13 de Junio: Cuando un país también es pobre
This week I discovered a few articles that emerged in the Bolivian press over the last several months that reminded me of the stunning variety of personal consequences to national poverty. So often in this blog, I have identified particular government policies or cultural attitudes that affect Bolivian women, without placing these phenomena within the larger national and regional context. It is this context that I would like to discuss today. A context in which we recognize that Bolivia is the poorest country in Latin America (with the exception of Haiti). And when an entire country is poor–not just its citizens–its infrastructure and institutions also suffer. And suffering institutions, of course, means that many people’s basic needs are not being met. This is what is happening in Bolivia.
Last January, La Paz’s daily La Prensa reported on striking health care workers at one crumbling local hospital that serves both the urban El Alto and surrounding rural populations. Situated in the more middle-class, Ciudad Satélite neighborhood of El Alto, the Hospital Municipal Boliviano Holandés–often simply called the Holandés–was opened in 1999 to provide more health care options to alteños and to the rural population that often passes through the city. According to one social worker I spoke with that works at the hospital, up to 80% of the clientele of the Holandés are rural migrants, many of whom speak exclusively the Aymara indigenous language. (Most of the hospital staff also speaks Aymara.)
One of the reasons I was surprised to read this article is because, as part of my work in Bolivia, I have spent considerable time at the Holandés and the facility seems comparable to other hospitals in La Paz and El Alto. Clearly, this is evidence not of the health of the Holandés, but of the deteriorated condition of most Bolivian health care centers. As the La Prensa reporter notes, “In the pharmacy there are no medications, the [hospital] cots are rusted, they lack anesthesia for operations, there’s no food to give the hospitalized patients, the ambulances do not work, and when it rains, thanks to the broken roofs, there is almost as much water inside as out” (all translations mine).
Even more disturbing, one nurse at the Holandés commented that hospitalized patients–despite the existence of universal basic health insurance in Bolivia–must pay a daily fee for their care. He notes, “‘The Holandés functions currently as a private clinic. Whoever needs care has to buy their own medications.'” Before reading this, I was under the erroneous impression that much had changed since the 1990s, when women seeking treatment for incomplete abortions would be left waiting sometimes for days in their hospital beds until they could afford to pay for the dilation and curettage or the manual vacuum aspirator procedure they required. The deteriorated condition of the Holandés is taking its toll on both patients and staff. Said one worker, “‘It’s been two months since they have paid our salaries, but this isn’t that important…The most serious [problem] is that…the infrastructure [of the hospital] is very deteriorated.”
Our second story of crumbling Bolivian institutions comes this week from Cochabamba, where one Defensoría de la Niñez lacks the necessary staff to investigate all of the cases it receives. In Bolivia, the Defensorías are public institutions responsible for seeing cases of mistreatment of minors–including rape, physical and psychological violence, and abandonment. These agencies are also instrumental in facilitating the adoptions of abandoned and orphaned children, since the Defensorías provide children with the personal documentation and the court order of release necessary to be adopted. That is to say, when these institutions are not falling apart, they perform these functions.
In La Paz and El Alto, too, the Defensorías are facing difficulties. As minors are becoming more familiar with their rights, more and more cases of mistreatment–particularly of rape of adolescent girls–are arriving at these institutions, and most lack the resources to deal with the cases effectively. Most of the safehouses where adolescent rape survivors could be placed are already over-burdened, and the foster system in Bolivia is so inefficient as to be almost useless. Despite working long hours, most Defensoría staff feel unable to meet the needs of community members–and these community members, for their part, often opt not to report cases of abuse when they know they will face long lines and little follow-up. I will never forget what one Defensoría worker told me when I called her to request an interview; she said: “Sure, come whenever you want–I’m here 24 hours a day.”
In any country affected by crushing poverty, women (and children) are generally hit the hardest. Often dependent upon their male partners and extended families, and facing machista attitudes and sexist discrimination, women must struggle harder to achieve financial and social independence for themselves and their children. However, women’s struggles do not occur in a vacuum. The same phenomena that daily test women also test all Bolivians–patients and hospital workers, children and parents, government officials and social workers. There are a few wealthy folks that escape, but many are in the same boat. Because when it’s an entire country that’s poor, most discover that the effects of poverty trickle down to all.