Day 7

 
 
A picture of the statue of Jesus at night and a picture of the courtyard of the hotel I am thinking of staying at when Mike comes into town.

Honestly, I can't lie, I spent most of today sleeping and skyping with Mike. Woke up around 10, read until lunch and then after lunch we decided to rest a bit before heading out, but then we all slept until 7...much needed rest, but it does seem silly to rest when there is so much to see...then again, if I were home I would be doing yard work and cleaning house so maybe a person has to excape to another place to truely get a day of rest.
When we all were awake Betty, MaryBetty, Geronimo and I went for a car ride to look at hotels for when Mike comes. We drove by many and stopped at two. The second is Bettys favorite and is not expensive by American standards and is very beautiful so I think we will stay there. It will give Mike a chance to aclimate before diving into the rest of Bolivia.
It was interesting as we drove to see all of the large beautiful houses behind high walls with glass/spikes on the top. In a world where the is such a divide between the haves and have nots it takes a lot to guard what you have. Betty and family used to live in a house with lots of land on the third ring, but moved into the city for safety after their father died. It is safer here with people so close, houses touching eachother, but to not have a garden is hard...especially for the dog.

Day 6, more pictures

 
 

The missing pictures from my last post...one of Geronimo at the tennis club after swimming and one of my hamburger.

Day 6 continued

 
 
 
 

First, a picture of my favorite park because it is close to home and when I see it I know to tell the taxi driver to stop and just let me out. The rest are of the tennis club.

My thing about taxis. Today, I took one taxi to a store, which was closed, but the taxi had left so I started to walk home and called Betty to say that the store where I had wanted to buy scrubs was closed and she gave me the address to another store. I took a taxi to the other store (who dropped me on the correct street and told me that the store should be somewhere around where he had dropped me). The second store didn't have what I needed and they put me in a taxi to another store which was closed so at that point again I started to walk home at which point I should have grabbed a taxi because instead of heading home I got lost in the middle of a market...I kept my purse close and 8 eyes in my head (2 in front, 2 on the sides and 4 in the back per Bettys instructions). Finally I found my way out of the market and MaryBetty called to say, get a taxi home and after lunch we know where you can go. So I got in a taxi to go home and the man starts driving, but then after a bit he turns to me and admits that he doesn't know where my street is...I give him my map and he gets me home.
After lunch, the woman who does the laundry and cleans the house takes me to the fair and we find scrubs and then she puts me in a taxi home. This taxi driver is so busy singing along to his music that he nearly gets in an accident. Then he gets close to my house takes a wrong turn and five streets later admits that he doesn't know where my street is...if I don't die in, get lost in or get hit by a taxi I will be greatful.
Enough about the scrubs extravaganza...I forgot to mention that prior to the scrub search I got up, at oatmeal squares for breakfast and went to the gym, except for Mike not being with me it could have been any other day in Tucson. Then, this afternoon, we went to the Santa Cruz Tennis Club to swim and relax. It was beautiful! We swam, showered in showers with really good water pressure and good hot water and then ate dinner outside in a light beautiful cool breeze. Got to skype with Mike twice today...about to go on time nuber three, ate a hamburger (with corn on it) for dinner and I am living with a fabulous, generous family. Who could ask for more?

Day 6

My breast rant…Here is the thing, I am offended by how much people are offended by breastfeeding. It isn’t like this is a novel idea. I wish more people in the US would breastfeed since we know it is best for the baby. Here, women pull their breast out without a second thought, no embarrassment, no concern and no one is offended by it…this is a language that actually has two different words for breast. The first is pecho which is a mans breast or a womans breast for feeding a baby (leche de pecho = breast milk) and then there is sano which is a sexy breast essentially. A baby doesn’t drink from a sano, he drinks from a pecho and men don’t go to a strip club to see pechos, they go to see sanos. Maybe we should think up a new word for the breast when it is being used to feed a baby and then we won’t be so offended by breastfeeding...later today after a nap and some recovery, I will write more about my day and my love, or lack their of, of taxis.

Day 5

Today a picture of Geronimo (the son of the daughter (MaryBetty) of the woman I am staying with (Betty))

I was going to write about breasts today, but then something new came up so maybe I will go on my breast rant tomorrow…
Today, I saw my first febrile seizure, not my first patient diagnosed with a febrile seizure, but my first patient still seizing from his fever. It is interesting to me that I haven’t ever seen this, only the post ictal state and maybe is a statement to how slow we move in medicine in the United States. Here, the mother jumps in the car, drives to the ED and walks right in, no triage, no hoops, just right in. The doctors start treating and send the mom out to register and pay, this hospital doesn’t necessarily take insurance, but it is adjusted to make things really affordable for patients…for example, I had a child get a full blood work up with stool and urine labs and it cost her a total of $3. Anyway, the doctor gave the child diazepam (the South American version anyway) and then put the febrile child right in the sink to cool him down. Once fully bathed, due to concern for meningitis, the doctor told the parents he was going to do a lumbar puncture and just did it. No waiting around for the parents to decide if they were going to give consent and the LP was done quickly – FYI, they don’t use stylets at all in the LP needles. Now, for me, I like the fact that we give EMLA and lidocaine to decrease pain to the child, but on the other hand this is very time effective medicine.
It is amazing to me how much this hospital can do with so little. I am constantly surprised by the smallest things that I never noticed were a luxury…for example the tiny individually packaged alcohol pads that we use constantly – here they have a bowl of cotton balls, sitting in alcohol…just as effective and a heck of a lot cheaper. Plus less trash.
Another thing, now that I understand that the internos are actually in their last year of medical school, they totally kick our medical students butts. They essentially are residents right now because the residents are still on strike and they are doing so much. They do a lot without a doctor present and just know what to do. I think part of it is a product of our medical system limiting what a medical student can do…seriously people, would it really hurt the system to let medical student notes count in the chart for something as long as they are co-signed by a doctor. I am getting more and more of the opinion that the insurance companies in the US run too much of our medicine and maybe it is time that we take some of our medicine back from the insurance companies.
On another hand, sometimes the fact that someone is always watching out for us to mess up so they can jump in helps improve patient care…I can see Andy in this place going crazy due to the lack of safety…but then again, in a hospital like this, I don’t know how some things could run any other way.
If nothing else, I will definitely come out of this month with a good knowledge of just how much we take for granted in the US.
Plus, I chatted the whole with home with my taxi driver and understand the whole conversation and he only had to repeat himself a couple times (mostly because I couldn’t hear him, not because I didn’t understand)!
More Spanish classes tonight and in less than 3 weeks Mike will be here!

Day 4

Today, a picture of my room.

Today was even better. 1st, I ate a good dinner last night, 2nd I got to Skype with Mike last night, it was so good to see his face even though it made me home sick (I also got to skype with my dad, and my mom and Katie, briefly). Plus, at least now I am comforatble now in a routine even though most of the time I don't know what is going on. Get up at 6:30, breakfast downstairs - yogurt mixed with cereal and marmalade, coffee and a cheese sandwhich (half of which I save for lunch) then taxi to work.
The residents came in for a meeting today, Cynthia, the resident who showed me around on Tuesday, stopped by the clinic to let me know that they had a meeting, but then never reappeared so things must have not gone the way the residents had hoped. They are paid 800Bolivian a year which is a heck of a lot less than American residents make...I wonder how they afford everything.
Something, Raquel cleared up and I asked about today and the interns cleared up: the interns are not interns like our interns, they are still in their last year of medical school, but they take call like an intern so I still think it is too much, plus now, with the residents gone, they are picking up a lot of the slack.
Lunch was the same, but one of the interns sat and chatted with me as he drank a coke for lunch (my sandwich and diet coke kicked his cokes hiny)...I am guessing he ate again later since lunch is their big meal of the day.
Then I spent the afternooon in the ED, this time with a doctor who spoke a lot of English because he lived in Miami for two years. The interesting thing is that in Miami he spoke so much Spanish that he says his English never got as good as it could have because he was never forced to use it. He also speaks French and Italian so I felt safe talking because he has to understand where I am coming from with my broken Spanish. Also, I saw my first LP in Bolivia done by this doctor...it was the quickest LP I have ever seen. It was incredible. No lidocaine, but Midazolam on board so that helped with the patients anxiety and to keep the patient still. He said that he can usually tell by the color of the fluid if it is bacterial meningitis and this looked good to him which is good for the patient.
After work, I walked to the bank and then around the city a bit to work on getting my barrings...I am starting to miss the large Arizona sky, I always take for granted how much you can see there.
I got to see a parade with a man name Johnny and I need to ask who he is. Then I got myself some icecream. No way am I losing weight here with all the good ice cream.

Day 3 continued

I have made an amazing discovery! I spoke in Spanish with my Spanish teacher for 1.5 hours and understood at least 90% of what she said. My Spanish is getting better, I just don't understand when people talk so fast so tomorrow I will ask them to talk slower...I'll let you know how that goes, but the good news is that I am getting better at Spanish for my patients and that is what is the most important!
Second, I have come to the conclusion that Betty, the woman whose house I am living in, is a Saint. I got home from Spanish class and she asked if I had had dinner which I had not and was still starving from my lack of adequate lunch and so she walked me to an Italian restaurant and for the first time in Bolivia I am full to the top!!!
Life is good.

Day 3

These are pictures of the street I live on from the rooftop patio.

Today I experienced my first Bolivian strike, unfortunately it was the residents in the hospital I am working in because the hospital didn't pay them. Which makes me wonder, if we are unhappy with our program can we strike? Would that be unethical? Would the hospital be able to function without its residents? Who would spend the whole night writing orders for the nurses and who would write the gobs of notes in the morning? MaryBetty offered that if the residents don't come back and things are difficult for me at the hospital she has pediatrician friends who I could work with, but for now I will stay at the hospital where they worked so hard to arrange for me to come.
The interesting thing is that the interns don't get paid anyway so they aren't on strike. I can't imagine if we didn't pay our interns due to how much we put them through and how hard they work. Their interns work just as hard and want to do it so much that they do it for free.
The rest of the day was odd because I had no fellow second year to follow. I spent the morning in the clinic and the afternoon in emergency again. Which was ok, but I didn't know how to find lunch so I ate the second half of my cheese sandwhich that I had brought from breakfast and then when I came home ate achchairus (interesting Bolivian fruit that takes a lot of work for a little fruit, but that evidently has a lot of vitamins) which helped my hunger. Tomorrow, I find lunch or bring a granola bar to go with my half of a cheese sandwich. The stupid thing is that pleanty of people have offered to help me with anything and I didn't want to ask for help, but I really should just get over myself. Maybe tomorrow the residents will be back, or the interns will be around for lunch.
In the ER I spoke with a doctor who is applying to work in Canada, it was great to hear his English and he also offered to help if I need anything. Everyone is happy to offer to help, a very friendly country.
An bunch of interesting cases today, hard to focus on any. Metoclopramide intoxication, osteomylitis, stomach issues, stomach issues, stomach issues, cough.
Too tired to write more...tonight, my first spanish class.

Day 2 (posted actually on day 2 unlike day 1)

Woke up, went to work...thought this is crazy, got two blocks away and realized I had forgotten my sthescope and had to ask the taxi driver to go back, which he found amusing. Then I went to work, wandered around the hospital until I finally found someone to help me find Dr Romero which took me to Dr Jordin who brought me into morning report (literally they report on all of the patients that were admitted overnight to all of the residents unlike us just discussing one case). Then he talking with me about the hospital beds and deaths with a powerpoint which helped.
I then observed in clinic which is interesting.
Clinic:
Doctor (with multiple residents 1 second year and I think 2 interns) sitting at a desk in an exam room and someone keeps bringing in charts. When one patient walks out the door of the intern calls the next and they walk in. It is nice in that the doctor never has to move but also, interesting because people come in and out from the back of the room which is open to a hallway constantly - Definitely no HIPPA here. It would be nice to be able to practice medicine that fast. Also, the drug reps slip in a quickly between/with patients as they can and give samples
A resident, Cynthia, showed me where to put my bag and we had lunch. Then she showed me the emergency room where she had said she was spending the afternoon and then she disappeared, but that was ok, I had bothered her enough. The doctor in the pediatric ER (yes ER its one room) was wonderful to talk to and he talked slowly for me which minimized confusion. By late in the afternoon though I was so tired of working to hard to talk that I couldn't focus on anything...so as a brillant idea I set up a Spanish class for tomorrow night at 6:30pm - if I'm learning tired, I will be able to speak/understand tired, right?
This is a picture of where I am living, the outside today (and of course the dog), maybe my room tomorrow.

Day 1

Sat down to blog and post some awesome plane pictures I got flying over La Paz, not to mention of Cassie and Lilly before I left and my house and Tucson because Raquel said it would be nice to show the residents Tucson and somehow deleted them on my memory card before putting them in Picasa which evidently makes them permanently gone. Usually this would just make me mad at myself, but today it made me cry…guess that is just part of travel. At least I didn’t clear the card at the end of my trip. So, no pictures yet, but I will start over. Will try to recreate the picture of Cassie running where I moved the camera and so the ground was blurred, but she was a clear picture when I get home and as for the pictures of snow on the mountains surrounding Tucson, the residents here would never have believed me that it snows in the desert I come from anyway, I mean that is right up there with Kimi claiming that it rains all summer.

To clarify a few things about Bolivia…
Yes, you absolutely can get your Visa at the door $135 and a passport. Bring the other things just in case, but they just made us all fill out some more paperwork and then took our money and passed us through.
It is actually more uncomfortable here than New Jersey in July with the heat and humidity and you don’t have the hope of going to the shore to cool down because they don’t have a shore. That being said, the people are friendly and helpful despite the sweltering heat…its almost as if they don’t notice.
The taxi drivers are crazy and some are cheep and some aren’t, I still don’t understand the difference, but the family I am with is trying to help me.
They deal in boliviano money and US dollars 7:1, your choice and prefer cash over credit cards.

Looking forward to going to the hospital tomorrow…was headed to bed, but now it looks like I am headed to dinner at 9pm…hungry yes, tired yes, 30 hour shift has nothing on this.