It's been a good ride these last 6 months. I've been all over Peru, seen all aspects of health care here, and met the most amazing people. So, it's back to Chicago now, but it's not the end of relationship with this wonderful country & it's people. Hasta la proxima.
Thursday, May 14, 2009
Monday, May 11, 2009
Finishing up in Bolivia
I spent the rest of my week in Rurre at the clinic seeing patients. Dr. Jorge (the cuban doctor) started to come to work again so there were always two of us there, but it was never super busy. Maybe 3 - 7 patients per morning and then your occassional patient in the afternoon. A really super slow pace.
On Thursday afternoons, they have a pretty intersting program for sex workers. The program got started a few years ago after a few Rurre community members died of AIDS. The clinic and municipality partnered together on a program to check the sex workers each week for any signs of sexually transmitted diseases. Each worker has a book they carry around with them that has to get stamped saying they are healthy in order for them to be able to work. They get HIV and Syphilis testing (I´m honestly not sure how frequent it is, but at least yearly) and then weekly checks for any other STD symptoms. There´s no way to culture for Chlamydia or Gonorrhea, so i think if you suspect it based on symptoms you would just treat. They also get condoms and try to make sure they are on birth control as well. We had a total of 12 workers come in on that Thursday. Some are really young or have been at this since they were very young. Most have children. It´s good they´re getting checked, but any costs for visits/tests get taken out of their paycheck and that seems pretty unfair to me. It should be their bosses that have to pay. Anyway, it kept things interesting.
On my last day there I got to sit in during a staff meeting and it gave me a lot of insight into the struggles they are having. They are now facing competition from other NGOs and government medical teams that are starting to go out into the surrounding communities and provide health care. I don´t think they´ve figured out how to respond to this. This year La Fundacion started charging patients for medical care and medicines and it has significantly decreased their patient load (as most user fees do), but it has also made it more difficult for their work in the communities b-c the other NGOs aren´t charging. There is also concern that they will be over-visiting these communities. The people in these areas are farmers and it is hard to get them to come to the health campaigns as is, much less if it starts happening more frequently. Anyway, right now the NGOs aren´t working together - they´ve each got their mission and instead of complementing each other it seems like they´ll be repeating a lot of the same work. Work which in the long run might not be all that effective...i´m not sure anyone has clear goals their measuring as a way to evaluate these programs.
The other big problem they have is the car...it´s broken and they are using a loaner jeep that is barely hanging on and doesn´t have the ability to make it to some of the harder to reach areas while also sucking up gasoline. This is a huge problem for them b/c I think one of the main missions of La Fundacion is to reach these outside communities. They also have some staff issues. There are two doctors, but one usually goes out to the community, so if one gets sick or called away to La Paz they can´t cover both the clinic and the community work. And the Cuban doctor is leaving in October or November. They say that it is very hard to get Bolivian doctors to do this kind of work. And well, like many charities the financial crisis has made a dent on their donations as well, so they ´ve seen a pretty sharp drop in their income. They´re facing many challenges right now, but they are all very committed to the work and the fundacion so I´ll be interested to see what happens.
Anyway, so that´s it. Friday, was my last day of medical work down here in South America and it ended with a fun little celebration. Now I´m in La Paz seeing the sights and visiting with friends before I head back to Lima for a few days before I head back to the states.
On Thursday afternoons, they have a pretty intersting program for sex workers. The program got started a few years ago after a few Rurre community members died of AIDS. The clinic and municipality partnered together on a program to check the sex workers each week for any signs of sexually transmitted diseases. Each worker has a book they carry around with them that has to get stamped saying they are healthy in order for them to be able to work. They get HIV and Syphilis testing (I´m honestly not sure how frequent it is, but at least yearly) and then weekly checks for any other STD symptoms. There´s no way to culture for Chlamydia or Gonorrhea, so i think if you suspect it based on symptoms you would just treat. They also get condoms and try to make sure they are on birth control as well. We had a total of 12 workers come in on that Thursday. Some are really young or have been at this since they were very young. Most have children. It´s good they´re getting checked, but any costs for visits/tests get taken out of their paycheck and that seems pretty unfair to me. It should be their bosses that have to pay. Anyway, it kept things interesting.
On my last day there I got to sit in during a staff meeting and it gave me a lot of insight into the struggles they are having. They are now facing competition from other NGOs and government medical teams that are starting to go out into the surrounding communities and provide health care. I don´t think they´ve figured out how to respond to this. This year La Fundacion started charging patients for medical care and medicines and it has significantly decreased their patient load (as most user fees do), but it has also made it more difficult for their work in the communities b-c the other NGOs aren´t charging. There is also concern that they will be over-visiting these communities. The people in these areas are farmers and it is hard to get them to come to the health campaigns as is, much less if it starts happening more frequently. Anyway, right now the NGOs aren´t working together - they´ve each got their mission and instead of complementing each other it seems like they´ll be repeating a lot of the same work. Work which in the long run might not be all that effective...i´m not sure anyone has clear goals their measuring as a way to evaluate these programs.
The other big problem they have is the car...it´s broken and they are using a loaner jeep that is barely hanging on and doesn´t have the ability to make it to some of the harder to reach areas while also sucking up gasoline. This is a huge problem for them b/c I think one of the main missions of La Fundacion is to reach these outside communities. They also have some staff issues. There are two doctors, but one usually goes out to the community, so if one gets sick or called away to La Paz they can´t cover both the clinic and the community work. And the Cuban doctor is leaving in October or November. They say that it is very hard to get Bolivian doctors to do this kind of work. And well, like many charities the financial crisis has made a dent on their donations as well, so they ´ve seen a pretty sharp drop in their income. They´re facing many challenges right now, but they are all very committed to the work and the fundacion so I´ll be interested to see what happens.
Anyway, so that´s it. Friday, was my last day of medical work down here in South America and it ended with a fun little celebration. Now I´m in La Paz seeing the sights and visiting with friends before I head back to Lima for a few days before I head back to the states.
Tuesday, May 5, 2009
La Fundacion Rio Beni
The fundacion Rio Beni is an NGO that was started by Dr. Louis Netzer. I´m spending a little over a week here checking out there program. A friend of mine, spent two years here and loved it, so I had to check it out.
Monday, was my first day of work and I hung out in the clinic. The staff currently consists of Dr. Freida, the main doctora for the clinic, a Cuban doctor (who has yet to show up for work), Jose, the administrator, Modesto, the social worker, Lolita, the nurse, Antonio, the lab and pharmacy guy, and Maura, the health promoter. Patients begin arriving at 7:30am to buy their fichas to be seen and then the patients get split up between Dr. Freida and the other doctor. I started out with Dr. Freida to get a feel for their system, but since Dr. Cuban didn´t show up they asked me if I´d mind seeing patients on my own. So I did. It´s a lot easier than at the government health center, b/c since it´s an NGO I can sign prescriptions, my charts without any worries. Anyhow, it was pretty usual stuff...URIs, headache, UTI´s, etc. There were a couple cases that stood out. There was a gentleman that fell down and broke his wrist about 2 weeks ago. He had it wrapped up in an ACE bandage, but never got any other treatment. He came in b-c it was still pretty deformed and he had really limited movement of his hand and wrist. I sent him for an xray, which confirmed his fracture and partly healing....but the thing is there is no ortho here to send him to fix it back in place. And I just don´t have those skills. The nearest place he can go to see an Ortho is a 12 hour bus ride. So, he´s going to think about it or have a permanently screwed up wrist.
The other case that stood out to me was that a mom and child came in to be seen. The child had chicken pox, which isn´t crazy, but we just don´t ever see it in the states b-c of the varicella vaccine. But her mom was pregnant...but thankfully doesn´t have any symptoms of chickenpox. but she has a 6 month old and she really doesn´t want to have this baby. And well abortion is illegal in Bolivia so she really doesn´t have any options. This family was clearly poor, the children were not well nourished, and now she has to have another baby.
So our day isn´t all that hard, we see patients from 8:30am - 11:30am and then again at 2:30pm - 5pm. The afternoon is a lot quieter than the morning, people mostly come in for labs, follow up. So, that was day 1.
Today we tried to go out to the communities. It was raining pretty hard to today so when we got to the turn off for the community we were supposed to go to, we got told it was too dangerous to go. Instead we ended up going to a town another 45 minutes down the road and de-wormed all the kids at this school in an indigenous community (Chaman). I also saw a few kids that were sick with URI´s, pneumonia, and some skin infections. These families were really, really, poor. I´m glad we treated them, but continue to be convinced that these community visits don´t accomplish a whole lot. There does seem to be some continuity here so that´s good, but still.
On a lighter note, when we got to the community, there was a monkey playing with a dog. So cute!
Monday, was my first day of work and I hung out in the clinic. The staff currently consists of Dr. Freida, the main doctora for the clinic, a Cuban doctor (who has yet to show up for work), Jose, the administrator, Modesto, the social worker, Lolita, the nurse, Antonio, the lab and pharmacy guy, and Maura, the health promoter. Patients begin arriving at 7:30am to buy their fichas to be seen and then the patients get split up between Dr. Freida and the other doctor. I started out with Dr. Freida to get a feel for their system, but since Dr. Cuban didn´t show up they asked me if I´d mind seeing patients on my own. So I did. It´s a lot easier than at the government health center, b/c since it´s an NGO I can sign prescriptions, my charts without any worries. Anyhow, it was pretty usual stuff...URIs, headache, UTI´s, etc. There were a couple cases that stood out. There was a gentleman that fell down and broke his wrist about 2 weeks ago. He had it wrapped up in an ACE bandage, but never got any other treatment. He came in b-c it was still pretty deformed and he had really limited movement of his hand and wrist. I sent him for an xray, which confirmed his fracture and partly healing....but the thing is there is no ortho here to send him to fix it back in place. And I just don´t have those skills. The nearest place he can go to see an Ortho is a 12 hour bus ride. So, he´s going to think about it or have a permanently screwed up wrist.
The other case that stood out to me was that a mom and child came in to be seen. The child had chicken pox, which isn´t crazy, but we just don´t ever see it in the states b-c of the varicella vaccine. But her mom was pregnant...but thankfully doesn´t have any symptoms of chickenpox. but she has a 6 month old and she really doesn´t want to have this baby. And well abortion is illegal in Bolivia so she really doesn´t have any options. This family was clearly poor, the children were not well nourished, and now she has to have another baby.
So our day isn´t all that hard, we see patients from 8:30am - 11:30am and then again at 2:30pm - 5pm. The afternoon is a lot quieter than the morning, people mostly come in for labs, follow up. So, that was day 1.
Today we tried to go out to the communities. It was raining pretty hard to today so when we got to the turn off for the community we were supposed to go to, we got told it was too dangerous to go. Instead we ended up going to a town another 45 minutes down the road and de-wormed all the kids at this school in an indigenous community (Chaman). I also saw a few kids that were sick with URI´s, pneumonia, and some skin infections. These families were really, really, poor. I´m glad we treated them, but continue to be convinced that these community visits don´t accomplish a whole lot. There does seem to be some continuity here so that´s good, but still.
On a lighter note, when we got to the community, there was a monkey playing with a dog. So cute!
Saturday, May 2, 2009
Making it to Rurrenabaque
So, it´s been a bit of an adventure to get to Rurrenabaque (Rurre), Bolivia. But, yay, I´m here. The first road block was at the Lima airport. Friday was Labor Day, a national holiday, and the beginning of a long weekend. A lot of people were traveling, but on top of that the night before almost all flights were cancelled or delayed due to fog. So when I got to the airport it was a mess, people everywhere and lots of chaos. Plus with the whole swine flu thing going on, there are all these people wearing masks (mostly not in anyway that´s actually going to protect them) and well it just makes things seem more dangerous. Anyway, I figured out which line to get in and was told my flight would be leaving at 7pm instead of 12pm. Ok, well at least it wasn´t cancelled and they gave me a lunch ticket. Finally made it into La Paz at 10pm their time and to my hotel by 11pm. You can really feel the altitude here. I don´t usually get affected from being at high altitudes, but when I got to the hotel, i could see my fingers were this not so pretty blue-white color and a little tingly. Nothing that a little coca tea and sleep couldn´t take care of.
Anyway, so up very early to go to the airport for my flight to Rurre. The airplane to Rurre is one of those tiny planes that seats like 15 people and makes you nervous as hell. It was a beautiful flight over the andes and into the jungle. The landing was a bit rough, but not unexpected given that the runway is made from dirt. Rurre, is just beutiful. It´s what you expect from the jungle...totally green with mountains and hot. At the airport, I was expecting to find someone from the health center waiting for me, but that didn´t happen. So jumped on a moto and had him take me to the clinic. No luck there either, so I knocked on the door of this random house and this very nice lady let me in and told me to wait for her husband who knew where the people from the clinic worked. I´m so thankful for them...it would have sucked having to walk around the town with my bag.
Her husband arrived and took me to the main doctors house and she was super nice. People always seem to sort of know you´re coming, but also seem a little surprised. At least they´re nice and very welcoming. She was able to locate Jose, the man with the keys to my room and he got me settled. I´m staying in the clinic. My bedroom is literally in the clinic. Anyway, it´s really nice, so it´´ll be great.
I´ve been walking around the town today and it´s pretty big. Has a lot more infrastructure than the jungle area I was in in Peru. It´s a tourist hub for people that are going on jungle expeditions so there are lots of foreigners and pretty much everything you could need. They even have plenty of coca cola light here. Anyway, so since there is no work tomorrow i´m joining the rest and going on a day trip to Madidi National Park. So, it´s good to be here and looking forward to the week ahead.
Anyway, so up very early to go to the airport for my flight to Rurre. The airplane to Rurre is one of those tiny planes that seats like 15 people and makes you nervous as hell. It was a beautiful flight over the andes and into the jungle. The landing was a bit rough, but not unexpected given that the runway is made from dirt. Rurre, is just beutiful. It´s what you expect from the jungle...totally green with mountains and hot. At the airport, I was expecting to find someone from the health center waiting for me, but that didn´t happen. So jumped on a moto and had him take me to the clinic. No luck there either, so I knocked on the door of this random house and this very nice lady let me in and told me to wait for her husband who knew where the people from the clinic worked. I´m so thankful for them...it would have sucked having to walk around the town with my bag.
Her husband arrived and took me to the main doctors house and she was super nice. People always seem to sort of know you´re coming, but also seem a little surprised. At least they´re nice and very welcoming. She was able to locate Jose, the man with the keys to my room and he got me settled. I´m staying in the clinic. My bedroom is literally in the clinic. Anyway, it´s really nice, so it´´ll be great.
I´ve been walking around the town today and it´s pretty big. Has a lot more infrastructure than the jungle area I was in in Peru. It´s a tourist hub for people that are going on jungle expeditions so there are lots of foreigners and pretty much everything you could need. They even have plenty of coca cola light here. Anyway, so since there is no work tomorrow i´m joining the rest and going on a day trip to Madidi National Park. So, it´s good to be here and looking forward to the week ahead.
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