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Paper short abstract:

This paper focuses on patients' access to health services in the countryside of the Bolivian Andes. Health assistance is not only an important "service" doctors provide to patients but an "issue" that has to be negotiated on a municipal and community level.

Paper long abstract:

Whereas health politics are launched on a national level, everyday health assistance is fiercely contested and negotiated on a municipal and community level. Here do patients, community health representatives, health station staff (auxiliary nurses, nurses, and doctors), NGO workers, municipal government representatives, and traditional health experts try to put into practice decisions that were taken from the distance. The process of implementation varies from one to another locality in the Bolivian countryside. That means that health assistance is not a service a patient in the countryside can rely on.

In Aucapata municipality where I carried out fieldwork one health "station" and five health "posts" are meant to provide primary health care, but patients have to cope for instance with temporal and permanent closures, lack of health staff and infrastructure, and language barriers. Despite a national intercultural health initiative called "SAFCI" ('Intercultural Family Health Programme') which not only takes cultural health concepts of people seriously but tries to incorporate traditional medical experts, health assistance is not always guaranteed. It is therefore that people I spoke to opt for a combination of auto-curation, traditional health assistance by a practitioner, and health station.

Already back in 2006 Spanish anthropologists Gerardo Fernández Juárez and colleagues (2006) have dug deeply into the concept of interculturality in Latin American health politics in general, and Bolivia in particular, showing the difference between theory and practice. Inquiries into health-related issues are important because they can bring light into the constantly changing entanglements of patients, places, and politics.