Rurrenabaque, Bolivia

Devotion

2007-10-19T06:43:00.000-07:00

I was reading a devotional today (http://www.devotions.com/) and this poem was on the website. Author unknown.

It’s sometimes very difficult

For us to understand

The wisdom and the love behind

The things that God has planned.

But we wouldn’t have the rainbow

If we didn’t have the rain;

We wouldn’t know the pleasure

If we never tasted pain.

We wouldn’t love the sunrise

If we hadn’t felt the night;

And we wouldn’t know our weakness

If we hadn’t sensed God’s might.

We couldn’t have the springtime

Or the yellow daffodil

If we hadn’t experienced

The winter’s frosty chill.

And though the brilliant sunshine

Is something God has made.

He knew too much could parch our souls

So He created shade.

So God’s given us a balance:

Enough joys to keep us glad,

Enough tears to keep us humble,

Enough good to balance bad.

And if you’ll trust in Him you’ll see

Though yesterday brought sorrow,

The clouds will part and dawn will bring

A happier tomorrow.

2007-10-05T21:02:00.000-07:00

It is late Friday night, almost Saturday morning here in Rurre. This week was long and tough. Laura, the lady with the three children (11, 5, and 3) died peacefully Monday morning at 230am. She was laid out for two days in the family home with candles, flowers and lots of family and friends surrounding her. It was a sad day for all, but everyone seemed at peace knowing that their friend, daughter, mother, sister, aunt, grand daughter, was no longer suffering. I stopped by the house Thursday afternoon and shared a soda with the mother and grandmother. There grief is coming out in the physical, with shoulder pain, sore throats, coughs and general weakness. I can’t imagine the pain the mother must be going thru losing her daughter.

David (name changed) is 11 years old and has Downs Syndrome. He lives around the corner from the clinic and often I will see him hanging out on the bridge between his house and the clinic. Sometimes, he will stop by to see what’s going on and he always has a smile from ear to ear and a great big hug. David is so full of love and joy. No matter how good or rough the day is going, he always brings a smile to my face too.

Jori (name changed) is the 14 year old who came to the clinic last week and had a positive pregnancy test. The plan was for her to bring her boyfriend (22 years old) to the clinic so we (Dr. Frida and myself) could discuss options with the couple. Today, Jori showed up alone. Her boyfriend had to go to La Paz for a week to visit with his ailing father. Jori was tearful and doesn’t know what she wants. She is 7 weeks pregnant. She does not want to leave her house, but she says she will be kicked out of the house if her parents find out she’s pregnant. Jori is scared. I asked what she was most fearful of right now; being pregnant or her parents finding out. Jori shared that she is terrified of telling her parents because the only way they know how to deal with conflict is with physical contact. Jori is unsure how responsibility her boyfriend will take in caring for the baby. Abortion was discussed, as well as adoption. Recently, I met a woman who works at an orphanage. I am also going to talk with Pastor Jack and Daisy about possible homes for Jori until she gives birth. Jori will return to the clinic next Friday with her boyfriend to discuss the situation. If all goes well (please pray they decide to keep the baby), then we will all sit down with the parents on Saturday to discuss the situation and evaluate if Jori will be safe at home. If anyone has any suggestions, I am open to them.

Marlene is 16. She has a physical handicap and walks with a limp. Two Saturday’s ago, she was on a moto taxi and was flung off and landed on her knee. She had Xrays, but nobody gave the mother the results. It’s two weeks later and nothing has been done. I got my workout today, by carrying her around the clinic and then to the boat that crosses to San Buena Ventura. She was seen by a trauma MD and will have surgery on Monday.

Tonight, I played pool with my friend, Mette. She is a med student from Denmark. I play pool like my dad plays golf!!!! We had lots of fun anyway and I actually won a game.

Well, I am signing off for the night. I am going to bake a chocolate cake with Natalie, a teenage girl who wants to learn how to bake. I had to buy the butter tonight, because the only store that sells real butter is closed tomorrow. stocked up, so I should have enough for a while.

Love and hugs to all.

Life and Death

2007-09-29T18:41:00.000-07:00

Three boys on their way home from school, having fun climbing the walls!

The Macaw at Jack's house.

Whew! It is Saturday evening at 10pm and I am just slowing down after two LONG days.

Yesterday, we saw 24 patients at the clinic. On my way to the clinic, I witnessed two women in the middle of the road and a man in between them. One lady had her fists drawn. The women were circling the man. As I got closer, I thought "ok self, do I ignore what I am seeing and just keep walking or do I get involved?" What do you think I did? If you guessed I got involved you are right. As I got closer, I yelled out "hola, como estan" (Hi, how are you) I then walked up to the woman who looked agitated and I put my arm around her and starting chatting with her. As I was talking with her, we continued to walk toward the clinic and the other woman took off. Apparently, the two were fighting over a guy. I asked the woman what would happen if she got in a fight and the police came. She told me it wouldn't be good and I agreed. I think distracting her and talking about the consequences, she realized fighting would get her nowhere. As I arrived at the clinic, she gave me a hug and thanked me.

During a consultation, I heard a loud shreek and lots of screaming and crying. Dr. Frida knew exactly what was going on. She jumped up from her desk, grabbed the ambu bag, told me to take my stethoscope and we both ran down the street. The house on the corner is owned by a young couple. Laura is 26 years old, and married with three young children; 11, 9 and 6. Laura is dying of cancer. I don't know where it started, but it has metasasized throughout her body. Because of all the fires, the air has been thick and Laura was having difficulty breathing. Dr. Frida used the ambu bag and shortly thereafter, Dr. Crispen, from Rurre Hospital arrived with a small oxygen tank. I stayed with the family for a while and tried to console the mother of the 26 year old. I can't imagine how she must feel, losing her daughter. I didn't say much, just let the family know I was there if they needed anything.

Back at the clinic, we had a 14 year old girl come in. Her complaint was a stomach ache. When asked about her menstrual cycle, she told the MD, she hasn't missed. She has a 17 year old boyfriend and is sexually active. We sent her for a urine test (Antonio, our pharmacist does dipsticks), and sure enough, the HCG test came back positive. When Dr. Frida shared the results with the girl, she started to cry uncontrolably. She asked the MD to help her....meaning abort the baby. Thank God, Dr. Frida does not believe in this practice. We are going to meet with the girl and her boyfriend on Monday. The girl is afraid her parents will kick her out of the house... So, for all my prayer warriors out there, please join me in praying for this situation, that God would give us wisdom and guidance on how to address this delicate situation.

As we continued with the consultations, a gentleman came to the door. His wife was seen in the clinic two weeks ago. She is six months pregnant and extremely anemic. Her legs also had 4+ pitting edema. When she was seen by us two weeks ago her hematocrit was 22%, and we sent her by moto taxi to the hospital. Apparently, they did nothing for her and sent her home. Why the husband waited two weeks to come back, I don't know. But, there he was in our clinic asking us to help. "My wife is very weak and can't walk. The hospital sent her home. I am worried about her". After consulting with Dr. Frida, I packed my bag with my stethoscope and a month supply of Ferrous Sulfate with Folic Acid. I told the husband I would follow him to the house. He told me he couldn't go back to the house because he was working (he sells ice cream on the streets). I explained to him I was not that familiar with Rurre and the streets and he would have to show me where he liveed. He reluctantly agreed. When we arrived at his (house), I found the wife sitting on a piece of plastic washing clothes. I gasped, which I know was not the thing to do, but seeing her there was disturbing to me. Thank GOD!!!! I gave the husband 5 Boliviano's for the return trip and left.

I assessed her and took her vitals. She was tachy and pale as could be. Her conjunctiva was white. The gums of her teeth were white. I asked her what had been going on and she told me she fell yesterday and after was vomitting blood. She began crying and was scared. I felt the baby moving and could hear the heartbeat. Without trying to be alarming, but needing to be firm to get my point across to her, I told her she needed immediate medical attention. I helped her to the (bed) and propped her legs up on some rolled up clothes. Her bed was floor level with a bamboo platform and some blankets on top. She didn't have any pillows, just blankets and clothes. We made do with what we had. I told her I was going to talk with the MD. She needed to stay in bed until I returned.

Back at the clinic, I updated Dr. Frida on my findings. We both agreed she needed immediate medical attention. Dr. Frida wrote a note to the San Buena Ventura Hospital which is across the river. Dr. Frida asked if I would accompany her and I agreed. When I returned to the house, the husband was gone and the wife was back washing the clothes. WHAT ARE YOU DOING, I wanted to scream at her. Deep breath, Deep breath... I am missing something. During my earlier visit, the neighbor told me many people have offered to help, but neither the husband or wife have accepted help. I didn't react. I just asked if I could return when her husband was home and she told me I could come back in the morning. So, this morning, I made my way back to their house. Both the husband and wife were there. Thankfully, the wife was in bed. I talked with both of them and explained that the wife needed to get to the hospital. The husband agreed and I told them I would return in 15 minutes with three moto taxis. I went home, called three moto taxis and they took us to the river. We crossed the river by boat and then took three more moto taxis to the SBV hospital. I am really getting good at side saddeling!!! At the hospital, Dr. Jaimie greeted me and immediately took in the patient to be evaluated. A few minutes later, he come and told me they would be admittng the pt.

Tonight, I was invited to a birthday party and tomorrow I am going horseback riding with Christian and Mette, two medical students from Denmark. I am off to bed! I hope you are all enjoying the pictures. Love and hugs to all

San Pedro

2007-09-27T17:53:00.000-07:00

The children of San Pedro, one of the community visits we do. The children heard me say OK as I was getting out of the jeep after our 3 1/2 hour ride and they clung to that. I would be walking into the makeshift clinic and I would hear "OK" in the background. I would turn around and they would all look at each other and giggle! I was seeing pt's with Dr. Frida and the children were standing in the doorway, motioning me to come. I went to see what they wanted and they were holding a flat basketball and invited me to play soccer with them. I explained to them I was in the middle of seeing patients and would play with them when I was done. They agreed, but didn't budge. They all waited for me in the doorway and watched every move I made. Later, we played soccer with a flat basketball. At the end of the day, I attempted to teach them how to make a human pyramid. As you can see, we need a bit more practice!

Don Saul

2007-09-27T17:27:00.000-07:00

Don Saul

This is Don Saul. He is a patient at the clinic. Everyday, I pass his house on my way to and from the clinic. He is always sitting in the chair that you see in the picture. If he's not snoozing when I pass by his house in the afternoons, I will often stop and sit and chat with him for a few minutes. He's always asking me on a date, and I remind him he is a married man and I am way too young!!! Wednesday, I was walking home from the clinic and his wife came out to greet me. She sent me on my way with some tamarinda seeds to make tamarinda juice. Ooh it's delicious with ice and a bit of sugar!

Poor Don Saul. As you can see from the picture, Don Saul walks with wooden crutches because he has arthritis so bad. I think it was Monday morning he came to the clinic to get his monthly meds and injection. His house is about 3 blocks from the clinic and he was only half way home twenty minutes after he left us. I was leaving the clinic for siesta when I saw him.

Baby Simba

2007-09-22T07:01:00.000-07:00

The circus came to town the last week of August and I was invited to go with Dr. Frida and the health care promoters. During intermission, there was an opportunity to have your picture taken with baby Simba. What do you think, shall I bring one home?

Pictures of Serafim

2007-09-22T06:24:00.000-07:00

Serafim

Right thigh abscess. Second day of treatment. My first day of seeing this.

Sunday, Sept. 2nd. Serafim wanted to go back to his community, but I asked him to stay one more day. He returned on Monday for one more dressing change and then I sent him on his way with his promise that he would return the following Sunday. He did. Unfortunately, I don´t have a picture of the ulcer, but it was almost completely healed. Serafim did a great job with his dressing changes at home and really made some great improvements. I promised Serafim I would give him a copy of his picture. I will have to go to La Paz (18 hour drive or I can go by plane). I will get all my pictures in prints in December. That way everyone will have a copy.

Victory!!!!!

2007-09-18T14:49:00.001-07:00

Saturday, the temperature here was about 90 degrees. Three weeks ago, I was invited to play soccer as part of the Rio Beni Health Project. There were eight teams total; 4 mens and 4 women´s. I repeatedly reminded Lola that I have never played before, but that didn´t seem to phase her in the least bit. I agreed to play. The team designated me as goalie.

There were only three games. We were 1-1. This was an important game. I was sweating before I even got on the paved field. Thank God as goalie, I could choose my own shirt to wear and I didn´t have to attempt one of the XS that the team ordered!

Since the men played first last week, the women were up first this week. We did our huddle and cheer and ran out on the field. I took my spot as goalie. The ref blew the whistle; within the first half of the game, the other team was ahead 3-1. As I was walking off the field, one woman was glaring at me as if to say ÿou got one more chance gringo, don´t blow it¨.

The whistle was blown and again we made our way to the field. Maura, a team member scored within the first 5 minutes and shortly after another team member scored. God was listening to my plea for help!!! So we were tied 3-3. The rest of the game was neck and neck. We went into overtime; you play for 5 minutes than switch sides and play for another 5 minutes. Neither team budged. The score remained 3-3. This meant we had to go into Sudden Death. (btw... thanks to http://www.firstbasesports.com/soccer_glossary.html, I got a quick education on soccer terminology).

So, since I was the goalie, that meant I had to block all the shots in this modified version of ¨sudden death¨. Instead of the game ending when the first person scored, all players had a shot at scoring. While part of me was determined for our team to win, all I really wanted to do at this point was get on the next plane to La Paz. By the grace of God, I blocked all the shots. The other team missed one. We won!!!! The lady that looked at me with such disgust earlier was now hugging me and acting like my best friend!!!! We took home the plastic trophy, but it will proudly be displayed in the clinic for all Rurre to see.

Moises

2007-09-14T18:05:00.000-07:00

Moises, a middle aged man in a far away community was next in line to be seen at the makeshift clinic held in the school. ¨Doctora¨he spoke in a soft, mumbled voice, speaking a mix of his native tongue of Chimani, and Spanish. He pointed to his left lower quadrant and winced when he spoke. It was obvious Moises was in pain. I read his history-and the MD attending last year noted Moises had an inguinal hernia. Apparently, his case was discussed at length last year and the MD wanted him to go to Rurre for surgery. The patient, for whatever reason, declined treatment at the time. Now, the pain was so bad, he wanted to get help.

Tuwanda, a former MD volunteer at the project came for a week visit. She has been great with showing me some of her favorite places as well as helping with the patient load. Tuwanda took Moises to a ¨private¨area to examine him. She came back several minutes later with a concerned look, ¨he needs to have this operated on, before it´s too late¨. Tuwanda explained that she attempted to push the hernia back in and it wouldn´t budge. Strangulation, a life threatening complication of inguinal hernia´s was her fear for this man.

Moises was convinced that this couldn´t wait much longer and was willing to travel. BUT... he needs someone to travel with him to translate and prepare his meals while he is in the hospital (did I mention in earlier blogs, patients have to bring their own food and prepare it?). The school teacher was the only Chimani-Spanish speaking community member. Traveling for him was out of the question as he had classes to teach. We were told a campesino was coming in later that day. He spoke Chimani and Spanish and would likely be able to accompany Moises.

I am hoping Moises was able to receive medical attention. I will definitely know in two months when we return to the community, but I am hoping we can connect with someone (somehow) before then.

We Went from 2 to 8 overnight

2007-09-13T04:36:00.000-07:00

Good Morning,
Dora gave birth to 6 beautiful kittens sometime between Tuesday night and Wednesday morning. Mother is doing well and taking good care of her little ones. Tiger is a bit disoriented and not quiete sure what to do with this.

Incasuyo

2007-09-11T17:18:00.000-07:00

Inguinal Hernia

Pato, Pato, Ganzo

Dust, Dust, DUST!!!

2007-09-10T18:48:00.000-07:00

it´s official...there are NO can openers in all of Rurre. I went to at least 14 stores on Commercial Blvd and scanned the market on Sunday. Not one can opener existed. Every store owner pointed me to the next store. It is an abrelata that I´m looking for, right? I asked one store owner how the locals open a can. He showed me how they use a knife and hammer into the can. Ok, it works, whatever. Dad, please add a can opener to the care package... thanks!

Baby Richar is back in his community. I díd not see him again before he left, but the med students from Denmark said he had made some improvements.

There was a school fair yesterday to raise money to have a patio poured for the quad. I think Dr. Frida said it would cost $500 US dollars. BINGO was the hit game, tug o war, sack races and hoola hooping were all part of the festivities.

Cases of the day... the adults always complain of ¨kidney pain¨. After a full assessment we assure them that their kidneys are fine and the pain they are experiencing is lower back pain. A lot of time is spent educating them on proper lifting techniques as well as stretches they can do. They are given a script for ibuprophen and instructed on how to do thermal therapy(warm packs to the affected area).

4 year old with Hepatitis A.

45 year old male with ciatica

2 year old with chicken pox

76 year old female with a fractured and dislocated radius. She fell two weeks ago and was referred to a specialist. Because she couldn´t pay, nothing was done. Her arm was severely disfigured. She has a son in La Paz, and she will talk to him and see if he can help her out financially. If so, the project will pay her transportation to La Paz so she can have surgery.

Serafim did come back for a dressing change. He was an hour late, but he showed up!!! The ulcer is almost healed!!!

We head out to the communities tomorrow.

Love and hugs to all!

Baby Richar

2007-09-08T07:59:00.000-07:00

I have been visiting the hospital daily to check on baby Richar and his mom. Richar is still very weak, but is making some progress. He has been receiving IV ABX, and some IV hydration, but mostly taking the Prosoy mix the clinic purchased for him. I will go visit this afternoon to see how he is doing.

Friday Evening

2007-09-07T16:23:00.001-07:00

Above, are two butterflies I have seen an abundance of.

It´s 7:30pm, Friday evening and the week is over!!! Don´t get me wrong, it was a good week and all, but I am glad the weekend is here and I can put my feet up.

Yesterday was my first river trip. We travelled two hours up river on the boat many of you saw in the video. I finally figured out what Tom was telling me about having to push!! About an hour into the trip, the boat came to a screetching stop and as I looked down into the water, I could see we were hitting bottom. The river was less than knee deep on me. I saw Lola and Modesto getting out of the boat. They both grabbed onto the sides and started pushing the boat up stream, against the current. Ok, I can do this no problem. I get myself psyched up(because you all know what a whimp I am when I can´t see my feet in water). I had my Teva´s on, so my feet were somewhat protected. Ok, the water is warm. I can actually see the rocks that my feet are stepping on. Änotonio¨, I yelled... äre there alligators and snakes in this water¨? ¨Si¨ (yes) he replied. Great! I began to push with the other team members. The water started getting deeper and we jumped back in the boat. From this point on, we were in and out of the boat at least 10 more times pushing upstream.

We saw about 20 pts in the community we visited. This particular community had 6-8 families. For the most part, they just live off the land. There was a community center near the school, that had a TV. Where do they get electricity from?

Many of the patients seen had skin infestations. One boy had a huge abscess on his head. A buro had been nesting there for some time. The mother was explaining to me that it was about an inch long when she pulled it out. So this poor kid has been walking around with a bald spot on his head and a major infection. Dr. Frida was able to expel some of the pus, and then spoke with the health care promoter in the area on further treatment. The healthcare promoter agreed to treat the boy daily.

First Road Trip

2007-09-04T16:22:00.001-07:00

Dust, rocks, cows crossing...(they have the right of way here in Bolivia), windows up when big trucks passing to avoid a mouthful of dirt, bumps. It is 8am and we just began our two and a half journey south of Rurre. Being the youngest, I decided to take the jumpseat in the back of the Nissan 4x4. The first 30 minutes, I was fine. Oh, this is better than I thought. I have plenty of leg room, there is some air flow, no problem. Then, we hit rougher terrain. My stomache was not as strong as I thought. No, I am going to be strong. I can´t let the team down on my first trip, I thought. I could feel my stomache churning with each bump. I put my head down, I look straight ahead, thinking this will help. I can´t talk. I can´t follow the conversation taking place in the back seat with the team members. The only thing I can think of is ¨Heather, don´t yack¨! About an hour and a half into the trip, I give in. Äntonio¨, I yelled. ¨Por favor, para el coche ahorita¨ (please stop the car NOW). I stumble out of the back of the 4x4. Dry heaves only. The team was supportive and agreed that the trip is a difficult one. We re arranged the seating. Tom got in back(he could have sat in the middle, but wanted to go in the back, REALLY!!!).

We start up again and stop about 10 minutes down the road. ¨Wow, that wasn´t as long as I thought¨. WRONG!!! Dr. Frida gets out of the car and calls me to come with her. I learn that we are visiting a health care promoter who has been sick with an ulcer. She`s been taking metoclopramide and has been experiencing all the adverse effects of the medication. Dr. Frida advises her to stop the med and just continue with omeprazole. The health care promoter agrees to come to the clinic on Friday for a follow up.

More bumps, dust and cows crossing. All of a sudden, Antonio, our fearless driver and pharmacist, takes a right, what looks to me like we are heading into the woods. Oh, we are heading into the woods. There was a narrow dirt path and some tracks, most likely from the teams previous trips. As Antonio is driving deeper into the woods, I am thinking to myself ¨how can there really be a community this far removed from civilization? We had to cross three wooden bridges, and I thought for sure each time I would be taking my last breath. See the video attached and come to your own conclusions. We finally arrive at the community, 2 1/2 hours south of Rurre. (name withheld for confidentiality)

We saw a total of 13 patients in this community. Lots of lice, colds and parasites. Richar, is the youngest of four children. His mom is 27 years old and she found out today during the clinic that she is 3 months pregnant. Her son Richar, has not eaten any solid food in almost a month. He weighs 6.6Kg (14.52 punds). Richar is 2 1/2 years old. He laid lifeless in the sheet that was wrapped around him, being held in his mothers arms. We unbuttoned his sleeper. His skeloton frame was frightening to look at. His little ribs were sticking out of his chest. Temperature 35.6 (96). Heart rate faint, lungs, congested. Every few minutes, Richar would attempt to cough. His eyes rolled from side to side and then closed. His neck lacked any muscle tone. Dr. Frida and I looked at each other. ¨He has to get back to Rurre¨. The father came and we had to convince him that if his wife and son didn´t get to the hospital, his son would die. His affect to me, seemed almost indifferent. What was he thinking? Maybe he was thinking about the children and child care while he had to go to work, or maybe he didn´t want his wife to go because no one would be home to cook/clean and care for the children. How would he survive?!? It is a sad reality, but people are more accepting of death here than in the states. Richar also has epilepy and hydrocephalus. Maybe he is too much for the family to care for. I don´t think they are wanting this boy to die, but maybe they see their limitations with family resources and limited health care. Richar´s body was covered with black. At first look, I thought it was from malnutrition and decomposition, but then Dr. Frida told me many of the families in the campos use home remedies to ward off evil spirits. The black on this baby was ashes. The couple used the ashes to reduce the pain and fever. Apparently, the health care promoter in the community tried to start the baby on antibiotics to treat his pneumonia, but the couple declined treatment. Now, it was a matter of life or death.

The entire ride back to Rurre, I couldn´t take my eyes off this child. His mom sat in the back seat with me and Lola. At times, the baby would drift off to sleep and I couldn´t help but wonder if he had taken his last breaths. ¨God, please don´t let this child die¨, I prayed. I placed my hand on the mothers right shoulder. I asked her how she was doing. Her body was rigid and she looked down at her son and then straight ahead. I rubbed her shoulder a little and then removed my hand. We both looked at the baby. I offered her some water and then peeled an orange for her. ¨God¨, I thought to myself, ¨what am I suppose to do¨? I can´t even imagine the pain and suffering this lady is going thru. I can´t identify with this. I don´t have kids of my own yet. I don´t want to know what this feels like, but I want to be able to help. ¨God, please watch over this little one¨. He never cried, only let out a weak cough every now and again.

We arrived at the hospital around 430pm. Thank God Dr. Frida knows the staff and MD´s at the hospital. She went directly to one of the MD´s and within minutes, there was an available bed for the baby. We walked into the room and there were 3 other babies in the room with their mothers. One person in allowed to stay with the child. They are also responsible for feeding, bathing and caring for their children. The nurses are responsible for the meds. No smart pumps, only IV to gravity. No automatic beds to adjust the height or head of the bed. Nope, single beds with a thin black mattress. The room reaked of urine. The mother was told to sit in the wooden chair in front of the bed while she waited for the nurse to admit the patient. I realized I was alone with the child/mother. Dr. Frida had left. I was stroking Richar´s head when I heard Dr. Frida yelling my name from down the hall. I told the mom I would be back tomorrow to visit.

What will tomorrow be like?. I wonder.

Serafim

2007-09-02T08:54:00.000-07:00

Serafim is the man with the abscess. He lives in el campo (the countryside) and has been staying with a friend in San Buena Ventura. He has been coming in every morning for a dressing change and each day he is looking better. San Buena Ventura is the town across the river. It costs 2 biliviano´s round trip. Yesterday, Serafim came to the clinic and told me he wanted to return to el campo because he was very bored in San Buena Ventura. He hasn´t been working, which means he is not making any money. He then told Crister, that the boat trip each day was becomming a financial burden. I talked with Serafim and explained the importance of the dressing changes and he agreed to stay thru Monday. I also have been helping him out with transportation costs, because it is so important that he receive proper care for his abscess. Today, he let me take a picture of him. I showed him the digital picture and he said ¿y para mi? Since there is no place to print digital pictures here in Rurre, I told him I would get a copy made for him when I go to La Paz in December. He said he would be back.

I am off for a short hike and hopefully to take some good photos.
Later...

I Can´t Sleep

2007-08-30T23:18:00.000-07:00

The cat is about to go into labor, the dogs in the community are all barking their fool heads off, and this darn mosquito continues to buzz in my right ear just as I get comfortable. It is 230am. So, since I can´t sleep I thought I´d get caught up a bit on the blog.

Yesterday, we (Joselo, Christer and myself) travelled by car to check on a community that has the water filters. Water filtration is one of the projects that Concern America is working on in Rurre. The water systems are great because the majority of the communities are without clean water. Communities who have purchased the filters have had a significant decrease in the amount of antiparisitic meds being administered. Good news! It is hard to believe that cement, gravel and sand is all that is needed to produce clean water. There is minimal maintenance with the filters, but left undone, they will no longer work. You also have to have the right consistency of sand. Joselo has 3 screens that we sift the sand thru. The first sift gets us the bottom layer, small pebbles, the second sift tiny pebbles and the third sift is a fine sand. These three layers are added to the filter, then a small bucket of water. There is a thin piece of metal with tiny holes for the water to pass thru that is placed on top. Water to be filtered is added and the results are amazing. One house was putting in rust colored water and the outome was clear! This was my first trip out with the filters, but as I begin to travel to the river communities within the next couple of weeks, I would like to hear stories from the communites.

It only took me 14 matches to light the gas stove. Tom, who works with Concern America, is here thru mid October and he showed me how to adjust the gas tanks.

Went shopping at the market today. 1Boliviana for a Kg of carrots. That is about 12.5 cents. A head of lettuce, 1 B, broccoli 2B´s, spinach 5B´s for 1/2 Kg. You get the idea. So, it cost a less than 1.50 for a salad!

This is my second night in the house. The bed is more comfortable than at the clinic, but I think I´ll take piece and quiet over comfort at this point. As I write this, it sounds as if the dog choir gave up for now. I think I will try to get some sleep.

Thanks all for your wonderful emails. I really look forward to reading them, so keep them coming.

Clinic starts at 8am, so I better get some shut eye. It´s going to be a busy day.

Monday Clinic

2007-08-28T05:22:00.000-07:00

Yesterday, I worked with Dr. Frida all day. During some of the conultas, Dr. Frida told me to do the assessment and then we discussed the treatment together. At the end of the day, a mother brought her 2.5 year old daughter in. The little girl has Down Syndrome and over the last four days had high fevers a cough and shallow breathing. Upon assessment, we observed the classic signs of respiratory distress in children. Nasal flaring, increased respirations, rales and wheezing on auscultation of the lungs and a temporal temperature of 102.3. This was a sick baby. She was very flacid and didn´t even flinch when we were examining her. Dr. Frida attempted to give her ibuprophen susp. via a syringe, and that is when the little girl fought back. So, Dr. Frida sent the mother and child to the Hospital in Rurre. Hopefully they will start an IV on the baby and begin repletions as well as some ABX therapy.

Another pt we saw was a 9 year old boy with anomolies and epilepsy. He and his family are from San Jose, the furthest community that the clinic travels to. By boat, it is an 8 to 10 hour ride up the Beni River and then up the Tuichi River. A little about the boy´s history is he is the last of 6 children and his mother had him when she was 43 years old. At nine months of age, the family brought the boy to La Paz because he was having seizures and they noticed the shape of his head was deformed. After a work up in La Paz, the medicos told the family to bring him back in 6 months for a follow up. So, as you can imagine, the 30 or so hour drive was not possible for the family. Additionally, the mother thought the boy was going to die, so they that was another reason they did not follow up. The mother brought him to the clinic because in the past week he had 3 attacks. When I greeted him, he gave me this great big smile and his eyes were dancing back and forth. His mouth was full of decay. He reminded me of the children I visit at the pediatric nursing home in Plymouth, MA. This was his first time being seen by Dr. Frida. She started him on an anti seizure medication and he will come in for a follow up in 10 days. The mother was instructed on how to administer the medication as well as tracking the number of seizures, duration and activity preceding the seizure. This was an upsetting case because the mother had a small stick and was using it on the child everytime he would do something the mother didn´t like. Dr. Frida at one point stopped the consultation and addressed this behavior with the mother. The mother downplayed the whole thing. I was thinking of my friend Rosie back in the states who just finished school to be a special education teacher. Maybe she could come and give some Charlas(mini education talks) to the health care promoters and the parents of special needs. Here in Bolivia, if there is a child with special needs, they are seen as an outcast. This little boy has never been to school, doesn´t talk well and is socially isolated from other children his age. I wanted to cry when he left. I was remined how fortunate we are in the states.

Thursday August 23rd

2007-08-24T18:05:00.000-07:00

This posting is a day late, since I just really figured out how this blogging works...

Today, the clinic was closed because Katherine and Brett are leaving on Monday, so the team had a farewell party for them. We went to a lake about an hours drive on this rocky, dusty road. However, it was well worth the drive, because the lake was beautiful. There were 17 of us total. 11 adults, 7 children and one vehicle. Half the group rented a mobilidad, basically it is a taxi service. Getting there wasnt a problem, but on the return trip, none of the mobilidad drivers wanted to take us because they would have had todrive back in the dark. Ok, now what do we do? Thankfully, Brett and a Bolivian team member were finally able to flag down a driver. Lunch is the big meal of the day and since we were at the lake today, Joselo cooked steak and chicken. Oh, but wait... the chicken arrived whole... head, liver, heart and all. The next thing I saw was the chicken head laying on the plate. Dont worry, I have a few pictures to prove it!!!

Didnt swim. Oh, i didnt eat the chicken either, but the steak was fabulous! You have to come get some!

Dr. Brett saw a pt before we left today. She actually came in yesterday with high fevers, chills, malaise...He sent pt for blood work and told her to come back in the am. She was complaining of some RUQ pain, so Dr. Brett was about to send her for an echo of her liver. Sometimes, amaebos can form these cysts on the liver and it can be very painful. Anyway the pt told Dr. Brett, oh, the Dr. in another town sent me for one and it was normal. Apparently, this happens a lot. The pts will omit very pertinent information.

Lots of hugs. love you all lots!

2007-08-24T17:41:00.001-07:00

Saw this guy today who had a tree fall on him and crush both of his legs. His left leg is in a plaster cast and his right leg is severely bruised from thigh to ankle. He has about 24 stitches on his calf from where a branch hit him. I did CSM checks on him and then washed his calf, put some cream on and wrapped it with Kerlex. I also gave him supplies to do his own dressing changes at home. He promised me he would buy a liter of water to clean out the wound. Antonio, our pharmacy tech put together a wheelchair that was donated from an NGO. It was made of one of those white plastic seats we use in the states to put around our pools and then what looked like mountain bike wheels. When Antonio finished putting it together it looked really sturdy. The pt tried it and I think he will do well with it until he is able to transition to crutches.

Dr. Brett called me in to see a pt who had a bee in his ear. He went to a local hospital and they ruptured his typmanic membrane and the bee still remained in there. Dr. Brett attempted several methods to expel the bee, but was unable to. He prescribed Cipro drops and the pt will come back on Monday.

Sterile procedure?!?!

Tomorrow we will spend the morning taking inventory of the pharmacy before Katherine and Brett leave. A full inventory has to be done every 3 months. We even write scripts for Tyelonol here in Bolivia.

I Made It!!!

2007-08-23T16:50:00.000-07:00

This is Alfredo. He was the first person I met in Bolivia. He made sure I made my connection from La Paz to Rurre!

I arrived safely in Rurrenabaque Bolivia at 11am on Tuesday morning. My first stop was La Paz where the altitude was 11,000 ft. UGh, I felt like I was going to die with each step I took. The puddle jumper from La Paz to Rurre was a bit shakey getting off the ground, but provided a great view of the Andes.

Today I am in clinic all day. We have lunch and siesta from 12-2pm so I have to get back soon. This morning I worked with Dr. Freda. She is really neat, fun and vivacious. I think we will get along just fine. Praise God, I am understanding the Bolivians very well.

Well, I have to get back to work. I love and miss you all already. I will keep you posted on my travels.

5 Days Til Departure

2007-08-15T14:33:00.000-07:00

Hello everyone,
Five days til departure. I sent you all an email of my contact information. Please let me know if you did not receive it.