Prison Medicine in La Paz

Centro de Orientacion Femenino Obrajes (CoF) is a state prison for women in La Paz. One of the things that makes this prison remarkably different from other prisons is the large population of children that call it “home”. In Bolivia, when an individual is sent to prison either awaiting a court date or carrying out their sentence, they are allowed to bring their children with them. Many convicts do not have anyone on the outside available to care for their children. In CoF there are currently over 250 children from newborn to 14 years of age who will remain in prison until their mothers complete their sentence or until they “age-out” often going back out into the streets of La Paz . To these children, prison is a “normal” home and every day, they make their way to either day care or school.

The grounds are far from the sterile, modern grounds seen in much of our penitentiary system in America. Instead, they all live in what appear to be dilapidated ruins of times gone by, fenced in with high walls. Dr. Sergio Armaza, a physician in general medicine, and Dra. Mary Pally, a dentist, come weekly to serve in an ambulance from Hospital Arco Iris. They are eagerly welcomed by the children and mothers. The consult room gets busy as the children rapidly line up. Many come without their mothers with a series of complaints. Some, I am sure, show up to receive the warmth and support of this excellent team that treats every inmate and child with outstanding concern, compassion and dignity. The complaints varied from skin infections, malnutrition, urinary tract infections, to upper respiratory infections. Some of the children, needing further testing, will be taken to the hospital by the social worker. One mother brought with her four of her five children ranging from two years of age to ten, all in need of medical treatment. Most of the children had rotten, black teeth, if any, from the candy and sodas fed to them from early age. Dra. Pally did dental care, gently filling each cavity, giving fluoride treatments and applying sealants with absolutely no anesthesia of any kind. The amazing thing was watching three year olds sit with their mouths wide open without flinching or complaining. Most of these kids live in a world with much pain. Dental care is nothing to them. Every child was treated, compassionately and thoroughly even though it meant staying a few hours beyond the allotted time, without a hint of a complaint from the medical staff. It was medicine the way it should be, with the needs of the patient of primary importance.

-Lin Beaty

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