Friday, April 30, 2010

“Lo que no haces podría matarte, or, what you don’t do may kill you”

 

image Eugenia de Altura is a female graduate student conducting research on issues of women and gender in the cities of La Paz and El Alto, Bolivia. Bolivia is the poorest country in Latin America with the exception of Haiti, and over 60% of the country’s population is of indigenous descent. Eugenia’s postings explore women’s rights, sexuality, and reproductive health in Bolivia and in Latin America as a whole.

When Bolivia’s Ministry of Health announced earlier this month that it would vaccinate 30,000 adolescent girls against the human papillomavirus (HPV)—a leading cause of cervical cancer—I was surprised by only one thing: the complete absence of opposition to the plan.  In the United States and in other countries where the vaccine has been introduced, conservative elements and religious institutions have often opposed it for the same reasons they oppose birth control education in schools—that these measures will somehow encourage young people to have sex.  (Instead, the rightwing argues that if we do not vaccinate and provide birth control to young people, they will abstain…forever.)  Whether because the HPV vaccine is so little known in Bolivia, or the Catholic Church is too busy with other issues, the campaign sparked not a peep of protest from the right.

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 And I must say: thank goodness.  Cervical cancer is the leading cancer affecting women in Bolivia, with five women dying daily from the disease.  Since cervical cancer typically has few symptoms until it is quite advanced, the best way to check for cervical cancer to get a yearly pap test (which detects changes in cervical cells).  While 11% of women in the U.S. fail to get their yearly pap tests, 72% of Bolivian women report never having had a pap.  With such low rates of screening for cervical cancer, it is not surprising that so many women in Bolivia have the disease.

Undoubtedly, part of Bolivian women’s reluctance to go to medical centers for pap tests is that western medical facilities often fail to address the cultural differences of their patients.  Over 60% of Bolivia’s population is of indigenous descent, and many indigenous Bolivians report suffering mistreatment at western hospitals. Patients report being yelled at or called stupid by medical personnel, and pregnant women are often prevented from giving birth in the traditional squatting position and from taking the placenta home with them (many indigenous women bury the placenta in the earth following delivery).

Too often, Bolivian women’s reluctance to get their yearly pap exams is chalked up to their “ignorance”  and lack of acceptance of western medical care.  While it is likely true that too few women in Bolivia understand the importance of the pap test, it is also unrealistic to expect them to go get the test, when so many report suffering mistreatment at these facilities.  Don’t get me wrong—I am delighted that there is a growing interest in Bolivia in preventing cervical cancer, and the vaccine is a great way to start.  But training medical personnel to provide comprehensive, non-judgmental care to women will, I expect, accomplish even more.

Editors Note: Eugenia requests that if you are interested in specific subject on Latin America that you would like to see more coverage on to please let her know.