Post #7: Final reflection on LACS 20 and the CCESP

Looking back on the past ten weeks, I am amazed at how much my level of preparation for the CCESP has increased. When I first imagined the type of “preparation” LACS 20 would provide me, I thought purely in terms of intellectual preparation. For example, I thought that learning the political history of Nicaragua, the workings of its economy, the diversity of its various indigenous populations, and the basics of its healthcare system would sufficiently arm me to be an effective CCESP participant. I’m not surprised by my initial naïveté; almost every class at Dartmouth has only taught me didactic lessons to prepare me for an exam. However, LACS 20 is fundamentally different since its purpose was to prepare me for an experience. Accordingly, the most important preparation I have gained has not been from traditional readings, but rather from the people that LACS 20 has brought me into contact with.

It’s been an invaluable experience to be in a classroom full of nearly 30 like-minded students. My classmates have been a sounding board for the ideas we’ve discussed in class and have engendered thoughtful discussion. Also, I initially underestimated how beneficial it would be to get to know the other CCESP participants this fall before embarking on the trip. We’re all going to be thrown into an unfamiliar environment in Nicaragua, so I think the fact that we’ve already established a baseline level of comfort with each other will ease that transition considerably.

Being able to hear from guest speakers like Dr. Turco and Dr. Saunders was also vital to my preparation. Not only did they share intimate accounts of their experiences in Nicaragua in a very direct and candid manner (which I really appreciated), but I was also interested to see two very distinguished physicians who simultaneously engaged in both a traditional academic medical career at Dartmouth and also significant medical service abroad. I hope to integrate those two dimensions of medicine into my future career as a physician, so listening to their stories was particularly moving for me.

Finally, hearing from our friends from Nicaragua (members of Las hijas de maíz, the URACCAN students, and some Bridges to Community employees) was indispensible preparation for the CCESP from a cultural point of view. I was very interested to hear their perception of the United States, particularly how they said that although Americans may be better off materially, they lack true happiness and try to use material objects to achieve satisfaction, and that they would much rather live in Nicaragua because they’re proud of their country and heritage. Of course, the Nicaraguans I will meet in Hormiguero may feel differently, but having some sort of context of how I will be perceived by our hosts will be helpful on the trip.

Overall, I am extremely satisfied with how much LACS 20 has prepared me for the CCESP. However, I think that just as my conception of the CCESP has changed immeasurably from 10 weeks ago to the present, I’m sure my reflection on the trip after the fact will likewise be radically different than what I expect right now. I’m very much looking forward to once again having my preconceptions, stereotypes, and values challenged, because that kind of tumultuous experience will surely add to my character and teach me lessons that will endure for a lifetime.

Post #6: A “bio-social” approach to global health

Last fall I took History 36: Healthcare in American Society, which provided an interesting cross section of the history of medicine in the U.S. and also contemporary issues and systemic challenges of the healthcare system. Among some of the most shocking moments I remember from that course are learning that there are ~15% of Americans without health insurance, hearing the anecdotal stories illustrating the emotional and financial plight of uninsured Americans who fall seriously ill, and realizing that statistically, income is one of the best predictors of access to various medical services. This information was very troubling for me- I think it’s a fundamental human right to have access to healthcare and scientific advances regardless one’s socioeconomic status.

“I argue that equity is the central challenge for the future of medicine and public health. It is easy to document a growing ‘outcome gap’ between rich and poor and show that it is caused in part by differential access to increasingly effective technologies.”

-Paul Farmer, Pathologies of Power (20)

With this prior knowledge from my history course in mind, reading the excerpt from Paul Farmer’s book was particularly moving. The lack of healthcare access in the U.S. can, at best, be attributed to systemic inadequacies, but the historical incidents that Farmer points out amount to nothing less than the deliberate deprivation of basic healthcare from vulnerable populations, be they refugees, prisoners of war, or indigenous peoples caught in the middle of a conflict. With such emotionally charged portrayals of injustice, I certainly sympathize with Farmer’s call to action on behalf of victimized individuals. As if an appeal to common decency isn’t enough to convince someone of the urgency of Farmer’s message, one could also argue that keeping all people in good health is of direct benefit to society: healthy individuals can contribute to the workforce and fill innumerable productive roles in society, whereas an ailing population cannot.

Post #5: Comments on Final Presentations

This post will focus on some feedback for my classmates’ final presentations.

Kira & Kayuri: Mining in Nicaragua

I liked how the overall flow of the presentation followed a trajectory from objective to humanistic. The initial parts of the presentation discussed a chronological history of mining, the laws that regulate mining, and some political and economic statistics of the mining industry in Nicaragua. This information was fairly factual and objective, and served to inform the audience of the basics needed for the pursuant discussion. The latter half of the presentation then made a strong emotional appeal by focusing on the negative impacts that mining has had on the environment and the health of Nicaraguans. This second part of the talk certainly made a strong argument against the mining industry of Nicaragua as well as the companies that perpetuate it and the politicians that permit it. I think that the abrupt transition from the objective aspects of mining to the harsh consequences of the industry made for a persuasive and engaging argument. One particular piece of content that I enjoyed was the video of community members protesting the actions of a large mining corporation. I think that relevant video clips of appropriate length serve to change up the rhythm of a presentation. This particular clip served as primary source documentation of the conflict between corporations and the miners and their families. I think one deficit in the content of the presentation is more evidence for the supposed “economic stimulus” that mining brings to the country. I know that politicians such as President Ortega often cite general economic benefit as rationale for allowing foreign and domestic mining companies to invest in such activity, but critics are quick to label this as an exaggeration or just plain falsehood. If available, I’d be interested to see different economic reports/analyses/forecasts that quantify the amount of economic activity that mining generates and the share of the benefits that would realistically be enjoyed by the workers involved. Obviously the agency creating such a report would introduce their own bias, but it’d be nice to have some numbers to put to this debate.

Enat, Celeste, & Jennifer: The role of women in revolutionary Nicaragua

One of the biggest assets of this presentation was the clear and logical organization of information into 3 categories: the role of women before, during, and after the revolution. This structure was very intuitive, guided their presentation and made it easy for me to absorb the comprehensive research they’d done. However, there are two things about the presentation I wasn’t satisfied by. One is that at the end, it seemed that the role of women after the revolution essentially returned to what it was before: the role of a domestic housewife subservient to their husband. This seemed like such a let down compared to the great independence, leadership, and empowerment that women assumed during the war. I know that reality can’t be changed of course, but it would’ve made for a more uplifting conclusion if the presenters had focused on some of the ways women retained their empowerment, even if it wasn’t as pronounced as the educated women who were able to climb the ranks of government after the war, for example. Also, the presenters stated that the “war gave women a platform for organizing themselves” and achieving greater independence, which I took to be the main thesis of their talk. I think that by comparing the Nicaraguan case study to other Central or South American countries, they could’ve made a very strong case for their thesis. For example, further investigation might show that other countries with revolutions in the same time period also gave women the opportunity to assume greater roles in society, whereas countries without such turbulent politics did not show that same pattern.

Post #4: Reflections on ‘Under Fire’

I will use this blog post to share some of my reflections on Under Fire, which Patricia, Perla, Oscar and I presented on to the class. In my interpretation, the film does an excellent job of using journalism as a proxy for highlighting and condemning the condescending lens through which many people in the “first world” view people in the “third world.” To be more specific, we have discussed in class and learned through our readings that many Americans (and citizens of other developed countries) view developing countries as primitive, unsafe, and in political disarray, and perceive the people living in such places as uneducated, ignorant, and poor. Following from this diagnosis is the moral “obligation” to help these people by giving them the modern marvels (healthcare and hygienic practices, etc.) of our wealthy, democratic, and technologically advanced nations.

Under Fire does an excellent job of portraying these warped viewpoints through the proxy of a fictional story of journalists reporting on the Sandinista-led movement to overthrow the Somoza dictatorship in Nicaragua. The reporters describe Nicaragua as a “neat little war and a nice little country,” trivializing an entire nation and it’s population down to a transient spectacle on the world stage. The three protagonists travel the country taking pictures of the conflict, in one case opting to photograph a dying man from afar instead of trying to help him. Russell and his boss frequently discuss the merits of one story versus another in the context of which will generate the most sensational headlines. The list goes on, but it’s clear that these journalists hold the stereotypical and erroneous views on people in the developing world that I discussed above. Although the director condemns the journalists’ behavior, they ultimately redeem themselves when they come to realize the humanity and genuineness of the Nicaraguans. When Somoza’s soldiers kill Alex in cold blood, Russell and Claire can, for the first time, appreciate the magnitude of loss and sadness that thousands of Nicaraguans endure each day under Somoza’s regime.

Another reason I chose to talk about Under Fire in my blog post is that the themes of this movie tie into some of the pitfalls of service trips that we talked about earlier on in our class. We discussed how viewing developing nations as inherently inferior to developed ones could cause a volunteer to automatically discount the locals’ approach to solving a problem in favor of the “accepted” solution that we might implement in a developed country. One example that comes to mind is how service workers doubted the ability of sunlight to purify water in favor of a “high-tech” solution like iodine pills or an expensive filter. Neil Bhatt, my interviewee for the ethnography study, gave a similar example. He told a story of when a woman came to an American physician complaining of chest pain, and the doctor instinctively sent her to have an ECG reading in a nearby town, acting on a knee-jerk reflex likely common to hospital protocols in the US. However, such habits may not always be appropriate in developing areas. This movie served to remind me that keeping an open mind during the CCESP and being careful not to impose my preconceived notions on the Nicaraguans I meet will be paramount for making sure that my time spent there will be as effective and harmonious as possible.

Post #3: On conducting ethnography

For my ethnography project I interviewed Neil Bhatt, a Dartmouth ’14 and former student director of the CCESP. The ethnography process was relatively simple and easygoing, although there were certainly a few challenges, both logistical and fundamental, that required me to give considerable thought to planning and executing this study. On the day of the interview, I realized that Starbucks, where we originally planned to have the interview, might be too noisy to get a good quality recording. So, thinking on my feet, I suggested that we walk over to the Visual Arts Center down the street after getting our coffee where I figured it would be quieter. Other logistical issues were timing and technology. I wanted to find the right balance between asking all the questions I had written down ahead of time and allowing for the natural ebb and flow in the conversation, and of course I didn’t want to cut Neil short in the middle of a thought. This process led to a 35-minute interview, which was longer than I intended but I felt it was more natural and complete. Another unexpected challenge was that having a recorder was distracting. I think it made both of us feel if not slightly uncomfortable, then at least more conscious of what we were saying than we would’ve been otherwise. Also, I kept finagling with my phone to keep track of the time, ensure that the recorder was still active, and to write down time stamps for quotes I wanted to come back to later. Although this made it easier to stay on schedule and to transcribe key parts of the interview afterward, I realized that it may have distracted Neil and it certainly stopped my train of thought once or twice. These challenges that I experienced when interviewing Neil will certainly be applicable when conducting an ethnography study in Nicaragua, so I will be sure to keep them in mind moving forward.

However, I anticipate that I will encounter additional challenges when interviewing Nicaraguans that I didn’t experience with Neil. The foremost challenge I expect to face is the language barrier. Although I’ve studied Spanish for a number of years, I still have trouble understanding spoken Spanish in certain scenarios, and I know that this will impede the flow of the interview to at least some extent. I think that I speak clearly enough and have sufficient vocabulary that the interviewee will understand 99% of what I say, but I’m afraid I may lose valuable insights from them that will be lost in translation. To hedge against this likelihood, I am glad that we will be recording the interview. This will allow me to run certain parts of the interview by other CCESP students who speak Spanish natively to make sure I captured the essence of what the interviewee meant to say. A second challenge that I didn’t face with Neil is a cultural barrier (and I believe that this stems in large part from the language barrier). I will be easily recognizable as a foreigner in Nicaragua, if not by my appearance, then by my accent. Although I’m sure the members of the communities we will visit have interacted with Americans before, I am still a stranger and I’m afraid this may prevent the interviewee from opening up completely to my questions. To try to mitigate the interviewee’s discomfort and my own awkwardness in such a situation, I will try to break the ice by making conversation with the respondent (i.e. introducing myself, who I am, why I’m interviewing them) to put us both at ease and to establish some baseline level of trust and familiarity before starting to record the interview.

Although I know that there will be several challenges associated with conducting my ethnography study in Nicaragua, I have given thought to how I might overcome these issues. I believe ethnography is an art form capable of preserving the vitality of a culture just as powerfully as any written or painted form of art, and I feel privileged that I will be able to participate in this process on the CCESP this year.

Post #2: Thoughts on Nicaraguan visitors

During our classroom conversation with the visitors from Nicaragua, I found the humility with which Ana Narvaez spoke about Women in Action’s projects compelling. She seemed very cognizant of the modesty of the projects they undertake, yet still proud of the impact and reach that WIA has on the women involved. When she told the history of how the organization got started, Ana mentioned how at first they didn’t have much (just a small space and a few interested participants), but how little by little it grew and they were able to expand their activities. I noticed a tone of immense gratitude for each successive step they achieved, like being able to rent a larger space and when they experienced success with their soybean program. These sentiments of gratitude for small things were echoed in the video clips that Mike played between the dance performances. The families interviewed in the video appeared very self-aware. They stated that compared to many people around the world, they aren’t materially well off, nor do they have the most luxurious homes. However, they also said that they are happy with what they do have, and that the most basic things like having a healthy family and having a home at all are enough to make them content. These words were moving and for me represent a sense of appreciation that I and other Dartmouth students should try to adopt.

Before beginning LACS 20, I was skeptical about the degree of impact NGOs or similar organizations could achieve in developing places, and my only conception of such entities were similar to the portrayals of ineffective NGOs that we’ve heard about in our class readings. However, after hearing more about Bridges to Community’s model for development, I’ve been convinced of BTC’s effectiveness and how other organizations with similar models can have an impact of the communities they partner with. The key aspect of BTC’s model in my mind is the community “buy-in.” It seems intuitive that by having community members contribute both monetarily and physically to constructing a project, they will be motivated to maintain it over time. When I consider BTC’s involvement from this perspective, it seems that they really serve as a catalyst to help organize a community, rather than a foreign entity simply providing unsolicited aid. I would be interested to see whether communities that have successfully completed one project with BTC might later on initiate and execute another community-wide project, but this time on their own. It would mean that BTC was able to teach a community to be self-starting, organized, and coordinated- which could lead to “sustainability” in the most intrinsic sense of the word.

Post #1: Tourism in my time

I have been a tourist in Latin America on several occasions, some of which were your typical tourist vacations, and other instances where I felt much more connected to the place and people I was visiting.

In the spring of 2014 I did the Buenos Aires FSP and lived with a host family. After a few weeks in Argentina I realized I was beginning to feel like a local rather than a tourist. I took public transportation to school every day, I read the newspaper, I knew my neighborhood and where the best ice cream shops and parks were, and I even gave walking directions to Argentine pedestrians a few times. I think that the duration of the FSP made my stay in Argentina less of a “see as many sites as you can in one week” sort of trip. Moreover, living with a host family was a great experience. My host mom was really sweet, and she and I along with the other members of the family had interesting discussions over dinner, and learned about each other’s life styles. I would consider this the most authentic “cross-cultural exchange” I’ve experienced to date.

As an interesting side note, for Easter weekend during my FSP, a few friends and I went to Montevideo, Uruguay, for a weekend trip. In a few instances, some strangers (usually homeless) on the street would quietly curse at us in Spanish, give us dirty looks, or spit on the sidewalk in our direction, which in the most optimistic case I will interpret as them projecting disdain for American tourists. This was probably the only time I have ever experienced such a negative reaction to my presence while traveling in Latin America, so I felt it was worth mentioning.

My 10-day Medlife service trip to Cuzco, Peru was similarly meaningful. The area of the city we stayed in was off the beaten track, and we spent most of our time in the rural, mountainous communities on the outskirts of the city setting up and running mobile medical clinics. Thus, most of my interactions were far removed from the typical tourist traps of Cuzco. I felt particularly engaged with the Peruvians I met there because I was able to communicate with them in Spanish. However, we visited a different village each day and therefore I was disappointed by the lack of continuity in the interpersonal relationships I formed there.

In contrast, I have also been a tourist in Latin America in the most superficial and typical sense when I visited Costa Rica, Mexico, and Puerto Rico multiple times (on different occasions) with my family. We stayed in those typical vacation resorts and saw very little of the surrounding area aside from the hotel grounds. I would say that these types of experiences (which my family members love but I find unfulfilling) are the antithesis of the meaningful experiences I had in Peru and Argentina.