While the medical system in Bolivia is miles behind those of the west, our current socialist government ensures everyone can afford to get some basic care. Unfortunately, however, when I say basic I really mean basic.
Bolivian nationals are all entitled to treatment under the public system known as Caja Nacional de Salud (National Health Fund) which provides heavily subsidized and often free medical care for a variety of ailments. The downside is that the public system is under a lot of strain, with too many patients and very limited funding.
Patients are typically required to travel to a clinic to take a ficha (ticket) at 6 a.m. if they want to see a doctor that day, a painful task especially for those who are ill. Arrive at 6:30 a.m. and there’s a good chance all the doctors will be fully booked so you’ll have to come back tomorrow. Public hospitals tend to be overcrowded, dirty and chaotic, while endless queues are the norm.
Health care in the countryside is considerably worse, where many people live without access to basic services and rely on traditional medicine which is often ineffective. Things are getting a little better though. Since he was elected, Evo Morales has been credited with building over 600 new clinics throughout rural Bolivia.
Those with money avoid the public system and use private clinics which are more convenient and provide a much better quality of care than their public counterparts. However, being more expensive means they are out of reach of the majority of the population.
A popular complaint among expats across the entire medical system is the lack of good hygiene practice. Horror stories abound of nurses not using gloves (patients should BYO), recycling needles, staff not washing hands, insufficient cleaning of beds and linen between operations and open waste containers resulting in cross contamination.
First hand experience
I had my own experience with the public system after crushing my finger in the car door of a taxi. Five hours later it still hurt like crazy so I went to the public hospital in Miraflores, La Paz to get it checked out. Nobody seemed to want to prescribe me painkillers as I waited in queue after queue. After some hours, I managed to get my thumb X-rayed which thankfully revealed my bones were still intact.
Some doctors told me I should get the fluid drained out from under my fingernail to relieve the pressure. Sadly, they changed their mind when it became apparent they would have to do it themselves.
After insisting with them to at least provide painkillers, a nurse sent me away with a prescription to buy some from the pharmacist across the road and charged a 10 BOB “under the table fee” to administer the injection. The shot did absolutely nothing to relieve the pain, which leaves me to suspect it was just a ruse to earn a few extra Bolivianos.
A week or so later my thumb was still throbbing with pain so I went to the nearest hospital, this time in Santa Cruz.
Santa Cruz experience
It was the week between Christmas and New Years so the hospital was desperately understaffed, though luckily the clinic for Curaciones (minor treatments) was still open.
After waiting for an hour or so, a nurse told me I needed to remove the whole fingernail which they couldn’t do themselves so I would have to go to emergencies. I queued up again to pay for my ficha to visit emergencies and tried to get a refund for Curaciones. The cashier told me he couldn’t give a refund without a written explanation from the nurse at Curaciones. I went back to look for the nurse only to discover she had gone home for the day. The ficha only cost a few dollars so I decided to just write it off as a loss.
The emergency ward was predictably chaotic. Hoards of desperate looking people milled around in the corridors while blood soaked patients were pushed back and forth on stretchers.
After a while someone told me there’s no real queuing procedure, you just sort of push your way to the door and try to get the attention of a passing doctor or nurse. To my dismay, a young doctor told me they couldn’t attend to my finger and that I would have to go to back to Curaciones. I explained the back-and-forth situation and insisted they should at least write this on paper so I could get a refund. It turned out only the boss was authorized to do so, and he wasn’t available, so it would be easier to just treat me after all.
The treatment itself was efficient and professional. They opted to drain the excess blood under the fingernail rather than remove the whole thing which turned out to be the best decision. Adequate anesthetic and and sterilized utensils were used, the whole procedure only took 10 minutes and suitable antibiotics were prescribed afterwards.
The takeaway from this was that, in my experience, the actual medical personnel are competent, although the administrative and procedures are inept and chaotic. Of course, there are undoubtedly plenty of incompetent doctors out there too.
My experiences in these two hospitals were testing to say the least, but at the end of the day they provided reasonable health care for a very low price. For just US$12 (X-ray $9, treatment in emergency $3) I received the basic care I needed. Regardless of the chaos, affordable basic healthcare is the most important thing in a country where millions live in poverty.
For any serious medical issues it’s best to avoid the public system if possible. The following are recommended private clinics or hospitals.
Pro Salud (Nationwide) – Various location across the country and generally good repuation.
Clinica del Sur (Obrajes, La Paz) Supposedly good but they have a habit of price-gauging clients without insurance.
Clinica Unifranz (Plaza Estudiente, La Paz) – Connected to the university of the same name and said to be very good.
Clinica Foianini (Santa Cruz) – recommended by expats online
Clinica Suiza (Santa Cruz) – recommended by expats online
For more specific recommendations, take a took at the US embassy approved list of medical practitioners.
Do you have any recommendations or comments? Let me know in the comments bellow.