Tuesday, July 7, 2009

AH1N1 update

So after further fact checking, I realized I made a mistake about my AH1N1 information (and to respond to questions).

Here is the correct update:

- From May 17th to July 2nd there were 8,160 confirmed cases of AH1N1 registered by the Chilean Ministry of Health

- As of July 2nd, there were 16 confirmed deaths from AH1N1

However, despite AH1N1, the winter here is beautiful and on clear days, you can see the Andes Mountains from the university. Below, I attached a photo of the PI, Dr Lilian Ferrer (R) and the research coordinator, Lisette Irarrazabal(L).

Thursday, July 2, 2009

"eticquette": learning the day to day

And here comes another long awaited update…

Rio de Janeiro, Brazil…

Rio was amazing. The LASA Congress panel schedule alone was over 200 pages long and filled with presentations from those doing research in Latin America. I had the chance to hear presentations in: English, French, Portuguese, and Spanish. Part of LASA´s agenda is to encourage a dialogue between academics, scholars, and civil society working in Latin America. It was truly an exercise in fact production and information sharing. For example, at one panel I attended, two presenters spoke Portuguese, one presenter spoke Spanish, and the other presenter spoke English. They all managed to communicate and share information. I befriended a lot of historians, talked a lot about memory production, came to the conclusion that a global ethnography of 1968 would be so interesting, and jumped off a cliff with a parachute (not part of LASA).

Before I talk about the parachute, let me share what I learned about Rio de Janeiro. Some people may be familiar with the term favelas, which are densely populated neighborhoods (small cities within the city) consisting of substandard housing, lack of a state presence and basic services, and characterized by violence. They have been made famous by movies like Cidade de Deus (City of God) - to name one. However, I found that I knew relatively little about the historical context of the favela. So in an effort to historicize, here I go.

Brazil abolished slavery in 1888 and was the last country to do so in the Atlantic slave trade. After abolition, former slaves and their families moved to cities, like Rio, looking for employment. However, the transition into another economy was complicated of course, by issues of race, class, economics, etc… and most black Brazilians did not have access to financial capital. Jobs were located in large cities, like Rio, and so in order to be close to employment, settlements with inexpensive housing started to pop up in pockets of the city where there was no state infrastructure. Of course Rio grew, in and around the favelas, and the favelas grew in and around Rio. Favelas are also the producers of a great national Brazilian icon: samba. The best samba schools (escolas de samba) are located in the various favelas of Rio and samba is a form of political expression—especially during Carnival. However, samba was actually illegal until the 1930s, until the Brazilian government decided that Brazil needed distinctly Brazilian elements to fortify what it meant to be Brazilian. Thus, the favela became a key producer of Brazilian culture. You may not think this is interesting, but I love context!

So now, I will explain the parachute adventure that marked the end of my excursion to Brazil. While in Rio, I had the chance to reunite with a former professor of mine, Manuela, who had a great impact, and still does, on my academic development. One evening, while eating some fried chicken hearts with farofa (ground-up yucca) and sipping caipirinhas (the “national” drink of Brazil and made with sugar cane rum, cachaça), I was brainstorming with Manuela about my project. She mentioned that I should try parapente (parachuting) or asa delta (hang gliding) in the context of, “Ted, it will clear your head—give you perspective.” She´s a carioca (person from Rio) and has been hang gliding since she was 14—so I trusted her judgment. To make a long story short: drove up the side of a mountain in a tiny Volkswagen filled with equipment, strapped into the tandem parachute with a friend of Manuela´s who is a hang gliding instructor, looked at the mountains on the other side of the city and ran off the slide of the cliff. It was amazing.

Overall, Rio was quite inspiring and I made a lot of really great contacts who work, in one way or another, in the field of public health in South America--Brazil, Chile, Argentina, and Peru.

Back in Santiago…

I returned to Santiago and was greeted by grey skies, cold, and rain. The temperature is dropping as we move into the heart of winter—July. At night, the temperature hovers around 28F to 35F and daytime temperature ranges from 45F to 60F. Usually, the week starts out with sun, then becomes increasingly cloudy/smoggy until the weekend, when it proceeds to rain for 12-30hrs non-stop. The rain limpia el aire (cleans the air) and thus we start the cycle again. Santiago, because of its distance from the sea and its proximity to the Andes Mountains, has very poor air quality and lots of particulate contamination—smog. An equivalent in the US would be Los Angeles. I have noticed a difference in my respiratory health as I find myself winded and/or coughing when I go running.

Thus we arrive at: public health. Air quality is actually a very big public health issue for the Santiago metropolitan area. Poor air quality coupled with seasonal influenza makes for busy consultorios (primary health clinics). Including heart and other chronic diseases, respiratory diseases rank high among the leading causes of death in Chile. To add to the normal Seasonal Influenza and RSV (Respiratory Syncytial Virus) cases that come in the door, Chile has the highest reported incidence of the AH1N1 flu (known as flu porcino here, or “pig flu”) in Latin America right now.

On a side note: Before I came, my friend Ariana forwarded me a message from the Univ. of Michigan’s chief medical officer predicting high levels of AH1N1 in South America and recommended that staff and students traveling to the region bring Tamiflu. Unfortunately, I read this email about 3 days before I departed Chicago. So, as of right now, I am depending on my own immune defenses, hand washing, chamomile tea, and mandarin oranges. So far, I’ve just had a seasonal cold (probably a rhinovirus) that lasted about 6 days.

Actually, with such high numbers of people reporting to medical centers, the Ministry of Health made an announcement a couple of nights ago on the evening news asking for any health personnel who were currently not working to come in and help relieve the ever growing burden of patients. Here in the office, my co-workers are saying that it is a truly historic time to be in Chile and working in health because the health system has never experienced something of this magnitude. Luckily for Chileans, everyone in Chile is guaranteed health coverage and Chile’s health infrastructure is very solid and well developed. The system is a public-private mix: FONASA is the public system and the private system is comprised of ISAPREs, which are similar to the private plans people purchase in the United States. 70% of Chileans are enrolled in FONASA and the main source of financing comes from a 7% payroll tax. There are 4 levels: A, B, C, & D. Each level corresponds with an income range, with A & B for lower income and C & D for higher income. A & B do not have deductibles or co-pays, while C & D have small co-pays and deductibles. It will be interesting to see how AH1N1 develops and how Chile, as well as other neighboring countries, react as we pass through the peak of the flu season in the southern hemisphere.

Los Chicago Boys…

Moving from the health system to research HIV/AIDS research, I was out at a Mapuche ruca (community center) with 2 members of the research team the other day when something very interesting happened. We were there preparing to do class 3 & 4 of our 4 class HIV/AIDS intervention curriculum and were setting up our projector, computer, and materials. There was a group of elderly Mapuche women having tea at the same time and we went over to introduce ourselves to them. When it was my turn for introductions, I stated that I was from Chicago and was a student working in the field of public health. The women were very kind and had a lot of questions for us, but started to chuckle when I mentioned I was from Chicago. They were talking in Mapudungun (language of the Mapuche), but in the middle of their conversation they said "Chicago Boy." And then there was some chuckling. I thought it was a very clever comment.

Get ready, because I am about to condense about 35 years of Chilean history into a nice web 2.0 format in order to explain the comment. You see, the Chicago Boys were the group of economists from the University of Chicago, headed by the famous Milton Friedman, who came to Chile in the 1970s to test neoliberal economic theory. The term "Chicago Boys" also loosely represents the US forces, mainly the CIA, which backed the coup d´etat that occurred in Chile on September 11th, 1973. On this day, the Chilean military bombed the presidential palace La moneda; Salvador Allende, the democratically elected president, was murdered; and a military dictatorship, headed by the US backed Agosto Pinochet, assumed power. The years of the dictatorship (1973-1989) were marked by political desaprecidos (people who were “disappeared” by the government because of their perceived political activity) and murders; a severe restriction of civil liberties; and an overall suppression of political life. In true Cold War form, the actions of the dictatorship were justified in the name of “national security.”

Through neoliberal economic policy, steps were taken to control inflation and the economic crises of the 1970s (oil shocks, inflation, etc…) and an “opening up” of the economy occurred through foreign direct investment. It is up for debate if the neoliberal economic policy of the dictatorship or reforms that Allende put in place stabilized the economy. However, at the end of the 1980s, the economy was again in crisis and thus the “transition” to democracy in 1989. Michelle Bachelet, the current president of Chile (who has a degree in Epidemiology, among others), was arrested with her mother, detained, tortured, and exiled from the country in 1975 by the military government. She came back to Chile in 1979, earned her medical degree and would eventually lead HIV/AIDS research programs in the country and be the first female head of the armed forces for Chile. She won the election for president in 2006 and has an incredibly high approval rating right now.

So, back to the ruca with the Mapuche women. I laughed and smiled, feeling proud that I knew what Chicago Boy meant with a thumbs-up in the name of good natured sociopolitical teasing. Welcome to Chile-Chicago relations. I need to thank my Latin America Politics professor from my undergrad for helping me understand the situation—putting a liberal arts education to good use.

This past week…

In order to improve my Spanish and make some friends, I joined a GLBT Literature club at the Santiago Public Library. I am now possess my very own Santiago Public Library Card-- of which I am extremely proud. For the book club, I chose to read the book "Tengo miedo torero," by Pedro Lemebel (a famous Chilean author), which is a great read (although I must confess, quite challenging… I am still reading). The discussion was great and apparently we recorded it and it will be turned into a Podcast. When that happens, I will post the link. There is nothing like talking about Michel Foucault or Judith Butler—in Spanish. I felt very happy because I met some great people and afterwards, we went to the Día de la no discriminación, which also commemorates the Stonewall Riots in NYC in 1969 (similar to Pride in the US). A transnational gay holiday? You had your usual transformistas (drag queens) putting on a very politically charged show and a very fun celebration. I would say that there were about 500 people there. Issues of gender and sexuality are still emerging in the public discourse here, but to see so many people out in public was quite exhilarating. Most importantly, we all had fun.

Not related to gender or sexuality at all, but still just as exciting for me: I found a pair of running shoes! Seriously though, I am a giant in South America and was lucky to find anything. I celebrated my new shoes by taking a run up el cerro san cristobal, which is located on the northern side of Santiago. I would describe its size as maybe… a foothill to the Andes Mountains? A bluff? Not as tall as climbing 3000m mountain, but much larger than a hill. The run had some amazing inclines and because the path wraps around el cerro, you get incredible 360 degree views of Santiago and the Andes. Plus, it was a sunny day, the air quality was great (no ehsmog), and I drank something at the top called mote—a sweet, amber colored drink filled with what looked and tasted like oats complete with a dried peach. To top it all off, the woman who was selling the mote said I had a Portuguese accent and guessed that I was Brazilian. People who communicate in a 2nd language know that this is an incredible compliment. It indicates some sort of language mastery. Unfortunately, my accent was Brazilian Portuguese and not Chilean Spanish, but I will settle for that any day.

Monday, June 8, 2009

First 3 weeks: Santiago

The UIC School of Public Health created this blog as a way to connect students' work abroad with the campus community in Chicago. As I am new to blogging, please bear with me as I try to paint for you, the reader, my global public health experiences as not only a graduate student learning the ropes in research, but as someone taking his first steps in a new place, space, and culture.

Before I begin I would like to thank Lanny & Terry Passaro for providing the support to make this type of summer research experience possible for students through the Douglas Passaro International Award and for their continued support of the Global Health Initiative at the UIC School of Public Health. I would also like to thank Dr. Judith Levy and Dr. Lilian Ferrer for all of their time, guidance and support in the development of this field experience.

Now on to the first 3 weeks....

So after a months of preparation and many emails back and forth, I arrived safely in Santiago, Chile and have been here almost a month now. For those of you who don´t know, I am working as a research assistant at la Pontificia Universidad Católica de Chile (PUC) in the School of Nursing. The project is called "Mano a Mano" (Hand in Hand) and has a variety of funding sources, but is primarily funded by the NIH. Mano a Mano aims to create a comprehensive HIV/AIDS intervention in Chile and is a multi-faceted project with a diverse population sample (men, women, and health workers). I am working on the research that focuses on an intervention tailored to Chilean men.

More or less, on a daily basis, I work from 830am to 500pm at the PUC office and in the evening or on the weekends the research team goes out into the field to conduct the baseline or follow-up interviews for our male population. The interviews are paper-based and take about 1 hour to complete-- quite in depth and very interesting. Both the control and intervention groups receive the interviews, but the intervention group also includes a 4 module HIV/AIDS curriculum developed by Mano a Mano. Basically, we´re trying to measure to see if the curriculum (our intervention) does indeed increase knowledge, positively change attitudes, and decrease risk behaviors that pertain to HIV/AIDS. We are also interested in incorporating a Mapuche (indigenous group) male population into the research as well.

I am also helping with the qualitative analysis of the qualitative data taken during a series of focus groups and narrative interviews that occurred in 2007/2008. This analysis is very exciting and I just started, but it is going to take up most of my time while I am here. Dr. Lilian Ferrer, the PI on the project is amazing and I am so excited and happy to be working with her. The rest of the staff have been very warm and welcoming and it already feels like we've been working together a long time.

So with brief synopsis of the project done we move to the "adventures." I arrived in Santiago on May 18th, 2009. that first week was spent: 1) learning how the metro works 2) looking for an apartment 3) getting to know Santiago 4) finding my way around the university, and 5) buying a phone. I accomplished #'s 1,2, & 5- still working on 3 and 4. I found a flat (or a "pieza" as they say here) that I share with other folks: 2 internationals (Julien from Niece, France and Claudia from La Paz, Bolivia) and a Chilean (Ruben). I originally thought of staying in a place by myself, but the flat mates are great and very helpful if I need to find important things (like the grocery, etc...). Plus, there are a lot more "hidden costs" when renting an apartment here and it ended up being too much of a hassle.

I am still learning Santiago, but let me just say that the metro here is 1000000x better than the EL in Chicago. Incredible. It is so quiet, fast, and clean! I feel spoiled. Other than adventures in the metro, I found a new love for the Chilean hot dog: el completo. It comes with a tomato sauce (but with lots of tomato chunks in it... more like salsa), sauerkraut, avocado (depending on the style), and mayonnaise-- so delicious. My intake of Nescafe (instant coffee of the world) has increased 3 fold and I have been running in the morning, which helps me to orient myself in the city. Fun times.

Last week I went to a Rotary Club in a neighborhood located just south of the city to do some interviews with the research team (they donated a space so we could conduct interviews there). I talked to one of the Rotary members for 3 hours about pretty much everything: credit, international economic crisis, the dictatorship in Chile, the return of democracy from the dictatorship, public-private partnerships in government, the best place to get a Tom Collins in Santiago, municipal governments, federalism, and the french revolution (he studied political science, can you tell?). oh. my. god. it was great, but i am still exhausted. I think i forgot how tiring it is when you are communicating in a 2nd language-- a lot of concentration and a lot of endurance.

Right now in Santiago, the leaves are changing colors, the night temperature hovers around 32F and the day temp is around 55F. Fall is here in full force and I am told July and August will be cold, with a chance of snow. PUC´s campus is absolutely beautiful.

On June 10th I am headed to the Latin American Studies Association Congress in Rio de Janeiro, Brazil. I can assure you this congress is all work (although I will be in Rio de Janeiro). I was looking through the program and there is a lot of amazing interdisciplinary health research happening and I am excited to see the presentations and hopefully meet some of the researchers-- hats off to health research and the social sciences!

more updates to come soon!

un abrazo,