Under the dim hospital light, a midwife, a doctor, a pregnant woman, and her mother silently ponder what they should do with a baby that fiercely resists coming out of the womb. The longer the labor, the more dangerous it gets, and it has been almost a full day since the woman arrived here at the hospital. In Bolivia, which has the second-highest maternal mortality rate in South America, such a delay is a mortal threat. But here, in the high Andean plateau, hours from any major hospital, the mother is in very good hands.
The pregnant woman never wanted to go to the hospital. The night before, her mother called Doña Leonarda, the midwife, or partera, to attend the delivery according to traditional Aymara customs. Doña Leonarda was working at the hospital today, so the woman reluctantly came here. Lying on her back, eyes wide open, the mother looks terrified. A young nurse turns to the physician, Dr. Henry Flores, and asks whether she should call the ambulance and take the woman to La Paz for a C-section.
"That would be unwise," Flores answers in a smooth, low-pitch tone.
Doña Leonarda is a partera, a midwife, and she has been in charge of delivering babies since she was twelve | (Courtesy Narratively)
It would take more than two hours to get to the capital city and that could be too risky, too late for her. Her pain is increasing and she is already dilated. The doctor measures her contractions and tells the nurse to give the woman an IV solution. "It's only vitamins," Doña Leonarda says. But she knows better: they are dripping a painkiller into a plastic bag hanging from a pole — one of the few traces of modernity in this small chamber of the rural hospital. Three deep breaths later Dr. Flores makes a decision.
"Should we try the traditional way?" he asks the partera.
"She is weak but she can do it," Doña Leonarda answers.
Mother, partera, doctor, and nurse place a green mat on the floor of the hospital and gently move the woman over it. She is on her knees, her head on her mother's hands; Doña Leonarda rolls up the woman's skirt. It's going to be a vertical delivery, virtually unheard of in Bolivian hospitals but the traditional method in the Andean region. It's the way this pregnant woman was born herself, thirty years ago, just like her mother before her, and her grandmother, and so on. Dr. Flores learned the delivery method from the indigenous healers of El Altiplano — Bolivia's Andean plateau — and he is one of the few doctors in the country who is confident enough to try it.
Here on the Bolivian side of El Altiplano, a vast plateau 13,000 feet above sea level, the difference between life and death wears a bowler hat and a rainbow skirt. Far from medical facilities, lacking academic training and marginalized by the public healthcare system, parteras provide the only help that most women get during childbirth. But their efforts are not enough. Hundreds of people die every year during labor, a curse that haunts one of the most vulnerable groups on Earth: rural, poor, indigenous women. Bolivia trails behind almost every other place in the Americas with 206 deaths per 100,000 live births. (The rate in the United States is just 14 deaths per 100,000.) This revolutionary hospital might be showing the way to put an end to this ongoing tragedy.
Quinoa and potato crops surround Patacamaya, an Aymara town on the Bolivian side of the high Andean plateau, at 13,000 feet above sea level | (Courtesy Narratively)
Dr. Flores, who runs the local hospital in Patacamaya, approached Leonarda Quispe 10 years ago to recruit her for the outpost, even though she had never set foot in medical school and she barely speaks Spanish. Born in a small indigenous Aymara community, Doña Leonarda, as people know her, has been delivering babies since she was 12. Nobody has ever died under her care, she says "neither a woman nor a newborn,"which might be a record for someone who has attended more than 10,000 childbirths. Seven years ago, Dr. Flores realized the partera was getting more calls than any of his obstetricians and came up with a surprisingly straightforward and inexpensive idea. His plan was to develop a new healthcare system that would attract the local population to the hospital by combining traditional indigenous practices and modern academic knowledge. Should it prove to be successful, it might be adapted and applied everywhere — not just in Bolivia, but around the globe.
In Dr. Flores' hospital, parteras are welcomed and traditional indigenous doctors have their own offices, alongside skilled surgeons and trained specialists. Doña Leonarda and her husband, Don Vitaliano, are part of the staff; medical doctors like Flores often consult with them. Delivery rooms in Patacamaya's hospital look like little rural houses: There are kitchens, windows with thick curtains, walls painted in warm colors, wooden furniture, and flurry blankets. Nothing is white or shiny. By the pale red cribs, a banner reads "Ususiñ Uta" (birthing chamber), although in the hospital everybody knows these spaces as "intercultural delivery rooms."
Nearby, in the two-story brick house where Leonarda and Vitaliano live and run their own private practice, there are two bedrooms, plus an examination room filled with jars, syrups, ointments, a couple of tables, some notebooks, and a stretcher. As modest as the facility might look, Doña Leonarda and Don Vitaliano attract patients from as far as Chile, Brazil, Argentina, Peru, and even Spain.
A baby is delivered in the clinic | (Courtesy Narratively)
Hidden in Leonarda's pollera, a large cotton skirt typical of the Altiplano, a small cellphone insistently buzzes. "Another patient," she says in Spanish while excusing herself with a gentle gesture of her hand before leaving the room. Wearing a pink sweater and a colorful skirt under a blue apron, she takes her bowler hat off for a second, revealing all of her braided black hair, almost three feet long. Don Vitaliano, a large man with gelled hair, the arms of a builder, and the smile of a high school student, stays behind. Ten years younger than his wife, he is her voice, her aide, and her driver. A Honda off-road motorcycle, the engine still warm, waits outside the house. They have just returned from the hospital, where they attended a delivery in the middle of the night.
It's now seven in the morning. The previous night a woman called from La Paz to ask Doña Leonarda to attend her delivery. Leonarda told her to come here, to her private office in Patacamaya. But when the woman and her mother arrived in the early hours, Don Vitaliano had to convince them to meet his wife at the hospital, where she was still working, rather than at their place. It was a difficult task: They traveled three hours at night to give birth in a traditional environment, with a partera, far from medical doctors and their scary bright-white delivery rooms.
Convincing an indigenous woman to set foot in a hospital is like inviting her to take her life into her hands. "There are some diseases here, in the Altiplano, that urban doctors don't want to treat," Don Vitaliano says. Projecting his voice like a Roman orator, he explains the condition of sobreparto, a commonly reported postpartum condition among the Aymaras. Everybody in the rural area has heard about sobreparto and can describe its symptoms: headaches, swelling, fever, fatigue, and inability to perform complex tasks. But this malady is not recognized by modern medicine. Therefore, it has no treatment. Indigenous women, however, are extremely scared of it. It attacks them when the rooms are frigid with tiles and metals and when nurses wash them with cold water. "Some mothers prefer to stay at home because they are afraid of getting cold," Vitaliano says. "When they go to hospitals they are not taken care of properly and, then, they get sick. Sometimes they don't even speak the same language and doctors yell at them; they cannot talk to anyone and they are terrified."