Last week in Bolivia: Maldita Neumonia and Afterlife

Yesterday started my last week in La Paz. By this time next week I should be in Miami getting my connecting flight to SF. My trip has been good. Bolivia and I developed a love-hate relationship. It decided to give me Pneumonia my last couple weeks here. I was kind of partying too hard. However, I do not think that is a legitimate cause of my illness. I am sure it compromised my immune system while I was inebriated (many times), and could not gauge the coldness of the country. I seriously thought I was never cold and now, everyone who always suggested I put on my jacket when it felt cold to them, makes sense. I have been sick a total of 4 times here over the last 2.5 months. I have had stomach problems, requiring antibiotics. I have been very nauseated, requiring altitude medication and coca leaves (definitely enjoyed the latter). {Side note: I enjoyed the coca leaves so much that I increased my tolerance for other things; not only for alcohol but also codeine. I took a double dose of this cough syrup to suppress my cough and it should have knocked me out, but I definitely did not fall asleep. It suppressed my cough, but no change to the sleep pattern-effects of chewing coca} Then I had another bout of stomach problems and now this. The cough that comes along with this disease is like none other. It is nagging. Does not let you sleep at night. Makes you want to vomit. Gives you nausea when you aren’t coughing. Makes you realize how much your muscles are connected to your whole upper body because they tighten up when you cough so hard. You seriously feel like you have not breathed while you are coughing. I had not slept for the last 7 days. Here and there, on average daily, I probably got 2 hours of sleep, in small episodes throughout the days and nights. Nothing continuously. At least until yesterday. I started Levofloxacin last night. 2 doses every 12 hours of 500mg each. One dose last night got rid of my continuous coughing. Now I only have coughing here and there. It is kind of weird because it is awkwardly silent now around me. I got accustomed to my noisy cough. So since I have so much time now on my hands, I have been thinking a lot about my career and other things.

Last Saturday, my uncle in India passed away. He was a good man. Very loving. Honestly, the pillar of our family. Without him, the rest of the family does not seem to exist, caringly enough. He was 61; young undoubtedly. It has made me reflect on my life. My cousins, the children of my uncle, are all scattered throughout the world. He was with his wife during his last moments, but not with his children or grandchildren. Sadly, my cousin (his daughter) was in labor the morning he passed away. She did not know about his passing, until today. We all agree he is in a better place, no suffering now. But, when one leaves, you try to give yourself some hope insofar as you can cope with their departure and believe in a better afterlife. Afterlife- I think when one goes, it’s a sleep into eternity. Then your soul leaves your body and disperses into pieces into those who really cared and loved for you. Those pieces remind your loved ones of your goodness and all that you did for them in their life. The more you affected, the more pieces will be distributed. And this is how you are remembered. My papa (uncle) definitely spread his love. I am certain many have a piece of him with them today.

Some music pieces

Atajo- Bolivian Musicians; really good!

Some romantic music- Mexican trio

Photos of Copacabana and Lake Titicaca, Bolivia

 A view of Lake Titicaca and the shore in Copacabana

 The center of Copacabana with the famous church in the middle

 One of the 12 stations of the cross, hiking up the stations was literally breathtaking but the views were also so it made up for it

Another view of town with the lake.

Difficulties

The reason this post is entitled "Difficulties" is because I have been facing some recently. First, I have been told that Cambodia will not be happening and for those of you who knew why this was going to happen, understand how sad and upset I am with this. Apparently, the NGO will not fund for a research assistant, only a translator, of course. I even thought about taking up Khmer. Okay, maybe not. Second, the study I have been doing here for my field study, of course, does not get sanctioned by our lovely IRB committee at Touro. Definitely pissed. I have already been interviewing and all, so everything came to a hault and all I have been doing is partying. I have met some interesting people and one of the Cuban doctors I work with just got married yesterday. Beautiful, simple ceremony!

I will try to post some pictures of my travels here. Apparently there is an option I was unaware of.  So how have I been dealing with these difficulties? Well, I definitely think certain things happen for a reason. I did delay my medical school entrance for January so I could go to Cambodia, but now I think I will stay in Bolivia longer. I am planning on staying here an extra month and hopefully being able to go to Peru and possibly Argentina on my way out of South America. Life definitely has been blissful and I am glad I am able to practice my Spanish. I have been told it is getting better and I hope to continue being invested in learning this beautiful language once I return. I will definitely be returning to Latin America and possibly Bolivia. This country has so much to offer and is very loving. I hope that someday every one of you can experience Bolivia in your lifetime. I will keep you updated on my studies here. I am looking forward to getting published, so everyone's well-wishes are definitely appreciated. This photo above is the view a few blocks up from where I work: Alto Llojeta, Bolivia. Alto Llojeta is a barrio of El Alto and El Alto is the most impoverished area surrounding La Paz. It is infiltrated with violence, however during my home visits for my study, the women have been very welcoming and receptive, surprisingly.

AlcohoL always makes things better

Since my fight with E coli, I now have the sniffles and congestion. If it is not one thing, then its the other. I have been running a subjective fever. Despite these things, life is good. Why? Because alcohol always makes things better. I have been living in Bolivia as if it was Vegas. I have been drinking loads almost every night. It has been incredible. I actually got drunk last night after 28 (less than 40oz) bottles of beer among 6 people.  (The preferred drink is Bock- Bolivian Beer, see photo above) The 6 people were Cuban/Bolivian doctors. They are people who are Bolivian by descent but go to Cuba to complete medical school. Now they are in their internship year and are pretty amazing people. They run several hospitals and clinics in La Paz and I visited the Cuban hospital yesterday. All the services are free. They offer OB/GYN, surgery, internal medicine and trauma/emergency services, all for free. It is a really nice hospital with very minimal resources, but they definitely are saving lives. I have been told that in the morning, starting at 4am, you cannot walk around freely because the patient population is so large. I have been conducting interviews with several directors of NGOs also and that has been very blissful, insofar as, that I actually am starting to feel useful to society. I am able to ask intellectual questions to country directors of reproductive health services, have a conversation with them and be considered an important individual. It is very awesome that I am able to meet such influential people. After my tour at the Cuban hospital and drinking, we did a little bit of dancing and headed home.

My day today (6/2/2011)- I was really drunk at 10am today (this is incident number 2, you think I would learn from incident #1, but no).  I decided to sleep in especially since I did not have to be somewhere until 230pm. I did some chores and then headed to work, forgetting that I actually did not have dinner last night and that this might be the reason why my stomach is feeling funny at 130pm. So I bought a picante empanada-delicious!

I headed to work and after many bus rides, I realized I am at the wrong place (surprise, surprise). It was definitely a miscommunication. So I chewed some coca leaves because the new place is at a higher altitude and I wanted to prevent nausea. So, it now is approximately 4pm and I really think the whole day was a waste. But, wait. I am in Bolivia, and of course, no day goes by without feeling some sort of awe. I was told that we were going to take a few buses and head up this other clinic in Pasankeri (rural La Paz). But, of course, my preceptor decides to take me the back route via walking. I was kind of upset at first, but once we went through this hike through all these trees and dirt and mountains (the paths are very narrow), I came upon the view of the entire city- rural and urban. It felt like I was in a plane. The aerial view of the whole city is spectacular and now, all my tiredness and frustration with trying to get to this place has diminished into the thin air surrounding me. Finally, I arrive at my clinic and started to do my interviews with the women. I am conducting a study here among the women in Pasankeri and El Alto- to understand what women think and know about cervical cancer/pap smears/violence (both domestic and sexual). The women are so sweet but scared in the beginning. I am asking questions about their past sexual lives, so it is a bit difficult to become comfortable right off the bat. Nonetheless, life is action packed nowadays and my time here is definitely going to start flying now. I have made some local friends and now I need to practice my Spanish even more when tipsy; I think that is the best way when compared to in-class learning (at least for adults, do not recommend it for children, of course).

Final Diagnosis: E. Coli

So I was bedridden for about 5 days now and the verdict is E. Coli. I had blood tests and stool sample tested and the cause of my illness was E. Coli. I really do not each much salad here, of course because that is too healthy! Regardless, I got the damn bugger! I think it was the uncooked beef (mysteriously hidden in fried dough) I had here, but still that should not have given me a near-death experience...Okay, I am exaggerating..but still, I seriously felt close to death considering my symptoms of vomiting, diarrhea and lightheadness and being near febrile for many days. I visited a local gastroenterologist a few days ago and he diagnosed me with gastroenteritis (duh!) and then prescribed Cipro antibiotics for 6 days twice a day, so my friends at Touro, I ask, is that an adequate supply or is it too adequate? I ask because the NP at our school prescribed half of that amount. I just finished that much and decided to not take no more (the reason being is that I would much rather eat what I want and drink loads on the weekend :) Let me know what you guys think....So this is day 2 of finally feeling better and I am back into a balance that I have always been in. Thank God!

The Last Couple of Weeks

Sorry for the delay in posting blogs up frequently, but it is just really hard considering my health and time here in La Paz. It is getting somewhat easier to acclimatize, however there is still the food to get used to. Nonetheless, Bolivia is great and I have been doing some interesting stuff.

Let's start with the latest event since my last post: Rurrenabaque. This place is beautiful and is the gateway to the Amazonian Jungle. So, I met a few American and Canadian friends who are here through Child and Family Health International. They are primarily focusing on health care delivery here in La Paz. I decided to join them on this trip to the Jungle. I was really not prepared for what was about to come. We took a flight to Rurrenabaque; its a two people in a row kind of jet, and let's just say that my seat number on the ticket did not match the seat number I ended up sitting in and the pilot, right before we boarded, turned the wind blades outside himself. That truly was a scary flight and the mantra that was running through my head was: buses and trains are more scary here, buses and trains are more scary here.

So, after we landed in an "airport", which was in the middle of nowhere among many trees and no pathway for landing really, we boarded a bus to check-in our arrival by pencil-ling our name in their name binder along with our passport numbers. Needless to say, I do not think anyone was expecting us. After all the logistics were done, we hopped onto a 4x4 to drive about 3 hours to River Beni, which runs through the Amazons. Those 3 hours of driving were horrifying! The driver did not want to stop when a bus was coming straight towards us, he had some challenging attitude, I believe. As a result, something happened to our car's aixle and the right side of our car had to be taken apart midway. After about 1.5 hours later, we resumed our route. We reached our destination and was told to aboard a canoe with our belongings. The ride on the river was spectacular. The views of the river in between all the lush- trees, grass, and animals was really beautiful. Our tour guide was kind and stopped at many places for use to take pictures. I wish I could post them here, but I do not see an option. Check Facebook. We saw monkeys, turtles, pink dolphins (yes, PINK dolphins), crocodiles and many birds. The place is very serene. Our eco-lodge was in the middle of no where, on the river, about 3 hours from shore. Our beds had mosquito bed nets, thank God! We toured the area on boat. Went on a night tour to go hunting for crocodiles. You can see them at night because of the reflections their eyes exhibit on the river. Red eyes, right underneath some trees, in the river, while you are on a small canoe, is very thrilling and scary. I was pretty afraid that one of them was going to come and bite the canoe and consume some of us, but that did not happen, fortunately. The next day we toured the Pampas. The Pampas is a vast plain of high grass signature of the lowlands in South America. Here,  we were to hike through the Pampas almost in knee-deep (in my case thigh-deep) water. They provided rainboots which had many holes and the water was very, very dirty. Nonetheless, after a 45 minute to an hour trek through this water we reached an island where we can look around for anacondas and different types of insects. We spotted a bright yellow anaconda. It was wrapped around a branch on a really high tree and all the tour guides were super excited because not all tours get to see an anaconda. That was exciting. However, I got chewed by probably every single mosquito there was in the area. Resulting in a little more than 45 bites to my thighs, arms and of course, ass. Awesome! Furthermore, I forgot that the area may be infested with malaria and dengue, so I should have taken my malaria medication. Oops! But, I started them now, so it should be good protection anyways. I asked the Cuban doctor I have been shadowing for a while now in a nearby (1 hour commute daily) clinic and she said to take them anways.

So, about my life otherwise:

The Cubans are all about prevention and health education. Its pretty amazing to see how community medicine and public health really work together and how effective it is in low-resource settings.  As for my public health work, what I am really here for, I am working with Cuban doctors who are providing FREE services to the community in Llojeta. This community is very impoverished and still has women resorting to home births, even after gravida 3! As for the commute, its traditonal like I have mentioned before, but the work I get to observe makes it all worthwhile. I am loving the city of La Paz and its acceptance to tourists. There is all sorts of food here- German, French, Bolivian (of course), Japanese, Thai/Indian and Korean. Surprisingly, they are all good, especially the French place with its wine and the German beers!! I have made some good friends and will probably be in touch with a select few for the rest of my life. We have been taking trips together. Recently Andrea, Dawn, and I, along with some other fellas and gals, visited the town of Coroico. It is known for its dangerous roads, which many say is not so dangerous when you take a bus ride instead of biking it. Some girls decided to bike the dangerous road, while most of us chickened out and took the bus. Well, that was definitely scary and probably more than the bike ride. But, the town is beautifully set in the middle of very high mountains that have recently been snowed on and the weather there is hot! So its practically like Lake Tahoe, but better because everything here is cheap and the landscape is very easy to visualize and absorb considering the lack of development in the area. We drank a lot and I finally chose my favorite Bolivian beer- La Autentica. Now I am back in La Paz, with some stomach problems, oh natural! Life is good still and I am glad to be here.  More to come.

My "visit" to la clinica del carmen...or the lack thereof

So today Andrea and I decided to go to the Plaza del Estudiante to catch a ride (either a minibus or large bus) to go to my worksite for my field study for the first time. I was advised to take a bus to go to "Stadium Bolivar" just to find out that the bus driver takes off the sign for the place after I ride the bus for a few minutes...he apparently decided to just not go there OR just not to let anyone know he just passed by the area where you could walk to easily access that stadium. Okay...so Andrea and I re-route...definitely wished I had GPS here!!! We went down a very steep hill (of course, the one that the bus we just took drove up on), after getting to the bottom of the hill, we look for a minibus (which is equivalent to a group taxi and stops at certain areas) and this one has the sign for Stadium Bolivar, Awesome! Plus, the driver cannot take the sign off because they are sticky signs on the windshields...Whippie Right? Uhhh wrong! So the driver drives down the hill and Andrea (bless her heart) asks where we should get off, okay so we get off because apparently this is the Stadium we need to be at. After arriving at the Stadium, we need to ask to go to the Collegio Iglesia Nazareno and no one knows where that is. Fortunately, Andrea has a phone and we call the director of the clinic (who, by the way, has not been picking up the phone the past 3 days so I could not ride with her) Luckily, she picks up the phone, tells us to go to Plaza del Carmen, so we have to walk up a few more hills (the ones that the minibus driver actually just drove down with Andrea and I inside)...and its about 80 degrees Fahrenheit also. So we reach the plaza, ask around and FINALLY find the place I need to be. Our conversation with the ladies at the clinic lasts about 10 mins maximum and Andrea and I are sweating bullets, no clean water around...then we leave. This whole endeavor was solely to establish contact with the ladies and find direction. The former was completed, but the latter not so much. The ladies at the clinic advised us to take the M or 3-numbered bus, which, miraculously, drops us off in 20 minutes right in front of our house.

So you are probably wondering why I just did not take either of those buses, well, I am wondering the same thing? Also, wondering why my public health preceptor did not mention the possibility of figuring out the bus route when he contacted the director to tell her that I was arriving. I think I will never know.  

My arrival to La Paz, Bolivia

So I have finally arrived in La Paz and things are looking beautiful. The landscape is amazing but the altitude is kind of hard to get used to. I took the medication prescribed at the right time, however nausea and headaches are kind of unavoidable. In addition to that, your feet tingle when asleep and to the point where you are extremely uncomfortable but all you can do is suck it up! I absolutely love my homestay, the lady who owns the place is very warm and welcoming (also not here the majority of the time, which is awesome for what its worth). The condo is on the 13th floor and overlooks the plaza and a good portion of the entire city. There are mountains in the distance and they have snow remaining from the prior winter, so its an amazing white backdrop for photos. As for the slums, they are right behind skyscrapers of the area and at night the area just looks like a huge Christmas tree with lots of lights. Its pretty but a very sad juxtaposition. If you are in the middle of the plaza, it makes you forget that there might be poverty outside of it.

Today, since I am trying to recover from a cold (yes, still), I watched Slumdog Millionaire with the girl who takes the role of a nanny. She cooks and cleans for us, her name is Sonia. She´s a really sweet girl and I know this because she started to blush during the romantic scenes in the film, so adorable! The challenge, however, was trying to explain India in Spanish. Not only was the film in Spanish, but some of things were still in Hindi. First, I had to understand what was being said in Hindi (which I needed to refresh even though I had seen the movie) but explaining India was difficult since Bolivia is somewhat different, especially to a girl who has not stepped outside of South America and only knows her indigenious languages along with Spanish. She does not know English. It was interesting, however, how similar La Paz is to Mumbai. Sonia was pretty amazed herself by the slums and the poverty associated with it in India. Also with the corruption among the police force in both countries. I guess, developing countries are more similar than I thought.