Bolivian healthcare and culture: summative blog post

Judithe and I got home safe and sound on Monday morning around 11. Thankfully, everything went smoothly this time around unlike our multiple delays in getting there. We had to spend Sunday night in the Washington D.C. airport since we had a long layover there. One last adventure to end our trip (although I would like to take this opportunity to remind my future self that it is probably not worth it…just pay the little bit of extra money next time to get home sooner…haha). I have been processing all that I saw last month, and still feel like I have a lot to think about. This will be my last post but if any of you have questions about my trip, I would love to chat about it 🙂 The major thing I learned while in Bolivia is how much culture truly affects every area of one’s life, including their health and how they view medicine. I have not talked much about Bolivia’s culture on these blogs yet but hopefully I can give you a good overview. Both my host mom and Spanish teacher were so knowledgeable about Bolivia’s history, culture and traditions, and took every opportunity they could to teach us about it. I have mentioned that the majority of Bolivia is Catholic, but many of the indigenous people who live in the Andes mountains, and even some in La Paz, worship the goddess “Pachamama,” or “Mother Earth.” There is a whole month-long festival in La Paz starting in January where people come from all over and purchase miniature items to offer to Ekeko, the Aymara god of abundance (the Aymara people are one of two indigenous people groups who live in the Andes – the other being the Quechuans). For example, if someone wants a new house, they can purchase a miniature house and offer it to Ekeko. Or if a girl wants a boyfriend, she offers a miniature rooster to Ekeko. Many couples come and purchase miniature chicks because they are infertile but really want a child, etc. Many indigenous people have little booths where they sell various items such as fruit, street food, candy, cheese, etc. It was very common to find them sitting on the ground while selling their things. I asked Jenny why they do not sit on chairs as it seems it would be uncomfortable to sit on the ground all day, and she said they do that to be closer to pachamama. We also saw many llama fetuses for sale at the witch market, which was very sad to me. It is an expectation when building a house or other building to buy one of these llama fetuses to bury as an offering to pachamama before the foundation is laid. The people believe that if they do not do this, pachamama will take the life of one of the workers while they are in the process of building.

Witch market with llama fetuses. The street is called

Witch market with llama fetuses. The street is called “Calle de las Brujas,” or “Street of the witches.”

The doctors at the hospital also touched on the importance of knowing a patient’s culture. I took a cultural competency class during my first two years of medical school so this was a great refresher for me. Dr. Valasco, an infectious disease doctor who we met the first day of our rotation, explained to us how important it is to meet patients on their level. For example, many people in Bolivia (and probably around the world) believe that when someone gets diarrhea, the best thing to do is to stop giving them liquids. This makes sense when you think about it. Of course, the best thing to do in this situation is keep drinking as much as as you can because you don’t want to get dehydrated from the loss of fluid. Another example is that many of the Bolivian people from the mountains believe the sun revolves around the earth. Again, this makes sense – they see the sun rising in the east and setting in the west every day, so it seems logical to them. Dr. Velasco explained to us that education in these instances is important but you should not do it in a way where you consider yourself as superior and the patient as inferior; rather, it is an equal partnership, meeting the patient where they are and educating them at whatever level that may be. This is critical for providing the best healthcare you can, as well as building a relationship with the patient. We learned of another example of how the culture affects medicine in the teenage pregnancy lecture with Dra. Uribe, which I believe I touched on in a previous blog. She said that all forms of birth control are free in Bolivia but young girls often do not use them because they are discouraged by their families or boyfriends or husbands, or whatever the situation may be – it is simply the culture. There is not much education about sexuality in schools (which I believe they are trying to change now), and many girls do not know the options available. This contributes to a high rate of teenage pregnancy, especially in El Alto. The Aymarans and Quechuans (indigenous people groups) used to be looked down upon and discriminated against by the Europeans and others who had entered the country during the time when Spain ruled over them. They were often not served at restaurants and were discriminated against in the public education system, even up to a few years ago. My host mom is a dentist and she would tell stories of how difficult it was for indigenous students to get into programs like dentistry, and when they were in, how difficult it was for them to get any grade higher than a C because the (foreign) professors would fix their grades. However, Bolivia now has the first indigenous president, Evo Morales. He is Aymara and has been in office since 2005. He seems to be doing a lot of good things for the country.

There were signs up everywhere in support of Evo Morales. This one was in El Alto.

There were signs up everywhere in support of Evo Morales. This one was in El Alto.

One of the first things he did when he got into office was to get rid of this discrimination. He got rid of many of the foreigners in the government and bigger businesses, and put indigenous people in their place. It is also very common to find sons and daughters of indigenous people graduating from university, which we got to witness firsthand our first week in Bolivia when we went to the graduation downtown with Jenny. Many indigenous people teach now in the law schools (my host mom is now working on her law degree so we got to go to school with her one night!), dental schools, etc. teaching classes. It is also a law that every single business put a sign up that says discrimination is illegal. The public school children are now learning Aymara in their classes. He also has a campaign for Bolivian women and their rights. He has put many women in high government positions. There were big signs up everywhere in the downtown area that said “stop they violence against women. Report this violence.” Apparently before Morales got elected, if a case of domestic violence was reported to the police the person responsible might have gotten fined, if they even chose to do that. Many times it was simply ignored. However, now it is a crime punishable by a jail sentence. We drove by President Morales’s house every day on the way to Spanish class and I aways saw the guards out in front but never saw the President, sadly.

One of the signs that bans discrimination. This one has chickens on it because we were in a chicken restaurant. It says

One of the signs that bans discrimination. This one has chickens on it because we were in a chicken restaurant. It says “We are all the same before the law.”

This trip really emphasized the importance of knowing a person’s cultures and their beliefs so you can meet them where they are in their life. I learned so much about the Bolivian culture and their beautiful, kind people, and personally saw how cultural beliefs intertwine with medicine on a daily basis. I am so grateful for these lessons (and many more) that I learned this month. I am thankful that my new Bolivian friends took time out of their busy days to teach me these important things. And I am thankful for all of you who followed along with me on my journey! Thank you to my friend Meredith for taking time out of your super busy schedule to share your wisdom about CFHI programs with us before we left – it was very helpful! You are the best! I also want to say a special thanks to Judithe (or Judithecita, as we liked to call her in Bolivia haha), my classmate and good friend. It was such a joy to travel with you and get to know you better this month. I had a wonderful time and I am glad the trip was with you!! God knew what he was doing when He sent us to Bolivia! Ya te extraño y estoy feliz que vas a estar cerca el proximo año 🙂

Hasta luego, La Paz! Thanks for all the memories and lessons that will stay with me for a lifetime!

Working in the general pediatrics ward.

Working in the general pediatrics ward.

Such a privilege to work here for the month.

Such a privilege to work here for the month.

Wrapping up

Hard to believe it is our last night in Bolivia. On one hand, it feels like we have been here FOREVER but on the other it feels like we just got here and the time flew by. I am definitely ready to get home and see my husband and family, but goodbyes are always hard. I have made some great friends this month that I will really miss- Jenny and Phillip (from our homestay), Jenny (Spanish professor), friends from church and Bible study, new friends at the hospital….what a great experience!! Thank you so much to everyone who donated to make this trip possible. I learned so many lessons that will stay with me for life!

Today we got up really early to meet (Spanish) Jenny at the teleferico station. It is about a 15 minute teleferico ride from Obrajes where we live to El Alto at the top of the mountain. I always enjoy teleferico rides. Round trip 30 minutes with stunning views all around for less than a dollar. Can’t beat it 🙂 We then took a short van ride from the teleferico station to a plaza where we met the tour group. The tour lasted about 4 hours and took us all over El Alto to see these colorful houses where the (rich) indigenous people live, called cholets. There are some interesting videos if you google them in case you are interested in learning more. Generally the first floor is the family’s business, usually a little shop; the second floor is a SUPER elaborate “ballroom” of sorts that they rent out on weekends for weddings, parties, etc.; the third – fourth floors are apartments that the family rents out; and the family lives on the highest floor. Each building has its own unique design picked by the owners but almost always has shapes and patterns inspired by the culture (i.e. Tiwanaku…I will talk more about this on my next post). Today we had a tour guide as well as two amauta’s, which are older men whose job it is to pass on cultural beliefs to the next generation…so basically experts in Andean culture. They explained the symbolism on each building we saw…pretty neat! I got to be friends with one of them by the end of the tour. His name is Victor and he took the time to answer my questions and point out different things to me. He wanted a picture with me when the tour was done, gave us his email address, and told me I have to send it to him haha. There were several architect students on the tour, as well. More and more people would join the tour sneakily after each stop and by the end of the tour they could barely close the bus door because the bus was so full. Hilarious! We also got to go to an overlook of the city of La Paz and an art museum. All for $1, which was for the transportation to and from El Alto 🙂

El Alto overlook.

El Alto overlook.

One of the cholets we saw.

One of the cholets we saw.

Judithe and I with our new friends from the tour (Victor is in the middle of us). Such nice gentlemen!

Judithe and I with our new friends from the tour (Victor is in the middle of us). Such nice gentlemen!

Judithe and I were sad to say goodbye to Jenny after the tour but so thankful for her patience and encouragement over the last month. He aprendido MUCHO español!! In fact, there were journalists today on the tour and they were interviewing various people about their thoughts on El Alto and the cholets (this is the first time they are publicly showing this architect’s work). Before I knew it the guide looked at me and asked if I spoke Spanish to which I replied, just a little. And then he told me they wanted to interview me…in Spanish. WHAT?! I tried to protest but they were persistent so they took me to this porch overlooking the city and stuck a microphone in my face and began before I had time to think. I feel like I started off pretty well, talking about how El Alto has a lot of people and vibrancy and life, and how I liked the cholets because they are so colorful…but then my mind went blank and I forgot EVERY SINGLE SPANISH WORD I EVER KNEW. Which was unfortunate timing. So I ended quickly, stating my name and where I am from, all the while looking desperately at Jenny, who was behind the camera encouraging me. They also interviewed Jenny, who did a wonderful job. On the way out of the building the journalists told us that the interviews would be in the newspapers, radio stations, and TV….no big deal….oh boy… Jenny told me that she would look for the story and if I am in anything, she would let me know. Oh well, it was an interesting experience!

Jenny rocking her interview.

Jenny rocking her interview.

And finally here are the promised pictures (in no particular order) from my last post. We will see if the wifi at this cafe cooperates tonight…enjoy! I will post one last blog when we get to Miami tomorrow night. We have to leave bright and early tomorrow morning to catch our 7:30 am flight out of La Paz!!

Tiwanaku replica with the stadium in the background. On a random note, foreign soccer teams who play here in La Paz have to come 3 weeks before the game to get used to the altitude.

Tiwanaku replica with the stadium in the background. On a random note, foreign soccer teams who play here in La Paz have to come 3 weeks before the game to get used to the altitude.

Jenny and I. For our last day of Spanish class, she took us to a replica of Tiwanaku by the soccer stadium, and then we went to a Children's museum (admission $0.40...what a deal!). We played and made bracelets and had a wonderful time :)

Jenny and I. For our last day of Spanish class, she took us to a replica of Tiwanaku by the soccer stadium, and then we went to a Children’s museum (admission $0.40…what a deal!). We played and made bracelets and had a wonderful time 🙂

Judithe, Amina, myself and Kayla at a museum about the culture of Bolivia.

Judithe, Amina, myself and Kayla at a museum about the culture of Bolivia.

Grand rounds at the hospital Wednesday morning (where a resident presents a case and everyone discusses it). I really enjoyed this one because there was a case from the NICU and one from infectious disease, both patients I saw during my month here.

Grand rounds at the hospital Wednesday morning (where a resident presents a case and everyone discusses it). I really enjoyed this one because there was a case from the NICU and one from infectious disease, both patients I saw during my month here.

Exploring La Paz with Kayla and Amina (and Jenny and Judithe who did not want to enter the sea of pigeons ha). This is in Plaza Murillo, where all the government buildings are located.

Exploring La Paz with Kayla and Amina (and Jenny and Judithe who did not want to enter the sea of pigeons ha). This is in Plaza Murillo, where all the government buildings are located.

About half of the Bible study group.

About half of the Bible study group.

The cake they got for us at our Bible study despedida

The cake they got for us at our Bible study despedida

Rounds on the general peds ward

Rounds on the general peds ward

Dra. Uribe and me

Dra. Uribe and me

LAST DAY OF MEDICAL SCHOOL!

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.

 

 

 

Nefrologia

Just a quick update (I will post a longer update later this week when I hopefully have faster wifi). This week, we have been working in nephrology. It is combined with the general pediatric ward at Hospital del Niño, so it has been a nice mix.

The doctors we are working with are nice but also talk to us less than the previous doctors we’ve worked with. They just seem busy all the time. But the residents are nice and willing to answer questions. One of the residents speaks English pretty well, which is a nice change. There are several interesting cases and sooo many sweet kiddos. One little 6 month old girl has suspected Apert’s syndrome (I had never heard of this, either)- it is basically a genetic syndrom where babies have craniosynostosis, meaning the bones in their skull fuse too soon and don’t allow their brain to grow properly which usually requires neurosurgery (which she has already had). Her fingers and toes also didn’t separate properly during development, which I believe is part of the syndrome. There is also another little girl that is my favorite. I believe she had cleft lip, and also has a tracheostomy (a tube through her throat to help her breathe). I am not sure of her whole story as her medical history is complicated, and even more complicated to understand in Spanish. But I do know that she was abandoned by her young mother at birth because of the way she looked. Such a sad story for a beautiful little girl. I would just love to take her home with me!! She LOVES to play with toys all the time and the nurses (and even the other mothers in the unit, since there are around 12 beds in one big room) come play with her all the time. She has one particular toy that makes tons of noise- a Doc McStuffins phone that sings and plays songs when you press the numbers. Today it was hard for me to hear the presentations on rounds because she kept pressing the buttons and the song played over and over haha. She smiles and giggles and is the cutest thing ever.

Other casesthat we have seen this week in case you are interested- nephrotic syndrome (not sure of the cause at this point but they plan on doing a kidney biopsy soon), non-Hodkins lymphoma, a couple inguinal hernia cases (apparently the beds were full in the surgery unit so they were hangig out on the general peds unit), a little girl with recurrent UTIs, a boy with severe anemia (Hemoglobin of 4 on admission…although I could have understood that wrong on rounds) that was vomiting blood and required many transfusions, TTP, and bronchopulmonary dysplasia.

There is also a hemodialysis unit which has 2 beds for dialysis patients. I saw a young patient yesterday getting dialysis but have not actually been in the unit yet.

We also had our last meeting with Doctora Uribe last night and she lectured on teenage pregnancy here in Bolivia. More on that later! Hope you all are having a fantastic week so far!

 

 

Random-ness

I wanted to leave you with some random photos haven’t uploaded yet. Enjoy! And sorry they are in no particular order.

Vicuñas :)

Vicuñas 🙂

Dia del Niño (Kid's day) was last week. They had a huge dance at the school in San Cristobal to celebrate and all the kids were dressed in their little dresses and suits! So cute. They have also been celebrating at the hospital all week...all the patients got balloons!

Dia del Niño (Kid’s day) was last week. They had a huge dance at the school in San Cristobal to celebrate and all the kids were dressed in their little dresses and suits! So cute. They have also been celebrating at the hospital all week…all the patients got balloons!

A beautiful old church in the city of San Cristobal, where we stopped for a break on our trip.

A beautiful old church in the city of San Cristobal, where we stopped for a break on our trip.

Loved this Bible verse on the menu at Breakfast Noni's in Uyuni. Made me think of you, Mrs. Shanahan! (Sorry it is sideways, not quite sure how to turn the picture on my phone)

Loved this Bible verse on the menu at Breakfast Noni’s in Uyuni. Made me think of you, Mrs. Shanahan! (Sorry it is sideways, not quite sure how to turn the picture on my phone)

Beautiful.

Beautiful.

Rock climbing :) On volcanic rock formations.

Rock climbing 🙂 On volcanic rock formations.

A cool statue made out of salt on the salt flats. Dakar is apparently a car race (or something) that came through Uyuni. Apparently pretty controversial with the local people because it ruined a lot of the landscape. But the statue was cool!

A cool statue made out of salt on the salt flats. Dakar is apparently a car race (or something) that came through Uyuni. Apparently pretty controversial with the local people because it ruined a lot of the landscape. But the statue was cool!

Judithe in Valley of the Rocks.

Judithe in Valley of the Rocks.

At the Green Lagoon (this one is for you, mom, since you have been reading all about it).

At the Green Lagoon (this one is for you, mom, since you have been reading all about it).

From this past weekend. Llama crossing :)

From this past weekend. Llama crossing 🙂

I got my picture with a zebra! They have zebras here as a part of "Project Zebra" which was started in 2005. This project employs 250 zebras each year (boys and girls ages 15-23 from the most vulnerable populations in La Paz an El Alto). They mostly help people cross the street, which is great because crossing the street here is crazy. Little kids also LOVE seeing and meeting the zebras (but Judithe might love them even more haha).

I got my picture with a zebra! They have zebras here as a part of “Project Zebra” which was started in 2005. This project employs 250 zebras each year (boys and girls ages 15-23 from the most vulnerable populations in La Paz an El Alto). They mostly help people cross the street, which is great because crossing the street here is crazy. Little kids also LOVE seeing and meeting the zebras (but Judithe might love them even more haha).

From this past weekend. Made it to the top of Fish Island! Incredible views of the salt flats.

From this past weekend. Made it to the top of Fish Island! Incredible views of the salt flats.

My Spanish teacher, Jenny. She is fantastic! I am learning so much and feel more comfortable with my Spanish now than I ever have. Spanish class is always a highlight of my day!

My Spanish teacher, Jenny. She is fantastic! I am learning so much and feel more comfortable with my Spanish now than I ever have. Spanish class is always a highlight of my day!

Third week: Neonatology

We are downtown for the night in our new favorite cafe to use the wifi again. Supposedly the wifi at our apartment will be fixed Monday or Tuesday…we will see! This week Judithe and I were back at Hospital del Niño in the NICU. I did a NICU rotation back in the fall at Dayton Children’s and really enjoyed seeing their unit here. There were 6 main patients for the week, and a few others that were in and out for less acute things like hyperbilirubinia (jaundice). Some of the more interesting cases were:

1. Suspected Tetralogy of Fallot (a heart condition that some babies are born with) as well as sepsis (bacteria in the blood) that was being treated with antibiotics. They were waiting to do surgery on her heart because she was too unstable due to the infection. We got to witness several talks with the baby’s aunts about how grave her situation is and how the prognosis is unknown. Her mom is 19 years old and home sick so wasn’t able to visit. The doctor told us that teenage pregnancies are common here (guess that is a universal thing!). He also reminded us how very important it is to have several talks with families about the medical condition on different occasions so they can fully understand.

2. Our favorite baby, who had a surgery done for a diaphragmatic hernia. The diaphragm is a big muscle that helps you breathe and separates your chest cavity from your abdominal cavity. This baby’s intestines were up in his chest due to the hernia. He recovered really well from the surgery and is just waiting for his older brother to recover from a case of pneumonia before he can go home. Judithe and I visited him every day and talked to him, sang to him, and even got to hold him/help feed him on our last day 🙂

3. A case of ileal atresia (where your intestine doesn’t develop right and it is not open so food can’t pass through). This little guy had already had surgery and was just in the unit as he recovered.

4. A case of intestinal volvolus with obstruction (where the intestine twists on itself). This is a surgical emergency because the blood supply can be cut off and cause that part of the intestine to die.

We worked with a nice doctor again, a neonatologist whose last name is complicated to spell so I will just call him Dr. P haha. He took time each day to ask us of we were understanding everything on rounds ok. He also asked several questions about the United States and how things work in hospitals at home. For example, he was telling us one day that it is very common here for babies to be abandoned (sadly one of the little guys in the unit was in that situation, from what I could gather from rounds) and left to go to orphanages, especially if the parents are young or already have many children and can’t afford another. He was surprised to hear that we have many problems with social situations in the U.S., as well. I asked about his training and it seems to be the same here as at home for neonatology- pediatric residency followed by a neonatology fellowship.

Neonatology unit

Neonatology unit

Part of the unit.

Part of the unit.

Resident workstation, complete with paper charts and typewriters.

Resident workstation, complete with paper charts and typewriters.

There was another strike on Thursday and Friday, but it didn’t affect our work in the NICU at all. We did manage to get a picture of the sign on the front door this time!

This sign (more or less) says "The lack of human resources, infrastructure, and teams within the hospital...is this not negligence?"

This sign (more or less) says “The lack of human resources, infrastructure, and teams within the hospital…is this not negligence?”

We also got to go to Down Syndrome clinic again with Dra. Salete on Wednesday as there were only 6 patients in the NICU at that time and rounds were over by 10:30. I love love love working with Dra. Salete! Always a breath of fresh air, how passionate she is about helping her patients. This week she even paid for a patient’s x-ray with her own money since his family couldn’t afford it.

We got a double lecture on Tuesday evening from Dra. Uribe since she had a sore throat last week and couldn’t lecture- one on surgical emergencies and one on Chagas disease (a parasitic infection). Chagas is not endemic in La Paz because of the colder temperatures but is a big problem in the more southern, tropical areas. Very interesting talks! And pretty easy to follow even in Spanish because there were accompanying powerpoints. Plus a lot of the medical words are similar, so that helps.

This morning, we got up bright and early to travel to Hospital de Los Andes, a maternal infant hospital located about an hour away in El Alto, the highest part of the city (the rim of the “bowl”). This is where Dra. Uribe works and she picked us up this morning at 7:30 to drive us there. Judithe, Amina and I each got to work with different groups of residents. Judithe was in the OR and got to observe a C-section, Amina was in the neonatology unit, and I was in the post-partum section. Compared to this hospital, Hospital del Niño is pretty high tech. El Alto had around 1 million residents and is well known as one of the poorest sections of La Paz. I got to see about 10 babies with the resident, and do physical exams on them. I also saw the OB rounding on the moms but didn’t get to work with him personally. The residents’ notes were all hand written here (no type writers that I saw). I feel like I am a little spoiled with our electronic medical records at home. It takes impressive stamina to write all those notes so quickly without your hand falling off! Skin to skin contact between the baby and mom right after birth is the practice here, as well. They also put an emphasis on teaching moms’ the importance of breast feeding. In the postpartum unit, there were 30 beds. Each big room had 6-8 beds- no private rooms. The baby stayed in the same bed as the mom.

I was also excited to work more closely with the residents because I got to talk to them a lot. They of course asked me a lot of questions about medicine back home, and I in turn asked them lots of questions 😉 There doesn’t seem to be work hour restrictions here during residency, as opposed to home (80 hours per week). I asked one resident how many hours she worked every week and she told me this is much more than work because it feels like she lives at the hospital. So not much changes between cultures… That is how I feel some months, and I am sure how I will feel for the next 3 years 🙂 We also got to attend didactics this morning on neonatal sepsis, which was interesting. One of the residents presented. I am glad I went and was able to see the hospital! A very eye-opening experience for sure.

Tomorrow we plan on visiting the zoo and maybe going to see a movie in Spanish (super cheap here compared to home!!). There is a new PA student coming tomorrow so there will be 4 of us this week 🙂

Judithe and I will be doing nephrology Monday, Wednesday and Friday this week, and going to an adolescent medicine clinic on Tuesday and Thursday. Should be a great end to a great rotation! I will update again as soon as we are back in wifi-land. Hope you all enjoy the rest of your weekend!

Adventure is out there!

I will start out by apologizing for the lack of blog posts last week. After we got home from our trip this past weekend, we found out that the wifi at our apartment is down (and things don’t seem to get fixed very quickly around here). We have tried at least 5 places around our neighborhood that advertise that they have wifi, but none of them worked. We FINALLY found a cafe downtown close to our Spanish class that has wifi…still slow but at least functional! Judithe and I did neonatology this week- more on that next blog.

The title of this post is one of my favorite quotes ever from one of the best Pixar movies (in my opinion), Up. We definitely experienced that quote this past weekend! We had so much fun on our trip to Salar de Uyuni. This will probably be a long post so just warning you ahead of time! So many cool things/pictures to share. We left super early in the morning, at 5 am in the pouring rain, caught a taxi to the La Paz bus station, and took a 3 hour bus ride to another city called Oruro. We arrived to Oruro around 9:30 a.m. and shopped in the local market, walked around the city, and ate lunch at a delicious restaurant called Restaurante Nayjama. We bought a huge bottle of water for the weekend and headed to the train station, where we took a 7 hour train ride to Uyuni which is in southern Bolivia. So fun to ride a real, old fashioned train!

Lunch at Restaurante Nayjama

Lunch at Restaurante Nayjama

Train to Uyuni

Train to Uyuni

We arrived to Uyuni around 9:30 p.m., where a lady from the tour company we travelled with met us at the train station to take us to our hotel. Judithe and I shared a room, and Amina had her own room.

Saturday morning, we woke up nice and early to take a hot shower (which is impressive here…we were so excited to have hot water. Not that common!). That was the only one we got all weekend because it cost money to take showers at the other hotels, and who wants to waste money on cleanliness?! So we roughed it 😉 We ate breakfast at a cute and super cheap restaurant near our hotel called Breakfast Noni’s. There are lots of stray dogs everywhere in Bolivia and Uyuni is no exception. There was an adorable little dog who followed us around Uyuni all morning. When we stopped to take pictures, he would stop and wait for us. I would love to take him home with me!! I named him Maxcito haha.

Maxcito. How cute is he?! See, you all want him too right?

Maxcito. How cute is he?! See, you all want him too right?

Our tour left at 10:30 am Saturday morning. We traveled with a tour company called Empexsa (which I would highly recommend if any of you plan to visit here in the future). Our tour group had 6 people- a married couple from Bolivia, a girl from France who took a year off to travel around South America, and Amina, Judithe and me. And of course our guide, Milton (who also happened to be our driver, mechanic, chef, and photographer haha). The first stop

Train cemetery

Train cemetery

on the tour was a train cemetery, where antique trains are kept. Our guide told us that these trains used to run on carbon and water, and when newer versions of the trains came out, they had no use for these trains anymore so they now sit in a “cemetery”. I enjoyed seeing all the trains as well as climbing on them 🙂

Our next stop was Salar de Uyuni, aka the salt flats. It was SPECTACULAR to see. Prior to entering the salt flats, we went to a city called Colchani, where the salt from the salt flats is processed (and of course there were souvenirs made totally out of salt). We first went to the “salt pyramids” which were really just mounds of salt. We ate lunch out of the back of our vehicle outside of a salt hotel on the salt flats. We had llama and quinoa for lunch. The llama was really good! We also visited an “island” in the middle of the salt flats where they had HUGE cacti growing. The type of cactus here only grows 1 cm a year. Our group hiked up to the top of the island. Again…spectacular views. Pictures don’t do it justice! I will definitely upload pictures later for you to see. This is probably one of the most stunning/weirdest landscapes I have ever seen before. The majority of the world’s lithium comes from this area (a fun fact for you, dad).

Salt flats. It recently rained so it made it look like a mirror!

Salt flats. It recently rained so it made it look like a mirror!

Hiking on Fish Island

Hiking on Fish Island

Saturday night we stayed in a salt hotel, where literally everything (except the mattress and pillow thankfully haha) is made of salt. So neat! It was fun to sit around and talk with our group before dinner- we all got along really well. The girl from France, Louise, was so fun. She spoke English, French AND Spanish- pretty impressive.

Salt hotel dining room- tables and chairs made of salt!

Salt hotel dining room- tables and chairs made of salt!

Sunday morning, we ate breakfast at the salt hotel and headed to several lagoons even farther south. We also got to see the border of Chile. And maybe my favorite part of the trip…seeing wild flamingos in the lagoons!! We also drove through the Sitoli desert, which was awesome (and long, because there was nowhere to use the restroom ha). While our first day was pretty hot, the second day was freezing. It even started snowing in the desert (a pretty weird site to see). Another fun part of the day was the Stone tree. There are volcanoes in the area that leave all kinds of cool rock formations. I couldn’t stop taking pictures! I also loved climbing all the rocks 🙂 I never encountered a paved road the whole weekend, so it was a lot of bumpy rides (I usually don’t have a problem with motion sickness but sometimes did on this trip).

Laguna Cañapa. And FLAMINGOS!!!

Laguna Cañapa. And FLAMINGOS!!!

Stone tree

Stone tree

Louise in the Sitoli desert. I didn't get a picture of it snowing but it was COLD!

Louise in the Sitoli desert. I didn’t get a picture of it snowing but it was COLD!

A highlight of the day for me was the Red Lagoon, where a lot of borax comes from (that is another fun fact for you, dad). Also tons of wild flamingos!! TONS. We stayed in a hotel near the Red Lagoon in the national park, where our group slept in one room. As a side note, it was still at freezing temperatures the last night and last day….SO. COLD. But we persevered and still had a great time. Judithe, Louise and I took a small hike in the national park but mostly sat by the fire in our hotel and played pictionary the whole night. Amazing how creative you can be with no phone service and no wifi to distract you! We had so much fun.

Laguna Colorada (Red Lagoon). All those dots in the water are flamingoes.

Laguna Colorada (Red Lagoon). All those dots in the water are flamingoes.

Hiking with Judithe and Louise

Hiking with Judithe and Louise

Hot springs

Hot springs

The last day of our tour, we got up at 4 am so we could have breakfast and leave by 5 am in order to see everything before starting the long drive hack to Uyuni. I was really sick this morning and was afraid that the day would be slightly miserable (no bathrooms really, out in the boonies) but it turned out to be a great day! I started feeling better by mid-morning. Cipro does wonders and just may be my new favorite drug! We saw geysers early in the morning and later got to swim in a hot springs. I didn’t get all the way in since I had not been feeling too well but dipped my feet in. It felt great! It was 32F outside but the water in the hot springs felt lovely. We were at the hot springs during sunrise, and there were mountains all around. Beautiful!

After the hot springs, we drove to another lagoon (Laguna Verde- the green lagoon), which was also gorgeous but sadly no flamingos. Our guide said this lagoon is naturally toxic. We dropped Lousie off at the Chilean border since she was traveling on to Chile, and then drove back to Uyuni. We saw many wild vicuñas (which look kind of like llamas) and llamas along the way. We also stopped at the Valley of the Rocks…where I of course climbed more rocks. We got hack to Uyuni around 5:30 in the evening and went to the bus station, where we caught an overnight bus back to La Paz. We got into La Paz around 6:30, caught a taxi back to our apartment, showered (after 3 days haha), and rushed off to the hospital for a new week of clinicals! Overall an INCREDIBLE

Our group at Laguna Verde - Judithe, Jennica, Amina, me, Louise and Herman.

Our group at Laguna Verde – Judithe, Jennica, Amina, me, Louise and Herman.

experience. Trips like these, where I get to see so many beautiful things in nature, always leave me in awe of my Creator and His creation. So intricate, unique, and fun!

Climbing rocks with Jennica in Valley of the Rocks!

Climbing rocks with Jennica in Valley of the Rocks!