Dr. Velasquez picked us up early (5:30 A.M,) and headed up, out of the valley, toward the rising sun. Thru the rolling hills of small family farm plots and eucalyptus forests, we found our way onto increasingly narrow and infrequently used dirt roads. Eventually we drove into Cotani Bajo, a very small village of Quechua speaking farmers.
Their only health facility was an old adobe structure, crumbling back into the earth from which its bricks had been formed, decades before. It was dark and cold inside. Flashlite and parka. The waiting chairs were bare metal. A wire of 220 volts hung menacingly from the shower head in the (frankly disgusting) bathroom. But it was the “Sala de Partos” that was most telling.
Women were put into the rusted metal beds covered with tattered blankets, to labor their children into the world of Cotani Bajo. Paint peeled from the walls. In the middle of the stark room loomed a metal delivery table. No bassinet. No incubator. In the ceiling over one of the two beds was a gaping hole above where a mothers head would be.
Bolivia has an Infant mortality rate more than ten times that of California.
Its Maternal mortality rate is over 300 deaths per 10,000 live births, twenty times that of the U.S,
The townspeople, who came out to greet us in the cold dawn at 9000 feet, had requested that Mano a Mano help them build a new Health Center. They had a site, a plan to provide electricity and running water, and were already building a plaza of carefully laid stones. Altho crude, I could see in their rock work the visual echos of the work of their ancestors – the Classical Incas.
We shook hands with all the coca chewing men, walked around the grazing cows and sheep, and drove on to our next stop, the trucks heater blasting.
Later, in another town, we stopped to inspect an operating Mano a Mano Health Center. The doctor was busy with patients, all smiles, working in his well-lit, clean, brick and tile building. The dentist showed off his new Brazilian dental chair, hydralics and compressed air and integral plumbing. He had just bought colorful toothbrushes for the local school kids. For contrast, I looked into the Sala de Partos. Clean, well lit, an incubator waiting, clean bed, sterile equipment. A cheerful room.
Since the new Health Centers construction, Infant and Maternal mortality stats have begun to fall.
When Cotani Bajo gets its new Health Center, it will be Mano a Manos 125 th over the past 15 years.
Sex, Drugs, and Public Health 