By Jean Friedman-Rudovsky
Thursday, December 30, 2010
Mobile health units are rolling clinicians into remote parts of Bolivia and helping to lower one of the world's worst rates of maternal mortality. Reporting costs for this story were partially funded by International Planned Parenthood.
LA PAZ, Bolivia (WOMENSENEWS)--On a recent winter morning in the tiny Bolivian village of Tayasigua, Deogracia Otega sat on a wooden bench, nervously clutching her purse.
The indigenous Guarani woman with tired eyes said that it burned when she urinated and her lower abdomen ached. "I'm worried about cervical cancer," said the 45 year-old grandmother of two as she waited to consult the doctor setting up opening up shop in the one-room brick school house behind her.
Half an hour later, Otega emerged, relieved. She was in the clear for now, she said. "I didn't even know what a cervix was before the mobile health units starting arriving," she added with an embarrassed half-smile:
Otega's medical care was likely not discussed at the recent U.N. summit on the progress of the world in meeting Millennium Development Goals by the deadline year in 2015. But it could have been. Her consult is an example of what's helping South America's poorest country advance in its maternal health goals, as well improve its populations overall sexual and reproductive health.
Through a program funded by International Planned Parenthood Federation--which also paid for some of the costs of reporting this story--three white pick-up trucks traverse the unpaved Bolivian countryside 36 weeks a year, offering care and educational workshops to over 100,000 Bolivians, including many of the low-income women in rural areas who are among those at greatest risk of maternal mortality. The trucks are known as mobile health units.
"These mobile units are a great advance for the country," says Jaime Nadal, the United Nations Population Fund representative in Bolivia. "They are bringing quality services to those who need it the most."
Every day, about 1,000 women around the world die during pregnancy or childbirth; 99 percent of them are in developing countries, according to U.N. statistics.
This causes a strong ripple effect throughout the women's communities. A child whose mother does not survive childbirth is 10 times more likely to die prematurely and motherless children, according to the U.N., are less likely to receive adequate education, health care and nutrition.
Though maternal death rates have dropped by 34 percent globally since 1990, the millennium development goals target a 75 percent decline by 2015 and to achieve universal access to reproductive health. It's doable, says the U.N. and global health experts: the vast majority of maternal deaths are preventable if the right care and supplies are available.
Bolivia could be a case in point.
In 1990, the country registered 416 maternal deaths per 100,000 women giving birth, U.N. figures indicate. By 2003 that figure was down to 239. It may be as low as 180 now, says Nadal, though reliable data are scarce since most of these deaths happen in rural areas, off the hospital grid.
Despite this improvement, Bolivia still has one of the highest maternal mortality rates in the western hemisphere. The only country with a worse figure is Haiti.
Roaming health units have been used for decades in a variety of emergencies such as by the International Red Cross to bring medical attention to combatants in conflict zones.
But the Bolivia teams rarely dodge bullets. Instead they tackle rocky roads, flooded valleys and mountainous cliffs.
Their vehicles are packed with a stretcher, oxygen tank, intravenous kits and a ready supply of dozens of medications for the most commonly seen sicknesses.
"We have to use what we can," says Dr. Rosario Cervantes, as she glides a pocket-sized battery-operated ultrasound machine along the belly of a 16-year-old expectant mother stretched out on a make-shift examining table in Bolivia's Chaco region.
Cervantes works for the Center for Investigative and Educational Services, Bolivia's premier sexual and reproductive health non-profit since 1987 that began administering this mobile program in 1996.
She still has a headlamp strapped to her head from the pap smear she performed on another patient moments ago as she speaks sweetly but directly to the apprehensive teenager gazing up at her. The patient shakes her head sheepishly when asked whether she has gotten any pre-natal care other than this review.
Gloria Rivera, a nurse at the center's mobile unit, says it's not just the long and expensive trip to conventional medical clinics that keeps pregnant women away. There's a cultural barrier too.
"Most won't find anyone who even speaks their language," Rivera says, as she takes the blood pressure of Cervantes' next patient and chats in Guarani--her native language as well as that of most indigenous here in Bolivia's lowlands.
For many women in Bolivia, particularly the majority indigenous, a hospital is a place of unintelligible words and of doctors who criticize cultural customs that clash with western medicine's doctrines.
The center's staff creates a different dynamic.
Rivera is the child of indentured servants. Cervantes uses words such as "aji" (the common Bolivian word for spicy) to describe a burning sensation. And clinicians don't chastise teenagers for neglecting to see a doctor.
Beth Whitfield is a registered nurse who runs a mobile health unit operated in Bolivia by Western Kentucky University. She sees the mobile units as offering a long-term solution because a big component of what they offer is preventive medical advice.
"If you bring this knowledge to people and get them to do it, they are more likely to stay healthy in the long run."
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Jean Friedman-Rudovsky is a reporter based in La Paz, Bolivia.