Indigeneity in Bolivia
The Infant Mortality Rate of Bolivia
Noting that higher levels of societal discrimination exist for indigenous populations (Gracey and King), higher infant mortality naturally follows. According to the Instituto, the language with the highest corresponding risk of being affected by infant mortality is Quechua, which is also the largest indigenous group in Bolivia (Bolivia - CIA . Factbook). The provinces that generally contain the highest levels of infant mortality are located in the southwest of the country, with isolated islands in various provinces in the tropical north.
The Instituto Nacional de Estadística defines the infant mortality rate (IMR) as a social issue, noting large differences between groups. According to the INE, infant mortality rates in rural communities are 56% higher than in urban settings. Modern medicine has drastically reduced infant mortality in the Western Hemisphere since the 1950s.
Since 1999, the country has cut its rate by about half, making the country successful in reducing its infant mortality rate over time.
Interculturality and Indigeneity in Healthcare
One of the earliest implementations of interculturality in Bolivian healthcare took place in 2001 in rural Potosí, one of the poorest departments in Bolivia. At the end of the study, the successes of the study were that health professionals saw their skills in interculturality increase tremendously and that local citizens in different villages were taught how to teach these. Of course, these two share much of the defining characteristics in common, but these groups of peoples also feel an ancestral bond to the lands and natural resources whose control is often taken away from them by the colonizing power.
Instead, they received regular resettlement programs, which sent them to unproductive and unwanted land, beyond the purview of national politics or production. Unfortunately, the nearly 400 million indigenous peoples worldwide have a much lower standard of health than the rest of the world. Due to similar patterns of colonization and industrialization of such countries, many of these health indicators for indigenous peoples worldwide can be quite similar.
Given that this thesis attempts to validate the effects of the Bolivian intercultural reforms, which are predominantly aimed at indigenous peoples, the effects on these variables manifesting in indigenous communities will be of great importance to note.
Socioeconomic Implications on Healthcare
In other words, while social scientists are asking what factors are causing this health trend, medical researchers are looking at the physical characteristics of disease, such as malnutrition or infection, without focusing on social factors. Mosley and Chen attempted to reconcile these two philosophies in order to have a benchmark for more accurately assessing and predicting infant mortality trends in developing countries. Medical research, on the other hand, examines the health status of survivors on a much smaller sample.
By merging what may appear to be disparate variables, the Mosley-Chen model for analyzing infant mortality tends to reveal a more complete picture of health trends. This system revolutionized the way the infant mortality rate in developing countries should be viewed, as "it suggests that child mortality should be studied more as a chronic disease process with multifactorial origins than as an acute, single-cause phenomenon." As such, infant mortality in Bolivia will be treated as a chronic disease process. Unfortunately, due to the unavailability of data, I will not be able to apply all of these measures that these two researchers have suggested.
However, I will follow this paradigm in looking at socioeconomic determinants as dependent variables for infant mortality rates in Bolivia.
Comparison with Peru and Tuberculosis Rate
Using these two different philosophies in research, Mosley and Chen suggested using the combination of mortality rates along with rates of "malnutrition", a concept that will be explored in more depth in the next paragraph. Considering that they are geographically, culturally, and economically similar, especially in the shared altiplano region, one would suspect that these two nations share similar rates of concurrent tuberculosis and HIV infections. The high rates of co-occurrence of HIV and tuberculosis would be crazy to believe.
I was making heads or tails of the data against what I was hearing and seeing, I was sitting on my bed doing a blog post, then it hit me. The problems of the minority groups are either projected back onto them or completely forgotten. The fact that this reform targets the cultural traditions and desires, rather than changing or completely destroying them as a means to an end, makes the set of reforms in Bolivia of extreme interest and curiosity to me.
Throughout the research, I was frequently told by doctors, NGO workers, and others familiar with Bolivian health care that the three biggest factors causing a high IMR in Bolivia are the poor infrastructure and long distances from remote villages to clinics .
The Rural Perspective
Since the clinic had a professionally trained women's health team, a good part of the waiting room was covered mainly with mothers and their children. They were SAFCI beneficiaries and many of them gave birth to their children in one of the available cross-cultural ways. Of the three women I spoke with, they all mentioned how important community is to them personally and as mothers.
In a country where women, especially from indigenous communities, can be oppressed by male chauvinism, putting the power to be a competent and self-sufficient mother in the hands of women can have tremendous results. Replicating a birth process like they might have at home makes these women feel more comfortable entrusting their babies to the clinic. It is no wonder that the general director of traditional medicine in the Bolivian Ministry of Health, Dr.
Clearly, the legitimization process for these doctors, discussed in Chapter Two, was an important step in putting more power in the hands of the traditional doctors.
The Urban Perspective
Martinez also described another key to getting mothers to clinics is getting their traditional healers on board with biomedical practitioners. Coincidentally or not, Japan saw a drastic improvement since 1967 and now has the lowest infant mortality rate in the world at 2 deaths per 1000 births) (Worldbank – Infant Mortality Rates). Although every clinic is technically required to have cross-cultural birthing methods, this clinic only offered standard Western biomedical birthing.
As my bivariate function withered in the midst of the reality of a ridiculously more complex sociomedical issue, I must have wondered how this clinic, which offered not the slightest hint of interculturality, was able to attract the indigenous women I saw in its lobby tending to children. or patiently reading the attached government pamphlets. In the more urban La Paz, indigeneity could certainly take a more urbanized form in this vibrant area. Despite the lack of cross-cultural birthing methods, the clinic, on the other hand, is still full of initiatives that came from the cross-cultural reform.
One graphic on the wall that caught my attention was one that warned women of common dangers during pregnancy, which included vaginal bleeding or fluid loss, swelling of the extremities, lack of baby movement, fainting, constant vomiting, headaches and hot flashes .
The State of Infant Mortality throughout the Nation
Just as it would be foolish to believe that reform in New York would take the same form as in Mississippi, the effects of cross-cultural reform may also differ. Unfortunately, such communities are those in which maternal autonomy is minimized and have expectedly higher infant mortality rates. In conclusion, I will offer the government's action plans, detailed in the state-sponsored health journal Mi Salud, to reduce and expand maternal infant mortality rates.
Unfortunately, there is no telling where the truth of the situation lies, but one would assume that it would not be as happy as the government would have hoped. If the government is covering up the true extent of the bleakness of the situation, then we could expect levels to fall even further behind Peru and closer to the aforementioned West African countries and Haiti. However, the analysis conducted in this chapter does not undermine the merits of cross-cultural reform itself.
From there, I conclude the chapter with a discussion of the implications of what happened in the presentation of the data and where one might expect the truth to lie.
What is Going on with the Data?
In this chapter, I will first present evidence that I have found that I argue reveals a significant chance that the government either collected the data in a careless manner or is simply distorting it on purpose. Except for a few cases, census and infant mortality data indicate that rates of IMR decline with higher poverty rates. Unfortunately, I have to use the independent variable to be the year that comes after the infant mortality rate for 2011; Despite this non-ideal method, however, I believe I have proven that the data is generally spurious.
However, one would think that the government would be more cautious in releasing the data, knowing that people would be scrutinizing their claims. Therefore, I use these aforementioned cases to assert that the government distorts the data knowingly and the IMR levels in the country may not be as cheerful as it appears at a cursory glance. To demonstrate this phenomenon, I averaged the three determinants across municipalities11 to find the averages from 2011 of hospital care coverage, antenatal care coverage, and family planning.
We will note that family planning instructions are almost half of the hospital delivery coverage.
Discussion of Findings
To truly address the problem of IMR, the government needs to reach those citizens who have historically been excluded in terms of resources and medical care. Fortunately, I had the perspective of those who were very familiar with the reality of IMR in Bolivia and steered me in the right direction throughout my work. If and when the topicality of the matter emerges, the intercultural reform will not be seen as the magic wand that cured everything in just six years.
But it certainly couldn't fix the nation's dismal infrastructure or recruit talented doctors to the rural areas that need them. These people desperately need the ideals of intercultural reform, which preach inclusivity and an inalienable right to health care. Second, distorting statistics also hide the true benefits of the intercultural reform that is crucial for post-colonial nations with a large indigenous group to implement.
Beyond that, of course, I could not spend enough time or resources to really explore the scope of the intercultural reforms.
