I've made a huge mistake...

So, when Kara left with the car to pick up Marvin (lab jefe) from the highway, and they returned walking to the clinic we were appropriately concerned.  On our drive out to clinic, it had been pouring and we knew that the roads in Palacios would be bad.  We had been warned by previous coordinators who had themselves gotten the car stuck...  Kara did have the bad luck of encountering a tractor on her way back and in her efforts to pull to the side and out of the way, she did not realize how deep the water was there.  Well one thing led to another and her expedition returned to the clinic on foot...

 

 I have to be careful with this blog, since with 6 and a half months remaining in our Bolivian adventure, there is more than enough time for me to create a similar blog-worthy debacle.  What complicated this situation was that there was a visiting endocrinologist, Dr. Terry Unterman, who needed to return to Santa Cruz that afternoon! 

 

Put your back into it...

Dr. Unterman was a good sport--more than happy to help with our collective efforts to pull the car out.  But, as you can see in the above picture, it was really stuck.  We had 4-5 people pulling from the front, we tried pushing it back in reverse, but nothing would work.  Our spirits were beginning to drag...

I wasn't quite ready to joke about our situation...

Fortunately (especially for Dr. Unterman) another tractor happened to come by while we were attempting to free our vehicle.  They were muy amable and offered to help us--they even had a metal chain pull our car out.  The wheels of the tractor give some idea of the force it was able to generate, and we had our coche back in a matter of seconds. 

Gracias para su ayuda!

So Kara was able to take home the title of first coordinator to get the car stuck (this year).  Although I hope we will be able to avoid this scenario, since the rainy season hasn't even started yet--I have some sincere doubts.  Dr. Unterman may have gotten a bit more than he expected with his one day trip to Palacios, but at least he got to go home with a story. 

Empanada Making

Since we have been here we have found out that there are "days" for everything here. Day of the Dogs, Day of the Mujer (lady), Day of the Social Workers, Day of the Students, etc.  Several weeks ago we celebrated "Day of the Doctor" and got up early to make and eat empanadas before clinic.....in reality Mumi had already made the dough and the filling, we just helped to put them together! They were delicious.

You can see the dough Mumi prepared ahead of time...and her adorable granddaughter Ariana

The process begins. Mumi is actually using a pasta maker to roll out the dough.

 My hands, putting the filling of potatoes and chicken into the dough. Interesting fact, notice that the filling is red. However, there is no spice that makes it red, they literally use red food coloring in powder form because it looks boring if its not red. In order for it to be a true empanada here, it has to have the food coloring; if not you will definitely be criticized.

 The process at work, me folding the filled empanada.

 

Probably my best folding job.....looks pretty good. Twong, this reminded me of the day we made dumplings!

 

 Pepe, doing the frying.

 Finished product, golden brown and very tasty

Ready for our pre-clinic feast!

Samaipata

So I just posted all of the photos from Samaipata...we actually visited this town a while ago but never wrote about it.....sorry. I just figured out how to post a lot of pictures quickly to the blog so forgive me because I did not go through the pictures before posting them so there are probably some very boring pictures in this album.
Anyways Samaipata is a small town about 2 and a half hours away from here. The drive there was slightly terrifying at times (also very pretty) considering we were moving along a narrow road curving through the mountains. While there we enjoyed walking around the city and having a very traditional lunch of majadito (a rice dish) and a giant bottle of juice (don't worry we only drank half of it). We then went to visit El Fuerte, a Pre-Inca and Incan archeological site very close to Samaipata.

4. samiapata

Click here to view these pictures larger

PT stuff

Sorry for the delay with the updates!
Some PT stuff:
Fanny, the young woman with the fractured hip is scheduled to have surgery October 18th! Right now, we are continuing to work on strengthening, balance, and endurance (especially in regards to safely walking longer distances with the crutches). I'm able to see her 2-4 times every week and she has been doing a lot on her own as well. And her new baby is growing so fast; she's two months old now and has the biggest eyes. It is so easy to make her smile and she always watches me when I am there.. It's been a really cool experience for me getting to know Fanny and her family; because I see Fanny at her house I'm able to spend time with her kids as well and get a better idea of what their life is like. Definatley gives me an idea of what Home Health PT is like. And Fanny's two year old son Pablito is adorable! Normally I have no idea what he is saying and half the time I think he is scared of me but the other half of the time he takes me around their house and takes me to the fruit trees in their backyard. The other day when I was there he had his mom help him take off his shirt, said he wanted to take a bath and then ran out the back door. The next thing we know he comes running back in butt naked and soaking wet and laughing....apparently he'd jumped under the shower for a minute and then he said he wanted to go down to the stream to bath with the baby ducks (actually I had no idea what he was saying but after about 5 minutes of explaining from Fanny and her mom I finally understood).

In the last two weeks I also have spent time working with a seven year old girl. She broke her arm (distal humerus) in April, had two screws put in, and was immobilized in a cast in elbow flexion for two months. After the cast was removed her elbow was stuck at about a 65 degree flexion angle. She then had an injection and manipulation performed; that enabled her to move to about a 90 degree angle but she still only had about 10 degrees of motion. I worked with her and her mom for about two weeks teaching them stretching and active range of motion exercises as well as performing some mobilizations. She gained about 10-15 degrees of motion but still can only actively move about 20 degrees. I think that she would benefit from a dynamic splint but I don't know if we are going to be able to get her one. In the meantime her mom was educated on the need to stretch her elbow multiple times a day for increased amounts of time. She is actually related to Fanny as well (I think everyone in Palacios is related somehow) and it worked out well because at times I would go see her in her house after seeing Fanny; again it was really cool to be able to visit them in their homes and see more of the community.

There is also a young boy who I think has CP, spastic quadriplegia. His mom and he were supposed to come to the clinic today but for some reason they couldn't. I am going to try to visit them in the next several weeks and hopefully talk to the social worker about getting him a better wheelchair.

And during the clinic day I am seeing many patients with adhesive capsulitis, chronic back pain, chronic shoulder pain, chronic pain all over their body! I need your skills Tricia! I'm still trying to figure out the best way to see patients at the clinic; it's tough to know if I should get the patients that look like they need therapy before they see the doctor or wait until they finish with the doctor and have the doctors send them to me....so some days I'm pretty busy and other days I don't really have any patients to see.

Greetings From Bolivia!!!

It has been a busy couple weeks at Centro Medico, capped off with seeing 40 patients yesterday!  We are all starting to get comfortable with our roles in the clinic.  There have been some interesting patients--ranging from diagnosing a new-found stenotic valve in one of our patients to draining a nasty bacterial abscess in another.  Most of the patients are coming for follow-up management of chronic problems (lots of diabetes/high blood pressure/high cholesterol...etc), but we also deal with some more complicated problems such as hypothyroid disease and seizure disorders.  Kara has been seeing a couple patients everyday, although it can be difficult to decide who can really benefit from Physical Therapy as almost every patient complains of some form of chronic pain.  She has also been doing home visits most days to Fanny--the woman in Palacios who broke her hip while pregnant.  Fanny has been making wonderful progress.  When Kara started she could hardly sit up in bed.  Now she is able to stand up and balance on her good leg and even walk with crutches!  We are excited because she is meeting soon with her surgeon to plan her next surgery.  Hopefully it will be soon, so that Kara will be able to assist with her post-surgical rehabilitation.

 

 Rebecca and I getting ready for our first patient.  Nice morning hair. 

Kara with Fanny: Hard at work building up strength!

Walking with crutches for the 1st time!

On other important fronts, I shaved off my bigote/mustache...which I know must upset most of our readers.  I'm biding my time to give the beard another go.  More updates to follow.  

 

 In the mean time, one for the memories...

In Santa Cruz, we have been going to our local park where there are basketball hoops--but of course everybody plays soccer on the court!  We had a bit of a scare last weekend.  After shooting around for a half-hour Kara and I were about to leave.  That is when Kara saw a group of tree trunks lined up together--begging to be skipped across.  Needless to say, the first trunk was not as sturdily planted to the ground as one would have imagined.  Kara never made it to the second trunk as her leg came out from under her and her thigh crashed into trunk.  It was one of those terrible moments where you have to stop yourself from chuckling as you realize that your companion may be seriously injured.  She turned pale white and was even on the verge of vomiting.  After resting for 15-20 minutes, she was able to make the walk back to the house.  She recovered well and was walking with a minimal limp the days after the fall.  As the picture shows, she is currently holding the honors for most impressive bruise in Bolivia.  Im not sure if she even told her parents yet, so Marty and Vicki, you don't need to worry she is doing fine. 

 Yikes.  Glad you are okay Kara

Life at the clinic is surprisingly busy.  We often go for runs in the morning, to avoid the heat and humidity.  Then we drive to Palacios to pick up Mumi (the woman who looks after the clinic and cooks meals for the staff), Vicky (one of the health promoters who is our active nurse because Guinda is pregnant), and Chaobella (one of the laboratory technicians).  Patients show up anytime in the morning, but the clinic starts at 9 o clock.  Vicky checks patients in and takes their vitals.  Usually the physician (either Dr. Vargas or Dr. Guerero) doesn’t show up until 10ish.  Rebecca (the other med student coordinator) and I start seeing patients a little after 9 so that we will have a patient or two to staff with the physician when they arrive.  Clinic lasts anywhere from 3-8 hours depending on how many patients show up.  After clinic, we try and get some studying done—Spanish, medicine, physical therapy, etc.  But we always make some time for a game of futbol or futbol-tenis with Don Pepe (the man who stays with us at the clinic during the week, Mumis esposo) and Alec (the pharmacist at the clinic and Mumi and Pepe’s hijo).  As coordinators we are in charge of cooking dinner for whoever is staying out there at the clinic.  I must say last week’s menu was pretty impressive: Chicken fajitas with guacamole, baked potatos with chorizo, and a baked pasta with vegetables.  I even whipped up the semi-famous Schuler-Murray Curry Chicken recipe last week.  Knocked our Bolivian hosts calcitines (socks) off!  Muy Rico…

 Reigning Champs of Futbol Tenis--mostly due to Don Pepe's fine work from the back line

 Padre-Hijo header battle at the net. 

 DJ--the clinic perro, taking it easy

 Grace with Mathew, one of Mumi and Pepe's grandchildren. 

 Look out Palacios, K O'Malley getting comfy with the stick shift

 Fanny's beautiful family

 La Cena is on the way...

We celebrated a couple birthdays at the end of August.  Mumi and Chaobella were our August birthdays and we had a little party after finishing clinic.  We sang in Spanish and then English—all the coordinators still need to work on the lyrics in Spanish I’m afraid.  As Bolivian tradition dictates, Mumi and Chaobella both had their faces shoved into their pieces of cake.  We now know to be cautious on our own cumpleanos…

 

 Cumpleanos Feliz!

Sunset in Palacios

We are currently back in Santa Cruz.  Sunday is our day off as nothing is open in the city.  This is the first week of the NFL, and I am dismayed to find that despite out 72 channel cable, I can’t find the Bears game.  Kara and Grace are going into the city for frozen yogurt and said that they would look for a bar with some football on.  We will be cheering for Andy Murray tomorrow, but I’m not getting my hopes up.  Followed the Skers game online to a tough loss—of course Alabama wins easily.  It looks like it could be a difficult year for me rooting for our mediocre Cornhuskers while Kara gets to cheer on the Tide as they roll over their opponents.  Oh well.  

We hope all is well with all of our friends and family in Chicago, Mobile, Omaha, and elsewhere.  Already looking forward to our visit in December/January. 

Fun

What we do in our free time?

Rebecca, one of the other coordinators is also keeping a blog this year
http://rinbolivia.tumblr.com/

More at the Clinic

Although we are still working on completing our papers for our temporary residence, in the last three weeks we have been able to spend more time working at the clinic and beginning our job as coordinators. Rebecca and Grace are both here too so now all 4 of us can begin working together. This weekend we went out to the clinic for a couple of days to complete an inventory during the days the clinic was closed.

No escaping them...on the drive out to clinic we pass through at least 4 toll booths! Thankfully you only have to pay at the first one and show your "ticket" at the others....and as long as you save your ticket you don't have to pay on the way home!

Most of the drive from Santa Cruz to Palacios is on a nice paved road (however some of the road is a one lane highway, to pass you have to go into oncoming traffic...I drove on it yesterday with a stick shift car, somewhat terrifying). However once you near the town we get to drive on this dirt road for about 7 or 8 miles.

Once on the dirt road its very common to see cows or horses right along the side and chickens or dogs in the middle of the road necesitating some honking to get them out of the way

Sign outside of the clinic

 The house we stay in when we are in Palacios is connected to the clinic; the house is the building on the left in this picture; you can see a little of the clinic in the right

Another picture of the property with slightly more of the clinic in view; in the back you can see one of our two horses....although the last time I rode a horse I broke an arm hopefully I'll get to try it soon

For you Donovan; a sign that the horses were on the road....they also leave numerous presents on the soccer field.

A view of the "soccer field," it's pretty nice and Don Pepe said we don't have to really worry about snakes here because it's kept so short; however there is no net in the goal and if you notice the brush behind it is not kept so short....

Some views from inside the clinic

Without patients

The lab; here Marvin can do basic blood and urine tests and take specimens to send to Santa Cruz for additional analysis. We're in the process of trying to find additional supplies for the lab in order to increase the types of tests Marvin can perform....this task is somewhat difficult as one of the chemicals needed is strongly regulated here because it is reportedly used in the production of cocaine

One of the exam rooms; this one also has the EKG machine in it, I'm practicing making sure I get all of the leads in the right place so I can start doing this with patients

One waiting area

In most of the waiting areas there are posters hanging made by health promoters to educate patients on different topics including nutrition, STDs, exercise, etc.

The pharmacy, the jefes wanted us to inventory all of the meds so we spent the last two days counting all of the medications in the clinic; more than 350,000 in total....with 5 people working it took us more than 9 hours to complete....but now we have it!

David hard at work putting the inventory into the computer; on clinic days this is the desk where patients check in with the nurses.