Unequal Cures

Public Health and Political Change in Bolivia, 1900–1950

Unequal Cures

Book Pages: 264 Illustrations: 12 b&w photos, 2 maps Published: January 2007

Author: Ann Zulawski

Gender and Sexuality > Feminism and Women’s Studies, Latin American Studies > Andes, Medicine and Health > Public Health and Health Policy

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 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.” — Susan Tanner, Journal of World History

Unequal Cures is an elegantly written and accessible social history that investigates the role of scientific medicine in Bolivian state formation, where governing elites saw racial and cultural heterogeneity as an impediment to modernity.” — Tien-Ann Shih, Ethnohistory

“[A]n important study of the problems of disease and the politics of public health, race, and gender in Bolivia. Her work is a vital contribution to the new literature on the history of medicine and public health in Latin America in part because of its originality. Unequal Cures is the first major historical study of Bolivian public health to be published in English. Zulawski, moreover, draws from archival sources few have touched in the development of this project. . . . I hope that this work will be widely read, as its usefulness and relevance extend far beyond the interests of Bolivianists and other Andeanists.” — Adam Warren, A Contracorriente

“[W]hen she deals with disease, medicine, and the challenges of provisioning public heath care, Zulawski makes an extraordinarily strong contribution.” — Ronn Pineo, Hispanic American Historical Review

“Ann Zulawski . . . has taken on the considerable challenge of missing archives with courage and creativity. . . . Unequal Cures . . . offers one of the first gazes into the social history of public health in Bolivia.” — Anne-Emanuelle Birn, Social History

“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.” — Julia Rodriguez, The Americas

“Ann Zulawski's excellent book focuses on the negotiations over Western medicine in Bolivia and contributes a rich, insightful case study to the scholarship on the politics of health. . . . Zulawski's detailed depiction of Western medicine in Bolivia represents a greatly appreciated contribution to the study of health, ‘race,’ gender, and nation-building. It will also serve as a valuable teaching tool in courses on the politics of public health, and in classes that address the histories of health and citizenship rights in the Americas.” — Jadwiga E. Pieper Mooney, Canadian Journal of History

“By historically enlarging the present, Unequal Cures opens an important analytic door for the reflection about current health problems in Latin America in a so-called global era.” — Gilberto Hochman, Global Public Health

“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.” — Teresa Meade, American Historical Review

“This is a well written piece of historical research that remains highly objective. It has a strong focus on the everyday experiences of ordinary people, and its inclusion of high politics and the opinions of top medical practitioners serves to re-emphasise how social and economic progress was made at a grassroots level. At the same time, the author throws up intriguing observations about Bolivian life at all levels that will capture the interest and imagination of the general reader as well as the student of Latin American history and politics.” — Jay Kerr, Latin American Review of Books

“This new monograph on the history of medicine and health care in Latin America is a welcome addition to a rapidly evolving historiography. Where most of the literature on the subject addresses the major and intermediate countries of the continent, this examines a minor republic that was the poorest in South America in the period covered.” — Christopher Abel, Medical History

“Zulawski demonstrates that Bolivian biomedical doctors were always already political figures engaged in a complex negotiation and definition through their practice of ethnicity and Bolivian identity. . . . And she backs up this conclusion through careful historical scholarship.” — Katherine McGurn Centellas, Journal of Latin American and Caribbean Anthropology

“Zulawski has written one of the most comprehensive histories of public health on a country often deemed, even by foreigners, of little importance to the region. Her book will help to transform this misperception. [E]ssential reading for anyone interested in the history of medicine or public health in the developing world and specifically in Latin America.” — Gabriela Soto Lavega, Bulletin of the Pacific Circle

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


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Author/Editor Bios Back to Top

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.

Table of Contents Back to Top
Illustrations viii

Acknowledgments ix

Introduction 1

1 Hygiene and the “Indian Problem”: Ethnicity and Medicine in the Early Twentieth Century 21

2 The Medical Crisis of the Chaco War 52

3 The Rockefeller Foundation in Bolivia, 1932-1952 86

4 Women and Public Health, 1920s-1940s 118

5 Mental Illness and Democracy: The Manicomio Pacheco 157

Conclusion 190

Notes 197

Bibliography 225

Index 243
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Additional InformationBack to Top
Paper ISBN: 978-0-8223-3916-8 / Cloth ISBN: 978-0-8223-3900-7
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