There will be blood transfusions

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.

Fade into Bolivian...with Centro Medico Humberto Parra

The following is a brief recap of a typical Saturday at the clinic. I'll be posting more pictures of our tooth brushing campaign with the local kids (really cute stuff) and other related public health shenanigans. Enjoy!

I have a really complex camera that I still do not know how to use so many of the pictures came out blurry or too dark. The real documentary stuff is done by pros that come down here, like Brenden Walsh aka "90210", who left last week and is dearly missed but who shot some really great stuff with the people down here and will be posting the video to be shown at the Global Health Initiative fundraiser in Chicago sometime in the coming months. While I'm learning to use this infernal camera please have patience with the quality of the images.

The night before we left for Palacios we decided to rotisserie chicken hearts marinated in port wine and soy sauce. They were delicious and accompanied by heartbreakingly bad puns.

The clinic attended over 60 people on Saturday, not including the number the dentist ended up seeing. They come by any means necessary, micro bus, packed hatch-backs with four people in the front seat, or motorcycle, typically with at least three people--though sometimes a small child or two seated on the gas tank.

They also come on horseback.

This Saturday was the second training session for the new wave of community health leaders, the majority of whom are women, with our senior nurse Maria Cespedes instructing the proper method of taking a blood pressure. There are no CVSs around the corner here so these community leaders will be the ones responsible for hypertension management in each of their own small villages.

Although we do utilize electronic medical records for many patient charts, a written registry of patients and which communities they come from is still the Bolivian gold standard in "real-time" analysis.

This is Rudy, the dentist. He is extremely nice and has a sick motorcycle that he rallies up to the clinic on each Saturday. He also is very thorough and creative. Once when attending patients at the government health post in La Arboleda because the road to the clinic was impassable he was seen pulling teeth out of a kid's mouth on a porch while some stray dogs lapped up the blood. Let's just say he brings the romance back to dentistry.

It's called lunche (okay, it's actually called almuerzo) and it's where we discuss whether agua con gas is more or less liable to explode after thawing and the likelihood ratio that the amazing pork we ate last Sunday will give us neurocysticercosis.

This is Mumi, who almost always is smiling or cracking jokes. Here she is preparing empanadas for patients and probably laughing about how I screamed like a little girl when I went fishing with her son Alek and thought a fish was biting my butt cheek. The notorious muerde-nalgas fish (g-translate that if you don´t speak Spanish).

Though changes in diet can vastly improve outcomes for patients with hypertension and diabetes, Marcelo, Mumi's son, merrily tends the skin frying in oil so it comes out with lush golden brown hues.

Sometimes you have to pick your battles.

The front desk at the clinic, with 15 year old volunteer Georgina at the helm. Burak and Andrew discuss a case.

Interpretation of the day's lab results with the patient.

Micaela gets smiley and sentimental and perhaps a little teary-eyed as she looks over her last patient's chart on her last clinic day at Centro Medico HP before returning to work in Haiti's Port Au Prince.

The clinic empties out for the day as patients board the micro for Yapacani. Many of the patients from the clinic speak Qechua as their first language and come from places whose names translate to "Viper field" and this is their only real access to medical care.

Alek and I being flojo before going out with the net to fish. By the way, fish head soup makes a very nutrition and complete breakfast.

Don't you worry about Blog, let me worry about blog.

I have since given up my post at Centro Medico. Entonces: here is my new blog: www.therealityinstitute.net

mike!

Blogs? Blogs! You're not looking at the big picture!

Hola, soy Veronica Ribera. Este es el primer Blog que yo hice y, boy, estoy divertiendome! No sabia que tan bueno eran los Blogs. Mike me dijo muchas veces pero no lo crei! Ahora yo se y nunca voy a ignorar lo que dice otra vez.

Soy del pueblo donde queda la clinica, se llama Palacios. Palacios es un pueblo pequeningo que tiene 70 familias (incluyo la mia). Mucho del resto de mi familia todavia vive alla, como mi mama que es la alcalde del pueblo y cocina en la clinic para los trabajadores. Ahora yo vivo aqui no mas en Santa Cruz en la casa Molitch-Hou. Voy a la Universidad Gabriel Rene Moreno y estudio bioquimica.

Anyways, es bueno. Yo salgo con Mike que es muy guapo. toca la guitarra muy bien, y que baila como un rockstar. Tambien, voy a muchos conciertos de rock que es differente del rock de Estados Unidos porque aqui es mas duro como un rock. Por eso se llama rock. Tambien yo miro television y hang out con mi hermano Xavier y mis amigas Zoila y Ibana. Oh, also, juego con DJ, el perro de la casa.

Ahora, voy a hablar en ingles. Hi my name is Veronica Ribera. If it weren't for Blogs, I couldn't express myself in all of the ways that I would want to to all of the people I want to. Mike's parents are paying for me to go to school in Santa Cruz and they're not even making me convert religions to do so (which is good because the conversion rate is like so bad right now). My English is getting better every day and so is my Blogging. Of course, it helps to have Mike reading over my shoulder and telling me what to write (he's so good at Blogs! he makes sure I capitalize Blog every time I Blog!).

Eso es todo.

Blog!

Vero

Don't you worry about Blog. Let me worry about Blog.

Well, faithful Bloggers and Bloggees, I've resigned from my post as clinic coordinator once again. You're probably asking yourself, "But, Mike! What are you going to do now?" Then, you're probably thinking, "Oh, well, it's probably not really any of my business. Look at me! I'm being as nosy as a Nosy Sarah." It's only natural to have feelings of nosiness from time to time. As growing boys and girls, nosiness can creep up on you without any warning. You might even find yourself with a case of nosiness in the most awkward of places, such as a classroom or church meeting. Whenever I feel a bit nosy, I just look myself in the mirror or in the reflection of someone's sunglasses and say, "Mike, now is not the time."

But, as for the clinic, I realized that I've left you hanging on a few stories. For example, the woman, Aidee, who we sent for a cardiac catheterization had one done and the doctors found nothing, so her heart appeared to be fine. Then, she and her husband, Celso, the caretakers of the clinic, up and left with only about a day's notice for a different job. We were all taken by surprise and all pretty beat up about the whole thing. So, we all went out for milkshakes and talked about it and, by the end, we all felt a lot better. Except me, I was still a little peeved because Celso said he wanted my biscotti and I told him he could have a piece and then he ate the whole thing. He said I could use a diet. Can you believe that! But then he called "caballero" because he knows how much I like it when he calls me that and I couldn't stay mad.

Dr. Duke also came and did a surgery on a prolapsed bladder. I always wondered what a bladder was. My dad thinks its one of the more extinct dinosaurs, but I thought it was still alive. Then it turned out to be part of the female anatomy. I always wondered what the female anatomy was. My dad thinks its the study of the stars in the sky and I agreed. It turns out to be the same thing as male anatomy but for ladies. Anyways, Duke did the surgery and it all went great. The lady who's bladder was falling through her vagina now feels a lot more comfortable. And we can do more small surgeries at this hospital in the future, such as: hernia repair, gall bladder surgeries, hysterectomy, appendectomy, the works! I'm not sure what kind of surgery the works is, but it sounds fun!

The man we sent into Santa Cruz recently for a heart check up was a bit non compliant, going to Santa Cruz, getting an EKG done and then refusing to do more tests and going back to Palacios. We sent him back to Santa Cruz a bit worried that he'd need a pace maker for his low heart rate, as is often the case with people with Chagas disease, but it turned out that he just had a virus that caused a low heart rate and now he's all better and still has Chagas. Chagas is a life long disease for the most part. It causes problems with the heart and abdomen and things like that, but you can't really do anything about it until these big problems present themselves. Just about everyone I know from Palacios has Chagas. It comes from a big bug that lives in thatched roofs that comes out at night, bites your skin and then poops into your bloodstream. I'm not sure if I have all of those details right. I could look it up to double check, but there's no time. I'm blogging!

Rachel does not have anymore Dengues as far as I'm aware of. So she's returned to her post as coordinator. She said, "Thanks, Mike. I couldn't have done it without you. Here's a lollipop."

As for the blogs. Blogs are a beautiful thing because you can do them anywhere. On a bus. On a train. Under a bridge. In a drain. Just remember, don't you all blog too much. Long term blogging affects the brain.

MIKE

Take me where the Blog Blogs and all the Blogs are Blogs

Well, it´s been a long time since we´ve last Blogged. In fact, since I´ve even been coordinator of Centro Medico, but just like love, Dengue Fever does crazy things to this world.

I remember it like it was this past weekend... The new coordinator, Rachel Trotta, fell ill in our house in Santa Cruz. Says she´s got a bad fever and the only cure is Mike. Calls me up on the phone, she does, and says, ¨Hey, Mike, I think you´re gonna need to come back to Bolivia. I got it real bad, Mike. Real bad.¨

Luckily, I was already in Bolivia. I took some time off up in Chicago, the Silly City, with my friends and to ¨sort some things out¨ (I am legally forbidden to discuss what took place). I came back to Santa Cruz, Bolivia for the love of a lifetime, but got a lot more.

Now, Rachel is in bed in the big city with Dengue and counting platelets and I´m in Palacios Blogging Blogs. Things aren´t that much different. We still have medcial people and non medical people and patients and not patients. We just recently sent a man to the city to see a cardiologist about his low heart rate (due to that Chagas disease). When he got there, the cardiologist sent him for some more tests and instead the guy said,¨ Ï don´t want more tests, I want to go back to Palacios¨. Which he did. We told him to go back to Santa Cruz so he did. He´s there right now so we´ll see how that goes.

What have I been doing when I´m not helping with the clinic, you ask yourselves in your darkest hours? Well, I´ve got a plan, see. I´m going to write me a book, start me a magazine, make me a CD, and paint me some 12 odd paintings. By the end of next year, I hope to have me a publishing company a love stroner than the bars of a prison train. We´ll see how that goes.

I take myself where the wild wind blows, the women are fine, and where there are Blogs as far as the Blogs can Blog, that´s where I go.

Mike Out!

Blogged if you do and blogged if you don{t

I know that I{ve been writing blogs the American way this whole time (Patriotic and humble), but because I{m stuck with a Bolivian keyboard, I thought I{d give you a taste of Bolivia by typing up a blog using this [crazy[ keyboard. So instead of apostrophe{s, you{ll see brackets and instead of quotes you{ll see that other kind of weird bracket.

So I just got back from Country Gooding Junior (a country so wacky that they named an actor after it) and boy is my liberty tired. I{m not aloud to say the name, but it{s famous for the trade embargo imposed on it and t-shirts with some dude named Chet on them. It was like that time that Sam Becket got sent back in time to the 1950}s and had to prevent a vanguard revolution and he couldn{t figure out why he couldn{t leap until he realized it wasn{t the revolution he had to stop, but the marriage a dictator to his highschool sweetheart who everyone knew he didn{t really love, thus saving space-time-God-everything forever. It was an okay episode.

This week, a woman named Aydee who works at our clinic was put into the hospital to have a cardiac cathederization. This procedure will reveal whether or not she needs to have an open heart surgery, a stent, or not. It is very expensive and the surgery is even more expensive. The procedure itself will cost around 600 dollars, which is a fifth of our budget for a month, and the surgery might end up costing around 6,000 dollars. So this is a pretty big thing. Normally our surgeries for the month, we do one or two, cost around 200-300 dollars total. She works for us and lives with us at the clinic, so are going to do it everything we need to, whereas normally we might have to discuss it some more.

As I was not in Bolivia last week (the country where the famous Chet Gutenberg was killed by the Center for Immunizing Animals, a major agency for the Unlimited Stuff for All-People), the volunteers had to survive without me. And did they ever! They sent two patients to Santa Cruz, the big city, to be seen by specialists and took really good notes for me for when I got back from Country Gooding Jr.

This week we{re going to cook Thanksgiving dinner (turkey burgers and egg nog) at the clinic and in Santa Cruz. That{s two more dinners than the piligrims ever had with the indians, which is zero.

I will be going back to Chicago in December, but I{ll be staying here for all of next year, unless the Center for Immunizing Animals has anything to say about it.

¡Peace out!

¡mike!