Colombia in its Labyrinth

A maze in the Jardín Botánico del Quindío, in Calarcá, Quindío, Colombia. (Photo by Sergio D. Botero.)

A maze in the Jardín Botánico del Quindío, in Calarcá, Quindío, Colombia.
(Photo by Sergio D. Botero.)

By Daniel Payares-Montoya

Colombia was on the verge of collapse at the beginning of this century. Violence by Marxist and Maoist guerrillas, paramilitary groups, drug cartels, and renegade state forces was present in every corner of its territory. The country was also hit by the worst economic crisis in its history, and the political equilibrium was precarious.

Businessmen, politicians, military strategists. and normal citizens thought that the country was becoming a failed state, if it was not one already.

Over the next two decades, what happened was something just short of a miracle. Improvements in national security allowed for narco-paramilitary groups to be demobilized in 2006. Ten years later, the FARC Marxist guerrillas, the oldest insurgent group in the hemisphere, signed a peace agreement with the government. Narcotics traffickers and cartels were systematically weakened. Although violence persisted, the homicide rate in 2017 was the lowest recorded since 1975.


Violent forces like the Marxist Fuerzas Armadas Revolucionarias de Colombia (FARC, left, in 2008) and the right-wing paramilitary Autodefensas Unidas de Colombia (AUC, right, in 2006), were a constant threat in the early part of this century. (Photos from Wikimedia.)

The commodity boom between 2005 and 2014 fostered economic growth and attracted investment into the country. Thanks to that increased investment and the revenues generated by oil, the government was able to increase social spending, improve access to education and health services, and invest in infrastructure.

More importantly, programs to alleviate poverty were created and strengthened. In 2014, for the first time in Colombia’s history, the number of households categorized as middle-class surpassed those labeled as poor. Between 2002 and 2018, the portion of the population in poverty decreased by 23 percentage points, from 50% to 27%.

Those improvements were widely celebrated by Colombians and the broader international community. For a brief moment, it seemed possible that the country might finally achieve long-lasting peace and sustained prosperity.


Construction in Bogotá amidst the economic boom in 2015. (Photo by Peter Angritt.)

Recent years have shown that peace and prosperity are not so easily attained, however.

During the “miracle” period, political fragmentation and polarization began to reach critical levels. The country’s leadership was unable to unite Colombians around a national project, a common idea of a shared future, that could at least protect what had been already achieved.

Necessary actions were dismissed because of a lack of consensus and political will to push them forward. Those parties and political coalitions in power were almost exclusively concerned with keeping a patronage system in place and pork barrel spending, both structural deficiencies of the Colombian democracy. Special interests fiercely resisted any attempt at reform, instead pouring money into political campaigns and the pockets of elected officials to assure favorable results. The reform of the justice system, the implementation of progressive tax reform, a more decisive fight against corruption, the diversification and sophistication of the economy, expanding formal employment, increasing the quality of education and health services, and the reduction of development gaps between regions were some of the actions that were abandoned.1

After those projects were put aside, security and socioeconomic improvements began to stall in 2018 and 2019.

Criminal gangs evolved and became powerful actors in some regions, financing their private armies through extortion, illegal mining, land grabs, modern slavery, and drug trafficking. Former paramilitary leaders regrouped after serving their time in jail, and the implementation of the peace agreement with FARC was systematically hindered by the current government.

On the socioeconomic front, the end of the commodity boom and uncertainty in the global economy reduced investment, creating fiscal pressures and curtailing the government’s capacity to continue expanding social spending and investment. Economic growth diminished, and unemployment surpassed 10%. High levels of inequality, informality, and self-employment made almost 4 out of 10 households vulnerable to economic shocks.

It was under these already grim circumstances that the Covid-19 pandemic hit, compounding the multifaceted challenges Colombia already faced.

Since March, at least 28 human rights defenders and social leaders who have denounced the atrocities of illegal armed groups and the military have been assassinated. More than 150 such defenders and leaders have been killed this year. Criminal gangs are the de facto authority in many municipalities and neighborhoods; in some cases, they even enforce the curfews and shelter in place measures mandated by the government.

Banner of killed social leaders in Colombia

A banner bearing the names of social leaders killed in Colombia in recent years hangs from a library and crosses the campus of Universidad del Valle in Cali, Colombia. (Photo by tefita228.)

In 2020, Colombia could have its worst economic performance in the last 100 years. One study predicts that poverty could also increase by 15 percentage points, creating 7.3 million more poor people than in 2019. By the end of June, the unemployment rate reached 20.1%, the highest among OECD countries.

Paradoxically, the current crisis and a future recovery may present an opportunity for the government and the political class to progress towards a national pact for the future of Colombia.  But if political factions continue to place their interests above those of Colombians and engage in petty in-fighting, the chance for the country to consolidate liberal democracy and create sustainable development for this and future generations will be squandered.

Countries like South Korea and Israel faced similar challenges not long ago. Their societies were able to come together to overcome complex historical, political, social, and economic challenges, actively reshaping their futures. Today, even if they are far from perfect, both nations are regarded as international examples of how to produce structural transformations and improve the well-being of their citizens.

If Colombia does not want to return to the worst years of the previous century, the country needs to be united around a common goal: creating the opportunity for every Colombian to achieve well-being. To make that happen, political leadership must guide the society into a new national program to consolidate and expand the progress made in the last 20 years. Even if they are fiercely resisted by special interests, the reforms mentioned above must be implemented to advance toward that goal. The social movement that began to consolidate from the end of 2019 until the beginning of the pandemic, resembling in some ways what was happening in Chile, could be an important ally in those efforts. Dismissing that movement could prove a fatal error and might bring the country a populist leader eager to capitalize on the existing discontent among important parts of the population. And a populist government is the last thing Colombia needs right now.

The questions that remain to be answered are: is there someone willing to take the lead in trying to unite the country? And if they do come forward, will it be too late?

Daniel Payares-Montoya.Daniel Payares-Montoya, from Medellín, Colombia, works as a Research Assistant at UC Berkeley’s Center for Latin American Studies on issues related to public policy and international development in Latin America. He has a master’s degree in public policy from Universidad de Chile and a master’s degree in development practice from UC Berkeley.


(1) Every year, Colombia’s Consejo Privado de Competitividad (Private Council on Competitiveness) publishes a national report presenting policy proposals to address the country’s bottlenecks in different areas.


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Epidemics and Containment: Cuba and the HIV/AIDS epidemic

By Nancy Scheper-Hughes

The principle upon which the fight against disease should be based is the creation of a robust body; but not the creation of a robust body by the artistic work of a doctor upon a weak organism; rather, the creation of a robust body with the work of the whole collectivity, upon the entire social collectivity [my emphasis].
(Che Guevara. On revolutionary medicine, 1960.)

One of my earliest memories was being pulled into a New York public health documentary on urban poverty, complete with scenes of open rubbish bins, scrawny looking cats, East River rats the size of armadillos, rabid dogs, and equal sickness for all. It was filmed on South Third Street in Williamsburg, Brooklyn when the neighbourhood was still a post-WW2 immigrant slum. As proud children of tough immigrants, we laughed at the visiting public health nurses, singing our anthem “Marguerite, go wash your feet, the Board of Health is across the street,” as they barged into our homes to check our heads for nits and our bodies for malnutrition, or worse. We chased the nurses away as we showed off our strength, picking up dirt from the pavement and putting it in our mouths. Our mothers had told us that it would take a peck of dirt to make any of us die.

Since then, however, I have been in the field as a medical anthropologist during several epidemics, from schistosomiasis, malaria, cholera, Chagas, bubonic plague, tuberculosis, HIV/AIDS, to Zika and Chikungunya. The latter two arrived in Brazil in February 2015, just in time for a collapse of Brazil’s national health-care system, the Sistema Unico de Saude.

In 1990, I began to study the HIV/AIDS epidemics in the U.S., Brazil and Cuba, each led by different public policies (Scheper-Hughes 1994). In 1981, at roughly the same time that AIDS first appeared in San Francisco and New York City, Cuba faced its own crisis, when its military forces returned from Angola and Mozambique with a sickness that even the best tropical medicine scholars could not identify. In 1983, Fidel Castro made a visit to Cuba’s Institute of Tropical Medicine ‘Pedro Kourí’ (IPK) accompanied by the president of Kenya. Fidel surprised the scientists who were then working on infant mortality when he asked the director of the institute what he and his colleagues were doing to stop an unknown, new syndrome from taking hold in the nation. Professor Gustavo Kourí Flores, virologist and director of the institute, did not pay much attention to Fidel, but one of the doctors at the IPK, Jorge Pérez Ávila, listened carefully to what President Castro had to say. He took it to heart.

Jorge told me: “Fidel said that nobody in the world knew much about this new virus. At that time, there were only a small number of cases in Africa and the U.S. I had just returned from Africa where I treated a Cuban international worker who was ill with an unknown virus.” After Fidel’s speech at the institute, the director boldly told Fidel that the new virus was too small a problem for the IPK. Fidel looked at him and pulled at his beard before he replied bluntly: “You are wrong. AIDS is going to be the disease of the century, with many populations ravaged. It’s your responsibility to see that this does not happen in Cuba.” Although no one yet had an inkling of how the new virus was transmitted, Dr. Pérez said he was ready to put aside his research on malaria to explore the new epidemic threat. He was later assigned to serve as medical director of the first Cuban AIDS sanatorium.

Dr. Jorge Pérez. (Photo courtesy of Nancy-Scheper Hughes.)

Dr. Jorge Pérez Ávila. (Photo by Sheri Fink.)

The first Cuban response to this new epidemic was a ban on imported blood derivatives in countries where blood banks were commercially owned (‘capitalist blood’). Next, the government tested for HIV antibodies beginning with all Cubans who had been out of the country since 1981. Then, as Cuba had done in earlier epidemics, the Ministry of Public Health (MINSAP) organized mass testing of young and older age adults and social groups who were sexually active or especially vulnerable. Both Dr. Jorge Pérez and the Vice Minister of Epidemiology for Public Health, Dr. Héctor Terry Molinet, worked together to make sure that tracing the sexual partners of infected individuals followed the testing. My interviews with Dr. Héctor Terry in 1990 were edgy. He asked why HIV tests were not obligatory in the epicentres of the US HIV/AIDS epidemic, especially New York City, Miami and San Francisco. Based on my interviews with public health officials I replied that American citizens would never accept it.

Comfortable residences at 'Los Cocos.' (Photo by Nancy Scheper-Hughes.)

Most housing at ‘Los Cocos’ was in duplex apartments with gardens. (Photo by Nancy Scheper-Hughes.)

Cuba opened its first HIV/AIDS sanatorium in 1986, in a rural suburb of Havana officially named Santiago de Las Vegas, but locally referred to as ‘Los Cocos’. It was built on the large but abandoned estate of a colonial finca (farm). At that time, the infection was seen as a military medical issue, and Castro put the medical project in the hands of the Cuban military. The AIDS ‘sanatorium’ was thus run according to military structures, which led to savage critiques from AIDS activists in San Francisco and Miami, who described it as a military prison for gays in Cuba. Indeed, from the old photos, it did look like a military barracks. However, it was more inviting when the old colonial villa was refurbished and opened to house the HIV/AIDS military heroes who had returned from Africa. Gradually, new buildings were built, and a wall surrounded the military AIDS estate. In the beginning, most of the staff were military doctors, until 1986, when a new group of people with the same infection, who had never been in the military or lived in Africa, began to show symptoms of HIV. Most of these second-generation HIV+ patients were gay or bisexual. 

Juan Carlos, a doctor and a patient in his home at the AIDS Sanatorium. (Photo by Nancy Scheper-Hughes.)

Dr. Juan Carlos, a patient and medical doctor at the sanatorium. (Photo by Nancy Scheper-Hughes.)

While there was no cure, the government put their energy into containing the AIDS virus. All those whose tests proved positive were sent to the sanatorium, where they were asked to identify the names – promised to be confidential – of those with whom they had sexual relations. The names were tracked and brought to Los Cocos for testing. The ‘positives’ would have to reside at the sanatorium until a cure or a vaccine could be developed. Dr. Jorge insisted that the sanatorium was not based on quarantine — an absurd idea, as the virus was spread by contact with infected blood and by sexual relations. I visited the sanatorium in 1990, 1991, 1994, and 2000, where I was free to walk anywhere and to talk with anyone. I took notes, visited the apartments and homes of the residents, and observed their daily routines and their relations with each other and with the doctors and nurses. Los Cocos was neither a hospital nor a prison. Nor was it anything like we might call a sanatorium — a closed and isolated place where sick people suffering from tuberculosis or other respiratory and highly contagious diseases are kept in medical quarantine.

A staff member, Dr. Jorge Pérez, and a patient at Cuba's AIDS sanatorium in 1991. (Photo by Nancy Scheper-Hughes.)

A staff member, Dr. Jorge Pérez, and a patient at Cuba’s AIDS sanatorium in 1991. (Photo by Nancy Scheper-Hughes.)

The sanatorium at Los Cocos was a blend of scientific data gathering of epidemiological statistics, AIDS research, and intensive medical and psychological care and treatment for all the patients. It was the best of Cuban social and socialist medicine. I may chase my readers away by arguing that the Cuban AIDS project was democratic insofar as its goal was to diagnose, treat, and to support all those who had a positive test. Dr. Pérez wanted to know all the patients as individuals, and he spent most of his days walking and talking with the clients and asking them what changes were needed to enrich their lives. There were some problems between the two different classes of people: the Cuban soldiers who had worked in Africa, and the men (and some women) who had never gone abroad but had sexual relations with men who were carriers of the virus. The so-called sanatorium was then somewhat divided between the military and civilian patients. However, all were treated the same, and all were given the only drug then at hand, AZT (100-300 mg per day), with marginal results.

Over time, the patients began to trust Dr. Pérez and together they made new accommodations to fit people’s basic needs: more freedom, paid work, music, sports, and the right to safe sex. After the first three months of open-ended educational seminars, the patients were grilled about their knowledge of the sexual transmission of the virus and the risks of transferring it to healthy partners. A committee, which included patients, made the decision as to when a patient would be deemed ‘guaranteed’ — that is, trustworthy regarding HIV/AIDS transmission and the dangers of drugs and alcohol. Trusted patients were allowed to return to their families or friends on weekends and to take days off to do errands outside the complex. Some of the patients I met held jobs in the sanatorium, while others taught sex education classes at local schools. Some returned to the day jobs they once had.

A volleyball match at the sanatorium. (Photo courtesy of Nancy Scheper-Hughes.)

Volleyball was the favourite sport at the sanatorium. Cuba’s national volleyball team dominated the sport in the last decade of the 20th century. (Photo by Nancy Scheper-Hughes.)

Many contradictions played out in the so-called sanatorium. I met with the official epidemiologist at Los Cocos, who kept all the records and statistics bearing on the growth of the epidemic. He was delighted to learn that I knew University of California, Berkeley professor, Peter Duesberg, who was an infamous AIDS heretic. Duesberg did not believe that all the deaths were the result of a virus alone. Other factors, he said, such as recreational and pharmaceutical drug use, made people sick. The epidemiologist was a fan of Duesberg. Hearing this, one of the patients replied: ‘If you really think that AIDS is caused by multiple factors, then why am I here at all? If you are correct, I will kill you’, he said.

The bottom line, however, is that the containment of sexually active HIV/AIDS patients stopped an epidemic which neighbouring Caribbean countries, such as Haiti, could not (Farmer 1999). The numbers of cases and of deaths in the sanatorium were far fewer per capita than AIDS deaths in New York City and San Francisco. Global AIDS experts and the World Health Organization (WHO) praised the Cuban response to the epidemic. The New York Times described Dr. Pérez as ‘Cuba’s Anthony Fauci’ who was then the leading figure responding to the AIDS epidemic in the US. However, the US outcomes were dire as AIDS was politicized in the US as a human rights issue rather than as a catastrophic epidemic. Mandatory testing of partners of AIDS patients and of adult men living in areas with high rates of HIV was not seen as feasible. At the end of 2008, an estimated 1,178,350 persons in the United States were living with HIV infection, while in Cuba there were only 10,454 who were AIDS positive. In 1993, New York, which had roughly the same population as Cuba, had 43,000 cases of AIDS, while Cuba had only 900 validated by the WHO.

Residents of the sanatorium. (Photo by Nancy Scheper-Hughes.)

Patients in the hospital inside the sanatorium. (Photo by Nancy Scheper-Hughes.)

The sanatorium complex made sense within Cuban structures of social medicine and values of solidarity. Cuba was the only country that stopped the virulent spread of the epidemic before the discovery of retroviral drugs. As soon as these ‘miracle’ drugs became available in Cuba, the sanatorium became an ‘open door’ and voluntary community in 1994. Many patients chose to continue living there, and in some cases, to bring their partners and children to live with them. One story not yet told is how the patients at Los Cocos, over time, created the first official, open, gay community, which was recognized by the staff led by Dr. Jorge Pérez and his assistants. As the sanatorium changed, so did Dr. Pérez, who once told me that he had changed from a typical macho man to a softer person, one who now supports what he calls ‘love without boundaries’.

In 1993, I travelled to Cuba with CBS’s 60 minutes, for a segment on the AIDS sanatorium at Los Cocos. Dr. Pérez agreed to their visit as long as they would be open to a quite different point of view. The segment was played on US CBS Television on 3 October 1993. It was the first US media TV report that was critical but respectful and truthful about the positive results of the Cuban containment of HIV/AIDS. The brief documentary received an Emmy Award. Following my field trips to the sanatorium, I invited Dr. Jorge and two of his patients to give a public lecture at the University of California, Berkeley, to explain the logic of the Cuban AIDS project. During that time, California Americans saw the idea of an AIDS sanatorium as a human rights violation.

Residents on the grounds. (Photo courtesy of Nancy Scheper-Hughes.)

Residents on the grounds. (Photo courtesy of Nancy Scheper-Hughes.)

To bring Dr. Jorge Pérez and two of his patients to speak at the University of California, I needed an official letter from our chancellor to obtain visas for visitors from an ‘enemy’ country. Chancellor Chang-Lin Tien was enthusiastic about the invitation. I warned Tien that the university regents might be critical. The chancellor shrugged his shoulders and said: ‘Do you think we could bring Fidel Castro here as well?’ He really meant it.

When Chang-Lin Tien was an undergraduate at Princeton University in 1959, Fidel Castro made a visit to the university and to New York City. Tien was impressed with Castro and said that in his opinion, the US made a bad mistake in refusing to support Fidel at that time. So, with the support of our chancellor, Dr. Jorge Pérez and two of his patients arrived at our university. One of the Cuban patients had been infected while working as a Cuban doctor in Angola; the second was a civilian who contracted the virus in Havana and who worked inside the sanatorium as an IT manager.

The "AIDs Venus" on the grounds of Los Cocos. (Photo by Nancy Scheper-Hughes.)

The “AIDs Venus” on the grounds of Los Cocos. (Photo by Nancy Scheper-Hughes.)

As the Cuban doctors and researchers learned more about the virus, and after the arrival of antiviral drugs, the sanatorium at Los Cocos became voluntary. What an ‘open door’ sanatorium means is difficult to translate. After my third visit to the Cuban ‘complex’, I told Dr. Pérez that should I ever become seriously ill, I would ask permission to come to the sanatorium. To me, it was one of those practical utopian communities that can emerge from what Goffman called a ‘total institution’. Perhaps only a woman who once hoped to be a Carmelite nun and later to be a revolutionary Marxist health agent in Brazil during the dictatorship would feel this way. I suppose I was a bit of each.

The worst mistake about the AIDS epidemic in the U.S. was the decision to make HIV testing optional and voluntary, both for those who were ill and those who had lost a sexual partner to the virus. U.S. epidemiologists, public health leaders, and bioethicists argued that mandatory mass AIDS testing would result in AIDS-positive individuals going underground. But without the mandatory tests, America was flying blind into and throughout the AIDS epidemic, one that cost the deaths of thousands of people. Cuba managed to head off a potential disaster, especially given the 25,000 Cuban troops returning from Angola, many of whom arrived home with HIV and full-blown AIDS. The Cuban sanatorium at Los Cocos was an authoritarian institution which fermented anger and criticism in the United States, but praise in countries in Europe, Latin America, Asia, and Africa that were struggling with the epidemic.

From left: Dr. Jorge Pérez, Dr. Robert Herricks, and Nancy Scheper-Hughes at the sanatorium in 1990. (Photo courtesy of Nancy Scheper-Hughes.)

From left: Dr. Jorge Pérez, Dr. Robert Herricks, and Nancy Scheper-Hughes at the sanatorium in 1990. (Photo courtesy of Nancy Scheper-Hughes.)

When the sanatorium became a voluntary community in 1994, many patients chose to remain living in the community in which they had been well treated and where they had created friendships and solidarity. This reminds me of how the radical Italian psychiatrist, Franco Basaglia, deinstitutionalized mental health patients by first turning the traditional ‘mad house’ (manicomio) into an experiment in democratic psychiatry that resulted in Psychiatry inside out and a ‘revolution within the revolution’ (Scheper-Hughes & Lovell 1987).

It is no surprise that hundreds of Cuban doctors have been sent around the world to assist nations grappling with the Covid-19 pandemic. They have flown to at least 14 countries, where they have worked side by side with traumatized doctors like those in Bergamo, Italy, who had to make decisions that no doctor would want to make: deciding who would be most likely to live and those who had to be left to die. The Trump administration has ridiculed the Cuban doctors as medical diplomats for Cuba, while Cuba is also battling its Covid-19 epidemic.

Meanwhile, the U.S. president cannot recall from day to day whether Covid-19 is over or not, or who is next to be blamed for the miserable failings of his administration. As of this writing, the Covid-19 epidemic has taken 81,779 American lives. We first learned that the victims were elderly. Then we learned that most of the dead came from poor communities. Lastly, we learned that a disproportionate number of the deaths happened to be black.

Originally printed in Anthropology Today on June 4, 2020. Used by permission. Nancy Scheper-Hughes. (Photo by Mike Hughes.)

Nancy Scheper-Hughes is an activist and engaged anthropologist who has worked around the world, including Brazil. She is a professor emerita of Medical Anthropology at UC Berkeley.

REFERENCESFarmer, P. 1999. Infections and inequalities: The modern plagues. University of California Press: Berkeley.
Scheper-Hughes, N. 1994. AIDS and the social body. Social Science & Medicine 39(7): 991-1003.
— & A.M. Lovell 1987. Psychiatry inside out: Selected writings of Franco Basaglia. New York: Columbia University Press.

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Covid-19, Farmworkers and Research

By Johanna K. Schenner

Strawberry plants in Ventura County. (Photo by Amadeo Sumano.)

Strawberry plants in Ventura County. (Photo by Amadeo Sumano.)

The Covid-19 pandemic has demonstrated who the “essential workers” are that keep societies from collapsing. These include nurses, doctors, janitors, food processors, and farmworkers, among others. Another issue to which the pandemic has drawn increased attention is the high level of inequality that pervades employment in the United States.

My research focuses on how the health and safety concerns of farmworkers in the California strawberry industry are being addressed, including in relation to Covid-19. Many farmworkers are foreign-born, and either lack valid documents or are required to work under the particular rules set out by agricultural guest worker programs, making them ineligible for unemployment benefits, adequate (and paid) sick leave, and stimulus payments. This topic has become even more salient as farmworkers are labeled “essential workers.”

It is true that farmworkers’ employment conditions do not necessarily make them vulnerable to contracting Covid-19. They work outside, and implementing social distancing may be more easily accomplished than in other workplaces, although the successful implementation of these guidelines does depend on the crop. For instance, crews can be reduced in size and split across the field in the strawberry industry, while harvesting celery or lettuce comes with challenges, because workers for those crops follow the rhythm of a packing machine. At the same time, issues remain about accessing restrooms during breaktimes; the number of restrooms is limited in the fields, as is the amount of time allowed for breaks. Thus, farmworkers may risk exposing themselves to the virus from a co-worker.

Field workers during a break. (Photo by Amadeo Sumano.)

Field workers during a break. (Photo by Amadeo Sumano.)

However, the risk of contracting the virus is high when one looks beyond the field to consider other work-related factors that impact employees’ lives: transportation to and from work, as well as living situations. In order to arrive at work, farmworkers often share rides in cars or buses. Maintaining six feet of separation in such settings is difficult, although it can be done if enough vehicles are available, or if employers arrange for multiple trips to pick up workers in smaller numbers. A survey by the California Institute for Rural Studies has shown that farmworkers tend to live in overcrowded spaces. Both the lack of choice in mode of transportation and overcrowded housing are directly linked to their employment, as farmworkers are not necessarily able to make different choices due to their comparatively low wages.

While the Quarterly Census of Employment and Wages claimed in 2016 that farmworkers could earn up to US$30,300 per year, Martin and Costa have demonstrated that, realistically, the average farmworker’s annual wage is just below US$20,000. Considering that California is experiencing an affordable housing crisis, it goes without saying that farmworkers are unlikely to make ends meet by themselves, and therefore many of necessity have to share rides [1] and live in overcrowded residences.

Kicking off work in the morning. (Photo by Amadeo Sumano.)

Kicking off work in the morning. (Photo by Amadeo Sumano.)

These observations take place against the backdrop of California’s acute agricultural labor shortage. The labor shortage in this sector is not new, as shown by the ten-fold expansion in the use of the H-2A agricultural guest worker program. With a lack of workers to fill open positions, one would assume that the employment conditions in any industry would improve, because workers have a greater pool of employment opportunities than normal from which to choose, and therefore greater leverage/power in deciding which jobs to accept and under what conditions.

Unfortunately, this is not the situation for farmworkers. Employment may be comparatively “better” in California and on the West Coast of the United States in terms of pay — US$12-13/hour, depending on the size of the company — at least in comparison with the South, where wages do not necessarily exceed the federal minimum wage of US$7.25/hour. But even with such “good” wages, and in spite of the growing awareness of their essential role, farmworkers are at higher risk of poverty than other groups of laborers due to the high cost of living. Without farmworkers, there would be very little produce available on supermarket shelves, in farmers markets, and for food banks, as automation has not yet replaced manual labor in agriculture.

Covid-19 has plunged the world into the worst economic, political, and social crisis of the 21st century. However, moments of crisis are also opportunities to think about the bigger picture, and how to address issues that have persisted for too long, such as homelessness, lack of health care, and the plight of the working poor.

The author working in the field among workers in the fields. (Photo courtesy of Johanna K. Schenner.)

The author on the road. (Photo courtesy of Johanna K. Schenner.)

So where does the pandemic leave my research on employment conditions in the California strawberry industry? As a qualitative researcher who mostly conducts face-to-face interviews, I am currently “stranded,” as this method of data collection has been suspended by the Office for the Protection of Human Subjects (although interviews can be conducted over the phone and through teleconference services). It remains unclear when this suspension of fieldwork will be lifted. Though I may eventually be able to get into the field again, new precautions will have to be implemented, which will in turn change my mode of fieldwork: no more conducting interviews inside laundromats, but perhaps in parking lots and at a distance of six feet. Even with these changes, I am looking forward to getting out into the field as soon as possible and catching up in person with people to learn how they are coping with the pandemic.

[1] Sharing rides is not a ‘bad’ option per se, implying as it does less traffic congestion, CO2 emissions, and providing workers without cars the opportunity to labor in the fields. Indeed, some workers may actively choose to share rides for a variety of reasons. However, other workers have no other option if they want to get to and from work. In any event, sharing a car during the crisis — particularly if several workers are in the same vehicle — means they may be at a greater risk of exposure to Covid-19.



Johanna K. Schenner is a visiting researcher at the Institute for Research on Labor and Employment (IRLE) at UC Berkeley. Her research focuses on how multistakeholder initiatives attempt to alter employment conditions.

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Brazilian Youth Mobilize in the Streets and through the Digital, during Coronavirus and Beyond

By Alice Taylor

Brazil is now a coronavirus epicenter; it recently became the country with the second highest number of cases in the world, after the United States. At the time of writing, the number of confirmed cases surpassed 411,000 with over 25,000 deaths. Like Donald Trump, Brazil’s far-right President Bolsonaro’s pandemic-denying response has endangered citizens and led to the firing and resignation of two consecutive health ministers. The Lancet referred to Bolsonaro as perhaps the country’s biggest threat.

The first reported coronavirus death in Rio de Janeiro state was of a Black woman and domestic worker, an early and emblematic warning of the classed and racialized dimensions that the pandemic would take. In urban favelas of Rio de Janeiro and other cities, volunteers have been met with recent, though hardly new, police raids. Recent invasions have killed dozens of residents, including João Pedro, a 14-year-old boy. Coronavirus has not brought an end to violence against poor and Black Brazilians; it has compounded it.

When faced with injustices committed by the state, taking to the streets is among the most powerful tools citizens have. Yet the pandemic raises the question: what can be done when going to the street comes to a halt?

Building upon a long history of mobilizing, Brazilian social movements have confronted Bolsonaro’s anti-poor, violent, racist, and misogynistic rhetoric and policies at every turn. But with social and economic conditions worsening as the pandemic progresses, a range of social movements, urban favela organizers, and other citizens have stepped up even further. They not only speak out against Bolsonaro, but distribute food and supplies (which his administration does not provide), disseminate accurate information, and raise funds for their own communities. Youth movements, typically led by those aged 18 to 24, join forces to provide this kind of frontline aid in communities. But they have also held fast to a vital, long-term struggle: the fight for equitable access to public education.

Through ethnographic research in Brazil, my dissertation examines these youth movements and the practices and politics of their navigating classroom, street, and social media spaces to defend public education alongside struggles against capitalism, racism, and gender inequity. And since the start of the pandemic, I have observed how youth collectives have swiftly amplified their digital strategies.

A flag from the popular education movement Emancipa states, “Education is our weapon!” It depicts the face of Marielle Franco, a city councilwoman and former popular educator in Rio de Janeiro assassinated in 2018. (Photo by Alice Taylor.)

A flag from the popular education movement Emancipa states, “Education is our weapon!” It depicts the face of Marielle Franco, a city councilwoman and former popular educator in Rio de Janeiro assassinated in 2018. (Photo by Alice Taylor.)

The so-called Tsunami da Educação (Education Tsunami) protests of May 2019 and May 2020 are a case in point. Not long after entering office in January 2019, Bolsonaro attacked public education, severely cutting scholarships and budgets. On May 15, 2019 — and in several more protests in the following weeks and months — tens of thousands of youth and student activists took to the streets in every Brazilian state and the capital, Brasilia, chanting and raising banners to insist, “education is not a commodity” and “our weapon is education!” Inspired by popular education approaches, young activists and politicians in Rio de Janeiro spoke in public classes before marching down central streets.


“Classes will be in the street!” Protests from May 30 and June 14, 2019: during the pandemic youth activists are providing dozens of popular education classes and engaging in other forms of activism online. (Image left from estudantesninja social media, photo right by Alice Taylor.)

Digital poster from RUA Anti-capitalist Youth Movement, calling to postpone the ENEM and “No ENEM without us.”

Digital poster from RUA Anti-capitalist Youth Movement, calling to postpone the ENEM and “No ENEM without us.”

Fast forward to May 2020: As coronavirus swept their nation, youth looked back to the mobilizations on May 15, 2019 (there were subsequent education protests last year on May 30 and in the months that followed.) This time, the task at hand was to postpone the ENEM, Brazil’s primary university entrance exam. For 50 days, youth and student activists posted messages through campaign videos and organized a signature campaign which gathered over 350,000 supporters. A central site rallied over 4,000 campaigns and schools across the country to protest “no classes, no ENEM,” and provided statistics on how administering the exam as scheduled would more deeply divide the already unequal access to universities and education: 80% of state high schools have not held classes, and 42% of Brazilian youth lack computer access (with numbers up to 70% in the poorest communities.) By late May, the Senate voted to delay the exam.

Youth movements were digitally savvy long before the coronavirus, but the ways in which they are transforming activism is shifting the very nature and meanings of collective organizing in surprising ways. Since the first days of the pandemic, they have organized dozens of popular education courses, debates, events, and workshops that include scholars, activists, and politicians. Their approaches to addressing multiple grievances offer important lessons for other quarantined activists seeking social change across the world.

The puzzle of how to mobilize from a distance against the injustices that coronavirus exposes is one that Brazilian youth activists face together with organizers across the world. Some reporters have described protests as quieted, on hold, or “forcing activists to innovate.” Latin Americans in several countries revived traditions of pot-banging from their windows (panelaços or cacerolazos). Activists in Poland and Israel held socially distant protests. In Hong Kong, activists inserted pro-democracy messages in video games. In the U.S., health and other essential workers held strikes. Anti-government protests that began in Chile in October continued as activists projected images of protests onto buildings. Similarly, in Brazil empty night streets glowed with projections of Bolsonaro’s pandemic-denying rhetoric on tall buildings.

From the distribution of aid and fight to end police violence to providing and insisting upon access to education, from social media to new digital platforms, Brazilian youth activists have hardly remained quiet. The pandemic has heightened the need to defend lives already at risk. The ingenuity of youth activists is impressive, but the full burden cannot be left once again in the hands of the poor, youth, and unemployed who are often at the forefront of Brazil’s popular movements. As youth re-imagine a more equal society, they emphasize organize collectively; this organizing is shifting the very nature of activism, education, and everyday life in both transnational and local spaces.

NOTE: This blog post was written prior to the series of street protests that began in late May in nearly 150 cities across the U.S. after the police murder of George Floyd and others, and against ongoing racialized violence. Protesters now must weigh pandemic risks with outrage at police violence. Even as protesters return to the streets, digital activism continues to shift and be shaped by these events and the pandemic. In Brazil, young activists are protesting in solidarity and making parallels with the multiple killings in both countries. They simultaneously insist #vidasnegrasimportam in Portuguese, and #blacklivesmatter. Latin America matters for Black Lives Matter.


Alice Taylor
is a Ph.D. Candidate in the Graduate School of Education. Her work examines education, social movements, and critical studies of race, class and gender. She is affiliated with the Federal University of Rio de Janeiro’s Núcleo de Estudos de Trabalho. She lived and worked in Brazil from 2010-2016, and received the CLAS Summer Field Research Grant (2017, 2018).

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Argentina en tiempos del Coronavirus

por Martín Caruso Bloeck


El presidente Alberto Fernández se reunió, el 28 de enero, en Casa Rosada con el titular de la cartera sanitaria nacional, Ginés González García, quien le expuso un informe de situación acerca de la información epidemiológica existente a nivel mundial sobre el Coronavirus. (Foto de

Ya hace un mes que Alberto Fernández, Presidente de la República Argentina, anunciaba la entrada en vigor del llamado “aislamiento y distanciamiento social obligatorio”, el 20 de marzo. La medida implicó un cambio radical en la respuesta a la amenaza del Covid-19 cuando se lo compara a las insólitas declaraciones del Ministro de Salud, quien indicaba que “el coronavirus no funciona en el verano [argentino]” y que el país tenía otras prioridades.

A mi parecer, cabe caracterizar las medidas tomadas por el Gobierno desde entonces como terminantes. Las medidas de confinamiento en Argentina se destacan por su vigor: nada de traslados innecesarios, un paseo recreativo, ni siquiera ir al supermercado en pareja. A pesar de la falta de previsión y cierta inoperancia que suelen caracterizar a la dirigencia argentina, evidenciadas aún más por el coronavirus, me parecen dignos de destacar el liderazgo y la firmeza presidencial para tomar medidas frente a la situación.

La bala de plata, rehén de su propio éxito

Las medidas parecen estar dando resultados esperanzadores, aunque preliminares. La propagación de la enfermedad es lenta, el sistema sanitario no ha colapsado, y la proporción de tests positivos sobre realizados es relativamente baja. Es que en Argentina se ha venido probando de todo con tal de ayudar a mitigar la crisis. Aislar a comunidades enteras, tomar temperaturas, pruebas de olfato, tapabocas: lo que sea. Sin embargo, el ingenioso uso de estas herramientas low-tech (de baja tecnología) pone en evidencia fisuras que son transversales a muchos aspectos de la sociedad argentina. La cuarentena y todas estas medidas complementarias son lo único que hay para hacer frente al coronavirus, y por más ingeniosos que seamos los argentinos, la falta de recursos y previsión nos obligan a adoptar medidas con significativos daños colaterales.

Un conductor de autobús argentino usa una máscara para protegerse contra el coronavirus, marzo de 2020. (Foto de TitiNicola).

Un conductor de autobús argentino usa una máscara para protegerse contra el coronavirus, marzo de 2020. (Foto de TitiNicola).

Es así que nuestra bala de plata, el confinamiento, es rehén de su propio éxito. La ralentización del virus posterga el pico de contagios, lo cual obliga a una cuarentena más prolongada. Mientras que otros países han usado el tiempo ganado para implementar medidas menos perniciosas, cualquier intento por flexibilizar el confinamiento tiene complicaciones. Desde un aspecto operativo, está la consistente lentitud con la cual el país ha estado testeando a potenciales enfermos, lo cual pone en duda la capacidad de una rápida detección y respuesta ante un nuevo brote. Por otro, y esto es más bien una apreciación personal, está la manera en que puede ser interpretado cual intento de flexibilización. No por nada los argentinos tenemos un dicho que advierte sobre darle la mano a alguien y que éste nos agarre hasta el codo.

El menor de los males

Mientras más se extiende la cuarentena, más visibles se hacen sus perjuicios. La informalidad y las deficiencias crónicas en el mercado de trabajo dificultan la protección de los más vulnerables. El derrumbe en la actividad ha puesto en jaque a muchísimas pequeñas y medianas empresas (pymes) que arrastran una recesión de por lo menos dos años. El Gobierno ha hecho lo que ha podido para paliar los efectos de la crisis, otorgando ingresos de emergencia a los beneficiarios de programas sociales y créditos subsidiados a las pymes para que puedan pagar los sueldos de marzo. Y los de abril, Dios dirá. Para hacer las cosas peor, el país se encamina a su segundo año con inflación cercana al 50% y con poca perspectiva de que eventuales aumentos salariales lleguen a compensar más que una fracción de eso.

Es así que en todos los aspectos la capacidad de respuesta se termina chocando con la realidad que es la falta de recursos. Si el distanciamiento social hace estragos en las economías más pujantes del mundo, el problema es aún más grave en una economía como la Argentina que básicamente no ha crecido en diez años.

Captura de pantalla de un mapa constantemente actualizado de casos de coronavirus en Argentina desde La Nación. (Haga clic aquí para ver el mapa en vivo).

Captura de pantalla de un mapa, constantemente actualizado, sobre los casos de coronavirus en Argentina. Fuente: La Nación. (Haga clic aquí para ver el mapa en vivo).

Lo paradójico es que aún si Argentina fuera inmune al coronavirus, el efecto que éste tiene sobre los demás países sería por sí sólo un golpe durísimo a la economía argentina. Históricamente, Argentina ha sido especialmente vulnerable a los vaivenes de los mercados internacionales, y esta ocasión no es ninguna excepción. Para el colmo, el país se encuentra encarando una renegociación de deuda soberana con destino incierto en medio del riesgo de colapso en los mercados internacionales.

Probablemente sorprenda a muy pocos al recalcar lo nutrida que es la historia argentina en crisis económicas, tanto por su frecuencia como por su profundidad. Desde pequeños, nuestros padres nos cuentan las historias de las hiperinflaciones, crisis bancarias y fiscales. Y es así que intento disimular lo que puede terminar en una crisis de proporciones bíblicas cuando mi mamá me cuenta con angustia cuán complicado se pone el día a día. “No es nada por lo cual no hayamos pasado antes” le digo.

Mientras tanto, me pregunto si algún día estaré del otro lado del teléfono, si esta crisis será la que finalmente ponga al país en un sendero de progreso o si será otro tren que dejaremos pasar. Reflexiones de un día de sol californiano.

Martín Caruso Bloeck se encuentra actualmente cursando un Ph.D. en el Departamento de Economía de UC Berkeley. Antes de venir a Berkeley, Martín estudió en la Universidad Nacional de La Plata en Argentina y trabajó como consultor externo para el Banco Interamericano de Desarrollo. Sus intereses de investigación se encuentran en los campos de la macroeconomía y las finanzas internacionales.

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Understanding Amazonian biodiversity patterns through an economically important palm Oenocarpus bataua

By Giovanna Figueroa


Measuring an ungurahui leaf as part of the research. This one measured 8.81m long.
(Photo courtesy of Giovanna Figueroa.)

Notes from the Field: Student Research in Latin America
CLAS awards financial support to graduate students to travel to Latin America for pre-dissertation research. The following is a reflection on one student’s summer fieldwork experience. (For more information, please see CLAS Summer Field Research Grants.)

The Amazon basin is known to be the world’s most biodiverse region, harboring a variety of flora and fauna. Recent fires in the Brazilian Amazon have brought a lot of attention to the ways in which forest resources are managed and the rapid loss of tropical habitats due to deforestation. While it is true that we must act quickly to protect this ecosystem, the notion of a “pristine” forest that is often presented in popular news can be misleading. In actuality, humans have been managing the forest and domesticating plants for at least 10,000 years. (1) The main difference between then and now is the ways in which humans are using the forest.

Through the generous support of the Center of Latin America Studies at UC Berkeley, I was able to spend three months in the Peruvian Amazon studying an economically important palm tree, Oenocarpus bataua, locally known as ungurahui. This tree provides both humans and animals with a nutritious fruit, rich in protein and oil year-round. Additionally, its trunk and leaves are used for construction and crafts. The ecology of this plant is interesting, as it is the 7th most abundant tree species in the Amazon basin, found in Venezuela, French Guiana, Brazil, Colombia, Peru, and Ecuador. It is part of a subset of 227 species of trees which are considered hyperdominant, because they are much more abundant than the rest of the estimated 16,000 tree species in the region, and together make up more than half of the individual trees found in the Amazon. (2) Put another way, 1.41% of the estimated 16,000 tree species are very common, and the other 98.6% of tree species are rare. Being hyperdominant and economically useful isn’t unique to ungurahui. Studies have found that plants which are used by humans tend to be hyperdominant, and archeological sites have a higher proportion of hyperdominant tree species than surrounding forests. (3)

At the crown of an ungurahui. (Photo courtesy of Giovanna Figueroa.)

At the crown of an ungurahui.
(Photo courtesy of Giovanna Figueroa.)

This begs the question, are these plants abundant as a result of human management or have humans simply learned to use the resources which are most readily available to them? Perhaps this pattern could be due to some combination of human management and the overall ecology and survival strategy of these plants. These are the questions that initially brought me to Peru to study ungurahui. There has been a notable increase in demand and consumption of Amazonian products around the world (think açai), from which ungurahui is not exempt. Its pulp is used to make ice cream and oil for hair and cosmetic products in areas outside of the its natural range. In order to keep up with the demand, some people have turned to cutting down trees to harvest the fruit instead of traditional climbing methods. What are the possible implications of recent changes in human management of this hyperdominant species?

In order to begin answering these questions, I started working with a local pulp processing organization – Recursos Amazonicos Frutales (RAF SAC), based in Iquitos. They have designed specialized palm climbing gear, called a maquisapa, which makes harvesting fruits both safer and easier. RAF SAC personnel go around to communities where ungurahui is found and provide training workshops on how to use the maquisapa. They then work with these communities to purchase sustainably harvested fruits from them, which are processed, frozen, and sold around Iquitos.


A different view of the 8.81m leaf shown earlier.
(Photo courtesy of Giovanna Figueroa.)

I targeted communities where RAF SAC works, which are found along different watersheds, to collect O. bataua fruits, leaves, and soil samples. I also recorded census data to understand how ungurahui varies in different locations and habitat types. My research began in San Juan de Raya (Raya), a community of about twenty houses found on the bank of the Río Pintuyacu. I teamed up with a resident of Raya who helped me find a population of Oenocarpus bataua about 30 minutes upstream. We used the maquisapa to climb the trees and a special pole saw to collect fruit samples and leaf tissues, which will be used for genetic analysis and to make herbarium specimens. After talking to a few locals from Raya, I learned how local changes in the weather affect the time for fruit to mature — more rain speeds up the ripening process. I was taught how to prepare chapo, a traditional beverage, which is made by macerating the pulp in a small volume of water and drunk with sugar and dried manioc. The chapo was shared with the community, but I kept the seeds for subsequent analysis and experiments after the collection trips.

Making chapo de ungurahui by macerating fruits in water (left), and picking out seeds from macerated pulp mixture to use for germination experiments (right). (Photos courtesy of Giovanna Figueroa.)

Making chapo de ungurahui by macerating fruits in water (left), and picking out seeds from macerated pulp mixture to use for germination experiments (right).
(Photos courtesy of Giovanna Figueroa.)

After a few days back in Iquitos, where we sterilized and froze the collected fruits, our team arrived in Nueva York, a larger community found on the Río Tigre. We had heard that the fruits from this site were different in texture and produced more oil than fruits from other regions. Locals confirmed this, but we were not able to find any trees bearing mature fruits to see for ourselves. We learned that felling trees is more common than climbing there, which we were able to confirm during our search for fruiting trees. The only trees which had any signs of recently producing fruits had been cut down.

A recently felled O. bataua tree in Nueva York. (Photo courtesy of Giovanna Figueroa.)

A recently felled O. bataua tree in Nueva York.
(Photo courtesy of Giovanna Figueroa.)

Our last two trips along the Ríos Blanco and Ucayali were completed in October 2019. We were able to census and collect from three ungurahui populations, and found two other Oenocarpus species, O. balickii and O. mapora, that were also sampled. Using all the seeds from the collecting trips, I set up a manipulative experiment aiming to understand how density, distance, and different origin sites affect seed germination and survival. These will be monitored while I am offsite by local collaborators.

I will be collaborating with researchers from the Institute of Research and Development in Montpellier, France and the Instituto de Investigación de la Amazonía Peruana in Iquitos to perform nutritional content studies on the fruits that we collected. We will also be extracting and sequencing DNA from leaf samples in order to get a better understanding of the ways that humans and the environment influence one another. I will be returning to Iquitos in a few months to continue collecting and monitoring the progress of my experiment.

1. Clement, C., De Cristo-Araújo, M., Coppens D’Eeckenbrugge, G., Alves Pereira, A. & Picanço-Rodrigues, D. Origin and Domestication of Native Amazonian Crops. Diversity 2, 72–106 (2010).
2. ter Steege, H. et al. Hyperdominance in the Amazonian Tree Flora. Science 342, 1243092–1243092 (2013).
3. Levis, C. et al. Persistent effects of pre-Columbian plant domestication on Amazonian forest composition. Science 355, 925–931 (2017).

Giovanna Figueroa.Giovanna Figueroa is a Ph.D. candidate in the Department of Integrative Biology at UC Berkeley. She specializes in tropical plant ecology, specifically understanding drivers of plant abundance and diversity patterns in Amazonia. She has worked in the Peruvian Amazon since 2018 and will continue to expand her work there and in other Amazonian regions for her dissertation.

Giovanna is a recipient of the 2019 CLAS Summer Field Research Grant.

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Investigating the link between Drinking Water Quality and Chronic Kidney Disease in Jalisco, Mexico

By Kaitlyn Jackson


Kaitlyn at the biology laboratory of the Instituto Tecnológico y de Estudios Superiores de Occidente (ITESO), analyzing water sample results for total coliform bacteria and E. coli. Yellow bottles indicate positive for total coliforms. (Photo courtesy of Kaitlyn Jackson.)

Notes from the Field: Student Research in Latin America
CLAS awards financial support to graduate students to travel to Latin America for pre-dissertation research. The following is a reflection on one student’s summer fieldwork experience. (For more information, please see CLAS Summer Field Research Grants.)

Mexico is currently facing a public health crisis in chronic diseases. The Institute for Health Metrics and Evaluation (IHME) most recent data for Mexico (2017) shows that chronic kidney disease (CKD) is the second largest factor in Disability Adjusted Life Years (DALYs), a metric that combines deaths and disability. This trend has held constant since 2007. In 2016, non-communicable diseases (NCDs) were responsible for 80% of the countrywide deaths in Mexico, with diabetes and heart disease accounting for 40% of all NCD-related deaths. Chronic Kidney Disease in Mexico causes 25% of deaths related to diabetes and 28% related to heart disease. Hospital admissions for patients under the age of 25 suffering from CKD have skyrocketed, tripling in some areas of Mexico in the last five years.

Concurrently, over-exploitation of Lake Chapala, Mexico’s largest freshwater reservoir, has resulted in a serious water crisis. The state and federal water authorities continue to utilize this precious resource for drinking water, agriculture, and industry, and continue to develop infrastructure in response to increasing urban and agricultural demands. Lake Chapala provides sixty percent of the drinking water to Guadalajara, a city with a population of over four million. Not only have population growth and agricultural demands depleted Lake Chapala’s water levels, which in turn lowers water quality, but also the Santiago River, which is fed by Lake Chapala, contains an estimated 1,090 toxic pollutants. Inhabitants of rural communities such as Mezcala, San Pedro Itzicán, and the small city of Chapala are suffering from epidemic rates of CKD, especially in young adults and adolescent populations. This is highly unusual, as CKD typically affects older adults or those with diabetes.


Children playing in Chapala, Jalisco, Mexico. (Photo courtesy of Kaitlyn Jackson.)

Chronic diseases place a burden on both individuals and healthcare systems, and hinder economic growth, highlighting our purpose in investigating all risk factors of CKD, including drinking water quality, access, and consumption behavior. Under the guidance of Professor Charlotte Smith, we set out to unravel the mystery behind this drastic rise in CKD within the rural and primarily indigenous communities Mezcala and San Pedro Itzicán, as well as in Chapala, one of the more prominent cities within the region of the Chapala Lake basin.  

Beginning in January 2019, our research team formed a collaborative partnership with the Instituto Tecnológico y de Estudios Superiores de Occidente (ITESO) to develop a mixed-methods study to collect preliminary data in Mezcala, San Pedro Itzicán, and Chapala, under the framework of the 6th Sustainable Development Goal — access to safe water as a human right. Over the last five years, ITESO has built extensive and trusted relationships in the three communities mentioned above. A strong alliance was built combining ITESO’s expertise in hydrology and engineering and UC Berkeley’s in drinking water exposures and public health.

The town of San Pedro Itzican from above on the shores of Lake Chapala. (Photo courtesy of Kaitlyn Jackson.) 

Between May and August 2019, we conducted 99 household surveys, 12 key informant interviews, and 6 focus groups regarding perceptions of drinking water, health behaviors, exposure to environmental and occupational contaminants, and relevant disease history. Through 15 key informant interviews with religions leaders, local non-profits, municipal government employees, indigenous leaders, and distinguished academics with knowledge and experience working in the Jalisco region of Mexico, we gained insight and built the trust which allowed us to return each and every week.

Because chronic disease exposures are more complex than acute diseases like diarrhea, and often involve multiple exposures as well as genetic predispositions, we conducted a project to both amplify the local voices who had previously been silenced and ignored, and additionally share collected information to give these vulnerable populations the tools to call for action. Organizing focus groups with volunteer brigade members, youth leadership organizations, fisherman unions, families suffering the severity of a CKD diagnosis, and the board members of an indigenous community group allowed for us to have extended conversations with diverse groups of people, to hear first-hand of their lived experiences. Elderly participants gazed into the distance with a forlorn look in their eyes, describing a time when, as children, they swam, drank, bathed, and played in Lake Chapala. When we gazed out into the vast hazy green lake, our research team listened as these same participants described with disgust the decline of the lake’s health over the last 20 years. No one dares to take a swim these days.


The community church located in the town square of Mezcala, located on the banks of Lake Chapala. (Photo courtesy of Kaitlyn Jackson.)

Simultaneously, our team collected data on drinking water quality, food consumption, and occupational and lifestyle behaviors. We tested water quality in participating households, measuring levels of arsenic, copper, nitrate, nitrite, total chlorine, free chlorine, and the presence or absence of total coliforms and E. coli. Primary drinking water sources included purchased 20-liter garrafones from local manufacturers, tap water, and rooftop water tanks. Water quality testing for environmental and microbial contaminants allowed for comparisons between water quality perceptions and reality. After analysis, members of our research team will return to Mezcala, Chapala, and San Pedro Itzicán to deliver individual participant results, as well as workshops to discuss and interpret the importance and meaning of each and every result.

It was tragic to meet mothers, brothers, sisters, and daughters, all of whom either had or knew someone dying of kidney failure. Seeing this first-hand has motivated our research team to continue forward with our project in a way that directly benefits the involved communities. Following the lead of our collaborators at ITESO, we have agreed to assist in the production and content of a documentary to spread awareness throughout Jalisco and Mexico about this public health crisis. We have begun to analyze our dataset using geospatial statistical methods. Preliminary results suggest that inhabitants of the Lake Chapala basin face significant structural barriers in accessing safe drinking water. We hope that our results from this study will support calls for action by local communities during this water crisis. The knowledge gaps surrounding the true CKD burden, in tandem with a growing local water crisis and decreasing water quality, highlights the need for increased attention to Lake Chapala and the need for access to clean drinking water. The hope is that by synthesizing public health research with community participation, we can provide these vulnerable populations with the strength and confidence to seguir adelante.

KaitlynJackson-250pKaitlyn Jackson will be graduating with her MPH from the UC Berkeley School of Public Health Global Health & Environment program this May. A backpacking fanatic from the Pacific Northwest, Kaitlyn’s passion for Spanish was born while spending two weeks living in a coffee farming community in the Dominican Republic when she was 15 years old. This passion led her all the way to Santiago, Chile, where she spent three years working for two social impact organizations. Kaitlyn’s dedication for global public health stems from her desire to focus on enhancing the lives of the most vulnerable and underserved through public health solutions grounded in data driven evidence. In her free time, you can find Kaitlyn experimenting in the kitchen with spices from across the globe or walking her black lab, Layla. Kaitlyn is a recipient of the 2019 CLAS Summer Field Research Grant. 

A photo of a household water sample directly taken from the tap. Yellow indicates coliform bacterial contamination. Two live mosquito larvae were also detected. (Photo courtesy of Kaitlyn Jackson.)


Drinking water well pump in San Pedro Itzican. This pump pulls water from a thermal underground water source. The pipes of this well are therefore scalding hot to the touch, due to the high natural water temperature. A pigpen is located next to the well.  (Photo courtesy of Kaitlyn Jackson.)


The author conducting a focus group with fisherman and fishing families in the town of Mezcala. (Photo courtesy of Kaitlyn Jackson.)

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Why Bolsonaro backtracked on firing Mandetta

By Carolina Botelho

20/03/2020 Coletiva de Imprensa do Presidente da República, Jai

Brazil’s president, Jair Bolsonaro (with mask off), at a press conference on Covid-19 with his health minister (third from left), Luiz Henrique Mandetta, March 22, 2020. (Photo by Isac Nóbrega / PR.)

The president’s backtracking was only possible because a considerable part of the Brazilian elite felt threatened.

Read this article in Portuguese

(Please note: After this article was written, President Jair Bolsonaro of Brazil fired his health minister, Luiz Henrique Mandetta, on April 16, 2020.)

April 6th was a particularly tense day for Brazil. Not for the normal reasons to which we have already become accustomed, such as the President of the Republic, his children, and his supporters. No, this day went beyond that. The threat to dismiss the only minister who seems to value the idea of the republic, as is expected from a public servant, had already been announced. Bolsonaro was going to fire Luiz Henrique Mandetta, the Minister of Health. Mandetta is the only person on Bolsonaro’s team who has shown concern and acted to save lives in this horrible epidemic that has generated alarm in almost all of the world, or at least the “civilized” world. By the end of the day, the president had backtracked, or rather, others had pushed a reversal of Bolsonaro’s decision. Who were they?

This is an important question at the moment. Who made Bolsonaro backtrack on his decision? Normally in a democracy, it would be expected that political and social institutions would recommend the necessary caution to the president in the face of the threat of Covid-19. It would also be expected that he would accept these recommendations. In the case of Brazil, institutions have fulfilled their roles, but Bolsonaro has disregarded all of them, dismissing scientific debates and expert knowledge. The results of this equation are simple: our democracy loses on a daily basis. However, April 6th seemed different. Many analysts argue that it was the generals who surround Bolsonaro and contain his “excesses” who demanded that the president backtrack. While I agree with this theory, it is not the complete answer. So, I rephrase the question as, “Who were the generals listening to before they made Bolsonaro backtrack?”


I want to emphasize a common theme in social science literature (the field most despised and denigrated by Bolsonaro): elite theory. I studied a little of this theory as an undergraduate, and then used it in my master’s thesis almost two decades ago. In 2019, when organizing an undergraduate course, I judged the theory to be important enough to include in the bibliography, and I do not regret it.

Jair Bolsonaro com o presidente dos EUA, Donald Trump, na Flórida, em 7 de março de 2020. Um membro da equipe de Bolsonaro testou positivo para o coronavírus alguns dias depois. (Foto de Alan Santos / PR.)

Jair Bolsonaro with U.S. President Donald Trump in Florida on March 7, 2020. A member of Bolsonaro’s team tested positive for the coronavirus a few days later. (Photo by Alan Santos / PR.)

Recently, a Datafolha poll showed that 51% of people interviewed said that Bolsonaro is more harmful than helpful in the fight against the coronavirus, and 39% of interviewees disapproved of the President in general. This would be easy enough to accept. However, this data also highlights more interesting results: Bolsonaro is poorly rated by women (43% disapproval), people with higher education (50%), and the rich (those with wages equal to or greater than 10 times the minimum wage, 46%).

The president will say that he does not trust polls, but elite theory explains why Datafolha is correct, and why part of Brazilian society has backed away from its support of Bolsonaro.

With the caveat that social isolation has altered the methodology of the most recent polls, disapproval of the President among the richest Brazilians has grown from 28% in December to 46% in April. The importance of this group is not trivial. Bottomore, an elite theorist, has shown that elites can exercise a true veto power in support of a country’s economic and political development. As observed by Elisa Reis, even the possibility of gradual change depends considerably on the acquiescence of the elites. According to Reis, “the importance of the elites lies in the direction and control they can exercise over the complex and difficult transition of one form of organization to another.”

Abram de Swaan’s work addresses the emergence of national social welfare policies in Europe. To de Swaan, the elites’ perception of social problems has a fundamental importance. Along with Reis, de Swaan argues that, in the case of Europe, the elites saw advantages in the collectivization of solutions to social problems, and public power became the natural agent in the provision of “citizenship goods” like health, education, and social security. For de Swaan, the elites are, as a general rule, self-serving, and they act to avoid “negative external effects” such as epidemics, pollution, crimes, rebellions, and migrations.

Ruas vazias em São Paulo, 5 de abril de 2020. (Foto de Elize Massard da Fonseca.)

Empty streets in São Paulo, April 5, 2020. (Photo by Elize Massard da Fonseca.)

In my master’s thesis, my main hypothesis suggested that among the Brazilian elites, there are few similarities with the European ones analyzed by de Swaan. I argued that there is no awareness of interdependence of social classes, which would enable mobilization to solve problems in Brazil in a cooperative way, facilitating the creation of social policies that favor the poor. However, at that point we had not felt the weight of an epidemic, or rather, of a pandemic such as we are experiencing today.

Brazilian society is facing many risks if the government does not take urgent responses. I say the entire society because the negative effects will be shared by all. It is certain some will be affected more than others, but all will lose. Losses will start with the spread of a lethal and up until now little-known virus, which entered the country via the travel of elites. Losses will continue with the lack of hospital beds, a worsening economic crisis, the threat of social upheaval, and looting by groups that are desperate for assistance. Everyone will be affected.

The decision to backtrack on the firing of Mandetta was only possible because a considerable portion of the elite were feeling threatened, as reflected in the polls. While this does not guarantee that the Minister of Health will remain in office, it does add support to some of his policies that will help control the epidemic. It remains to be seen what these elites think about the importance of democracy.

This article was originally published on Nexo on April 7, 2020, and was translated by CLAS staff.

Carolina Botelho.Carolina Botelho is a researcher at Pontifícia Universidade Católica do Rio de Janeiro, and a professor and postdoctoral fellow at Escola Nacional de Ciências Estatísticas / Instituto Brasileiro de Geografía e Estatística. She holds a doctorate in political science from the Instituto de Estudos Sociais e Políticos da Universidade do Estado do Rio de Janeiro, and a master’s degree in sociology and anthropology from the Universidade Federal do Rio de Janeiro. She is an Affiliated Scholar of the Center for Latin American Studies at UC Berkeley.

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The Treatment and Control of Chronic Disease in Chile

By Claire Boone


Very excited to be at the Ministry of Health in Santiago, Chile. (Photo courtesy of Claire Boone.)

Notes from the Field: Student Research in Latin America
CLAS awards financial support to graduate students to travel to Latin America for pre-dissertation research. The following is a reflection on one student’s summer fieldwork experience. (For more information, please see CLAS Summer Field Research Grants.)

Chronic diseases such as hypertension and type 2 diabetes are increasingly affecting Latin America: currently about half of the years of life lost in the region are attributable to chronic disease. (1) In Chile about a third of the adult population has hypertension, double the prevalence in the United States. (2) While Chile has recently been categorized as a high-income country by the World Bank, income inequality is extremely high, and the difference in quality of life between the richest and poorest wealth quintiles is stark. Unsurprisingly, the poorest sector of the population also bears a disproportionately large disease burden, particularly of chronic diseases.

Risk factors for chronic diseases are often more prevalent in low-income populations, and Chile is no exception. Common risk factors include being overweight or obese, a diet low in fruits and vegetables and high in sugars, and a sedentary lifestyle. In 2015, Chile set the then-record for the highest consumption of soda calories per capita, surpassing the United States.

So, how can a country halt or even reverse the trend of increasing chronic disease?

There are two main policy areas to focus on: prevention and treatment. Prevention – or preventing those who aren’t sick from becoming sick – has been the focus of a major policy movement in Chile, something the New York Times recently called “the world’s most ambitious attempt to remake a country’s food culture.” (3)

The movement includes several high-profile policies: a sugar tax introduced in 2014, which at 18% is one of the highest in the world. A ban on marketing of unhealthy foods to children, which includes the removal of all mascots from cereal boxes, cookies, and candy. And the Food Labeling Act, which adds stop sign-shaped labels to all foods high in sugars, salt, fat, or calories.


The Primary Care Division (División de Atención Primaria, DIVAP) at the Chilean Ministry of Health in Santiago was where I called home this summer. My coworkers supplied me with a desk, great internet, and excellent lunch company. (Photo courtesy of Claire Boone.)

Evaluations of these policies are currently ongoing and it is likely too early to say whether they have successfully prevented any chronic disease. They do seem to be changing behavior, which is a crucial first step: a recent evaluation found the promising evidence that the food labelling policy was associated with a 18-25% reduction in sugar-sweetened drink consumption.

In the meantime, Chile is also working to better control disease among patients already diagnosed.

Health care in Chile is two-tired, with three quarters of the population using the large government-provided system, FONASA, and the rest paying for private insurance. In the public sector, the Ministry of Health established the Programa de Salud Cardiovascular (Program for Cardiovascular Health) over 15 years ago. This program includes free primary care as well as free medications for patients diagnosed with hypertension, type 2 diabetes, and/or dyslipidemia.

An interesting component of the cardiovascular program, and the focus of my research, is the appointment reminder system. Patients attending primary care facilities who are enrolled in the cardiovascular program receive an SMS reminder 24-48 hours before their scheduled appointment. If they do not have a cell phone, an automated call is made to their landline. Importantly, the patient has the option to respond either confirming or cancelling the appointment. If it is cancelled, the slot is automatically assigned to another patient.

In a public health care system health care provider working hours and wait times for appointments are major ongoing concerns. This appointment rescheduling program has the capacity to function both as a timely reminder to patients with chronic disease and as a way to improve efficiency within the system. Since patients are able to cancel on short notice the facility might be able to see more patients overall, as fewer slots will be wasted on no-shows.

Last summer, our team worked to evaluate the impact of the SMS appointment reminder program on the number of appointments made at each facility. Since the program was implemented in different facilities at different times, we were able to evaluate the program’s impact on two groups: chronic patients who receive the SMS reminders, and non-chronic patients who do not receive the reminders but who attend clinics where the SMS program was implemented.

Mornings were improved after the discovery of a cheap fruit vendor near to the metro! (Photo courtesy of Claire Boone.)

A typical work day at DIVAP included meetings, brainstorming with ministry of health workers, and lots and lots of wrestling with very large datasets. Mornings were improved after the discovery of a cheap fruit vendor near to the metro! (Photo courtesy of Claire Boone.)

Interestingly, we found that the SMS reminders did not change the number of appointments chronic disease patients attended, on average. While at the time we didn’t have the data to test this, it seemed that some chronic patients were cancelling on short notice. This allowed for more appointment slots to open up for non-chronic patients: we found that non-chronic patients who attend clinics with the SMS program attended more appointments.

This study left us with more questions than we started with, and so I returned to Santiago, Chile in summer 2019 to continue the work, this time more closely with the Ministry of Health.  I was based on the Primary Care Division of Chile’s Ministry of Health in Santiago (MINSAL DIVAP). During the month I spent there, I worked with local researchers to access and clean the four large datasets we will use in this new impact evaluation: electronic health records from primary care appointments, medication prescription and withdrawal data, emergency room records, and data on SMS reminders sent and received.

These data are huge in scale – they represent about 60% of all patients in Chile with a chronic disease. Now we will be able to measure not only the impact on appointment attendance, but also the impact of the program on health and health behaviors, such as prescription refills.

The evaluation team — myself, DIVAP, and collaborators at the public policy school at La Pontificia Universidad Católica de Chile — worked to create an evaluation plan and formalize study outcome definitions. Using very large datasets has its challenges, but working with the ministry’s IT team, we managed to transfer all the data we need to complete this evaluation in a couple of months.  The analysis is well underway, and the results of this study will be used to directly inform decisions at Chile’s Ministry of Health.


  1. Anauati MV, Galiani S, Weinschelbaum F. The rise of noncommunicable diseases in Latin America and the Caribbean: challenges for public health policies. Lat Am Econ Rev. 2015 Dec 1;24(1):11.
  2. Fasce E, Campos I, Ibáñez P, Flores M, Zárate H, Román O, et al. Trends in prevalence, awareness, treatment and control of hypertension in urban communities in Chile: J Hypertens. 2007 Sep;25(9):1807–11.
  3. Caballero, Victor Ruiz, “In Sweeping War on Obesity, Chile Slays Tony the Tiger.” The New York Times, February 7, 2018.

Claire Boone.

Claire Boone is a Ph.D. student in Health Policy/Health Economics at UC Berkeley. She holds an MPH in epidemiology/biostatistics. She specializes in the evaluation of health policies and programs, and is particularly interested in the prevention and management of chronic diseases. She has been working with researchers and policy makers in Chile for three years, and plans to continue this work for her dissertation.

Claire is a recipient of the 2019 CLAS Summer Field Research Grant. 

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Por que Bolsonaro recuou e não demitiu Mandetta

Por Carolina Botelho

20/03/2020 Coletiva de Imprensa do Presidente da República, Jai
Presidente Bolsonaro e seu ministro da Saúde (à sua direita). (Foto de Isac Nóbrega/PR.)

A marcha à ré do presidente só foi possível porque uma parte considerável da elite brasileira se sentiu ameaçada

A última segunda-feira (6) foi um dia especialmente tenso para o país. Não pelos motivos ordinários que já estamos nos acostumando a naturalizar em relação ao presidente da República, seus filhos e seus apoiadores. Não, esse dia foi um pouco além. A ameaça real de demissão do único ministro que parece valorizar a ideia de república como se espera de um gestor público tornou-se quase palpável e já havia sido anunciada. Bolsonaro iria mandar embora o seu ministro da Saúde, o único do time que tem se preocupado e agido para poupar vidas num período horrível da história das epidemias com o qual o mundo “quase” todo, ou pelo menos, o mundo “civilizado”, tem se preocupado. O presidente ao final do dia voltou atrás, ou melhor dizendo, voltaram atrás na decisão de Bolsonaro. Quem foi?

Essa é uma importante interrogação neste momento. Quem fez Bolsonaro voltar atrás? Em uma democracia na qual os eventos ocorrem de maneira tranquila, seria esperado que as instituições políticas e sociais recomendassem ao presidente a prudência necessária diante da ameaça da covid-19, e ele aceitaria. No caso brasileiro, as instituições têm cumprido seu papel, mas Bolsonaro despreza todas elas, desqualifica o debate científico e deslegitima os especialistas. O resultado dessa equação é simples, nossa democracia perde diariamente, mas ontem pareceu diferente. Uma grande parcela dos analistas afirma que foram os generais que hoje circulam em torno de Bolsonaro para conter seus “excessos” que exigiram a marcha à ré do presidente. E eu concordo, só que essa não é toda a resposta. Dito isso, reformulo mais uma vez a frase: a quem os generais ouviram para depois fazerem Bolsonaro recuar?


Tenho insistido em um tema muito frequente nos estudos das ciências sociais, aquela ciência mais desprezada e desqualificada por Bolsonaro (por quê?): a teoria das elites. Estudei um pouco sobre ela na graduação e também utilizei a teoria na minha dissertação de mestrado há quase duas décadas. Em 2019, ao oferecer um curso para a graduação, julguei o assunto importante para incluir na bibliografia e não me arrependo.

Jair Bolsonaro com o presidente dos EUA, Donald Trump, na Flórida, em 7 de março de 2020. Um membro da equipe de Bolsonaro testou positivo para o coronavírus alguns dias depois. (Foto de Alan Santos / PR.)
Jair Bolsonaro com o presidente dos EUA, Donald Trump, março de 2020. Um membro da equipe de Bolsonaro testou positivo para o coronavírus alguns dias depois. (Foto de Alan Santos / PR.)

Recentemente, o Datafolha mostrou que 51% das pessoas entrevistadas disseram que Bolsonaro mais atrapalha do que ajuda no combate ao coronavírus e 39% reprovam o presidente de modo geral. Seria algo simples de aceitar, mas esse dado traz um resultado mais interessante. Bolsonaro é mais mal avaliado por mulheres (43% de reprovação), pessoas com curso superior (50%) e mais ricos (acima de 10 salários mínimos mensais, 46%).

O presidente dirá que não confia em pesquisa, mas a teoria das elites explica por que o Datafolha está correto e parte dos brasileiros desembarcou da sandice do projeto Bolsonaro.

Embora a metodologia tenha sido alterada nas últimas pesquisas devido ao isolamento social, entre os mais ricos, a reprovação ao presidente subiu de 28% em dezembro para 46% em abril. A importância desse grupo nas sociedades não é trivial. Bottomore, um teórico das elites, já mostrou que elas são capazes de exercer um verdadeiro poder de veto aos rumos do desenvolvimento econômico e político de um país. Como observou Elisa Reis, até as possibilidades de uma mudança gradativa no Brasil dependem consideravelmente da aquiescência das elites. Segundo ela, “a importância das elites está na direção e no controle que elas podem exercer sobre a complexa e difícil transição de uma forma de organização social para outra”.

Abram De Swaan tratou da emergência de políticas nacionais de bem-estar social na Europa. Para ele, a percepção das elites sobre os problemas sociais possui um significado fundamental. No caso da Europa, e como bem lembrou também Elisa Reis, De Swaan mostra que as elites viram vantagens na coletivização de soluções a problemas sociais e que o poder público tornou-se o agente natural na provisão de “bens de cidadania” como educação, saúde e previdência. Para De Swaan, a elite é, em regra, interesseira e age com o objetivo de evitar os “negative external effects” que ele exemplifica com epidemias, poluição, crimes, rebeliões e migrações.

Ruas vazias em São Paulo, 5 de abril de 2020. (Foto de Elize Massard da Fonseca.)
Ruas vazias em São Paulo, 5 de abril de 2020. (Foto de Elize Massard da Fonseca.)

No meu estudo realizado no mestrado, a minha hipótese principal sugeria que não há, entre as elites brasileiras, semelhanças com as analisadas por De Swaan, ou seja, não existe entre elas uma consciência sobre a interdependência das classes sociais, o que viabilizaria uma mobilização para a solução dos problemas no Brasil, de forma cooperativa, para facilitar a criação de políticas sociais que favorecessem os pobres. Entretanto, até aquele momento, ainda não tínhamos sentido o peso de uma epidemia, ou melhor, de uma pandemia como o que estamos experimentando hoje em nossas vidas.

Concretamente falando, a sociedade corre muitos riscos, caso o governo não tome medidas urgentes. Digo toda a sociedade porque os efeitos negativos serão partilhados por todos. Está certo que recairá mais para alguns grupos do que para outros, mas todos vão perder. A começar pela contaminação por um vírus até então pouco conhecido e letal, que entrou no país via elite, mas também pela falta de leitos, a crise econômica que se agravará, a ameaça de convulsão social e de saques pelos grupos que estão desassistidos. Todos vão ser afetados.

A marcha à ré de Bolsonaro só foi possível porque uma parte considerável do grupo da elite captado pelas pesquisas se sentiu ameaçada. O que por sua vez, não garante longa permanência ao seu ministro da Saúde, mas dá fôlego a algumas políticas de controle da epidemia. Resta saber o que esse grupo pensa sobre a importância da democracia.

Publicado originalmente no Nexo, 7 de abril de 2020

Carolina Botelho.

Carolina Botelho é pesquisadora da PUC-Rio (Pontifícia Universidade Católica do Rio de Janeiro), professora e pós-doutoranda do Ence/IBGE (Escola Nacional de Ciências Estatísticas do Instituto Brasileiro de Geografia e Estatística). É doutora em ciência política pelo Iesp/Uerj (Instituto de Estudos Sociais e Políticos da Universidade Estadual do Rio de Janeiro), mestre em sociologia e antropologia pela UFRJ (Universidade Federal do Rio de Janeiro) e Visiting Scholar do CLAS/UC Berkeley (Estados Unidos).

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