Health in Ruins: The Capitalist Destruction of Medical Care at a Colombian Maternity Hospital by César Ernesto Abadía-Barrero (review)

Reviewed by:

• Health in Ruins: The Capitalist Destruction of Medical Care at a Colombian Maternity Hospital by César Ernesto Abadía-Barrero
• Hanni Jalil

César Ernesto Abadía-Barrero. Health in Ruins: The Capitalist Destruction of Medical Care at a Colombian Maternity Hospital. Experimental Futures. Durham, N.C.: Duke University Press, 2022. xxiv + 287 pp. Ill. $27.95 (978-1-4780-1893-3).

This past February, Colombian president Gustavo Petro shared the specifics of one of his administration's most significant goals—reforming the country's health care system. As proposed, the reform seeks to provide and guarantee universal coverage, promote primary care, and improve health care workers' rights and protections. As Colombians debate the reform inside Congress, on the streets, and in their homes, César Ernesto Abadía-Barrero's book provides a timely window into understanding the effects of neoliberal health care reforms in transforming medical practice and health care in this country. In describing this transformation, he has written a rich, multilayered, and collaborative ethnography of El Materno, the country's oldest maternity, neonatal health care center and teaching hospital, and one of the country's most visible symbols of the social pact that characterized the welfare state in Latin America in the second half of the twentieth century. The author defines this ethnographic exercise as a collective and political project, one that acknowledges the ethnographers' dual role as scientists and fellow citizens and that relies not on a single authorial voice but instead on a team of scholars and activists whose voices and experiences inform the book's arguments and contributions.

The history of El Materno, its workers, students, professors, and patients, illustrates the effects of market-based health care reforms on public institutions. But this is not a linear or neatly packaged story. Instead, it shows that while neoliberal reforms altered how we imagine health and medicine, physicians, nurses, staff, and patients at El Materno embodied and fought to preserve "epistemologies of care" that challenged market-based and for-profit logic. Abadía-Barrero and collaborators use the term "epistemologies of care" to describe "how medical care is created, practiced, taught, experienced, researched, validated and confronted" (p. 3). Through their analysis of the conflicts and tensions that arise when different "epistemologies of care" are confronted, we learn about the cultural norms and health care practices embodied by workers, students, and professors at El Materno and the ways they resisted the "commodification of health" (p. 4). Health in Ruins shows how neoliberal health policies became hegemonic and how they were continuously challenged and contested. As the book departs from a Gramscian understanding of hegemony as never complete or total, we see health care workers, professors, and hospital patients fighting to preserve alternative ways of understanding medical care and challenging the structures that promote profit over people.

Chapter 1 centers the voices of professors of medicine and program alum, like Carlos Pacheco, Luis Carlos, and Elena Fino, who shared their experiences at El Materno. This chapter describes a particular type of clinical practice and medical care embodied by professors, students, and workers, one that combines clinical analysis with an understanding of how social, political, and economic realities impact patients and their health outcomes. Chapter 2 turns to "subaltern health [End Page 649] innovations," such as the Kangaroo Mother Program or the delayed clamping of the umbilical cord, to explain how clinical practice at El Materno combined excellence in care with "advocacy and project-based projects that tackled the structural inequalities that affected patients' health" (p. 47). Chapter 3 examines how religious faith provided emotional support and encouragement to patients and workers beyond clinical knowledge and practice, turning love and caring into fundamental pieces of the "epistemology of care" that characterized El Materno. Chapter 4 focuses on understanding how neoliberalism, via Law 100 of 1993, transformed the "state-hospitals-health triad," moving the system from a "welfare-like system in which money was transferred directly from the state to a market competition model" (p. 103). Chapter 5 chronicles the violent transformations that occurred in labor conditions for workers in the health care sector, showing the destabilization and precarization of labor under the neoliberal model and...