salud publica

A recent e-mail from Hugh was a terribly sad reminder of the extent to which people living in Bolivia suffer because of inadquate and/or inaccessible health care. The following is something I wrote in 2005 about a visit to a local community.
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For more than three years, Dr. Moises Zabaleta has visited small towns in Bolivia’s mountainous Nor Yungas region where he provides consultations and medicines to the local people on a weekly basis. The people whom he serves are some of the poorest in all of South America.

Every Sunday, Dr. Moises loads up his little 4X4 jeep with a scale, a big wooden box filled with medicines, and his black leather doctor’s bag. He is always accompanied by at least two students from the UAC’s nursing program who agree to help him in exchange for hands-on practice and a free lunch. On this particular morning, Moises plans to visit Tocana, a small African-Bolivian community that is a gorgeous, 25 km drive on rough, switchback mountain roads. His two student assistants for the day are Chela and Luz Mila, Tocana natives and best friends who are also sophomore nursing students at the College.

The four of us arrive in Tocana at 9am and are told by community members that Dr. Moises and his “staff” will see patients in a little room located in the bell tower next to the church. Although the second-story room is quite tiny, Dr. Moises says it will suffice. Chela brings two wooden chairs from her family’s nearby home and Dr. Moises piles several straw mattresses to be used as a table. The room is miraculously transformed into a primitive doctor’s office. In Tocana, a village of approximately 30 families, word travels fast that the doctor has arrived; a line of patients soon forms.


While Luz Mila quickly organizes the medical cards that track each patient’s history, Chela welcomes the first person. Before a patient meets with Dr. Moises, they must have their vital signs checked. The two nursing students take turns weighing, measuring height, and checking blood pressure and heart rates. Once the patient’s vitals have been recorded, they take a seat and explain their ailments to Dr. Moises. He then reviews their health cards and asks a series of questions that, like a detective, help him piece together clues to determine how he can best treat his patients’ ailments.

The first patient to arrive is an elderly woman who has a bandanna wrapped around her head; it is strapped under her chin and tied together on top of her head. She obviously is suffering from severe tooth aches. It is very probable that she has never been to a dentist. After asking her a series of questions, Dr. Moises checks his supply of medicine and prescribes her something. She walks away, bent over, carrying her pain medication in one hand while holding the side of her jaw with the other. Once she has left, an elderly man with his arm wrapped in a sling takes a seat across from Dr. Moises. And so continues Dr. Moises’ visit with patients in Tocana.


Although the medical supplies are donated, Dr. Moises pays for all other expenses himself. Therefore, no fees are charged and no payment is expected. However, many patients bring gifts to show their gratitude. Two women waiting in line have their arms full of bananas—a fruit that grows abundantly in Tocana. “Many times the women cook a special lunch for me,” Dr. Moises says. “They are so poor and can’t pay me, but they are very appreciative of the work that I do.”

By 1pm, the line has evaporated. Dr. Moises, Luz Mila and Chela, are tired and hungry. They pack up the scale, thermometers and measuring tape. With difficulty, they put all the medicines neatly back into the wooden box. Within 15 minutes, the room is once again an empty space with an assortment of straw mattresses.

“We assisted 19 people today,” Dr. Moises announces after reviewing the health cards. He recounts that a majority of the patients who came suffered from lower back pain related to the manual labor they perform as farmers. All of their work, he says, is done by hand and often requires that they transport heavy loads on their back. He also treated a couple of people for diabetes, a common problem among the indigenous population who eat a diet high in carbohydrates because they cannot afford the luxury of meat or a wide variety of vegetables. Unfortunately, most every person who has diabetes goes untreated. Although very few children came for a check-up, Dr. Moises notes that the leading cause of death among children is diarrhea—a problem that could easily be improved, if not prevented, by cleaning up the water supply.

Dr. Moises reminds me that it will be another month before he and his team of nursing students return to Tocana. The following Sunday they will visit a different community. Meanwhile, the people of Tocana will hope that no one suffers a medical emergency. In small, rural mountain villages, transportation to Coroico (the closest town with a hospital) is usually only available on Saturdays when farmers bring their products to be sold in the market. Walking from Tocana to Coroico takes almost three hours. With no transportation, people can die of relatively insignificant injuries that, gone untreated, become infected. “You can sometimes wait for one or two days before you go to the hospital,” Dr. Moises says. “But you can’t wait a week.”

Staring out the backseat window as Dr. Moises drives us back to the UAC, I find myself reflecting on a morning well spent. Despite the fact that basic health care in Tocana is so limited, I find it somehow comforting to know that educated young men and women from the College, like Chela and LuzMila, will some day be able to improve the living standards within their own communities. In the future, I think, the people of Tocana won’t need to wait for Dr. Moises to come once a month—they will have Chela and Luz Mila.

* Chela, is finishing up her thesis work and will graduate from the UAC-CP with a nursing degree in August 2008. Dr. Moises currently lives in La Paz. Luz Mila died in the Fall of 2006.