The end is near… literally and metaphorically. I think we are at the end of the year, but we are also at the end of something and we are not yet sure what it is. This has been a year of big events and shifts. As a Latin American, I saw with disbelief and frustration the impeachment of the first female president of Brazil, Dilma Rouseff; the neoliberal government of Macri in Argentina promising to abolish advances in social welfare of what was known as the decada ganada (the gained decade); Venezuela on the brink of economic collapse; Colombia voting NO to a peace agreement; Fidel Castro’s death and the polarized views on Cuba’s legacy… and now at the end of the year, the militarization of the ancestral Nankintz territory in the Ecuadorian Amazon jungle. It looks like the socialism of the 21st century has not really taken off yet…  This is a rather dark picture, especially to folks from my father’s generation who dreamt of socialism and the expansion of the Cuban project in Latin America. There is confusion around what to do next or what to believe in.

Although these recent events in South America do not explicitly have the word health inscribed in them, there is in fact an important space for reflection for health systems. The last decade has indeed brought great gains in health. Increasing attention has been given to the achievement of universal health coverage; there has been the recognition of intercultural health systems, and in many countries people are now able to access free health care. My grandfather for instance receives dialysis three times a week without incurring any out-of pocket payment.  So then, what is going to happen with these gains now that the revolutionary project of socialism in the Americas is failing to keep up its promise and is now taken over once again by neoliberal “values”? How do we, as individuals and health professionals, contribute towards the protection of these important gains? How do we engage with these political conversations?

I have been thinking about these questions in the last few days and the Zapatista phrase, “Otro mundo es posible” came to my mind.  I think that yes, we have the obligation to protect and foster the achievements in health care from the past few decades! However, to do so we also need to go through a process of deep deconstruction of our beliefs and the parameters in which we think about the world. The events of this year are pushing us all over the line and the only possible solution in my opinion is to dream! To dream and create! I think a time begins were creativity will be essential. We need to destroy ideological dichotomies. I firmly believe that another world is possible; there must be a third or fourth or fifth direction to take and it’s time we create those options for ourselves.

We as societies are dealing with complex global issues that require a lot of joint effort and collaboration. Yet, in the spirit of the Zapatista phrase used in this reflection, I also think that more and more we need to move towards local solutions to global problems – I know this has been said before but I think it’s relevant to remind ourselves of the importance and significance of local contexts. I am not talking about local in terms of national government. I think the idea of locality needs to provide people in neighborhoods, small towns, and organizations, the opportunity to generate solutions to their problems, including health systems issues.  It is in light of this reflection that I’m looking forward to the possibilities that next year might bring.  I invite us all to talk with people who might not be health researchers or who might have nothing to do with health at all and find intersections between problems and disciplines. Let us start designing a new system for the world and our communities.

Next year in Ecuador we will be hosting the Latin American congress of Cultural Viva Comunitaria, which is a regional movement trying to foster local expressions of community organization based on cultural contexts and built on the idea of sharing experiences across regions. This congress engages multiple areas of social organization across culture, popular education, arts expressions and economy… however there is not yet a space for health. So! We have proposed the inclusion of health in their agenda, which is exciting. We hope that we can think about health from a cultural lens and beyond the idea of traditional medicine. How do we talk about health within the organizational culture of our communities? I am excited to find ways in which I can start thinking about health systems and its intersections with other social processes, looking forward to building new, stronger systems.

On that note, have a great end of the year!