Monday night was a great night. We met with Dr. Uribe, a Pediatrician, who gave us our first lecture. She spoke about the structure of the healthcare system here. Overall, there is a universal healthcare model- any employed citizen of Bolivia receives free healthcare and it covers pregnant mothers and infants, the elderly, those with disability, and various programs to cover specific illnesses such as HIV and TB.
There are different tiers to the system- the first tier is primary care visits and maternal/ OB-GYN care; the second tier includes hospital visits. Those who are unemployed (such as street vendors) can also receive free medical care if they become sick or injured, provided they first see a primary care provider (PCP) first; the third tier involves medical care by specialists. As with many other health systems around the world, none is truly perfect.
When I asked what kind of problems there are with this system, the doctor responded ‘muchos problemas!’ For one, many people flood the ERs and urgent cares when they become ill (particularly those who are unemployed and skip the first tier of seeing a PCP, and a fee would be required if they go to the hospital without first seeing a PCP). Secondly, doctors go on strike because of unfair pay. There was an instance a couple years ago where doctors went on strike for 54 days: they are required to work 6 hours a day, but don’t get compensated for working nights and weekends, while other workers of other occupations work 8 hours a day and get compensated for working nights and weekends. Since that strike, doctors are now compensated for extra hours, but are still required to work 6. Another interesting fact is that no matter the specialty, all doctors receive a similar salary, which in the US would seem unfathomable.
Tuesday was our first day on the in-patient infectious disease floor. Much of how the medical education is conducted is the same as the US: residents are always on the move and busily typing notes (however here there are paper charts and notes are typed on a typewriter); rounds are in the morning and there were at least 15 people congregated in front of the rooms (including nurses, medical students, nursing students and a nutritionist); residents are pimped just as hard (for my non-medical readers, to be ‘pimped’ is to be asked a bunch of questions back to back about a patient or medical topic, with everyone staring at you, and doctors looking at you with judgmental eyes); and residents give presentations. The presentation was on ‘tos ferina’ (whooping cough). Erica and I did our best to understand what the resident was saying during patient presentations, but most of our understanding of the cases came from reading the charts since a lot of the medical words are similar (i.e. ‘hiporexia’, [we figured that was ‘anorexia’/not eating]).
There were about 15 patients, ranging between the ages of one month to 8 or so years old. A boy about 3 years old with swelling on his right lower jaw was diagnosed with chronic osteomyelitis suppurativa. There was a one month old who we saw in clinic on Monday who was admitted for bronchiolitis. There were several others with abscesses. One patient had Well’s Syndrome which is an uncommon eosinophilic cellulitis (an ‘eosinophil’ is a type of white blood cell that works its way into the skin and causes itching and swelling). I wasn’t familiar with it, but I remember seeing the face of the little boy swollen up. A bite or sting or a viral infection can lead to this hypersensitive reaction.
Highlights: understanding more Spanish!; learning about Well’s Syndrome; visiting Plaza Murillo; trying out a highly recommended pizza place