Thursday, April 5, 2012
Expectations - Updated
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...