Orientation

Monday. A busy day. We had breakfast, which consists of coffee or tea, different types of bread, cereal, and butter or marmalade or nutella. Our host mother, Isabel, is really nice and she said we should make ourselves feel at home. So we are allowed to make eggs, toast the bread, take whatever cereal we want, and have coffee and tea whenever we want. Afterwards, we met our director at Plaza Avaroa, and then we walked to his office for lectures. He talked a lot of Bolivian culture – how it’s a very multinational country with many different beliefs. This obviously makes medicine difficult, as well learn in the United States because you have to adapt to your patient’s beliefs while also making sure they get the best care possible. Apparently, around 65% of Bolivia’s population is indigenous, and they speak a myriad of languages, the main ones being Quechua and Aymara. The other 3 countries with an indigenous majority are Mexico, Guatemala, and Peru. Overall, Bolivia is a safe country. It has no serious international disputes with any nation, no guerillas, and very little drug-trafficking relative to other countries. Bolivians prefer to keep their coca leaves natural. Side note: I finally chewed coca leaves. It was pretty good but I think I prefer the tea.
When I knew I was going to Bolivia, I thought I was going to stand out in the crowd. And I do. But I’ve noticed that most Bolivianos don’t notice me, or if they do, they don’t really care. Of course, there are pickpockets everywhere, but so far, no one has taken covert pictures of me or stared at me like they do in China apparently. Maybe the beggars plead a little bit more when I walk by than another Boliviano, but besides that, I don’t feel too inconspicuous.
Later that day, we had a Spanish placement exam. Two students opted out of the language lessons and are volunteering at an orphanage (Alalay) instead. It’s an organization that takes kids off the streets and provides them with a daily routine in their lives. They go to school, have chores, play in the playground, and have set meal times. I think after 3 weeks of language classes, I am going to volunteer there too. For now, I need to learn some Bolivian slang. Apparently, in Spain, “tirando” means bothered by, or annoyed. In Bolivia, it’s a slang term for having sex. Sigh, why does each Hispanic country have to have its own dialect and vocabulary?
After the placement exam, we went to another meeting, this time at the office of the medical director – Dr. Cecilia Uribe. Her office was small and cozy, with hard wood floors. It reminded me of my mother’s work in Russia – everything seemed so similar – a little run down, cozy, cold but with warm people (even if they pretend to be cold) and a certain air of simplicity. There is something magical about how simple life becomes when you travel. All of a sudden, you only know 5 people, and your decisions consist of where to eat, where to go, and when to sleep. My free time here usually consists of writing, reading about various diseases, or talking to people. When there aren’t too many choices, I feel more at peace. During traveling, indecisiveness doesn’t play a huge role in my life and probably is the cause of most of the stress of life at home. Anyways, Dr. Uribe talked to us about health coverage in Bolivia. At the moment, they are working on universal health coverage, but they haven’t achieved that yet. Here are some of the health insurances that cover people (all are from the government):
- SUMI: for pregnant women, 6 months after birth, and all children under 5 years of age.
- All government workers (inc. physicians)
- 6-18 year olds from El Alto who go to school
- Bank workers
- People in the oil industry
- People over the age of 60 (I think)
You can also buy insurance, most likely. But everyone who doesn’t have insurance can go to a public hospital which is very cheap. There, a social worker goes over your salary and assets and dependents, and decides how much you can pay. Its not the best system in the world, but it seems to be pretty good. Dr. Uribe says the problem is that many people never go to the hospital – especially among the indigenous populations (unless it’s the children who are sick). They only go when the person is very sick. This makes it very difficult to promote preventive healthcare. The doctor also works with pregnant adolescents, which she says is a huge problem in Bolivia. Contraception is not very popular here and sometimes the man wants to have the upper hand, so he prevents the mother from using contraception. Abortion is also very rare. Among the very young teenage girls (13-15), pregnancies are usually caused by sexual abuse and are probably the only cases in which abortions are done. Overall, it was a very informative talk.

Next, Hospital de los Ninos.