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. 

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