Go eat your chuño...and french fries.

In my efforts to kick myself back into shape before the fall frisbee season, I’ve joined the gym on the corner of my street. It’s pretty basic, with some rather old and worn looking weight machines, but the real reason I signed up was to go to spinning and some of the aerobic classes that they offer in the evenings. Last night I had my first experience in a Step class, where I proved myself to be the token white girl who had no rhythm…at least for the first half of the class. I joined the group a bit late, and then spent the next 30 minutes admiring the male teacher’s hips swaying to the blasting techno music. He was going through everything so fast that I kept tripping over my feet, and sometimes over the wooden step (it was rather unstable and flipped over a few times), until I finally figured out how to move and started enjoying the movement. Finally, I could feel the workout, which probably would have been easy at sea level, but at altitude left me feeling tired and exhilarated.

Today I made a journey to a different hospital called Juan XXIII located very, very high in the city. Due to its proximity to El Alto, the hospital sees a lot of very poor patients (even more so than the Hospital de Clínicas) with very grave conditions, a lot of time because the people wait until their conditions are very serious before they seek medical treatment. My goal in visiting this hospital was to talk to a Pneumologist about her experience with tuberculosis, and in particular how poor nutrition affects susceptibility to TB infection. I got to see a 20 year old girl with military tuberculosis, the most severe form of the disease where the bacteria spread from a lesion and infect all of the tissue and organs in your body. I also heard a 78 year old aymara woman cringe at the though of putting an IV in her neck, as she asked “Why are the doctors trying to hurt me?” She didn’t understand that the procedure was necessary for her health, and seemed to instead view it as a form of torture.

The doctora was quite overbearing in the way she interacted with the patients and the staff (she openly castigated the interns, in front of 20 people, about their medical ignorance), but it was a great opportunity to get one perspective on tuberculosis in Bolivia. I have always attributed the problem of poor nutrition to a combination of traditional food (which consists of chuño, freeze-dried potato, corn, potatoes, bread, and rice) and poverty, but the doctora asserted that the influence of western fast food practices has had a monumental effect. The traditional food that grows in Bolivia is actually quite diverse and healthy, like quinoa and fruits and vegetables, but according to the doctora, people have turned to French fries and fried chicken as the primary food because it is cheap and fast. So while “Bolivia tiene todo” (Bolivia has everything), the diet is all carbohydrate and lacks vitamins and minerals. Furthermore, the doctora seemed to think that coca chewing, especially in the lowlands, leads to poor nutrition, which leads to tuberculosis susceptibility. Coca gives you more energy and suppresses appetitive, so that people don’t feel the need to eat as often.

Her opinions raise a lot of questions and doubts in my mind. There are so many doctors here who look down upon indigenous practices, and who also criticize western medicine. While there is some merit to both of these viewpoints, I find myself in a weird position as someone who is trying to learn about aymara culture with an open mind, and as someone who is also part of an obviously problematic but nonetheless effective culture of western medicine.

I was left wondering about her blaming poor nutrition on coca consumption – she didn’t seem to consider that there are reasons that people need to consume coca, like lack of resources to buy food. Furthermore, as I think about how the poor nutrition in the campo is derived from fast food, and also as I think about the food that is actually native to the Altiplano (i.e. not fruits and vegetables). It made me start to think about the fast-food industry in the United States, not in the sense that it is responsible for obvious health problems like obesity, diabetes, and heart problems, but also in the possibility that it is making people more susceptible to infectious disease. I honestly don’t know that much about this field of study, but it’s something that I would definitely like to look into, for its obvious relation to what I am seeing in Bolivia. People here just aren’t overweight and unhealthy in the same way as the United States.

It seemed like this doctora had quite a bit of a grudge against the United States and “western ways.” Most strikingly, when I was talking about the correlation between AIDS and TB in Bolivia, something that I have witnessed repeatedly in the Hospital de Clínicas, she interrupted me and said, “AIDS, no, that’s in your country.” Everyone in the room burst out laughing at the point, but I think I was the only one thinking how ridiculous her statement was. When we were talking about protein, as well, and I mentioned that I was vegetarian, she looked at me incredulously and said “But you have to eat meat,” as if there was absolutely no other way to live. I explained to her that the meat in the United States is less than appetizing, and she scoffed and turned to her patient and said “There they inject cows with all sorts of hormones so that they grow big and fat.” While it is a true statement, the accusatory tone of her voice made me realize how her vision of the world and culture was truly uninformed.