This week I spent three days at Centro de Salud Alta Mariscal, with Dra. Salazar, and one day at Hospital los Andes, with Dra. Uribe. Dra. Salazar is so sweet and talented. She has an essence about her that calms the children she treats and its has been amazing to watch. Most of the patients that came to the center had colds, vaginal infections or were just getting a check up. One patient came in thinking she had a vaginal infection because she was secreting blood with clumps in it. After Dra. Salazar examined her, she realized that the swelling was coming from her urethra. Dra. Salazar sent her to a hospital, because she believed it was a tumor. The lady didn't want to go to a hospital because she was afraid and it was a long way to go by herself. This a a very common issue in Bolivia because people don't like to seek medical attention until they absolutely have to, causing treatment to be much harder.
Dra. Salazar also performed a birth control implant which was very interesting to watch as it was much more complicated than the procedure I watched in the US. Dra. Salazar had to prep the patient and use sanitary equipment. She first injected the patient with anesthetic, then sliced a hole in her arm, then used a little tool to inject the first and second implant. The whole procedure took about 20 minutes, where as in the US it takes about 2 minutes. In the US the doctor inject anesthetic then use a gun apparatus to inject the implant. There was much less chance of infection and it was a lot less traumatic for the patient. Amazing the difference one simple tool can make.
Dra. Salazar also talked to us a lot about sexual violence in Bolivia, which is a big problem. We saw an 11 year old girl who had a baby by cesarean in Hospital los Andes. She had been sexually assaulted, but decided to keep her baby and the nurses said she had been very responsible to far, better than a lot of other mothers. We brought this up with Dra. Salazar and she told us a little more about sexual assault in Bolivia. Most of the time young women are assaulted by good family friends who are around there homes very often. This is very traumatic for you women, and can take away their ability to love their children in the future. This causes a repeating cycle as children don't grow up in a loving family, and then don't know how to love their own children. Women will often treat their sons with aggression due to the way they have been treated by men, which causes their sons to treat women aggressively in the future. A lot of families in Bolivia are not wealthy enough to own houses with multiple rooms, so multiple generations live together in the same room and even share beds. Children often explore their sexuality sooner because they watch their parents have sex. This is one of the causes for such young pregnancies in Bolivia.
Hi there! My name is Jenna Grunwald and this summer I will be gaining an understanding of the relationship between disease processes, social-economic circumstances, poverty, geopolitical realities, historical contexts, culture, and how these play into the complexity of healthcare in Bolivia and Argentina with Child Family Health International.