In Bolivia, the government does not provide free service for the care of many diseases and disabilities, and the public health system in the country does not serve the general population. Public hospitals are worn and uncared for, and there are not enough doctors or hospitals. Things seem to be getting worse. Low-income people die for lack of care or lack of medicine because there is no subsidy for many cases.

There are not enough medical specialists in the country to meet the demand of the population. People with diabetes do not receive any kind of help to get insulin and other supplies. Low-income people struggle every day to buy their insulin, which is not cheap. In addition to that, there is no public or private health care that supports people with diabetes or other diseases.

What happens if you need to see a doctor?
The public health system in the country is collapsing, and to see a doctor there are long lines of people waiting to be served. There are no diabetes specialists and very few endocrinologists that work with diabetes. Because there is not enough education for people with diabetes to have a good control, many with low incomes turn to natural medicines that lead to serious health problems.

Who decides what doctors can prescribe?
The health ministry is responsible for seeing that the medicines enter the country, doctors prescribe based on what laboratories and importers offer. However there is a lot of smuggling in the country and medications appear which no one can confirm the kind of quality they have. Doctors prescribe medication depending on their criteria and sometimes the economic level of the patient.

Practically, what is it like to live with type 1 diabetes in Bolivia?
To survive with diabetes in Bolivia you have to be lucky. More than 60% of the population in Bolivia is poor. Out of every 10 people with diabetes, six are low-income and only four have the economic availability to support treatment. With so much poverty in the country, many people living with diabetes can only use NPH and R insulin. They can´t use analogue insulin, pens, nor can they measure their blood sugar more than two or three times a day. They wouldn’t dream of having an insulin pump due to the high cost. People’s care varies a lot depending on their economic power, many people do not have money to buy test strips and spend weeks without measuring their glucose.

What about getting admitted to hospital?
When you are treated at a hospital and say you have diabetes the treatment is different, as many physicians are not well informed ad believe that having diabetes means you are doomed to suffer all the complications. Not all doctors in Bolivia know how to treat an emergency with a patient who has diabetes. Moreover, education about diabetes for both doctors and the public does not exist. As a result, many people of all social classes have complications of diabetes.

How does diabetes care vary throughout Bolivia?
In the cities, people have to work themselves hard to get money to buy your insulin. The economic level of most people is not enough to afford a good treatment. Unlike the upper class, who can access analogue insulins, test strips and insulin pump therapy.

In many parts of the country people don’t know the treatment for diabetes or have false beliefs about how to treat it. From remote populations to cities people do not have adequate education and prefer natural medicine. As a result many people die from herbal poisoning or become very ill. In many cases they must make what little they have last as long as possible, so people turn to urine strips or use insulin past the expiration date.

Thanks to Laura Ortiz and Natán Gutiérrez from Bolivia for providing this information.