Bolivian healthcare and culture: summative blog post

Judithe and I got home safe and sound on Monday morning around 11. Thankfully, everything went smoothly this time around unlike our multiple delays in getting there. We had to spend Sunday night in the Washington D.C. airport since we had a long layover there. One last adventure to end our trip (although I would like to take this opportunity to remind my future self that it is probably not worth it…just pay the little bit of extra money next time to get home sooner…haha). I have been processing all that I saw last month, and still feel like I have a lot to think about. This will be my last post but if any of you have questions about my trip, I would love to chat about it 🙂 The major thing I learned while in Bolivia is how much culture truly affects every area of one’s life, including their health and how they view medicine. I have not talked much about Bolivia’s culture on these blogs yet but hopefully I can give you a good overview. Both my host mom and Spanish teacher were so knowledgeable about Bolivia’s history, culture and traditions, and took every opportunity they could to teach us about it. I have mentioned that the majority of Bolivia is Catholic, but many of the indigenous people who live in the Andes mountains, and even some in La Paz, worship the goddess “Pachamama,” or “Mother Earth.” There is a whole month-long festival in La Paz starting in January where people come from all over and purchase miniature items to offer to Ekeko, the Aymara god of abundance (the Aymara people are one of two indigenous people groups who live in the Andes – the other being the Quechuans). For example, if someone wants a new house, they can purchase a miniature house and offer it to Ekeko. Or if a girl wants a boyfriend, she offers a miniature rooster to Ekeko. Many couples come and purchase miniature chicks because they are infertile but really want a child, etc. Many indigenous people have little booths where they sell various items such as fruit, street food, candy, cheese, etc. It was very common to find them sitting on the ground while selling their things. I asked Jenny why they do not sit on chairs as it seems it would be uncomfortable to sit on the ground all day, and she said they do that to be closer to pachamama. We also saw many llama fetuses for sale at the witch market, which was very sad to me. It is an expectation when building a house or other building to buy one of these llama fetuses to bury as an offering to pachamama before the foundation is laid. The people believe that if they do not do this, pachamama will take the life of one of the workers while they are in the process of building.

Witch market with llama fetuses. The street is called

Witch market with llama fetuses. The street is called “Calle de las Brujas,” or “Street of the witches.”

The doctors at the hospital also touched on the importance of knowing a patient’s culture. I took a cultural competency class during my first two years of medical school so this was a great refresher for me. Dr. Valasco, an infectious disease doctor who we met the first day of our rotation, explained to us how important it is to meet patients on their level. For example, many people in Bolivia (and probably around the world) believe that when someone gets diarrhea, the best thing to do is to stop giving them liquids. This makes sense when you think about it. Of course, the best thing to do in this situation is keep drinking as much as as you can because you don’t want to get dehydrated from the loss of fluid. Another example is that many of the Bolivian people from the mountains believe the sun revolves around the earth. Again, this makes sense – they see the sun rising in the east and setting in the west every day, so it seems logical to them. Dr. Velasco explained to us that education in these instances is important but you should not do it in a way where you consider yourself as superior and the patient as inferior; rather, it is an equal partnership, meeting the patient where they are and educating them at whatever level that may be. This is critical for providing the best healthcare you can, as well as building a relationship with the patient. We learned of another example of how the culture affects medicine in the teenage pregnancy lecture with Dra. Uribe, which I believe I touched on in a previous blog. She said that all forms of birth control are free in Bolivia but young girls often do not use them because they are discouraged by their families or boyfriends or husbands, or whatever the situation may be – it is simply the culture. There is not much education about sexuality in schools (which I believe they are trying to change now), and many girls do not know the options available. This contributes to a high rate of teenage pregnancy, especially in El Alto. The Aymarans and Quechuans (indigenous people groups) used to be looked down upon and discriminated against by the Europeans and others who had entered the country during the time when Spain ruled over them. They were often not served at restaurants and were discriminated against in the public education system, even up to a few years ago. My host mom is a dentist and she would tell stories of how difficult it was for indigenous students to get into programs like dentistry, and when they were in, how difficult it was for them to get any grade higher than a C because the (foreign) professors would fix their grades. However, Bolivia now has the first indigenous president, Evo Morales. He is Aymara and has been in office since 2005. He seems to be doing a lot of good things for the country.

There were signs up everywhere in support of Evo Morales. This one was in El Alto.

There were signs up everywhere in support of Evo Morales. This one was in El Alto.

One of the first things he did when he got into office was to get rid of this discrimination. He got rid of many of the foreigners in the government and bigger businesses, and put indigenous people in their place. It is also very common to find sons and daughters of indigenous people graduating from university, which we got to witness firsthand our first week in Bolivia when we went to the graduation downtown with Jenny. Many indigenous people teach now in the law schools (my host mom is now working on her law degree so we got to go to school with her one night!), dental schools, etc. teaching classes. It is also a law that every single business put a sign up that says discrimination is illegal. The public school children are now learning Aymara in their classes. He also has a campaign for Bolivian women and their rights. He has put many women in high government positions. There were big signs up everywhere in the downtown area that said “stop they violence against women. Report this violence.” Apparently before Morales got elected, if a case of domestic violence was reported to the police the person responsible might have gotten fined, if they even chose to do that. Many times it was simply ignored. However, now it is a crime punishable by a jail sentence. We drove by President Morales’s house every day on the way to Spanish class and I aways saw the guards out in front but never saw the President, sadly.

One of the signs that bans discrimination. This one has chickens on it because we were in a chicken restaurant. It says

One of the signs that bans discrimination. This one has chickens on it because we were in a chicken restaurant. It says “We are all the same before the law.”

This trip really emphasized the importance of knowing a person’s cultures and their beliefs so you can meet them where they are in their life. I learned so much about the Bolivian culture and their beautiful, kind people, and personally saw how cultural beliefs intertwine with medicine on a daily basis. I am so grateful for these lessons (and many more) that I learned this month. I am thankful that my new Bolivian friends took time out of their busy days to teach me these important things. And I am thankful for all of you who followed along with me on my journey! Thank you to my friend Meredith for taking time out of your super busy schedule to share your wisdom about CFHI programs with us before we left – it was very helpful! You are the best! I also want to say a special thanks to Judithe (or Judithecita, as we liked to call her in Bolivia haha), my classmate and good friend. It was such a joy to travel with you and get to know you better this month. I had a wonderful time and I am glad the trip was with you!! God knew what he was doing when He sent us to Bolivia! Ya te extraño y estoy feliz que vas a estar cerca el proximo año 🙂

Hasta luego, La Paz! Thanks for all the memories and lessons that will stay with me for a lifetime!

Working in the general pediatrics ward.

Working in the general pediatrics ward.

Such a privilege to work here for the month.

Such a privilege to work here for the month.

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3 thoughts on “Bolivian healthcare and culture: summative blog post

  1. your kind, caring soul and your deep faith in God is going to make you an extraordinary doctor. I am so proud of you!

    Like

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