Unbillable and formidable care: Child and maternity health care during neoliberalism in Colombia

• In Event: Healthcare challenges and transformations under neoliberalism

Abstract

Ethnographic research at the oldest child and maternity hospital in Colombia, El Materno, depicts how medical care is being transformed by neoliberal health care reforms. Before the 1993 market-based reform, El Materno was characterized by a complex mixture of top of the art medical care provided by professors of the most important medical school of the country, a comprehensive biosocial understanding of health care problems and a charity-oriented care provided by one of the largest catholic congregations that had at its core the principle of humanization of medical care. Patients, referred from all parts of the country, were mostly poor pregnant women with high risk pregnancies and their newborn babies. Physicians and nurses, some from other countries, received clinical training in one of the successful programs of El Materno.

Neoliberal reforms hit hard public hospitals like El Materno. Hospitals either transformed their institutional culture to a for-profit orientation or were forced to close down. Many of the workers and university professors of El Materno found jobs in other institutions. They struggle to make sense of the change brought about by the reform while they use strategies to maintain the legacies of care that characterized their institution. Under a managerial mentality, however, many of the activities that they held as valuable for their patient’s care are no longer logical given that they cannot be “scientifically” assessed and are “unbillable”. This paper concludes that the evasive materiality of many of the hospital’s care activities contest the for-profit logic of neoliberal care.

Author

• Cesar E Abadia-Barrero, University of Connecticut