This week was my first in the children's hospital in La Paz - Hospital del Nino - and was a drastically different experience than the adolescent clinic. My rotation this week was in the Infectious Diseases department of the hospital and I did not really know what to expect. My supervising doctor was Dr. Velasco who has been working with Family Child Health International for 8 years, and coordinates the hospital program. This man is extremely passionate about this internship opportunity and public health, which made for endless learning opportunities for us. He also happens to be the director of the tuberculosis program in the hospital. We began the day with rounds, where a resident in the department presented the doctors and students with the history of each patient and then discussed treatment plans. The inpatient unit is relatively small, about 12 beds, several per room (which doesn't seem logical for an infectious diseases unit). The doctors do not wash hands between patients and rarely wear gloves. Parents have a plastic chair to sit and sleep on while they stay with their children.

Some of the cases we saw:

- 14-year-old with tuberculosis, doing well and going home soon

- several children with complicated pneumonias, some with draining tubes from their lungs

- a 2-year-old with an abscess on her back, bad infection from something

- baby with whooping cough, saw her face turn purple several times

- 12-year-old girl with parasite in her lung causing a build up of puss, needs surgery but parents can't afford it - waiting for a volunteer surgeon from Europe (dad had to go home, 6 hours away, to work during the day or else he couldn't afford food while staying with his daughter who is one of 10 children)

Aside from checking on patients, we had small tutorials during the week about identifying different types of pneumonia from x-rays, as well as the levels of diarrhea and corresponding treatment plans. Learned so much! We also role-played breaking the news of a sick child to their parent in order to give the medical students a chance to practice this.

On Thursday of this week, we accompanied Dr. Velasco to his outpatient office. We saw 4 patients, two babies whose moms have HIV and were too young to test for the virus, and two older girls with HIV. For each patient, Dr. Velasco had us compare their height and weight with the averages, and then do physical exams ourselves while he filled out paperwork! We checked their hearts, lungs, abdomen, eyes, ears, nose and genitals.

My most embarrassing moment of the trip also happened on this day. During my first abdomen exam on a baby boy, I pushed down on his belly and he immediately sprayed a stream of pee up and onto my lab coat! Fortunately HIV cannot be transmitted by urine.

Busy week full of interesting cases and firsts for me. Excited for whatever comes next!