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…