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The Crisis in Healthcare in Rural BoliviaCross-cultural Barriers Between Doctors and Indigenous PatientsThe number of people who die from treatable diseases reaches tens of thousands per year as Western medicine fails to benefit rural populations.
Limitations of Western Medicine in Rural BoliviaIn rural Bolivia, there is only one doctor for every 7,000 people, and many medical personnel at all levels need more training. Although local universities produce plenty of doctors, 70% of these eventually emigrate to the United States (Bastien 1996). Many communities are without health clinics, and patients often die on long rides in the back of trucks as they make multi-hour journeys in search of treatments. Even if healthcare is readily available, it can be expensive. A simple shot of penicillin can equal several days’ wages for a Bolivian agricultural laborer (Bastien 1996). Yet it is not only physical distance and prohibitive costs that separate rural Bolivians and health practitioners. Distinct worldviews often cause mistrust between patients and doctors. For their part, doctors and nurses often do not speak Aymara or Quechua (Bolivia's main indigenous languages) and many consider peasants to be socially inferior. In turn, the Aymara view biomedical practitioners, particularly doctors, with great suspicion. Aymara ethnomedical therapy relies on keeping the body “sealed” and healing through ritual. Biomedical practices, however, often pierce, cut and “open” the body through injections, transfusions, blood tests and surgery, leaving the Aymara feeling especially vulnerable (Fernández 1995). Why Aymara Patients Often Mistrust DoctorsThe folk belief in kharisiri underscores the Aymara mistrust of doctors. The kharisiri was originally a spirit who stole the fat from the kidneys of unsuspecting victims during the dead of night. During the colonial period, the kharisiri was the ghost of a Franciscan monk who gave the fat to the bishop for the production of holy oils (Crandon 1991). Concurrent with increasing modernization after the Revolution of 1952, the popular image of the kharisiri changed to a person, usually a doctor, lawyer or politician, who sold the kidney fat either in La Paz, for production of soap to sell to foreign tourists, or for export to the United States where it was converted into electricity (Crandon 1991). When one’s fat is snatched, it creates a cultural illness called liquichado, evidenced by incision marks on the thorax left by the kharisiri; the victim gradually weakens and dies. Doctors, with their surgical methods, are easily associated with kharisiris, and thus many Aymara fear to go to hospitals (Bastien 2003). On a deeper level, the kharisiri is a manifestation of the feelings of powerlessness and oppression the Aymara experience, and doctors are considered part of the framework that socially victimizes them. Indigenous Bolivians fear the biomedical system for other reasons as well. Hospitals isolate patients from their critical social support network. Furthermore, the Aymara associate the white color of hospital walls and uniforms with the death and burial of babies, and believe the metallic equipment attracts the malevolent force of lightning (Bastien 1996). Women prefer not to give birth in hospitals or clinics, since doctors cut boys’ umbilical cords too short, demeaning their masculinity, and prevent families from serving the traditional meal of sheep soup to the mother after the emergence of the infant. Many rural Bolivians also believe vaccinations cause sterility, largely since medical personnel do not see the value in explaining their purpose (Bastien 1995: 83). Consequently, up to 441,000 infants die every year in Bolivia from neonatal tetanus – a disease preventable by vaccinations. SourcesBastien, Joseph. Qollahuaya-Andean body concepts: a topographical-hydraulic model of physiology. American Anthropologist 87(3), 1985: 595-611. --Cross-cultural communication of tetanus vaccinations in Bolivia. Social Science and Medicine 41(1), 1995: 77-86. --Drum and stethoscope: integrating ethnomedicine and biomedicine in Bolivia. Salt Lake City: University of Utah, 1996. --Sucking Blood or snatching fat: Chagas’ disease in Bolivia. In Medical pluralism in the Andes. Joan Koss-Chioino, Thomas Leatherman and Christine Greenway, eds. Pps. 155-187. New York: Routledge, 2003. Crandon, Libbet. From the Fat of Our Souls: Social change, political process, and medical pluralism in Bolivia. Berkely: University of California Press, 1991. Fernández Juarez, Gerardo. Ofrenda, ritual y terapia: las mesas aymaras. Revista Española de Antropología Americana 25, 1995: 153-180.
The copyright of the article The Crisis in Healthcare in Rural Bolivia in Latin Am/Caribbean Affairs is owned by Colin Forsyth. Permission to republish The Crisis in Healthcare in Rural Bolivia in print or online must be granted by the author in writing.
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