Wow. What an incredible first week in Bolivia! Almost every aspect of the past few days surpassed my expectations. I have settled in and have fallen completely in love with La Paz. The people are genuine, warm, and welcoming. The city is gorgeous. My first experience in the clinic was profound.

My rotation this week was in a clinic for adolescents, where I shadowed Dra. Santivanez, who specializes in girls 15-25 years old. Here, that means almost all girls who are pregnant or have young children. Adolescent pregnancy is extremely common and problematic, especially in the poorer neighborhoods where education is limited and there are little resources available to this population.

The very basic clinic consists of a few doctors, nurses, a dentist, and social worker. Every morning this week I met Jodi - an intern from California - and we walked about a half an hour to meet the doctor. The 3 of us then took a mini-bus to the clinic, which is up in the hills in the outskirts of town called Mariflores. On our way into the clinic Dra. Santivanez greeted all of her coworkers with hugs and kisses. We then followed her into her office/exam room where we began seeing patients almost immediately. The room is small, has a desk, exam table with one set of sheets that are never changed or cleaned, an attached bathroom, and a small table on which sits all of the equipment: a blood pressure cuff, measuring tape, battery-operated fetal hear monitor, vaginal speculum, and a bottle of hairspray.

The doctor tells us the first patient's name, and asks us to call her in from the packed waiting room (rows of chairs where young women and children wait to be called).

When the patient enters the doctor welcomes her warmly and asks her questions about her pregnancy and/or children, health (emotional, sexual, social), and anything else that brought her in. She then has us help the young lady onto the exam table. With the pregnant girls, she feels for the fetus - finding its back and head. Then, using the fetal heart monitor she listens for a heartbeat. Using the measuring tape, she measures the length of the fetus and that concludes the prenatal exam. Other exams include PAP-smears, and general exams.

One 17 year old girl came in to have her stitches removed after having a sesection. She lifted her shirt, showing us a vertical incision with think, uneven, black stitches. The whole area was infected and she was in a lot of pain. I offered her my hand to hold - the only pain relief she got while the doctor removed the stitches one at a time.

During the first two days Jodi and I watched the doctor perform the exams, mostly listening but also feeling anytime she would let us. I always offered to hold the patients' babies while they were examined. Bolivian baby smiles were definitely the highlight of any day. The third day we got to do the exams while the doctor watched! Finding the fetal heartbeat using the monitor for the first time by myself was one of the most exciting and rewarding things I have ever done. The young mom's face lit up and I immediately felt a connection with her that I have not ever experienced with a stranger.

After each exam the doctor spoke with the patient about her health, having us fill out prescriptions and paperwork. She offered a lot of advice, talked about birth-control options, diet, and plan for the upcoming months. During this time, she also asked the patient about her partner, which often brought up incidents of physical, emotional, and sexual abuse. This was the most challenging part of this week. Many of the girls were in abusive relationships and many were depressed. The doctor explained to them that they have rights and that this is not how relationships are supposed to be - a surprise to many of them. She referred them to the social worker and offered them whatever other support she could. For many of these girls, this doctor is the healthiest relationship that they have in their lives. This warm, motherly, compassionate and empathetic women never rushed a patient out of her office. She explained every detail to the girls in a way that they could understand, and was always patient with them when they got upset or confused. This woman is a sunshine in this dark and depressing place, playing the role of not only doctor, but also mom, therapist, mentor, and most importantly, friend.

It was sad to say goodbye today, but I am also full of excitement for the next rotation and new relationships. The next 4 weeks I will be in the children's hospital starting with an infectious disease rotation, followed by oncology, pulmonology, and finally, surgery.

Tomorrow, the 13 of us interns are going on a weekend trip to Lake Titicaca - on of Bolivia's most prized oases. You can read more about it in the following link:

http://en.wikipedia.org/wiki/Lake_Titicaca

As always, excited to be here and feeling more fortunate every day that I am exposed to how challenging and frustrating life could be. We are luckier and more privileged than we could ever imagine.