Sailing with FAmily, celebrating my mom's 50th birthday

A tidbit from my final summary paper for my Bolivia trip

For the few who read my blog, I thought you might like to read a bit about what my work entailed in Bolivia and a bit of a personal piece to open up the paper, enjoy my 3 readers!

Upon arrival into the La Paz, Bolivia airport the notion was instantly reinforced that I had entered a third world country.  Despite my native Bolivian preceptor Dr. Oscar Lanza’s efforts to convince me that there is no such thing as a third world country, by prompting the question, “where are the other two worlds, we are all part of one world together.” It was apparent that this country was far different from my country of origin in the United States. The airport was small and after a lengthy discussion with the customs officers (entirely in Spanish), I finally convinced them with my entrance letters and home residence in La Paz, that I should be allowed to enter the country legally, but unfortunately I was not cleared until 1:00 am.  As I drove through the quiet streets of La Paz, I could not help but notice that hollow red brick homes towered on cement stilts hanging off the sides of steep hills and cliffs.  They were built, seemingly, on top of one another and if any tectonic shifting were to occur hundreds of families would plummet to their deaths.  Despite the obvious poverty evident throughout every make-shift home, barred store window and scattered sidewalk mounds housing chilly persons in dirt stained blankets, I could not help but be impressed by the effort made to create beautiful shrubbery designs and soot covered pink flowers which ran down the middle of the downtown streets.  This little insight provided affirmation that even the populace of these so-called “poor-third-world-countries” want to beautify and take pride in their homeland and helped me realize that we really are not that different after all.

Statement of the Problem

 The Bolivians have an aphorism that states “when God designed Bolivia he gave the country every single natural resource needed for self-sustenance and provide richly for its citizens.” The country lays claim to many natural resources including large petroleum deposits and massive gold and silver mining operations.  The country boasts miles of prosperous agricultural lands providing work for many of the poorest residents.  The landscape varies from desert salt flats in the south, to the humid Amazon jungle in the north and the impressive Andes’ Mountains which span the entire country presenting its majestic peaks and substantial glaciers which provide pure sources of water.  Despite the countries obvious assets, it continues to struggle financially and, more related to my topic, it suffers from substandard nutrition and health.  Many of the country’s poorest citizens lack access to nutritious food and basic healthcare.  At first glace, I can assume many explanations for such sorry access to basic needs - my assumptions include the obvious such as poverty, rural living, or lack of or inconsistent education and, if access is afforded, then poor hygiene, decreased access to sanitation services and potable water for cooking, showering and hand washing.  I have described these Bolivian predicaments in minimal detail merely skimming their complexity, and their deeply seeded social and political implications.  Once contemplating their immensity you might find yourself at odds with the country as I did, feeling as though anything I can do, would not address the problem in its entirety or even place a dent in the massive poverty/health/nutrition crisis that this country faces.

Context/Organization Setting and Project

A few days after my arrival I was introduced to the Centro Comunal Del Carmen, a medical clinic focused on serving women and children.  The clinic is comprised of three separate clinics, the other two being Pasankeri and Llojeta.  These clinics are funded primarily by two agencies, the Madrid Paz y Solidaridad located in Spain and secondly, a German organization named CBM. There is also minimal support from the Cuban government, in the form of Cuban doctors working in the Pasankeri clinic. The clinic’s mission focuses primarily on what they call “primary care.”  Primary care in Bolivia is not the same as in the United States, in the Bolivian context it refers to preventative medicine, or in other words, public health education.  Because Bolivia does not have the infrastructure to manage large numbers of sick persons, the doctors (trained in western medicine techniques) must turn towards prevention as their greatest defense against severe sickness and death in the case of children.  The three clinics focus a great deal on preventative measures and education and have created a program called “Crecimiento y Desarrollo” (Growth and Development program – C&D) which encompasses part of their mission, and to enroll as many children and mothers as possible.  Promotion of this program ensures that children are seen on a monthly basis and therefore watched closely for signs of malnutrition, acute diarrheal episodes and complications including dehydration and other significant illness such as acute respiratory infection.  This monthly visit is also used to educate parents regarding a variety of topics ranging from the care and feeding of newborns, hygiene practices, the importance of washing hands and using bathrooms and discussions on healthy diets rich in fruits and vegetables.  These clinics are built along the outskirts of the city of La Paz, bordering the neighboring city of El Alto.  El Alto is notoriously known for its soaring rates of extreme poverty, lack of clean water and minimal sewage services. When navigating El Alto, you know the city limits because seen along telephone poles are stuffed scare-crows hanging by their necks, warning people of the fate that awaits them due to violence and crime. Theft is rampant in El Alto, the enticement to steal is for provisions that will prolong life another day; starvation makes burglary profoundly tempting. It is the goal and mission of these clinics to provide quality medical care for the poorest of the neighborhoods.  The clinics Llojeta and Pasankeri are proudly free-of-charge and Centro Comunal Del Carmen charges a minimal fee of five Bolivianos, an equivalency just shy of one US dollar.  However, it is difficult to enroll children in the C&D program because parents work long days on the streets, doing whatever is necessary to earn a living and/or because the later two clinics are relatively new and more marketing is needed. 

The clinic is desirous to obtain more funding to demonstrate statistical proof that their methods and model have had an impact on the community; therefore they have been very pro-active in accumulating statistical data from their patients. Data was collected for children 0-5 years old in the following categories: Acute Respiratory infections (with or without pneumonia), Acute Diarrheal infections (with or without dehydration), Skin eruptions, hospital admission, and favorable outcomes.  The same information was collected for 6-14 year olds, but with additional conditions such as acute gastrointestinal, pulmonary, genitourinary and dermatological infections. Other data sets were collected regarding malnutrition status, mental health and immunization status.  These large data sets were nothing short of extraordinary and a large effort was required on the part of the clinic staff to compile these numbers.  All the data was then compiled into a 55 page annual report, detailing various sorts of percentages and numerical informational data. When reviewing this report one mistake however, was noted by Dr. Oscar Lanza.  All of the data was subdivided as ages 0-3 years and 3-5 years.  This division of ages is not in accordance with the National Institute of Health (NIH) and therefore all their calculated tables are incomparable with the national database.  This is because the NIH requires that childhood data be categorized starting with ages 0-1 years and subsequently ages 2-5 years.  It is important for the Centro Comunal Del Carmen to submit their data to this database, as well as compare Bolivian health rates with those of other countries.  This age discrepancy led to me and Erin Littman’s project; we were assigned to re-stratify the data into the correct age groups as defined by the NIH. 

All of the data has been acquired for years by grouping children ages of 0-3 and 3-5.  Not only has the incorrect age groupings not allowed comparisons and submissions to the NIH, also it has not allowed any assessment regarding the critical age of change; one year old.  In Bolivia, this age is when many adjustments occur, the child is often un-swaddled for long periods of time, experimenting with new foods, learning to walk and the mother might be pre-occupied with a forthcoming new baby.  Once the data is re-tabulated in order to fulfill NIH requirements, we produced two main objectives.  The primary objective being to identify the most vulnerable age group (i.e. ages 0-<1 or 1-5).  Our secondary objective was to identify the most vulnerable age group, further categorized by one of the clinics three programs (Crecimiento & Desarollo – C&D, Jardin Infantil – JI or Poblacion).  The importance of our secondary objective was to obtain evidence of the clinics failure or success regarding increased rates of health. If success was found, we hypothesized that the highest health rates would be linked with the C&D program.  This program, as described previously, is based on preventative medicine (or primary care) and the child is seen monthly for General checkups monitoring growth and development status.  

Results Achieved

Our original goal was to re-calculate the acute-illness tables, malnutrition rates and attempt re-tabulation of ages 6-14. Because of the vast amount of data and our primary limitation; the language barrier, we simply focused on acute illness for children 0-5 years.  Because none of the staff spoke English, understanding, computing and writing a report in Spanish was an enjoyable yet daunting challenge.  After many days of difficult data interpretation, a few mistakes and formatting issues, we were able to complete four tables (Pages 12-13).

The tables signify the following:

1.      Table 1: Medical intervention for children ages 0-5 years enrolled in Jardine Infantil (JI)

2.      Table 2: Medical intervention for children ages 0-5 years enrolled in the Poblacion en General.

3.      Table 3: Medical intervention for children ages 0-5 years enrolled in Crecimiento & Desarollo program (C&D)

4.      Table 4: Medical intervention for children ages 0-5 years enrolled in C&D, JI & Poblacion.

Once the tables were computed two comparisons were made.  First, a comparison of the individual tables 1-3 comprising 0-<1 years and 1-5 years of all three groups: JI, C&D and Población.  This comparison enabled us to make the following statement and ultimately answer our primary objective.[1]

§  The healthiest group is: 0-<1 of the C&D group (TABLE 3, 79.4%)

§  The least healthy group is: 1-5 of the Poblacion en General (TABLE 2, 21.2%)

§  The group with the highest amount of respiratory infection: 1-5 of the Poblacion en General (TABLE 2, 53.6%)

§  The group with the least amount of respiratory infection: 0-<1 of the C&D group (TABLE 3, 17.6%)

§  The group with the highest amount of EDA: 1-5 years of the C&D group (TABLE 3, 9.7%)

§  The group with the least amount of EDA: 1-5 years of the JI group (TABLE 1, 1.5%)

§  The group with the highest rate of other pathologies: 0-<1 years of the Poblacion en General (TABLE 2, 20.6%)

§  The group with the least amount of other pathologies: 1-5 years of the JI group (TABLE 1, 6.0%)

§  The group with the highest amount of reconsults: males  0-<1 years of the Poblacion group (TABLE 2, 90.9%)

§  The group with the least amount of reconsults: males 0-<1 years of the C&D group (TABLE 3, 19.2%)

Our conclusion, based on the aforementioned bullet points, we have identified the most vulnerable group, as was our initial purpose.  The group identified was the children ages 1-5 years of the Poblacion en General.  This group displayed the lowest healthy percentages and the highest rates of respiratory infection of all groups studied. 

Our second comparison was of TABLE 4; strictly contrasting the age groups 0-<1 years with 1-5 years, all three groups combined (C&D, JI and Poblacion).

§  The healthiest group is: 0-<1 ages with a 58.9% (compared to 44.9% of the 1-5)

§  The least healthy group is: 1-5 ages

§  The highest amount of respiratory infection: 1-5 ages (with 38.9%)

§  The Least amount of respiratory infection: 0-<1 year olds (with 24.7%)

§  The highest amount of EDA:  1-5 ages (with 5.4%)

§  The least amount of EDA: 0-<1 ages (with 4.1%)

§  The highest amount of other pathologies: 0-<1 ages (with 11.0%)

§  The least amount of other pathologies: 1-5 ages (with 9.5%)

§  The highest amount of reconsults:  1-5 ages (with males 62.0% & females 56.4%)

§  The least amount of reconsults: 0-<1 ages (with males 40.5% & females 47.2%)

Our conclusion, based on the aforementioned bullet points (regarding TABLE 4), we identified the most vulnerable age group as the ages of 1-5 years (outlined in red TABLE 4).  This group displayed the lowest healthy percentages, and the highest rates of acute respiratory and diarrheal infections.  The age group 1-5 also had the highest rates of reconsults possibly indicating advanced severity of illness compared to the 0-<1 age group.

The significance of our results was three fold.  First, by identifying the least healthy group,  Poblacion ages 1-5 years (health rate of merely 21%), the clinic can now change their medical and public health approach to this specific age group.  Because it is so apparent that these children suffer greatly from acute infections, when a child does arrive at the clinic, health workers can tailor their care and preventative health education to the specific needs of this population.  Via group discussion many theories were proposed by the staff explaining the low health rates (21% TABLE 2), but no one anticipated such a low rate of health. Some of these theories of course included cessation of breast feeding which usually occurs around this age therefore, those children become susceptible to Bolivia’s elevated malnutrition rates. Also many governmental programs have been designed to decrease the infant mortality rate but, their scope usually supports children until the age of one. 

            Second, by identifying the age group most vulnerable as ages 1-5 years, the clinic had insights regarding their current efforts.  For example the staff noted when community education is provided in the indigenous language of Aymara, even though the direct translation of the word “child” means “child,” culturally the Aymara people tend to relate the word “child” with the word “infant.”  This simple oversight, is confirmed since preventative education functions effectively for infants (0-<1years) evident by the  excellent health rate of 79.4% (TABLE 3) but not as much for children 1-5 years evident by the average health rate of 54.3% (TABLE 3). Therefore, these data have indicated that more specificity is needed regarding education, instead of saying “children etc….” the age range must be clearly stated, this will avoid any confusion or meaning lost in translation.

            Finally, by identifying the highest health rate of 79.4% (Table 3) for 0-<1 years in the C&D program (compared to averages of 50%), this granted evidence supporting the successful medical methods utilized by Centro Comunal del Carmen.  The C&D program is the best health program that the clinic has to offer, and these data provide strong support on behalf of grant proposals and reassurance that the C&D program is outstanding at reducing rates of acute infection. It was proposed during the presentation, that Centro Comunal del Carmnen could become a medical model for other third world countries due to their tremendous success.

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[1] The tables and conclusions are color coded, Blue Generally means “better” and yellow generally means “worse.”  When viewing the graphs you can see this colorful trend and can loosely identify which group is most vulnerable). The colors also aided in presentation/understanding purposes for the clinic.

San Diego here I come :/

So in a week I am moving to San Diego for 6 weeks to complete my Internal Medicine rotation.  For the next year I will be moving every 6 weeks, back to my house and somewhere else back and forth, back and forth.  I don't know what to think about this.  Anything is BETTER at this point than sitting in my classroom for hours on end, but by the end of the year, having to leave Jake again and again is going to try me.  Man, this schooling takes it all sometimes.... but, on the bright side Jake and I are going to go to Disney Land while I am down there and lots of time at the beach, as we will see each other every weekend. 


I am finishing up my surgery rotation and have loved every minute of it, besides being allergic to some of the soap.  I'm pretty excited for San Diego!!!

Until next time!

Kim

Ideas for Young Women Activities

So I am involved in YW and am very interested in hearing anyone's ideas for YW activities.  I have a few, but I know my awesome, talented friends have participated in many YW activities.  What are some of your favorites, please share with me! 

TTYS ;) Kim

The Last Days! Tiwanaku Ruins

 This is a topographical map, which I liked because it really demonstrates the altitude of Bolivia and how high it is.  The black arrows indicate the Tiwanaku movement/expansion from Bolivia. 

 Tiwanaku  is an important pre-columbian archaeological site in western Bolivia. Tiwanaku is recognized by Andean scholars as one of the most important precursors to the Incan Empire, flourishing as the ritual and administrative capital of a major state power for approximately five hundred years. The site was first recorded in written history by Spanish conquistador and self-acclaimed “first chronicler of the Indies" Piedra Ceazea de Leon. Leon stumbled upon the remains of Tiwanaku in 1549 while searching for the Inca capital Collasuyu. Some have hypothesized that Tiwanaku's modern name is related to the Aymara term taypiqala, meaning "stone in the center", alluding to the belief that it lay at the center of the world. However, the name by which Tiwanaku was known to its inhabitants may have been lost, as the people of Tiwanaku had no written language

 The three pictures before are some of my favorite and are what made is stand out a lot to me.  These heads represent all the governors of the Tiwanaku empire.  I found them beautiful and interesting to note the many differences between them all.

 This hole is really interesting because it is considered a type of "microphone" you speak in it, and your voice is amplified a lot.  The cool thing about it is that the hole is actually carved in the same manner and with the same curvature as the human ear.  So beautiful! and when you speak in it, it actually works very well!

 This is the famous "Sun Gate" it is entirely carved out of one stone and all the inscriptions on the top tell us a lot about the history of the people.  These gates and stones used to be covered in Gold and precious metals.  We know this because if you look on the side you see hammer marks from the Spanish, when they destroyed these ruins and took all the precious metals with them, making their country rich off of the wealth of these indians.

 This is a baby of indigenous heritage int he area, the indigenous people are so cute, becuase they always want you to take pictures with their children.

The Best Face Product Ever

So even though I'm in Bolivia, I can't refrain.  I've been using this now for over two months and I have not worn face make-up in TWO MONTHS.  I used to wear face make-up every day.  The reason is because my skin without make-up actually looks prettier.  I have only been using the Youth Code Serum and the Eye Cream and the best thing is that the serum is only $22 at Wal-Mart.  When I worked at Lancome (which is owned  by Loreal) they were working on this product for 10 years.  I started using the Lancome version samples, and decided to give the Loreal version a try, because I know that they both use the same science for their products (Lancome is the high-end brand and Loreal is the "regular") and I have to tell you that the Wal-Mart Loreal version works just as good as the $75 Lancome Nordstrom version.  My skin tone has evened out so much and it has brightened noticeably.  So like I said, even after a month I noticed a difference, but now I am hooked.  Just FYI for anyone interested. 

Another product I've been using for a couple years is for acne and scarring, it has been the only thing that could control my acne.  I have had such good results with it, and I tried getting it from a guy in SF before I left for Bolivia and he told me it sells out a lot because it works so well, he said people should bathe in this stuff.  Anyways it is more for acne and scarring.  IT is called Jan Marini Bioglycolic Acid Face Wash and PCA skin hydrator Plus (phase 6) face cream the packaging just changed to a little pump, not the cream jar.

The Pampa's; preview to the jungle and the Amazon river

 One of my favorite things about 3rd world countries and their rural airports are the fact that the runways are dirt and located in the middle of the jungle usually, covered in mud.  This airplane is abnormally large for such a little airstrip.  but I love it anyways.  If you notice I was wearing a jacket, leggings etc... because La Paz is really cold, but the second they open the cockpit door and you walk out of the plane, in this little city called Rurrenabaque.... the 100% humidity 100 degree weather hits you like a wall of wet sticky yuckiness.... Bolivia’s Amazon Basin is one of the world’s largest intact wilderness areas. The rain-forests, swamps and wetland savannas, through which many rivers flow, combined with many villages make for an awesome adventure. There is a sheer abundance of wildlife, including monkeys, alligators, macaws and  anacondas, piranhas and many types of birds.

 I dislike humidity more than most other things in life.  This picture demonstrates the runway carved out of the jungle and my friends all walking to the jeep for our 3 hour jeep ride to the Amazon river, which proved to be terrible, because there are no such things as paved roads here and it's more like a 3 hour long roller coaster.  Luckily I don't get car sick and don't mind the bumpiness for about 2 1/2 hours.  The heat is what gets to you.

 If you look behind me you will see a sheet of water, this demonstrates the flash rainstorms that come on without warning and leave just as quickly as they arrived.

W

We started our awesome Pamapa's Amazona tour in log canoes, they are essentially really long logs, dug out in the middle with the sides built up.  They made me a bit nervous at first, but our guide, said that it is nearly impossible to capsize them. Next I'm going to share with you many of the awesome animals that I saw along my treck on the river!

 In this photo, if you look really closely you can see the eyes of an alligator, we were in our canoe just slowly moving past it, while his eyes checked us out.

 this bird is very common in the Pampa's it is called Hoatzin or Bird of Paradise

 These two big daddies are called the Amazon King Fishers, very majestic and at least a few feet tall, massive birds!

 This guy is the largest rodent in the world he is called Capybara.  They are essentially large rats, cute little guys right?

So the first day I arrived in Bolivia, I had a meeting with my professor Dr. Lanza and Gonzalo Caure and I asked them "Where can I pet monkeys"  they didn't really have an answer, after that I made it my goal to pet and hold a monkey and if you look at my lap...... ahhhhhh an adorable bright yellow monkey!

NOT ONLY DID I HOLD ONE, THEY CLIMBED ALL OVER ME AND SAT ON MY HEAD.  If you will notice, we are all wearing jackets and long socks etc.... turns out the mosquito's eat you alive there, and our guides failed to tell us to buy DEET, so in the 100 degree 10% humidity we were dressed for the snow.  But worst of all.... these mosquito's EAT THROUGH YOUR PANTS they are genetically evolved to eat through your clothes, you have to drench your clothes in DEET in order to avoid being eaten alive.  Later when we got some DEET we were able to go in swimsuits and not die.... but until then winter in the Amazon!

I KNOW I LOOK LIKE A COMPLETE MANIAC, BUT I WAS REALLY SHOCKED THAT THEY WERE CRAWLING ALL OVER ME, AND THAT THEY WERE SO ADORABLE AND THAT THEY WERE ON MY HEAD!!!

This HOT fella was hanging out by our lodge when we arrived.  We just waited it out in the boat.  It's funny because when we arrived he started walking away and there was a boat of 6 or so people already there just sitting in the boat, and they told us that they thought the Gator was fake, because he didn't move for so long and didn't realize he was real until we pulled up.  They thought their guide was just having them look at a stuffed gator!  Good thing they didn't get out of the boat!

This is a picture of my housing for two days, my cabin is the one on the right.  You have the walk-ways in order to not get wet in the rainy season and avoid the local gator who slept under my house all night long.

Me, And my awesome friend Maria, Justin and Craig enjoying the mosquito's and the sunset!

Finally some shelter from those crazy mosquito's in this mesh "common area" complete with 15 hammocks and you could actually not wear winter-clothing in there.  Pretty awesome, I thought I was going to die from the heat!

One of the activities that you do at night is go Croc and Gator hunting at night.  I got this great picture of a spider eating and spinning it's prey in it's web.

If you look closely in this picture you will see a small glowing light in the top middle of the photo.  That is a Caiman Crocodile.  At night you go in the canoes and search for them in the bushes, by shining you flashlight and it catches the croc's eyes and glows intensely.  I have a lot of these glowing eyeballs.  It's a bit creepy to see them slowly creep back into the shadows and the glowing eyes disappear.

This is me with my night-time alligator neighbor that slept under my house.  Turns out he's pretty friendly and if you feed him chicken you can pet his nose.  Apparently he's a local at this eco-lodge!

The next activity for the next day was my LEAST-FAVORITE although these pictures do not do it justice we went ANACONDA HUNTING. We trekked through a couple miles of marsh-swamp land in galloshes (mine had at least ten holes in them) trying to find them.  We were out there almost three hours  and the mosquitos were insane and it was raining.  As my friend Guy likes to say "We're trying to find the Anaconda's, isn't it the other way around, they are supposed to find us!"  We didn't end up finding any... secretly I was VERY HAPPY THAT WE DIDN'T FIND AN ANACONDA!

NOW THIS PICTURE IS VERY SPECIAL, BECAUSE I WAS ABLE TO CATCH BRIEFLY THE BLOW HOLE OF A PINK DOLPHIN, THEY ARE VERY DIFFICULT TO TAKE PICTURES OF,  it's located to the right of the canoe and looks more like a white frothy thing rather than the blow hole of the dolphin. 

This area with the dolphins is where we went swimming because they scare away the croc's and so it is relatively safe to swim there.  It was so fun and such a neat experience, I never got to actually touch one, sometimes they come up really close to you and nip your feet and play with you, these one's didn't they just swam near us.  The picture above is us hanging onto our canoe and being dragged around by it while swimming.

This adorable guy is called Rutherford (I named him) the Three-Toed-Sloth, he is freakin adorable!

More Rutherford the Sloth!

After our swimming adventures we went to the "futbal field"  where we played a rousing game of soccer, in a half soaked, muddy field along with our friends the Ostriches!!!  I was the only girl that played and I soon realized why many didn't, I was soaked from head to toe in mud.

Here is Me, Justin and Guy's victory shot.  We lost the game 3 to 4 (to the Bolivian's) we were the Gringo's.  I actually made a great goal just before being pummeled into the mud and eating some sort of manure.  I topped it off with a victory mud slide into the goal!!!  I just can't get over our Ostrich team mates though, it was so funny!

My awesome Pampa's Amazona vaccacion ended SOOOOO WELL with a huge bottle of DEET and my good friend the Caiman Crocodile PEPE!!!

Best wishes mi amigos!

Hope you've enjoyed my adventures!

Love, Kim    

Some other animals I met are:
-Howler monkeys

·         Brown capuchin monkey
·         Capybara
·         Pink river dolphin
·         Black caiman
·         Spectacled caiman
·         Yellow spotted river turtle
·         Macaws and parrots
·         Hummingbirds
·         Herons
·         Amazon kingfisher
·         Black vulture
·         Three-toed sloth
·         Red brovker deer
·         Anaconda: 3!
·         Toucans
·         Paradise bird/hoatzin
·         Storks
·         Red cap cardinal and red crested cardinal
·         Turkey vulture