A few more thoughts about my time in Torotoro

I feel like I got to experience Andean culture a little more deeply there; it's so incredibly different from ours. Something I really like, and am trying to understand better is the concept of Ayni, or reciprocity. People give to eachother so generously even when they have very little because there´s an understanding that someday in the future, be it tomorrow or in 20 years, that person will give back to you in some way. I said something to Don Luciano, the traditional healer who helped me translate interviews in the rural village of Tambo K'asa, about how I felt bad I hadn´t brought something to give to the people I was interviewing, like a mandarine orange or a bag of coca. He said to me,"That´s okay, there's always next time," with full knowledge that it could be years before I ever came back to Tambo K'asa. But time is a different concept here.

The cool thing about Ayni is how it binds a community together. When someone gives you something without pay, you stay connected to them because you have to return the favor someday. In contrast, when we pay someone for a service or good they give to us, the social interaction ends right there, it´s paid and done with. Torotoro is a very poor place economically, but even though they don't have money, hardly anyone goes hungry because the community shares and trades with eachother. Sometimes a guy would show up at our house with a huge bag of potatoes and I would think, how did we pay for that? But it turned out we'd given them corn a few weeks ago. It's this continuous web of reciprocity that connects people in deeper ways.

I thought a lot about how individualistic we learn to be in the U.S. and how I find it hard at times to even make myself share my food with a stranger on the bus. But it's just what you do here, you never eat in front of someone without offering them some. I really believe that humans aren´t innately selfish or individualistic, it´s just that we´ve become socialized that way in the Western world.

So in case you´re interested, here is the abstract for my project in Torotoro. It sounds better in the original Spanish, though, I suck at translating:

Intercultural Public Health in Torotoro, Potosí

In much of rural Bolivia, the population has difficulty accessing the public health system. Physical, economic, and cultural barriers all prevent the indigenous quechua population from using the public health services available to them. The Evo Morales administration has proposed a new public health model called “Salud Familiar Comunitaria Intercultural” (SFCI) that attempts to remedy these cultural barriers, such as language, beliefs, customs, traditions, and the preference for traditional medicine. But it still hasn´t been defined what the model SFCI will look like once implemented. Torotoro, in the far north of the department of Potosí, is a municipality that has begun to adapt their services to the local culture and integrate tradicional medicine into the public system. Torotoro is one example of how certain aspects of SFCI might be implemented.

In hopes of better understanding this new model, the cultural barriers for the indigenous quechua population´s usage of the public health system were investigated in Torotoro. The central questions of the investigation were, “Do cultural barriers prevent the population from using the services available to them?” and “Does the population access the services more, now that they´ve been made more culturally appropriate?” Using interviews with health center personnel, traditional healers, and residents of the municipality, three aspects of culturally appropriate health services were studied: intercultural attention of the birthing process, intercultural practices of the health center personnel, and the satisfaction with and use of traditional medicine.

It was documented that the implementation of intercultural attention of the birthing process has resulted in increases in the percentage of births that are attended in the health center. The personnel have good knowledge of the quechua language and the beliefs and traditions of the population and respect the knowledge and skills of the traditional healers. The majority of the population interviewed have positive feelings towards the health center and support the idea of having traditional medicine also available there. Furthermore, the traditional healers in the municipality are very organized and commited to their project, although they lack somewhat the resources to provide the best attention possible. Cultural barriers to the usage of the center still do exist, but the progress that has been witnessed in Torotoro suggest that the model SFCI will indeed be able to increase access to the public system in other areas as well.

Interculturalidad y Accesibilidad: Un Nuevo Modelo de Salud Pública en Torotoro, Potosí

En mucha de la zona rural de Bolivia, se ha visto una falta de acceso de la población a los servicios de salud. Las la geografía prohibitiva, la falta de recursos, y las barreras culturales como el idioma, las creencias, costumbres, tradiciones, y la práctica de la medicina tradicional por la población impiden el uso de los servicios por la población originaria campesina. El gobierno de Evo Morales ha planteado un nuevo modelo que se llama Salud Familiar Comunitaria Intercultural (SFCI) que enfrenta estas barreras culturales. Pero todavía no se ha definido específicamente como va a funcionar. El municipio de Torotoro en el extremo norte de Potosí ha empezado un proceso de adecuación con interculturalidad y la integración de la medicina tradicional y es un ejemplo de como se podría implementar estos aspectos del modelo SFCI.

Con el fin de entender mejor este nuevo modelo, se investigó el problema de la vivencia cultural como un factor para el acceso a los servicios de salud de las poblaciones originarios quechuas. Las preguntas centrales eran ¿Son las barreras culturales un factor para que la población no acuda al servicio de salud? y ¿La población acude más y tiene más satisfacción con los servicios de salud ahora que hay adecuación intercultural? A través de entrevistas con el personal de salud, los médicos tradicionales, y la población de Torotoro, se estudió tres aspectos de la adecuación: la utilización del parto intercultural, las prácticas que realizan el personal de salud sobre la adecuación intercultural, y la satisfacción y el acceso a la atención de la medicina tradicional.

Se ha visto que la implementación del parto intercultural va aumentando cada año el porcentaje de partos atendidos en el Centro y que el personal de salud maneja muy bien el idioma quechua, conoce muchas creencias y tradiciones de la población, y respeta los conocimientos de los Médicos Tradicionales. También, la mayoría de la gente que entrevisté se siente bien con la atención del centro y apoya la atención de la medicina tradicional en el Centro. Además, los Médicos Tradicionales son muy organizados y comprometidos a su proyecto, aunque faltan materiales y ambientes para brindar la mejor atención a sus pacientes. Todavía existen barreras culturales al acceso al Centro pero a pesar de eso, el progreso que se ha visto en Torotoro sugiere que el modelo SFCI podrá mejorar el acceso al sistema público en otros lugares también.


Some pictures from Cochabamba:

A walk in Parque Nacional Tunari, 2 blocks from where I live in Cochabamba.



The Cochabamba Valley at sunset from Parque Tunari.


So this I just thought was a funny picture; what the call a "euro-casa" with a painting of Che. Lots of Bolivians go to Spain to make money and then come back to Bolivia to construct huge, grandiose, and in my opinion ugly houses in the style they have in Europe. A lot of times they´re half finished becuase the person has returned to Spain to make the rest of the money to finish it. They always stick out strangely in comparison with the normal houses around them, and seem like a gaudy expression economic inequality. Thus plastering Che´s face across the side of a euro casa seemed to me an ironic mixture of symbols.