This paper examines the general state of health care provision for small-scale miners in the city of Potosi, Bolivia. Then, I present an overview of the contrast between the “usual” form of treatment and their experiences with Cuban doctors. I follow this with an examination of the Potosino General Strike in 2015 which included demands to change the current state of the health care system. Here I argue that part of that “re-examination of societal values” which Feinsilver (Cuban Studies 41: 85–104, 2010) argues necessarily occurs in countries who host Cuban doctors, that miners’ experiences with a kinder, more humane, form of public health care, shaped their ongoing demands for dignified forms of care. Finally, I conclude with some comments on their use of the concept “trato humano” and its relevance for political discussions about value for health. This paper demonstrates that beyond simply providing a fundamental service, the kinds of medical practice that Cuban doctors provide in Potosi is what makes them truly revolutionary in the context of a hyper for-profit medical health care system. It is constructed from fieldwork I completed in Bolivia with small-scale miners during several trips from 2011 to the present, and 18 months intensive fieldwork in the city of Potosi with small-scale miners, from 2016 to 2017, and again with retirees for a month in 2018.
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This paper builds off a talk I gave at the Canadian Anthropological Society’s Annual Conference in Santiago de Cuba. Part of the motivations for its inception was political. Reflecting on and engaging in conversations we were having with Cubans working in the tourism industry about the Cuban health care system and its complexities caused me to reflect on my own research with small-scale miners and the intricacies of their experiences with public, private and Cuban health care in the city of Potosi (Francescone 2018). I am also motivated due to my experience in an increasingly undercut public health care system here in Canada, and by the ongoing conversations in the USA, about the possibility for a publically-funded health care system.
I expect that Sean P. Brotherton’s forthcoming, The Socialist Humanitarian Imperative: The Logic and Practice of Cuba’s Quest for Global Health in the Americas will provide more insight on the medical practices Cuban doctors use when treating patients abroad.
For a city that has nearly 8,000 small-scale miners, plus a couple thousand private-mine labourers and mill workers, there are only two pulmonologists in the city of Potosi. One of them works in the public hospital (Bracamonte) and one works in the Caja Nacional de Salud, Regional Potosi (Sociedad de Neumologia Boliviana). It is common that doctors who study to become specialists end up working in the high-paying hospitals in La Paz or Santa Cruz, which results in an unequal concentration of specialists in the urban centres and a dearth of professionals in smaller cities (Tapia 2010).
Many investigators have revealed the ways that cooperative partners, and their hired-hands (peones) fail to pay their insurance dues. If a miner fails to pay for a 3-month period, then they lose their eligibility for insurance. Miners often see cutting their dues as a way of saving money, and today, this is especially the case due to declining mineral grades and stabilizing prices.
Primer Nivel, or First-level hospitals are categorized as clinics which are deemed to be the first point of medical intervention and can only complete basic health care. The Segundo Nivel clinics are said to include basic specialists, gynaecology, paediatrics, general surgery and internal medicine. Finally, third level is where major surgical interventions happen. Cuarto Nivel, or fourth level, of which Potosi has none, includes specialized attention and research institution.
This distribution changes as you move up to the more specialized levels. For instance, of the 2nd and third level hospitals, one is public and one is a health insurance hospital.
Of the two major studies completed about discrimination and quality of attention in Potosi, neither one probed nor challenged the existence of a for-profit health system as a potential cause.
Simon was quite surprised about this, since they are of humble origins and this would be a very uncommon practice for someone who wasn’t family, let alone a professional, in Bolivia.
The fact that this doctor would even spare some time to speak with me, was something I had not experienced in the city. I was used to doctors trying to escape my questions, or telling me they were too busy to attend to my requests. The Cuban doctor was not only open; she believed it part of her responsibility as a doctor to talk about these things.
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Special thanks to Marco Quiñones a medical student in Potosi, and Juana Silveria Miranda, a lawyer and daughter of a cooperative miner, for their very capable assistance with research for this paper. Thanks to Bernhard Leistle and the graduate students who were involved in the Special Topics tutorial which examined the CASCA conference in Santiago de Cuba for their stimulating discussions about Cuban health which pushed me to review my own work. Special thanks to the reviewers for their thoughtful contributions, and to Lindsay DuBois and Daniel Salas Gonzales for their hard work and initiative in organizing the panel and special edition.
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Francescone, K. Situating “el trato humano”: the role of Cuban medicine for political discussions of value in Potosi, Bolivia. Dialect Anthropol (2019). https://doi.org/10.1007/s10624-019-09571-4