The typical symptoms of Typhoid Fever, according to the CDC, are high fever, stomach pains, and loss of appetite. Aside from moderate stomach pains a few days in the past week, I didn’t really have any of the above indications, but lo and behold, I have Typhoid.
I’ll spare you the moaning and whining about the condition – it suffices to say that I reluctantly decided to go see a doctor today after being nudged by my roommate (who ironically had Typhoid about 3 weeks ago) and parents. I showed up, he looked at my tongue – which is apparently a bit yellow and a good indication of a bacterial infection – and then poked my stomach for a while. 30 minutes later, after a blood test, diagnosis confirmed. I have to go on Ciprofloxacin for 8 days, and I was told not to eat a relatively long list of foods because they will “upset my stomach.” I have to say, some of the items on the list seem awfully random - in addition to no fried foods and alcohol, I’m not supposed to touch peanuts, white bread, avocado, or unpeeled tomatoes. Huh?
More than learning that I have a weird bacterial infection that no one gets in the United States (as my friend Liz pointed out, “You have an Oregon Trail disease! And not a lame one like a broken arm.”), it was interesting to see the incredible contrast between healthcare in this private clinic in the Zona Sur and the Hospital de Clinicas. The difference begins upon walking in – unlike the dark, dirty, undecorated rooms in the Hospital, the waiting room in the “Trauma Klinik” had a formal, glass-fronted reception desk, artwork on the walls, colorful clean couches, and even an elevator.
Beyond the appearances, the treatment was much more informative and personal (obviously) than anything I had seen at the Hospital. The doctor asked me for a full history of my symptoms, which seems to be rare here, and then proceeded to discuss the actually pathology of the infection during the exam. Contrast that with the “get ‘em in, get ‘em out” methodology at the Hospital de Clinicas. Everything was also very fast – I called the doctor on his cellphone this morning to make an appointment, and 2 hours later I was in the exam room. I also had a blood test right after my exam, and the results were ready not 30 minutes later. In the Hospital de Clinicas, doctors evaluate patients for an external consult only when they are in bad shape, and then they often have to wait an entire day before they are seen.
What is most striking to me, however, is the informal way paperwork is done around here. After the exam, the doctor wrote me a prescription on a non-descript piece of paper, and then he gave me a handwritten bill right then and there, cash-only. And there was the same sort of informal system for the laboratory work.
As I was sitting in the clinic, I couldn’t help think to myself about to what level patients are informed of their conditions and tests here. In the Hospital de Clinicas, as I’ve mentioned before, there is a complete lack of communication between doctors and patients. But on the other hand, all of the papers, exam areas, and testing facilities are so visible that if people knew what they were looking at, they could easily get some sort of idea. In this clinic, there was a bit more privacy, but the testing equipment was in the same room as, and in plain eyesight, the room where they took my blood. And in the end, the doctor sat down with me and went over the data, number by number, so that I could actually view the process of making a diagnosis. Then think of the United States, where the exam rooms are completely separate from any of the diagnostic equipment, and patients are supposedly more informed by their doctors, but yet have to rely on hearing the words from a medical professionals mouth instead of viewing actual numbers or data.
In the end, is communication actually that much better in the United States, and how does this communication affect the quality of medical care? And can I only say this because I have had a rigorous education that has not only exposed me to biology and medicine, but has also taught me to question my surroundings?
lunes, 30 de julio de 2007
domingo, 29 de julio de 2007
Concert Part II
The concert was a real riot: the goth-metal-rock venue was located in a community center that usually plays folk music. I arrived a bit early and, as usual, was the only gringo in the place, and the few black-clad people sitting there gave me a look like “What are you doing here?” I ran into a few familiar faces, notably my former roommate Evan, and as we watched the Metallica and Apocalyptica music videos they were playing before the show, I myself was thinking “What am I doing here?”
When the band got on stage, the lead singers were decked out in black corsets, skirts, and commando boots. They played a lot of screaming cover songs, and while my friend Karim looked a bit stiff, the other singer had her curly black hair whipping and her hands writhing through the air (it was a bit cliché). When the next group went onstage I just about lost it – it took me a double take to figure out that the lead singer was, in fact, a man…he had long, straight hair and was wearing a skin-tight full-length strapless pleather dress. To complete the ensemble, he had painted his face white and his eye sockets black, and he was playing a huge white double bass in a rather phallic fashion. I applaud the groups for their enthusiasm, but in a venue with not more than 50 people, it was kind of comedic.
After Evan and I couldn’t bear it anymore, we headed out to my new favorite place in La Paz – it’s a bar/lounge called “Adam’s Rib”, situated in an unmarked, white house at the end of a very, very steep street in Sopocachi. From the outside it looks like a ordinary place, but when you go, after you’re personally greeted by the jolly owner, you’re overwhelmed by the sheer amount of kitsch. Every room in the house has been converted into a makeshift lounge that is decorated with colorful odds and ends that should look tacky, but in combination give the place a charming and unusual feel. We ran into another friend, Dado (who happens to be the AP photographer for La Paz), and ended up chatting until 3:30am, while the resident Siamese cat wandered in and out of the rooms meowing.
Yesterday, on our way up to buy a few DVDs from the electronics market, I paid a visit to my former landlady, Doña Emma, who owns one of the tiendas in the witches market. I brought my 5 gringo friends into the back of her store, which is dark and dusty but filled with thousands of interesting things, where she had us participate in an Aymara misa/ritual. She had a small bowl in the middle of the floor filled with leaves and some sort of liquid, which she lit on fire to form a flaming bowl of incense (which is great for me, being afraid of fire and all). Chanting in a mixture of Aymara and English, she had us sprinkle sand and then some flammable powder on the bowl. After we “washed” or faces and bodies with the flames, we then had to walk over the foot-high flame three times.
During the ceremony she offered us coca leaves, which is chewed along with a burned quinoa paste. As my first time chewing coca (you don’t actually chew it like gum, more let it sit between your back teeth), it was actually quite pleasant – the juices are a bit sweet and have a numbing effect on your mouth. I suppose this weekend in general was a first for coca experiences - at “Adam’s Rib I also tried a coca-infused rum mixed with lemon and some sugary substance. (I’ve also seen fish with coca-cream sauce and coca flour).
When the band got on stage, the lead singers were decked out in black corsets, skirts, and commando boots. They played a lot of screaming cover songs, and while my friend Karim looked a bit stiff, the other singer had her curly black hair whipping and her hands writhing through the air (it was a bit cliché). When the next group went onstage I just about lost it – it took me a double take to figure out that the lead singer was, in fact, a man…he had long, straight hair and was wearing a skin-tight full-length strapless pleather dress. To complete the ensemble, he had painted his face white and his eye sockets black, and he was playing a huge white double bass in a rather phallic fashion. I applaud the groups for their enthusiasm, but in a venue with not more than 50 people, it was kind of comedic.
After Evan and I couldn’t bear it anymore, we headed out to my new favorite place in La Paz – it’s a bar/lounge called “Adam’s Rib”, situated in an unmarked, white house at the end of a very, very steep street in Sopocachi. From the outside it looks like a ordinary place, but when you go, after you’re personally greeted by the jolly owner, you’re overwhelmed by the sheer amount of kitsch. Every room in the house has been converted into a makeshift lounge that is decorated with colorful odds and ends that should look tacky, but in combination give the place a charming and unusual feel. We ran into another friend, Dado (who happens to be the AP photographer for La Paz), and ended up chatting until 3:30am, while the resident Siamese cat wandered in and out of the rooms meowing.
Yesterday, on our way up to buy a few DVDs from the electronics market, I paid a visit to my former landlady, Doña Emma, who owns one of the tiendas in the witches market. I brought my 5 gringo friends into the back of her store, which is dark and dusty but filled with thousands of interesting things, where she had us participate in an Aymara misa/ritual. She had a small bowl in the middle of the floor filled with leaves and some sort of liquid, which she lit on fire to form a flaming bowl of incense (which is great for me, being afraid of fire and all). Chanting in a mixture of Aymara and English, she had us sprinkle sand and then some flammable powder on the bowl. After we “washed” or faces and bodies with the flames, we then had to walk over the foot-high flame three times.
During the ceremony she offered us coca leaves, which is chewed along with a burned quinoa paste. As my first time chewing coca (you don’t actually chew it like gum, more let it sit between your back teeth), it was actually quite pleasant – the juices are a bit sweet and have a numbing effect on your mouth. I suppose this weekend in general was a first for coca experiences - at “Adam’s Rib I also tried a coca-infused rum mixed with lemon and some sugary substance. (I’ve also seen fish with coca-cream sauce and coca flour).
viernes, 27 de julio de 2007
Bolivian Goth-Rock, Ye-uh
Well, I had my first experience with all-out food poisoning here, which was lovely. I spent some time curled up on the floor wanting to die, but all seems to be well now (fingers crossed).
My good friend Karim, a La Paz native, has a rock band named Libellula that is going to going to be putting on a show tonight at a club in Miraflores. It's pretty hilarious (I mean that it an endearing and admiring sort of way) - it's a group of middle-aged women who all love classic rock bands like Guns N' Roses, Led Zeppelin, The Cure, etc., and they play covers of hard-core, goth-rock music. I think many of them are involved in video productions in La Paz, so they made a music video (complete with a "Making of" documentary). It was filmed in the Valley de La Luna, and all of them are wearing dark red lipstick, heavy black eye-makeup, corsets, and black leather boot. Amazing.
During my first week here, Karim invited me to a dinner at the drummer's house, where I had a Bolivian version of Lasagna and was introduced to the chicas of the band. They sat around in her living room, chain-smoking, eating, and singing along to Matchbox 20. The word to describe it here is "chistoso", which roughly means funny but has more of an endearing, joking connotation.
I was originally going to play violin with them for one or two songs, but that sort of fell through when I sat in on one of their rehearsals (in a tiny, tiny room with the amps blaring and the drums blasting), and realized that my poor little violin would be completely overwhelmed by their sound. So I guess I'll have to put my dreams of being a goth-rock violinist on hold for the time being, and settle for watching their show. More to come later...
My good friend Karim, a La Paz native, has a rock band named Libellula that is going to going to be putting on a show tonight at a club in Miraflores. It's pretty hilarious (I mean that it an endearing and admiring sort of way) - it's a group of middle-aged women who all love classic rock bands like Guns N' Roses, Led Zeppelin, The Cure, etc., and they play covers of hard-core, goth-rock music. I think many of them are involved in video productions in La Paz, so they made a music video (complete with a "Making of" documentary). It was filmed in the Valley de La Luna, and all of them are wearing dark red lipstick, heavy black eye-makeup, corsets, and black leather boot. Amazing.
During my first week here, Karim invited me to a dinner at the drummer's house, where I had a Bolivian version of Lasagna and was introduced to the chicas of the band. They sat around in her living room, chain-smoking, eating, and singing along to Matchbox 20. The word to describe it here is "chistoso", which roughly means funny but has more of an endearing, joking connotation.
I was originally going to play violin with them for one or two songs, but that sort of fell through when I sat in on one of their rehearsals (in a tiny, tiny room with the amps blaring and the drums blasting), and realized that my poor little violin would be completely overwhelmed by their sound. So I guess I'll have to put my dreams of being a goth-rock violinist on hold for the time being, and settle for watching their show. More to come later...
miércoles, 25 de julio de 2007
Everybody Dies
Patient #10 - Female, 52 Years
Diagnosis: renal insufficiency secondary to sepsis, chronic gastroenteritis, hydroelectric disequilibrium, moderate anemia
As I was waiting for the interns to finish their morning paperwork (there’s a flurry of activity as they rush to finish the clinical evolutions from the past day and distribute all of the charts and relevant materials to the beds), I was wandering around the ward looking at the patients and trying to figure out how to occupy my time. I glanced at the woman in bed #10, and I saw her on her back with her mouth open, not really moving. I thought to myself "Hmmmm, she doesn’t look so good, in fact she sort of looks dead...no, it can’t be, they’re keeping an eye on her." And I continued on my merry way.
10 minutes later I came back to the ward, and the woman was on the floor surrounded by several doctors and nurses. Her mouth was still wide open, exposing all of her teeth, as the doctors took turns trying to resuscitate her by pumping her chest. There was no machine keeping track of her heart, there was no defibrillator, and there wasn’t an oxygen mask ready at hand. Everything seemed rather haphazard. They spent more than 15 minutes trying to bring her back when I was standing there thinking "She’s dead, I saw her like that more than 20 minutes ago. " There were a lot of thoughts rushing through my head, but I couldn't help but wonder if I could have prevented her death if I had said something earlier? Is it even my job to be keeping track of that, and shouldn’t someone have been keeping a closer eye on her?
As I was standing there watching them pump her chest, her limp body moving back and forth, they asked me to help... my immediate, panicked reply was ¨I can’t, I don’t know how.¨ While it was partly true, I think I was also afraid to get close to a dead body. All of my experiences thus far have involved some degree of separation from sickness and death, and that was so real and so accessible. After I said that I was mad at myself for turning down the first opportunity to help someone hands-on. Why did I do that?
When they realized they couldn’t bring her back, they wrapped her up in a sheet, leaving half of her face with its wide eyes and open mouth still showing, and they left her lying on the floor for another 20 minutes while they went to look for a dolly to take her away. They finally wheeled one out of the back, placed her on it, and then left it in the corridor outside of the interns´ room while they called the family and cleaned up her bed. The poor girl who was sharing her habitation was sitting in a chair next to the desk, hugging a raggedy stuffed animal. I asked her if she was okay, and she said yes...and explained how one moment the woman was breathing, and then she just stopped.
I’m surprised that I’m not more disturbed by this. Even though this is the first time I have ever seen a dead person, more than horrified, I was fascinated by the process of trying to bring her back. The only explanation I can find for how I feel is that I didn’t see her dying, and that she seemed so dead to me during the whole ordeal that I could file it away nicely in my brain as something that had ceased to be human.
martes, 24 de julio de 2007
Following the Interns
I went to work yesterday to talk to Dr. Revollo, the head of the Unidad de Infectologia, to receive an official introduction to the new interns in the unit. To my surprise, he suggested that I go find the two Claudias in their new section - a combination of Cardiology, Nephrology, and Gastroenterology - because it would interesting to see different types of patients. I tracked the building down all the way on the other side of the Hospital campus, only to find that in contrast to the complete lack of privacy and security in Infectologia, this area had a locked front gate controlling access to the wards. After waiting at the gate for a few minutes I flagged down one of the Claudias, who then introduced me to one of the Jefe's, a very cold and intimidating man compared to the jolly and "chistoso" (funny) Dr. Revollo. After a bit of explaining, and more due to the fact that I have white skin and blond hair, he told me that I was allowed to follow them around, but that I had absolutely "no responsibilities".
This area of the Hospital is completely different from the Unidad de Infectologia. The building gets a lot more light, which not only makes the wards warmer, but also gives them the allusion of being cleaner. Instead of dormitory-style beds, there are partitions separating every two patients, and the blankets on the beds are actually embroidered with the hospital logo. There is a reception desk with a centralized location (at least nominally) for the patient charts and paperwork. In general, there is much more of a flurry of activity - more nurses, more doctors, and much fewer visitors. It's kind of ironic that access to the patients with heart and kidney problems is strictly controlled, while access to tuberculosis and AIDS patients is not.
My day itself was kind of boring, because I ended up following Claudia #1 around while she filled out paperwork and accompanied the Jefe's on rotations. This is especially hard because the doctors rattle off a string of clinical indications that I have never heard of...but at least I was inspired to go home and look up things like renal tuberculosis, uremia, and congestive heart failure.
On a completely unrelated note, I have a few yummy recipes to share...of course with slight modifications. Saturday night I made tortilla soup (with corn added in), and also zesty quinoa (with apples and zuchinni because I couldn't find sundried tomatoes.) Also, last night we had avocado enchiladas with a mexican chili sauce and sprinkled with cheese. The tortillas were a bit mushy because we didn't fry them before baking them, so if you don't mind extra oil I would recommend that. Serve them with black beans, rice, salad, and a nice glass of red wine.
This area of the Hospital is completely different from the Unidad de Infectologia. The building gets a lot more light, which not only makes the wards warmer, but also gives them the allusion of being cleaner. Instead of dormitory-style beds, there are partitions separating every two patients, and the blankets on the beds are actually embroidered with the hospital logo. There is a reception desk with a centralized location (at least nominally) for the patient charts and paperwork. In general, there is much more of a flurry of activity - more nurses, more doctors, and much fewer visitors. It's kind of ironic that access to the patients with heart and kidney problems is strictly controlled, while access to tuberculosis and AIDS patients is not.
My day itself was kind of boring, because I ended up following Claudia #1 around while she filled out paperwork and accompanied the Jefe's on rotations. This is especially hard because the doctors rattle off a string of clinical indications that I have never heard of...but at least I was inspired to go home and look up things like renal tuberculosis, uremia, and congestive heart failure.
On a completely unrelated note, I have a few yummy recipes to share...of course with slight modifications. Saturday night I made tortilla soup (with corn added in), and also zesty quinoa (with apples and zuchinni because I couldn't find sundried tomatoes.) Also, last night we had avocado enchiladas with a mexican chili sauce and sprinkled with cheese. The tortillas were a bit mushy because we didn't fry them before baking them, so if you don't mind extra oil I would recommend that. Serve them with black beans, rice, salad, and a nice glass of red wine.
domingo, 22 de julio de 2007
Journey to the Outskirts
Today my friend Rossana took me for a ride in her car (no taxis or minibuses, what a treat) to see the outskirts of La Paz. We didn’t go as far as the areas that are considered the “campo,” where I’ve heard that the poverty and landscapes are truly shocking, but we did drive about an hour outside of the city proper, quite far enough for me to be stunned by the landscapes. On the road that winds down from Sopocachi you pass through the various “barrios” of the Zona Sur, and then as you head past Mallasa and the Valle de la Luna the road starts to get a little bit worn, with increasing numbers of potholes and sections of gravel.
The lower areas afford a better glimpse of the surrounding mountains and hills, and they are unlike any rock formation I have ever seen. Here’s my geeky geologist side surfacing: the bright red, orange, and pink stones (as you can sort-of see from the pictures of the Valle de la Luna) jut into the dazzlingly blue sky in ragged formations of what looks like sandstone. There are houses and little tiendas dotting the sides of the road, perched alongside crumbling rock formations that look like they are made of rough cement. It’s some bizarre mix of desert and barren forests - as the road winds up and down the hills, on one side you have cacti and on the other patches of bright green growing alongside the numerous streams. Some of the hills remind me the badlands of the Southwestern United States or of the weird Hoodoo rock formations in Southern Alberta. But here everything is so much more dramatic. It’s unfortunate that I didn’t have my camera, because my words just can’t do it justice.
Rossana took me to a really great restaurant along the side of the road, which I suppose serves a mixture of “comida típica” and more international entrees. The restaurant itself was an enclosed courtyard, which provided a respite from the dusty road, and as we sat down we were immediately served what looked like a tiny glass of orange juice, but turned out to be something like a Bolivian version of a screwdriver, de gratis. I’ve taken to ordering fish at Bolivian restaurants because being a vegetarian means eating overcooked pasta, French fries, or a salad that has a good chance of making you sick. I ordered the “Trucha a la diabla,” trout from Lake Titicaca in a spicy tomato sauce served with French fries, “arroz chino” (white rice), and salad. The trout, which is a Bolivian specialty, was delicious and tasted surprisingly like salmon (it had the pink color and all). Rossana ordered a typical dish that turned out to be a huge hunk of roasted pork (about 1/ 2 the size of a football) perched on top of sweet potato, an ear of “chuño” (corn), and a roasted plantain…with a salad on the side. I have never seen so much food in my life for $4.50.
On the way back Rossana gave me a tour of the distinct parts of the Zona Sur, which gave me more of an understanding of quite how different the suburbs are form the rest of the city, or say, El Alto. Even more so than the houses I talked about and photographed in Obrajes (where USAID is located), the houses in the more isolated parts of the Zona Sur are huge and stunningly beautiful. While some of them appear to be copies of the ugly modern architecture in the suburbs of the United States, others are colorful and full of character. Every now and then we would catch a whiff of the rivers, open sewage systems, running alongside these ritzy neighborhoods. The terrain is so much more exposed than in the city – you can actually see the jutting cliffs and how the houses have (for the most part) been made to adapt to the ups and downs of the land.
But the Zona Sur really bothers me, not so much because it is a deliberate display of wealth (the people have lighter skin, wear fashionable clothing, and their own sets of stores), but more so because it is an obvious attempt to be separate from the rest of the city. I became almost angry when I saw the Colegio Alemán and the Club Alemán. It’s a very pretty compound - it has patches of green grass, a pool, and beautiful buildings – but more than anything it seemed like a snobby attempt to be isolated from the vibrant culture of La Paz. I suppose I don’t understand what people are thinking when they build a replica of a German institution and when they work so hard to defeat the natural beauty of the land…when the whole point of being a foreigner in a country like Bolivia is (or should be) cultural exchange. After seeing this, I have a better understanding of the signs like “The rich are crying…” that I saw at the Cabildo in El Alto.
The lower areas afford a better glimpse of the surrounding mountains and hills, and they are unlike any rock formation I have ever seen. Here’s my geeky geologist side surfacing: the bright red, orange, and pink stones (as you can sort-of see from the pictures of the Valle de la Luna) jut into the dazzlingly blue sky in ragged formations of what looks like sandstone. There are houses and little tiendas dotting the sides of the road, perched alongside crumbling rock formations that look like they are made of rough cement. It’s some bizarre mix of desert and barren forests - as the road winds up and down the hills, on one side you have cacti and on the other patches of bright green growing alongside the numerous streams. Some of the hills remind me the badlands of the Southwestern United States or of the weird Hoodoo rock formations in Southern Alberta. But here everything is so much more dramatic. It’s unfortunate that I didn’t have my camera, because my words just can’t do it justice.
Rossana took me to a really great restaurant along the side of the road, which I suppose serves a mixture of “comida típica” and more international entrees. The restaurant itself was an enclosed courtyard, which provided a respite from the dusty road, and as we sat down we were immediately served what looked like a tiny glass of orange juice, but turned out to be something like a Bolivian version of a screwdriver, de gratis. I’ve taken to ordering fish at Bolivian restaurants because being a vegetarian means eating overcooked pasta, French fries, or a salad that has a good chance of making you sick. I ordered the “Trucha a la diabla,” trout from Lake Titicaca in a spicy tomato sauce served with French fries, “arroz chino” (white rice), and salad. The trout, which is a Bolivian specialty, was delicious and tasted surprisingly like salmon (it had the pink color and all). Rossana ordered a typical dish that turned out to be a huge hunk of roasted pork (about 1/ 2 the size of a football) perched on top of sweet potato, an ear of “chuño” (corn), and a roasted plantain…with a salad on the side. I have never seen so much food in my life for $4.50.
On the way back Rossana gave me a tour of the distinct parts of the Zona Sur, which gave me more of an understanding of quite how different the suburbs are form the rest of the city, or say, El Alto. Even more so than the houses I talked about and photographed in Obrajes (where USAID is located), the houses in the more isolated parts of the Zona Sur are huge and stunningly beautiful. While some of them appear to be copies of the ugly modern architecture in the suburbs of the United States, others are colorful and full of character. Every now and then we would catch a whiff of the rivers, open sewage systems, running alongside these ritzy neighborhoods. The terrain is so much more exposed than in the city – you can actually see the jutting cliffs and how the houses have (for the most part) been made to adapt to the ups and downs of the land.
But the Zona Sur really bothers me, not so much because it is a deliberate display of wealth (the people have lighter skin, wear fashionable clothing, and their own sets of stores), but more so because it is an obvious attempt to be separate from the rest of the city. I became almost angry when I saw the Colegio Alemán and the Club Alemán. It’s a very pretty compound - it has patches of green grass, a pool, and beautiful buildings – but more than anything it seemed like a snobby attempt to be isolated from the vibrant culture of La Paz. I suppose I don’t understand what people are thinking when they build a replica of a German institution and when they work so hard to defeat the natural beauty of the land…when the whole point of being a foreigner in a country like Bolivia is (or should be) cultural exchange. After seeing this, I have a better understanding of the signs like “The rich are crying…” that I saw at the Cabildo in El Alto.
viernes, 20 de julio de 2007
The Cabildo in El Alto
Everything is closed today. The city is even more deserted than it was on the 16th of July, La Paz Independence Day, because today is the Cabildo, the meeting held in El Alto to protest the possibly movement of the seat of the government (administrative capital) from La Paz to Sucre. The hospital was eerily quiet - the Claudias and a few nurses were the only people I could find – and there were no mini-buses sputtering up and down the streets. Because it seemed like the whole city was in El Alto, Alison (my roommate) and I decided to head up to the Cabildo to check out the scene. The speeches were scheduled to start at 1:00, but because people from all over the Department of La Paz (which includes La Paz, El Alto, Lake Titicaca, and the neighboring mountains) had come to the meeting, the streets in and around El Alto were completely packed as early as 11:00, making it very hard to get near the action.
We found a trustworthy taxi to take us up the “back way,” which instead of the highway-like Autopista is a set of narrow and mostly cobblestone streets that wind through the heights of Sopocachi Alto. It’s actually the same route that the taxi used to take me from the El Alto airport to the city center when I first arrived, and the trip was just as stunning in the daylight. The taxi took us as close as he could get to the center of the Ceja, the center area of the Cabildo, and we (surprisingly) only had to walk about 5 blocks until we were fully immersed in the horde of people gathered around the platform and cheering on the speakers.
It was a fascinating experience being in the middle of not only a political, but also a cultural rally. Situating the administrative capital in La Paz, with its location in the Andes and with it’s heavily Aymara population, is symbolic of the political and cultural importance of the indigenous people. After the election of Evo Morales, who is the country’s first Aymara president, for the first time in the history of Bolivia the indigenous people (who only received voting and land-owning rights in the 1950s) seem to have representation and recognition in the government. Also, the decision to hold the Cabildo in El Alto is meaningful because La Paz’s sister city is considered the indigenous capital of Bolivia, further emphasizing the importance of the indigenous community. If the administrative capital were moved to Sucre, which is in the south of the country, I think many people in La Paz and El Alto feel that the newfound appreciation of indigenous rights and culture would disappear.
[People cheering as a helicopter, possibly with Evo Morales in it, flew by]
[“In Defense of the Department of La Paz: The Seat of the Government Will Not Be Moved”]
[Flag of the Aymara Nation]
[“The Rich Also Cry: They Can’t Govern Us Anymore”]
Being one of only two white people walking through the streets of a completely indigenous community, I sensed an interesting mixture of curiosity and also hostility. People all around me were looking at me with such scrutiny that it was impossible not to feel subconscious. Some people would shyly smile, while others would snidely call us “gringas” under their breath. When one woman saw me with my camera, she grabbed my arm and started to yell at me in Aymara (I think that some indigenous people believe that cameras and photography can steal their soul). When we were sandwiched in the middle of the crowd, most of the people were paying more attention to us, trying to figure out what we were doing holding Bolivian flags in the middle of the Cabildo, than they were to the political speakers.
I know that these people have an incredibly history of oppression, but it really bothers me that foreigners are consistently treated with such hostility. I guess I just don't understand how there can be such malice when we are clearly there to appreciate the politics and indigenous presence of the country.
We found a trustworthy taxi to take us up the “back way,” which instead of the highway-like Autopista is a set of narrow and mostly cobblestone streets that wind through the heights of Sopocachi Alto. It’s actually the same route that the taxi used to take me from the El Alto airport to the city center when I first arrived, and the trip was just as stunning in the daylight. The taxi took us as close as he could get to the center of the Ceja, the center area of the Cabildo, and we (surprisingly) only had to walk about 5 blocks until we were fully immersed in the horde of people gathered around the platform and cheering on the speakers.
It was a fascinating experience being in the middle of not only a political, but also a cultural rally. Situating the administrative capital in La Paz, with its location in the Andes and with it’s heavily Aymara population, is symbolic of the political and cultural importance of the indigenous people. After the election of Evo Morales, who is the country’s first Aymara president, for the first time in the history of Bolivia the indigenous people (who only received voting and land-owning rights in the 1950s) seem to have representation and recognition in the government. Also, the decision to hold the Cabildo in El Alto is meaningful because La Paz’s sister city is considered the indigenous capital of Bolivia, further emphasizing the importance of the indigenous community. If the administrative capital were moved to Sucre, which is in the south of the country, I think many people in La Paz and El Alto feel that the newfound appreciation of indigenous rights and culture would disappear.
[People cheering as a helicopter, possibly with Evo Morales in it, flew by]
[“In Defense of the Department of La Paz: The Seat of the Government Will Not Be Moved”]
[Flag of the Aymara Nation]
[“The Rich Also Cry: They Can’t Govern Us Anymore”]
Being one of only two white people walking through the streets of a completely indigenous community, I sensed an interesting mixture of curiosity and also hostility. People all around me were looking at me with such scrutiny that it was impossible not to feel subconscious. Some people would shyly smile, while others would snidely call us “gringas” under their breath. When one woman saw me with my camera, she grabbed my arm and started to yell at me in Aymara (I think that some indigenous people believe that cameras and photography can steal their soul). When we were sandwiched in the middle of the crowd, most of the people were paying more attention to us, trying to figure out what we were doing holding Bolivian flags in the middle of the Cabildo, than they were to the political speakers.
I know that these people have an incredibly history of oppression, but it really bothers me that foreigners are consistently treated with such hostility. I guess I just don't understand how there can be such malice when we are clearly there to appreciate the politics and indigenous presence of the country.
jueves, 19 de julio de 2007
The Cost of Medical Care
I found out today that my interns, the Claudias, are moving to another unit tomorrow after a 20 day stay in the Unidad de Infectoligia. At first I was quite worried, thinking "How am I going to deal with this, the reason I enjoy work right now is because I like the two girls so much, oy oy oy..." But I've adopted a "this is the way things work" attitude in my time here, since the decision about whether I follow the chicas to their next assignment or stay in my current unit is out of my hands. It's just that it's hard to have to build a relationship with two new interns, especially after I was just getting close to these two. Oh well.
Today I was asking Claudia #1 a little bit about how the healthcare system works. As I've been stressing over and over again, the Hospital de Clinicas treats the poorer people in the system, and it functions as a sort of social welfare system. This is reflected both in the cost and quality of treatment. Apparently, if patients do not have "seguro" (insurance) it costs them *ba dum ching* 20Bs per day to be interned in the ward. For those not familiar with the conversion, that's about $2.5 a day. I know that the cost required of patients does not amount to the cost spent on a patient, but I was doing a bit of research, and the cost per patient per day in U.S. hospital is more than $1000 a day, on average, and for patients with bedsores it is more than $2000. I can't find the cost per patient per day for the Bolivia hospitals, but I can guess that it's around $50 a day. (This website indicates the cost per patient per day in countries such as Tanzania, Kenya, and India is less than $20 a day.)
Also, today when I stopped in for a brief chat with Dr. Revollo, he said his usual "Ohhhh Nadine, deliciosa!" and then followed it immediately with "Did you eat some seafood with garlic last night? I can smell it!" I had to stop and think for a minute, and then remembered that I'd made and eaten roasted garlic. Embarrassed, I told him "Yes, but I brushed my teeth?" He just smiled and said "It's in the blood."
Today I was asking Claudia #1 a little bit about how the healthcare system works. As I've been stressing over and over again, the Hospital de Clinicas treats the poorer people in the system, and it functions as a sort of social welfare system. This is reflected both in the cost and quality of treatment. Apparently, if patients do not have "seguro" (insurance) it costs them *ba dum ching* 20Bs per day to be interned in the ward. For those not familiar with the conversion, that's about $2.5 a day. I know that the cost required of patients does not amount to the cost spent on a patient, but I was doing a bit of research, and the cost per patient per day in U.S. hospital is more than $1000 a day, on average, and for patients with bedsores it is more than $2000. I can't find the cost per patient per day for the Bolivia hospitals, but I can guess that it's around $50 a day. (This website indicates the cost per patient per day in countries such as Tanzania, Kenya, and India is less than $20 a day.)
Also, today when I stopped in for a brief chat with Dr. Revollo, he said his usual "Ohhhh Nadine, deliciosa!" and then followed it immediately with "Did you eat some seafood with garlic last night? I can smell it!" I had to stop and think for a minute, and then remembered that I'd made and eaten roasted garlic. Embarrassed, I told him "Yes, but I brushed my teeth?" He just smiled and said "It's in the blood."
miércoles, 18 de julio de 2007
The Socioeconomics of Healthcare
Now that I've been working long enough at both the Hospital de Clinicas and the Hospital Militar to get over the initial shock value and start to observe interesting things about the patients, I've begun to realize quite how different the two institutions are. Both are governmental institutions (not private), but there are a few key differences. The Hospital de Clinicas treats the poorest patients in La Paz and El Alto, and it seems that most patients (understandably) use it as a last resort for medical treatment...which also means that most of the illnesses are quite grave by the time they are treated. The Hospital Militar, in contrast, is open to members of the military and their extended families.
Most strikingly is how differently the patients dress in each institution. In the Hospital de Clinicas the people dress in the “indigenous style” (forgive my crudeness, I don’t know how else to describe it) – the women wear the clothing typical of cholitas, and the men wear simple pants and sweaters. There is no makeup, and things are often worn, stained, or torn. In addition, people bring their snacks or chores (the sister of one patient brings her knitting every day) to the waiting room. In the Hospital Militar, the women wear paint suits and makeup, and they dye their hair, while the men wear nice suits or military uniforms and have shiny leather shoes. Interestingly, the Spanish is also a lot easier to understand in the Hospital Militar, probably because it has less of an Aymaran accent.
It’s kind of interesting to think about how in one place I’m seeing a woman with peritoneal (abdominal) tuberculosis, while in the other I’m seeing a little boy who has a wart on his hand. I’m sure there are areas of the Hospital Militar with more serious infections, but compared to the Hospital de Clinicas it feels like a walk in the park. For example, today a mother brought in her 6 year old boy who had some sort of viral warts or pox in the interior of his bottom, and for treatment (they’re contagious I think) they had to be removed one-by-one with a pair of tweezers. This involved having the boy lay down on his stomach with his pants pulled down as the nurse attempted to anesthetize his bottom. His mother was telling him that it wouldn’t hurt at all, but as soon as he felt that needle, he started crying, screaming, and clenching the muscles in his bottom. “Tengo miedo de las agudas, quiero ir a casa AHORA!” (I’m afraid of needles, I want to go home NOW!) I felt genuinely sorry for him, because until recently I’ve had a mortal fear of needles (along with fire), and I always hated when doctors would tell me that the needle wouldn’t hurt when it was always extremely unpleasant. But at the same time, the situation was inherently funny – here were the nurses wrestling with this little boy’s clenched but muscles while his mother told him to stop crying. I didn’t know whether to cry from sympathy or burst out laughing.
I find it hard to take an episode like that seriously after treating infected bedsores.
Most strikingly is how differently the patients dress in each institution. In the Hospital de Clinicas the people dress in the “indigenous style” (forgive my crudeness, I don’t know how else to describe it) – the women wear the clothing typical of cholitas, and the men wear simple pants and sweaters. There is no makeup, and things are often worn, stained, or torn. In addition, people bring their snacks or chores (the sister of one patient brings her knitting every day) to the waiting room. In the Hospital Militar, the women wear paint suits and makeup, and they dye their hair, while the men wear nice suits or military uniforms and have shiny leather shoes. Interestingly, the Spanish is also a lot easier to understand in the Hospital Militar, probably because it has less of an Aymaran accent.
It’s kind of interesting to think about how in one place I’m seeing a woman with peritoneal (abdominal) tuberculosis, while in the other I’m seeing a little boy who has a wart on his hand. I’m sure there are areas of the Hospital Militar with more serious infections, but compared to the Hospital de Clinicas it feels like a walk in the park. For example, today a mother brought in her 6 year old boy who had some sort of viral warts or pox in the interior of his bottom, and for treatment (they’re contagious I think) they had to be removed one-by-one with a pair of tweezers. This involved having the boy lay down on his stomach with his pants pulled down as the nurse attempted to anesthetize his bottom. His mother was telling him that it wouldn’t hurt at all, but as soon as he felt that needle, he started crying, screaming, and clenching the muscles in his bottom. “Tengo miedo de las agudas, quiero ir a casa AHORA!” (I’m afraid of needles, I want to go home NOW!) I felt genuinely sorry for him, because until recently I’ve had a mortal fear of needles (along with fire), and I always hated when doctors would tell me that the needle wouldn’t hurt when it was always extremely unpleasant. But at the same time, the situation was inherently funny – here were the nurses wrestling with this little boy’s clenched but muscles while his mother told him to stop crying. I didn’t know whether to cry from sympathy or burst out laughing.
I find it hard to take an episode like that seriously after treating infected bedsores.
martes, 17 de julio de 2007
Jail Cell for Rent
Treating that patient from the La Paz jail the other day made me realize that I haven't had the chance to talk about how fascinating the jail system is here. The main jail is called San Pedro, and the BBC did an excellent photojournalism piece on the place not too long ago. Unfortunately my knowledge is pretty limited because it isn’t easily accessibly to foreigners (there are no tours) and because, thankfully, I don’t know anyone who has lived in the jail.
[The Plaza outside of the Jail]
[Family members lined up outside of the main entrance]
[San Pedro Church]
Before I lived in Sopocachi I used to walk by the jail almost every day without realizing it because the area is so well integrated into the rest of La Paz. The building is pretty unremarkable other than the fact that it has no windows, but more striking is the complete absence of extra security precautions. There are no barbed wire fences or control towers, and the only policemen are those stationed right at the front door. Interestingly, most of the street vendors seem to cater to the “jail crowd” and sell significantly more hard alcohol and drinks, as opposed to fresh fruits and vegetables.
The way I understand it (and I’m sure the BBC article explains it much better), is that people go into the jail and are expected to not only pay for their living space, but also all of their provisions. The cells range in cost and quality, and prisoners sometimes resort to bringing their families (especially children) to live with them inside the prison. I don't think there's a security system, so people have to work within the jail to pay for their cell space. I don't understand how prisoners are prevented from escaping to roam the streets.
So just like everything else in Bolivia, the government doesn’t seem to have the resources (or the desire) to provide supplies/services for incarceration. It’s interesting when you think about how much money the United States spends on both medical care for the underprivileged, and on keeping large portions of the urban poor in jails. In addition to wondering how anyone can possibly recover in the Hospital de Clinicas, I’ve been surprised by how much these doctors can do for patients with so little supplies (and for such little cost). I’ve also begun to wonder if there’s some balance point between spending very little on patients and keeping them in the hospital for a long time because they don’t recover, and spending more money and speeding up recovery time. It would be an interesting study…if only La Paz had any sort of data collection system for these things.
[The Plaza outside of the Jail]
[Family members lined up outside of the main entrance]
[San Pedro Church]
Before I lived in Sopocachi I used to walk by the jail almost every day without realizing it because the area is so well integrated into the rest of La Paz. The building is pretty unremarkable other than the fact that it has no windows, but more striking is the complete absence of extra security precautions. There are no barbed wire fences or control towers, and the only policemen are those stationed right at the front door. Interestingly, most of the street vendors seem to cater to the “jail crowd” and sell significantly more hard alcohol and drinks, as opposed to fresh fruits and vegetables.
The way I understand it (and I’m sure the BBC article explains it much better), is that people go into the jail and are expected to not only pay for their living space, but also all of their provisions. The cells range in cost and quality, and prisoners sometimes resort to bringing their families (especially children) to live with them inside the prison. I don't think there's a security system, so people have to work within the jail to pay for their cell space. I don't understand how prisoners are prevented from escaping to roam the streets.
So just like everything else in Bolivia, the government doesn’t seem to have the resources (or the desire) to provide supplies/services for incarceration. It’s interesting when you think about how much money the United States spends on both medical care for the underprivileged, and on keeping large portions of the urban poor in jails. In addition to wondering how anyone can possibly recover in the Hospital de Clinicas, I’ve been surprised by how much these doctors can do for patients with so little supplies (and for such little cost). I’ve also begun to wonder if there’s some balance point between spending very little on patients and keeping them in the hospital for a long time because they don’t recover, and spending more money and speeding up recovery time. It would be an interesting study…if only La Paz had any sort of data collection system for these things.
lunes, 16 de julio de 2007
Copa America and Curaciones
Yesterday, as I mentioned before, was both the Independence Day of La Paz and the finals for the Copa America - the soccer tournament that is basically the Latin American World Cup. Soccer is a huge deal in Latin America, kind of like Football is in the US, so you can only imagine how excited people get about this tournament. The whole point of soccer (for me at least) is that you go watch it with a bunch of fans and be there for the collective experience, so I headed out to the nearby coffee shop. The finals were Brasil vs. Argentina, and while Argentina was favored to win, I decided to cheer for Brasil because I feel that they’ve represented the spirit of Latin American soccer for a very long time. The whole place was filled with Argentinians, chain smoking their cigarettes and looking arrogant, but I found myself in a corner with a tiny group of very loud, very energetic Brasilians. Brasil finished with a pretty definitive 3-0 win, so while our crowd was making merry and being obnoxious in the corner, the rest of the coffee shop was giving us dirty looks and taking long, annoyed drags from their cigarettes.
Today, despite it being a very important holiday, I decided that I would go into work at the Hospital to see if I could be of any help. On my way over this morning this city was markedly deserted. None of the usual shops are open, and the traffic has been reduced to about half. When I got to the hospital it too was deserted – only a handful of doctors were there, and there were no patients or students wandering around the corridors. Due to the low volume of hospital traffic, the two Claudias actually had time to do their “curaciones” (treatments) early in the day, so for the first time I was able to watch the actual process involved in treating and dressing wounds.
I almost ended up going home because we couldn’t find an extra face mask and hair net (I was not about to deal with sick patients without them), but I ended up borrowing one from Claudia #2, complete with makeup stains (they re-use them here). The majority of the cases currently in the ward are infected bedsores, which while interesting from a medical and immunological point of view, are quite disturbing. The first patient we treated, a 60 year old woman with both a mental and physical disability, was quite the introduction. The patients in the nearby beds had to leave the room because of the apparent smell (I was breathing through my mouth) of this woman’s two bedsores on her back and hips, the smaller of the two (about 3” in diameter and exposing her hip bone) which was infected and oozing a nice grayish liquid. Although I don’t like the sight of blood, I would say that I have a pretty strong stomach for these things after several years of working with animals in my lab…but I was this close to running to the bathroom to vomit after the sight of her wounds. The only way I could stand being there was by forgetting that this woman was a living, breathing human being, which presents quite a quandary for me after my critique of how the doctors here treat these people more or less like animals. But now that I actually have experience with treating patients, I can say that this is the only way I can handle medicine, by putting up some sort of mental block.
The actually procedure of treating these patients involves wiping down the wounds with an antibiotic, the hydrogen peroxide, and then iodine (no anesthetics are used to ameliorate the pain). While the tools in the US come individually wrapped in plastic and are discarded after a single use, these tools come in burlap sacks in a sort of “kit”, along with the cotton, the gauze, and the tray for pouring the treatment liquids (I just hope it’s all been sterilized). I’m not so familiar with the procedure for treating bed sores in the US, but I can tell you that when the interns used a minimal amount of clear packing tape to secure the gauze, my head started to explode. I couldn’t stop thinking, How does anyone leave this place alive?
All in all I got to help out with 6 patients, most of them with bedsores. One man is actually a prisoner from the city jail (a car thief, so I’ve heard), and he’s there because he was (apparently) playing soccer, received a small injury on his leg, and then winded up with an infection that ate away at all of the skin from his ankle to his upper thigh and left the muscle exposed. So while one leg is wrapped entirely in gauze, the other is tied to the bed with a chain…as if he’s going anywhere, anyway. I also had the delightful experience of treating the 15 year old boy with cerebral palsy, which isn’t so bad because of his wounds, but because of the piercing screams he lets out every time we try to move him. This poor child is so pathetically thin and incontinent, and he moves like a lizard, waving his cross-eyed head back and forth as he reaches his arms out to grip his legs or my hand.
Now that I’ve been there for a few days, and now that I’ve proven that I’m there to get my hands dirty, a few of the nurses and patients have started to warm up to me. They’ve stopped going “oh my, there’s a gringa” and started to ask me questions like “Why exactly are you here?” I had a bit of a shock when the attending nurse asked me “So, what do you think of that guy who’s in the government in the US?” As I started talking about how I despise President Bush (she couldn’t remember his name) and how I think the War in Iraq is a disaster, just to make sure she was following along I asked her if she knew about the War, and he reply was “A little bit, I’ve heard of it.” That was when I realized that an awareness of International News is basically non-existent here. It’s a different world, in every respect.
Today, despite it being a very important holiday, I decided that I would go into work at the Hospital to see if I could be of any help. On my way over this morning this city was markedly deserted. None of the usual shops are open, and the traffic has been reduced to about half. When I got to the hospital it too was deserted – only a handful of doctors were there, and there were no patients or students wandering around the corridors. Due to the low volume of hospital traffic, the two Claudias actually had time to do their “curaciones” (treatments) early in the day, so for the first time I was able to watch the actual process involved in treating and dressing wounds.
I almost ended up going home because we couldn’t find an extra face mask and hair net (I was not about to deal with sick patients without them), but I ended up borrowing one from Claudia #2, complete with makeup stains (they re-use them here). The majority of the cases currently in the ward are infected bedsores, which while interesting from a medical and immunological point of view, are quite disturbing. The first patient we treated, a 60 year old woman with both a mental and physical disability, was quite the introduction. The patients in the nearby beds had to leave the room because of the apparent smell (I was breathing through my mouth) of this woman’s two bedsores on her back and hips, the smaller of the two (about 3” in diameter and exposing her hip bone) which was infected and oozing a nice grayish liquid. Although I don’t like the sight of blood, I would say that I have a pretty strong stomach for these things after several years of working with animals in my lab…but I was this close to running to the bathroom to vomit after the sight of her wounds. The only way I could stand being there was by forgetting that this woman was a living, breathing human being, which presents quite a quandary for me after my critique of how the doctors here treat these people more or less like animals. But now that I actually have experience with treating patients, I can say that this is the only way I can handle medicine, by putting up some sort of mental block.
The actually procedure of treating these patients involves wiping down the wounds with an antibiotic, the hydrogen peroxide, and then iodine (no anesthetics are used to ameliorate the pain). While the tools in the US come individually wrapped in plastic and are discarded after a single use, these tools come in burlap sacks in a sort of “kit”, along with the cotton, the gauze, and the tray for pouring the treatment liquids (I just hope it’s all been sterilized). I’m not so familiar with the procedure for treating bed sores in the US, but I can tell you that when the interns used a minimal amount of clear packing tape to secure the gauze, my head started to explode. I couldn’t stop thinking, How does anyone leave this place alive?
All in all I got to help out with 6 patients, most of them with bedsores. One man is actually a prisoner from the city jail (a car thief, so I’ve heard), and he’s there because he was (apparently) playing soccer, received a small injury on his leg, and then winded up with an infection that ate away at all of the skin from his ankle to his upper thigh and left the muscle exposed. So while one leg is wrapped entirely in gauze, the other is tied to the bed with a chain…as if he’s going anywhere, anyway. I also had the delightful experience of treating the 15 year old boy with cerebral palsy, which isn’t so bad because of his wounds, but because of the piercing screams he lets out every time we try to move him. This poor child is so pathetically thin and incontinent, and he moves like a lizard, waving his cross-eyed head back and forth as he reaches his arms out to grip his legs or my hand.
Now that I’ve been there for a few days, and now that I’ve proven that I’m there to get my hands dirty, a few of the nurses and patients have started to warm up to me. They’ve stopped going “oh my, there’s a gringa” and started to ask me questions like “Why exactly are you here?” I had a bit of a shock when the attending nurse asked me “So, what do you think of that guy who’s in the government in the US?” As I started talking about how I despise President Bush (she couldn’t remember his name) and how I think the War in Iraq is a disaster, just to make sure she was following along I asked her if she knew about the War, and he reply was “A little bit, I’ve heard of it.” That was when I realized that an awareness of International News is basically non-existent here. It’s a different world, in every respect.
domingo, 15 de julio de 2007
Hike to the Cemetary
I’ve been feeling a bit restless for the past few days, so I decided that I would take a hike today from my apartment in Sopocachi, which sits at the far south-east end of the city, to the Cemeterio of La Paz, which is at the opposite north-end of the Prado. On my way there I passed through the food section of the upper markets, which was even more crowded than usual because today is the 15th of Julio, the day before the “Independence Day” of La Paz.
There were also quite a few fiestas in the street, and one group was especially endearing – I heard drums and trumpets blasting from about two blocks away, and when I wandered towards the music saw a group of people dancing, singing, and laughing as taxis and buses rolled by.
After huffing my way up quite a few steep streets, I finally found the cemetery (I could literally feel the change in altitude). Amidst the bustling markets and street vendors, not to mention the smell of fried and roasted meat that is even quite enticing for a vegetarian, the cemetery was a large and fenced-in, and was surprisingly filled with trees and greenery. In comparison to the cement, cobblestones, and trash in the streets, it’s quite shocking to see a little oasis in the middle of a rather poor area.
The La Paz cemetery differs from those in the United States in several ways, but most markedly by the fact that people are not buried underground, but instead stacked vertically in building-like structures, as many as 10 “people” high. Instead of stone gravestones, each person has a little glass enclosure where their family members place fresh flowers, mementos, etc. There was so much greenery and fresh flowers that I didn’t feel like I was walking through a cemetery – instead of the somber, creepiness of American cemeteries, it had a festive and peaceful ambience that was almost akin to a sculpture garden.
[Flower market across the street from the cemetery]
There were also quite a few fiestas in the street, and one group was especially endearing – I heard drums and trumpets blasting from about two blocks away, and when I wandered towards the music saw a group of people dancing, singing, and laughing as taxis and buses rolled by.
After huffing my way up quite a few steep streets, I finally found the cemetery (I could literally feel the change in altitude). Amidst the bustling markets and street vendors, not to mention the smell of fried and roasted meat that is even quite enticing for a vegetarian, the cemetery was a large and fenced-in, and was surprisingly filled with trees and greenery. In comparison to the cement, cobblestones, and trash in the streets, it’s quite shocking to see a little oasis in the middle of a rather poor area.
The La Paz cemetery differs from those in the United States in several ways, but most markedly by the fact that people are not buried underground, but instead stacked vertically in building-like structures, as many as 10 “people” high. Instead of stone gravestones, each person has a little glass enclosure where their family members place fresh flowers, mementos, etc. There was so much greenery and fresh flowers that I didn’t feel like I was walking through a cemetery – instead of the somber, creepiness of American cemeteries, it had a festive and peaceful ambience that was almost akin to a sculpture garden.
[Flower market across the street from the cemetery]
sábado, 14 de julio de 2007
Valle de La Luna
Today I decided to venture out of the city to see some famous rock formations called the Valle de La Luna and its accompanying town Mallasa. The Lonely Planet guidebook gives a brief description on how to get there, either by hired taxi for 50+Bs or a minibus for 2.50Bs, which I opted for. After about a 20 minute wait I found a minibus going that far into the county, and it was actually quite a comfortable 30-minute ride. We first drove through Obrajes and Calocota, the two components of the Zona Sur which I had explored briefly in the past, and then crossed the Rio Choqueyapu, the foaming orange river that runs underneath La Paz and dumps out further into the valley. The filthy river is used as an open sewer, and while it’s kept underground in the more populous highlands, in the lowlands it is used, despite its contents of sewage and chemicals, for the irrigation of the crops that make their way back to the city – thus my avoidance of unpeeled fresh fruits and veggies. Once we had crossed the river, the road turned into a rough cobblestoned path that wove through the smaller, further out villages. While the poverty and aridness of the terrain no longer shocks me, it was very strange to see crude brick, windowless houses within twenty feet of huge, elaborate fenced-in mansions. The juxtaposition of the poverty and the wealth is so blatant and shocking.
Although I was a bit confused about when to get off the minibus, I managed to find the place because (contrary to typical Bolivian fashion) it did have a relatively large sign marking it as a tourist destination. The Valle de La Luna was every bit as surreal and wonderful as the guide-book suggested – it was a large, fenced-in area with a narrow trail winding through the rugged, sandy rock formations. The terrain is actually quite desert-like, and it’s considerably warmer because of the pounding sunlight and the lower altitude. There was even a bit of grass speckled in with the numerous cacti jutting out of the sides of cliffs and the occasional flowering bush. The view from some of the higher points was breathtaking, and afforded a view of the mountains, the valley, and even bits of the Zona Sur.
[A view of the roads near the entrance]
To complete the serenity of the Valle de La Luna, two men were standing on top of the rocks playing wooden flutes and chirangos (traditional Andean instruments that look like mini-guitars). The sound projected all the way across the hiking area, and it made the experience simply perfect. I complemented the guy on his music afterwards, and although he tried to sell me a flute, he did show me how it worked and how he could play 3 octaves with only 8 stops/holes.
[Chirango player perched on the rocks]
The whole trail took about an hour and half because I was taking so many goddamn pictures, and afterwards I decided to trek down to the accompanying village, Mallasa, to find something to eat. I skipped the Zoo because I’ve heard that the animals are quite depressing, and instead found a hole-in-the-wall joint selling nothing more than ice-cream and cheese empanadas – my first experience with these delicious pastries of La Paz.
[The town of Mallasa]
Although I was a bit confused about when to get off the minibus, I managed to find the place because (contrary to typical Bolivian fashion) it did have a relatively large sign marking it as a tourist destination. The Valle de La Luna was every bit as surreal and wonderful as the guide-book suggested – it was a large, fenced-in area with a narrow trail winding through the rugged, sandy rock formations. The terrain is actually quite desert-like, and it’s considerably warmer because of the pounding sunlight and the lower altitude. There was even a bit of grass speckled in with the numerous cacti jutting out of the sides of cliffs and the occasional flowering bush. The view from some of the higher points was breathtaking, and afforded a view of the mountains, the valley, and even bits of the Zona Sur.
[A view of the roads near the entrance]
To complete the serenity of the Valle de La Luna, two men were standing on top of the rocks playing wooden flutes and chirangos (traditional Andean instruments that look like mini-guitars). The sound projected all the way across the hiking area, and it made the experience simply perfect. I complemented the guy on his music afterwards, and although he tried to sell me a flute, he did show me how it worked and how he could play 3 octaves with only 8 stops/holes.
[Chirango player perched on the rocks]
The whole trail took about an hour and half because I was taking so many goddamn pictures, and afterwards I decided to trek down to the accompanying village, Mallasa, to find something to eat. I skipped the Zoo because I’ve heard that the animals are quite depressing, and instead found a hole-in-the-wall joint selling nothing more than ice-cream and cheese empanadas – my first experience with these delicious pastries of La Paz.
[The town of Mallasa]
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