1 de Mayo: Siempre equivocada
This week, the La Paz daily La Razón reported on a slew of complaints being leveled by patients of the local Hospital de Clínicas and their families for mistreatment and misinformation. Apparently, the Minister of Transparency and Against Corruption, Nardi Suxo, visited the large public hospital in order to speak with patients in person about their complaints, which are largely that, “‘[they] do not have information about their family members or about the treatment that they must follow, in addition to mistreatment'” (all translations are my own).
Regarding the visit, the director of the hospital, Dr. Eduardo Chávez Lazo, remarked that, “‘it has been seen that the care (at the hospital) is very appropriate, and in any case, the Minister has come to verify this in person.'” With respect to patients’ complaints, Chávez said, “‘a patient, when s/he is sick, changes her/his character and way of being, and becomes depressed, whiny, and aggressive… When one is sick, the treatment that the patient receives is not what s/he expects, and this results in complaints.”
To avoid the long lines and mistreatment at many public hospitals, many people go to small private clinics like these ones in busy market districts of La Paz. The care here is not necessarily any better than at the larger facilities.
In my mind, this piece is a non-story. I have become so accustomed to hearing women state that they are “afraid” to go to medical centers, that sometimes I forget to ask why. When I do remember, they say that they are afraid of being yelled at and chided for: crying out during childbirth; for not going to prenatal visits; for coming in to the hospital either too soon, or too late, in labor, or for having any request at all during their hospital stay. Indigenous women are often yelled at for not understanding Spanish, for requesting food and hot beverages during labor, for wanting to give birth in the traditional squatting position, for asking to be bundled in blankets during labor, and for requesting to take the placenta home after the birth. (Consuming hot food and drink and being wrapped in blankets are indigenous birth rituals that heat the body and facilitate cervical and pelvic dilation for birth, while burying the placenta protects the child from illness throughout its life.)
Dr. Chávez’s dismissal of patient complaints is, although infuriating, completely unsurprising. The fact is that, with regards to medical care, the old customer service adage is reversed: if the customer is always right, in Bolivia, the patient is always wrong. In Bolivia, where higher education is less of a universal right than a luxury for the few, poorer, uneducated Bolivians are taught to treat doctors and other professionals as their superiors. Most Bolivians recognize that they are being mistreated at medical facilities, but rather than confronting well educated doctors and nurses about the abuse, they prefer to simply not go to the doctor. In addition, many indigenous Bolivians prefer to visit medical providers from their own communities, rather than western medical institutions. The government, rather than dealing with the mistreatment, instead institutes poorly conceived, incentive-based health care programs like the Bono Juana Azurduy or the tuberculosis testing program to lure patients into hospitals. They do this rather than deal with the abuse because they are more concerned with Bolivia’s international reputation, which is scarred by high maternal mortality and other health statistics, than with the health of actual Bolivians.
This La Razón article may tell us nothing new, but at least it gets the word out there about the poor state of affairs at many Bolivian medical facilities. While medical infrastructure and technology in the country have improved considerably over the past several decades, these achievements will not bring patients in the door. And they will not substitute for comprehensive, sensitive, culturally competent, and non-judgmental care.