Last week for group 3

After a weekend in the jungle, our group was refreshed and ready for our final week in Cochabamba. 

Monday, from Brett;

Today was a day full of kids. Sick and well kids. I find myself really drawn to pediatrics because a child in a room can really brighten your day. They can be really sick or hurt and still smile at simple things like a finger puppet. One thing that really stands about pediatrics here is that it is all about education. The parents need to be educated on what to feed their children especially. I also appreciated how upfront the doctors were about overweight children. They called things how they were and would tell the parents if their child was overweight or 'Gordo'. I was shocked how many parents give their kids coke instead of milk and was especially surprised to see this in an obese 8 month old. I got done earlier in the morning and decided to go play with one of the boys in the burn clinic. I could only make him smile once, which just about broke my heart. It was even more difficult because he wanted something but I had no clue what he was saying in Spanish. Situations like that make the language barrier just an annoyance. It's amazing how much I  can understand from one doc appointment and then entirely miss what the problem was with the child in the next appointment. I wish I could have been more fluent in Spanish before this trip, but I have definitely been motivated to work on my language skills. My afternoon consisted of observing pediatric nutrition lessons from a specialist. I learned that 20 years ago, about 60% of all children born in Bolivia would die before age 1 due to malnutrition. They have come a long way since that and all children under 5 receive free prescriptions and vitamins. The best part of peds is definitely the fact that all children act similar no matter where they are from and you can make them laugh doing the same things.

Primera Semana para Groupo 3

Perspective From Brett Fornell:

Our first week has been all about getting oriented to the town and to our shadowing experiences. Juana had been such a blessing to us and has been like a mom, tour guide, chef, and more. I can definitely understand Spanish better than I can speak and this week I have tried to learn more medical Spanish. It has been exhausting trying to comprehend and speak with the doctors and nurses. I have enjoyed the Latin American tradition of 'siestas' and think I could move here just to be able to take a siesta every day. I have spent time in the burn clinic and have fallen in love with the kids. The procedures are performed in a hot room and the dead skin is taken off while the kids are mildly sedated. I also saw a skin graft where skin was taken from the patients back and side to be used on his legs. On one of the days this week I made the journey to Clinica Americana Boliviana, another hospital, and was able to see a breast reduction. The plastic surgeon was very meticulous and made sure he was matching the size of each breast. 

The food here has been excellent but my favorite meal has been when Juana made Stromboli and homemade juices. We are eating like kings and queens here. Lets just say iIt is a good thing we are walking everywhere. 

Spanish-English Misinterpretation of the Week: In my Spanglish, I asked Juana If we could practice interviewing in Spanish with her and she thought I meant practice procedures such as breast reduction on her. It was quite humorous. 

View from our apartment:

Planes, trains, and automobiles.

Hola! We are the last group of the summer headed to Cochabamba to start our rotation-Drew, Brett, Kasey, and Brett.  After venturing around Peru, we finally crossed into Bolivia. Copacabana was the first stop in Bolivia where we rode in swan paddle boats, got caught in a snow storm, and ate quinoa pudding for desert. After two days, we hopped on a bus to La Paz. The bus ride was supposed to be an hour but our Spanish comprehension may have been lacking since it took 4 hours. Next stop: Cochabamba. In the La Paz bus terminal we wandered around trying to find our departure gate, which was a wild goose chase. Finally, the Bolivar bus pulled out of the station and within fifteen minutes, our bus was in an vehicle collision. We arrived to our wonderful apartment in Cochabamba at 4:00 AM. We are so grateful to start this journey and can't wait to learn along the way. Juana, our Bolivian house mom who will be taking care of us, has been so kind to us this far and took us to the hospital today. We're able to see the BCI clinic and some of the patients. Tomorrow will be the start of our shadowing experiences and we couldn't be more ready and excited. More to come!

Round 2 Final Week

The project is over. We did our damage, and pulled wisdom from our respective experiences, hopefully. As always, the weeks fly by too quickly but here's how our last week went.

We started our last week upon our return from the jungles. Unfortunately, the workload was fairly light so I did not soak up as much at clinic as I had hoped in my final week here. We continued to see rinoplasties, hysterectomies, laparoscopic cholecysectomies, and such. However, Tuesday was the first day a doctor invited me to scrub in. I had been happy enough watching from the sidelines, but participating in an open cholecysectomy made my experience this week. For obvious reasons, my responsibilities were limited to holding tools. Nevertheless, I feel like this invitation was some form of acceptance after 4 weeks of simply observing. Having just reached this point, I wish we could stick around longer.

Our final day in clinic was Wednesday due to travel plans. Will and I decided to find Dr. Wallace and shadow him our last day here. In hindsight, I wish we had reached him sooner because we only tapped the surface of experiences and insight from Dr. Wallace. I was introduced to ultrasound and finally began to orient myself with the equipment. Ultrasound seems to require a good sense of three dimensional imagination, an understanding of physics, and knowledge of how the tool works. Otherwise, it is very difficult to read the images. We saw several pregnant patients, ovarian cysts, and normal imaging angles of the gallbladder, pancreas, and uterus.

Apart from some basic introduction to the equipment, Dr. Wallace also shared the history of his clinic. He moved to Bolivia some 25 years ago because his wife decided to work there. They started a small clinic in a hotel that his wife's parents owned. The hospital grew from a back room in a hotel with three employees (including Dr. Wallace, his wife, and a nurse) to the entire hotel with a fully functional operating floor and over 40 staff members. The growth of the clinic was the result of Dr. Wallace's desire to better serve his community and the interest of other local medical doctors who saw the potential of his project. In addition, Dr. Wallace was initially a pediatrician. He became an expert in ultrasound after he saw the need for it in his clinic, which brings me to a final point that Dr. Wallace shared with us about pursuing a medical education.

Dr. Wallace laid out an outline for us of how to study. Perhaps the most important wisdom he shared with us (which he wished he had found out sooner himself) was that a student must know what he is looking for in order to get the most out of his education. He gave himself as an example. When he first started learning ultrasound, he read the books and took the courses. He soon came to discover, however, that teachers and courses tend to push certain agendas, products, or simply teach what is easiest. Dr. Wallace had his own questions and he soon saw the redundancy in many of his courses. He realized that he could save himself hours of work and pursue his education with much more efficiency by asking his own questions and actively engaging himself in the learning process. He became his own teacher and searched for answers himself.

The main point, know what you're looking for. Ask the questions and do some research yourself. You learn much more this way because the questions are yours. The research is goal oriented from things you want to know. Anyway, that was Dr. Wallace's soap box, and I plan to put his advice to good use.

After Wednesday, we took the part of traveling hobos and have been on the road since then. Thursday, Nicole(squared), Will(squared), Maggie, Carolyne, Juana, Sandra, and I traveled to Copacabana. We visited the ancient sites of Incans on Lake Titicaca and nearly walked ourselves to exhaustion. The lake was vast, the skies were clear, the uphills were treacherous, but I enjoyed every minute. Afterward, Nicole, Will(squared), and I traveled to La Paz for the final day before my flight out of Bolivia. We enjoyed each others company walking around the city, sharing some brews, and meeting fellow travelers. I ended my stay in Bolivia in the highest beer spa in the world. Basically a bathtub, a fire underneath, and people pouring cold beer on your back as you steam in the chilly La Paz night. 2 AM rolled around and I made my way to the La Paz airport. Now I am here, in Bogota with a 14 hour layover thinking back on all the events of the past month. I cannot express how lucky I was to grab this spot and make the trip. I lost a few things, but gained so much more... cliche, AND true. I look forward to discovering how this experience will influence my future decisions as a medical student and doctor.

Round 2 Week 3

Week 3 has come to a close. We started our week coming off a visit to the Cristo. I am recounting the week as I look out toward that behemoth of a rock statue from Cindy's apartment halfway across the city.
I found a local church with my compadre, Will Pryor last Sunday. It was my first experience in a Mormon church. The congregation was incredibly friendly. Many came up to greet us, however, I still relied on Will for most of the translating. My listening abilities have always lagged behind my ability to speak Spanish, and this was no exception.  Just when I thought I was getting a handle on the language, I realize how much more I have to learn as I failed to follow the reverend's sermon.
The rest of the week was dedicated to gaining more medical exposure. Several nights, Will and I stayed in the American clinic until 11 PM. We've been told that the Concha, the neighborhood surrounding the Clinica, is very dangerous at night. However, we have grown comfortable enough with the city to grab radio taxis back in the evening when it gets dark. One evening we were pressed to jog back without a taxi, and we still made it back safely. Nevertheless, I still hesitate to make walking from the Clinica an option during the evening... day-time, no problem.
Anyway, back to the medicine. The week continued to have its fair share of plastic surgeries. Nose jobs take the cake. The procedure seems to be associated with a status statement as some doctors have told me. Several new procedures were scheduled this week, but Will and I continued to get great exposure to laparoscopic cholecysectomies, rhinoplasties, and cesarean sections. Appendectomies (which I found out can also be done laparoscopically... go figure) made their appearance this week. I observed one surgeon repair hemorrhoids. One young patient had an orchidotomy (an elegant euphemism for dropping testicles). Another patient had a perineal abscess repaired (ask me about the process if you ever care enough to know, also very interesting!). Several hysterectomies were performed. One of which removed a tumor. But when discussing tumor removal, the one I saw compares very dimly to what my friends Will Royster and Nicole Haghaasdfjbasdkj saw while in Viedma (see their blog).
Despite blood, fecal accidents, and some surgical instruments inspired by the SAW-series, I have discovered that lack of anesthetics makes me most uncomfortable in the surgery room. Until this week, I have found surgeries procedural and painless. Yet, it was one of the smallest surgical procedures that I found most disturbing. A patient came in with a dislocated distal phalanges in his thumb. The patient was provided lidocaine for the first 20 minutes, but he was not unconscious. Every prick and push was accentuated with a painful groan or scream. The experience only underlines what I hear from Nicole and Will and past groups who have spent time in the Burn Clinic where children are under sedated, lack pain killers, face debridement and amputations and the painful process of recovery.
All in all, this experience is wonderful. I may be lacking the limited resources and painful stories found in the Burn Clinic, but I am still having to swim in unfamiliar waters. While I am improving my Spanish, I am still interacting with people I barely understand. I am seeing surgeries with much more ease than I would experience in the States. I am also experiencing an amount of independence in traveling and city living that could land me in serious trouble if I make stupid mistakes. I know that I'm becoming a better person from this.
A quick blurb on our weekend Chapare adventure. Six hours of beautiful Amazonian forest, rivers, waterfalls, and cliffs. Jumped off a cascade several times only after Nicole and our guide, Ghino, did so. Rappelled down a cliff for the first time. Stayed in a hostal for the first time. Got lost and nearly exhausted funds that would have stranded us in Villa Tunari. And finally took a last minute, God-send, taxi trufi back to Cochabamba during a rainy night with several near collisions head-on with 18 wheelers. Great bonding time, great spiritual refresher, and no regrets. Planning to finish up this last week with a light dose of AWESOME.

Viedma: Week 3

Week 3 was our most routine thus far - Will was in the burn surgeries for the first two hours every morning while Nicole was observing and assisting in the Microbiology/Infectious Diseases department.  When a natural break in the surgeries occurs midway through the morning, we switch and Will goes to the children's rooms to observe burn aftercare.  It is significant to us that the actual burn surgeries are becoming routine - we're better able to participate in the burn operations as well as pay attention to the finer points of the reconstructive surgeries.

Nicole: I've been able to participate in the burn surgeries as thoroughly as the residents they train in the hospital - cleaning and debriding wounds, and re-wrapping them.  I also participated in culture-work with the Microbiology Department testing antibiotic sensitivity.  The parasitologist is very enthusiastic to teach, and shows me every egg, larva, and nematode that she finds in various biological samples.  I toured the Pathology Department with a visiting French student - we held various organs and tumors that had been removed for analysis, and observed their slide preparation.

Will: As my time in the burn clinic has gone on, Dr. Romero has started to allow me more freedom in the OR. He will request that I scrub in with him when we have extensive cases and will allow me to practice what I have seen for the past two weeks on patients. There are patients with full thickness burns that cover all 4 of their extremities. In order to keep the children under anesthesia for as little time as possible, I join Drs. Romero and Quiroga and will debride, clean, redress, and place skin grafts under their supervision. However, I am still trusted with a certain level of autonomy with the patients that I will not be privileged with until my surgical residency.

On Thursday, we followed Dr. Montano through his high-risk obstetric surgeries, while Will Pryor and Jon Chu observed in the burn clinic.   Nicole almost passed out observing her first natural birth.  We also observed a Cesarian on a woman who was 32 weeks pregnant with pre-eclampsia.  The child weighed 2.5lbs and has a 50% chance of survival.  There were a few other natural births and a D&C, but the incredible sight was the oophorectomy.  The woman was 16 years old, 90lbs, with 2 children and a husband.  Her belly was distended as if she were 4 to 5 months pregnant, but once opened up, the distention was revealed to be a 6.8kg ( ~15lb) ovary which had stretched with its tumor.  The entire surgery took 15 minutes from first incision, because the tumor was entirely encapsulated in the ovary and only required cutting two vessels to remove in its entirety.  Dr. Montano says it is the largest tumor he's ever removed, but that the other surgeon had removed an 8kg (~18lb) tumor just the previous week.  It honestly looked like a 15lb turkey, but with fimbrae.

Friday was our night in the Infant-Maternal Emergency OR.  It was a slower night, several natural births that went very well and a few D&Cs.  Later in the evening, we were able to observe an emergent pediatric surgery. There was a 4 month old infant with hydrocephaly that need a shunt placed. We saw the CT scans of his brain that showed drastically enlarged ventricles. The pediatric surgeon started by opening the scalp and drilling a hole in the skull with the scalpel. He then made  a small incision in the abdomen for the shunt to drain. He then used what is basically a Teflon tipped metal straw to guide the plastic tubing for the shunt from the scalp, behind the ear, down the neck, over the rib cage, and into the abdomen. Finally, the surgeon inserted the shunt into the ventricle, checked the flow, and finished placing the drain in the abdomen. From open to close the procedure took only one hour.  As he intends to do this post-residency - Will is geeking out the entire hour.

The weekends have been very thoroughly enjoyed by all - last weekend we all struggled up the 1400+ steps to the Cristo de la Concordia which perches above Cochabamba, and this past weekend we visited Villa Tunari in the Chapare region of the Bolivian Amazon.  There was an animal sanctuary with various food-stealing monkeys and a fantastic 6 hour trek through a local valley, as guided by a friend of our host family.  The path was wide enough for one person, steep, challenging, and beautiful.  We hiked up to a small waterfall (3-5m) with a pool deep enough for jumping off and then moved to a second waterfall (18-20m) which we rappelled down.  The clumsy gringas and gringos struggled to walk down Amazonian rocks for another hour and a half, surrounded by the most lush, verdant scenery and clear water you can imagine.  It didn't look real, and the pictures will never do it justice. 

Cochabamba.... week 2 (aka how to climb two thousands steps without dying...)

This week has been an absolutely amazing one, as we continue to wander around the City of Eternal Spring and become better acquainted with its citizens.  Becoming more familiar with the hospital system at the Clinica Americana Boliviana, we were able to witness more surgeries than we had in the previous week.  These surgeries varied from simple skin grafts to massive sub-dermal liposuction.  In retrospect, it is clear to see that there is a wide gap between what we see at the Clinica and what must be happening at the Viedma Hospital.  With all these experiences at the Clinica, I can not help but wonder if what we are experiencing is only a skewed view of the Bolivian healthcare system.  After all, one can only imagine the expense required to have a massive liposuction in a country where the average worker only makes B150 (~$21) per MONTH!  Consider, also, that the average antibiotic and cough syrup combined costs B125 (~$17).  While this is relatively cheap for Americans, given the favorable exchange rate, it is a crippling cost for a family where everyone must work just to make ends meet.   Nevertheless, the indomitable spirit and optimism of the Cochabambian people is insatiable.  It is a lesson that each of us can and should learn from when faced with daily trials and opposition.

When you look out at the Cochabambian skyline you are surrounded by beautiful mountains and small villas that extend up as far as the tree line.  Lately the weather has been cold enough to allow pure white snow to cap the tallest of these peaks, providing an ample contrast to the beautiful flowers and lush palm trees that intermingle with the wide variety of man-made structures.  There is so much good in the world that at times it can be practically overwhelming.  Despite difficulties with the language and expressing oneself in it, smiles and stumbling through it always proves to bring a smile to the most tired nurse.  Although we may only be rising second years and, thus, unable to provide as much help as maybe a fourth year resident, in many respects our constant presence is enough.  One of the goals of the program is not only to provide service where needed, but to also build bridges and increase the goodwill that exists between all parties.  Every time we witness a c-section or witness a physician listen to the heart rate of an elderly patient, both parties synergistically benefit in what could only be described as pure magic.  While at times it is easy to only see the negative around us, only through a positive and persistent perspective are we able to accomplish the mission that we have accepted.  Every day more doors are opening; you just have to be willing to take the first step and walk through them.

Round 2 Week 2

Week 2 has been much more productive. After our trip to Salar de Uyuni, we returned to the Clinica Americano Boliviano with fresh enthusiasm. Increasing familiarity with the hospital, the city, and the language has encouraged us to explore more and interact with more people. I keep an open mind because I find myself learning several topics simultaneously. Medicine, Spanish, and geography are all important, but I have placed the most emphasis on learning the language. While medicine and geography help, I find the most pleasure in connecting with others through language. I am making a feeble attempt at learning Quechua, the native language of Cochabamba and surrounding regions. The language is very difficult for several reasons. It is clearly not a Romanic language, the words share no similarity with English, and the texts I am learning from are all in Spanish. An ambitious goal, but I love the expression of pleasure that overcomes the locals as they hear me murder their language.

Within the hospital, my colleague and I have remained mostly on the operating floor. Surgeries typically start at 8:30 AM. There is no set schedule as the agenda written on the whiteboard changes on an hourly basis. I may try to gather more on the history of the clinic. So far, from what I gather, the Clinica Americano Boliviano was started about 25 years ago by American Dr. Tim Wallace. The clinic started as a small back-building off San Martin Street, but it has been growing over the years. Now, the clinic has expanded to a 5 story building with a courtyard and various offices behind it. Today, the hospital is staffed by about 80 doctors who come and go around the clock. All the doctors also have offices elsewhere.

When Will and I are not shadowing on the operating floor, we follow other doctors in their temporary offices or around the clinic. The Spanish remains the largest barrier. It is very tough to learn anything about medicine in the office because everything is conversation. There are a few small tests and procedures performed that remind me of first year. In that way, I am able to follow the doctors more closely. The operating room is an easier learning atmosphere. With some Spanish under our belt and first year anatomy relatively fresh in our minds, Will and I are able to follow the surgeries, understand particular methods, and learn proper protocol in the OR.

We are expected to compare American medicine with the practices here. My experience in American operating rooms, however, is limited. Interestingly enough, I am getting my introduction to surgical procedures from a Bolivian perspective. I will not be able to properly compare the two practices until future years in medical school. This is what I know, and this will be the standard by which I compare surgeries.

This week I shadowed a pediatrician and two traumatologists in their offices. I was able to view a few X-rays although I had difficulty analyzing them until the doctors relayed the problems through very strained very slow Spanish. In the OR, Will and I observed many operations. We saw several rhinoplasties, a skin graft, laparoscopic cholecystectomy, liposuction, several cesarean sections, and an open cholecystectomy. The gallbladder could not be removed, however, in the open procedure due to complications that neither Will nor I were able to understand in Spanish. From this week, we inferred that the American Clinic seems to place much emphasis on aesthetic plastic surgeries (although the skin graft and one rhinoplasty seemed to be reconstructive). Why this is so, we still need to ask. This demonstrates a noticeable difference with the burn clinic in Viedma hospital where children are in dire need for reconstructive surgery. Nevertheless, the doctors in Clinica Americana Boliviano are excellent and I am impressed repeatedly with the ease and precision that they operate.

As for our main contact, Dr. Wallace, we have not had much time to connect with him, but it is our intention to shadow him and learn a little bit about ultrasound in the coming weeks. I also wish to learn how a man such as Dr. Wallace finds a calling that places him thousands of miles from home to build a fully staffed clinic from scratch.

As a cap to the week, Will (squared), Nicole (squared), Maggie, Carolyne, and I trekked to the Cristo statue that looms over Cochabamba. After having acclimated over a couple of weeks, one would expect to climb the 2,000 stairs with more ease than we experienced today. We realized how long the hike would be after stopping to catch our breathe after the first 50 stairs. Regardless, the view is amazing, Cristo is large, and the snacks sold beneath his outstretched hands are incredibly refreshing. We opted to take the cable-cars back down. I look forward to what Cochabamba has to offer over the next couple of weeks as I continue to learn more Spanish... and maybe some Quechua.

Viedma: Week 2

We started Monday just as we had started all the other days last week. Nicole was observing in surgeries in the morning. Will was with the children in the clinic. In the afternoon Nicole went off to the pathology and microbiology department and Will went in to observe surgery. The surgeries were pretty straight forward, just cleaning and re-wrapping some wounds. Nicole saw Tuberculosis, Paratuberculosis, Giardia, and a hand full of other bacteria and parasites.

Tuesday was scheduled to have 6+ surgeries, but most were put off to later in the week after a 5 year old girl who had swallowed flaming checha (Bolivian moonshine) suddenly began vomiting blood and eventually died.  She had been recovering at the clinic for over a week and the change in her condition took everyone by surprise.  All possible resources were diverted to her, but after endoscopy and efforts to cauterize the ulcers in her esophagus failed, she passed away.  This is the first patient that the clinic has lost in over 2 years and Dr. Romero is taking it very personally. 

Wednesday was the first day both of us were allowed to scrub in on surgeries. Nicole scrubbed in on a 10 year old boy with second degree burns over approximately 35% of his body all on his front, from his face down to his feet. Will scrubbed in on the previous patients brother, who had burned both of his feet, hands, and his face. Both surgeries were very labor intensive each taking about 2 hours to finish. Everyone involved was drenched in sweat after each procedure. The OR stays at a constant 85 degrees and gets warmer under the OR lights due to burn patients inability to properly thermoregulate. There have been a few procedures that we had to stop in the middle of to apply electric blankets and hot water bottles to the patients because their body temperatures would drop despite the ambient heat in the room.

Thursday Nicole went back to pathology to learn from the parasitologist, visualizing different ameoba, larvae, and discussing diagnostic criteria.  Will's only surgery for the day lasted 6 hours and required harvesting deeper skin from the adolescent's abdomen than is typically required for skin grafts.  Sadly, this boy's burns were 3rd degree and deeper, which meant that the fresh skin also had to be.  The last 2.5 hours of the surgery were exclusively suturing of the skin onto the boy's left hand.  Once the procedure was completed, the improvement was incredible.  Will is really looking forward to seeing the bandages come off in approximately 5 days.

Cochabamba: Week One (or how not to get run over by renegade truffis)

Cochabamba, Cochabamba, Cochabamba...  What a city of paradoxes!

I am continually astounded how paradoxical life can be in this incredible city.  One minute you are dodging taxis and street rubbish and the next minute you are surrounded by buildings and riches equivalent to anything in the States.  Indeed it is an interesting setting to learn medicine and to, more importantly, learn about humanity in vivo.

When one considers American culture with its broad and blurred spectrum of socioeconomic classes, it can be a rude awaking to step into an environment such as exists in Cochabamba.  Like many cultures of the world, Bolivian culture is extremely polarized.  At the very tip are the richest of the rich, who live lives of unsurpassed opulence.  This elite class is built on the foundation of the low class, the commoners, who in some way or another work to support the rich.  It is this lower class in which we have the most exposure and for which our influence that the Clinica Americana Boliviano and the Viedma Burn Clinic has the most relevance.

During my first week working at the Clinica Americana Boliviano, I can honestly state that I have learned more about how to operate healthcare with limited resource than I could have ever from a library of literature written on the topic.  There is simple not the time, nor the copious resources that are otherwise available in the States.  However, if we assume the Bolivian perspective it is fair to wonder if some of what we as Americans do is simply excess, overkill.  Now let me be clear that I am not talking about not ensuring sterility in the OR or cleanliness in the outpatient clinics.  Both are very important, no matter where you go.  However, it was not that long ago in the States that surgical gowns and clinic tables were dressed in heavy canvas that was washed and sterilized daily as they are still done here in Bolivia.  While according to American standards of disposable plastic everything the idea of reusing anything seems purely heretical, in many regards the Bolivian idea seems the most sensible (assuming the levels of sterility are comparable).

While some Americans may scoff at reusable nature of the clothing, dressings, and clinic table coverings that exists in Bolivia, they will be more surprised to know the level of technology that exists from the outpatient clinic to the OR suite.  Yes, I will concede, we are in a third-world country.  However, if one compares an OR at the Clinica Americana Boliviano to an OR in the States, it becomes abundantly clear that the same basic structure exists in both.  For example, the anesthesia machine in Clinica Americana Boliviano might be a decade or two older than one in the State, but it still allows the anesthesiologist to safely maintain a patient in an anesthetized state during an operation.  Similarly, consider the operating table.  Sure the operating table at the Clinica Americana Boliviano requires one to manually pump it higher or lower, but does it still do the job?  The obvious answer is yes.  In many respects it could even be argued that the older equipment used at the Clinica Americana Boliviano and elsewhere is better than that in the States.  However, I have no desire to open the can-of-worms concerning the idea of planned-obsolescence which is so ubiquitous in the States these days.

Although Cochabamba may exist as a city of extreme paradoxes, the opportunity to serve and learn here is already a richly rewarding one.  Every human life is precious, and the more I work around the Cochabambians the more I am reminded of this point.  If only every person had an opportunity to see for themselves the lives of these humble, but happy people, perhaps many of the woes-of-the-first-world would be greatly diminished.

Week 1 - Viedma

It was an in-depth introductory week at Viedma, both as to the manner in which medicine is delivered and as to Latin American culture.  After meeting critical personnel on Monday, we arrived at the clinic ready for surgery at 8am Tuesday and discovered a mariachi band setting up for Dr. Romero's 70th birthday party.  It was explained to us that Bolivian culture values relationships above all else, and the clinic's head surgeon was being honored for his lifetime of service to Viedma and paternal relationship to all of it's patients.  After speeches and cake, surgeries resumed as usual.  We took the day to learn about the children present, and the way of Bolivian medical education. 

Nicole: My lack of any prior Spanish has hindered me significantly in building relationships with the nursing staff and Bolivian medical residents.  Any efforts on my part are met with encouragement, but the language barrier does prevent the transmission of specific details of burn care.

Will: Having been to Honduras on two prior medical trips before starting medical school, I had an exposure to medical Spanish that has helped both inside and outside the clinic.

In the rest of the week we've observed between 6 and 7 procedures every day, ranging from mild wound redressings to skin grafts and reconstructive surgery, in addition to the constant physical therapy and nutrition administration of the recovering patients.  It is not uncommon for the two surgeons on hand to be called out of long procedures, such as wound debridement, for simple redressings and initial evaluations of new patients.  The juggling of such responsibilities are facilitated by an experienced nursing staff and a simpler procedure room.

One of the more impressive procedures we witnessed was a reconstruction of an adolescent patient's left neck and ear.  Will was present for the Z-plasty of her neck to remove fibrotic scar tissue which lasted 2.5 hours, and Nicole was present for the reconstruction of her ear from the mass of remaining tissue, which was an additional 2 hours.  The procedure not only restored her range of motion, but was a day-to-night difference in the young girl's cosmetic appearance.  Physical therapy was observed over the next two days. 

Startling information for both of us was the fact that sedation for these incredibly painful burn injuries is only provided by the clinic for children under 5.  Older patients must have medicine provided by the parents, at an extreme cost for these patient families.

MS4BCI Round 2

BCI Bolivia is the first trip I've made out of country alone. As such, this project has been a series of challenges and firsts for me. For instance, simply making my connecting flights was a challenge since I've never been accountable for myself in such a situation. The project provides much freedom, allowing students to engage in varying degrees with their experience. Our freedom here has challenged me to show more initiative.

My rookie travelling status, and novice medical and Spanish skills have made me hesitant in my interactions with others. However, Dr. Bynum and last year's gang of MS4BCI students forewarned about this feeling of ineptitude. Confronting my hesitation, I could either limit my interaction with the Clinica Americano Boliviano (where virtually nobody speaks English) or I could dive head in.

Of course I opted to not dive head in, however, neither was I discouraged from engaging with the clinic. Interacting with the staff has been the most difficult because I only understand a fraction of what I'm told. I discovered that I can speak Spanish much better than I can comprehend it. With that in mind, my first week has been an orientation. I have remained a little side-lined due to the difficulty in communication between the staff and me. This upcoming week, I plan to stay longer hours and get more exposure as I develop better language skills. 

Nevertheless, Will P. and I witnessed a superficial parotidectomy last week. I was also able to shadow a trauma doctor and a gynecologist. My companions in the burn clinic seem to have had more exposure to medicine, but I believe this is because the burn clinic is familiar with MS4BCI and its goals. The American Clinic should become a great place to send students as the staff becomes more accustomed to our presence. The American Clinic also seems surprisingly sophisticated compared to descriptions about the limited resources in the burn clinic, but I shall remain uncertain until I visit the burn clinic the week after next.

   

Overall, our theme for the first week has been adjustment. The great thing about a project like MS4BCI is that we have to take charge. We have run into mis-communication and unexpected circumstances, but I believe this has hardened our determination to make this a great experience. We remain flexible and eager to learn. Because I am just getting my bearings, it is difficult to report on too much within the first week. I take this new week with more enthusiasm after a refreshing weekend trip to Salar de Uyuni. More to come and a more descriptive account next week!  

Rotation Number 2, Summer 2013

Our first team is finished up and still on their way back home but the second group of students are already on their way to Cochabamba. This is the place to keep up with all their experiences in the hospital and community. Here is the team for this rotation:

Nicole Haghshenas
Rising MS-II at the University of South Carolina School of Medicine
Undergraduate: College of Charleston

I have a B.S. and M.S. in Biological Sciences from USC with a concentration in Microbiology. I did research at MUSC for 3 years before starting med school, and in my free time perform on an improv team, kayak, and play soccer. I currently hope to go into pathology or infectious diseases.

Will Royster
Rising MS-II at the University of South Carolina School of Medicine
Undergraduate: University of South Carolina

I was born in Chicago, but raised in South Carolina. I graduated South Aiken High School in 2006 and then graduated from USC in Columbia with a BS in biology and a double minor in Chemistry and Psychology in 2010. I took some time off to do volunteer work as a nurse and pharmacy tech at the Free Medical Clinic in Columbia and went on two medical mission trips to Honduras to act as a nurse, translator, and pharmacy tech. I've worked as a server and bar tender at Villa Tronco, an Italian restaurant in Columbia since 2008. In my off time I traveled around the south east playing bass in a rock band. I'll graduate from USC-SoM in 2016 and plan on pursuing a career as a pediatric surgeon.

Jonathan Chu
Rising MS-II at the Medical University of South Carolina
Undergraduate: Duke University

I am a rising second year at MUSC. I graduated from Duke University class of 2011 with a major in Classical Studies Civilizations and minors in Chemistry and Biology. I am a Navy ensign with their Health Professions Scholarship Program. I plan to serve as a Navy doctor and hopefully connect with some Navy Special Warfare units along the way as a Dive Medical Officer.

Will Pryor
Rising MS-II at the Medical University of South Carolina
Undergraduate: Brigham Young University, Hawaii

I am originally from Columbia, South Carolina. I completed my undergraduate education at Brigham Young University Hawaii, majoring in Biochemistry. During my undergraduate education I took a two year leave of absence to serve a religious mission in Southern California, were I worked with Latinos and grew to love their various traditions and beliefs. I have traveled extensively throughout Europe, Asia, and the United States and enjoy the opportunity to learn from various cultures. I am presently interested in pursuing a career in Interventional Radiology, although I feel strongly that learning the basics of medicine in a global medical setting is essential to becoming a knowledgeable and effective physician. I look forward to learning and serving during my time in Bolivia.

Blog #3: First week in the hospital and Toro Toro

We have now been in Cochabamba for over 2 weeks, and as you can see from Alex's post we have been fortunate to witness a lot of diverse pathology you wouldn't normally see in the US.  In this blog, I would like to highlight my first week in the Burn Clinic OR, and then (on a lighter note) tell  you about a trip that Alix, Alex and I took last weekend to a Bolivian national park called Toro Toro, just 5 hours south of Cochabamba.  Forewarning, this blog will be a little bit graphic.

For our first rotations, Barb somewhat delegated what part of the hospital we would work in.  It was decided that due to my quasi intelligible Spanish, I would start off in the Pediatric Burn OR, where nobody speaks a lick of English.  Dr. Romero is the main doc in charge of the Burn Clinic... this is his domain.  In fact, Dr. Romero started the clinic himself 20 years ago, recognizing that there was no such treatment center for children in all of the city.

A little bit about the types of burns we see in the pediatric burn unit.  Surrounding Cochabamba is an expanse of very poor, very underserved homes that they refer to as "El Campo" (literally translates to the field).  We have passed through this area on our various excursions.   The living conditions are substandard, and many people from El Campo come to our hospital because it is free and public, instead of one of the other private hospitals in the city.  Just as a side note, our hospital is a teaching hospital, so we constantly interact with medical students, interns, and residents.

The women in these areas are not allowed to use birth control of any kind (which one can easily buy from any pharmacy for cheap).  In fact, I was told today that for these people, the use of birth control indicates promiscuity, and upon discovery can result in severe domestic violence from husbands.  This means that these women often have LOTS of mouths to feed (could be more than 10!) and not a lot of time to supervise their children.  Additionally, the substandard housing is such that one room suffices as kitchen/sleep/play area.  Thus, at a very young age (let's say 6), children are left unattended to watch their brothers and sisters and cook for their families.  They are constantly playing amongst the numerous dangers of the kitchen, and their real enemy in this case: hot water.

The majority of burns I saw in the clinic last week were from hot water.  Most often, the children were playing in the kitchen unattended, grabbed pot handles, and dumped scalding hot water on themselves. Its a travesty to look into their deep brown eyes and think how much pain they have already endured, at no real fault of their own.

Moving onto the surgery itself.  Sterility is attempted in the OR, and if it is maintained I do not know.  No stainless steel scrubbed walls here.  People walk in and out frequently.  Blankets and saline solution are heated on radiators that are placed cumbersomely throughout the room.  I don't mean to say that it is really that bad.  There is still much of the necessary technology needed to give general anesthesia/heart moniters/etc.  In fact, I was pleasantly surprised by how well equipped they seemed to be.

Most certainly, there is no lacking in experience of the doctors.  I have been humbled and awed by their  expertise and gentility with the children.  They care so much for the welfare of their patients, that they work for pretty much nothing, spending hours each day performing surgery after surgery.

Watching them work was a lot like putting together a puzzle, literally and figuratively.  For one thing, as I have already mentioned my spanish is not superb.  For most days, I had no idea what was coming next, when all of a sudden they had taken out a skin grafting instrument (looks like a giant electric razor) that slices off a thin piece of skin from an unburned section of the body, that is then placed on the deeply burned part.  And then there is the cheese grater.

We were told prior to departure about this instrument from our good friend Colin Kane.  I believe he has detailed his experience with the cheese grater in his own blog.  On my first day in the OR, I was pretty anxious about the appearance of the cheese grater.  I sort of knew it was coming but I didn't know when.  The second surgery of the day was a boy with a second degree burn on his arm.  Dr. Romero wasn't operating, it was Dr. Juan Pablo, a plastic surgeon.

Dr. Juan Pablo is, I'm guessing, in his mid 30s, and is one of those people that just lights up the room.  He started his career performing only aesthetic surgeries in Buenos Aires for 10 years.  He told me, "You know, I do, the boobs?" And cupped his chest where they would be.  He laughs and sings during surgery, making the somewhat dismal subject matter a little bit more bearable.  He is totally charming, and the story of how he started working with Dr. Romero in the burn clinic is nothing short of inspirational.   He told me that the salary he makes doing the surgeries in the burn clinic for a whole month equals what he would make doing 2 botox injections.  But he knows its important, and he loves doing it.

Anyway, Dr. Juan Pablo took the cheese grater.  Wanna know what it looks like?  Go into your kitchen and open up the drawer that has your cheese grater.  Thats what it looks like.

Picture of a cheese grater I got off of google images.  Looks exactly like the instrument the Drs. use to grate off the necrotic skin from the children's burns.

Yes, this is a little disturbing.  But the theory behind it is that grating off the top layer of skin of a second degree burn helps with reperfusion, thus expediting the healing process of the skin.  The doctors swear by it, and are convinced that it helps immensely.  I'm pretty sure that this technique is not used in the US, but that certainly doesn't mean its ineffective.

Dr. Juan Pablo was grating away, and then looked up at me and said "Look, it's ensalada de nino!  What do you think?"  Of course I said something really dumb "Um........ preferisco ensalada de lechuga?"

His eyes lit up in a smile above his surgical mask and his infectious laughter erupted throughout the OR, making all 10 of us in the OR laugh too.

Meanwhile the boy lay in his sedated state, blissfully unaware of our morbid senses of humor, and he will never know it happened.  Speckles of blood dotted his arm where Dr. JP had been grating away at his exposed flesh.  

It may seem pretty disgusting that we were able to laugh at this obviously terrible situation, but how can you not, at least a little?  These doctors, Dr. Romero, Dr. Juan Pablo, and their resident perform these burn surgeries like clockwork, one after another after another.  They are desensitized to their job, just as we all will be one day as doctors, and it was just me as an outsider looking in that saw how puzzling it is to joke during such a situation.  And, inevitably, by my 3rd day in the OR I was desensitized too.

Dr. Romero, Dr. Juan Pablo, and their resident working away in the OR.

  

That story pretty much illustrates my time in the burn OR that first week.  I obviously took away numerous lessons from the experience, and I am incredibly grateful at how welcoming, patient, and open the staff in the OR was to have me there.

Moving on to Toro Toro.  This national park is incredibly unique, and for future MS4BCIers, you are foolish to not take advantage of it.  A simple 5 hour bus ride at night plopped us off in the sleepy town of Toro Toro.  Of course, it didn't all go off without a hitch and once again we almost missed our bus.  One of my favorite aspect of language barriers is well illustrated by our difficult departure.

We had gone through a tourist agency of sorts to arrange our plans for Toro Toro.  We were to take a taxi to the bus, where some woman named Cynthia would meet us with our bus tickets.  Once we got to the bus area, we looked around and saw like 30 buses, spread out over a couple of different streets.  We had no idea which was ours, and it didn't help that whoever is in charge of the weather decided this would be a great time for it to be pouring rain.  I called Cynthia, and she tried to tell me on the phone, in Spanish, the location of our bus.  

I can't remember what she said, but the point is that I didn't understand.  No matter how many times she gave me directions, no matter how simply she put it, there was no way for her to get her point across.  We had reached the classic phenomenon of language barriers I call "the standstill".  She had said what she needed to say.  I had no idea what she said.  We both sat in a tense silence for about 15 seconds, each pondering our next move. 

She hung up on me.

In the end, of course, we found the bus when Alix had an epiphany about its location (not before I stepped into a big pile of Cochabambian mud trash in my open toed sandles).  We made our way to Toro Toro.

The landscape of Toro Toro is stunning.  Tectonic plates somehow pushed up the land into mountains creating these unique, scalloped humps. 

Landscape of Toro Toro

One of the best parts of Toro Toro is that there are literally no other tourists there.  Look at that landscape.... in the US this place would be swarming with people!  Our first day in Toro Toro took us via guided tour to a cave about 3 miles away.  Mind you, this whole weekend (hotel, guides, food, transportation, etc.) ended up costing each of us around $150.00.  It pains me a little to share this information with the world, because I almost don't want to let the secret out.  But Bolivia is an AMAZING place to travel, and for Americans, unbeatably cheap.  Do it.

The caving experience was great, and actually quite dangerous, even for me (sorry mom).  If you have  been to a cave in the US, you know that they are highly protected.  They have rules like, "No touching the stalagmites!  No flash photography!  Hey, don't go beyond that rope!" 

Not in Bolivia.  We had free range to do whatever we wanted, with no barriers, and again, the three of us and our tour guide were the only people in this enormous cave.  At different points, they had set up ropes so that you could repel yourself down unclimbable and slippery rocks.  That was about it.  If I wanted to, I could have gone up to a stalagmite and given it a great big hug. (I didn't)

Cave pic.

Blind Fish in the Cave.

The town of Toro Toro is, like I said before, sleepy.  Not a tourist town at all.  I think there were 2 restaurants in the whole place, with lots of stray dogs and sheep.  It was a nice departure from the craziness of Cochabamba.

Toro Toro

The second day of adventures took us to what our guide called, the "grand canyon of Bolivia".  All the blogs and trip advice we had read before coming to Toro Toro called it a "legit canyon", and indeed it was.  Our guide led us all the way down to the bottom of the canyon, where we hiked around on the boulders and eventually got to a picturesque watering hole with tropical vegetation.... a paradise.  We gleefully jumped off rocks into frigid water.  Our ascent out of the cave was a combo of bouldering and rock climbing, which our guide ensured us he saved only for the young and strong, and not for the faint of heart.  

Canyon.

We left the next day with the sunrise, sad to leave the tranquil bubble of Toro Toro.  It was an unforgettable trip.  

Judy

Blog #2: Our First Week in the Hospital

Buenos Tardes. This is going to be a short post as we are just about to get on a bus to travel to Torotoro National Park in a few minutes. Furthermore, this post will be written in much less literary splendor than Jude's previous one, so please lower your expectations before reading on.

Our first week in the city has been absolutely amazing. The weather continues to live up to its expectations, and I feel that we have successfully learned how to take advantages of some of what Cochabamba has to offer including restaurants, markets, nightlife, etc. We have now spent four days shadowing different physicians at Hospital Viedma, and all of us are having a blast.

I have spent most of my time with a pediatric endocrinologist named Doctora Rodriguez in part because she is fluent in English. The patient population that Dra. Rodriquez has seen in just four days has made my hospital experience so far very exciting. Iodine deficiency is very common in Bolivia, so hypothyroidism has been a very common finding. Furthermore, I have gotten some exposure to patients with Grave's disease, metabolic acidosis due to Coca leaf tea (an unfortunately common folk remedy for babies with diarrhea), and congenital adrenal hyperplasia due to an enzyme deficiency. I have come to realize that the doctors here rely a lot more on physical diagnosis tests, as the laboratory diagnostic testing is not quite available to the level that we have it in the states.

I have spent my remaining time with a 5th year medical student, which are what everyone calls interns here in Bolivia. Vladimir is an intern currently rotating on the pediatric internal medicine ward, the pediatric emergency department, and the neonatology ward. Currently Vlady is just about to finish up a 36 hour shift at the hospital. These long hour shifts are the norm for the interns, and I was shocked to learn that he sometimes will only have a few 15 minute breaks while working these long hours. Vladimir is also covering for one of his buddies 36 hour shifts this weekend, which means that he will be working another 36 hour shift after he gets 2-3 hours of rest in between. I am very glad that medical school in the U.S. is not quite this intense. It has also been very exciting following Vladimir around the hospital, and I have gotten to see many devastatingly sick babies with diseases such as dengue fever, HIV, and whooping cough.

Jude has spent the week with Dr. Romero, a plastic surgeon who works in the Children's burn clinic. She has seen many different surgeries so far, and I'm sure she will blog about her experiences very soon. This week was Kiandra's first experience watching a surgery, and has now been exposed to several types including an orthopedic surgery, a hysterectomy, and cesarian section. Alix P. has spent most of her time on the OB wards, witnessing several births and surgeries as well.

We will be sure to update the blog with our experiences at Torotoro National Park after this weekend. Take care and thanks for stopping by.

Alex W.

Blog #1: Arrival in Cochabamba

I am happy to create the first entry for our group of 4 as we embark on our much anticipated rotation here in Cochabamba, Bolivia.  Having been here for all of 8 hours (2 of which were just spent on a post lunch siesta, a wonderful Bolivian tradition) this entry is more a tale of our journey from Charleston, SC to Cochabamba, a snapshot of my first impressions towards the experience, and the recent development of a new language I call Spitanglish.

I'll start out by saying that these past two weeks have been a sheer whirlwind of activity.  Preparing for this trip in the midst of studying for our last exams as first year medical students at MUSC has been a test, and truthfully everything didn't come together until the day before our departure.  It certainly wouldn't have been possible without the guidance of our trips predecessors, Matt, Colin, and Meg.  Luckily, we did get it together.  And made our plane to Cochabamba..... barely.

Our trip began with a 10 hour drive from Charleston to Miami, where we were greeted with the warm hospitality of one of my dearest friends of many years, Alex Fulton (yes, a third Alex).  Alex F. drove us all over Miami, ensuring that we all made it to our flights on time.  Our experience in Miami is for another day, but I would like to highlight what happened when Alex W. and I were dropped off for our flight.

Coming off of a high from the fun times and mojitos we had had in Miami, Alex and I felt like we were on top of the world.  We had made it to the airport.  We were about to check our fancy new backpacking packs.  Nothing could stop us, and we were home free to passively sit on our non-stop red eye flight and let the airplane gods magically transport us to our destination while we reveled in what awesome travelers we are.  Obviously, this is not what happened.

We approached the kiosk and the smirky airline guy asked for our paperwork.  I handed it all over, very proud of myself for keeping all of it straight in a green binder that I kept in my carry on.

"Um, excuse me, miss but where is your 4x4 photo?"

"er.... what are you talking about? My passport? Or, one of the 10 photocopies I printed off of my passport?"

"No... its for your VISA??  I can't let you on this plane without it.  You see?"

And then he had me get back behind his little podium and look at his computer screen, where there blinking at me was "required: 4x4 printed passport photo".  We definitely didn't have it, and following this heart dropping discovery ensued a flurry of Alex and I pleading and trying to compromise with this man and his supervisor, and coming to grips with the fact that without these pictures we were doomed.

The supervisor scribbled down the address of the closest Wallgreens and said,

"Yeah, you have a half hour till we can't let you on this plane.  You gotta get a taxi and try to get these passport photos."

In disbelief and anger that we actually had to do this, but scared to death knowing that we had to leave right in that moment to try to salvage what little hope there was for us to make our flight, we sprinted away from the kiosk with our bags flailing around us, stuffed ourselves into a cab, and I THINK we said this to the driver:

"Quick!  To the nearest Wallgreens, and make haste, for time is of the essence!!!"

Anyway, at that point there was nothing else we could do but hope this Wallgreen's wasn't in the middle of nowhere.  Alex and I tried to calm down, but our sympathetic nervous systems were firing with a fury I had never known before.

When we got to the Wallgreen's, somehow luck shined upon us and we were immediately helped by the most gentile woman I have ever met.  She took both our pictures with a knowing smile (obviously we weren't the first frantic 20-somethings to need passport photos at 10 pm) and then made fun of mine for how bad my hair looked.  In fact, she didn't even charge us for that picture because it was so terrible.

Our faithful cab driver was outside Wallgreen's with the meter running, and he drove us back to the airport.  We didn't yet know our fate... we were arriving for round 2 at the kiosk but 45 minutes early for our international flight.

And we made it.

The photos that almost cost Alex W. and I our trip to Bolivia.   Don't be fooled by those smiles.  We were freaking out.

After that, it was pretty smooth sailing.  When we got to La Paz at 5 AM and went through immigration, Alex W. actually lost the passport photo we had spent all that ridiculous stress getting.  To which the immigration officer responded, "Oh its ok.  You don't need that" (thanks American Airlines).  Moral of the story for future MS4BCIers: get the passport photo.  Even if just in case.

The La Paz airport is the highest altitude airport in the world, at over 13,000 ft.  We were warned repeatedly of altitude sickness.  Alix, Kiandra, and I were fine, but at one point Alex W.  looked over at me and said 

"Hey, do you feel ok?  I feel sweaty and sick and like I'm going to pass out."

I quickly used my Spitanglish to ask the flight attendant for coca tea and water, and Alex W. felt a lot better.  So yeah, altitude sickness is no joke.

Mountain visible on the plane from La Paz to Cochabamba.

When our flight from La Paz to Cochabamba landed, Alix, Alex, Kiandra and I were greeted by two of our contacts, Barb and Dean.  They picked us up in their white 1974 defender.  Alex climbed on the roof of the car to hoist all of our bags on top.

Barb and Dean immediately began to tell us about the extremely high tensions and political unrest we had just walked into in Bolivia.  I'm still not 100% sure exactly whats going on, but basically the government cut pensions for most of the people in the city.  Here is a short article I found highlighting the problem:

http://www.usatoday.com/story/news/world/2013/05/16/bolivias-morales-protests/2192637/

They told us that things hadn't been this bad in Bolivia since the water privatization fiasco of the early 2000s.  If you are curious about that, here is a good article.  This event basically set the political landscape seen in Bolivia today.  

http://www.citizen.org/documents/Bolivia_(PDF).PDF

We have yet to see any protests in the streets, and Barb and Dean ensured us that by simply avoiding any street blockades we will be perfectly fine.  I'm sure we will continue to blog about this issue as time goes on.

Since our arrival yesterday, we have been able to check out the city a bit and today took a taxi to Laguna Argostura, which is about 30 minutes away.  I would rank this lake as one of the top 10 weirdest places I have ever been... but it was really pretty, and we had a great time.  We are hypothesizing that the lake was created by a manmade dam that you can walk across.  I quickly nicknamed that bridge, "The Bridge of 1000 Wasps".  It weirdly had tons of wasps that were swarming around us as we crossed.  I think it was Kiandra's favorite thing, and I have a feeling she will be returning many times to walk across that bridge.

The Bridge of 1000 Wasps, as seen from our boat.

A strange pirate ship yard jutting into Laguna Argostura.

We walked around the lake along this abandoned railroad track, and took a 20 minute boat ride on the water.  After that, we ate dinner in a restaurant with a beautiful view of the lake.  My meal was called "Pique Macho" or something of the sort, and all I knew was that it had beef.  Lucky for me, it had beef, filleted hotdogs, onions, and french fries all in a great big pile... it was more than I could have hoped for.

Alex W. enjoying a fine cerveza on the Laguna.

Our living situation is wonderful, as our host mother, Juana, is the sweetest woman alive.  She speaks no English, and I have been barely getting by communicating with her in Spitanglish.  She has already made us numerous delicious comidas Bolivianas tradicionales, including empanadas, chicken soup, and Api, a yogurt-esque breakfast drink made from purple corn.  I am really looking forward to getting to know her better the rest of this trip.

View of Cochabamba from the apartment.

We are by no means roughing it here in Cochabamba.  We are staying in a very nice apartment, with hot water and comfy beds, and obviously, internet.  Cochabamba itself is a beautiful city at around 8000 ft, and it sits within a valley giving it a mild climate (its nickname is the "City of Eternal Spring") and great landscape.  In fact, it sort of reminds me of the landscape of Boulder, CO. At the street level, there is pollution, lots of stray dogs, and definitely a dichotomy of extreme poverty and wealth, as one sees in many South American cities.

Tomorrow is our first day in the hospital, and I think we are all very excited.  Our next blog updates will surely include more of the medical aspect of the trip.

Judy

Beautiful view of Cochabamba.

Rotation Number 1, Summer 2013

We've just had our farewells for our first rotation of four students from MUSC going down to Cochabamba to work at Hospital Viedma.  They are well prepared to have a meaningful and productive experience in Bolivia, sharpening their clinical skills, learning about global health issues specific to Bolivia, and embracing a new culture.  Check back here regularly for more updates from the team as they experience it.  For now, a few introductions:

My name is Judy Staub from Wilmington, NC and I am a rising second year medical student at MUSC. I got my BS in Biology from UNC in 2010. I'm a snowboarding fanatic, a lover of the outdoors, and travel as much as possible. Although I have no idea what kind of doctor I want to be, I hope to incorporate global health and wilderness medicine into whatever I do.

My name is Kiandra Scott and I am from Charleston, SC. My hobbies include dancing and singing. I attended Clemson University with a degree in Microbiology/Biomedicine. In the future I hope to work in global health as a pediatric cardiologist or cardiothoracic surgeon.

My name is Alix Pommerenke and I am a rising second year medical student from Greenville, SC. I graduated with a degree in Biological Science from Clemson University in 2010. During my time off before med school I did some volunteer work in Nairobi, Kenya and worked as a research coordinator in Charleston, SC. Some of my interests include hiking, reading, traveling and spending time with friends and family.

My name is Alex Wharton and I graduated from Clemson University in 2012 with a degree in biochemistry. As of right now I am most interested in pursuing a career in surgery. In my spare time I enjoy playing golf, tennis, squash, soccer, and guitar. I am really looking forward to expanding my understanding of a different culture this summer in Bolivia.