Ever wondered why cities are cities? When I thought of this, I immediately began to remember bits and pieces of high school history, and the settlement of people close to bodies of water… So, I decided to google the definition of city and found that it means “a large town” or “short for city of London”: Hmm… But I ask this question because it seems like cities are often the geographic epitome of the conglomeration of capital (money, jobs…) and resources, leaving other locations dry—sometimes of people and of more resources, including healthcare. Ironically, within cities themselves, resources are usually unfairly distributed—if you can’t find one (which will be a big surprise), look no further than my borough, the Bronx, N.Y.
(Downtown, Bogotá)
In the city of Bogotá (Colombia), I visited both the rural and urban parts. Something I found unique to urban Bogotá were the roads on which their local public buses (TransMilenio) travel; the buses have designated pathways (only for them) centered in the middle of the road, so if you want to get to a place fast, the bus, as opposed to the taxi, might be your best bet. In rural Bogotá, I was able to shadow on a 2019 Andean Region Social Innovation in Health case study. This project works to cater to different villages in the mountainous Sumapaz.
Google Map of Drive from Urban Bogota to Sumapaz
Unlike urban Bogotá, which holds libraries, restaurants, and museums (checkout an artist by the name Fernando Botero, whose work I found very interesting and funny, at the Museo de Botero), Sumapaz is known for its Paramo ecosystem, which is mainly found in the Andean region of South America. This ecosystem holds beautiful giant rosette plants, shrubs…
(Sumapaz, Bogotá)
In Sumapaz, the people live in small, dispersed communities, making access to healthcare difficult since they have one centralized health facility: El Tunal hospital. Thus, the Model of Integral Healthcare of Rural have taken it upon themselves to work with these local communities to ensure that they access healthcare that is grounded in their own culture, while utilizing resources they have available by working with a multisectoral team including doctors, nurses, agricultural engineers, and nutritionists to communicate and work with the community members. They use tools like music that narrate their history and connects to their ecosystem—led by the doctor, who is also a guitarist—and offer cooking lessons that combine locally grown produce like the romero spice, from their organic garden, with other ingredients.
I could feel the passion that exudes from Andrea (the head of this project) when she talked about the work. She lives in urban Bogotá and yet she commutes the 3 hours drive several times a week to work on the organic garden and leads the work of her professional team, to visit the homes of their patients. And these roads of the mountain are tough; I had an intense headache from all the rounds of curves we had to maneuver to get to the different communities and the change in altitude. “Here, try this!” she said as she offered me a freshly removed cilantro plant from the garden of seedlings of different vegetables she grows and regularly shares with the Sumapaz community, to increase access to and uptake of vitamins.
The team was selected as one of the top social innovations from the Andean Region Call, focused on countries that hold parts of the Andes mountain including Colombia, Venezuela, Ecuador, Peru, and Bolivia. In a 2017 call for social innovation in health from the general South America region, Eco-health’s approach to fight Chagas Disease and MosquitaMed: Shortening Distances Through Telemedicine (which I briefly introduced in the previous blog) were nominated and highlighted. I also had the opportunity to informally interview them to learn a bit more about how they approached their work, some of their challenges and how they overcome them.
On November 7th, Carlotta of Eco-health (Guatemala) discussed with me that, “before we began our work, we researched and identified (17) risk factors for the infestation of households by the bugs.” They decided to tackle households risks (crack on walls , floors, and the upkeep of farm animals), to remove the habitats of the bugs. She said, “when we are venturing into a community, we reach out to community leaders to discuss Chagas and the ways in which we can overcome the reluctance of certain communities and work on finding ways to use their local building resources (like volcanic ash) to repair walls and floors. We also sometimes build a model house by the road so all can see.” The two main approaches they use are: increasing awareness via community leaders who can train others and spread the word, and developing customized local strategies to avoid and remove the presence of vectors inside the house. Now she is exploring ways of proving that their intervention is working, including looking for more sensitive biological research tools and techniques to investigate the blood sources of the insects and see if they have stopped affecting the people within those communities.
Manuel from MosquitaMed in Honduras talked about their work of incorporating digital technology into the healthcare system of their communities. He works on “encouraging other institutions including the Universidad Nacional Autónoma de Honduras (to get the doctors in their residency program) to join [their] work in telemedicine (via telephone calls and videoconferencing), so that local patients can access healthcare without spending money on costly long transportation…” Also, he expresses his concern about the lack of “data driven culture… We are working with the Ministry of Health staff and medical personnel to train them on mobile data entry, to keep track of medical records and to also ensure that, for example, medications don’t expire in storage.” Manuel and his team are currently working on developing a stronger team structure to allocate roles and responsibilities; they are also working on implementing a base-line study to understand how to effectively navigate the implementation of health technology into their local communities.
Based on these conversations and interactions with these changemakers, I have realized one theme that I think cuts across all of them, and it is how they navigate through different localized nuances (some apparent, some unspoken—whether cultural or bureaucratic…), so that they effectively implement their projects.
Now, this got me thinking about implementation research, where you look at roadblocks that hinder the success of interventions. Because scientists, engineers… can build a device or produce medication to assist and treat, and they might appear effective under laboratory settings, but when they hit the real world, all hell breaks loose… and they don’t work out as expected. We need to find ways to ensure that the different tools and interventions we have created to tackle challenges in health, reach all, whether in rural or urban parts of a city and outside of them. This means more programs and training focused on understanding and navigating culture, language, geography… in healthcare and health research.
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