So, I’ve described servicio de adolescents to everyone in excruciating detail, probably because it has been my favorite rotation so far, but I did other things that week besides medicine, I promise. We had no Spanish classes this week to I had the chance to go out and explore La Paz.
On Monday, I took a long nap after almuerzo and then went to Cecilia’s office for our meeting on malnutrition. It’s a big problem in Bolivia, and all pediatricians make sure to check for it at each checkup. Apparently, it wasn’t until recently that South America made its own growth chart for kids. Before, they had been using the one made by the United States and had a huge amount of kids who were malnourished and below the normal growth curve. Some smart people finally spoke up and said, hey, Bolivians in general are smaller than Americans so maybe we should make our own standards instead of using someone elses. So now they have their own standard growth curves which reduced the amount of malnourished children just by reducing misclassification, but the numbers are unfortunately still high. In Bolivia, most of the malnutrition comes from lack of enough calories, more so than lack of protein, and the reason for that comes mainly from poverty. Like most things in Bolivia, the poverty is not as obvious as you might imagine (or at least its not to me) but once in a while, you’ll see a patient that comes in and says that all they eat everyday is bread and water or a patient who comes to you in sandals with her feet wrapped in toilet paper because she doesn’t have shoes for the winter. At those points, poverty stands right in front of you and you can’t help but pay attention.
At times like these, I feel medicine can only do so much. This is when international public health workers, engineers, architects, and social workers can do more good internationally than a doctor can. Medicine can only fix so much and much too often, it only ends up being a temporary cure.
Tuesday, Sophie, Annie and I spent the afternoon working on our lovely “Lactancia” poster for Wed’s health fair. When Sophie came over, she said our flat looked “very posh” – apparently its more spacious and warmer than hers. I definitely lucked out with my host family here. For dinner, we met Jolene and Jenna for anticucho, beef heart that is grilled to tenderness and served with potatoes and a spicy aji sauce. Even though I’m not a fan of meat (except for ground beef of course), I thought it was quite delicious.
Wednesday, Sophie, Annie, and I decided to go visit the National Museum of Art. It was located east of El Prado in the financial district of La Paz (or so it seemed to me) and it was interesting to see a different side of La Paz for once. It was a well organized museum and spanned early colonial art to contemporary abstract art. I think prehistoric art has its own museum which I have yet to see. It was very cool to see the art because the themes (religion, portraits, landscapes) were the same as for European art of the same period, but the technique was distinctly different. In one sala, they portrayed religious figures with actual wings, and there was a few paintings where there were 3 jesuses, which apparently is called El Gran Poder (the Great Power) here. Obviously, indigenous faiths got incorporated into Catholicism and created a distinct Bolivian Christianity. All in all, a pretty cool museum. Afterwards, we had a meeting with Gonzalo and we had to make it across the city in 15 minutes. We tried to take a micro there but got stuck in paralyzing traffic and ended up walking the rest of the way. After the meeting where we got money for taxis to take to the airport (not me – I’m staying 2 more weeks!), we went to our empanada place for dinner. Lauren and Siobhan, two girls from the program who went to this place for dinner everyday, wanted a picture with the owner Fernando. At first, he seemed embarrassed by the request but then he went to the back, put on his jacket, and asked for a picture with his camera as well. Afterwards, he requested a picture of just him and Lauren and then just a picture of Lauren by herself. The next day, he befriended her on facebook. It was pretty hilarious and at that point, we were all cracking up uncontrollably. I’m not sure I’ll be able to go back to that empanada place for the remainder of my time in La Paz and keep a straight face. Thanks Lauren.
Wednesday, July 6, 2011
Servicio de Adolescentes - Day 5
Friday was a slow day – when we asked why there were fewer patients, Dr. Santivañez told us it was because of the cold. Today was a cloudy day in a place that rarely sees clouds, and as the houses rise on the slopes of the mountain, the temperature quickly drops. The past few days we’ve been wearing gloves to warm up our hands before touching the women’s bellies. I am very glad that at least my stethoscope isn’t metal, even though I am sure my hands are more freezing than metal could ever be. It’s a -1 point for my being human. We finished seeing patients early, around noon, and since this was our last day working with her, she invited us out for coffee. We happily agreed. Still in our white coats, we left the doors of the clinic and saw snow. SNOW! La Paz has a cool rainy season (summer) and a cool dry season (winter) when it doesn’t rain for months and clouds are non-existent. Although mornings and nights are cold, it rarely gets below freezing except in El Alto and during the day, the sun is strong enough to warm everybody up. I’ve acquired quite a bit of freckles since coming here… So, obviously no one was expecting snow. It fell slowly, in thick snowflakes, like it does in those magical nights in movies, except that it was in the middle of the day, it melted as soon as it reached the ground, and cholitas still passed by in the street in skirts and shawls, shivering. Our friends who had rotations down in central (i.e. lower) La Paz on the other hand, had not seen any snow, although they did say it rained for a while.
We ran across the street to a tiny open window in a wall of a building and asked for 4 cups of hot coffee. We huddled over the tiny awning and shivered. Then, the window closed, and the door opened. “Pasen, pasen” said the owner and ushered us inside the cluttered shop to a small table in the back. The room was packed to the ceiling with STUFF (newspapers, boxes, posters, broken appliances, etc), similar to severe hoarder’s house, to the point where only a tiny path was cut out that led from the entrance to the table and to the kitchen and sleeping quarters of the elderly couple that ran the shop. They brewed real coffee from Las Yungas and also brought out cheese and tomato sandwiches. Those were some of the coziest minutes of my life. This is exactly what makes traveling worth it. These are the moments that make up for the long, uncomfortable flights, the upset stomachs, and the constant awkwardness of being a foreigner and speaking in a foreign language. A steaming cup of sweet, strong black coffee inside a tiny shop in the middle of a non-descriptive neighborhood is more memorable than any cathedral or museum that I may see while traveling. As in all of life, it’s the little things that matter most.
We ran across the street to a tiny open window in a wall of a building and asked for 4 cups of hot coffee. We huddled over the tiny awning and shivered. Then, the window closed, and the door opened. “Pasen, pasen” said the owner and ushered us inside the cluttered shop to a small table in the back. The room was packed to the ceiling with STUFF (newspapers, boxes, posters, broken appliances, etc), similar to severe hoarder’s house, to the point where only a tiny path was cut out that led from the entrance to the table and to the kitchen and sleeping quarters of the elderly couple that ran the shop. They brewed real coffee from Las Yungas and also brought out cheese and tomato sandwiches. Those were some of the coziest minutes of my life. This is exactly what makes traveling worth it. These are the moments that make up for the long, uncomfortable flights, the upset stomachs, and the constant awkwardness of being a foreigner and speaking in a foreign language. A steaming cup of sweet, strong black coffee inside a tiny shop in the middle of a non-descriptive neighborhood is more memorable than any cathedral or museum that I may see while traveling. As in all of life, it’s the little things that matter most.
Servicio de Adolescentes - Day 4
Thursday was a hectic day because not only did the doctor have us do all the physical exams on prenatal checkups, but we also saw 3 pap smears and an IUD insertion. As I mentioned before, there was definitely a difference in hygienic standards. When she first inserted the IUD, she used a long metal rod that is usually only used to measure the length to the uterus for the IUD to also open up the cervix more because it was very tight. Then, she placed the instrument into a bucket with water (or some other solution?) that would eventually be washed and sterilized and used again. However, the IUD opened too early while she was inserting it, so she had to get a new IUD and repeat the procedure. To insert it again, she took the instrument out of the bucket, sprayed some alcohol on it to disinfect it, and inserted it back into the woman. It all looked very painful but the woman did not wince even once.
IUD’s are pretty popular here as a method of contraception, probably because of its efficacy and low maintenance. I wonder how often pelvic infections occur though. I guess it’s better than no contraception at all. A lot of the women here are distrustful of hormone contraceptive methods because they believe its carcinogenic or cause awful unknown side effects. It’s hard to persuade a woman that these methods are safe, especially when their family (most importantly mothers) say the opposite. Many women choose to listen to their mothers instead of the doctors and when the opinions oppose each other, it’s difficult to decide what is best for the woman.
IUD’s are pretty popular here as a method of contraception, probably because of its efficacy and low maintenance. I wonder how often pelvic infections occur though. I guess it’s better than no contraception at all. A lot of the women here are distrustful of hormone contraceptive methods because they believe its carcinogenic or cause awful unknown side effects. It’s hard to persuade a woman that these methods are safe, especially when their family (most importantly mothers) say the opposite. Many women choose to listen to their mothers instead of the doctors and when the opinions oppose each other, it’s difficult to decide what is best for the woman.
Servicio de Adolescentes - Day 3
Wednesday there was no consultorio because the clinic was holding a health fair. Annie, Sophie, and I prepared a poster and an explanation on breastfeeding (preparation, how to breastfeed, and what to do if breastfeeding becomes painful). I told you I am learning a lot. We worked on the poster most of Tuesday afternoon. The health fair itself was composed of 3 tents and held right outside the clinic, on the street. We were not welcomed by all the busses and micros that had to pass through a throng of people without running someone over. In true Bolivian fashion, at 9am when the fair was supposed to start, we were only beginning to set up the tents. It took about 30 minutes with a few failures where a tent actually collapses (luckily no one got hurt) but eventually, we managed to make ourselves look presentable. The 1st tent focused on the health risks involved with pregnancy, the 2nd tent measured weight, height, BP, and blood sugar, and the 3rd tent was composed of the posters of the Young Leaders on HIV/AIDS, violence, and contraception, and us 3, with our poster on breastfeeding. Annie was the artist and drew some very nice boobs. In order to keep it classy, we kept the drawings in black and white. Throughout the day, curious cholitas would stop by on their way and ask someone what this was all about. I might be feeling sentimental, but it gave the entire fair a very neighborhood feel. Lots of young women and couples came out (almost all were of indigenous descent whether they wore the traditional clothing or not) and I think it was truly educational for many. One girl learned about the IUD option at the fair and came by the clinic the next day to talk to the doctor about it. I noticed that a few mothers who came by our poster were actually grateful for our presentation, and it felt empowering when a young mother asked why her baby cries in the middle of breastfeeding and we were actually able to give her an answer and what she could do about it.
There was also another couple that came by and after we gave the speech to the expecting mother, the guy wanted a picture with us. I don’t particularly like it when men want their pictures taken with other women in front of their wife or girlfriend, so after the photo I asked him the take a picture of us with the expecting mother. The guy (and the girl) were both surprised, but he obliged.
Around noon, the fair was supposed to finish but there was still ton of people there, so a doctor came by to ask us if we wanted her to get us sandwiches. We were starving so we said yes. Yup, I am at the point of eating egg sandwiches with tomatoes off the streets now. Later, the same woman came by with a 2L bottle of Coca-cola and a small, used, clear plastic cup. “Do you want some to drink?” the doctor asked us. Annie: “I don’t have a cup though”. The doctor looked at her with a weird look and held out the used cup “Here, I have one”, as if it was obvious. We shared the cup of Coke between the three of us and then she moved on to the next group to offer them some Coke from the same cup. I think my immune defenses are getting stronger each day.
At the end of the day, when all the tents were packed up, the only trace of the health fair were the numerous opened condom wrappers and “used” condoms that littered a 3 meter long portion of the sidewalk. Imagine what a passerby might think if they walked past the sidewalk in the afternoon…
There was also another couple that came by and after we gave the speech to the expecting mother, the guy wanted a picture with us. I don’t particularly like it when men want their pictures taken with other women in front of their wife or girlfriend, so after the photo I asked him the take a picture of us with the expecting mother. The guy (and the girl) were both surprised, but he obliged.
Around noon, the fair was supposed to finish but there was still ton of people there, so a doctor came by to ask us if we wanted her to get us sandwiches. We were starving so we said yes. Yup, I am at the point of eating egg sandwiches with tomatoes off the streets now. Later, the same woman came by with a 2L bottle of Coca-cola and a small, used, clear plastic cup. “Do you want some to drink?” the doctor asked us. Annie: “I don’t have a cup though”. The doctor looked at her with a weird look and held out the used cup “Here, I have one”, as if it was obvious. We shared the cup of Coke between the three of us and then she moved on to the next group to offer them some Coke from the same cup. I think my immune defenses are getting stronger each day.
At the end of the day, when all the tents were packed up, the only trace of the health fair were the numerous opened condom wrappers and “used” condoms that littered a 3 meter long portion of the sidewalk. Imagine what a passerby might think if they walked past the sidewalk in the afternoon…
Servicio de Adolescentes - Day 2
Today was much of the same, except that we were given more of the responsibility in the physical exam. We saw many more pregnant women and we had to take their blood pressure, measure the height of their belly, find out where the back and the head of the baby was, and listen to the placenta and heartbeat with the little Doppler machine. Since there are so many patients to see everyday, and the doctor spends as much time as she needs with each one of them, we usually finish around 1:30-2pm, much later than many of the other rotations. But I realized that I don’t mind – I really like working with these women. This rotation is a good combination of learning, practicing, and listening to the patients stories. Some are heartbreaking and others are hopeful – most make you want to smile encouragingly because you hear they have been through a lot but you want to encourage them to have the strength to keep going and not lose confidence in themselves.
One 21-year old girl came in and Dr. Santivañez spent about 30 minutes just talking with the girl, giving her advice on her life and encouraging her to continue school. When she was 16 years old, she became pregnant but she didn’t want to marry her boyfriend, so they broke up. Her family was super distraught, especially her older brother, but they decided to help her raise the child so she could finish up school and start a career. Right now, she has one year left of accounting school. But lately she has been dating another boy, and once she accidently spent the night with him and didn’t come home until morning and of course, her parents flipped out. I wasn’t sure of her housing situation at the moment, but apparently the issue was not resolved and she wasn’t on good speaking terms with the parents. Dr. Santivañez was sympathetic and walked her through the different options (she either move in with her new bf, or she reconcile with her parents and stay at home). She asked her of any good reason she has to move in with her boyfriend and said she recommended that she stay at home, with her family who obviously care a lot about her. She made sure to mention that whatever the girl chose (and that the ultimate decision is up to her because she is an adult), the doctor would not stop speaking to her so she could always come to her for help if she needed it. At the end, she asked about the new boyfriend. “Does he have a future, is he in school?”. The girl replied that he recently dropped out of school but intended to go back in the future. “What does he do now?”. The girl said he worked in a breadshop (un panadero). “A breadboy?! Do you really want a husband and father who is a breadboy?!” I almost laughed but I did think it got the point across. The girl is obviously intelligent and has a lot going for her as long as she doesn’t get tied up with a breadboy who’ll keep her down. This is how Dr.Santivañez is with all of her patients. Even though she has limited resources to work with, she never makes it known that she is in a rush to see all the patients.
Another reason that we get out late is because of inefficiency. Once, the doctor searched for a specific form around her entire disorganized office for 10 minutes muttering to herself about how “tengo que organizarlo” (I have to organize [the office]) while the patient sat in the room and waited.
The last patient of the day was a woman who had just given birth and had a particularly severe cut from childbirth – it was bloody and moist and the sheets on the examining table got stained with blood while she was examined. This is when hygiene habits really came into question. The ants – they don’t really bother anyone. To change sheets for each patient who uses them would be nice but seems also kind of wasteful. To not change the sheets when they are stained with a patient’s vaginal blood that’s where I draw the line. In terms of American germophobia, I am not very hygienic. I share my glass and drinks with others, I let people use my mascara when they need it, and if I am really hungry I am even willing to extend the 5-second rule to 10 seconds. I know I know, it all sounds gross and not proper, but I argue that it builds up my immune system. But bloody sheets?! Putting a microscope slide with a pap smear culture on the windowsill where the ants crawl all over it? Throwing bloody tissue into the garbage can and smearing it with blood in the process (and not cleaning it for days – it was still there this Monday)? That goes even beyond my lax hygienic standards.
Then again, who am I to criticize a facility that lacks so many resources. At first glance, it’s not very noticeable. Yeah, it looks a little run down and everything from the seats to the doors and the floor is an older version of what is seen in the U.S. But at first, the care seems adequate – they see all the patients, they prescribe them medicine, and have the materials to perform pap smears and IUD insertions. But the more time I spend there, the more I learn about how much they truly need and do not have. There is no heating in the entire building – the actual exam rooms have little electric heaters but the waiting room is absolutely freezing. Since windows are small, the rooms don’t really heat up as the sun rises. Because of that, on super cold days, many less patients show up for their appointments. Today, the doctora also told me that the instruments that we use (otoscope, BP machine, and the Doppler machine) were all donated by previous CFHI students. She had to control her emotions when Sophie accidently dropped the otoscope on the floor and for a minute we thought it was broken. The little black caps that go on the otoscope that we throw out after each use? - They have 3 of them and clean them with alcohol before each patient. Regardless, the clinic and Dr.Santivañez are a great resource to these patients. The doctor takes her time with each patient, asking them about their academic future, encouraging them to finish school, and makes sure they know all the facts about family planning. I never saw her rush a patient, even when we were running late on time.
One 21-year old girl came in and Dr. Santivañez spent about 30 minutes just talking with the girl, giving her advice on her life and encouraging her to continue school. When she was 16 years old, she became pregnant but she didn’t want to marry her boyfriend, so they broke up. Her family was super distraught, especially her older brother, but they decided to help her raise the child so she could finish up school and start a career. Right now, she has one year left of accounting school. But lately she has been dating another boy, and once she accidently spent the night with him and didn’t come home until morning and of course, her parents flipped out. I wasn’t sure of her housing situation at the moment, but apparently the issue was not resolved and she wasn’t on good speaking terms with the parents. Dr. Santivañez was sympathetic and walked her through the different options (she either move in with her new bf, or she reconcile with her parents and stay at home). She asked her of any good reason she has to move in with her boyfriend and said she recommended that she stay at home, with her family who obviously care a lot about her. She made sure to mention that whatever the girl chose (and that the ultimate decision is up to her because she is an adult), the doctor would not stop speaking to her so she could always come to her for help if she needed it. At the end, she asked about the new boyfriend. “Does he have a future, is he in school?”. The girl replied that he recently dropped out of school but intended to go back in the future. “What does he do now?”. The girl said he worked in a breadshop (un panadero). “A breadboy?! Do you really want a husband and father who is a breadboy?!” I almost laughed but I did think it got the point across. The girl is obviously intelligent and has a lot going for her as long as she doesn’t get tied up with a breadboy who’ll keep her down. This is how Dr.Santivañez is with all of her patients. Even though she has limited resources to work with, she never makes it known that she is in a rush to see all the patients.
Another reason that we get out late is because of inefficiency. Once, the doctor searched for a specific form around her entire disorganized office for 10 minutes muttering to herself about how “tengo que organizarlo” (I have to organize [the office]) while the patient sat in the room and waited.
The last patient of the day was a woman who had just given birth and had a particularly severe cut from childbirth – it was bloody and moist and the sheets on the examining table got stained with blood while she was examined. This is when hygiene habits really came into question. The ants – they don’t really bother anyone. To change sheets for each patient who uses them would be nice but seems also kind of wasteful. To not change the sheets when they are stained with a patient’s vaginal blood that’s where I draw the line. In terms of American germophobia, I am not very hygienic. I share my glass and drinks with others, I let people use my mascara when they need it, and if I am really hungry I am even willing to extend the 5-second rule to 10 seconds. I know I know, it all sounds gross and not proper, but I argue that it builds up my immune system. But bloody sheets?! Putting a microscope slide with a pap smear culture on the windowsill where the ants crawl all over it? Throwing bloody tissue into the garbage can and smearing it with blood in the process (and not cleaning it for days – it was still there this Monday)? That goes even beyond my lax hygienic standards.
Then again, who am I to criticize a facility that lacks so many resources. At first glance, it’s not very noticeable. Yeah, it looks a little run down and everything from the seats to the doors and the floor is an older version of what is seen in the U.S. But at first, the care seems adequate – they see all the patients, they prescribe them medicine, and have the materials to perform pap smears and IUD insertions. But the more time I spend there, the more I learn about how much they truly need and do not have. There is no heating in the entire building – the actual exam rooms have little electric heaters but the waiting room is absolutely freezing. Since windows are small, the rooms don’t really heat up as the sun rises. Because of that, on super cold days, many less patients show up for their appointments. Today, the doctora also told me that the instruments that we use (otoscope, BP machine, and the Doppler machine) were all donated by previous CFHI students. She had to control her emotions when Sophie accidently dropped the otoscope on the floor and for a minute we thought it was broken. The little black caps that go on the otoscope that we throw out after each use? - They have 3 of them and clean them with alcohol before each patient. Regardless, the clinic and Dr.Santivañez are a great resource to these patients. The doctor takes her time with each patient, asking them about their academic future, encouraging them to finish school, and makes sure they know all the facts about family planning. I never saw her rush a patient, even when we were running late on time.
Servicio de Adolescentes - Day 1
Today I started Servicio de Adolescentes. For the most part, the patients are adolescent mothers but there are also other adolescents that come in with whatever problem they have. To get to the clinic, I first walk for 30 minutes uphill to get to Hospital Obrero. From there, I wait for Dr. Santivañez, and then together we catch a micro to take us up to the northern neighborhoods of La Paz, where there is almost no such thing as a flat street. The clinic is located in Alto Miraflores, a north central neighborhood and most of the patients come from the surrounding neighborhood for their check ups. Apparently, in order to be able to get an appointment at a hospital, everyone must first go through their neighborhood clinic which then refers them to a nearby hospital. It’s a good idea to reduce clogging of the health systems but here, it definitely hasn’t eliminated the problem, probably of just the sheer need for doctors, time, and resources.
The clinic itself is very similar to the clinic I described in El Alto, except here I think they have a much better education program. They hold classes for young mothers and pregnant women on how to take care of their baby, themselves, and teach them different skills like knitting or sewing so the women can make goods and sell them to make a living. They also created a Young Leaders program where they take a 10-20 young adolescents from the neighborhood schools (13-16yrs) and put them through an educational program on adolescent health – everything from STD’s and AIDS to contraception and domestic violence. When the teenagers pass the program, they are certified Young Leaders in their community who can go out and teach others about what they have learned and participate in health fairs. It seems like a great idea – we got to meet the current Young Leaders and they were a really cool group. They knew about some things more than I did and they were mature enough to discuss sexual matters and female and male anatomy without breaking into fits of giggles. Although they did play a lot with the condoms that they were supposed to be using for demonstration.
Anyways, the room where Dr. Santivañez works is frigid, just like the one in el Alto. It has a desk, a filing cabinet, an exam table, and a small (dirty by our standards) bathroom where women can change into gowns. The walls are painted yellow so it is not difficult to notice the permanent line of ants that crawl in a line around the window every day.
Monday, we saw a lot of pregnant women who were all under 20 years of age. It always surprised me when I saw their age on the chart because my guess was always around 3 years too high. They all looked older however and some were pregnant with their 2nd child. The doctor was a great teacher, and the first day she taught us how to measure the height of the stomach, find the baby’s back and head by feeling the mother’s stomach, and listen to the baby’s heartbeat. Everything in children is different – and being in this high of altitude doesn’t help. Apparently, normal percentage of oxygen saturation here is around 88%, Hb numbers less than 14.5 is deemed as anemia, and the HR of a newborn is around 148. It makes me feel like I know nothing but I am also learning a lot because of that.
We also saw some women who had just given birth and we had to look at their wounds to make sure there was no infection and that they healed well. Some of their wounds were kind of gruesome and one girl couldn’t sit down because it hurt too much. I think the obstetricians made the cuts in order to prevent natural tearing but it still seemed barbaric and made me want to never give birth.
We saw a variety of patients – pregnant women, women who have just given birth, and women coming in for other problems. We saw a couple of which we suspected domestic violence because the woman was unhappy, shy, and refused to make decisions, deffering to her husband instead. Sometimes it seems to me that the single women I see seem happier than the married women. Maybe its because their family is more willing to help them out or because they at least feel they have some independence. It’s obviously too small a size sample to make conclusions and I know that this is not something that can be generalized – each case is unique. Our last patient was a 16 year old girl whose mother brought her in because of self-mutilation. She asked to speak to the doctor in private, so we were given most of the details afterwards by the doctor. She was really pretty and had a wonderful, joyful smile. The doctor said she wanted to refer the girl to a psychologist/psychiatrist but that the mother did not have the money to pay for one. Instead, she introduced the girl to the “Young Leaders” group and said she should get involved. Dr. Santivañez blamed the depression on the dysfunctional family, as she called it. According to her, parents try to control their adolescent too much, causing the child to rebel and desire all the things they are not allowed to do, leading to bad behavior and depression. Makes sense to me.
The clinic itself is very similar to the clinic I described in El Alto, except here I think they have a much better education program. They hold classes for young mothers and pregnant women on how to take care of their baby, themselves, and teach them different skills like knitting or sewing so the women can make goods and sell them to make a living. They also created a Young Leaders program where they take a 10-20 young adolescents from the neighborhood schools (13-16yrs) and put them through an educational program on adolescent health – everything from STD’s and AIDS to contraception and domestic violence. When the teenagers pass the program, they are certified Young Leaders in their community who can go out and teach others about what they have learned and participate in health fairs. It seems like a great idea – we got to meet the current Young Leaders and they were a really cool group. They knew about some things more than I did and they were mature enough to discuss sexual matters and female and male anatomy without breaking into fits of giggles. Although they did play a lot with the condoms that they were supposed to be using for demonstration.
Anyways, the room where Dr. Santivañez works is frigid, just like the one in el Alto. It has a desk, a filing cabinet, an exam table, and a small (dirty by our standards) bathroom where women can change into gowns. The walls are painted yellow so it is not difficult to notice the permanent line of ants that crawl in a line around the window every day.
Monday, we saw a lot of pregnant women who were all under 20 years of age. It always surprised me when I saw their age on the chart because my guess was always around 3 years too high. They all looked older however and some were pregnant with their 2nd child. The doctor was a great teacher, and the first day she taught us how to measure the height of the stomach, find the baby’s back and head by feeling the mother’s stomach, and listen to the baby’s heartbeat. Everything in children is different – and being in this high of altitude doesn’t help. Apparently, normal percentage of oxygen saturation here is around 88%, Hb numbers less than 14.5 is deemed as anemia, and the HR of a newborn is around 148. It makes me feel like I know nothing but I am also learning a lot because of that.
We also saw some women who had just given birth and we had to look at their wounds to make sure there was no infection and that they healed well. Some of their wounds were kind of gruesome and one girl couldn’t sit down because it hurt too much. I think the obstetricians made the cuts in order to prevent natural tearing but it still seemed barbaric and made me want to never give birth.
We saw a variety of patients – pregnant women, women who have just given birth, and women coming in for other problems. We saw a couple of which we suspected domestic violence because the woman was unhappy, shy, and refused to make decisions, deffering to her husband instead. Sometimes it seems to me that the single women I see seem happier than the married women. Maybe its because their family is more willing to help them out or because they at least feel they have some independence. It’s obviously too small a size sample to make conclusions and I know that this is not something that can be generalized – each case is unique. Our last patient was a 16 year old girl whose mother brought her in because of self-mutilation. She asked to speak to the doctor in private, so we were given most of the details afterwards by the doctor. She was really pretty and had a wonderful, joyful smile. The doctor said she wanted to refer the girl to a psychologist/psychiatrist but that the mother did not have the money to pay for one. Instead, she introduced the girl to the “Young Leaders” group and said she should get involved. Dr. Santivañez blamed the depression on the dysfunctional family, as she called it. According to her, parents try to control their adolescent too much, causing the child to rebel and desire all the things they are not allowed to do, leading to bad behavior and depression. Makes sense to me.
Sunday after Uyuni
Our bus left Uyuni at 7pm and arrived in La Paz around 6am. Since the road from Uyuni to Oruro isn’t paved (about a 3 hour bus ride) – we jumbled along, trying to sleep but being jolted awake with every pothole and giant rock that the busdriver couldn’t avoid on the road. I also got the seat next to the broken window that wouldn’t shut – with each jolt, it opened up just a little bit until it got so cold that it drew me out of my stage 2 sleep and I shut it. Halfway through the bus ride though, the heating was turned on, or at least it did for me. My feet became so warm then that I eventually threw off my blanket and relished the opened window for some cool air. Yup, they give you blankets on public overnight Bolivian busses. At first I was surprised, but I’m sure that if they didn’t, there would be news coverage of the people who lost fingers or toes to frostbite during the trip. It’s that cold.
We arrived home at 7am, I took a shower, and went to Alexander Café to spoil myself with some coffee and warm chocolate chip muffin. Everything is better when its warmed up. It was a pretty uneventful day – I tried to upload as many photos as possible and then later we walked around the city. I crashed pretty early that night.
We arrived home at 7am, I took a shower, and went to Alexander Café to spoil myself with some coffee and warm chocolate chip muffin. Everything is better when its warmed up. It was a pretty uneventful day – I tried to upload as many photos as possible and then later we walked around the city. I crashed pretty early that night.
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