Week 1- Infectology Hospital de los Niños

Ok, journal in hand, lets review:

I'm officially finished with my first week of medical placement here in La Paz, Bolivia.
I spent it working with Dra. Maria Salete Queiroz Tejerina in the Infectology department of the Hospital de los Niños.


First let's talk about the hospital. The hospital is the largest children's hospital in Bolivia and serves as the "rule maker" of sorts for standardizing medical practices for all other children's clinics and hospital in Bolivia. That being said, it was still far below the standards of the American hospitals I was used to. For example, private rooms are not thing. All rooms are shared and contain multiple beds. There is one main waiting room in the front entrance, and the hospital itself has four floors with ten departments in total, I think. They have computers and properly document everything as common medical practices dictates. They have a pharmacy, a lab, and a sufficient staff of doctors and nurses and residents. There are far less luxuries in terms of equipment. For example

Week 2 - Hospital de los Niños, Oncology and Surgery

In the past week, I have learned so much about medicine, compassion, culture, and myself.
I spent the past week in both the Oncology ward and in Surgery.

Monday, Tuesday, and Wednesday I spent only in Oncology. There was so much to learn about the different types of cancer and associated treatments. I did some research myself over the weekend before to try to familiarize myself beforehand. There were about nine children in total over the few days I spent there.
Most of them had Leukemia, so I learned a lot about the course and treatment of that cancer. One had a tumor in the upper portion of his right cheek, although the scans revealed that it penetrated far back into his head. There was one boy with Leukemia in grave condition due to the presence of another infection, Sepsis.

All of the children had one parent by their bedside.
There was one moment that was hard, and that was when the mom of the boy with the facial tumor saw the scans and just how large the tumor was. She cried pretty hard for a while and it was difficult to stand and observe.

Week 3 - Centro de Salud - Adolescent Pregnancy

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.

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.

Week 1 - Centro de Salud Nestor Paz

My first week in Tarija!

First thing, I absolutely love this city. It's warm and so friendly. It's much smaller than la Paz, so it's very common to run into people you know.

I spent my first week working in the clinic of Dra. Amanda Delgadillo. She works in a neighborhood here in the outskirts of Tarija. It has a relatively poor patient population and offers basic services such as consultation, vaccinations, dentistry, and a minor inpatient room if people need to stay to let stitches heal.

Dra. Delgadillo is a super nice doctor and the whole clinic in general has such a welcoming, family vibe. All of the nurses were hilarious and always joking about the "pretty new student." We all had coffee and snacks after the work day together and I really felt like I was a part of the clinic.

The one downside to this week was that Dra. Delgadillo already had a student in the final stages of her internship about to enter residency. Because of this, I felt like I was really an unnecessary third wheel in her clinic. She is a general medical doctor, so we had cases ranging from pregnant women, to a man with tuberculosis, and a lot of sore throats. The coolest parts of the week were the occasional moments I spent working with the doctor in the laboratory looking at fluid samples and diagnosing different parasites!

On Friday, I accompanied two of the interns on their community work. It was a lot of fun! It was National Children's Day, so we walked around farmland to different houses asking if they had young children and distributing nutritional supplements to help kids get their vitamins.

Overall, the week was rather low-key, but a super friendly environment to be working in!

Week 2 - Hospital Obrero - Internal Medicine

For a very interesting ward in the second largest hospital in the district of Tarija, this was by far my most boring week.

I realized here what an immense difference in my experience the personality of the doctor I'm working with makes.

I spent my time here working with Dr. Victor Vilcaez.

Monday was Tarija's anniversary, so no one worked. So my first day was on Tuesday, and I arrived at the hospital at 7am. In Internal Medicine I asked if Dr. Vilcaez was there and they said not yet. After about twenty minutes I asked again and they said Oh yeah, he's in that room. I introduced myself but he told me to wait and then came out and said we were going to do rounds.

As per usual, rounds consist of the residents taking the doctors around to all of the patients and explaining their case and any recent developments. They're always the hardest for me to understand because the Spanish is so fast and mumbled.

Week 3 - Centro de Salud Hospital San Lorenzo

I spent this week working with Gynecologist Dra. Mary Yucras in her consultation in Hospital San Lorenzo. San Lorenzo is a pueblo about a fifteen minute drive outside of Tarija. Thankfully the Dra picks me up in the morning and I don't have to worry about trying to catch a bus to get out to San Lorenzo.

Dra. Yucras is a very extroverted women and loves teaching and having me practice everything she does to become familiar with the procedures. Over the week, we performed several PAP Smears, did some routine pregnancy check-ups, diagnosed various infections, and gave information about and performed various methods of birth control. By the end of the week I was able to conduct many of the visits all by myself thanks to all of the practice I got working with Dra. Yucras.

Week 4 - Plataforma de Chagas

I spent my fourth week working in a clinic for Chagas Disease.

Chagas is a tropical disease caused by the parasite T. Cruzi, usually carried by the vinchuca bug. This bug lives in many natural environments but has also been found in many homes in the farming regions of Bolivia. The disease is found in all of Bolivia, as well as Argentina, Peru, chile, and many other South American countries. It has also recently been encountered in the United States and Spain.
There is a cure for the disease, but because it can go up to twenty years without displaying any symptoms, many people do not know they have it or do not want to seek treatment.

In the platform, I worked in the diagnostic laboratory, in the consultation of Dr. Rodriguez, and with the nurses. At the end of the week I had an exam on Chagas to make sure I had learned as much as possible while I was working there.