The town of Copacabana is nestled high up in the Bolivian Altiplano (“high plateau”) on the shore of the world’s most elevated lake, the Titicaca. To get there from the main city of La Paz, one must take a 3 hour winding car ride through the lush, green plateau and cross the lake in a ferry. The majority of the people that live in this area belong to the Aymara ethnic group, a traditionally agronomist indigenous culture with ancient Incan roots. Needless to say, Copacabana is abundantly rich in culture, history, and breathtaking physical beauty. However, poverty presides over the region in a very real way, and access to basic healthcare is quite restricted for many traditional Aymara families. The Copacabana Municipal Hospital, located in the city center, and its two small rural satellite health centers serve a total population of over 11,000 people. However, surprisingly, there were less than 150 deliveries recorded at the hospital last year. The birthing rate amongst this group is quite high, so where are all the women having their babies?
Some Aymara women, as you may have guessed, are delivering their babies at home, attended by their mothers and grandmothers. Also, the pregnancies that the Copacabana physicians are able to determine as high-risk get referred to higher-level care centers in La Paz for delivery. Surprisingly, however, many women who can afford it are choosing to are cross the Peruvian border to deliver in a larger hospital in the town of Yunguyo, which is only 20 minutes away from Copacabana Hospital but much better equipped. “Last year we had about 360 prenatal patients,” says Copacabana Hospital Director Dr. Jorge Gutierrez, “but less than 50% of them delivered here.”
The Hospital lacks basic supplies, equipment, and medical specialists to be able to fully service the local population in healthcare. “We have three basic delivery sets that we have to wash and reuse every time,” the charge nurse explains. “And our only two obstetrical tables are 23 years old.” Right now the Copacabana Municipal Hospital is classified as a primary level hospital, the lowest on the three-tiered scale of hospital care, but this year the administrators hope to acquire the necessary specialists and equipment to become a secondary level facility. An OB-Gyn, a surgeon, and a general family practitioner are expected to be added to the medical staff, and MedShare should be able to donate surgical supplies such as masks, sutures, and drapes to be used during Caesarean sections and other surgeries. A baby warmer and transport incubator are also desperately needed; currently the newborns are being received on a makeshift table with no side rails and just a lightbulb to keep them warm, and critically-ill infants requiring emergency transport to La Paz are simply carried skin-to-skin by a nurse or their mother (“Kangaroo Care”) during the 3+ hour journey. “Sometimes we can put some bags of hot water around them, for warmth.” Dr. Gutierrez said.
Besides the care level scale-up, there is another project happening at the Copacabana hospital that is undoubtedly going to save many lives. A large Bolivian charity in La Paz called Hospital Arco Iris and Geneva University Hospitals RAFT Network are partnering together to provide telemedicine in Copacabana. A donated, low-resolution portable ultrasound connected to a laptop is incorporated into the Hospital Arco Iris network. Now, specialists in La Paz can view ultrasound scans of patients in Copacabana, consult with the medical staff there, and make their diagnoses and recommendations. It’s an innovative way of using technology to reach those patients in the most remote areas, and hopefully identify the high-risk pregnancy cases early enough to provide transport to referral care centers.
MedShare is excited about the opportunities for improving maternal-child health indicators in this area of Bolivia. By working together with partners like Hospital Arco Iris and our corporate sponsors at Kimberly-Clark Bolivia S.A. and the K-C Foundation to deliver much-needed supplies and equipment, pregnancy, birth, and infancy should become safer and easier for the Aymara and other populations in the Copacabana region.
Makeshift newborn receiving table