Through the beauty of good networking, Dra. Uribe was able to find us somewhere else to work that first week, since everyone was apparently on vacation. So rather than wander aimlessly around Hospital del Niño, we went to a clinic in Chasquipampa, a small pueblo just on the outskirts of La Paz, to assist and observe a doctor who specializes in adolescent medicine. As the population of Bolivia is comprised largely of adolescents (as of 2014, 19% of the population was between 15-24 years old, compared to 13% in the US), and the adolescent pregnancy rate is relatively high (79/1000 pop, compared to 60/1000 pop in the US), a large part of adolescent medicine here is related to pregnancy. In fact, every single patient we saw that entire week was either: A) Trying to not get pregnant, B) Already pregnant, or C) Had just had a baby. Dra Santivañez showed us how to measure the uterus, find the fetus's position by identifying the spine and head, and then find the heartbeat (and differentiate it from the placenta). We also did all of the charting -- making sure the mother's weight was within reasonable limits, charting her visit, and writing up any lab orders needed. By the end of the week, Karina and I were able to virtually carry out the entire pre-natal visits with just supervision.
Bolivia has a history of very high infant and child mortality rates, which has lead to their current maternal and childhood health incentive program. If the mother complies with her pre-natal visits, and gives birth in a hospital, she receives a monthly stipend, adding up to 1800 Bolivianos ($260) over the course of about 2.5 years. While that doesn't sound like a lot, any little bit helps, and this program does seem to be helping a lot with the mortality rates. Previously, it had been common to not seek any medical attention at all, pre-natal or otherwise. Anemia is quite common here, due to the general lack of protein combined with the high altitude. So if a women was slightly anemic before becoming pregnant, it would get even worse, and when born the child would develop severe anemia. This "bonus" is helping women overcome their prior fear of the medical system and they're now getting the education and treatment they may need for a healthy and successful pregnancy.
One of the things that surprised me most that week was the general lack of education regarding reproductive health. Coming from Oregon, where we were all required to go through sex ed in 5th grade, and then again in high school, it's easy to forget not everyone has had the opportunity to receive such necessary information. We had one patient come in who was about 17 years old, and her main reason for coming in was that she had a partner, and didn't want to get pregnant. When asked what her current form of birth control was, her response was "none". That was the general theme of the week, as almost every woman who came in had very-little-to-no knowledge of birth control. Birth control in Bolivia is free, all they have to pay is the 5 Bs (less than $1) consult fee, and yet women are afraid to seek it out, or apparently unaware of its availability. Women's' rights in general seem to be a current hot topic, as there are huge banners and signs all over the city saying "Stop Domestic Violence!". The culture has a very strong machismo background, and it seemed to me that the women we saw were so used to not making their own life choices that when they were faced with a choice (which type of birth control, or to use it at all), they had no idea how to make the choice for themselves. For example, in order to have a tubal ligation, a woman must have written consent from her husband. It should be noted that to get a vasectomy, men need no such consent. Another woman even called in her husband after we'd finished explaining all the different types of birth control to her, so that he could decide what form of birth control was best for her.
One of my biggest realizations this week was definitely how lucky I am to come from a place where not only are we (men and women alike) educated on reproductive health, but we're all given the opportunities and resources to make decisions for ourselves. I'm not sure exactly what the future holds for me, but working with these amazing women who were simply lacking in some fundamental education made me realize how passionate I am about these issues, and I hope to some day maybe be able to educate more women and empower them to make the decision that is right for them.
Bolivia has a history of very high infant and child mortality rates, which has lead to their current maternal and childhood health incentive program. If the mother complies with her pre-natal visits, and gives birth in a hospital, she receives a monthly stipend, adding up to 1800 Bolivianos ($260) over the course of about 2.5 years. While that doesn't sound like a lot, any little bit helps, and this program does seem to be helping a lot with the mortality rates. Previously, it had been common to not seek any medical attention at all, pre-natal or otherwise. Anemia is quite common here, due to the general lack of protein combined with the high altitude. So if a women was slightly anemic before becoming pregnant, it would get even worse, and when born the child would develop severe anemia. This "bonus" is helping women overcome their prior fear of the medical system and they're now getting the education and treatment they may need for a healthy and successful pregnancy.
One of the things that surprised me most that week was the general lack of education regarding reproductive health. Coming from Oregon, where we were all required to go through sex ed in 5th grade, and then again in high school, it's easy to forget not everyone has had the opportunity to receive such necessary information. We had one patient come in who was about 17 years old, and her main reason for coming in was that she had a partner, and didn't want to get pregnant. When asked what her current form of birth control was, her response was "none". That was the general theme of the week, as almost every woman who came in had very-little-to-no knowledge of birth control. Birth control in Bolivia is free, all they have to pay is the 5 Bs (less than $1) consult fee, and yet women are afraid to seek it out, or apparently unaware of its availability. Women's' rights in general seem to be a current hot topic, as there are huge banners and signs all over the city saying "Stop Domestic Violence!". The culture has a very strong machismo background, and it seemed to me that the women we saw were so used to not making their own life choices that when they were faced with a choice (which type of birth control, or to use it at all), they had no idea how to make the choice for themselves. For example, in order to have a tubal ligation, a woman must have written consent from her husband. It should be noted that to get a vasectomy, men need no such consent. Another woman even called in her husband after we'd finished explaining all the different types of birth control to her, so that he could decide what form of birth control was best for her.
One of my biggest realizations this week was definitely how lucky I am to come from a place where not only are we (men and women alike) educated on reproductive health, but we're all given the opportunities and resources to make decisions for ourselves. I'm not sure exactly what the future holds for me, but working with these amazing women who were simply lacking in some fundamental education made me realize how passionate I am about these issues, and I hope to some day maybe be able to educate more women and empower them to make the decision that is right for them.