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.
Wednesday, September 8, 2010
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.
Sixth Week: Internal Medicine and Cardiology
My first week of rotations in Tarija resembled much of what I did in La Paz. I was actually shocked and was expecting it to be different. I spent my first week at Hospital San Juan de Dios in the internal medicine and also cardiology unit. San Juan de Dios is the main hospital in Tarija, and it isn’t very big.
The first morning I arrived at the hospital there was a long line of people, which extended a little past the hospital gates. The line is a permanent characteristic of the hospital because the people are in line waiting for a consult with a doctor.
In addition, on that first day, I saw my first live death take place. Basically, what happened is that the doctor, his intern/med students, two other CFHI interns, and I began the regular rounds. Our first patient was an older man who the doctor said had a stomach hemorrhage and had been vomiting up blood the night before. After viewing this patient briefly, we moved onto the next patient. The second patient was suffering from bronchopneumonia, cellulitis, and had a UTI. After about 7 min with this second patient, a nurse ran into the room and told the doctor that he needed to hurry up and return to the other room that we had just left. The doctor rushed out of the room, and the next thing I know is that the other students and I quickly trail behind him. Apparently, our first patient’s esophagus began to fill with blood, and they need to create an air opening ASAP. As the med students tried to open the patient’s airway, they were also using a tube to suck up the massive amounts of blood that the patient was loosing. While all of this was happening, the patient’s wife kept trying to enter the room but the nurses were trying to keep her out and they kept asking her what blood type her husband had. Within minutes, a nurse showed up with a bag full of blood so they could begin a blood transfusion. The next thing I know is that the man goes unconscious and the doctor and med students begin to try to revive him. As the doctors try to revive the patient, the doctor asked for a specific type of instrument (some type of endoscope, the name that I wasn’t able to make out). The nurses then told the doctor that the hospital did not have that specific instrument. The doctor and medical staff literally try to revive the man for about 15 min. When I saw the doctor look at his clock, I knew that the man had passed. When the doctor told the wife that her husband had passed, I’ll never forget the scream/cry that came from her. After the whole incident, the doctor said that this man’s life mostly likely could have been saved only if they [the hospital] would have had that ONE instrument. To me, it’s crazy to think how just one medical instrument could have saved this man’s life.
Following that epic first day, the rest of the week was very chill and relaxing. I didn’t get to see as many chagas patients as I had hoped for. However, the chagas patients that I did see were in the cardiovascular unit because chagas can affect an individual’s heart. All the chagas patients that I did encountered had very enlarged hearts.
For this week, I will be doing a lot more chagas work; specifically public health and diagnostic work out in the rural communities of Tarija.
The first morning I arrived at the hospital there was a long line of people, which extended a little past the hospital gates. The line is a permanent characteristic of the hospital because the people are in line waiting for a consult with a doctor.
In addition, on that first day, I saw my first live death take place. Basically, what happened is that the doctor, his intern/med students, two other CFHI interns, and I began the regular rounds. Our first patient was an older man who the doctor said had a stomach hemorrhage and had been vomiting up blood the night before. After viewing this patient briefly, we moved onto the next patient. The second patient was suffering from bronchopneumonia, cellulitis, and had a UTI. After about 7 min with this second patient, a nurse ran into the room and told the doctor that he needed to hurry up and return to the other room that we had just left. The doctor rushed out of the room, and the next thing I know is that the other students and I quickly trail behind him. Apparently, our first patient’s esophagus began to fill with blood, and they need to create an air opening ASAP. As the med students tried to open the patient’s airway, they were also using a tube to suck up the massive amounts of blood that the patient was loosing. While all of this was happening, the patient’s wife kept trying to enter the room but the nurses were trying to keep her out and they kept asking her what blood type her husband had. Within minutes, a nurse showed up with a bag full of blood so they could begin a blood transfusion. The next thing I know is that the man goes unconscious and the doctor and med students begin to try to revive him. As the doctors try to revive the patient, the doctor asked for a specific type of instrument (some type of endoscope, the name that I wasn’t able to make out). The nurses then told the doctor that the hospital did not have that specific instrument. The doctor and medical staff literally try to revive the man for about 15 min. When I saw the doctor look at his clock, I knew that the man had passed. When the doctor told the wife that her husband had passed, I’ll never forget the scream/cry that came from her. After the whole incident, the doctor said that this man’s life mostly likely could have been saved only if they [the hospital] would have had that ONE instrument. To me, it’s crazy to think how just one medical instrument could have saved this man’s life.
Following that epic first day, the rest of the week was very chill and relaxing. I didn’t get to see as many chagas patients as I had hoped for. However, the chagas patients that I did see were in the cardiovascular unit because chagas can affect an individual’s heart. All the chagas patients that I did encountered had very enlarged hearts.
For this week, I will be doing a lot more chagas work; specifically public health and diagnostic work out in the rural communities of Tarija.
Finally in Tarija
As some of you may know, I switched sceneries, and I am now in southern Bolivia (been here for a little over one week) in a small town called Tarija. Since I’ve been here, I’ve been asked multiple times if I prefer Tarija or urban La Paz. My answer remains constant: I like both places for completely different reasons. Here in Tarija, I get that small town feeling and atmosphere, and the people in Tarija are nicer and friendlier.
When I’m out and about, I usually wonder into the downtown area where there is a ton of boutiques. Since I mention boutiques, I must also comment on prices here. I thought prices in La Paz were astonishing low but here the prices are even more astonishing low. I’ve hardly spent a dime here, which is great because I’m a broke college student. The only thing that I don’t like is that most of the things here are imported from Argentina (which resemble a lot of modern American merchandise) so I’m having a difficult time finding truly authentic Bolivian things.
Since Tarija is small, I’ve practically seem most of the city. I’m not too concerned about becoming bored because I’m sure there is something to do that I haven’t done already. In addition, my evenings are filled with a Spanish language class.
My host family here is awesome. Of course, I have a host mom (named Sandra) and dad (named Daniel). I also have three host siblings. First is Mayra, who is 18 yrs old and gorgeous, and is studying civil engineering at the local university. She and I have become like best friends. Then there is Daniel, who is 17 yrs old, and is finishing up high school. There is Fernando, who is 7 yrs old, and has the cute, big cheeks. Also living in the house is the grandma, who loves to continuously feed me food. Overall, I connect really well with my host family. I also like the fact that I’m the only exchange student living in the house because I’m forced to only speak Spanish, which is great because I’m practicing way more Spanish than I was in La Paz.
I’ve already gone on some pretty cool adventures here, which I’ll blog about in the next couple of days….so stay tuned.
When I’m out and about, I usually wonder into the downtown area where there is a ton of boutiques. Since I mention boutiques, I must also comment on prices here. I thought prices in La Paz were astonishing low but here the prices are even more astonishing low. I’ve hardly spent a dime here, which is great because I’m a broke college student. The only thing that I don’t like is that most of the things here are imported from Argentina (which resemble a lot of modern American merchandise) so I’m having a difficult time finding truly authentic Bolivian things.
Since Tarija is small, I’ve practically seem most of the city. I’m not too concerned about becoming bored because I’m sure there is something to do that I haven’t done already. In addition, my evenings are filled with a Spanish language class.
My host family here is awesome. Of course, I have a host mom (named Sandra) and dad (named Daniel). I also have three host siblings. First is Mayra, who is 18 yrs old and gorgeous, and is studying civil engineering at the local university. She and I have become like best friends. Then there is Daniel, who is 17 yrs old, and is finishing up high school. There is Fernando, who is 7 yrs old, and has the cute, big cheeks. Also living in the house is the grandma, who loves to continuously feed me food. Overall, I connect really well with my host family. I also like the fact that I’m the only exchange student living in the house because I’m forced to only speak Spanish, which is great because I’m practicing way more Spanish than I was in La Paz.
I’ve already gone on some pretty cool adventures here, which I’ll blog about in the next couple of days….so stay tuned.
Tuesday, August 10, 2010
Fifth Week: Obstetrics
For my last rotation in La Paz, I was at a small clinic called Servicio Adolesencias, which was located pretty far from where I was staying in La Paz. It was a bummer that I was really sick this week and couldn't make it to clinic everyday because this was by far one of my favorite rotations.
I found this rotation to be the most hands on rotation that I completed while in La Paz. On the first day, the doctor and Lila (another CFHI intern who had already done this rotation before), showed me how to complete an exam on a pregnant woman. After the first couple of patients, I was taking the patient's blood pressure, pulse, measuring the patient's belly, and finding + checking the baby's heart rate with a fetal heart rate doppler and reporting the information to the doctor. I also found myself filling out some of the patient forms that the doctor gave me to complete.
For this rotation, I think that the most shocking thing that I encountered were the number of pregnant teenagers. The youngest patient that I saw was 16 years old. I was also shocked by the amount of support that these young-soon-to-be moms had from the baby's father.
Overall, I really enjoyed the hands on experience, and as a result, I am considering becoming an OB-GYN.
For the remainder of my stay in Bolivia, I will be in southern Bolivia in a town known as Tarija, which is world famous for their wine. The rotations that I will be completing in Tarija will center on an infectious disease known as Chagas. I'm looking forward to my time in Tarija because infectious diseases fascinate me. In addition, I'm also looking forward to observing rural medicine and comparing it to what I encountered in La Paz.
I found this rotation to be the most hands on rotation that I completed while in La Paz. On the first day, the doctor and Lila (another CFHI intern who had already done this rotation before), showed me how to complete an exam on a pregnant woman. After the first couple of patients, I was taking the patient's blood pressure, pulse, measuring the patient's belly, and finding + checking the baby's heart rate with a fetal heart rate doppler and reporting the information to the doctor. I also found myself filling out some of the patient forms that the doctor gave me to complete.
For this rotation, I think that the most shocking thing that I encountered were the number of pregnant teenagers. The youngest patient that I saw was 16 years old. I was also shocked by the amount of support that these young-soon-to-be moms had from the baby's father.
Overall, I really enjoyed the hands on experience, and as a result, I am considering becoming an OB-GYN.
For the remainder of my stay in Bolivia, I will be in southern Bolivia in a town known as Tarija, which is world famous for their wine. The rotations that I will be completing in Tarija will center on an infectious disease known as Chagas. I'm looking forward to my time in Tarija because infectious diseases fascinate me. In addition, I'm also looking forward to observing rural medicine and comparing it to what I encountered in La Paz.
Monday, August 2, 2010
In and about La Paz
For the last two weeks, I haven’t done any major traveling outside of La Paz. However, I must say that I have really enjoyed just exploring La Paz more.
I was invited by two other CFHI interns to join them and Dra. Terejina for a trip to Valle de la Mallasa. The valley is located about an hour outside of La Paz. This valley was just as beautiful as Valle de la Luna that I visited my second week in La Paz.
The other interns and I also took a day excursion to Tiwanaku. Tiwanaku is an archaeological site that contains small ruins and reconstructed ruins of an empire that was established around 1000 BC. Tiwanaku came before the great Incan Empire. Some historians and archaeologist say that this empire fell because the people of Tiwanaku were no longer able to farm the land. Overall, I liked the trip but was expecting a lot more ruins like those that I had seen in Machu Picchu. In addition, I visited a couple museums there.
This past Saturday (July 31), my housemates and I went to the big parade that ran through the Prado (the main street in La Paz, which is very long). The parade is an annual celebration of that includes traditional dance (each dance told a specific story) and music. From what I was told by a couple of Bolivians is that almost all public university students are required to perform in the parade by law and that the parade was designed as a way to preserve Bolivia’s traditional culture. For me, the parade surpassed what I was expecting. Most of the outfits/traditional wear had such fine detail that highlighted Bolivian culture. Overall, my favorite parts of the parade were the bands, especially the drumming.
This past week I also visited the Zona Sur, which is located about 30 minutes from where I live in the Sopocachi neighborhood in La Paz. The Zona Sur is an elite district in La Paz where all the rich people live like the diplomats. The area is nice and the buildings are spectacular, especially the houses. While in the Zona Sur, my friends and I went to a restaurant called Charlie Papa, which reminded me so much of Red Robbins. The food was excellent, and I would highly recommend the restaurant to anyone visiting La Paz. In addition, the prices were very reasonable.
Besides the things mentioned above, I finally was able to make it to La Paz’s famous Mercado Hechicería. This market is famous for its continuous display of dried llama fetuses. I must say that I was shocked to see how big the llama fetuses were (they aren’t small by any means).
This week I was also reminded once again of how dangerous La Paz can be. One day as a group of my friends and I were walking through one of the markets, one of my friends had dirt spilled on him. As the dirt was thrown on him, we suddenly found ourselves in a swarm of people. As we were in the swarm of people, another one of my friends spontaneously yelled, “Watch you stuff you guys!” At first, I was so confused as to why all of a sudden we were in a crowd of people that just kept bumping us, and I also was confused as to where the dirt had come from. However, as quickly as the crowd appeared, they disappeared. After the crowd disappeared, my friend took off his jacket in order to get the dirt off. As he put his jacket back on, he checked his coat pocket and wa-la….. his camera was missing!!! He had just been robbed. We immediately stopped walking and stopped in front of one of the vender stalls. We were in shock of what had just happened. We told the woman vender what had happened, and she explained that the whole throwing of the dirt on a person and then the spontaneous crowd was one of the tricks that pick-pocketers used. She explained that a person on a bus most likely threw the dirt. Even though I was wearing a backpack, I wasn’t pick-pocket because 1) I never carry anything valuable in my backpack or in my pockets and 2) I wear a money belt around my waist and and the money belt is always under my shirt. I really felt so bad for my friend. He literally lost all his pictures that he had taken of his trip thus far and the worst part is that he hadn’t uploaded any of his pictures onto a computer.
Although the whole pick-pocketing put a little damp on our spirits, I must say that I have enjoyed La Paz. This is my last week in La Paz because I will be spending the rest of my time in southern Bolivia taking more Spanish classes and learning more about the infectious disease known as Chagas.
I was invited by two other CFHI interns to join them and Dra. Terejina for a trip to Valle de la Mallasa. The valley is located about an hour outside of La Paz. This valley was just as beautiful as Valle de la Luna that I visited my second week in La Paz.
The other interns and I also took a day excursion to Tiwanaku. Tiwanaku is an archaeological site that contains small ruins and reconstructed ruins of an empire that was established around 1000 BC. Tiwanaku came before the great Incan Empire. Some historians and archaeologist say that this empire fell because the people of Tiwanaku were no longer able to farm the land. Overall, I liked the trip but was expecting a lot more ruins like those that I had seen in Machu Picchu. In addition, I visited a couple museums there.
This past Saturday (July 31), my housemates and I went to the big parade that ran through the Prado (the main street in La Paz, which is very long). The parade is an annual celebration of that includes traditional dance (each dance told a specific story) and music. From what I was told by a couple of Bolivians is that almost all public university students are required to perform in the parade by law and that the parade was designed as a way to preserve Bolivia’s traditional culture. For me, the parade surpassed what I was expecting. Most of the outfits/traditional wear had such fine detail that highlighted Bolivian culture. Overall, my favorite parts of the parade were the bands, especially the drumming.
This past week I also visited the Zona Sur, which is located about 30 minutes from where I live in the Sopocachi neighborhood in La Paz. The Zona Sur is an elite district in La Paz where all the rich people live like the diplomats. The area is nice and the buildings are spectacular, especially the houses. While in the Zona Sur, my friends and I went to a restaurant called Charlie Papa, which reminded me so much of Red Robbins. The food was excellent, and I would highly recommend the restaurant to anyone visiting La Paz. In addition, the prices were very reasonable.
Besides the things mentioned above, I finally was able to make it to La Paz’s famous Mercado Hechicería. This market is famous for its continuous display of dried llama fetuses. I must say that I was shocked to see how big the llama fetuses were (they aren’t small by any means).
This week I was also reminded once again of how dangerous La Paz can be. One day as a group of my friends and I were walking through one of the markets, one of my friends had dirt spilled on him. As the dirt was thrown on him, we suddenly found ourselves in a swarm of people. As we were in the swarm of people, another one of my friends spontaneously yelled, “Watch you stuff you guys!” At first, I was so confused as to why all of a sudden we were in a crowd of people that just kept bumping us, and I also was confused as to where the dirt had come from. However, as quickly as the crowd appeared, they disappeared. After the crowd disappeared, my friend took off his jacket in order to get the dirt off. As he put his jacket back on, he checked his coat pocket and wa-la….. his camera was missing!!! He had just been robbed. We immediately stopped walking and stopped in front of one of the vender stalls. We were in shock of what had just happened. We told the woman vender what had happened, and she explained that the whole throwing of the dirt on a person and then the spontaneous crowd was one of the tricks that pick-pocketers used. She explained that a person on a bus most likely threw the dirt. Even though I was wearing a backpack, I wasn’t pick-pocket because 1) I never carry anything valuable in my backpack or in my pockets and 2) I wear a money belt around my waist and and the money belt is always under my shirt. I really felt so bad for my friend. He literally lost all his pictures that he had taken of his trip thus far and the worst part is that he hadn’t uploaded any of his pictures onto a computer.
Although the whole pick-pocketing put a little damp on our spirits, I must say that I have enjoyed La Paz. This is my last week in La Paz because I will be spending the rest of my time in southern Bolivia taking more Spanish classes and learning more about the infectious disease known as Chagas.
Fourth Week: Oncology
For my fourth week of clinical rotations, I was back at Hospital del Niño in the oncology unit with Dra. Riveros. Oncology is a medical topic that I’m not that familiar with although I have learned a little bit about the development of cancer from my biochemistry, cell biology, and genetic courses at school.
In this rotation, the most common cancers that I encountered were acute lymphoblastic leukemia (ALL), retinoblastoma, sarcoma, and accompanying several of the cases was leucopenia (a reduction in the amount of leucocytes). Dra. Riveros told me that ALL is the most common pediatric cancer. ALL occurs when there is a lot of lymphoblast (immature lymphocytes) in the blood. Furthermore, retinoblastoma is a cancer that affects the patient’s retina. In patients that had retinoblastoma, I saw the characteristic whitening of the pupil. Finally, another common cancer that I saw was sarcoma. Sarcomas are malignant tumors that affect a variety of tissues (ex. bone, muscle, fibrous tissue, etc). Dra. Riveros said that sarcomas are named after the parent tissue in which they originate. For example, if the sarcoma were found in the bones then the sarcoma would be called osteosarcoma. One case that I saw involved a young girl, who I’ll call Patient M. I was able to view Patient M’s radiographs and tomographs. In these, one could clearly see that the sarcoma had engulfed her abdominal region, esp. her liver. But now the tumor had been reduced in size thanks to chemotherapy. However, the doctors weren’t able to specify the type of sarcoma because they were not able to identify the starting tissue in which the tumor began.
In addition, to completing rounds with Dra. Riveros, she also took the other two CFHI interns and me down to the pathology lab. In the pathology lab, we looked at slides that contained samples, and the pathologist went over how to identify cancer cells in the tissue samples. I found this to be pretty cool because I’ve never done anything like it before.
Furthermore, because there was quite a bit of downtime in the oncology unit, I really got to know the kids beyond their medical conditions. Often, I found myself just talking and playing with the kids. I must say that the kids in this unit are super sweet and cute. I had a great time playing with them. On a couple of the days, I brought the kids crayons, necklaces, bracelets, and a couple small toys and handed them out to the kids on the unit. When I gave each of them a gift, they were appreciative. It was nice to see them smile and escape the reality of their lives for at least an hour and just to have fun with me.
Overall, I enjoyed this rotation.
In this rotation, the most common cancers that I encountered were acute lymphoblastic leukemia (ALL), retinoblastoma, sarcoma, and accompanying several of the cases was leucopenia (a reduction in the amount of leucocytes). Dra. Riveros told me that ALL is the most common pediatric cancer. ALL occurs when there is a lot of lymphoblast (immature lymphocytes) in the blood. Furthermore, retinoblastoma is a cancer that affects the patient’s retina. In patients that had retinoblastoma, I saw the characteristic whitening of the pupil. Finally, another common cancer that I saw was sarcoma. Sarcomas are malignant tumors that affect a variety of tissues (ex. bone, muscle, fibrous tissue, etc). Dra. Riveros said that sarcomas are named after the parent tissue in which they originate. For example, if the sarcoma were found in the bones then the sarcoma would be called osteosarcoma. One case that I saw involved a young girl, who I’ll call Patient M. I was able to view Patient M’s radiographs and tomographs. In these, one could clearly see that the sarcoma had engulfed her abdominal region, esp. her liver. But now the tumor had been reduced in size thanks to chemotherapy. However, the doctors weren’t able to specify the type of sarcoma because they were not able to identify the starting tissue in which the tumor began.
In addition, to completing rounds with Dra. Riveros, she also took the other two CFHI interns and me down to the pathology lab. In the pathology lab, we looked at slides that contained samples, and the pathologist went over how to identify cancer cells in the tissue samples. I found this to be pretty cool because I’ve never done anything like it before.
Furthermore, because there was quite a bit of downtime in the oncology unit, I really got to know the kids beyond their medical conditions. Often, I found myself just talking and playing with the kids. I must say that the kids in this unit are super sweet and cute. I had a great time playing with them. On a couple of the days, I brought the kids crayons, necklaces, bracelets, and a couple small toys and handed them out to the kids on the unit. When I gave each of them a gift, they were appreciative. It was nice to see them smile and escape the reality of their lives for at least an hour and just to have fun with me.
Overall, I enjoyed this rotation.
Saturday, July 31, 2010
Third Week: Internal Medicine
For my third week of rotations, I was placed at a different hospital than the previous weeks. The hospital that I was at is called Hospital Arco Iris. Hospital Arco Iris is a lot different from Hospital del Niño. Hospital Arco Iris treats all ages and still provides free care to children and young adults. However, in order to be operational, the hospital provides private care to patients that can afford it. Interestingly, the building belongs to a Catholic foundation but the doctors, nurses, and other staff is paid by the government.
When I first walked into the hospital, I was literally in shock because the hospital was clean and very well kept in comparison to Hospital del Niño. I was greeted by Dra. Inaburu who showed me to the second floor, which houses internal medicine. I was then handed off to Dr. Bguia who was very welcoming and was actually happy that I wasn’t in med school yet because he thinks med students are very pompous.
Dr. Bguia literally introduced me to everyone on the floor and to the two interns that work with him. After the formal introductions, rounds began.
Even though it was the internal medicine unit, I felt like a lot of the cases also involved geriatric care. I thought this was cool because I’ve never really been exposed to geriatric care.
Throughout the week, I saw some very interesting cases and learned about diseases that I’ve never heard about before. Below are some of the cases that I encountered during the week:
• An interesting case presented this week involved a young woman, who I’ll call Patient I. Patient I has Guillain-Barré Syndrome. Guillain-Barré Syndrome is an immunological disorder that leads to damage of the nerve’s myelin sheaths. The body’s T-cells and macrophages literally remove the nerve’s myelin sheaths. In some cases, the axon is also destroyed. Most people who have this experience tingling, numbness, and even weakness throughout the body. The cause of Guillain-Barré Syndrome is not fully but it most likely results from a bacterial or viral infection.
• When I first saw Patient P, I was shocked by how thin this elderly woman was. At first, I thought she was suffering from malnutrition. However, the doctor explained to me that Patient P has cachexia and cancer that is rapidly spreading. After the doctors told me this, I still had no idea what cachexia was. The doctor explained to me that cachexia is when a person has severe muscle wasting, which usually occurs after a major illness (ex. cancer). Dr. Bguia certainly emphasized that muscle wasting in cachexia is not due to malnutrition. He also said that both doctors and researchers still don’t know the direct cause of cachexia.
• The hardest case that I witnessed this week involved a 67 yr old male. The doctors told me that the man was suffering from TB and that the man was most likely going to die the next day and there was nothing more that they could do except help him pass his time on earth peacefully. When the doctors told me this, I was a little blown away and asked the doctors if they had already told the family. The doctors said they hadn’t, but later in the day, the patient’s wife was coming and they were going to tell her then.
Later in the day, the wife did come to the hospital. The doctors allowed me to be present while they explained to the wife her husband’s condition and that he was going to die. As the doctors told the wife, I felt the wife’s pain. After all, how is someone supposed to handle knowing that her husband or family member had less than 24 hours to live? After telling the wife the dreaded news, the doctors first offered the wife intermediate care for her husband, but the wife rejected it and opted for hospice care. However, later in the day, the wife spoke with the doctors again and decided not to take hospice care. The only thing that the wife wanted was her husband to be transported back to their house where he could die surrounded by family and die peacefully. At the wife’s request, the ambulance transported the man back to his house.
• Patient J came to the hospital with an asthma attack. After reviewing an x-ray, it was determined that the patient had TB and fibrosis. Because of fibrosis, Patient J’s trachea was displaced to the left side of his body. By just looking at the patient, I could see that his trachea was located more toward the left side of his body. Dr. Bguia explained to me that fibrosis occurs when tissues or organs become thick because the body replaces the original tissue with very collagenous fibrous tissue, which leads to scarring. He also said that fibrosis usually occurs in a location that has been injured.
• Patient B came to the hospital because she was wheezing and couldn’t breathe. At first, the doctors thought that it was TB. Later, after a TB test and an x-ray, TB was ruled out. By looking at the x-ray, as one moved up towards the patient’s head on the x-ray image, the x-ray was no longer well defined. Dr. Murillo told me that this suggested tissue damage and that the patient most likely has a tumor in her trachea region.
• Another case that I saw, which I actually found very sad, was one in which a 64 yr old patient (who I’ll call Patient M) was suffering from abandonment. Because the patient had been abandoned, she was in poor health. Patient M had a series of multiple problems that included renal problems, varicose veins, chronic depression, cellulitis, edema, and bedsores. She was also very dehydrated, and because of dehydration, most of her body minerals were very concentrated.
• One patient had obstructive jaundice. Obstructive jaundice is the result of a blockage in either the liver or bile duct and prevents bile flowing normally. Such things as gallstones can cause blockage and yellowing of the patient’s skin.
• I saw a patient who has extrapulmonary TB.
Although I did get to help with a few exams during the rounds, it was a lot less hands on experience in comparison to the infectious disease rotation that I completed the previous week. Nevertheless, I learned a ton about human physiology and diseases that I’ve never even heard about.
In addition to completing a rotation in internal medicine, I was also able to observe a neurosurgery this week. I was invited to observe the surgery by neurosurgeon Dr. Montilla in which he removed a tumor lodged in the brain of a 20 yr old female.
The surgery began on Wednesday morning at 9:15am. In the operating room, I was confined to a small square in which I had to stand for about 3 hours with my arms behind my back (except when taking pictures) so I wouldn’t contaminate anything. I was able to see the surgery very clearly because I was literally less than 10 feet away from where the operation was occurring. In the US, I would never be able to observe a surgery so close up. One thing that I’ll never forget was the sound of the patient’s cracking skull as Dr. Montilla worked to remove a portion of skull. Overall, the surgery went smoothly and the tumor was removed. Some people may wonder if I was grossed out at all and my answer is a definitive NO, even though there was a lot of blood.
When I first walked into the hospital, I was literally in shock because the hospital was clean and very well kept in comparison to Hospital del Niño. I was greeted by Dra. Inaburu who showed me to the second floor, which houses internal medicine. I was then handed off to Dr. Bguia who was very welcoming and was actually happy that I wasn’t in med school yet because he thinks med students are very pompous.
Dr. Bguia literally introduced me to everyone on the floor and to the two interns that work with him. After the formal introductions, rounds began.
Even though it was the internal medicine unit, I felt like a lot of the cases also involved geriatric care. I thought this was cool because I’ve never really been exposed to geriatric care.
Throughout the week, I saw some very interesting cases and learned about diseases that I’ve never heard about before. Below are some of the cases that I encountered during the week:
• An interesting case presented this week involved a young woman, who I’ll call Patient I. Patient I has Guillain-Barré Syndrome. Guillain-Barré Syndrome is an immunological disorder that leads to damage of the nerve’s myelin sheaths. The body’s T-cells and macrophages literally remove the nerve’s myelin sheaths. In some cases, the axon is also destroyed. Most people who have this experience tingling, numbness, and even weakness throughout the body. The cause of Guillain-Barré Syndrome is not fully but it most likely results from a bacterial or viral infection.
• When I first saw Patient P, I was shocked by how thin this elderly woman was. At first, I thought she was suffering from malnutrition. However, the doctor explained to me that Patient P has cachexia and cancer that is rapidly spreading. After the doctors told me this, I still had no idea what cachexia was. The doctor explained to me that cachexia is when a person has severe muscle wasting, which usually occurs after a major illness (ex. cancer). Dr. Bguia certainly emphasized that muscle wasting in cachexia is not due to malnutrition. He also said that both doctors and researchers still don’t know the direct cause of cachexia.
• The hardest case that I witnessed this week involved a 67 yr old male. The doctors told me that the man was suffering from TB and that the man was most likely going to die the next day and there was nothing more that they could do except help him pass his time on earth peacefully. When the doctors told me this, I was a little blown away and asked the doctors if they had already told the family. The doctors said they hadn’t, but later in the day, the patient’s wife was coming and they were going to tell her then.
Later in the day, the wife did come to the hospital. The doctors allowed me to be present while they explained to the wife her husband’s condition and that he was going to die. As the doctors told the wife, I felt the wife’s pain. After all, how is someone supposed to handle knowing that her husband or family member had less than 24 hours to live? After telling the wife the dreaded news, the doctors first offered the wife intermediate care for her husband, but the wife rejected it and opted for hospice care. However, later in the day, the wife spoke with the doctors again and decided not to take hospice care. The only thing that the wife wanted was her husband to be transported back to their house where he could die surrounded by family and die peacefully. At the wife’s request, the ambulance transported the man back to his house.
• Patient J came to the hospital with an asthma attack. After reviewing an x-ray, it was determined that the patient had TB and fibrosis. Because of fibrosis, Patient J’s trachea was displaced to the left side of his body. By just looking at the patient, I could see that his trachea was located more toward the left side of his body. Dr. Bguia explained to me that fibrosis occurs when tissues or organs become thick because the body replaces the original tissue with very collagenous fibrous tissue, which leads to scarring. He also said that fibrosis usually occurs in a location that has been injured.
• Patient B came to the hospital because she was wheezing and couldn’t breathe. At first, the doctors thought that it was TB. Later, after a TB test and an x-ray, TB was ruled out. By looking at the x-ray, as one moved up towards the patient’s head on the x-ray image, the x-ray was no longer well defined. Dr. Murillo told me that this suggested tissue damage and that the patient most likely has a tumor in her trachea region.
• Another case that I saw, which I actually found very sad, was one in which a 64 yr old patient (who I’ll call Patient M) was suffering from abandonment. Because the patient had been abandoned, she was in poor health. Patient M had a series of multiple problems that included renal problems, varicose veins, chronic depression, cellulitis, edema, and bedsores. She was also very dehydrated, and because of dehydration, most of her body minerals were very concentrated.
• One patient had obstructive jaundice. Obstructive jaundice is the result of a blockage in either the liver or bile duct and prevents bile flowing normally. Such things as gallstones can cause blockage and yellowing of the patient’s skin.
• I saw a patient who has extrapulmonary TB.
Although I did get to help with a few exams during the rounds, it was a lot less hands on experience in comparison to the infectious disease rotation that I completed the previous week. Nevertheless, I learned a ton about human physiology and diseases that I’ve never even heard about.
In addition to completing a rotation in internal medicine, I was also able to observe a neurosurgery this week. I was invited to observe the surgery by neurosurgeon Dr. Montilla in which he removed a tumor lodged in the brain of a 20 yr old female.
The surgery began on Wednesday morning at 9:15am. In the operating room, I was confined to a small square in which I had to stand for about 3 hours with my arms behind my back (except when taking pictures) so I wouldn’t contaminate anything. I was able to see the surgery very clearly because I was literally less than 10 feet away from where the operation was occurring. In the US, I would never be able to observe a surgery so close up. One thing that I’ll never forget was the sound of the patient’s cracking skull as Dr. Montilla worked to remove a portion of skull. Overall, the surgery went smoothly and the tumor was removed. Some people may wonder if I was grossed out at all and my answer is a definitive NO, even though there was a lot of blood.
Friday, July 23, 2010
My Travels in Peru (Cusco, Aguas Caliente, y Machu Picchu)
Coming to Bolivia, I never imagined that I would end up traveling in Peru. It was an easy decision for me when some of the other interns proposed that we head to Peru and check out Machu Picchu. After all, who knows when I’ll come back to South America next? As soon as we had decided to go to Peru, we started searching for the cheapest way there. Eventually, we settled with using a travel agent in La Paz called Enjoy Bolivia.
We left La Paz early Thursday morning (on 7/15) by bus. To be honest, I wasn’t that thrilled with busing it all the way to Peru but as broke college and medical students, it was the cheapest option for us. At the beginning of the bus ride, everything was running smoothly minus the traffic jam in El Alto. Once we reached the Peru- Bolivia border, we had to get off the bus and pass through immigration. We had to get our exit papers from Bolivia and then fill out our entrance forms for Peru. Furthermore, I found it quite funny that the only thing separating the borders was a rope that a police officer held and would let go of when a bus or car needed to pass through. Overall, the transition across the border was simple and easy but the lines were long.
Once we crossed the border that’s when the bus began to have problems. About five minutes after leaving the border, the bus driver made a stop at a mechanic shop. As we waited for the bus to be fixed, all the passengers (including myself) became very agitated because the bus driver didn’t even give us an update on what was going on. All we inferred was that something was wrong with the bus because we were parked outside of a mechanic shop. We stayed at the mechanics shop for about 40 minutes.
A few minutes after the bus left the mechanic shop, motion sickness hit me. Throughout the trip, I had been in and out of sleep. But, with the onset of my motion sickness, I really tried to sleep in order to ease the nauseous feeling I had. However, I found it extremely difficult to sleep because 1) there were a lot of turns and curves and 2) the couple sitting across from Julia (one of the interns) and I kept kissing which was very distracting. Eventually, after spending 11.5 hrs on the bus I vomited. Luckily, I had a plastic garbage bag.
We eventually arrived in Cusco at night. In total, the supposed to be 8-10 hour bus ride really took 12 hours. A driver provided to us by our travel agent picked us up at the bus terminal. The driver drove us to our hotel. Driving through Cusco at night, the lights illuminated the city’s wonderful architecture and made it gorgeous. After settling in to our very comfortable hotel (which I found to be very nice), we headed out to dinner and walked a little through the city to take pictures of the city at night.
The next morning, we were up very early because we had to catch a train that took us to a town called Aguas Caliente where we would spent the day. Riding Peru Rails was quite fun. We were able to see amazing landscapes that blew my breath away. Overall, the train ride was very comfortable and relaxing.
When we arrived in Aguas Caliente, we had trouble finding our hotel. Eventually, we paid someone to show us our hotel. The hotel in Aguas Caliente wasn’t as nice as the hotel in Cusco.
After settling into our hotel, we were in search of food. One thing about Aguas Caliente is that employees of almost every restaurant bombarded us. The employees stood outside of every restaurant and offered all by-passers a menu and a deal just to eat at their restaurant. I was a little overwhelmed by the choices although most of the restaurants had the title “pizzeria” in their name.
As we were in search of a restaurant, I heard the sounds of drums. At first, I thought that this was a little awkward since I didn’t see anyone playing the drums. Within minutes of hearing the drums, I saw a bunch of Peruvians in elaborate outfits and traditional wear dancing and walking down the street. I was still confused on why a parade was occurring. Eventually, I saw a banner that said “Virgin del Carmen.” The people were celebrating the Virgin Carmen.
After watching the parade, we headed to a restaurant and finally ate. Following the restaurant, we went to the hot springs. When I first saw the hot springs, I was like “yuck” because 1) the water looked dirty and 2) there were many people. I finally convinced myself to get into the hot spring b/c I didn’t want my 10 Soles (the name of the Peruvian currency) to go to waste. We spent a little over an hour at the hot springs. The hot springs were so relaxing, and I highly recommend that if you visit Peru that you stop in Aguas Caliente and enjoy the hot springs.
The next day we were up by about 2:30 am. The reason being is that we had to catch a bus to Machu Picchu and we wanted to be the first in line because every day only 400 tickets are given out to people so that they can hike Waynapicchu. We were one of the first groups in line at the bus station. Unfortunately, we had to wait in the cold and rain until 6 am for the bus to leave to Machu Picchu. Thankfully, the bus ride was not long and it lasted only 20 minutes.
Once we got to Machu Picchu, we had to wait another 20 minutes or so for the gates to open so we could enter. When the gates opened, we saw our guide. As I took my first steps into Machu Picchu, I was a little overwhelmed because I had only read about this great Incan Empire in books and never thought that I would one day set my eyes upon it first hand. I’ll never forget what I first saw, and I don’t think that I can accurately describe what I saw b/c it was just too beautiful. When I first entered, there were low-lying clouds that hid some of the stone buildings and in the backdrop also slightly hidden by the clouds was Waynapicchu. Although the clouds hid a good portion of the structure, the clouds also made the place mystical.
Our guide walked us all throughout the structures. I was extremely happy that we had a guide because every rock is strategically placed and has a significant meaning. Our guide was able to explain the rocks to us. For example, there are rocks that form the condor. The condor is significant because it represents the flying of the Incans to heaven. In addition, a rock had engraved in it the Southern Cross. This rock oriented the Incans to the stars that made up the Southern Cross thus providing them one way to tell the seasons. I highly recommend that if anyone is planning to go to Machu Picchu that they hire a guide, its well worth it and you’ll have a better understanding of the Incans.
After our guide had showed us the structures that the Incans had built, we hiked Waynapicchu (which means small mountain). Let me tell you, hiking Waynapicchu was extremely difficult for me and what made it even more difficult was that I was carrying my heavy backpack. The mountain was so steep and the paths were very narrow. On multiple occasions, I wanted to turn back around and just forget the hike. However, a part of me knew I could complete the hike. Eventually, I made it to top! In all, my recommendations for those wanting to hike Waynapicchu are only carry water or else you’ll be in more pain. Also, wear comfortable hiking clothes. Overall, it took me 3 hrs to hike up and down Waynapicchu. Currently, the world record is 25 minutes (I seriously don’t know how someone can do that)!!!!
Upon leaving Machu Picchu, we had lunch at a nice buffet in Aguas Caliente. From Aguas Caliente, we headed back to Cusco to spend the night. The next day, we just walked and shopped around Cusco. Also, in Cusco we visited Qorikancha Convento De Santo Domingo. Following Qorikancha, the other students went to check out one of the churches that we had seen earlier. I personally didn’t go look at the church b/c I feel that it is wrong for a church to charge money for people to view inside it, and plus I’ve been inside multiple churches in La Paz. While the other students checked out inside the church, I sat on a bench in the plaza where an elderly Peruvian man was sitting. The next thing I know is that the man is talking to me in Spanish. We actually had a great conversation and I liked it because it was a way for me to practice more of my Spanish. He told me a lot about Peru and then we discussed corruption + oil/petroleum in Nigeria.
We eventually left Peru on Monday morning and headed back to La Paz. The trip back to La Paz was even more hectic than on our way to Peru but I won’t go into the details of that because it is extremely long. Overall, I highly recommend that if anyone comes to South America that you visit Machu Picchu and Cusco. Both places are definitely tourist central so be prepared for high prices.
We left La Paz early Thursday morning (on 7/15) by bus. To be honest, I wasn’t that thrilled with busing it all the way to Peru but as broke college and medical students, it was the cheapest option for us. At the beginning of the bus ride, everything was running smoothly minus the traffic jam in El Alto. Once we reached the Peru- Bolivia border, we had to get off the bus and pass through immigration. We had to get our exit papers from Bolivia and then fill out our entrance forms for Peru. Furthermore, I found it quite funny that the only thing separating the borders was a rope that a police officer held and would let go of when a bus or car needed to pass through. Overall, the transition across the border was simple and easy but the lines were long.
Once we crossed the border that’s when the bus began to have problems. About five minutes after leaving the border, the bus driver made a stop at a mechanic shop. As we waited for the bus to be fixed, all the passengers (including myself) became very agitated because the bus driver didn’t even give us an update on what was going on. All we inferred was that something was wrong with the bus because we were parked outside of a mechanic shop. We stayed at the mechanics shop for about 40 minutes.
A few minutes after the bus left the mechanic shop, motion sickness hit me. Throughout the trip, I had been in and out of sleep. But, with the onset of my motion sickness, I really tried to sleep in order to ease the nauseous feeling I had. However, I found it extremely difficult to sleep because 1) there were a lot of turns and curves and 2) the couple sitting across from Julia (one of the interns) and I kept kissing which was very distracting. Eventually, after spending 11.5 hrs on the bus I vomited. Luckily, I had a plastic garbage bag.
We eventually arrived in Cusco at night. In total, the supposed to be 8-10 hour bus ride really took 12 hours. A driver provided to us by our travel agent picked us up at the bus terminal. The driver drove us to our hotel. Driving through Cusco at night, the lights illuminated the city’s wonderful architecture and made it gorgeous. After settling in to our very comfortable hotel (which I found to be very nice), we headed out to dinner and walked a little through the city to take pictures of the city at night.
The next morning, we were up very early because we had to catch a train that took us to a town called Aguas Caliente where we would spent the day. Riding Peru Rails was quite fun. We were able to see amazing landscapes that blew my breath away. Overall, the train ride was very comfortable and relaxing.
When we arrived in Aguas Caliente, we had trouble finding our hotel. Eventually, we paid someone to show us our hotel. The hotel in Aguas Caliente wasn’t as nice as the hotel in Cusco.
After settling into our hotel, we were in search of food. One thing about Aguas Caliente is that employees of almost every restaurant bombarded us. The employees stood outside of every restaurant and offered all by-passers a menu and a deal just to eat at their restaurant. I was a little overwhelmed by the choices although most of the restaurants had the title “pizzeria” in their name.
As we were in search of a restaurant, I heard the sounds of drums. At first, I thought that this was a little awkward since I didn’t see anyone playing the drums. Within minutes of hearing the drums, I saw a bunch of Peruvians in elaborate outfits and traditional wear dancing and walking down the street. I was still confused on why a parade was occurring. Eventually, I saw a banner that said “Virgin del Carmen.” The people were celebrating the Virgin Carmen.
After watching the parade, we headed to a restaurant and finally ate. Following the restaurant, we went to the hot springs. When I first saw the hot springs, I was like “yuck” because 1) the water looked dirty and 2) there were many people. I finally convinced myself to get into the hot spring b/c I didn’t want my 10 Soles (the name of the Peruvian currency) to go to waste. We spent a little over an hour at the hot springs. The hot springs were so relaxing, and I highly recommend that if you visit Peru that you stop in Aguas Caliente and enjoy the hot springs.
The next day we were up by about 2:30 am. The reason being is that we had to catch a bus to Machu Picchu and we wanted to be the first in line because every day only 400 tickets are given out to people so that they can hike Waynapicchu. We were one of the first groups in line at the bus station. Unfortunately, we had to wait in the cold and rain until 6 am for the bus to leave to Machu Picchu. Thankfully, the bus ride was not long and it lasted only 20 minutes.
Once we got to Machu Picchu, we had to wait another 20 minutes or so for the gates to open so we could enter. When the gates opened, we saw our guide. As I took my first steps into Machu Picchu, I was a little overwhelmed because I had only read about this great Incan Empire in books and never thought that I would one day set my eyes upon it first hand. I’ll never forget what I first saw, and I don’t think that I can accurately describe what I saw b/c it was just too beautiful. When I first entered, there were low-lying clouds that hid some of the stone buildings and in the backdrop also slightly hidden by the clouds was Waynapicchu. Although the clouds hid a good portion of the structure, the clouds also made the place mystical.
Our guide walked us all throughout the structures. I was extremely happy that we had a guide because every rock is strategically placed and has a significant meaning. Our guide was able to explain the rocks to us. For example, there are rocks that form the condor. The condor is significant because it represents the flying of the Incans to heaven. In addition, a rock had engraved in it the Southern Cross. This rock oriented the Incans to the stars that made up the Southern Cross thus providing them one way to tell the seasons. I highly recommend that if anyone is planning to go to Machu Picchu that they hire a guide, its well worth it and you’ll have a better understanding of the Incans.
After our guide had showed us the structures that the Incans had built, we hiked Waynapicchu (which means small mountain). Let me tell you, hiking Waynapicchu was extremely difficult for me and what made it even more difficult was that I was carrying my heavy backpack. The mountain was so steep and the paths were very narrow. On multiple occasions, I wanted to turn back around and just forget the hike. However, a part of me knew I could complete the hike. Eventually, I made it to top! In all, my recommendations for those wanting to hike Waynapicchu are only carry water or else you’ll be in more pain. Also, wear comfortable hiking clothes. Overall, it took me 3 hrs to hike up and down Waynapicchu. Currently, the world record is 25 minutes (I seriously don’t know how someone can do that)!!!!
Upon leaving Machu Picchu, we had lunch at a nice buffet in Aguas Caliente. From Aguas Caliente, we headed back to Cusco to spend the night. The next day, we just walked and shopped around Cusco. Also, in Cusco we visited Qorikancha Convento De Santo Domingo. Following Qorikancha, the other students went to check out one of the churches that we had seen earlier. I personally didn’t go look at the church b/c I feel that it is wrong for a church to charge money for people to view inside it, and plus I’ve been inside multiple churches in La Paz. While the other students checked out inside the church, I sat on a bench in the plaza where an elderly Peruvian man was sitting. The next thing I know is that the man is talking to me in Spanish. We actually had a great conversation and I liked it because it was a way for me to practice more of my Spanish. He told me a lot about Peru and then we discussed corruption + oil/petroleum in Nigeria.
We eventually left Peru on Monday morning and headed back to La Paz. The trip back to La Paz was even more hectic than on our way to Peru but I won’t go into the details of that because it is extremely long. Overall, I highly recommend that if anyone comes to South America that you visit Machu Picchu and Cusco. Both places are definitely tourist central so be prepared for high prices.
Second Week: Infectious Diseases (July 12-16)
Infectious diseases...probably one of my favorite topics in medicine. Luckily, for me, last week I was able to do a rotation in the infectious disease unit at Hospital del Niño. I worked with Dr. Velasco, who is one of the top doctors that runs the hospital.
As I walked into the infectious disease unit on my first day of this rotation, I was greeted by an entirely white ward that contained small rooms. Each room had windows in which one could look into. This ward was certainly different from the general pediatrics ward that I had visited the previous week. In addition to being greeted by the whiteness of the ward, I was also warmly greeted by Dr. Velasco who introduced Lila (the other CFHI intern) and me to an American pediatrician who was visiting Bolivia.
After being introduced to the American doctor, Lila and I followed Dr. Velasco to his office. I was a little shocked that we were not doing rounds because the previous week in general pediatrics, we always started each day with rounds. Nevertheless, once in Dr. Velasco’s office, he introduced Lila and me to three Bolivian medical students that were working with him.
After the brief introduction to the medical students, Dr. Velasco began to teach us the basics of a physical exam in pediatrics. Although the medical students already knew how to complete one, Dr. Velasco found it important for Lila and I to know because later in the week he was going to expect us to do some exams all by ourselves and report back to him with our results. He reviewed how to listen to the heart and lungs and what to expect in a healthy child and also how to check testicular dissension in baby boys. In addition, he went over developmental stages. For development, he went over the physical, cognitive, language and motor development stages from newborn to age five because as interns we were also going to have to check the child’s development. In addition, Dr. Velasco said that the 5 most common infectious diseases in Bolivia are leishmaniasis, malaria, chagas, dengue, and yellow fever so we should expect to see these cases presented most often in the infectious disease unit, especially TB.
Following Dr. Velasco’s lecture, I saw my first patient who was a young boy suffering from a fever, has asthma, and possibly TB. I must admit that I was nervous because, after all, I had just learned everything that I would need to know to complete an exam. In addition, not only was Dr. Velasco watching but also so were the medical students. Luckily, as I completed the exam, Dr. Velasco walked me through ever step. For the rest of the week, I was paired with one of the medical students, Juan Jose, and together we completed several exams.
Overall, I felt that Dr. Velasco’s consults were weighted more towards general medicine than infectious diseases. Because it is somewhat the start of flu season here, I saw cases in which Dr. Velasco had to differentiate between the common cold and the flu. Because of the large volume of these types of cases, Dr. Velasco went over how to differentiate between the two. For example, with the flu, one can expect high fever, body aches, headaches, weakness for a couple of weeks, coughing that can become severe, and some other symptoms. While with the common cold, fevers and headaches are not that common, some body aches, mild weakness, sore throat, stuffy nose, and coughing.
Although I felt that the consults were more heavily weighted towards general medicine, I did see a case of whooping cough and several cases of TB and probable TB. Dr. Velasco told us that when a child has probable TB or is TB positive, they most likely contracted it from an infected adult. He also stated that it is difficult to diagnose TB in children b/c of the difficulty in obtaining a good sputum sample and even interpreting a chest x-ray. Nevertheless, there are often good indicators that a child has TB (ex. contact with an infected adult, coughing, malnutrition, etc.). During the consults, Dr. Velasco often went over the patient’s chest x-rays and I must say that it was difficult to see if the child had TB.
Also during the week, I did get to do rounds with Dr. Velasco. One case that I saw involved a boy who was about 6 years old. He had a staphylococcal infection and an abscess. In addition, the boy had pneumonia and was suffering from paralysis in which he couldn’t move his jaw. Another interesting thing was that because the boy was receiving insufficient amounts of calories, he had cold arms. The doc was going to give him antibiotics and increase the boy’s calorie intake.
Furthermore, most of the cases in the infectious disease unit involved some pulmonary problem or TB.
Most days after finishing the rotation, Lila and I would stop and visit the children in the burn unit. I must say that even though these kids were in severe pain, they were the happiest children that I had seen in the hospital thus far. The kids absolutely loved to play with Lila and I, and they always wanted us to return the next day. I personally enjoyed just hanging out and playing with these kids.
Overall, I enjoyed the infectious disease rotation. Besides the medical part, this week I was more aware of the interaction between the doctor and the patient. Not only does the physician have to be able to connect with the kids by being theatrical and playful but the physician also has to connect with the parents. I remember one particular consult in which the mother just walked in and as soon as she sat down began to cry. She hadn’t even said anything to the doctor yet. Dr. Velasco, who at first was standing, sat down so that he could be at her level. In this world, doctors (and the medical profession itself) are often viewed as some of the most powerful people in the world with everyone else beneath the doctor. I have certainly witnessed some doctors that are very cocky and not humble. By taking his seat, Dr. Velasco made himself equal to this mother and showed empathy. To me, this situation highlighted one of the reasons why I want to go into the medical profession. To me, medicine is not just about human biology and science but includes humanism.
As I walked into the infectious disease unit on my first day of this rotation, I was greeted by an entirely white ward that contained small rooms. Each room had windows in which one could look into. This ward was certainly different from the general pediatrics ward that I had visited the previous week. In addition to being greeted by the whiteness of the ward, I was also warmly greeted by Dr. Velasco who introduced Lila (the other CFHI intern) and me to an American pediatrician who was visiting Bolivia.
After being introduced to the American doctor, Lila and I followed Dr. Velasco to his office. I was a little shocked that we were not doing rounds because the previous week in general pediatrics, we always started each day with rounds. Nevertheless, once in Dr. Velasco’s office, he introduced Lila and me to three Bolivian medical students that were working with him.
After the brief introduction to the medical students, Dr. Velasco began to teach us the basics of a physical exam in pediatrics. Although the medical students already knew how to complete one, Dr. Velasco found it important for Lila and I to know because later in the week he was going to expect us to do some exams all by ourselves and report back to him with our results. He reviewed how to listen to the heart and lungs and what to expect in a healthy child and also how to check testicular dissension in baby boys. In addition, he went over developmental stages. For development, he went over the physical, cognitive, language and motor development stages from newborn to age five because as interns we were also going to have to check the child’s development. In addition, Dr. Velasco said that the 5 most common infectious diseases in Bolivia are leishmaniasis, malaria, chagas, dengue, and yellow fever so we should expect to see these cases presented most often in the infectious disease unit, especially TB.
Following Dr. Velasco’s lecture, I saw my first patient who was a young boy suffering from a fever, has asthma, and possibly TB. I must admit that I was nervous because, after all, I had just learned everything that I would need to know to complete an exam. In addition, not only was Dr. Velasco watching but also so were the medical students. Luckily, as I completed the exam, Dr. Velasco walked me through ever step. For the rest of the week, I was paired with one of the medical students, Juan Jose, and together we completed several exams.
Overall, I felt that Dr. Velasco’s consults were weighted more towards general medicine than infectious diseases. Because it is somewhat the start of flu season here, I saw cases in which Dr. Velasco had to differentiate between the common cold and the flu. Because of the large volume of these types of cases, Dr. Velasco went over how to differentiate between the two. For example, with the flu, one can expect high fever, body aches, headaches, weakness for a couple of weeks, coughing that can become severe, and some other symptoms. While with the common cold, fevers and headaches are not that common, some body aches, mild weakness, sore throat, stuffy nose, and coughing.
Although I felt that the consults were more heavily weighted towards general medicine, I did see a case of whooping cough and several cases of TB and probable TB. Dr. Velasco told us that when a child has probable TB or is TB positive, they most likely contracted it from an infected adult. He also stated that it is difficult to diagnose TB in children b/c of the difficulty in obtaining a good sputum sample and even interpreting a chest x-ray. Nevertheless, there are often good indicators that a child has TB (ex. contact with an infected adult, coughing, malnutrition, etc.). During the consults, Dr. Velasco often went over the patient’s chest x-rays and I must say that it was difficult to see if the child had TB.
Also during the week, I did get to do rounds with Dr. Velasco. One case that I saw involved a boy who was about 6 years old. He had a staphylococcal infection and an abscess. In addition, the boy had pneumonia and was suffering from paralysis in which he couldn’t move his jaw. Another interesting thing was that because the boy was receiving insufficient amounts of calories, he had cold arms. The doc was going to give him antibiotics and increase the boy’s calorie intake.
Furthermore, most of the cases in the infectious disease unit involved some pulmonary problem or TB.
Most days after finishing the rotation, Lila and I would stop and visit the children in the burn unit. I must say that even though these kids were in severe pain, they were the happiest children that I had seen in the hospital thus far. The kids absolutely loved to play with Lila and I, and they always wanted us to return the next day. I personally enjoyed just hanging out and playing with these kids.
Overall, I enjoyed the infectious disease rotation. Besides the medical part, this week I was more aware of the interaction between the doctor and the patient. Not only does the physician have to be able to connect with the kids by being theatrical and playful but the physician also has to connect with the parents. I remember one particular consult in which the mother just walked in and as soon as she sat down began to cry. She hadn’t even said anything to the doctor yet. Dr. Velasco, who at first was standing, sat down so that he could be at her level. In this world, doctors (and the medical profession itself) are often viewed as some of the most powerful people in the world with everyone else beneath the doctor. I have certainly witnessed some doctors that are very cocky and not humble. By taking his seat, Dr. Velasco made himself equal to this mother and showed empathy. To me, this situation highlighted one of the reasons why I want to go into the medical profession. To me, medicine is not just about human biology and science but includes humanism.
Friday, July 16, 2010
First Week: General Pediatrics July 7-9
Last week I completed my rotation in the general pediatric department with Dr. Bocangel. I enjoy general medicine because of the variety of cases that general practitioners can see on any given day. In the general pediatric unit, here at Hospital del Niño the cases presented are as varied as are the patients.
Each day on the general pediatrics ward began with “rounds.” Rounds is a term that referrers to the act of the doctors reviewing the patients chart, completing an assessment of the patient, and then making any adjustments to the patient’s treatment plan. During rounds here in the general pediatrics ward, there is often about four doctors, several med students, a nutritionist, a psychologist, and a nurse per a patient. The bedside of the patient is surrounded by a ton of people, and I somewhat feel sorry for the patient because he/she probably feels smothered by the amount of health professionals.
There were definitely several patients that I encountered during the week that stuck out in my head. One patient, who I’ll call Patient C (male; ~10 yrs old), was admitted to the hospital because he had sharp pains on his side and had difficulty breathing. The sharp pains started after a ball hit him on his side while playing with his friends. After being admitted to the hospital, the doctors took a chest x-ray. During the rounds, I listened as the doctors discussed the results of the chest x-ray. With the result of the chest x-rays, the doctors concluded that something was pushing on Patient C’s lung and therefore his lungs could not properly expand. He was going to need surgery as soon as possible to prevent complete lung collapse. To complicate matters, Dr. Bocangel told me and the other two interns in Spanish that Patient C had “quiste hidatidico” which was slowly leading to multiple organ failure. When the other two interns and I heard this, we immediately looked at each other in hopes that one of us knew what this disease was but none of us did. We asked Dr. Bocangel to explain what it was and she did. She translated “quiste hidatidico” into English for us; the English term is hydatid disease. Even though she had just translated the word into English, we were still confused because none of us knew anything about this disease. She began to explain in Spanish what hydatid disease is. From Dr. Bocangel, I learned that tapeworms cause hydatid disease. The tapeworm cycle that normally occurs in animals such as dogs causes illness in humans when present. In addition, the tapeworm is able to enter the human blood stream via the intestines and then is able to travel via blood to other organs thus causing organ damage. In Patient C’s case, cysts had begun to form in his abdominal region. Dr. Bocangel said that more likely than not Patient C has had the tapeworms for a while. She also said that the Patient C is currently undergoing dialysis b/c he has not been able to pee for 11 days and that he is anemic. As the doctors finished discussing Patient C’s case, they concluded that the most important thing right now is to have Patient C undergo surgery for his collapsing lung and to worry about the hydatid disease later.
Furthermore, during rounds I saw a variety of patients each with different symptoms and diagnoses. The following is a list of some conditions and diseases that I observed in while in the general pediatric unit:
Neurofibromatosis (A genetic disease that leads to tumors in the fibrous sheaths of nerves and in some cases causes mild mental retardation)
Urinary Tract Infections (UTI)
Fractured knee caps
Fractured skull
Edema (but source/cause not known)
Abuse (both mental and physical)
Besides doing rounds, I was also able to work with Dr. Bocangel as she did consults on Tuesday. By trade, Dr. Bocangel is a nephrologist (deals with the kidneys). During her consults, I noticed that most of her patients suffered from some sort of UTI. I asked her if this was common and she said yes because in Bolivia most children get a UTI because of poor hygiene. By being present during Dr. Bocangel’s consults, I learned so much about UTIs. I learned about the three main types (acute pyelonephritis, cystitis, and urethritis), differences in symptoms for the three types, tests/diagnosis, and treatment. Dr. Bocangel also showed me what to look for in x-rays when suspecting UTI or other renal problems. Not only did she teach me those but she also taught me how to “read” lab results, specifically she went over the normal ranges of the chemical, sediment, and physical results. She let me review some of her patients’ labs and would ask me my opinion of the results. I thought that was pretty fun because I have to use the knowledge and information I had just learned and put it into practice.
For this week, I’m in infectious diseases working with Dr. Velasco at Hospital del Niño. I can’t wait to write about everything that I’ve done so far in the infectious disease unit.
Each day on the general pediatrics ward began with “rounds.” Rounds is a term that referrers to the act of the doctors reviewing the patients chart, completing an assessment of the patient, and then making any adjustments to the patient’s treatment plan. During rounds here in the general pediatrics ward, there is often about four doctors, several med students, a nutritionist, a psychologist, and a nurse per a patient. The bedside of the patient is surrounded by a ton of people, and I somewhat feel sorry for the patient because he/she probably feels smothered by the amount of health professionals.
There were definitely several patients that I encountered during the week that stuck out in my head. One patient, who I’ll call Patient C (male; ~10 yrs old), was admitted to the hospital because he had sharp pains on his side and had difficulty breathing. The sharp pains started after a ball hit him on his side while playing with his friends. After being admitted to the hospital, the doctors took a chest x-ray. During the rounds, I listened as the doctors discussed the results of the chest x-ray. With the result of the chest x-rays, the doctors concluded that something was pushing on Patient C’s lung and therefore his lungs could not properly expand. He was going to need surgery as soon as possible to prevent complete lung collapse. To complicate matters, Dr. Bocangel told me and the other two interns in Spanish that Patient C had “quiste hidatidico” which was slowly leading to multiple organ failure. When the other two interns and I heard this, we immediately looked at each other in hopes that one of us knew what this disease was but none of us did. We asked Dr. Bocangel to explain what it was and she did. She translated “quiste hidatidico” into English for us; the English term is hydatid disease. Even though she had just translated the word into English, we were still confused because none of us knew anything about this disease. She began to explain in Spanish what hydatid disease is. From Dr. Bocangel, I learned that tapeworms cause hydatid disease. The tapeworm cycle that normally occurs in animals such as dogs causes illness in humans when present. In addition, the tapeworm is able to enter the human blood stream via the intestines and then is able to travel via blood to other organs thus causing organ damage. In Patient C’s case, cysts had begun to form in his abdominal region. Dr. Bocangel said that more likely than not Patient C has had the tapeworms for a while. She also said that the Patient C is currently undergoing dialysis b/c he has not been able to pee for 11 days and that he is anemic. As the doctors finished discussing Patient C’s case, they concluded that the most important thing right now is to have Patient C undergo surgery for his collapsing lung and to worry about the hydatid disease later.
Furthermore, during rounds I saw a variety of patients each with different symptoms and diagnoses. The following is a list of some conditions and diseases that I observed in while in the general pediatric unit:
Neurofibromatosis (A genetic disease that leads to tumors in the fibrous sheaths of nerves and in some cases causes mild mental retardation)
Urinary Tract Infections (UTI)
Fractured knee caps
Fractured skull
Edema (but source/cause not known)
Abuse (both mental and physical)
Besides doing rounds, I was also able to work with Dr. Bocangel as she did consults on Tuesday. By trade, Dr. Bocangel is a nephrologist (deals with the kidneys). During her consults, I noticed that most of her patients suffered from some sort of UTI. I asked her if this was common and she said yes because in Bolivia most children get a UTI because of poor hygiene. By being present during Dr. Bocangel’s consults, I learned so much about UTIs. I learned about the three main types (acute pyelonephritis, cystitis, and urethritis), differences in symptoms for the three types, tests/diagnosis, and treatment. Dr. Bocangel also showed me what to look for in x-rays when suspecting UTI or other renal problems. Not only did she teach me those but she also taught me how to “read” lab results, specifically she went over the normal ranges of the chemical, sediment, and physical results. She let me review some of her patients’ labs and would ask me my opinion of the results. I thought that was pretty fun because I have to use the knowledge and information I had just learned and put it into practice.
For this week, I’m in infectious diseases working with Dr. Velasco at Hospital del Niño. I can’t wait to write about everything that I’ve done so far in the infectious disease unit.
Weekend at Lake Titicaca, Copacabana, and Isla del Sol
This past Saturday and Sunday, I took a weekend vacation to Lake Titicaca with the other interns. I must say that the beauty of the lake and the surrounding scenery blew me away.
We left La Paz early Saturday morning via bus and set out towards Copacabana. On our way to Copacabana, we picked up our tour guide, Victor. I slept most of the time on the bus, but I must say that when I was awake it was nice to see another side to Bolivia. Currently, I’m living in one of the richest areas in La Paz called Sopocachi and haven’t really seen the “poverty stricken” Bolivia besides at the hospital.
About three hours after our departure from La Paz, we arrived at a river crossing in which we had to get off the bus and take a ferry across a river. The bus was also ferried across the river on a different ‘ferry.’ After we crossed the river, we got back on the bus and drove for about another hour to Copacabana, a place filled with a lot of European tourist and touristy shops. When we first arrived, we had lunch at a cute little restaurant and then after lunch we headed to a docking site on the lake where we chartered a private boat to take us to the Isla del Sol.
The boat ride from Copacabana to the Isla del Sol was close to an hour. Once we arrived on the Isla del Sol, we had to hike uphill for about another forty minutes to our hotel. I must say that I was definitely not prepared to hike UPHILL for forty minutes! I was in so much pain; I’m definitely not in shape.
Our hotel was on the top of the island and it overlooked Lake Titicaca. It was cool to see the lake and the rest of the island- definitely a site to behold. All I could see for miles upon miles was hills of all different shades surrounded by dark blue crisp water. Also in the background was snow covered Mt. Illimani.
After settling in at our eco-friendly and somewhat luxurious hotel, we decided to take another hike to a higher spot so we could watch the sunset. This time the hike wasn’t that bad and the sunset was gorgeous.
After watching the sunset, we returned to the hotel and had dinner. Following dinner, the other interns and I decided to sit under the stars and just hang out and chat. Because there were no tall buildings, I could see miles upon miles of stars. I could even see the Milky Way. In addition, for the very first time in my life, I saw a shooting star!
On Sunday morning, we woke up about 5:50 am and by 6 am we were on another walk so we could watch the sunrise. As the sun rose, I sat in silence and just admired the beauty that God had created.
As soon as the sun had fully risen, we returned to the hotel, had breakfast, and set out to return to La Paz. However, before we left the island, we made a stop at some Inca ruins. The ruins were awesome! After the ruins, we took a boat back to Copacabana where we walked around, shopped, and watched the final World Cup game. I must say that I was supper happy that Spain won.
However, because we decided to watch the final soccer match, we were not able to take our regular scheduled bus back to La Paz. Therefore, we had a difficult time securing a bus that would take us back to La Paz. Thankfully, we were able to find one and arrived back in La Paz around 10:30pm.
My next adventures include visiting some more museums in La Paz and taking a trip to Peru.
We left La Paz early Saturday morning via bus and set out towards Copacabana. On our way to Copacabana, we picked up our tour guide, Victor. I slept most of the time on the bus, but I must say that when I was awake it was nice to see another side to Bolivia. Currently, I’m living in one of the richest areas in La Paz called Sopocachi and haven’t really seen the “poverty stricken” Bolivia besides at the hospital.
About three hours after our departure from La Paz, we arrived at a river crossing in which we had to get off the bus and take a ferry across a river. The bus was also ferried across the river on a different ‘ferry.’ After we crossed the river, we got back on the bus and drove for about another hour to Copacabana, a place filled with a lot of European tourist and touristy shops. When we first arrived, we had lunch at a cute little restaurant and then after lunch we headed to a docking site on the lake where we chartered a private boat to take us to the Isla del Sol.
The boat ride from Copacabana to the Isla del Sol was close to an hour. Once we arrived on the Isla del Sol, we had to hike uphill for about another forty minutes to our hotel. I must say that I was definitely not prepared to hike UPHILL for forty minutes! I was in so much pain; I’m definitely not in shape.
Our hotel was on the top of the island and it overlooked Lake Titicaca. It was cool to see the lake and the rest of the island- definitely a site to behold. All I could see for miles upon miles was hills of all different shades surrounded by dark blue crisp water. Also in the background was snow covered Mt. Illimani.
After settling in at our eco-friendly and somewhat luxurious hotel, we decided to take another hike to a higher spot so we could watch the sunset. This time the hike wasn’t that bad and the sunset was gorgeous.
After watching the sunset, we returned to the hotel and had dinner. Following dinner, the other interns and I decided to sit under the stars and just hang out and chat. Because there were no tall buildings, I could see miles upon miles of stars. I could even see the Milky Way. In addition, for the very first time in my life, I saw a shooting star!
On Sunday morning, we woke up about 5:50 am and by 6 am we were on another walk so we could watch the sunrise. As the sun rose, I sat in silence and just admired the beauty that God had created.
As soon as the sun had fully risen, we returned to the hotel, had breakfast, and set out to return to La Paz. However, before we left the island, we made a stop at some Inca ruins. The ruins were awesome! After the ruins, we took a boat back to Copacabana where we walked around, shopped, and watched the final World Cup game. I must say that I was supper happy that Spain won.
However, because we decided to watch the final soccer match, we were not able to take our regular scheduled bus back to La Paz. Therefore, we had a difficult time securing a bus that would take us back to La Paz. Thankfully, we were able to find one and arrived back in La Paz around 10:30pm.
My next adventures include visiting some more museums in La Paz and taking a trip to Peru.
Thursday, July 8, 2010
First week and a half in La Paz
I can’t believe that its already been about 1 ½ weeks since I’ve been in La Paz! It seriously seems like I’ve been here forever because I have so much to write and tell. I really wish that I had more time to blog in-detail about what I’ve been up to but I’ve been extremely busy with school, interning, and traveling. Well, with no further ado, let me write about my time here thus far:
Internship: Currently, I’m interning at Hospital del Niño. Hospital del Niño is one of the oldest government run hospitals in Bolivia dedicated to pediatric care, especially pediatric oncology, gastroenterology, infectious disease, neurosurgery, emergency, and outpatient care.
On the first day, the other students and I arrived at the hospital at 9 am dressed sharply in business attire, ironed white lab coats, and stethoscopes around our necks ready to do work. As soon as we walked into the hospital, we were greeted by the stares of many Bolivian parents and children that were sitting in the large lobby. As we walked passed the parents and kids, their eyes and heads followed us. We made our way up to the 3rd floor to wait for Dr. Velasco (the main doctor at the hospital) so he could take each group of students to the doctor that they would be working with.
For this week, two other interns and I are working with Dr. Bocangle. Dr. Bocangle does general pediatrics and also specializes in nephrology (aka the kidneys). On the first day, I noticed several things. The first thing that I noticed was the lack of privacy given to patients in comparison to that of the US. The patient beds are in two neat rows with about five or six in each row and are closely spaced apart. There are no curtains or other dividers that create privacy. Furthermore, there is about 5 doctors plus a couple of medical students that attend to one patient during each round. In addition, dictation is done on the spot; it is quite interesting the way it works here. One doctor will dictate and another doctor will type on an old-school typewriter what the other doctor(s) is saying. In the US, dictation doesn’t happen in the presence of the patient and a doctor dictates into some type of recorder. A medical transcriptionist then transcribes the doctor’s dictation.
So far this week I have seen many interesting things. In the next couple of days, I will post one or two case studies of patients that I’ve seen here.
In and About La Paz: La Paz is a city that has so much to offer. Last week Friday, some other students and I went to the Museo Nacional de Arte. The museum was very cool and the artwork was incredible. There is a variety of artwork in the museum that highlights Bolivian artwork from different periods. The Flemish, Italians, and Indians influenced Bolivian artwork. I found the artwork displayed at the museum to be quite interesting and it covered a wide variety of topics from religion, historical figures, and modern artwork. If you ever come to La Paz, I highly recommend you check it out.
I also hiked in La Paz with some friends to a viewpoint known as “Killi Killi.” The viewpoint is awesome b/c it allows one to literally look down into La Paz. Let me tell you, the name given to this viewpoint was justly given b/c it was a ‘killer’ workout to hike up the hill. Nevertheless, the viewpoint provided a gorgeous view of La Paz.
In addition to those, I visited Valle de la Luna (Moon Valley) on Sunday. This place is located about 20-30 min out of La Paz and is basically a beautiful valley. I was amazed by the houses that had been built into and around the valley.
On Sunday, my friends and I also checked out a local soccer game between two local teams: Bolivar vs. San Jose. I must say that the game was quite interesting. When we first got to the game, we had no idea which team was which. One team was wearing white and the other black. We assumed that the white team was Bolivar (the team we wanted to cheer for) b/c they had blue on their jerseys which was similar to the official colors of the Bolivar hats that we bought. Well, come to find out during the second half of the game, we had been cheering for the wrong team AND we were sitting in the San Jose section. The whole situation was absolutely hilarious. Another highlight of the game was that during the second half, one of the San Jose players almost beat up the ref b/c he didn’t like the call that the ref had made. Nevertheless, Bolivar won with the score being 5 to 1. It was interesting to see at the end that the refs literally had to be escorted off the field by a riot police squad.
La Paz wouldn’t be somewhat of a vacation if I didn’t go shopping. So far, I’ve visited a couple of the markets. The markets are what I pictured them to be. I must say that going to Nigeria in the past and learning to bargain at Nigerian markets has served me well here. I’ve bought a couple things that I’ve had to bargain for and I must say that I’m proud of myself. I’ll probably be making a couple more trips to the market in the next few days.
Currently, I’m at an internet café and have to head home for lunch. But in the next couple days, I’ll post a blog about some case studies. Chao!
Internship: Currently, I’m interning at Hospital del Niño. Hospital del Niño is one of the oldest government run hospitals in Bolivia dedicated to pediatric care, especially pediatric oncology, gastroenterology, infectious disease, neurosurgery, emergency, and outpatient care.
On the first day, the other students and I arrived at the hospital at 9 am dressed sharply in business attire, ironed white lab coats, and stethoscopes around our necks ready to do work. As soon as we walked into the hospital, we were greeted by the stares of many Bolivian parents and children that were sitting in the large lobby. As we walked passed the parents and kids, their eyes and heads followed us. We made our way up to the 3rd floor to wait for Dr. Velasco (the main doctor at the hospital) so he could take each group of students to the doctor that they would be working with.
For this week, two other interns and I are working with Dr. Bocangle. Dr. Bocangle does general pediatrics and also specializes in nephrology (aka the kidneys). On the first day, I noticed several things. The first thing that I noticed was the lack of privacy given to patients in comparison to that of the US. The patient beds are in two neat rows with about five or six in each row and are closely spaced apart. There are no curtains or other dividers that create privacy. Furthermore, there is about 5 doctors plus a couple of medical students that attend to one patient during each round. In addition, dictation is done on the spot; it is quite interesting the way it works here. One doctor will dictate and another doctor will type on an old-school typewriter what the other doctor(s) is saying. In the US, dictation doesn’t happen in the presence of the patient and a doctor dictates into some type of recorder. A medical transcriptionist then transcribes the doctor’s dictation.
So far this week I have seen many interesting things. In the next couple of days, I will post one or two case studies of patients that I’ve seen here.
In and About La Paz: La Paz is a city that has so much to offer. Last week Friday, some other students and I went to the Museo Nacional de Arte. The museum was very cool and the artwork was incredible. There is a variety of artwork in the museum that highlights Bolivian artwork from different periods. The Flemish, Italians, and Indians influenced Bolivian artwork. I found the artwork displayed at the museum to be quite interesting and it covered a wide variety of topics from religion, historical figures, and modern artwork. If you ever come to La Paz, I highly recommend you check it out.
I also hiked in La Paz with some friends to a viewpoint known as “Killi Killi.” The viewpoint is awesome b/c it allows one to literally look down into La Paz. Let me tell you, the name given to this viewpoint was justly given b/c it was a ‘killer’ workout to hike up the hill. Nevertheless, the viewpoint provided a gorgeous view of La Paz.
In addition to those, I visited Valle de la Luna (Moon Valley) on Sunday. This place is located about 20-30 min out of La Paz and is basically a beautiful valley. I was amazed by the houses that had been built into and around the valley.
On Sunday, my friends and I also checked out a local soccer game between two local teams: Bolivar vs. San Jose. I must say that the game was quite interesting. When we first got to the game, we had no idea which team was which. One team was wearing white and the other black. We assumed that the white team was Bolivar (the team we wanted to cheer for) b/c they had blue on their jerseys which was similar to the official colors of the Bolivar hats that we bought. Well, come to find out during the second half of the game, we had been cheering for the wrong team AND we were sitting in the San Jose section. The whole situation was absolutely hilarious. Another highlight of the game was that during the second half, one of the San Jose players almost beat up the ref b/c he didn’t like the call that the ref had made. Nevertheless, Bolivar won with the score being 5 to 1. It was interesting to see at the end that the refs literally had to be escorted off the field by a riot police squad.
La Paz wouldn’t be somewhat of a vacation if I didn’t go shopping. So far, I’ve visited a couple of the markets. The markets are what I pictured them to be. I must say that going to Nigeria in the past and learning to bargain at Nigerian markets has served me well here. I’ve bought a couple things that I’ve had to bargain for and I must say that I’m proud of myself. I’ll probably be making a couple more trips to the market in the next few days.
Currently, I’m at an internet café and have to head home for lunch. But in the next couple days, I’ll post a blog about some case studies. Chao!
Tuesday, June 29, 2010
First couple days in La Paz
Hello!!!!!!!! I made it to Bolivia safely, thank God. But I must say that I had one of the most interesting flights every from Dallas to Miami. First, we flew right by the BP oil spill and the location where they are burning off the oil. Secondly, there was an in-flight medical emergency, which was quite scary.Thankfully, there were doctors on board so we didn't have to do an emergency landing.
Now, onto Bolivia! When I first arrived we flew into El Alto, which is situated above La Paz. La Paz is about 11,000 ft above sea level and El Alto is about 13,000 ft above sea level. This makes these two cities one of the highest elevated cities on earth. If you think of a bowl, the very outer edges are El Alto. El Alto is a poor area. As you reach the center of the bowl, some wealth starts to appear. But it is not until you are at the bottom of the bowl, in La Paz, that most of the wealth is concentrated.
At the airport my program director picked me up and as we drove from the airport down into La Paz, the taxi was able to stop and I took one of the most beautiful pictures that I have ever taken.La Paz is an incredibly beautiful city surrounded by mountains.
When I arrived at my host family's house, I was greeted by Senora Elizabeth (my host mom). She is a sweet lady who has (I think) 5 kids. Only her youngest is still at home. She told me that there were 3 other girls (who were part of the June program) also staying with her but they would be leaving this week (but they weren't home b/c they had taken a weekend trip to Peru), and she would get another 3 girls that we're going to be part of my program. The house is really nice. If you can picture a Macy's home furniture catalogue then you'll see her house. The house has all the modern day appliances and has constant electricity and running water. Luckily for me, I have my own room.
I've been able to venture out into La Paz with other participants that will be leaving soon but my group will be coming on Saturday. However, its very difficult for me to walk and I am often short of breath b/c of the high altitude. I'm currently on high altitude medicine which is helping me to adjust quicker to the high altitude.
On my second day in Bolivia, I walked alone through La Paz looking for the language school so I could take my Spanish placement exam. Finding the place was quite difficult, and inevitably I got lost. Eventually, I asked a couple strangers for directions, and they pointed me in the right direction.
Yesterday, unfortunately, one of the girls in my homestay was pick-pocketed in La Plaza del Estudiante as she was walking back from the language school with some other people. That event just made is that much more surreal that things like this do happen here and that I have to always have my guard up.
Yesterday, I also attend a medical lecture with the medical director of my program and the other program participants. The lecture was over Leishmaniasis. Thankfully, I already knew a lot about the disease via the Diseases of Africa course I took this past spring @ UO.
Well, I'm at an internet cafe and my time is almost up so I have to go. Hasta luego
Now, onto Bolivia! When I first arrived we flew into El Alto, which is situated above La Paz. La Paz is about 11,000 ft above sea level and El Alto is about 13,000 ft above sea level. This makes these two cities one of the highest elevated cities on earth. If you think of a bowl, the very outer edges are El Alto. El Alto is a poor area. As you reach the center of the bowl, some wealth starts to appear. But it is not until you are at the bottom of the bowl, in La Paz, that most of the wealth is concentrated.
At the airport my program director picked me up and as we drove from the airport down into La Paz, the taxi was able to stop and I took one of the most beautiful pictures that I have ever taken.La Paz is an incredibly beautiful city surrounded by mountains.
When I arrived at my host family's house, I was greeted by Senora Elizabeth (my host mom). She is a sweet lady who has (I think) 5 kids. Only her youngest is still at home. She told me that there were 3 other girls (who were part of the June program) also staying with her but they would be leaving this week (but they weren't home b/c they had taken a weekend trip to Peru), and she would get another 3 girls that we're going to be part of my program. The house is really nice. If you can picture a Macy's home furniture catalogue then you'll see her house. The house has all the modern day appliances and has constant electricity and running water. Luckily for me, I have my own room.
I've been able to venture out into La Paz with other participants that will be leaving soon but my group will be coming on Saturday. However, its very difficult for me to walk and I am often short of breath b/c of the high altitude. I'm currently on high altitude medicine which is helping me to adjust quicker to the high altitude.
On my second day in Bolivia, I walked alone through La Paz looking for the language school so I could take my Spanish placement exam. Finding the place was quite difficult, and inevitably I got lost. Eventually, I asked a couple strangers for directions, and they pointed me in the right direction.
Yesterday, unfortunately, one of the girls in my homestay was pick-pocketed in La Plaza del Estudiante as she was walking back from the language school with some other people. That event just made is that much more surreal that things like this do happen here and that I have to always have my guard up.
Yesterday, I also attend a medical lecture with the medical director of my program and the other program participants. The lecture was over Leishmaniasis. Thankfully, I already knew a lot about the disease via the Diseases of Africa course I took this past spring @ UO.
Well, I'm at an internet cafe and my time is almost up so I have to go. Hasta luego
Tuesday, June 22, 2010
I'm headed to Bolivia!
¡Hola mis amigos y mi familia! As some of you may know, in the next couple of days, I will embark on one of the most incredible journeys of my life. For the next three months, I will be in
Looking at medicine from a global health perspective has been something that has captivated my attention since sophomore year
I am extremely grateful for this opportunity that God has given me. Through this experience, I hope to learn more about myself and to take away knowledge and memories that will serve me better as a future doctor. In addition, I hope that I can share my experience with others through this blog and pictures that I post upon my return. I am currently unsure of how often I will update this blog but my goal is at least once a week so please check this blog out once a week. Also, if you want to skype with me while I’m abroad my skype name is simply ann.oluloro
Please keep me in your prayers.
With the deepest love,
Ann Oluloro
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