I finally made it down to Argentina! Although I really wanted to go to Buenos Aires, I wasn’t able to go there because of cost; plane tickets from Tarija to Buenos Aires were ridiculously expensive. As a replacement for a trip to Buenos Aires, I settled for Salta. Salta is located in the northern region of Argentina and is one of the largest cities in Argentina. Overall, I must say that I was quite impressed with Salta and enjoyed my time there.
Three other CFHI interns and I left Tarija for Salta on Thursday morning at 4 am by bus. We didn’t get to Salta until about 1:30 pm due to a few delays (ex. flat tire and an almost dead transmission). When we got to Salta, the first thing that we did was set out to find a hotel or hostel. Luckily, for us, we found a very nice hostel in which we had our own bathroom and hot water; it only cost us about $23/day. At first, I was a little nervous to stay in a hostel because I had never stayed in one before, and I have heard terrible stories about them. Overall, I liked our choice of hostel.
For the three days that we were in Salta, we did a couple fun activities. For one, a person can’t go to Argentina without shopping. In my opinion, Salta seemed to be a hub for fashion. Everywhere I turned, I found myself looking into a clothing store or upscale boutiques. Things were definitely a lot more expensive than in Bolivia so I didn’t buy that much stuff because I didn’t want to drop the big bucks.
In addition to shopping, we took the teleférico (it’s like a tram) up to a viewpoint that overlooked the city. At the top of the viewpoint, there is a little café and we had coffee there because it was freezing outside. We also walked around the man-made waterfalls. In my opinion, the view overlooking the city was spectacular and Salta looked very pretty. If you plan on going to Salta, I would recommend going on the teleférico up to the viewpoint.
If you’re into the nightlife scene then Salta can satisfy you. For us, we went to a couple discotecas. The discotecas were a lot of fun, music was great, and I personally found it to be a lot more fun than the disoctecs I have encountered in Bolivia. In addition to the discotecas, there is one major casino called Golden Dreams Casino. Before Salta, I had never even stepped foot into a casino let alone gambled. Our first night at the casino, I played only one slot machine and of course lost my 5 Argentina Pesos (current exchange rate is about 4 Argentina Pesos = $1 US Dollar). We returned to the casino two more times. Of course, each time that I went to the casino I set a cash limit for myself and didn’t bring any extra money that way I wouldn’t lose all my money. The second night at the casino I came out ahead by 5 Argentina Pesos and the third night, I lost all 50 Pesos that I had gambled. From my experience at this casino, I’ve learned the golden rule to gambling that one of the interns told me “Always set a limit and stop while you’re ahead.”
On Saturday, we ended up at a ranch located in the hills of Salta. The purpose for our journey to the ranch was so that we could go horseback riding. Horseback riding was another first for me, and I found the experience to be very enjoyable. When we first arrived at the ranch, the ranch workers made an excellent barbecue of steak and other meats for us accompanied with potatoes and salad. After eating, we rested for a bit and then got prepared to go horseback riding. I absolutely loved my horse, whose name was Princess. We went horseback riding for about a good hour and half through the hillside. For anyone who has never been horseback riding before, I would recommend that you try it because it’s so much fun.
Sunday was our departure day because we needed to be back to Bolivia by Monday for work. Overall, even though I didn’t have a chance to go to Buenos Aires, I really did enjoy Salta and would recommend that if anyone is in Argentina that you take a trip to Salta.
Wednesday, September 8, 2010
Public Health: Chagas Treatment
With a diagnosis comes a treatment plan. A couple weeks ago, I completed the chagas diagnostic rotation. To complement the diagnostic rotation, my ninth week of rotations was chagas treatment. My ninth week of rotation was a bit short because on Thursday I left for Argentina. Nevertheless, for the days that I was present for the rotation, I worked with Dr. Soledad and Nurse Selima.
With the chagas treatment program here, Dr. Soledad explained to me that there are two main categories: 1) treating patients for chagas and 2) treating patients for adverse reactions to chagas medication (usually benznidazol).
On the first day of this rotation, we drove out to a local school to meet with a couple of students that were positive for chagas. At the school, we met with two young female students; both girls had received benznidazol. The first girl that we saw had been experiencing adverse reactions to the medication. Because of the reaction, rashes began to develop on the girl’s arms and legs. To treat the reaction, Dr. Soledad gave the girl three different anti-allergic medications- loratadina, betametasona, and dexametasonar. The second girl was not taking her medication as the doctor had prescribed. She had missed several doses. When Dr. Soledad heard this, I could see that she was upset with the girl. As Dr. Soledad tried to explain to the girl the severity of chagas and the effects it has on the body, I noticed that the demeanor of the girl and the way she communicated with the doctor was as if she didn’t care that she had chagas. I had a hard time comprehending why this girl wasn’t following her treatment plan. After all, all the medicine that she was receiving was free. I guess I realize that even though you provide someone with resources it’s up to them to ultimately decide if they use that resource to bring about change and there is nothing more that the helper can do.
In addition to visiting the schools in Tarija, we also went to the countryside to treat chagas positive children under the age of 15. In my opinion, treating kids in the countryside is more difficult than treating kids in the city because it is difficult to deliver medicine to the countryside kids due to location. In order to make the process simpler, we went to schools and hand out prescriptions there. If possible, we tried to have parents present but most often the parents weren’t there. Most parents were absent because their houses are far from the school and they are often out working. To put distance into perspective, for the school located in Chaupicancha, on average it takes a student about 2.5 hours just to walk to school. This means that a student spends about 5 hours commuting to and from school! Most students have to leave their houses by 6 am in order to arrive at school on time. So, I can understand why some parents weren’t present. By not having a parent present this did create a problem because most kids didn’t understand the amount of medicine that they need to take each day and the time of day that the medicine needed to be taken. In order to provide a solution to this problem, we sent each kid home with an instruction letter to give his or her parents. The downside to this is that some parents in the countryside are illiterate. In addition, we also sent each kid home with a medicine-tracking card. The medicine-tracking card is a piece of paper that is divided into dates and the two different times of day that the kid needs to take the medicine. The card also has a picture of how the kid needs to divide the pills. Under each time column and day, the kid is supposed to record whether or not he or she has taken his or her medicine at that specific time.
Furthermore, for the chagas treatment program, we also made house calls. House calls are when we went to the houses of chagas positive children, who are currently taking chagas medication. At the child’s home, the doctor reviewed the child’s medicine tracking card and counted the remaining pills that the child had in order to make sure that the child was following the correct treatment plan. Also, while at the house, Dr. Soledad did a physical examination of the child to make sure that he/she wasn’t experiencing any adverse reactions.
In my opinion, I really enjoyed the house calls, and there definitely were a few interesting house calls that we made. At several house calls, we encountered patients in which the medicine-tracking card didn’t match up with the number of pills that the patient had remaining. When we encountered situations like these, I could see the frustration sweep across the doctor’s face. She would then begin her long explanation to the child’s parent(s) on the importance of diligently filling out the medicine-tracking card. Furthermore, during some house calls we had a feeling that the kid would be re-infected because of the environment that the child lived in. There was one house in particular that I remember in which there were huge piles of trash and debris inside and outside the house. Of course, the best way to prevent chagas is through vector control and one way to do that is to keep a very clean environment so that the vinchuchas can’t hide.
Furthermore, at one house call, we encountered a girl who had been taking benznidazol. However, she was having a very bad reaction to the medicine. She had edema all throughout her body and a rash that covered the entirety of her body. The doctor said that if we had not shown up and begun the treatment for her adverse reaction, she would have most likely developed Stevens-Johnson syndrome. I had never heard of Stevens-Johnson syndrome so I asked the doctor what exactly it was. She told me that Stevens-Johnson syndrome is a severe condition that affects the skin and mucous membranes. With this syndrome comes ulceration and the person’s skin begins to fall off. The cause is due to adverse reactions with drugs and all drugs have the potential of causing it. Unfortunately, for this girl, she can never again take any of the chagas medicines or else she’ll experience the same severe adverse reactions again. Moreover, because she can’t take chagas medication, she will never be cured of chagas and will have it for the rest of her life, which I find to be quite sad.
For this rotation, my job was quite simple. Besides observing the doctor work, I helped to calculate the amount of medicine that the patient would need based upon body weight and then counted the pills and put them in medication containers that the kid could take home.
With the chagas treatment program here, Dr. Soledad explained to me that there are two main categories: 1) treating patients for chagas and 2) treating patients for adverse reactions to chagas medication (usually benznidazol).
On the first day of this rotation, we drove out to a local school to meet with a couple of students that were positive for chagas. At the school, we met with two young female students; both girls had received benznidazol. The first girl that we saw had been experiencing adverse reactions to the medication. Because of the reaction, rashes began to develop on the girl’s arms and legs. To treat the reaction, Dr. Soledad gave the girl three different anti-allergic medications- loratadina, betametasona, and dexametasonar. The second girl was not taking her medication as the doctor had prescribed. She had missed several doses. When Dr. Soledad heard this, I could see that she was upset with the girl. As Dr. Soledad tried to explain to the girl the severity of chagas and the effects it has on the body, I noticed that the demeanor of the girl and the way she communicated with the doctor was as if she didn’t care that she had chagas. I had a hard time comprehending why this girl wasn’t following her treatment plan. After all, all the medicine that she was receiving was free. I guess I realize that even though you provide someone with resources it’s up to them to ultimately decide if they use that resource to bring about change and there is nothing more that the helper can do.
In addition to visiting the schools in Tarija, we also went to the countryside to treat chagas positive children under the age of 15. In my opinion, treating kids in the countryside is more difficult than treating kids in the city because it is difficult to deliver medicine to the countryside kids due to location. In order to make the process simpler, we went to schools and hand out prescriptions there. If possible, we tried to have parents present but most often the parents weren’t there. Most parents were absent because their houses are far from the school and they are often out working. To put distance into perspective, for the school located in Chaupicancha, on average it takes a student about 2.5 hours just to walk to school. This means that a student spends about 5 hours commuting to and from school! Most students have to leave their houses by 6 am in order to arrive at school on time. So, I can understand why some parents weren’t present. By not having a parent present this did create a problem because most kids didn’t understand the amount of medicine that they need to take each day and the time of day that the medicine needed to be taken. In order to provide a solution to this problem, we sent each kid home with an instruction letter to give his or her parents. The downside to this is that some parents in the countryside are illiterate. In addition, we also sent each kid home with a medicine-tracking card. The medicine-tracking card is a piece of paper that is divided into dates and the two different times of day that the kid needs to take the medicine. The card also has a picture of how the kid needs to divide the pills. Under each time column and day, the kid is supposed to record whether or not he or she has taken his or her medicine at that specific time.
Furthermore, for the chagas treatment program, we also made house calls. House calls are when we went to the houses of chagas positive children, who are currently taking chagas medication. At the child’s home, the doctor reviewed the child’s medicine tracking card and counted the remaining pills that the child had in order to make sure that the child was following the correct treatment plan. Also, while at the house, Dr. Soledad did a physical examination of the child to make sure that he/she wasn’t experiencing any adverse reactions.
In my opinion, I really enjoyed the house calls, and there definitely were a few interesting house calls that we made. At several house calls, we encountered patients in which the medicine-tracking card didn’t match up with the number of pills that the patient had remaining. When we encountered situations like these, I could see the frustration sweep across the doctor’s face. She would then begin her long explanation to the child’s parent(s) on the importance of diligently filling out the medicine-tracking card. Furthermore, during some house calls we had a feeling that the kid would be re-infected because of the environment that the child lived in. There was one house in particular that I remember in which there were huge piles of trash and debris inside and outside the house. Of course, the best way to prevent chagas is through vector control and one way to do that is to keep a very clean environment so that the vinchuchas can’t hide.
Furthermore, at one house call, we encountered a girl who had been taking benznidazol. However, she was having a very bad reaction to the medicine. She had edema all throughout her body and a rash that covered the entirety of her body. The doctor said that if we had not shown up and begun the treatment for her adverse reaction, she would have most likely developed Stevens-Johnson syndrome. I had never heard of Stevens-Johnson syndrome so I asked the doctor what exactly it was. She told me that Stevens-Johnson syndrome is a severe condition that affects the skin and mucous membranes. With this syndrome comes ulceration and the person’s skin begins to fall off. The cause is due to adverse reactions with drugs and all drugs have the potential of causing it. Unfortunately, for this girl, she can never again take any of the chagas medicines or else she’ll experience the same severe adverse reactions again. Moreover, because she can’t take chagas medication, she will never be cured of chagas and will have it for the rest of her life, which I find to be quite sad.
For this rotation, my job was quite simple. Besides observing the doctor work, I helped to calculate the amount of medicine that the patient would need based upon body weight and then counted the pills and put them in medication containers that the kid could take home.
Wednesday, September 1, 2010
Eighth Week: Rural Medicine
It still surprises me how quickly time flies by. I’ve been in Bolivia for 9 weeks already and have completed eight different rotations. My eighth week of rotation was rural medicine. For the week, I was at Hospital San Andres, which is located in a very rural area known as San Andres.
On the first day, one of the CFHI interns and I were warmly greeted by Dr. Yucra. Dr. Yucra showed us around the small hospital. There were aspects of the hospital that shocked me. First, the hospital has bedrooms where some of the nurses sleep. The reason that there are bedrooms is because some of the nurses live far from the hospital and commuting to and from the hospital each day just doesn’t make sense. Another part of the hospital that shocked me was the fact that there was a laboratory there. For a small hospital that size, I would have expected that if any laboratory work needed to be done that they would send it to Hospital San Juan de Dios, the main hospital in Tarija.
Furthermore, since Dr.Yucra is practically the only medical doctor (there is a dentist also) that works at Hospital San Andres, I spent all my time working with him. Dr. Yucra left me in charge of checking the patients’ lungs and hearts and reporting to him. Since this rotation was mainly general medicine in a rural setting, we saw all types of cases. However, most of the patients we saw either had a cold, fever, or body pain (due to their past or present work in the agricultural sector).
Besides the medical aspect of this rotation, I really enjoyed observing the business aspect of running a clinic when resources/supplies are short. One of the hardest aspects of running a rural clinic in an underdeveloped nation is 1) the need of medical supplies and 2) the need of more trained professionals. I was curious to know how exactly Hospital San Andres was able to stay operational because it served a population that doesn’t have a lot of money to pay for services. In order to find an answer to my question, I asked Dr. Yucra. Dr. Yucra explained that a program known as SUSAT pays for most services at this hospital. SUSAT is a healthcare program unique to Tarija, and is funded by the Tarija government and not the federal government. There is also a federal program known as SUMI, which pays for medical services for pregnant females and their infant child. In terms of medications, Dr. Yucra said that since he receives many prescription samples from pharmaceutical reps, he often gives these to patients.
Overall, this rotation provided me with a different atmosphere that I’ve never been exposed to, and I really enjoyed it.
On the first day, one of the CFHI interns and I were warmly greeted by Dr. Yucra. Dr. Yucra showed us around the small hospital. There were aspects of the hospital that shocked me. First, the hospital has bedrooms where some of the nurses sleep. The reason that there are bedrooms is because some of the nurses live far from the hospital and commuting to and from the hospital each day just doesn’t make sense. Another part of the hospital that shocked me was the fact that there was a laboratory there. For a small hospital that size, I would have expected that if any laboratory work needed to be done that they would send it to Hospital San Juan de Dios, the main hospital in Tarija.
Furthermore, since Dr.Yucra is practically the only medical doctor (there is a dentist also) that works at Hospital San Andres, I spent all my time working with him. Dr. Yucra left me in charge of checking the patients’ lungs and hearts and reporting to him. Since this rotation was mainly general medicine in a rural setting, we saw all types of cases. However, most of the patients we saw either had a cold, fever, or body pain (due to their past or present work in the agricultural sector).
Besides the medical aspect of this rotation, I really enjoyed observing the business aspect of running a clinic when resources/supplies are short. One of the hardest aspects of running a rural clinic in an underdeveloped nation is 1) the need of medical supplies and 2) the need of more trained professionals. I was curious to know how exactly Hospital San Andres was able to stay operational because it served a population that doesn’t have a lot of money to pay for services. In order to find an answer to my question, I asked Dr. Yucra. Dr. Yucra explained that a program known as SUSAT pays for most services at this hospital. SUSAT is a healthcare program unique to Tarija, and is funded by the Tarija government and not the federal government. There is also a federal program known as SUMI, which pays for medical services for pregnant females and their infant child. In terms of medications, Dr. Yucra said that since he receives many prescription samples from pharmaceutical reps, he often gives these to patients.
Overall, this rotation provided me with a different atmosphere that I’ve never been exposed to, and I really enjoyed it.
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