Unequal Cures

Unequal Cures illuminates the connections between public health and political change in Bolivia from the beginning of the twentieth century, when the country was a political oligarchy, until the eve of the 1952 national revolution that ushered in universal suffrage, agrarian reform, and the nationalization of Bolivia’s tin mines. Ann Zulawski examines both how the period’s major ideological and social transformations changed medical thinking and how ideas of public health figured in debates about what kind of country Bolivia should become. Zulawski argues that the emerging populist politics of the 1930s and 1940s helped consolidate Bolivia’s medical profession and that improved public health was essential to the creation of a modern state. Yet she finds that at mid-century, women, indigenous Bolivians, and the poor were still considered inferior and consequently received often inadequate medical treatment and lower levels of medical care.Drawing on hospital and cemetery records, censuses, diagnoses, newspaper accounts, and interviews, Zulawski describes the major medical problems that Bolivia faced during the first half of the twentieth century, their social and economic causes, and efforts at their amelioration. Her analysis encompasses the Rockefeller Foundation’s campaign against yellow fever, the almost total collapse of Bolivia’s health care system during the disastrous Chaco War with Paraguay (1932–35), an assessment of women’s health in light of their socioeconomic realities, and a look at Manicomio Pacheco, the national mental hospital.

“Unequal Cures is an original and well-crafted historical study that opens fresh new perspectives on old issues, namely the formation of racial, class, gender, and national identities in a modernizing multiethnic nation—in this case, Bolivia. This fascinating and sweeping history of nation-making told through the rare lens of public health discourses and policies is a first-rate contribution to the fields of Andean studies and the social history of medicine in Latin America.”—Brooke Larson, author of Trials Nation Making: Liberalism, Race, and Ethnicity in the Andes, 1810–1910, “This meticulous study of Bolivia, one of the poorest countries in Latin America, shows why doctors and public health officials were unequal to the task of improving the health of the majority of its citizens in the first half of the twentieth century. Using the tools of social and medical history to great effect, Ann Zulawski demonstrates that the divisions of ethnicity separating the small white elite from the mass of the Indian population meant that the gap between the rhetoric of biomedical improvement and the reality of Indian ill health remained huge, even in the more progressive 1940s and 1950s. A sad and important contribution to the field.”—Nancy Leys Stepan, Professor of History, Columbia University, “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.”, “Ann Zulawski’s study of health and the distribution of medical care in Bolivia in the first half of the twentieth century provides an insightful and subtly drawn account. It is a welcome addition to, and one of the finer examples of, a growing literature on health and medicine in Latin American history.”, “This is a significant contribution to the field of Andean historiography, as well as to broader studies of gender, ethnicity, health and politics. . . . [T]he book’s originality rests in the way it links conflicts and policies pertaining to the establishment of a public health program in a small, poor country during the first half of the twentieth century to the larger context of gender, ethnic, and political history.”

Ann Zulawski is Professor of History and Latin American Studies at Smith College. She is the author of They Eat from Their Labor: Work and Social Change in Colonial Bolivia.