Pictures and Reflections From Dr. Yablon In Bolivia

Blog entry, photos and captions are all by Dr. Brian Yablon, 4th year medicine-pediatrics resident at University of Minnesota, and participant in the Pediatric Global Health Track.

This is positive proof that I was in Santivañez!

I have just finished my second week in Chilimarca, Bolivia, doing a 2-month rotation through the University of Minnesota with support from a MAP International fellowship.

This international rotation is unique for our residency in several respects. First, the clinical piece is outpatient rather than inpatient. There is no hospital affiliated with this site.

Secondly, MAP Bolivia is a multifaceted organization with the aim of promoting total health. Health is looked at not as the absence of disease but as a culmination of positive factors in the environment, the culture, and the family.

There are several programs under the umbrella organization. I am working in Health Services, which is the clinic. The team includes a nurse, two nurse auxiliaries, a laboratory technician, a physician, and a dentist.

I have been seeing patients of all ages (the oldest so far being 94), but they have mainly been sending the pediatric patients my way. The consultations are actually pretty similar to what we see in the U.S.--respiratory viruses, gastroenteritis, pharyngitis, rashes, and ,of course, well child checks.

This weekend, I will accompany Teo, the clinic nurse, out into the community to do well child exams and vaccines. Next week, we will be doing health maintenance for all the children in the MAP school (about 160 children), which is done quarterly.

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Teo, the clinic nurse, in the process of removing an infected toenail. I have much more graphic photos that I elected not to send.

A remarkable MAP program here is called Health Promoters, where people from the surrounding communities can come for intensive 5-week courses to become first level promoters, with additional complementary and follow-up courses offered later to become second- and third-level health promoters.

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Here is one of the health promoters, Asunta (the woman in the hat). She is from remote Morichata, and she trained 18 years ago at MAP in Chilimarca. She has developed many projects in her community for health and wellness, education, and sustainable agriculture.






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We met with a woman who had completed health promoter training 7 years ago. She explained that it gave her confidence, helped her establish equal footing with her husband, and enabled her to successfully manage several gardens and give first aid to people in her community.






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Health promoters and auxiliaries meeting together.

The knowledge and skills that people develop in this program are impressive, and they bring back to their communities very practical ideas about how to implement water purification, organic family vegetable gardens, home building and maintenance to keep out the beetle that spreads Chagas disease, and waste management.

The upper level promoters also learn health care skills, from first aid to suturing to childbirth.

The program is predicated on participants thinking critically about themselves, their families, and their communities, analyzing the embedded power structures that act as barriers to achievement of health, and committing to making changes through consensus-building.

Last week, we went to visit the group of promoters, almost all teenagers, who just finished their first-level training. They were all positive about the experience and enthusiastic about making changes in their families and their community.

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These were the teenagers who completed level 1 health promoter training and were excitedly reuniting after the course. We drove 4 hours to their village of Santivañez.





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Five of the new health promoters.

MAP also has a school, "Comunidad Educativa para la Vida," which has pre-kindergarten through 8th grade. Consistent with the rest of their philosophy, students do a lot of interactive games to teach each other while the teacher facilitates.

The students, starting from a very young age, also plant and tend the garden where they grow the food that is used in their lunches. Not only do they learn about agriculture, but they are also proud of what they have grown and consequently actually like to eat their vegetables.

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Kids of all ages working in the school garden. They tend the soil, fertilize, weed, and perform manual pest control. They are very proud of the food they grow and they eat the veggies in school lunch.





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This second graders is teaching us the importance of eating our fruits and vegetables.





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Here is Claudia, the director of the MAP school, with her son.





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This group of 3-year-olds at the preschool were extremely well behaved.





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This is a photo of the kids with an American visitor named Deborah from MAP in Georgia and a Swedish volunteer named Maria.






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Here is the lunch room with smiling kiddoes.





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The fifth graders made maps of Bolivia--here's one of them!

Two other programs aim at integrating marginalized groups back into the community. One, called Learning About Differences, works with children with disabilities to develop their strengths and to facilitate an ethic where families and communities accept and embrace these young people.

The other, CUBE, is a center for children and adolescents who are victims of sexual violence.

They have a multidisciplinary team of psychologists, social workers and lawyers, and they have achieved good results in helping children cope with horrific violations and also in successfully prosecuting perpetrators, who (as in the U.S.) are most often members of the family.

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MAP team meeting on Monday morning, 2/7. They always meet in a large circle and have a ¨horizontal¨ team structure.

I have been able to see and hear about all of the various programs so far, and I have participated in meetings with all the local MAP staff.

When not at work, I have gone one some beautiful hikes to waterfalls in the

mountains, as well as to explore the nearby city of Cochabamba.

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This is a view of the bustling city of Cochabamba from the van, with mountain backdrop.





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¨Micro¨ number 211 van that almost brought us halfway back from Pairumani before it ran out of gas. Good thing I wore my hiking boots.





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This is the outside of our auspicious van. We also drove around with a dog and solved mysteries.





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This is the inside of the van before it got a lot more crowded. The other pale people are American visitors from MAP International headquarters in Georgia. They were both auditing and helping to collect stories for fundraising for the program.

I also have informal gigs as a math and English tutor.

I am extremely grateful to the University of Minnesota for allowing me and other residents to do rotations in other countries in order to develop a valuable new perspective about health.

I am also very indebted to the staff of MAP Bolivia, who adopted me from the first day and who have made this such an amazing and inspiring experience so far.

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Here are the mother and daughter who live upstairs from me. Their family took me out to dinner at an American-style fast food place my first Saturday in Bolivia.





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Here's a cafe outside Pairumani park, where I went hiking on Sunday, Feb 6. The subsequent photos are all of the views in the park, which has mountainous terrain with a lot of eucalyptus trees and a fairly large waterfall. The views are of the whole Cochabamba valley.

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This was our early dinner after the hike.





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This is at a state park on the way to visit the newly trained health promoters. These structures are recreations of Inca-era corn storage silos, with ventilation to allow the wind to dry the corn and thatched roofs to protect from sun damage.







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For any resident with Spanish proficiency and an interest in community health, I highly recommend this rotation and would be happy to talk with you in more depth when I get back to Minnesota.

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This is the view of the mountains over the MAP school (my neighborhood) at dusk.