Zulawski, Ann. Unequal Cures: Public Health and Political Change in Bolivia, 1900-1950.
Hall, Michael R.
Zulawski, Ann. Unequal Cures: Public Health and Political Change in
Bolivia, 1900-1950. Durham, NC: Duke University Press, 2007.
Unequal Cures: Public Health and Political Change in Bolivia,
1900-1950 is a welcome addition to the growing number of scholarly works
dealing with the history of medicine in the Third World that have been
published during the last twenty-five years. Ann Zulawski, a Professor
of History at Smith College, posits that "scientific research and
medical treatment are part of the social and political realm" (pp.
5-6). Her investigation, therefore, is an attempt to analyze
Bolivia's major medical problems during the first half of the
twentieth century. At the same time, Zulawski strives to uncover the
political, economic, geographic, climatic, and social factors that
exacerbated the medical problems and what was done by the medical
profession to rectify the situation. She concludes that medicine
"was influenced by and intrinsic to the most important social
debates in Bolivia" (p. 5).
Bolivia's health problems at the beginning of the twentieth
century were shaped by an unequal social and economic system, geographic
and climatic diversity that required the treatment of both tropical and
temperate zone diseases and ailments, and the lack of qualified medical
personnel. At a time when the medical profession was making advancements
in basic health care and the treatment of disease, public health care in
Bolivia remained static and, in some instances, declined. As late as
1950, small pox, malaria, and tuberculosis were still prevalent in
Bolivia. At the beginning of the twentieth century, public health
initiatives were viewed primarily as efforts to contain the spread of
disease. By 1950, however, significant sectors of Bolivia's
population, especially within the medical profession, began to view
public health as the government's responsibility. Public health
programs, the medical doctors argued, should be more proactive than
reactive. Notwithstanding these progressive ideas, most doctors still
"singled out" Indians and women "as being the cause of
national health problems" (p. 16).
Each of the book's five chapters could easily be published as
a self-contained journal article. In fact, two of the chapters were
previously published by the author in a different format. As such,
Zulawski's work is more a collection of five case studies that
examine various aspects of Bolivian public health during the first half
of the twentieth century than a chronological analysis of the
development of Bolivian public health between 1900 and 1950.
Zulawski's first case study examines the views of Jaime Mendoza and
Nestor Morales, two prominent Bolivian doctors, for improving the health
of the Indians. The doctors were especially concerned that the increased
mobility of Bolivia's Indians, who accounted for a significant part
of the national population, enhanced "the possibility that epidemic
disease might spread" more quickly (p. 17). Her second case study,
which examines the public health crisis engendered by the Chaco War,
reveals that the Paraguayan victory did more than discredit the ruling
Bolivian oligarchy and contribute to the 1952 Revolution. It also
"contributed to a reevaluation of the nation's public health
system" (p. 53). After the war, doctors came to view public heath
as "a right, not a privilege of the rich or a means of preventing
the poor from spreading disease" (p. 17). Zulawski's third
case study examines the impact of public health assistance in Bolivia
from the Rockefeller Foundation. The breakdown of the Bolivian
oligarchic system and "how thinking about public health changed in
a more populist political atmosphere" is a common theme found in
the first three case studies (p. 18).
The author's fourth case study evaluates women's health
care during the second quarter of the twentieth century. Regardless of
the increasingly progressive attitudes of the medical profession in
Bolivia, women were still blamed for health problems associated with
infant mortality, abortion, prostitution, and venereal disease. Indian
women "were often singled out as being unhygienic and most likely
to spread disease" (p. 119). Zulawski's final case study,
enhanced by period photographs, examines the plight of the mentally ill
at the Manicomio Pacheco, Bolivia's national insane asylum.
Significantly, doctors at the institution believed that Indians and
women were psychologically inferior to white men.
Zulawski's study ends in 1950, just before the political,
social, and economic upheavals unleashed by the 1952 Revolution.
According to the author, the 1952 Revolution "marked a watershed
and a new political context for understanding the connection between
medicine and social life in Bolivia" (p. 20). One can only hope
that Zulawski's next scholarly foray will delve into the realm of
public health in post-revolutionary Bolivia.
Michael R. Hall
Armstrong Atlantic State University
