Friday, March 18, 2011
Wednesday, September 8, 2010
Salta, Argentina
I finally made it down to Argentina! Although I really wanted to go to Buenos Aires, I wasn’t able to go there because of cost; plane tickets from Tarija to Buenos Aires were ridiculously expensive. As a replacement for a trip to Buenos Aires, I settled for Salta. Salta is located in the northern region of Argentina and is one of the largest cities in Argentina. Overall, I must say that I was quite impressed with Salta and enjoyed my time there.
Three other CFHI interns and I left Tarija for Salta on Thursday morning at 4 am by bus. We didn’t get to Salta until about 1:30 pm due to a few delays (ex. flat tire and an almost dead transmission). When we got to Salta, the first thing that we did was set out to find a hotel or hostel. Luckily, for us, we found a very nice hostel in which we had our own bathroom and hot water; it only cost us about $23/day. At first, I was a little nervous to stay in a hostel because I had never stayed in one before, and I have heard terrible stories about them. Overall, I liked our choice of hostel.
For the three days that we were in Salta, we did a couple fun activities. For one, a person can’t go to Argentina without shopping. In my opinion, Salta seemed to be a hub for fashion. Everywhere I turned, I found myself looking into a clothing store or upscale boutiques. Things were definitely a lot more expensive than in Bolivia so I didn’t buy that much stuff because I didn’t want to drop the big bucks.
In addition to shopping, we took the teleférico (it’s like a tram) up to a viewpoint that overlooked the city. At the top of the viewpoint, there is a little café and we had coffee there because it was freezing outside. We also walked around the man-made waterfalls. In my opinion, the view overlooking the city was spectacular and Salta looked very pretty. If you plan on going to Salta, I would recommend going on the teleférico up to the viewpoint.
If you’re into the nightlife scene then Salta can satisfy you. For us, we went to a couple discotecas. The discotecas were a lot of fun, music was great, and I personally found it to be a lot more fun than the disoctecs I have encountered in Bolivia. In addition to the discotecas, there is one major casino called Golden Dreams Casino. Before Salta, I had never even stepped foot into a casino let alone gambled. Our first night at the casino, I played only one slot machine and of course lost my 5 Argentina Pesos (current exchange rate is about 4 Argentina Pesos = $1 US Dollar). We returned to the casino two more times. Of course, each time that I went to the casino I set a cash limit for myself and didn’t bring any extra money that way I wouldn’t lose all my money. The second night at the casino I came out ahead by 5 Argentina Pesos and the third night, I lost all 50 Pesos that I had gambled. From my experience at this casino, I’ve learned the golden rule to gambling that one of the interns told me “Always set a limit and stop while you’re ahead.”
On Saturday, we ended up at a ranch located in the hills of Salta. The purpose for our journey to the ranch was so that we could go horseback riding. Horseback riding was another first for me, and I found the experience to be very enjoyable. When we first arrived at the ranch, the ranch workers made an excellent barbecue of steak and other meats for us accompanied with potatoes and salad. After eating, we rested for a bit and then got prepared to go horseback riding. I absolutely loved my horse, whose name was Princess. We went horseback riding for about a good hour and half through the hillside. For anyone who has never been horseback riding before, I would recommend that you try it because it’s so much fun.
Sunday was our departure day because we needed to be back to Bolivia by Monday for work. Overall, even though I didn’t have a chance to go to Buenos Aires, I really did enjoy Salta and would recommend that if anyone is in Argentina that you take a trip to Salta.
Three other CFHI interns and I left Tarija for Salta on Thursday morning at 4 am by bus. We didn’t get to Salta until about 1:30 pm due to a few delays (ex. flat tire and an almost dead transmission). When we got to Salta, the first thing that we did was set out to find a hotel or hostel. Luckily, for us, we found a very nice hostel in which we had our own bathroom and hot water; it only cost us about $23/day. At first, I was a little nervous to stay in a hostel because I had never stayed in one before, and I have heard terrible stories about them. Overall, I liked our choice of hostel.
For the three days that we were in Salta, we did a couple fun activities. For one, a person can’t go to Argentina without shopping. In my opinion, Salta seemed to be a hub for fashion. Everywhere I turned, I found myself looking into a clothing store or upscale boutiques. Things were definitely a lot more expensive than in Bolivia so I didn’t buy that much stuff because I didn’t want to drop the big bucks.
In addition to shopping, we took the teleférico (it’s like a tram) up to a viewpoint that overlooked the city. At the top of the viewpoint, there is a little café and we had coffee there because it was freezing outside. We also walked around the man-made waterfalls. In my opinion, the view overlooking the city was spectacular and Salta looked very pretty. If you plan on going to Salta, I would recommend going on the teleférico up to the viewpoint.
If you’re into the nightlife scene then Salta can satisfy you. For us, we went to a couple discotecas. The discotecas were a lot of fun, music was great, and I personally found it to be a lot more fun than the disoctecs I have encountered in Bolivia. In addition to the discotecas, there is one major casino called Golden Dreams Casino. Before Salta, I had never even stepped foot into a casino let alone gambled. Our first night at the casino, I played only one slot machine and of course lost my 5 Argentina Pesos (current exchange rate is about 4 Argentina Pesos = $1 US Dollar). We returned to the casino two more times. Of course, each time that I went to the casino I set a cash limit for myself and didn’t bring any extra money that way I wouldn’t lose all my money. The second night at the casino I came out ahead by 5 Argentina Pesos and the third night, I lost all 50 Pesos that I had gambled. From my experience at this casino, I’ve learned the golden rule to gambling that one of the interns told me “Always set a limit and stop while you’re ahead.”
On Saturday, we ended up at a ranch located in the hills of Salta. The purpose for our journey to the ranch was so that we could go horseback riding. Horseback riding was another first for me, and I found the experience to be very enjoyable. When we first arrived at the ranch, the ranch workers made an excellent barbecue of steak and other meats for us accompanied with potatoes and salad. After eating, we rested for a bit and then got prepared to go horseback riding. I absolutely loved my horse, whose name was Princess. We went horseback riding for about a good hour and half through the hillside. For anyone who has never been horseback riding before, I would recommend that you try it because it’s so much fun.
Sunday was our departure day because we needed to be back to Bolivia by Monday for work. Overall, even though I didn’t have a chance to go to Buenos Aires, I really did enjoy Salta and would recommend that if anyone is in Argentina that you take a trip to Salta.
Public Health: Chagas Treatment
With a diagnosis comes a treatment plan. A couple weeks ago, I completed the chagas diagnostic rotation. To complement the diagnostic rotation, my ninth week of rotations was chagas treatment. My ninth week of rotation was a bit short because on Thursday I left for Argentina. Nevertheless, for the days that I was present for the rotation, I worked with Dr. Soledad and Nurse Selima.
With the chagas treatment program here, Dr. Soledad explained to me that there are two main categories: 1) treating patients for chagas and 2) treating patients for adverse reactions to chagas medication (usually benznidazol).
On the first day of this rotation, we drove out to a local school to meet with a couple of students that were positive for chagas. At the school, we met with two young female students; both girls had received benznidazol. The first girl that we saw had been experiencing adverse reactions to the medication. Because of the reaction, rashes began to develop on the girl’s arms and legs. To treat the reaction, Dr. Soledad gave the girl three different anti-allergic medications- loratadina, betametasona, and dexametasonar. The second girl was not taking her medication as the doctor had prescribed. She had missed several doses. When Dr. Soledad heard this, I could see that she was upset with the girl. As Dr. Soledad tried to explain to the girl the severity of chagas and the effects it has on the body, I noticed that the demeanor of the girl and the way she communicated with the doctor was as if she didn’t care that she had chagas. I had a hard time comprehending why this girl wasn’t following her treatment plan. After all, all the medicine that she was receiving was free. I guess I realize that even though you provide someone with resources it’s up to them to ultimately decide if they use that resource to bring about change and there is nothing more that the helper can do.
In addition to visiting the schools in Tarija, we also went to the countryside to treat chagas positive children under the age of 15. In my opinion, treating kids in the countryside is more difficult than treating kids in the city because it is difficult to deliver medicine to the countryside kids due to location. In order to make the process simpler, we went to schools and hand out prescriptions there. If possible, we tried to have parents present but most often the parents weren’t there. Most parents were absent because their houses are far from the school and they are often out working. To put distance into perspective, for the school located in Chaupicancha, on average it takes a student about 2.5 hours just to walk to school. This means that a student spends about 5 hours commuting to and from school! Most students have to leave their houses by 6 am in order to arrive at school on time. So, I can understand why some parents weren’t present. By not having a parent present this did create a problem because most kids didn’t understand the amount of medicine that they need to take each day and the time of day that the medicine needed to be taken. In order to provide a solution to this problem, we sent each kid home with an instruction letter to give his or her parents. The downside to this is that some parents in the countryside are illiterate. In addition, we also sent each kid home with a medicine-tracking card. The medicine-tracking card is a piece of paper that is divided into dates and the two different times of day that the kid needs to take the medicine. The card also has a picture of how the kid needs to divide the pills. Under each time column and day, the kid is supposed to record whether or not he or she has taken his or her medicine at that specific time.
Furthermore, for the chagas treatment program, we also made house calls. House calls are when we went to the houses of chagas positive children, who are currently taking chagas medication. At the child’s home, the doctor reviewed the child’s medicine tracking card and counted the remaining pills that the child had in order to make sure that the child was following the correct treatment plan. Also, while at the house, Dr. Soledad did a physical examination of the child to make sure that he/she wasn’t experiencing any adverse reactions.
In my opinion, I really enjoyed the house calls, and there definitely were a few interesting house calls that we made. At several house calls, we encountered patients in which the medicine-tracking card didn’t match up with the number of pills that the patient had remaining. When we encountered situations like these, I could see the frustration sweep across the doctor’s face. She would then begin her long explanation to the child’s parent(s) on the importance of diligently filling out the medicine-tracking card. Furthermore, during some house calls we had a feeling that the kid would be re-infected because of the environment that the child lived in. There was one house in particular that I remember in which there were huge piles of trash and debris inside and outside the house. Of course, the best way to prevent chagas is through vector control and one way to do that is to keep a very clean environment so that the vinchuchas can’t hide.
Furthermore, at one house call, we encountered a girl who had been taking benznidazol. However, she was having a very bad reaction to the medicine. She had edema all throughout her body and a rash that covered the entirety of her body. The doctor said that if we had not shown up and begun the treatment for her adverse reaction, she would have most likely developed Stevens-Johnson syndrome. I had never heard of Stevens-Johnson syndrome so I asked the doctor what exactly it was. She told me that Stevens-Johnson syndrome is a severe condition that affects the skin and mucous membranes. With this syndrome comes ulceration and the person’s skin begins to fall off. The cause is due to adverse reactions with drugs and all drugs have the potential of causing it. Unfortunately, for this girl, she can never again take any of the chagas medicines or else she’ll experience the same severe adverse reactions again. Moreover, because she can’t take chagas medication, she will never be cured of chagas and will have it for the rest of her life, which I find to be quite sad.
For this rotation, my job was quite simple. Besides observing the doctor work, I helped to calculate the amount of medicine that the patient would need based upon body weight and then counted the pills and put them in medication containers that the kid could take home.
With the chagas treatment program here, Dr. Soledad explained to me that there are two main categories: 1) treating patients for chagas and 2) treating patients for adverse reactions to chagas medication (usually benznidazol).
On the first day of this rotation, we drove out to a local school to meet with a couple of students that were positive for chagas. At the school, we met with two young female students; both girls had received benznidazol. The first girl that we saw had been experiencing adverse reactions to the medication. Because of the reaction, rashes began to develop on the girl’s arms and legs. To treat the reaction, Dr. Soledad gave the girl three different anti-allergic medications- loratadina, betametasona, and dexametasonar. The second girl was not taking her medication as the doctor had prescribed. She had missed several doses. When Dr. Soledad heard this, I could see that she was upset with the girl. As Dr. Soledad tried to explain to the girl the severity of chagas and the effects it has on the body, I noticed that the demeanor of the girl and the way she communicated with the doctor was as if she didn’t care that she had chagas. I had a hard time comprehending why this girl wasn’t following her treatment plan. After all, all the medicine that she was receiving was free. I guess I realize that even though you provide someone with resources it’s up to them to ultimately decide if they use that resource to bring about change and there is nothing more that the helper can do.
In addition to visiting the schools in Tarija, we also went to the countryside to treat chagas positive children under the age of 15. In my opinion, treating kids in the countryside is more difficult than treating kids in the city because it is difficult to deliver medicine to the countryside kids due to location. In order to make the process simpler, we went to schools and hand out prescriptions there. If possible, we tried to have parents present but most often the parents weren’t there. Most parents were absent because their houses are far from the school and they are often out working. To put distance into perspective, for the school located in Chaupicancha, on average it takes a student about 2.5 hours just to walk to school. This means that a student spends about 5 hours commuting to and from school! Most students have to leave their houses by 6 am in order to arrive at school on time. So, I can understand why some parents weren’t present. By not having a parent present this did create a problem because most kids didn’t understand the amount of medicine that they need to take each day and the time of day that the medicine needed to be taken. In order to provide a solution to this problem, we sent each kid home with an instruction letter to give his or her parents. The downside to this is that some parents in the countryside are illiterate. In addition, we also sent each kid home with a medicine-tracking card. The medicine-tracking card is a piece of paper that is divided into dates and the two different times of day that the kid needs to take the medicine. The card also has a picture of how the kid needs to divide the pills. Under each time column and day, the kid is supposed to record whether or not he or she has taken his or her medicine at that specific time.
Furthermore, for the chagas treatment program, we also made house calls. House calls are when we went to the houses of chagas positive children, who are currently taking chagas medication. At the child’s home, the doctor reviewed the child’s medicine tracking card and counted the remaining pills that the child had in order to make sure that the child was following the correct treatment plan. Also, while at the house, Dr. Soledad did a physical examination of the child to make sure that he/she wasn’t experiencing any adverse reactions.
In my opinion, I really enjoyed the house calls, and there definitely were a few interesting house calls that we made. At several house calls, we encountered patients in which the medicine-tracking card didn’t match up with the number of pills that the patient had remaining. When we encountered situations like these, I could see the frustration sweep across the doctor’s face. She would then begin her long explanation to the child’s parent(s) on the importance of diligently filling out the medicine-tracking card. Furthermore, during some house calls we had a feeling that the kid would be re-infected because of the environment that the child lived in. There was one house in particular that I remember in which there were huge piles of trash and debris inside and outside the house. Of course, the best way to prevent chagas is through vector control and one way to do that is to keep a very clean environment so that the vinchuchas can’t hide.
Furthermore, at one house call, we encountered a girl who had been taking benznidazol. However, she was having a very bad reaction to the medicine. She had edema all throughout her body and a rash that covered the entirety of her body. The doctor said that if we had not shown up and begun the treatment for her adverse reaction, she would have most likely developed Stevens-Johnson syndrome. I had never heard of Stevens-Johnson syndrome so I asked the doctor what exactly it was. She told me that Stevens-Johnson syndrome is a severe condition that affects the skin and mucous membranes. With this syndrome comes ulceration and the person’s skin begins to fall off. The cause is due to adverse reactions with drugs and all drugs have the potential of causing it. Unfortunately, for this girl, she can never again take any of the chagas medicines or else she’ll experience the same severe adverse reactions again. Moreover, because she can’t take chagas medication, she will never be cured of chagas and will have it for the rest of her life, which I find to be quite sad.
For this rotation, my job was quite simple. Besides observing the doctor work, I helped to calculate the amount of medicine that the patient would need based upon body weight and then counted the pills and put them in medication containers that the kid could take home.
Wednesday, September 1, 2010
Eighth Week: Rural Medicine
It still surprises me how quickly time flies by. I’ve been in Bolivia for 9 weeks already and have completed eight different rotations. My eighth week of rotation was rural medicine. For the week, I was at Hospital San Andres, which is located in a very rural area known as San Andres.
On the first day, one of the CFHI interns and I were warmly greeted by Dr. Yucra. Dr. Yucra showed us around the small hospital. There were aspects of the hospital that shocked me. First, the hospital has bedrooms where some of the nurses sleep. The reason that there are bedrooms is because some of the nurses live far from the hospital and commuting to and from the hospital each day just doesn’t make sense. Another part of the hospital that shocked me was the fact that there was a laboratory there. For a small hospital that size, I would have expected that if any laboratory work needed to be done that they would send it to Hospital San Juan de Dios, the main hospital in Tarija.
Furthermore, since Dr.Yucra is practically the only medical doctor (there is a dentist also) that works at Hospital San Andres, I spent all my time working with him. Dr. Yucra left me in charge of checking the patients’ lungs and hearts and reporting to him. Since this rotation was mainly general medicine in a rural setting, we saw all types of cases. However, most of the patients we saw either had a cold, fever, or body pain (due to their past or present work in the agricultural sector).
Besides the medical aspect of this rotation, I really enjoyed observing the business aspect of running a clinic when resources/supplies are short. One of the hardest aspects of running a rural clinic in an underdeveloped nation is 1) the need of medical supplies and 2) the need of more trained professionals. I was curious to know how exactly Hospital San Andres was able to stay operational because it served a population that doesn’t have a lot of money to pay for services. In order to find an answer to my question, I asked Dr. Yucra. Dr. Yucra explained that a program known as SUSAT pays for most services at this hospital. SUSAT is a healthcare program unique to Tarija, and is funded by the Tarija government and not the federal government. There is also a federal program known as SUMI, which pays for medical services for pregnant females and their infant child. In terms of medications, Dr. Yucra said that since he receives many prescription samples from pharmaceutical reps, he often gives these to patients.
Overall, this rotation provided me with a different atmosphere that I’ve never been exposed to, and I really enjoyed it.
On the first day, one of the CFHI interns and I were warmly greeted by Dr. Yucra. Dr. Yucra showed us around the small hospital. There were aspects of the hospital that shocked me. First, the hospital has bedrooms where some of the nurses sleep. The reason that there are bedrooms is because some of the nurses live far from the hospital and commuting to and from the hospital each day just doesn’t make sense. Another part of the hospital that shocked me was the fact that there was a laboratory there. For a small hospital that size, I would have expected that if any laboratory work needed to be done that they would send it to Hospital San Juan de Dios, the main hospital in Tarija.
Furthermore, since Dr.Yucra is practically the only medical doctor (there is a dentist also) that works at Hospital San Andres, I spent all my time working with him. Dr. Yucra left me in charge of checking the patients’ lungs and hearts and reporting to him. Since this rotation was mainly general medicine in a rural setting, we saw all types of cases. However, most of the patients we saw either had a cold, fever, or body pain (due to their past or present work in the agricultural sector).
Besides the medical aspect of this rotation, I really enjoyed observing the business aspect of running a clinic when resources/supplies are short. One of the hardest aspects of running a rural clinic in an underdeveloped nation is 1) the need of medical supplies and 2) the need of more trained professionals. I was curious to know how exactly Hospital San Andres was able to stay operational because it served a population that doesn’t have a lot of money to pay for services. In order to find an answer to my question, I asked Dr. Yucra. Dr. Yucra explained that a program known as SUSAT pays for most services at this hospital. SUSAT is a healthcare program unique to Tarija, and is funded by the Tarija government and not the federal government. There is also a federal program known as SUMI, which pays for medical services for pregnant females and their infant child. In terms of medications, Dr. Yucra said that since he receives many prescription samples from pharmaceutical reps, he often gives these to patients.
Overall, this rotation provided me with a different atmosphere that I’ve never been exposed to, and I really enjoyed it.
Sunday, August 29, 2010
What exactly is chagas?
I just realized that for some of you who may be reading my blogs you may have never heard of chagas or if you have, you may not know that much about it. In addition, since I’m working with chagas patients and my blogs in the next several weeks will most likely have something written about chagas, I figured that it would probably be a good idea to give a brief overview of what I have learned about chagas since I’ve been here in Tarija. So here it is….
What’s the cause of chagas? Chagas is an infectious disease discovered in 1909 by Carlos Chagas. Chagas is also referred to as South American trypanosomiasis. It is caused by the parasite Trypanosoma cruzi. Members of the Trypanosoma family can be found in different parts of the world. For example, in Africa, there is Trypanosoma bruci, which leads to African sleeping sickness.
What body parts are affected by the parasite?The parasite usually causes irreversible damages to the heart and the intestines. In the cardiovascular rotation that I did a few weeks back here in Tarija, I encountered several patients that had chagas. In each of the patients that had chagas, they also had very enlarged hearts and as a result were suffering from heart failure. Also, one common sign that a person may be infected with chagas is Romana’s sign. In Romana’s sign, one eye of a person is closed due to swelling in the upper eyelid because of infection.
Transmission
Here in South America, one way chagas is transmitted is via an insect known as the vinchuca. What happens is that after the vinchuca feeds on a person`s blood , the vinchuca deposits feces (which contain the parasite) on the top layer of the skin. Then, when a person goes to scratch their skin that is when the parasite is introduced into the person. Furthermore, transmission can also happen from mother-to-child and through blood transfusions.
Here in Bolivia, the areas that have the highest prevalence rates are Chuquisaca, Tarija, Cochabamba, and parts of Potosi, La Paz, and Santa Cruz. Out of these, Chuquisaca has the highest.
Diagnostic
The only way to confirm that a person has chagas is through doing a blood analysis. Here in Bolivia, ELISA is one of the most common methods used.
Treatment and Prevention
The most common form of treatment is with a drug known as Benzindazol. An infected person takes this drug for 60 days. There is also another drug known as Nifurtimox that a person can take. In order for treatment to be successful, early detection and diagnosis is needed.
The best way to prevent chagas is through vectoral control. In addition, education and control in blood banks are also important.
What’s the cause of chagas? Chagas is an infectious disease discovered in 1909 by Carlos Chagas. Chagas is also referred to as South American trypanosomiasis. It is caused by the parasite Trypanosoma cruzi. Members of the Trypanosoma family can be found in different parts of the world. For example, in Africa, there is Trypanosoma bruci, which leads to African sleeping sickness.
What body parts are affected by the parasite?The parasite usually causes irreversible damages to the heart and the intestines. In the cardiovascular rotation that I did a few weeks back here in Tarija, I encountered several patients that had chagas. In each of the patients that had chagas, they also had very enlarged hearts and as a result were suffering from heart failure. Also, one common sign that a person may be infected with chagas is Romana’s sign. In Romana’s sign, one eye of a person is closed due to swelling in the upper eyelid because of infection.
Transmission
Here in South America, one way chagas is transmitted is via an insect known as the vinchuca. What happens is that after the vinchuca feeds on a person`s blood , the vinchuca deposits feces (which contain the parasite) on the top layer of the skin. Then, when a person goes to scratch their skin that is when the parasite is introduced into the person. Furthermore, transmission can also happen from mother-to-child and through blood transfusions.
Here in Bolivia, the areas that have the highest prevalence rates are Chuquisaca, Tarija, Cochabamba, and parts of Potosi, La Paz, and Santa Cruz. Out of these, Chuquisaca has the highest.
Diagnostic
The only way to confirm that a person has chagas is through doing a blood analysis. Here in Bolivia, ELISA is one of the most common methods used.
Treatment and Prevention
The most common form of treatment is with a drug known as Benzindazol. An infected person takes this drug for 60 days. There is also another drug known as Nifurtimox that a person can take. In order for treatment to be successful, early detection and diagnosis is needed.
The best way to prevent chagas is through vectoral control. In addition, education and control in blood banks are also important.
Tuesday, August 24, 2010
Seventh Week: Public Health-Chagas Diagnostics
With the start of a new week came the start of a new rotation. Week 7 of my rotations focused on public health and the diagnostics of chagas. I worked with Dr. Edith, who works for S.E.D.E.S, which is an acronym for the public health department here.
On the first day of rotations, Dr. Edith, a couple other CFHI interns, and I went to a local elementary school to teach the parents about chagas. Surprisingly, the room was filled with parents to the point that there were no empty seats and parents were standing in the back. We gave a powerpoint presentation and handed out brochures that contained information about chagas infection, treatment, and prevention. I noticed that most of the parents were very interested in the presentation and learning about chagas. They even asked some very good questions. However, one aspect that I found to be slightly ineffective was the brochures that we handed out to the parents because some of them couldn’t read. However, thankfully, the brochures had pictures on them to help explain some of the concepts that we were trying to get across. At the end of the presentation, Dr. Edith explained to the parents that in the next following weeks we would be returning and giving free rapid chagas test. Of course, several of the parents were very concerned about the process since we would need to obtain a small blood sample. One parent even stressed concerned that he didn’t want any medical students, interns, or unqualified people performing the test on his child. Dr. Edith handled the situation gracefully and went through the process of rapid chagas testing. The test is really simple and is a qualitative test for the detection of antibodies to Trypanosoma cruzi, which is the causing parasite. First, the doctor uses a small “pincher” to poke the child’s finger in order to cause bleeding. The doctor then uses a plastic pipette to suck up some of the patient’s blood and places the blood in a sample well. A diluent is then added to the well. The results of the test are read within 15 minutes after the diluent is added. If one pink line appears in the “control” area and no line in the test area then that is a negative result. However, if there is a line in the “control” area and also one in the “test” area then the person is “suspected” of having chagas. We use the term “suspected of having chagas” because it isn’t 100% sure that the kid has chagas. In order to confirm 100% that the kid has chagas, a sample of the child’s blood is taken to the chagas lab at Hospital San Juan de Dios and is analyzed. After Dr. Edith’s explanation, many of the parents seemed more at ease.
For the other days in the week, my internship consisted of traveling to different schools and giving the rapid chagas test. One of the schools we visited was Escuela Seccional, which is in Chaupicancha. Chaupicancha is located very far in the countryside, and it took us about 1.5 hours just to get there. Not only at Escuela Seccional did we test the kids for chagas but there was also a doctor on our team that held consults and people from the community visited him. For the remainder of the week, we tested kids at a kinder called PanAmericano.
At the schools, my job basically consisted of prepping/setting up the stuff for the test, running the rapid tests after the doctor had obtained the blood sample, and filling out a portion of the paperwork.
Overall, I really enjoyed this rotation because it is an area of public health that I am interested in pursuing one day. Out of the 167 kids that we tested, only 16 were “suspects” of chagas. In Bolivia, the prevalence rate of chagas in those less than 15 yrs old is 5.5%. Overall prevalence (including adults) is about 70%. What I really liked about this rotation was the fact that this diagnostic program actually went to the people instead of having the people come to them. For example, I know for a fact that if we had not gone to Chaupicancha there would have been no way to test the kids because Chaupicancha is really far away from the center of Tarija and most families that live in the countryside do not own vehicles. In addition, although Bolivia is the poorest country in South America, the Bolivian government seems to be investing what little money they have in trying to keep Bolivian children healthy. In my opinion, I believe that when it comes to an infectious disease such as chagas, prevention and early detection in children is key because if we can prevent and treat a problem now then in the long run there is the possibility of a healthier country with the potential of increasing the country’s productivity and development and also lowering long-term healthcare costs.
In addition to the rotation this week, I was also able to spend some time in the vinchuca lab. Vinchuca’s are the insects that act as vectors and transmit the parasite. At first, I was a little freaked out by the lab because I don’t like bugs (even if they are in glass containers), and in this lab I was surrounded by them. Julio, who is the man that runs the lab, gave me a tour of the lab. He also showed me the bugs that resemble vinchucas and how to differentiate the look-alikes from the real thing. In addition, he showed me how to test a vinchuca for epimastigotes (the Trypanosoma cruzi morphological stage found in the vinchuca)
On the first day of rotations, Dr. Edith, a couple other CFHI interns, and I went to a local elementary school to teach the parents about chagas. Surprisingly, the room was filled with parents to the point that there were no empty seats and parents were standing in the back. We gave a powerpoint presentation and handed out brochures that contained information about chagas infection, treatment, and prevention. I noticed that most of the parents were very interested in the presentation and learning about chagas. They even asked some very good questions. However, one aspect that I found to be slightly ineffective was the brochures that we handed out to the parents because some of them couldn’t read. However, thankfully, the brochures had pictures on them to help explain some of the concepts that we were trying to get across. At the end of the presentation, Dr. Edith explained to the parents that in the next following weeks we would be returning and giving free rapid chagas test. Of course, several of the parents were very concerned about the process since we would need to obtain a small blood sample. One parent even stressed concerned that he didn’t want any medical students, interns, or unqualified people performing the test on his child. Dr. Edith handled the situation gracefully and went through the process of rapid chagas testing. The test is really simple and is a qualitative test for the detection of antibodies to Trypanosoma cruzi, which is the causing parasite. First, the doctor uses a small “pincher” to poke the child’s finger in order to cause bleeding. The doctor then uses a plastic pipette to suck up some of the patient’s blood and places the blood in a sample well. A diluent is then added to the well. The results of the test are read within 15 minutes after the diluent is added. If one pink line appears in the “control” area and no line in the test area then that is a negative result. However, if there is a line in the “control” area and also one in the “test” area then the person is “suspected” of having chagas. We use the term “suspected of having chagas” because it isn’t 100% sure that the kid has chagas. In order to confirm 100% that the kid has chagas, a sample of the child’s blood is taken to the chagas lab at Hospital San Juan de Dios and is analyzed. After Dr. Edith’s explanation, many of the parents seemed more at ease.
For the other days in the week, my internship consisted of traveling to different schools and giving the rapid chagas test. One of the schools we visited was Escuela Seccional, which is in Chaupicancha. Chaupicancha is located very far in the countryside, and it took us about 1.5 hours just to get there. Not only at Escuela Seccional did we test the kids for chagas but there was also a doctor on our team that held consults and people from the community visited him. For the remainder of the week, we tested kids at a kinder called PanAmericano.
At the schools, my job basically consisted of prepping/setting up the stuff for the test, running the rapid tests after the doctor had obtained the blood sample, and filling out a portion of the paperwork.
Overall, I really enjoyed this rotation because it is an area of public health that I am interested in pursuing one day. Out of the 167 kids that we tested, only 16 were “suspects” of chagas. In Bolivia, the prevalence rate of chagas in those less than 15 yrs old is 5.5%. Overall prevalence (including adults) is about 70%. What I really liked about this rotation was the fact that this diagnostic program actually went to the people instead of having the people come to them. For example, I know for a fact that if we had not gone to Chaupicancha there would have been no way to test the kids because Chaupicancha is really far away from the center of Tarija and most families that live in the countryside do not own vehicles. In addition, although Bolivia is the poorest country in South America, the Bolivian government seems to be investing what little money they have in trying to keep Bolivian children healthy. In my opinion, I believe that when it comes to an infectious disease such as chagas, prevention and early detection in children is key because if we can prevent and treat a problem now then in the long run there is the possibility of a healthier country with the potential of increasing the country’s productivity and development and also lowering long-term healthcare costs.
In addition to the rotation this week, I was also able to spend some time in the vinchuca lab. Vinchuca’s are the insects that act as vectors and transmit the parasite. At first, I was a little freaked out by the lab because I don’t like bugs (even if they are in glass containers), and in this lab I was surrounded by them. Julio, who is the man that runs the lab, gave me a tour of the lab. He also showed me the bugs that resemble vinchucas and how to differentiate the look-alikes from the real thing. In addition, he showed me how to test a vinchuca for epimastigotes (the Trypanosoma cruzi morphological stage found in the vinchuca)
Wednesday, August 18, 2010
San Jacinto, Wine Tasting/Tours, and San Lorenzo
Although Tarija is a very small town, I have so far found several things to do around the town. The first stop on my list was Lake San Jacinto, which I spent the day at with my host family. The lake is no more than 30 minutes from the center of Tarija. When we reached the lake, I was greeted by its beauty and scenery. While at the lake, I had a chance to eat some of the local food. For all those that know me very well, then you know that I absolutely love seafood. At the lake, I ate some freshly caught fish (known as Pejerrey or Doraditos) from the lake. The fish was fried and tasted so good. I also ate corn pancakes, which is a local food. Overall, I really enjoyed the lake community because I was able to relax and it was nice to have a little get-away. If I was to go back to the lake another time, I would rent a canoe and go canoeing on the lake.
Furthermore, being in Tarija without going on several wine tours is like a cardinal sin because Tarija is known world wide for their production of wine. My friends and I spent last weekend going on several wine tours. To add a twist to the adventure, we decided to rent bikes from a local bike company called Sur Bike. Well, in my opinion, it was a HUGE mistake to rent bikes and then bike it all the way to the vineyards. We literally biked for 25 km through the countryside until we reached the Valle de la Concepcion, which houses many vineyards and where most of the wine tasting takes place. For someone who is not in optimal shape, the bike ride was horrible and I was in a lot of pain so I couldn’t enjoy the beautiful scenery around me. During the bike ride, we stopped at a vineyard (also known as a bodega here) called Pampos de Solana. At Pampos de Solana, one of the employees gave us a tour of the vicinity. The employee went over the process of wine making, the storage of wine, and which wine to have with different types of food. At this bodega, we didn’t sample any wine because we were in a rush to get to some of the other vineyards before they closed.
Eventually, we reached the Valle de la Concepcion. In the valley, we ate at a restaurant and sampled wine at a couple different places. Since I don’t drink alcohol, this wine tasting adventure was quite interesting. I had no idea what made a wine good and whether or not I would like wine. Nevertheless, through test tasting, I’ve discovered that I’m a gal that prefers the sweeter wines. My friends thought that I was crazy because I preferred the sweeter wines.
After we were done wine tasting, my friends and I headed to the local hostel where they were going to be staying for the night. I didn’t stay in the hostel but instead I headed back to Tarija. And NO I didn’t ride my bike back to Tarija! Instead, the owner of the bike company came to pick me up from the valley and drove me back to Tarija. On the way back to Tarija, one of the cars had flipped over in a bad car crash. A drunk driver who had too much wine to drink caused the accident. This just goes to show the dangers of drinking and driving. Overall, I really enjoyed my first time ever wine tasting. I would recommend that if anyone every comes to Tarija to also go on some wine tasting tours.
Finally, my last adventure consisted of me going with my host family to a small pueblo called San Lorenzo. San Lorenzo is located about an hour outside of Tarija in the countryside. Each year San Lorenzo has a huge festival rightly named Festividad del San Lorenzo. I found the festivities to be fun, and I enjoyed the dancing of the participants through the streets in their traditional wear. Also in San Lorenzo, I had a chance to meet and have lunch with members of my host family’s family. Overall, San Lorenzo was fun.
So far, I’m really enjoying Tarija and my new host family and I’m looking forward to other adventures that await me.
Furthermore, being in Tarija without going on several wine tours is like a cardinal sin because Tarija is known world wide for their production of wine. My friends and I spent last weekend going on several wine tours. To add a twist to the adventure, we decided to rent bikes from a local bike company called Sur Bike. Well, in my opinion, it was a HUGE mistake to rent bikes and then bike it all the way to the vineyards. We literally biked for 25 km through the countryside until we reached the Valle de la Concepcion, which houses many vineyards and where most of the wine tasting takes place. For someone who is not in optimal shape, the bike ride was horrible and I was in a lot of pain so I couldn’t enjoy the beautiful scenery around me. During the bike ride, we stopped at a vineyard (also known as a bodega here) called Pampos de Solana. At Pampos de Solana, one of the employees gave us a tour of the vicinity. The employee went over the process of wine making, the storage of wine, and which wine to have with different types of food. At this bodega, we didn’t sample any wine because we were in a rush to get to some of the other vineyards before they closed.
Eventually, we reached the Valle de la Concepcion. In the valley, we ate at a restaurant and sampled wine at a couple different places. Since I don’t drink alcohol, this wine tasting adventure was quite interesting. I had no idea what made a wine good and whether or not I would like wine. Nevertheless, through test tasting, I’ve discovered that I’m a gal that prefers the sweeter wines. My friends thought that I was crazy because I preferred the sweeter wines.
After we were done wine tasting, my friends and I headed to the local hostel where they were going to be staying for the night. I didn’t stay in the hostel but instead I headed back to Tarija. And NO I didn’t ride my bike back to Tarija! Instead, the owner of the bike company came to pick me up from the valley and drove me back to Tarija. On the way back to Tarija, one of the cars had flipped over in a bad car crash. A drunk driver who had too much wine to drink caused the accident. This just goes to show the dangers of drinking and driving. Overall, I really enjoyed my first time ever wine tasting. I would recommend that if anyone every comes to Tarija to also go on some wine tasting tours.
Finally, my last adventure consisted of me going with my host family to a small pueblo called San Lorenzo. San Lorenzo is located about an hour outside of Tarija in the countryside. Each year San Lorenzo has a huge festival rightly named Festividad del San Lorenzo. I found the festivities to be fun, and I enjoyed the dancing of the participants through the streets in their traditional wear. Also in San Lorenzo, I had a chance to meet and have lunch with members of my host family’s family. Overall, San Lorenzo was fun.
So far, I’m really enjoying Tarija and my new host family and I’m looking forward to other adventures that await me.
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