The Bolivian Medical System – at least it’s cheap

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.

medical miraflores

Main public hospital in La Paz: Source – La Razon

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.

Treatment

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.

medical japones

Hospital Japones in Santa Cruz: Source – El Dia

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.

Practical Information:

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.

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8 Responses to The Bolivian Medical System – at least it’s cheap

  1. Rosanna says:

    My husband went to Clinica del Sur when he was having stomach problems. They were efficient but he had to sit through a doctor shouting at him and berating him for eating street food (in fact we had been cooking all our own food since being in Santiago de Chile six weeks earlierand had yet to try Bolivian food). A friend of mine was researching rural healthcare policy and she told me that many people were hesitant to visit doctors because of how they treated them with disdain. On the other hand, they love the Cuban doctors who volunteer in the poorest areas and build up a good relationship with patients.

    Oh, and I too had to pay an under the table fee to get a prescription for antibiotics on a Sunday.

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    • That’s funny because I recently dealt with an amazingly condescending doctor from Clinica del Sur too. He even scheduled a completely unnecessary repeat consultation (presumably to make more money). I won’t go back.

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  2. Daniela says:

    I was born and raised in Bolivia, trained as a doctor there and I now live in the US, where I practice medicine. Morales did build clinics and also provided them with ambulances. The little problem is that the clinics are there but there is no equipment or medications and most of the ambulances don’t even have breaks (true story, one of my co-interns almost died in an accident). As an intern in Quillacollo and Sacaba (specifically Villa Moderna Hospital in Quillacollo) we shared ONE ambulance with 2 other hospitals. Those hospitals which belonged to the State didn’t even had amoxicillin let alone blood and the phone bills had not been paid for months. So, we had to use our cellphones, pay for those phone calls and even use our cars to transport patients. La caja nacional de salud only takes people who have insurance (not every single unemployed Bolivian) and the government only pays for medical care provided to pregnant women and children under the age of 5. Also, I should point, that the government’s paperwork for contraception requires the signature of the husband (yeah, Morales is that sexist). I could go on and on because I was inside the system for years. Yeah, the US healthcare system has terrible issues but Bolivia it’s an absolute nightmare
    If you can afford a private hospital in a main city, good. Drive 30 min away from downtown Cochabamba or La Paz, that is the reality for most people

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    • Interesting and insightful comments from someone who has worked within the system, thanks Daniela. Even though la caja isn’t free, it does provide basic affordable care. As bad as it is, it is still a step up from similar developing countries. I was recently charged just 6bs for a simple consultation, for example.

      Unfortunately, don’t get seriously ill is the best advice I could give to those without decent health coverage here. I wouldn’t trust la caja with anything remotely serious.

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  3. susan wieczorek says:

    My son plans to be a “Gringoinbolivia” this summer, studying the health system. Do you have any recommendations and might you be interested in interacting with him/me? I myself am a professor and hope to do my own study much later this summer on the Bolivian healthcare system from a medical communication standpoint. Any contacts you might have would be appreciated. We both plan to visit Cochabamba.

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  4. archercrosley says:

    Well, if you are still living in Bolivia, have your friends who know people in healthcare check out my website on healthcare reform. http://www.fixthebus.com. This is a system that can work. I’m counting on Bolivia to follow what I say so I can travel down there to get my healthcare. Pretty soon our healthcare here in the states will be like that of Bolivia if the know-nothings have their way.

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