juan cesar garcía y el movimiento de la medicina social

8/18/2019 Juan Cesar García y El Movimiento de la Medicina Social

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Universidad Nacional de Lanús | Salud Colectiva | English Edition ISSN 2250-5334

Juan César García and the Latin American socialmedicine movement: notes on a life trajectory

Juan César García y el movimiento latinoamericanode medicina social: notas sobre una trayectoria devida

Galeano, Diego1 ; Trotta, Lucía2 ; Spinelli, Hugo3

1Professor and resarcher,Institute of Collective Health,Universidad Nacional deLanús (UNLa), [email protected]

2Professor and researcher,Institute of Collective Health,Universidad Nacional deLanús (UNLa), [email protected]

3Director, Instituteof Collective Health,Universidad Nacional deLanús (UNLa), Argentina.

[email protected]

ABSTRACT This article analyzes the trajectory of Juan César García, one of the referentialgus f th lt amc sc mdc mvmt. Th qust tht sd thswork sought to uncover in what moment and in what circumstances García incorpora-td Mxst fmwk t hs wy f thkg but hth bms. Fwg thmethodological guidelines proposed by Pierre Bourdieu, we used the concept of “life tra-

jectories” to reconstruct a life path that divides in various directions: from his birthplace ncch t th cty f l pt, fm th t Stg d Ch d, y, hs u-mus ts fm Wshgt DC t g t f lt amc. i d t tc thspaths, we carried out semi-structured interviews with key informants: family members,fds, d cgus fm agt, Bz, ecud d Cub. W s yzd thbooks included in his personal library, donated after his death to the international foun-

dt tht cs hs m, d dcumts fm dfft s chvs.KEY WORDS History; Social Medicine; Public Health; Social Sciences; Pan American Healthogzt.

RESUMEN Este artículo analiza la trayectoria de Juan César García, uno de los referentesd mvmt tmc d mdc sc. l gut qu dscdóst tbj buscó dg mmt y s ccustcs qu Gcí có sí mtz d mxsm s s bms d sud. D st m,sgud s mts mtdógcs usts p Budu, utzms có d “tyct d vd” cstu u cd vt qu s bfuc varias rutas: de su Necochea natal a la ciudad de La Plata, desde allí hasta Santiagod Ch y, mt, sus umbs vjs dsd Wshgt hc g t d

améc lt. p , zms tvsts smstuctuds c fmtscv: fms, mgs y cgs d agt, Bs, ecud y Cub. asmsm,zms s títus d su bbtc s, dd fudcó tc quv su mb, y dcumts d dstts chvs tcus.PALABRAS CLAVES Hst; Mdc Sc; Sud púbc; Ccs Scs; ogzcópmc d Sud.


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286 Galeano D, TroTTa l, Spinelli H.

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INTRODUCTION

Juan César García (1932-1984) is known in

many parts of Latin America as one of the leadersof “social medicine,” a school of thought that in

the second half of the twentieth century beganto change the way health-disease-care processes

(HDCp) w studd. i fct, sc mdc wssomething more than a school of thought, as it

hd my mts f tc mvmt.There was a certain consensus about what the

concept of “social medicine” meant, although itcoexisted with the ideas of “public health,” “sani-

tarism” [sanitarismo], “preventive medicine” and“cmmuty mdc.” ech f ths ts

hs scc d tvy utmus g-gy. Th ubc hth dgm mgd thmd eu Stts, tcuy Fc

and Germany during the eighteenth century,through historical processes that – as countless

scholars have studied (1,2) – were closely relatedto social moral reform projects and hygienist

cds f ut ct.However, the Latin American thinkers iden-

td wth th sc mdc mvmt c-kwdgd ths g qut t; dug th

1960s and 1970s they tended to regard “socialmedicine” as a counter-hegemonic movement,

opposed to the medicine provided by the indi-vdustc, bst d ctst mkt. i thlast text García wrote before his death, a sort of

self-interview he was able to outline – althought sh – wh h ws susy , h ckw-

dgd tht g hsty. H skd hmsf: “Whtis the history and the meaning of the term socialmedicine?” and answered:

Eighteen forty-eight (1848) is the year the

cct f sc mdc ws b. it s s

the year of great European revolutionary move-

mts. lk th vuts, th cct f

social medicine emerged in various European

cuts t th sm tm. [...] Th cct,

although ambiguously used, attempted to

highlight that diseases were related to “social

problems” and that the State should actively

tv t sv hth bms. Sm-

larly, the term “social medicine” was interre-

td wth th w qutttv ccts

of health and disease, disregarding the

quttv dffc btw ths stts.

Therefore, social medicine emerged as a

“modern” conception, adapted to the new

modes of production that were developing ineu. (3 .22) [ow tst]

Latin American hygienism, developed as apolitical rationality starting in the mid-nineteenthcentury, implied an institutionalization of social

medicine and its more ambitious interventionjcts, ft mtd by bst sstc. By

contrast, during the postwar period of the followingcentury, the “preventive medicine” paradigm pro-

moted by the United States provided a new idea ofhealth care that articulated private medicine with

ubc hth thugh scc mchsms such s“cmmuty mdc” “fmy mdc” (1).

The Latin American social medicine movementemerged from a critical view of this inherited

knowledge, emphasizing the necessity of paying at-tention to the “social determinants” of the HDCP asw s t quts th dstbut f hth

c svcs. Ths chg ws csy tdto a growing dialogue between the medical and

sc sccs, tcuy scgy d hsty.This path from the medical sciences to the social

sciences was precisely the intellectual trajectoryof Juan César García, who studied medicine at

the Universidad de La Plata (UNLP) (Provinceof Buenos Aires, Argentina) and later decided to

continue his academic education at the Santiagode Chile branch of the Latin American School of

Sc Sccs (FlaCSo, fm th Ssh Fac-ultad Latinoamericana de Ciencias Sociales).

Both the choice to study sociology and the

scholarship provided for graduate educationabroad were paths marked by particular university

policies related to developmentalism [desarro-

llismo]. nvthss, Gcí’s dcs ws s

ucd by hs dvdu tjcty shd byhs sc d tc ctvsm. Ths s th st

kw sct f Gcí’s bghy, whch mybe connected to the little attention he has received

in his own country (Argentina), as compared to theuc h hs hd d st hs ths such s

Brazil, Ecuador, Mexico and many parts of Centralamc d th Cbb.


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SOME METHODOLOGICAL

CONSIDERATIONS

In order to reconstruct the life and profes-sional trajectory of Juan César García, we utilizeddfft tys f sucs. Fst, w vwd hsown writings and the existing literature about him,

as well as literature regarding the social medicined cctv hth mvmt. Scdy, thks

to the generosity of his family, friends and col-leagues, throughout the research process we had

access to different documentary sources: pho-tographs and letters from his youth; copies of a

newspaper in which he participated while he wasstudying in La Plata; writings, newspaper clippings

and correspondence from his years in the Panamc Hth ogzt (paHo). Dug

this documentary search we also had access tomt but Gcí’s ys s studt ctvst,kt th itgc ofc f th Bus as

pc Fc (DipBa, fm th Ssh Dirección

de Inteligencia de la Policía de la Provincia de

Buenos Aires) and now under the custody of theProvincial Commission for Memory (ComisiónProvincial por la Memoria).

We also conducted interviews with family

members, friends, fellow students from UNLP,d s fm FlaCSo d fm Gcí’s st x-

periences organizing Latin American social med-c twks. Th k wth th Bz “saúde

coletiva” movement was fundamental, for whichreason we interviewed representatives of thismovement, in addition to analyzing interviews

fm th chv t th osvd Cuz Fu -dt d fm th jct Sg auc’s

tjcty cd ut by Uvsdd Fd destd d r d J. Fy, w tvwd

colleagues from other countries who were closelyconnected to the leftist thought being developed

surreptitiously within the PAHO, in particular theecud Mgu Máquz.

Many of these interviews became part ofarchive of the Thinking about Health Documen-

tation Center (CEDOPS, from the Spanish Centro de Documentación “Pensar en Salud”) at the In-stitute of Collective Health (ISCo, from the SpanishInstituto de Salud Colectiva) of the UniversidadNacional de Lanús, with the aim of enriching the

oral memory of Latin American social medicine

and making the material produced during the re-sch css vb t th g ubc.

The task of reconstructing a life trajectoryenters into some amount of tension with the legacy

of Juan César García and the social medicinemvmt. ay hstghc cstuctof the life of a physician has as a backdrop the

model of the traditional history of medicine, madeup of a collection of biographies of illustrious

dcts. Ths dgm ws hghy ctczd bythe school of thought called the “new history of

medicine,” which, using various theoretical ap-proaches, prioritized the study of healthcare

systms d g csss d stuctus. Cs-quty, f sts w ft sd d t gv

way to the analysis of healthcare institutions andt th ctcsm f kwdg-w mchsms.

To what extent, then, would a research study ofthis nature imply a return to the traditional historyof medicine, even when this study is based on the

life of a physician who was paradoxically againsttraditional approaches?

Ths qust ds t utty cutdebate; some Latin American historians of HDCP

are discussing the necessity and importance of “areturn to life stories” as a new and fresh impetus

csgy stutd d f study. Ths

impetus has already proved fruitful, as shownin the publication of works that have achieveda more or less successful synthesis of the critical

corpus produced by the new history of medicineand the use of biographical analysis as a method-gc t (4).

In this work, the concept of “life story” wasreplaced by the notion of “trajectory,” following

p Budu’s suggsts but th sksof using life history methodology, very much in

vgu wth th sc sccs (5). Ths Fchsociologist made a suggestive criticism of what he

calls “biographical illusion,” that is to say, the ten-dency to regard a whole life as if it were a coherentstory . istd, Budu ss yzg f sa trajectory, the way in which an actor takes posi-

ts sc d, usg sucs d msthat are always limited, negotiating and competingagainst others for the control of economic and

symbc ct.This trajectory, like any other, not only con-

sists in a movement through time, but also a seriesf dscmts thugh sc. Th st th s


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tcd by Gcí’s v th cty f l pt

1950 from his hometown (Necochea, Province ofBuenos Aires, Argentina) to his departure for San-tg d Ch hfwy thugh th xt dcd.

His most well-known facet in Latin America drawsa second path that goes from Chile to the United

Stts, wh h st jd sch tm tHarvard University and then started work at the

paHo. ad, bsd ths gzt, Gcícoordinated the creation of various social med-

icine networks in Latin America, an activity hecductd qut ymusy, sc ts tc

content was incompatible with the hegemonicds wth th paHo.

This article is therefore structured in twots. Th st t cmss Gcí’s ductat UNLP and his participation in university pol-

itics; his specialization in pediatrics at the samesttut; hs st mdc wk t th Mdc

Student Association (Sociedad de Estudiantes de

Medicina); and his role in the creation of a Nec-

ochea Student Union (Centro de Estudiantes Nec-

ochenses) and of a team of physicians that traveled

thugh th pvc f Bus as. Th x-rience of this physician traveling to Santiago de

Ch d t study t FlaCSo, th ctxt fthat decision and its implications are also explored

ths t. i summy, ths sct ks t decade and a half of academic and political ex-perience to detect many of the problems García

would attempt to analyze with new intellectualts dug th fwg ys.

Th scd t s fcusd Gcí’s x-c th paHo’s Hum rsucs d r-

search areas, that is, the almost two decades of hisf h st Wshgt. Dug ths d,

th st sch study cd ut by Gcí udthe sponsorship of the PAHO proved to be key;

it was carried out from the time he joined the or-ganization in 1967 until 1972, when the results

were published in the book La Educación Médicaen America Latina (6). Ths sch ws sgf -icant because it made it possible for him to dis-

cover in depth the teaching of social medicine invarious Latin American countries and to start to

build a network of contacts, accumulating an im-portant social and political capital that helped him

maintain certain lines of work inside the PAHO,even under the suspicious eye of many directors

wh w t symthtc t ths ctvts.

UNIVERSITY, STUDENT ACTIVISM AND

SOCIAL SCIENCIES

Juan César García was born on June 7, 1932,in Necochea, an Argentine town located in thecoastal area of the Province of Buenos Aires, whereh st hs chdhd d dscc. Th,

hs ssd hmtw, my f Gcí’s sch-mates who we interviewed remember him to this

day as a lively student, a sensitive person whows wys dy t st t ths (7,8). Gcí

came from a humble household; his father was afarmworker and his mother did the housework, so

the possibilities of intergenerational upward socialmobility depended on what his academic edu-

ct ws b t vd hm.In secondary school, García experienced a

very particular climate of the time in which politicsbegan to permeate the educational sphere: in fact,the Head of Necochea National School (ColegioNacional de Necochea), where he studied, was asocialist leader of the area and a promoter of novel

dggc mthds d ts (). accdg tsome of the interviewees (9,10), the political in-

uc fm Gcí’s uc Ju lbd, hsmth’s bth, ws s mtt f hm. Th

lbd fmy cm fm Bsqu mmgts wharrived in Argentina in the nineteenth century and

sttd th f Ququé s gcutu dtts. Gcí’s uc cm b d th M

del Plata Communist Party and later Secretary ofthe Central Committee of the party in Avellanedaas well as the director of the newspaper NuestraPalabra and the journal Nueva Era. Dug th -tvw, Mgu Máquz cs cvsts

which Juan César told him that it was this unclewho introduced him to readings related to so-

csm, such s th wks f Jsé igs (11).oc Gcí hd shd scdy sch,

his family decided to sell the house in Necocheaand move to the city of La Plata so that Juan César

could continue his studies and attend the uni-vsty. H sttd th wth hs mth, sst

d bth. Hs dcs t study mdc – c-cording to a schoolmate from Necochea – wasframed by the climate of the time, when opting

for a traditional and professional course of studyin the university meant attempting to achieve

uwd sc mbty (7).


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This possibility of accessing higher edu-

cation arose within a historical context in whicha university degree would be the key to the labormkt d btt sc st. Hvg studd

th tw’s nt Sch wud b mystudents, who like García came from humble

backgrounds, to get a good education and thinkbut th ssbty f ctug th studs.

The value that a professional degree had in Ar-gentina led people to attend educational institu-

tions, and in particular universities, which for themiddle class was the avenue for social mobility par excellence. i ths ty f scts, whthe production (and educational) structure is little

dvsd d th fss ds yslightly specialized, obtaining a university degreebecomes of utmost importance to the composition

f th sc csss (12,13).During the nine years he lived in La Plata

(1950-1959), García passed through not onlyuniversity classrooms, but also several collective

spaces where he built social networks that wereundoubtedly central to his trajectory, and in

whch h ft hs w mk. Dug hs st ysin La Plata, he worked as a medical assistant in

the periphery of the city, a position provided bythe Medical Student Association that helped him

vt th cmc dfcuts hs fmy wsxcg t tht tm.

At the same time, García was an advocate

of the Necochea Student Union, which broughttogether the university students from Necochea

that were studying in La Plata, the capital city ofth vc. Th vs s uvsty studts

and the concerns they shared as students comingfrom a small outlying city brought together these

young people with different courses of study anddfft dgc bckguds. amg thm

were two well-differentiated groups: one con-sisting of García, his sister and other students, all

of more humble origins; and the other consistingf studts fm th Fcuty f agmy – futuagronomical engineers – connected to nationalist

Peronism, who came from a higher socioeco-mc sttus (9).

After his graduation, García would onceagain become involved in the types of tasks that

hd std hm twd th study mdc. Hsdecision to specialize in pediatrics led him to

complete his residency in the third ward of Sor

Mí ludvc Chd’s Hst l ptand then to a health clinic in Berisso, a locality

contiguous to La Plata, where he would take hisst sts fss d cmmuty mdc

ctc. as sut f ths xcs d thclose contact with the social problems that theyprovided him, at the end of 1958 García and other

colleagues decided to travel around the Provinceof Buenos Aires in order to collect information

about health conditions in the towns and citieswth th vc. Thy thus tvd t Td,

Balcarce and their own hometown, Necochea,mg th cs (Fgu 1).

Another important moment at the beginningof his trajectory was his relationship with the

Sch f Jusm. oc hs studs t thMedical Sciences School were advanced, helooked for other areas in the university where he

cud ch tsts d qusts utsd thch f mdc kwdg. accdg t th

interview with one of his fellow students at thattime, García formally enrolled in the School of

Jusm, thugh h dd t sh ths cusf study (14). Hwv, wh studyg ths -

cently created school, he was one of the advocatesof the Student Union statute and of the library, and

hd csdb uc th ss whch

would result in the transfer of this school to the jusdct f th Unlp. Gcí’s tsgnature, as well as his interest in cultural debates,ws s ctd th ct f th wsEdición (Fgu 2), whch ws ducd wth thfellow students from the School of Journalism and

1955 ubshd tw ssus. F fm fcusg scc f cutu, th ws -

cluded articles about science and art as well asvus ssys d tvws. Ths sc twk

also facilitated book exchanges among students;authors as diverse as Borges, Sábato, Estrada,

Mcd Fádz, St d th Fchexistentialists provided Juan César with readings

that fascinated him and which he would often rec-mmd t ths ud hm.

Juan César García started his studies at the

UNLP at a particular moment in the history ofhgh duct agt. Th uvsty

reform of 1918 had created a series of tensions thatwould persist throughout time, with core debates

regarding different “university models”: the primarydilemma at stake was the creation of an institution


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m ccd wth sctc duct vsus

an institution concerned with issuing degrees forfss ctc. Wht ws s tcu but

th cgut f th agt uvsty ftthe reform was how it maintained a highly profes-

sional structure, in relation to the relative weightof the studies of liberal professions, while at the

same time containing modernizing and democraticelements such as student participation in university

gvmt (15-17). Udubtdy, th fmmade it possible to conceptualize a universitywith open doors, thereby democratizing access to

higher studies; but also, by removing the conser-vative elites from the university government, the

reform allowed for a strong connection with pro-fss gzts (18 .137-143).

pó’s st dmstt (1946-1955), whchccdd wth Gcí’s ys s studt, ws

time of changes in the classrooms, and universitiesbg t b csgy tczd. pty tcs

burst onto the academic scene with regressions to

the period prior to the university reform (includingsuspension of institutional autonomy; derogation of

the tripartite government [among faculty, students,and graduates]; absence of academic freedom and

of a public, competitive faculty selection process),by means of political overhauls, purges and an in-

creasing regulation of the political activity at theuvsty. Ths gut bcm tght v tmd, dug th st ys f th 1950s, studts

became the most fervent opponents of State inter-vention, forming one of the main fronts of resistance

gst th t gvmt. i ths sct, tshud b cd tht th dymc f ths studt

opposition did not represent a rupture with the past,but rather a deepening of the defense of university

autonomy and of reformist principles that had beencd ut sc th 1930s. it s bught tgth

an amalgam of different sectors within the studentfederations, joined not only by their defense of the

university reforms but also their anti-Peronist stance(19 .79, 20 .150).

Figure 1. Juan César García (on the left) and the group of physicians from La Plata touring theProvince of Buenos Aires (Tandil, December 8, 1958).

Source: Photograph provided by García’s family.


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On the other hand, these years were marked

by a world context of a growing tendency towardth mssct f hgh duct studs dcsd studt mt. i agt, ths

process had particular characteristics, not only be-cause it was a country with one of the highest rates

of secondary school attendance in all Latin America(that is to say, it had larger potential enrollment

pool for higher education), but also because thePeronist government introduced policies that fa-

vored access to the university for students fromwkg css scts. athugh th sc f

these policies is controversial, what stands out isth mct f ccss md th systm

of scholarships in effect during the late 1940s, theelimination of student fees in the 1950s as wellas the abolition of the entrance examination in

1953. at th sm tm, md ctd -fessional development was strengthened, as was

ctd th cmst f th mt: tthe beginning of the 1950s, 30% of the university

student enrollment of the entire country was con-cttd mdc studs (18 .160).

Th mct f uvsty ccss wthth Fcuty f Mdc Sccs l pt svs

as a case study of these national and internationaltsfmts. Uk th st f th mdc

schs th cuty, t y dd th Fcutyhave an entrance examination, but also an en-mt qut cy. Th bt f ths -

qumts tgth wth th stbshmt ffree university education had a bearing on the

substantial increase in the number of students en-rolled: in 1945, there were 128 students enrolled

th Fcuty; ths umb hd m th dubdby 1952 (288 students), and in 1953 it jumped ex-

ty wth 630 w d studts (21).García spent his years as a medical student

in La Plata immersed in this context of universityccss mct d tczt. Mv,

he actively experienced these tensions in theduct d, std wth th -fmforces, where he was an activist against the na-

t gvmt. F tht s, scuty fcsburst into his house on two different occasions to

st hm. o th st ccs Gcí mdin custody for several days, while on the second

his family prevented the arrest by showing the se-cuty fcs ht f pó tht by chc thy

hd th hus (9).

The Medical Student Union (CEM, from theSpanish Centro de Estudiantes de Medicina),

of which García was an activist, had a strongpresence among the student federations organized

gst th t gvmt. Th tswhich permeated the university sphere during thest pst dmstts tk tcu

chctstcs wth ch cdmc dtmt.One example was the implementation of Act

13.031 1947, whch stbshd studt -resentation in the Governing Council through a

student elected by the university authorities fromamong those students with the highest grade point

averages; this representative had the right to voice but t th ght t vt.

At the UNLP the student representatives at-tempted on one occasion to voice reformist posi-tions of the student assembly before the governing

Figure 2. First page of the newspaper Edición. 1955.

Source: Original provided by María Luisa Gainza.


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council; in response, the General University Con-

federation (CGU, from the Spanish ConfederaciónGeneral Universitaria) sought to generate parallelchs f dgu wth th uthts. Th

members of this confederation, aligned with thePeronist government, developed a regulation to

allow all students the possibility to petition the au-thts d, thus, s submt th w dmds.

Dug th st ys f th 1950s, th cft-ts btw studts fv f pó’s gv-

ernment and students of the reformist wing werecsgy ts. a th sts th Fcuty

tended to become more polarized; the authoritieswere sympathetic toward the national government,

wh th studt fdts w sd t t.Thus, the atmosphere of the time among

the student representation was tinged with anti-

psm. Th studt us cd f st-ration of democratic values and the principles of

the reform, positioning themselves against whatthey called the “totalitarian advance,” the “dic-

tatorship” that “tried to control them with hiredthugs and political overhauls in the universities”(22) (b). Ths cftt csd wth ct

measures taken by the university authorities infv f th t gvmt. Such ws th

case of the commotion caused by a formal speechby th Unlp ct d fss f th Fcuty f

Medical Sciences that urged the university com-muty t vt f pó’s sdt ct,

or by those proposals of the CGU to rename thefcuty ft pó d t gv th m ctu

h th m f “evt pó” (21 .73).Sv ghts w thf cd ut by

th l pt Uvsty Fdt (FUlp, fm

the Spanish Federación Universitaria de La Plata)(Fgu 3). Ths cudd ghts fv f

student cafeteria; against the Act of Residence[that allowed the government to deport immi-

grants without previous trial] and against the il-legal pressure exerted upon students who carried

out political activities; against the political over-hauls, the presence of the CGU inside the uni-

versity, arbitrary professional appointments,

budget cuts, the image of the university as an“unidad básica” [a name given to basic electoraldistrict organizations of the Peronist Party, inchg f dssmtg ts ds, qufyg ts

mmbs d mtg ft t th ty,among other tasks], the promotion of courses re-

lated to the “National Justicialist [Peronist] Doc-t” d, th Fcuty f Mdc Sccs,

scc stugg t mt th mdctc cus (22).

In 1954, García participated in the Pro-Reform Student Organization (ADER, from the

Spanish Agrupación de Estudiantes Reformistas)(23,24). Ths gzt ctd cddt st

in order to contest the leadership of the MedicalStudent Union, in which García is listed as can-ddt f substtut sttv f th FUlp

f th d 1954-1955 (Fgu 4). Th aDerlist competed against the list of the Unitary Or-

ganization of Medicine (“ Agrupación Unitaria

Medicina”) d th std by Fdm

and Reform (“Libertad y Reforma”) according to DipBa t (c).

Figure 3. Pamphlet of the University Federation of LaPlata (FULP). 1952.

Source: DIPBA archives. Table A, student factor, File No. 1 (FULP).


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ADER had a deep pro-reform bent; it was asso-

ciated with the Radical Party, and its members wereworking class students, while “Libertad y Reforma”shared the reformist ideals from a more libertarian

perspective, but most of its members came from themdd d u csss. Ths suggsts tht, k

my uvsty studts f tht tm, Gcí’s -st t studt tcs ws t y ucd

by his political ideas, but also by the people whowere close to him and the social capital he had ac-

cumutd, whch ctd sm dstc fm thlocal elite families that historically produced the

mst dstgushd mdc fsss.During the beginning of the following decade

(1955-1966), known as the “golden age” of theArgentinean university, García actively took partin the debates going on behind the scenes in the

uvsty. Fm th stt, th agt UvstyFdt yd sst cvg

autonomy and also in appointing rectors anddeans within the political overhaul (in La Plata, the

vhu d f th Fcuty f Mdc Sccsws sd by th fmst studts). Th exc-

utv od n. 6403/55 f th dmstt fthe so called “Liberating Revolution” (RevoluciónLibertadora) determined the direction of the uni-versity reorganization, by reestablishing not only

the principle of autonomy, but also the policy ofa competitive and public faculty selection processin order to reinstate those who had been dismissed

throughout the previous decade and to discrim-inate against those who had connections with the

vthw gvmt. Ths xcutv d sestablished – in Article 28 – the authorization to

create “universidades libres” [private universitiesfree from State control], one of the sources of

tension that would later undermine the harmonytht vd dug ths uvsty ssc.

In 1956, an Advisory Board was created atth Unlp Fcuty f Mdc Sccs md u

of professors, graduates and student representa-tvs, f whch Gcí ws . Th w twcentral debates during the existence of this board:

the competitive faculty selection process and thetc xmt. Wth gds t th s-

lection process, despite the rebuttals presentedby graduates and students, the dean approved a

th mtd qutty f fcuty mmbs. Thdbt v ty qumts t th mdc

school continued for years, and is still to this date

a contentious and unresolved issue in the historyf th sch. at tht tm, th d, umb f

professors and the graduates of the Advisory Boardfought for the creation of some kind of mechanism

that would partially limit admission to the school,on the grounds that the scarcity of material and

human resources was further complicated by themssv ux f w studts.

In representation of the students, García de-manded issues more central to the Argentine edu-ct systm b ddssd, td t th quty

of secondary school education and the budgetdct, s w s sg -mty

tc xmt. Ths dbt cy cdinto evidence a new antinomy between the old re-

formists and the younger ones, who had becomefmsts th ht f th ght gst th p-

onist government, but had also mostly been able tog ccss t th uvsty thks t ts cs.

Figure 4. Ballot paper of the Reformist Stu-dent Organization (ADER), of the MedicalStudent Union of Universidad Nacional deLa Plata. 1954.

Source: DIPBA archives. Table A, student factor, File No. 39 (CEM).


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Restrictions on the access to higher education

were no longer imaginable to them, generating amixture of reformist ideas with advances achieveddug pó’s dmstt (25 . 17-18).

Major historical processes therefore allowus to understand the political positions taken by

Gcí dug hs ys s studt ctvst. Thcultural and social changes experienced in the

postwar world serve as the framework withinwhich these events took place, and, in Argentina,

these changes took on singular characteristics ofa clearly political nature, starting with the over-

thw f th pst gvmt (26 .54). i context in which Peronism was synonymous with

an archaic past to be left behind, the diagnosismade was one critical of a university that had beenmtd. Bkg wth th mmdt st wt

hand in hand with the restoration of the reformsd th uftg f dmctc vus (27).

This de-Peronization of the university oc-curred in a context in which the prevailing de-

velopmentalist ideas were promoted in most oflt amc. Scc d tchgy w th

two privileged areas upon which all economicand social development programs were based,

and the State was considered the privileged agentf mkg ths chgs vb. Wth ths

framework, several innovative practices of culturalmodernization were adopted and the universitybecame a legitimate space for knowledge pro-

duct d ct. Ths ws ccmd byan accelerated academic institutionalization and

th stgthg f dscy ds tht, s wsth cs wth th sctc scgy mtd by

Gino Germani, would contribute new theoreticalelements such as American structural function-

alism as well as a local view of the developmentcsss f h scts.

It was within this panorama that García, en-couraged by a friend from the School of Journalism,

decided to dedicate himself to social studies, andd t study t th FlaCSo bch Ch.By means of a scholarship, he was able enroll in

the Latin American School of Sociology (ELAS,from the Spanish Escuela Latinoamericana deSociología), whch ws ddt FlaCSo.Thus, in 1960, García travelled to Santiago de

Chile with the intention deepening his search forsws t hs qusts d dg m -

tgtd ch t th study f th HDCp. Hs

sty t FlaCSo-Ch vd t b fudmt ths c. Th vg cmt th sttut

during that time was one of great effervescence,creativity, and commitment to knowledge and to

th dvmt f c hum sucs. Ths,at least, is how García explained his experience:

It should be kept it mind that the Latin

American School of Social Sciences, sponsored

by UNESCO to raise the standard of social sci-

ences education, was created at the end of the

1950s. at th sm tm, schshs w

awarded to foreigners with the aim of gener-

ating, through this and other mechanisms, a

“ctc mss” f sc sctsts. of cus,

for how could it have been otherwise, the edu-

cation provided was under the hegemony of

sociological positivism, which does not mean

tht th schs f thught dd t ush

and that students did not react against the pre-

vg duct. (3 .XX) [ow tst]

Gcí studd t FlaCSo btw 1960 d1962. lt, t th suggst f pt Htz, d

of the ELAS during those years, García became amember of the teaching staff as professor of Social

Thy ut th d f 1963. Htz hmsf th

recommended García to work with Alex Inkeles,sociologist of the institution, although this job didnot work out and was one of the incentives for him

to accept the scholarship that would take him toHvd th fwg y (28). Gcí cm t

contact with this US university as a result of aninternational research study carried out in sevencuts gdg “Th uc f th wkg

environment on the behaviors of individuals,” inwhich García participated along with other col-

gus. Ths sch, bsd t FlaCSo, quda group of students to systematize information col-

lected by means of 1,500 surveys conducted inChile, which gave them important methodological

xc d d t th csqut vttfm Hvd Uvsty.

Th ssbty f tctg dwk wspart of a pedagogical strategy promoted by Heintz

within the institution, where education was basedon teaching content related to sociological theory,methodology, research methods and empirical as-

cts f cmc d sc dvmt. Sucha course of studies implied the participation of


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students in concrete research studies seeking to

combine theory, methodology and empirical re-sch sg css. accdg t svinterviews and the work of García during those

years, the education had an eminently structural-functionalist approach combined with some ele-

mts f Gm’s scgc ch thtcm fm agt. a studt fm th thd

cohort describes it as follows:

i fud tht FlaCSo hd xtmy c-

svtv cmt. Th d t tht tm ws

pt Htz, Swss m hvy ucd

by US trends – Parsons, Merton – and also by

th wfu uc f G Gm fm

agt. Th w cuss Mxsm,

everything was structural functionalism, with

sght thgc tt (29 .73)

[Own translation]

as th chvs t FlaCSo-Ch’s byshow, García graduated with a thesis entitled “Vari-

có gd d m có médc-paciente en un hospital” (Variation in the level of

anomie in the doctor-patient relationship at a hos-t) (30). Ths ws th st f ss f studs

with topics centering on the medical elite, the

doctor-patient relationship and authoritarianism,csdd by Gcí t b dg mt th dct-tt tsh. Ths st wks

showed an incipient dialog between the social sci-ences and medicine, a horizon he would neverbd. as wtt by Gcí dug ths d

(1961-1964) were the articles “Sociología y me-dc: bss scógcs d có médc-

paciente” (Sociology and medicine: sociologicalbases of the doctor-patient relationship) and “Com-

tmt d s ts médcs u stucóde subdesarrollo“ (Behavior of the medical elite in

ctxt f uddvmt) (31,32).In these works from the early 1960s, García

used categories from American medical sociology,but also a critical analysis of the practical “problem

svg” ch mdc. as sut f hsinvestigation and his critical interpretation of thisliterature, he organized a collection in 1971 with

the aim of informally circulating a series of works byTalcott Parsons, John Simmons, Edward Suchman

d J Hff Ws. Ths tst d hm t gd-ually focus on the medical education processes and

on the role of social sciences in the medical cur-

ricula: this main object of study in his 1965-1972wtgs w b yzd th fwg sct.

Hence, the training of health professionals at

higher education institutions would be decisive inth cstuct f w dgm. F Gcí,

universities were historically determined and in-tegrated the production, transmission, and social-

ization of knowledge according to the concretesc fmt whch thy td. i ths

way, the role of medical education became centralt th duct f hthc svcs. at th

same time, García ascribed these institutionscertain autonomy and ability to create spaces for

chg d vt (33,34).Gcí’s st xcs s uvsty ct

in that context of student politicization and in thedsuts v th dt f th uvsty md

may have been the elements that, in the followingyears, served as the foundation from which to askqusts but th tsh btw sc

structure and the prevailing mode of productionf hth fsss.

SOCIAL MEDICINE AND LATIN

AMERICAN COOPERARION NETWORKS

In March 1966, Juan César García joined

the Human Resources Department of the PAHO,wth hdquts Wshgt DC, wh h

wkd ut hs dth. it ws tm f gt -litical upheaval; the backdrop was marked by the

Vietnam War, the escalation of anti-imperialism,th My f 1968 Fc d th vuty

movements in Latin America, with the Cubanrvut s th symb. Wh Gcí jd

the PAHO, he was 33 years old; he had a degree Scgy fm FlaCSo-Ch d xcs sch ssstt t Hvd Uvsty.

In the 1960s, a sector of the PAHO ledprojects to reformulate public health courses from

a perspective critical of the biologicist paradigm ofth tu hsty f dss. it ws fudmt

in this process to incorporate knowledge from thesocial sciences which permitted awareness of the

multi-causality of health problems, knowledgeoriginating from both the US preventive model as

well as from the historical-structural perspectives


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that were emerging in Latin America as a new

ch (35,36). Fm Hvd, Gcí ws -corporated into the PAHO through an ambitioussch jct ssd by th Mbk Fu-

dation, whose aim was to map the advances madeby the preventive and social medicine disciplines

in the education of health professionals in LatinAmerica; this project would then extend to a cur-

cu yss f mdc duct g.Th dwk f ths sch study gv

García the opportunity to visit a large number ofcuts, t s st-hd hudds f schs f

medicine, to engage in dialogues with numerouscolleagues and to being to weave social networks

tht wud t gv wy t th st mtgs “social sciences applied to health,” according toth m tht ws us th 1970s. oc m,

as had happened during his years of activism atth Unlp Mdc Sccs Sch, th qust

of curriculum design became an area of disputed th st f y f ssbts f chg.

García explained that this interest in drawing amap of the medical education processes in Latin

America had some precedents at the PAHO,which had previously organized two seminars:

one held in Chile in 1955 and the other in Mexicoin 1956, “both attended by representatives of

almost every school of medicine in the continent”(6 .2). Mtg tcts cmmdd thtthe PAHO take on the task of assessing the actual

reach of social sciences knowledge within the cur-cuum dsg f ths schs.

Fwg ths suggst, th paHo dcddto gather a team of experts in Washington, who

discussed (between 1964 and 1967) the possibilityof developing a research study that would serve

as “frame of reference” for the recommendationof policies whose aim was to homogenize criteria

f mdc duct. Gcí ws hd s fth cdts f th dwk, cd ut b-

tw th d f 1967 d th bgg f 1968.Altogether, the work took more than four yearsand local professionals from 18 countries collabo-

rated in the data collection; they were in charge ofdmstg qusts vusy dsgd

by paHo’s Hum rsucs Dvmt D-tmt. amg thm w sv cgus

with whom García would later strengthen his con-nections in the organization of the movement of

sttsts td t sc mdc (d).

One such colleague, the Ecuadorian phy-sc Mgu Máquz, summzs wht my

hghght gdg Gcí’s wk sty, dsydall over Latin America with medical colleagues

and other health professionals: “he had a greatability to bring people together ” (11). Gcíut Máquz chg f th dt cct

ecud d sx Ct amc cuts.Máquz xs tht h mt Gcí Cuc

bf th dwk bg, wh Gcí tk trip through the countries to be included in the

study. accdg t ths tvw, gt fftws qud Gcí’s t t cvc my

colleagues to take part in the study; those whobelonged to university federations aligned with

cmmust ds w t st suscus f sch study bsd ut f Wshgt d -cd by US fudt.

When García arrived in Ecuador to visitschs f mdc, Máquz ws dvs t th

Mdc Studt Fdt Cuc. Gc’sst st ws t tk t th studts d x

t thm th bjctvs f th jct. Th studts(some Maoists, others more pro-soviet) then went

to their advisor to express their suspicions: theythught Gcí ws Cia sct gt. Máquz

asked them to allow him to speak with García per-

sy. Thy hd xtmy g cvst, tht std th wh dy. “i cutd man of few words, and I learned where he camefm,” sd Máquz gd t Gcí’s scst

gs d scgc duct (35). Thtday a long-standing friendship began, one full of

cbts.In 1972, the same year that García published

La educación médica en América Latina (Medicaleducation in Latin America), he managed to bring

together a number of these colleagues in the cityf Cuc, ecud, wh f th st tm th

incipient group took an explicitly critical positionregarding the functionalist theoretical framework

that prevailed in the sociological analyses of healtht tht tm. Just bf hs dth, Gcí ssssdthe results of this meeting whose aim was, at that

mmt, “t d m cy th d” f scsciences in health; that is, he acknowledged that it

implied a search for the theoretical and method-gc fudts tht cud sut ths d f

study th mkg. Th gu ws gwg but, Gcí’s w wds, “t ws ckg th d-


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logical cement needed to go beyond these friendly

relationships, differentiating social medicine frompublic health and separating it from preventivemdc” (3 .XX).

In order to understand the context in whichthe Cuenca discussions took place, it is necessary

to recall what “social sciences applied to health”meant in Latin America at the beginning of the

1970s. Fsty, th sttut st f thsknowledge did not extend beyond a handful of

cuss vtv d sc mdc. Wththe bibliography the most abundant references

were to the “behavioral sciences” approach, whichwas developed in the US after the Second World

W. Gcí, ctc f ths ch, qustdits positivist methodology and the use of a term(behavior ) which made invisible the historical root

f hum cts. i tht ss, th gu gthdin Cuenca jointly expressed that the “application

of the functionalist analysis to health issues,” aswell as the reductionist view of works based on

the natural history of disease paradigm and on thestudies of the determinants of individual behavior,

all contributed to a “static conception” and to a“formalist description” of health processes (37

.XiX).According to the opinion of several of our

interviewees (11,38,50,71), García was the maindvct f tht st sm d f th tconsolidation of this group that remained in close

ctct dug th fwg ys. Thy dto hold another meeting similar to the one held in

1972, whch ws y hd 1983 c g Cuc. evd nus, f th ttds

at both meetings, stated during his interview thatGcí, wh ws dy qut , cmmssd

him to compile the works submitted to that secondsm (38). Tht qust ws fud d sutd

in the release of the book entitled Las ciencias so-ciales en salud en América Latina: tendencias y

perspectivas (Social Sciences and Health in LatinAmerica: Trends and Perspectives), publishedbth Ssh d ptugus (37).

Not long after the second meeting in Cuenca,Gcí dd. Sv f th ttds – Sú Fc

Agudelo, Asa Cristina Laurell, Hesio Corderio, Jaime Breilh, Sergio Arouca and Everardo Nunes,

among others – met again at the end of thaty th Bz cty f ou pt. at tht

meeting, attended also by Mario Testa and Susana

Berlmartino, the Latin American Social MedicineAssociation (ALAMES, from the Spanish Asoci-

ación Latinoamericana de Medicina Social) wasstbshd. i th dts f ts fudg dc-

ument, the signatories decided to make “a specialmention” of Juan César García, in recognition of“his pioneering work in social medical thought in

Latin America, his substantial theoretical contri-bution to this thought and his leadership in our As-

sct” (39). pdxcy, wht ws bbyGcí’s gtst st cm t ss th sm

y s hs dth.Although functionalism had contributed to the

incorporation of social sciences in the analysis suchproblems as the doctor-patient relationship and the

link between social structure and health, the crisisof the developmentalist project and the emergenceof other approaches, such as dependency theory,

strengthened resistance to the prevailing function-st dgm. Th “dgc cmt” Gcí

referred to was Marxism and, as Hugo Mercer welldescribed, the transition from functionalism to his-

torical materialism was a process of “substitution ofone structuralism for another,” since the Marxism

that took hold in Latin America was in line withathuss thught (40).

Csquty, Gcí’s wk (t y hs

written and published works but also the moresilent work of organizing the Latin Americansocial medicine movement), showed, at the be-ginning of the 1970s, what might be called a

“Mxst tu.” Gmss f ths shft c b b-served in previous years, when García traveled

to Harvard with his colleague Carlota Ríos, an at-ty wh hd s studd t FlaCSo d ws

td Ch scst thught. Th sch-arships at Harvard were to work with George

Rosen and Milton Roemer, both of whom hadstudd ud Hy Sgst (11).

Sigerist (1891-1957), known as one of themost important historians of medicine, was head

of the Institute of the History of Medicine at JohnHopkins University in Baltimore from 1932 untilthe mid-1940s, and was one of the pioneers in

using a historical and sociological analysis to thinkbut mdc. H ws b t udstd th

limitations that the social structure imposed onhealth phenomena, incorporating into his scien-

tc csss Mxst sctv whch wudlead him to consider socialism a superior way of


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f f th hum bg (41). Th sc f ths

uth Gcí’s wk c b bsvd thbibliography he used within a number of writingsafter this period, such as in the work entitled “Las

ciencias sociales en medicina” (Social sciences inmedicine), which was presented in the 23rd World

Congress of Sociology held in Caracas, Venezuela, nvmb 20-25, 1972 (42). Udubtdy, ths

change of direction was related to a particular en-vironment of readings and theoretical discussions,

but there was also a leaning toward the Cuban andNicaraguan experiences, where Marxism went

byd ty dw by bks. Mgu Máquz, cgu f Gcí’s vy cs t th Cub rv-

olution, remembered that during the 1960s, beforeGcí’s tu twds Mxsm, thy hd mt gthe path of social medicine, to which they had ar-

rived with very different ideological backgrounds:Gcí wth scsm d Máquz wth lbt

Thgy. Th 1970s, hwv, y csdtdthis structuralist Marxist point of view, incorpo-

tg dfft txts.An inside look at his personal library, donated

after his death to the International Social Sciencesd Hth Fudt f ecud (), ws t st

xmt cstuct f ths dgs.Several sources indicate that García was not only

vd d but s gu buy f bks. Hslibrary consists of approximately 3,700 volumes;hf f ths dc sctc jus,

conference proceedings and institutional reports,while the other half consists of books of individual

d cctv uthsh. amg th sctc journals, a series of US journals on sociology stand

out ( American Sociological Review, Theory and

Society, The American Journal of Sociology, tc.);

journals of sociology of science and education (So-

ciology of Education, Science in Society, Harvard

Education Review ); and several publications on thesc sccs d hth ds, sm egsh

(Social Science and Medicine, Journal of Health& Human Behavior ), but most of them in Spanishand in Portuguese: Revista Panamericana de SaludPública, Gaceta Médica de México, Revista Cubana

de Salud Pública, Revista Ecuatoriana de Higiene y Medicina Tropical, the Chilean Cuadernos Médico-

Sociales, and the Brazilian Cadernos de Saúde Pública. PAHO bulletins and various publications ofthe World Health Organization (WHO) constituted

gt umb f th ubcts h cvd.

Gcí’s by mks t ssb t mnot only his readings, but also his contacts, since

many of the volumes stemmed from trips andtwks wth th cgus. i ths ss, -

though García was living in Washington, there arenumerous books in Spanish and Portuguese: halfof his books (approximately 1,170) are written in

Spanish, one-third are in English and the rest are inth gugs, scy ptugus. Dug

his successive trips to Brazil, he collected closet hudd tts fm gt vty f ds,

which suggests that his library was not only madeup by gifts from his Brazilian colleagues of the san-

tst mvmt. i fct, th vy fw bkson health topics, as compared to the number of

publications by sociologists such as Caio Prado Ju, octv i Gbt Fy; c-mists and political scientists of dependency theory

such s Cs Futd; s w s umus wkson Brazilian history and a considerable amount

of books on the labor movement, anarchism andMxsm.

Although in his library a trace of Anglo-Saxonfunctionalist literature (of which he amassed

many books) remains, the number and diversityof books on Marxist theory, anti-imperialism and

lt amc hsty s twthy. Shty ft

th st mtg Cuc, Gcí std hsprogrammatic work “Las ciencias sociales en me-dicina” (Social sciences in medicine), in whichMxst thkg dy fuy mtd hs c-

ts. i ths wk, Gcí sd th study fthe social structure to understand the production of

diseases and of healthcare services; he also statedthat the “position taken by a physician” as a social

actor was “determined by the mode of production,”b t svy, fudsm ctsm (42 .21).

However, this search for “ideological cement”and for a new “frame of reference” different from

that of US functionalism was far from an abstractd mt-thtc tsk. Bsd th paHo,

García supported two complementary processesdeveloped during the 1970s: a remarkable impetustoward empirical research and the institutional

dsg f gdut cuss sc mdc.a cdt td by Mgu Máquz cy

ustts ths tst qucky tug thtcdscusss t tgb suts. at mtg

held in 1978, it occurred to García to address hiscolleagues with a parable he called “the beast


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d th ctxt.” it ws th sty f qut jug

where a strange beast appeared, causing a stir andmuch dbt mg th ms. Th w, thphilosopher of the jungle, wanted to organize

the discussions, arguing that before debating itwas necessary “to have a frame of reference or a

ctxt t dscuss th cus f ct.” o f thanimals then proposed discussing the matter under

the elephant, who could serve as a context and atth sm tm vd sht f thm . evy

time the animals seemed to reach an agreement,the owl expressed a doubt and the debate started

w. at t th ht, td d hvgforgotten what was going on due to his rather poor

memory, lay down and crushed all the conferencetcts. Fm ths b, s tv s t wseffective, García drew the following moral: it is

better to stop debating and do something before thectxt vwhms us (43).

In fact, the context had already overwhelmedthem: the military dictatorship established in

Brazil in 1964 was spreading, along with theNational Security Doctrine, over a large part of

lt amc. Th cu d’étts Ch (1973),Uruguay and Argentina (1976) were seriously

threatening the political aspirations of the sani-tarists and physicians who had links with working-

css, ftst Mxst mvmts. Sc Gcíhad begun working at the PAHO, his strategy forucg cuts gvd by mty fcs

consisted in a capillary resistance, nourishingthose more surreptitious channels opposed to

th mty gm. Ths ws th cs Bz,where close bonds were established with the uni-

versity groups posing the strongest resistance toth dcttsh.

In the state of São Paulo, García connectedwith the Preventive Medicine Department of the

Universidade Estadual de Campinas (UNICAMP),created in 1965 under the preventive model

promoted, among other international organiza-ts, by th paHo tsf. at th bgg f th1970s, th md bg t b qustd by -

fessors of that department such as Sergio Aroucaand Anamaria Tambellini, who had been deeply

ucd by th st txts Gcí wt butmdc duct. Thy ctd th Mdc

Education and Community Medicine Laboratory(LEMC, from the Portuguese Laboratório deEducação Médica e Medicina Comunitária),

incorporating theoretical debates about the socialdeterminants of health and disease processes in

order to move beyond the biologicist paradigm,as well as discussions about the structural founda-

ts f th gzt f hthc svcs.The laboratory also coordinated works that tookthese ideas beyond the university walls, particu-

y t th mucts Cms (38).The experience at the LEMC and the Pre-

ventive Medicine Department was one of thecornerstones of the Brazilian sanitarist movement,

which, in turn, served as foundation for the con-stitutional reforms that, after the restoration of de-

mccy, stbshd th Ud Hth Systm(SUS, from the Portugese Sistema Único de Saúde)

Bz. o f th hyscs wh tctdin this experience, Alberto Pellegrini, explains thatthe relation with the PAHO through Juan César

Gcí yd dcsv . i tcu, Gcíenabled access to bibliography that did not cir-

culate easily due to economic and the censorshipstcts. accdg t pg:

Juan César García made a list of selected

bibliography, which he later sent to his

fds. H hd twk, h’d sd txts

that at that time we would read avidly: pho-

tcs f tcs by Fucut, pck [...].We all received the texts directly and orga-

zd udtb dscusss. it ws wy f

giving us academic training that was almost

hc tu. (44) [ow tst]

Several of these missives, neatly typed on

paper with a letterhead, remain in the personalcollections of colleagues that were part of this

twk. Mgu Máquz, f xm, hs copy of a letter dated October 31, 1973, which

we reprint in its entirety in this article, as it pro-vides some keys for understanding the reach this

tsk f dstbutg bbghy hd (Fgu 5).Apart from the most noticeable element in

this letter, which is how up-to-date the bibliog-

raphy was – the texts on urbanism had all beenrecently published – there are other important

mts t tk t csdt. Mst m-tantly, García makes mention of two books by

Fdch egs but th ub qust (“ThConditions of Working Class in England” and “The

Husg Qust”). Stgy ugh, uk th


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other authors whose names are written in full,

egs s fc by th ts “F.e.” d thtwo books are cited in English, as if García werevdg tub wth tt cs.

García established a strong relationshipwith Latin American physicians who had solid

Mxst bckguds. ag wth hs cs tsto the Cuban sanitarists, his friendship with

Sg auc ws s sgct ths ss.Arouca was not only one of the most prominent

gus f th pvtv Mdc Dtmt fUNICAMP, he was also an important member of

th Bz Cmmust pty. i 1975, wh thmilitary regime had strengthened its repression of

political dissidence, the LEMC experience couldno longer be sustained and many members of thisgu dcty ft th uvsty. auc hd -

ished his doctoral thesis O dilema preventivista (45) but was only able to defend it in 1976, after

he had a secured position in the Escola Nacionalde Saúde Pública r d J. i hs thss,

Arouca mentioned his colleagues at the PAHO,Mgu Máquz d Ju Cés Gcí, mg

the professors who had contributed to his intel-ctu fmt (45). lt, th 1980s, d

after having been in Rio de Janeiro, Arouca went toNicaragua as advisor to the Sandinist government,

invited by García himself in his capacity as PAHOadvisor to the Ministry of Health of the country,wh Mgu Máquz ws s wkg (f).

Sarah Escorel remembers that “most of thefounders of Centro Brasileiro de Estudos da Saúde

(CEBES) were members of the Brazilian Communistpty, whch td udgud.” aft vg

Campinas and before going to Nicaragua, Aroucawas the head of this center, which brought together

all the people who were thinking about health issuesfm Mxst sctv. accdg t esc:

The source of inspiration was truly Marxist,

m td t Mx’s ds th l’s.

They all read various thinkers, particularly

those mentioned in the bibliography sent by

Ju Cés Gcí. [...] Gcí ws fc

of an international organization, but what he

really did, outside his bureaucratic job at the

PAHO, was stimulate those Latin American

groups by sending them bibliography that

ws t ubshd d dd t xst h. (47)

[Own translation]

i th 1970s, th ws ud tsh

between these Marxists intellectuals – who werebeginning to discuss healthcare policies in LatinAmerica – and the sectors within PAHO that

were more receptive to leftist ideas, such as theHuman Resources and Research Departments,

which supported the publication of the journalEducación Médica y Salud. One of these Brazilians

intellectuals, Carlyle Guerra de Macedo, who hadworked in these areas of the PAHO and eventually

became director of the organization from 1985through 1991, emphasized the clandestine nature

of many of the debates that were held at the timefrom a Marxist perspective: “We discussed all these

thgs t ght, sct, t fds’ huss, thw ubshd thm, d tht’s hw w ctdwht w cd th admd pjct.” Mcd,

Arouca, Hésio Cordeiro and other members ofwhat would be known as the sanistarist movement

w s vvd ths jct. Dug tmwhen the dictatorship had further reinforced

the vigilance mechanisms against communistctvts, ths gus – ccdg t Mcd –

“were debating in the shadows” and “conspiring”against the dictatorship, taking advantage of their

trips abroad as a way to organize networks ofdssdc (48). at tht mmt, ccss t th

PAHO and its resources for trips, meetings and thegzt f sms smd t b gutd.As Nelson Rodríguez, another member of the

Andromeda Project, adds:

W mt th wtg s f ts [...].

There were no more than 15 or 20 of us, but

w w b t mv ud ffctvy [...]

we took part in conferences, roundtable dis-

cusss, sch jcts tht cd u

ts. o ths ccss, w hd sv

cdst mtgs [...], w cdtd u

travel schedules to meet at airports or houses

in capital cities like Rio de Janeiro, Belo Hori-

zt, Sã pu. [...] W w bg cd

f fc wk ts wth scc sttut

objectives that we accomplished, but we

managed to assure some time during those

ts t xchg ds. (49) [ow tst]

If we return once more to the letter García

wt 1973 (Fgu 5), w c s tht t hdsanother element key to understanding the tasks


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Figure 5. Letter from Juan César García. October 31, 1973.


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Source: Personal collection of Miguel Márquez.

Figure 5. Continued


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Source: Own translation of letter from the personal collection of Miguel Márquez.

Figure 5. (Translation)


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Gcí cd ut fm Wshgt. i ddt

to introducing new bibliography and subtly in-serting Marxist texts, it is important to stress themtc Gcí gv t mc sch. i

short, what García proposed in this letter, apartfrom theoretical and methodological discussions,

was a “hobby-research study” that could be rep-ctd dfft lt amc cts. it c-

sstd f ctg th quts ub swth th uqu dstbut f hthc s-

vices, introducing the idea of human geography asa way of debating what he called the “hegemonic

methodology,” which was based on samplingstht tk th dvdu s th ut f yss.

This spirit of empirical research was whatGarcía tried to convey at the numerous coursesand seminars he gave in various Latin American

cuts. accdg t sm f hs cgus, htook the opportunity he had to travel as a PAHO

“expert” to teach different courses on social re-sch mthdgy d t hth. Th Cub

hysc Fcsc rjs och ttdd ssof these courses, offered in Cuba at the beginning

f th 1970s. at tht tm, och ws hd fstatistics at the Cuban Ministry of Health; this is

how he remembers the impact García had on thestudents of the course, most of them psychologists

and only two of them physicians:

at tht tm, my ch ws qutttv.

The research had a lot to do with statistics, with

hth dcts. W wtd t msu v-

erything: the mortality rate, the morbidity rate,

th sz f chd, th fm mtty t.

We had even conducted a national research

study on growth and development, based

on anthropometric measurements, a strictly

qutttv xcs tht cudd sc

scts whtsv. it ws just msug d

wghg th chd. W csdd u-

selves to be dialectical materialists, but, in that

ss, w w m stvsts. Ju Cés

Gcí d w hz u t us. (50)

[Own translation]

Ths w hz ws tht f quttv -

sch. Gcí cm t Cub wth dfftlanguage: he brought to the course a selection of

sctc tcs but sch th hth d,most of them written by US authors, and what he

proposed was not exactly reading theoretical textsor methodology manuals, but rather discussing

these articles, focusing on the method and onwht y bhd th duct f ch wk.

Fy, t s cssy t mt st stof activities that García helped carry out from the

paHo: th ct f th st gdut cussin social medicine and support for bringing to

Latin America, within these new graduate courses,my dstgushd eu tctus. Th

st cus sc mdc ws gzdin 1973 at the Universidade do Estado da Gua-nabara – now Universidade do Estado do Rio de

Janeiro (UERJ) – sponsored by the PAHO and theKgg Fudt; d, th fwg y, thy

were able to organize another graduate course insc mdc t th Uvsdd autóm d

Méxc, Xchmc (51).rbt psss ngu, f th st stu-

dts f th Mst’s pgm Sc Mdc tUERJ, explains that several of his classmates were

fgs (fm Hdus, Cst rc, pu, tc.)who had been granted scholarships by Juan César

Gcí fm Wshgt. ngu cs tht thsPAHO policy, which consisted in granting scholar-ships to train human resources in social medicine,

depended to a great extent on García, who was

also the one who promoted the visits of foreign pro-fsss such s iv ich d Mch Fucut (52).

Fucut’s v r d J cy -

lustrates the how these networks functioned and, wy, th shtcmgs. Fucut hd dy

b t Bz; hs st t hd b 1965,when he had been invited by Gérard Lebrun, who

was at that time visiting professor to the School ofPhilosophy and Letters of the Universidade de São

pu (USp). at th tm, Fucut hd ubshdonly Maladie mentale et psychologie (th st fhis works that was translated into Portuguese),Histoire de la folie and Naissance de la clinique.These works did not have a great impact on Bra-

zilian philosophy students, who were immersed inth Mxst dgm. o th th hd, thy hd

csdb uc sychgy studts,especially among heterodox psychoanalysts such

s Jud F M, rbt Mchd, rtMz d Suy rk (53).

Fucut tud t Bz ght ys t,paying visits in four consecutive years: 1973,

1974, 1975 d y 1976. athugh Fucut’s


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vst t Sã pu dug th st ys f th dct -

torship had been largely discreet, his visit in 1973had much more impact: in Belo Horizonte, he of-fered informal lectures to students in psychiatric

hospitals and in Rio de Janeiro he gave a famouscyc f v ctus t th ptc Uvsdd

Ctóc (pUC), whch w t gt xtt -cursors to the thesis of Discipline and Punish, and

whch w ubshd Bz (54). i octb1974, Fucut tud t r d J, ths tm

visiting the Social Medicine Institute, which hadbgu Mst’s pgm. accdg t Máquz

(11), thy w ssb f ctctg Fucut,along with Juan César García from the PAHO and

Sg auc fm Bz.i fct, th ctus h gv 1974 w st

were published in Spanish before they were pub-

lished in Portuguese: “La crisis de la medicina o laantimedicina” (The crisis of medicine or the crisis

f tmdc?), “iccó d hst la tecnología moderna” (The incorporation of the

hospital into modern technology) and “Historia de mdczcó” (Th hsty f mdczt).

These transcripts were published by the PAHO journal Educación Médica y Salud between 1976

and 1978, and were then compiled in a singlebk ubshd ptugus (55); wh th st

two lectures were also published, together with“El nacimiento de la medicina social” (The birth ofsocial medicine), in Revista Centroamericana deCiencias de la Salud wth th sm d (56).

What is interesting to note about these lec-

tures, particularly the lecture on the birth of socialmdc, s tht Fucut bught wth hm ds

that shook parts of the discourse upheld by thisftst stst gu. Tht dy, Fucut qus-

tioned the opposition between market-based,individualizing, professionalist, liberal medicine

and social medicine, contrary to capitalist logicd csquty, tty vuty. H

proposed the following hypothesis:

...wth ctsm, w dd t g fm c-

ctv mdc t vt mdc. ex-

actly the opposite occurred: capitalism, which

developed from the end of the eighteenth

century to the nineteenth century, started by

sczg st bjct, th bdy, s fct

f ductv fc, f b w. Scty’s

control over the individual was accomplished

not only through consciousness or ideology

but s th bdy d wth th bdy. F

capitalist society, it was biopolitics, the bio-

logical, the somatic, the corporal, that mat-

td m th ythg s. (2 . 365-366)

This single paragraph contained several chal-lenges to the Marxist thought of this group of Latin

amc hyscs: ctqu f th t fideology, an insistence on the biological body as

the main object to be governed and a review ofthe concept of “social medicine” that inscribed its

ggy wth md ctst scts. FFucut, md mdc ws vtby sc

and interest in caring for the health of workers, ofthe poor, of beggars, was an invention of European

ctst stts. rd Gumãs xs a collective interview held with other colleagues

f th Sc Mdc isttut t UerJ, tht Fu-cut’s vst ws “ mtt tht ws t tty -

svd” wth th gu. nt f hs ds wrejected, in fact, they were almost unanimouslycsdd “ttctv,” thugh t ws dfcut t

reconcile them with the discourse the group sup-td. “W hd tdt,” xs Gumãs,

“it was based in the State, it was socialism, it wasrbt C, d Fucut thw tht vbd

[...] it ws thtc d tc ssu tht thBrazilian sanitarist movement was never able to

dquty sv” (46).It was probably Sergio Arouca who, in his

thesis, took the greatest leap towards incorpo-tg Fucut’s ds; h yzd th -

ventivist paradigm as a “discursive formation”(cct tk fm Fucut’s Archéologie du

savoir ), whose genealogy he traced back to the

tth ctuy. Mgu Máquz ts us tht Juan César García always claimed Arouca to be

the strongest critic of the ideas that García at thattime had adopted to think about health problems,

d tht ths ctcsm chgd Gcí’s wy fthkg. Dug th scd hf f th 1970s,

García gradually incorporated an analysis of thehistorical roots of the concept of social medicine

and began to show interest in other Marxist re-searchers, especially from Italy (such as Giovanni

Bg d Fc Bsg), wh hd mhstc mtst sctv.

Dug hs st ys, Gcí’s w d-

gc g ws ctd txt ttd


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“Medicina y sociedad: las corrientes de pensa-

miento en el campo de la salud” (Medicine andscty: th schs f thught th hth d),in which he stated that there was a “current the-

tc btt th hth d,” sttd th1970s, and that Marxism was one of the rivals in

cmbt. H ckwdgd Fucut’s ctbu-tions but he did not agree with the methodological

proposal that other colleagues – such as Arouca –had much more enthusiastically accepted, because

he considered that “archaeology does not have aclass perspective and disregards answers provided

by hstc mtsm” (57 .45). Hs Mxstleanings remained intact, although he highlighted

the importance of continuing with these theoreticaldebates in order to think about health in Latinamc, st h wud v bd.

PAN AMERICAN HEALTH

ORGANIZATION: TENSIONS AND

CONFLICTS

Throughout this article we have scrutinizedthe constant, sustained and meticulous task of pro-

moting the development of Latin American social

medicine which García carried out based in thepaHo. it ms y t yz, bt by,Gcí’s xc wth ths gzt.

García joined the organization when it had alreadybeen operating for more than half a century and

hd st f cy dd s f wk. Sc tsct 1902 d thughut th st hf f th

twentieth century, the PAHO was marked by a par-tcu dt f p-amcsm, subdtdt th hth cs f th U.S. gvmt d

biased by the presence of private foundations thatcd ct hthc cs, msty vtc

gms t ct fctus dsss (58).García would maintain a critical attitude

twd th paHo’s hstc gcy; ths ctcsmwas evidenced in a text published in 1981 entitledThe laziness disease. i ths txt, Gcí studd thmgc f ths cct th st dcds f th

twentieth century, as well as the central importancef th rckf Fudt itt Hth

Cmmss. Fm quttv ch (bsd the ideas of Lukács regarding social categories andof Canguilhem on the historical nature of diseases),

García suggested that the “discovery” of a para-

stss fqut mg u wks d chdin Latin American tropical areas was not the result

f th fudts’ hthc humtsm

but rather the result of interests in the productivityof the people who worked in coffee, cacao, rubberand sugar cane plantations in Brazil, Colombia, Ec-

ud d g t f Ct amc (59).After the Second World War, and funda-

mentally after the WHO was established in 1948,

the economy of international relations changedand substantially altered the way the PAHO op-

td. Swy but stdy, th cm dduring which more Latin American countries

became involved in the management of thePAHO, reaching an apex in the appointment of

the Chilean Abraham Howitz as PAHO generaldct (1958-1975). it ws dug Hwtz’s tm

s dct tht Gcí td t th paHo.They both had something in common: like García,

Howitz was also a descendant of immigrantswithout university education and had studiedmdc thks t th schshs h cvd.

In this sense, it is worth noting how individualtrajectories and particularities can permeate in-

stitutions; we are referring to the considerablegrowth of the scholarship awarding policy during

Hwtz’s tm, schshs mst f whch wallocated to studies of public health and, later, of

sc mdc. Hwtz udtk, s st fpersonal commitment, the strengthening of the

human resources area and the scholarship policy,which in turn made possible many of the projects

Gcí cd ut lt amc (58 .150).However, adopting a depersonalized view-

point, it should be acknowledged that all these

changes also resulted from the existence of news f wk wth th paHo d w ds

f ssbts tht hd mgd. Th sm yHorwitz assumed the leadership of PAHO was also

the year the Cuban Revolution broke out, an eventthat would spread a climate of international rivalry

throughout Latin American akin to that being experi-cd fth th du t th Cd W. Th Cub

gvmt’s chgs t US hgmy ltamc hd gt mct th d f hth

cy (g). Th mbtus fm gm gdupon by the so-called “Alliance for Progress” in theCharter of Punta del Este (1961), and the meetings

held by the Ministers of Health of the Americas and


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promoted by the PAHO that followed, have been

interpreted as strategic responses to the advance ofCub cs wth th ubc hth d (62).

In this context, two different perspectives co-

xstd t th paHo. Hwtz’ f hth -icies focused on the promotion of programs for the

economic development of “peripheral” countries,including the expansion of healthcare services to

rural and marginal urban areas, all under the strictsuvs f paHo-td xts. Gcí

represented another line of work that aimed atproducing changes from the ground up, so that

the Latin American countries themselves couldimprove their human resources and discuss more

hzt hth cs. as Mcs Cut x-plains in his history of the PAHO, “the tension be-tween these two viewpoints persisted throughout

th 1970s” (58 .147). accdg t M Tst,Horwitz was rather conservative politically, but he

was in a way progressive in a technical sense –so much so that under his watch the PAHO was

the only organization of the United Nations tomaintain relations with Cuba, because he con-

sidered that in health matters the revolutionarygvmt ws dg gd jb (63).

The Brazilian Alberto Pellegrini, who duringthat decade worked as an advisor to PAHO and

t tk v Gcí’s , dscusss ths t-ss wth th sttut. H xs tht thline of research on medical education was initiated

in the Human Resources Department, but gainedgreater autonomy in the research area: “strictly

speaking, it was not an area for carrying out re-search, but rather an area of science policy, of

scc d tchgy” (44). pg sttd ttv fquty t Wshgt t wk ths

programs that promoted academic production,whose creation he attributes to García: “inside the

paHo h ctd scc cy” (44). H wudstay in the United States for a few months and then

tu t Bz t cy ut th mc sch.Gcí’s cdt f th sch d

schsh cs ws t fmzd. oy t

th bgg f th 1980s ws h fcy -pointed as the head of this area; immediately

fwg, h f d dd. Th paHo thd ubc sct css t th v-

cancy and the position was obtained by Pellegrini,wh th mvd mty t Wshgt. at

that time, the term of the PAHO director Héctor

Acuña (1975-1983), from Mexic

juan cesar garcía y el movimiento de la medicina social

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