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]

Family Values

I haven’t done much of anything today – I’ve allowed myself to have Fridays as my day off from work, so I’ve pretty much been sitting around, practicing my violin, and eating. This is actually really hard for me, because I constantly feel the need to be moving around and seeing things and “feeling productive.” But no, today I made myself be a couch potato, damn it. There’s actually a really great Vegetarian buffet 2 minutes from my house that I tried for the first time today. A full meal without meat is a rare commodity in La Paz, but it was quite tasty, and for 20Bs (about $2.5), I’d say I’ll definitely be visiting again. It’s just a shame that I’m at work during the typical “almuerzo” hours because I miss out on a lot of the lovely set-lunch menus and experiences.

Last night I gave my friend Vivi another violin lesson at her house up in Miraflores. Like most of my 30-something Bolivian friends, she lives with her mom, dad, sister, and grandparents. The family here seems to be a much more powerful force. Unless children get married (and even sometimes if they do), they continue to live in the same house with their entire family. Contrast that with the typical route for kids in the US: go to college and live with a bunch of friends hundreds of miles from your family. I shamelessly admit that part of my decision to go to Chicago had to do (initially) with its distance from my home, just like most college kids go through the “get me the hell away from here” impulse. But now that I’m living in a culture which values the family unit above the individual, I’m amazed and appalled that children are encouraged to leave the nest at such an early age, and moreover that they are encouraged to never come back.

Doesn’t it make sense from both an economic and a social perspective that single adults should live with their families? In addition to pooling resources, there’s also something inherently comforting about being with your relatives. While the family without a doubt comes with a fair amount of bickering, it also comes with an unconditional love that friends can never truly provide. More than anything, it’s just nice to see that my Bolivian friends have maintained such close relationships with their families, and I think it shows in the general level of happiness. People around here (for the most part) work what we would consider “crappy jobs” and have a much “lower standard of living”, and yet from what I’ve seen there’s a certain sense of content and tranquility that is totally absent from American culture. I fully admit that this is a combination of factors ranging from religion (Catholicism vs. Protestantism), proximity to nature, and lack of the western “work ethic”. In general, Latin American culture seems to have much more of a focus on the importance of social interactions, which makes North American culture feel disjointed and isolating.

I guess what I am trying to say is that after seeing this particular aspect of Andean (and I suppose Latin American) culture, I have begun to reconsider how my family will fit into my plans for the future. While I want to do things for myself, like travel and pursue international job prospects, I also want to be able to see my family on a weekly or even daily basis. Maybe even more than want it, I think I need it. Yes, we fight, we argue, and we get snippy with each other, but in the end I can’t think of anything that I’d rather be doing right now than eating dinner with my mom, my dad, and my two dogs.

The Power of the White Coat

Now that I’ve finally established a (sort of) regular work schedule, which involves going to the Unidad de Infectología in the Hospital de Clínicas in the morning and then going to the Dermatología office in the Hospital Militar in the afternoon, I find myself dead tired. I’m not even working a full 8 hour day, but I realized that this is my body’s way of telling me that it’s working overtime trying to understand so much Spanish, much less medical terminology. At the moment I feel like my Spanish (accent, vocabulary, grammar, you name it) has actually gotten worse, and I find myself pretty confused about what’s going on more or less half of the time. But I’m hoping I’m in one of those moments where things get really jumbled and confusing before they make a giant leap forward.

I had been warned that some of the doctor’s can treat the patients, who are mostly aymaran and from El Alto like complete crap, but luckily Dr. Revollo and the two Claudia’s don’t fall into this trend. However, upon bringing some of the patients to other doctors for consultations, I really started to get a sense of how much of a problem discrimination and disinformation can be. During the mornings the hospital is filled with patients and the families of patients wandering down the open-air corridors or sitting in waiting rooms, and it seems like no one really knows what is going on. The doctors fail to tell the patients why they are being taken to x building, why they need a consult, what the diagnosis of the consult is, or how their medicine will help them get better. How can they blame these people for failing to take the full course of their medications when they are constantly left in a state of confusion?

Yesterday a new patient with pulmonary tuberculosis was admitted to the ward – he was so sick that he couldn’t swallow a pill, much less speak. They had this frail, pathetic man walk from the Infectología unit to his throat consult, supported by two family members on each side, so weak that he had to stop halfway to sit down and catch his breath. Once he was in the exam, the doctor sprayed an anesthetic in his throat that hurt him so much that he started to gag, drool, and cry. The doctor examined him, as the man visibly cringed, tears welling in his eyes, and then without saying a word more than “tilt your head back and open up” the doctor started talking to Claudia #2 about the diagnosis (laryngitis as a complication of TB) and the treatment. The man was left sitting there, silent and dejected, his head practically hanging between his knees. I reached out, touched his arm, and said “está bien” (it’s okay) - with that tiny gesture, for the first time he seemed to relax and smile just a little bit. Come on doctors, is that so hard?

Most of what I’m doing now involves paperwork—reading charts, watching other people read and write in charts, bringing the charts to different areas of the hospital. It’s hard to believe how incredibly decentralized this hospital is. You have to personally walk each individual “consulto external” sheet and it’s accompanying patient to the distinct units, and then you have to wait in person while the patient is seen, so that you can then bring the patient back with the appropriate paperwork. I honestly have no idea how they keep track of everything here – when we went to the test results office, it was filled with piles and piles of papers spilling out of cabinets onto the floors and shelves, in no apparent system of organization. While I didn’t come here to experience the joys of medical paperwork, I have no doubt that once I’m more familiar with the basics of the system, and once I develop more of a relationship with the patients (since most of them are there for at least a week) that things will get a lot more interesting. Hell, I guess they already are.

Everyone in this hospital, especially the little children, look at me as if I’m some sort of alien.
Just because I am Caucasian and I wear a white coat (which as I mentioned earlier, I bought on the street, which means anyone can buy one), patients and families refer to me “doctora” and ask me for medical advice. I am completely (in every sense of that word) unqualified to give any recommendation, and yet people try to ask me about their medical conditions and take every word that I say as truth. A tuberculosis patient in our ward was asking Claudia #2 about a toothache – she wanted to know if the pain from her wisdom teeth could spread to her throat and make her sick again. Claudia kept telling her no, I don’t think so, really, but it was only until I said that I didn’t think so either that she really started to believe us. She looked at me with the penetrating stare, and without questioning what I said, she started to nod. That sort of power really makes me scared.

Every time I walk in there I have to overcome the urge to escape, not only because I can see the sickness, but also because of the smell, a gut-wrenching combination of sickness, dirty bed linens, and stale food. Today another TB patient came in, and I actually got the chance to see them reading his X-Ray (which showed dense clouds of white in his lungs) and also diagnosing him with renal insufficiency. He was clearly quite sick, talking with a rasping voice and coughing every now and then. What really disturbed me, however, was as he was describing that he had been coughing blood, one of his relatives opened up the drawer of his bedside table and held up a plastic cup filled with bloody sputum. And while I was thinking “Oh my god, someone please throw that away,” the 15 year old boy with cerebral palsy and bedsore was screaming and crying as the nurses tried to change his sheets and re-dress his wounds.

Day #1 in the Unidad de Infectologia

First of all, here are a few pictures to show the crazy weather we’ve had in the last few days. The white background isn’t because I have a crappy digital camera, but rather is the clouds that were sitting in the valley and causing a perpetual drizzle. It’s stopped raining now, but I’m a little sad that I no longer see the lady on the corner sporting her bowler hat wrapped in a plastic bag.







I guess I should also mention that I moved – to Sopocachi, actually, the neighborhood that I’ve mentioned in the past. The decision was a combination of factors, but was mostly because my future but not anymore roommate decided to come to La Paz later than expected, and I was quite tired of living alone. I suppose I should also mention that the new apartment is gorgeous, probably nicer than my apartment in Chicago, and is also about a 10 minute walk to the main part of the Prado. I feel more comfortable in every respect…except for the fact that we have an empleada (the La-Paz term for a maid). Doña Rosa is a lovely lady who comes every morning for a few hours to make breakfast, clean, do laundry, and cook lunch. This is extremely weird for me. I’m usually up around 7:30, a bit before she arrives, so I usually make my own breakfast and leave before I see her in action. But I haven’t at all gotten used to the fact that someone is cleaning my dirty dishes, making my bed every day, and addressing me habitually as “señorita.”

I’ve officially started working at the hospital. IIt was still dark out and bitterly cold (about 25 degrees), so much that my toes started to go numb, when I arrived at 6:45 to make the rounds with the two interns and Dr. Revollo. I found the Claudias in their room, which is located not 20 feet for the ward, as they were getting out of their queen sized bed (which practically fills the space) and watching TV. At 7:00 we met up with the doctor, who seemed very surprised to see me there so early, and proceeded to check in with all 20 or so of the patients. The ward is divided into two large rooms, one for women and one for men, with all of the patients in side-by-side numbered beds (picture an orphanage). As we walked around I began to develop a genuine admiration for Dr. Revollo because he treats these patients not with the usual medical indifference, but rather as if they are living, thinking, and feeling human beings. He’s this 60 year old man with wiry gray hair that sticks up from his forehead in an Einstein-esque fashion, and as he moved from bed to bed he was laughing and joking with each patient. He radiates a light-heartedness that I believe these sick people desperately need in order to put up with the misery of their surroundings.

I was a bit overwhelmed by all of the medical terminology that was being thrown at me, so I decided that it would be a better use of my time to read the case histories of each patient and then come back the next day with a more informed idea of what was going on. While the Claudias were off at a seminar, I sat down with the pile of metal files, conveniently labeled with each bed number at the top. First of all, when I first asked the presiding nurse if I could read the files, she told me “Sure…for two minutes.” I was a bit taken aback by the randomness of her response, which she justified by saying “I don’t know who you are, you could be anyone.” So after I dropped Dr. Revollo’s name, she immediately warmed up to me, handed over the files, and exclaimed, “Well, how rude that he didn’t introduce me!” So while I familiarized myself with the terminology for pulmonary tuberculosis, hepatitis A, bedsores, and Karposi’s sarcoma, patient #5, the 39 year old alcoholic with pneumonia and gastroenteritis, shuffled up and down the ward in his bare feet, wearing only a bathrobe and a hat.

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.

It's not Miss America?

I hate the Miss America pageant - I saw it a few times when I was little, mostly at family gatherings - while at age 7 a lot of ridiculously done-up women prancing around in bikinis saying they want to stop world hunger is entertaining, now that I have some perspective on what these things entail, they make me question what the world is coming to. These women are supposed to represent “American culture,” right? What a joke.

In La Paz, they have “Miss Cholita Paceña”. A little explanation of the terms might help. A “cholita” is one of the women that I’ve described briefly before – they are indigenous women who wear bowler hats, shawls, long braids, and very elaborate skirts. “Paceña” is the word that refers to people native to La Paz – if you think about the etymology it makes sense as a derivative of “Paz”, because it’s basically like saying “Chicagoan” or “New Yorker”. Instead of being judged on a bikini, a formal gown, whatever, these women are being judged on their traditional chola clothing, their participation in the local markets, and their knowledge of the history of La Paz and the Aymara language.

For those of you who read Spanish, the article is here http://www.eldiario.net/noticias/nt070706/5_01nal.php, and for those of you who don’t, I’m going to translate some of (what I think are) the highlights.

They choose contestants for the contest “Cholita Paceña 2007.”

“19 cholitas were registered to participate in the election, the same that will represent the distinct markets and public and private institutions located in the district...there will be the participation of three musical groups, a Folklore Ballet and a fashion show of cholitas that will display beautiful mantas (shawls), polleras (skirts), and hats made by artisans.”

“Cholitas of age 18 to 22 are able to participate in the event, they ought to be residents of their neighborhood, gremailes (artisans?), trabajadoras de hogar (workers of the home), and representatives of the markets, joined locales and associations of the macro-districts.
The participants ought to present themselves in the clothing typical of the Chola Paceña (skirt, shawl and hat), furthermore they ought to have general knowledge about the anniversary of La Paz and knowledge of the aymara language.”

“The subalcaldía Max Paredes will carry out the Second Contest of Student Bands and Plato Típico (Typical Foods)…All the vendors of the markets, popular eateries and others related to this activity are able to enroll…For this year the participants will be able to present, optionally, any of the three following dishes: sajta according to the variety, chairo paceño and fricasé (I don’t know what those are.)”

Make your cake and eat it too.

Last night I held my first ever dinner party in La Paz…and also had my first experience using my kitchen for anything more than making hot water or toasting bread. Initially I had a really hard time figuring out what to cook, because not only am I unfamiliar with the common ingredients around here, but also my apartment here, in comparison to the one in Chicago, has only the bare bones of cookware. While I have everything I could possible want and need in Chicago (garlic press, food processor, lasagna trays), this place has a baking tray, a frying pan, a big soup pot, a smaller pot…and that’s about it. Even after I had finished cooking, I realized that I only had enough forks and plates for about 4 people, not to mention that we didn’t have enough cups, so I had to ask my friend Karim to bring over extra place settings…sigh.

Anyway, after perusing the commercial supermarket (called Hipermaxi, which caries a lot more foreign goods compared to the little stalls where most people buy their food), I decided that I would make carrot-ginger soup, polenta pie (with queso fresco and parmesan instead of mozarrella), and brownies. The adventure began when I realized that the supermarkets around here don’t sell measuring cups…so for all of the ingredients which required some sort of measurements, I was going to have to eyeball things. Luckily the proportions for the soup and the polenta aren’t so critical, but for baking, especially at high altitude, it’s kind of essential to get the right proportions. I ended up modifying the instructions which came on the back of the semi-sweet chocolate I bought, which had all of the measurements in grams: I threw in a bit more chocolate and butter than the recipe called for, an extra egg, roughly a mug-full of what I thought was flour (it was sitting in my pantry, and while it looked like flour, the end result was a lot chewier than I expected), some sugar, a large spoonful of vanilla, a couple pinchfulls of salt, and (this is the part that killed me) a small spoonful of baking powder. I was hoping that the extra egg and baking powder would compensate for the difference in altitude, but the end result was poofy and didn’t taste very much like chocolate.

I suppose that the lack of measuring cups was complicated by the fact that the oven actually had no indication of temperature. Lighting the stove or the oven here is actually quite an ordeal for me – I hate fire, and there is not pilot light, so in order to get it going you have to take a match or a lighter, turn on the gas, and hope that you don’t burn yourself. When I first got here I was incapable of using a lighter, so I immediately went out and bought one of the long gas-grill lighters that let’s you be a comfortable 9 inches away from the flame. When I was baking the polenta and the brownies, I had to reach inside the oven to light it, and then I had to keep an eye on the food every 5 minutes to make sure it was cooking at more or less the right temperature. When I was almost don’t cooking, actually, my long lighter crapped out on me, so in order to get the burnings going I had to resort to lighting a long piece of paper on fire from the flame already going at the bottom of the oven – fun for someone who hates fire.

All and all, I would give the food a 5/10 and the experience a 10/10. The soup was excellent, the bread I bought to go with it not so much, the polenta was good but needed more cheese, and the brownies, while everyone really seemed to like them, were pretty tasteless and weird. Compounded by altitude, measuring, and ingredients, it’s also hard to keep food here warm because there is not heating in the houses, so that certainly doesn’t help when you’re serving soup or something that is supposed to have melted cheese. While it stressed me out to cook (I made a point to make it different from the local cuisine) and have people over an apartment that is so much more bare and unattractive than my usually living space, it felt good to have a bunch of local Bolivia people hanging out in my living room, drinking soft drinks and wine, and eating my rather mediocre food.

Perhaps to highlight the strangeness of the night for me, there was a thunderstorm at about 10:30 at night, complete with lightening, pounding rain, and hail. While it rains a lot in the summer in Bolivia, in the winter (now) it’s very rare to have such a storm. It was short – it only lasted 30 minutes - but as I heard the hail pounding on the tin roof, instead of being all alone there were actually people sitting and laughing in my living room, and that made all the difference.