[4][5] One of seven children born to Dionisio Morales Choque and María Ayma Mamani,[6] only Esther and two of her siblings, Evo and Hugo, survived past childhood.

[1][5] Esther Morales, who had to leave elementary school when she was just 8-years old, was also responsible for raising her younger brothers, including Evo, when their mother died.

[1] Still, in January 2006, he announced that his older sister, Esther Morales, who was still working as a small scale grocer at the time, would assume the role of acting First Lady of Bolivia for official functions and protocol events.

[1][2] Esther Morales, then 55-years old, appeared at her first event as Bolivia's first lady-designate on 21 January 2006, one day before her brother's inauguration, when she visited Tiwanaku, a historic Pre-Columbian indigenous site near Lake Titicaca.

[1] On 8 March 2006, Esther Morales closed her store in Oruro and traveled by bus to the Casa Grande del Pueblo in La Paz to attend a presidential ceremony honoring Bolivian women.

"[2] Observers noted that the appointment of his sister to acting First Lady indicated that President Morales wanted to focus on the poor and Indigenous peoples in Bolivia.

[2] The Daily Telegraph wrote in March 2006 that, "Her elevation is a strong indication that her brother aims to define his period in power as the peasant presidency.

"[2] Esther Morales spoke of her excitement at the prospect of official travel to represent Bolivia abroad, though she admitted she had much to learn in-role.

[9] In January 2012, First Lady Morales met with members of the Bolivian immigrant community [es] at the Casa Amèrica Catalunya [ca] in Barcelona, Spain.

[3] Despite the president's public reversal, Esther Morales continued to serve as the acting first lady (or its equivalent) for several years,[13] though in a diminished capacity.

She had initially been treated in the emergency room of San Juan de Dios General Hospital, but was not admitted due to a shortage of beds in the intensive care unit.

[14] Relatives unsuccessfully tried to have her admitted to several private clinics and hospitals, but they reportedly could not reach them due to road blocks and political unrest in the region.