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7/28/1955 - Doctor in Cliza by Charles R. Temple

INSTITUTE OF CURRENT WORLD AFFAIRS CRT Cliza Hotel Colon Doctor Cliza Casilla Cochabamba Bolivia July Walter S Rogers Institute Current World Affairs Fifth Avenue New York NeW York Dear Rogers Last night seven thirty I knocked Jos Ruiz study first floor building which Dick Patch I living Jos usually called Pepe Cliza resident doctor He rents living quarters which uring colder night He Calls gomestic refrigerator When I entered Pepe closed thick reading light single unfrosted ceiling It turned Tratado Mei In terna Cecil Loeb originally published United States translated Spanish published Mexico City Pope explained basic textbooks medical school although costing equivalent doctor interested internal medicine would without It The study furnished chairs table Empire style painted Scattered papers prescription blanks medical journals mostly borrowed other doctors since Pope cannot afford suscribe journals present pencils books speculum vintage typewriter A family heirloom Pope The tered walls washed chilly peeling dirty concrete floor metal seamed cracks In terms rented rooms Cliza however considered first class acoomodation Pepe slender narrow which large predominate His serious repose quite comic smiles In conversation Latin Americans I aware facial pressions always eloquent shoulder gestures shrug shoulders question sentence twirling hands express unity CRT series ideas slump either table underline despair frmstration Jos Ruiz mining Oruro Bolivian Altiplano He primary school there returned Cechabamba father original secondary school education entered Universi San Sim6n In completed studies received title Bachelor He accepted Co rporai6n inera Bolivia state mining Cata_v intending examinations qualify doctor practice anywhere Bolivia June The student faculty strike San Sim6n April question university autonomy impossible Since Pepe special arrangement board examiners August In May accepted present assignment Cliza resident doctor This service fulfill government requirement doctor first spend least provincial practice before being certified There state effect practice provincial mandatory The university grant medical dents status licenciado medicine President Republic issues Ttulo CSruJno final approval If provincial service tificate withheld Pepe pointed other Latin American republics university proper grants ttul0 He friends pactice Cochabamba jokes visiting Argentines pretended wonder President economist training become competent qualifications medical degrees Still Pepe approved requireme service province being benefit doctor rural populations When Pepe passes examinations August ciruano general practitionerwith surgical competence If wanted specialize brsin surgery heart would Argmntina Chile United States further training The which would return would state additional capability would certi Ministry Health Occasionall doctor simply pretends training treats accordingly which course means higher patient The general practitioner operate discretion anywhere country situation Pope feels Always doctor sometimes fatal patient According Pope almost overwhelming number blems confront doctor working outside cities He first income compared returns private practice salaries mining monopoly Pope government Bolivianos month which current exchange about In addition Alcalde Cliza Bls about holding clinic nearby Toco Out basic salary board clothing recreation equipment This proved special resources When arrived Cliza inherited things predecessor brought instruments purchased during amplify supply order effectively oreover checks arrive irregularly which Dick Patch tells Common government departments He months January February check arrive He suppl ement salary visits proven small source revenue If campe doesn visit andro comes clinicwhich If asked usually patient muyrf unable probably nearly visit campesino wax1s Another general problem doctor teacher matters health sanitation which Pope feels specialist His energy already fully occupied medical treatment explain infection domestic animals which share house patients penicillin cureall harmful human taken indlscriminately certain diseases require special addition medication Aside expenditure extra minutes these lectures often becomes nnecessarily tense angry confronted living conditions patient finds himself berating person relatives In instance CRT called delayed delivery He found woman lying discharges floor liberally sprinkled garbage animal He temper spent minutes excoriating finally induced labor behind living mother child Later heard which justified assigning septi cemic infection In daily practice Pepe strongly feels local hospital laboratory which clinical tests Although Cliza political social center Cliza Valley hospital The Alcalde having remodelled serve completed uncertain At present sending patient hospital Cochabamba Punata additional expense added often impossible campesino hospitals Pope thinks latter might minimized personally could escort patient hospital explain mysteries bolster patient confidence ledical supplies pharmaceuticals quickly Ideally doctor office should pharmacy sorts acquire stock supplies would require outlay capital which Pepe cannot afford Aside these problems there whole attitudes campesino toward sickness doctors medicines treatments sanitation In first place reckon nature illness defined campesino himself medical science An illness arise itself represent punishment meted Pachamama important deity survive Cetholic caused witchcraft Each category demands different treatment although anyone three Pope office other resources Generally curanero first consulted makes statement category illness adminis appropriate remedies Often diagnoses sickness medic I terms apply knows cases The campesino conception sickness disease activities curandero fully covered Dick Patch Newsletter This purely interpretation bodily ailments means doctor automatically CRT consulted cases sickness often brings patients advanced stages disease In addition point general standard health illnesses untreated partially cured adoption various sanitary controls achieve Peps cited office nephritis advanced His curandero treated swellings which disease produce tying around abdomen patient could enough Peps often before himself court resort asked treat disease which could cured extensive hospital treat readily available expensive feared patient In second place there intensity campesino Peps called turally inbred resistance sickness Symptoms which medically conCious person would visit doctor order disregarded adult campesino Only sufficiently incapacitated consider andero doctor By contrast children taken treatment almost symptoms appear since child makes strong response disturbance organism justifiable intensity thereby present In place campes unwarranted faith medicines accompanied belief visit doctor sufficient Injections tablets powders popular considered exceptionally potent Peps avoid disappointment patients always write prescription Armed campesino instances Peps asked return further consultation A point Pope experience cases hepatitis frequent ailment One necessary measures treatment control coddle liver patient family rarely bother relying instead administration doctor called visit check patient progress If Nature weren physician despite Valley would littered liver patients This prescription passion catered curanderos CRT2 adopted echniques medicines Bolivia A curandero simply write prescription paien filled repre black marke drugs flourishing especially antibiotics One sidelights prescription peddling decene leading izens Cliza curing write prescriptions hemselves which effec giving prescription special value coming ownsman Pepe feels rogly control drugs should established government preven writing prescriptions unauthorized persons ransfer adulered drugs He found satisfactory answer problem having compete curandero This things stand accept Someday however hopes never again answer question Was person treated doctor reply He knows doctor Sabe uraren_o _mdici I suggested might interesting experiment nonetheless utilize curanderos If could points entry sanitation medical practices paying certain alary replace whatever might Pepe thought under present circumstances approach might valid particularly since curandero hiself campesino knows local situation unlike doctor stranger In would foolish ignore present campesino attitudes opinions regard sickness treatment planning range medical health program Pepe suggested certain steps which might taken regard ruralmedicine The Bolivian government should rural practice attractive young ctors increasing annual salary underwriting purchase necessary euipment supplies special reference areas hospital pharmacy facilities He pointed private practice mining monopoly CRT2 doctor income sense rural areas competition desirable outlets practice medicine Oe advantage however offered beginning doctor rural areao He physician surgeon pediatrician gynea cologist obstetrician since medical available He extemporize often invent treatments solely knowledge ingenuity There should expansion current hospital oratory facilities rural areas assist practicing doctor ognize campesinos income badly strained travel distance hospital Pepe admitted ruefully these things itself great value without range conception scheme health sanitation throughout nation whole which course would include programs raising standard increased education The country general short Uni1ed Nation_s Statistical Yearbook reports there physician every persons scarcer nurses He knows gevernmemt shortages personnel achieve goals In fundamental Bolivias problems needs thoroughly interdependent undue stress exclusion ethers imsue At point Peps called attend birth I returned upstairs feeling I talked would ntinue disposal Dick earlier previous doctor Cllza refuse calls totally uninter ested prophylactic medicine I hought overnment oubly fortunate Jos Ruiz Cllza counteract impression which predecessor increase government presitge these rural people first history Bolivian Republic Sineerely Charles R Temple Received New York