First day on rotations

Yesterday we went on a tour of the burn clinic, the children’s hospital, and the adult hospital. Dr. Montano introduced us to enough doctors and residents to make our heads spin, but meeting them all the first day will prove helpful in the future. We also decided the rotation schedule for the remaining time that we have in Cochabamba. I will be rotating through the burn clinic first, Celia will be in obstetrics and gynecology, and Andy will be in pediatrics. We are planning a trip to Sucre for this weekend and our work and social calendars are rapidly filling. I don’t know if 3 weeks is enough time to get everything in, but we are sure going to try!

Jen - Today was my first day in the burn clinic. For the first hour or two I got acquainted with the layout of the clinic and met some of the children. One of the little girls that I met was named Daniela. She is about eight years old. I am unsure of whether she was too shy to talk to me at first, or if she couldn’t understand my broken Spanish. After attempting to talk to her for a little while she warmed up to me. Although she is bed bound with significant burns on her left leg, she was in surprisingly high spirits as she played with her fake musical cell phone. After playing with the kids for a while I went in to observe some surgeries and one of the patients happened to be little Daniela. Dr. Romero debrided her leg and put a cast on it to prevent it from contracting and leaving her with a permanently bent leg. It was slightly emotional seeing her on the operating table after I was playing with her not more than an hour before. She did well in the surgery and was recovering in her bed when I left the clinic this afternoon. I was able to see and experience so much in my first day at the burn clinic and I am looking forward to more interesting experiences and getting to know the kids at the clinic better as the week progresses.

Celia – After a rushed morning and a definite overcharged ‘gringo’ taxed taxi ride (12 instead of 8 bs) to the burn clinic, we were three minutes late to meet Dr. Montano at 8am. Fortunately he was working on Bolivian time as well and met us as soon as we got changed. He did note that we forgot Josh (MS4BCI filmmaker extraordinaire) but Josh made his way there on foot (amazing!) without any help. Today I began my obstetrics rounds through the OB-ER, Labor and Delivery and also maternal intensive care (MICU). He gave me the option of staying at one site or going to all three. He stressed the importance of greeting the doctors in charge as they were lovely and patient enough to allow us there. The doctor I met at the OB-ER was not the one on the sheet but he received me gladly before tossing me to some internists. Some medical students pulled me aside and we started chatting in our limited respective languages. They wanted to know the differences between our hospitals and theirs and whether ours were much better. Upon reflection, I realized some differences. There is an initial assessment charge of 20bs and the consultations (for dermatology or cancer etc) are in offices along a row. I understand that medicine here is a bit socialized and that the current leader wants to make health care free for all (in order to win another term some say). However, the facilities were very clean and I thought fairly up to date. It was a very nice hospital, with separate buildings for the medical school, burn center, pediatrics and women’s care and GI. The OB-ER wasn't too busy that morning but I was able to do rounds with the resident and learn a few things I didn't know about cervical cancer. One patient had cervical cancer and the students were trying to figure out which stage she was in. I left the ER with hopefully a chance to hang out with some fellow medical students soon.

Andy- Today we began our rotations in the hospital. My first stop was in the pediatric intensive care unit. Dr. Montono dropped me off in the picu and then after a quick introduction left to take Celia to the Ob/Gyn ward. It was intimidating at first because no one spoke any English at all, and my Spanish just wasn’t cutting it that morning. There were about 6 children there, and all were very sick. Most of them had their conditions written on a white board and several had a laundry list of very serious conditions. After about an hour of just observing and asking questions when I got bold enough to try my Spanish again, a doctor came in with a group of medical students in tow. He asked me to join them and I went on rounds with them. The residents presented each patient going over the symptoms, differential, diagnosis, and treatment, with the doctor periodically interrupting to ask questions or make a point. We went through each of the six patients, and the whole thing was really interesting, but the language barrier makes all of it very difficult. I really wish I had paid more attention in Spanish class now. After rounds had finished, I went over to the burn center to see what was going on over there. Jen was over there for the day, as were Eva and Josh. I played with the kids for a little while when I first got there. I played legos with some of the kids and then I walked around to meet the rest of the kids. In the burn center there are three rooms with beds in it. In one room there was only one boy so I went in to talk to him. Ricardo was about four years old and I think he was Quechua because I couldn’t understand anything he said to me. Not that that is anything new though. He was my favorite patient at the burn clinic. His left hand and left leg were both heavily bandaged but he was still a lot of fun. I think he was my favorite because of his predilection toward cannibalism, as he kept indicating to me that he wanted to cut off my finger and eat it. I played games with him for a little while and then I went into surgery where Dr. Ramero was operating on the hand of a boy who had been burned. The boys hand had been bandaged in a fist after the burn, and it had subsequently healed like that. When I walked in, Dr. Ramero was inserting pins into the boy’s fingers using the new drill we had brought down last time we were down here. We had to leave before the end of the surgery since we had all planned to meet at 12:00 and eat lunch. We got lost walking the 2.5 miles back to the apartment, but it all worked out well.