Experiencing the Bolivian Healthcare System Firsthand: A Personal Account

It was 3 am when I woke up and rushed to bathroom. Diarrhea. Ok that’s not a good sign, but I went back to sleep anyway. 7am I woke up feeling extremely tired, and my head was in a haze. I just laid in bed. I took Advil for the stomach pain. At one point I tried to get up to cook myself some congee, but I was so dizzy and tired that I just fell right back into bed. I also began shivering, and no matter how many layers I wore, I was still freezing cold. I also had diarrhea 6 more times. I tried to eat something, but I had no appetite. Finally, at around 4:30 pm, I was so feverish and hazy that I finally acknowledged that I had to go to the hospital. I could barely stand.

Harsh and Claudia brought me to La Clinica Copacabana which is apparently one of the best clinics in the city. My admittance to the ER was fast, which I definitely appreciated. Nurses took my vitals and some doctors saw me relatively quickly. I noticed how none of them introduced themselves, contrary to the United States. When the nurses had to insert the IV line, apparently they couldn’t locate my vein, so they tried a total of 3 times before finally getting it. It turned out that because I was so dehydrated, my veins had shrunk to the point of disappearance. Despite their difficulties, I appreciated their warm hands that soothed me. The ER bed was a hunk of metal covered in sanitary plastic, so it wasn’t too comfortable, but I didn’t really mind. My fever was 104 F.

Around 6 pm, a medical student came to take my history, and what blew my mind was the she admitted to me that she was NERVOUS! She confided in me that she had only been at the clinic for a week, and she was still inexperienced with all this. I empathized with her because I can imagine how I, as a future physician, would be nervous my first time as well. However, I never thought that that information would be divulged to the patients! I ended up having to comfort her by saying she was doing a good job! She ultimately took my patient history with a nervous smile.

I was moved into an overnight room, and Akshay stayed with me. The move was wild. This nurse haphazardly wheeled me into a wall and giggled manically, saying “whoopsies!” Earlier, she also wheeled a man with a broken foot into a wall. When we arrived to our room, she tried to explain to me to keep my arm down by my side, and when I didn’t understand the first time, she slapped my arm down. An interesting show of patience, I thought. While waiting, a medical student came in to take a more complete patient history. Again he didn’t introduce himself; only when I asked him, did he introduce himself with some hesitation. It was also interesting the levity of interaction. His girlfriend came in when he was doing the history, and they began to chat. We all ended up talking about random things. While I was caught off guard by the immensely relaxed nature of how medical professionals interacted with patients, I also appreciated how they were able to talk to patients as a normal human being. I could have been their friend another day another time. Add me on Facebook, Matias?

Many nurses came to check in on me. I noticed my IV wasn’t dripping, but it wasn’t until the 3rd or 4th nurse that told me it was because my arm was bent and had to be straight. The room was nice overall. Nurses came in to check on me throughout the night, so I couldn’t really get an extended period of sleep, but I definitely appreciated the attention. In the morning, a bunch of medical students would walk into the room, look around and leave. This disoriented me because I had no idea who they were and what they were doing. I understand this is a valuable experience for medical students, but the least they could do was to introduce themselves and explain what they were doing, especially to patients who are unaccustomed to westernized healthcare systems and may be scared or confused.

I’m resuming writing this mini blog post early Saturday morning. Yesterday, I definitely became visibly frustrated with the hospital. They had told me that I could be discharged by Friday afternoon. Then, the time that the gastroenterologist was supposed to visit me kept on getting pushed further back. In addition, I was seen probably by 30 different people, and not everyone was on the same page with my medical course of action. I noticed how different it is in that patients don’t get assigned a single nurse, but rather I believe it’s basically who’s available. I remember one point I became visibly rude was when a medical staff came in and told me to do another stool sample, so I asked him for gloves because the way to get stool samples is to hold a cup under your butt. Yeah, messy potential. The guy stares at me and goes why do you need gloves. I was so surprised and frustrated. This is a hospital; hygienic practices are supposed to be maintained! I shouldn’t have been rude though.

The doctor finally came in around 6 pm. The rest of the gang was in the hospital room with me. He had clearly prepared because during his explanation he was citing articles and practices in the United States. On one hand, I felt slightly bad since we had indeed been pestering the medical staff for more medical information that they may not have had. However, I also believe that it was good that the doctor did his research to provide the best possible care and ease our minds. His ultimate diagnosis was that he thought I had gastroenteritis caused by some bacteria, likely salmonella. Looking back, I am appalled at how long it took to reach that conclusion that I’d need antibiotics. Some other volunteers actually got sick and presented with the same symptoms as mine, but they were given antibiotics within 2 hours of arriving at the hospital. The doctor explained to me that the reason that didn’t happen to me was because I presented with other symptoms such as high fever and malaise, so I had to go through a differential diagnostic route instead of purely a clinical, empirical one. It still doesn’t quite make sense to me. Maybe, once I’m practicing, I’ll understand this more.

Ultimately, I had to stay in the hospital another night. Seeming to know what was in store with the two rounds of antibiotic treatments, I was a lot more relaxed. I watched Alice in Wonderland in Spanish. Perderá la cabeza! Also, I was pretty hungry. I only had soup for the past 48 hours.

Overall, it was an interesting experience being hospitalized in a Bolivian clinic these past three days. Many Bolivians have told me that the healthcare system lacks resources and given the new penal code, doctors are under more stringent conditions than usual. However, I was lucky to be in such a good clinic, La Clinica Copacabana. I received a lot of attention and care from caring nurses, and my gastroenterologist treated me with respect and explained things very clearly. There were some clear differences in the way the staff operated between Bolivia and the United States, but what was clear is that the spirit of medicine and healing is strong no matter where you are.