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.
No comments:
Post a Comment