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.

Incroyable 6:35 PM

Please pardon my French. Incroyable just has a more astonished sound to it than increíble or incredible (in my head, of course).

Anyway, the incroyable moments have been happening a lot for me. Sometimes it's a good incredible, sometimes it's just pure surprise, and other times it's like a scene from a bad movie. [Note: the picture to the right isn't amazing, except for my hair maybe... I just thought it was decent evidence of my continued good health and actual participation here.]

The most memorable bad movie scene happened on Tuesday morning. As I think I've said before, Hospital del Niño is a teaching hospital, so there are residents and interns and medical students floating around all over the place. Then there are the bosses, and one in particular for this story. His name is Doctor Jefe (ok, so it's not his real name), and he is a striking figure on any day. He is taller than most Bolivians, probably in his 50s, with a very masculin, latino face. His hair is always combed and parted just right, and his black shoes are always spotless (which is hard to do in dusty La Paz). Dr. Jefe also leads rounds every morning. He may ask questions of his senior resident, he may look you in the eye, but you always have the distinct feeling that he is in charge. Often times he doesn't seem to acknowledge the patient's or their parent's presence. I am not sure if he could get away with some of this in the United States.
That said, I happened upon his dictations this Tuesday morning. He was pacing around the nurses' station (looking very distinguished), dictating to a senior resident. All this probably wouldn't have been so funny to me, except for the fact that the poor senior resident was on a type writer. Oh, and he looks like Dr. Jefe's sidekick - like a smaller version of him, possibly just as smart but destined to be only second in command due to his height and sidekick-ish appearance. I wish I could have videotaped the scene, but instead I got the photo to the right. At least we know that if sidekick doctor needs some extra income, he can set up a table in the street. (There's just one in the picture, but there were many more desks with typewriters and their owners lined up along the street. So logical, so surprising.)


On the other hand, I got to go to the neonatology ward (photo to the left) this morning. And Dr. Jefe of that department was almost the opposite. Still very well dressed and with an air of knowledge... but so nice! compassionate! human! It was a good thing to see.

Another unbelievable moment happened today in the clinic. A kid came in with a fever, cough, and a rash... and the Dr's tentative (waiting for lab results, but 99% sure) diagnosis was scarlet fever. I kind of felt like I was in Little House on the Prairie. I put a lot of antibacterial stuff on my hands after that.


And finally, to the right is one of many baffling signs I have seen in La Paz. Maybe I am missing something in translation. Isn't using a naked woman in an advertisement for unlocking cell phones a bit misleading??

Medical Monday 4:25 PM

I am back at Hospital del Niño this week. We had some interesting cases at rounds this morning. They have lifted the isolation of the Departamento de Infectología, so we got to join the doctors and staff for rounds. The girl with monkeypox looks a lot better. She's sitting up and all the lesions have scabbed over.

We also saw a child with leishmaniasis, which is a tropical disease not found in La Paz. The room was so crowded that I didn't get to see the lesion. Hopefully I'll get in there another time this week.

And then there was an 11 year-old girl with chickenpox complicated by necrotizing fasciitis. It was clearly an interesting case to the doctors. Dra. Paula was sent to fetch cameras from cars and offices, and we were all allowed to take photos. If anyone is interested, I've posted my photos in a Picasa web album here. One picture is of the infection site on her leg, and the other is of the infection site on her back.

On another note, one of the blogs I read posted these interesting posters from the Zurich Chamber Orchestra. I really like how they blend music and physiology.

Soy americana 10:10 PM

I discovered what my problem is today... I'm an American.

To preface this, I had a particularly humbling day last week. It started in the morning when I asked a woman sitting on the stone steps of a church with her child if I could take her picture. I offered to pay her, but she refused. I felt silly, and thanked her, thinking "I wouldn't have wanted a stranger who thought I was "beautiful" to take my picture either... why did I just do that?" I guess I wasn't sure what to think of myself; the scene had just been too much too resist - like something out of National Geographic - and now I had behaved "badly."

Later that night, I was walking down the street, enjoying the music. It was coming from a stereo of a street vendor selling CDs, so I turned around and asked him who was singing. It was Nat King Cole (haha), and so I asked how much it was. Since it was less than a dollar, I said I would buy it. At which point, he takes it out of the CD player, puts it in a plastic sleeve and hands it to me. Again, I felt pretty dumb. By trying to take a part of the evening with me, I had ruined the scenery and the mood.

So today, I am walking down the street when a group of traditional musicians comes marching along. I happened to be in the touristy part of La Paz, and the band was like honey to bees. White people popped out of shops and from around corners, surrounding the group with their cameras and camcorders. Hmmm...

As I was walking away (after getting the two pictures here of the onlookers and the musicians... read into that as you will), I was reminded of something Dra. Santivañez said on Friday. We were talking about patient privacy, and we asked if some patients felt uncomfortable with five Americans in the room. Liz said that she had always been asked before observers were allowed to participate in/watch an examination or procedure. The doctor smiled and said "yeah, but if we asked them, they might say no."

So either I need to stop asking people in the street if I can take their picture... or feel more guilty about invading patient privacy (and stop going to rotations?). Why does being a hypocrite feel more comfortable?

Two weddings and a reception 8:07 AM

Last night many people traveled to Tihuanaku to celebrate the Aymaran new year, but staying up all night in the freezing cold didn't sound extremely appealing to me so I stayed in La Paz instead. Plus, I was invited to the wedding of the brother of Heidi, my host mom.

I was told to be at the church at 7 pm, which means no earlier than 7 pm in Bolivian time. I took a taxi to Miraflores and walked into the church at 7:02 pm, and since there was a wedding going on, I sat down. It was a pretty big church, so I couldn't see the people at the front very well.

So it turns out that wasn't the wedding I was invited to after all. I eventually walked out of the church, and lo and behold there was the groom and his dad. They didn't seem surprised to see me walk out of the church either... they were more concerned that I know that Heidi was on her way (or something...). I guess there were about 5 or 6 weddings scheduled for that day, and they were running a bit behind.

Anyway, the next (real) wedding was more beautiful, and a bit longer. It was a Catholic service, but in Spanish. So I knew where we were most of the time, I just couldn't respond to any of the prayer calls and such. Below is my host family getting ready to walk up the aisle. Heidi is the oldest child in her family I think, and since their mom passed away a while ago, she walked her brother up the aisle.

The reception was held in a hotel about a 20 minute drive away in Zona Sur (which is sort of the posh part of La Paz). It was a big party! And I felt sorely underdressed.







There was dancing and a live band, and dinner was eventually served at midnight. But perhaps the most interesting part (besides the music choice) was the alcohol. The groom's side of the family is Mormon, but since the bride is Catholic - she wins. There was a bottle of Bacardi and Old Parr at every table, with an ice bucket and little pitchers of coke to make drinks. Champagne was passed around for toasts, and wine was served with dinner. Of course, all of this was turned down at my table. If my Spanish was better, there were probably a couple interesting conversations to have about the wedding.


I chose to go home with Laurence (host dad) and the sleeping kids after dinner. Heidi had to stay until the end, and most people were still there and dancing when we left at 12:45 am. Adrian had been asleep since 11, wrapped up in that coat and lying across two chairs. Sometimes I relate most to the two year-old in the family.

Presentation, presented! 8:00 PM

As part of the rotation at Servicio de Adoloscentes, Dra. Santivañez asked us to do a 30-40 minute presentation. We chose the topic of nutrition during pregnancy and the first year after giving birth (i.e. nursing). I have been nervous about this all week, and I am so glad that it is over now! I videotaped parts of it and had Alexis videotape my part, so you can see how awful my Spanish is.


Despite the fact that I would rather not have had to give a presentation, I do have a bit of a crush on Dra. Santivañez. First of all, she is really pretty and well-dressed. The photo doesn't do her justice, so you'll have to trust me. Second, and more importantly, she addresses the person and not just the symptoms during visits. Every morning I saw her walk into the clinic and at least one girl in the waiting room would brighten and want to hug her and ask her something. As I understood more and more Spanish as the week went on, the conversations Doctora had with her patients were more impressive to me. She never preached, but she counseled. Sometimes she scolded, but never without seeming like a concerned mother. Basically she supports her patients in a way that empowers them. It's very impressive to me.


We walked down from the clinic to Hospital Arco Iris (which is where most of the adolescent moms go to have their babies) after seeing a few patients and doing the presentation. The picture to the left is looking down on a small marken in Alto Miraflores. There are similar ones all over the city, although the ones betweeen San Francisco and the cemetery seem to run into one another so it's just one enormous open air market, which gets set up and taken down every day.



I also took the picture to the right on the walk down. I've only seen these hung doll-men in Alto Miraflores, and they scare me a bit. I asked Dra. Santivañez about them, and now I know they are supposed to scare you. There have been a number of house break-ins in the area, and the dolls are meant as a threat to potential thieves. His shirt has some writing on it which I think says something about burning thieves.

Young mothers 5:43 PM

I didn't really want to get up this morning (can you tell from the photo on the left?). I slept fine, but it was cold... and the prospect of getting out from under the covers was not really appealing.

From right to left: me, Amanda, Liz (and Greg is taking the photo). This is the group I will be with for the rest of the month for rotations. In this picture we are waiting outside Hospital Obrero for Dra. Santivañez to come and hop on a minibus to the clinic, Servicio de Adolescentes.


We had a busier day at the clinic. Lots of young mothers-to-be, and a couple women at 40 weeks. The belly isn't so squishy at 40 weeks... but lumpy, like skin stretched over a baby. Sorry that wasn't very poetic. The picture to the right is a view of the clinic as we arrived this morning - the line is forming out the door and the sign on the building reads "Centro Municipal de Salud - Alto Miraflores." The bottom of the sign also names three sponsors - USAID, Save the Children, and a third which I'm not sure of. We weren't told much about this clinic before we got to it, so I have some research to do on my own time.

We also got to sit in on a support group for young mothers. It was led by the woman in the baseball cap to the left, and I kept thinking of you, Mom, when you were at the center in Ione. She talked about communication (nonverbal cues from children, what it means to really listen to someone) and sexually transmitted infections (methods of prevention like fidelity, condoms). There was a big turnout (see picture below) with lots of kids - running around or nursing. The only downside was the glaring sun.



So now I'm back at home (after an afternoon Spanish class and some homework-doing), and trying to think of something "interesting" to say about my day at the clinic. Each woman has her own story with its own problems (some of which come out in the doctor visits), but as a whole, they don't strike me as very different than other underpriveleged, young mothers. They don't even strike me as very different than other people "dealing with life." Am I missing something? Maybe there is something more profound to say about them being Bolivianas and mothers at 17. This might sound weird, but I don't think I have anything profound to say about them because I feel oddly close to them, and anything I could say would just belittle the whole situation and make me feel like a traitor to something inside me.

Pregnant bellies are squishy 2:39 PM

I am sitting at the kitchen table right now while Lorena and Daniel do their homework. Hanna Montana is playing also, so they are both having a hard time concentrating (although, because Daniel keeps leaving the table, he gets most of the attention for this... "Tu tareeeea, Danieeel!"). I am snacking on a bowl of popped trigo... it has another name, but it's difficult for me to remember. Like a lot of things I taste here, it is made palatable... delicious by the addition of a lot of sugar. Yay!

This morning I went to Servicio de Adolescentes. It's further up the hill than Hospital del Niño, so it's a bit colder there and we had to take a minibus to get there. Since it's somewhat out of the way for most La Paz residents, it's also a slower pace than Hospital del Niño - we only saw three patients today! Two were pregnant (both around 15-16 weeks), and we got to feel the fundus and listen to the baby's heart beat using a Doppler fetal monitor. So cool! Dra. Santivañez counseled the first girl on her nutrition (leche, yogurt, green vegetables, fruit...) and the necessity of not wearing tight clothes anymore. And then we got to explain to the second patient about the same things. These are the moments that I feel I am learning the most.

In Bolivia, there are many different types of government and private health insurances. One of them is called SUMI (Seguro Universal Materno Infantil), and it covers (mostly) all medical treatment of pregnant women from the first day of pregancy to 6 months after giving birth, as well as of the children from under the age of 5 years. There is some criticism of the program, but I think the ultimate goal is met - it reduces infant and maternal mortality rates. In any case, it doesn't cover multivitamins... which means that the nutritional advice for these new mothers is really important!

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Update: I just got back from a Hatha yoga class. I went with two other girls from the program, and it was a lot of fun. Very relaxing, lots of stretching and breathing, and only 10 Bs. Liz and I are planning on trying a hot yoga class later this week... I'm so excited!

La fin de la semana 4:39 PM

First, a shout out to Evan. I was walking around today (shocker), and I saw this little Lebanese restaurant. So I took the photo of "comida arabe." It's funny, but I didn't see any Arabic script... just Hebrew. There are a lot of Israeli tourists in Bolivia, I guess? Anyway, I thought it was fun.

Second, I meant to post yesterday, but the day got away from me. I agreed to go shopping on Saturday morning with my host mom's sister, Mariela, and (silly me) I thought this would take no more than 4 hours. We were gone for 10. And the whole family came. And it didn't happen in the morning at all.

On the bright side, I got to see the extensive open-air market(s) of La Paz. Mariela still lives with her dad (as do another sister and brother), so he drove us to the top of the markets, and we walked down (over the course 6 hours). There aren't many traffic laws here, so the car rides were a little harrowing... baby sitting on grandpa's lap while he's driving, plus there were 8 of us in the 2-door Volkswagon. That kind of stuff kind of freaks me out.

We went back to Abuelo's house in San Pedro (a neigborhood just north of Sopocachi) after shopping, and I got to watch a bit of Anastasia in Spanish while I wondered what was going on. Then we ate lunch. We had eaten little snacks along the way (like bubble-gum flavored yogurt and "las ricas tripitas"), but since Bolivians consider almuerzo to be the big meal of the day and don't typically eat dinner at all, this was lunch. Steak (I think), and potatoes, ocas, and coca-cola. Yum! Much better than tripe.

So after all that, I had to get out of the house by myself today. I felt out of control yesterday, even though everyone was super nice and I was happy that I got to go to the market with Bolivianos. Also on my walk today, I got up the courage to talk to some vendors. I asked permission to take the photo to the right (and paid 5 Bs) of a stand in El Mercado de Brujas. I uploaded it a little bigger so that you could see the dried llama fetuses and other curiosities better. Not much more to report. Tomorrow I start a rotation in Servicio de Adolescentes.

For those of you interested, I uploaded two more short videos of La Paz showing the arts and crafts area on Sagarnaga and more traffic.

Friday afternoon 9:13 PM

Still getting a feel for the city. I took another long walk around this afternoon. I found the Witch's Market where they sell dried llama fetuses and other strange things. I didn't take pictures since there were people involved, and I'm not up to asking for permission yet. Being a tourist/foreigner is weird sometimes. But I did take a couple videos. I was trying to capture the public transportation -which is a bunch of white-ish buses that go all over the place for about 1.50 BS (so about $0.19 USD) and shout out their stops and rates as they pass by. I'll try to upload and share the other videos later.



On the clinical side: I got to examine kids in the clinic of Hospital del Niño this morning. I held open the mouth of a 4 day-old baby with a cleft lip to see if it was also a cleft palate (it was), and I successfully made another child cry trying to see the back of her throat. Unfortunately, I don't think it was the first time I've ever made a child cry... so I wasn't that uncomfortable with it. Is that a bad thing? So far, pediatrics looks as appealing as ever. The picture below is taken in Dr. Velasco's office/clinic room. From left to right: Erin, Zarah, Dra. Paola, me, Dr. Velasco.

Another holiday 6:46 PM

Today was Corpus Christi, which is a national holiday here (even though Bolivia no longer has a national religion). I will have work at the hospital again tomorrow, but my Spanish class has been canceled.

I spent the morning reading (I finished Revolutionary Road) and hanging out with my host family, and then after lunch I took a big walk around part of the city. I started out going to Hospital del Niño so I could take pictures of my morning "commute" I am doing this week (and in a couple weeks again). It's only about a 20 minute walk, but I'm always sweaty and exhausted by the end, partially because of the bridge I have to cross. You can see Puente de las Americas in the photo on the left as it looks before you cross it. The photo to the right is what you see over the edge, in the middle of the bridge. I know that it might not look like much, but it terrifies me. I try to walk as far away from the railing as possible, but it's really only a two-person sidewalk, and the drop from the sidewalk into oncoming traffic doesn't look like fun either. To say the least, my heart starts pumping and my palms get sweaty every time I cross the stupid thing.

Once over the bridge, I have left the neighborhood where I live (Sopocachi) and entered Miraflores Bajo - which is where the medical district is. Hospital del Niño is situated a little back from the street, and the entrance is on a sidestreet from the main avenue (Saavedra) of different hospitals, clinics and the medical school.


Yesterday I got to sit in on Grand Rounds at Hospital del Niño. Three different cases were presented - a burn victim, a child with gastrointestinal problems, and another with neurological damage. My descriptions are vague because my understanding of everything is also vague. After Grand Rounds I shadowed a generalist and a dermatologist in the clinic. Lots of pneumonia and eczema, with one case of chicken pox (the varicella vaccine is not one of the vaccines given to Bolivian children - mostly due to cost) and one child with a bad case of flat warts all over her face and neck. The dermatologist slapped a patch on her arm and (when I asked what she was doing) said it was a type of vaccine for HPV. I think something was lost in translation though, because I can't find a vaccine for HPV that works after the fact.


I walked up through Miraflores via Avenida Busch after that. I actually walked further than I meant to, and then didn't reach the place that I had intended to see when I planned the walk due to dwindling daylight and gigantic mountains. But it was a nice 3 hours... the streets were pretty empty due to the holiday, and I got a better feel for part of the layout of La Paz.

Intro to Hospital del Niño 6:21 PM

I had my first day at Hospital del Niño this morning. It's a teaching hospital, so there were a lot of people at rounds... and of course, it was all in Spanish. I think maybe my head hurts sometimes not from the altitude, but from concentrating so hard on what everyone is saying to me. Anyway, we started in the infectious diseases ward (Infectología) and then went to the respiratory medicine wing (Neumología). There was a child in Infectología that had been living there for 3 years. He was found in a plaza (like Plaza Murillo to the left) nearly dead when he was 2. The doctors diagnosed him with myelodysplasia. I couldn't understand how they had treated him or why they would keep someone in his condition in an infectious disease ward, but he had recently needed an operation on an abscess in his neck, so I think his health problems must be ongoing. On the other hand, it seemed a little like they just didn't have anywhere else to put him.

The other interesting case in Infectología was a 9 year-old girl with lesions all over her body. Her mother claimed that she had had a fever for over 3 months and had recently developed a cough. It felt like an episode of House... all the doctors stood around discussing the possibilities, while the head doctor kept insisting that the mom was wrong about the details (¿Estás segura? No te creo, no te creo). The dermatologist thought that it was a bad case of chicken pox, but the head doctor thought it was monkeypox. Huh? Yeah, I looked that one up.

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The picture to the right was taken this evening (I walked around after Spanish class ended at 5). You can't really make it out very well in the picture, but it's a long alley of stalls that sell books. There are street vendors for everything you can possibly imagine - some of them specialize and some of them don't (you can make a phone call, buy toilet paper, get a bottle of coca-cola, and pick out some earrings at a lot of them). But this particular spot is just a bunch of "book vendors." It feels medieval, but modern... a little like City of Lost Children - but a lot lighter outside and not an evil plot at work. So maybe it's not the same. Ah well, I tried to explain it and I failed.

Past and future (mashup of thoughts) 8:17 PM

I met people from the group today, finally. We had an orientation meeting in the morning, a Spanish placement test and Spanish class (after the assignments had been made) in the afternoon, and a meeting with the medical director after that. And tomorrow I get a cell phone, so that should make communication and socializing a bit easier. In the meantime, I have a great host family with three young children and extended family... all of whom speak little English (except for the host dad... but he's not around as much). So, yeah, I am getting lots of practice at Spanish.

On another note, we were talking about cultural competency and global health this morning in the orientation - most of which was kind of boring. But I did find this interesting (and this is all according to the local CFHI coordinator here):

The Aymara have a different way of looking at time than the Western world. When they refer to the past, they point in front of them; and when they want to indicate the future, they point behind them. They say that the past is kept in front of you while the future is behind you because you can see the past, but you can't know the future.

Furthermore, this reversal of the Western concept of time can be detrimental to Aymara health because it facilitates an "everyone dies sometime" attitude, which can lead to postponement of treatment.

I don't know how true or untrue the last statement is, but I think a similar situation arises in "uneducated" populations in developed countries - even without the "time reversal" thing. But regardless of the actual effects on health care, I still like the philosophy. It relates nicely to the book I was reading last night (yeah, so I finished A Ticket to the Boneyard) - the detective is reading Marcus Aurelius' Meditations and he reads the part that says "Whatever happens at all happens as it should; you will find this true, if you watch narrowly." He obsesseses about it a bit, but it's understandable. If everything is as it should be, why try? But next to the Aymara insight into past and future, I think there is a better meaning. I think there is peace to be found in knowing the past and letting go of the future - not so that you fail to take care of yourself and your family, but just to put everything into perspective. 'Cause, you know, we're all going to die someday.

Then again, I also think that it's hard to draw the correlative line between philosophy and life practice. Philosophizing thoughts are intangible (or at least not quantifiable) and highly personal, so I have a hard time sticking with the idea that one philosophy is valid for all people. Ack. I think I'm ready for bed now.

Oh the views 10:59 AM

A few things about La Paz:
1. It's definitely a city. It's not any more or less smelly/dirty than any other city in the world. Except maybe in Singapore (but they're the exceptions to many generalities). Picture to the right is taken on the main avenue (Prado) - which is where "la entrada" festivities took place yesterday.



2. The temperature drops and rises really fast. People are out in t-shirts and jeans this afternoon. Also, I think I should have worn sunscreen this morning...



3. The streets have no names. Well, actually there just aren't any signs. And posted addresses are either just numbers or "Edificio Fill-in-the-blank." On the bright side, I am getting really good at asking where I can buy a map. I am not so good at understanding the responses though.


4. Ok, this isn't about La Paz, but A Ticket to the Boneyard is really creepy. Thanks, Hana! (I know it's my fault, but it's so nice to share the blame sometimes) I started reading it last night when I couldn't sleep. I think I might not read it again until I'm on my way home to Michael. Then again, I kind of want to know what happens next.


5. There are fantastic vistas all over the city. Or maybe I just like mountains and rooftops more than other people. The picture on the left shows the mountain we drove down yesterday to get here (I guess El Alto must be at the top). If you look closely you can see all the adobe houses built into the side of it. And below is opposite-ish the El Alto side. It's the mountain that sort of got erased by the glare from the sun in yesterday's photo.