Palacios, Bolivia

I can't believe this adventure is almost over. It has flown by. We've treated way more patients than I expected, and I am pleased that I am finally able to communicate a little better with our patients and clinic staff. My favorite experience so far has been traveling out to the surrounding villages. Although, frustrating due to our limited resources on site, we had a great time presenting our public health interventions about oral hygiene to 40 children in one village.

The most difficult situation I have dealt with on this trip has involved one of our patients, who was so severely anemic that his hemaglobin level was 4. He was almost white, he was so anemic. To make a long story short, he was taken to the nearby "hospital" last night, and our whole stritch team was blood typed this morning to determine if any of us could donate blood. Two of us matched his blood type, O+, leaving us the only two with the pressure and responsibility of deciding to donate our blood to this man in grave need, or not. All eyes were on us to help this man, who needed our blood, and at the same time, the two of us had seen the conditions of the hospital...not an ideal place to have people mess around with your blood. To me, this posed an ethical issue, and two of us were stuck in the middle of it. We came to Bolivia to offer our voluntary services, and our limited medical knowledge, so did this mean that we were also expected to willingly have our blood taken, even if it meant potentially risking our own health?

Western Influence...the Good, the Bad, and the Ugly

Everyday in the US, we go about our day bombarded with the signs, symbols, and propaganda of the Western world in all its glory. Yet, we hardly notice the tacky billboards, neon signs, and human interactions that indicate the "development" of our civilization because they have become such an accepted part of our lives. It is only when we enter the developing world that we are made acutely aware of the influence of our "developed" ideals on the people and culture of developing countries. During my time in Ghana, I have become increasingly aware of the Western influence present in the country, specifically the city of Kumasi. Don't get me wrong - the Western influence is not 100% detestable...it has its shining points alongside its downfalls.

As you drive through Kumasi and its outskirts, you experience street vendors (children, adolescents, grandmas - all walks of life) walking up and down the streets selling their goods. Upon entrance to Kwame Nkrumah University of Science and Technology, you pass through gates guarded by men stopping cars in the hopes of obtaining money. Huge billboard advertisements are everywhere - encouraging passersby to indulge in FanMilk or to choose Vodafone over MTN or Zain for cell phone service. The market in Kumasi is one of (if not) THE biggest markets in West Africa - full of people selling food, shoes, handbags, and of course Ghana Black Stars memorabilia. TV shows, commercials, and music videos all portray lives of lavish...something experienced by only the most elite Ghanians. As you drive down the streets of Kumasi, you are struck by the number of people who are doing more than "trying to make a quick buck..." - they're trying to make a living.

While in Ghana, I was surprised at how shocked I was by the overwhelming amount of advertisements...of course there are just as many hideously tacky billboards proudly paraded all over our nation. I was surprised that men guarding gates would stop cars just to get money. I was overwhelmed by the number of kids walking the streets, trying to make money, instead of going to school. Perhaps clarification came to me as I watched a music video commercial during the World Cup. It exemplified a lavish life of driving around in a BMW, a person surrounded by wealth and happiness. It was in this moment I realized how much developed Western nations have influenced the attitudes and culture of select less developed countries into nations obsessed with the acquisition of money and material wealth. It is almost as though Western influence has caused some nations to undergo an identity crisis...the "Western life" appears so appealing that it causes people to "forget" their roots in an attempt to reach "greener grass."

Yet, I also consider the "good" of Western influence on developing nations. Although we appear to be (and arguably are) a society of material wealth, we are also a society of dreamers and goal-makers. We are visionaries. Through this, we show people in other nations that dreams can become reality. Goals can be achieved. While I feel ashamed that the focus of money and material wealth rules the Western influence on developing countries, I delight in the idea that the Western ideals of opportunity, dreams becoming a reality, and perseverance can serve as a beacon of hope to other nations.

Knowing a Language

Travelling to a country such as Ghana, which has English as a national language, I didn’t think I would find the language barrier so frustrating. Most of my trip was spent speaking English with my hosts as we discussed life in Ghana, but a good portion of my time was spent in silence as I took the blood pressure and recorded daily activity levels (with the help of a machine…so no words needed) of local community members.

I was frustrated as I all I could do was point to a chair where the participant would sit. I would then measure their arm circumference to choose the correct armband size and then I would fit the armband and push start. The machine I was using would take three pressure readings. In between each reading there would be a minute break to help normalize the pressure of the arm. In total, I sat in silence with each participant for about 4 minutes. I have rarely felt so awkward in my life. Because these community members speak in a local dialect and almost none of them have ever been to high school they never had enough practice with English to be able to communicate in English as an adult.

While this time was frustrating for me a few times I was able to make eye contact with the participant and we would smile at each other knowing we couldn’t communicate in any other way. This experience further drove home the point that if I truly do want to work in International Health someday I need to make language a priority. I don’t need to know just the national language, but I need to spend the time learning the local or regional language which will help me communicate with the community I will be directly working with.

Nate

Being a Patient in a Tanzanian Hospital

My first week I got to follow docs around the hospital. For my second week, my body decided it wanted to become a patient to really see the ins and outs of a rural hospital. Needless to say, it was an adventure (and the reason for this post being a few days delayed)...

It all started with a few stomach rumbles and what I thought would be an innocent day trip to Arusha (a larger town about an hour and a half away). Little did I know that in the middle of my delicious cup of tea, I would develop chills, a horrible fever, and a host of other symptoms not worth getting into. After taking a bus home two hours after we arrived, I proceeded to sleep for the rest of the day. By Sunday I had a really high fever, was shivering under blankets, and was unable to eat or drink. Anything.

So, on Monday morning, I headed of to St. Joseph's hospital as usual. However, this time I took a taxi (instead of the lovely dala-dala we have as our public transportation), and went straight to the lab to get tested for Malaria. Lovely.

While waiting for the test results, I was put in a private room.

Side note: Malaria testing in Tanzania is as follows:

1. Prick finger

2. Squeeze blood onto a slide with a number marked on it. This number is also written onto their chart of patients.

3. Set slide on the windowsill to dry

4. Dip slide into a succession of dyes

5. Dry slide on window

6. Look through a microscope and count the parasites

Thus, it took some time to get the results. My private room was great by African standards. It had a plastic cover over the bed, a blanket, a chair, and best of all, a western toilet. None of the rooms have pillows or any amenities. Since most patients share a room of the same size with about 7 other people and have to use a squat toilet down the hall, I considered myself lucky.

Another side note: there are no building codes in Tanzania. St Joe's is in the process of building a new wing, which means that they have built and filled the first floor, while they are still constructing the second and third. Conveniently, the first floor contains the delivery rooms and the private rooms.

On the day that I chose the be a patient, they decided to drill holes between the first and second floors. James told me that there were actually chunks of cement falling in the hallway right outside the door. I'm not even going to begin to mention the noise. I just feel bad for the women who have to give birth there.

While I got to enjoy the peace of my private room, I was given oral rehydration salts to help prevent dehydration. They tasted like the ocean. Like all those times you accidentally swallow sea water when you get hit by a wave. Now imagine drinking a liter of it. With the soft background noise of drilling cement behind me. Quite peaceful.

Turns out it is really funny when a white person gets sick. In fact, so many people where amused that they found it appropriate to come into my private room, speak in swahili (even if I knew what they were saying when I was healthy, there was no way I was about to translate in my delirious fever state), and then laugh while saying "pole" (sorry). Let me tell you, white people get sick too.

A few hours after my arrival, we established that my Malaria test was negative, but that I had some intestinal something. Despite the lack of malaria in my finger, the doc thought I might still have it, and put my on a 5 day course of IM anti-malaria treatment. Let me tell you, waking up every morning and getting an injection in your butt for a straight week is not the most pleasant wake up call. I was also given anti-parasite pills and a general antibiotic. After a few more hours of trying to drink the ocean, I went home to get some real rest.

The following morning I had begun to improve (my fever broke)! But I was still really weak. So, we returned to St. Joe's to get my injection and to ask for IV fluids. Some time in the night, they had lost the key to my private room, so I was put in the ward for all the pregnant women waiting to give birth. Fortunately, no babies wanted to come that day, so I got to be by myself. This was when the real fun started. The nurse insisted on using my hand for the IV, which turned out okay, but didn't seem so promising at first. Once it was in (she was happy because it's supposedly easier on white people), she decided to poke holes in the container with my D5/saline. Now, I understand that from a physics principle- the fluid comes in a semi-rigid container and not a soft bag- but let's think about the safety of that for a sec. Now I am in a dusty, dirty room with holes in the supposedly sterile fluid that is flowing directly into my blood. hmmmm.

Fortunately, I avoided that infection, and was left alone for quite some time (most of my "well-wishing" happened the first day). So much time in fact that my IV emptied. Still no one. Luckily, James noticed and turned it off. Another hour. Still no one. Here I am lying in a bed in an empty pre-birth ward with an empty IV. Great. James finally found the French doctor (she's working at St. Joes for 6mo), who came in and was mortified that my IV was still attached. She left muttering something about delinquent nursing staff and infections. Sure enough, the nurse soon followed and detached the empty container. When she started to leave and we asked her to remove the catheter, she calmly replied "what if she needs something else?" Innocent enough. When told that we were going home and thus would need nothing more that day, she explained, "but, she might need something tomorrow!" Yes, in Africa they send people home with catheters in their hands. And you wonder why the rate of infection is high.

To make the rest of this long story short, we convinced her to remove it, got the hell out, and got me home to sleep. Luckily I needed no more services from St. Joes in the following days. I recovered just as rapidly as I got sick, and made it back home alive and well. All in all, what did these hospital ordeals cost me? About $40. Not too bad. Overall, I really loved my time in Africa. I really think that I got to see a perspective of the African medical services that many miss. While it has it's downfalls, they still cured me. And many others. And for a tiny percentage of what it would have cost here. So, life's not all bad, and at least I'm here to tell the tale...

We're just finishing our second week of language school in Santiago, Dominican Republic and are finally getting acclamated to the hustle and bustle of one of the DR's biggest cities. With two weeks down and three to go, I have started to wrap my mind around some of the social and cultural aspects of the country. Here are some excerpts from some of the emails that I've sent to friends and family over the past two weeks that will hopefully capture some of what we have experienced so far...

6/14/10
subject: adventures in santiago
"It's only 2pm on our first day and already, we've had quite an adventure. We rode the "concho," a public car (and a standard form of transportation here), to school today for the first time. The conchos run a particular route through the city, and stop at various points along the route to pick people up and take them where they need to go. On paper it sounded fine when our host mom explained it to us, but it wasn't until we got into the car that we realized that the normal capacity is 2 people in the front seat and 4 in the back. It costs about 20 cents per ride, and needless to say it is always pretty squished, so we hug our bags as tightly as possible and make sure to have our fare out and ready before we get in.

This morning we went over some grammar and a lot of medical vocabulary in class. Our class is just Alaina, the teacher and I this week, so we really get to discuss everything that we have questions about, and are getting a lot out of the sessions. Our teacher is also a medical student, so we've spent a good portion of our time discussing the differences between our medical systems, including topics like how insurance works and how the hospitals/clinics are set up. Tomorrow we are going to the public hospital for a tour and to learn more about the health care system. Our teacher told us to be prepared to see some tough things, as the public hospitals here have doctors, but none of the resources needed to properly treat most patients, so we will see lots of people that are dying or otherwise in pretty bad shape, without much hope of recovering."

6/16/10
subject: ants in my cereal and cockroaches in the shower
"let's just say i got a little extra protein with my breakfast and saved Alaina from a cockroach in the bathtub this morning...

Interesting start to our day, but I'm trying to take everything in stride and get in touch with my "survivor" alter ego. It's only going to get more "au natural" once we get to the campo, so I'm managing my expectations appropriately and getting used to being sweaty and a little dirty all the time.

One of the most striking things that we have seen so far has been the stark disparity that exists between the rich and the poor. It is amazing to see how intermixed the rich and the poor are here. It is not uncommon to see a Corvette, BMW or Hummer on the road next to a group of beggars. There doesn't appear to be much of a middle class, and the impression that I have gotten so far is that the rich are very focused on gaining even more wealth and seem to enjoy the opportunity to place themselves on a pedestal away from the poor (and as such supposedly "lower" class). We have heard stories of clubs and bars discriminating based on race, even though the racial make-up of the country is equal parts Spanish/white as African/black, and most people here have at least some African ancestors. This discrimination leads to hatred between the groups which then ends up in crime.

Additionally, we are starting to learn about the corruption in the government, and although we haven't seen it directly ourselves, the stories that we have heard from our host brother Alban and his friend Hilario about their experiences have started to paint a picture for us. It seems as though much of the aid from more developed countries often ends up in the hands of the corrupt politicians and is distributed mostly among the rich class, propagating their wealth and promoting the poverty of the rest of the country. This contributes to the fact that economically, the DR appears to be growing but from a social standpoint, the disparity between the classes and poverty is only getting worse.

I am so fascinated by everything that I am experiencing and am really trying to absorb everything that I see and hear to get an idea of how things work and what the state of the country really is. Of course, in such little time and with limited resources I wonder how complete of a picture I really can get, but I am trying my best."

6/18/10
subject: machismo in action

Over the past week we have come to experience first hand the chauvinistic reality that is machismo in Latin America. It is impossible for us to go down the street without getting cat called by every single man, young (and I'm talking like 10 years old) or old that we pass. The cat calls have ranged in severity from the men yelling out "Americana!!!!!!!!!!!" to ones too graphic to post here. Even as we walked around the hospital with stethoscopes around our neck, we were not immune from the cat calls from patients sitting in the hallways. Our teacher was with us in the hospital she didn't seemed phased by it at all, saying that you just have to ignore them and go on with your business. It's amazing to me that the women here just accept comments like that as normal and don't see anything wrong with being subjected to such subordinating behavior day in and day out. My skin is slowly but surely getting thicker, but it's hard not to let it get under your skin.

Despite this, our visit to the hospital was exciting because we actually got to talk to patients and take histories. Most of the patients were from rural areas so they were a little harder to understand than most people we've talked to so far, but it was definitely good practice for what we'll experience in the campo. The hospital was super different from anything I've ever seen. This was the public hospital and inside it was really chaotic. Anyone could walk anywhere, and there were armed guards with huge guns to "keep order." All of the rooms had at least 4 beds but were big enough to not be too crowded, but there was nowhere to wash your hands between rooms and no hand sanitizer anywhere, so it's easy to imagine how easily infections can be spread. When we came back to the school we presented each case to each other and the teacher. It was great practice and will definitely give us a leg up by the time we get to the medical portion of the trip."

We're looking forward to our last week in the city before heading to the ILAC Center next Sunday! Besos a todos!!

FIFA World Cup 2010: Soft Power of North Korea and South Korea

Amongst all the recent news of a potential military conflict between North and South Korea, the two countries are involved in another battle- the 2010 FIFA World Cup. For two small countries that are relatively unknown outside their spheres of influence, these two nations rally behind their soccer teams in order to make an impact on the international stage.

When I landed in Seoul, South Korea, North Korea was facing off against Brazil (a soccer powerhouse). While waiting at Incheon Airport for my bus, I found a bunch of spectators watching the game. Brazil would score first and again to the groans of the onlookers. North Korea would score in the 2^nd half and to my surprise, many of the people watching jumped up and cheered on North Korea. Weren’t North and South Korea two countries on the brink of a war? Weren’t the South and North Koreans supposed to despise each other as the media would make it appear? When I asked these people why they cheered for North Korea, many people answered along the lines of “우리는 형제기때문에” (“because we are brothers”) or “우리는 같은민족이니까” (“because we are the same people”). After having spoken to so many people over the years about their impressions of North Korea, this was a side of South Korea that I would never have imagined to see. And yet, having a younger brother myself, it is easier to understand the sentiment of the South Koreans for their Northern families, even after all the fights and loss each have experienced at the hands of the other.

Maybe there really is room for reconciliation between the two nations even after nearly six decades apart. In fact, as this year’s 육이오 (Yuk-ee-oh) or simply 6.25 (the Korean War started on June 25, 1950) approaches, it will represent 60 years since the beginning of the Korean War and the 60 years of loss and heartbreak that have followed the Korean War. Unbeknownst to many, the two Koreas are still war as they only signed an armistice at the end of the military conflict in 1953.

One interesting story that has surfaced from this World Cup is that of Jong Tae-se, the Japanese-born, South Korean citizen who elected to play for the North Korean National Team during the 2010 World Cup: http://articles.latimes.com/2010/jun/14/world/la-fg-north-korea-soccer-20100614. Even in the midst of all the reports of hardship and starvation that has emerged from North Korea, Tae-se wanted to play for North Korea due to his nationalism. Is it possible that there is more depth, culture and pride to North Korea than meets the eye? Even amongst all the evil that is associated with North Korea, is there some great things about the country? Having talked with several North Korean defectors, many seem to love their former countries and possess a strong national pride for North Korea. I wonder whether these North Koreans would have defected if they did have enough to eat in North Korea.

Soccer, particularly the World Cup, holds a special place in the hearts of South and North Koreans alike. It is a time where these two nations, with similar pasts, but very different present situations can compete at an international level without any casualties or military conflicts. Soccer has the uncanny ability to unite two close-to-war nations to put aside their differences and root for each other, for no matter how long the two nations remain divided or how dissimilar they may seem, “우리는 같은민족이니까.”

Currently:

South Korea has 1 win, 1 loss and hopes to do well in their next game in order to advance to the round of 16.

North Korea was the last place team in the FIFA World Cup and was drawn into the “Group of Death.” North Korea already has 1 loss against Brazil. Tonight they play Portugal and it appears that they will have to play exceptionally well to make it to the next round.

Culture, Respect, and all those other words we throw around...

Akwaaba! That is, WELCOME to Ghana (well, at least to the blog written while Nate and I are in Ghana). After spending a little over a week in Kumasi (the city in which we are staying), I have at least picked up a little Twi, the local dialect spoken by the Ghanians here. Although I may be an "obroni" (a white person), it is important to me that I make an honest attempt to show my respect for the Ghanian culture - and part of that is learning to speak with the people. In addition to speaking the language, we of course sample the local foods (lots of fish, plantains, yams, and fried things), and I have asked our "boss" Albert countless questions about the traditions, history, and life of the Ghanian people. It is through these conversations with Albert, alongside my own frustrations as an American comfortably accustomed to the ways of American culture, that I began to consider the concepts of culture and respect - terms that we as Stritch students are all too familiar with thanks to PCM and our yearly lectures on what it means to be a "culturally competent" physician. But what do these terms REALLY mean - not just to me, as a visitor in the country of Ghana - but what does culture mean to the Ghanians.

Of course the culture of Ghana includes the rich flavors and spices of the food, the twi, fanti, and pigeon dialects, the huge market and countless vendors selling their goods, and the traditions of the ruling Ashanti kingdom. In speaking with Albert (our "boss" that is working on the research project with us and also serving as a fabulous guide to Kumasi and informant of Ghanian history), I have found that not all Ghanians perceive their culture as good and, in fact, find the traditional ways of their culture restrictive to the growth of the country. Of course, there are the "right and left wingers" who will argue opposite ends of the spectrum concerning the growth of the nation, just as in any heated debate. I continue to consider Albert's words as I continue my experience in Ghana and reflect on his words in the following example:

In Ghana (and this is a very generalized statement), the women are initially "cold" - that is, it takes a while for them to open up and have a conversation. The men, however, are very open and welcoming at the onset of interaction. Albert explained that this is because women are slow to trust others, due to the history of male dominance (that persists) in the Ghanian culture. During my visit in Ghana, I empathize with the women here as I have experienced the culture of male dominance that I am not at all used to as an American. Instead of asking for something, things are demanded (without a please or thank you...which, I realize happens in the U.S. as well, and perhaps I am speaking simply as a product of my upbringing). And in just listening to some of the surrounding conversations, I am made aware of the inferiority experienced by the women here. I do not know if this is what Albert was referring to when he mentioned the way in which components of the Ghanian culture restrict its growth, but in my short experience here (and because I come from a place where I do not feel such inferiority), I might suggest that perhaps it is.