Week 4 - Hospital de los Andes - Infant medicine

I spent my fourth and final week in La Paz working with Dra. Cecilia Uribe at her consultation in the Hospital de los Andes in El Alto.
First let me fill you in correctly:
I was supposed to work with a Dra. Gutierrez at the Hospital de los Andes during my final week here, but on Sunday, my medical director, Dra. Uribe texted me telling me that Dra. Gutierrez wouldn't be in so I should go back to Hospital de los Niños.
So I did. I went back and found Dra. Cruz, an incredibly nice maxillofacial surgeon I had been with when I was in the surgical room in my second week. I asked her if there was anything to see in surgery, and she said no, but I was welcome to come with her on her rounds!

This was an incredible experience because as she is a specialist and surgeon, we got to go to all of the departments to offer inter consultation on the difficult cases. We started in oncology and looked at some solid tumors and talked about surgery options. Then we went to Gastroenterology and saw a boy born without eyes, a cleft palate, all of his organs reversed (eg, heart on right side), scoliosis, severe malnourishment, and anemia. It was a heartbreaking case.


Next we went to Infectology. There we saw another case of Miasis (this time larvae inside the girls eye), a boy with necrosis of half of his face, a girl with potential leukemia, and a girl with a large abscess on her neck.
All of the visits took until about noon, and then it was decided to operate on the girl with the abscess to remove it ASAP.
Because it was an infectious surgery we had to wait an hour and a half for all of the other surgeries to finish. Dra. Cruz asked me if I wanted to scrub in and help an of course I said yes. She taught me about proper aseptic technique in surgery (washing up to your elbows and never putting your arms down, having another resident put on my sterile overcoat and my gloves for me) and then the two of us drained the abscess and stitched it up. It was a simple surgery, but super exciting that I got to help her with it!
So that was Monday.

That night during my weekly class with Dra. Uribe she told me that Dra. Gutierrez would be out all week. So I asked if I could work with her instead! She said of course! So the next morning she picked me up and we were on our way to her consultation in Hospital de los Andes.

First, El Alto is a very poor community. It's to the side of La Paz, up the mountain. It's often warned to tourists not to visit because it can be very dangerous.

Hospital de los Andes is a second level hospital, meaning they have inpatient capacity and can perform minor surgeries. It is very poor. For example last week they were working with candles because the lights stopped working.
Dra. Uribe works specifically with the babies of adolescent parents, and with this she still has a huge patient load. She works three hours at the hospital in the morning, a few hours at a private clinic in El Alto, and then a few hours at a clinic in La Paz.
Her consultation at the Hospital was exhausting. Together we could see two or three patients at a time, with me examining them and talking with the parents about any problems or symptoms while Dra. Uribe was with the previous patient talking about a diagnosis and prescribing medication based off my examinations. If I ever had a question or wanted her to double check something she would, but for the most part I felt really confident in my ability to examine these infants, which made me feel really proud about how much I've learned.
This was all done in a tiny office, with a crowd of women outside the door trying to be seen without an appointment (many of the women had been at the hospital since dawn just trying to get a number in line to be seen that morning). There were babies crying, mothers crying, women trying to get in to be seen and others complaining they had been waiting for hours, screaming children in the waiting area, pharmaceutical reps trying to bring in new medicines, and a huge patient load on the list for the three hour consultation.
It was, I repeat, exhausting. But such a rewarding experience!! I have never felt more proud of the work I was doing. Every day I get more and more excited for a career in medicine.
I worked with Dra. Uribe for two days, but then she left for a vacation with her family. On our second day, I asked her if it would be possible to come back to the hospital the next day even though she wouldn't be there and try to see the Sal de Parto (or maternity ward) where the women went into labor.
She told me the doctor I needed to find to ask, which I did, and he told me of course!
So the next day I woke up really early to begin the long and confusing commute up to El Alto without the luxury of a ride.
I finally got to the hospital and the doctor rushed me in telling me I was lucky because there was a women going into labor! He told me they don't always have a patient so I was lucky to get to see one.

Turns out I would be lucky enough to see three. Within one hour.

Now don't get me wrong, miracle of birth and all, but wow. Talk about an intense morning. It was my first time watching a woman give birth, and it was fascinating!

Only one of three had come in for pre-labor contractions. The other two came in so late that they were dilated enough to come right to the sala de Parto. One of the three was having her first child, one her second, and one her third. All had healthy baby boys and no complications! It was an incredible experience and more than I had even hoped for. The doctor kept telling me how lucky I was to have been there for such a busy morning.
After that we went to see the rest of the inpatient ward at the hospital, and then I sat in on a consultation for a woman who was having premature contractions (only at 28 weeks). During the exam, the Dr. Found she was already to dilated to stop the labor, and had to tell her that she was going to go into labor and was going to lose her baby, which was really sad. He told me that had she been in the United States they would have been able to stop the labor because we have the medicine to do it, but they couldn't afford it at the hospital so she was going to have to lose the baby. It wasn't the first time I heard the "had ____ been in the US" line too. It's always a strange thing to hear that the medicine exists they just can't afford it or access it.

Overall, my fourth and final week in my program here in La Paz has been a very interesting experience with a lot of hard work and a lot to see. I learned a lot about medicine in poor communities and the best way to deal with parents who knew very little about modern medicine.