26 de Septiembre: Hasta en las ciudades…

Earlier this week, the UK’s Guardian released a video chronicling the efforts of UNICEF representatives and their local allies to improve sanitation and access to clean water in Bolivia’s rural communities.  The video features interviews with Bolivian community members about the frequency of child death due to diarrhea and describes recent latrine construction projects in what looks like the country’s temperate and tropical regions in the east.  Sanitation projects in the area are being undertaken by UNICEF in an effort to speed progress on the UN’s “Millennium Development Goal” 7: to decrease the population lacking access to clean water and sanitation services by half by 2015 (the MDGs were established in 2001).

The infamous “camino de la muerte,” on which this truck is driving, carries travelers between La Paz and rural communities in the Yungas.

The state of sanitation services in Bolivia is undoubtedly the worst in rural areas, where lack of running water and sewer systems make illness frequent, even for the most dedicated of hand-washers.  If UNICEF truly wants to speed progress on MDG 7 in Bolivia, however, it would be wise to install potable water in city taps, and to support hand washing in cities, as well as rural areas.

In La Paz and El Alto, the majority of Bolivians buy their produce and other food stuffs in busy outdoor markets lacking adequate bathroom facilities.  Vendors and customers have to pay .50Bs to visit public toilets where, even if there is running water, soap is rare.  Market-goers then handle produce, passing whatever bichos they may have acquired at toilets on to consumers back at home. While it is standard practice in these cities to wash fruits and veggies before eating them, most use tap water to do so–a water that is so contaminated that it often emerges from the tap smelling of sewage.

This health care facility sits right above a public market.  The fact that hand washing is rare in both arenas provides ample opportunity to spread communicable disease.

Even more distressing, many hospitals and clinics in La Paz and El Alto fail to provide adequate sanitation services to patients and their families.  Over the past couple of years, my work has taken me for several hours each week to both public and private medical facilities in La Paz and El Alto. At the public hospitals I visited, neither public nor staff bathrooms provided toilet paper or soap to users. This means that not only patients’ families, but likely medical personnel had a hand in passing illness on to patients with vulnerable immune systems.  At one private clinic I visited in El Alto, three pans of blood and human tissue lay on the floor in the corner of the bathroom, ostensibly standing in for legitimate biohazard containers.  I was lucky to not have tripped over them and spilled them on the way to the toilet.

Poor hygienic conditions in Bolivia have often been explained in racist terms by policy makers and other professionals who pointed the finger at the country’s “dirty Indians” as vectors of disease transmission.  Arguments that indigenous populations were “naturally filthy” or resistant to personal hygiene were often promoted by western doctors attempting to push indigenous midwives and traditional medicine practitioners from the country’s health care scene.

The above observations, however, reveal a different truth: Bolivia’s western, state-run hospitals lack proper sanitation infrastructure.  Doctors, nurses, and patients alike are denied the tools they need to ensure their own and others’ safety.  And this is occurring not just in rural communities miles from the nearest “modern” clinic–this is happening in your mother’s, your sister’s, or your daughter’s hospital room in the center of La Paz city.

3 Responses to “26 de Septiembre: Hasta en las ciudades…”

  1. Brooke Harlowe Says:

    It’s not just a lack of clean water, it’s a lack of ANY water sometimes. During the dry season in the Yungas, water is often not available for any purpose. In Coroico, taps were shut during the day in some years. A public health doctor told me, “how am I supposed to tell a mother to wash her hands when she barely has enough water to cook the soup!” A new resevoir project is supposedly being built, but I’ll believe it when I see it.

    As for hygenic conditions in hospitals…. When I asked the director of the hospital for ideas on seminars for her staff, she replied, “We really need help with biohazard disposal. We don’t know enough about that.” There’s an idea for an NGO…..

  2. Brooke Harlowe Says:

    Follow-up thought….I have a theory that the increasing water shortages in the dry season in the Yungas may be the result of damage to the watershed from deforestation. Old timers say, “we never had water shortages.” Now, as people cut down more of the monte (to replace worn cocales, mostly), the forest no longer holds the water. I’ve been trying to get some ag buddies to look into this, but no luck so far….

  3. Hi Brooke, thanks for your comments. I know far too little about the situation of water in places like the Yungas, outside of the highlands. But clearly, even in cities or towns like Coroico, there is much to be done. You are probably right about the deforestation, as well. It seems like we are far from understanding the full effect of environmental degradation on all of our life systems.

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