Hospital Take Two

First of all, I just want to say that the weather for the past few days has been crazy. We’ve had a combination of rain, hail, and even snow, which has left La Paz in a perpetual cloud of dense white fog. I am beginning to wonder if buying a pair of Converse Allstars before coming here was such a good idea – the rain leaves the cobblestone streets so slick that I quite literally can’t walk uphill in some places.

And today…after getting over my fear of returning to the Hospital de Clínicas, I met up with Dr. Guillermo, the guy who has been helping me out and putting me into contact with other people. After the customary kiss-on-the-cheek greeting, he walked me all the way across the hospital to the department of Infectología, where I was introduced to yet another older, director-type gentleman. Luckily this guy, Dr. Revollo, wasn’t nearly as scary as the “jefe” – he sat me down and immediately started joking around. “Oh que bonita, un ‘blondie’ no?” After a brief introduction (thankfully done by Dr. Guillermo, who is quite superior at describing who I am and what I want to do), he introduced me to two interns who work in the unit, Claudia #1 and Claudia #2, no joke. This time I made sure to ask rather extensively about the kinds of things they did, and Claudia #1 explained to me that they had a patient with tuberculosis, one with gastroenteritis, one with necrosis, and one with a sarcoma in his head (did I get that right?) Right up my alley with infectious diseases.

Immediately, there are two things that struck me as fascinating. In the middle of the room there was a nurse, dressed in the 50’s style white apron and little hat, cooking food in steaming pots and pans and giving it to other nurses to serve to the patients. Also, the perpetual lack of supplies leaves people at a real loss here – basic medical supplies like bandages and syringes are not at all included in hospital care, and instead doctors send the families of patients to local pharmacies with a list of supplies. If the supplies are too expensive, the patients go without the treatment. As I told the Claudias that I would be more than happy to write asking for medical supplies, Claudia #1 pointed to a young boy who has a form of tuberculosis that has spread to his intestines (I think?), and shaking her head, she told me that even though the young boy has a family, they never come to see him. The reality for many patients here is that their families cannot afford to take care of them, so they are often brought to hospitals, abandoned, and left to die.

So…who knows how this is going to turn out, but I’m more optimistic that it will be a better fit, in particular because it will be more of a personal interaction.

But that’s not all. I’ve made contact with a doctora who works in the dermatology section of the Hospital Militar, and while this isn’t the discipline I find most interesting, I decided it was worth a shot. Since she seemed nice, and since I was only going to be working with her 6 hours a week, I thought I could at least use it as a starting point. But working with her today was actually fascinating. You would think that dermatology would just be a lot of mother bringing in their adolescent girls with bad acne, but in reality it’s much more based in pathology. While there were the cases of pimples and dry skin, there was also the case of a woman with a huge cancerous lesion on the side of her nose which had been growing for more than a year (!). However, the most interesting part of the case was that she was actually terminally ill with colon cancer, but none of her family members wanted to break the news to her. She only knew that she had stomach pains, and Doctora Gúzman later explained to me that her families reluctance to explain her condition to her came from the fact that people here go crazy when they find out they have cancer.

There were also several cases of leishmaniasis, a parasite transmitted from a sandfly that leaves nasty looking skin lesions. Since most of the patients in this particular hospital are from the military, and are therefore often stationed in the campo, they are exposed to all sorts of nasty tropical bugs, leishmaniasis included. However, the most interesting case was a young soldier who presented with general inflammation of the skin on his arms and legs. Turns out the cause of this inflammation is probably a general allergic reaction…to three simultaneous parasitic infections (giardia and two different types of entamoeba). What makes his case fascinating is that his bloodwork shows a complete lack of eosinophils, which are the innate immune cells that are the frontline of defense against parasite infections. So either there was a problem with the blood test, or this young man has a rare genetic defect with his immune system. Doctora Gúzman ordered his bloodwork to be redone, so I eagerly await the results…

Two hours later, after we had seen 15 or so patients, the doctora led me up to the fifth floor to see the hospital’s catholic mass. It wasn’t located in a real room, but more like an open space filled with a few sets of plastic waiting room chairs and a priest standing in front of a metal hospital table covered with a tablecloth. I’m not usually a fan of religious ceremonies, especially if they are in so-called “public institutions,” but there was something quite moving about the solidarity of the people—patients and doctors alike—gathered there. Even though I lack a religious sentiment, I could appreciate the scene of the priest reciting mass to the crowd of mostly young military boys, patients from the nearby ward, with a spectacular view of the Andes out of the window.