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…

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.

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

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.