R&R in Bolivia- SB2011

Tuesday March 1, 2011

My first three days in Bolivia have further opened my eyes to the realness of culture. Its hard to believe that in a world where one can be taking a medical exam in Chicago on Friday at 4 pm but arrive over 4,000 miles away less than 36 hours later that cultural difference are still capable of persisting, but it’s very real and it’s a nice surprise. While I love the American way of life, it’s refreshing to find that on a Sunday morning in Santa Cruz, Bolivia the streets are eerily empty, the stores are all closed aside from a few cafes and supermarkets, but the central plaza is filled with people of all ages sitting on park benches chatting and reading quietly to themselves. As I strolled the plaza I thought to myself, when was the last time that I had a day where nothing needed to be done? Where no textbook needed to be studied? No errand needed to be ran? No appointment scheduled? I sadly couldn’t recall. It certainly wasn’t a weekly occurrence. I thought this could be nice to spend the afternoon reading in the park. I found an open bench and opened my new free reading book- Cutting For Stone. I must have read the first 10 pages over and over again. I felt uncomfortable just sitting reading a book in a foreign country; there must be something to see, somewhere exciting to hit on the to-do list. But there wasn’t. So I convinced myself to sit and read for at least another half hour. It was refreshing.
The next morning I was eagerly awaiting my afternoon meeting at 3:00 and the patient neurology consult at 4:30. Finally, something to do! We arrived for the meeting a bit before 3 pm to find the doors to the clinic locked. We waited on the street for the next 30 minutes before being let-in by one of the receptionists. After another 20 minutes, the physician with whom our meeting was with finally arrived. However, he needed to see a patient first. We just sat and waited. It was now 4:30, still no meeting, but we had another appointment to be at. So we left, without the meeting. If that wasn’t frustrating to a timely American like myself, the afternoon just got better. We arrived about 10 minutes late to the neurology consult to discover that the patient was unsure how to get to the appointment so rather than call for directions, he just decided not to come. Therefore, the consult would be rescheduled for the following day. Two and a half hours after departing the house we had accomplished nothing. If I hadn’t been on vacation, forcing myself to embrace the culture and whatever came my way, this would have really irritated me. I learned that this is a common practice in Santa Cruz. Whether it be lunch dates with friends or business meetings, people come when they are ready and no one (but the Americans) seems to be frustrated or bothered by this lateness. I even asked one of the coordinators who had been there for months have you figured out what “late” means here? Meaning, if someone says 3pm does it mean 3:30, 3:45 or 5:00? She said it all depends and sometimes 3pm actually does mean 3:00 sharp. I think this is one cultural phenomenon that I am incapable of adopting. How does anything ever get done? It seems unfathomable in my mind, but it certainly must work for them. Imagining these exact same scenarios in the states makes me chuckle- the outcomes would have been very different.
The final cultural aspect I was bombarded with was on day number 3- Tuesday morning rounds at the hospital. We arrived a few minutes past the seven am start time and had to tip-toe quietly into the presentations that had already begun (see some things do start on time). It was a small room filled with rows of young people in white coats and what I inferred to be attendings in standard business attire. One resident presented his case and was promptly questioned and “pimped” by the chief at the front of the room. While the dialogue was completely in Spanish (so I wasn’t able to fully grasp the medicine), this meeting appeared to be extremely similar to rounds in the US. There were many doctors nodding off, some were eating their breakfast, others were coming and going and having side conversations about patients. Aside from the dialect I could have been right back at Loyola. The rounds on the ICU floor were also very similar to those that take place in the states. A resident presented the patient to their attending and was promptly instructed on how to improve. A small insight into how my third year might look. The discussion of patient care, the questions that needed to be answered, the medicines that should be dosed were all extremely similar. I sat in the lobby afterward trying to make sense of or take note of what my first few days had shown me. It took some time, but I realized that every country and every profession has their own culture and when you aren’t accustomed to it you feel uncomfortable and sometimes uncertain in how to act. While being at the hospital, I didn’t question my actions or my role. I struggled certainly with trying to understand the language, but I knew how to fit into the medicine culture. This was not so in my other adventures of the week. I also wonder at what point did I suddenly become comfortable with and accustomed to the culture that is medicine? Has it really only taken the past 18 months of medical school or did I learn this customs earlier in my life? If its true that I only learned them recently, then certainly it could be possible to adapt to a new culture or a new way of life in another country. I suppose there’s hope that I might one day be able to not feel uncomfortable without having a task at hand or be okay with a meeting that takes place 90 minutes after it was supposed to.

Saturday March 5, 2011

I'm now at the clinic and its more fun than the city of Santa Cruz, but it certainly comes with its challenges. Yesterday I saw a man who had come to the clinic in November and was diagnosed with kidney stones. He was sent on a consult with a nephrologist in Santa Cruz. For various complicated reasons between x-rays being lost, translation errors and not being able to reach the gentleman by phone he was told that he 100% needed surgery to remove the stones in early January, but he had returned to the clinic in March not aware of this. Can you imagine? I certainly cannot. Consistent painful, destructive kidney stones for four months! Obviously, all of us understood the importance that he needed to get this surgery as soon as possible. Well, the difficulty became that once we spoke to the Nephrologist he was able to see the patient that afternoon and potentially perform the surgery the next day. If not, then it was Carnivale and the nephrologists would be out of town for the following month. In the US you'd simply drive your car to the doctor have the necessary pre-operative tests at the hospital and be set for surgery; that was not the case here. Someone had to drive him to a nearby town (ie about 50 minutes from the clinic) for the xray and ultrasound and then we had to give him money and directions to take a bus to the doctor in Santa Cruz (another 90 minutes or so from that hospital). It was not the easiest plan to execute, but it was done. I don’t even want to think about what happens to individuals suffering from these ailments who are without an advocate from a clinic like this.
In the afternoons I have been traveling with Alice, a clinic coordinator and Maria, the clinic nurse, to the various towns that the clinic serves to help implement a new de-parasitization program. We spend the first few minutes presenting proper food handling and safety to avoid contaminated their food with parasites and then Maria discusses the importance of and the meaning of proper nutrition. We then proceeded to get the heights, weights and ages of all children who attended and provide them with albendazole and Vitamin A. On our last afternoon we treated over 80 kids in the afternoon ranging in age from three to fifteen. It was also Carnivale starting that weekend so the younger children were running around the school wearing homemade masks, painted on beards and banging on improvised drum sets. At the end of the afternoon I was beyond exhausted and ready to head back to the clinic for a cold shower and a nap when we were invited by one of the families to stay for dinner. I should have been elated and grateful, but instead I was irritated. I grudgingly (not visibly) drove to their home where they were preparing a homemade sopa for us. As we sat outdoors under a large collection of trees, dogs and roosters milling around us, listening to them discuss local politics and concerns my irritation quickly dissolved. Here I was a guest in their country and their home and I was being ungrateful because I wanted to what, sleep? Ordinarily being a conversationalist I tend to monopolize conversations in the states. However, with my fatigue and my sadly deteriorating Spanish skills I spent the next hour mainly listening to the conversation. It was a nice change. It was interesting to hear their thoughts and concerns. I feel blessed that these individuals had been willing to allow me to be part of their lives. Needless to say, it was a fulfilling day on so many levels.