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.
Sunday, August 29, 2010
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.
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