Unequal Cures: Public Health and Political Change in Bolivia, 1900 – 1950

Abstract

Despite the title, this volume actually deals more with public health than with political change, and this is probably a good thing given that the sections on public health are more convincingly argued than those on politics. A core goal of this book is to examine and evaluate the Bolivian public health-care situation from 1900 to 1950. The author identifies key health concerns, analyzes their social and economic origins, and assesses the progress made in alleviating them. In this the author succeeds admirably. Zulawski also seeks to place her book within the context of a relatively new approach to the history of medicine, the “literary turn” taken by numerous writers over the past couple of decades. With this she succeeds far better than most, wisely situating her exploration of language and meanings within the changing landscape of Bolivian society, economy, and politics. However, Zulawski also sees her study as a contribution to the recent literature on postcolonial state formation. Zulawski discusses the impact that the writings of doctors and politicians had on the political project of Bolivian state construction, examining what doctors said about Bolivian politics and what Bolivian politicians said about medicine. While this is a clever turn of question, the answers are not all that revealing. It turns out politicians do better when discussing politics and doctors make more sense when talking about medicine.When Zulawski focuses on disease she is at her best. Two strong chapters stand out in this regard. She provides an enormously insightful look at the medical side of Bolivia’s experiences during the Chaco War with neighboring Paraguay (1932 – 36). As in nearly all wars in human history, disease claimed many more lives than enemy fire. For Bolivian soldiers the utter failure of their government to provide them with water and basic supplies led to countless deaths from dehydration and outright starvation. Others were so enfeebled by these conditions that they fell prey to an array of lethal infectious afflictions. Those who did not die where they dropped might be transported back to highlands cities for treatment, although they were little better off for this. As Zulawski documents, Bolivia’s all but nonexistent health-care system quickly came to be overwhelmed. Wounded, gangrenous, and malnourished soldiers were deposited under makeshift tents to weaken, suffer, and die. In the end some 50,000 Bolivian soldiers were lost, or one out of every five conscripts.Equally strong is Zulawski’s consideration of the efforts of the Rockefeller Foundation in Bolivia. While the Rockefeller Foundation did well against yellow fever in Santa Cruz in 1932, it overreached after that, spreading its resources too thin in subsequent campaigns against malaria, yaws, typhus, and hookworm. One very interesting finding, which should give pause to those who frame historical studies by focusing on “postcolonial” imperialist “hegemony,” is that the Rockefeller Foundation deepened its commitment to assisting Bolivia even after the nation confiscated Rockefeller’s Standard Oil Company holdings in 1937.Overall, Unequal Cures provides a sobering historical health profile of South America’s poorest country, with infant mortality rates often well over 200 per 1,000 live births (among the worst in Latin America); severe problems in provisioning potable water; epidemics of typhoid fever, urban yellow fever, and typhus; endemic whooping cough, smallpox, measles, malaria, and tuberculosis; and rampaging everyday respiratory and digestive killers.Yet at points the author’s arguments fail to convince. For example, Zulawski insists that Andean herbalists “arguably had a success rate at least as great” as university-trained doctors (p. 22). In exploring women’s health issues she takes a critical view of the rise of professionalization in maternal care, a time when arrogant male physicians often forcibly displaced female folk midwives. The author interprets this as a largely unwelcome development, although many would insist that it actually led to improvement in care and far better survival rates for both mother and child.Of larger concern is the author’s attempt to relate her story to the theme of the construction of Bolivian nationhood. Not every new history book has to be about the topics that happen at the moment to be preoccupying the field. Sometimes these are just passing fads and are surely not the only source of legitimacy for a topic of inquiry. Books about public health do not have to relate their findings to “postcolonial” themes to find legitimacy, and it can be painful here to watch the contortions when Zulawski tries to make that reach. Fortunately, sometimes she forgets to try, and when she deals with disease, medicine, and the challenges of provisioning public heath care, Zulawski makes an extraordinarily strong contribution.