What I Have Learned- Bolivian Healthcare and Summative Blog

It is the end of my four weeks in Bolivia! I have learned so much about the healthcare as well as the culture during my stay, and this will be my final blog. Thank you to those who have been following along with me 🙂

In my previous blog, I had a picture of Dr. Uribe, the Pediatrician who also does a great deal of work with adolescents, especially teen girls. She gave us a lecture on teen pregnancy and how much of a problem it is. Adolescent pregnancy is defined as pregnancy within the adolescent years, between about 12 and 17. In the lecture, Dr. Uribe explains that there are several different causes as to why adolescent girls get pregnant at such a young age:

-Lack of sexual education- many of the adolescents are neither educated about sexuality in general, nor contraceptive methods, and a lot of the perception of sexuality is from social media.

-Alcohol- this also plays a big role in teen pregnancies.

-Sociocultural- while there is access to birth control, many of these girls won’t use them because contraceptive methods are generally not used.

Some of the stats she shared with us showed that in 2008, a staggering 83% of adolescent girls were pregnant in the city of El Alto which has a high poverty rate. Some of these teen moms have been abandoned as a baby themselves and they’re looking for love  and affection. Many times there can be as many as 4 or 5 different fathers for each baby and the sad cycle continues. Dr. Uribe is involved with a ‘guardería’ (nursery/ child care center) that supports these young moms. It’s a system that allows the moms to go to work while another mom takes care of the children. Having this in place helps teen moms see that there are options besides abortion.

During our Neonatology week, the Neonatologist was asking about baby abandonment in the US. It was interesting to see his reaction when we told him that yes, this happens in America too. We asked if there are children’s services available for when the babies are left in the hospital and he said there is something in place for when that happens (thank goodness!).

There are programs in place where the mom will receive money and food for the baby until he or he reaches 5 years old and until the moms stops breast feeding.

In terms of malnutrition, Bolivia has made great strides in reducing child malnutrition rates. For example, organizations such as UNI (Unidad de Nutrición Integral) promotes healthy eating practices and prevention of malnutrition. Our host mom also explained to us that families with children under five and pregnant mothers receive a daily ration of bread, quinoa, and other sustaining foods for free. Ever since this started, there has been a drop in child malnutrition.

One main lesson I’ve learned during my stay in Bolivia is how culture influences healthcare:

-On our very first day of clinic, Erica and I met with Dr. Velasco, a General Peds doctor who spoke both Spanish and English. He spoke about understanding the cultural aspect of healthcare in order to meet the needs of the people being served in the most effective ways possible. He gave an example of how he had an indigenous patient with diarrhea. It’s important to remain hydrated in order to replace the fluids lost, but the patient thought it didn’t make any sense to add more fluid to the body when it’s being lost through watery stools. Patient education is major and understanding their thoughts and beliefs can lead to more effective care.

-In the general Peds unit, there are about 12 beds in one large room, as I mentioned in my previous blog. The way parents were able to interact with each other, the way patients interacted with each other and even the way the doctors interacted with the parents was really nice to see. I spoke with one of the mothers (she was the mom of the boy with nephrotic syndrome who was trying to raise money for his biopsy) and while I was doing that her son was playing with another little girl who was there for recurrent UTIs. It’s like they were siblings and I’m sure this kind of ‘community’ is in ways very therapeutic versus the ‘private’ atmosphere that exists in the states.

-Doctors are very much respected here. It is very common to hear the parents of the patient say ‘yes Doctor, sure Doctor (in Spanish) to whatever recommendation is made to them. Sometimes, though, there can be some resistance to recommendations. For example, the mother of the boy with Non-Hodgkin’s Lymphoma did not want a biopsy on her son, mainly for economic reasons. The doctor was able to explain to her the importance of the biopsy and it was helpful too that there was a social worker present who explained to her different options available to help with funds.

It has been wonderful being immersed in a different culture and learning so many new things. I know that this rotation has given me plenty of things to think about. It is so important to be culturally competent as well as medically competent (especially as a Family Medicine doc!) because the world is quickly becoming more and more diverse. I expect to encounter  patients from all walks of life and this experience opened my eyes to what I can expect in the very near future 🙂

Farewell La Paz 😉

image

Potpourri 2

There’s so much to share! Enjoy 🙂

image

Dr. Uribe- she gave us our weekly lectures. She does great things for the adolescents she works with, especially with teen girls. More on that in the next blog.

image

This is a unique design on a side street we visited

image

I loved this street- it’s so quaint

image

This pic is dark, but do you notice anything interesting about this clock?

image

This protest had something to do with transportation.

image

My Spanish teacher Jheny! She’s great and she showed us around town several times. She even set everything up for our trip to Salar de Uyuni! The perks of having a tour guide as a teacher 🙂

image

This is a small model of the monoliths of Tiwanaku. Erica and I didn’t get to go, but Jheny showed us this replica in downtown La Paz.

image

This stone is called the ‘Bolivianita’. It’s a semi- precious stone only found in Bolivia. It has an interesting story behind it about why it has 2 colors 🙂

image

Seeing him play the violin took me down memory lane of when I used to play.

image

I put this on my previous blog- this is a cholet, the big, colorful and shiny buildings of the cholitas of high standing.

image

This is inside one of the cholets. It’s so extravagant! There are lots of colors and lights, like Vegas or a cruise ship!

image

My host family! Jenny took good care of us. She always told us to be careful when we went out and she even held my hand when we crossed the street, much like what my mom would do lol. Her husband Phil told us a lot about Bolivia. Their daughter Valorie is very creative and talented 🙂

Winding Down the Last Week

It’s already our last week at the hospital! This is going to be a long one, so brace yourselves!

This week, we were on Nephrology/ General Peds.

image

There were several interesting cases we have seen:

1) A 6 month old girl with Apert’s Syndrome. This is a genetic disorder that causes a premature fusion of skull bones leading to facial deformities, developmental delays and other deformities such as syndactyly (fusion of fingers and toes). She had previous surgery since her head was still wrapped in bandages.

2) A 2 year old girl born with a cleft lip. Her story is pretty sad. She was abandoned by her mom once she saw her deformity. The baby would later develop pneumonia then sepsis and she had to be on a me hanical ventilator. The doctors had trouble weaning her off so she ended up getting a tracheostomy to help her breathe. She has been in the hospital for most of her life, but she gets lots of support from the hospital staff. She has lots of clothes and toys that were donated to her too, and she was affectionately given the nickname ‘la dueña del hospital’ (the owner of the hospital). She is my favorite patient in the unit- her face lights up when she smiles and she gets happy when we visit her 🙂

3) There is a 12 year old boy with Non- Hodgkin´s Lymphoma (NHL). This is a cancer of lymph nodes, the areas of the body that contain immune cells. He has a history of TTP and was diagnosed with NHL in 2013. He had a course of chemotherapy that he didn´t respond to and is currently on paliative chemo. He has several masses with the largest one on his left submandibular area. I also found out by reading his chart that he also has PCP, a type of pneumonia that can happen when the body is immunocompromised. He has Bactrim on board and is also scheduled for biopsy. Since he has failed 4 courses of chemo in the past, they’d like to do a biopsy to be as specific as possible with treatment. He also has been oxygen- dependent with his lowest recorded O2 saturation being 65%.

4) A 6 month old female with bronchopulmonary dysplasia (BPD). This condition occurs in premies that did not develop surfactant yet because they were born too early. Surfactant is the fluid that helps keep the lungs open to facilitate breathing. Oftentimes, these babies will require oxygen for a long period of time. This particular baby has a very audible stridor and is on oxygen for certain time periods during the day.

5) A 3 year old boy who accidentally ingested detergent. Apart frrom some oral pain,  he is doing well. There were no concerns for any internal damage, as imaging did not reveal anything. He will be discharged today.

I´ve seen and learned a lot on this rotation and it´s been great seeing the differences between Peds here vs. the US. On the General Pediatric floor, there are about 12 beds in one large room. At first, I had concerns about HIPAA, especially since one of the mothers asked us about another child’s case (which we didn´t give any information to). But later, it was heartwarming to see how another mother would soothe and hold a crying baby in the next bed over and the kids would play with each other too 🙂

image

In addition to clinic, there were several great things we did this week.

On Sunday, we visited the local zoo and got to see some interesting animals native to Bolivia such as llamas and vicuñas.

On Wednesday, our Spanish teacher Jheny took us to the different markets downtown. She had us taste two different fruits I´ve never seen or heard of before: pacay and cherimoya. I didn´t enjoy Pacay too much because it has a fuzzy texture that threw me off (I don´t like cotton candy either!). But I loved cherimoya! The taste reminds me of a mango, but slightly different. There´s even a cherimoya flavored ice cream!

image

Top: pacay; Bottom: Cherimoya

Later that day, the Bible study Erica and I attend had a small farewell party for us (called a ‘despidida’). It was so heartwarming! To begin,  the couple who hosted the Bible study every week were very hospitable and sweet. They were always so happy to see us and they loved it when we read in Spanish! This Wednesday, they had a cake ready for us,  along with some tasty empenadas too! And they gave us each a beautiful hanging plaque that had Proverbs 31: 29 on it. They told us that it was nice to see young Christians like us because in Bolivia, it’s very hard to find Christians our age.

On Thursday, our host mom introducecd us to ‘api morado’, a purple corn drink that can be served for breakfast, and oatmeal and fruit can be added to it too. It is really good! Not only is it pretty, it’s also chockful of vitamins and protein too. I brought 2 small bags of it to make some at home =).

image

Good stuff!

Jheny then took us to a museum later that day, Museo MUSEF (Museo Nacional ded Etnografia y Folklore) which displays the cultural history of Bolivia. We weren´t allowed to take pictures inside (without paying anyway), but there were lots of interesting things we saw like the different tools and large pots they used to use. There were also replicas of the ancient civilizations of Tiwanaku, the capital city of the empire at the time.

image

One of many ‘cholets’. Usually, the first floor houses different businesses (to help generate income), the second floor is for weddings and parties, the third floor has apartments for rent, and the owner of the building lives on the top floor.

On Saturday, Jheny took us to see the ‘cholets’, the super elaborate and extravagant architectural work-of-art buildings designed by cholitas, the indigenous Aymara and Quechua women of Bolivia. In the past, they were discriminated against and weren’t served at restaurants. However, ever since Evo Morales, the first indigenous president came to power, the indigenous people have made great strides in different arenas such as in business, politics, and education. These women who were once looked down upon are now becoming more the forefront of society. This is clearly shown by the amazing wealth they have accumulated and worked hard for over the years and they proudly show it through these buildings as well as their elaborate clothing.

Highlights: learning so much about the culture; going home tomorrow!! 🙂

Potpourri

This post is just to share a couple more pictures I haven’t posted yet. They’re from rotations and weekend outings. Enjoy!

image

The Peds clinic at Hospital del Niño

image

image

From left to right: the red and green one is the flag of La Paz, the one in the middle is the Bolivian flag, and the last one is called ‘Whiphala’ (the Aymara word for ‘flag’) which is the flag of the indigenous people of Bolivia

image

Several times along our weekend trip, our driver stopped to help other SUVs with flat tires, engine issues, and other car troubles

image

Llama crossing!

image

Our dinner when we were at the salt hotel: potatoes, llama (yes llama! I didn’t know people ate llama, but it tastes like steak!), onions, boiled eggs. It was delicious 😋

image

Being… adventurous?

image

A nice area where we stopped for lunch… It had the most picturesque scenery!

image

This is a list Dr. Salete had me write, it’s a list of labs and tests needed for her patient diagnosed with Down Syndrome

image

During the 48 hour strike earlier this week, one of the doctors were getting interviewed by a TV station

image

I was coming from Spanish class and we came across the zebras that help people cross the street! There’s a great story behind this called the ‘Zebra Project’. It’s very interesting 🙂

New Hospital

Today, Erica, Amina and I visited Hospital de Los Andes which is a maternal and infant hospital about 45 minutes away from where we stay. Thank goodness we were able to catch a ride with Dr. Uribe, the awesome pediatrician that gives us our weekly lectures.

image

We started off with a lecture that talked about the incidence and mortality rate of neonatal sepsis. We were then assigned a resident to follow for the day. I followed two seniors that seemed to have a pretty light schedule, but after asking if they’ll see patients today, one of them told me they just came off of a 48 hour shift and this morning’s light schedule was pretty rare.

A moment later, one of the residents had me follow her to the ‘quirofano’, which is the OR, to see a C-section. I scrubbed in, but I just observed from the back of the room. Once the little baby boy was out, the resident took him to the next room for routine post-natal things: she rubbed him down, clamped and cut his umbilical cord, weighed and measured him, gave him vitamin K, put ointment in his eyes and filled out his birth documents. She did, however, have to put on an oxygen mask on him because he was a bit cyanotic, but it didn’t take long for the baby to become a healthy rosy color. Next thing I know, the resident was telling me to get some gloves. I did, and she handed me a diaper and baby clothes to put on him. Afterwards, she swaddled him and set him in the crib.

image

The delivery room.

After seeing the C-section and helping with the baby, we walked to the delivery room where another delivery had just taken place. The other resident took the baby and did the routine baby  care procedures. Not long after that, Erica and I headed back to the homestay. It was nice to visit that hospital and see a delivery and C- section; I haven’t been on an OB floor since my 3rd year and it was a nice refresher.

Highlights: seeing more babies!; having a relaxing evening 🙂

Neonatology

My second post for the day, I have a lot to catch up on! After our fun weekend, it was back to work again! Erica and I started Neonatology this week…

Earlier in the week, however, there was a 48 hour strike.

image

This more or less states ‘The absence of human resources, infrastructure, and equipment within the hospital… Is this not negligence?’

The strike, however, did not affect our rotation on the Neonatology floor. There were 6 babies in the unit this week…

Baby 1: there was a baby girl only a couple days old with a congenital heart  defect, which the doctor suspects is Tetralogy of Fallot (pronounced ‘Fuh- low’- a condition where the baby’s heart has 4 defects- a VSD, which is a hole between the ventricles; an enlarged right ventricle; an overriding aorta; and an a narrowing of the pulmonary valve). All this leads to ineffective pumping of blood, oxygenated and deoxygenated blood end up mixing together, and the baby doesn’t get adequate oxygen leading to cyanosis or ‘a blue baby’.

Unfortunately, surgery could not be performed in her right away because she also has sepsis and is currently on antibiotics. The other unfortunate thing is that her mom is a teen. It seems to be a common occurrence for teen moms or moms with several other children to abandon their babies 😦

Baby 2: this baby was also only a couple days old and he has a tear in the anterior wall of his stomach along with a volvulus (or a twisting) in his small intestine which lead to obstruction. He is currently on antibiotics as well and is scheduled for surgery.

Baby 3: this 7 day old has ileal atresia, type I. Atresia occurs due to ischemia (lack of oxygen) to a certain part of the intestine and blockage occurs. There are 5 types (I, II, IIIa, IIIb, IV). According to the Children’s Hospital of Pittsburgh, Type I is where there is a ‘web- like membrane that forms inside the intestine’, but the intestine still grows to its normal length. He is also scheduled for surgery.

Baby 4: he was our favorite! He’s only 1 month old and had surgery for a diaphragmatic hernia, where part of his intestines ended up in his chest. He is recovering well enough, but he can’t be discharged yet because he has a brother at home with pneumonia. His crib was towards the back of the room away from the other babies. Erica and I made sure to visit him everyday we were there and talk to him a little bit. Today, I got to hold him and feed him his milk 🙂

There were other babies that were discharged throughout the week that were in for jaundice, and other less critical conditions.

image

The Neonatology Unit

 

image

A baby under a bili light for jaundice

Highlights: having Internet access!; getting to hold my favorite baby 🙂

Work Hard, Play Hard

I don’t even know where to begin! It’s been a while since I’ve posted, and it’s because there was no wifi access for several days! But I’m excited to share all we’ve seen and done! Work hard, play hard right?

Getting there:

image

We took a taxi to the bus station, then from the bus we took a taxi to the train station. Our car 1551

image

Llamas I saw from my train window! Llamas are as common here as Coca Cola!

Both the bus and train rides were hours long! Not much else to show… Onward to the next day!

Day 1:

image

Breakfast in the morning at ‘Breakfast Noni’. All this for less than $5!

image

At Uyuni, where all the fun begins!

image

The resolution isn’t so great, but this is us at the train cemetery! These trains were once functional, but now they’re just fun photo props! 🙂

image

The Salt Pyramids, one of my favorite places we visited!

image

Now THIS is my favorite place! The salt flats of Uyuni is the world’s largest salt (and lithium) deposit. We’re actually standing on salt! When it rains, there’s a beautiful reflection that forms and it looks like a mirror, it’s so breathtaking!!

image

The super flat terrain makes it easy to take ‘perspective photos’. This, however, looks like a scene from a bad Jurassic Park movie lol. Oh well.

image

This is Fish Island (called so because the land mass is shaped like a fish). It’s covered with tall cacti such as this that grows about 1 cm per year. They grow super tall!

 

image

We then stayed in this hotel where most of everything was made of salt!

image

Our salt beds! They had soft mattresses on top so they were pretty comfortable

Day 2:

image

At a semi- active volcano, there are mounds and mounds of volcanic rock around

 

image

This is one of several beautiful lagoons we’ve visited

image

The Rock Tree!

Day 3:

We met other students along the way too. We met a fun and super energetic girl from France named Louise who was traveling throughout South America for a year! We went on a hike with her 🙂

image

Louise!

image

Our tour group: me, a couple, Erica, Amina, and Louise at Lagoona Verde (Green Lagoon)

 

Highlights: the whole weekend!; starting Neonatology 🙂