Bolivian Moments and Bailando Caporales!

Every once in a while I get these “oh my god I’m in Bolivia” moments. Today I had a particularly beautiful one: I walked into an aisle of the Cancha (the largest open air market in Latin America, or so I’ve heard) thinking I would find a small refrigerator for my new apartment and instead stumbled upon stacks of dried llama fetuses, supplies for K’oas (burnt offerings to the Pachamama) and a row of yatiris reading people’s suerte (luck) in coca leaves and tarot cards... pucha, que maravilla.
The thing about the Cancha is that there’s really no way to find what you’re looking for without asking at least 4 people and/or getting hopelessly lost for half an hour or so. On the one hand totally inconvenient. On the other hand, shopping in the Cancha inspires way more social interaction than it takes to drive to Fred Meyer, park in the parking lot, and buy everything you need in 15 minutes. You have to talk to the 4 people who give you directions, the aproned women that you inevitable bump into in the crowded stalls, the casera that bargains with you over the coveted item once you finally find it, (and maybe even throws in a “yapita” or couple of extra fruits or vegetables as a kind of thank you and insurance of future business.) You trade convenience for human contact. Yep, I’m definitely in Bolivia.
Tomorrow is my caporales dancing debut in Punata. Its the Convite, kind of like a dress rehearsal, where we’ll parade all over town with our fraternity of dancers, but in matching t’shirts rather than the whole caporales outfit. Oh, yes, except we do get to wear the huge, jingle-bell covered boots. Which have no padding so you have to stuff them with cotton to survive the 2 hours tour of leaping and twirling across the paved streets. Hopefully we’ll have the kinks worked out for the Fiesta Senior de Milagros next weekend, where well dance in full costume for people from all across the Valle.
Learning the steps has been SO much fun though. My block of dancers includes myself and 2 friends who are Japanese (peace-corps-type) volunteers and we rehearse for an hour and a half every night. The scary thing is I’m technically “comanding” the block, or calling out the steps before we do them and yelling the signals to start and stop them… and with just the 3 of us pale white foreigners, I’ve a feeling we’ll be watched by pretty much everybody. Ack.
I will post pictures and hopefully videos of this ridiculousness after the fiesta, but for now, here’s a few videos to give you an idea of what the caporales dance is like. Enjoy!


Note: i will be dressed like the guys, not like the ladies in short skirts... thank goodness!

Casa Materna in the News!

Some exciting news this week: A Cochabamba newspaper came to report on the Casa Materna in Punata! I have some issues with the reporting, for example we're trying to get people to stop using the term "humanized" (as if the other way of attending births was inhuman). I also don't think any of the women gave their consent to have their names printed in the paper. But "informed consent" doesn't seem to be a priority for everyone here. All the same it's great that people will be reading about the Casa Materna! Here is my (rough) translation of the article, the title just doesn't translate well though... (let me know if you have suggestions!). Here is a link to the original. Also check out this cool video with one of my colleagues describing the Casa and one of the health promotors as well!!

In the Punata Hospital, women of quechua origin can give birth in a squatting position, with the presence of their family members and traditional midwife, just as they would in their homes.

Four babies born with "humanized birth"

By Alcócer Caero Gisela - Los Tiempos - 9/09/2009

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Attending to an expecting mother in the Casa Materna de Punata yesterday. -Goitia Rodolfo Los Tiempos

The "humanized birth" model, a project which was first presented six months ago in the Punata Hospital has now brought into this world four children. Three were born without a single problem, while the fourth with complications, but the life of the baby was saved thanks to a cesaerean section that prevented him from being strangled by the umbilical cord.

The Casa Materna of the Punata Hospital began attending its first patients that seek respect for their cultural traditions (such as giving birth in a squatting position) while ensuring a healthy birth.

According to the doctor responsible for the center, David Antezana, although it was inaugurated in March of this year, it began to function in June, since it lacked staffing to care for the women and now the Mayor's office, Hospital, and an organization from the United States (i.e. Compton Mentor Fellowship!!) obtained the resources to get the project going.

The center was installed to fulfill Law 496 that establishes that every woman has the right to be attended in accordance with her customs and understanding of her pregnancy and birth.

The first woman to give give birth with the "humanized birth" model, in the squatting position and with a midwife and the supervision of a doctor (note: this is not actually true, her husband supported her but there was no midwife present) was Valeriana Mamani Chura, aged 41, who learned of the center from her neighbors in Vacas and decided to come. The birth was a success, although the child weighed 4.100 grams. She left the hospital the next day with her son in her arms.

The second was Arminda Panozo Zurita, from Punata and 24 years old. She didn't want to renounce her family's traditions and opted for the special ream where she could have her baby in a squatting position and with the presence of her mother and a midwife. Her baby weighed 3.400 grams.

The last woman to use the Casa Materna was Aida Jiménez Saavedra, who learned of it in Toco. Her last birth was in her home and with the help of a midwife, she suffered a lot and almost lost the child. For this reason, she decided to come to the hospital for the security, but she didn't want to use the gynocological table and opted for the mattress to give birth in the squatting position. Her daughter weighed 2.600 grams and she left the hospital 2 days later.

Respect for traditions

The first humanized intercultural birth room in Cochabamba was inaugurated March 3rd of this year in the Hospital Manuel Ascencio Villarroel de Punata, with the economic support of Japonese Cooperation, which invested 65,000 dollares to make the space function.

It is hoped that this initiative will reduce the deaths in childbirth in all of the country, that are at least 190 cases for every 100,000 women of reproductive age and 61 of every 1,000 children born alive. These rates are so high in Bolivia because the women in the rural areas culturally give birth in their homes, acompanied by their husbands and other family members, in vertical positions and without the possibility to survive potential complications because there aren't specialiests or equipment for cesaerean sections and can bleed to death.

This new birthing center is designed so that indigenous women that come to the hospital don't feel traumatized by a health system opposite to their traditions, whichh, until now, obligated them to wear light colored gowns, impeded their family members from entering the room and made them lie down to give birth in a horizontal position.

Poco a poco...

Well, time is flying by and I am learning tons and tons everyday, about Punata, about Bolivia, about international cooperation, and about myself. Here's a few examples:

1. Punateños really like meetings. And there are many rules that accompany said meetings. Like you must add at least half an hour to the set meeting time in order to predict when the participants will arrive. Introductions are formal, and there is a lot of summarizing and repeating what other people have said. They also have this very useful practice of writing by hand the main conclusions of the meeting in a "Libro de Actas" which everyone then signs at the end if they're in agreement. Although ususally I can't read the handwriting, so I'm not totally sure what I'm agreeing to...

2. Formalities are really important here. You can't just invite someone to a workshop by phone or email. You have to deliver them a letter. The more official seals and signatures the better. If not, they may get angry.

3. I think that the language of community diplomacy is probably the most complex level of communication in a second language that one could reach... and I am NOT there yet. Body language, tone of voice, word choice... yeesh. Needless to say, I feel like a bumbling idiot a lot of the time. Luckily, most people here seem to expect nothing less of me...

4. It's really strange to play the role of "financiadora." It makes it hard to tell when people are being sincere sometimes, and when they're being strategic. And being the only one here identifiable with the Compton folks, I'm the point person for "Couldn't your project also buy this equipment? Or hire one more nurse?". This is when # 3 becomes really important.

5. One of the hardest questions to answer is when people ask me what my profession is. Technically, I guess I should say "Biológa." But that doesn't really clarify too much. And after 17 years of perfecting the art of being a student, its hard to feel like I know how to do anything else.

6. A nice thing about being a student is that most of the time you have control over who you spend your time with. If you don't like a prof, often you can switch courses. If you don't like a fellow student, the most you have to work with them is for a group project or presentation of a few weeks. In the workplace, however, if you don't like someone, or, say, they treat you like you're a 12 year old girl, you still have to work with them, possibly every day. I've realized that learning to deal with people that rub you the wrong way is just something that you don't learn in college. But I'm working on it!

7. I have a hard time concealing my emotions in any context. This makes number 6 a little more difficult.
The view from my room in Punata.

Things are going really well in Punata though. We've hired our three promotoras and two doctors who are all very committed and excited about the project. What's more, we've signed an agreement with the hospital that they will hire on the two doctors at the end of January, so that they can continue to share their skills and knowledge with the rest of the staff for the future sustainability of the Casa Materna.

This week we had two days of training and planning sessions for the entire Casa Materna team. It was a challenging and really exciting experience, despite some logistical kinks (see number 5 above). My favorite part was just reveling in the depth and diversity of knowledge in the room as we sat around a table planning out every aspect of the care we're going to offer in the Casa Materna; the gynocologists, the traditional midwife, the nurses, and promotoras all had something to offer.

Then, that night, one of our projects doctors attended her FIRST intercultural birth in the Casa!!! I had the awesome experience of interviewing the mother and father after the fact, who were SO positive about the care they'd recieved, so grateful for the chance to give birth like they had 10 times before in their home with the husband kneeling and supporting his wife from behind, rubbing her back to ease the pain. They wanted to thank the "Doctorita" for being so patient and for not immediately ordering a C-section as others sometimes do. Their main suggestion was for more medicinal plants that we could stock up on, for matés that ease the birthing process. Hopefully there will soon be many more happy families like theirs!

So I have yet to take pictures of the Casa Materna, but to keep this from being one long block of text, I will share a few shots from the incredible festival of the Virgin of Urkupiña two weeks ago. It's like Carnaval, but minus the water balloons...

Dancing with my friend Julia and the Tinkus

Julia and I with the Caporales of San Simon (who inspired me to join a fraternity to dance Caporales in Punata in September.... more on that soon!)

My friend Aida with el Supay (Diablo) of the Diablada.

On Saturday night there is a 16km pilgrimage from Cochabamba to Quillacollo (where the Virgin of Urkupiña appeared to a little girl back in the day). My friend Julia and I decided we couldn't miss out. So at about 2am we left the bar where'd been dancing and joined the thousands of Bolivians all walking down Av. Blanco Galindo to pay respects to the Virgin. Like a giant moving party basically, until we arrived at 8:30 in the morning at the Calvario. Which was a little anticlimatic, but probably because of the exhaustion and our lack of personal commitment to the Virgincita.
Arriving at the Calvario: so many people!

You can see more pictures of Urkupiña here: http://picasaweb.google.com/kirsten.hansenday/FiestaDelUrkupina#

¡Back in Bolivia!

Dear Family, Friends, Professors, and Interested Strangers,

Welcome back to my blog! As many of you know, I have returned to Bolivia for a year to work on a maternal health care project with the support of a Compton Mentor Fellowship. I hope to keep you all updated on the progress of our project throughout the year, as well as my other adventures and musings on life in Bolivia. I hope you enjoy it and don't forget to leave comments! :)

So what exactly am I doing here? At its core, the goal of my project is to increase indigenous Quechua women's access to and satisfaction with maternal health care services in the Valle Alto of Cochabamba. We plan to do this by promoting an Intercultural model of hospital care that increases women's autonomy in the birthing process, valorizes traditional Quechua practices, and minimizes medical intervention in low-risk births.

Note: For those of you who want all the background info, read on. For those of you who've heard me talk about this a million times, feel free to skip to "Casa Materna Punata"

Background Info: Maternal Mortality and Sociocultural Barriers to Care:
So why is this necessary? Bolivia suffers from the highest rate of maternal mortality in Latin America: in the year 2000, an estimated 290 women died in childbirth for every 100,000 live births. There are a lot of reasons for this. For Bolivia's rural, indigenous majority, financial, geographic and sociocultural barriers restrict access to public health services. The health ministry has made many efforts to remedy this by building physical infrastructure to serve remote areas and providing free health insurance for pregnant women and children under age five. However, use of these services remains low. For example, in 2003, only 30% of births in the country’s rural areas took place in health care centers or hospitals.
While the geographic and financial barriers to maternal care have been addressed to an extent, cultural and social barriers remain a serious obstacle. Birth is a sacred event for the Quechua people of the Andean highlands, as evidenced by the wealth of rituals, beliefs, and customs that surround it. But for many Quechua women, giving birth in a hospital setting can be a traumatic and humiliating experience. Traditionally, women give birth in the home, surrounded by their family members. They often undergo labor fully clothed and in a squatting or kneeling position, which with gravity and the woman’s natural body movements, proves to be physiologically beneficial for both the mother and the infant. The husband may rub his wife's back, support her, and give her herbal teas to speed the labor. Dark colored blankets cover the floor and the room is dimly lit because strong light is believed to damage the baby's eyes. After the birth, the placenta is buried in the family’s patio with small gifts and food to ensure the future prosperity of the child. Family members perform a symbolic ritual burnt offering called the Q'oa, to give thanks for the new life, and prepare special foods so that the new mother can regain strength.
The contrast between these customs and the standard procedures of a modern hospital birth could not be starker. Many women are scared or ashamed to be attended by an unfamiliar male doctor. In addition, husbands are known to become jealous as a result of perceptions of the doctor’s central role. Women have also experienced discrimination or mistreatment by biomedical doctors who are often simply serving their obligatory six months of rural service before returning to a more lucrative practice in the cities. Regardless of their upbringing, university training tends to encourage doctors to exclude themselves from Quechua culture and to value Western knowledge over all others.
Bathing, shaving, and touching the woman's genital area is traumatic to many Quechua women, for whom modesty and privacy are very important and the chilly, sterile hospital environment can provoke anxiety over catching a cold, a common fear in the harsh Andean environment. Women may fear staining the white sheets with blood, bodily fluids, or dirt, as bathing is not always possible in their rural lifestyle. And the requirement that a woman undergo labor on her back on a gynecological table with her genitalia exposed is humiliating, as well as physiologically disadvantageous. Thus, it is not surprising that so few women are inclined to seek medical attention when they go into labor.
Many women believe that only complicated births require hospital delivery, but often problems aren’t apparent until labor has begun, so medical assistance does not arrive in time. Thus the cultural inaccessibility of hospital birth attention has serious and significant implications for women’s survival when problems arise during labor

An Intercultural Model of Care
For many years, Bolivian organizations like Acción en Salud Integral (ASI) and Causananchispaj have been working to address this issue and develop new models of care that better respond to the cultural practices of indigenous populations. ASI has helped various clinics in the rural provinces of Cochabamba and Northern Potosi implement a new model called "El Parto Intercultural." The model emphasizes communication and collaboration between the family, healthcare staff, and traditional birth attendants. Modern medical techniques are available should the need arise, but primarily the woman is allowed to give birth naturally with the support of her partner and family members. Intercultural birth rooms are designed to feel more similar to the homes where women would traditionally give birth. The sheets and bedding are dark-colored and the room is kept at a warm temperature by boiling water on a gas stove. Family members may feed the mother familiar foods or teas and the mother is supplied with a hospital gown that is similar to her usual dress. Unnecessary procedures such as shaving the mother's pubic hair, enemas, and routine episiotomies are eliminated.
Most importantly, the mother is allowed to labor in the position she prefers, whether walking, standing, sitting, kneeling or squatting on a specially designed mattress, while supporting her weight on a shoulder-height bar. This practice not only is more culturally acceptable, but also healthier, as it dilates the blood vessels, improving oxygenation to the mother and child, and decreases pressure on the uterus, reducing the effort and duration of labor.

The need to adapt birthing protocols to indigenous cultural practices has been recognized in other Andean countries as well. In Peru, after the implementation of such changes, health ministry studies found that in the rural areas, the proportion of births that took place in public health centers increased from 22% in 2000 to 40% in 2004. A similar project in Chile found that the Intercultural attention and vertical birthing position actually diminished the risk of cesarean section.
Various hospitals that have implemented the new model have already demonstrated the potential to greatly increase use of maternal health services and thus reduce maternal mortality. For example, in Torotoro, Potosí, in the year after the Intercultural Model’s implementation, deaths due to complications of childbirth were reduced from twelve in 2005 to only one in 2006.
Yet, there is still much resistance to these changes on the part of biomedical practitioners. The supine gynecological position is more convenient for the delivering nurse or physician to be able to medically intervene, especially if complications arise in during labor. The herbal medicines, vertical birthing position, and other traditional practices are often misunderstood and viewed as evidence of rural peoples’ “backwardness” rather than appreciated for their cultural and physiological merits.

Casa Materna Punata
So back to the original question: What am I doing here? Well the truth is a lot of that I am figuring out day by day. My project revolves around a Casa Materna, or intercultural birthing center, that was recently built by Japanese foreign aid in Punata, a mid-sized town 45 minutes from Cochabamba. It is the first center of its kind in the area, and the first in the country to be built next to a higher level hospital, where medical specialties like gyneco-obstetrics are available. While the physical infrastructure is there, the Casa Materna has yet to begin functioning, primarily for lack of human resources and resistance on the part of those specialist doctors, who dont see the necessity or importance of the intercultural model.
So our project is filling in that niche. We're hiring two doctors who will be trained to attend births in the center, in collaboration with the husband, midwife, and/or family members that the mother chooses to accompany her. The part I'm the most excited about will be working with a promotion/ investigation of team of 3 women from the community to spread the word about the new model through workshops, sociodrama skits in the marketplace, and home visits with families in the rural communities surrounding Punata, as well as interviewing women about their experiences. Once things are really working well, the plan is for the doctors to train each of their colleagues, one by one, in the new model. Because honestly, it seems that most of their resistance stems from an inability to imagine how one might attend birth in a vertical position and what it would be like to actually collaborate with family members and midwives, and that witnessing a colleague attending in this way might reassure them. I guess we'll see!
The second half of the year will be devoted to diffusing the results of the investigation and spreading the intercultural model throughout the region.... but I’ll have to tell you more about that when we get to it!
So thats the scoop for now, things have been going really well, the local government approved the project, I’ve been making friends in Punata, and we’re hiring doctors next week! Hope you all are well, take care, and I hope to write more soon!



New Friends on a Weekend Trip to Chapare!

Pictures!!

Hi Everyone-
So I finally figured out how to upload my pictures to Picasa so you guys can see more of them than I've put on the blog. They aren´t very organized but hopefully you´ll enjoy them! The address is www.picasaweb.google.com/kirsten.hansenday

I just got back from touring the Salar de Uyuni with my dear friends Katherine and Katherine from Oberlin and Seattle. We´re headed to Tiwanaku for the Aymara New Year celebration tomorrow night and then on to Lake Titicaca and the Isla del Sol and then Peru!!! I´m super excited to be traveling with them, but it was definitely sad to leave Cochabamba.

Chau for now!
Kirsten

Naomi Klein in Cochabamba!

A few weeks ago, the journalist Naomi Klein (of The Nation) came to Cochabamba to talk about the Spanish version of her book, The Shock Doctrine: The Rise of Disaster Capitalism. It was so incredible to hear her talk, especially in the city that first showed that a popular uprising can indeed triumph over an irresonsible transnational corporation, driving Bechtel out of Cochabamba after they privatized the public water utility and hiked prices 300 percent in 2000.

Klein´s book documents the history of the idea first espoused by Milton Friedman that "only a crisis, actual or perceived, produces real change" when it comes to economic policy. She details examples of how the IMF and their elite allies in governments around the world have used the state of shock after natural and man-made disasters to implement unpopular economic austerity measures and privatizations when people are least likely to resist them. From the 1973 coup of Allende in Chile, to Russia in 1993, China in 1989, the Falklands War that gave Margaret Thatcher the popularity to make serious changes in Great Britain, to the ugly aftermath of Hurricane Katrina, to the most privatized war in history in Iraq, this pattern repeats itself.

Klein gave a disturbing description of the way companies took advantage of the aftermath of Hurricaine Katrina to benefit themselves. Blackwater provided policing, other companies found a market in building shelters or selling water. And the reconstruction process has totally changed the face of much of New Orleans, replacing public housing with condos and casinos. Five thousand black families had lived in housing projects on some of the most valuable land in the city before the hurricaine. Klein quoted a New Orleans politician as saying "We couldn't clean out the housing projects, but God did."

Her argument really confronts the assumption that neoliberal economic policy goes hand in hand with democracy. Bolivia was a turning point for this ideology in 1985 because it was the first time that a democratically elected government implemented the neoliberal program. Before it had only worked in dictatorships like Pinochet´s, a marketing problem for Milton Friedman and his "Capitalism and Freedom" thesis.

In Bolivia the "shock" was the terrible inflation crisis caused by the collapse of tin prices and an inept leftist government in the early 1980's. But what get´s left out of the official history is that Bolivian President Victor Paz Estenssoro never mentioned his neoliberal plans to reorganize the economy during his election campaign and designed the whole policy in secret with an emergency economic team. They showed their new policy to the IMF even before his own cabinet or the Bolivian congress had seen it. Apparently the IMF official told them the package was everything they could ever dream of, but that if it didn´t work, he had diplomatic immunity and could hop a plane to Miami.

After the policy was implemented and thousands of miners lost their jobs, Bolivians held huge strikes and protests. The government declared a state of seige and arrested 1,500 protesters and kidnapped 200 of the top labor leaders to the Bolivian jungle. It was hardly a democratic process.

Klein´s message is that being aware of this pattern can help us confront it, instead of deferring to strong leaders in the aftermath of a crisis we can organize, the way that workers did in Argentina after the 2001 economic crisis, when they took over their shuttered factories and started cooperatives to continue producing without the management.

I think we have a lot to learn in the U.S. from a country like Bolivia. As Klein put it, the societies with the most powerful historical memory have stronger resistance to neoliberalism. We´ve become so comfortably indifferent in the U.S. that there´s little protest when public housing's mowed over or private companies win outrageous contracts to repair the destruction we´ve caused in Iraq. But after 500 years of resistance to colonialism, Bolivians are no longer willing to sit quietly in the face of such exploitation.

Here are a few market scenes from my second visit to Potosí, I love the markets here!

These are special honey covered pastries for Corpus Cristi.

Why would you ever go inside to buy anything? :)
Cool mural in Potosí "For brotherhood between the peoples of Latin America."

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.