Episode 5: “Medical anthropology and social medicine: (ad)dressing the colonial wounds”

00:00:00 Laura Montesi: Embodied inequalities of the Anthropocene. Building capacities in medical anthropology. A podcast series that analyses the human and non-human health impacts of this geological epoch of profound transformations.

00:00:30 Ceres Víctora: Welcome to another podcast episode of Embodied Inequalities of the Anthropocene, a collaborative space between the University College London, UK, the Federal University of Rio Grande do Sul in Porto Alegre, Brazil, and the Centro de Investigaciones y Estudios Superiores en Antropología Social Pacifico Sur in Oaxaca, Mexico. In this project, we explore health in this epoch that is being defined as the Anthropocene. We are currently developing medical anthropology expertise in areas such as the Indigenous experience and the coloniality of the Anthropocene; gender reproduction and environmental justice; multispecies ethnography and human animal health; COVID and public understanding of the Anthropocene; and toxicity and chemical exposure.

Our guest today is Doctor Cesar Abadia-Barrero, associate professor in the Department of Anthropology, University of Connecticut, where he’s also the director of the Buen Vivir and Collective Healings Initiative. Professor Abadia-Barrero’s work focuses on the intersections between capitalism, health as a human right, and communities of care. He has carried out research in different contexts in Brazil, Colombia, and the United States, and he’s published several articles and book chapters, and is the author and co-editor of remarkable books in the field of medical anthropology, such as ‘A Companion to Medical Anthropology’ in 2011, ‘Salud Normalización y Capitalismo en Colombia’ in 2013, ‘”I have Aids, But I’m Happy” Children’s Subjectivities, AIDS, and Social Responses in Brazil’ published in English in 2011 and in Portuguese in 2022, and ‘Health in Ruins. The Capitalist Destruction of Medical Care’ published in English and Spanish in 2022. Professor Abadia-Barrero is the recipient of a number of awards in Colombia, Brazil, Venezuela and in the United States for his excellence in research and academic trajectory.

Welcome, Cesar. Thank you for accepting our invitation to speak about your research and your books. I’m very excited about this conversation and the possibility of learning more about your theoretical framework and the concepts you use to make sense of the ethnographic research you have carried out in different contexts. I’m Ceres Víctora, I’m a professor of Anthropology of health and the Body. And together with Jean Segata and Ivana Teixeira, I work with the group from the Federal University of Rio Grande do Sul in Brazil. Thank you, Ivana and Jean, for helping us to put together this episode. I’ll be conducting the interview today.

To start our conversation, Cesar, can you tell us a little bit about yourself, where you were born, where you went to school, if you had a mentor, how you became interested in medical anthropology and in the relations between capitalism and health?

00:03:40 Cesar Abadia-Barrero: Hola Ceres. And hello everyone who’s listening to this podcast, and thank you to Ivana and Juan as well for inviting me and putting together this podcast. I’m Colombian, I was born in Bogotá, the capital, and I went to dental school there. And I think my first immersion in medical anthropology is perhaps back at the time in dental school, although probably I didn’t know the field of medical anthropology. The training of health professionals in Colombia, but also across many Latin American countries, is very much influenced by social sciences. I trained in the late 80s, early 90s and, you know, community-based education, community-based care were very important in our training. There was a lot of influence of participatory action research of popular education with Paulo Freire. We studied a lot of social sciences and trying to make sense of the realities of inequality in the country. Of course, there was, there is, the big current of Latin American social medicine.

And so, I think one of my dear mentors from the time who really started me on this path, and actually one of the assignments was to conduct fieldwork. And my first field notes and diaries were back in the dental school with this Professor Lila Piedad de la Rosa, who is an amazing community-oriented dentist. So that was like the first immersions. And then I did the PhD at Harvard in medical anthropology, and I found those commonalities between the tradition of social medicine in Latin America and the critical medical anthropology perspective. I was very honoured to be trained by… My mentor was Paul Farmer, and there was Byron Good, and Mary-Jo Good were members of my committee. And so, with them, I learned critical medical anthropology, and I was able to sort of create my own path, learning a lot of you know Euro-American discussions of critical medical anthropology, but mixing them with critical traditions and perspectives from Latin America. And then I would just mention my last mentor, perhaps, was when I was conducting my doctoral dissertation, which I did in Brazil, and that resulted in that book. I was also very fortunate that José Ricardo Ayres from the University of Sao Paulo was my mentor in Brazil. So, I also finished sort of like my training under him and conducted research, trying to learn a lot from the tradition from ‘Saúde Coletiva’ in Brazil. So, you know, it’s kind of an eclectic mix of interesting people who has influenced me. And then many other, you know, colleagues and friends that I continue learning from throughout these years.

And I would say the interest between capitalism and health, I think for a lot of people with this kind of trajectory that comes from the health field, health professional practice, and moves into medical anthropology is through the lens of inequalities, that really troubled scenario in the clinical practice, when you feel that poverty and inequalities are shaping a lot of what you can and cannot do as a health professional. And then as I finished my training in dental school in 1992, there was the passing of the privatisation law, the healthcare reform in Colombia as it was the global neoliberal trend, right? So, I think that was what pushed me into studying more social sciences and anthropology to be able to understand what was happening politically and economically in the country. And thank you for that question Ceres.

00:07:41 Ceres: Thank you. Actually, in Brazil, the two fields – field of medical anthropology and social science and medicine, if you can say so – have trailed different paths, but in actual practice, they come together. You know, like, we are obviously different departments, we sometimes don’t go to the same congresses, but there is a lot of people who trained in medical anthropology who have done fieldwork, research in general, in collaboration with doctors or medical professionals who work in the field of collective health. And so, I can see what you are saying and, you know, actually seeing it in my everyday practice.

Cesar, in the Embodied Inequalities of the Anthropocene project, like in your research projects, we take on a critical medical anthropology perspective to look into historical aspects that have shaped current health practices, and the connections and disconnections between global and local logics of health care. Can you tell us how the connections between the past and the present, the global and the local, became evident in your fieldwork in Latin America? In other words, I’m asking if and how did you see Latin American’s colonial past in everyday health practices? In your fieldwork in Brazil and in Colombia, you give examples from your books or ethnographic examples that ended up not being part of the final publications.

00:09:22 Cesar: Yes, that’s excellent Ceres. Thank you. And I think that’s a big question for all of us that do critical medical anthropology, how we think about history and how history becomes evident and visible in the work and in the interactions. So, for example, in my work in Brazil, which was with children and adolescents affected by the HIV/AIDS epidemic, that was the doctoral research that then turned into that book. At the time, there were very few studies with children, and there were the groups that were considered at risk, like street children. So, I was able to sort of hang out, as we do fieldwork in anthropology, at one of the shelters for street children in Sao Paulo, and contrast their lives with the NGOs that were created to take care of children living with or being orphaned because of the HIV/AIDS epidemic. And we know that the colonial history in Brazil against street children, what with the murder and criminalisation of poor black children in the cities, primarily Sao Paolo, actually it was one of the big epicentres of the murder of street children. Was that part of the racial histories of coloniality in Brazil and the embedded racism by which poor, black, unkempt children on the street are deemed dispensable? And not only that, but they are actively murdered, right?

So, when I contrast their lives to the lives of children who were now being protected by these NGOs, for example, I guess the main result of that research was the paradoxical situation, right, in which street children were actually living more precarious lives, and were less hopeful about their future than children who were living with HIV or AIDS, right? And it was at the time like a death sentence and, you know, just with antiretrovirals and things like that, most of them orphans. Street children, most of them had families, right? But the conditions of that… and then it allowed me to think kind of why was that historical shift? What made it so that children living with HIV/AIDS seemed to have better life options and future than street children that were only at risk of HIV/AIDS, right?

And I think that’s one of the ways in which histories of colonialism were present, and how that also signals that democratising efforts in Brazil and the efforts of, for example, the identity politics of multiculturalism at the time by which particular struggles – for example, the struggle to run HIV/AIDS under the leadership of the gay movement in Brazil – really conquered a lot of rights, right? But in this multicultural, very neoliberal, fragmented emphasis. And so, you know, the final discussion of the book is that this democratising efforts are not enough, right, for the overall transformation of reality, right? So, you do see history as becoming part and embedded into what we are seeing as unfolding pieces of history, right? So, I always argue against thinking of history as context, but rather as the dynamicity of how power relationships evolve over time and continue to be transformed and continue to be present. And perhaps I’ll talk a little bit more about the Colombian case in other questions, just to not make it so long and to leave this particular question for thinking about Brazil.

00:13:13 Ceres: Absolutely. Thank you. That’s really insightful. While being myself a Brazilian and Ivana who also is present here, we sometimes lose sight of this whole… unless it’s something that is really applied to our everyday. Cesar, you told us a little about this first book – the first book that I read at least – that was ‘I have AIDS, but I’m happy’. And now I want to ask you something about your other book. The other book that I think is very important for the field of medical anthropology, which is ‘Health in Ruins’, and you show how care is being transformed. And so, could you tell us of the notion of epistemology of care seen from the South and the subaltern perspective?

00:14:14 Cesar: Yes, thank you Ceres. This second book, monographic book, ‘Health in ruins, the capitalist destruction of medical care at a Colombian maternity hospital’. What’s really interesting, in my training in dental school, I had the opportunity to do a clinical rotation at this maternity hospital. So, this was not only the oldest and most legendary maternity hospital that started actually in colonial times, right, with the Spanish crown and then evolved, you know, like sort of overseeing being a witness and participant of the country’s evolving history. And so, I trained there. But because of the privatisation reform that I had mentioned before, all the public hospitals and the public sector got defunded so that private, for profit and insurance-based systems emerged as the centre of the new system. So, a lot of the hospitals were being closed down. So, when I saw that this hospital was going to be closed down, I started the ethnographic work, trying to be present and act in solidarity with the professors and the workers of the hospital that were trying to keep the hospital alive and open.

And then throughout this, you know, close to 15 years of just, you know, doing active participatory action research with the people, what emerged was that – what we were witnessing was not just the closing of the hospital, but the closing of particular histories of medical care. How is medical care? So, what was interesting was the understanding that even though medical training, medical education, in a Western perspective is the same, that is to say, any physician who is trained in their Western paradigm in Brazil, in Mexico, in the UK, in the US will learn exactly the same physio-pathological principles and diagnostics and therapeutics, right? The way medicine is practised is different based on what you’re trained. So, the question then becomes, how is it that each political history of the institutions, of each medical school, of each university hospital, shapes the kind of training and political subjectivities of physicians? Right? And so that is where I started to think about that there was a different conception of what medicine should be about and should be practised. And that led me to think about different epistemologies of care that are always contesting imposed powers, for example, from hegemonic and medical trainings in the global North, right? Like medicine should be this, this and that. When we know that depending on where you’re trained, you are going to challenge that training based on your reality. To think that perhaps the conditions here require that medicine is being practised differently, right? So, it’s not a refusal or a denial of the power, for example, or the importance of a biological understanding of diseases. But it is more about how that politicisation of physicians training promotes a different kind of perspective of what is needed, for example, in a patient doctor-interaction.

And there are several beautiful examples in the book, but let’s just present for the audience one, so they might feel enthused to read the book or to explore this more. So, for example, at this hospital called El Materno Instituto Maternal Infantil was the origin of the Kangaroo Care programme, or Kangaroo Mother Care programme, which I call the Subaltern Innovation in Health Care, right? So, it contested at the time when it was created, late 70s, that the incubator, the medical interventions by neonatologist, were the most important elements for the care of low birth-weight babies or premature babies. And these physicians, professors of neonatology in Colombia, wondered if human bodies couldn’t do the same things as marsupials do. You know, like the baby marsupials are born very immature in a foetal like state, and so they understood that these marsupials finished really their growth extra uterus. So that’s when they created this very basic approach to caring for low birth newborn babies as well as, you know, giving them, offering them all the necessary care. So, it’s not that Kangaroo Care was replacing medical interventions, but it was a way to control how much medicalisation should be put in place. And so these kind of creative ideas can only emerge when they are linked to these histories of a different kind of understanding of what the politics of care are. And that’s where the epistemologies of care came about.

00:19:36 Ceres: It’s brilliant this kangaroo system is, like, so basic, but so revolutionary at the same time. Thank you. I was also sort of looking through the courses that you teach in Connecticut and among the insightful courses you teach at the graduate level, one seminar especially caught my attention, the one called Decolonial Alternatives: Sense Making, Political Practices and Collective Experiences. And from this standpoint, how do you see the debate about coloniality and health from the perspective of climate change and the Anthropocene? As you know, it’s precisely the countries from the global South that bear the brunt of climate change. I wonder if you could share your thoughts about how we could move to solutions without perpetuating the colonial dynamic.

00:20:35 Cesar: Right. Thank you for that question, Ceres. Yes, this course and this perspective, you know, has emerged from my latest work and it does relate a lot to discussions about the Anthropocene or Capitalocene – depending on, you know, the different discussions and the effects of climate change. So yes, I’ve been working with Indigenous communities in the Amazon region, in Colombia, working in post peace accord settings – for the audience: remember, in 2016, Colombia signed a peace accord between the oldest guerrilla in the planet and the government and so, we became a post peace accord time. And these rural regions, and the Amazon in particular, has become sort of an epicentre of the understanding of what to do. And of course, the Indigenous people are the stewards of the land and the people with ancestral knowledge and traditions as to how to take care, for example, of the Amazon, right?

And I think you are right, how to move forward with solutions without perpetuating colonial dynamics. And I think what I’ve become to learn, and I tried to implement in the courses, is that we have so much to learn from them. And this is not new, of course, for anthropology, but perhaps we are now in a different political moment in which we now understand differently the relationships with ancestral knowledge and practices. So how do we support them without intending to either speak on their behalf or co-opt their voices for academic purposes, right? So, I remember some of the Indigenous elders in the Amazon, right? They laugh about how, you know, European countries send them experts so that they learn how to take care of the Amazon, right? And they are like, yes, you know, please, please get away from us, you know, we’ve been taking care of ours and for thousands of years. And we are, you know, the least to blame in terms of the catastrophic consequences of the Capitalocene and the destruction of the Amazon right now.

But what I’ve been learning from them is that perhaps a way to move forward is not only to now finally start to listen to what elders have to say about the ancestors and ancestral knowledge on how to steward the land, but also it requires a different kind of sensitivity and imagination, right? Because I think I’ve been learning with them the role of art, for example, or poetry or different kinds of sensitivity. Because I think the question with that is not a question of knowledge, right? It’s not that we don’t understand the catastrophic consequences of the Anthropocene for climate change or the planet, right? But with the indigenous elders, we have to dismantle the colonial matrix of power from our imagination and sensibilities, right? So, I am more convinced that it’s not an intellectual debate, but it’s more a spiritual debate, if you will. That’s how they would put it. And I’ve been really immersing myself more and more in the role of art and other kinds of expressions that can really bring about those sensitivities.

So, for example, in one of the last iterations of this course you mentioned, I think the most effective session that we had with the grad students was when we were able to present an indigenous film, a short indigenous film, that got at the core of what colonialism means from a very spiritual, gut feeling perspective by showing what an indigenous world would look like. And I think it’s in those kinds of things where the hope rests. I’m liking very much the idea of different movements about indigenousing the West. And I think that’s where some of the efforts should go, in my perspective. And just a short commercial, I was very honoured to be invited by Carolyn Smith Morris who is a senior medical anthropologist. She invited me very graciously to co-edit a book that will come up this year. It’s called ‘Countering Modernity: Communal and Comparative Models from Indigenous Peoples’. And I mention it because I think it addresses exactly this by giving direct voice to Indigenous people. So, one of the beautiful aspects of this book was that almost all chapters are co-written or authored by indigenous people, criticising modernity and showing different ways in which indigenous epistemologies continue contesting and challenging Western power to remain vital and remain active. So, I think over there is that we’re trying to find solutions and listen anew, right? Like listen differently to what Indigenous peoples have always been saying to the world, but that the West have either co-opted or eliminated in this epistemicide struggle, right, of who owns the power of the world.

00:26:15 Ceres: Thank you. This is brilliant. Maybe this is exactly the connection I wanted for my next question, which is: I was very interested in learning more about the Buen Vivir and Collective Healings Initiative. So please tell us about what kind of activities carried out within this initiative, who is involved and where it is. I really want to know everything possible but kind of already connect with what you said before.

00:26:46 Cesar: Yes, wonderful. Thank you Ceres. And this is a brand-new initiative. So, everybody is welcome and everybody who’s listening to the podcast. We’re trying to create really a network of indigenous healers, right? The basic question with this new initiative is how do we heal colonial wounds? So, I’m thinking about it as a twist in medical anthropology. Right? Like that departs from the traditional patient-doctor, practitioner-sick person relationship, and thinks historically about groups of people that have been harmed historically through colonial legacies and continue to be harmed, right? So how do we heal racism? How do we heal dispossession of lands? How do we heal sexual exploitation of women’s bodies? Right? Like I think the answers, again, rest in this process of ritualising ancestral knowledge for the benefit of everyone. And of course, along the lines of what we now callin anthropology multispecies. But it’s about that deep connection between humans and nature, right? As the possibility to regain that place of the human as part of nature and as part of history, right?

So, of course, this initiative started just through the work and through the honour of being with Indigenous elders and learning from them and trying to bridge a little bit of what I was learning from academic standards, for example in Buen Vivir, which became this very important Andean indigenous epistemology that made its way to the Ecuadorian and Bolivian constitution and made it to its way to the Colombian peace accord. And it’s interesting because the indigenous elders don’t necessarily think about this concept, although, at least in the Amazon, when we talk to them, there are other, you know, similar kinds of concepts. So, it was just through talking to them that I started to think about what would it take to start this process and to start this network of multiple processes by which elders of different kinds are making efforts to heal their communities, to keep them together, to move forward with ideas of taking care of the planet, taking care of the new generation and things like that. You know, that’s the project that started in Colombia and Amazon, and it’s sort of growing in different ways. So, I’ve been able to work with them.

And now we are working with some communities in Hartford as well, trying to work here locally, where I’m now teaching in the US with local indigenous communities. Also, to think about how do we heal lands, what’s the meaning of being on borrowed lands? What’s the meaning, for example, of the indigenous diaspora, indigenous migrants from Latin America that arrive to other lands that also are, you know, the stewards of other indigenous groups from North America, right? And how do we make that bridge and those alliances so that we recuperate that sense of being placed in a territory that is so important, for example, to heal colonial wounds. Right? And to be able to take care of the land and things like that.

So, it’s a brand-new initiative. It’s emerging. I started to create with the elders a Buen Vivir index, for example, that it’s still very much in the works. We’re trying to support their work. They are creating new ecological and epidemiological calendars for the Amazon. Right? And it’s in that process of what needs to happen to recuperate the Amazon and to recuperate the people of the Amazon that have lost their knowledge to take care of the Amazon, right? So, these elders are very much invested in recuperating the knowledge so that the new generations of indigenous people can then become the new caretakers of the Amazon. Right? So, I think it’s in that kind of line that we’re doing efforts in this initiative.

And so, I’m starting to make connections and trying to bring everybody on board. We are working on a webpage. We’ll have it ready hopefully soon. And we’re doing, you know, some initial events. I have a new professor in residence who is a Mapuche Indigenous filmmaker, who is working also here locally with indigenous migrant communities in Hartford. And he does these indigenous films. He calls them ‘cine medicina’, you know ‘medicine film’. And so, it’s a beautiful perspective also to let us see how indigenous worlds are and what they are about, and how visual and aesthetic processes are so different from the Western aesthetics. And how if we recuperate that sensitivity and we start intervening the West to become indigenous, then there is hope that we can all heal and move forward.

00:32:01 Ceres: That’s brilliant. Thank you so much. We have one of the researchers, who is connected to our group is Maria Paula Pratis. You know, she developed a long-term research with indigenous communities, of course not about but with them. And so, we have been able to get some films or some forms of art that came from that collaborative work that she has been doing. And so, I’m sure there is a line of dialogue here. Cesar, going to my last question to wrap up actually our conversation today. I wonder if you can share some of your projects, the projects that you are working on at the moment – I believe this is one of them – and also new projects for the future, new books… Well, you have mentioned the one with Carolyn. And so anyway, if you can just wrap up with your future plans.

00:33:09 Cesar: Yes. Thank you. I mean, it’s a little bit of what I was mentioning. So, I’m continuing working with the indigenous elders from the Witoto and the Korebaju indigenous groups in the Amazon. So, we are hoping to be able to support their ecological and epidemiological calendars – that it’s so fascinating because they are very much respectful of other elders knowledge. So, they also, for example, as a difference from the West, advocate for not a universal ecological calendar, not a universal epidemiological, but they are very territorial based and they are very specific for each community. So, the idea is that each community actually in facing climate change, it has altered the cycles of reproduction of the Amazon jungle, for example. So, they have to think about there are tools in ancestral knowledge about how to deal, right, with the new cycles in climate, right, and climate alterations. The rainy season, the dry season has changed due to climate change, so we’re going to continue working with them in that project.

We are going to continue working with the indigenous Mapuche filmmaker Francisco Huichaqueo in creating here a film that intersects some of the local initiatives that are happening here in the Hartford area with indigenous migrant communities. So, we’re working with him around also a film that it’s going to be presented there, and that’s part of the of this initiative.

We have another art project, which is an embroidery based project with victims of the armed conflict in Colombia that ended up in an art piece, which has been touring in different areas in Colombia and in the US and in Canada. And it’s now going to go back to Colombia. So, we’re also creating a website for that and thinking about creating a piece. And we did a short presentation of that in the last Anthropological conference of the American Anthropological Association, and we did a panel on collective healings from the global South that you were invited.

And so we are looking forward to putting together a special issue on collective healings of the Global South that is linked with this. And we had beautiful papers presenting and really capturing this idea. And a lot of the work is fascinating across different perspectives, primarily from Latin America with different indigenous communities, and on what these kinds of different healing strategies that are about collective bodies that, for example, ‘Saúde Coletiva’, collective health in Brazil taught us so much about how to think, not about individual bodies, but what constitute groupings of people and what these groupings of people need to heal. And so, I think we’re going to have fun putting together this special issue. And that will help us tremendously.

And I will perhaps end with another beautiful project in collaboration with one of my graduate students. I’m also very honoured to have a student, also a Mapuche indigenous leader woman who is Catalina Alvarado-Cañuta, who is trying to do a PhD project in which we link what it means for Mapuche people to heal colonial wounds and colonial trauma and the role of weaving in that process. She is going to insert in her project a personal weaving piece. She’s learning from women who are incredible weavers in the Mapuche culture to tell the story and to think, if it’s true, that telling of stories of weaving and art, that it’s another expression in which we can heal this colonial wound. So, I think, you know, my new phase in my trajectory will concentrate on trying to recuperate and to put together, put in conversation, all these many interesting dynamics that people are doing to figure out how we continue, you know, existence on this sore planet and their indigenous stewardship. So that’s the concentration of my new efforts moving forward. And again, everybody is very much invited to be a part of this. And thank you so much Ceres and everyone.

00:37:40 Ceres: Thank you. Thank you for taking the time to talk to us. Would you like to say anything else? Is there anything that we didn’t cover – I’m sure there are many – but anyway, would you like to add something just, you know, as a final?

00:37:57 Cesar: No Ceres. Thank you again. I think I will just reiterate that I think we are in a very interesting moment in which it’s demanding more and more from us to be very humble in terms of the knowledge we think we have and the role of academia in all these endeavours, and how to redefine what is our role in these, right? Like we are helpers, we are collaborators, but the stewards are other people who really know how to take care of the land and the earth. Right? So, I think it’s a beautiful challenge, you know, like we are all bright and PhDs and professors and whatnot, right? So, it invites us to really be humble and to find joy in supporting those who know how to take care of the land. So, I think we’re also in a very fascinating conceptual moment, right, and theoretical moment, to think through these things. Right? So, what’s the meaning of Western knowledge as we know, doesn’t hold the most valuable insights? So, what do we do as people trained in the West? So that’s a beautiful invitation that I would like to end for all of us to think about and to find solutions.

00:39:09 Ceres: Thank you so much on this beautiful note, we end our podcast today. Thank you again. Thank you, Juan. Thank you, Ivana.

00:39:22 Laura: This episode was recorded virtually between the US and Brazil, Ceres Víctora conducted the interview. Ivana Teixeira wrote the script. Laura Montesi lent her voice for the jingles. Gabriela Martinez managed the general production and script writing, and Juan Mayorga took care of the audio edition and post-production. This podcast is an international collaboration between the University College London in the United Kingdom, the Universidade Federal de Rio Grande do Sul in Porto Alegre, Brazil, and the Centro de investigaciones y Estudio Superiores in Anthropology Social in Oaxaca, Mexico.