"We need a physician to run our pediatrics clinic in Bolivia. Will you do it?"
This is how the adventure starts. If I'm being frank, this is USUALLY how the adventure starts, as it's rare for me to decline an offer when a memorable experience awaits. I blame my love for travel when combined with my passion for medicine. I just can't say no.
This trip, however, is different. Rather than working out of a hospital or a clinic, our medical team is working out of Palmasola prison, one of Bolivia's most notoriously dangerous prisons. Located in Santa Cruz, it currently houses around 4000 prisoners - men, women, and children. Bolivian law mandates that children under the age of six may live inside the prison with their families. Thus, when a parent is sentenced to time inside the prison, rather than being orphaned, they may continue to live with their family unit, albeit under very different circumstances.
Aligning with the small city feel, Palmasola is laid out with a main alleyway lined with makeshift shops and inmate-owned businesses, where handmade trinkets and food are sold. The alleyway leads to a dusty pitch where inmates don jerseys and play a rugged game of futbol at dusk. Children run barefoot among the inmates - murderers, pedophiles, robbers among them. It is organized chaos at best.
In Bolivia, the prison system is quite different than in America. Similar to most prisons in Latin America, the prison is mainly run by inmates. Palmasola is structured with two surrounding walls, heavily secured with guards around the outer perimeter. Just inside the outer wall is a grassy area where horses roam free amongst trash. In the evening, guards ride the horses around the walls to make sure everything is in order. Inside the inner wall, the prison becomes the domain of the inmates. There is an established hierarchy, known locally as the Disciplina Interna, with more powerful inmates acting as 'guards' and officials - these guards will be our personal security while inside.
We are transported from our hotel into the prison by a prison bus - a windowless tin cage on wheels. We cross security checkpoints, getting stamped on our arms, our identification cards taken from us and our names checked off on list after list. Finally, we file single file through a large metal gate and are inside PC4, which feels like it could be any city slum in any country in the world. There are four different sections inside Palmasola: 1) the administration block, 2) PC2, the women's prison where we will go in two days' time, 3) PC3, where the most dangerous inmates are held and 4) PC4 where we will see most of our male prisoners as well as children.
We file through the dusty alleys toward the building where we will set up our clinic. Inmates line the walkway and a crowd gathers, feeling like a makeshift parade.
A call from the crowd: "Doctora! Una besito?!" I continue walking, eyes on the ground in front of me.
We arrive at a large open building and are ushered up a set of smooth tile stairs into an open room. An open balcony spans one wall, beckoning the breeze into the room. It stirs the dust into tiny tornados along the floor, which move in time to music booming from huge speakers along the wall. The inmates have arranged for one of them to work as a DJ for our clinic - Americans, after all, must love music. Our clinic will be lively today.
I set up my clinic - one table, four plastic chairs, and a bench along the wall that holds my supplies: my stethoscope, an otoscope which barely made it through airport security, a blood pressure cuff, minor procedural tools, and a vast array of medications.
Around me, my colleagues have set up similar workstations around the room and in the middle of the room, long wooden benches act as a waiting area. Our triage station at the top of the stairs is already bustling with activity and the air in the room is thickening with humidity and anticipation. Soon, patients approach my clinic and as I start to work, the surroundings fall away and I'm left with the reason I came: medicine.
For more information on Palmasola and its infrastructure, this is a good article: