Adolescent Services

My 3rd week was spent at the adolescent services. It is a primary care clinic for 15 to 25 year olds. It ended up being a good review of obstretrics. 90% of the patients we saw were pregnant. It was really great primary care in the trenches. The Spanish was better for me than at the hospital because it was less technical and will likely be more useful in the future. By the 3rd day, I was largely doing the physical exam, vitals, doppler, etc. while the doctor wrote the notes and interviewed the patient. I didnt see any crazy diseases not in the US but quite enjoyed my time seeing a clinic in Spanish.

There were a few differences I saw from the US. They were much more quick to diagnose a disease and give medicine. Nearly all pregnant women with vomiting were diagnosed with hyperemesis gravidarum, a disease of vomiting too much during pregnancy. I rarely saw it diagnosed in the US and have not heard of much medication being given for pregnancy related nausea, but at this clinic anti-nausea medication was given to most people with nausea. Similarly, nearly every pregnant women with a headache (none of whom had any symptoms of a runny nose or cough) were diagnosed with sinusitus and given antibiotics. Vaginal discharge was given a slew of medications to cover yeast, bacteria, and STDs because they didnt have a microscope to diagnose if there were any disease at all.

I cant judge, especially since they have much lower rates of antibiotic resistance.

Next week I will do pulmonology.

Weekend of soccer and Tiwanaku

Facebook pictures are up. I was able to fill this last weekend up with some cultural events, both old and new.

I took a trip to the old capital of the Andean region called Tiwanaku. It is thought to be the most powerful city from roughly 1000 BC to 1000 AD. It was a economic and religious center. It is thought that human sacrifices of the gruesome type were performed. A lot of the buildings and statues were destroyed by the Spanish to "modernize" their cultures. They used the stones of the temples to build churches and beheaded statues, etc. Academics still dont understand how they built a lot of the large temples with the techonolgies at the time.

I personally had a great time as I really haven´t had much experience with ruins this old.


The next day, I went to a soccer game. There are 2 teams in Bolivia, Bolivar and The Strongest. They were playing each other making for a big rivalry so some of us students decided to go. We got about the best seats in the place for 10 dollars. I bought a jersey for 5 dollars and of course routed for that team, Bolivar. Bolivar did win so it was a good day. The ends of the stadium held the hard core cheerers that were constantly singing, jumping up and down in unison in support of their teams. While certain areas of Souther America are a little famous for violence at soccer games, Bolivia seems to be pretty tame. I was surrounded by families with little kids. It was an excellend venue.

Next trip on the schedule: Uyuni salt flats.

Weekend in the city

I didnt take any trips last weekend, so I stayed in La Paz. I like having time at my homestay so I have time to chat in Spanish with my host family. They are extremely nice and have the patience to work with my Spanish. My host dad has a house out a ways from the city that he is building, all by himself. It is very impressive. He is making the cement pillars for support, buying and shaping the iron girders, planning the whole thing out. He was a civil engineer when he was working. So we took the form of public transportation out their and gave it a look. Hen then showed me around the touristy parts of the city that have all the markets for souvenirs, the giant old church (St. Francisco Cathedral), while we were looking for some parts for his house. He really likes oldies so we watched some dvds that he has of some of his favorite artists: Paul Anka, Enrique somebody that apparently was the Mexican equivalent of Paul Anka, and The Platters. I know my dad would have had a good time joining us that evening. A quick note about public transportation. Traffic is so bad here that I cant imagine owning a car here. The roads are constantly congested and as I mentioned in my last post, the traffic laws seem flexible. Similar to many countries, most of the public transportation is conducted by vans that fit a lot more than they look like they would. They are only about 25 US cents to take. There are a few busses that are even cheaper. The vans look like they will stop in the middle of the road any time someone wants to get on or off. There really is only 2 things that I am not a huge fan of in Bolivia that I have experienced so far. Littering, and honking. I have personally witnessed littering a number of times, people just throwing packages on thr ground or out of their car. I heard it is just common here from people who live here. Its not something I can understand. Honking here is soooo common. Everytime traffic causes a car or 20 to stop, every car just honks until it goes, which is pretty much all the time. Honking has lost all meaning in this city as it is just one honk after the other, as far as I can tell. But dont get me wrong, I like many and most things about this city and country. On Sunday, I went to the local Latter-Day Saint church. Someone here told me that Mormonism is the second most common religion here, next to Catholicism. I would believe it, as I saw some LDS churches in some very rural places on my trip over 1 week ago. The church I went to was huge. I arrived 30 minutes early, but ended up being later, because I found out I was waiting in the wrong chapel. They have 2 entire chapels and churches in 1 building to accomodate more people. I could only understand bits and pieces, but I had a good time. There are always lots of nice people at church. One of the biggest differences was timing. I had heard that punctuality isnt stressed in much of Latin America. People slowly streamed in at the beginning of church and I dont know if it is normal, but we ended a good 30 minutes late. That being said, I look forward to going next week if possible.

Pictures

I have taken most of my picturew with my phone and with my laptop acting funny, I have had to rely on my facebook app to upload pictures. Here is a public link. http://www.facebook.com/album.php?aid=2321810&id=2410201&l=ac7617ef91

Week 2 in hospital

I have seen some new and familiar diseases in the hospital this week. We see a bit of HIV and TB. I have seen these before, but the main difference is how advanced they get. I think it is because these diseases are often picked up sooner in the US. People that live in rural areas have a harder time making it to hospitals. I have heard of and seen patients that have relied on traditional healers which has delayed the doctor visit. Here is a list of traditional beliefs that was given to us in a talk by one of the Boilivian doctors. (disclaimer: this talk was given in Spanish and is my translation, take it for what its worth) This is not a list of bad beliefs, just of beliefs. However, some of these do not improve the health of the Boilivian population. 1. To take and rely on herbs and teas, different ones for different types of pain. I believe chewing on coca leaves is good for stomach pain. 2. To take herbs and teas to get a baby to be born sooner. 3. I am not positive on the translation, but toss a pregnant women around by putting her on a blanket and throwing her up and and down to help the baby. I didnt understand the Spanish on how it was supposed to help the baby. 4. No bathing until 45 days after birth for the mother. 5. No light or sunshine 45 days after the birth. I think this has something to do with evil spirits. 6. Wrap the baby very tight with multiple layers. 7. Do not cut the baby`s fingernails as it has a connection with them becoming robbers. 8. Calling on spirits of dead people for help. 9. Using massage on particular points of the body to relieve stress and pain. 10. The mom makes all the medical decisions and gets all the respect and honor. There are times that I hear diseases as a possibility, or on the differential, that we would not consider in the US very often. We saw a cyst on an xray, and the doctor thought it could probably be a hydatid cyst, a type of parasite. I saw a little girl recovering from leishmania today, another type of parasite I have only read about. Today is Childrens Day in Bolivia. Per my little Internet search, it said it was to highlight the exploitation of children and declare their rights since many children are forced to work at very young ages, etc. What I have seen is a lot of balloons and clowns and games throughout the city. In the hospital, we were visited by famous soccer players from the top soccer team in La Paz, clowns, and people in zeebra costumes. One of the players I had seen on tv the previous week. I clearly was not as excited as the Bolivian medical students who knew them well, but it was fun to be a part of. A quick random fact: in Boilivia, the traffic is crazy. Lanes seem somewhat optional, like turning left from the right lane, red lights also seem optional. And there is often no stop in traffic so you just kind of have to cross the street when it seem the most possible or when there are so many cars they are forced to stop. I kind of try and stick close to a Bolivian person and do what they do. The government or somebody recognizes this and since they apparently refer to the striped crosswalks as zeebras, they have these volunteers in zeebra costumes control the traffic. I saw a car stop in the middle of the crosswalk after the light was red, and 3 zeebras surrounded the car and kind of waived their flags and shook their heads. I have to say, I like it.

Night out on the town

I decided to join some other students who went out to a restaurant that has live music and dancing, traditional style. It was very entertaining. The first half was traditional Bolivian dancing. It is somewhat similar to Spanish and Mexican dancing but has its differences. I heard it can be called Andean dancing, as a lot of the culture comes from areas surrounding the Andes Mountains. Very fanciful costumes were probably the most unique part. Other students took pictures which I will try to get soon. At times, they invited us up to join the dancing, which I was able to take part of. The second half was a live band. It was 4 guitars of diffent sizes and drums. They were all very good and did great harmonies. Much of the crowd was from Latin America and knew a lot of the songs that were played. Our table of North Americans and Asians was a little more quiet as we couldnt sing along and did not understand all of the jokes, as everything was in Spanish as you would expect. They would ask where everyone is from and play some songs from your country. They played Only You (the old romantic song) and some Elvis for the US. I really enjoy being home in the early morning and evenings because that is when my host parents have time to chat. I am trying to balance getting out and seeing the city and enjoying some Spanish with my host family.

Patient log

As part of our program, we are asked to keep a blog of our experiences in the hospital, including the types of patients that we see. Since I already, have a blog, I am just going to add it to my personal one. I have spent 4 days in the hospital so far. I spent it in the division of infectious diseases. I am hoping i will see some cases that I wont really see in the US. I have seen and heard of patients in the hospital that I hadnt seen in medical school. For the most part, the hospital is fairly similar to US hospitals. I have been going to the main referral hospital for children in Bolivia. At this time of the year, they are beginning to enter winter, and have a lot of bronchiolotis-RSV patients, a viral infection of your smaller airways. There are also patients with meningeal tuberculosis, adenitis, pneumonia, and some other infections. We had a grand rounds (basically a presenation in the auditorium for all pediatricians) where they discussed a case of rheumatic fever. When you get strep throat and it isnt treated, it can turn into rheumatic fever, which is a serious infectious that can effect the heart, joints, skin, and other parts of the body. That is the main reason to treat strep throat. It is very rare in the US. We also had a referral for a little girl who has bruising all across her legs for no reason (there is no suspect of abuse), called purpura. We just found out her platelet count (the part of the blood that keeps us from bleeding) is normal. I gave a little presentation in Spanish on what can causes this and on a benign tumor we saw called a nevus sebaceous. There are times that I understand most of what is being said and there are times that I understand nothing. The times that I understand most is when they are discussing a topic that I already know about. I have the most medical experience out of all the students here so they often discuss topics that I already know. Overall, my Spanish is slowly coming along. I can often carry 1 on 1 conversations about simple topics or medical topics, but that is about it. My grammar is decent, but my vocabulary is not too good since I havent really been studying for too long and havent taken formal classes where they pound new vocabulary. I have noticed enough progress to not get discouraged at least.

Weekend trip to the island of the sun

Over the weekend, I joined a couple of other students on a trip to a place called Copacabana. There are a few in the world now, but the first was in Bolivia. It is a popular tourist location with lots of restaurants, shopping, and it is on the water and a beautiful location. I am afraid the camera I brought wont turn on so I am using my phone for my pictures. I cant find an easy way to upload them to picasa, so I am just using facebook for now. I uploaded a bunch of the photos on facebook, so for those with access, feel free to take a look. We spent most of the time travelling as it was a little far for a 2 day trip, but the travelling was full of natural beauty. I am in a place at a very high elevation. There are lots of lakes, fields, and snow covered mountains. We took a bus and a boat to get to Isla del Sol, or Island of the Sun. According to Incan tradition, this is where the sun was born. We were able to see an ancient Temple of the Sun, which was built about 1250 AD. The oldest ruins were built in about 2200 BC. I will post more pictures once I get them from my friends. There are many islands in the area. It is in the famous Lake Titicaca, which gets its name because it looks like a puma hunting a rabbit. It is the highest commercially navigable lake in the world. The islands are all very and to use them for farming, they built terraces into the sides, like giant steps. It was said to have taken hundreds of years. Unfortunately, it still didnt work very well and most of them are not used today.

Eating in Bolivia

So far I have loved the food here. There is a fair amount of fresh fruit and vegetables used and always a lot of flavor. Breakfast we usually have milk, tea, and bread. The bread here is not bought in loaves but in separate pieces, kind of like rolls but flat and a little larger. Sometimes we have eggs. My host mother always makes fresh juice with her blender. My host family eats quite early as they leave for work from 6 to 730 am. Lunch is the biggest meal of the day. It is often a little late, from 1 to 2pm, and is very large. It is one of the biggest cultural differences that is easy to see. Most people return home from work and eat lunch with their family, and return to work later. All of the offices I see have office hours from like 8 to 12, and 230 to 6. It is a given that there is a break for lunch. We have had several different items, some familiar and some knew. There is almost always a salsa type of spice that we can put on. It is homemade salsa and is delicious. The spice level may be too much for many Americans but for me it is often just right. They dont use too much meat either. It seems to me a fairly healthy diet. Dinner is light, often just some bread or leftovers from lunch. I have been told that due to the high altitude (we are up in the mountains) it is hard to digest at night. For me, I always like a large lunch and light dinner any ways since my stomach feels better that way in general. I have to say, the food and eating schedule seems a great fit for me.