Sunday, April 22, 2012

Goodbye Bolivia

This was my last night in La Paz.  I have spent today sharing time with some great friends and family that I've gotten to know and love over just my short time here.   I'm so thankful for the HOPE team that is working so diligently and full of the Spirit of God to bring people to Him.  Their goal is to love the people of this city - the poor and the rich, the children in the orphanages, the taxi drivers, those who know Christ and those who don't, the doctors, nurses, hospital staff at Arco Iris - so that they may see God and glorify Him.  They are giving their hearts and being strengthened by God daily.  I'm also blessed by the friendships I've made here, both in and out of the hospital.  Many have been asking me about the one big thing that I've liked the most about La Paz.  I'd have to say it's the people I've met and the relationships I now have.  There are many needs here and many opportunities for any and all of us to serve.

To wrap up a few things on my last blog from Bolivia (unless something crazy happens at the airport tomorrow!), I now have experienced Bolivian karaoke, have taken every form of public transportation in the city, have walked from one end of the city to the other, have tasted a saltena (like a handheld steak pot pie), had a Bolivian doughnut, drank the best limeade in town, and climbed up a mountain next to the President's guarded house to get to the bridge that connects the city so we could cross on foot.  All of this was done under supervision of course, with the help and guidance (and encouragement!) of my two good friends... and carrying a plastic sack of mega popcorns so that I can bring them home for someone special (starts with a T-h) to taste. 

The people are great, but I can't say that I like the food here.  Some of the best food I had was cooked by my friends for dinner both on Easter and tonight, and it wasn't Bolivian!  Tonight we had tacos, chili, rice, beans, chips, and salsa.  Yum!  I can't wait to have a pizza again, to be honest.  I'm sure I'll have interesting stories from the airport tomorrow morning where Bolivian time will again be in action as I wait in line.  More to come...


Thursday, April 19, 2012

Life (and Food) can be Tough

It's been a few days since my last blog - apologies!  Since Monday, many things have happened.  First, I successfully traversed the mini bus system to my home on my own, a thirty minute drive for 2.30 Bolivianos (less than 50 cents).  Second, I met a friend from church at a place called Dumbo's (yes, the Disney Dumbo, picture and all) which is actually a really good place for dessert.  We had an awesome chocolate almond cake with a funny lemonade and milk mixture that was just ok for me.  The people here that I've met are amazing, really.  Good, caring people.  On Wednesday I gave a presentation via powerpoint (in Spanish - wow!) about a case from UNC Hospital to a group of 30 attendings and interns at Hospital Arco Iris.  It went well, thankfully! 

This week I've been going to the clinics during the morning to see how outpatient pediatrics works here.  This morning, BT set in again, but all was well and I still got to see quite a few patients. Apparently, first thing in the morning (7am), people start waiting in the halls of the hospital clinics for the office to open so they can be first in line to ask for an appointment for that day. If the appointments fill up, they're off to the ER to be seen.  Children under 5 have free health care through an insurance called SUMI, but over that age, it's all out of pocket.  I've seen lots of drug reps going in and out giving away samples to doctors, then seen the samples go right into the hands of single moms with three kids who barely could afford the trip to the hospital. 

I've been reminded recently about how different life is for people here- and how "tough" things can be.  Take first, the scenario above with the waiting room.  Imagine you're an Aymara lady with your bowler hat and long braids.  You've carried your baby on your back from your neighborhood in El Alto (on the mountain, a 30 minute overall trip, bus plus walk) because she's sick and you need to see a doctor.  You've heard about Arco Iris having good pediatricians.  There are only adult doctors in El Alto, plus most of the public doctors are on strike right now and refuse to see patients (true statement).  You successfully get your baby to the hospital (oh yeah, with your 3 other small children at your side), then you take a number and sit...and wait...for 3 hours.  Your child is actually quite sick and needs labs and radiology studies.  If your child is over 5, you pay out of pocket, up front.  You take the order to the lab, pay them, and they do the labwork.  You then take your order for the xray, pay for it, and then are expected to return and pick up the results, then make another appointment with the doctor to review the results the next day.  That means that you have to come right back in less than 24 hours.  You are relieved that, if she has to be admitted to the hospital, you don't have to pay, because the hospital covers the cost.  Life is tough for you.

Yesterday afternoon I called the doctor in charge of ambulances to ask if I could go to a prison or school to see some kids with them.  We went to an elementary school in a poorer part of town where the children had dirty faces and fingers (like many children, I know), as well as wet clothes.  It's been raining a lot here, almost every afternoon.  It made me sad to pat each kiddo on the leg as they moved through and feel a wet pant leg, then notice that their sweaters were wet, too.  They looked at me with their sweet faces and smiled, many with teeth that were decayed, brown, or missing from cavities.  Tough life for some tough kids.

On to a lighter topic which I've seemingly enjoyed this entire trip: food.     

Chicharron (aka "pork cracklings") was ordered as take out for a birthday celebration for one of the attendings today.  This is supposedly a treat for all Bolivians.  I was reminded of my previous encounter with this thoughts went to....
this picture of what my lunch looked like from last week.  Yep, appetizing I know.  You may be wondering what you're seeing above.  Those smaller yellow things are corn or hominy(?).  The ones from my previous blog (where my friend was cutting off the tips before she ate them) were like these, but even bigger.  The black things are small freeze dried potatoes that can last FOREVER and are super popular here called chuno (with a tilde over the n).  The brown things on top are pork.  This is often served, as is every other dish I've ever eaten here with....
Bolivian hot sauce.  So today, the treat for all the interns and docs were take out boxes of the plate above.  I tried the pork again, thinking it may be better the second time.  These things are not able to be cut with a knife - only with teeth, and they still don't work that well.  Five minutes after taking my first bite, I swallowed.  Enough for me! 

Another common food here, which I attempted to drink today, is juice in a bag.  I've seen people drinking juice from the corner of plastic bags multiple times, but today was the first time I attempted it myself.  It took me 10 minutes to tear the plastic corner off of the bag so I could start to drink it, then when I tried, it spilt of course, on my shirt.  Bags are actually used for TONS of things here.  Take out food is placed on a plate which is pre-wrapped around the bottom with a bag, then when done serving the plate, pulled up and tied together so you have a big food bag to carry out.  Oatmeal and milk are served in bags tied together around little straws which stick out the top.  A lady and her husband sell this every morning at the front of the hospital, making some Bolivianos and saving the environment at the same time!
Yep - tough meat, tough juice bags, tough Bolivians.  Gotta love 'em. 

Monday, April 16, 2012

Bolivian time

All is well in Bolivia, including my digestive system (for those of you interested!).  Today was a not-so-interesting day that reminded me of a common topic here that I haven't yet discussed: Bolivian time (BT).  You may be thinking to yourself, "Does that mean that time is somehow different in Bolivia than it is here in the U.S.?"  The answer is yes, absolutely.  That is, the people perceive time differently.  It actually does still go by at the same rate.

I was thinking of this and other deep thoughts today as I sat in the front of an ambulance, watching the people and cars on the street in front of the hospital...waiting.  I was scheduled to go with the ambulance to the women's prison and then to a school later in the day to do check ups and administer medicines.  I'm told to be at the ambulances at 8:00am so we can leave around 8:15 to 8:30.  At 9:30am, we left the hospital.  This was no big deal because, hey, we were starting the day!  Yay!  However, somehow I missed that we had to drop off some important paperwork at the boy's orphanage instead, then return to the hospital for medicine supplies before actually going to the prison.  No big deal, right? 

It depends...  Bolivian time (BT) set in and a few minutes waiting became an hour.  We left the orphanage and went back to get the medicines at 10:45am.  I sat again in the ambulance outside of the hospital waiting on the doctor I'm working with to return.  [Insert Bolivian time]  At 12:30pm he returned with medicines, saying that not only could we not go to the prison because of time spent with the errand of the paperwork at the orphanage, but that we didn't have the needed medicines to go to the school this afternoon.  Bummer!  Someone must have gotten stuck in BT and not picked up the right meds! 

As a "gringo" (or foreigner) here, I and the rest of our team from the U.S. have been forced to accept this new way of seeing the world.   Phrases now have different meanings.   "I'm on my way" may mean, "I'll be there in the next 2 hours."   "Yes, we will meet you at the entrance at 7pm" means "Yes, we will meet you at the entrance at some point tonight."  Even scheduled professional events such as the one I attended with my friend last Saturday night (Selected songs and dances from the TV show Glee) do not start on time. Not even close. ("Show starts at 7:30pm" = doors open at 8:10pm and show starts at 8:25pm.)   Some things start on time despite BT: the movies (more or less) and restaurant reservations...I think.  Also, the church services start pretty close to on time, which I think is important.  (We should at least be on time for God!) 

I suppose at times, BT can be a breath of fresh air, especially when you don't want to rush around and have no time schedule in particular.  Plus, it's important to appreciate other cultures unlike our own.  Because of Bolivian time, people here are (and must be) more patient....well, unless you're in a taxi in a traffic jam.  

There were redeeming qualities of my time spent in the ambulance, stuck in Bolivian time: 1. a chocolate croissant, 2. a lot of great conversation with the driver and a new friend, 3. practicing my Spanish, 4. sunshine (when stepping out of the ambulance), 5. lunch (that's now 2 food items), 6. getting home early to finish my presentation for Wednesday (yay!), and last but not least, 7. a lesson in patience.  Thankfully, during my hours of sitting, my mind wanted to become frustrated and sad because I missed my chance to see things on my last Monday with the ambulances, but I tried to renew my mind.  This verse popped into my head: "The fruits of the Spirit are love (for those in BT), joy (despite frustration), peace (when you want to be angry), patience (enough said!), kindness (to those who made me enter BT), goodness (always), faithfulness (when I'm disappointed), gentleness (when I'd rather be harsh) and self-control (to keep my mouth shut if I have nothing good to say!).  Against such things there is no law." Galatians 5:22.

Friday, April 13, 2012

If it's going to happen....

Who knew that corn could be SO big?!?!  That's what I thought to myself when I saw the cafeteria worker pile up some large yellow things with a red, oily sauce on my plate.  I had asked my friend earlier, "Are those shrimp?" (in Spanish of course) and I got a big laugh in return.  "No!  Es maiz!(corn)".  On top of the corn went some yuca (potato like food) and then some super tough, greasy and salty pork.  This pork was not to be cut - it was to be torn with the teeth and chewed...for a while.  I went ahead and tried the food, as I only have one option in the cafe each day and I didn't bring my peanut butter sandwich today.  I decided that the corn was a good thing to focus on, so I proceeded to eat multiple kernels (each about 1 inch in diameter).  I noticed my friend to my right.  She was cutting off the ends of each kernel before eating them, leaving the small gray colored tips on her plate.  I then became curious.  "So, what are you doing?" I asked.  Then, my friend, who knows that I am the girl from the U.S. who asks everyday about what the food is in order to assess it fully before eating it, tells me that those parts of the kernels give her diarrhea....

Tonight I planned to go with two other girls from North Carolina to a Korean restaurant that we were told was the best in La Paz.  We made our way to the center of the city and found ourselves speaking Spanish to a Bolivian waitress about Korean barbecue while sitting next to Chinese businessmen.  We first had appetizers of sesame flavored spinach-like leaves, green beans, and spicy cabbage.  Then I shared the barbecue (which cooked on an electric skillet like thing in front of us) with my friends.  It actually was great.  I took a big piece of lettuce (that appeared recently washed, though this is a big risk for me right now) and packed it full of sticky white rice, added some sauce, then piled on the beef and bell peppers.  I wrapped it all up and ate it, with a smile on my face!  It was good!  I basked in the goodness of lettuce at that moment, hoping that it wouldn't come back to bite me.

I've made it thus far without digestive problems thanks to my careful choosing of foods, I think.  Last week I slowly branched out to trying any safe-appearing foods for lunch at the hospital.  However....

If it's going to happen, it will happen in the next 24 hours. 

Wednesday, April 11, 2012

Adventure in an Ambulance

I spent most of Monday inside of an ambulance.

Here in Bolivia, ambulances go to schools to do check ups for the children.  In the morning, we examined almost 100 children while sitting on a small bench inside of an ambulance with each child moving through in assembly line form.  First, they were weighed and their heights were measured.  Then they saw either me or Dr. Carlos, the attending doctor I was following.  I asked them their name and if anything hurt.  If so, I asked about medicines that they were taking and many times we dispensed a box of vitamins, a few Tylenol pills, mucolytics, etc....all based on what a 5 year old reported (No parents involved).  One worried 5 year old asked me, "Am I ok, doctora?", to which I laughed and told her that she was.  Then she scooted down the stretcher in front of the dentist who put fluoride on her poor cavity-filled teeth.  One thing's for sure - these children have LOTS of deep, terrible cavities.  Only 1 of the 90+ kids we saw had none. 

Later that day, I found myself in the back of an ambulance taking care of an older man who needed to be transported to his home in Copacabana.  This trip is a 3 hour drive from La Paz.  The ambulance staff from Arco Iris was asked to help with the transport, as he was under hospice care and desired to be in his own home.  I thought I was going along only for the ride.  Little did I know that I would be in the BACK of the ambulance, attempting to keep things from falling and tubes from flying out of this man, while suctioning his nasogastric secretions every 30 minutes and keeping his head straight on the stretcher. 

We left La Paz with sirens screaming and lights flashing, weaving in and out of trucks and cars, going up and down hills, around curves....over bumps....  I can't describe this well enough.  I tried so hard not to throw up...and thankfully was successful.  We weaved up into El Alto, which has to be one of the dirtiest cities I've ever seen.  People, cars, dogs, fumes, children, and trucks were everywhere!  We dodged people and cars while racing over speedbump after speedbump (they use these here I think in leiu of stopsigns...they're brutal!).    I thought to myself, "Never in a million years would I have imagined myself in this situation!"   Finally we got to flat ground, and the view opened up into this picture below - the beautiful Andes.

The next best part of the trip came when we arrived to Tiquini (I think?).  This town is split into two parts by Lake Titicaca, which is a huge lake on the border of Peru and Bolivia.  The road we were on dead ended at the lake and a big flat boat with large wooden planks awaited us (see below).  As I wondered what was happening, I noticed other vehicles on these things, moving across the lake.  Next thing I knew, we drove onto the boat (carefully), and 2 men grabbed very long wooden sticks to push us off of land.  Then one of the men cranked up what looked like a speed boat motor and we slowly inched across the lake.  The man below in the picture has been doing this job for almost 50 years.  The second picture is the view from the middle of the journey across the lake. 

With gastric secretions on my ungloved hands and a patient who was breathing harder with an almost empty oxygen tank, we successfully made it to Copacabana.  We pulled up to the house and carried him inside, only to find that in a few minutes after being home, he would pass away.  Sadly, we said goodbye to the family and went to the "tourist" area for dinner.  I had trout with potatoes and rice (of course, the carb duo of Bolivia).  We then grabbed some pasancalles (HUGE popcorns that are chewy and sweet - que bueno!) and made our trek back to La Paz.  We almost missed the ferry back across the lake!  It closes at 9pm, and we arrived at 9:20 - thank goodness for Bolivian time!  (Bolivian time = at least 20 minutes late).  After hours of sitting sideways, listening to Flamenco music, eating huge popcorns, and being stopped and questioned by police (standard procedure on the roads - no worries!), we made it back home to Calacoto (my neighborhood). 

What a day!

Tuesday, April 10, 2012

La Via de La Cruz

This means the Way of the Cross or the Walk of the Cross.  On Good Friday, La Via de La Cruz is a Catholic tradition that many people attend from different churches/districts across the city of La Paz and across Bolivia.  There were 20 or more different walks in La Paz on Friday.  My friends from here were invited by a couple who comes to their marriage class through the church, so I went along as well. 

We started in the middle of the street in a neighborhood called MiraFlores (note: middle class neighborhood).  I first noticed a large group of people (above), four of which were carrying a casket with a mannequin inside with blood stains meant to represent Jesus.  They also carried, further back in the crowd, a figure that represented Mary (who wore purple, but had a blue poncho when it started to rain).  The people in the streets walked from station to station, 14 in total, down the street.  Traffic was stopped for this procession.  Certain store owners asked that their store fronts be used for the walk (see below).  At these store fronts, the owners usually decorated, and the Jesus and Mary figures were placed on a table while the priest read verses and led prayers.   The procession in total lasted about 3 hours.   

How interesting are the different traditions in different cultures!  I know many Catholics in the U.S. do something similar to this in churches across the country for Good Friday. 

Saturday, April 7, 2012

Changing Lives with Taxi Drives

Taxis are the way that we get around here in La Paz.  I have spent most of my taxi rides with my brothers and sisters from the church in North Carolina who are now here working with HOPE (an International project started by the church) and who are helping spread the news of Jesus to the people here in multiple ways.  These ways include working directly with the church and its disciples here in La Paz, with leading Bible studies/marriage classes, with working with the orphans and children who live on the streets, taking taxi rides.  I've gotten to know Raul, Bernandino, Gabrielo, and many other drivers during my short time here thanks to my friends who initiate conversations with these men.  During many rides, we just chat about the city or how our Spanish is not great.  Others involve more personal conversations about family and God.  Many of the men have thanked us at the end of the ride, and even asked more about our faith.  The point is to love like Jesus did so that they may come to know Him.

Orphans and street children have been supported here in La Paz by Foundation Arco Iris (Rainbow Foundation) which was founded in 1994 by a priest from Germany named Padre Jose.  The main goal of the foundation is to help the children in La Paz, many of whom are homeless and who have no caregivers, left to live on the streets.  Arco Iris therefore started many social projects (an orphanage for girls and boys, homes for teen mothers and their children, "pass through" houses for teens who abuse drugs and children on the streets) as well as a hospital (Hospital Arco Iris).  The objectives of the hospital were first to be the "sanitary prevention and rehabilitation" of all of these children, as well as "basic health training" according to their website.  Currenly I'm working in this hospital.  It continues to serve children from the city and has traveling clinics for prisons where children must live with their parents if the parents are put into jail.  There's no such thing as foster homes here (I've asked), just adoption, which occurs rarely.   

The first time I went to the orphanage (called Ninas de Obrajes or Girls of the neighborhood Obrajes), I rode in - you guessed it - a taxi with other ladies from the church.  We brought with us 2 big bags full of games, cards, and suckers for the girls.  As we pulled up the stony, steep hill, I wondered what this orphanage would be like.  We were allowed in through the gate and were met by group after group of excited girls running towards the lady from my church and her daughter who have been here for 7 months and have become like a mother and sister to these girls.  They were so excited to have our time and attention.  The girls range in age from 5 to 18.  After 15 years of age, Arco Iris helps find jobs for the girls so that, when 18 years old, they can transition out to a job and find a place of their own.  Children here go to school either in the morning OR in the afternoon with a lunch break.  The older teen girls will attend school in the morning, for instance, and work in the evenings.  I've made friends with 4 of the teen girls who now think I'm a good way I think!  We talk about music and food - they make jokes with me about funny Spanish words, and we all laugh together.

I've only gotten to go to Ninas (the orphanage) a couple of times so far, but these times have made a huge impact on me.  I've spent much of my time with one girl who I'll call Valerie.  On my first visit, she wouldn't speak, but played games with me and showed me how to make bracelets.  She is new to the orphanage and says very little to anyone.  She's 12 years old.   The next day I returned and spent most of my time with her again.  She opened up about her life, how her parents died when she was young, and she has a grandmother and aunts and uncles that she hasn't seen in over 1 year.  She's unsure where they live now.  She has no other family, and has been moved to this orphanage recently.  I remember her face when she said, "They didn't want me".

HOPE's goal and our goal as a group of Christians here is to love kids like Valerie.  We are doing our best to also love the teens who are abusing drugs, the moms who are attempting to get out of their lives of prostitution, the children of these moms, and the staff and workers who work so hard to keep these organizations running.  We love them by providing their needs (food, clothes, health), by helping them find ways out of their situation by giving eduation and providing job opportunities, by being their friends and family they never had, and by telling them the truth about why this is important - because Jesus did it.  They, just like everyone, need to know. 

My apologies for finally sharing with you all the important things about this trip. 

Friday, April 6, 2012

Worth 1000 Palabras

Per the request of some special people, these are more pictures for your viewing pleasure.  Above is the view of my house from the end of the driveway inside the large metal gate.  The car belongs to the lady who lives with me (whose parents own the home).  Note the large apartment building being built directly behind it.  It may be hard to see, but just behind the door of the house is Shadow, my terrier mix friend who is - you guessed it - black.  He's here with me now, in my room because he is super afraid when nobody's home (lots of scratching and barking).  He's also deaf, which makes for a challenging situation with a dog who is barking.  He says hi to you all (he's looking at me right now). 

Above is a great example of an unfortunate form of artistry that's seen all over the city: graffiti.  I don't think I've seen one city block without it.  What you see above is a normal street in La Paz in a neighborhood that's known to be "middle class".  Most of the day, the stores have open doors (I think I took this before 8am).  Also note the low hanging electricity wires.  (Apparently there is a tourist bus that's double decker where you have to duck at times to dodge the cables.)  Low hanging wires remind me of one fun fact that I haven't shared yet: I am taller than half of the people that live here.  Yes, that's right.  All 5 feet, 3 inches of me is just the right height in La Paz, Bolivia. 

Above is another view of the city from a community called La Bitana in the main part of the city.  Note the mountains in the distance.  The views here are amazing.  Just today I noticed for the first time a snow-capped mountain in the distance which was outstanding! 

 Another fantastic view. 

An interesting sign (of course with graffiti) that I found walking the street today during the "Walk of the Cross" which is a Good Friday tradition in Bolivia.  The sign must be from years ago...?  It says "Tuberculosis is cured...with directly observed treatment by the health [department]".  Also see behind the sign that the mountains appear to be dirt and not rock.  This apparently is true, making mudslides a common occurrence during the rainy season. 

Bolivians looking down to the street from their apartments.  Most families have little to give, but lots of love to share.  

Thursday, April 5, 2012

Expectations - Updated

I commented on expectations in a previous post.  Really, I had no idea what to expect from La Paz or Bolivia.  Here's a follow up to some of my previous thoughts.

Language: Yes, the people here speak Spanish, but of course, there's a different dialect and special Bolivian phrases that I'm starting to learn.  I'm filling my ears and head with medical Spanish all day long right now, and it's quite overwhelming.  I've learned so much in 3 days (charts = carpetas, daily notes = valoraciones.  Why not "notas"?  I mean, come on!)

People: Yes, there are many with dark hair and eyes, most very nice.  The general clothing styles vary enormously.  While walking down the street, I've passed an Aymaran woman with the long colorful skirt, flat shoes, thick socks and Bowler hat with braids, then seen a contemporary business person in a suit and tie while walking by a group of young girls in cute boots and jeans.  Most I've found very friendly and helpful.  I work with another resident and a "medical doctor" (which means he's finished med school and intern year and is now a general doctor until he picks a residency).  They are super nice and SO patient with me.  Today Roxana helped me find food for a late lunch and then hailed the RIGHT kind of taxi for me since we got out of work late.  What an awesome Boliviana!

Transportation: There are 5 modes of transportation here: bus (a green "microbus"/school bus), minibus (small van where people pile in and ride together to main destinations), regular taxi (you pick up other travellers and all pay about 3 Bolivianos/ 50 cents), radio taxi (what we think of as a normal taxi), or of course walking.  Seat belts and stop signs are rareities.  Be ready to crash into a person or another vehicle at any moment. 

City: Most streets are paved, but many closeby my house are stone (making car rides super loud ).  The picture above is from the main part of the city (I live in the Southern Zone with newer buildings).  The streets curve and wind around mountains and hills.  Buildings in most of the city are spray painted with graffiti and look very old.  Just walking is a task in most of the city because of the hills and stone streets.  

Hospitals/Healthcare: On my first day of work, I pulled up to the front door of the hospital not knowing what to expect.  As I walked through the front doors at 7:30am, there was a waiting room filling up with people waiting to be seen in clinic.  There are 4 floors in the hospital, the third floor being the pediatrics floor.  I've found that, in general, the patients are cared for the best that can be expected given a huge lack of resources.  I've only worked in the NICU/PICU up to this point.  Each ICU room houses about 3 babies.  There is a huge effort to encourage hand washing at the hospital, so each of these rooms has sinks with soap and alcohol gel.  Gloves are hard to find. 

The general pediatrics floor has multiple large rooms (about 4-5) that house 6-7 patients per room.  There are no curtain dividers for rooms, and only 1 private room on the floor.  The "respiratory" room had 6 children all with respiratory infections placed together with room only for a chair between beds where their mothers sat.  Nobody was wearing a mask.  Another large room housed 6 postpartum mothers with their newborns at the bedside and as many other family members that you could fit.  Parents, family, and other patients line the hallway.  On my first day, my attending doctor was pulled aside multiple times just in the hallway for questions about kids (not in the hospital or clinic), and was writing prescriptions and handing them out.  He is a busy, busy man!  (He's less busy the past 2 days since the private doctors in the city stopped their strike.)  Early in the morning, the "interns" (med students in their 6th year of school) are busily typing their daily notes on typewriters, filling the hall with the loud clicks and clacks.  The ICU has one computer that we use for some of our notes.

In the NICU, there is one "certified nurse" (RN) for all the patients.  We have had up to 12 patients.  That's right.  Today, I realized how outstanding this lady is.  We had a very busy day and the RN was literally running around, sweating, trying to do all the work that she could.  She has about 2-3 "auxiliary" nurses that help her with tasks and 1-2 other staff members, thankfully.  In the U.S., there is typically 1 nurse to 2 ICU patients.  Other interesting facts: x-rays are reviewed by holding the small film up to the window or light and certain labs have to be driven by a med student via taxi to another hospital across town to be run by the lab.  Despite some problems with resources, the hospital has access to pediatric neurosurgery, pediatric surgery, genetics, and multiple other consultants.  People work hard to take care of their patients.  I've been impressed with the people, and saddened by the lack of resources.

Food: I've been super conservative with food choices.  The only Bolivian food I've tried was some sort of country fried steak with french fries and today an egg and cheese tortilla with a boiled potato.  Hmm...  Otherwise, I'm sticking with peanut butter and yogurt.  We'll see how this goes...

Wednesday, April 4, 2012

A Comparison: Part 2 - La Paz

Currently I'm sitting in a house that belongs to a family originally from Spain who came to Bolivia many years ago as a part of Spain's conquest of this area of South America.  They have a brick house with a full, metal security gate and barbed wire around the top of a surrounding brick wall.  On the grounds are 2 small guest homes and a nice yard with flowers and a stone driveway.  There's a car parked out front, that usually stays parked as walking or taking taxis is the norm here. 

My room is spacious - with a bed, a desk, a closet, and my own bathroom.  The shower has hot water immediately.  The heating for my room comes from a convection-type heater along the bottom of the wall.  My window looks out directly into a construction project for a new large apartment complex.  During the daytime hours I hear the sounds of people hammering, shouting, working to build another tall building to surround this old home (think about the movie Up - the setting is just like that with the tall buildings around a small house).  There's one light in the room - hanging from the middle of the ceiling.

Outside I can hear the construction and sounds of taxi's honking (they honk as they fly through intersections - no such things as stop signs around here apparently).  Dogs are everywhere!  They have ability to roam as they'd like.  They walk on the streets next to you in groups of 2-3 most of the time, all different sorts.  Apparently many are pure bred according to the people who live here. 

I'm about to go out to the street and walk 2 blocks to my friends' house where we'll take a taxi together to church tonight.  It'll probably cost 20 Bolivianos for a 15 minute ride (about $2.75).  I've got to wear shoes good enough to walk on bumpy stone streets (though most are paved with asphalt).  I'll say hi to my friends with bowler hats as we pass by each other on the sidewalk. 

Monday, April 2, 2012

Bowler hats

I keep seeing these amazing Bolivian women called the Aymara who are an indigeneous group in this country.  [This photo is not my own - I haven't snapped one of a person at this point!]  Most of them live outside of the city of La Paz in the country or in El Alto, the city to the north of La Paz where many of the poor live and migrate into La Paz to work.  The thing I love about these women, having only spoken to one in my life (the lady who works as a "maid" in our house), is their bowler hats.  They also wear flat black shoes, long flowing brightly colored skirts to below the knee, and always bright colors on a scarf that's tied around their neck or shoulders.  Their hair is long and black, almost always in 2 braids, and on top of their head sits a bowler hat like Charlie Chaplin's.  These hats in the picture above MAY fit, but most that I see are obviously too small.  But so stylish!  Many of them appear more Native American with sharper facial features.  Younger women carry babies on their backs in these brightly woven sacks with 2-3 children at their feet.  They sell things on the street, from shirts to foods.  They are in all parts of La Paz, selling their goods that they've gathered in the field or made at home.  Bernie, the maid in our home three days a week, is an Aymara who lives in El Alto.  She has no bowler hats that I've spotted (unfortunately).

I'm starting to learn about Bolivia and it's past.  They were a colony of Spain for hundreds of years, so for most of recent history until about 20 years ago, there was a huge separation of classes (caste system) between the rich "White" people of Spanish descent, and the poor indigenous populations (like the Aymara above).  They live and work in different places - the rich with the money and poor with little of it.  There has emerged a middle class here of sorts with business people, lawyers, doctors (who get paid little with socialized medicine and most of whom have 2 jobs).  However, it is still required to pay for medical care in most places and the rich fly to other countries to get better care than what is offered in La Paz.  I'll be learning more about this in the coming days. 

Another problem here in Bolivia: money for social programs to help children without parents, street children, teen mothers, better education for children of the working poor.  Thanks to Foundation Arco Iris (Rainbow Foundation) which was started about 15-20 years ago, many of these programs have been started and continue on with funding through the Foundation.  It runs on volunteers and attempts at self-sufficiency with bakeries and clothes-making businesses.  The Hospital where I'll start tomorrow is another part of this Foundation's work.  

I tip my bowler hat to all of you - thanks for reading!  And more to come....

Sunday, April 1, 2012

Fish out of water

That's what I felt like in the Ketal supermercado yesterday.  I needed some snacks and bottled water, so what better way to branch out into a country and culture than to go shopping in my local supermarket?  Turns out, this had to be one of nicest markets in La Paz.  I've found out that my community (Zona Sur and the Calacoto community) houses some of the wealthiest in Bolivia, making it a bit safer for us to live here.  Don't get too excited - this was no Publix or Harris Teeter...or Food Lion, or Wal-Mart.  Here's where the fish out of water comes in...

I walk into a nice appearing establishment and was happy to find that they provided buggies AND bags for carrying!  (In Spain, buggies weren't an option, and paid for those!  Even the plastic ones!)  What small conveniences that we take for granted!  I walked straight into the section with the worst reputation of them all: the dreaded produce.  [See previous blog.]  This area of the grocery store felt off limits.  Almost as if I needed a mask or gloves or something.  (The meat guy did wear a mask that normal?)  I looked around, just out of curiosity, and I was only deterred by the pile of apples that increased my doubts about my previous apple ingestion.  So I moved on, noting only the mountains of potatoes.  [Fast fact: out of 600 different types of potatoes in the world, Bolivia grows 400!  They love them here!]

Then I turned to find the meat section.  More reminders popped into my head: "Don't eat ANY raw meat.  Only totally cooked!  You don't want to be sick for weeks!" In front and all around me all of a sudden appeared piles of plastic wrapped RAW MEAT!  Yikes!  Chicken, pork, beef, more beef.  The meat guy with the mask then walked out, and I immediately fled, not to return.  Not even lunch meat would be acceptable to buy at this point.  Next up: cheese.  I'll be honest.  I had no idea what I was looking at.  The only thing familiar was the Philadelphia cream cheese box (3 times more expensive than the other items).  Otherwise, the random assortment of letters for the trademark with a "QUESO" under it left me baffled.  Is it goat cheese?  Cow cheese?  Soft, hard, in between?  Do I just eat it alone?  Where are the slices?    Do they eat those here?

Keep walking.  Yogurt seems safe to me for some reason.  I found some reasonably priced peach and strawberry yogurt with a Spanish label and put 2 in the cart.  First items in, check.  OH!  And bottled water!  Found it on the end of the aisle - that was easy!  I put an 8 pack in the buggy and then I felt like a bonafide Bolivian grocery store shopper, stuff in my cart and all.  All I need now is a bowler hat.  (See coming blog post.)

I then proceeded to wander around every aisle, just to see what they had.  I had found out that 1 dollar is equal to 7 Bolivianos, which makes everything in the store seem super expensive.  First thought: "What?  $35 for granola bars?!?!"  Not the case, but I still couldn't bring myself to buy them.  I later eyed the juice from afar, but didn't go for it.  I found out this morning that juice comes either in large boxes or small packets, like Hot Pocket-sized things.  The lady I live with gave me some of these little packs for breakfast.  Thinking it was yogurt, I popped open the bag with my fork and pushed out the contents when all of this pineapple juice went rolling on my plate.  Then I thought, well maybe there's chunks of pineapple in here??  I then pushed harder and only more juice came out!  Looking around the kitchen, not knowing what to do next, I just picked up my plate and tried to drink the juice.  Yeah.  Mom would be proud of me for this one. 

Conclusion: My tribute to coca tea.  This pic is from my welcome pack from the team of people working here.  Thanks to Diamox and coca tea, I'm still altitude sickness-free.  Thank you coca!

Saturday, March 31, 2012

Apples and altitude

I've never thought about altitude sickness until this trip.  I've been to Colorado for a few days to ski, but I've never climbed Mt. Everest or lived in the Alps like Julie Andrews.  La Paz is apparently 16,000 feet high.  I'll do my stats, but I'm pretty sure that's higher than the Rockies.  These are the Andes!  Last night as we flew in, it was hard to see the mountains, but as we drove into La Paz from it's neighboring city El Alto, it was a downward spiral around mountains and cliffs with beautiful lights from the homes that dotted the hills. 

Altitude sickness apparently is due to the decreased about of oxygen in the air.  It's your body adapting to this change.  Your pH gets thrown off I think as your body becomes more acidic and your bone tries to make more red blood cells to carry oxygen around to your organs.  It manifests as nausea/vomiting, headache, weakness, fatigue.  The cure for Americans: prevention with a diuretic called Diamox (pre-treats you make you more acidic beforehand so you can catch up sooner), then hydration.  The cure for Bolivians: coca tea.  That's right, it's the plant that ends up becoming cocaine when super concentrated.  It's actually illegal in the U.S. (so I won't be bringing any home).

True confession: I'm currently on my 4th glass of this today.  (Per the recommendations of the "gringos" who are from the U.S. now living here. "Drink as much as you can!" they say.  "It only helps!")  It's just like green tea, no big.  And currently I'm headache and nausea free.  The only symptom I JUST had was muscle pain on the way home from the store carrying 2 2-liter waters and another 8 pack of bottled water.  I'm better now! (as I sip on my tea...)  More to come on my grocery store experience today....

On the drive in from the airport, my new friends Gwen and John were giving me all the hot tips on living in Bolivia (including coca tea).  One big piece of advice: don't eat cut fruit.  If you REALLY want it, you have to wash it in a bleach bath first.  Wow.  I'd heard that bananas or things with skin may be ok, right?  Next tip: to be safe, don't eat meat that's in any way not cooked fully.  Better yet just to become a vegetarian at this point maybe.  AND watch out for that running water!  Bottled water only, even for tooth brushing.  Yikes!  I knew I was sunk when the first thing I did before bed this morning was put a big handful of sink water in my mouth.  I froze.  Oops.  I immediately spit it out and rinsed with that life saving bottled water!  Hope that did the trick.  :)  This morning I stood staring at my breakfast: bread, honey, butter, and, you guessed it, green apples.  Apples.  Did they say anything about these?  Are these off limits?  I pondered this thinking first, well, I'm just not going to do it.  Then hunger and the thought of a fresh apple overwhelmed me and I went for it: took the apple to the sink, washed it with [bottled] water, cut it into wedges, and carefully ate only the insides of the wedges.  No touching that skin!

Hope that worked. 


Hi all!
I'm here!  And tired... so not much blogging to be done right now.  I got a taxi ride with my friends from the church here who met me SUPER early at the airport this morning.  It took a while to organize getting my tourist visa ($135 dollars cash on demand plus multiple forms), but I made it out as a legal Bolivian tourist with all my luggage and now am in a comfortable home in the Zona Sur (South Zone) of La Paz.  I plan on sleeping for a while.  More to come... (The Internet works!)

Friday, March 30, 2012


I had low expectations for dinner tonight at the airport (see previous blog).  I found La Carretera, a Cuban meat and three, and was I surprised!  No Manchu Wok here!  I stood there with my tray and silverware looking around at all the Cuban meat selections and various rice mixtures asking the workers, "What's the best?"  The lady responded to me in Spanish,  "Whatever you prefer, really, " with an unsure look.  Then the man to my right pipes up, "Do you like pork?"  I said sure and followed his lead.  I ended up with a fat-filled shredded pork mixture with some dirty rice (with black beans) and, you guessed it, fried plantains.  (Picture to come.)  Super awesome. 

So what are my expectations about Bolivia?  To be quite honest, I have no idea what Bolivia is like other than I expect that they speak Spanish.  What else?.... I think that the people will have dark hair and dark eyes and generally be more tan than I am.  They will be very friendly to me, a "gringo" as they say.  I expect most areas to be poorer than where I have lived and spent my life - gravel roads, no super nice shopping establishments or malls.  Somewhere there will be large markets with meats, vegetables, flowers, maybe hats?  I heard it's super sunny.  I know for sure it's at high altitude, but not sure what that means other than great mountain views maybe?  Hot water will be short lived if present.  And the food?  Really, I have no idea.  Maybe rice and beans?  Do they eat tortillas?  I don't want to be one of those people who think that every Spanish speaking country eats tacos.  Trust me, this is not true.  Not one taco in the country of Spain.  I know, hard to imagine, right?  They don't even know what tortilla chips are in Spain!  How bout that?!?!

And healthcare in Bolivia: again I have no idea.  Are there thousands of boxes of non-latex plastic gloves lying around for every patient encounter?  Sinks in every room?  Alcohol foam at every door?  Computers?  Hmmm....

Post your thoughts on this!


These bustling, hectic, and unique establishments are such interesting places.  Even in Raleigh, NC you can find such a variety of people headed in different directions or, more surprisingly, the exact same city as you.  Well, I haven't found anyone else going to La Paz, Bolivia yet except for me, but I'm not asking around necessarily.  I found most people on the plane were headed to the Keys or one of the Caribbean islands for vacations.  Fun!

I'm writing this in the Miami International airport.  Current setting: a table against a wall next to a coffee shop.  No plugs to be found.  I'm paying $8 to use their Internet, and they don't supply plugs except for once in a 1/2 mile stretch of the terminal where there's a column self proclaiming to be a "media center" where there are 3 plugs available.  What I'm hearing and seeing: a man walks by audibly huffing and puffing to get to his gate (hope there was no chest pain involved), Spanish words fly all around as tall tan ladies in strappy high heels push through the crowd in short skirts, techno music in the distance, a wall of faces of 100 Miami Latinos looks down on me ("A Journey of Success"), a nice African American man asks me about Internet access, a hot pink shuttle flies by carrying people, and I see the 10th person holding or reading Hunger Games.

That's right, Hunger Games is everywhere!  For those of you that don't know, the Hunger Games is a book that has recently been made into a movie.  It's a part of a series, and I think that since the movie's now out, it has exploded into everyone's personal novel collections.  It's in my purse right now, it was in the man's hand behind me in security, and I have reason to think that almost every individual in the airport has it hidden somewhere on their person (if they know what's good for them).  Gotta see that movie when I get back!

Speaking of security, what an experience!  I feel that almost every person, after going through security, has some very mild form of PTSD, or maybe just anxiety reaction.  There's so much pressure to perform!  I'm working on perfecting the skill of removing my shoes and taking the laptop out from the backpack while placing 4 buckets on the assembly line all at the same time. 

Well, I'm now about to embark now on the challenge of finding food that is appealing and yet not extremely expensive.  The main choices I've seen so far include a few different types of Mexican restaurants (usually the word "Tequila" is in there somewhere), mixed with Manchu Wok and Nathan's hot dogs.  We'll see what happens! 

Thursday, March 29, 2012

A Comparison - Part 1: The United States

Currently I'm sitting in a townhome that I'm renting with my husband.  We live in a complex with paved streets next to a nice lake with a fountain.  There are cars out front, my Honda being one of them.  Our second car is in the garage in the back.  Most of our neighbors are young couples with lots of pet dogs that they frequently walk around the lake.  I'm on the second floor in one of our three bedrooms at a desk using a laptop.  Tonight for dinner I ate a piece of pizza and multiple various and sundry snack foods (we had people over) including broccoli, Ranch dip, grapes, tortilla chips, Velveeta and Rotel, and chocolate pie.  I used my cell phone to talk with my mom for a while, then I watched TV for a few minutes.  Later tonight I'll go to the bathroom where I'll turn on the sink to wash my face and brush my teeth.  I'll plug my cell phone into the wall and set my alarm.  Then, I'll put one more sweater on the suitcase full of clothes in preparation for tomorrow when I fly to my destination: La Paz, Bolivia.