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!
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!