At this point, I was actually supposed to leave Bolivia. But, I loved Tarija so much that I didn’t want to leave! Luckily, my host mom and program were open to having me stay for more time. And, I’m very glad I did, particularly for this rotation.
Image: The waiting room of El Centro de Salud
For this rotation, the other students and I went to El Centro de Salud in San Andres–a rural community about a 30 minute drive from the city. This was a public primary healthcare center, so everyone who came was seen for free, and just about every condition was seen and treated there (except for more complicated cases which were sent to a tertiary care center). There was an area for labor/delivery, dental care, and even hemodialysis.
We split our time between three different tasks. We shadowed the director of the clinic as he saw patients, helped organize/re-file patient charts, and also participated in community outreach with a team of nurses. The latter was one of the highlights of my experience in Bolivia.
I hopped in the back of an ambulance as we drove about ten minutes across rocks, rivers, and unpaved roads to the village of San Pedro de Sola. The houses were very spread out from one another, and the clinic didn’t even know of all inhabitants in this village; but, they did have a map of all the settlements they were aware of, and color coded them based on whether they had running water, electricity, fences or none/all. Most had one of the three, but not all; there was a decent amount that had none.
I was a bit confused as to why “fences” were considered equivalent to water and electricity. However, a doctor explained to me that in Bolivia, it’s technically a law that your animals have to live 15 meters (about 50 feet) away from your house. However, this just isn’t feasible for families whose livelihood is dependent upon their livestock, especially if they don’t have fences to keep out predators. Stable fences on large plots of land are not cheap to build and there are not many other options than to live closely with your livestock which, as we know, means a heightened risk of transmission of zoonotic diseases.
We arrived at the first home. There was a fire burning in the front yard, chickens and cows roaming freely. The house and outdoor kitchen were made of adobe. Here, there was no electricity. A young lady was taking clothes off the line; she shook a T-shirt and out flew a bug. I later learned that the bug was a vinchuca; it’s common for the vinchucas to hide there.
We were first greeted by a young girl who had just turned fourteen; the nurses first went to check on the baby she was holding. At first I thought that she was just helping her mother care for the baby, but I soon learned it was her own. The doctor went to speak with the lead female of the household, who looked no older than me, to inquire about what vaccinations the kids had. Two of the boys needed flu vaccinations. The eldest boy was actually the father to the fourteen year old girl’s baby; he was scared of the vaccinations and ran away and hid somewhere. I don’t blame him, he was only a kid himself. No kid likes shots. The youngest boy was eager to show his older brother that he was stronger than him, so he gave a big grin and rolled up his sleeve without much hesitation. There was also a baby girl, about 2 years old. She had been having pretty severe diarrhea and vomiting for the past week so the doctor gave her an antiparasitic medication. She also prescribed Vitamin A tablets to protect her eyesight.
After about an hour at this house, we drove to the farm of an elderly man. The clinic hands out free bags of
“Carmelo,” which is powdered milk with all the necessary vitamins and nutrients an elderly person needs. He was very happy to receive it and as a thank you gift, handed us all a yacon–a root only grown in the Andes. I actually learned that yacon are especially sought after for their medicinal properties; their leaves are used to lower cholesterol and yacon syrup is made to manage diabetes (see image on the right!).
Speaking of herbal medicine, Bolivia is actually one of the only healthcare systems in the world that incorporates traditional medicine clinics into its universal healthcare system, largely due to the fact that Bolivia has one of the highest indigenous populations in Latin America and traditional medicine is still widely practiced. In the clinic, there was a poster detailing the most common plants used to heal different conditions, and doctors often recommended them alongside pharmaceutical treatment; for example, one young lady came in with an STD, so the doctors recommended she take a 30 minute bath in daisy water twice a day in addition to her antibiotic.
Later that week, I followed two nurses out into the community where they sought to vaccinate as many children under the age of 5 as possible. They had a list with them of children who had come to the clinic before, but had not fulfilled a second dose of a certain vaccination, or who had not come for a vaccination at all. They didn’t know where these children lived, but with the help of neighbors they were guided in the right direction.
“Donde viven wawitas que tienen menos de 5 años?” was a question I heard about 100 times that day (“wawita”, or baby, is a word derived from the indigenous language Quechua that is widely adopted in Bolivia). We knocked on one person’s door; they had a child but they were up to date on their vaccinations. “Donde viven wawitas que tienen menos de 5 años?” We were then directed “up north.” So, we started walking north. We encountered an elderly lady who owned a little corner store. “Donde viven wawitas que tienen menos de 5 años?” She said she thought there was a lady who owned a store a few streets down who had a baby. So, we went there. And, indeed there was a child there who needed both polio and flu vaccinations! The nurses, carrying around an ice chest full of vaccines, were able to give the shot right then and there in the store after educating the parents about the importance of these vaccinations. With the help of community members who pointed us in the right direction, about 5 children were vaccinated against polio and the flu just that morning.
Image: Nurses discussing childhood vaccinations with a parent
I really think that the United States could expand upon programs such as this in rural, low-income, and underserved communities. It was really fascinating to me how members of the community helped the nurses find children under 5 years old. They didn’t know where they lived but they were able to point us in the right direction; it was definitely a community team effort. Many of the homes and shops we visited were not more than a one minute walk to the clinic. But, even then, parents cannot bring their children to the clinic due to work/home obligations. And, from what I observed, “well-child visits” aren’t really a concept; parents usually only bring their kids to the doctor if they are sick. If we can expand upon programs where community health workers are able to deliver vaccinations directly to the homes of children on a regular basis, I think that would make a significant positive impact on preventing communicable diseases in low-resource settings and preventing early childhood mortality rates in communities that are disproportionately affected not just in Bolivia, but really anywhere in the world, including the United States.
Continuing our home visits in San Pedro de Sola.
The aforementioned clothesline where vinchucas (unfortunately) like to hide.
Left: Me in the back of the ambulance. Right: A typical outdoor kitchen in rural communities.