Bates in Bolivia

Where am I?

I am near Santa Cruz, Bolivia which is in the very center of Bolivia (think of it as an equilateral triangle whose apex points to 11:00). Bolivia is pretty much in the center of South America, bordered to the east by Brazil and Paraguay, to the south by Chile and Argentina, and to the north by Peru (here's a map). The clinic, which is called the Centro Medico Humberto Para, is about 1.5 hours east of Santa Cruz.

What am I doing in Bolivia?

Great question. Officially, I'm doing a four week rotation and getting credit for medical school. Unofficially, what that entails is pretty much up to me and the clinic. What I learned the first time I was there is that planning in advance isn't that important. So, all I know is that I will definitely be spending time with the Villarroels and at the clinic. We'll figure the rest out when I get there. My friend Monica who is going with me this time is also going to be a pediatrician, so we may have more of a kids-themed experience. Or not. And there will be traveling, to other parts of Bolivia and possibly Peru.

How can you contact me?

The best way to get in touch with me is by email.

If you'd like to read blog excerpts about my last trip, you can download them here.

email me | archive

Thursday, March 10, 2005

I think I may be the only person still reading this, but at least for my own benefit I feel like I should write some kind of a wrap up for this trip to Bolivia. I should have done it a week ago, but I got lazy!

Anyway, going back was great. It was a totally different experience in many ways, but exactly the same in the really important ways. Having a much larger base of clinical knowledge meant that I played a totally different role in the clinic. Rather than observing others treat patients, I was the practicing clinician. This was a level of autonomy that I've never had before and probably won't have again for a while--here there's always someone looking over your shoulder to make sure you're not screwing up. Out at the clinic, there was help if I needed it, but it was my decision whether or not I wanted to run something by the attending or not. Along with my increase in medical knowledge, my Spanish skills were definitely at a much higher level this time. This obviously was really helpful out at the clinic--it was still a struggle to communicate with patients but I could do it on my own for the most part. I felt like I was still getting a halfway decent history out of them even with the language barrier. Then again, undesrtanding more of the language has its drawbacks as well--I discovered on this trip that one of my favorite songs from last time is not actually about a condiment...I won't go into it but suffice it to say that it's rated PG-13 at least. That was a surprise!

A huge difference for me this time was just being comfortable there as soon as I arrived. When I went in 2002, I realized that it was the first time that I'd ever thrown myself into a situation where I literally didn't know anyone. That was even tougher since I'm not the kind of person who deals with change really well! Because of all that and the language barrier, I was definitely homesick at times, especially at the beginning. But on this trip I was so happy to be back and comfortable with everyone that I didn't really miss being home at all. I think I appreciated just being there more this time because it was so much easier.

Other things that were different included experiencing Carnaval (see entries from early February!) and being there with a bunch of other students. We had no idea when we left that we would be 2 of 11 fourth year students there this month, so it was a surprise. Because of the big group, we spent less time at the clinic than I expected, but one thing I've learned about Bolivia is that it will be different than what you expect! Going to the hospital was really valuable and interesting, and of course we were lucky enough to be able to travel since there were plenty of students to keep the clinic running without us. Plus, it was really fun to meet a group of great people, so I wouldn't trade the experience even if I could.

Being there as a student this year felt more appropriate to me than being called a volunteer, because I always feel like I take so much more from Bolivia than I give. I definitely saw pathology there that I probably will never see at home, which is always interesting for us medical nerds. I learned a lot of Spanish from Chemita and it will be a struggle to keep it up at home. The problem with medical school is that in order to survive, you get really good at learning something for when you need it, then pushing it deeper and deeper in your mind when something new comes along. Unfortunately, that skill tends to carry over into other areas of knowledge that I don't necessarily want to lose! I also think it's fascinating to study the Villarroels--how they live their lives and the people they surround themselves with. It seems to me that people who have a chronic disease, especially from a young age like Douglas, tend to live life differently than the rest of us. They do more with their time and appreciate everything more than most other people I know, often regardless of their quality of life. As an organ transplant recipient, Douglas takes that motivation and appreciation to a different level. It's refreshing to see and inspiring...we should all be so wise in our decisions about how to live our lives.

The best part for me, of course, was seeing all my Bolivian friends again. We started a journal for volunteers to write in at the end of their time in Bolivia, and in Monica's entry she talked about how the Villarroels had a lot to live up to based on everything she'd heard. She said that it was obvious as soon as I got back in 2002 that I'd fallen in love with them, which I think is a pretty good description (when Douglas reads this, he will probably interpret it the wrong way, but it's the best way to say it). I'm so glad that I could take 5 weeks away from here to be with them and celebrate Carnaval, Douglas's kidney anniversary, Chemita's birthday, etc. I love knowing that there's a place on the other side of the equator where I'm always welcome and loved. It's fun to see the kids growing up and the clinic developing. I hope I can go back again soon. Hopefully I'll be able to contribute even more to the clinic as my training progresses. Until I return, I have my pictures and my memories, and of course the dozens of pages of blog that I've written.

Thanks for reading, and my apologies to those who will miss their daily Bolivia fix. I could keep writing about what I'm doing now, but it is really boring (ie, got up, watched TV, ate breakfast, watched more TV, read a book, went to class for 2 hours...you get the idea).
Posted at 2:40 PM

Friday, March 04, 2005

I've been back for almost 48 hours, and it's nice. I do miss Douglas's jokes, Chemita's hugs, hearing a 4-year-old singing at the top of his lungs and the sound of Susan's giggle. But it's nice to be home. My parents just got back from a 10 day trip to Maui and my sister Mollie just returned from a week in Florida, so the four of us are home in Kalamazoo catching up and trading souvenirs. The other students are gradually posting their pictures online. I will get mine developed, eventually.

Our trip home went smoothly, although it was a long day. I got frustrated in the morning when the check-in lady explained the boarding pass to Monica in Spanish (I understood completely) and then turned to me and explained it all again in English. I guess my blue eyes betray the fact that I'm not Latina. So I was really looking forward to coming home where I can talk to anyone I want and where people don't judge my intelligence level before they talk to me. Then of course we did a number of dumb things in the Miami airport, so I realized that really, I'm just dumb. Except it's worse here because I can't use the language excuse! At one point we had two customs agents laughing at us because it took us four tries to get into the right line. Then the guy who stamped our passports said "so what happened in Bolivia?" We weren't sure if he were asking us a serious customs-type question (ie, how many kilos of cocaine did you bring back) or not, so Monica explained the whole clinic thing. His reply was "you must have broken a lot of hearts down there." Yeah, something like that. Then I couldn't figure out how to get onto the airplane so the attendant had to explain that stepping on the floor pad would open the door to the hallway, etc. We were almost crying by the time we got on the plane because we were laughing so hard.

It is nice to be home. When we boarded in Santa Cruz, an American flight attendant named Sunny greeted us which was great--first taste of home. We were thrilled to eat lettuce and drink tap water at the Chili's in Miami...it's the little things you miss. We were not thrilled to see the snow on the ground when we landed, but it is Michigan in March, after all.

More random stories that should be told:
Monica and I are considered ugly and fat, respectively, in Bolivia. There are stories behind this, but we think it's just funny to call each other ugly and fat. Monica is considered fat because when she showed a picture of her fiance to Douglas, Chemita, and everyone else in the house, no one could believe how cute he is. They seemed genuinely surprised, which made Monica feel like they think she's not attractive enough to be with him. Anyway, we of course told Douglas about this, so the last 3 days he and Chemita would randomly tell Monica that she was beautiful to make up for it. I am considered fat because Nico (who weighs in at less than 100 pounds and is less than 5 feet tall) told me so. And she's right--everyone is compared to her.

Monica and I reached a weird state of traveling zen about midway through our traveling stint. We had been a team before, but during our trip we actually started thinking the same thing at the same time. This continued right up until we got home. I think all the other students thought we were completely attached at the hip before the trip, which really we weren't, but it's understandable why they think that. Especially when we accidentally wear matching outfits and have identical backpacks.

Speaking of those backpacks (which we bought before we even knew each other), they formed an important part of "dino walking," another big joke. When we were in Sucre looking at dino footprints, there were two sets from the same species that started out slightly staggered and then lined up perfectly. The guide said that they knew that these were male and female dinos because at first the female is walking behind and to the side of the male, then she lined her feet up in his tracks. (We of course wanted to know why the female had to follow). Often when we were walking through cities with our (identical) big packs on our back and small packs across our chest, we'd have to walk in a line to get through the sidewalks...and of course we called this dino walking. Yes, we did take a picture.

One of our last nights in Santa Cruz, we went to check out a rock festival that was going on at Octopus, the pub where we saw the band that inspired the previously published "Top 10 signs your Bolivian cover band sucks" list. (this perhaps should have been our first clue) Anyway, we got there and saw that there was a band named Crap on the lineup (clue #2). Then we went inside and saw that the average age of concert attendee was 14 (clue #3). We stuck it out for one band and the first song of the second band's set before we ran outside screaming. It was horrible. So next we went to the bar called Oz, where we'd seen a decent band a few weeks before. We sat down between sets then went up to check out the band when they started again. The lead singer looked familiar to me, and sure enough, it was the first band we saw--the inspiration for the top 10 list. Somehow, they were better this time but it could have been only because of the comparison to Crap.

More to come...keep reading. And hopefully pictures.
Posted at 8:18 PM

Tuesday, March 01, 2005

It´s our last night in Santa Cruz...hard to believe that five weeks are over, although it does feel like we´ve been here forever. I´m ready to go home and get started on everything I need to do this spring. Keep checking this site for the next week or so and I´ll add a bit more as I decompress and adjust back to reality.

Last night we went out for dinner to celebrate Chemita´s birthday, which is today. We ate at the best restaurant in Santa Cruz, a nice Italian place. My present to Chemita was wearing a skirt and "dressing like a woman." I did it once for Douglas´s kidney party and they were still commenting a week later that I looked really nice in real clothes rather than the teeshirts and shorts I wear the rest of the time. After dinner we went over to Douglas´s best friend´s house where his friends were throwing him a surprise party because his birthday is today as well! They had hired an 8 person mariachi band which serenaded Alfonso outside his house, then once the family got up, everyone trooped in for more music and of course food. We were out late but it was really fun.

Today we had the family over for a big lunch to celebrate again. Monica and I had decided to bake brownies for Chemita´s birthday as a gift--we had been worried that she wouldn´t have a cake but then figured that someone would bring one to the party, so we thought brownies would be a good non-cake treat. (I made them last week and received rave reviews from everyone) So at the beginning of the party, Douglas mentioned to Monica that it was his job to get the cake for Chemita, but he had forgotten. We volunteered the brownies as a substitute, so I presented them to Chemita and explained that Douglas had forgotten the cake. She said "oh I ordered it because I knew he would forget!" Then the problem was hiding the brownies because everyone had seen them and wanted some (and Chemita didn´t want to share them all). I think it turned out okay--we hid a plate of them for later and she ended up giving some away so clearly there were enough. It was nice to see the family again and say goodbye to them--they really are all so warm and inclusive.

More funny Monica and Katie stories to follow. For now, here are some pics from our travels and work...(again, sorry they´re so big!) This was our favorite tourist attraction in Sucre: a model of dinosaurs coming to drink at the lake. Sadly, we had lost our hardhats by this point

This is the tiniest part of Macchu Picchu...I almost hate to put it up because it doesn´t do it justice!

Not really worth it beyond that--it hurts me too much to cut the pictures up! I will hopefully be able to upload some more this weekend once my more-talented little sister and I are hanging out and she shows me how to make the files smaller.
Posted at 6:02 PM

Monday, February 28, 2005

Sorry it´s been so long since I´ve written. I would like to say that we´ve been really busy, but that would be a lie! The computer has been pretty busy though.

Anyway, we drove out to Palacios last Tuesday for our 2.5 day stint at the clinic. Monica, Jenna and I got there in time for lunch and the Wright State crew had pretty much finished the 30-40 patients who had shown up that day. So at 2pm we started playing the first of many, many games of Oh Hell--over the next couple days we played more games than I have played in the last two years. It was fun for me to explore the changes in the clinic since the last time I was there--during my time they started an addition to house a dentist´s room, ophthalmology room and a lab, so that has been completed (and is pretty old news). Just having a rudimentary lab and an EKG machine makes a huge difference clinically--although they teach us in school that you can make most diagnoses based on history and physical alone, we´re definitely used to confirming our ideas with tests. It took me a minute to recognize Maria, the nurse who married the town pastor after I left. She seems to be pretty settled into Palacios which is great for the clinic. Both she and Antuco, the caretaker, were happy to see me again. The first thing Maria said to me was "you kept your promise to come back!" It´s nice to be remembered.

We did have a couple of patients that stopped in during the afternoon. Monica and I successfully treated one who initially complained of fatigue in his chest (any kind of discomfort in the chest freaks doctors out so we were worried) but ended up describing a hangover. Go figure if you drink heavily every weekend, you feel kind of crappy the next day. Prescription? Mas agua, menos cerveza. The other patient I had that afternoon had rushed in after one spell of diarrhea that afternoon. I wanted to tell him that half of us gringoes probably had much worse diarrhea at the time, but I left that out. Shouldn´t disclose too much personal information, huh? Anyways, those two patients are fairly representative of a large portion of the patients I´ve seen in Palacios--they come in for things that we would never dream of seeing a doctor for at home. I don´t know if they come because we have free medicine, because there are American doctors, or because they just don´t have the common sense to distinguish between serious problems and nuisances, but it´s probably a combination of the three.

The next two days were BUSY. Because Douglas, Maria and Steve knew that we would have tons of people working at the clinic this month, they had arranged for transportation from more distant communities so that a different community was represented each day. While the Loyola group was out there, they saw as many as 100 patients in a day between 5 students and 2 attendings. The first day we ended up seeing around 80 between 6 students and Jan, the ob-gyn attending from Wright State. I had a hard morning seeing patients by myself. Of course, as a future pediatrician, I was most interested in seeing kids. But picking up a kid´s chart (and by chart I mean piece of paper with name and age) means that you´re going to get their parents or grandparents as well. It really is family practice. So I saw one or two standard pediatric problems, lots of bichos (parasites that live in your GI tract--I think the prevalence is 4/5 kids have them), and a lot of adult problems. It was a fantastic reminder of why I don´t want to do adult medicine--this one guy just kept going on and on with his problems: hypertension, diabetes, possible hernia, prostate problems. But he didn´t bring his medicines with him and I couldn´t understand the names, so we didn´t get very far. And, remember that I´m trying to understand all of this in Spanish, and not the slow, clear Spanish that the Villarroels and their friends are used to speaking to us gringoes! It was tiring. Monica helped me out after lunch which was a big relief.

The next day was even crazier. I went to the nearby town of Buena Vista with Tammy, another student, in the morning to work on a study Douglas had designed. Diabetes is really common in Bolivia and so he wanted to do a big screening study to detect people with the disease and encourage them to get treatment. Weeks ago we figured out how to do the study and Monica and I struggled our way through translating a consent form. The original goal was to get 1000 patients in the study, which Douglas thought would be pretty simple. Well, turns out it wasn´t. I think we ended up with 40-some in all, and the morning that Tammy and I were there, we only had 4 who qualified for it. The tough part was that they had to be fasting overnight in order to have the right test in the morning. I think it would be tough to recruit a big population like that at home, but here it was even harder and just didn´t happen. Oh well. It was kind of exciting to just be able to make up a study and do it--at home everything has to go through all kinds of review boards and I hvae no concept of how much time it actually takes. We just decided to try it and the next week we did it.

Anyway, we returned from our morning to find the clinic swamped with people. Not only had the scheduled community showed up, but a couple of other minibuses had come from other communities. You could hardly walk through the halls because it was so crowded. I tried to orient myself for a minute but immediately found a chart shoved in my hands by a staff member who said: "this woman is really sick." I was of course concerned, so we ran into the closest room even though there was only one chair and nothing like an exam table. Turns out she has been having headaches for 5 years, just like her mom and siblings, which means that she´s not really that sick. Miserable yes, but dying no. I gave her my most prescribed remedy of the day--tylenol and water--and sent her on her way. I don´t know how many patients I saw that day, but I think it was at least 25. It was exhausting. I was using the most drastic definition of the focused history and physical which I felt kind of bad about, but we needed to leave before dark and there were just so many people (we saw 180 between the 7 of us) that it was the easiest way to see as many as possible. I would have had a hard time seeing 25 patients at home in a day, but adding the language barrier made it a lot harder. Most of the time I was surprised at how I would just open my mouth and Spanish would come pouring out. I think they understood me, but I definitely didn´t give them as much counseling as I would at home. At one point, I opened my mouth and only gibberish came out! I had to hide in the pharmacy for a minute to regroup. After a few hours, the staff took pity on me and brought me a desk so I looked a little more official--two plastic chairs facing each other doesn´t really look too professional. But I was definitely the one in charge, a big change for a 4th year medical student. There were too many patients for us to discuss them all with Jan, the attending, so we basically had complete autonomy if we wanted it. Kind of scary...I won´t have that again for a few years!

The people who come during these campañas (campaigns--the organized transportation) mostly fall into two categories: not really sick at all and really sick. The not really sick group is there for free medicine (many ask for vitamins, most end up going home with tylenol as well). They complained of this pain or that pain when it´s hot, or when they´re washing clothes, etc. like any other middle aged adult who has worked hard for decades. The really sick group are the people who should have gotten medical attention a long time ago--the woman with advanced cervical cancer, the man who had a stroke a year ago, etc. I didn´t get any of those tough ones this time, luckily. I did have one patient who should have gotten a blood transfusion because she was so anemic, but we don´t have blood so I gave her iron and vitamins and asked her to come back soon. It´s tough to treat things when you know the likelihood of follow-up is pretty small. I gave out more antibiotics than I would have at home because I knew that people wouldn´t come back in a couple of days if they weren´t better. I gave one former preemie antibiotics for a fever because she had a history of febrile seizures, several hours later the family brought her back and she seized right in the clinic.

So, finally, we finished with everyone and loaded into the cars to come back to Santa Cruz. Everyone here was pretty surprised at how many patients we saw...we were just tired. I was still feeling a little bad about not being more thorough with patients and worrying about the one lady with anemia. Steve, who has worked out there for 6 months now, reminded me that if we hadn´t been there, there would have been nobody. So being an okay almost-doctor is better than no doctor at all. I didn´t hand out any drugs that could really hurt someone, so I doubt that I broke the "first do no harm" rule, but it´s definitely a different feeling than treating patients at home. At the end of the day, it´s hard to feel like I really made any significant difference in anyone´s life, but I guess as a part of the whole project that ultimately is helping, I did.

We came back to Santa Cruz that night and had one more night out with some of the Loyola students and the Wright Staters who all took off on Friday morning. We were out until 4 drinking, dancing and singing karaoke (not pretty). The rest of the weekend was pretty low key. Saturday was a lazy rainy day (a nice change from the heat and humidity). I wowed everyone with my mom´s brownie recipe, which we polished off in a matter of hours. That night we saw "The Sea Inside," a Spanish movie up for an Oscar this year, which I think was good even though I didn´t understand a lot of it. No need for English subtitles in a Spanish-speaking country.

Sunday we had a hilarious outing. Douglas had told us that we were going to go fishing at a place on the way to Palacios. After much confusion in the morning, we finally set out with the entire family in tow. The fishing spot was an artificial pond, literally 20 feet from the main highway. The owner stocks the pond with fish and charges you for rod rental as well as a fee for each fish you catch. You can cook your fish right there or eat in their restaurant. Anyway, you have to see the pictures but it was just too funny that the place was practically on the road and so artificial. We managed to catch 4 fish in total--good sized river fish that made the bluefish and sunfish of Eight Point Lake look like minnows. I didn´t catch any mostly because I didn´t try. Taking pictures and drinking beer was more fun.

Okay, enough. More later. Monica and I have some funny tidbits that should be recorded for posterity and hopefully Douglas will write something as well. We leave Wednesday morning, so I´ll be home soon!
Posted at 11:48 AM

Friday, February 25, 2005

We´re back in Santa Cruz after a busy couple of days at the clinic. Yesterday we saw 180 patients between 6 medical students and one attending (you do the math). And yes, that was in Spanish. It was exhausting, but we made it. Monica and I were feeling kind of bad about the fact that we spent only 2.5 days out of the month at the clinic, but I pointed out to her that in 2 of those days, we saw as many patients as we would see at home in a week. I´ll write more later this weekend...we were out until 4 am last night celebrating the last night in Bolivia for the 7 students who left today, so my head is a little foggy.
Posted at 11:44 AM

Monday, February 21, 2005

My email has chosen this time to completely block me from getting into my primary UM account, and I can´t figure out how to fix it. So, if there´s anything that I really need to know, please email me at katieebates@hotmail.com. I hate computers.
Posted at 5:58 PM

Sunday, February 20, 2005

We are back in sweltering Santa Cruz which was a rude awakening after the cool weather of the mountains. We didn´t end up doing too much in Cusco--did some shopping (most of the stuff was identical to that in La Paz, but more expensive), saw a couple of churches and a museum because we were there. One night we ate at a very touristy buffet place which was nice because we got to try a bunch of different dishes (alpaca is not as tasty as llama) and there was live music and "traditional" Peruvian dancers. The whole thing was definitely packaged for American tour groups. I don´t mean to sound super anti-tourists, it´s just that the whole scene in Peru was so different from what you see in Bolivia where everyone is basically backpacking independently.

We made some friends along the way, of course. You can´t walk down the street in Cusco or, heaven forbid, sit in the main plaza without being harassed every 30 seconds by kids selling postcards or people promoting trips or bars. It´s quite annoying--Monia and I each had our day where even saying "no gracias" was too much effort but since we took turns we weren´t as rude as we could have been. Our favorite 8-year-old postcard sellers caught us at a vulnerable time when we were lost and consulting a map. They tried to help us find our way so in return we looked at their postcards. When they got to ones that showed people, they would say "this is my mother" or "this is my sister," etc. which was pretty funny. So we played along...I really got them when I asked if a group of kids were their children. We also had a great llama photo op--a woman had brought her llama into the city specifically for tourists to take pictures with. I´m a sucker for llama pictures.

All in all, I felt like I didn´t have much of a Peruvian experience, although that may be because we were only there for a few days and my experience of Bolivia obviously is so much more comprehensive in comparison. Because we were in such a touristy area, it felt like a much less authentic experience of the culture, but we did get some true Peruvian things in. We tried Inca Kola, THE drink of Peru which is a neon yellow, sickeningly bubble gum-flavored concotion that actually wasn´t that bad. We also tried Cusquena, the local beer, which does not live up to the smooth taste of Pacena, Bolivia´s #1 beer. I think Pacena is on par with your basic Budweiser or Miller, just to give you a reference point. We did not try guinea pig, a major part of the Peruvian diet (yes they are bigger than the ones we have as pets), so I´ll have to go back for that.

Somehow we both managed to fall for ceramic stuff in Peru so we had a lot to lug on the plane Saturday. And around the airport in La Paz during our 6 hour layover. We have spent a disproportionate amount of time in airports on this trip. In the airport, we played a mean game of War (neither of us can remember any 2 player card games besides War, Go Fish, Memory and double Solitaire) which was absolutely riveting to a five year old named Mario. We were both happy to arrive at our home in Santa Cruz--10 days of backpacking was tiring.

Today we had a big party to celebrate Douglas´s kidney. That may sound strange, but it´s because Tuesday is the 11th anniversary of his kidney transplant, so it´s a big deal. We had a huge party at Susan´s house with Douglas´s family and the Pinatas, his friends from high school. Chemita, Flora and Nico cooked up tons of wonderful Mexican food--enchiladas, tacos, guacamole, etc. Chemita makes an incredible mole sauce that I would lick off a tire if I had to. We had live music, speeches by Douglas, his mom, and a couple of friends, and of course tequila shots. The Pinatas are the group that Ben and I did shots with last time. It always ends up being a performance--each person goes up individually to do their shot while the rest of the group watches. I got to go first, again. We got a great picture of Chemita who did her obligatory shot while holding baby Susan--that picture wouldn´t go over well with child protective services but it made us laugh. Anyway, it was a fun afternoon. Hopefully I´ll have time to write more tomorrow because I think Tuesday we head out to the clinic. I know, we´re actually going to do something medical which is shocking (to be fair, I answered 2 travelers´ health questions while we were on the road, so I did contribute something to the overall health of Bolivia. Really).
Posted at 9:17 PM

Thursday, February 17, 2005

It´s been a busy and long couple of days, definitely time for an update. We had a 12 hour day of traveling on Tuesday which included a plane, train, automobile, mini bus, and large passenger van. We got out of La Paz with no problem and arrived in Cusco where we found lots of headaches. The goal was to get to Macchu Picchu, a large complex of ruins dating from the 1400´s which is one of the biggest tourist attractions in South America. We could immediately tell that we had left Bolivia as we walked out of the luggage claim: eight different tour companies started screaming at us in English. Needless to say, Peru is well aware of the income potential of Macchu Picchu and the tourist industry is very well developed, versus Bolivia which hasn´t really figured out how to take advantage of tourists yet. Anyway, we agonized over the train schedules at the airport and then at the visitors center. The typical schedule had us leaving Cusco at 6 am for a 4 hour train ride and then arriving back in Cusco at 8:30pm which would only leave a few hours for all of Macchu Picchu. And of course it was exorbitantly priced. So we decided to wing it and took two buses to a town outside of Macchu Picchu. There we managed to get on an afternoon train to Agua Calientes, a dump of a town that exists only because it´s the last stop on the train line before MP. It still cost a ton of money, but we felt better since it gave us more time inside MP. We could tell that MP was very different from Bolivia just by the higher prices and sheer volume of tourists. I don´t think we encountered a single American over the age of 30 in Bolivia, but there were swarms of American retirees all over Agua Calientes. Lots of them were in tour groups and at least half of them were wearing those pants that zip off into shorts or capris, which I have decided are the official uniform of South American tourists (yes, I do own a pair but Monica does not!).

Wednesday we got up super early for a vacation (6 am!) and caught the bus for MP. The good thing about the whole place being so developed is that it runs smoothly--buses depart as soon as they´re full and there´s no shortage of people so they fill quickly. When we got to MP, the whole thing was enveloped in mist. We were a little worried that we´d never get to see it out of the fog, but our guide assured us that we would. And indeed, as he told us the story of how MP was rediscovered in the 20th century, the fog lifted right before our eyes. It was pretty cool. The ruins are perched in between gorgeous mountains as far as you can see. They´re not entirely sure what the Incas used the complex for, but it clearly was something important and they know a lot about what individual buildings were for. We had our guided tour for about 2 hours and by the end of that time the sun was pretty much out, so then we took another trip around the site in search of the best photo opportunities. The whole site is pretty awe-inspiring...definitely worth the trip if you ever find yourself in South America, despite the commercialism of the whole thing.

After our photo shoot came 2 of the scariest hours of my life. My faithful readers will remember that I mentioned my fear of heights briefly on the bat cave day. You would think that since I had recently remembered that fear, I would not be all gung ho to dive into it again. You would be wrong on that count. There´s an Incan outpost on the mountain right next door to Macchu Picchu that offers a great view of the ruins. I thought it would be cool to climb up it to check it out. It was an incredibly steep hike...we were hurting. People assured us that it was worth it, so we kept going up switchback after switchback, at times on all fours since the "steps" were slippery and there were only a few spots that had a rope on the side for you to hold on to. As we were climbing up, I joked that I should have brought some Valium for the way down since that tends to freak me out more than going up. Then we finally got to the top 20% of the mountain and I officially shifted down into survival mode because I was so freaked out. The whole top of the mountain is exposed, so you can look straight down and see how high you are. No railings to prevent you from falling over the edge, of course, and the "stairs" are about 6 inches deep and very steep. Incas were apparently very small people with tiny feet. The funniest part was the cave we crawled through on the advice of a "helpful" worker who assured us that it was only 15 feet long and it was the easiest way to get to the top. It was only 15 feet long, but he failed to mention that it was only about 3 feet tall and 3 feet wide, so we had to crawl through it! Monica was awesome and very patient with me (she had a sneak preview last year when we were in Mexico and I had to descend the pyramid at Chichen´Itza by sliding down on my rear end). We did take a picture of MP below us just to prove that we made it to the top, but other than that and a quick snack break we didn´t stay for long. The scariest part of the whole descent was the staircase that probably had 100 steps (6 inches wide, maybe), no railings or walls to cling to, and an incline of probably 70 degrees. YIKES. We unfortunately forgot to take a picture of that one. Anyway, it wasn´t pretty, but I made it up and down the mountain. I´m glad I did it, but I think I´ll skip it if I´m ever in MP again.

After our descent, we got back to the main area of MP to find it completely overrun with tourists, probably 10 times as many people as there were in the morning. We again were relieved that we had chosen to come early when it wasn´t so crowded and easier to take in. We headed back to Agua Calientes on a bus which came with an enterprising local kid as entertainer. The road up the mountain to MP is really steep with lots of switchbacks as well as flights of stairs between the switchbacks for people who want to walk. This kid started at the top of the mountain with us and then ran down the flights of stairs so that he would show up at every turn we made. It took us four or five turns to catch on, but then it became a great game to watch for him running. He made every turn without fail, and we picked him up at the bottom of the hill. He collected tips from everyone on the bus--probably made 20 bucks for half an hour of running. Not a bad job for a 10-year-old.

After an agonizingly long train ride back to Cuzco, we finally got here around 9 last night, exhausted and cranky. Since then we haven´t done much besides eat and sleep since we´re a little tired of the whole backpacker scene. We are disenchanted with the higher prices here in Peru--Bolivia has spoiled us rotten! We also are grossed out by Peruvian men who have been hitting on us shamelessly despite our greasy, smelly traveling selves. We´ll probably have a relaxed couple of days here before we head back to Santa Cruz on Saturday.
Posted at 10:57 AM

Monday, February 14, 2005

Quick post from La Paz since I´m not sure when I´ll be at a computer again (okay, probably tomorrow). Last night I made a bunch of new friends in Sorata which I never do when I´m traveling. First I met this older couple in the internet place in Sorata. I couldn´t figure them out because they were clearly American but were talking with Bolivians about all kinds of different projects. Turns out they moved here 20 years ago and have basically started a bunch of things to improve various things in Bolivia. That sounds really vague, but they´ve covered everything from screening kids for hearing problems in La Paz to starting a store to showcase textiles made by artesians from Sorata (which happens to be my favorite store in Bolivia). Then I met 3 Canadian siblings who wanted the scoop on my hike yesterday and then invited me along with another American to dinner. We had pasta and vegetables which was a really welcome change--Bolivians do not like vegetables and they make no apologies for it. I networked a bit for the Canadians--they had brought down a bunch of school supplies but didn´t know what to do with them, so I introduced them to the first couple. Problem solved.

After we had dinner we caught the end of a parade of sorts in Sorata. Apparently it´s to celebrate the Sunday of Conception, which the couple told me was basically a pagan addition to the Lent season--your absolute last chance to sin before really getting serious. The parade consisted of a band and people marching around the square in random costumes--it seemed like the only requirement was that it covered your face--and throwing flour at people. Fun stuff. We managed to stay out of the line of fire. This morning I was up early enough to catch a glimpse of the huge peaks behind Sorata before hopping on the early bus to La Paz. Once I got here, I met up with Monica and we hit the shops hard. I think shopping is the main virtue of La Paz--there are some museums but beyond the coca museum, none sound that interesting. The tourist shopping is fantastic. Monica and I have both bought a lot of stuff for our new digs. She had a good time at Lake Titicaca and actually ran into a friend of hers from the time she spent in Mexico 2.5 years ago. He is doing a rotation in La Paz this month. Small world, huh? We´re meeting him for dinner in a minute.
Posted at 7:20 PM

Sunday, February 13, 2005

It occurred to me today, as I crouched in a cave, covered in a cold sweat and watching bats fly back and forth 15 feet away from me, that I had managed to design a face-your-phobias agenda for myself. Small dark spaces? Check. Bats? Check. Heights? Check. Even better, I got to do it all by myself. The funny thing is that last night I decided this weekend was kind of like a retreat with myself--no TV, no traveling buddy, nothing really to do in Sorata but read, think, and listen to the rain. So my long walk to the bat-cave this morning seemed like it fit in just great with my spa-like retreat weekend. I guess facing your phobias would be a good theme for a day hike at some expensive spa resort, but honestly, I didn´t plan it that way. I didn´t factor in how small the opening of the cave would be, or how close the bats would be to my head.

I set out following this little map in one of my guidebooks, which made the 10 km walk to La Gruta look fairly simple. What it didn´t include was the mud and the numerous ups and downs of the road, but the scenery more than made up for those two. It was all I could do to not stop every 10 feet to take a picture (but I did take a whole roll). I followed a river the whole way, so the sound of it rushing down the valley accompanied the occasional rooster crow. The mountains here are practically neon green with fields wherever people can possibly farm. It´s amazing to see how far up they go, literally into the clouds...I can´t imagine living in one of the tiny houses (maybe dorm room sized) but waking up every morning to an incredible view. I passed very few people along the way, my favorites being two kids leaning out the 2 windows of the second story of their house, just watching the world go by. They wouldn´t let me take a picture of them, unfortunately. The mud was challenging but I figured out how to get through it in tennis shoes--very slowly. I did have a few moments of paranoia when I pictured myself slipping on the mud near the edge of the road and plunging thousands of feet to my death (fear of heights), but luckily, that did not happen.

After 2.5 hours, I finally made it to La Gruta. I was half expecting to find that no one was there to let me in, but sure enough there was. I had to sign in--the only visitor of the day. He opened the gate and let me in for my allotted 40 minutes while he cranked up the generator to turn on the lights (fear of the dark). I started down the stairs and immediately realized that I was crazy. You couldn´t even see where the entrance to the cave was! But I made myself go in and crawled in a bit (fear of small enclosed spaces). There´s an underground lake about 200m into the cave and supposedly the cave opens up a lot at some point. I made it in about 25 yards before I saw the bats. Now, maybe if someone else had been with me or if the roof of the cave were higher than 4 feet, I would have been brave enough to keep going. Or maybe if I didn´t know anything about bats and rabies, which I do. But as I crouched there and pondered ducking underneath the bats in hopes that the cave would open up soon, one flew maybe 5 feet away from my head. I yelped and decided that I´d had enough of being brave for the day. So I scooted back out of the cave and back to open air. Total time in cave: maybe 5 minutes. So, kind of anticlimactic, but I guess the journey is more important than the destination, right? Okay, enough with the retreat-speak.

I made it all the way back to Sorata, barely. I hadn´t taken enough water with me and hadn´t eaten enough, so the last hour was pretty unpleasant. A hot shower (a rare delicacy in budget hotels in Bolivia), 2 liters of fluid and a bunch of crackers later, I felt much better. I´m already sore, which I think is fair since according to the books I walked 12 miles today. That sounds like a lot, but it did take 6 hours and I am not exactly a hiker. Tomorrow should be great between my already-sore legs and 4-5 cramped hours on the bus back to La Paz to meet Monica. It´s still the best rotation ever in medical school, so I shouldn´t complain.
Posted at 4:31 PM

Saturday, February 12, 2005

First of all, thanks everyone for the emails you´ve sent over the last few weeks. I don´t always answer them individually, but I do read and appreciate them all! I generally figure that my time is better spent broadcasting to the world on this thing than answering emails in depth. However, just a short one today since I´m paying a shocking $2.50/hour for internet (usually it´s about 75 cents).

I´m in Sorata, up in the mountains north of La Paz. It´s a small little town that us gringos pretty much just use as a base for backpacking into the mountains. I am not that hardcore, however, so I´ll just be doing a day hike tomorrow and then heading back to La Paz. I think I may be the only tourist in town. I definitely was the only gringa on the bus here. The ride was interesting, as always. We drove over the Altiplano, the big plateau that covers much of Bolivia, before driving up over some small mountains. Sorata is nestled into a gorgeously green valley which really makes you feel like you´re in the Andes! Unfortunately, it´s really cloudy so I can´t see the bigger peaks around the city. For much of the drive, it looked like we were just driving on a single lane road through the clouds. Before we went around a hill, the driver had to honk his horn really loud to warn anyone coming from the other side--glad my mom wasn´t with me since she doesn´t like mountain driving! We kept dropping people off seemingly in the middle of nowhere...I wonder how far they had to walk to get to wherever they were going. I´m off to explore this little town a bit more before it gets dark.
Posted at 2:22 PM

Friday, February 11, 2005

We have finally made it to La Paz, after another annoying morning of waiting in the airport for far too long. When we arrived in Sucre Wednesday, they told us that they had moved our flight up to an earlier time. Then they called Thursday and said they had pushed it back. This morning, we had the clerk at our hotel call the airline office and they said it was leaving at the early time which meant we had to jump in a cab immediately to get to the airport. Of course, once we got there, the flight was scheduled for an even later time, and it ran late on top of that. So we´ve had a long day of nothingness in the airport.

On Wednesday, we barely managed to leave Santa Cruz. We got to the airport just fine, but after they announced the second delay of our flight, we wandered away from the gate and didn t realize that they had cancelled the second delay until the plane was boarding. They even announced our names over the intercom just after we started running. Luckily there are only 4 gates in the airport, so you can never get too far away. Then we got kicked out of the exit row of the plane b/c the stewardess didn t think our Spanish skills were good enough to handle the bilingual emergency exit. However, she then seated us directly behind the now-empty exit rows, so we would have been the first ones to the door anyway which struck us as being quite funny.

We stepped out of the plane and were immediately relieved by the weather! Sucre is cool and non-humid which is a nice break after Santa Cruz. It s been rainy on and off since we got here but I resolved to not complain about cooler temperatures, so I won´t. Sucre is the other capital of Bolivia which is home to the Supreme Court, a lot of Bolivian history, and multiple universities. Chemita and Douglas both went to school here and this is where they married and had their first son, Daniel. It s regarded as the most beautiful city in Bolivia and is also famous for its chocolate. Not bad, eh? After getting into town yesterday afternoon, we walked around and got our bearings a bit. We also checked out a museum of indigenous tribes weavings. About 10 years ago, the people were losing the skills because machine-made weavings were taking over the market, so this project was started to teach the people how to weave again, etc. It was pretty interesting and the weavings were amazing. The concept of dying your own thread and then creating cloth is so far removed from my reality, needless to say. After a few guidebook misadventures, we managed to find dinner and a drink before crashing into our uncomfortable (but cheap) beds.

Yesterday we had a busy sightseeing morning. First we checked out the early 20th century home of a mining baron. He built this "castle" which basically is a combination of a bunch of different European architectural styles. It really has no business being in Bolivia, and currently looks even stranger because there s a huge military training base literally 15 yards away from it. We kept hearing volleys from the target range during our tour! We climbed up to the top of the Byzantine-inspired tower for a view of the Big Ben-inspired tower, the military camp, and the grounds which were inspired by Versailles, which is definitely a stretch of the imagination. Next our trusty cab driver took us to the cemetery which was an adventure before we even got out of the car. As soon as we stopped, 8 Bolivian kids literally stuck their heads in the windows of our car offering to be our guides. They were all claiming to be the best in rapid, loud Spanish and the cab driver was absolutely no help! One even stuck his hand in the window to unlock and open my door. Monica and I were totally taken aback. We picked one and he took us on a tour of the prettiest cemetery I have ever seen. Lots of presidents buried there along with the owner of the crazy Bolivian castle, but basically about as exciting as a cemetery can get. Next we went off to a former monastery which didn t have much of anything except for a view of the city.

Our last touristy stop of the day was Cal Orcko, supposedly the world´s largest collection of dinosaur footprints. It´s located right next to a cement factory which was slowly chipping away at the side of a mountain when someone finally realized that there were preserved footprints in the wall. The wall is perpindicular to the ground because of tectonic plate action in the past, so you stand and stare up at the footprints. It actually was pretty cool. The layers of stone are continually changing because of erosion and vibrations from the factory, so new sets of footprints keep appearing while others fade away. We missed out on the Dino Truck which picks people up in Sucre and drives them out, but we did take pictures. It´s interesting to see the progression of how the site is managed as Bolivia works to figure out how to attract tourists--my book from a few years ago said that the site was open once a week but if you show up any other time, someone will probaly let you in. Our favorite part of the whole day (besides wearing orange hard hats) was the lake display they had set up as part of the tour introduction: they had made a puddle on the ground and placed plastic dinosaurs around it to illustrate that Sucre was a lake 65 million years ago! It was hilarious and of course we took pictures with our dino pals.

Our cabbie dropped us off at a restaurant that he had recommended for lunch. Later we put together the fact that his niece worked there and the restaurant was way out in the boonies of Sucre. Finding our way back was a bit of an adventure, but we made it. We spent the rest of the afternoon shopping, sampling the chocolate which Sucre is famous for, and watching an impressive rainstorm. Last night we hung out in a cafe over a a bottle of our favorite Bolivian red, which runs you about $1.50 in the supermarket but was marked up to $5 at the restaurant. Then this morning we had our time in the airport and finally got here to La Paz. The altitude is so high that I could immediately feel the difference in the airport. This afternoon should be low key and tomorrow will mostly be spent traveling, so hopefully I´ll have time to adjust before doing anything too strenuous. Monica is headed to Copocabana, on the shore of Lake Titicaca, tomorrow while I head off to Sorata, a small town up in the mountains. Then we return back here Monday before heading off to Peru!
Posted at 2:45 PM

Tuesday, February 08, 2005

Not much to report today since we´ve done a whole lot of nothing for the last 24 hours (I know, it seems like we´ve been doing that for the last 2 weeks, but even more so in the last day). Tomorrow we take off for our big trip...I´m excited! I´m going to try to upload a picture here from Carnaval. I may not have a digital camera yet, but since everyone else in the world does, there´s no shortage of pictures! I have a feeling that this isn´t going to work because the picture may be too big, but it´s 11:30, the instructions are all in Spanish, and I have no idea how to change it in English anyway! So it may have to wait until I get back. But if this works, here´s a picture of me and Monica before things got really crazy.

Here´s me in action at the parade Saturday night

Chemita covered in la espuma (foam)

Esteban and Douglas in their parade outfits (and foam)

Here´s one of all the gringos at the party on Sunday

Douglas´s dad, Chino, with his favorite water bucket

And finally, typical attire during Carnaval as modeled by people on the street

Posted at 11:43 PM

Monday, February 07, 2005

I´ve tried to figure out for 24 hours how to best communicate the festivities yesterday, and the best I can come up with is comparing it to one of the best birthday cards I´ve seen recently. The front shows a bunch of kids having a food fight at a party, and it says "I hope your birthday is stupid and hilarious." That´s pretty much what yesterday was. Beyond that, pictures can´t capture it, video would have a better shot but still couldn´t quite communicate the fun, so you just have to be here. We headed over to Douglas´s aunt´s house around noon and found lots of meat grilling away inside their courtyard/driveway which opened up into the street. His brother Alberto, his wife Angela, and their four daughters were there along with Douglas´s parents, aunt, and some cousins. Quite the extended family gathering. The churrasco is basically Bolivian eating at its prime--multiple types of meat, 3 different starches, hot sauce, and a token salad (which the gringoes skipped for our best gastrointestinal interest). Yum. Everyone was able to eat in peace before we started the foam/water/paint fighting. I think I was completely doused in water within about 30 seconds after I got up from the table, and I didn´t dry off until 6 hours later when we finally made it home!

Basically the streets were shut down except for a pseudo-parade that came and went all afternoon--at times there were people parading in both directions at the same time in typical Bolivian parade anarchy! And everyone in the street was armed with something--tons of squirt guns filled with water or dye, water balloons, old ladies with buckets of water, and the ubiquitous foam. There was a band playing across the way and lots of houses had music inside their courtyards. A handful of relatives didn´t participate in the mad chaos, but most of the family was out there shooting each other with guns and hoses and foam. It was hysterical. It´s too funny to have everyone from a 6-year-old to a 70-year-old fighting like mad. Douglas´s mom was soaking wet, but still dancing away in her little dress. His dad is quite a character (he´s called Chino because his first name is hard to say and his eyes are squinty). He was running around shooting the hose/foam/dye with the best of them. The dye was a new innovation and it wreaked some serious havoc. People were literally covered in purple, green, or pink ink (and still are 24 hours and 2 showers after the fact). The beer supply seemed endless, the only problem being that it´s awfully hard to get through a whole can when you´re constantly being assaulted by foam and dye. I found that the best protection was to just stick my mouth over the opening since my hands were just as wet as anything!

The amazing thing was that the whole fight just never got old. There´s really no point to throwing a bucket of water on someone when they´re already soaked, but you just do it anyways, then add some foam for good measure. Then they´d have to get wet again to wash off the foam, and the cycle continued. Groups of people from the parade the night before would march by with bands, so we´d be shooting them and dancing in the streets. Apparently the point of the bands, including the one made up of Douglas´s friends, is to march into people´s parties, play some songs, and watch women dance. This worked just great at our house. Esteban wandered off with the group (luckily he was wearing his matching shirt from the parade the night before) and didn´t turn up until several hours later, his shirt, white pants, and head completely covered in dye.

After six hours of craziness, the party finally wound down and we came home to shower. The gringoes went out for dinner and caught the last quarter of the Super Bowl. The great part was that as soon as the came finished, there was no more coverage. No post-game interviews or other such nonsense. Then we tried to find a bar or somewhere to hang out but everything was pretty dead in town. I think after partying Friday night, Saturday night and all day Sunday, there wasn´t much motivation to continue Sunday night.

Today Susan hosted a housewarming party at her new house. She, Nico, Chemita, and Jan cooked up a huge variety of pan-Asian dishes which were wonderful. It´s also Esteban´s birthday today, so Douglas arranged for three guitar players to come over and play during lunch. Alberto and his family came over as well as Douglas´s parents, so the whole big family was there with the gringoes again. It was really nice--a low key afternoon with good food, nice guitar music, and the fam. I can´t emphasize enough how nice it is to live here with a family. It´s such a different experience from just traveling through a country and staying in random hotel rooms. I love it. They´re such a warm family that we always feel welcome. Douglas has had some American or another here continuously for 2 or 3 years, so everyone is pretty used to us being around! We spent a fair amount of time today comparing our battle wounds. Everyone´s hands are stained by dye--mine are a lovely shade of hot pink, mostly on the fingernails and cuticles. I found a big patch of green on my stomach after my shower this morning, and I have at least one purple toe. Other people have purple ears or green arms, etc. I also have a pretty darn pink and painful eye, which I think is officially something infectious. My eyes were red all day yesterday but one cleared up and the other was worse this morning. I broke down and bought some antibiotic drops (the instructions were in Portugese, hope I interpreted them okay!). Tonight I think we´re going to try to head out to a movie. Tomorrow is designated as the final holiday day, but I think we will be using it as a recovery day. Enough partying!!
Posted at 5:20 PM

Sunday, February 06, 2005

Round trip ticket from Detroit to Santa Cruz: $910
10 extra large cans of spray foam: $10
Being in Bolivia for Carnaval: priceless

Last night was one of the most ridiculous and most fun nights I have ever had. I was completely soaking wet for hours, but never had a drop of water spilled on me--it was all spray foam. We waited all day for Carnaval to begin, so it was a pretty low key day. Susan arrived in the morning and got to see her new house for the first time. There are currently 16 people sleeping over there--pretty impressive. Meals have become major undertakings for this group of 20. We gringos had heard rumors of the parade being a paint/water/foam fight, so none of us really knew what to expect. But we did know that we should not wear nice clothes. The disposable plastic goggles that were circulating around the house ahead of time gave us another clue. Finally, after much confusion and logistical manueverings, we figured out how to get everyone to the parade on the other side of town.

The street was set up with bleachers which were open to the public as well as plastic chairs which you can reserve in advance. We had a huge block of chairs right in front reserved for us. The foam started as we walked the block to our chairs. People in the crowd just started shooting it at us. Once we sat down and started buying our own foam, it was all over. The parade itself is pretty loosely organized--groups of people can sign up to walk in the parade. Because it´s Bolivia, this means that a group or four will come by and then there will be a 20 minute stretch without anyone parading. This is when the foam really comes in handy because spraying your friends is super fun. You can shoot it really well, like silly string, but it´s a foamier, wetter consistency than silly string and it smells like fake orange stuff. We were shooting each other from 8 feet away, or 8 inches. The instructions warned us to not shoot it directly at anyone´s eyes, mouth or face, so we did all three. Then again, it also said that it should only be used under adult supervision, and we´re all over 25. I was literally covered from head to toe in the stuff, over and over again for hours. And of course I was laughing hysterically for much of that time. Throw in a couple of cans of cheap Bolivian beer, and you´ve got yourself one hell of a party. We took pictures for a while but eventually our cameras and hands were so goopy that I couldn´t even turn the knob on my camera to open the lens. I had a hard time gripping the cans of foams because everything was so slippery, which was really unfortunate because I wanted to have two going at the same time but it was all I could do to hold and shoot one can.

We had a few fights with people in the crowd behind us, but we definitely seemed to be more into the foam than the Bolivians. People in the crowd would randomly spray people in the parade and vice versa. TV reporters were walking around with cameras and foam all over their heads. At the beginning, the police seemed to escape the foam, but as the night went on they eventually got little spritzes here and there. Douglas and Esteban were in the parade with a group of Douglas´s friends, so they marched by in matching outfits and hats and of course received lots of foam and cheers from us. Douglas´s mom was the funniest spectator in my book. She is a judge and kind of a proper older woman who doesn´t speak any English but really tries to share things with the gringos. So she´ll stop you and point at something to say it´s very typical of Bolivia or specifically bring over pastries typical of Santa Cruz, etc. Last night she was there in her dress and a pink straw hat to cover her hair. I think she only went through one can of foam, so she used it sparingly but viciously if someone was blocking her view of the parade. It was just too funny to see her with foam all over her back and hat, demolishing some poor 6 year old in front of her. Chemita was hilarious too. She´s one of the nicest people I know, but when the kids behind us attacked us, she fought back ferociously. At one point, she had goggles on and a rag to protect her nose and mouth which made her a fully decked out guerilla foam fighter.

We were probably at the parade for about 4 hours and the party was still going strong when we left. I came home and found that the whites of my eyes were completely pink, and they still are even after several hours of sleep. Our clothes still aren´t dry yet but I think we´ll probably wear them again for tonight because it´s going to be just as messy. We´re going to Douglas´s aunt´s house for a churrasco, which is basically a barbecue on crack. Douglas has bought 32 kg of meat (that´s about 75 pounds, or almost as much as Nico weighs--see my entry from a few days ago). Apparently downtown there´s more fighting with foam as well as water ballons and paint today. His aunt lives closer to the action so the party will be there. Wish me luck!
Posted at 9:44 AM

Friday, February 04, 2005

Well, we had an eventful morning. The first part was hilarious, the second part was really frustrating for me. I´m going to try to tap back into the hilarity here. So, we had arranged to meet Douglas´s friend the orthopedic surgeon at 8. We were just about ready to leave at 8:29 when he finally showed up, right on time according to BST (Bolivian standard time). The anesthesiologist who was working with him today had to go down the street to sedate another patient during a CT, so we went with him to check it out. This involved smushing in the back of an ambulance which was completely full with equipment and a bed, qutie possibly the most exotic Bolivian transportation experience I´ve had so far. We thought it was going to be a long trip, but it was literally half a block. Once we got inside, the anesthesiologist sedated the kid even though the oxygen tank in the room wasn´t working. Someone ran off to get another one and the doctor ended up giving the kid mouth to mouth breaths--I think another difference between American and Bolivian medicine is that they don´t practice under constant threat of lawsuits like we do.

Anyway, then it was my turn to be offended (only fair after Monica´s chat with Nico last night): when they were getting ready to start the CT, the doctor asked us if we were married. A normal question in Bolivia, but in this case it was his shorthand for "do you ever intend to have children?" because exposing yourself to radiation is not a good idea if so. I was like "oh great, he basically just looked at me and figured that if I wasn´t already married, there was no way I would ever have kids!" Real nice. Then he pimped us about CPR which we really should know the exact numbers of breaths to chest compressions, but I was having such a hard time understanding him that trying to remember that too was ridiculous. After the procedure, we all piled back into the ambulance. I was smushed up front with the two attendings who giggled when they turned the siren on and raced around the block back to the children´s hospital (no portable oxygen...yikes!).

Back at the children´s hospital, we changed into scrubs which was completely hilarious. They were decades old--my shirt had multiple holes in it--and sized to fit Bolivian men. So the pant legs were pretty short but the waist was huge--a XXL in the US. The shirts were long enough to be a dress on either of us and wide enough to accomodate a significant beer belly. We were laughing hysterically in the locker room (for those of you who keep track of such things, Monica was laughing hard enough to cry), and that was before we put on the cloth booties and hats which were actually even funnier. I´m just sad we didn´t have a camera today because between the ambulance and the two of us swimming in scrubs, there were a lot of photo opportunities.

Once we were all suited up, we went to the OR and watched them put lower body casts on 3 kids who all had broken femurs (I don´t know the proper name of the cast). The attendings were great about letting us do stuff--we got to play anesthesiologist from start to finish, but it would have been a lot better if I could have understood what was going on. It basically was like your first day of a surgery clerkship except that you can only understand about 30% of what´s being said, including what they´re asking you to do. The people we were working with would have been really fun to work with in the US because they were joking around, but I just couldn´t follow it in Spanish. I got really frustrated because I could tell they were making fun of me (not to be mean, but just as a joke). In fact, I was so frustrated that I wasn´t smiling like I usually do when I don´t understand...instead I resorted to giving dirty looks. They did the job though--everyone understood what I was thinking. When we finally left, the anesthesiologist wished us good luck, safe travels...and told me to change my expression!

We came home and met 5 people from Wright State who arrived this morning--four 4th year students and one ob/gyn attending whose daughter volunteered here. Our numbers are growing fast! Monica and I have really established ourselves as a team here. We even say "somos un equipo" multiple times per day (that´s "we are a team.") We finish each others sentences--usually it´s when Monica jumps in after I´ve been working on saying a sentence for five minutes, but sometimes I come up with the word she´s looking for. Susan insists on having each of us hold one of her hands even though she usually only holds one person´s hand at a time. Our names seem to be interchangeable too. The only time we really have to split up is for Spanish lessons--Chemita tried to combine our lessons earlier this week and it was a mini disaster. Speaking of lessons, I´m up soon so that´s it for today. Tomorrow...a report from Carnaval!
Posted at 11:53 AM

Thursday, February 03, 2005

This is going to be a really long post...sorry! (Or, you´re welcome!)

Yesterday we went back to Hospital Japones for another day on the peds ward. We had read a bit about malnutrition and other cases we saw on Tuesday, so we were able to ask more intelligent questions which was good. One of the residents gave us a mini lesson on physical findings of kwashiorkor (which is what those starving kids in Africa with huge bellies have--it´s actually due to severe protein deficiency). We also saw a horrendous case of hydrocephalus (excessive fluid around the brain)--the poor patient had been shunted 7 times but her head was still unbelievably awful, as was her head CT. Another interesting thing about that hospital is that we saw no evidence of any kind of cultures or even gram staining going on, so all infections were treated empirically.

Based on what we´ve seen over the last few days, my guess is that Bolivian medicine is a lot like what American medicine was maybe 30 years ago. Some of the nurses still wear silly white hats, and all of them wear all white. The hospital rooms are mostly open wards with up to 6 beds. Doctors are definitely held in much higher regard here--when we first walked into the hospital Monica and I were carrying our white coats, and Douglas told us to put them on so we could get through the halls more easily! Speaking of which, we have been wearing two of his long white coats which feel so weird. We´re used to the hip-length ones that brand us as medical students, so it kind of feels like we´re playing dress up wearing the real ones.

After yesterday, we felt like we had gotten as much out of Japones as we were going to, so Douglas offered to take us to the children´s hospital in town today. He didn´t set anything up ahead of time (probably because we didn´t remind him about it until 10pm) and basically just walked us into the hospital in hopes of finding someone he knows, despite the fact that he hasn´t been there in years. We ended up totally lucking out. He bumped into a medical school classmate who is now a pediatric orthopedic surgeon. We saw a couple of inpatients with him--rather than buy traction beds they attach pop bottles to the kids´ legs. After that we spent the morning in clinic with him and a ton of Bolivian medical students. It was great because neither of us has had any clinical exposure to ortho and because he had lots of students, he did a lot of teaching and spoke very slowly (this is especially important for me). We saw a lot of different but basic ortho stuff and were both quite happy with the morning. Tomorrow we´re going to the OR with him which should be interesting.

Two really funny things from this morning definitely deserve to make the blog. The first one needs some background: last week Douglas told me that I smile less now than I did 2.5 years ago. I did not like that, as you can imagine, and him telling me that maybe it´s because I seem more like a doctor now didn´t really help. (of course, he and Nico are also convinced that I am taller which is definitely not true) The least negative explanation I could come up with was that since I often just smile to cover the fact that I don´t understand what is going on and I understood less Spanish then, I probably did smile more. So this has become a joke and Douglas likes to point it out whenever I do smile. Today we worked with a group of 3 students from Brazil who we totally couldn´t understand. It took me a minute to realize that they were speaking Portugese, but even when they spoke really basic Spanish directly to us they were hard to understand. So, naturally, both Monica and I ended up smiling a lot when they were around. And I think maybe because of the smiling, after ten minutes the attending announced to us that all 3 of the students were in love with us. Or maybe it´s just us, because later we were walking down a street and had probably 200 men whistling and yelling at us (I am not making this up--there were two huge military trucks packed with army guys, all screaming).

The other funny thing--and I hope that the attending and students didn´t pick up on this--was how much our Western medical sensibilities were disturbed by daily practice in a clinic. We´re so used to everything being individually packaged in sterile containers and everyone being paranoid about infection in the US. Here they keep betadine and alcohol in large glass jars with nozzles that are just covered with cardboard. Every patient sits on the same cloth sheet (even after one baby peed on it--gross). At one point one of the students washed his hands and the attending directed him to dry them on a cloth towel across the room. I think Monica and I probably showed our surprise, because after that he brought some paper towels in and explained that the cloth ones have germs. When I was here before, it seemed natural to me that supplies would be different at the clinic, which obviously operates as cheaply as it possibly can. But in thinking about it today, I realized it´s not just the clinic, it´s probably the rest of the world. And it probably makes a lot more sense in terms of efficient use of resources, but it´s just completely the opposite of what we´re used to. The OR should be really interesting tomorrow.

Outside of the medical world, we´re keeping busy. Today was absolutely gorgeous--sunny, 85 degrees, 40% humidity. I got a little sunburned after half an hour in the sun. Spanish lessons march on. I currently hate verb tenses with a passion. Chemita is trying to cover a lot of ground with me very quickly, which is great but hurts my head sometimes. Diego and Susan have accepted us as friends and like playing with us now. Yesterday we booked 4 flights for a 10 day trip that will take us to Sucre, La Paz, and Cusco (in Peru). We leave next Wednesday after Carnaval, Latin America´s version of Mardi Gras which Douglas labeled as a 4 day party that´s all about "alcohol, food and sex." There´s a parade on Saturday that ends up being a huge foam and water fight--Esteban (American attending currently at the clinic) told us that all women have to wear white. Right. Should be quite the experience, especially since Douglas has planned a schedule for the weekend. The 3 Loyola students, Jenna, Esteban, 4 people from Wright State Med School (in Ohio) and Susan (the American doctor who founded the clinic) will all be here this weekend for the fun. Amazingly, they´re all going to have at least a mattress to sleep on in Susan´s new house, conveniently located a block away from Douglas´s house.

One last funny story from today: today Monica and I were eating our usual romantic dinner (the last couple of days, we´ve been the only ones around at meal times, so it ends up being just the two of us eating) which Nico had cooked for us over at Susan´s house. After stuffing ourselves, Nico asked if we want more, and I said no because we are going to be too fat. Then she asked me, logically of course, how much I weigh. I politely declined to answer, and she declared that she weighs 42 kg (about 100 lbs, typical for Bolivian women). Then she said to Monica, who is definitely petite by American standards, "how much do you weigh...65 kg?" It was hilarious. Monica now believes that you haven´t really lived until a teeny Bolivian has guessed that you weigh 50 lbs more than she does...I shot back that Nico didn´t guess how much I weigh because she can´t count that high!

Posted at 7:28 PM

Tuesday, February 01, 2005

Breaking news from Bolivia: Monica and I actually had to think today. It was rough. We got up early (7 am!) and went to Hospital Japones, one of the public hospitals in Santa Cruz, to hang out on the pediatrics ward. (Bolivia has a sizeable Japanese population which immigrated here after WWII. In fact there is an Okinawa, Bolivia. Japanese government constructed this hospital in the 80´s) Anyway, it was funny how familiar the whole hospital scene was--pretty much every day I´m struck both by how different some things are and how universal others are. Morning rounds were just the same as they are at home, except the doctors can wear jeans and sandals under their white coats. There isn´t any equivalent to medical students on the wards here: people enter medical school straight out of high school, do 4-5 years of classroom work and then do clinical rotations where they function as interns do in the US.

We showed up in the middle of rounds and didn´t get too much out of them since they were so fast, but then a senior resident took us around and explained some of the patients to us. We caught little pieces of each patient´s story, and then went back and read their charts and examined them. Nobody spoke English and nobody spoke Spanish quite slowly enough for us, so we made up a lot of explanations for ourselves. The whole enterprise was also hampered by the fact that we couldn´t read a lot of the charts because the handwriting was illegible (you just don´t appreciate computerized notes enough until they´re gone) and we didn´t have a dictionary. And then since the fourth year tends to be pretty...um...laidback, we realized that we had forgotten a lot of basic things. It took me at least 10 seconds to remember the cutoff for thrombocytopenia--it should take me 0.1 seconds. Plus we have pretty limited knowledge on, say, severe malnutrition because you just don´t see it in the US. It wasn´t pretty, but we did manage to appreciate some of what we were seeing. Skip this next part if you´re not medically inclined. We saw a 2 year old who weighed 6 kg (3 kg at birth) and had what I can only imagine is a ton of physical findings secondary to multiple nutritional deficiencies. We also saw a huge meningoencephalocele--folic acid is our friend. Also really interesting was a four year old with Pott´s disease. Two of his lumbar vertebrae had collapsed together and formed a bump on his back that protruded a good inch. He can´t walk and has some decreased sensation in his legs, poor little guy. We are pretty sure that we both contracted TB today, but it was interesting. We came home and did some reading today and will head back tomorrow armed with a bit more knowledge...and a dictionary.

In non-medical events, one of the students from Loyola caught el estomago del gringo this week. She was pretty miserable for 36 hours and had to stay behind in Santa Cruz while the others went to Palacios. Monica and I have been keeping her company. There´s a large cat who has taken up residence in the house--his name is Diego and even though he looks like a 4 year old boy, he is actually a cat. He is absolutely entranced by the movie Catwoman and announced to Douglas that he wants to be a woman. This does not go over well in the Latin American culture. Douglas talked him into being a lion for a few minutes, but the cat keeps showing up. Oh, and in weather news, today was a cold one in Bolivia. People were dressed up in sweatshirts, kids were wearing winter hats...I mean, it was in the high 60´s. Mucho frio! The Spanish lessons continue. I have decided that I need to start thinking in Spanish because I can´t think fast enough to think of something to say, translate it, and then get it out in time. Thinking in a foreign language is easier said than done, however, so we´ll see.
Posted at 7:56 PM

Monday, January 31, 2005

We´ve spent the last couple of days hanging out in and around Santa Cruz with the new students from Loyola. On Saturday we spent the afternon out in the country at a restaurant with a fantastic view of the foothills of the Andes and some random farm animals to look at. That night we met up with one of Douglas´s patients to learn how to salsa dance--that is, the girls learned a little while the guys drank beer and looked uncomfortable! That didn´t last too long, so we ended up at a "heavy metal bar" across the street where there was a band playing horrible covers of American music (see below).

Yesterday we had quite the voyage--I think we all felt a little more like we were actually in Bolivia! We had decided to go see some waterfalls which were supposed to be near Santa Cruz. They were nearby on the main highway, but once we got off the highway we had 17 kilometers of "roads" to cross. And by roads, I mean really muddy ruts that ran through the dense trees on either side. I think in the US it would definitely count as off-roading. The highlight was driving the 4WD vehicle right across a river. Esteban, the attending at the clinic, started across the river after some locals told us we could make it. He got worried when the car tipped to a 45 degree angle just a few feet into the river, so he pulled back and we asked the locals again if we could cross it. They said yes--just don´t stop. So he revved up the truck and we made it across with no problem, other than the rest of us laughing hysterically and a big splash of water into the car. We found the waterfall after a muddy hike and some people went swimming in the pool beneath it.

Last night Monica and I discovered the joys of Bolivian cable, which really is pretty good. They´re even showing Desperate Housewives down here already! We went to Douglas´s restaurant for dinner--as if the guy didn´t already have enough to do, he and his friends opened up a restaurant this year. The concept is healthy fast food, so they sell all kinds of delicious wraps and smoothies. It seems to be doing really well and they have plans to expand. Bolivian capitalism is alive and well, apparently. We were trying to think of what the current food craze is in the US so we could bring it down here and make our fortunes.

And, to wrap up, here´s a list that Monica and I made while we were watching the bad cover band at the bar:

Top 10 signs that your Bolivian cover band sucks
10. You cover Chris Isaak, heavy metal style
9. The lead singer is wearing a Tampa Bay Lightning teeshirt as if it were cool
8. You´re playing at Octopus, a music-pub heavy metal bar
7. The lead singer would actually look better WITH a mullet
6. The lead singer plays a red tambourine as if it were the greatest instrument ever
5. There´s no unifying theme to your setlist except that it´s all bad
4. The lead singer reads the song lyrics from a card in his hand
3. And by read, we mean he pronounces the lyrics phonetically
2. Your guitarist appears to be Yanni
1. You have to start your own applause at the end of each song.

Posted at 6:44 AM

Saturday, January 29, 2005

Yesterday was a historic day in Bolivia but it seems the rest of the world didn´t really notice (go figure). There has been a big movement in Santa Cruz lately called Autonomia in which the people of this state wanted to be able to appoint their own governor and have their taxes stay local. Right now, the president appoints the governor and all the taxes that come from this more prosperous area of the country go first to the capital, La Paz. La Paz and the highland part of the country ends up getting more money than the lowland area which makes all the money. This has been an issue for years, but this year they got really organized about it and stopped paying taxes. Yesterday there was a huge demonstration in Santa Cruz--350,000 people in a city of 1 million and a country of 8 million. And we were there!! (Special Mom reassurance: It was a very peaceful demonstration, so other than being laughed at a bit for being gringos, we were fine) Monica and I went with Chemita and three students from Loyola who arrived yesterday. The funny thing about it was that Chemita wanted to be right up in front of the whole thing, so she kept weaving herself deeper and deeper into the crowd with a trail of 6 gringos behind her. This was made much funnier by the fact she kept squeezing into these tiny spaces (which is easy to do when you´re 5 feet tall and maybe 90 lbs) so that we all struggled to follow her. But we did our Bolivian, rather Cruceño (people who live in Santa Cruz) political duty and tagged along behind her. The government agreed to hold a national referendum on Autonomia this spring which will certainly pass, and government structure in Bolivia will change significantly, and for the better for Santa Cruz.

Anyway, like I mentioned, three fourth year students from Loyola arrived yesterday. Two more are coming next week along with Susan, the American doctor who started the clinic. The week after that, another 4 people from Ohio are coming as well, so there will be a lot of people here. They´ve built up some infrastructure to deal with so many bodies--Jenna is serving as the volunteer coordinator, making schedules and contacting people at hospitals in Santa Cruz. Willy is the driver who was hired to help ferry people around (although at the moment he ís basically our chauffeur--a nice addition to our cushy lifestyle here). Steven is an American doctor from Loyola who has been at the clinic since September and acts as the attending out there.

Most of you probably won´t be that interested in this story, but anybody who knows Douglas should appreciate it. Douglas loves to create soap opera drama amongst the volunteers. He still asks me twice a day what happened between me and Ben when we were here and it doesn´t matter whether I deny it completely (the truth) or make up some grand romance story (a complete lie), the teasing continues. I am not, however, the only person subjected to his scrutiny. (And, when he heard that Monica was engaged, he pointed out that what happens in Bolivia stays in Bolivia...) At lunch yesterday, Chemita commented that Jenna and one of the residents who was here would make a good couple. Monica and I had noticed some...shall we say chemistry between them the first night we hung out. Douglas, however, missed all of this. Jenna blushed as soon as we started talking about it and Douglas was shocked that nobody had told him. Then he noticed that Jenna had a hickey (new vocab word in Spanish!) on her neck, and it was all over. Jenna tried pointing at her mosquito bites and saying the thing on her neck was the same thing, so Douglas dragged her over to the mirror and made her look at it. He was still in shock that he had no idea, so he asked Nico, the housekeeper at the new house, if she knew. She immediately replied "oh yeah, I saw it!" which completely finished off Jenna´s protests and made Douglas look even more out of the loop. The whole thing was hilarious. So, future volunteers be warned...what happens in Bolivia stays in Bolivia, and Douglas probably won´t forget it!

Posted at 8:50 AM

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