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.

Names:

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

-corroncho=tacky

-gusano=girlfriend stealer

-gonorrea!= insult, gross thing

-bareta=joint, blunt

-mono/a=blond

-emputar=to get angry

so many more…

Fruta:

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.

Comida/merienda

-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…

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.

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[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.

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…

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…