First Week in La Paz

A little about La Paz: La Paz has a bowl like formation, with the city center lying in the valley of the Andes mountain range and the city flowing up the walls of the steep hillsides surrounding it. It is surrounded by the Illimani, Huayna Potosi, Mururata, and Illampu mountains. El Alto lies above the city center on a flat area and is where much of the poor population lives. The city center is where people within the middle class live, and where my home stay is located. In the south, al sur, is where many of the rich people live. La Paz is a bustling and lively city with constant activity, honking, and protests.
For the rest of my first week I observed Dra. Gutierrez en el Alto. Most patients were young children, pregnant mothers, or old women. The most common diagnoses were malnutrition, obesity, hip dysphasia, vaginal infections, and arthritis. Education seems to be the biggest issue in Bolivia, as people don't know how to eat correctly or care for themselves. People wait until the last minute to receive medical attention, and because of this their infections are much harder to treat. There were so many mothers that didn't know how to feed their children correctly and because of this their children were not receiving the right nutrients. One day, we walked through el Alto and gave Vitamin A tablets and "Chispitas," which are supplements containing vital minerals and vitamins, to parents with children under the age of 5. We were rejected by a shocking number of parents who didn't want the nutrients for their children, the result of a lack of education.  This could also have been the result of Dra. Gutierrez's form of communication, as she does not come of as the friendliest person. Dra. Gutierrez has a very aggressive treatment approach and is very harsh with her patients. She would ask mothers "what are you feeding your child?" and then when they were part way through responding, she would interrupt and say "No! Where's the meat? Where's the fruit? Where's the vegetables?" It was a good learning experience to shadow her because now I know how not to interact with patients. I watched patients in their most vulnerable moments and saw their expressions change to embarrassment, astonishment, and disgrace when she spoke to them. I also noticed a lot of unsanitary practices in Dra. Gutierrez's office. She would perform pap smears on the same table, with the same cloth day after day. Healthy patients would sit on the same table with patients who had vaginal infections. She would also touch unsanitary object with her gloves, then perform the pap smear. 
Overall my time in el Alto was a great learning experience, teaching me about good and bad practices.