Working at the Hospital de la Mujer this week has brought up many questions for me about gender equality, identity, and practice in this country and all of the ways these aspects affect health. I have now had the incredible opportunity to hear from many different perspectives on this topic and wanted to share what I have learned with you.
The first person I discussed these issues with painted a very hopeful picture of progression in Bolivia. He spoke of many government programs that had been started to help support women and children by giving incentives for education, providing free health care and the creation of a multitude of social programs to help balance gender roles. There is one in particular that I found which I feel is quite interesting and important to note here. The group named Adela Zamudio was created in 2005 by two women who seek to empower and educate indigenous women about structure in community development work among men and women. The name of the group honors a Bolivian Poet (Adela Zamudio) who lived from 1854-1928 and is often credited as the founder of the feminist movement in Bolivia. Her birthday is October 11th which is celebrated at Bolivian Women’s Day.
This information was exciting to hear as I had learned of the severe gender inequality that still exists in Bolivia before arriving. The Office of the United Nations Development Program published a report that stated in Bolivia “men receive more and better education than women, receive increased and better health assistance than women, and have the possibility to generate greater income while working less…if we consider that women, as opposed to men, also have…the almost exclusive responsibility for domestic work”.
During these past 3 weeks, I have had the pleasure of speaking with many doctors about these issues and exploring these topics with a few natives of La Paz. Throughout these conversations I have found that a deeply rooted oppression of women still exists in Bolivia today. This oppression is embedded in historical context, culture perspective, educational access and a multitude of other factors and seems to be most prevalent within the underserved communities of La Paz.
Last night, we had the incredible opportunity to visit Dr. Uribe at her lovely home in the south region of La Paz. This area is peaceful, clean, warmer and much wealthier. It showed that a completely different community of opportunity, wealth and education exists within La Paz like most large cities. This realization was matched with my understanding of how income inequality can perpetuate gender inequality due to a lack of access to education.
We discussed domestic violence with Dr. Uribe which is possibly the best example of how gender inequality still exists in Bolivia and how it directly affects the health of women. The Pan American Health Organization conducted a study in twelve Latin American countries and found that Bolivia has the highest prevalence of domestic violence against women among these countries. We learned this is a very common issue in La Paz and even more so in El Alto. El Alto is the second largest city in Bolivia located adjacent to La Paz on the Altiplano highlands and has a population that is mostly indigenous including 76% Aymara and 9% Quechua. El Alto is a much more impoverished community than La Paz however the “Cholitas” (Aymara women dressed in traditional multilayered Andean skirts) have been working in recent years to break social and gender barriers by conducting television programs, working in offices and holding public offices. Even with this progression extreme domestic violence against women exists and is treated every day in the hospitals of El Alto.
Dr. Uribe shared many interventions and educational programs that have been created to help end domestic violence in El Alto but she shared the largest barrier is a lack of health care providers. The state of health in El Alto is one of extreme need. The providers that do exist in El Alto have little time to devote to patients and therefore little time for preventative and empowering education. It dawned on me as we were speaking that this is a pervasive issue in every health care system in underserved communities. The time a provider has to provide education, resources and support is the most vital source of prevention and is the greatest aspect lacking where it’s needed most.
Nonetheless, my experiences at Hospital de la Mujer this past week have been an incredible opportunity to witness the labor and delivery process and gynecological practices in La Paz. I have learned that pre-eclampsia is a very prevalent issue due to the high altitude among pregnant patients. I have also seen how a lack of medicine for epidurals and a difference in practice to not allow family members/partners into the birthing room can completely alter the birthing experience for a woman at the county hospital in La Paz. However, the most heartbreaking understanding I have gained from my time at this hospital is the high prevalence of domestic violence that still exists powerfully here.