Elizabeth Leith - Medicine & Healthcare in Bolivia
When I told people that for my gap year I wanted to spend time working in a health clinic in Bolivia I was faced by many different responses; ‘is that safe for an 18 year old girl on their own’? Or ‘how fun’! And pretty often ‘Bo-where’?
As I look back on how I ended up at the decision to venture to Bolivia I know it took a lot of consideration. It started with my desire to have a year out of education before studying for a medical degree but also doing something different and challenging with my time. Projects Abroad had come to my college at a higher education fair and after hearing through a friend at how proficient the company were I decided to apply for a brochure and organise a visit to an open day. This really gave me the opportunity to find out about the different projects in all the different countries. Having decided prior to the visit that I was interested in volunteering in South America the open day gave me an opportunity to find out a lot more about the different placements and countries.
I found myself pretty interested in Bolivia not only for its central location in South America but also because it is one of the poorest countries in the continent. After listening to a talk by the director of the company and receiving his advice that Bolivia offered one of the best medical placements I decided to go for it and to book my place. Initially I was a little daunted by the idea of living abroad and thought about only going for one month. However, after thinking a little more about what I wanted to achieve (to really understand how the medical system works and to learn Spanish) I decided to choose a two month placement.
All the pre-departure support was excellent and I was even phoned by one of the members of staff out in Bolivia, this proved a great comfort to me. I have to admit that spending two months in Bolivia out of my four and a half months travelling was the most daunting part of my trip… ‘what if I didn’t like it’ was the question that haunted me most!
I set off on the 6th March firstly travelling in Peru for ten days and completing the Inca trail. I arrived in Cochabamba on Sunday 16th March at 8am and was taken to my host family. My first impressions were that Cochabamba was quiet (wrong), calm (wrong) and beautiful (correct)! It didn’t take long to meet the other volunteers as my housemate offered to take me out to meet them for ice-cream. This helped me to settle pretty quickly as I realised there was a good volunteer social scene and that I probably wouldn’t be lonely.
The next day I received a tour of the city and soon realised that the lack of hustle and bustle was only a Sunday thing! The main part of the city was rammed with taxis, pedestrians and street stalls. Living in London my whole life this didn’t really phase me but I was still a little surprised by just how busy it was. The day after I was shown how to get to my placement, this consisted of catching the 101 truffi a few blocks away from my house and riding it towards the south of town. I watched as slowly the streets became less tree lined, houses less well built and roads more rubble filled. Although the area surrounding the Centre de Salud Lacma wasn’t the poorest I had ever seen it was definitely a lot less well off than where my host family lived.
It didn’t take long to realise that the centre is under-funded with the untidy outside appearance; many half built rooms (apparently the builders just stopped one day) and the crude and dated wall posters. The Projects Abroad member of stuff assisting me took me to meet Dr. Cespedes, the director of the centre and as he spoke rapidly to me in Spanish I suddenly felt a worry creep into me, ‘how was I going to get by when I had no clue what people were saying’? After spending the first day observing an intern with two medical students it dawned on me that the two months I was to spend at the ‘Centre de Salud, Lacma’ was probably going to be very different to any of the work experience I had done back in England.
I spent the first week getting used to everything; my host family, working in the health clinic and the public transport system. I managed to catch the wrong truffi on my third day and ended up pretty far past work! Thankfully I was lucky and had a lovely driver who took his ‘truffi 112’ sign off and dropped me at a point where I could pick up the right truffi for work. I felt pretty stupid but I guess all is well that ends well and a piece of advice for future volunteers, pay attention to your route to work!
My second week started a lot more positively as I was summoned by Dr. Cespedes, for what I had no idea. He introduced me to a female doctor who I ended up shadowing for the next few weeks. Being just the two of us I found myself engaging a lot more and I even started writing the prescription forms. Lucy was really keen on me getting involved and I got to listen to a lot of lungs and hearts during this time! I also had the opportunity to carry out a PAP (smear test) but as I’d never even seen one being conducted before decided to watch. I spent some more time in the nurses section and got to take out some stitches and even clean a little boys burn wound.
After having spent 7 weeks at Lacma I definitely have a better understanding of the free Bolivian healthcare system. This free healthcare is only provided to children under 5, pregnant women and people over 65 (which you don’t see many of due to the Bolivian life expectancy being a mere 66 years old). Not only is this free treatment restricted by age but also in the drugs available and some days if the SUMI (the main desk where the free medication is supplied) has run out of something and the patient doesn’t have the money to buy the medicine then it simply isn’t available e.g. one day the paracetamol had run out meaning a toddler with a raging temperature couldn’t be treated.
When walking through the streets of Cochabamba especially in the north, near where my host family live, it is easy to loose touch of the fact that ‘more than 60% of Bolivia’s population live in poverty’. But working at Lacma has definitely helped me appreciate this point. A lot of the patients we see come complaining of everyday problems that wouldn’t be unusual back in England for example a cold, temperature or diarrhoea. And sometimes I would find myself forgetting quite where I was however this never lasted long as all it would take is one patient to suddenly make you realise that ‘this is Bolivia’. For example late in the morning one Friday I was in a bit of a dream when a lady came in with a very high temperature and it was obvious that she wasn’t very well. Not being pregnant the doctor wrote a prescription where she could buy paracetamol. The nurse brought her back a few minutes later in tears as it turned out she couldn’t afford the 8 Boliviano medicine. This translates to around 50p and the idea that she couldn’t afford the medicine along with the reality of Bolivia’s poverty really hit home.
I think my most valued achievements during the time I’ve spent in Bolivia have been my Spanish improving from a complete beginner to now being able to make basic conversation. This was aided a lot by the complimentary 20 hours of Spanish tutoring which I didn’t realise was part of the project, it was extremely helpful. I have also grown in confidence when working at Lacma, engaging with patients and filling in the prescription forms in Spanish. I have to admit that in the beginning I found it tough to be accepting of the cultural differences but as time went by I found myself understanding and appreciating Bolivian culture more with each day. I was very sad to leave and am definitely going back when I’m next in South America.