What I Have Learned- Bolivian Healthcare and Summative Blog

It is the end of my four weeks in Bolivia! I have learned so much about the healthcare as well as the culture during my stay, and this will be my final blog. Thank you to those who have been following along with me 🙂

In my previous blog, I had a picture of Dr. Uribe, the Pediatrician who also does a great deal of work with adolescents, especially teen girls. She gave us a lecture on teen pregnancy and how much of a problem it is. Adolescent pregnancy is defined as pregnancy within the adolescent years, between about 12 and 17. In the lecture, Dr. Uribe explains that there are several different causes as to why adolescent girls get pregnant at such a young age:

-Lack of sexual education- many of the adolescents are neither educated about sexuality in general, nor contraceptive methods, and a lot of the perception of sexuality is from social media.

-Alcohol- this also plays a big role in teen pregnancies.

-Sociocultural- while there is access to birth control, many of these girls won’t use them because contraceptive methods are generally not used.

Some of the stats she shared with us showed that in 2008, a staggering 83% of adolescent girls were pregnant in the city of El Alto which has a high poverty rate. Some of these teen moms have been abandoned as a baby themselves and they’re looking for love  and affection. Many times there can be as many as 4 or 5 different fathers for each baby and the sad cycle continues. Dr. Uribe is involved with a ‘guardería’ (nursery/ child care center) that supports these young moms. It’s a system that allows the moms to go to work while another mom takes care of the children. Having this in place helps teen moms see that there are options besides abortion.

During our Neonatology week, the Neonatologist was asking about baby abandonment in the US. It was interesting to see his reaction when we told him that yes, this happens in America too. We asked if there are children’s services available for when the babies are left in the hospital and he said there is something in place for when that happens (thank goodness!).

There are programs in place where the mom will receive money and food for the baby until he or he reaches 5 years old and until the moms stops breast feeding.

In terms of malnutrition, Bolivia has made great strides in reducing child malnutrition rates. For example, organizations such as UNI (Unidad de Nutrición Integral) promotes healthy eating practices and prevention of malnutrition. Our host mom also explained to us that families with children under five and pregnant mothers receive a daily ration of bread, quinoa, and other sustaining foods for free. Ever since this started, there has been a drop in child malnutrition.

One main lesson I’ve learned during my stay in Bolivia is how culture influences healthcare:

-On our very first day of clinic, Erica and I met with Dr. Velasco, a General Peds doctor who spoke both Spanish and English. He spoke about understanding the cultural aspect of healthcare in order to meet the needs of the people being served in the most effective ways possible. He gave an example of how he had an indigenous patient with diarrhea. It’s important to remain hydrated in order to replace the fluids lost, but the patient thought it didn’t make any sense to add more fluid to the body when it’s being lost through watery stools. Patient education is major and understanding their thoughts and beliefs can lead to more effective care.

-In the general Peds unit, there are about 12 beds in one large room, as I mentioned in my previous blog. The way parents were able to interact with each other, the way patients interacted with each other and even the way the doctors interacted with the parents was really nice to see. I spoke with one of the mothers (she was the mom of the boy with nephrotic syndrome who was trying to raise money for his biopsy) and while I was doing that her son was playing with another little girl who was there for recurrent UTIs. It’s like they were siblings and I’m sure this kind of ‘community’ is in ways very therapeutic versus the ‘private’ atmosphere that exists in the states.

-Doctors are very much respected here. It is very common to hear the parents of the patient say ‘yes Doctor, sure Doctor (in Spanish) to whatever recommendation is made to them. Sometimes, though, there can be some resistance to recommendations. For example, the mother of the boy with Non-Hodgkin’s Lymphoma did not want a biopsy on her son, mainly for economic reasons. The doctor was able to explain to her the importance of the biopsy and it was helpful too that there was a social worker present who explained to her different options available to help with funds.

It has been wonderful being immersed in a different culture and learning so many new things. I know that this rotation has given me plenty of things to think about. It is so important to be culturally competent as well as medically competent (especially as a Family Medicine doc!) because the world is quickly becoming more and more diverse. I expect to encounter  patients from all walks of life and this experience opened my eyes to what I can expect in the very near future 🙂

Farewell La Paz 😉

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