HOME 7:48 AM

I made it! Everything went as smoothly as possible; I walked out of the airplane at SFO at 10:10 pm and saw Michael shortly after. Woohoo!!

Thanks for reading everyone! and Happy 16th Birthday to Lia!

Thanks for the sun spots 6:41 PM

Back in June, I posted about a walk that I had taken in which I missed my intended destination. It was just a landmark on a cheap map of La Paz, and nobody had ever mentioned it to me, so I didn't think much of it. But I wanted to do another big walk this morning (lots of time to sit around tomorrow!), so I decided to try again. First I walked to Plaza Murillo, where I sat down for a minute and got my shoes shined. It's something I've been wanting to do for a while. The shoes shine boys are all over the city. You can't see it very well in the photo to the left, but they wear ski masks over their faces. The first week I was here, I was startled several times when I looked up or rounded a corner and there was man in a ski mask, often in fatigues too. Anyway, the shoe shine was fantastic.

Everything was uphill to my destination, but it was so worth it. Mirador Killi-Killi has an almost 360 degree view of the city. I stayed for over an hour, reading and taking pictures. A couple tour buses stopped while I was there, filling the little park with people and then emptying out again. I asked one of the tour guides to take a picture of me, but of course I have my eyes closed in the photo. So I took a few of myself, and I think a couple actually look okay (i.e. you can tell that there is a gigantic mountain behind me).

















I walked home around noon to have lunch, and then went back out in the afternoon, so my legs are ready for their day-long rest tomorrow. My flight leaves at 6:55 am, so I have to be up around 4. I already have butterflies in my stomach... flying around in the air is just not my thing. Plus, the flight into Miami is notorious for being hours behind schedule. I only have a three hour layover, so it might be close. I am hoping for the best. At least my Blackberry should work in Miami. :)

P.S. Happy 4th of July!

Bambi 8:08 PM

I saw a baby struggling to breathe today. She was 9 months old, and the doctor wanted to hospitalize her. The parents refused. They said the last time she was sick, they let the doctor send them to the hospital, and they ended up getting pushed around to three different hospitals. Once they got to Hospital del Niño, the doctor told them nothing was wrong with the baby. So, four months later, they sign a paper saying they refuse hospitalization and the doctor, quietly resigned to the situation, gives them some antibiotics. I hope the baby is okay.

After finishing at the clinic, I got on a minibus back to La Paz. I took the last of my photos of El Alto, mostly of the graffiti there. I've put together a small album of street art around La Paz and El Alto... there's too much to put on the blog, so I'm just putting the link to it here. If I had more time, I would explore the politics of Bolivia. In the meantime, I find the slogans and writings around town fascinating.

I got off the minibus almost as soon as we got into La Paz so I could walk through the markets and get some fresh air on my way back home for lunch. I don't think I have talked about food much on the blog, so I'll comment briefly now: I am SO ready to eat some food at home-home. Although there seems to be plenty of everything and anything here (see photo below, right), this does not seem to translate into every day life - even for the people who can afford it. Meat is expensive, but it is the principle food at every meal, and cheap vegetables and fruits are not the go-to food. Go figure.

Plus, I know I'm not a big meat-eater in general, but I don't know how you could be after seeing the markets... i.e., photo, below left. Chicken, steaks, and whole fish get set out to be sold all over, in exactly this manner.















Ah well. At least someone has a sense of humor about all the dying animals.

Thursday night lectures 5:37 PM

Every Thursday night, I attend a lecture given by Dra. Santivañez to a group of CFHI students. The first week we went over health care and insurance in Bolivia, then we covered malnutrition, hip displasia, and (tonight) tuberculosis. All of the lectures have been extremely helpful to me, and I would have written more about it if I didn't think that it would bore most of you to tears. I mention it today because it was (a) the last one, (b) I was the only student there, and (c) I hadn't thought about it before, but I really hope I don't come home with TB.

I did a little more research after the lecture tonight, and here are the numbers I found from the WHO for 2007.


USAID also has a profile on TB in Bolivia which states that it "ranks third in the Western hemisphere in tuberculosis cases." The picture I took to the above left is at Hospital Los Andes. It basically says that treatment is free if you have tuberculosis (which is true). Unfortunately, people start to feel better a month or two into treatment and stop taking their medication... which is why it remains a big problem here and the free coverage program has had varied results over the years. Public health is fascinating to me, but I'm not sure if I could work in it for reals... at least not from a top-down approach. I'm much better at building up.

As my time is drawing to a close with this blog, I realize that I have taken photos of things that I meant to write about or mention, but haven't yet. So please forgive the haphazard transition from "serious tuberculosis discussion" to "things I think are silly."

It took me a week to realize what my association with "hipermaxi" was... but when I did, I had to take the picture. There is no way that a Bolivian would realize that most American women might think that "hipermaxi" is a brand of sanitary napkins, but that's the beauty of life in general, no?

Also note the ridiculous amount of power lines in the hiper maxi photo. The power/telephone lines are dense here, and that wouldn't be remarkable except that they also hang pretty low (at least for me, since I'm so tall here). More specifically, there are ones that hang down. For three weeks now, I have avoided the hanging cord a couple blocks from my building (I blurred the edges of the photo to the right to draw attention to the line... but it's still hard to see). Yesterday, I finally saw someone run into it and they didn't die! It was an exciting moment.

And finally, more spectacular signage. It reminds me of the restaurant "Cuteness," only this isn't even remotely fake. Babe looks so delicious when you put him next to a dead picture of himself.

Dancing in the streets 6:33 PM

I was walking home tonight and I saw 5 men dancing. They were on a part of the sidewalk that opens up to the university entrance, so they were out of the way of everyone save the couples smooching in the darkness around them. Nobody was really watching the men though. They were dressed in business suits and dancing in a line, coordinated moves, Latino music with a hint of Andean flute playing from a stereo somewhere. There is dancing almost every night in the plaza by my building... not like the business men, but men and women dancing in a group, Rennaissance-like. The temperature drops a lot after dark, so the women are bundled up on top and underneath their skirts. The skirts are often all the same color and they twirl all at the same time. It makes me want to reach for Michael's hand and go home together, which is strange because there isn't much dancing in the streets in the states.

Today was a long day. I saw the full patient load in the clinic in the morning and then I stayed in El Alto to see births. I saw one all the way through, and the end of another (they were about to move her from the emergency room to the birthing room when she pushed the kid out... I ran in just after). Both of the women were younger than me, but I only knew that because I read their charts. There was a lot of blood for one of the women, and she was in a lot of pain. It was exhausting just to watch.

I took some photos on the way up to El Alto today... the one below was taken near the top. There are better vistas, but they are hard to catch in a rapidly moving minibus.

Hospital Los Andes 8:11 PM

Today I was back in the clinic part of Hospital Los Andes doing wellness checks with a pediatrician there. In addition to the free health care insurance for children 5 years and younger all over Bolivia, children who go to school in El Alto also get free health care insurance. Unfortunately, some kids don't go to school, and then don't get covered. Sometimes the root of the problem is deeper than policy makers think it is? On the clinical side, I saw a few cases of malnutrition and one case of scabies that had been going on for months... His aunt brought him in because he "had lost his appetite, and oh, by the way, he has this itch..." Eek!

The pictures to the left are of the Hospital. On top is the hospital part (where I saw the c-sections yesterday) and on the bottom you can see the entrance to the clinic part (to the left of the yellow sign and behind the fence). Besides being colder, El Alto has a completely different look than central La Paz. Buildings aren't more than two stories and the terrain is flat (since it's at the top of the mountain). Dogs run wild, and when the streets are empty, they feel really empty (not like that city feel, where even when there isn't anybody around, you can sense people nearby). It's definitely lacking the wealth of La Paz, but it's also easier to imagine living in El Alto. At least for me.



And yet another bizarre sign. This is only a few blocks from where I live, but I didn't notice it until last week. I see that they have fixed the underbite... but what about her lips?

And I was so hungry 6:53 PM

A mostly uneventful weekend. I went to a picnic at Mallasa Park, which is in south La Paz near Valle de la Luna. I wish I had been able to take pictures of the rock formations that make up "Valley of the Moon" and of the view into central La Paz (Mallasa is higher up), but the minibus we took didn't really allow for that. Or shall we say that my tummy didn't allow for it (being carsick and scared you are going to fall off of a cliff at the same time is not conducive to taking pictures).

But I did get the shot to the left once we were at the park. It was quite beautiful, and it was nice to breath some fresh air. Also, I saw a bird other than a pigeon! I took pictures (I know this is sounding sad) because I didn't know what kind of bird it was. I'll have to show someone once I get home... Mom, do you still have that bird book?

Anyway, today was much more exciting. My final rotation is at Hospital de los Andes. It's located in El Alto about a 20 minute bus ride up the mountains to the north and 2º C cooler. I had been told that I might get to see a birth, but that it really only happened on Friday (not sure why exactly, but the supervising doctors are not the ones delivering babies, so they must have to ask a favor of the other doctors to allow us to see the deliveries). But... a half-hour into the morning, Dra. Gutierrez popped into the clinic and asked if anyone wanted to see a delivery! I was pretty enthusiastic in my "sí, yo quiero mucho!" response.

And then I waited. I was first told that the birth was happening right away, and I had to get my scrubs (pijamas) on. So I changed, and then I was led to another building (the hospital, as far as I can tell, consists of two one-story buildings), where I was told that it was going to be a C-section and it would be another 15 minutes. And then the doctor ditched me and another hour went by, during which time I tried not to wander too far or ask the nurses too many questions (ummm... so, like, can I see the surgery now??).

It was definitely worth the wait. I ended up seeing two césareas, both with the same team of doctors and nurses. The first one seemed a little more brutal than the second; the doctor did a lateral incision near the base of the woman's tummy and there was some serious tugging and pushing to get the baby through the hole. Also, the sight of a baby being pulled out from someone's belly is strange; it kind of looks like an alien emerging from a cocoon. Probably destined to be a cute alien, but still... an alien baby.

I know I didn't really do much today, but it was still one of the most rewarding mornings. I got to wear scrubs! I saw a real surgery! The doctor said my Spanish was good! (although I'm not sure if I believe him...). And the only part that I thought I might not make it through was when we were waiting for the anesthesia to kick in and the ob-gyn doctors to show up for the first patient. I got really really hungry, and thirsty, and I really wanted to sit down and have lunch. But then they made the incision and I was still hungry, but I didn't feel faint anymore. I just felt excited and a little teary-eyed.