Countries of the World/COUNTRYS.BIN/dp/0042/00423.txt

Text File | 1991-06-24 | 23KB | 387 lines

$Unique_ID{COW00423}
$Pretitle{266}
$Title{Bolivia
Chapter 7B.   Health}
$Subtitle{}
$Author{Thomas E. Weil}
$Affiliation{HQ, Department of the Army}
$Subject{health
percent
reported
public
rural
water
medical
available
la
paz}
$Date{1974}
$Log{}
Country:     Bolivia
Book:        Bolivia, A Country Study
Author:      Thomas E. Weil
Affiliation: HQ, Department of the Army
Date:        1974

Chapter 7B.   Health

Administration of Health Programs

     According to a manual prepared in the late 1960s for the training of
public health doctors, the coparticipation of various social security funds
(cajas-see Glossary) offering medical care for their individual participants
has made the public program of medical care one of competition and duplication
rather than one of unity and cooperation (see Welfare, this ch.). Generally
confirming this judgment, a Ministry of Planning and Coordination publication
reported that in 1969 some six of the then-existing thirteen cabinet
ministries and fourteen other public institutions had a hand in public health
administration. In addition, a small urban elite that probably numbered under
100,000 chose to pay for the good service available in a few private clinics
and offered by a few carriage-trade doctors in private practice.

     The public health training manual noted that, with responsibility for the
care of 78 percent of the country's population, the public health ministry had
1966 appropriations sufficient for a per capita expenditure of $b0.59 (for
value of the Bolivian peso-see Glossary) monthly (equivalent to US $0.04) as
compared with $b18.3 (equivalent to US $1.50) per capita available for persons
covered under the individual social security programs.

     In general, in the early 1970s the medical care program was an urban one.
Most of the rural care available was confined to immunization programs and the
occasional first-aid and sanitation practices instruction available from
mobile health teams. The public health training manual reported that, by
political department, availability of service ranged downward from 86.6
percent of the population in Chuquisaca to 19.5 percent in Pando.

Health Hazards and Preventive Medicine

     Only a fraction of the country's deaths are reported, and a substantial
portion of those reported are not defined by cause. Acute diseases of the
respiratory tract are, however, recognized as the principal causes of death.
According to one official report, in 1967 respiratory ailments were followed
in order of incidence as causes of mortality by diseases of early infancy;
senility and poorly defined causes; diseases of the digestive and intestinal
tract; tuberculosis in all forms; rheumatic fever; accidents and violence;
arteriosclerosis; and cancer.

     There was some regional variation in the causes of death. In all of the
country's nine departments acute respiratory ailments ranked either first or
second in incidence. In La Paz, Chuquisaca, and Oruro accidents and violence
constituted the other principal cause. Digestive and intestinal tract
ailments were most important in Sucre, Tarija, Cochabamba, and Pando.
Intestinal parasites were listed in El Beni and bacterial infections in Santa
Cruz.

     It has been officially estimated that diseases causing 10 percent of
mortality (such as yellow fever, smallpox, rabies, and typhus) can be
completely eradicated and that those causing 80 percent (such as tuberculosis,
diphtheria, tetanus, and polio) can be substantially reduced in incidence. The
campaign against these ailments would involve combating traditional health
attitudes, improving nutritional and sanitation levels, and better utilizing
the already available resources for health improvement. In particular,
unsanitary and crowded housing combine with poor ventilation to result in a
dangerously ready interchange of communicable diseases, particularly during
sleeping hours.

     Mortality is by a wide margin highest among the very young. One-fourth
or more of all infants die during the first year of life, and almost half of
all deaths reported in 1968 involved children under the age of five years. The
number of deaths under the age of five was almost ten times that between the
ages of five and fourteen.

     In the more remote parts of the countryside, delivery is presided over by
an unschooled midwife or family member who severs the umbilical cord with a
broken piece of pottery-in the belief that use of a metallic instrument may
cause the child to develop a belligerent character. No attempt is made at
sterilization, and the baby is made particularly susceptible to respiratory
ailments by the frequent practice of wrapping it in swaddling clothes in the
belief that the child will thus be endowed with a strong, straight body. Parts
of the anatomy are released from the swaddling for increasing lengths of time,
but the child may be two years of age or older before swaddling is altogether
discontinued. Because breast feeding is believed to be conducive to strong
muscles and virility, boys are frequently not weaned until they are old enough
to attend school.

     An immediate goal proposed by public health authorities during the late
1960s involved medical or paramedical care for at least half of the rural
deliveries. It would include three or four consultations during pregnancy, and
most deliveries would be handled at a health post by a trained midwife or a
nursing auxiliary; difficult deliveries would be handled by a doctor at the
nearest rural hospital. These modest objectives appeared still far from
attainment. A 1968 survey of eighteen rural communities in Cochabamba (a
department with better than average availability of medical care) found that 8
percent of all births were attended by doctors and 21 percent by midwives who
probably had little if any training. Some 15 percent were attended by
traditional practitioners (curanderos), and the remaining 56 percent were
attended by family members or neighbors. Some 92 percent of the deliveries
were in the home.

     Mining is the employment sector with the most serious health hazards.
Estimates of the proportion of miners afflicted with silicosis range as high
as 40 percent. A smaller proportion contract silicotuberculosis, and the
average age for retirement with disability pension was reported to be
forty-one years during the late 1960s. In addition, intense heat in the mine
shafts followed by exposure to the outside chill of the high altitudes made
mineworkers particularly susceptible to respiratory diseases.

     There has been an increase in the reported countrywide incidence of
tuberculosis since the end of the Chaco War (1932-35), a trend which may at
least in part be the result of a greater frequency of migration of campesinos
to the tropical lowlands, where they are believed to be more susceptible to
the disease. The apparently greater incidence may, however, be a reflection
only of improved medical reporting. In any case, the combination of crowded
and unsanitary housing and low nutrition levels makes much of the population
highly susceptible to the several forms of tuberculosis that the World Health
Organization in its 1962 annual report declared to be Bolivia's principal
health problem. The government estimated that there were 55,000 active cases
in the country in 1961, and new cases reported rose from 1,471 in 1964 to
2,947 in 1969.

     The two mosquito-borne scourges of the lowlands, malaria and jungle
yellow fever, seem to have been brought under a degree of control by recent
eradication campaigns. In 1970 the examination of 167,265 slides resulted
in detection of only 6,862 positive malaria cases. The number of reported
cases of yellow fever declined from thirty in 1960 to two in 1970, and
eradication of the aedes egypti mosquito, which acts as the vector, had been
declared complete in all areas of the country believed initially to have been
infested.

     Until recent years Bolivia had the highest reported incidence of smallpox
in the hemisphere. A ma