Week 1: Clinic in El Alto and Exploring La Paz

This week I have been going to a clinic in El Alto called Centro de Salud Puerto Mejillones. El Alto is part of La Paz but it is located on top of a plateau/mountain so the altitude is a little higher than where I am staying. The primary care clinic is small with 2 doctors and some nurses. It serves mostly pregnant women, children under 5 and the elderly. These populations are insured under SUMI (Seguro Nacional de Salud) so the services they receive are free. Alison and I have been taking 4 Teleférico lines. I didn’t realize how huge La Paz was before riding the Teleférico. It is located in a valley between mountains but there are also buildings on the sides of the mountains, up on top of the plateau. Something else I noticed on our commute was that in El Alto, and other areas of La Paz, there are tons of dogs on the streets. We also pass over the cemetery each day that is stacks of compartments with little glass doors for ashes of loved ones, organized into rows so people can visit and leave gifts or flowers.

One of our views on the way home. This was taken just leaving El Alto.
It is the part of La Paz in the valley between all of the mountains.

This is a market in El Alto that happens twice a week.
We stopped there on our commute home and walked through it.

Selfie in the Teleferico

Most of the week at clinic we have been in Dra Gutiérrez’s office. On the first day Alison pointed out that we saw 17 patients in 3.5 hours. We try to help by listening to kids breathing and heartbeats, listening for fetal heartbeats with a monitor, or distracting crying kids. But we are mostly there to learn and I am very grateful for the opportunity. There have been a variety of health issues but some reoccurring themes are teen pregnancy, family planning, malnutrition, and the use of antibiotics. Most of the moms we saw were between the ages of 14 and 25 and some were having their second or third child. Dra. Guitierrez is supportive but also direct when she asks them why they haven’t been taking care of themselves and done family planning. She explains that they have the option to take pills, get injections every 3 months. or an implant that is good for 4 years. Something else that shines through as a huge issue is malnutrition of both mothers, babies and toddlers. Dra. has long conversations with patients about the importance of being firm if their child is picky, making sure they are eating enough fruits, veggies, and meat. She explains to moms that good nutrition is essential for brain growth and a stronger immune system to protect against diseases like TB, which is more common here. Finally, I have noticed that amoxicillin, a basic antibiotic, is prescribed much more liberally here. Some patients have come in saying that their child was given amoxicillin but they haven’t gotten any better. This could be because the child has something viral rather than bacterial, or the bacteria in the child had developed resistance.

A couple of babies we saw had hip braces on. Many women in El Alto wrap their babies in lots of blankets. When wrapped with their legs straight and closed, their hip movement is limited which can be damaging to the babies development. Therefore some moms were told to have their babies wear hip braces to open up their hips more. Dra Gutiérrez showed other moms exercises they could do with their baby and a better way to wrap them to avoid this problem down the road. One day this week we went with one of the nurses to a local school where we gave out vitamins to the kids and left nutritional supplement and anti-parasite pills for their parents to give to them later. Since Día del Niño was this week, many of the kids wore costumes: super heroes, clowns, princesses etc. Pretty adorable. I am not posting pictures of any of the kids on here to protect their privacy.

After clinic we go home and eat lunch with Olga. It is usually soup and a main dish and is always delicious. We have had chicken tacos, quinoa tortillas (like veggie cakes with quinoa sort of), and even spaghetti one day. Alison and I learned to say “estoy satisfecha” (I am satisfied) when Olga offers us more and more food. I also tried Api, a traditional hot drink here made with purple corn, cinnamon, and lemon.

We have Spanish class in the late afternoon with Gonzalo. But the class time is mostly taken up by us talking about our day or asking questions about our weekend plans. We did discuss a patient scenario in Spanish, which Alison was much better at since I have not actually been to medical school :). One day after class we went to the Harry Potter themed cafe, Las Tres Escobas (the 3 brooms), and enjoyed some bebidas mágicas. Yesterday we went to an art museum instead of class which I really enjoyed. And after that Alison and I walked up to Mirador Killi Killi, a viewpoint up on a hill.

Am I in London or La Paz?
Harry Potter themed cafe.

Sunset at Mirador Killi Killi

Today we didn't have Spanish class so we went to Calle Jaen and El Mercado de Las Brujas (The Witches Market). La Calle Jaen is a preserved alleyway with colorful buildings and the architecture is reminiscent colonial La Paz. At the market there are tons of vendors who sell a lot of the same things: bags, alpaca fur sweaters, scarves, llama key chains and more. The actual witches market is named after the vendors that practice Aymaran, indigenous, beliefs. They all sorts of items that are supposed to be burned to bring people happiness, wealth, intelligence, health etc. In the tourist world these shops are known for the llama fetuses hanging from the ceiling. In the Aymaran culture, people burn them and bury them as an offering to Pachamama for good luck. And for those of you who are thinking, "these people our llama baby murderers", I read this on LaPazlife.com: "This is because Bolivians don't actually kill baby llamas, instead they use the fetuses that have come from miscarriages".

Overall, it’s been an overwhelming but great week. Started off a bit sick because of the altitude but I’m well adjusted now. I’m learning a lot about women’s and children’s health, practicing my Spanish listening and speaking skills, trying new foods and exploring La Paz.