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.
Stacie and I decided to visit Uyuni this weekend, the largest salt flat in the world. It was absolutely breathtaking!! We took an overnight bus from La Paz to Uyuni that took about 10 hours and arrived in Uyuni at 5:45 am. When we arrived it was below freezing so we went directly to a cafe to get some aggressively mediocre instant coffee which for some reason the Bolivians love. We waited in the cafe until our tour started around 10:30 am, then drove in a jeep through the salt flat until sunset when we returned to Uyuni to catch our overnight bus back to La Paz. We arrived back in La Paz at 5:30 am and were absolutely exhausted! Luckily, there was a strike that was blocking the road to our clinical location on Monday so we got to sleep in. Salar de Uyuni was amazing and I highly recommend visiting it to anyone who has the chance. It's unlike anything else, an absolute marvel.
Gran Poder is a huge day long parade in La Paz, paying homage to El Señor del Gran Poder or Jesus Christ. The name means “Festival of the Great Power”, and is a way for families to show their economic prosperity. The festival features thousands of dancers parading down the streets of La Paz, flaunting their colorful costumes while spectators line up along the sidewalks and pay for seats to watch. The fiesta began in the 1930s, as a simple candlelit procession performed among Aymara migrants and grew over the years into a major international street festival. Many of the original Aymaran (indigenous nation of the Andes) traditions still remain. The festival now contains conquistador, Inca, slave and Indigenous costumes which are bright and elaborate, representing historical events. Many of the costumes take months to create and include imported fine fabrics, sequins and threads from overseas. The tradition, so I'm told, is that families group together and each year a different family pays for all of the costumes for everyone else, displaying their economic status as costumes can be very expensive.
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.
On Monday, June 5, Stacie and I went to el Hospital del Niño and observed Dr. Velazco. All of the hospitals in La Paz are on strike right now, which is very common in Bolivia. The people here love to strike and protest, causing huge amounts of traffic within the city center. The doctors are on strike because they want the government to give more money to healthcare, as government officials are spending money on lavish things like palaces for there families, but hospitals in Bolivia don't have enough money for medical supplies. Due to the strike there wasn't much going on in the hospital so Stacie and I talked to a few of the children, but mostly stood around. Dr. Velazco taught us a little about child development and the different abilities children should have as they reach the age of 5. The standard for sanitation in Bolivia is very different to that in the United States. Dr. Valezco touched a patients genitals without gloves, and didn't wash his hands afterwards. The children who are sick with infectious diseases run around to each others rooms and play with each other, and the Doctors don't even blink an eye. There is a child who had chicken pox who I was asked to visit and ask some questions, without even knowing if I'd been exposed to the disease before. It's very strange adjusting to the difference in expectations.
In the afternoon I napped before going to Spanish class because I am still absolutely exhausted and adjusting to the altitude is very difficult. I run out of breath and my heart is beating so hard it feels like I just ran a marathon after going up the stairs! La Paz is at about 3,600 meters above sea level, which is very close to the altitude of a base camp. After my nap Stacie and I went to Spanish medical terminology class with our professor, Jehny. During Spanish class we learn about body parts, different facets of medicine, how doctors and patients communicate and some terminology original to Bolivia. After Spanish class we had our weekly meeting with Dr. Uribe, our medical director. She spoke to us about the most common medical issues in Bolivia, some of which include tuberculosis, leishmaniasis, malnutrition, obesity, HIV/AIDS and a few other things.
It is currently Sunday June 4 at 2:00 pm. I started my travels yesterday, Saturday June 3, at 5:45 am. I flew from Portland, OR to Phoenix, AZ to Miami, FL, to La Paz, Bolivia. I arrived in La Paz at 5:30 in the morning, and I am exhausted. I had a few forgetful moments already (I blame it on the lack of sleep), one where I forgot my purse on the airplane, and one where I forgot my water bottle on the airplane. Going through immigration and customs went smoothly and I received my visa with no issues. After exiting the baggage area I couldn't find the driver who was supposed to pick me up so I wandered around the airport for about 30 minutes before she found me. I was trying to find a phone to call the local coordination at the time, which wouldn't have worked out because CFHI gave me the wrong number for him! So I was quite lucky to find her. The drive into the city was absolutely beautiful. I arrived at the perfect time, emerging into the city just as the sun was rising, lighting up the city and the breathtaking snow capped mountains surrounding it. I am already in love with La Paz and look forward to exploring it some more. My host family lives in a very nice home of 4 stories. Señora Roca is the mother and her son, Mauricio, and her mother live here also. She rents out the bottom story of the house to two friends, Marco and Nelson. Stacie, the other person doing the CFHI program lives in the same house as me. We are suspicious that Nelson might be señora Roca's boyfriend because they always flirt and joke with each other.
As soon as I arrived in my home for the next few weeks I slept until about 10:30, then met my partner in the program, Stacie. Stacie is also a pre-med student and goes to UGA. In the afternoon I met with Gonzalo, the local coordinator. He showed my around La Paz and pointed out some of the clinical locations. Gonzalo is a professor at a private school in La Paz and is very nice. Tomorrow I start my first day of clinicals and Spanish lessons!
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.