I spent my third week here in La Paz working with Dra. Santivañez in the Centro de Salud in Alto Miraflores, a poor neighborhood in the outskirts of La Paz. Centros de Salud are first level clinics, which means they have consultations, can give shots, but can't do surgery or have inpatients. The same as an American doctors office.
Dra. Santivañez is a specialist in adescrnt medicine at one of these clinics in a poor neighborhood of La Paz. She is well recognized in her field! She was one of three contributing authors to the book of diagnostics for the Bolivian public health insurance manual for mothers and children (SUMI). She is often asked to contribute to studies, attend conferences, and give opinions. More than that though she is a very amiable and funny person to work with.
Each morning I would commute to Miraflores where she would meet me for my transfer and we would take the second bus up to the clinic together.
98% of her patients are pregnant adolescent girls, ranging from ages 14-25 (at least that's what I saw during my week).
She taught me the routine exam for pregnancy, which involves measuring the uterine size, feeling for the orientation of the baby, using a Doppler to check the placenta and fetal heart rate, and speaking with the mother about any concerns or questions.
The first day the Dra. examined them while teaching me what to do, but for the rest of the week I was responsible for doing all of the exams.We also saw girls who needed a PAP smear, which she taught me how to do as well, and girls who wanted to start on a contraceptive (which we always rejoiced, because even though free, many girls were reluctant).
We saw some cases of tuberculosis, and spent a lot of time talking to adolescent girls about problems they were having with their husbands or boyfriends and what was involved now that a pregnancy was in the picture. We talked a lot about Bolivian culture in reference to pregnancy, and the patriarchal society. I think that's one of the things I learned from the most.
We were always working hard and efficiently to get through the many patients each morning, although never without taking a coffee break! Each day a street vendor would bring in our thermos of coffee, freshly made and always extra hot :)
The clinic was small and very poor, but the staff there were like a family, and all so welcoming and appreciative of my help there.
On Wednesday I left early to go back to Hospital de los Niños for International Down's Syndrome Day. Since Dra. Tejerina (who I worked with in my first week) is in charge of the program there, the hospital had a big event where all of the families were invited to listen to medical lectures about different complications with the disease, and some of the kids who were a part of a dance group performed. It was a really cool event to see, and Dra. Tejerina was like. A celebrity being interviewed by countless reporters. I secretly felt really proud to have spent a whole week working one on one with her.
Overall, my third week was a VERY different experience from my first two working in Hospital de los Niños. The clinic was much poorer, and I got to see a lot more of the problems in the health care in Bolivia. Although an incredible doctor, Dra. Santivañez works in a very poor environment that lacks many necessary instruments and tools. I've learned so much about culture and the side of medicine that requires as much psychological counseling as it does medicine. Here, compassion is just as important as knowledge of pharmacology.
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