As I am investigating the infant mortality rate here in Bolivia, getting to get up close and personal with el Centro de Salud Rafael Pabón in Oruro was perfect for me. I was delighted to speak with its administrators about the immense care they provide for mothers and their children during all parts of the birthing process and the tremendous success of the intercultural approach employed there. Though I had certainly heard about it during my research, I truly did not have the faintest idea what a “intercultural approach” in healthcare could look like. What impact could culture possibly have in any field of science, much less that of medicine? Well, it turns out that in very traditional city like Oruro it can certainly make all the difference to its people.
Like other statistics in health, the rate of infant mortality is discriminatory and affects populations with poverty and minorities much more severely. In Bolivia, this can be a self-perpetuating problem. Many indigenous people adhere religiously to age-old Andean values which include the practice of traditional medicine. Unfortunately, it can be too easy for those with biomedical training to turn their nose up at what can be seen as “primitive” practices and alienate this group. When compromise fails between the traditional and Western styles of medical practice, many of Bolivia’s indigenous women are fearful of going to medical centers and opt to give birth at home presenting self-obvious problems.
For this reason, Rafael Pabón (like clinics in Bolivia are supposed to) has two different styles of birthing rooms. The first type of course would be the typical biomedical delivery rooms that we are accustomed to. However, the second is set aside for a room where practitioners can deliver the baby in one of four traditional manner that the mother prefers. Intending to appear colorful and traditional, the room is created to be cozy for the women who may feel out of place and offers the mothers a bed with wool sheets and maté. Though a simple thought this method, along with creating strong communities of the mothers for the mothers, has dramatically improved the rate of infant mortality in Oruro as more mothers feel comfortable entrusting their babies to this clinic.
This case brings two thoughts to mind. First, a doctor must be truly empathetic towards his patients. Sometimes, the most important service a physician can give is listen to the thoughts, fears and concerns of the patient. Moreover, the total alienation of a thought that the medical community can see as silly or rustic never will yield progress. Of course, some topics (vaccinations) are nonnegotiable, but there has to be some type of sensible discourse. In Bolivia, Save the Children has implemented a fantastic tactic in creating round tables for traditional Andean doctors to converse with the biomedically trained physicians to bring about cooperation between the two. Keeping the success in Oruro in mind, I will do well to never forsake or disrespect the power of culture in medical care.