The Relational Imagination: Bureaucracy, Decolonization, and the Promise of Care in Bolivia

• In Event: Aspirations to National Health: Social Medicine and Political Subjectivity in Latin America

Abstract

During Evo Morales’ presidency, Bolivian officials have sought to enact what they call a decolonized and intercultural health care system. Policy texts propose the articulation of plural healing practices and the revival of indigenous cosmovisión (cosmology, worldview) in the provision of care. At the same time, projects to decolonize health care are often underfunded or only partially implemented, seemingly taking a backseat to the Morales administration’s growing emphasis on techno-medical solutions to health inequality. Rather than taking national health policy as a given, I unpack how Ministry of Health bureaucrats constitute indigenous knowledge and cosmovisión in the making of official documents — and in particular, how they imagine these as the basis for transforming care in Bolivia. I argue that many strive to go beyond merely recognizing cultural difference and imagine indigenous cosmology as the very basis for a more ethical medical care, founded in “calidad y calidez” (quality and warmth) and horizontal relations. Yet rather than constructing a radical cosmopolitics — one that works from indigenous healing ontologies, or fundamentally challenges the colonial foundations of biomedicine — bureaucrats primarily strive to render diverse forms of relationality legible in generalizable terms of equity and well-being. The relational imagination becomes central to creating an aspirational narrative of the caring Bolivian state — one that can be flexibly applied to a range of health interventions, including those that seek to extend the primacy of biomedicine.

Author

• Gabriela Elisa Morales, Scripps College