The Need: An Introduction to Trauma in Bolivia

The Plurinational State of Bolivia is one of the poorest and least-developed countries in the Americas, with the lowest GDP per capita in South America and third lowest in the Americas. Its mountainous terrain and poor road conditions, combined with minimally-enforced vehicle and driver standards, result in an incredibly high number of fatal road traffic accidents.

This past week, I reviewed all of the articles pertaining to road traffic accidents dating back to the New Year.  What I found was shocking: between Jan 1 and Feb 12, 2013, there have been at least 118 people killed and over 374 injured from road traffic accidents alone.  To demonstrate the severity of the issue, I’ve briefly described some of the accidents below:

Jan 1-7: 3 accidents, 9 dead, 20 injured

Jan 8-14: 3 accidents, 6 dead, 22 injured

According to one of the survivors, “My wife has died due to lack of help, because we were stranded there for almost 2 hours.  There was nobody to save us; the other vehicles did not want to help us.”

Jan 15-21: 3 accidents, 40 dead, 76 injured

On Jan 21, a bus carrying 56 passengers (44 seats) fell 250 meters off a cliff and into the Unduavi River.  Miners downstream saw victims floating by but were unable to attempt rescue due to the force of the current.

Jan 22-28: 6 accidents, 44 dead, 126 injured

On Jan 23, a bus carrying 55 passengers flipped onto its side and fell 200 meters.  According to the police report, “the passengers found on the left side of the bus were injured the most because, during the fall, the bus decapitated, amputated, mutilated, and dismembered them.”

Jan 29-Feb 4: 2 accidents, 2 dead, 52 injured

Feb 5-12: 11 accidents, 17 dead, 78 injured

While road traffic accidents account for the majority of traumas worldwide, there also exist many other types of trauma throughout Bolivia.  One especially common type of trauma here in La Paz is stabbing.  Though we do not presently have data on the number of stabbings, there have been at least 2 publicized stabbings since my arrival 5 days ago, including a journalist who was stabbed 15 times by her husband.  The victim was brought to the nearest hospital where she was refused treatment, likely due to the extent of her wounds.  She was turned away at two more hospitals before she was finally accepted at a fourth hospital where she ultimately passed of two fatal wounds to the left lung and heart.  While it is inhumane to refuse treatment to a dying patient, it should also be noted that physicians in Bolivia do not receive any formal training in trauma care, and those in the emergency department are simply general physicians without training in emergency medicine.  Further, the vast majority of hospitals in Bolivia are understaffed and poorly equipped, making the care of severely injured patients very difficult.

Ultimately, these are the reasons we are here in Bolivia.  These vast numbers of mass casualties would be unacceptable in any developed country, yet they have become an accepted risk of daily travel here in Bolivia.  In addition, the lack of capacity to care for trauma victims at large results in many preventable deaths. While these issues are deeply engrained in the current structures in place, it is our hope that our projects will begin a movement of change in the care of Bolivia’s trauma victims.

“Asi quedo el bus que cayo a una profundidad de al menos 200 metros en el camino a La Asunta. Familiares rescatan pertenencias a sus seres queridos.”
“Here is the bus that fell a distance of at least 200 meters from the road La Asunta. Relatives gather the belongings of their loved ones.”