Public Health in Colombia 2018
Abigail, an MPH student from NYU, tells us about her time participating in the 2018 Public Health in Colombia course.
“Bogota has been extremely welcoming to all of us to the point it feels like I am home. Today marks the beginning of my third week here, and then I’ll have only one week left in Colombia! Red Tree Study has kept us engaged and occupied every day since we arrived, which is challenging for a big group with divergent interests. The coordinators’ efforts to make this a great experience for us has been astounding!
The social aspect of Bogota is just one part of my time here. I can certainly say that I now have a decent understanding of the civil conflict with the guerillas that Colombia has faced the last 52 years, and the other 10 civil wars it has been through since Colombia became an independent country. We have also learned about the Peace Accord and how they are finalizing the second attempt to validate this agreement. We discussed how it will work for the victims, the ex-combatants, the government, and the society. To put into words the complexity of this agreement would take me around 300 pages.
Aside from the peace agreement, the focus of our learning has been on the healthcare system of Colombia. Health is not one of the 6 sections of the peace agreement; however, some reference to health is made within 5 of the 6 sections of this process, highlighting how intertwined healthcare and the peace process are. Colombia’s healthcare system is universal, covering 96.6% of its population. It used to be a heavily patient-management-centered system, which neglected the rural areas and dispersed population; and now they are moving or trying to move towards a prevention-centered system, which is more inclusive of rural, indigenous, dispersed, and immigrant population. How the system is paid for is complex; and as of this third week of the course, we are still discussing it.
Both peace agreement and healthcare system are greatly theorized; however, there are many challenges facing actual practice or implementation of processes. So far, the major challenge for the healthcare system implementation of the prevention strategy and targeting of the neglected areas is money. This project alone cost billions of USD; thus, for a country with no international commerce such as Colombia, it may be extremely difficult to afford such amount of money. For this reason international aid is needed, such as the World Bank for instance. A challenge for the peace agreement might the new administration of Ivan Duque. Santos, the former president of Colombia agreed for the FARC (previously known as FARC-EP) to become a political party while they serve for their crimes. Petro, the rival candidate for the presidency, agrees with Santos. However, the new administration wants to change that section of the agreement. Duque believes that FARC members must serve or be convicted for their crimes before actually taking part of the Colombian government. I found very interesting one of the things that make Colombia unique, is also what makes very challenging target drug cartels, fight the guerillas, and expand healthcare to remote, indigenous, and rural areas is the naturally geographical architecture. As I have mentioned several times before, these are very complex topics, and many of the strategies discussed in class are not implemented yet, partly because financing is a huge problematic issue.
I neglected to mention earlier that our class day is split into two sections. The first section is for the lectures and the second section is for the site-visits. These visits are related to the lectures we have during the morning. So far, we have been to the British Embassy, Colombian School of War, Mission Verification of the UN in Colombia, Instituto Nacional de Cancerologia de Colombia (National Oncology Institute of Colombia) JaveSalud, Hospital Universitario San Ignacio, and to the Ministry of Health. During these visits, we have discussed the conflict, the peace agreement, and the healthcare system and its facilities. We have our lectures at the Pontificia University Javeriana, and our lecturers are professors of the institution who are experts on the topics and have worked in the government, health institute, and/or ministry of health. Our morning sections are in English; whereas, our afternoon sections are in either English and/or Spanish. For all our afternoon sections, an interpreter is always present.
Our social agenda is very versatile, something I very much appreciate. On the first week we met the British Ambassador to Colombia Colombia, travelled on a Chiva (like a party bus), hiked to Choachi Waterfall, and got together in the Auditorium to view the results of the elections. The second week was as rich on social activities as the first one. For instance, we partied at Gringo Tuesday language exchange, had a talk with US Foreigner Diplomats, went to see a play called Eclipse, and for those people who did not go to Villa de Leyva, we explored the local museums (National, Gold, and Botero Museums), the flea markets, and more Colombian food. This is only the beginning of the third week, but for the upcoming last few days, the RTS coordinators have plenty of activities planned for us. I am extremely excited to see what’s next to come, as well as nostalgic because this experience will soon come to an end. I am very grateful for this opportunity, the knowledge I’ve gained, the people I’ve known, the connections I’ve made, and for this beautiful country I’ve had the opportunity to love”.