Unequal Cures: Public Health and Political Change in Bolivia, 1900–1950 (review)

Unequal Cures is a well-written and thoroughly researched historical analysis of health care that neatly weaves together issues of gender, ethnicity, international health care, and medical access in Bolivia from 1900 to 1950. There is very little historical research on medicine or public health in Bolivia, and therefore Zulawski’s book is a welcome addition to the literature. Drawing on multiple text sources ranging from hospital documents, physicians’ writings, newspaper articles, and oral history accounts of soldiers’ war experiences, this book presents a thoughtful argument that encompasses both the highlands and lowlands of Bolivia.

A primary goal of the book is to evaluate and examine the Bolivian health care situation during a time in which Zulawski argues medical doctors were attempting to establish their professional authority and roles as national policy makers. In discussing the tensions between multiple medical practices such as Kallawaya healing, midwifery, and Western biomedicine, she presents analysis of the prevailing discussions on gender, identity, health, and illness in Bolivia during the early twentieth century. The book begins with a comparison of the writings of two prominent doctors on “the Indian problem” and establishes connections between the medical profession and debates surrounding Bolivian Indians’ eligibility for health and citizenship. It then traces the rise of a national health crisis prompted by the Chaco War and subsequent implications for emerging populist beliefs of health care as a right for all. The third chapter discusses the changing relationship between Bolivia and the Rockefeller Foundation. The Rockefeller Foundation was first welcomed in Bolivia with a campaign against yellow fever in 1932 and expanded with attempts to control malaria, hookworm, and other infections until their departure in the 1950s. The following chapter focuses on women’s health, primarily in the capital city of La Paz, and issues of gender and ethnicity. The final chapter traces the history of Bolivia’s national mental hospital.

The first three chapters build a solid historical picture and collectively contribute to the book’s themes. The chapter on the Chaco War with Paraguay (1932–1936) is as a particularly vivid and well-researched description of the role of war in shaping disease patterns, public health infrastructure, and national health and social policy. As is often the case, infectious disease combined with malnutrition and dehydration killed far more soldiers than combat, forcing health care into the government’s national agenda. Zulawski argues that the catastrophe of the Chaco War exposed failures in the medical system and allowed doctors the prestige to propose solutions to the countries pressing health care problems. As a result, the Bolivian constitution of 1938 recognized providing health care to all as a governmental service.

The final two chapters appear more as case studies, focusing on gender and mental illness respectively, that illustrate recurring themes from the first three chapters. In her chapter on gender, Zulawski notes that, although in postwar Bolivia health care was considered a government service and a right of all Bolivians, careful reading of medical documents suggest “even with this new rhetoric, women and native people still did not enjoy full citizenship” (p. 192). In facing medical challenges including high infant mortality rates and problems with infectious disease, writers often linked disease to gender, particularly to indigenous women. These women, who were accused of failing to fulfill family or social obligations, became potential sources of disease that could threaten national health.

Unequal Cures will be of interest to medical historians, anthropologists, and anyone with an interest in the history of health in Bolivia. This book could be suitable for upper-level courses in Latin American health or medical history, and several chapters would be suitable as stand-alone classroom readings. Although each chapter focuses on a different aspect of the Bolivian health care system, they each remain connected through a discussion of how Bolivian categories of class, gender, and ethnicity shaped the policies advocated by physicians.

In sum, Unequal Cures provides an...