The Yatiri in the Telehealth Consultorio: Ethnographic notes on telehealth under SAFCI in Bolivia

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

Abstract

This paper, based on 7 months of ethnographic fieldwork in Bolivia from 2016-2018, discusses how yatiris, galenic medical practitioners, and nurses in health clinics and reference hospitals implement telehealth. Telehealth was fully deployed in Bolivia in early 2018, with a minimum of one telehealth consultorio in every municipality. Policymakers promote telehealth as one element of sweeping healthcare reforms that promise to solve health disparities in Bolivia while maintaining a delicate balance of state-sanctioned medical pluralism and biomedical interventions. Bolivian reforms draw heavily on the Cuban model and have been implemented with Cuban advisors and medical training. Many practitioners, some trained at ELAM, experience telehealth as a step away from the more personal and social approach they were trained to provide, and resist utilizing the telehealth. Others, including some yatiris who work in 1st and 2nd level clinics, have embraced telehealth as a way of facilitating more personalized communication with patients and colleagues. This means that only some medical cases access telehealth, meaning implementation of the program is spotty and unpredictable. Many of the urban middle and upper class doubt the existence of telehealth in Bolivia, claiming it is a cover-up for corruption in the Morales administration, since they have never entered a clinic or hospital with telehealth. Utilizing three cases from two different clinics, I discuss the complicated relationship between technology, inclusion, and pluralism in Bolivian healthcare reform.

Author

• Katherine McGurn Centellas, University of Mississippi