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Infectology Unit
Mary Beth and I. This last week I was working with Dr. Velasco at Hospital del Nino in the Infectology Unit. I think that it was actually harder to work in this unit because most of the patients had more severe sicknesses and the challenges surrounding the culture of Bolivia are very apparent. Ever day Dr. Velasco would take the time to address some common challenges he faces as a doctor in Bolivia. I wanted to use this blog entry to explain some of the cultural and health conditions that are very common here in La Paz.
For example, as I mentioned earlier, malnutrition is a very big problem here in Bolivia. Our program doctor, Doctora Uribe, gives us a presentation on a health problem every week, and this week was malnutrition. Very often, Bolivian families have many children, even if they cannot appropriately finance the additional children. Most of the problems, especially with malnutrition, stem from a lack of education. In Bolivia there is an apparent class system and there are many poorer uneducated people. In the case of malnutrition, parents are unaware of the appropriate diet for their children. Starting from birth, many mothers do not know how to properly breast-feed their
Hospital del Niño
Me with one of the patients that is suffering from renal problems and the doctors didn´t know what was causing it. child. Within the past two weeks, many mothers have complained about not producing milk, and each time, the doctor explains to them that the baby has to suck for the milk in order for the body to produce milk. Dra. Uribe was explaining to us that when mothers don’t breast feed for whatever reason, then very commonly, the mothers will take a little bit of milk and dilute it with water and feed it to their babies because both milk and formula are expensive. Also, since Evo Morales became president and has encouraged the growth of Coca farms, they have taken over the farming of many fruits. Now because of this, fruit has become more expensive because it is imported from further away, and thus resulting in families not buying fruit because of the expense. Doctora Uribe said that most of her day consists of educating parents on the amount, frequency, and the type of foods their children need to be eating. She also attributes Bolivian’s short stature to malnutrition as a child. She said that as you go higher into El Alto, the people get shorter and shorter because the people are poorer in El Alto and malnutrition is
Dr. Velasco
Dr. Velasco, the infectology doctor, with one of the patients. extremely common. Part of it is of course genetic but many times a child does not grow to their full capability because of a lack of nourishment.
While I was working in the clinic with Doctor Velasco, many parents brought their child in because they thought their child was sick or suffering from some kind of illness. Each time, Dr. Velasco would have us do the physical exam, listen to the lungs and heart, and most times, the child was perfectly fine, except for maybe a runny nose. When we would ask the parent what was wrong, they would say that the child hadn’t been sleeping through the night, the child has had a cough for several weeks, or the child has been acting abnormally. In cases like these, Dr. Velasco would give the parents a placebo. He says that in many cases, he has to treat the parents rather than the child. He said that he could take the time and explain to the parent that nothing is wrong with the child, but with uneducated people, they are most likely going to just go to a different doctor the next day until they got an antibiotic for their
child that may just have a small cold. Dr. Velasco would rather give the parent a vitamin to prevent them from going to another doctor because antibiotic resistance is a big problem here. Since anyone can buy antibiotics over the counter, many parents and people will buy an antibiotic for just about anything, which is making the resistance within the population worse.
Dr. Velasco further explained to us how the lack of education creates barriers between doctors and Bolivians. For example, most uneducated Bolivians believe that doctors are wrong and stupid. They believe in practical things and don’t believe educated people when they tell them otherwise. For instance, many people believe that the sun revolves around the earth, simply because they physically see the sun move from east to west. Likewise with healthcare, they believe that they should not give their child liquids if they are suffering from diarrhea because they physically see that liquid is coming out of their child’s body, so the practical thing would be to stop liquids, which is completely the opposite. There are many uneducated Bolivians that have many magical and mystical ideas and they would rather trust their grandmothers and ancestors than doctors.
Dr. Velasco
Mary Beth, Aisha, and I with other US med students and Dr. Velasco. For example, a boy around 10 years old came into the hospital because he had abscesses all over his extremities and in his throat. He originally had a small abscess on his left foot but because he lives in El Campo, which is a very poor area where the agricultural fields are and is far away from the city and far away from health care, the small abscess was never treated. His family and people that live there tried to treat it using plants and other alternative, cultural ways of treating an injury. The bacteria eventually got into his blood stream and he has these terribly painful abscesses all over his body. Dr. Velasco was furious with the father for letting it get this bad, but this is just another example of the cultural barriers that are in place with uneducated people. When I left on Thursday, the boy had been there for a week and a half and was going into surgery so that they could clean out the abscesses. I hadn’t seen his father once because the father dropped the boy off and hadn’t come back yet. This is also very common in poorer families, because the father
Dra. Salete
Mary Beth and I with Dra. Salete, the respiratory and down syndrome doctor. came from far away and probably had to go back to work and can’t afford to take off work. I also know that the father could only pay for one dosage of the medication that the boy needed, so I don’t know what they decided to do about that.
The lack of funding and resources is also very frustrating for doctors and for us students from the US because we are used to the healthcare in the states. On Thursday, we went down with Dr. Velasco to the Pediatric General Surgery department to learn about different cases. One of the patients is suffering from kidney failure and they are not sure why. The doctor there really wanted an EKG done on the patient because she thought he might have a certain condition. However, EKG’s are very expensive and rare at the hospital. She was jokingly asking Dr. Velasco if he could prostitute himself out so that she can have an EKG for her patient. He was able to make some calls and got her an EKG. It is so hard to think about how many EKG’s I have done on patients, and here a boy really needs one and
Infectology Unit
Aisha and I in the Infectology Unit it is so hard to get one.
Overall, I learned a lot about the cultural problems the doctors face every day and how it creates boundaries for not only them but for the government too. It is very hard to establish health policies with such a low level of education. An easy answer would be to educate everybody, but because of the class system here, many children are born into a way of life and there is no “moving up” in society, Many of the poorer children are taken out of school in order to work. I admire the doctors here very much because they do the best that they can with the resources, education, and patients they receive. This week should be different since we are going to Hospital Arco Itis, which is a private hospital and was built from a German Foundation, so it has more money and resources.
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Mom
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Interesting Blog
Very interesting information Dudes. I can only imagine the frustration the doctors must feel. I really liked these pictures of the people you are spending your days with. The doctors seem very accommodating about having their picture taken - the little girl with Dr. Velasco is adorable! Love you, momma xxoo