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My 3rd rotation in Tarija, 8th in Bolivia was at a very basic, general clinic called Nestor Paz, about 15 minutes out of town. Everyday, I took a micro (minibus) which dropped me off about 5 blocks from the clinic, which I almost walked past the first day because it is completely unmarked. I walked into the not-very-busy lobby where waiting patients were watching the news on an old TV, seated on falling-apart plastic chairs. A few nurses sat at an admittance table, covered in papers and files, by the door. I walked in and found my supervising doctor for the week: Dra. Delgadillo. From the very beginning I knew that I was going to enjoy working with her. She was warm, welcoming, and excited to hear about my experience in Bolivia thus far. Not many patients came in, so we had a lot of opportunities to talk. Many of our patients were kids with the flu, stomachaches, or diarrhea/vomiting. There was the occasional older lady with digestive problems, and women who wanted to start using birth control. Many of the patients were with a parent or sibling that also needed something from the doctor, so I was able to see the structure of family medicine here.
With each symptom, the doctor explained to me the local protocol, which is very different from ours and was often surprising for me. For example, any patient with a cough or that is flu-ish is checked for tuberculosis. TB is extremely prevalent here. Patients with stomachaches and digestive problems are checked for parasites such as giardia. Babies around the age of 3 months are sent to have a hip x-ray to check for hip-dysplasia, a very common condition due to the way that babies are wrapped up tightly and placed on their moms' backs for hours. Also, any patient who presents with a combination of digestive issues and cardiac abnormalities is almost automatically diagnosed with Chagas, a complicated disease transmitted by a beetle that affects hundreds of thousands of Bolivians, and has been largely neglected by the rest of the world. I will learn more about it in my Chagas rotation, my last week here.
One of our patients was a 2-year-old whose mom said persisted with a bad cold. The doctor noticed that he had come in two days earlier, and said the medication may take a couple of days. The mother told us that she had no more medication, which left the doctor very confused because she had prescribed 7 days worth. The mom explained that her baby loved the strawberry-flavored antibiotics, and that she gave him more every time he asked for it. I think that this equally shocked the doctor and me, and I was extremely impressed with Dra. Delgadillo's patience as she explained to the mother that her child could overdose on the medication, and that this could be really dangerous for her child. The mom lives in the country with her family, and is not very educated on western medicine.
Our last patient that day was a 6-year-old whose teacher brought him in, because he had a wound on his head from a Tromp: a spinning top that the boys play with made of wood, with a sharp, metal foot. Someone had flung their trompo, and it had hit the poor boy right on the top of his head, making a deep hole. The doctor prescribed an antibiotic cream and sent the kid back to school.
Another day, the lab technician (an older, cheerful lady with a huge flower clip in her hair) pulled me into the clinic's lab to check out her samples. She showed me (under the microscope) giardia in different phases, the tuberculosis virus, amoebas, and then pulled out her "museum" - a collection that she herself had put together of different parasites that had been removed from patients in the clinic. She had little bugs and worms, and other pretty disgusting looking creatures. Enthusiastically, she pulled out one by one to show me.
My last day in Nestor Paz, I accompanied a group of doctors to a nearby daycare to do physical exams on the children. These kids come from very poor families and only receive healthcare in cases of emergencies, so the clinic has started a program where they go check up on the kids and make sure that they are receiving and vaccines or medication that they need. I checked their hearts and lungs, another doctor checked their teeth, another checked their medical history and another took their height and weight. The scale to measure their weight involved a harness attached to a rope with a weight meter on it, which the doctor had to strap the child into and then lift off the ground manually! I could not help but laugh the first time I saw this. The kids (1-5 years old) were extremely cute, and generally healthy. Overall I had a new and unique experience working with a much poorer population than I have in other clinics/hospitals.
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Sam Amazing to hear about all your adventures!! Keep up the good work!