Notes from the Field 2008

As time winds down on our field experience, the city of Medellin is winding up with the Feria de Las Flores (Festival of Flowers). With Colombia being the second largest exporter of flowers in the world, next to Holland, and Colombians being keen on maximizing their celebrations, we knew this 10-day festival of flowers would be extravagant.

Activities with the Faculty of Public Health kept us busy up until Thursday, which was Colombian festivo (holiday) in honor of the Battle of Boyacá in which Simon Bolivar liberated Gran Colombia (now Venezuela, Colombia and Ecuador) from the Spanish Monarchy. More importantly for Medellin, and for us, Thursday marked the Desfile de Silleteros (Parade of Flower Vendors).

The sun-soaked afternoon must’ve reached 95 degrees as the crowds moved like water into every inch of movable space. Fortunately for me, standing a good foot and a half over all Colombians, attaining a buena vista wasn’t too difficult. For Mo: not a chance. That was until I heaved her on my shoulders to serve as the photographer for the day!

The silleteros come from Santa Elena, a pueblo situated high in the Andes near to Medellin. The night before they prepare their silletas (flower displays) as onlookers admire drinking canelazo (warm fermented sugar cane drink) and singing Colombian anthems. The silletas come in all shapes, sizes and designs and are judged by a panel before entering the parade. Carrying the silletas, from Santa Elena to Medellin for the parade, appears to be the most physically demanding part of the processional as old women, as a matter of pride, take it upon themselves to carry silletas which weigh up to 200 pounds on their backs!

As no one seemed to return to work following the fanatical festivo on Thursday, Friday allowed us to see another marvel of the Feria de Las Flores; the International Orchid Exhibit at the Botanic Gardens of Medellin.

With three mountain ranges, a Pacific and Caribbean Coast, deserts, and a portion of the Amazon river basin, Colombia features a variety of climates and environments ideal for orchid plants. In fact Colombia is home to 3000 species of orchids, and has arguably (see Ecuador) the largest variety of orchids in the world!

As we entered the botanic garden we were impressed by its sheer floral capacity and the long lines of orchideologist waiting for their own intimate experiences with the esteemed flowers. Phylum by phylum Mo and I were introduced to some of the exquisite hieroglyphs of nature. Even photos can hardly do justice to the beauty that Mother Nature showed us Friday afternoon.

Unfortunately, the floral lavishness of the ‘Feria’ has a flip-side. Colombia is the main supplier of flowers to the United States accounting for more than one out of every two store-bought flowers. In Colombia the flower market offers hope; however working conditions are less than ideal. Nearly 80% of the flower workers are women, and they make less per day than what four carnations cost in Cub Foods. The Colombian Ministry of Health states that floriculture has the highest rate of workplace ailment due to the demands of the trade. Dole corporation, which owns the largest share of the Colombian flower market, demands its workers to strip, cut, and pack 350 flowers per hour. Unemployment (rate over 40%) and the high number of displaced persons (due to armed conflict) suit the flower producing companies because many people will accept work under anomalous conditions since they desperately need income.

It will be interesting to see what the imminent Free Trade Agreement will mean for the Colombian flower industry. Obviously a FTA presents an opportunity to maintain preferential tariffs for Colombian flowers, but it does not address the poor working conditions or agrochemical pollution and toxicity that are linked to floriculture.

Nonetheless, knowledge of the poignant floriculture working conditions has made me appreciate the seamlessly endless supply of flowers flooding Medellin in these beautiful days of Fería de Las Flores.

Posted at 7:06 PM | Permalink | Comments (1)

Medellín is a city of great contrasts. Salsa dancing the up-scale bars and restaurants of La Zona Rosa (the pink district) will leave you to believe Colombia’s problems are a thing of the past; however, ascending up to any of the shanty-town barrios surrounding the city will reveal another story.

The ‘Fortified Cookie Study’, which has targeted children from the most impoverished barrios of Medellín, has afforded Mo and me an unprecedented look at some of the most challenged areas of the city. As we’ve anecdotally learned, many of the families and their children are not living in these communities by choice but rather by forced displacement from their rural Colombian towns.

Although this story is sad, the situation seems to be improving. In an effort to reduce the health and educational disparities that have landed Colombia as the second most inequitable Country in the Americas (see gini coefficient), several aggressive local and national initiatives have been implemented in some of the least well off communities. One of these projects, of which we've learned quite a bit about, is Food and Nutritional Improvement Plan (MAN�?). This program has had amazing results in the department of Antioquía, seeing the deaths due to hunger drop from 145 in 2001 to 0 this year. AMAZING!

Below a Colombian girl feeds her friend sopa del dia (soup of the day) at a comedor in Barrio Paris. This meal is the only one some of the children receive in the whole day. Although some of this doesn´t look appetizing, as the Nun says “the kids eat everything, no matter what we feed them�?.

Another ground-breaking project is the opening of five new libraries, designated for the five neediest barrios in Medellin. Maureen and I have had a chance to visit one of these libraries on our Metrocable (Gondola) (see pic) trip high above Medellín to Santo Domingo Savio. This barrio, filled with ram-shackle tin roofed houses and twisting roads, was once one of the most dangerous neighborhoods in Medellin. Now, thanks to initiatives such as the Metrocable and the beautiful library (see pics below) it is safe to walk about Santo Domingo and even enjoy an arépa de chocolo (Sweet Colombian treat made of maize) at one of the little tiendas.

In a country historically known for the large inequality between the rich and poor (an inequality which has yielded 44 years of internal conflict), the Colombian city of Medellín is setting a precedent of positive change for the rest of the Colombia by public spending to attenuate inequities.

Posted at 4:01 PM | Permalink | Comments (2)

Hi Everyone!

Everything is going well in Medellin. It’s been only two days in Medellin and already Mo and I have lived in two apartments. Although we expected the up-in-the-air apartment search to be difficult, this transient living situation is cumbersome. No worries, although small, our current shared flat is quaint, has a window to the east and is cheap, or ‘barato’ as the Colombians would say.

Our first day in Medellin was spent orienting and acclimating ourselves to the University and City; today was spent learning of the studies in which we’ll be co-investigating and areas in which we’ll be doing some of the field work. We began our day early in the Department of Dietetics and Nutrition, a campus in-and-of the University of Antioquia. Our preceptor, Adriana ‘the hawk’ Suaterna, facilitated a meeting with some of the investigators we will be working with and already we feel as we are part of the team here. La Profesora Gladys filled us in on the details of the 'fortified cookie' study beginning this Saturday. Then, she took us to visit some students in their final rotation for dietetics at a Public Hospital in a marginalized shanty-town of Medellin. The majority of the patients had HIV, COPD and other chronic conditions for which the Nutrition students were consulting and appropriating therapeutic diets. Mo and I found this all too interesting and committed ourselves to returning next week Wednesday for the welcoming of malnourished HIV positive children. yay!

Tonight we'll be getting away from the University to show our gringo-salsa-dancing skills in the Parque Lleras of Poblado. This is one of the nicer areas of Medellin oft frequented by the surgically enhanced; vanity is a virtue among 'paisas'!

Tomorrow we look forward to our appointments with the investigators of Malaria in La Facultad de Salud Publica. This campus is within the Medical School limits but on across the city from the Department of Nutrition. As we'll be sharing our time between these two sectors of the University, this commute should enable us to be experts in navigating ourselves in this humongous city!

I do hope all is well in 'Los Estados'!

Noel-

Posted at 2:54 AM | Permalink | Comments (2)

Liberated: Ingrid Betancourt and 3 Americans

Front page of the NY Times is hosting the breaking story of the rescue of 15 hostages who have been held captive by the FARC (Revolutionary Armed Forces) of Colombia for over 5 years. The hostages include the former French-Colombian Presidential Candidate Ingrid Betancourt and 3 American contractors. This is a significant blow to the Marxist insurgent group who has been trying to overthrow the Colombian Government for over 50 years using kidnapping and drug-trafficking to fund their military operations. Today’s hostage liberation comes after a debilitating month for the FARC who lost 3 of their 7 leaders and saw over 2,000 of their 9,000 strong insurgents hand over their weapons for government-granted amnesty. The oldest and largest guerrilla movement in Latin America - once viewed as invincible - is at its most vulnerable point in years, and may be ready, once and for all, for peace negotiations with the government and an end to their 50+ year struggle in Colombia.

See the story at: http://www.nytimes.com/2008/07/03/world/americas/03colombia.html?ref=world

As you can tell, Maureen have been doing our homework on the history and politics of Colombia in preparation for our 1 month stint working in Medellin. We leave on July 14th and can't wait!

Noel-

"El pueblo unido jamas sera vencido"

Posted at 10:43 PM | Permalink | Comments (0)

Hi, folks.

I'd like to briefly introduce myself. I'm Noel Mueller, a future 'disease detective' in the MPH program. A myriad of interest and good intentions landed me in the field of public health. With a background in nutritional science, I now pursue an MPH in epidemiology with an emphasis in nutrition. Some of the areas currently peaking my interest include: globalization and the nutrition transition, biofortification of staple foods in developing countries and nutrition as it relates to disease. Over the Summer I hope to gain experience addressing some of these issues by working with Colombian epidemiologists in the city of Medellin.

Medellin, once fabled for its mean streets (see National Geographic Mean Streets of Medellin) has made remarkable strides over the last decade to improve the safety and health of it's dwellers. Referred to as the 'city of eternal spring' by Colombians, this Andean megalopolis of ~3 million people has decreased its homicide rate to that of Chicago or New York; thus, opening the door for health initiatives in some of the under-served slums surrounding the city. Unfortunately, US aid and Plan Colombia has not been able to resolve the internal conflict afflicting this country for 40+ years, and as a result, Colombia remains on the US State Department Travel Warning List.

--future advice for those intending to go to countries with travel warnings: start the application process early!--

Pending approval is the field experience: to evaluate the effectiveness of a Vitamin A supplementation intervention for reducing Malaria incidence in children under five years of age who are living in marginalized communities, endemic to Malaria, outside of Medellin. The intervention will be implemented in coordination with local epidemiologists from the Faculty of Public Health at the Universídad de Antioquía. Maureen and I will work as co-investigators on the project.

Wish us luck in gaining approval to embark on this wonderful public health endeavor!

Noel-

"el pueblo unido jámas será vencido!"

Posted at 9:05 AM | Permalink | Comments (1)