Dear all,
I've now been in Bolivia for six weeks, and the last one was certainly memorable.
I'll get the negatives wrapped up fairly quickly:
My driver's license was confiscated by Bolivian police because I wasn't carrying the hard copy of my passport when I traveled between Cochabamba and Oruro, but fortunately I reclaimed it after a tense encounter at the station.
My wallet was confiscated by parties unknown in Oruro during the Carnaval festivities after I had foam sprayed in my eyes and was shoved from two directions. Unfortunately, the money was not reclaimed, but fortunately I was able to cancel my credit and ATM cards before anyone tried to use them. And fortunately Rachel was able to help me out via Western Union.
I decided to drink juice of "canela" at Carnaval. When I got to the bottom of the glass, I realized that it just didn't taste right. Evidently my intestines agreed, and they protested vigorously for the next 6 days.
So my moral of the story is--"When you go to Oruro, bring your passport but not your credit card, wear a money belt, and consume only saltine crackers and Coca Cola."
Or just don't go.
Despite the above challenges, I am still enjoying my time here.
Before the Oruro fiasco, I accompanied one of the MAP teams to the village of Morochata, where I had previously failed to get to during heavy rains.
I observed and participated in a workshop where the staff of Morochata Hospital (functionally, a community clinic) learned about how to help parents take care of children with developmental disabilities.
The MAP team, "Aprendiendo de las Diferencias" (Learning about Differences), focuses on eliminating the stigma that often makes children with physical and intellectual disabilities second class citizens in their families and in society.
The team also wants to empower families to be the best caregivers and therapists they can be in order to maximize their child's potential.
During the workshop, I also demonstrated the maneuvers to evaluate for congenital hip dysplasia in neonates, though my model was a grown man.
On the other weekdays, I have continued to see patients at the clinic in Chilimarca. Thus far, I have seen over 260 patients, including many well child checks, respiratory and diarrheal illnesses, musculoskeletal injuries, and even a case of Bell's palsy.
Miguel, my last preceptor in the clinic, is no longer working there as of last week.
Instead, a new doctor named Gustavo started on Wednesday. However, on Friday he, too, was unable to come to clinic because of a renewed transit strike (giving me the opportunity to see 26 patients on my own, including 17 well toddler checks in a 2-3 hour span).
At this point, I have no idea whether the strike will still be on tomorrow. The issue is that the drivers want to raise the fare, but the people don't want the fare raised.
The drivers have a valid point--the price of gas is going up, the price of everything else is going up, they aren't able to make money at the current rate.
The people also have a valid point--they don't want to pay more.
Thus, the literal impasse--complete with road blockades on the weekdays.
Personally, this hasn't affected me as much because I live right next to the clinic. But it is wreaking havoc on schools, offices, clinics, etc.
The plan for Monday is to attend the weekly MAP team meeting and then get oriented at the Center for Children Who Have Been Victims of Sexual Abuse (CUBE). We will be doing health maintenance there later in the week.
With luck, transit will cooperate; otherwise, I may stay behind in the clinic. For the next couple of weeks, I'll be doing more rotating around the various MAP programs, pitching in where I can.
This past weekend, I went to the village of Tuini Grande, which, despite its name, is very small.
It is a very rural area past Morochata in a rugged and hilly landscape that is beautifully green (thanks to the last two months of rains).
I participated in a workshop about sorting trash into organics, combustibles, and toxics, and the MAP capacity-building team is going to go back in 2 weeks to help the community organize a clean-up and waste assortment effort.
We stayed at the home of Asunta, a health promoter I've written about previously.
She is a pretty amazing woman who does just about everything--gardens and farms, raises chickens, runs a knitting workshop, oversees efforts for water filtration and latrine use in her village, and provides health care to the children and adults in her community.
I can now also attest that she is an excellent cook, which was extremely necessary since we hiked 3 hours uphill to her village yesterday from the nearest accessible road.
(Incidentally, within the first 10 minutes of that hike, my left leg went knee deep into the mud, suggesting that I should spend more time looking at the ground than the gorgeous scenery.)
I continue to be impressed and humbled by many of the Bolivians around me who are working so tirelessly for their communities.
In some small way, I hope to approximate their energy and approach in the future. I am doing well, and owe that mainly to the help of my neighbors Emilio and Ada, who ensured my safe return from Oruro, loaned me money until Western Union came through, helped me get my driver's license back, and have been nothing short of guardian angels.
Big thanks also to my supportive family back home. Unfortunately, today's friendly internet cafe computer lacks a USB drive, so I am unable to share with you my most recent batch of photos. I will try to send them soon.
Much to my delight, Rachel gets here in one week and she'll spend several days seeing each of the programs here (clinic, school, CUBE, Capacitation, Learning about Disabilities) before we embark on a week of vacation around La Paz and Lake Titicaca.
Thank you for reading along.
I wish I could better capture my day to day life here. The last couple of weeks were good for me in that I am not romanticizing my experience as much as I was initially, but I still very much appreciate the opportunity to be here and to see an integrated model of health promotion in a resource-poor setting in action with all its incumbent challenges.
Being here has definitely been a transformative experience for me, and I hope to be a better doctor and friend when I return.
Best to all,
Brian
