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Patti and Miguel took her to the local clinic for regular checkups,
waiting in line with those who gather at 4:00 a.m. in the hope
of seeing a doctor that day, but she didn't seem to gain weight
or grow.
"They never gave us anything, not vitamins, not formula
that would help her grow strong. Nothing," her grandmother,
Lourdes, told me. "Women and babies are supposed to get good
care, but the laws are a joke. We are humble people; we are poor
people. They take one look at us and know we cannot pay."
No doctor ever determined why Rebecca didn't thrive. She was
three months old when she died. Though we were months away from
the rainy season, it poured all day. In the early hours of the
morning, a Sunday, her family took her tiny body to the coroner.
He pronounced her dead of malnutrition, despite Patti and Miguel's
care. He asked "Didn't you take her to the doctor?"
Luis' normally gentle voice rose in anger and frustration over
the telephone as he talked about the coroner. They had loved that
baby so much, the diagnosis seemed like an insult. But no one
was surprised by Rebecca's death. Families hope and pray, but
no one assumes a baby will survive here. When I spoke with Luis
that day his voice was hollow, exhausted. He had just buried his
three-month-old granddaughter. "Miguel and Patti are inconsolable.
But I told them they must move on. They are young, they can have
more children. They have to think of it that way. How else can
they continue?" Luis and Lourdes lost three children themselves.
And Rebecca became one of the thousands.
Every day in the Two-Thirds World, in countries like Bolivia,
over 30,000 children under the age of 5 die from preventable diseases
related to hunger and poverty. Every year, 14 million children
worldwide die of hunger (Jubilee 2000/USA). Mostly babies die
of wholly preventable diseases that do not require expensive treatment
or high-tech equipment. The number one cause of infant death in
Bolivia is diarrhea.
Understanding the context in which Rebecca died is complicated,
messy. During the 1980s and 1990s, under pressure from the International
Monetary Fund (IMF) and World Bank, Third-World countries like
Bolivia implemented economic austerity measures that slashed services
and subsidies, abruptly liberalizing their economy, and promoting
privatization, among other measures. Rather than investing in
the welfare of their citizens, many countries were forced to cut
spending on services like health and education. The policies that
were originally implemented in Bolivia during the 1980s to curb
rampant inflation are now criticized for having further concentrated
wealth into the hands of a few.
While the Bolivian government is now trying to invest more in
health and has reduced the infant mortality rate, it is still
astonishingly high. One third of Bolivia's budget goes to paying
off the interest on its debt. Not the debt itself, just the interest.
Both Bolivia's health and education sectors remain heavily dependent
on international aid because the government must devote so much
of its budget to paying off debt interest rather than investing
in its citizens' needs. In 1995, 88 percent of Bolivia's investment
into health came from donations and foreign credit (Instituto
del Tercer Mundo).
Bolivia's rampant, institutionalized corruption also prevents
money and materials from getting to those who need them most.
Did upper-level corruption or mismanaged funds prevent supplies
from reaching Rebecca and others entitled to them? Do people who
work in the hospital skim off the top because they, too, are trying
to survive as Bolivia's economic crisis worsens? What else contributes
to making the health care system so profoundly unjust?
The complexity can make the situation seem hopeless, almost not
worth tackling. And yet when I asked Luis' permission to tell
Rebecca's story, he didn't respond as I expected. When I offered
to change names and details to protect their privacy, Luis said
"No, you must tell it truthfully. Why hide our names? People
need to know."
Knowing that Rebecca's death was preventable, and that thousands
of children like her die daily, is maddening. But she is also
a powerful reason to keep working.
Susan
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