I can´t believe that title is true. It feels so good to be done with medical school!!! There have been many ups and downs during med school, but more than anything I have learned that God is faithful. And what a great last rotation! I have had a wonderful time this month and learned so much – not only about pediatrics but also compassion, global health, the Bolivian culture, Spanish and cultural competency in medicine. This week, we were technically on nephrology but ended up being in the general pediatric ward. Like I said earlier, the two wards are combined. There have not been any nephro patients the last few days because the nephrology doctor is on vacation. We have seen many interesting, and some sad, cases:

-hemophilia type A (two different cases). Hemophilia is a disease of the blood where you are missing one of the things you need for your blood to clot properly. One boy fell and has hemarthrosis (blood in a joint) in his left knee so is here recovering from that.

-a 4 year old who ingested 30 mL of what we think is bleach, although we don´t know the Spanish word for bleach so who knows what he really got into. He came into the hospital with intense pain in his mouth but is fine and going home today!

-an 11 year old with nephrotic syndrome, who went home yesterday. His biopsy is scheduled for April 29. His mom was finally able to raise all the funds for it. It will cost about 7,000 Bolivianos which is $1,000. Social work helped her a lot with the funding aspect.

-a 12 year old male with non-Hodgkin´s lymphoma that was diagnosed in December 2013. He had chemotherapy following his diagnosis without any success, and since February has been receiving palliative chemotherapy. He has several HUGE masses on the left side of his neck, and another mass in his left armpit. He was diagnosed yesterday with PCP pneumonia and they started him on Bactrim. His oxygen saturation dropped very low yesterday so he has been on oxygen since then; it improved today and is almost back to normal. I am not sure if they have the palliative care specialty here or not (it wasn´t even an official specialty in the U.S. until 2007), but this is a perfect example in my opinion of why palliative care is so important. The doctors plan on doing another biopsy to see how to further direct treatment. The family cannot pay for the treatment but social work is helping them. They are expecting the biopsy to show a very malignant form, and think his prognosis will be poor either way. 

-a 2 year old female who has a very complicated medical history. I wrote a lot about her on my last blog…she is my favorite. Such a sweet little girl. A nurse told me the other day that she is la dueña del hospital (the owner of the hospital). Everybody here loves her. She has her own chest of clothes next to her bed and also has tons of toys. Many people come and play with her – nurses, parents, residents… everybody. Yesterday, the parents of another kid in the unit went and bought her things she needed, like extra baby wipes. She also loves notebooks and will try to grab for any notebook in sight. They use a notebook to motivate her to do her physical therapy, haha. She is not walking yet but they do therapy with her every day and she is able to sit on her own. Today Kayla gave her her very own notebook and wrote her name in it, which she absolutely loved. I have been learning a little more about her history. She was abandoned by her young parents at birth and has been in the hospital since she was 1 year old (she is now 2 years 4 months). She was admitted to the pediatric ICU (I assume from an orphanage although I am not sure) at 1 year because she had pneumonia which turned into septic shock (bacteria in the blood which can cause multiple organ failure), which resulted in her being on a mechanical ventilator. They were not able to wean her off of the ventilator which is why she got her tracheostomy. She also has a Gastrostomy tube – a tube that was inserted surgically directly into her stomach – and receives all of her food that way. She is doing much better now, but no orphanages around here will accept her because she still has a lot of secretions coming from her tracheostomy which requires more care than they are able to provide. I am going to miss seeing her every day and playing with her!

As the weeks have gone on and I have been more exposed to the way things run at Hospital del Niño, I have decided that having one big unit with all the beds in the same room has many advantages. While children´s hospitals at home have playrooms where the kids can come together and play, most of the rooms are either private or have 2 beds. Here all of the mothers get to be good friends, especially if their children remain in the hospital for an extended period of time. The patients also get to be good friends. They play together all the time, and yesterday when one of the babies started crying on rounds (her mom had run down to the cafe to get some food), the 12 year old who was in the bed next to her came over to play with her so she would quiet down. Apparently hemophilia is not very common here, but the two patients with hemophilia are in beds right next to each other and I have witnessed the two moms talking to each other a lot. They help each other by talking about their own experiences. A very neat picture of community. I do appreciate private rooms and understand their importance (not to mention HIPAA), but also maybe think the United States might be missing out sometimes…

Dra Uribe also gave us a great lecture on Monday night about teenage pregnancy in Bolivia. She is an adolescent medicine doctor. By far, the highest rate of teenage pregnancy occurs in El Alto, which has approximately 1 million residents. El Alto has the reputation of being the poorest section of town. She said it is not uncommon for her to have 13 year old patients who live with their significant other and their child. Abortion is illegal here in Bolivia but many abortions still happen, especially in El Alto. When I was at Hospital de Los Andes last Saturday, I saw many young moms in the postpartum unit. All forms of birth control are free in Bolivia but often birth control is not used due to the cultural or religious beliefs. Dra Uribe has a really neat program that she started to help these young moms. She began a day care for around 20 children, where the moms take turns watching the children while the others go work. Dra Uribe visits the daycare often to educate the moms on basic health concepts. A great idea, and one that seems to be making a world of difference in the lives of these moms. The young moms here are also allowed to take their babies to school (high school or college) if they are still studying. She expressed her frustration that many Bolivians argue against abortion (it is a predominantly Catholic nation) but do not do anything else to help these young moms. I personally do not believe in abortion either, but wholeheartedly agree with her that just protesting against abortion is not enough. I think her program is a great solution and I am sad that I couldn´t visit the daycare! It has been great to work with her this month. I learned a lot from her weekly lectures…she spoke slowly during these lectures so it was easy for me to understand her Spanish. 🙂

 In other news, we have been trying to fit in all the things we want to do in La Paz since we leave this Sunday to come back home. Our host mom has been cooking us delicious Bolivian food, as usual, and I have gotten to try many new foods. We have also been exploring downtown more. Yesterday for Spanish class, our teacher took us to a big museum about the Bolivian culture, which was really neat. She is so knowledgeable about the history of the country and it was awesome to get the scoop from her (all in Spanish, of course). Today for our last Spanish class, she is taking us to more areas around the city where we have not been yet. We are also going with her early tomorrow morning to El Alto to go on a FREE tour of cholets, which are houses that the indiginous people live in. They are designed by a young Bolivian architect and are very colorful. They actually kind of remind me of Las Vegas a little bit. I love free things and am excited to get to spend one last day with Jenny.

Judithe and I went to our last Bible study on Wednesday night and they had a despedida (aka a going away party) for us. They had food and even a cake with our names on it! It was a great blessing for me as each person in the Bible study went around and encouraged us, and thanked us for being here in Bolivia. This Bible study has been one of my favorite things this month. They gave us a gift, a little plaque with a Bible verse in Spanish to hang on our walls at home. Judithe and I were praying before we came that we would find a good church to attend while we were here. Not only did we find a good church and Bible study, but our host family and Spanish teacher are both Christian, as well. So many new Bolivian friends, and so many answers to our prayers! We all exchanged contact information and plan to keep in touch…heaven knows I need to keep practicing my Spanish haha.

I am currently using the computers at the hospital library but will try to upload pictures from this week from my phone a little later tonight. Happy Friday!! Hope everyone has a wonderful weekend.






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