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.