Monday, June 1, 2009

salud pública

Tonight I returned from a brief three-day visit to the Bolivian lowland towns of Palos Blancos and Caranavi--located seven and four hours, respectively, from Carmen Pampa. 

Sign along the side of the gravel road in Palos Blancos indicates the hospital is 100 meters to the right.

The pueblos are, for reasons quite obvious to me, not tourist destinations (Caranavi, though barely mentioned in the Lonely Planet travel guide, is accompanied by the words "uninspiring" and "stuck here"--which, to be fair, is more mention than Palos Blancos receives). Needless to say, this trip was straight-up UAC-related; my main objective was to visit UAC-CP Nursing students who are doing their required public health practicums. 

Nursing students Alcira Pacajes, a native of Caranavi, and Vilma Callizaya, from Coroico, work at the hospital in Palos Blancos as part of their public health course.

In Palos Blancos, I met with fourth-year Nursing student Alcira Pacajes and third-year Nursing student, Vilma Callizaya.  On-call 24 hours a day, 7 days a week (in exchange for basic housing and food), the women had to ask for special permission to spend a few hours talking with me about their work in Palos.

Because Palos Blancos is a bit short on professional staff, both women have a variety of responsibilities.  They work in PAI (Amplified Immunization Program), DOTS (the World Health Organization's Stop TB strategy), and the hospital's sparsely equipped emergency room. Part of their public health responsibilities also requires them to give talks in local schools, participate in community health fairs, and visit homes in the countryside.

Compared to their experiences in hospitals in La Paz, both Alcira and Vilma said that they see much more need in the rural area for adequate access to health care and education.  They also said they see more incidence of accidents and disease. "Many people in the rural area do not trust modern medicine...and for that reason, people--especially pregnant women and children--die or become severely ill," Alcira said. Educating the public, often in their native Aymara, is one of their primary jobs.

Posters about Dengue Fever were plastered all over both hospitals in Palos Blancos and Caranavi. Dengue, transmitted by mosquitos, presented a severe epidemic in Bolivia's lowlands this past January and February. Some of our students are currently recovering from Dengue.

Though there are six UAC-CP Nursing students currently working as interns at the Caranavi Hospital (all of whom are responsible for paying for their own food and housing), I spent most of my time with third-year Nursing students Rosa Sejas and Gabriela Mamani. They work in the hospital's DOTS program that provides outpatient care to people with tuberculosis.

Gabriela Mamani stands next to an information panel outside the Caranavi hospital that explains how people can be tested for TB and the way the disease is transmitted.

"There is a very high incidence of tuberculosis here in Caranavi," 24-year-old Rosa said. Her classmate Gabriela explained that it is mainly attributed to poor nutrition--diets generally consist of very little meat/protein. 

"Because of the economic situation [ie. incidence of poverty], people here mostly eat a lot of rice, yucca, and plantain," Gabriela said.  She also said that unhygienic living conditions, high levels of stress, and inaccessibility to health care all contribute to the higher rate of tuberculosis in this area.  In Caranavi, she admitted, it's easy to understand why tuberculosis is referred to as the poor person's disease.

It's easy to identify our UAC-CP Nursing students--as demonstrated by this pocket protector.

All the students I met with agreed that while the health-related problems facing people in Bolivia's rural area are overwhelming, change is happening. Talking to our Nursing students I felt quite confident that they are part of this change.

Gabriela, who comes from the Isla del Sol--an island in Lake Titicaca located three hours by boat to the town of Copacabana--said public health practicums like the one she's doing in Caranavi will make her a better nurse.  "I hope to return to my community once I graduate," she said. "Right now there isn't much in the way of health care." In times of emergency, people must go to Copacabana.  And for emergencies that occur at night, people must wait until the morning. But often, people can't wait until the morning. "Many people die from things that they shouldn't have to die from," Gabriela said. "Maybe I can help make a difference; that is why I want to be a nurse."

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