Over the last seven and a half weeks I've been trying to recognise the differences in health care between the UK (one of the most advanced health care systems) and Bolivia (one of the most impoverished nations).
Medical Students
Students undertake five years of studying here, as in the UK. There is a large proportion of students from other South American countries as well; Bolivia is the cheapest country in the continent and so a lot of Brazilians and Peruvians come over to study. The system allows transfer throughout South America at any point, so they can transfer home just before they finish studying and then work there once they graduate. A lot of Brazilians are here just now; understanding their mixture of Spanish and Portuguese can be a struggle!
Once they finish their five years they work for one year as an intern (seemingly similiar to FY doctors in the UK). This year seems horrible - they work unpaid (in fact they have to pay to do it!) and rotate around different hospitals. Every third day they work from 7am until 2pm the next day (30 hour shifts) and the other two days they work 7-5. They have no holidays and can get 'punished' by the doctors here. One intern went to buy a new pencil without telling anyone and was made to work an extra five hours at the end of his shift!
The way of learning here is completely different as well. Students turn up at their clinic, and 4 or 5 of them will crowd into the room. The doctor sits behind his desk while the students stand crowding around him like little sparrows in their oversized white coats. The patient enters and sits nervously in front of the doctor, who speaks brusquely at them for a few minutes, sometimes scribbling down a prescription, glancing vaguely at an x-ray or looking distinctly bored. The students are rarely spoken to while the patient is there and seem to only learn by trying to read whatever the doctor is writing down, and copying it down themselves in little notebooks. I guess it encourages students to be more proactive in learning in their own free time, but it's not a welcoming learning environment!
Doctor-Patient care
While here I watched the film 'Patch Adams'. It shows the American health care system from a few decades ago, and how the patients are treated as 'diseases' rather than as people. It's amazing how much of a resemblance that has here!
The doctors will often not acknowledge the patient when they enter the room, they can be impatient with them and brusque with them, and never ask them about their quality of life, or how their illness is affecting them!
Patients are never referred to by their name, and on ward rounds one of the interns will present the patient to the doctor while 7 interns, 6 nurses, 4 doctors and myself all crowd round the bed. The patient themselves aren't consulted, to the extent that it almost seems unnecessary to have the discussion with them present!
Hospital Procedures
As a proud holder of qualifications in cleanliness champions and patient manual handling, I am disappointed in the standards here. Doctors usually wash their hands on average once a day, and then only with water. Each consulting room has had the same sheet on the bed for the last 7 weeks and alcohol gel hasn't yet made an appearance.
We had to move a patient from the ward to the x-rays once who was too frail to walk herself but for some still unknown reason was too sore to sit in a wheelchair! Two of us took her - each one grabbing hold of an arm while a nurse trailed behind holding her catheter bag. It was a good thing she didn't fall since I think the only thing we could have done was fall on top of her.
Many differences in healthcare!
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| Torotoro - 'straight out of the National Geographic'. |
Dinosaur Tracking
At the weekend we headed South for 5 hours, to Torotoro national park. It's a hidden gem of Bolivia - full of amazing natural wonder and historic marvels.
The park itself is a vast expanse of rocky hills, echoey caves and deep ravines - ugly big cracks in the surface of the earth. It's most famous for being the home of several prehistoric fossilized dinosaur footprints, and with a bit of imagination you could picture velociraptors and stegosauruses running riot in the mountains here.
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| Our transport on day one - an hours ride in the back of a pick-up, past enormous rocks towering over us. |
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| One of many stone formations. Here we are riding 'the tortoise'. |
You are required to take a guide with you whenever you leave the town of torotoro to enter the surrounding park, who takes great pleasure in pointing out all the different ways you can see dinosaurs - rocks, gaps in rocks, clouds..
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| Our group enjoying the view. |
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| The hard hat was the best use of 7Bolivianos so far, much needed for crawling under stalactites. |
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| Standard 'jumping' photograph to celebrate leaving the caves. |
We were able to go 800m into the caves which have been hollowed out over the years. It was amazing to be able to roam through stalactites and stalagmites, sliding down little slopes, crawling through holes we shouldn't have been able to fit through and getting completely disorientated trying to figure out which way to wriggle next.
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| A set of carnivorous footprints. |
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| A herbivorous giant. |
Hundreds of different trails of fossilized dinosaur footprints are trapped in the hillside. Some say the tracks were made in lava as the dinosaurs tried to flee from a volcano. It's odd to stand in footprints that are thousands of years old!
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| The rim of the canyon. |
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| The natural plunge pool. |
That afternoon we arrived at a canyon, cut out of the ground.
We descended 250m into it, to follow a river bed for half an hour, over huge boulders and along dirt tracks, until we found a little haven after several hours of dusty, sweaty and tiring walking - clear waterfalls to plunge into never felt so good.
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| Amazing waterfalls. |
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A great weekend trip exploring some of the practically undiscovered highlights ov Bolivia. In some ways it's a shame this place isn't better known; there is so much there! But on the other hand, the longer it stays as a remote and rustic secret, relatively cheap to enjoy and away from hoards of tourists, the better!
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| Alleged dinosaur bones... |
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