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.