Of Bogota’s 8 million inhabitants, more than half live below the poverty line, earning less than US$2 per day. Roughly 2 million live in Ciudad Bolivar, a giant low-income squatter settlement plastered against the steep slopes of the hills flanking the mushrooming city. The closest parallels are the precarious hillside favelas of Sao Paulo and Rio, in Brazil.

The houses of Ciudad Bolivar are mostly hazardously constructed of big thin bricks cemented together vertically to save costs. Some dwellings have been propped up by poles as the hillside erodes from under them. There has not been a major earthquake for more than 40 years, but if one ever comes the death and disability tolls will be enormous.

In the past few years, declining wages and cutbacks in public services have caused increasing hardship in the city and country as a whole. But in one part of Ciudad Bolivar, called Cerros del Sur, the health and living conditions of the inhabitants have been gradually improving. These improvements are the result of a unique community-wide initiative called ICES, or Instituto Cerros del Sur. It was started by a group of local activists, concerned school teachers, and anthropologists who have involved the people in building and running an ambitious community program for “integral development.”

Built by the people themselves, the large blue center on the hillside caters to the needs of those who so often fall between the cracks. It is a health care facility, rehabilitation center, and income-generating training center all rolled into one. It primarily serves unemployed persons, single mothers, and children who for reasons of poverty or disability have trouble gaining entry into the state schools.

Disabled Persons and Street Youth as Community Health Workers?

In Ciudad Bolivar as in most of Colombia government health centers are few and far between. Service fees keep rising as the supply of useful medicines keeps shrinkng. Public hospitals are being privatized, pricing their services out of the poor’s reach. For many people the right to basic health care has become empty rhetoric.

ICES is collaborating with a pilot venture called the “Model for Community Integration of Persons with Special Needs,” coordinated by Ashoka fellow, Tatiana Gomez Duran. In this model, an effort is made to integrate disabled and marginalized persons into respected service-providing roles in the community.

One purpose of my visit to Ciudad Bolivar was to explore the possibility of training street youth and disabled young persons as community health workers. This plan of enabling the neediest people as service providers parallels CIREC’s plan to train landmine victims as community rehabilitation workers.

I was delighted to learn that the inspiration for both these plans to train and empower marginalized persons as service providers came in large part from the example of projects Piaxtla and PROJIMO in Mexico, about which the facilitators in Colombia had read in our books (Where There Is No Doctor and Helping Health Workers Learn, as well as Disabled Village Children, and Nothing About Us Without Us). I am constantly amazed at how wide the impact of these books is, and how many innovative and empowering initiatives they have helped trigger. (Where There is No Doctor is now in over 90 languages.)

As in the CIREC Forum, the staff, families, and young people involved in the Ciudad Bolivar initiative were enthusiastic, and the prospects for launching a highly participatory community-based health initiative look very promising.