In the midst of two realities

Schiedam, Netherlands

I´ve been living in the Netherlands for over three years and this is a picture of my neighborhood, it is lovely, all houses are very similar and the land is very flat. A fun fact is that I am currently recording this session from a latitude that is below the sea level. And although the pandemic has hit hard, being here during the pandemic has felt like being abducted into a bubble of surreal calm and silence.

La Paz, Bolivia

The reason why is that I was born and raised, La Paz, Bolivia, in the heart of south America. There is a big difference in terms of the landscape, we are surrounded by beautiful mountains and we are above 3500 meters above sea level. Unlike the previous photograph, the contrasts related to poverty and marginality are always evident, the higher you live the more struggles you have to make it through the day. The burden of social inequalities was part of the context during my training as a physician. But just like when you see the same landscape every day through a window, during the training we had naturalized, normalized these inequities…we saw them as something distant that we could not change and the best we could do was focus on the biomedical profile of disease, focus on evidence-based medicine, the science that is written and published everyday in the the top journals of the global north.

Healthcare access and Quality Index

This graph represents the difference in the indicators of access to healthcare and quality published in Lancet by the global burden of disease commission. And of course we see a big difference between Bolivia and the Netherlands for all kinds of diseases. And although as medical students we acknowledged the lack of investment in health, both in terms of human resources and technology and that part of it was due to corruption and state negligence. Until very recently I thought that the way to shift these indicators to the right, the only thing we had in our hands was to learn from the countries that are at the top. Fortunately the pandemic made me realize how wrong I was. So let me tell you how that happened.

Globalized chola - Mujeres Creando

Somehow last year I started following in twitter more researchers in global health (a discipline I just learned about last year too). I was surprised to read and relate to tweets from peers from different parts of the world who shared some similar perspectives about the pandemic, somehow It made me feel less lonely about my perspectives. I joined a free course held by Partners in Health were I met field and academic epidemiologists and public health practitioners from Latin America and Africa. In this training I learned more about the root causes of disparities, such as colonization, capitalism, patriarchy and neoliberalism. They were challenging the structural forces of power that historically have created the gap between the global north and the global south, the roots behind the current inequities across countries such the ones I showed between Bolivia and the Netherlands. And that definitely opened my mind.

Epidemic Illusions - Eugene Richardson

This picture is from the book by Eugene Richardson, Epidemic illusions, on the coloniality of global public health. He discusses all the banned causes related to the ebola outbrake. Learning about coloniality in global health helped me realize how my understanding of public health, overall all about research, methods development, etc. was also stained by a colonized perspective that began in my medical training. When I realized that, for a moment I felt that I had been spending all these years away from home climbing an ivory tower in academia and that I had been distancing myself from the reality in which real changes to improve population health can be made. I felt guilty and naïve for not challenging the status quo.

Social power

And while I´ve been reflecting about these personal and professional perspectives related to my privileges, ambitions and dreams the more I understood in more depth the civil protests in my country and in all South America. Since 2019 our region has suffered from the injustice of antidemocratic governments and has lead to many deaths by the military and policy forces. The pandemics made everything worse, but the fight for fundamental rights has not stopped for the fear of covid. Even beyond, Ive come to understand the power of resilience in the population. And with this in mind I would like to send my solidarity to my Colombian peers.

Aborto Legal

And in the bright side, the latin American region has gained a historical victory related to women´s reproductive rights. For most women in the region, abortion is clandestine, risky, unsafe, specially for women from socio-economically disadvantaged backgrounds. According to Human Rights Watch, unsafe abortion was the leading cause of maternal mortality Argentina. Last December the Argentine senate approved the law to decriminalize abortion. Legal, free and safe abortion is now a public health policy, after decades of activism and civil protest. Since my first encounter with research was in a project related to teenage pregnancy in rural areas, this historical moment has made me aware of the power of people united for the same purpose, regardless of social class, professional background, age, nationality, etc. This spirit of victory is transcendental for all other countries in the region who are now setting the public health agenda to claim for the same rights. ## Scientific conquests only serve if they are at the service of the people – Ramón Carrillo

Before moving to the Netherlands I spent 4 years in argentina, and the natural science museum was my favorite museum. At their entrance there was this graffiti that said…. Since the pandemic I try to keep this always in mind. Life has taken me to places I never imagined, and I love working in methods development in causal inference, specially bridging the theoretical constructs to the applied setting. But I cannot stop asking myself, do we have to decolonize epi too? At least I realized that I can challenge the gap between the north and the south by translating all my work into Spanish. And although I am not affilitiated to any bolivian institution, I have been able to teach and mentor Bolivian students who are interested in becoming the future leaders in epi and public health. I´ve been learning a lot from them too.

Finally, all that has happened this year made me realize that if the aim of my work is to improve health then I have to stay connected to people who are actively defending our rights and work together with the communities. I want to challenge myself into how to frame better research questions even if they are considered too unconventional for the current paradigms of epi or seem impossible because there is not enough data to answer them yet so I look forward to discussing this in the Q&A.