Archive for La Prensa

6 de Noviembre: La feminización del VIH/SIDA

Posted in Bolivia, HIV/AIDS with tags , , , , , , , , , , on November 6, 2010 by eugeniadealtura

I’d like to apologize to my readers; lately, teaching and research responsibilities have made me unable to update the blog as regularly as I would like.  However, an article published today in La Paz’s La Prensa paper has prompted me to draft this brief post.  The article, entitled, “The La Paz resident with HIV/AIDS is young, male, heterosexual, a worker, and a city dweller,” explores the (growing) phenomenon of HIV/AIDS in the Andean city.  Despite the title of the article, it goes on to explain a trend occurring around the world–the feminization of HIV/AIDS.  Despite the fact that most known HIV/AIDS carriers in Bolivia are male, new cases of the virus are found just as often in women now as in men–particularly among younger generations.

Not surprisingly, local health department official René Barrientos noted that women are likely infected due to the infidelity (and sexual carelessness) of their partners.  “Generally,” states Barrientos, “women who complete domestic tasks are at home and are infected by their partners, since these also pursue sexual liaisons outside the household and then take the infection home.  In absolute numbers, 69 women who work in this area were found positive across the period [of study]…This is alarming because it places the household at risk” (all translations mine).

Barrientos also notes that life expectancy of HIV/AIDS carriers in Bolivia is considerably shorter than that of carriers in other countries, since people often do not know they have the virus.  In July and August of 2010, 38 new cases were discovered in the city of La Paz.  18 of these individuals already had AIDS.

Having spoken with a number of people of different social classes in the cities of La Paz and El Alto about sexual and reproductive health, I am convinced that few people seek testing for sexually transmitted infections (STIs).  In general, the population seems to believe that STIs affect only “dirty,” “promiscuous,” or “sexually deviant” individuals–ie., not them.  Attitudes such as these do not reflect the realities of STI infection and transmission, and typically stem from abstinence-only education and an atmosphere of fear and shame around the discussion of sex.  This article is a good reminder that abstinence-only education, the shaming of sex, the lack of acceptance and availability of condoms, and people’s reluctance to seek STI testing, equal death.

13 de Junio: Cuando un país también es pobre

Posted in Bolivia, poverty with tags , , , , , , , , , , , on June 13, 2010 by eugeniadealtura

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.”

Patient medical records stuffed into boxes are kept in this storage room in one local hospital.

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.

17 de Abril: ¿Por qué no, “algo porque sí”?

Posted in Bolivia, health care with tags , , , , , , , on April 17, 2010 by eugeniadealtura

This week, the La Paz daily La Prensa reported on four initiatives being undertaken in city of El Alto to combat tuberculosis (TB).  Luisa Mendizábal, the coordinator of the program, notes that El Alto saw 700 confirmed cases of TB in 2009.  One of the initiatives being used to combat the disease, however, has little to do with TB itself–instead, it uses pregnant women as, essentially, bounty hunters for potentially infected individuals.  The program is tellingly titled “Algo por Algo,” or “something for something”–as in, do something for us, and we’ll do something for you.

It works like this: if a pregnant woman brings an individual with symptoms of TB to her prenatal checkup, then she will not have to wait in line with the dozens of other expectant mothers to be seen.  Instead, she’ll pass directly through the double doors to see the doctor.  It bears mentioning that these women are forced to wait in line for hours because of their participation in another government program: the Bono Juana Azurduy.  As I have previously reported, the Bono Juana Azurduy pays pregnant women to go to state-run medical facilities for prenatal care and for the birth, rather than having their children at home.  While poverty has led expectant mothers to queue for hours to receive a bit of cash and what is often described as a cursory checkup, now Algo por Algo offers women the opportunity to cut down on their wait time by dragging a phlegmy, coughing, potentially TB-infected individual along with them.  Although TB is known to be contagious and potentially fatal, proponents of Algo por Algo are putting pregnant women at risk by giving them incentives to be in close proximity with infected individuals.

In part, I understand the impulse for programs like the Bono Juana Azurduy and Algo por Algo. Many women report being scared of health facilities, either because of their unfamiliarity, or because of the mistreatment that many have experienced there.  In the face of this fear, women often choose to have their children at home, where they are more likely to be attended in the birth by family members or by no one than by a midwife, whose services cost money.  The government officials who created the Bono probably genuinely hoped to reduce maternal deaths by getting women to the hospital.  (They also likely hoped to reduce the practice of traditional medicine and birthing methods.)  But programs like these are inherently flawed, for a number of reasons: they do not address the mistreatment that consistently drives women away from medical facilities, and they may expose pregnant women to TB, for example.

There’s another problem with incentive-based health programs, however, that I find much more fundamental: quality health care should NOT be something you get in exchange for something else.  Health care should be, and in some countries is, a basic human right.  A universal right. When reductions in maternal mortality or TB rates are achieved through cajoling and manipulation, rather than empowerment and education, I am uneasy to call this a true “win.” Rather than “something for something,” health care should be a question of “something just because.