Tomorrow am heading to Valle Grande for the 2nd International Che Cuevara Meeting. Dont know anything about him so going to have to do some reading as the people I´m going with worship him almost religiously! Should be interesting to learn a bit more about Cuban history and politics though, and Che´s time in Bolivia. Turns out that the soldier who killed Che had cataracts removed for free by the Cuban ophtalmologists who are working here! The whole issue of Cuban doctors in Bolivia is really complicated and controversial; I think I mentioned it earlier, but here´s a more in depth summary.....
The Cuban doctors in the hospital have been here since May 2006. They brought with them an X-ray machine, lab equipment and technicians, ultrasound, endoscopy, ECGs, equipment for theatres, a 6 bed intensive care unit, a team of well equipped ophthalmologists and lots of medicines, all of which are free of charge for Bolivian patients, who would otherwise have to pay for treatment which they cant afford. This is all paid for by the Cuban government, and without this help the hospital would be without many vital services (eg when the Cuban anaesthetist went on holiday there was no surgery for two weeks). The Cubans are good doctors and treat their patients much better than their Bolivian counterparts, probably because they have chosen to come here, a bit like people in the uK choose to volunteer with Medecins Sans Frontiers. They are really popular amongst patients in the country, but in more middle class urban areas people question whether they are in fact doctors at all!
Sounds great, but there are quite a few problems. Firstly, the hospital seems to be divided into two systems, the Cuban system and the Bolivian system - there are two laboratories, two pharmacies, two sets of patients notes, two teams on call at night. Patients choose which service they want to use - not surprisingly many choose the Cubans. This leads to several problems - the hospital is losing money which before it recieved from charging patients - and this means they cant employ the much needed social worker or secretary. Secondly, some of the Bolivian doctors now have very little work to do, and so feel demoralised and unwanted. Thirdly, the two teams dont work together as well as they could (both sides say that the other side isnt willing) and by duplicating everything they are wasting time and resources. And what will happen when the Cubans leave? (no-one knows if a new team will arrive when these guys leave in May 2008). They arent training any Bolivians to fill the gaps when they leave.
All in all, it seems to me a bit like a bad MSF project, with all the downfalls that people have pointed out in the past with many western NGOs - little thought for sustainability or long term effects, too much focus on equipment and medicines rather than management and training for the future, and poor co-ordination with existing local systems. In fact, thousands of Bolivian doctors across the country are unemployed - ´why do we need Cuban doctors here?´ they ask (though whether they would go and work in the remote areas where the cuban doctors are is another question).
Contrast all this with the work of Medicus Mundi, a Spanish NGO which is helping the hospital with training and support in administration, quality control, self assessment and hospital management. They seem to be doing good job but with many obstacles, lots of personal issues seem to get in the way of progress here, very frustrating. The focus seems to be on getting the hospital acredited as an offical secondary care establishment. Maybe a bit misfocused though as there doesnt seem to be any primary care here in the town, which would be the logical place to start, and a good place to send the Cubans too, who come from possibly the best primary care system in the world!
So, interesting to see the different forms of international aid - I think that things would be worse without the Cubans, but there´s a lot of room for imporvement.
