INTERACT fellow Saskia Schaefer discusses her recent Indonesia election research

Saskia Schaefer portrait

Saskia Schaefer, 2013 – 2014 INTERACT Postdoctoral Fellow in Modern Southeast Asian Studies at the Weatherhead East Asian Institute and part-time lecturer in Columbia’s School of International and Public Affairs, discusses her recent visit to Indonesia to study the country’s 2014 elections.

The International Network to Expand Regional and Collaborative Teaching (INTERACT) is a pioneering program at Columbia University that focuses on developing global studies in the undergraduate curriculum through a network of postdoctoral scholars focused on cross-regional, trans-regional and interdisciplinary teaching. Through innovative courses and active involvement in all dimensions of campus intellectual life, the INTERACT scholars seek to improve global literacy among Columbia students and equip them to be leaders in a globalizing world.     

[During my annual visit to Indonesia, in January of the election year 2014, I meet more pessimists than optimists.]

“Expectations? I am not expecting anything. I didn’t vote last time and I am not going to vote this time. During the first elections, in 1999, I wore a T-shirt with a slogan on it and went campaigning. They promised that we would be paid back all the efforts in cash. But that never happened.” Rudi’s eyes flash as he looks at me through the rear mirror. He is from West Java and has been working as a taxi driver in the capital Jakarta for 12 years. He knows about politics, he follows the debates. But he hasn’t voted since 1999. Asked about the upcoming parliamentarian elections in Indonesia, he smiles resignedly: “What for?”

In the late 1990s, when I first visited Indonesia as a student, most people I encountered were in a euphoric mood. Suharto’s crusted regime had just fallen in 1998, the new temporary president Habibie had been educated abroad and seemed willing to hand over power to democratically elected representatives. The media landscape was transformed into one of the freest in Asia; foreign-funded NGOs were blossoming and spreading an air of progress and optimism. From far, I followed Indonesia’s elections: 1999, 2004, 2009 — all classified as free and fair by international observers. Throughout my time as a student of political science and Southeast Asian history, I spent good parts of my holidays at Indonesian universities. Indonesian students love discussions; they meet and sit down to talk for hours while sipping sugary jasmine tea. They invited me to give small talks; I would find myself surrounded by curious students, keen to jump in and challenge and debate every little sentence. There is an indescribable energy in a room full of young eager students of politics, law, and philosophy who sense that they are living in a time and place in which they can newly shape their country. I remember drawing a circle on a blackboard, surrounded by small boxes: the elections, central to democracy, surrounded by political and civil rights and by the separation of powers. The Indonesian students and I looked at each other and knew that it wasn’t complete. We had a nice and neat model of the wisdom of liberal democratic theory here — but it didn’t help us grasp reality. “Should the elections really be in the center?” somebody asked. I shrugged: “I’m not sure. That’s what I’ve been taught. What do you think?” They weren’t so sure either. And this was what they had been taught too. I have since been trying to find out what else could possibly be in the center. Additionally, or instead.

This rainy season, while Jakarta suffers its annual floods, the Indonesian media is celebrating and watching Joko Widodo — known as Jokowi — the current governor of Jakarta. He is a potential candidate for the presidential elections that are scheduled for July. Famous for his spontaneous visits to slums and hospitals, people see Jokowi as “one of them” and admire the strength with which he seems determined to combat inefficiency and corruption. Another main contender is Prabowo Subianto, a businessman, politician and former Special Forces soldier. His background in business and the military, I was told many times, promises political potency. Neither of them has very detailed policy plans, nor do the other potential and confirmed candidates. Indonesian politics — as increasingly elsewhere — are more about personalities than about parties and their plans and programs. “They’re all the same!” sneered Rudi at the end of our ride.

 

Amy Dao’s Exploration of Health Insurance in Vietnam

Ethnographic Explorations of Health Insurance in Vietnam

By: Amy Dao, PhD, Mailman School of Public Health, Columbia University

It’s 2:00AM in the morning and I am waiting with my friends on the side of the road for a bus that will take us from Vinh Long Province back to Ho Chi Minh City, the largest metropolitan area in Vietnam. This is not a public transit bus, but a privately owned and operated service bus used by the residents of this largely rural province for transport into the city. What’s more intriguing is that passengers use this particular bus to travel directly to the city health facilities for medical treatment.

As headlights direct us through bumpy streets, we stop intermittently to pick up other passengers waiting in the dark with their bags full of clothes and various fruit. Right before sunrise at 4:00AM, I abruptly learn that some have even managed to sneak on two roosters. At the drop off, a female employee of the bus company decides who will continue onto the motorbike taxis first. She groups everyone by destination and tends to give priority to those going to hospitals. My friends leave first and I wait a few minutes before being called up. They pair me with a man who appears to be in his late 40s. The three of us, including the driver, cram onto the back of a motorbike and stop first at hospital where my companion is dropped off.

Zipping through the streets on a motorbike is the best way to experience everything Vietnam has to offer. From the city to the country-side, the unobstructed views of lush gardens, street food vendors, rice paddies, buffalo, tangles of floating electrical cords, karaoke bars, and endless rivers never cease to evoke mixed feelings of harmony and frenzy. My time here this summer was made incredible by the warmth and friendship that I received from both old and new friends as I made my way through an ethnographic exploration of health care reform in Vietnam. I recall one of the many stories told to me by a local café owner as I was scouting out a potential research site in Vinh Long province:

“When you pay the doctor with your own money, he feels that the money is coming from you so he will treat you better. When he is paid by the insurance department, the doctor feels like the money is coming from insurance and he won’t care,” says Dì Nhó* as she explains her reasons for not enrolling in the government sponsored social health insurance program. Her response is indicative of how people are making sense of an expanding health insurance policy in contemporary Vietnam. Dì Nhó’s explanation is only one example of how insurance can open a window onto the ways that these state-wide policies have affected social relationships within the broader culture of care in Vietnam. It also reveals how money comes to have social meaning via the way it is exchanged and represented at a time of increasing social, cultural, and economic change.

In 1986, Vietnam’s economic liberalization policy of Đổi Mới marked a transition from a centrally controlled economy to one that is open to the market flows of global capitalism. Along with the movement of economic capital came the influx of ideas about how a newly privatized health care sector could be improved. With the passing of declaration WHA58.33, the World Health Organization’s endorsement of universal health coverage resulted in a renewed global interest in health care financing. Vietnam, in particular, enacted laws to reform its health insurance program and reach universal coverage by 2020. Current data show that while health insurance has reduced the cost of catastrophic spending, the majority of health spending in Vietnam continues to occur within the private sector in the form of out-of-pocket payments. In my project, I hope to explore the disjuncture between these two phenomena.

Last year, the Weatherhead Sasakawa Young Leaders Fellowship Fund (SYLFF) provided me with the opportunity to collaborate with Hanoi Medical University on social science research on HIV in Vietnam in the summer of 2012, which culminated in an article published here. This summer, SYLFF continues to be instrumental in the development of my scholarship and professional career by enabling me to embark on my own independent research to pilot my ideas and hypotheses about the effect of health insurance on people’s everyday conceptions of managing uncertainty in Vietnam.

During this time, I was able to move forward on my path towards dissertation research. I had two wonderful language teachers who not only improved my Vietnamese, but also fielded all of the naïve questions I was too afraid to ask others. I established scholarly contacts and institutional affiliation by attending a qualitative interviewing training workshop that was supported by the Social Science Research Council (SSRC) and the Southern Institute of Social Sciences (SISS) in Vietnam that specifically examined health care seeking patterns in Vietnam. With the help of SISS, I was put in touch with a fellow anthropologist to help me navigate through Vinh Long province and test out my questions about health insurance by talking to locals about their experiences with the health care system. Obtaining this information in an open-ended fashion allowed me to situate insurance within the wider context of people’s social relationships, thoughts about the future, and concepts of money. More importantly, being there to see and experience the waits at hospitals, how people are divided into those with and without insurance, and the difficulty of traveling to medical facilities during the common summer floods gave me a sense of the social and infrastructural issues that arise when trying to obtain health care. Without the support from SYLFF, I would not have had the means nor the flexibility to think about new questions to ask about insurance.