Filadelfia, Santa Cruz/Bolivia and close to death....

When I was in Santa Cruz about twenty years ago, it was still practically impossible for a single traveller to cross the Gran Chaco from Bolivia to Paraguay by land. The South American Handbook stated: "We have received no reports from people, who have been travelling through the Gran Chaco by land". So you achieved something which was still impossible for me twenty years ago. Congratulations! Regarding your health problems, I can say, that the greatest danger in remote, isolated and largely uncivilized regions are not robberies, wild animals or the loss of documents or money, but a serious illness. You were lucky enough to get a good medical treatment in Santa Cruz - a rarity in this part of South-America. Santa Cruz is known for its good medical institutions - many Brazilians study medicine in that town.

Health in Bolivia X Brasil X South America
It is necessary to clarify some myths concerning Medicine in Bolívia. Of course there are doctors which are very good on what they do and others who are not - in Bolívia or any place in the world. The good side is that you were lucky to find a good doctor and that – for that region! Including Paraguay, Bolivia and other poorer neighboor countries – Medicine in Santa Cruz de la Sierra is good. But is not wonderful or international reference. The profile of boys and girls from Brazil who study Medicine in Bolivia consists of a youth from North and Northeast regions (mostly from Maranhão State) who not obtain minimum points to be approved on Brazilian “Vestibular” (is a test, a selection students in all areas do including all content taught during high school in order to verify if someone has conditions to go to university – I did Vestibular once, in 1994, to verify if I was able to study Social Communication at the University and I was approved). Courses like Medicine, Odontology, Law, Architecture, Social Communication and the several Engineers are very disputed and so the candidate must study a lot, like 16 hours a day (no joke…) because it is thousands running for 30 or 40 vacations per University… And if someone applies for the best, more renewed Universities, like University of Brasília or University of São Paulo (which require maximum punctuation on their tests, than the person sometimes studies for 2 or 3 years until being approved….. The Public Universities are more searched than the Private Universities here, because the teaching at a Public University is excellent, with professors with the best graduations, people who have, for example, PHD in Physics in Germany, for example. And so, some don’t like to wait studying for years until being approved and prefer to do Medicine at Bolívia or Cuba (to Cuba go those members from the MST, they go with a clear political purpose). That’s when their problems start. Some enjoy the teaching in Bolívia, others don’t (there are reports of students who said the professor gets delayed on classes, don’t apply enough content, approves students based in corruption…) and when they come back to Brazil in most of the cases they can’t exercise their profession in Brazilian soil…….. Why? Because the Brazilian Ministry of Education applies a test for Brazilians who went to a University abroad called “Revalida”. This test values for any area of knowledge – and in other countries the validation process is no different for foreigners. If I studied Jornalism abroad and came back to Brazil I would need to do this Revalida. The point is those who study Medicine in Bolívia and Cuba are, the majority, Reproved in this Revalida (i.e. can’t be doctors in Brazil, unless they want to be illegal and it’s a crime to exercise Medicine in illegal way). There are stories about people who spent the amount of U$ 10,000 simply because they cant be approved on the Revalida, they must travel to Brasília to do the test and with translation of documents. The thing is, students who did a graduation in Europe or USA are like 99% approved by the Revalida, while those from Bolívia are not………… If someone who did a course at Harvard, Cambridge, Oxford is approved at the Revalida and a student who did the same course in Bolívia or Cuba is not………. Then, obviously there’s something very wrong and the quality of teaching in Cuba and Bolívia is not the same as in other countries…... More than this, is the myth of Cuban Medicine going down, demolished by statistics. Here are some news (in Portuguese) about students from Bolívia and Cuba reproved in Brazil when they wish to transfer their diplomas: http://g1.globo.com/mato-grosso/noticia/2013/07/ufmt-aprova-apenas-um-entre-508-diplomas-de-medicina-da-bolivia.html (UFMT, a public Brazilian university at Center Region, approved only one among the 508 diplomas obtained in Bolívia) http://opiniao.estadao.com.br/noticias/geral,medicos-reprovados-imp-,661301 (on another selection, from 628 only 2 with diplomas from Bolivia were approved) http://noticias.terra.com.br/educacao/revalida-com-92-reprovados-cfm-cobra-rigor-com-medicos-de-fora,d34d67560b19c310VgnVCM4000009bcceb0aRCRD.html (92% of 884 reproved in 2013. Those who were approved studied Medicine at Argentina, Uruguay, Spain, Portugal, Germany, Italy, France, Poland) Now imagine a person studying abroad, spending time (6 years) and money (because in Bolivia university is private, paid), coming back and being not able to have the career they chose……. Contrary to Bolívia, Brazil IS international reference in Medicine (not only in plastic surgery, a speciality Brazil is famous for, attracting sub-celebrities from the world). Brazil is reference in treatment of AIDS, transplant of medulla (bone marrow) and tissues, surgery for burnt, etc. Brazil has very good hospitals among that 6,000 that belong to the Brazilian Health System, being 24 considered international pattern centres, having the most important hospital certification in the world, given by the Joint Comission International : in São Paulo, the Samaritan Hospital, the German Oswaldo Cruz, the Israeli Albert Einstein and the Syrian-Lebanese, the Heart Hospital (if I needed, would trust much more on those, than in hospitals from abroad); Moinhos de Vento, Hospital of the Child Santo Antônio and Hospital of Clinics, in Porto Alegre; Copa D’Or, National Institute of Cancer and National Institute of Traumatology and Orthopaedic, in Rio de Janeiro; Memorial São José in Recife, Northeast; among many others. The best countries in Latin America to study Medicine outside Brazil are in Chile, Colombia and Argentina (in Buenos Aires, not in the countryside). So, don’t believe when someone says it’s a rarity in South America………. That’s absolutely not true. There are problems in Brazil and neighbour countries, but it doesn’t mean that quality is rare or doesn’t exist. What happens is in those countries (Brazil included) there is not enough distribution for hospitals and doctors in more remote areas, rural, isolated, “uncivilized”. That is why the Brazilian government brought a lot of doctors from Cuba (and I already know about cases of medical mistakes done by them) and many hate their life in Cuba, are unhappy with the payments given by Brazilian government and so a considerable number used the program More Doctors asking for asylum in Brazil, to don’t go back to Cuba at the end of the program, while others see Brazil as an opportunity to move from here to the USA……. Imagine this situation. It is happening now. So, there is this problem concerning remote areas (few people, after graduation wish to work at a State in the North or Northeast – they prefer doing their professional careers at the States of the Centre, Southeast and South) and also the problem concerning the Public Health System in Brazil, for free. The problem in Public Health is the delay, the long queues and the bad humour and lack of specialization of doctors who receive a bad salary in public health (and wished to be working at a private hospital, with resources and excellent salary). Those who can pay for a Health Insurance Plan or a Private Hospital don’t face that reality. **Me** and everybody I know (middle class, which can also englobes low and upper middle class) have a Health Insurance Plan, paid each year to guarantee excellence in treatment. I never needed any treatment I wished abroad. Since I was born, I always was attended by doctors of excellent quality in all areas of health. Dermatology, Paediatric, Dentist, Ophthalmology, Endocrinology, Gastroenterology, Otorhinolaryngology: everything, including Psychology (excellent professionals oriented by Jung, Freud, Gestalt, Karl Rodgers, for all tastes). There are good things here and they are not difficult to find. But the person needs to know where to go to obtain those benefits.

Interesting painting. I've just noticed the presence of both a fascio (on the right) and a phrygian hat (on the left), a typical symbol for the jacobins. Funny.

Santa Cruz de la Sierra it's the zone of Bolivia that has more white population, according to statistics. Some also say it's the home of the hottest chicks in South America...

Being sick on the road
Welf, so glad you are feeling better. Being a nurse my heart was pounding as I read this blog. I couldn't read fast enough to find out your diagnosis and treatment plan. Thank goodness you got the help you needed when you did or this could have been a very different outcome. Being sick when traveling is never fun but pneumonia is nothing to mess around with especially in altitude. I was sick in Bhutan but fortunately I started taking meds right away. We always travel with a small pharmacy. Eager to hear more of your wonderful adventure.

Graδ' noch mal gut gegangen!!
Hi Welf ich bin sehr froh, dass es dir gut geht und das du auch dieses Abenteur gut überstanden hast. Lass dich aber zwischendurch noch mal untersuchen, denn mit Lungenentzündung ist nicht zu spaßen und man muss aufpassen, das einem nichts zurück bleibt. (Ich spreche hier aus eigener erfahrung!!! Deine Reiseberichte sind wirklich super, und eine Fotos finde ich auch ganz toll. Ein Freundin hat mir gesagt, du solltest mal versuchen einige bei NATIONAL GEOGRAFICS anzubieten ..... Take care of you self and stay safe. Big kiss your sister