Heartbreaking goodbye, check.

So its finally here, my last day in La Paz, and true to form I have slept through most of it. Last nights celebrations were a little exhuberant and I was very grateful to have cancelled my last morning spanish class. This last month has gone by way to fast and I when I was wondering how I wanted to spend my last days, the first thing I considered was making a list of all the things I wanted to do and making sure they got done. But then I realized my experience here hasn´t really been the kind that you can check off as you go. Saw Monkeys, Check. Froze in Uyuni, Check. Played alot of peekaboo, check. Ate Salchipapas, Check. just doesn´t really cover it.

So I said screw the list and decided to bask in living in La Paz  just as I have, for all its bizarre transportation rules, affection for organs as food, sliced hotdogs on fries, and breathtaking altitude. The last two weeks I have been on rotation at an orphanage outside the city and have been having so much fun. Gone is the pretense of work as a serious medical student, now I can just play like I have been wanting to for six weeks in the hospital. I am actually headed back there now, to get in a few short hours of fun before I jet off at 3:45 am tomorrow morning.

I didn´t expect the lessons that Bolivia has taught me, and while its hard to say how this will affect my decision to go into medicine, my time here has definitely been some of the most challenging, exciting and entertaining of my life. Thanks for listening and I hope I get to hear about some of your adventures to new worlds like Bolivia.  Beso y buen suerte.

THE FINAL COUTNDOWN

With only ten days left in beautiful Bolivia, its time to make a TOP Ten list, of ´

the very best reasons why everyone needs to come visit this incredible country:

10. 1:7. 1 USD: 7 Bolivianos. Street food: 1$; 1L Beer: 3.50$; Fancy dinner; 20$. Potentially saving money when traveling, priceless. Then deciding to spend more because everything is so cheap, typical.


9. Tuffis and minibuses. A way more fun, cheap and incredibly inefficent form of public transportation


8. Un beso por la doctora, cutest tradition ever. Hospital des Niños is such a great place to work.


7. This country has so many different climates, terrains and incredible sites. Salar de Uyuni is pretty incredible in an arid wasteland sort of way, like Mars I imagine. Ilsa del Sol is definitely beautiful enough to have been the birthplace of a few dieties. And the amazon has its own sort of magic thats pretty indescribable.


6. Small children speaking a foriegn language is the cutest thing I have ever seen. And it also makes me feel a little stupid because a two year old can speak better spanish than I can.


5. Latin Music is just more fun to dance to. Sorry, pop and hiphop, its not you, its me.


4. La Paz. Sitting in a valley surrounded by mountains and city lights, while the altitude has you breathing hard, the city takes your breath away.


3. Street food. Salteñas, Empanadas, fritas, salchipapas, Lomito, kebabs, pizza cones, api and these weird funnel cakes. All delicious, all for less than bus fair in Calgary. 


2. Getting to experience both the tourist circut and local life of La Paz with my fellow do-gooders has allowed me to meet some incredibly unique and interesting folks. Thanks for all the foody nights, salsa nights, starry nights, movie nights, bike rides, boat rides, bus rides, car rides, and plane rides that brought us here.


1. Everything sounds sexier in spanish. especially diseases.

Perspectives on Piraña fishing

Most of Bolivia´s terrain that I saw before this weekend had the same kind of beauty Alberta has. It is  dominated by wide dramatic landscapes where you can see for miles, with steep snowcapped mountains in the backdrop and the high arid climate keeps the sky blue and clear almost all of the time. But Bolivia, like a true beauty, has many faces, and this weekend we saw her mysterious side. By air, by car and by boat we journeyed deep into the wetlands of the Pampas, part of Bolivia's portion of the amazon rainforest.

As the small plane left La Paz and skirted over the moutains, only one song came to mind. The Adventure had officially begun.

   We decended from the clouds into a different world. A humid, cloudy, very green world. After fishtailing the landing, we disembarked onto the lawn adjacent to a farm that served as the terminal and a school bus that served as our shuttle into town. The 'NO ATM' disclaimer from our tour group was starting to sound symbolic.

With only a few minor delays we were soon headed out in our 4x4 to the Pampas. A long, muddy and bumpy car ride followed by a wet boat ride later, we reached our campsite on the Rio late on Sunday night. While the accomodations were spartan, the food would prove to be some of the best we've had in Bolivia, due to the unusually high proportion of vegetables and salads, which are pretty hard to find in La Paz.

But what seemed so different about this trip was setting of the jungle. With its lush greenery that extends into high canopy, it is hard to see much past a few boat lengths up the river, or past the nearest trees and reeds on our mud walk. While the wetlands are much more open than the Amazon itself (and this allows for some great animal sightings) the difference in terrain from the wide open desert of Uyuni last weekend could not have been more marked.

We saw an exciting laundry list of exotic animals and birds, such as a tarantula, an anaconda, capabera, many many turtles, pink dolphins, some south american eagles and many types of herins and pelicans (i think). We went swimming only a short ways from where we fished for piraña the night befor (delicious by the way). We had a aligator hanging out just outside our room for the day, whose cool stillness was rather unnerving. But my favorite by far were the monkeys! We saw three different kinds over our weekend, Capuchins, howlers and Amarillo (Chinchilla in the local spanish) and they were all adorable.

After a few weeks of being able to see everything on the horizon, it was remarkably refreshing to get a change of perspective for a few days. Sometimes a wide view can help you see the furthest into your future but you can also be crippled by the need to know exactly where you're headed. But the closed silence of the jungle helped remind me that it can be just as important to take steps forward, keep moving and experience whats around you, and let the big picture take shape with motion. Cliche as it is, it can be easy to forget. Maybe, Hamlet just needed to spend a little less time in flat barren Denmark and a little more time hunting crocs or fishing for piranhas in the Pampas.

A different kind of crazy

(NEW SECTION! ->) Word to the wise: When setting out on new adventures, imagine the worst possible series of events that do not include member death and then imagine yourself enjoying it. Maybe these terrible events will transpire, maybe every thing will go according to plan (god forbid, knock on wood) but either way you´re guarenteed a pretty good time.

The bus to the small frigid town of Uyuni took 11 hours and left at 7pm. Sleep was elusive. Enough said. 

Ann Marie (think cute, terrified, fiesty rabbit) and I (think sleep deprived doberman) hung out* for a while while waiting for further instructions after we arrived at 6am. The rest of our team of weekend expeditioners had been early birds in getting their tickets and were taking the 'nice' bus that had the luxurious amentites of central heating, bathrooms and a decided absence of adorable wailing children.
*in this instance should be interpreted as made up a game involving a dictionary and froze in direct sunlight.

After reuniting and breaking our fasts, we hightailed it out of town in a 'fancy' jeep that had the incredible attribute of playing music from iPods. FIRST TURNING POINT. While jamming to some very deep and spiritual music by Travie McCoy and Bruno Mars, we began to feel that our much anticipated adventure into the desert wilds of the south had finally begun, when we stopped not five minutes out of town at the Train Cemetary to pay our respects to these icons of industrialization. FIRST TURNING POINT ABBREVIATED.

 

 

Several hours later, we slathered on our sunscreen to hit the Salar de Uyuni, the famous Salt Flats. The only formation of its kind in the world (Our Guide, 2011) the Salt Flats are a remainent of an ancient lake that has since vanished but left hundreds of thousands of tons of Salt behind. It looks exactly like snow, and like good scientists, hypothesis testing is the rule we live by.

The salt of this region is shipped around the continent and is used in industrial, culinary, construction and decorative uses but they leave some here for the tourists.

 

That evening we stayed in a hostel with four walls and a floor (as expected) and beds! with blankets! pillows! and hots showers! SECOND TURNING POINT. After a delicious meal we were all so exhausted we fell asleep immediatly.

The next day we increased our altitude (think SOB, everyone feels a little sick, need less wine for a good time) and past through the valley of the rocks to reach the Laguna Colorado, a lake red from its algae with a community of flamigoes in residence. I cannot describe this day in much detail because after taking a NONDROWSY dramamine for nausea, I could not be roused from sleep. Unfortunatly, I didn't perk up until a fellow adventurer mentioned charades later that night, and as I'm sure many of you know, laughter is simply a wonder cure. I will bring my field tested methods back to the hospital with me.

Following a night of  hanging out*, we were greeted at 430 am by pancakes from our cheerful guide Edwin. As often happend on trips into the wild, my distaste for pancakes disappeared and they seemed the most delicious thing I ever ate. (I have since tested this new found 'like' of pancakes and can only attribute it to adventure induced temporary insanity) 
*should be interpreted here as many rounds of charades dominated by yours truly, some perfect stargazing at a foriegn sky accompanied by disney acapella, and huddling together in sleeping bags for warm but forgeting we each needed more oxygen at this altitude and readjusting to our own beds in the middle of the night to prevent suffocation.

Climbing even further the next day, we reached the hot springs and the Green Lake, before turning back all the way to Uyuni and boarding the last leg of our four day journey. Although this bus was cold, the toliet door refused to open, and Lydia snored, I couldn't help smiling as I drifted to sleep. An adventure shouldn't be defined by how many new and unique things you see. Or by how much longer or harder this trek or car ride or bike trip is from the last one you took. Its a strange collection of moments that you thought would be awful, that you knew would be hard, but some how that you knew would be worth it anyway and in fact turn out to be the ones you want to remember for the rest of your life.

Surgery, A Team Sport.

On Monday I walked into the hospital incredibly excited. It was to be my first day in Surgery, arguably the most competitive, driven and intense field in medicine. Anthropology has given me many things to question about surgery and its aggressive approach to healing but I couldn't help the anticipation building to witness my first surgery in person. It was to be only a simple umbilical hernia but as they say, those begging at the bottom of the surgery observation totem pole cannot be choosers.

It turned out to be nothing like I expected, including the patient. A baby girl a little over a year old had a benign tumor on her neck, that was nearly larger in size than her own head. I had seen this patient last week, in the neonatal unit when my oncology doctor was consulting on her case. It struck me then how much I wanted to help this tiny tiny person who squirmed, cried, and swatted at this enormous literal weight on her sholder. Its difficult even for me to understand my comparatively strong emotional reaction to this particular patient because I knew that once this tumor was removed, in all probablilty this child would live a long healthy life, that complications would be unlikely and that is not a statement that can be made for many patients in this ward of the hospital. But it was her who had me blinking furiously while pretending to read growth charts in a foriegn language and failing.

So when I walked into the OR and saw her lying on the table I was overjoyed. Here we would help her, these talented folks would take away the bad things and leave her healthy and whole. And they did. But Surgery, among other things, is a messy business. It requires emotional disassociation, for a short time to look only at the task and hand and forget that every cut is into skin, every tear into flesh,  every stitch into a tiny helpless infant, and precision was a pipe dream. And with this little girl that was a momentous task for me.

I have observed six different operations, simple and complex, interesting and heartwrenching, since this patient. And I can say it is getting easier to look at the task at hand, and I am beginning to become at least sensitized to the violence that is surgery in chaos. It is necessary, it is well intentioned and these surgeons are talented. And for the remaining day I have decided to take comfort in the buddist proverb, 'There are only two mistakes one can make along the road to truth; not going all the way, and not starting.' I have started in my journey to find something like a true calling, so I guess there is no turning back. But if I meet the buddha on the road, I may have to kill him.

Burgers, Blockades and some good, old, south american Fútbol rivalry

Fact of the day (at this rate more like week): Near the shores of the mesmerizing Lake Titicaca sits the ruins of one of the most significant civilizations in south american history. While the structures of Tiahuanacu (also known by the spanglised Tiwanaku) may seem dimitutive today, they mark the center of a major state power that is believed to have begun more than a thousand years ago. When asked where the stones that made of the walls of these once great structures have gone, our guide pointed in the distance to a rust red catholic basilica. Hey Colonialism, you ruined everything, but thanks for hamburgers and the postal service.  

Just returned from a great day trip to the ruins of Tiahuanacu that lie just an hour outside the city limits of El Alto, and we got off early enough to avoid the demonstration blockades. Oh yeah I forgot to mention, once every six seconds some one in Bolivia arranges a protest. All jokes aside, you have to admire this nation's respect for civil and political rights. Interestingly enough the only things these city wide protests seem to effect is the public transport known as minibuses, and provide plenty of footage for the local news to set to melodramatic music. Apart from the occasion firecracker for theatrical effect, many people who work in professions outside the unions simply go on about their day but might walk farther than usual, as the blockades are set up around the plazas that connect the main arteries of city traffic, making it difficult to get anywhere central. Note to parents, all is well these protests are very peaceful whatever shows up on the news!

Another great note from this week at the Hospital, Children's Day! After my emotional day in Oncology I was in my scheduled pulmonology and arrived just in time to celebrate sortof a birthday, but for everyone. With clowns, cake and plenty of toys to give away, the entire atmosphere of the hospital was transformed. The worry and stress was still there, but overlaid with such joy and real hope it is hard to describe. It didn´t hurt that many of the children in my ward were on the very tail end of their recovery from severe pnemonias, so after more than 3 weeks in bed they were ready to get up and play. In other parts of the hospital, we even got some surprise visits from the local futbol team, which I am told caused quite a rucus among children old enough to recognize them. And so the rollercoaster continues.

While many of the crew are away in Copacabana, a fellow student and I will be at 'El Classico' the highly anticipated matchup (if two people count as a representative sample) of La Paz's two futbol teams, Bolivar and The Strongest (that is really its name, you should hear with a bolivian accent). As they made the children of my hospital very happy I feel inclined to root for the underdog, the Strongest. Sneak peek: Our treacherous bike ride to Corico will take place next weekend and I can't wait!

Weekend Update on rollercoasters

Fact of the day: From La Paz to Corico is a trail known as the North Yugas, or as it is labled by the Inter-American Development index, the worlds most dangerous road. Although 69km in length most of the road is no wider than 3.5 meters, has dropoffs of 600m and since 1980 more than 120 people have died navigating the road on bike, car and bus. At long last in 2006 they finished a new road for commercial traffic and now the road is mostly used by mountain biking enthusiasts and deathwish burdened thrillseekers. Three guesses what my plans are for next weekend.....

This weekend consisted of some ups and downs, great highs big big lows and my first day in oncology has suggested that this may be a ongoing thing.

On thursday, we hit the peña known as Marka Tambo, a traditional dance and music venue, that while the performances were incredible and the restaurant was classy, there were not many people there leaving the ambiance a little to be desired. This was also one of our last nights with Lisita Bonita, who would head back on Saturday morning.

I havent spoken much about the hospital yet, mostly because it is difficult to find humor in the respiratory distress in infants, a five year old with heart failure, or tuberculosis meningitis. But my last day in Infectious Disease was a fun one with the other medical students from Bolivia. But late in the afternoon, after many cute kids who never hesistated to give 'un beso por el doctor' to every white coat in the room, a women in a government vest walked in with a beautiful baby girl. The other students gave me the lowdown, and brace yourself for a tearjerker. Luisa was four days old, and had been abandoned by her mother in the hospital the day after she was born. While they suspected schizophrenia in addition to other mental illness, they did know that her mother was HIV positive and as no measures had been taken, Luisa now has a one in four chance of being HIV positive aswell. It was hard to believe as she looked like an incredibly healthy baby girl, she had gained weight after birth and her skin was flushed. I hope I can tell you the rest of the story as I learn how Luisa fares in the social system here in La Paz. But as sometimes happens when faced with humbling story like this, I felt the need to head out an sieze life in La Paz like never before.

One of the ways that this weekend fluctuated, was in the size our little crew of LaPazian expats  We were connected with some other do-gooders, public health students from california affectionately named the beach boys, who would also be in La Paz for the next few weeks on a training rotation. After grabbing dinner and some drinks, most were ready to head home to get ready for our trip to visit the Tiwanaku ruins the next day, but myself and a few other decided to see how the other half, where bolivians of La Paz celebrated life and drank their sorrows, as your week may have gone.

Cada d'agua was the type of place I had expected of a peña, a packed crowd in an old basement, where you ordered your beer for the table and they gave you a bowl of coca leaves to chew to keep you awake for hours of music. Although the dancing to philosophical discussion ratio was alarming, we had an incredible time and I can't thank our 'local' Yeri for suggesting it.

Unfortuntly the coca could not keep me awake long enough and I missed the bus to Tiwanaku, and I blame my inner archeologist for the severity of the hangover that followed that day, as I expect it was some form of punishment for missing one of the pre-emminent historical sites of an early civilization. I shall remember his wrath the next time I choose between a visit to the past and another Paceña (local brew). Spending the next day or so in recovery, I also mourned the loss of my guide, roommate and friend by watching every romantic comedy in Mercedes collection, including the spanish ones.

Apparently that was not enough language practice for the weekend as I spent today straining my ears and had to remind myself not to tune out the foriegn language. I was rotated to oncology as my scheduled doctor was out of town and it took me by surprise how different it made me feel from Infectious disease. Infections can be just as fatal as any cancer, but our treatments for cancers can be as hard on the body as the disease. I also saw more infants and when they have tumors bigger than their own heads, it becomes pretty hard to maintain a mask of professionism, and the prognosis is pretty grim.

Tomorrow, I head back to by scheduled pulmonology and shall see whether the week takes an upswing or a down. I guess thats the thing about rollercoasters, the uphill has all the anticipation, but the easy part wasn't why you got on the ride in the first place.