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 it's not like in the states where every bed is connected to a plethora of electronic equipment. Vitals are all done by hand and, for example, blood samples are taken by hand with a syringe and then expelled into an open test tube to be sent to the lab.
Dra Tejerina was absolutely great to work with. She only speaks Spanish, but can occasionally translate some things to English.
My schedule for the week went as follows:
Monday: Pediatric clinical consultation
Tuesday: Infectology ward
Wednesday: special clinic hours just for kids with Down's syndrome
Thursday: Infectology ward
Friday: Pediatric clinical consultation
In the pediatric consultation it was Dra. T and I working the equivalent of a pediatric clinic day. Parents bring their kids in because they are sick. Usually minor things. And we see them. They come in and we talk to them and then go through the routine procedure like check their growth and weight development, look in their ears and throat. Listen to their lungs and heartbeat. Diagnosis.
There were kids with colds, flus, bronchitis, pneumonia, urinary infection, and some regular check ups.
It seems basic but I learned so many skills! I had never done check ups like that before so I got some great experience recognizing what symptoms look and sound like.
I think what I learned most from the Dra. was how to interact with parents and kids in a medical setting. She is really great with kids.
Down's Syndrome wednesday was incredible. For many of these parents it was the first time someone was explaining to them what Down's Syndrome is!!! It was still like a standard doctor's office. One patient at a time. But the parents, like in the regular consultation days, range so drastically. From poor indigenous looking Bolivians to modern looking city parents.
Two of the poor women had just recently been left by their husbands because they didn't want to deal with a kid with Down's Syndrome. Over half of the kids had heart defects (common with DS) and one couple had almost lost their child recently and had needed an emergency heart surgery.
Watching Dra. T explain to these parents that having a child with Down's is not the end of the world, and that they can live normal lives, was so inspiring. These mothers who came in believing they did something wrong to cause this left happy and assured that things were going to be ok. She had me explain some things to the parents too and I learned a lot about how, as a doctor, you very often play the role of a psychologist too. So much delicate word choice and communication must go into communicating with parents. I learned a lot about that skill, plus it was interesting to hear all of the different types of heart defects and observe the symptoms of DS.
My time in the actual Infectology ward was incredibly informative as well. I'll admit it was a lot harder to follow everything going on because it was a lot of fast medical Spanish. But there was one infant girl with Miasis, a disease where a fly lays eggs inside your skin (usually in a pre existing wound) and the larvae hatch and eat your flesh. It was third case this year so far. I assisted in the extraction! It was Dra. T and I putting, I kid you not, pieces of raw meat over the holes, yes holes, in the infants head where the larvae had burrowed into her flesh and created a cavity beneath the skin. The meat would draw them out where we could then grab them.
Although we got one the other one wouldn't come.
She ended up going in for surgery where they cut open the top of her head and pulled back the large section of flesh above the cavity. They removed the, not one other, but FORTY OTHER LARVAE.
Yep.
She's still there now while they wait for the plethora of antibiotics to fight all of the infections.
There was another girl with a disease of the blood giving her a bad rash that they're still trying to diagnose. They suspect it might be Vasculitis.
There was a girl with a parasite below her eye, a boy with what they now think may be a combination of Leukemia and a non-problematic birth disease that basically is just incompletely formed melanin and looks like bruises all over the lower back.
Point being. I learned SO MUCH about
1. Various diseases
2. Resident life and how doctors and residents work together
3. How diagnostics works
4. Probably most important, patient communication and how to talk with parents in a confident and informative and yet friendly and comforting manner. Again Dra. T really is just incredible.
So, week 1. Infectology. Great week! Definitely feel pressured to study the hell out of my Spanish medical vocabulary. Also going to work on being more assertive with asking questions next week. If I can't chime in with medical knowledge (of which I have very little at this point in my career) I'm going to try my best to work on asking intelligent questions to at least demonstrate my curiosity for everything going on. The other doctors and residents are REALLY friendly and helpful, you just need to speak up and do what you need to do to learn, no ones going to hold your hand and take you around.
Next week, Oncology. A bit nervous for the emotional aspect of that one.
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