Annina Lux - A Definition of Snow

Part of the problem was that there was only one prison guard, the police were on the other side of the block and all the inmates were men. I looked at the situation and realised that the inmates could abuse all three of us female doctors – a psychologist, another Medico General , and me – because there was neither any protection nor any guards close by. I told this to the heads of the hospital. They did not do or say anything. These experiences led to me distancing myself from these people, and it is for that reason that I no longer volunteer to give medical treatment in the prison, because sometimes patients confuse friendliness with flirting. That is unbelievable, but it happens.

Partly because of these kinds of experiences, I fought to have two police officers at the hospital, but I did not have the support of the Director. I even went to talk to the Departmental Director 7personally to negotiate the presence of the police officers in the hospital. I believe that all authorities should take this situation seriously and fight to have my plea, which I have already repeated to many people, including the previous mayor, recognised. I asked the mayor to help us put this in practice, but he did not do it. There is a lack of awareness, and we need to make people aware, so they learn to respect health care personnel.

On shift in A & E, you see very difficult cases, for example patients highly decompensated because of diabetes 8. You see many cases of attempted murder, physical aggression, psychological aggression and sexual aggression. You often see people intoxicated with drugs. This year, many critical patients have visited the hospital. Once, a young girl was thrown from a truck in front of the door of her house and left lying there after having taken drugs with some other people. She had gone to the river with her friends to drink and take an excessive amount of marijuana. She had lost consciousness. Her friends drove her back to her house and threw her on the ground in front of the door like a bag of sand. The people there shouted and called the police, who brought her to A & E. She was completely soaked and caked with sand and suffering from hypothermia. We called for the police, and gave a report, and checked her for signs of sexual violence. It was then that she said she had been subject to sexual violence by an adult since she was eight years old, following which she had attempted to kill herself to forget the situation. She survived, but she did not stop vomiting for a week. I experienced this case on my shift, and it made me so sad that these types of events happen in the village. I have also seen various cases of sexual or psychological violence against young people. These are always difficult situations to deal with. Many young teenagers’ futures are destroyed by unwanted and unplanned pregnancies. They bring babies into the world, sometimes after being raped on the street, or by close family members, but more often because of the lack of information and sexual education. Many young people don’t confide in their parents because of shame. I treated many pregnant young girls between 12 and 19 years old. They tell very sad stories. One, for example, said she did not want her son to see the light of the world because she had been raped.

I have seen how sexual violence psychologically traumatises young girls. What’s more, they do not have the financial resources to raise a child. Because of this, their parents will have to support the child after birth, and help in its upbringing, because many irresponsible men, after satisfying themselves sexually and impregnating the girls, do not assume the responsibility of fatherhood. You also see attempted abortions by young girls. To be honest, you see this in all ages, but especially for unwanted pregnancies in young girls after sexual abuse, sometimes by their own parents, uncles, cousins or other people they know. Abortions are illegal in Bolivia. A study I did, from June 2011 to June 2012, showed 143 pregnant girls between 12 and 19 years old attended the hospital. Of these, the majority were a result of sexual abuse. Sadly, in Bolivia there are cowardly men who do this to young girls and then escape or do not assume their responsibility. They damage the life of those young girls in that way, because their parents force them to work as a punishment in order to maintain the child. But there are also women that abandon the children to evade responsibility, or who give them away.

There is a lack of education and information in schools. In general, you only talk about sexuality in your family. In the past, you could not talk about sexuality with your parents because it was a taboo and a sign of lack of respect, but through technology, young people know much more about many good and bad things. Now, they wake up earlier to sexuality. But out of shame, they do not come to the hospital to receive adequate advice, so they run the risk of getting pregnant and contracting sexually transmitted diseases, including HIV or AIDS. The worst is, once they are pregnant, they cannot go to school or university to study and learn.

The saddest stories I have seen were young girls and boys with terminal cancer. In the town where I work, they don’t do chemotherapy – they only do that in larger towns – because the hospital has neither the equipment needed nor the specialists to do it. On top of that, chemotherapy is very expensive. It’s difficult for the patients that they have to go to a third-level hospital for this, but there is no choice.

I once had to take a 15-hour-old baby boy with sepsis to the nearest city 9in an ambulance, in a very bad general condition. He was moaning all the time. He also made crackling sounds, a sign of pulmonary disease. The paediatrician had said he had a high chance of dying on the way. On the difficult road, full of potholes and rough and uneven ground, he started to develop breathing problems. I helped him breathe by giving him oxygen in full flow. When he began turning blue because of the lack of oxygen, I helped him breathe with a bag valve mask (BVM) attached to the oxygen tank. Later I performed CPR. I intubated him and cleared his airways using suction. Despite the CPR, he died in the hospital in the city. Because of this, I cried a lot.

Road tracks are really bad – they are not tarmacked; they are just earth tracks with many deep potholes. These road conditions don’t help when transporting seriously ill or injured patients in need of urgent care. The ambulance does not have adequate equipment to transport those patients. It only has the very basics. It’s sad, but it’s the reality in rural areas.

I also remember doing a Pap smear campaign 10together with a colleague, and not having the conditions to do the tests, because we only had a few covers for all patients. The bed, a small old wooden school desk, was uncomfortable and unsuitable; the hut was dirty and pitch black due to the absence of electricity. I think all such procedures should be done in a sterile environment, to reduce the risk of infection and for the comfort of the patient. Pap smears manipulate the internal mucosa of the woman’s vagina, and the cervix, and germs can easily be introduced during the procedure, causing infections. The lack of light and microscopes makes it hard to take samples and evaluate them.

It’s incredible that they expect us to work like this, and don’t give us the conditions to do so properly, neither in terms of equipment nor material. Sometimes we had to do Pap tests using flashlights or attend births using flashlights. Sometimes we had to wait because of the absence of electricity, due to the lack of good management. Even worse, in A & E we do not have accommodation or bathrooms. Of course, you have to deal with biological necessities, and you have to walk half a block to find a bathroom. For the love of God, they don’t ever think about the fact that we are humans who can also contract illnesses and become sick.