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.
Saturday, July 31, 2010
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!
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