Dr. Flores first accompanied us to the private hospital run by Univalle Ayacucho, a private university in Coch­abamba, Bolivia. We were greeted by a well-dressed man whose name I did not catch. He quickly embarked with us on a tour, initially taking us to the top floor and subsequently venturing down to each one below. My preliminary reaction was one of extraordinary awe; the facility was cleaner than most hospitals I have visit­ed in the United States. The employees were uniformly dressed in quality scrubs and shoes, impressive enough for me to make a note in my written observations. I imagine you could see your reflection in the floors and windows, maybe even hear a pin drop in some of the corridors.

As we continued through the build­ing, these aspects I admired became the very ones that made me nauseatingly uncomfortable. Ask yourself, when have you ever been able to hear even your own thoughts in the hallway of a hospital? The passageways that compose the intricate labyrinth where beginnings and endings are only walls apart are lined with beds under patients who have yet to be as­signed rooms after waiting over 24 hours. Doctors and nurses shuffle through with exhaustive speed, and worried family members aimlessly look for the cafeteria to feel, at the very least for a moment, useful and in control.

4 floors.

44 beds.

6 ER rooms.

0 patients.

These stats rang in my head, back and forth, like the tolling of a heavy church bell as we reached the bottom floor. In the United States, we operate daily with the unconsciously privileged assumption that if we need emergency medical care, we can dial three numbers and receive help within minutes. The emergency medical response system in Bolivia is virtually nonexistent, with most people choosing to drive themselves to hospitals or seek alternative care.

“Why would you call for an ambu­lance if you do not know when, or if, it will arrive?” a local Bolivian remarked to me on another day.

As this conversation played across my mind like a rediscovered VHS tape, the pounding in my head and heart only grew. The well-dressed man was now proudly explaining how the facility had, to that day, not taken a single COVID-19 patient. Less than half of Bolivia’s popu­lation is covered by private health insur­ance, a necessity in many cases to acquire adequate COVID-19 testing and care.¹ He shook our hands and posed for a picture with us in the empty ER. I found myself thinking about a statistic from an article I read for our Contemporary Issues class: 3,000 people died outside of Bolivian hos­pitals at the height of the pandemic, wait­ing for care that would never come and that was at a cost they could not afford.²

Leaving this hospital, I truly felt numb. This beautiful palace of life-saving measures was unobtainable to most, a mi­rage of hope that was almost further away than space itself.

4 floors.

44 beds.

6 ER rooms.

0 patients.

1 pandemic.

3,000 dead.

Upon arrival at the public hospital, I tried to prepare myself for what I could only imagine would be the opposite of the eerie perfection of Univalle Ayacucho. The inability to go inside due to the pandemic left us with a unique observa­tional position. The gates were laced with people, sitting on the curb or standing, ac­companied by a stare that looked past the immediate and into something beyond. I noticed an older woman bleeding from the nose and holding onto the arm of a young­er man. Through the metal bars, hanging by the ER door, a triage poster was visible

The highest priority: red for resuscitation needed.

Alejandro, our accompanying transla­tor, scoffed with a knowing air.

“People die outside waiting right here in line all the time,” he said.

Two hospitals.

One with no patients.

One with too many.

 

All names have been changed to protect privacy.