Jesuit walks

Isama II Classroom

The clinic saw 688 patients in house and an additional 340 out of clinic in the campo. Some of our more seriously ill patients received blood transfusions, nebulizer treatments with steroids, potent IV antibiotics, cat scans, and transfers to Santa Cruz hospitals. We visited 6 remote communities up to two hours by car from the clinic on roads that cross rivers and often see only oxen and motorcycles--roads that could realistically only be traveled on by Land Cruisers with competent drivers. This was all made possible by the Loyola Stritch School of Medicine's trip down here, which brought with it a small part of the additional funding the clinic really needs.

Erin Feller examining a boy from Los Carbones

The Loyola team constituted 7 first year med students, 1 second year med student, 1 emergency medicine attending, 1 family practice attending, 1 pediatrics and internal medicine attending, and 1 urogynecologist attending, and 1 Jesuit chaplain. The med students were sprightly youngings who adapted well to the chaos that is developing world medicine and were well supported by amazingly talented attendings with venerable amounts of experience in the field.

Fording the river with suitcases of meds on the roof

The mobile teams were coordinated with government workers from a local hospital. The health apparatus in these areas consists of a number of health posts manned by nurses and the occasional doctor. Their charge is vaccination, primary care and referral, emergency medical aid, and public health campaigns. It is underfunded, underperforming, and of inconsistent penetrence, mostly due to geography and lack of oversight of the health workers. Some post we attended at were well-stocked, clean, and showed evidence of successful public health interventions in communities, while others laid fallow, more or less a guise of medical care with clear signs of rot. Some communities we visited were beyond the reach of a post; these were far and away the communities suffering most from preventable, treatable diseases.

Scabies with Impetigo of a 3 year old in Isama II

One such community was our first, Isama II, a recently founded community encroaching the boundaries of Parque Nacional Amboro, that was overrun with scabies, lice, pica (kids eating dirt because they lack vitamins), impetigo, and bichos, or intestinal parasites (I think I may have scabies, and I have already had to de-worm myself once this trip). We went through almost our entire supply of treatment courses for these our first day in the communities and had to purchase even more from our pharm supplier. The town's water supply was a river 50 m from the center of the town. A few households have a car battery that they will use to light their homes a night, but other than that the town remains pre-Edison. Lack of running, potable water is one of the main roots of their maladies, resulting in poor hygiene, higher rate of re-infection, and malnutrition.

View from the water tower in Cheyu during el Dia de Cheyu and a public health fair

The village of Cheyu, the following day, was a clarion call for the importance of public health. Just kilometers down the river from Isama II, Cheyu had a wind-mill pumped water tower, a few solar panels to light the town at night, a poured concrete school, soccer/basketball court, cafeteria, and, greatest of all, a well kept, well stocked health post with a heroically dedicated, compassionate nurse. Hygiene and nutritional-related health problems were scant in comparison to Isama II. While there was some lice, most of the people who presented to us with primary care issues. Going through patients, we caught a significant amount of cases that needed follow-up or immediate intervention. As a way of example, a pregnant woman came into the clinic who was past her due date and with breach presentation of the baby. Dr. Fitzgerald suggested she be transferred. Rapidingo, caballingo, we were able to have her transferred to a hospital for a caesarean. Another elderly woman presented with an advanced

pterygium, or wing-like growth on the white of her eye that can worsen vision. We gave her Lindsay Lohan-esque sun glasses and referred her to some Cuban ophtamologists in Yapacani.

A healthy Bolivian family that is particularly beautiful

Voluntourism, a portmanteau of the words "volunteer" and "tourism", is a term that came up often while Loyola was here. The term has been used to market volunteer vacations, but also frequently been used with a pejorative tint, especially when used in medical mission settings. There is a wide array of literature of the subject, including sharp critiques of the field and how it potentially damages local efforts in the same camp.

Children striking a brushing pose for camera after Dental Hygiene presentation by the students

One of the standard arguments here is that the transient trip from the States, which is vastly better funded and better equipped, erodes interest, funding, and utilization of indigenous efforts. Local efforts are dwarfed by the ostentatious, once-a-year trip made by foreigners, which in turn stymies the growth of the local, sustainable, and potentially more efficacious work done indigenously. This sort of thing has been documented by the VSO, though exhaustive studies of the effects these trips have are still waiting.

Dr. Mary Pat Fitzgerald, the trail-blazing Urogynecologist who has done fistula repair in Niger and is a personal heroine

I understand this argument, but it really lacks teeth until you start getting into the tailoring of a trip to the needs and wants of the volunteers, and not the host community. Then, the argument goes, there is a not-so-subtle shift from commitment to helping the members of the host community that transforms them into pawns in a pious, manicured celebration of charity. Any volunteer, like any person, has right to protect themselves from harm while on these trips. Almost equally, though, volunteers on these trips must recognize that, by coming, they are engaged to helping these host communities. Medical treatment of this kind, like human rights, are not simply like old clothes that you give to the poor. If you go on one of these trips, you better be committed.

Dr. Tracy with Alicia Stapleton and Matt Egan and a family from Isama II

There are, of course, critiques of these critiques, which basically take aim at the fact that, in the zero-sum game that is simply living a day to day existence, people receive care that would otherwise go without it. It's a hard argument to follow and in a brutal way it's true. But without structural changes, things will remain the same, and someone will always be bound to another's wanton charity. These seem to be the valences within this discussion, and it doesn't seem right to sit at either end of them, but to use them as tools to evaluate how to improve such and such a program.

Healthy Mom with a Healthy Kid with a Healthy Hairstyle

The most disturbing sentiment I heard from people down here was that the communities we treat were "not poor enough". I'll let that comment speak for itself. I guess it's just an expectation, but it still makes my stomach turn.

Lauren Valbracht, Coordinadora la Exploradora (Como Dora)

Weeks before the Loyola group was down here, it was el Dia de Palacios. A live band with cumbia played well into the madrugada.

¡Bailando Brah!

May at CMHP: Chagas

Lauren, our previous coordinadora who we miss, and the Don Pepe.

Busy month. Clinic saw 448 patients. Multiple consults. A couple hospitalizations.

Many patients receive excellent care for chronic diseases in our clinic, such as diabetes and hypertension, but there are other illnesses for which we can provide only modest care. Foremost among them is Chagas disease, which I mentioned in a previous post below.

Two of our patients succumbed to the disease this month, dying from heart failure despite our best efforts to manage their condition, and another woman miscarried most likely due to complications from Chagas.

Chagas, like many diseases in the developing world, is a preventable disease. Though steps have been taken towards its prevention, with nets and insecticides, it remains an endemic, neglected disease without cure or even effective treatment. In South America, it is responsible for more deaths than malaria and many do not know that they have been infected until it is too late.

In public health, there is a metric known as the DALY, or the disability-adjusted life year. It is calculated by adding the "years of life lost" (YYL) and the "years lived with disability" (YLD) both other figures that measure premature mortality in a population. All this amounts to is essentially a fancy way of measuring how many healthy years of a person's life are lost due to disability or disease. Bolivia, the poorest country in South America, leads the world in DALY for Chagas, something that all too clear to us at CMHP, as by some estimates nearly 70% of the surrounding population that we treat is infected. Chagas disease has been recognized as a neglected disease by many global health organizations, and some have said that it is the most neglected of the neglected diseases.

Many of these infections occur because of poor infrastructure. The bug that spreads the disease (the vector) is called the vinchuca, or the more ominous sounding blood-sucking assassin bug, or the more innocuous sounding kissing bug in English. These bugs hide in the leaves of the motacú, which are used to construct many of the roofs here, and come out while the inhabitants are sleeping. They crawl onto the faces of the inhabitants to suck their blood and in doing so infect the sleeping person. This is the reason for their namesakes in English.

Recently I had the privilege of presenting a class on first aid, with the help of Dr. Macneil, an ER doctora volunteering down here, to the new group of community health leaders that are being trained here in clinic every Saturday. As the primary health resource for many of the surrounding villages, I thought basic first aid skills would be useful to them. The course covered how to treat shock, wounds, choking, drowning, and ended with a practice session in CPR. The following week splinting and emergency transport was covered. There was a short, very difficult pop quiz afterwards, which I sort of feel bad about because a couple people had trouble just reading it (that said, Bolivia's literacy rate on the books is pretty good). Afterwards, we briefly read a section of the following poem, with the idea that the best medicine is in prevention. I've included it below in its entirety as my way of celebrating getting into medical school, and because it speaks to the fact that the root cause for many of the diseases we treat are symptoms of larger social problems, such as poverty and inequality.

"A worker's speech to a doctor" by Bertolt Brecht

We know what makes us ill.

When we’re ill word says

You’re the one to make us well

For ten years, so we hear

You learned how to heal in elegant schools

Built at the people’s expense

And to get your knowledge

Dispensed a fortune

That means you can make us well.

Can you make us well?

When we visit you

Our clothes are ripped and torn

And you listen all over our naked body.

As to the cause of our illness

A glance at our rags would be more

Revealing. One and the same cause wears out

Our bodies and our clothes.

The pain in our shoulder comes

You say, from the damp; and this is also the cause

Of the patch on the apartment wall.

So tell us then:

Where does the damp come from?

Too much work and too little food

Make us weak and scrawny.

Your prescription says:

Put on more weight.

You might as well tell a fish

Go climb a tree

How much time can you give us?

We see: one carpet in your flat costs

The fees you take from

Five thousand consultations

You’ll no doubt protest

Your innocence. The damp patch

On the wall of our apartments

Tells the same story.

(thank you Amo)

Contributions to Chagas research here:

http://www.treatchagas.org/

Mother's day in Bolivia featuring skits about domestic abuse, patriotic songs to the mother's of the nation, and this awesome dance with one of the volunteers from the clinic:

Diversiones

Disclaimer: Unfortunately I do not have many pictures of the clinic to post, so I am posting pictures from recent travels away from the clinic. The next post will talk more about how things have been going sans pictures, which I will have to spend more time writing since the text won't have the pictures to use as a crutch.

Weird Fruit #14. Name forgotten. Eaten on a whim in Cochabamba.

Qechuan cholita gathering dry flowers. Cochabambino parque ruins picture from the upper left.

Hut people live in at +4000m. Llamas and rocks and dogs and grit.

Feeling the altitude on the 5200m ascent that we failed to climb. Began raining/hailing/snowing. ER doc becomes hypothermic and the lack of climatizing to altitude catches up with us.

Possible leishmaniasis ulcer that has been growing for the past six months on patient's right hand to be biopsied and treated. Diagnosed by the acclaimed ID specialist Dr. Johnson, former president of the Anaerobe Society.

http://www.anaerobe.org/

¡¡Quinceñero!!

Things were mellow at the clinic this week as there were no American volunteers down here. The clinic relied on a Bolivian doctor or two a day with a cut back to the number of patients that could be slated to come. Luckily it was May Day on Saturday and people were busy barbequing and we could close the clinic.

This is a picture of the new crop of community health volunteers that are being trained. It's a twelve week course held every Saturday at the clinic, except this last Saturday was May day and it got moved to Friday. In the background you can catch a glimpse of one of our patients who arrived to the clinic in DKA, or diabetic ketoacidosis, a potentially fatal complication of diabetes that she is seen receiving treatment for. One of the virtues of the clinic is ability to provide long term, meaningful care to people who would otherwise not have access. At the same time, acute cases can be managed at the clinic or can be transferred to hospitals nearby, like in Portachuelo. This patient was interned in Portachuelo for observation, treatment, and diabetes education.

Mumi's son Lalo turned fifteen, which is a big deal in Latin America, so they had a quinceñero party for him. Lorenzo enjoyed the cake.

The mayor, Bladimir, of the closest major town, Buena Vista, stopped by with a case of beer and a couple friends. The road to clinic was discussed as his alcaldia had recently had a tractor groom the dirt road to the clinic. He mentioned a French experiment during World War II with termite saliva to bind soil in passing and then it was generally agreed that the road should be fixed in the manner leading up to the nearby bridge, without which the clinic would truly be out of reach.

By the end of the night things had gotten a little out of hand, as this photo shows.

There was lots of dancing and in the morning we rode the horses back to the clinic at sun up to pick up two ER attendings that will be here for some weeks. They are great!

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!

Golb!!bloG

There ain't nothin' like a fresh blog in the morning! And boy is this blog fresh. If you rearrange the letters in the previous sentence, you can spell: And frog boy hits Slibesh. Boy, I feel bad for Slibesh.

As you all know, today is All Saints Day to honor the day that all the saints died. Everyone dresses up like Saints and goes door to door throwing eggs at people dressed like witches. As for me, I'm going dressed as Saint #3. In Bolivia, Halloween is a new thing and we bought candy but we're not sure if anyone is going to come get it. We're going to throw a party.

I stayed in Santa Cruz this week and worked on getting this lady a hysterectomy and went to the doctor to get my hernia (and ascending testicle) looked at. The latter, apparently, is a result of the former. They're not going to operate on my hernia yet. If it gets worse then maybe, but for now I'm just going to take medicine. The lady will probably have the surgery next week.

We started working on planning a series of surgeries for December when a surgeon named Janice Duke comes. She's going to do some hysterectomy things and things in a local hospital near the clinic. It's pretty exciting because it seems like with this hospital's help, we might be able to perform more surgeries more easily.

Next week I'm going to a little country that I cannot say the name of with a couple people. Let's just say its an island with an embargo and dying dictator on it. I can't say anymore or else they'll put me in a prison on that island. I'm excited to smoke Cuban cigars!

Soon the next coordinator will be coming and I will have to tell her how to do the job. Wish her luck!

Blog!
mike

Blog Fever!

Sorry, Loyal Fans and Readers. I was sick. I had it real bad. A real bad case of Blog Fever! I couldn't stop thinking about Blogs. It was like every time I tried to blog I would get so excited that a fever would set in and I couldn't even blog. So I just relaxed and controlled the flow of blog thoughts to the mind until I could sit still long enough to just a blog a little bit before I went crazy.

So, since we had our last intimate conversation, Centro Medico Humberto Parra has had a whole bunch of volunteers and patients. All of the old med students and residents have left and been replaced by two female residents, a female med student, a male med student named my brother Ethan, a female nurse, and a couple of love birds who just flew in to help with "green" energy for the clinic and cervical cancer screening. Also, my mom is here, right now, starring over my shoulder and chuckling about the word "blog". I told her, "That's not funny, mom! Blogs are serious business!" But she'll never understand. Also three doctors were here. (In reverse alphabetical order) One's name was Steve, another was John, and another was Amish. Amish surfs, John plays guitar (like a real pro!), and Steve gets overly excited and spouts facts about trees uncontrollably. Here's something he said once: "Man, if you brought a pair of binoculars out here to the clinic, you could have a field day! Holy cow!" A typical conversation with Steve went:

Schlomo: Hey, Steve.
Steve: Holy cow! I can't believe it's you! I haven't seen you in like 5 minutes!
Schlomo: I've got bad news, Steve.
Steve: Great! I love news!
Schlomo: Brad Pitt died today.
Steve: What?! I can't believe it! That's terrible!
Schlomo: Hey, Steve, check out that ant hill!
Steve: Holy cow! What the hell do you thinks inside that thing? I'd love to get a hold of a hammer so I could see inside there!

So he was fun. Me and Gretchen, the nurse, translated for him and John because they're Spanish was not great. Then we had a party for my mom. It was an aloha party. John sang a song, Derek sang a song, I sang a song, and Dr. Suarez a Bolivian doctor from the Hopsital Japones sang "I can't take my eyes off of you" in Spanish. It was beautiful. I wept like a willow and lept like a frog! Or should I say, I weeped like a weelow and leaped like a frog.

I went to Samipata, the ancient city where different indigenous groups thrived (such as the Incans, the Spanish, and the Nazis). We stayed at La Vispera, a quaint little Dutch hotel/cabin place and I asked them if they would hire me, they didn't say no.

A man had a tracheotomy and can breathe a lot better. My brother helped him replace his trachea ring. He is very sweet and wrote me a little note (when he couldn't talk) that said thanks and that he can breathe tranquilly. A man came in with carcinoma and, although we cannot save his life, we are going to give him radio therapy and control his diabetes so that he might be able to live more comfortably. We are also working on getting a woman double header surgery, which will involve the removal of a polyp on her uterus and a reparation of her hernia. Man, I tell you, I haven't seen so many hernias in my life. One time I saw a fat man in a polo, but that's not quite the same thing. I also saw Rush Hour 3. Don't stop making 'em, boys!

I should also note that I got four strikes in a row in bowling, raising my score from 22 to something like 102. I was kind of "out of it" so it was a big surprise to everyone playing. I think we still lost. Also, Derek, the "green" energy guy, said this funny thing. I was putting my pants on one morning and he says to me, "Wait. You put your pants on one leg at a time?" It was the funniest thing I'd ever heard.

mike

Blogs, blogs, blogs! What are we going to do with all of these Blogs?!

People are really starting to rave about my blogs. I'm even keeping my fingers crossed for some sponsors! Possibly from Fingers Crosserstm which is a global chain of restaurants where they serve finger foods and hang finger related things on the walls.

I'm in Bolivia. Bolivia is the least famous country in South America, but don't tell that to any Bolivians because they don't think of it as the most unfamous, but the most landlocked. In a story as old as time, Bolivians and Chileans have been fighting over who gets to keep the sea. The Bolivians say they get it. The Chileans say that they get it. The Americans say that they don't care who gets it, as long as they can influence/control the government so that they get it. This last paragraph is as beautiful as it is historical.

All of the female volunteers from the States have left, so we're feeling like a post office around here: a lot of men! We have four male medical volunteers: two residents and two fourth year students. One resident wants to go into pulmonary critical care, the other is looking into hepatology, one student wants to do general medicine, and the other wants to be an anesthesiologist. We are all very different people, which becomes clear as soon as you see us because we do not share the same body and name! Neehar is an Indian vegetarian, Greg is a tall drink of Mormon, Matt is short white guy, Joe can read and be courteous, and I can write blogs. Somehow we all manage to get along.

We are working on some surgeries right now too. One man is in the hospital having a tracheotomy performed. His wife and kid left him and he said that he was alone, so we bring his medicines to him because his family cannot. We are also trying to repair a broken heart by getting new parts for a woman's pacemaker with help from a group called Solidarity Bridge. Finally, there is a boy with a big hernia who we will be helping to have an operation hopefully this week. I think that I have been having sympathy pains for this boy because I had a hernia the other day I have yet to tell my parents about, but I just pushed it back in so I should be fine and never have to worry about anything again. Soon I expect to have a broken heart and tracheotomy (Cross your fingers!).

Yesterday I shot a rifle at a tree.

Mike

Mikey's Second Blog

This blog is called Mikey's Second Blog because it's the second blog that I have written. It's about the time when I was in Bolivia also, but it has different information than the first blog that I wrote, which was also about the time I was in Bolivia, which is now. My brother told me I should start a blog. So that's what caused the blog to be started. In actuality, the blog was caused by the existence of the medical clinic at which I am currently working for. But enough about blogs.
So, Edith the former coordinator has been gone and I have taken over for her. She is dearly missed, like when a train misses a truck by just a few feet. I am doing an alright job so far, just getting my feet wet. I can speak more Spanish than before, can drive a manual transmissioned car, and have driven patients around the city of Santa Cruz so that they can get to their appointments. Daniel, the son of Dr. Douglas Villarroel (one of the founders of the clinic), says that he likes manual transmissions more than automatic ones because he feels like "I am in control of the car. When I drive an automatic, the car is in control of me." I said, "That's great. Now, can I control the radio for once?!" We had a good laugh about that, until I changed the radio station and he got mad. Then, we pulled over and had a good talk.
My parents were here. They also started the clinic. Their names are Dr. Molitch and Dr. Hou. My friends and neighbors ask me how it feels to have parents with the same first name. I always reply, "That's the least of my problems!". Everyone seemed happy to have them. My dad didn't fall asleep during anything that I'm aware of and my mom got to dress up in a lot of bright colors. I broke a bottle on the road that leads to the clinic. I thought everyone was going to yell at me, but when I was crying they said that it was okay because I was supposed to break it and that people always break bottles of champagne to christen things. That made me feel a whole lot better and have since felt completely comfortable christening just about everything. I even christened a man I met in a bar using a beer bottle. I know it's not the same, but I'm not too picky!
We had a big party for the anniversary of the clinic, celebrating six years. There was dancing and singing of the national anthem and speeches thanking the doctors who started the clinic. It was very nice and sweet. There was an old couple from a town called Warnes that did a cute dance that made me look forward to being an old man some more. The group from a town called Yapacani did a dance using really brightly colored masks that looked like monsters. I like monsters so I was a bit biased towards their dance. Also, there was a soccer tournament in which one of the medical volunteers participated. In fact, her team, the team from Palacios where the clinic is located, won the women's tournament and all the players got to take home watches as prizes.
Oh, that volunteer is new. We're currently the only two volunteers from the States here right now.
Alright, bye.

Mikey's first blog!

This blog is called Mikey's First Blog. It's about the first time I made a blog, which is right now, in fact. It's called this because this is the first blog I have written. So now begins the blog part:
My name is Mike Molitch-Hou and I am in Palacios, Bolivia, the World. I am working the the Medical Clinic Humberto Parra, which is a clinic that my mom and dad and their friend Douglas invented in 2000. I got to Bolivia about two and half weeks ago or so. I was very nervous about not being able to speak Spanish. I am still nervous, but after much practice, I have gained some confidence
So far, I have tagged along with Edith who is the current coordinator. She is good at her job, I think. That is my opinion. She is very reasonable. Like a robot. Unlike our current breed of robots, she has a heart. She is able to process decisions in a very efficient manner, but also remembers people's names and birthdays and to sometimes have feelings. She never stops working, like the Energizer(TM) bunny robot, so that she is exhausted when she gets home at 9 at night. Then she writes emails to all the people in the United States letting them know how the clinic is doing.
There were two other volunteers here. They're gone now. I don't remember their names. I think one was named after a cup of coffee and the other after a Simpson's character, but I have already erased them from my memory as to not "feel" sad.
I went to Saimipata, a nice town two hours outside of Santa Cruz that has a lot of history involving Incans and a lot of conspiracy theories about aliens. It's very pretty and cold. There there is a parrot that can say "Hola" (which is some sort of Spanish I assume) and can cry like a "baby" (which is some sort of human I assume). I went with Edith, Javier, Daniel, and Nuna. They were fun. I practiced Spanish by taking the phrases I already knew and inserting new vocabulary words into them like a game of MadLibs(tm):
"Cuantos anos tienes?" was replaced with "Cuantos moleculas/muertos/miedos tienes?"
So instead of asking people how many years they had, I asked them how many molecules/dead/fears they had. I was also taught how to say, "Que te hago un hijo?" which means "So why doesn't that person make you a child?".
I tengo hambre a lot right now, so I'm going to go. This was getting long anyways.
[End Mikey's First Blog]