WARNING!!!! If you are easily nauseated by graphic content do not continue reading this post. Personally, I think it’s super cool.
This week I was in the burn unit of the hospital and it was awesome! By far my favorite rotation so far. I spent a few days in the surgery sector of the burn unit and it was quite fascinating. The surgeries I saw were for patients who had third degree burns and unfortunately their skin wasn’t healing. To remedy this, the doctors cauterized the dead skin, which meant literally removing huge layers of skin from the patient’s body. They then placed cadaver skin over these areas, and stapled the skin down. I can’t believe that they heal burns with dead people’s skin! If the cadaver skin meshes well with the patient and the healing process begins as planned, then in a few weeks they will remove the cadaver skin and replace it with a skin graft from the person’s body. I was also able to see a skin graft be placed and it was pretty gnarly to watch. They literally used a huge knife to saw off a layer of skin, then staple this skin to the burn. The most interesting case I saw this week was a man who was paralyzed from the hips down, and because of this had gotten bed sores. He didn’t realize he had bed sores because he couldn’t feel them, and they ended up getting so badly infected that he now has four huge holes on his butt and hips. There is a picture of this below.
Some of the things I noticed that were different to surgeries in the US is that all the cloth used to cover the patient is made of fabric, whereas in the US it is all disposable fabric. Patients also wake up before they leave the surgery room because it’s too expensive to keep them under until after they get back to their room and they are usually encouraged to leave the hospital right after surgery. Patients in the US are usually admitted for a few days after surgery. One of the biggest differences I observed is that HIPAA does not exist in Argentina. Doctors take pictures of the patients all the time without the patients knowledge.
A few people from my group and I decided to go to Mendoza for the weekend. We took a 12 hour night bus to get there and arrived Friday morning. We checked into our hostel and signed up for an afternoon wine tour. On the wine tour we visited three wineries and an olive oil factory. I wouldn’t say I have the best taste for wine, but I think the wine in Mendoza lives up to its reputation. On Saturday a group of us went hiking at Cerro Arco. Online this area was described as a nice mountainous hike that locals often do on the weekend, but I think whoever wrote that was misinformed. The mountains were beautiful and great to hike up, but extremely challenging because there were no trails! We ended up hiking up what we think was a trail made by cows. It was quite the adventure, but well worth the view at the top. On Sunday, I was planning to go hike to a Lake Potrerillos, but unfortunately I was unable to because the receptionist at my hostel gave me the wrong bus schedule and I would not have been able to return in time to catch the bus back to Córdoba. So instead I journaled, relaxed, and watched some of the Harry Potter movies.
This week I spent my time in the guardía, or emergency room. It was quite relaxed and boring at some points, and then extremely exciting at others. The most interesting cases I observed were a man who had over dosed on cocaine, a man who had a head trauma, and a man who was epileptic and diabetic. The man who had over dosed on cocaine was screaming and resisting medical attention, so about 5 people ran in to hold him down. The man with the head trauma had something fall on him and he was extremely pale with blood all over his body. One of the doctors shaved his head with a small blade, then began to stitch up the wound with a huge needle and what looked like string. Instead of just placing stitches, the doctor used the string to tie a cotton swab to the patients head. I found this odd as it seems like an invitation for infection, but I'm sure he knew what he was doing. The diabetic and epileptic came because he couldn't see, due to convulsions in his eyes. He was very confused and flustered, which made it very difficult for the doctors to figure out what was going on with him. He had a packet full of papers, but the doctors couldn't find what he was talking about and it wasn't until they talked to a neurologist that they realized he was epileptic. He had missed several referred appointments and hadn't been taking his medicine, so as you can imagine he was not in great shape.
This week I had more basic Spanish classes as well as some interesting cultural classes and our group had a wine tasting event together. One of the most interesting things I learned is that in Argentina they have a huge amount of sales taxes, for example the tax on buying a car is 56%!! These taxes are due to the amount of free programs in Argentina. They have universal healthcare, as well as some other free programs and their way to fund them is through taxes. Fun fact: bus drivers make more than doctors in Argentina!! How could this be? Bus drivers have unions, and are crucial for everyday transport, so any strike they have is extremely effective. In contrast, doctors don't have a union and work in a system that is almost completely free. I know, its shocking.
Today I experienced the typical Argentine Caballero lifestyle and took a stroll through the Sierras surrounding Córdoba. A big group of people from my program decided to go horseback riding and took a van early in the morning to a beautiful country style home. The tour was led by a middle aged couple and their neighbor, a little boy in an adorable beret. We rode the horses for about an hour and a half to a pretty river, then returned back to the house to eat dinner. I rode a horse named Estrella, who was the oldest horse and very well behaved, but refused to go fast. Dinner was delicious, we started with fresh homemade bread and wine, then had a plate of potatoes, chicken, and vegetables, followed by tea and coffee. After dinner a few of us went back out for a ride, and I rode Tostada, who was very fast and fun. The beautiful rolling hills of the Sierras truly made me feel like a caballero, as a galloped through the wilderness.
My first week in Argentina was a very busy week of introduction. I could barely stay awake at orientation, as I had spent the night in the Santiago airport the night before and was exhausted all week. I can already tell there are some major differences in the level of organization between the programs in Bolivia and Argentina. This program is much more organized and hopefully I will get to see some more interesting things. I had Spanish class everyday this week for two and a half hours, which you can imagine was exhausting on top of my lack of sleep, hospital rotations, and adjusting to the new culture. The Spanish in Córdoba is very different and difficult for me to understand, but by the end of the week I started to catch on. In Argentina, they pronounce the double L not as a "Y" sound, but as a "schh" sound.
My rotations are taking place at Hospital Córdoba, and this week consisted of mainly touring the hospital. On Monday I was shown how to get to the hospital and introduced to the hospital coordinator. Tuesday I spent the morning with a phonologist who gave me a very brief tour of the hospital. On Wednesday I also spent the day with the same phonologist and she showed me a little more of the hospital. The doctors here love to chat over a cup of mate, which they all share, and often times spend more time amongst their colleagues than actually treating patients. I find it a little peculiar as they are surrounded by disease in the hospital, but I guess it strengthens their immune systems! Thursday was a holiday so I didn't go to the hospital and was able to sleep in. Friday I spent the day in the burn unit and it was definitely the most interesting day of the week. I was with a doctor who was doing consults simultaneously in two different rooms, so it was very fast paced and quite intense. The burn unit in Hospital Córdoba is one of the few in Argentina so patients come from all around to receive attention. The burns ranged from first degree to third degree, and treat enemy varied based on the degree and development of the burn. Most of the burns were treated with a film and a antibiotic medicine which were placed over the burn. I think the film contained nutrients that help skin to heal and regrow. The burn unit was very intense and really difficult on the patients, I was shocked by the ease with which the doctors treated the patients and the sort of numbness they had to how horrible and painful the burns were.
I really can't believe how quickly my time in Bolivia has gone by, it feels like yesterday that I was arriving! This week I shadowed Dra. Salazar, who is now my favorite doctor. The week was a little crazy as there were blockades almost everyday that caused Dra. Salazar to be late to meet me! I secretly appreciated it though because it meant I could stop and have a cup of coffee before shadowing. Most of the consults we received were for colds and controls, but there were a few interesting cases. There was a lady who had come in about a month before with a lump in her breast. Dra. Salazar told her to take vitamin E, which reduced the size of the lump, but it was still there. Dra. Salazar was worried because the lump was causing her nipple to retract into her boob, so she recommended the lady to see a specialist to have some tests done. Another interesting, but very sad case was of a boy with a second degree burn on his lower leg. He was burned by hot water before bathing. Dra. Salazar let me help her clean and dress his burns which was really fun for me, but not so fun for the little boy, but he was very brave.
I truly can't believe how fast my time in Bolivia has gone by! Everyone here has been so kind to me and I will really miss my host family. Before leaving we had a little dinner party, and shown below are some picture of the food.
Today I biked the most dangerous road in the world!!!
It was once considered the most dangerous road in the world, but nowadays it doesn't experience much traffic. But seriously, look up picture of "Death Road Bolivia," because there were some pretty crazy accidents back in the day. The road is lined with 600 meter cliffs, and most of the road is barely wide enough for one single car. I truly can't believe two way traffic used to drive on this road, I would have been terrified.
Biking death road was very fun and thrilling! We started the ride on a beautiful clear day with a brief portion on a paved road about 4,000 meters up in the mountains (most of the ride was down hill, thank goodness!). As we biked down into the valley we watched the vegetation change from quite bare snow capped mountain plains, to beautiful jungle fauna. The whole ride is about 64 kilometers and took about 4 hours. Some crazy people race the route and bike it in under 45 minutes! HA. Can you believe that?! I would certainly fly off one of the cliffs.
After the short paved section we reached the ominous death road, which quite dramatically was covered in fog. This section of the ride descends 2,000 meters, lined with 1,000 meter drops on the left and cascading waterfalls on the right. The first half of the ride had quite a bit of fog so I couldn't see the drop offs I was biking next to, something I'm kind of thankful for as we had to bike on the left side of the road due to traffic regulations. The ride then dropped into the valley of las Yungas, with an amazing view of the rivers and towns below and a substantial change in temperature. We ended the ride at a private house and had a pool party with some beers and a buffet.
Biking down death road was quite exhilarating and fun, I highly recommend it to anyone that feels confident in their bike riding abilities.
This week was a little odd, as there was a holiday, I was sick, and our Spanish professor went missing for a few days. This Monday I shadowed in Hospital de la Mujer. It was very boring for three hours, as I was observing women in labor and taking their vital signals. I was on the verge of leaving from boredom, right as two women gave birth!! I was pulled into the delivery room to watch a birth from a patient that I had been observing, and then 2 minutes later another patient came in. The two women gave birth in the same room, side by side. It was a crazy experience to literally watch two birth simultaneously.
On Tuesday, I observed Dra. Salette, who specializes in the phenomenology and down syndrome. From the short amount of time I spent with her I could tell she is very respected within the hospital. Her work is quite fascinating and she is very good with the children. We followed her during her rounds in phenomenology, which was rather entertaining. There was a little boy who was quite the troublemaker and kept trying to play with the doctors the whole time. He had leishmaniasis on his nose, which was beginning to destroy his cartilage tissue and caused a lot of swelling. He had been in the hospital for a few weeks and had improved immensely, but had a lot of pent up energy. After rounds Dra. Salette gave us a mini tour of the hospital which was very fun. After the hospital we rushed to eat lunch, then met our Spanish professor, Jehny, to go to Valle de la Luna! A beautiful park in La Paz, which sadly is very small as a neighborhood was built over it, destroying most of it. Entering Valle de la Luna feels like entering another planet, the land formations are seriously amazing.
On Wednesday, we were planning to go to Coroico, a town in the jungle as it was a holiday. Unfortunately, Jehny, who has been helping us a lot with planning our trip, went MIA so we found ourselves stranded in La Paz. Jehny ended up being MIA for three days!! I guess this is normal for Bolivian standards, but for me it was shocking! Stacie and I ended up catching up on some work and relaxing for the day. On Thursday, I woke up feeling a little sick so I stayed home again and caught up on some more work.
On Friday, Stacie and I shadowed Dra. Salette again, but this time she had consults. She only received three patients, but they were three really interesting cases. Dra. Salette is using an experimental drug, ayahuasca to treat some of her patients. One of the patients was born with a distal perfusion (if I understood correctly) and it was amazing to hear his improvement after just ten days of treatment with ayahuasca. His mother and grandmother described how he had become more attentive, social, and was even beginning to eat on his own. Medicine is quite the mysterious miracle!
This weekend Stacie and I went to visit Copacobana. Copacobana is a beautiful, quiet town on the shore of Lake Titicaca. On our first day in Copacabana, Saturday, we took a boat to una isla flotante, which is a floating "restaurant," as you can see in the pictures above (middle, bottom). It was absolutely adorable and the view was amazing. We ate fresh trout which the chef picked out of the water for us, and it was delicious. After lunch we went back to Copacabana and walked around for a while, then went back to our hostel to relax. Our hostel was absolutely adorable, we stayed in an adobe cottage with a very nice garden.
On Sunday we visited Isla de la Luna and Isla del Sol which are two very quiet and beautiful islands. The islands have a long history as people have inhabited them for centuries. Our Spanish professor was telling us about how during the Incan Empire, the emperor would visit the Isla del Sol once a year for a giant celebration in honor of the sun. During the celebration sacrifices such a alpacas, food, even people, were made to the sun! Before the celebration, some of the young women, usually between 13 and 15, would be taken to Isla de la Luna for a celebration in which their "virginity" was taken. During this celebration the women would be chosen by men in the tribes to be their wives. If a women wasn't chosen, she would be sacrificed during the ceremony to the sun as she was not a suitable wife. ¡Que Loco!
We took a boat to visit the two islands, starting with la Isla de la Luna. The Isla de la Luna is a very quiet island, with little inhabitants. The main attraction of the island is the small ruins that are located on the side which tourist visit. The island has an amazing view of the mountains and you can see left over walls made by farmers on the steep hillsides. The Isla del Sol has two main villages, on the northern and southern sides of the island. The two islands have been experiencing conflict for a few months now, so the northern part of the island, which contains more of the ruins and cultural attractions, was closed off to tourist. The southern part of the island is very touristy and this is where all the hostels and restaurants are. We had a very nice lunch at a hostel on Isla del Sol, with the most amazing view, as shown in the photo above. Overall it was a great, relaxing weekend with beautiful views and delicious food.
This week I spent three days at Centro de Salud Alta Mariscal, with Dra. Salazar, and one day at Hospital los Andes, with Dra. Uribe. Dra. Salazar is so sweet and talented. She has an essence about her that calms the children she treats and its has been amazing to watch. Most of the patients that came to the center had colds, vaginal infections or were just getting a check up. One patient came in thinking she had a vaginal infection because she was secreting blood with clumps in it. After Dra. Salazar examined her, she realized that the swelling was coming from her urethra. Dra. Salazar sent her to a hospital, because she believed it was a tumor. The lady didn't want to go to a hospital because she was afraid and it was a long way to go by herself. This a a very common issue in Bolivia because people don't like to seek medical attention until they absolutely have to, causing treatment to be much harder.
Dra. Salazar also performed a birth control implant which was very interesting to watch as it was much more complicated than the procedure I watched in the US. Dra. Salazar had to prep the patient and use sanitary equipment. She first injected the patient with anesthetic, then sliced a hole in her arm, then used a little tool to inject the first and second implant. The whole procedure took about 20 minutes, where as in the US it takes about 2 minutes. In the US the doctor inject anesthetic then use a gun apparatus to inject the implant. There was much less chance of infection and it was a lot less traumatic for the patient. Amazing the difference one simple tool can make.
Dra. Salazar also talked to us a lot about sexual violence in Bolivia, which is a big problem. We saw an 11 year old girl who had a baby by cesarean in Hospital los Andes. She had been sexually assaulted, but decided to keep her baby and the nurses said she had been very responsible to far, better than a lot of other mothers. We brought this up with Dra. Salazar and she told us a little more about sexual assault in Bolivia. Most of the time young women are assaulted by good family friends who are around there homes very often. This is very traumatic for you women, and can take away their ability to love their children in the future. This causes a repeating cycle as children don't grow up in a loving family, and then don't know how to love their own children. Women will often treat their sons with aggression due to the way they have been treated by men, which causes their sons to treat women aggressively in the future. A lot of families in Bolivia are not wealthy enough to own houses with multiple rooms, so multiple generations live together in the same room and even share beds. Children often explore their sexuality sooner because they watch their parents have sex. This is one of the causes for such young pregnancies in Bolivia.
Hi there! My name is Jenna Grunwald and this summer I will be gaining an understanding of the relationship between disease processes, social-economic circumstances, poverty, geopolitical realities, historical contexts, culture, and how these play into the complexity of healthcare in Bolivia and Argentina with Child Family Health International.