Nicole L. Pacino
César Moscoso Carrasco (1904–1966), a central figure in Bolivia’s mid-20th-century public health system, wanted to liberate Bolivia from malaria. In a career that spanned three decades, he came close to achieving this goal, but ultimately did not live to see successful eradication. Moscoso was one of the first Bolivian public health specialists in malariology, and was recognized by the World Health Organization for his contributions to the field in 1963. At all stages of his career, he fortuitously aligned himself with the individual or organization that could help him accomplish his professional ambitions and his mission of eradicating malaria in Bolivia. He was the founder and director of the National Anti-Malaria Service in 1929, where he made a name for himself working to halt the spread of malaria in Mizque, in the Cochabamba region. In the 1940s, he secured a position with the Rockefeller Foundation, where he had access to resources beyond the scope of the Bolivian government and an international network of public health specialists. Finally, in the 1950s, he headed the newly formed National Service for Malaria Eradication, which was a Bolivian government initiative supported by international organizations, such as the World Health Organization and the Pan-American Sanitary Bureau. In the 1950s and 1960s, he came the closest to achieving his goal. Unfortunately, he died the same way he lived: fighting a disease, possibly malaria, which he contracted on a visit to Ceylon as a malaria expert and consultant.
Moscoso’s life is a window into many aspects of Bolivia’s 20th-century history. First, his life story illustrates both the potential and limitations of the Bolivian healthcare system. Indeed, Moscoso often had to work with international or binational organizations to accomplish the work that he saw as necessary and important. Second, his career shows how political changes in Bolivia impacted healthcare. Since his career spans the Chaco War of 1932–1935, the politically tumultuous 1940s, and the 1952 National Revolution, it provides a personal account of how these events changed healthcare in Bolivia. His story demonstrates the hardships that Bolivian doctors faced as they worked to improve their healthcare system, including low pay, few resources, and little respect from their foreign colleagues.
At the beginning of the 19th century, Colombian physicians thought of food as an essential factor in shaping human character and corporeality. Framed in a neo-Hippocratic system, health and racial differences were related not only to climate but also to the connection between food qualities and humoral fluids. For example, it was believed that the tendency to eat cold and moist food, as well as greasy substances, was one of the reasons why people in warm regions of Colombia were choleric, phlegmatic, and indolent. By midcentury, it was further argued that each regional type—a local racialized categorization based on geographic determinism—had certain diet habits and physiological characteristics that explained its character (sober, obedient, lazy, industrious, etc.), and that made this type “naturally” suitable for different kinds of work. During this period, the working population’s diet was not perceived to be a social problem requiring regulation, at least not by the government. In the midst of liberal reforms, the political elites were more focused on the economic and genetic integration (“whitening”) of highland Indians, and to a lesser extent blacks, than on producing a supposed “better race” through nourishment.
But by the late 19th and the early 20th centuries, however, a new cultural framework that crossed the boundaries of thermodynamics, political economy, experimental physiology, and eugenics had begun to emerge in Colombia, converging in the social problem of nutrition. Centered on the analogy of the human body as a heat engine that transforms energy, local scientists began to conduct surveys of the eating habits of the “working classes,” analyses of the chemical and caloric composition of their foods, and studies on the metabolic characteristics of different regional populations. The results of these investigations were used to push the government to “restore the energies” of an impoverished population that was consistently thought to be weak and racially inferior, but capable of physiological and hereditable improvement. The cry of conservative elites for political and moral “regeneration” at the turn of the century also had a biological component—the optimization of the human motor. In the 1920s and 1930s, several campaigns and institutions were created for this social engineering, aimed at producing a modern, healthy, and industrious citizen. These campaigns gained special political force after the Liberal Party returned to power in 1930.
Nicole L. Pacino
During the pre-Columbian and colonial periods, Andean cosmological understandings shaped indigenous approaches to maternal health. Women typically gave birth at home with the assistance of a midwife (also called a partera or comadrona in Spanish). Birthing and post-partum care relied on local herbal remedies and followed specific social rituals. Women drank teas derived from anise or coca during the labor process, gave birth in a squatting position (toward Mother Earth, or Pachamama), and drank sheep soup after labor to replenish strength and warm the body. Rooms were kept dark because the common perception was that bright light injured newborn babies’ eyes. After labor, families buried or otherwise disposed of the placenta to keep the baby and mother healthy and facilitate lactation, as per Andean tradition.
Changes in maternal health rituals began in the 18th century, as colonial rule became more consolidated. The rise of a distinct medical profession and government interest in population growth gradually shifted responsibility for maternal health from the Catholic Church and charitable organizations to the state. Throughout the 19th and 20th centuries, the growing power and authority of the state and the medical profession led doctors and urban-based reformers to attempt to change long-standing Andean birthing practices, which they considered archaic and unsanitary. These reforms emerged from a desire to reduce infant mortality rates and to replace traditional healers with medical professionals who were trained, licensed, and regulated by the state. As reformers looked to replace Andean maternal health and healing practices with new scientific understandings of the female body and birthing process, they also worked to discredit and displace midwives’ knowledge and practices. In particular, they encouraged women to give birth in newly constructed hospitals and to seek the guidance of medical professionals, like obstetricians. However, these reforms met with limited success. In the Andes today, midwives still attend to roughly 50 percent of all births, and in some remote areas, the figure is as high as 90 percent. It is also more common today to see the merging of biomedical and ritual practices to increase women’s access to and acceptance of health services and to reduce overall mortality rates.