Interview with Cruz María Esquivel, President of Corporación Tribunal de Derechos de Cartagena de Indias,
1.Cruz Maria, let’s start this interview presenting your organization to whom does not know it outside Colombia
In mid 2009 some officials of United Nations and of an Italian organization arrived to the neighborhood of “La Esperanza”. They wanted to talk with us about topics related to health and participation.
At the beginning we were really sceptical, above all because in Cartagena many institutions get in touch with the neighborhoods to present projects and activities that do not bring to concrete result at the end. In this case it was a volonteer, something strange to see in our poor communities. In spite of this, the idea of defending our community’s health seemed really interesting.
During these days, a group of people, mostly housewives and students of the neighborhood accepted to take part in this project and Cittadinanzattiva (the Italian organization) supported us with training activities and put us in contact with the Local Health Authority (called ESE – Empresa Social del Estado de primer nivel de Atención) and the Primary Care Server (CAP – Centro de Atención Primario) in the neighborhood of “La Esperanza”.
Besides us, Cittadinanzattiva and the United Nations Development Programme (UNDP) were developing other activities with other groups of citizens concerning the use of public services, training and helping them to create Civic Commitees (called Comités Desarrollo y Control Social) for the defence of the users.
In collaboration with a group of the neighborhood La Esperanza, mostly composed of women, it was created the Tribunal for Patients’ Rights in March 2011. Moreover, collaborating with other groups (El Pozón, La Reina, Daniel Lemaitre and other neighborhoods) other Civic Commitees in the neighborhoods were created and presented in the municipality.
With the support of the Universities (Sinú, Tecnológico Comfenalco and Rafael Nuñez), Cittadinanzattiva and UNDP started awareness campaigns together with training and organization activities. The Tribunal for Patients’ Rights (dealing with health issues) and of advisory citizen centre (called Punto de Atención Ciudadana – PAC) were named in accordance with the Italian experience of Cittadinanzattiva and in coordination with the colleagues of Pasto (in the Colombian Region of Nariño) who were doing activities like ours with Cittadinanzattiva and UNDP.
We took as slogan “Citizens for citizens” because we live in the same neighborhood, suffer from the same economical problems and have the same needs of people who come to our
advisory centres. We are at the end all citizens living in a similar way, so here comes the slogan, as we decided to be trained to help our neighbours and relatives protecting their rights.
In my case, the helplessness when my grandchild died due to the lack of rapid and needed attention gave me the motivation to participate; today I feel satisfaction in helping patients through this activity with visible results. All this is an important input to continue to update ourselves trying to avoid that what it is currently going on in the health context will be repeated and to make sure that the citizens do not live in the ignorance of what their rights are.
The Association “Corporacion Tribunal de Derechos” was created as a social actor after three years of experience and consolidation of team work in a democratic way in an Assembly where everyone participated in each step from the draft of the Statute to the election of the executive management.
2. Protecting rights in Cartagena: how do you do it?
We do the work of protection and promotion of the rights in an office given to us in the CAP of Esperanza, thank to an agreement with Cittadinanzattiva. There we meet every day from 8 am to 10:30 am (sometimes later) and we receive and try to fix all kind of problems and doubt that patients or thier families bring to us. We register everything and we accompany people until the final resolution of their cases. For the most complicated ones, we count on the technical support of the students of the Comfenalco Technological Institute (for the cases concerning health) and of the University of Sinù (for the cases of public services), as well as of their professors of the juridical counselling for the most complicated issues. In the context of public services we receive people every day from 8 to 12 or later.
We currently count on 31 volounteers (mostly women) including 20 coming from the
Social Departments of Cartagena who are traines with us consolidating their abilities to face the future, even if the personal difficulties make work very hard, considering that all of us are mothers in charge of whole families with low incomes.
3. What is your personal motivation in this social activity and the one that makes citizens approach this reality?
What motivates us are the injustices and the disadvantages that citizens with low incomes have in our healthcare system; we are motivated by the idea of being trained as liders learning from daily experience; we are also motivated by the wellness of our families and the fact that we can count on partners willing to go with us in our work.
4. Who are you working with?
With citizens that bring us their cases and issues, the Universities, the Social Department of Cartagena, UNDP, the Local Health Authority, Primary Care Servers and others.
5. Concerning health, what are the most relevant problems that citizens of Cartagena have to face?
a) Urgency. For instance there are delays in the emergencies and patients come to us to ask for new interventions, even if the majority of cases they have problems of information and they do not understand that there are more urgent and serious cases than theirs to treat first.
b) Burocracy (double affiliation to the health system). For example when a person who is part of a subsidiary health system (minimum assistance provided by the State) because unemployes finds a new job, he or she switches to the contributory health system. In the case that the person lost the job again, those facilitations that he or she previously had as unemployed are not recognized anymore and this causes confusion and enconvenience.
c) No access to drugs. This is the case of poor patients with no money that do not receive the drugs in case of need. So, they are obliged either to buy them or to wait for an authorization that will allow them to receive the medicines.
d) Access to prompt and appropriate treatments. Many are the cases of delays for appointments, treatments and drugs delivery. In many occasions the delays are more than the time patients can wait for.
6. Concerning home help services, what are the most serious issues that citizens of Cartagena have?
a) Costs of services and increase of consumption bill
b) Payment of services not required or not asked by users
c) Increase of instalments in case of arrearage
d) Pick up and inspection of the meters
e) Increase in the consumption bills
f) Interruption of the service because of the opposition to the inspection or change of meters
g) General information
h) Interruptions in the services
7) In the last two years, what have been the most relevant activities that you have realized?
a) Assistance and orientation to more than 2000 citizens in four years
b) Awareness campaigns
c) Information to citizens in different neighborhoods of the city
d) Participation in the UNPD study “Risks of Corruption in the health sector in Colombia. Study of the case of Cartagena”
e) Partnerships with the institutions of public services and health
8) What are the objectives for the next years and what is need to realize them?
a) To have an advocacy centre in each neighbourhood of the city as there are more than 50 of them in Cartagena. Also to bring the project to every part of Colombia;
b) To strengthen the partnership and create solid relationships with all components of the public services and health sector;
c) To influence the health policy with studies, researches and projects being protagonists in the local, regional and national politics;
d) To obtain that more people are trained and organized to protect their rights.
Interview by Mariano Votta, Director of Active Citizenship Network News, August 2014
Cruz María Esquivel
Presidente Corporación Tribunal de Derechos de Cartagena, Colombia