The next week I went back to the clinic in Chasquipampa, but this time with Liz, who had not yet been. It was nice to pick up where I'd left off, and know exactly how I could help the doctor right from the start. I also got the chance to follow up with some patients I'd seen the last time I'd been at the clinic. I really didn't mind being in the same rotation again, as it's what I want to do when I'm a practitioner (and doing it for another week only confirmed that). The situation that really stood out to me that week was a 27-year-old woman with 5 children who came in to get her PAP results. After going through the whole spiel about birth control and how it's her who takes care of the kids, not her husband, and therefore should be her making choices about her birth control, she asks us for a copy of her PAP results. Turns out she needed something to show her husband to prove where she had gone when she left the house. UM, I'm sorry, WHAT?!? This simultaneously broke my heart, and really just made me mad. I know stuff like this happens in the states, but women there usually know it's not healthy and try to hide it. This woman was so unaware of how not-normal that was, she directly told us about it, like it was just a run-of-the-mill thing. Unfortunately for way too many women (particularly here), it is. Bolivia has made a big effort recently to combat domestic abuse, but there is still so far to go.

On a lighter note, that weekend, Liz and I decided to do the "World's Most Dangerous Road" mountain biking trip. Originally, we'd planned on going to Rurrenbaque, a popular destination in the Amazon Jungle. However, as it's the rainy season here, we were told it would be much too dangerous for us to try to get there by bus (dirt roads don't do well with lots of rain, and there's always the chance of landslides), and apparently the airport there isn't able to land planes using instruments, so if it were rainy and visibility was poor, the plane wouldn't be able to land at all. We'd heard a lot about the mountain bike tour, and since it ended in a small town bordering the jungle, we decided it would be a good compromise. The road itself used to be the only way to get from La Paz to the Northeastern part of the country, and is dubbed the "Death Road" due to the narrowness of the road -- often only wide enough for one vehicle to pass, and the fact that there is a huge cliff off to one side of the road. Before the new road was constructed, an estimated 200-300 people per year died on the road, most when their cars fell off the cliff when attempting to pass oncoming traffic. 

The day of the bike ride was one of the best, and most eventful, days of my life!After a slight delay in leaving due to mechanical difficulties, we were comfortably en route when we noticed a few vehicles pulled off to either side of the road. I didn't give it too much thought, that is until we passed an upside minibus with a large group around it, seemingly trying to upright it. Our bus pulled over, and I ran out, heart pounding and with Liz right behind me, to see if there was any way we could help. Even though I'm trained in first aid and CPR for my CNA certification, I've thankfully never had to use it, but was prepared to if need be. Once we reached the bus, the onlookers had changed strategies, and were busy popping out the plexiglass windows of the minibus to let the trapped passengers out. I observed the passengers as they exited, seeing lots of bumps, scrapes, and a few pretty bloodied up faces. There aren't seat belts in minibuses, so they'd all undoubtedly hit their heads during the collision. However, thankfully no one seemed to be critically injured (at least no resuscitative measures were needed), and since ambulances were already on the way, Liz and I agreed we weren't needed. 

I stood back to take it all in, and saw the taxi that had hit the minibus pulled off on the opposite side of the road -- it's front end completely totaled. The driver of the taxi was stumbling around, apparently inebriated. What I couldn't believe was that there was a government checkpoint not even 15 minutes before, so if the driver was inebriated (and it wasn't an injury from the accident), he would have had some form of contact with a government official just prior to crashing into the bus. An official who could have easily stopped him from driving on. A woman was yelling at him, berating him for driving drunk, and before I knew it, she had slapped him square across the face. A man in the crowd of about 20 stepped between the woman and the driver, and Liz and I looked at each other, deciding it was time to go before anything escalated.  As I got back on our bus, I looked at the steep hill on the other side of the road from where the minibus had gone, and thought about how lucky they were. Had that they had gone off to the right, it might have been a very different scene, and quite likely not everyone would have been as lucky.

It was definitely a surreal experience. You spend years preparing yourself "just in case", but can never really know how you'll react in a potential emergent situation. I'm glad that apparently all that time put into practice and prep paid off, and if I'm ever in the situation again, I'm confident in my ability to act quickly (which is certainly a necessary skill in the health care field).

We continued up to the top of the mountain and pulled into a gravel lot on the side of the road. It was higher up than in La Paz, and not only was it insanely foggy, it was also snowing a bit. We had about a 10-minute briefing on safety and basic biking technique, and then the guide pulled out a little plastic bottle filled with clear liquid. He said it was tradition to offer Pachamama (mother earth) a sacrifice to keep us safe. So, we each took a turn pouring a little of the liquid on our front bike tire, on the ground, and then taking a sip. UGH, it was awful! It was some type of alcohol, and  how I imagine rubbing alcohol tastes. I was the first to take a drink, and it was fun to see people who'd originally thought I was just a wimp take a swig and spit it right back out.

The bike ride itself was 62 km (about 30 miles), luckily mostly downhill. We chose the most well-known company since we were told by numerous people it was the safest, and they were great! The first 18km were on the new, paved, road to give us a change to get used to our bikes. The very first leg was a bit of a struggle as the condensation from the clouds we were in kept me blinking every second or so, making seeing a bit tricky. But that issue was easily solved by grabbing a pair of ski goggles to wear at the first stop. The rest of the ride was a BLAST! Speeding downhill around curves, with the wind in your face, is quite possibly one of the best feelings in the world, turns out. After a quick stop for lunch, it was time to start the actual "death road" part of the road, which meant going from nice, new, pavement to gravel roads with potholes, rocks of all sizes everywhere, and the occasional water block. The death road definitely earns its name, as the entire ride was spent about 5-15 feet to the side of a cliff whose height was somewhat unknown, due to the fog and mist that made it impossible to see the bottom. About halfway through the ride though, the sun came out, and we were able to enjoy the amazing views as we entered the rainforest. 

Sadly, the ride had to come to an end at some point, and it did, as we rode into a tiny village at the bottom of the road. We all got our "celebratory" cold beers -- provided by the tour company, as well as a few snacks. We were just hanging out, taking it easy, when our guide announced he had the forms for anyone who wanted to do the zip line. Liz and I looked at each other, and after a little discussion, decided -- when are we ever going to have the chance to do this again? For $30, it would be totally worth it. And it was! The zip line had three separate parts to it, the first being the highest above the rainforest floor, the second the fastest, and the third the longest. Now, a lot of you who know me will know I'm not exactly a fan of heights. But, somehow if put me in a "superman" pose about a thousand feet above the ground, I'll be alright!

The last part of the day was dinner and a shower at an animal refuge. The four of us who'd decided to do the zip line were taken in a taxi to meet up with the rest of the group, who was already there. I was slightly dismayed to see our Bus unattended on the side of the road, with my belongings in it, so my first priority was finding someone to let me into the bus so I could grab my backpack. One of the guides came back out with me, and much to our surprise we found our bus not completely empty -- someone was in the process of going through all our stuff!!

The guide with me opened the door and asked the thief what he thought he was doing. I stepped behind the guide to block the door -- the way the bus was set up, the open door was the guy's only way out. The guy inside was young -- maybe 20, and as soon as he knew he was caught, he took everything out of his pockets and put it back, pleading with the guide to just let him go. He even offered the guide money to just let him go, to which the guide (obviously) said no. Then, for some reason that I will never understand, the guide told me to go stand by the driver's side door. The door that wasn't actually a door, and therefore didn't open. The window was open and we assume that's how he got in, but it was a pretty small space, and if he attempted to escape through it, he would definitely take long enough for the guide to grab him. The door would be his only escape route, so I stood my ground there. However, the guide insisted I go to the driver's side door, so I did. And, naturally, the thief used that as a chance to get past the guide. I ran back over to the door I had been guarding, but by that point he had a lot of momentum, and I was only able to grab his wrist, a grip which he easily overpowered. 

The thief started running back toward the town we'd stopped at earlier, with the guide in close(...ish) pursuit. They passed a man walking on the road who just kind of watched until I yelled "Help!!", and he seemed to go "Oh, right!" and then started chasing after the man, too. Luckily, another tour group bus was coming up the road and saw what was going on and managed to block the road so the thief had nowhere to go. He thought about turning around and running back the other way for a second, but seemed to realize that would get him nowhere, and resigned himself to being caught. 

We all waited by the bus while someone went to get the rest of the group so they could do an inventory check on their belongings. As I stood there, I watched the thief. He was young, as I said, and there was nothing malicious about him at all. He had no weapons, he'd not tried to hurt anyone, and he was now sitting quietly  on the front bumper of the bus, awaiting his fate. I've experienced plenty of thievery in my lifetime -- things that meant so much to me, that someone felt they had the right to take away. And I never got the chance to tell those thieves how they were affecting my life, but here was this guy right in front of me who (I'd already figured out) had tried to steal my money. I finally couldn't stand being quiet anymore, and just kind of let him have it. 

"What, do you think we're all just rich Americans who have so much money it doesn't matter if you take it?" I asked him. He nodded his head a little in agreement.
"Well, look. I am American. But I'm definitely not rich! I'm a student, and I came here not as a tourist, but to learn about the culture and people. I spent all of my money -- money for rent, for food, to come here, and then people like you do this."
I don't remember exactly what else I said, but apparently it got to him, as he actually started crying. I have no idea if he actually thought about it more after that, but either way it felt amazing to be able to talk to him face-to-face, and at least try to help him see the people he was hurting by continuing to steal.

Thankfully, the rest of the day was uneventful as we drove back to La Paz. I don't think I had enough energy in me to deal with anything else. While it wasn't the rainforest tour Liz and I had originally hoped for, it was such an amazing experience in and of itself, and was definitely one of the best, and craziest, days of my life!

Since Thursday, January 22nd was a holiday here (inauguration day), and there wouldn't be anyone at the hospital, Liz and I took the opportunity to travel, and headed to Lake Titicaca. 

We gave ourselves an hour (more than enough time) to get to the bus terminal that morning, but still just barely made our bus. We didn't realize that all of the main streets in the city would be closed for a parade (not even the Bolivian residents seemed to have been warned), so it was almost impossible to get to the bus station. As our minibus began the detour, I asked my neighbor, an older gentleman (around 50+), to please let us know when to get off for the Bus terminal, as we were taking a route I was unfamiliar with. The bus driver finally gave up and dropped us all off at a random location far away from where we were supposed to be going, as there was just no way into the city. The man I'd been sitting next to, along with another older woman from the bus, both came up to us to give us directions and make sure we knew where to go to get to the station. At this point we only had about 30 minutes until our bus left, so we grabbed our bags and started booking it up one of the many hills of La Paz's downtown. We got to the end of the street, where it forked, and were just trying to figure out which fork was "straight", as he'd told us to go, when none other but our male friend from the bus comes strolling down an adjoining street! He told us it would be easier to take another minibus, since we were short on time, and told us to follow him. Liz and I knew we were at a loss on how to get to the station on our own, so we followed him to another minibus working its way through the city. This bus took tiny cobblestone streets and alleys that were it not for the parade no car would have taken, and about 15 minutes into the drive I was utterly confused as to where we were. But then I finally recognized the street adjacent to the bus station, when our friend (who had been sitting up front in the bus) called to us that we should get off, as he did the same. When we went to pay our fare, we found that not only had this kind stranger made sure we'd made our bus, but he'd paid for it, too! I don't care what people say about Bolivia, but it's acts of kindness like this that I see way more often than any thievery or danger.

A short buse ride later (for Bolivia, about 4 hours), and after a quick boat crossing, we were in Copacabana -- the main city that sits on the Bolivian side of Lake Titicaca. Well, I use the term "city" very lightly here. It's very small, I would guess around a population of a few thousand or so,  with a few hundred tourists at any given time. We grabbed a quick (but delicious) lunch while we waited for the boats to la Isla del Sol, which didn't leave for another 45 minutes. Since it was hot and sunny, we decided to ride on the top of the boat, and take advantage of the views that offered. Well, it was hot and sunny on land. But put us on top of a boat out on an enormous lake, and it gets cold fast! The supposedly 20-minute boat ride turned out to be more like two hours. Boat after boat passed ours as we puttered along, barely seeming to move. It wasn't until we were about 80% of the way there that they must have decided to try the other motor or something, because we seemed to kick into hyperdrive and make the last bit of the way about three times faster. 

Isla del sol was much smaller, population-wise, than I could have ever imagined. So much so that I can't seem to even find census information on the population, more than an approximation of about 800 families. Liz and I took the boat to the Southern portion of the Island, planning to hike the about three-hour-long path to the Northern side the next day. As soon as we got off the boat, we were greeted by tons of little boys calling out "Hotel ____!! Solo x Bolivianos por la noche!" (Only x Bs per night!), some of which were pretty tempting, at about $2 per night. However, our Spanish teacher, Jenny, also works as a tour guide and has amazing recommendations for everywhere, as well as tons of connections. So she had called ahead and reserved a hotel that she recommended for us, Hotel Caluche. We asked around for our hotel, and the only answer we were really able to get was "Up there!" *pointing toward the very top of the hill*. So, we started climbing these enormous stone steps toward the top of the hill. Eventually, after turning around a couple of times and asking probably way too many people, we found our hotel. 

THE BEDS! Those must have been some of the most comfortable beds I've ever slept in. Or, maybe I was just that tired. Either way, it was one of the most relaxing weekends I've had in a long time. That night I ended up getting pretty sick, we deduced from dehydration, so having a nice place to sleep and get better was a godsend. Our room was very simple -- beds, a coatrack made from an old branch, and a bathroom with a sink, toilet, and open shower. But the view from our beds was amazing. Each bed faced a huge window looking out onto the lake and the Andes mountains across from us. A huge storm rolled in that night, and the rain continued into the morning, making the trail we'd planned on hiking impassable. Since I was still recovering from the day before, we decided to spend the morning taking it easy, playing cards and reading (I'd brought Harry Potter in Spanish), and then we would take the afternoon boat back to Copacabana. 

After a slow morning and an amazing breakfast (fresh baked bread with fresh butter and peach jam, scrambled eggs, coffee, tea, and "juice" made from banana blended with milk, all included with the $10/night for the room!), we packed up our stuff and headed back down to the dock. This time we knew to sit in the lower deck portion of the boat... which turned out to be just about as hot as the upper deck was cold. We saw a group of European-looking tourists who had seemed to find the perfect spot to sit by climbing over the railing on the upper deck and sitting on the windows of the lower deck -- they didn't seem to get as much wind, but just enough to not be sweltering either. Definitely made a note of that for next time! 

We spent the rest of the day in Copacabana chatting with other tourists (we met people from Sweden, Turkey and Germany), and exploring all of the little touristy shops the town has to offer. It's definitely a tourist town, but had the best prices on llama sweaters, so Liz and I each got one -- you can't be in Bolivia for 3 months and go home without a llama sweater! 

Oddly enough, my favorite part of the trip was the drive home. I'd spent so long enjoying the amazing beds at the island hotel that I was able to stay awake the whole bus ride (virtually unheard of for me -- put me in a moving vehicle and I'm out)! The sun came out, and the water was this gorgeous green-ish blue that I'd never seen before except for in photos of exotic tropical waters. That combined with the simple serenity of the family farms was something I've never come close to experiencing before. 

As we got closer to La Paz, we got to this odd in-between, where the very poorest of the poor lived -- not so far out that they had huge farms they were making money off, but not close enough to probably have ever been to the city, either. Each house was no bigger than one room, probably smaller than 300 square feet. It was so sobering to see so many people living in such poverty -- and yet so many of them seem so incredibly happy. The kids find whatever they can to play with, and are glad to have anything at all to use for a toy. Whereas kids in the states play with a toy maybe 10 times and then need the newest, latest or greatest. In the states, it's so easy to focus on what you don't have rather than what you do; see all the families with so much and wonder why you don't have all the same things, rather than see the even larger number of families who have so little, and appreciate where you land in the mix. I like to believe I'm appreciative for all the opportunities I've been given, and the wonderful people in my life. But this bus ride, giving me glimpses into lives that so easily could have been mine, was extremely sobering, and made me realize more than ever how impossibly lucky I am, and how important it is to give every shot 100%, for all the people who will never even be given that opportunity to begin with. 

I can't believe I've already been here a month! Time seems to pass so differently here -- I can fit so much into one day that the individual days seem to go so slowly, but at the same time the weeks are flying by. 

The week after the clinic in Chasquipampa, Liz and I were in surgery with Dr. Galindo. He's a slightly older gentleman, and one of my favorites that we've worked with. Our first day, he asked me where I went to school, and when I told him I went to the University of Oregon, his response was "Ducks!!". He was really great at helping us understand what was going on in surgery, and letting us know what other interesting surgeries were going on that we could sit in on. The first day he had a liver biopsy, to confirm hepatoblastoma (a malignant liver tumor) of an infant about 15 days old. It was great having Liz there, because she's a 4th year med student about to graduate, so with her medical knowledge and my spanish, we were able to figure out why they were doing the biopsy and what they were expecting to find. Apparently the approach they used was much more invasive here than in the states, where needle aspiration is the most common form of biopsy. Here it was a proper surgical procedure, involving cutting out a very small portion of the mass to biopsy. Our best guess was that they didn't have the equipment to do the needle biopsies, as we saw several others done the same way, meaning the approach wasn't specific to the patient. 

The other surgery we saw that day was an appendectomy, and oddly enough my years of highly-technical experience (...via Grey's Anatomy) came in handy. The number of appys on that show helped me recognize as they opened, irrigated, identified, clamped, removed the appendix, and inverted the stump into the cecum. So, thanks for that,  ABC! We also saw a few orthopedic surgeries throughout the week, including what appeared to be surgery to correct hip dysplasia in a toddler, a few broken bones, and an elbow dislocation. Dr. Galindo had a really interesting case where the patient had a giant choledochal (bile duct) cyst, and  he removed the gallbladder and parts of the hepatic trunk, using the intestine to create a biliary-enteric anastomosis, or direct connection for the bile from the liver to enter the intestine.

One of the last surgeries we saw was the removal of a tooth. Now, you might be wondering why that would require a surgeon, and not just a dentist. Well, we all know that kids lose their deciduous baby teeth, and adult teeth take their place. But, did you know that those adult teeth are actually situated in the maxilla and mandible long before they descend? Look up a picture, it can be crazy to wrap your head around. Anyway, this child had a tooth that had developed a little too far above where it should have -- it had developed far up his maxillary sinus! He had been having issues with lots of sinus infections, and when they did an x-ray to check for deformities of the sinuses, they instead found a tooth. So the surgeon went in through the mouth -- cutting the connection between the gums and inner upper lip, to retrieve the tooth.

All in all, I LOVED surgery, and Dr. Galindo was great. It was a bit sad when I showed up on the second day and he asked me how the national championship had gone, but I love that he cared so much and was so into the whole thing.

The next week, Liz and I were in Nephrology, which was a little bit harder to follow, since it's all labs and charts, but with Liz's medical knowledge, and my Spanish, we were able to follow along pretty well. We saw a lot of nephrotic syndrome (protein in the urine generally accompanied by edema), nephritic syndrome (damage to the glomerulus allowing protein and red blood cells to pass through), some UTIs, and a few other more specialized cases. One little girl, about 6 months old, needed surgery to correct the position of her ureters. Ureters form the pathway that urine uses to drain from the kidneys to the bladder. In this girl's case, her ureters weren't in the correct place, allowing urine from the bladder to back up into them, causing numerous infections. The great thing, as hopefully I've mentioned, is that the health care system here for children under five years old is free. They receive any and all vaccinations and treatment for free. However, el Hospital del Niño doesn't have a urologist to do the surgery, so the family would have to find a private clinic, which isn't covered by the government. The team didn't really know what to do, and were stuck trying to find a way to help the little girl without bankrupting her family. Hmmm, sounds like health care somewhere else I know! The interesting thing to me was that this little girl was the exception, rather than  the norm. It was hard for the medical team to see this one patient who needed surgery the family couldn't afford, whereas in the states it's the other way around -- so many patients who need surgery but can't afford it. The SUMI program, as it's called, seems like a great way to help lower the child mortality rate, which has been shown to lead to people having fewer children, and will end up saving Bolivia a lot of money in the long run. Healthier children now means healthier adults later.

     Through the beauty of good networking, Dra. Uribe was able to find us somewhere else to work that first week, since everyone was apparently on vacation. So rather than wander aimlessly around Hospital del Niño, we went to a clinic in Chasquipampa, a small pueblo just on the outskirts of La Paz, to assist and observe a doctor who specializes in adolescent medicine. As the population of Bolivia is comprised largely of adolescents (as of 2014, 19% of the population was between 15-24 years old, compared to 13% in the US), and the adolescent pregnancy rate is relatively high (79/1000 pop, compared to 60/1000 pop in the US), a large part of adolescent medicine here is related to pregnancy. In fact, every single patient we saw that entire week was either: A) Trying to not get pregnant, B) Already pregnant, or C) Had just had a baby. Dra Santivañez showed us how to measure the uterus, find the fetus's position by identifying the spine and head, and then find the heartbeat (and differentiate it from the placenta). We also did all of the charting -- making sure the mother's weight was within reasonable limits, charting her visit, and writing up any lab orders needed. By the end of the week, Karina and I were able to virtually carry out the entire pre-natal visits with just supervision. 
     Bolivia has a history of very high infant and child mortality rates, which has lead to their current maternal and childhood health incentive program. If the mother complies with her pre-natal visits, and gives birth in a hospital, she receives a monthly stipend, adding up to 1800 Bolivianos ($260) over the course of about 2.5 years. While that doesn't sound like a lot, any little bit helps, and this program does seem to be helping a lot with the mortality rates. Previously, it had been common to not seek any medical attention at all, pre-natal or otherwise. Anemia is quite common here, due to the general lack of protein combined with the high altitude. So if a women was slightly anemic before becoming pregnant, it would get even worse, and when born the child would develop severe anemia. This "bonus" is helping women overcome their prior fear of the medical system and they're now getting the education and treatment they may need for a healthy and successful pregnancy.
     One of the things that surprised me most that week was the general lack of education regarding reproductive health. Coming from Oregon, where we were all required to go through sex ed in 5th grade, and then again in high school, it's easy to forget not everyone has had the opportunity to receive such necessary information. We had one patient come in who was about 17 years old, and her main reason for coming in was that she had a partner, and didn't want to get pregnant. When asked what her current form of birth control was, her response was "none". That was the general theme of the week, as almost every woman who came in had very-little-to-no knowledge of birth control. Birth control in Bolivia is free, all they have to pay is the 5 Bs (less than $1) consult fee, and yet women are afraid to seek it out, or apparently unaware of its availability. Women's' rights in general seem to be a current hot topic, as there are huge banners and signs all over the city saying "Stop Domestic Violence!". The culture has a very strong machismo background, and it seemed to me that the women we saw were so used to not making their own life choices that when they were faced with a choice (which type of birth control, or to use it at all), they had no idea how to make the choice for themselves. For example, in order to have a tubal ligation, a woman must have written consent from her husband. It should be noted that to get a vasectomy, men need no such consent. Another woman even called in her husband after we'd finished explaining all the different types of birth control to her, so that he could decide what form of birth control was best for her. 

     One of my biggest realizations this week was definitely how lucky I am to come from a place where not only are we (men and women alike) educated on reproductive health, but we're all given the opportunities and resources to make decisions for ourselves. I'm not sure exactly what the future holds for me, but working with these amazing women who were simply lacking in some fundamental education made me realize how passionate I am about these issues, and I hope to some day maybe be able to educate more women and empower them to make the decision that is right for them.      
     

Monday was my first day at el Hospital de Los Niños and Karina (the other intern) and I showed up right at 9 am, as I’d been instructed. The day before, Gonzalo had showed me exactly where to go when I got there, and told me to ask for Dr. Velasco, who from what I understand is the coordinator/head honcho at the hospital for CFHI. Karina, who will be leaving this weekend, needed to return a book to him anyway, so she said she could just show me where his office was. However, on finding his office empty, we returned to the information desk at the entrance and asked one of the receptionists to please page him for us. We were promptly informed that Dr. Velasco was in fact on vacation, and will be until February. Oops. So I decided to just go with Karina, who was assigned to work in Neonatology that day. What could be a better intro to working in the hospital than brand-new babies, right? The hospital is very old, and built somewhat like a maze, so it took us a good while to find the unit. But once we finally found it, the nurses buzzed us in, looking a little confused. I told them that we were students, and that we’d been told we would be working there that day. Well, turns out you need to wear scrubs to work in Neonatology, a detail that had unfortunately somehow been missed. As it’s not the norm to wear scrubs on a daily basis here, neither Karina nor I had worn them that day, so we were once again out of luck.  
I decided to go ahead and call Gonzalo, and see what ideas he might have. I told him what had happened, and he said he was going to check in with Dra. Uribe, who works with the doctors at the hospital to set our rotations, and get right back to me. He texted me right back and told me to look for another doctor Karina had previously worked with. She knew who it was, and so we went back down to her office. Only to be told, once again, that she was on vacation. Apparently it’s a pretty common thing for doctors to go on vacation for a month at a time, particularly around Christmas/New Years. So I texted Gonzalo again, and he said to go to Oncology and work with one of the doctors there. Thankfully, once we got to Oncology and asked about her, we were told she was in a meeting and would be there within the half hour. 
The Oncology unit was very small, with about 10 small rooms separated from each other only by glass and sliding doors. Once the doctor arrived, we washed up and donned masks, before entering the hallway housing the rooms and meeting up with the rest of the doctors, who had already begun rounds. The doctor we were working with that day told us to go meet one of the patients, and take a look at his tumor. We went in and greeted the boy and his mother, introducing ourselves and asking if we could take a look. The boy was fairly small, I would have guessed he was about 8 or 9, so I was surprised when he started talking, and I quickly realized he was older. While HIPPA very much isn’t a thing here (more on that later), I’m still going to try and be somewhat vague to protect patient privacy, so I will simply say that he was somewhere between 10-13. He was extremely friendly, and even though he was obviously undergoing chemo and having a rough go of it, he was cheerful and talkative. We examined his tumor, and got a brief patient history from him and his mother. 
     As the doctor wasn’t expecting us, there wasn’t a ton to do, but she still did a really good job of explaining things to us, and going through the diagnostic process. She gave us a chart to read, and then asked us what it said, and what the various tests and results meant. We mentioned how much we liked the little boy we’d met earlier, and she told us that his condition was grave, and he most likely wasn’t going to make it. She then handed us a piece of paper and told us to have the boy write a letter to his mother that she would hold onto, and give the mother after the boy died. Not quite what we’d been hoping to hear when we brought up how great this little boy was. When we went back to his room, a group of volunteers was entertaining the children: reading to them, clowning, anything to brighten up their day a little bit. This boy had a volunteer playing video games with him, and when the volunteer had to leave, I somehow ended up taking over for him. Let’s just say FIFA isn’t exactly my specialty. I much prefer GTA, or a good FPS. But, I was willing to take one for the team, and ended up getting whooped, 5-1. Karina and I spent the rest of our 40-some minutes left playing with the boy, and keeping him company. Although it’s not exactly what we’d expected to do that day, it was absolutely worth it, getting to keep this boy company while his mom was away, and we left for the day feeling good about what we’d gotten to do.
     Later that evening after lunch (which is the biggest meal of the day and is eaten at home), we went to Dra. Uribe’s office. Dra. Uribe is a pediatrician, and besides scheduling our rotations, we meet with her once a week for a lecture on a specific health topic. This first topic was undernourishment, which historically is a pretty big issue in Bolivia. Undernourishment, simply put, is not getting enough to eat. Undernourishment isn’t to be confused with malnutrition, in which case one can be getting plenty to eat, but of high-fat foods with little-to-no actual nutritional value. Undernourishment is a more severe problem, Long-term undernourishment can lead to short stature, decreased mental capacity, and death. In the past, undernourishment was a high contributor to high infant and child mortality rates here in Bolivia. To combat the issue, the government and health care system alike stress the importance of a healthy diet to pregnant women, and have increased education regarding the issue. They also have pushed breastfeeding as an extremely cost-effective primary form of nutrition for infants at least until 6 months of age. In fact, there is a law that made it illegal to advertise infant formula of any kind, as many mothers ended up using only a tiny little bit of the formula with a lot of water to save money – leaving their infant undernourished. While the government apparently also gave themselves a boost in appearing to have addressed the issue by narrowing the parameters of what constitutes undernourishment, their other approaches seem to be working, and there isn’t nearly as much as in previous years. I’m interested to see what happens in the next few decades, as the country gains access to more high-fat, high-calorie foods, I wonder if they will move more toward problem with obesity and malnutrition – from one extreme to the other!

     After 36 hours of travel, I finally made it to La Paz around 3 a.m. local time. Just getting here was an experience in and of itself, with the greatest take-away from the whole thing being that we Americans are seriously ripped off by our airlines. The South American airline I flew here on (Avianca) provided free meals on every flight, no matter how short the flight. Oh, and FREE ALCOHOL. Yep, that's right. All beverages, including wine (red or white), or any mixed drink, was free. It's a good thing too, because my last flight from Bogota to La Paz had some major turbulence, and it seemed that the "decaf" coffee I got in Colombia wasn't in fact decaf. I'm really not big on flying, and turbulence only makes it that much worse, so a nice glass of white wine helped me get through the flight. They also provided free personal entertainment units, so I got to watch an episode of Friends, followed by the movie Frozen to keep me occupied.
     CFHI had a driver there waiting for me once I got through customs and had my visa taken care of (which was really quite easy to do). One of the very first things I learned on the drive home was that there are no rules to the road here, and red lights are more of a suggestion than anything.  A lot of the roads here don't have yellow lines dividing the lanes, but just white lanes. So the drivers just take whichever lane they want, and eventually move back over if someone else is coming the other way in the same lane. The cab driver was very friendly, and we chatted the whole way home (which, thankfully wasn't as hard as I expected it would be; apparently I've retained more of my Spanish than I'd feared).
     Upon arriving at my homestay, I was greeted by Jenny, who showed me to my room, and as it was 4 am, she left me to sleep. The couple who is hosting me more or less own the apartment building we're in, and although it's several stories high, with two apartments per floor, there's only one other family living in the building. I'm sharing the apartment across from theirs with another student here, whom I have yet to meet, as she's been traveling this weekend. But, we corresponded via email prior to my arrival, and she was extremely helpful.
     My first day here was a Saturday, which was perfect because I was able to sleep in (which was much needed after not sleeping those 36 hours of traveling).  After lunch (which was really good, a basic lentil stew over rice), Jenny showed me around the city. La Paz is HUGE. I mean, obviously I expected it to be big -- it's the capital. But the city is very densely packed, and sprawling. The hills and mountains that surround the city are almost completely hidden by little houses, and the city seems to go on forever. Public transportation here is insanely cheap, and there are a lot of options to choose from. You can take a private taxi, a "trufi", which is like a taxi except it's shared with others and has somewhat set routes, a minibus (same idea more or less as the trufi, but larger), or a regular bus.  A trufi costs about 2.40 Bs (about $0.34), no matter where you're going. They also have a very new suspended cable car system that runs East-West. For 3 Bs, you can go from the city center to El Alto, a very large community in the Eastern hills/mountains surrounding the city, or to the West to Obrajes (where I live). Jenny and I took the teleferico (the cable car) to the farthest stop to the West, where there is a somewhat new mall. She explained to me that it's the first of its kind here, and the people here had never seen anything like it. It's really interesting to see all these intersections of traditional and western cultures -- indigenous women (very easy to spot with their colorful hoop-type skirts and big bowler hats that sit on top of their heads) riding cable cars and shopping in big malls, or the seemingly millions of telephone and internet cables criss-crossing above cobblestone streets lined by traditional Spanish houses dating back to who-knows-when. 
     Today I met Gonzalo, one of the program directors, and he showed me El Hospital del Nino, and the office of one of the doctors with whom I will be working. He took the time to show me exactly how to get there, and the best forms of transportation to use, which I greatly appreciated. He showed me all the points of interest in my neighborhood with great detail, and made sure I know how to add minutes to my phone, or get money, or anything else I might need. He had some great advice about being safe in the city, and gave me lots of examples of things to do, and not do. He was extremely friendly, and spoke absolutely perfect English, to make absolutely sure I understood everything. 
     Tomorrow will be my first day at the hospital, and I'm excited to see what I will be doing for the next 5 weeks!