability…It just sort of came up when we were talking about the song. I think I will interview him a bit more formally and try to catch some missing details):

“You see, I was born in a maternity/youth house in the center, in Bogota. Then I moved with my parents to Pedrera. I did my first, second, third all the way to eighth grade there. In Pedrera my parents began to fight and my father moved to Soacha, a poor suburb, South of Bogota. I had some trouble in school and couldn’t continue there. My mom didn’t want me at home anymore so she sent me to live with my dad. And my dad told me to get a job. My job was on a construction site at the North of Bogota. My dad would wake me up at 3 in the morning. I’d splash cold water on me, hop on the crowded bus and get stuck in traffic. It took me 4 hours to get there, because I lived in the hills in Soacha where the poor people live and I had to walk down the hill to get the bus. One day I arrived a bit late to work and my boss told me I couldn’t work. He told me I had to be punctual and I wasn’t responsible for the job. That was when I was 18 and I’ve been on the streets 5 years now. I am trying to get my cédula (identity card), because I need it to try to get a job or help from a foundation, but my mom has my original copy in Pedrera. I brought a photocopy in, but I was rejected and sent back. I never have the right form; I always go back and forth. The cédula takes 6 months to get once you send your forms in! She told me she would send it to my uncle in Bogota, but I don’t know if he got it or not. And by the way, my friend gave me these clothes…I’m only wearing them because I’m cold, normally, I wear jeans. ”

Willie looked at me a bit out of breath. He was wearing a “Scary Movie” mask pulled back on his head. He had an overgrown khaki suit on with a missing button. In addition to his story, I also knew that he was a serious drug user. I wondered how he had found the Parche and if he had ever sought help for his drug problem and what kind of experience he may have had with the health system given his missing identity card and difficulty in renewing it.

Ten-year old Nicolas walked over to us and Willie became childlike again. We had a fan-making contest and Willie won. Then Willie showed the other kids how to make boats and paper airplanes. “Hey Nicolas, you can finish painting my Che Guevara if you want. There is no black though, so you’ll have to make him monito! haha!” Mono is what they call blonds here. Willie called me blond all morning because he couldn’t remember my name.

Finally, when it was time to go, I asked Willie if he had written the song we translated. “No, I think it’s by a group called La Etnia…I’ll write it in your notebook,” he said. He copied out the entire song in Spanish and closed with: chao Celín!

Today I realized how dissecting the meaning of “the street” for street people is essential in understanding their concept of present and future and consequently their notion of self-care and health. To them, the street, rather than the state, is the affiliative group. So how can they trust the state to take care of them? What does it mean for a street person to leave the streets? What does this transition require, psychologically, physically?

*Names have been changed

viernes, 9 de abril de 2010

César and Citizenship

I just returned from a meeting at la Universidad Nacional de Bogotá, a prestigious public university in Bogotá.  I went to meet with César, an Anthropologist and Public Health professor there and the author of Itinerarios Burocráticos.  The university had a typical sprawling campus with various squares and greens with students reading, rolling cigarettes, protesting and playing the guitar.  The buildings were all names of well-known revolutionaries with the Plaza Guevara as the central meeting point.

We met in the cafeteria and César treated me to jugo de Feijao (green fruit that tastes kind of like a kiwi).  César looks kind of like my father and has similar mannerisms, so I immediately felt comfortable with him. I wanted to talk to him about researching in Colombia and the ethical questions that pertain to using human subjects.  Unlike the US, there is no Institutional Review Board, but there are different ethical committees depending on where the research is to be published and who the researcher affiliates with.  I have no idea where/if I will publish, but César gave me some names of university and health publications and also intellectual magazines like Malpensante (The New Yorker equivalent) and Nueva Caseta.  I think that the language/style I use for my research will help determine where I will try to publish.  Obviously the important question is: Why publish? For whom? Who does it benefit?  Right now, I would just like to make my research useful for the population I am interviewing. Unfortunately, it will not change their personal situations in any way, but perhaps the article could promote awareness for the NGO’s that are providing them care and help increase funding for these NGO’s.

César helped illuminate one of the central problems of the health system: it assumes that all people living in Colombia consider themselves citizens and understand what citizenship entails.  This assumption forces the subject to play by the rules of citizenship or die.  Legislation, then, is a strategy of social cleansing.  How can street people operate in the health system if they are considered to be outside of the law?  Do street people think they have the right to be attended to at the hospital? Some important questions to ask my interviewees (street people, drug users, sex workers, and transvestites) might be:

“Are you Colombian?”

“What does it mean to be Colombian?”

“Do you consider yourself a Colombian citizen?”

“If so, do you feel like you have certain rights as a citizen?”

“What rights do you feel entitled to?”

“Do you feel like you have a right to health?”

César told me that when he was conducting interviews for his research on barriers in access to healthcare, he sometimes would ask his subjects, “Where are you from? Colombia?” and they might reply, “No I’m not from Colombia, I’m from La Pedrera (little city in Southern Colombia).” In other words, they didn’t have a concept of national, territorial identity, inherent in the concept of citizenship.  Or perhaps they didn’t believe in this notion of citizenship and belonging to the state.

But when people don’t see themselves as part of the system, because they can’t find a job, or don’t vote or engage in illegal actions, they often don’t think they have a right to demand for healthcare (even though it is usually the structure of the system that creates and reproduces their conditions).  If the healthcare system refuses to give an appointment, or pay for necessary post-operational physical therapy, would these street people conceive of taking legal action if they have no concept of citizenship? What type of knowledge does engaging in “legal action” require? In reality, it is not simply a notion of right or wrong, but rather the perception of the individual’s power vis-à-vis the state.   A street person, unaware of the rights of the citizen, feels powerless and stays sick. Slowly the system kills off these outliers. I will try and see if these ideas are consistent with reality in my interviews. Based on the stories I have heard so far, they seem all too true.

Like Dr. T and Timothy, César is yet another inspirational thinker I have been lucky to meet here. I left the Universidad Nacional with an energy I remembered feeling in college after an incredible lecture. In Plaza Guevara, clubs were making jewelry, planning political strategies and selling food and burnt DVDs. To cope with my nostalgia, and feel part of the university world, I bought a buckwheat flour arepa and a copy of SICKO.



martes, 6 de abril de 2010

First Day at Work

Today I went to the Parche.  The Parche recently changed locations, so this morning we walked around the neighborhood fetching children who might want to attend the alphabetization workshop.  The people that live in the Santa Fé area, where the Parche is located, generally live in utmost squalor.  

We turned onto cracked streets and knocked on doors inside smelly, dumpy apartment buildings.  The smell was a mixture of excrement and weed. First, a woman answered with a big smile and a naked little boy behind her.  I peered inside her living space and couldn’t understand how smiley she could be when the ceilings were nearly collapsing and the only light peaking into the room came through a greasy, splintered, window.  “Si! Take Miguel Angel!” she exclaimed as her other little boy wandered up the apartment building steps with a notebook and pencil in hand. Today, because the mother had to take care of her youngest one, Miguel Angel could not be accompanied to school, instead, he would come read stories in the Parche.

This boy was truly an angel.  He had huge eyes with long eyelashes and a quiet, innocent demeanor. “Tengo cuatr-lo años,” he said, rolling his r into an l and holding up four wrinkly fingers.  We started talking about the jungle and things you could find in it, like the parrot on his notebook.   I waited outside with him while Dr. T. knocked on more doors.  We headed back to the Parche, passing prostitutes of all sorts, a few cripples and many stragglers. I tried to imagine being this child…what was his concept of safety and comfort? What did his surroundings mean to him? How much does a four year-old understand about danger?   How might this shape his concept of “future” when he grows up?

We headed into the Parche and met the other kids. We split the kids up into mini groups each with a story in hand. I had Johan and Angie, a brother and sister, ten and eleven. “Saben leer?” I asked them. “No,” They answered together. So I began to read about Alice in Wonderland and their new years resolutions, Mickey and his roller skates and Pooh and the lost baby kangaroo. Now and then I’d ask them a word and they would sound it out perfectly. They DID know how to LEARN how to read. They also told me back the stories in perfect detail so excitedly…I had thought that they might get discouraged if they couldn’t read the words. On the contrary, they were eager to sound words out.

After everyone had read their stories we all came together to paint our favorite parts. The kids helped each other; the big kids opened the paints and showed the littler ones how to avoid big blobby drips on the paper. “Ella no sabe nada!” Miguel Angel cried, pointing to the teeny three year-old beside him.  I looked at her smiley face and noticed that all she could say was “Sí!” and smile, like a baby. “Pués, ayúdale y enseñale!” I cried back. But it seemed like she couldn’t follow anything he tried to show her. On our way to the Parche, Dr. T had told me that many of the babies born in this area spend a lot of their babyhood in the hospital with respiratory infections and asthma due to the lead in the paint and the poor air quality in the apartments.  Lack of oxygen to the brain obviously leads to cognitive impairment. How much damage had been done to her cognitive capabilities?  And could she recover if she kept living in these conditions? (picture a closet and then four people living in it. That was her home).  The importance of adequate housing for positive health/development was further illuminated when I went to the Proniño foundation to teach English.

Proniño is in another barrio called Patio Bonito. When I got off the Transmilenio Bus (really effective public transport, but a nightmare in rush hour!), I was hurled backward by the wind and noise. Rickshaws and donkeys sped around me creating clouds of dust.  Proniño was a few dirt roads away, tucked in between a tire shop and a split-level, brick apartment compound. When I walked in, two kids were gobbling up their chicken, beans and rice at the table. They told me with gestures and noises, not daring to open their full mouths, that my class was waiting for me upstairs.

I began to sweat a little, then slowly crept upstairs not knowing who or what was waiting for me…for some reason I had thought that I had taught English before, but as I climbed up each stair, I realized that I had only tutored French and Spanish. How long would I have to draw out “How are youuuuu?” to make my lesson last 2 hours and a half? I pushed open the door and saw six students (three girls and three boys on opposite sides of the room of course) leaning back in their white, plastic chairs. Oh! Six! Not bad at all…but then ten…oh twenty…hmmm. Twenty pairs of eyes staring right up at me!

I had no time to think. Suddenly we were going around the room saying our names, where we were from, what we liked to do and what we’d like to be when we grew up. They were silly and enthusiastic. We played a game that Hannah taught me to learn body parts, sticking colored cards with the English word on each part.  My fourteen year-old volunteer helper, Tatiana, screeched with laughter as she covered her eyes and nose with the cards.  Although my voice had turned completely hoarse by the end, I was amazed to see how fast it went by.

At the end of class, a group of the kids surrounded me, asking questions about the difference between “didn’t” and “do not” and other random vocabulary words. One of the talk-all-the-time boys asked me “how to say, asesino?” At first I kind of shook my head and told him we weren’t learning that now, but then I thought again, why not? How would not knowing the word change anything? It wasn’t that surprising that a teenage boy would want to learn the word for assassin. Then Jason, the oldest and most mature looking of the bunch gave me a hard stare and asked, “Y cómo se dice, ‘gente de la calle’?” I told him “street people” and ended class.  As they walked out, they said, “Bye TEECHER!” and I was left with scattered plastic chairs and empty milk bags on the floor.

One of the other teachers at Proniño walked me back to the Transmilenio and told me about the workshop he was leading for the kids. “Se llama ‘Valores.’” The workshop was inspired by the suicide of a thirteen year-old several months ago. In the workshop, the kids are supposed imagine receiving a phone call from a friend who is saying he wants to commit suicide and then respond to him in a letter telling him why he might reconsider.  The kids need to know their worth, he told me. But we also do this by playing fun games too! Like learning guitar and making art.  We kissed goodbye and I hopped onto to the long red bus, thinking about how learning English might help a street kid feel worth it.


domingo, 4 de abril de 2010

Sex-ed Made Fun

 Today was a perfect example of Fenix’s effectiveness and success.  Two of the Fenix girls, in nursing school, led workshop on Family Planning and sexual health.  There were about ten Fenix girls who attended, along with boyfriends, siblings, volunteers and some others (perhaps students or potential Fenix beneficiaries?). 

The workshop started with basic female and male sexual anatomy.  It was a great feeling to be learning along with the other girls. My “elite, privileged” liberal arts education did not make me any more knowledgeable than the some of the girls around me who have had disrupted education due to abuse, displacement, prostitution etc.   My interest in the subject also reassured me a bit more about medschool since this is really the only type of human anatomy study I have done in a long time (aya!).

We discussed contraception and I learned about the Norplant.  I had never heard about this contraception and was so happy to discover D’s (a Fenix girl training to be an orthodontist’s assistant) experience with it.  The Norplant is a form of contraception that looks like two matchsticks and is implanted under the skin on the upper, inner arm.  It works from 3 to 5 years (secreting reproductive hormones) before it needs to be replaced.  D. walked around the room and let us all feel it (it feels sort of like a small scar), while we all asked questions and scribbled down notes excitedly about this option. 

The Norplant (and other contraceptives like birth control) is absolutely free in Colombia. Timothy read the state-written law declaring the Norplant free for Colombians (not sure if this includes minors or not…). Apparently, some employees refuse to offer it for free since it is costly for the hospital. The reading was a way to show the girls that they need to assert their rights to health. In the case where they might be refused the contraception, Timothy encouraged them have a copy of the law with them to pressure the employee and threaten to press charges. The workshop synchronized the key aspects of sustainable outreach: Health, Education, Rights (HER!).

We also reviewed the various abuelita myths about contraception methods. Some of them, like the “Billing test,” I had never heard of.   It is said that when you are most fertile, your discharge is more sticky and can be stretched like a bubble or mucus between two fingers. Of course this is a MYTH, but it is strange/interesting (for some reason this often means the same thing to me…) to think that decades ago, and still people today, might test their discharge and say “OH! We probably shouldn’t do it today honey unless you want to have a baby.” Another one was the idea that when your temperature rises by 1 degree centigrade when you are most fertile.  I wondered how many of these girls had heard these stories or if they had tried these tricks before.  The myths were a great way to lighten up the workshop with humor.

After it was over, one of the girls told my director Timothy and fellow Fenix volunteer Rosie that she didn’t want to leave.  She lives with her “aburrido/abusivo” boyfriend because she has no other home…it was a bitter sweet comment that only heightened the importance of the workshop, but also showed its limitations. Effective family planning requires a positive relationship with a partner…how could she apply what she learned if her boyfriend refused to listen? And might she be afraid that he would throw her out if she tried to assert herself? Her only solution seems to be to move out, but for this, she needs plata… 

martes, 30 de marzo de 2010

Would a sex worker go to church?

Woke myself up again sneezing twelve times. In polluted cities, sneezing is the rousing rooster. Then I took my first shower in my apartment…it called for a “would you rather” question: would you rather have a trickle of HOT water or a strong FLOW of cold water? These are showers that choose to save energy when they feel pooped out, turning off every 3 minutes or so…ah well, still emerged with a clean head.

Today I met with Amy, a PHD Fulbright scholar and Fenix volunteer who is researching everyday lives of street girls. She has become close enough to the some of the street girls here and transvestites to go out dancing with them. Her research is based on participatory observation where she gains insight on the girls’ lives by hanging out with them (in addition to interviews and street outreach).  Amy has been here since 2008 and knows so much on street life function. 

On the bus ride to the center, I asked her some of the burning questions I had.  For example, when I went on the street the other day, I didn’t see any pimps.  Apparently, the type or presence of the pimp depends on where the sex worker is prostituting herself and her age.  Most of the minors that hang around la Mariposa (a huge blue, somewhat cubist, statue of a butterfly in one of the center’s squares) don’t have pimps at all. Some of them are there on their own accord and some are there because their mothers sold them into prostitution.  The minors can charge a lot because they are “fresh.” In some cases the prostitutes have husbands that send them out to the streets and tap into their revenue.  The more commonly known “pimp” tends to be associated with more established brothels.  These brothels run off drug money that is also used to bribe the police. 

We got off the bus at la Mariposa to observe the city’s main site of minor prostitution and see if any of Amy’s girls were there. We passed a tree by the road and Amy told me this tree was called “La oficina.” The office? The lesbian sex workers often congregate here.  We met two girls, not looking so young, and one of them greeted me with an extra polite speech.  We chatted and she started to complain that the “Patio” (a Christian foundation/homeless day shelter offering meals, a space to wash clothes etc.) was forcing the girls to go to church for Easter.  Ha! Amy and I both laughed.  Then I wondered: What is the relationship these girls have with religion?

On one hand, the church chastises them, but on the other, church related foundations provide them much needed help. Furthermore, many of these girls were raised Catholic and believe in god.  Amy explained that god is a part of their everyday lives…many of their expressions end with “Si dios quiere” (But how much does one actually think about god when saying “god willing?”…Still, using “god” in language indicates a sort of socialized relationship with religion).  It must be that this girl does not want to be told what to do, particularly if going to church is an attempt to “save” her as she knows it will not. Has the church ever really saved anyone?

And what about transvestites? The Catholic Church condemns them here and associates them with P y P, “Puta o Peluqueria” (see Amy’s blog). After Wanda Fox, a “trans” activist in sexual empowerment for transgender / transvestites with Zona Trans (here they just say “trans” so I’m not sure they differentiate between transgender and transvestites) was murdered, her trans friends had a priest perform the memorial ceremony on the street at the site of the murder.  Amy reports that they were all praying at the site. In this instance, there is an obvious separation made between religion and spirituality and religion and the state. Religion is called upon in a time of struggle as an all-forgiving arc of support…it is an extra source of energy and inspiration. The trans individual’s relationship with religion is direct; it does not pass through the state.  These are purely suggestions to try to make sense of the contradictions that riddle questions of religion and sexuality…






lunes, 29 de marzo de 2010

Cracks and Crack

We trot down 19th street taking turns tripping over tree roots that bust up the sidewalk: “Nature asserting itself,” Rosie remarks. The farther south we go, the larger the cracks become. Looking down, I see the cracks become dog-size, forming homes for parched beasts and empty corn chips bags. Suddenly, we are there.

            Tim turns left and we follow.  And there, on the corner, is the first prostitute I shake hands with while on the job.  At first, I wonder if she feels like this is an annoyance, that we are disturbing her work. Then, Timothy takes her by the hand and tells her how he remembers her when she was “chiquitica.” How has she been? Her shoulders roll down her back and she smiles. She tells us that, ay si, todavia igual, lo mismo. “You know that you can do something else if you want or you can come talk to us if you want, right?” She answers “Si,” greatfully accepting the condom, lubricant and shoulder squeeze. This is Fenix street outreach: intimacy, honesty, and empathy.

            We pass white boots and painted eyebrows, fried pig ears on oiled bread, and make our way towards “El Parche.” El Parche is one of PROCREAR’s efforts to create a space where the city’s “desechables” (prostitutes, transvestites, street kids) can seek medical consultation and attend workshops (in literacy, art, street activism etc). The word “Parche” comes from “Patch,” as in territory, or patch of land. Instead of referring to the place where they live as a “home,” it is a patch, an understood section of the neighborhood. Patch became “Parche.” “Parchando” became the term for going out as a group in the patch, or doing streetwork. 

A small, smiling lady greets us at the door and ushers us in. This is T. The “wonder woman” doctor who treats anyone and writes amazingly detailed case histories, according to Timothy. The meeting is highly energized. T. is excited about the prospect of conducting research in barriers in access to healthcare amongst the population she sees.  My case histories will be perfect for your work! She says. How many times has she seen patients who say that they will no longer try to go to the state hospitals because of the endless lines, or the unhelpful employees who refuse to treat them because they are missing some particular insurance paper that they have never heard of.  Timothy jumps in: This is the perfect question for your research! This is what you have to ask the people who come to El Parche: “Why are you here and not at the state hospitals?” This question inevitably raises the point of barriers. I need to find out exactly what are the conditions that these vulnerable populations are subjected to when they try to seek medical care. How do these barriers contribute to an increase in HIV transmission?  Timothy showed me a frightening article in EL TIEMPO (the main newspaper here) from February 2010 stating an increase HIV cases from 1 to 50 in minors over the past year. We want to figure out why…

T is in a rush and leads us over to the Procrear base a few blocks away. Some of the Fenix girls (check out Fenix website, it’s the main organization I am working with, are organizing for street outreach.  The flyers they distribute are hilarious. They use word plays on vulgar street language to get sexual/anti-drug messages across. For example: "Pichas por Bichas? Pilas con el bicho!" translation: a fuck for crack? Beware of the bug (HIV)! This translation seems STRONG and crass, but this is exactly what catches the street workers eye; these flyers speak THEIR language. They are also written in soft, attractive and warm colors, such as orange and blue, as opposed to aggressive, fear-inspiring colors like red and black. Condoms, KY, and flyers in hand, we head out to 16 and Santa Fe, some of the major prostitution zones.

We pass a young man H. who nods at Timothy and waves him over. Hmmm…is he trying to deal drugs to Timothy? I wait a couple of moments and suddenly, H exclaims: aqui esta mi bebe! H’s girlfriend strolls over to us with a responsive and healthy looking baby. I can’t believe that we are meeting a baby and parents while prostitutes/drug dealers hang around us! As we wave goodbye to them, Timothy tells me about the mother. S. was a highly active prostitute, “The baby might be the one thing that saves her.” I start to realize some of my own judgments…I couldn’t imagine a sweet-faced, young, mother to be a prostitute.  But this must be exactly what Timothy wants me to see: prostitutes have babies and boyfriends. They are human (this may sound obvious, but I think that when people think of “prostitutes” they don’t imagine a person, but rather an object for sex. This is not to say that I think this, but rather I hadn’t imagined a potential life a prostitute might have outside her profession.)

Meanwhile, across the street, 4 bombshell transvestite prostitutes, more beautiful than the surrounding born female prostitutes, shake their bodies (mostly plasticized) in front of SUVs that roll by. A., a transvestite that does outreach with us watches them and quietly compares her small breasts to theirs…Could you give me some sunblock? she asks, “I just got my laser treatment done.” Does A. envy these transvestite prostitutes who have attained the ultimate contemporary image of “female” beauty (big breasts, tight booty, flat stomach, long legs, voluptuous lips, curly lashes and long, soft hair)? How much is the body part of transvestite identity? If body=identity, then does a price tag on the body make the identity more straightforward, particularly if it is a high price?

Up to here, I feel strangely comfortable (considering the circumstances)…I haven’t seen any clients approach the prostitutes and more and more smile at us. They seem to all know Timothy and appreciate the work Fenix is doing. I turn to my left and there is a girl, probably 18 years old just getting a fresh tattoo in the street. Hepatitis anyone? She walks over to us while Timothy is talking to minor and seeing if she might want a different option than prostituting herself. The freshly tattooed girl’s eyes wander about as she sniffs glue out of an old “DETOX yogurt” cup. This is the moment when the reality of the place, of the lifestyle hits me. I feel something break inside me and start to tear up. This is the misery here. The girls prostitute themselves for drugs, and the vicious cycle continues…

Walking out of the 16th I see a chicken’s head dried up on the sidewalk. I am ready to go to my colleague Rosie’s cozy apartment and have some tea. This has been a lot in one day. 

Here I Am

Perhaps a first blog entry is meant to be introductory; I’ll try. I have only been here for a week and already feel as if a month has gone by. Along with a felt month of time is a felt month of information/experience I've been exposed to since I've arrived. In a nutshell, I am working with Fenix ( Fenix aims to prepare vulnerable young women (victims of sexual abuse and/or neglect, former sex workers etc.) to enter social and health science professions. This organization works side by side with Procrear, another Bogotà based NGO that focuses on health/social intervention through outreach in vulnerable populations (prostitutes, transvestites, street people). My involvement in these NGO's is a developing process.
Here I sit in the studio I just moved into, thinking this is probably the nicest studio I'll ever live in!  I lived the first week here with my supervisor/director Timothy who showed me the ropes (i.e the best antique/junk shops around Bogotà and where to find organic artichokes) and shared some incredible stories about covering the drug war (he was a photojournalist in the 80's, making the cover of Newsweek and Time before becoming a nurse and a million other things).  Mainly, by living with Timothy, I understood Fenix’s central value: care.
I wrote the next entry last week after my first day observing street outreach.