This chapter explores the social and physical landscape of a Colombian city, and how mosquitoes and water cover, to prevent their breeding, exemplifies the importance of assessing local notions of belonging in participatory health programs. The history of Girardot, as an urban physical space, is both ecological and socio-political. As with much of Latin America, it begins with European conquest and colonial subjugation. In many ways, Girardot has followed a general pattern for growing Colombian cities, where agricultural and industrial activities have gradually been abandoned and replaced with service, retail and recreational industries. The perception of instability, as a defining sentiment about the identity of Girardot City, was overwhelmingly explained in reference to institutions and governance, predominately as a lack of confidence in municipal authorities. Since the founding of the Republic of Colombia in 1886, society has undergone important transformations with the creation and growth of modern cities, transport networks and government institutions.