Documents, education, and aesthetics: Exploring processes of subjectification among community health workers in Peru

ABSTRACT

This article examines the processes of subjectification involving community health workers in the Peruvian Andes. Community health worker programmes keep education at the core, striving to provide marginalized people with information about mother-and-child health, family planning, nutrition, and illness prevention, among other things. Education is one of the arenas where Foucauldian themes of subjectification are most explicit (Kipnis 2011). However, the subjectivities such development programmes seek to produce by training and monitoring those involved are not necessarily those that emerge. In studies of health policies and their implementation in targeted areas, the focus tends to be on how governmentality discourses and techniques produce responsible and governable subjects. However, little attention has been paid to understanding the processes of subjectification and how they are interpreted and enacted by the targeted subjects (Winkler-Reid 2017). This article aims to illuminate how community health workers use their embodied understanding of school literacy and aesthetics to engage with specific community health-related tasks. It argues that aesthetics is a central part of the formation of subjectivity and that expectations of aesthetic qualities similar to those of classroom situations contribute to accentuating the community health workers becoming ‘good students’. In this specific setting, being evaluated as a ‘good student’ receives more emphasis than other goals of the community health worker programme, such as providing easier access to health care services for their fellow community members.

KEYWORDS:

• Community health workers
• documents
• education
• literacy
• aesthetics
• Peru

Introduction

After an educational training session (capacitación) on ‘healthy homes’ in 2015, Imasumaq, a 20-year-old woman and the mother of two boys, had decided to reorganize her house’s living- and sleeping area. ‘They told us it was important not to sleep in the same bed [as our children] and to keep the furniture away from the walls because of spiders’, she said while explaining to some of her neighbours how she had reorganized her home. She described how she and her husband had refurnished their house of two rooms into ‘zones’ before she concluded her monologue, stating that: ‘[What is] most important is to refurnish once in a while so that the spiders do not nest.’ Imasumaq was one of seven people recruited to work voluntarily as Agentes Comunitarios de Salud in the Colca Valley rural area of Sumaq Llaqta.¹ One of the main tasks of las Agentes, as they called themselves (they were six women and one man), was to participate in capacitaciones led by social workers and health workers. In addition, to participate in capacitaciones, the community health workers operated the Metacentro, which was a nickname for Centro de Promoción y Vigilancia Comunal del Cuidado Integral de la Madre y el Niño – CPVC – meaning ‘Centre for Community Promotion and Supervision of Integral Mother and Child Care’. This was a community-run subdivision of the regional Centro de Salud² (health centre) and central in a national development programme aiming to improve ‘community health’. Visitors at the Metacentro would most often be mothers and pregnant women in the neighbourhood, who sometimes were provided with biomedically accepted messages on health, nutrition, family organization, and public healthcare or asked if they had visited the Centro de Salud for regular prenatal check-ups or received nutritional packages. Officially, los Agentes Comunitarios de Salud were presented as community actors with a central supporting role for pregnant women, mothers, babies and toddlers. According to the Ministry of Health, their role was to ‘promote health and prevent illnesses’ (MINSA 2009, 13; 2015, 12). They were seen as a link between the expanding Sumaq Llaqta and the Centro de Salud in Chivay. One of their main tasks was to convey and advocate for biomedical knowledge on health, nutrition, pre- and antenatal health and childcare. The intention was that the Agentes Comunitarios de Salud would be recruited from the same community where they would work. The idea was that since they knew the families they interacted with, they would ‘share the same problems’ in addition to knowing ‘that the most important parts of a family and a community are the children’ (MINSA 2009, 13). Because the concept of ‘community health agents’ resonates with the international development scheme of ‘community health workers’, I will use the latter term to come into dialogue with a broader academic literature on health policies and development programmes.

One of the community health workers’ most significant tasks was to record information about visiting women and their children in special notebooks (cuadernos). The notebooks were ‘checklists’ (listas de chequeo) with a dual function: each community health worker kept her own notebook that targeted a specific ‘vulnerable’ category (example ‘pregnant women’, ‘babies’, ‘toddlers’, or ‘elderly’). However, the notebooks were also material proof of the community health workers’ work effort and competence, as these were sent regularly to the local regional authorities to be ‘approved’. Given that the checklists were approved, the community health workers would receive a canasta (basket) containing kitchen and food supplies such as rice, cooking oil, flour, and other basic foodstuff as compensation for their efforts (see MINSA 2012, 36; 2015, 20). In the words of Mary Douglas (in Appadurai 1986, 24–5), the notebooks were valuable as some kind of ‘commodity coupons’ and would confirm expectations of how the community health workers should complete their tasks. If the health authorities were not satisfied with the content of the notebooks, they would send them back with instructions on how to ‘revise and resubmit’. In addition to being the strongest material evidence of performance and a monitoring tool for ‘healthy behaviour’, the notebooks were also an educational tool for teaching and reminding the community health workers of a biomedically defined moral realm of pregnancy, motherhood and health care.

This article focuses on educational and monitoring activities within a Peruvian community health worker programme. It examines processes of subjectification within the community health workers’ work efforts and educational activities. Education is one of the arenas where perhaps Foucauldian themes of subjectification are most explicit (Kipnis 2011). However, the subjectivities such development and educational programmes seek to produce through training and monitoring of those involved are not necessarily those that emerge. In Anthropological studies of health policies and their implementation, the focus tends to be on how governmentality discourses and techniques produce responsible and governable subjects. Yet, too little attention has been dedicated to understanding the mere processes of subjectification and how they are interpreted and enacted by the targeted subjects (Winkler-Reid 2017). This article aims to illuminate how community health workers use their embodied understanding of school literacy and aesthetics to engage with specific community health-related tasks. By investigating the ‘social stuff in-between’, I argue that aesthetics is a central part of the formation of subjectivity and that expectations of aesthetic qualities similar to those of a classroom contribute to the community health workers becoming ‘good students’. In this specific setting, being evaluated as a ‘good student’ receives more emphasis than other goals of the community health worker programme, such as providing easier access to health care services for their fellow community members. Using literature concerned with the ‘ethnography of schooling’, I will explore how complex webs of graphic practices are interconnected in people’s interactions with documents and literary practices. I am inspired by Annelise Riles’ call to ask ‘how else documents may be ‘good to think with’ as for scholars as much as for their subjects’ and to go beyond Foucauldian dwelling with the hegemony of document technology (2006; 13 in Salomon and Niño-Murcia 2011, 12).

To illustrate, the community health workers in Sumaq Llaqta treated the books with care by binding them with plastic book covers and decorating them with carefully drawn drawings, while the grid tables inside the notebooks were neatly filled with flawless handwritten letters. The aesthetics of the notebooks interestingly echoed colour systems like those produced by pupils in Peruvian schools. On one occasion, the community health workers asked me to help them draw new sets of tables on blank pages in one of them. However, being unaware of and inattentive to the expectations of how the pages should be organized, I did not do a good job. Not having understood the aesthetic norms for the notebooks, I had ‘messed up’ their system, using a black marker to line up crooked squares and writing the text inside the squares with the same black pen. They did not correct me specifically; however, I noticed how the community health workers looked at each other when seeing the result of my ‘help’. A week later, I noticed that they had made my checklist anew, in its ‘correct’ aesthetic form: one colour for straight lines and another for the text inside the squares. The importance of careful management of documents has been observed by others, such as in Kristin Skrabut’s (2018, 526) work on legal documents (birth certificates, education certificates, marriage certificates, proof of residency, vaccination certificates). She observed how these documents were provided with particular care and kept neatly in plastic folders.

The notebooks and other checklists offer food for thought in themselves. A straightforward way of analysing these documents and their related practices would be to focus on their normative aspects as texts and to see them as instruments of political control or as a ‘technology of government’ in Foucauldian terms (Reed 2006, 159). From this perspective, the checklists can be understood as educative objects that symbolize the community health workers’ personal and collective capacities as ‘good workers’ and as tools of governance that articulate the ideal subject. In his description of Foucault’s three modes of objectification, Paul Rabinow names the third mode ‘subjectification’, which concerns the ‘way a human being turns him- or herself into a subject’ (1984, 11). With this, he refers to Foucault’s work with the ‘processes of self-formation in which the person is active’, when the person forms the self, concurring with external expectations (1982 in Foucault and Rabinow 1984, 11). The Metacentro development programme in which community health workers are central, indeed shares features of what Foucault (1977) called a ‘disciplinary apparatus’, with its elements of ‘correct training’ in the form of a training session (capacitación); ‘normalising judgement’, in terms of posters and questionnaires that underline the correct and incorrect health-situations and -practices; and ‘examination’, in the normalizing gaze of health workers. The community health workers’ main task is to record health information from ‘vulnerable’ fellow citizens. Additionally, they attend training sessions (capacitaciones). These were held regularly by health workers from the regional health centre (Centro de Salud) and can certainly be seen as crucial sites in which subjects are ‘schooled in the demands of neoliberalism and its ideal subject, the autonomous, responsible and self-monitoring individual’ (Winkler-Reid 2017, 138). In combination with training sessions, the checklists could also be understood as tools for forming community health workers into role models of ‘good’ health conduct. However, this text attempts a different approach.

In the literature on modernization processes, there is an extended focus on how state and NGO projects seek to form indigenous, poor, and other non-desirable citizens into beneficial subjects according to dominating discourses of development (Ewig 2010; Stephenson 1999). However, such literature tends to take for granted that ‘the articulation of ideal subjects results in the actual creation of these selves in everyday life’ (Winkler-Reid 2017, 140). There is also a tendency to ignore the agency of actors involved in development processes, maybe as an analytic side-effect of illuminating the power of institutional structures. Maja Green, for instance, notes that both James Ferguson and Arturo Escobar ‘present an alienated view of development’, where they see development as a ‘bureaucratic machine that overrides the agency of the individuals engaged in it’ (2014, 60). Such focus on a bureaucratic state apparatus can illuminate aspects of power and the techniques of government that seek to form subjects into governable citizens. However, it may also overlook how the subjects themselves interpret, receive, and negotiate information provided in educational activities through posters and forms. To assume that the community health workers would always repeat the advice and information they are provided at training sessions would be naïve at best. Even though scenes like the one introducing the article could be observed, it was rare that a community health worker would re-narrate what she had been told during a training session. Nonetheless, the scene demonstrates the hegemony of the biomedical scientific knowledge proclaimed in the training sessions.

Less attention has been paid to understanding how the community health workers themselves receive and relate to educational activities and their tasks of monitoring their neighbours’ health information. Anthropological literature has looked at the link between subjectivity and power in attempts to explore ‘anthropology as cultural critique’ (Ortner 2005). Subjectivity, here, is referred to as ‘the ensemble of modes of perception, affect, thought, desire, fear, and so forth that animate acting subjects […] as well the cultural and social formations that shape, organize and provoke those modes of affect, thought and so on’ (Ortner 2005, 31). To illuminate how the subjectivities of community health workers are being formed and reshaped, this article tries to unwrap the processes of subjectification by exploring the aesthetic dimensions of some of the most central documents produced and used by community health workers. By aesthetics, I mean the documents’ ‘status as artefacts and the actions of their design’ (Reed 2006, 163). In exploring how the community health workers carried out their work and how they manoeuvred internal and external expectations for the result of their work, the article tries to dig deeper into a dimension of governmentality research that is often left unattended. Inspired by Adam Reed and his attempt to ‘demonstrate one way in which documentary practice may become an orienting analytical procedure’ (2006, 163), this article pays special attention to the dimensions of aesthetics and literacy in how people engage with tools and technologies of government. To illuminate these social dynamics, it is fruitful to consider perspectives on material culture and the social lives of documents (Appadurai 1986). The checklists have indeed social lives; they take part in interactions between the community health workers and other community members, community health workers and health/social workers, and they inhabit different kinds of value as they are exchanged for food baskets. Although forms may appear as ‘suffused with neutrality’ (Raman in Lorway 2017, 178), the form-filling practices themselves, alongside the aesthetics of the forms, show that they are ‘responsible for producing or objectifying the subjects who use them’ (Reed 2006, 158). However, the community health workers actively engage with the documents they are set to produce, as they do with the educational sessions arranged for them. As I will demonstrate, they internalize their work through aesthetics and humour and do not just ‘do as they are told’ by the social workers and other health authorities. The information produced in the notebooks was carefully written and organized. It was not a passive response to the verbalized expectations of health authorities but rather the attempt of the community health workers to show themselves as schooled and worthy.

This article builds upon six months of fieldwork in the Colca Valley in Peru in 2015 as a Master’s student. Most of my interlocutors used Spanish as their primary language of communication (although they used Quechua on occasion). Since I could speak and understand Spanish as a third language, I did not use a translator or a research assistant. My fieldwork consisted of open-ended, unstructured interviews with community health workers, socias of various community programmes, health workers, social workers, and schoolteachers, and on occasion, I had interactions with leaders, politicians, and public functionaries. I presented and positioned myself as a student who was there to learn about how women conceptualized and talked about health in the Colca Valley. I asked for permission from local authorities and my interlocutors to participate in activities to learn and write about everyday life, particularly discourses concerning women’s health. I followed the Guidelines for Research Ethics in the Social Sciences and the Humanities issued by The National Committee for Research Ethics in the Social Sciences and the Humanities (NESH); the research project was also registered in the Norwegian Centre for research data (NSD). In the field, I also carried a letter of identification from the University.

In addition to having unstructured interviews, I did participant observation at the Metacentro and a comedor popular (community kitchen) in an area I have named Sumaq Llaqta, in addition to a pharmacy in the town of Chivay. These various ‘field sites’ provided access to the life stories of those doing volunteer labour in their home communities. Through regular conversations with people with middle-class and urban backgrounds working at various health facilities within the region, I got a picture of their perspectives on health-related challenges in the region. In addition, I lived in a residency for teachers, which provided insight into teachers’ perspectives on schools and students in that particular setting. While my experience was that it was relatively easy to engage in conversations with people from the urban middle class, the interactions with women living in Sumaq Llaqta occurred differently. Interlocutors from urban middle classes frequently provided verbal details from narratives and personal experiences, leading to long, informative conversations. In Sumaq Llaqta, however, it was not until I stopped asking questions that people were more relaxed in my presence and would eventually tell me excerpts of their life stories. Much of the information concerning the community health workers is based on my interpretations of observations of everyday encounters and practices and spontaneous conversations in groups where I was participating, although less actively in terms of attempting to lead the conversation somewhere. In the next section, I elaborate on the Community Health Worker programme as a global development scheme while exploring the gendered dimensions of unpaid labour and how this connects to a long trajectory of political discourses where indigenous identities have been portrayed as a barrier to socio-economic development.

Community development on the global and national agenda

From a global health policymaker’s perspective, community health workers are a tool to ‘bridge the gap’ between health services and marginalized populations, particularly in low- and middle-income settings. Simultaneously, using volunteer and unpaid labour tends to be portrayed as a good way to address the chronic shortage of skilled health workers (World Health Organization 2006). One of the WHO’s central strategies to address the health worker shortage has been ‘task-shifting’. In health services, this refers to delegating specific healthcare tasks to the ‘lowest’ category that can perform them successfully (Lehmann and Sanders 2007, 9). Although with some local variation, globally, community health workers are put to do home visits where they conduct surveys about ‘health practices’ in the area (Westgard, Naraine, and Paucar Villacorta 2018) or promote certain kinds of information in campaigns, such as prevention of dengue fever or HIV/AIDS (Maes 2015; McKay 2020). In Zambia, community health workers are even trained and licensed as medical practitioners at health posts, performing ‘preventative and basic curative services’ in the lack of sufficient numbers of health workers (Keller et al. 2017, 2; see also Wintrup 2022). Policies and practices of shifting tasks within public services are neither neutral nor unproblematic. In the chase to solve a crisis, much literature on health issues (particularly within the field of public health) tends to forget to scrutinize the role of power in volunteer labour. Romantic ideas of the motivations behind community work are tightly connected to notions of altruism within volunteer work (Prince and Brown 2016). Community health workers in community-based health programmes in Bolivia in 1975, for instance, were thought to be motivated by the ‘love of neighbour and welfare of the community’ and working without salary (Bastien 1990, 282). The strategy of ‘task-shifting’ is not unique to the management of health services. It can also be linked to tendencies in neoliberal policies of outsourcing state responsibilities such as infrastructure development, maintenance, and public services to ‘community-based’ organizations. In Peru, the government authorities have a long trajectory of using (free) community labour to complete state policies. One example is how, in new urban neighbourhoods created by collective work, Peruvian authorities have co-opted local movements into official policies by making the collaborative construction of infrastructure compulsory (Ødegaard 2010, 113).

Community health worker programmes worldwide focus on preventing ‘unhealthy behaviours’, improving adherence to drugs and other biomedical technologies, and lowering morbidity and mortality rates. The Alma Ata Declaration of 1978 envisioned community health workers as the key to improving well-being, enhancing social solidarity and reducing poverty (Haines et al. 2007). Critical attention, however, has been directed at global health bodies’ focus on the importance of community health workers’ efficacy. Nading (2013, 99) has warned that if the effectiveness of community health workers is reduced to successful distribution of medicines and the generation of numbers and quantifiable results, the CHWs’ ‘parallel capacity to act as advocates for a more empowering public health based on a nun-numerical quality of service may be obscured’. From a global health perspective, the community health workers’ key competence is their ability to ‘act as professional mediators of biomedical technologies and as models and monitors of healthy behaviours’ (Maes 2015, 98). However, on the one hand, community members are supposed to be trained and ‘transformed’ into good role models and conveyors of biomedically approved health practices. On the other hand, they also conduct cheap labour directed and organized by the state. In Peru, targeting women with low socio-economic status and indigenous backgrounds in development programmes has deep historical and colonial roots. The constructed links between indigeneity and ‘barriers’ to economic development have not only been visible in historical intellectual and political debates (a topic often referred to as ‘el problema del Indio’, see example Manrique 1999, 6–9; Obando 2002); it has also materialized into some of the worst cases of political violence and human rights violations. One of the most recent examples is the sterilization campaigns conducted by the government of Alberto Fujimori (1990-2000), where thousands of mainly rural and indigenous women were unknowingly or forcefully taken through surgical sterilization as a so-called ‘family planning’ method (see, example Gianella and Yamin 2018). Although the details of this campaign were not thoroughly presented to the international stakeholders, Fujimori’s health sector reform in the early 1990s was part of a broader structural adjustment policy that followed World Bank recommendations of using targeting methods to get to the most needy instead of dedicating resources to universal programmes (Gianella and Yamin 2018, 49).

The pendulum of global health policy is, by most scholars, known to be shifting according to political changes (see Béhague and Storeng 2013); however, public health policies focusing on ‘community development’, ‘community participation’, and ‘community empowerment’ have a long trajectory. In low- and middle-income countries, economic shifts and a growing lack of public resources have since the 1980s supported the idea that ‘local people’ should develop their own solutions and depend less on the central government for support (Lupton 1995, 58). For instance, the community health worker programme has been seen as a potential solution to the problem of chronic malnutrition. This has been globally targeted by international health organizations and aid-financed development programmes. One example is the UN Millennium Development Goal (MDG) 4, which aimed to decrease under-five child mortality by two-thirds between 1990 and 2015 (Huicho et al. 2016, e414). In Peru, chronic malnutrition has long been formally on the national agenda, at least since the late 1970s. It has been addressed through various local programmes such as the comedores populares (soup kitchens) and vaso-de-leche (the glass of milk programme). While the vaso-de-leche programme provides basic food supplies to the poorest families to benefit at-risk children under six years old, the comedores populares prepare nutritious meals that are sold at a low price or given for free to the poorest in the neighbourhood (Ødegaard 2010). Such programmes were interconnected with political attempts to resonate with strong Andean practices of communal work. Ødegaard states that ‘by appealing to Andean traditions of communal work, governments and state institutions have in this manner come to rely on the initiatives and accomplishments of local organisations for the improvements of marginalised urban neighbourhood’ (2010a, 121). These community initiatives rely heavily on unpaid voluntary, and particularly female labour. Unpaid labour is also tightly connected to gender, and work associated with the house, home and family tends to be (yet not exclusively) reserved for women in many contexts.

The idea of women portrayed as ‘natural’ caregivers tends to be justified by women’s essential roles within family care settings and the domestic sphere (Olesen 1997, 398). Feminist writings such as those of Federici (2020) on the reproduction of housework point to the fact that the gendered dynamics of housework are closely linked to capitalistic structures that reproduce highly gendered social infrastructures. In Peru, like in many other countries locus for development projects, women have been specifically targeted. Perceptions of a ‘natural’ interconnection between women, reproduction, and the domestic sphere have guided a number of development policies that see women as essential for community development (Ewig 2010, 7). Engagement in waged and non-waged forms of work is also a way of integrating women into relations that contribute to producing specific biopolitical subjects. Work does not only create economic goods and projects, but it also produces social and political subjects that are governable, disciplined, and responsible (Weeks 2011, 8). The gendered dynamics of community work in Peru are also deeply racialized, according to de la Cadena’s (1996) exploration of how women tend to be more linked to indigenous identity markers than men. In her ethnographic work with campesinos in Cusco, she observed that indigenous women tended to be thought of as those least capable and skilled for work (de la Cadena 1996, 188). In the rationalization behind this perception, it was also said that because of women’s ‘incapacity’ of working, they were the ones with less connection to the urban environment associated with work and modernity, which in return ‘kept’ women more closely linked to the rural and indigenous spheres than men. This interconnection between gender and indigeneity has a long trajectory in development discourses. Historically, women’s position has often been limited to health programmes, family planning, nutrition, childcare and home economics, while men have been conceived as the most productive workers (Ewig 2010, 7). One of the programmes that has a clear gendered preference for mothers is the Peruvian Conditional cash transfers (CCT) programme called Juntos (‘together’). These are cash incentives provided to poor households on conditions they adopt to idealized ‘health- and education seeking behaviours’ (Patricia Cookson 2018, 2). Critics have questioned the social effects of CCT as it links motherhood, poverty and ‘responsibility’, which enacts that poor women are labelled as ‘irresponsible’ (Patricia Cookson 2018, 10).

Consequently, a dominant focus on women’s role in the domestic sphere can contribute to an illusion that women in the Andes do not fully participate and contribute in public domains. This can be observed in popular notions of ‘women are less corrupt than men’ and being ‘closer to the earth’, which have been frequently deployed within development narratives (Cornwall, Harrison, and Whitehead 2007, 2). The portrayal of indigenous women as curators of some kind of ‘purity’ free from the potentially destructive forces of the market has been criticized by scholars who challenge the idea that indigenous peoples were only participating in commercial activity under pressure (see Harris in Ødegaard 2008, 246). The perceived interlink between indigenous women and poverty, or rather, the distance between them and the market economy, has been challenged by Ødegaard (2022, 436), who argues that the participation of Andean people in the market economy has been a way to ‘avoid other exploitative conditions and even to maintain indigenous forms of sociality, including political and economic organization’. In their comparison of the social character of market relations in the eighteenth and the twentieth century in Tapacarí, Larson and León suggest that the postcolonial transformation and decentralization of markets cannot be explained by ‘teleological notions of progressive marked penetration’ (Larson 1995, 33). Instead of seeing the rise of ferias (marketplaces) as a destruction of non-marked forms of circulation, they argue that Andean ayllus (kinship corporations) and communities have integrated cultural logics of capitalist commerce into already existing social organizations (Larson and León 1995, 247). Trade activity in the Andes is essentially relational and has deep roots in communal work, called faenas (Ødegaard 2008, 245). Additionally, the marketplace is a clearly ‘feminine space’ in the Andean context and a profoundly public space (Larson and León 1995, 247).

This fact breaks with narratives of gender and development policies, where women tend to be viewed as symbolic ‘keys’ to society development and social engineering (an illustrative example of this is Quisumbing et al. 1995). There are, however, apparent paradoxes in how women are portrayed within discourses of development. On the one hand, women are seen as a problem for modernity because of their symbolic connection to the ‘traditional’. The ‘traditional’ has a long history of being seen as interlinked with ‘backwardness’ and perceived as having nothing to contribute to the process of development (Escobar 1995, 78). On the other hand, women are portrayed as representing a solution for issues of health and modernity because of their essential symbolic interconnection to the home and the family. In critical studies and popular characterizations of women, notions of the ‘biologically fixed’ nature of women’s reproductive activities link them to the domestic space as if it were the core of womanhood (Stephenson 1999, 59). When employed in development discourses, this representation interlinks womanhood, the domestic, motherhood and family health, providing a hegemonic ground-base for encouraging myths that produce and reproduce a generalized picture of women as solutions to, and responsible for, development and modernity. The justification for using unpaid female labour tends to be linked to how women are considered to lack basic organizational skills and that they may gain such skills through participating in specific development programmes, such as the comedores populares (community kitchens). As socias (volunteers) in comedores populares, women participate in capacitaciones (training) about hygiene, nutrition, organization and trade, and the idea is that they will take these skills home and use them in other areas of their lives (Schroeder 2006, 664). By engaging women in work, the state also integrates women in wage relations that generate ‘disciplined individuals, governable subjects, worthy citizens and responsible family members’ (Weeks 2011, 8). Historically, the state’s intention to create certain kinds of subjects through work and school is linked to colonial efforts to regulate citizens (Salomon and Niño-Murcia 2011, 11). However, the efforts do not necessarily result in creating the envisioned subjectivities. For the community health workers in Sumaq Llaqta, how they interpreted the expectations of the results of their work was tightly connected to their previous literacy practices that occurred in school settings. Nevertheless, the dominating ideas of Andean (il)literacy have received substantial criticism from anthropologists and sociolinguists.

Andean literacy and the creation of new elites?

To some extent, rural Andean villages are still perceived by city elites as a linguistically and racially stigmatized Other. ‘Illiteracy’ has been blamed in national and global development discourses for rural inequality, as if ‘illiteracy’ is inherent in the peasant condition. The Pan American Health Organisation (PAHO), for example, portrays indigenous women as ‘triply disadvantaged due to their sex, ethnicity, and rural residency patterns that limit their access to resources’ (Cooley 2008, 151). Development discourse has long been fed by specific ideas of literacy. In what Brian Street refers to as ‘the autonomous model of literacy’, literacy tends to be represented as a technical issue that can be solved by teaching people how to decode letters. This model assumes that ‘literacy in itself – autonomously – will have effects on other social and cognitive practices’ (Street 2001, 7). However, literacy is not just technical or neutral; it is a social practice ‘embedded in socially constructed epistemological principles’ (Street 2001, 7). Street argues that ‘the ways in which people address reading and writing are themselves rooted in conceptions of knowledge, identity, being’ (Street 2001, 7). Rather than viewing literacy as merely the decoding of letters and that becoming ‘literate’ happens ‘naturally’ after this skill has been required, we should ask how meaning is provided through literacy practices, which refers to a ‘broader cultural conception of particular ways of thinking about and doing reading and writing in cultural contexts’ (Street 2001, 11). The particular ways in which meaning is being provided in the literacy practices of community health workers are culturally, locally and contextually specific and deeply interrelated to their previous experiences of interacting with texts and practices of writing. Gee (in Street 2001, 8) argues that this particular version of literacy, including its meanings and practices, is always contested, hence ‘ideological’ and ‘rooted in a particular worldview and a desire for that view of literacy to dominate and to marginalize others’. Reading and writing processes are not only about cultural meanings but also about power; thus, it is relevant to ask who has the power to define what counts as literacy.

A common view of Andean Americans is that they were, and to some degree still are, marginal members of the world of letters, barely consumers of the written word and not producers of it (Salomon and Niño-Murcia 2011, 2). Peruvian authorities have long stereotyped Andean peoples as ‘oral’ cultures and as ‘tragic Rousseauian resisters against alphabetic regimentation’ (Salomon and Niño-Murcia 2011, 1). For instance, the Peruvian state has historically not regarded indigenous languages as part of the nation’s alphabetic, graphic community (Salomon and Niño-Murcia 2011, 7). Salomon and Niño-Murcia (2011, 11) argue that this is profoundly mistaken and related to ‘the image of so-called ‘yndios’ as illiterate latecomers to the bookish world’, which is an oversimplification. However, studies of contemporary and historical literacy practices have shown that literacy, the writing of letters and keeping records have long traditions in the Andes (de la Piedra 2006; Rama 1996; Salomon and Niño-Murcia 2011). For instance, when the newly independent Republic took shape in 1825, people living in Andean villages had already ‘internalized the graphic order’ without formal schooling (Salomon and Niño-Murcia 2011, 10). With this, Salomon and Niño-Murcia refer to the literacy practices in which the Andean society had already established its own ‘advanced resources for recording information through the ancient medium of the khipu, or knot-cord record’ (2011, 10). They argue that the relationship between traditions of recording and the ‘writing proper’ was not simply one of replacing one system with another, but they coexisted and interacted. The Andean peoples were quite early connected with a global textual community through the growth of ‘Andean graphic habits’ such as the formation of colonial native nobles, described by the scholar Angel Rama as letrados (1996 in Salomon and Niño-Murcia 2011, 11). The letrados were trained in the alphabetic code and would document legal decisions, draft governmental edicts, maintain church records and author literature of Latin America (Metcalfin Salomon and Niño-Murcia 2011, 15). This training was practically reserved for the letrados alone, as engagement with texts was highly restricted to governing elites and their allies (Rama 1996, 30). Similarly, Bennison shows in her ethnography from Huarochiri in Peru that individuals who ‘fulfilled their obligations throughout their lifetime are deemed to be moral authorities and icons of good work ethic and as such are conferred a special social status’ (2022, 228). That documents are socially and ritually ‘heavy’ in Andean societies has also been noted more subtly by scholars like Catherine Allen, who, upon arrival in the community of Sonqo, could not be refused because she was dokumentuyuq (possessed of documents) (1988 [2002], 49). Written documents and those managing them have played, and still play, central roles in various contexts in Peru. Except for bureaucratic documents and plans implemented in government work, documents are also central to community tasks. In ayllus (kinship corporations) and communities, collective tasks such as canal cleaning, cattle branding, or road mending are not considered finished unless complemented by a document (Rama 1996). Texts and documents are ritually crucial in the Andes and should be seen as a ‘coequal part of the social fact, no less than its ritual or its labour’ (Rama 1996, 153).

The community health workers programme has interesting parallels to the training of letrados during colonial times. To some extent, community health workers could be seen as a contemporary ‘lettered elite’ in their immediate access to particular training (capacitación), which makes them, to some extent, ‘skilled’ within hegemonic biomedical knowledge. In the training session in which this knowledge is conveyed, they are being taught the importance of adhering to biomedical knowledge concerning nutrition, family planning and ‘healthy behaviour’, practices that the representatives of the state highly value. A contrast, however, is the contemporary focus of social engineering in development schemes on how these ‘skills’ could also be transferred to others to improve a broader population base. Nonetheless, the making of ‘good role models’ requires symbolic rituals of inauguration, which, according to the Peruvian Ministry of Health, comes in the form of institutionalized ‘public and social’ recognition, such as a public celebration of the ‘Día del agente comunitario de salud’, and participation in anniversary parades and national holidays (MINSA 2015, 26). Interestingly, four of the six women who volunteered as community health workers in Sumaq Llaqta during the time of fieldwork were also socias in other community institutions, such as the community kitchen, the women’s group anchored at the municipal level in Chivay, and the Wawa Wasi (kindergarten). Additionally, three of them were in the same family: a mother, a daughter, and a daughter-in-law. This implies (also confirmed by social workers in the municipality) that recruiting local volunteers was challenging, and the interest in volunteering as a free labour source was not high. Instead, those already involved were under heavy pressure to engage in several activities (or to recruit their relatives). Even though volunteers would be promised compensation through food baskets and free meals, many would tell me that the tasks would require more hours than they wanted to invest. Several of the volunteers also talked about how they wanted to quit to get more time for tasks waiting at home. Although all seven community health workers were supposed to rotate the responsibilities of keeping the Metacentro offices open to the public, only three-four would follow up on the regional authorities’ expectations regarding opening hours and completing all listed tasks. A significant proportion of the work was related to filling in documents. In the next section, I will scrutinize how these documents can be ‘good to think with’, which Riles (2006) has encouraged as a way to go beyond Foucauldian engagements with the hegemony of document technology. I explore some ways in which the community health workers engage with their checklists and notebooks and argue that the community health workers not only engage actively with their work but also negotiate, reject, and remake the documents according to literacy practices well-known to them.

Aesthetic (re)creation of checklists

Form-filling and capacitaciones at the Metacentro in Sumaq Llaqta were principal activities of the community health workers. These are classical examples of what Michel Foucault called technologies of government. A common way to assess the technology of documents such as the Metacentro checklists is to analyze their normative dimensions, that is, how they seek to create and re-establish norms. Foucault’s (1979) ideas on the discursive power of documents have led many to view documents not only as tools but as texts that are ‘responsible for producing or objectifying the subjects that use them’ (Reed 2006, 158). Something that could demonstrate this was the two large checklists measuring 3 × 1,5 metres that hang almost like wallpapers inside the Metacentro. The ‘wallpaper checklists’ were explicitly oriented towards pregnant women and children under five and monitored certain aspects of health behaviour. The columns included criteria such as ‘name’, ‘ID-number’, ‘age’, ‘vaccination’, ‘educational package’ (paquete educativo), ‘growth and development control’ (CRED), ‘month of pregnancy’, ‘antenatal examination’ (atención del embarazo), and ‘examination of growth and nutritive condition’. Not only do these criteria express differences between individuals that can be assessed, but they also create an archive of individual case histories and underline the normative ideas on what healthcare individuals have the right and an obligation to receive. This work of classification has two distinct temporal dimensions: the children are followed up until the age of five, while the women are followed up throughout their pregnancies. The checklist also anticipates future events, as its subjects are expected to return every month for an update.

In a Foucauldian-inspired analysis of these checklists, one may draw links between the ‘technology of the document and the regimes of observation or surveillance that makes this documentation possible’ (Reed 2006, 159). A certain kind of (political) subject is made visible and hegemonic through such processes. At the same time, certain kinds of desirable actions, such as following a biomedical check-up and educational scheme, are established over time. However, the formation of subjectivities is more complex than what seems to be the tendency in Foucauldian ways of thinking. The documents mentioned above do not establish biomedical subjectivities in themselves. The culturally produced subject ‘is defined not only by a particular position in a social, economic, and religious matrix, but by a complex subjectivity, a complex set of feelings and fears’ (Ortner 2005, 37). More elements come into play in the processes of subjectification, and those are mainly related to feelings, social relations, and locally constituted norms. The community health workers were supposed to regularly remind their neighbours of the importance of seeking biomedical care by carrying out health campaigns and door-to-door visits organized by the health centre.

The various kinds of checklists at the Metacentro not only illustrate and measure the status of vaccines, medications, and physical growth, but they also signalled what kind of care-seeking actions a mother should pursue. The community health workers were not only mediators of these ideals; they were simultaneously targeted as subjects that could incorporate them and serve as good role models for their neighbours and friends. However, the ideals and ideas considered ‘good’ were not always the same for the community health workers as for the regional and healthcare authorities. Interestingly, the wallpaper checklists were, in practice, rarely used by the community health workers during fieldwork; only two individuals registered at the wall over four months. Despite instructions from social workers and nurses on the importance of using them, the community health workers said they tended to forget to fill out the wallpaper checklists because they were so busy playing with the children visiting the Metacentro, interacting with mothers and fathers, and filling out the notebooks. In contrast to the wallpaper checklists, the notebooks were often brought to health campaigns with hopes of collecting additional health information. More importantly, they were the principal documents that verified the community health workers’ work efforts and guaranteed them food baskets as monthly compensation. In form and function, the criteria and content of the wallpaper checklists and the notebooks were quite similar; thus, the wallpaper checklists were also viewed as somewhat superfluous within a busy work schedule.

The notebooks were standard notebooks with checkered paper. The front covers were decorated with drawings made by the community health workers themselves, while on the inside, the checkered paper was covered by a standardized table. The table’s straight lines were drawn in solid colours like red, purple, blue or green. The text inside the table squares was written with neat, printed letters, always in a different colour than the lines, and perfectly placed in the centre of each square. With such a neat and organized system, filling out the checklists was time-consuming. The community health workers had been instructed to follow a specific table template for the checklists they had to draw manually on each notebook page. The episode where I failed to follow the aesthetic standards the community health workers placed for the notebooks may illuminate how tidiness and neat writing were perceived as particularly meaningful. At the same time, works of writing may generate meaning in their own ways. The tasks created for the community health workers were not passively conducted but performed according to the value the community health workers saw in each specific task. What is considered ideal by public healthcare authorities is not necessarily perceived similarly by a community health worker.

A way to explore this gap and better understand how community health workers negotiate the number of tasks and labour placed on them is to examine how they carry out their mission. Regarding documentary practices, the checklists do not only have what Reed (2006) calls a ‘strategic status’, in which the checklists can be understood as an instrument of political control, which in turn may lead to some form of subjectification. However, the documents also have aesthetic dimensions. There has been a tendency to look beyond the design, but studying an object’s significance is a fruitful aspect to explore (Reed 2006). Nevertheless, anthropologists should also consider how people relate to the objects they use. In the case of the community health workers and their checklists, they were, at times, more concerned with notebooks’ aesthetic and functional qualities than the regional authorities, who mainly assessed the content provided within them. For an outsider familiar with administrative work, the content of the headlining categories will probably appear as the most significant when using a form. One may also wonder why the public display of the wallpaper checklists would not increase the task’s status. After all, making it publicly visible would demonstrate the importance of the work at the Metacentro. To the community health workers, however, the notebooks, although they were ‘semi-private’ notebooks, were generally a more significant part of their work because they were subject to regular inspection by the health bureaucracy.

The notebooks served as objects of trust that authenticated the accomplished results of the community health workers. Sarah Lund argues in her work on letter exchange among Andean non-literates that a letter ‘generates meaning on its own terms above and beyond the written meaning on its page’ (1997, 193). Writing is a literate social practice, and notebooks are associated with schoolwork and bureaucracy. These two spheres have rigidity, structure and expectations of aesthetic qualities that signal professionality in common. James Paul Gee stated that ‘[o]ne always and only learns to interpret texts of a certain type in certain ways through having access to, and ample experience in, social settings where texts of that type are read in those ways. One is socialized into a certain social practice’ (1988; 209 in Lund 1997, 193). The writing practices the community health workers were socialized into through their reporting tasks were similar to those they learned in school.

In rural areas of Andean regions, the school literacy practices are claimed to be relatively rigid, using teaching methods that result in the children rarely writing texts. In the context of the school in de la Piedra’s work from Urpipata, a village close to Cusco, ‘‘reading’ meant pronouncing correctly and ‘writing’ meant spelling correctly and drawing letters neatly’ (de la Piedra 2006, 388). The hegemonic literacy of schools that the teachers conveyed valued ‘transmission of basic decoding skills and the formal features of texts, sentences, and words […] over understanding, construction of meaning, and student creativity’, resulting in the teachers seeing errors ‘in relation to the formal aspects of language (that is spelling, penmanship, pronunciation when reading aloud, [and] doing neat work)’ (de la Piedra 2006, 388). Additionally, teachers did not consider how the vernacular uses of alphabetic literacy occur in the household (de la Piedra 2009). De la Piedra describes how children’s homework often consisted of ‘simple tasks of copying lines of words and sentences’ (2009, 7). What was communicated as important within hegemonic school literacy was not only the correctness of writing but also formalities related to orthography. For example, de la Piedra observed a ninth grader spending ‘two hours copying a paragraph because he continuously ripped pages out or erased what he had written, trying to correct his own writing’ (2009, 7). Similarly, the community health workers in Sumaq Llaqta would spend time carefully and neatly filling in details in the notebooks. On one occasion, when she was not happy with the result, Imasumaq ripped out a page in which she had hastily written in the details about which toys visiting children had played with the day before. She then had to re-write all the details from the torn page onto a new page in the book.

The community health workers were not only active producers of ‘the written word’ but also active agents in forming the framework and structure for producing information. On occasion, the community health workers complained about the stress and the workload following the form-filling of the notebooks. They valued the neatness of their notebooks but had, after a while, gone tired of the time spent filling out the checkered tables and drawing and organizing them from scratch. One day, the community health workers were very proud to have developed a system that reduced the repetitive drawing and lining up of new sets of tables in their notebooks. Ximena, who invented the system, explained that if they cut the paper sheets in a certain way, it would only be necessary to draw the table template once, that is, on the first page of the book. The others were eager about the new system and described it as ‘genius [because it] saves us much work!’. To the community health workers, the new checklist system was also a way of (re)confirming their relation to the checklists and transforming a foreign and bureaucratically heavy system into something much cleverer. This transformation resulted from creativity but was also a continuation of aesthetic modifications of the notebooks, which they had already decorated with drawings and plastic book covers. Through manipulating and (re)creating personal aesthetics in the notebooks, the community health workers reproduced and reconfirmed ownership of their work. The subjectivities being reinvigorated were also motivated by a desire to create documents that confer aesthetic norms in school.

The community health workers, who all had been schooled within the literacy traditions of rural schools, decorated their notebooks in similar ways to that of school children in Chivay. In learning how to write, children are instructed to use various colours organized in a system that represents the rules of writing: majuscule letters in one colour, dots, periods in another, and so on. A teacher in Chivay once explained to me that this teaching technique was more common in rural areas than in the cities. Teachers’ distinctions between rural and urban schooling were sometimes expressed in terms of stereotypical ideas of literacy in rural areas. Similarly, de la Piedra (2009, 120) observes that teachers tend to subscribe to hegemonic discourses about language, literacy, and education that ‘stigmatize the so-called ‘illiterate’ as unintelligent, uneducated, ignorant people’. The combination of strict formal school literacy and the stereotypification of ‘illiteracy’ in rural contexts may help explain why the community health workers paid particular attention to the ‘correctness’ and aesthetic appearances of their writing. In attempts to be interpreted as ‘educated’, they adhered to the familiar standards from their school days. Although the social reality encompassing the subjective experience of the community health workers heavily involves the school literacy that they had embodied many years before they volunteered at the Metacentro, it is also relevant to pay special attention to the aesthetic dimensions of their work.

Bourdieu (1984) insists on addressing socio-historical factors, particularly class, in order to understand people’s judgments of taste, as ‘the capacity to see (voir) is a function of the knowledge (savoir)’ (Bourdieu 1984, 2). The symbolic capital of a community health worker was tightly connected to the aesthetics of schools. In his explanation of symbolic capital, Bourdieu reminds us that ‘Everyone knows that ‘it’s not what you give but the way you give it’ that counts, that what distinguishes the gift from mere ‘fair exchange’ is the labour devoted to form: the presentation […] inspired by pure respect for the customs and conventions recognized by the group’ (1977, 188–9). For the community health workers, the notebooks and other checklists represent their collective efforts; the aesthetics of the documents provide symbolic capital. The customs and conventions in schools include neat organization and ‘correct’ answers. From this perspective, where we understand the community health workers’ effort as a response to expectations from formal educative structures, Bourdieu’s statement that ‘all structures of inseparably material and symbolic exchange […] function as ideological machines […]’ (1977, 189), appeals to the ideological function of the metacentro programme.

For the community health workers, their notebooks needed to represent proper written work because their work was also a reflection of themselves in front of the administrative bureaucracy, within their community, within their own intimate group of community health workers, and for themselves. The community health workers’ responsibilities consisted of being role models, which meant being more ‘schooled’ and ‘trained’ than their neighbours. The similarity to school contexts is apparent, as the community health workers were expected to participate in several capacitaciones (training sessions) analogous to classroom lessons, where the authoritative instructor ‘knows’ and the students that are being ‘taught’. As you may observe from the session described below, those who are not obedient and behave like ‘good students’ are reprimanded.

One day, a hand-written poster on the Metacentro entrance door said: ‘Training: healthy lifestyle for pregnant women and children and family planning for all young people, youngsters, gentlemen, and ladies. At 4 pm, do not miss it!’³ Even though the poster had invited ‘everyone’ to come, only the community health workers had shown up. Half an hour late, two social workers and a midwife arrived to lead the capacitación. One of them, Juana, started inspecting the Metacentro, chatting casually with the community health workers about the importance of their work. She led them towards two checklist banners that covered two of the walls and said: ‘These need to be properly filled out,’ while pointing at the blank space between the columns. Only one of the many rows had been filled out with the personal health information of one individual. Juana fetched a whiteboard marker and explained how the banners should be used to show how physical development in children and pregnant women is documented. Unexpectedly, we heard giggling from the back of the classroom. Juana snapped, annoyed at Imasumaq, one of the community health workers standing closer to her and writing something in her notebook: ‘Do not write, now you are going to learn!’ she shouted. Imasumaq quickly closed her book and put it behind her back. Juana continued explaining while pointing at one of the columns: ‘Here, you will write the total number of pregnancies.’ The giggling in the back continued. Rosmery (who always lightens the mood by goofing around) was whispering something in her neighbour’s ear. Juana approached her and asked abruptly: ‘Have you been pregnant?’ Rosmery straightened her back in a soldier-like manoeuvre and said, ‘Yes’. Her face looked surprised, like a child who had just been scolded, but her manoeuvre revealed hints of the teasing I had seen her doing of health personnel and other authorities before. ‘Okay, have you ever aborted?’ Juana asked. ‘No, never,’ she answered. ‘Then you will write the total number of pregnancies [including possible abortions],’ Juana said as she pointed at the checklist banner with the whiteboard marker. ‘¡Callate tú!’ – Shut up! She suddenly yelled at Ximena, who was giggling again because of something Rosmery whispered in her ear when Juana was not looking.

This session demonstrates the teacher-student dynamics where one party provides information and knowledge, and the other receives. There are right and wrong answers and instructions on how to comply with the expectations of how community health workers should do their job, yet there are also other similarities to school settings. After every session like this, all tables and chairs in the Metacentro were cleaned and cleared up. The chairs and benches were placed on top of each other, a practice also common in classrooms. Additionally, the regular inspection of the notebooks parallels a teacher’s inspection of the homework in the schoolbooks just as much because both inspections offer rewards or punishments.

Concluding remarks

One of the most striking social implications of the community health worker programme was the reluctance of neighbours to participate in activities arranged by the community health workers. While the primary goal of the metacentro programme was to build bridges between health workers and the local communities by recruiting local volunteers, the key effect of the programmes was more visible in terms of the processes of subjectification of the community health workers themselves. What was considered important by the authorities was not necessarily thought of in the same terms by the community health workers. A simple answer to why the actual information and content within the checklists were not seen as the most important is that it was also challenging for the community health workers to get hold of personal information from their neighbours. Numerous times, I witnessed the community health workers knock on someone’s door to ask for their ID numbers or other information lacking in the notebooks. The scepticism towards handing away personal information can be linked to Peru’s long history of state rituals of ‘checking’ IDs and ‘reading’ lists.

In colonial times, ID documents were requested at every ‘checkpoint’, and every encounter with state agents required documents (Skrabut 2018, 526). In the 1980s, the relatively ‘relaxed’ policing practices that long had regulated trade routes intensified and tightened as the violence started to escalate during la epoca de terrorismo (‘dirty wars’) (Das and Poole 2004). At military checkpoints, the lists of names of passengers on cargo trucks were carefully read by young military recruits assigned to look for potential ‘terrorists’ among peasant crowds. This ‘mysterious ritual’ where lists were carefully scrutinized, Poole argues, was not only a depiction of all the ominous uncertainty of the war, but it also brought with it an arbitrariness in the power dynamics between citizens and state institutions (2004, 36).

Within systems of value, documents are given a particular meaning and are crucial to an existential level in many forms of engagement with the state. Poole describes the power relations between citizens and the state as a ‘slippage between threat and guarantee’ (2004, 38), as documents have the capacity to represent uncertainty, vulnerability and guarantee at the same time. The arbitrary power of the state, particularly during the decade of violence, would materialize through document-related practices in which the lack of identity documents would cause detention, existing documents might be misread, at the same time as personal identity cards would be the only guarantee in meeting state institutions (Das and Poole 2004, 36). In the meeting points between the population and the state, documents may signal distance to the state and simultaneously its ‘penetration into the life of the everyday’ (Das and Poole 2004, 15). The processes of subjectification do not only represent a question of the disciplining technologies of documents and documentation practices. The dynamics of power also include individuals’ views of themselves and their understanding of and desire to live up to meaningful norms and values. The question is thus not about subjectivities of submissiveness or resistance but of the processes in which they are formed, shaped, renegotiated and played out in action.

Acknowledgements

Many thanks to the community health workers in Colca Valley for sharing so much with me. I would also like to thank Professor Cecilie V. Ødegaard at the Department of Social Anthropology at the University of Bergen (UiB), who supervised my Master’s project with the utmost care, guided me through a long learning process and provided constructive and engaged feedback on my thesis, which this manuscript is based on. I am very grateful also for your time, guidance and generous feedback in the writing process of this article. Thank you to the Global Health Anthropology Research Group at UiB for commenting on an early draft, the SASS collective for providing feedback and encouragement, the anonymous reviewers providing constructive and positive feedback to this article, and to Osmund B. Grøholt for your love, kindness and inspiring reflections. This research was funded by Lauritz Meltzers Høyskolefond and Signe Howells feltarbeidsstipend, for which I am very grateful.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by L. Meltzers Høyskolefond and Signe Howells feltarbeidsstipend.

Notes

1 Pseudonym. Quechua, lit. ‘beautiful village’

2 A Centro de Salud is a public health care facility that provides health care services and medical care to all citizens

3 Capacitación: estilo de vida saludable para gestantes y niños y planificación familiar para todos jovenes, adolescentes, cavalleros, señoras. Las 4.00 pm ¡No falta!