Monday, July 18, 2011

Humma

So the last couple of weeks in La Paz were hectic. I did a surgery rotation with Dr. Galindo in the hospital, explored La Paz, met up with Gabriel and Maria who came over for the weekend from Santa Cruz, and spent my last night in La Paz drinking coca liquer and $2 mojitos on a latin night at a bar. There was also anticucho, pastries, and a lecture on anorexia and bulimia that was involved. All in all, a successful night and a successful trip.
Now that I am back in the states, at sea level, I have tons of energy. It's like a persistent natural high that lasts about 2-3 days i think.
It's nice to be back home, where you don't feel stupid reasking what someone said and where things are familiar and you know how to approach each situation. For the same reason, coming home is anticlimatic because nothing is so new anymore. Life becomes easier and with that, the constant excitement of basic daily living is lost. I miss the streets, the constant Spanish, and my host family. I also miss the lack of insects in La Paz. I've encountered a multitude of spiders and flies already, as well as an oppossum (or a raccoon) that was roaming around our front yard last night. Oh yeah, and the sound of crickets and frogs at night...ahhh, florida.

I am SO glad I have another month of vacation left. EEK!!! =D

Wednesday, July 6, 2011

El Alto otra vez

I made a big deal about wanting a full week at Hospital Los Andes with Dr. Gutierrez because I wanted to learn how to work with children, especially the crying children (apparently holding their hands down by force or tying them up in their sweater like a straight jacket works pretty well if you don’t mind going deaf while doing it). So, this week, Tuesday – Friday, I signed up to go back to El Alto. Except that when I got up at 6am on Tuesday, before dawn, I couldn’t make it out of bed. I needed to eat before ascending another 500m into the air, and the sight of food nauseated me. So I sent some texts to Cecilia and Gonzalo, hoping that they would receive them soon, and collapsed back into bed to sleep. I slept until noon, at lunch, read a while in bed, and then fell asleep again until 6pm. Got a light dinner, went back home, read a little, and was asleep by 10pm. Ahh, the adventurous life of a traveler…

This morning, after getting about 30 hours of sleep the day before, I felt energized. I ate a large breakfast full of peanut butter and Coca-cola and ran down the still deserted streets of La Paz to meet the doctor at 7:15am. Since I never got an answer neither from Gonzalo nor Cecilia, I was worried that they may not have ever received the message, thus never letting Dr. Gutierrez know that I wasn’t coming. Thus, she may have assumed I wasn’t coming the entire week and not meet me this morning on the steps of the church. Luckily, I was wrong on one of the points – Dr. Gutierrez did meet me on the steps but she never got the message that I wasn’t coming yesterday and she was worried that something happened. Even worse, a doctor at the hospital in El Alto told her he rode the micro with a gringuita, and Dr. Gutierrez had the horrible thought that I had disappeared somewhere in El Alto. Thankfully, it isn’t in the culture of Bolivians to worry too much, and today everything was okay.

We saw children from 9-12:30pm and examined everyone from newborn babies only 5 days old to 10 year olds. The older ones are much easier to check the throats of because they actually understand instructions of open your mouth and stick out your tongue, but the newborns are so much nicer because they can’t push you away with the tiny arms (muahaha). We saw a girl with scabies, many kids with gripe (flu), and a baby with a vaginal infection. I am getting really good at examining genitals, thanks to parents who never clean them.

Last day in servicio de adolescentes - i promise!

Since today is technically a holiday in CFHI world – the new students are doing orientation – instead of starting a new rotation, I went back, with Dr. Santivañez’s invitation (“What else would you be doing?” she asked me) to servicio de adolescentes. You guys are probably totally sick of hearing about this rotation but I kind of like it, so I will keep talking about it. Two things happened today:
1. I got to hold a child – like really, really hold it. Meaning, if I let go, it would fall and die. I had someone’s else life in my hands for a very long 5 minutes. The most surprising part was that I actually enjoyed it (it was a quiet child). She was pretty heavy in my arms, like holding a dog, and she sat in my arms silently, looking around with that unique child curiosity. Slowly, I’m coming around to thinking like my gender. Before, I wanted a child but only after it passed the toddler ages. Now I’m okay with a baby, but not with the giving birth part yet. One of these days…

2. Our homely, demure, donated instruments started failing us, one by one. First, the Doppler machine started wailing – it’s been wailing its low battery siren for the past few days now, but we had chosen to ignore it, until today, when it refused to do anything except wail in its piercing voice. I’m not sure which sound is worse, a crying baby or a crying Doppler machine. Both are eardrum-piercing and headache inducing after long-term exposure. Anyways, a patient later our BP machine did the same thing, except silently. So now we had patients coming in for prenatal checkups and we couldn’t check their BP nor their baby’s fetal heartbeats. Later, another doctor lent us a mini-doppler machine that turned out to not be able to pick up nada (nothing). It just statically sheeped (that’s not a word, I know) at us. Not to be deterred, the doctor continued to utilize the non-functioning mini-doppler machine on each patient that came on the prenatal visit, each time muttering that it’s useless. I’m pretty sure she kept up the charade specifically to make sure the patient didn’t feel as though they came for nothing.

At the end of the day, a girl came in who wanted an IUD put in but the clinic had run out, so Dr. Santivañez told her to come back Thursday instead. On my way out, I glanced at the trashcan – it still had the smeared blood on it from last Thursday. I think the doctor noticed and called the janitor woman. When the doctor questioned why the janitor woman wasn’t wearing gloves, she mentioned that they had none (or had run out).

Other than all of that, things went pretty smoothly.

Madre y Hija

Sunday I went to see another movie at the cinemateca boliviana, basically the La Paz version of the Hippodrome or the Gene Siskel Film Center. And since I have a little more time on my hands here than at home, I can finally take advantage of it. Madre y Hija (Mother and Daughter) is the latest of Iñarritu’s films, who also filmed Crash and Babel. The movie is mainly about abortion and how it affects people’s lives. It’s hard to talk about the movie without giving away the outcomes of the stories, but basically it follows different women through their lives and how their lives are affected by abortion. The thesis of the movie is that abortion is unnatural and created by society. I found it a pretty interesting point of view, first because I am a big fan of the movie Juno (it was one of the first movies in a while showing that life doesn’t end if you make a mistake) and secondly because I just finished a week working in Servicio de adolescentes with pregnant women. The movie follows a middle aged woman who gave up her daughter for adoption when she had her at age 14 and has never stopped thinking about her since, a 37 year old woman who was given up for adoption and thus never wants to have kids, a woman who can’t have kids but wants a child very badly, and a 20 year old girl who is pregnant with a child and wants to give it up for adoption. In almost all the cases, the supporting characters are against the adoption, maintaining the opinion that giving up a living thing that you bred inside of your body for 9 months is completely against our nature and that the baby is always better off with their birth mother. If the woman can’t have kids, then it just wasn’t meant to be. The movie obviously has a twist at the end and doesn’t maintain a black/white opinion on the subject by the end, but I thought it was a thought-provoking subject. Lately, with movies like Juno and documentaries on international adoptions, we see the many happy couples who are finally able to love a child of their own, and the conservative’s opinion on how adoption is better than abortion because a live is saved, but I haven’t seen as much media portrayal of the other side, of the mother who gives up her child for the rest of her life, making a decision that may later cost her years of her child’s life. Maybe in some cases, abortion may be a better option than adoption for the mother’s psyche, because then she has less time to get attached to the child while it’s in her womb.

Obviously, each case is different and what’s the best decision for one woman may not be the best for another woman, and to say that adoption (or even abortion) is always a good choice or a bad choice is juvenile and inconsiderate. Nevertheless, I appreciate it when someone creates a film, a book, or even a song about an intimate and powerful subject that causes people to re-evaluate their own beliefs, even if they don’t end up changing them.

Regarding Bolivia, abortion is pretty much illegal here except for special circumstances when the mother’s life is in danger. Almost every patient I have seen, no matter what age (I haven’t seen any girls younger than 16), whether or not they are married or with someone, choose to have the baby and keep it. Abortion or adoption doesn’t really seem to even be brought up in discussion. There are obviously other debatable issues that surface, since many of these babies end up living in poverty either because their mothers never finished high school or because it’s her 5th child and she can’t feed that many children. Is it better to live in poverty and be beaten by your alcoholic stepfather or not live at all? Is it better to be adopted into a nice family or to live in a slum with your birth mother? And of course, there are all those lovely gray areas in between where we must accept that we don’t really know how a child’s life will turn out based on only one decision – we can only guess and hope that we can live with the decision we have made. After all this, all I can say for sure is that the women I see in clinic who decide to go back to school after having a child are some of the strongest that I have ever seen, and I hope they are the ones who improve the amount of opportunities that their children have with the amount that they have had.

Why I will never be a photojournalist

Saturday, Annie, Manu, Jolene, Jenna, Hannah, and I went to the World Press Photo 2010 exhibit. I’m pretty sure the 2011 exhibit is floating somewhere around the U.S. right now but Bolivia just received the 2010 exhibit. It’s a cool compilation of the best photojournalism of the 2010 events. Since photojournalism is the other main thing that grasps my attention and interest as much as medicine, I was very excited. I think I may have even ended up as a photojournalist if it wasn’t for my inability to take photos in the face of tragedy and suffering. The photos at the exhibit featured the Pakistani floods, the Haiti earthquake, the wars in Mexico and DRC, as well as the torture of women in Afghanistan. The images were informative, powerful, and heart breaking. The most intense was of a male Haitian nurse literally flinging a dead body onto a pile of other rotting bodies. The photos are important because even if we can’t do anything about it, it doesn’t mean we have to be oblivious to the horrific things that happen in the world. Just by acknowledging that they exist, it puts my life into a different perspective.

I see a lot of similar images of poverty in Bolivia. I would love to take a photo of the 18 year old mother who looks 15 years older than her age, of the cholitas and their goods in a multitude of colors that attempt to obscure the poverty, and the 16 year old girl with the smoothest skin and the darkest eyes who walks on the side of the road alone, with cut up wrists. I want others to see it as I see it and if not do anything about it, to at least be cognizant of the fact that these people exist somewhere, leading the same 24 hour days as us, with the same emotions. But something inside me won’t let me dare take out my camera – it’s not that I don’t want to stand out (as if I don’t stand out already) but more of how the camera will change my relationship to these people and these places. I change my place as a silent observer to an active intruder on their lives, and with a camera I run the risk of objectifying them.

I am not saying that photojournalism objectifies its subjects or that it shouldn’t exist. On the contrary, I admire the people who can do it as a profession and I wish I could do the same. For a while I thought I would grow out of it, that maybe on this trip I would feel more comfortable taking pictures but today, standing alone in El Alto waiting for a micro to go back home, I saw two Aymara women in their colorful skirts and shawls and braided hair selling oranges on the side of the street. It captures one of the main points in Bolivia and its large gap between the rich and the poor. Most poor Aymara women do just that – they are sellers of fruit, candy, food, spices, and even napkins on the ground of the street. I wanted to take a photo to show everyone else what I see everyday, but instead I just stared and stared, imprinting the image in my mind for later recall.

I always come back from trips with the worst pictures because my pictures are of landscape and empty streets while my stories are of the people and their daily lives. A great photojournalist creates a complete idea through photo and words. I will never be that photojournalist.

Friday - cozy day

Despite the time I went to sleep, I had to get up at 7am. It was less brutal than I expected. Plus, at the end I got coffee with the doctora. Then Annie and I came home for lunch and Isabel and Rodrigo (her bf) offered us coffee and cake. Two cups of real coffee in one day! Afterwards, Annie, Manu, and I watched “Atonement” on Manu’s computer. It was drizzling outside so we bundled up in our warmest socks, turned on the electric heater, and watched the movie. Then, Annie and Nathan wanted to get ceviche (marinated seafood – a Bolivian/Peruvian specialty) so Manu and I went back to the Thai place to try out some more dishes. Afterwards, I met everyone else at the Irish Pub for the Bolivian vs. Argentina soccer game, the first game of the Latin American Cup. It ended in a tie, 1:1. I obviously cheered for Bolivia but it was hard to ignore that the Argentinians played better. Bolivia had a great defense but the ball was mostly in Argentina’s possession throughout the game. Afterwards, we said goodbye to the people leaving Sat. morning which was most of them and then went home to our cozy beds.

Everything you ever wanted to know about coca leaves (not really...btw)

Sophie, Hannah, a girl from Cologne, Germany who just started a 2 month internship in La Paz, and I went to the Coca museum. It was tiny but packed in a lot of information. Here’s what I learned:

1. Coca leaves are native to Bolivia, Peru, Colombia, and Brazil. They grow in warm climates (like las yungas) but can grow in different altitudes so usually in order to breed diversity in the plant, they are grown on step-like terraces in the mountains. That’s pretty clever.

2. Coca leaves actually contain the cocaine molecule, as well as two other cocaine molecule derivatives in smaller quantities. Although its not concentrated in the coca leaf, that’s why the effects of the leaves are weaker versions of the cocaine’s effects.

3. The leaves, especially when chewed, act as an anesthetic, a pain reliever, a stimulant, and as a strong hunger suppressant. For a while, they were traded as money and its use was promoted among the slaves because it allowed them to work longer with less food.

4. Coca extract was used in Coca-cola (hence the name) until it was deemed too dangerous to health by some people. Apparently, a coca-enhanced wine was introduced in Europe first and was very popular among the elite. However, because of prohibition in the United States, the inventor had to create a non-alcoholic drink and came up with Coca-cola. Proof that suppression does indeed bread creativity.

5. The United Nations has listed coca leaves as the cause of poverty in Latin America, especially Bolivia. (I still haven’t figured out this one…)

6. About 92% of men and 82% of women in rural Bolivia chew coca leaves

7. The museum showed all the steps that are taken to make cocaine out of coca leaves. Cocaine ends up containing ammonia, sulfuric acid, as well as other chemicals that I cannot remember. Apparently, synthesizing cocaine exposes the workers to a lot of toxic chemicals and is detrimental to their health. I doubt the drug lords are the ones making the white powder.

8. The majority of the cocaine is exported to, of course, the United States

9. Coca leaves remind me of green tea, for its color, slightly bitter taste, and its ability to be used as a flavor in everything. Coca drinks/foods that I have tried:
- chewing coca leaves
- coca tea
- coca candy
- coca liquer
- coca smoothie
- coca cookies
*I’m on the lookout for coca-flavoured ice cream, it must exist somewhere, right?

After the coca museum, I went home to make myself look a little more presentable (I brushed my hair) and we all met up at a nice Thai restaurant for our last night together, since many had early Sat. morning flights. Silly, if you ask me. Don’t they know that the best way to NOT miss your flight is to never go to sleep and celebrate?

Anyways, we went to a very nice Thai restaurant to begin our night. At first glance at the menu, it looked expensive. 50B’s for a main plate?! Until we did the math and realized its about $8. My perception of what is cheap and expensive has been so warped by Bolivia that its going to be painful to come back to the States and have to pay $3 for a croissant. The restaurant and food was superb. There were 20 of us seated at one big, long table and everyone was in a jolly mood, downing cocktails and appetizers. After dinner, we caught the last 20 minutes of a happy hour in a café where we got 2x1 mojitos/caipirinhas for25B’s. (yup, that’s 12B’s, or $1.50 for each mojito). They weren’t the best mojitos ever, but they were drinkable. Then we went to Melangrina, a local dance bar. It was a non-descript place off a side street but inside it was decorated with maroon walls and Andean masks and textiles. There I tried Chuflay, which is Singani, the local clear liquor, with sprite. I liked it enough to buy 2 during the night. The music choice was eclectic but mostly Spanish and dancing was optional. Then, around midnight, the beating of African drums began. Five women and 5 men came out and performed African dances that were brought over by the slaves to Bolivia. The men beat the drums while the women danced and sang. It was pretty incredible. I wonder why most African-Americans in the U.S. don’t have similar dances and culture than the Africans that came over as slaves to the Caribbean or Latin America. They danced for about 20 minutes and then again at 3am. I was there for both performances…We walked home around 3:30am, when the streets were empty and quiet. This will be about the time I will have to catch a taxi for my flight home in two weeks.