Another week of unpredictable work in Bolivia.
Last Tuesday night I received a phone call that a seventeen year old boy from one of our communities was involved in a very serious motorcycle accident that had resulted in serious brain injury. The health leader for a village called El Torno asked me to see if I could go and speak with the family about possible organ donation. Though I would have much preferred that someone else went to the hospital, my Spanish would enable me to communicate best with the patient’s family. I asked Micaela to come along because she has years of experience in the ICU and ER. Burak Gezen, who is a resident going into palliative care, counseled me on how to have that type of conversation and reminded me that the goal of such of talk is not to “get” the organs but to gain the family’s trust and confidence so that the family can make an informed decision on what their family member would have wanted.
We arrived at Hospital San Juan de Dios at eight at night with only the name of the patient—let’s call him Julio Choque Basala. It’s dirty, poorly lit, and muggy throughout the halls of the hospital. Micaela and I bounce from one ward to the next, wandering from room to room to see if we can find the poor kid with the traumatic brain injury. At this point I realize things are getting pretty heavy and also, for some reason, I’m reminded of a Cortazar story, La Noche Boca Arriba. After having checked in the ER, the neurology ward, the pre-op, I am ready to leave and chalk this up to misinformation. After all, this is a whisper down the lane situation and I’m not even sure we are at the right hospital or have the right name. Micaela doesn’t demur, however, and we end up outside of intensive care, ringing the bell every two minutes until someone appears behind the frosted glass door. I ask if a boy is being held inside by the name of Julio Choque Basala when a woman comes up to us in tears saying that this is her son. We get half the story from her and then half from the doctor caring for Julio. The prognosis is much better considering the severity of the crash and injury, and thankfully we can avoid the organ donation conversation for the moment. Instead, Micaela and I need to give blood for the surgery to manage the hematoma that is growing and pushing the brain across the midline of the skull.
In Bolivian medicine, any operation that is scheduled that may require a blood transfusion needs to have a sort of down payment of blood made by the patient’s friends or family. This more or less works as a quid pro quo for blood—one unit in, one unit out. For instance, the fact that I am A+ and the patient’s blood type was O+ makes no difference because there is no net loss to the blood bank. The next day we line up at around seven, after which they take us in and draw samples to test for blood-born infectious disease, primary among them in Bolivia being Chagas disease.
Chagas is caused by protozoa that invade the body and over the course of years enlarge the heart pathologically, often causing it to become overgrown and loose the ability to pump blood effectively. It also irritates the esophagus, which dilates to become a cavernous, atrophied trunk, inhibiting proper swallowing and absorption. The colon undergoes the same, causing constipation, cramping, and sometimes requiring interventional surgery. It is acquired by a bite by the kissing bug, which attacks mainly the lips and eyelids of sleeping animals. Despite knowledge of the disease process and it’s impact in South America, there is no cure for Chagas. Chagas is a disease of the poor and will likely remain without a cure for some time.
Luckily, Micaela and I do not have Chagas and were able donate for Diego. I filled up my bag in just under 4 minutes, which is not my best time but not bad. Micaela did quite well considering she usually faints when giving blood. She was even in good enough shape to throw a line in one of the volunteers who was need some IV meds once we got back to the house. By the time we leave the blood bank, we are a little faded and what little conversation we do have moves along like we are both day-dreaming out loud. Micaela asks me if I'm going to be writing the foundation newsletter report, (or some similar-sounding thing, I forget what it's called), and I respond with an "oh yeah I forgot about that thing." She mentions how we should include what we just did, that a dramatic presentation, one that includes phrases like, "gave blood in order to save the patient's life", is the type of story people like to hear. She's right, but I can't bring myself to write stuff like that.
The week at the clinic was busy despite a rain day on Friday. Thursday we made it out to a government health post with some of the doctors to see patients that are perhaps too delicate to make the trip to the clinic. One patient in particular had an advanced lesion on his hand that is could be a metasisis of his melanoma from a couple years ago, which has left a 3 cm open wound right between his eyes. I am working on getting surgery for him this week.
Other news:
Sharon, a social worker who comes down now and then dug up some old intake forms she was working on to try and stratify the aid that families are able to receive for procedures.
Dr. Marianne Tschoe, Burak Gezen, Jerry Lu, Michael Chan, Andrew Read, and Rachel Macorie saw around 60 patients this week with the help of Dr. Vargas. Micaela left for Port Au Prince for six weeks but will probably make it back down here for the Palacios village party. Ibania, one of the girls from Palacios who is now in med school, gave birth to her first child on Saturday night and there is now a baby in the house.
This is some of the fish Don Pepe caught with a beet salad, garlic aioli and pasta with sauce.
Your eminence, Burak.
