Medicine & Healthcare in Bolivia by William Richter
I am William Richter, a 21 year old volunteer from Washington, DC. I am a pre-med student at Cornell University and will be entering my 4th year come August. I have been studying Spanish for several years and wanted a placement abroad where I could gain medical experience and improve my Spanish. I searched online for such a programme and found Teaching & Project Abroad´s Bolivia medical programme. It seemed to have everything I wanted so I applied and four months later found myself working at Centro de Salud Lacma for seven weeks. Now at the end of my placement, I feel satisfied and rewarded with the experience I have had.
Centro de Salud Lacma is located in Barrio Don Bosco in the southern part of Cochabamba. Luckily from where I lived it was an easy 101 taxi-trufi ride to within three blocks of the centre. The Centro consists of a laboratory, four doctor's offices, a pharmacy, a tuberculosis room where TB patients´ information and medicines are kept, several other rooms, and a central courtyard with an adjacent common room for tea and snacks, and a front desk and waiting area. The staff consists of three doctors, one head doctor, several medical students and nurses, and a pharmacist.
When my friend, Sameer and I first arrived in Lacma we were introduced to all the staff and then began working on the front desk where patients are signed in and have their files taken out and placed in the infirmary. We began observing the pharmacist who works at the front desk, Javier. While he tried explaining to us the procedure of signing in patients, we had difficulty understanding and he was not too eager to help us out so we learned most of the work through observation and trial and error. At first the work was quite difficult. We had trouble understanding patients, many of whom are campesinos with minimal knowledge of Spanish and tough-to-understand accents. Luckily, the majority of patients covered by SUMI (the universal health care programme for pregnant women and children), only needed to show their medical cards and state their illness to be signed in. And within a week we were successfully signing in about 80% of the patients. While we felt proud to be able to help the health centre with practical work, we soon become tired of this boring and repetitive job.
While the front desk duties were not the best part of the experience, we were not without interesting work the first two weeks. Two days we were able to travel around the neighbourhood with nurses as they finished up the end of the May Rubella Campaign and went around surveying households and vaccinating people without the vaccine. Additionally, we travelled in a jeep with 2 doctors as they announced information about the campaign to the neighbourhood. This gave us a brief yet interesting look in to the execution of public health campaigns in Bolivia.
After working the front desk, more interesting opportunities opened up such as working in the infirmary, laboratory, or with doctors. While we only had one day in the lab, the doctor there was eager to teach us about all the tests they perform, what they look for, and what they do with different results. It was nice to see that the Centro was provided with the equipment to inform patients promptly about their health and contracted diseases. The nurses too were excited to have us work in the infirmary. We helped them weigh and measure patients and they would happily answer all our questions and teach us how to take blood pressure in the down time. However, the bulk of the days were spent observing with doctors. Here we really got to understand and observe the direct treatment of patients. The doctors were all pleased to have us with them and often spent time explaining what they were doing with patients and why. Additionally, they taught us how to fill out much of the paperwork which allowed us to help them out as well.
We saw many different cases observing with the doctors and experienced Bolivian health care first hand. Many of the patients were young children with stomach problems, cold, or cough which doctors would check out quickly and then sometimes let us check out the children lungs or throat. Several patients were pregnant women coming for prenatal checkups. We were able to feel their bellies for the baby and help determine its location and size. We even got to help perform pap smears and insert IUDs on some women. The experience helped us see doctor-patient interactions under conditions with limited health care tools and allowed us to work closely with patients in a way we would not be able to in the US.
Another highlight of the experience was going with two of the medical students to the medical university and seeing cadavers and the human body part exhibit. Overall, the staff were very friendly, encouraged us to observe and learn about all their duties, and made us feel welcome.
Most of the difficulties we had were language related. As I said before, we had difficulty at the front desk when patients with complex problems came to us. Occasionally, we would have trouble understanding the doctors but towards the end we had no problems communicating with each other as our Spanish improved. Difficulties with the pharmacist were a little frustrating but just led us to better positions. I would say I was impressed with the lack of difficulties we had and the way our health centre made work enjoyable and rewarding for us.
The only recommendation I would make for this placement is that the volunteers should not work in administration for too long. While it may be beneficial to see and understand this part of the clinic, it can slow down traffic at the Centro and becomes repetitive and boring after one week. Future volunteers should not be hesitant to ask the staff any questions and should be eager to learn and work closely with the doctors. For Projects Abroad, I recommend that they make it obligatory for volunteers to have prior Spanish knowledge or take intensive classes before coming to Bolivia, to make the experience more rewarding. Luckily I had previous tutelage in Spanish, which not all volunteers had.