Bolivia - Country with High Mortality Rates - Research Paper Example

? Bolivia: Country with High Mortality Rates Until the election of the President Evo Morales in 2005, Bolivia faced economic and political uncertainty. The two then adversely affected the health status of many citizens, resulting in poor standards of living for the most, especially native Indians (Gritzner & Gritzner, 2004, p.15). Though inequalities have decreased, there is still a long road ahead in improving the health of the indigenous populations. When one speaks of bad health in Bolivia, one speaks of the country’s indigenous population, which forms the majority. One speaks of poverty, malnutrition and lack of trust in the western medicine. Location/Geography Bolivia’s total area is over one million square kilometers, which makes it a 28th country in the world by its size (CIA, 2012). Due to its large area and the presence of the Andes Mountain, Bolivia’s climate ranges from pine trees to palm trees (Gritzner & Gritzner, 2004, p.9). However, despite its size, Bolivia has no exit to the ocean (CIA, 2012). Moreover, arable land covers only 2.97 percent of total land area (CIA, 2012). Population  In 2012, there were over 12 million persons living in Bolivia (CIA, 2012). However, there are large minorities present, with the whites being a minority: Quechua comprise 30 percent; mestizo, or offspring of white and Amerindian ancestors, comprise 30 percent; Aymara comprise 25 percent; and whites of European ancestry comprise only 15 percent (CIA, 2012). The official language is Spanish, but languages of Quechua and Aymara are spoken as well (CIA, 2012). The population is quite young, with 34.2 percent being younger than 14, and only 4.7 percent being older than 65 (CIA, 2012). Most Native Americans are illiterate and uneducated (Gritzner & Gritzner, 2004, p.15). Government Bolivia is a republic with 112 provinces (Gritzner & Gritzner, 2004, p.79). However, its stability is overshadowed by its violent history. From 1960’s till 1980’s, Bolivia experienced one coup after another (Gritzner & Gritzner, 2004, p. 63). An entire spectrum of systems exchanged, from military oppressions to liberal governments (Gritzner & Gritzner, 2004, p.64). Heritage of revolutions, such as the one by Che Guevara or Simon Bolivar, hinder governmental policies on elimination of coca or inflation (Gritzner & Gritzner, 2004, p.65). Constant coups and revolutions exhausted the country by having created too much instability in the economy. Political instability was also exacerbated by the struggle for water resources by the poor and the multinational company attempting to buy their water resources from the Bolivian government (Gritzner & Gritzner, 2004, p.85). In short, though Bolivia is a democratic country, rule of law and trust in the government are not strong. Economy Since 2005, Bolivia has experienced average economic growth of 4.7 percent (The World Bank, 2012). It is a lower middle income country (The World Bank, 2011). The causes of the increase in GDP are the rise in prices of raw goods, current account surpluses since 2003, and positive fiscal balance since 2006 (The World Bank, 2012). Goods exported are oil, natural gas and minerals (Canadian International Development Agency [CIDA], 2012). Growth decreased inequalities, as poverty decreased from 63 percent in 2002 to 59 percent in 2008 (The World Bank, 2012). Rural poverty decreased by ten percentage points (The World Bank, 2012). However, dependence on raw goods exports and an informal sector make Bolivian economy vulnerable to shocks such as raw goods price fluctuations. Moreover, the indigenous and the women and children are the most vulnerable, as one out of eight Bolivians lives on less than $1.25 a day (CIDA, 2012). State of Health Bolivia is one of the poorest countries in the world in terms of the inequalities and the share of the population below the poverty line. As a result, Bolivia ranked 108th out of 187 countries on the 2011 human development index (HDI) (CIDA, 2012). Child and maternal mortality are among the highest in the world. Low economic development results in low incomes, sanitation and thus high levels of infections and lack of access to primary care. Key Determinants of Health Skolnik (2012, pp. 18 – 19) defined determinants of health in terms of social, physical and economic environment an individual is located within. According to WHO, social determinants are shaped by economics, politics and social policies (WHO, 2012a). Social determinants determine the health status of an individual the most, as the poorest around the world, regardless of the development status of the country, have the worst health levels (WHO, 2012a). This is in particular the case of the indigenous in Bolivia, who are the least educated and the poorest in the country (Gritzner & Gritzner, 2004, p.15). There are several key health determinants. Most are predicated on the socio – economic status of the person, and whether they live in a country with equitable wealth distributions (Public Health Agency of Canada, 2001). The most important are: income and social status, employment status and working conditions, existence of social support networks such as friends and family, education, physical environment such as mountains and deserts, healthy child development, and social participation which in turn increases ownership of one’s health, are only some of the key health determinants (Public Health Agency of Canada, 2001). In Bolivia, health depends on infrastructure, as 25 percent Bolivians lack access to drinking water and 44 percent lack access to proper sanitation services (CIDA, 2012). Indigenous populations lack almost all of the key determinants for health. They are marginalized, poor, uneducated, live in rural areas, unemployed, cannot provide their children with healthy childhood and have low participation levels in the government. Key Health Status Indicators  Human development indicators are very low for Bolivia. Life expectancy at birth is 66.6 years (HDI, 2011). Vaccination coverage ranged from 27 to 90 percent for 2011 (WHO, 2012b). Child malnutrition stood at 28 percent in 2001 (WHO, 2001). One in three rural children and one in five urban children suffered from chronic malnutrition (WHO, 2001). Bolivia is a country ridden with inequalities in child and maternal mortality. Education of a mother determines child mortality levels. According to WHO (WHO, 2012a), children born to mothers with no education have mortality higher than 100 per 1000 live births (10 percent of all newborns die), whereas children born to mothers with at least secondary education have mortality rates under 40 per 1000 births (four percent of all newborns die to such mothers). One woman out of 89 dies during childbirth (CIDA, 2012). Moreover, one child out of 16 dies before the age of five (CIDA, 2012). Burden of Disease Lost years of life are high for Bolivia. DALY is the most used composite indicator used in global health (Skolnik, 2012, p.24). It is a health gap measure, as it is a measure of premature deaths and lost ability to work due to the illnesses and disabilities in a society (Skolnik, 2012, p.24). It is measured as years that are lost because of a burden by comparing the affected population to the healthiest possible population (Skolnik, 2012, p.25). Three categories are used: communicable, including maternal and perinatal diseases, non-communicable diseases, injuries and violence (Skolnik, 2012, p.25). Healthy populations have very low DALYs. In 2004, DALY for all diseases per 100,000 persons was 25,423 (WHO, 2009). Of that, over 8,000 went to communicable diseases, 14,000 to non communicable and over 2,000 to injuries (WHO, 2009). However, it is important to note that neuropsychiatric conditions amounted to almost 4,000 among non communicable diseases, depression being the most represented disorder (WHO, 2009). The cause of high DALYs is high disease incidence. Non - communicable deaths amounted to 57 percent of all deaths, with communicable, maternal, nutritional and perinatal deaths amounting to 35 percent (WHO, 2010, p.1). Of total deaths, cardiovascular diseases caused 22 percent deaths (WHO, 2010, p.1). In 2008, over 18,000 females and 19,000 males died from non - communicable diseases (WHO, 2010, p.1). In 2007, between 6,500 and 11,000 were infected with HIV (WHO, 2008, p.4). Since 2001, the numbers increased by 2,000. In 2011, 205 per 100,000 individuals suffered from tuberculosis (WHO, 2011). Moreover, 65 percent of tuberculosis infected individuals relapsed (WHO, 2011). Indigenous populations are five to eight times more susceptible to tuberculosis and other communicable diseases (WHO, 2001). Only 20 percent of all deaths were certified by a health professional in 2001, indicating low access to healthcare (WHO, 2001). Culture/ Traditional Medicine Bolivian government encourages traditional medicine as a substitute for the unaffordable mainstream medicine (Stix, 2008). Homeopathy, or so called herbal medicine in specific, is controlled by the government. A registry of all homoeopathists was composed by the government and made available to the public (Stix, 2008). Their products are sold to the hospitals and most likely patients directly. This development is supported by the indigenous population who distrust the conventional medicine (Stix, 2008). Moreover, this innovation has economically benefitted the women, who traditionally produce such medicines (Sikkink, 2010, p.x). Healthcare System and Delivery I Though healthcare in Bolivia is universal, most indigenous citizens exhibit low levels of health. Nongovernmental institutions, however, address the core causes of low health levels, such as malnutrition. Governmental Health-Related Ministry of Health and Social Services controls the universal healthcare system in Bolivia (WHO, 2001). The Ministry controls private, public, traditional medicine and nongovernmental health sectors (WHO, 2001). In 2001, 896 health centers were operational across the country (WHO, 2001). The health system since the President Morales has been improving. As already noted, Bolivia is one of the unhealthiest countries in the world, despite the fact that it has not experienced any type of a war that could have destroyed its infrastructure. Morales attempted to improve maternal and child health by imposing free healthcare to mothers across the country (Stix, 2008). He also brought 1,500 trained physicians from Cuba to improve the quality of primary healthcare (Stix, 2008). Only 10 percent population uses private healthcare services (WHO, 2001). International aid is crucial in assisting the poorest. CIDA addresses maternal and child mortality through primary care access, improved sanitation and access to drinking water and decreased malnutrition to address key health indicators (CIDA, 2012). Though only 10 percent of the population utilizes primary care provided by nongovernmental organizations, other health promotion activities, such as nutrition, are much more widely used (WHO, 2001). Health Priorities  As indicated by the data above, Bolivia lacks economic foundations to improve the health of its population. Primary healthcare is universal, yet children suffer from malnutrition and mothers from lack of proper care. The poor lack the funds to take care of themselves, and also, since most are minorities, they distrust the physicians. Due to poverty, they cannot access primary healthcare specialists as easily as their wealthier countrymen. Lack of funds for transportation might be a big contributor to search for more accessible local medicines, besides cultural reasons. Poverty might be the cause of high incidence of depression, which increases DALY. Lack of access to drinking water is a byproduct of poverty, but it contributes to malnutrition and infections. Nursing Implications There is no doubt about the shortage of nurses in Bolivia. In 2001, there were only 1,894 nurses, as compared to 4,011 physicians (WHO, 2001). However, nurses assist physicians and they provide primary healthcare such as vaccinations. Moreover, over 80 percent of medical facilities were located in cities, indicating that the rural poor could not reach these services (WHO, 2001). However, the government by 2001 created over 5,000 trained midwives and health promoters which were dispatched to the 20 percent of less developed regions that lacked trained health personnel (WHO, 2001). Nurses are fundamental to primary care in developing countries. According to the Pan American Health Organization (2004, p.1), nurses are able to provide most primary healthcare services. In Brazil, they provide over 90 percent services in pediatric care (Pan American Health Organization, 2004, p.1). Nurses thus could play an important role in childcare in Bolivia too, where children are especially vulnerable. Moreover, they play a crucial role in mental care in Belize, which too could be applied in Bolivia, where depression is widely spread (Pan American Health Organization, 2004, p.1). Nurses could educate on nutritional needs of children and vaccination benefits, as well as accessible health programs by aid agencies. Additionally, they could coordinate with homoeopathists and act as glue between the two sectors of medicine. Conclusion   As burden of disease indicates, primary health care access is only a part of the much greater story, and that story is economic inequality. Nutritional causes of deaths were among highest causes of deaths, together with maternal deaths, perinatal and communicable (WHO, 2010, p.1). The cause of such health status inequality lies in the lack of education of the indigenous population, which in turn cannot obtain better employment, wages and access to better living conditions that would pull them out of poverty. Without international help and a flexible government that encourages traditional medicine, the health status of the poorest would have been much worse. This is where nurses can play an important role. As indicated by the Pan American Health Organization, “[h]ealth care management is a sphere of action that requires a broad and intense contribution from nurses” (2004, p.1). This is especially true in Bolivia, where lack of access due to poverty and mistrust in mainstream medicine hinder good health practices that could increase health levels of the indigenous population. References Canadian International Development Agency [CIDA] (2012). Bolivia. Retrieved from http://www.acdi-cida.gc.ca/acdi-cida/acdi-cida.nsf/eng/JUD-129112821-MBV Central Intelligence Agency (CIA) (2012). Bolivia. In The World Factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/bl.html Gritzner, M.L. and Gritzner, J. (2004). Bolivia. Philadelphia: Chelsea House Publishers. Human Development Indicators (2011). Bolivia (Plurinational State of). Retrieved from http://hdrstats.undp.org/en/countries/profiles/BOL.html Pan American Health Organization (2004). Nursing and midwifery services contributing to equity, access, coverage, quality, and sustainability in the health care services. Retrieved from http://new.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=14595&Itemid=2095 Public Health Agency of Canada (2001). Towards a common understanding: Clarifying the core concepts of the population health. Retrieved from http://www.phac-aspc.gc.ca/ph-sp/docs/common-commune/appendix_c-eng.php Sikkink, L. (2010). New cures, old medicines: Women and the commercialization of traditional medicine in Bolivia. Wadsworth: Cengage Learning. Skolnik, R. (2012). Global health 101. Burlington: Jones and Bartlett Publishers. Stix, G. (2008). Bolivia tries to bolster public health with traditional medicine. Retrieved from http://www.scientificamerican.com/blog/post.cfm?id=bolivia-tries-to-bolster-public-hea-2008-10-06 The World Bank (2011). Bolivia. Retrieved from http://data.worldbank.org/country/bolivia The World Bank (2012). Bolivia overview. Retrieved from http://www.worldbank.org/en/country/bolivia/overview World Health Organization (2001). Bolivia. Retrieved from http://www.paho.org/english/sha/prflbol.htm World Health Organization (2008). Epidemiological factsheet on HIV and AIDS. Retrieved from http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_BO.pdf World Health . (2009). Disease and injury country estimates. Table 6: Age- standardized DALYs per 100,000 by cause, and Member State [Data File]. Retrieved from http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html World Health Organization (2010). Bolivia (Plurinational State of). Retrieved from http://www.who.int/nmh/countries/bol_en.pdf World Health Organization (2011). Bolivia (Plurinational State of). Retrieved from https://extranet.who.int/sree/Reports?op=Replet&name=/WHO_HQ_Reports/G2/PROD/EXT/TBCountryProfile&ISO2=BO&outtype=html World Health Organization (2012a). Social determinants of health. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html World Health Organization (2012b). Immunization profile: Bolivia (Plurinational State of). Retrieved from http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=bol Read More