Spring traveling during third year (New York, Orlando, and Philly)

During this spring semester I booked a few flights for conferences and visits home to see family and friends.

Over spring break in late March, I took off for New York right after our OB/GYN shelf exam. I stayed in the Bronx with one of my best friends from college. I also went to a scholarship interview in Manhattan, visited with the fam in New Jersey for a day, and hung out with a few friends who live in New York. 

Here are a couple of places I visited with friends that I highly recommend:

• Mulberry & Vine 
• A super delicious fresh, organic food place in Manhattan close to the Brooklyn Bridge. Well, actually, they're all over the place, but we went to the one by the Brooklyn Bridge. It's a pretty popular spot, and the place gets packed during the lunch hour!

• Le Baobab Gouygui
• This place is an incredible Senegalese restaurant in the heart of Harlem. My friend and I went out and ate here afterwards. We stayed there until 5AM. Isn't that crazy? My friend ordered the dibi lamb (Senegalese grilled lamb) and I ordered the dibi chicken with fries (they were out of rice) and a sweet ginger drink that tasted a little bit like Jamaican sorrel. That made me nostalgic.

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In early April, I flew to Orlando to give a poster presentation on some of the research that I assisted with over the past year and a half in Loyola's Department of Pharmacology & Therapeutics. 

Brief spiel on the project:

We have been investigating the mechanisms underlying fear and anxiety in male and female rats following a myocardial infarction (MI). Corticotropin-releasing factor 1 (CRF-1) receptors in the rostral locus coeruleus are upregulated following an MI, leading to an increase in glutamatergic activity. Our results suggest that this increase in glutamatergic activity is over-activated more in the female rats following an MI, and this mechanism may explain the anxiety observed more commonly in the peri-MI period for females than for males, which would increase risk of morbidity and mortality. 

On our last night, I went out with my PI, a Loyola PhD student, and several of their colleagues to an awesome Greek restaurant in Orlando called Taverna Opa Orlando. The description in Google says, "Diners climb on the tables & shimmy with the belly dancers at this family-friendly Greek chain link." This couldn't be more true! The music was bound to get you movin' and groovin'. I ordered the Greek lemon and chicken soup, which was delicious. (I learned that Greeks like to put lemons in a lot of their dishes? Pretty interesting).

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This past Easter weekend I went to Philadelphia for the American Medical Education Conference  (AMEC) through the Student National Medical Association (SNMA). It was a perfect networking and professional development opportunity. The mission of SNMA is to support and promote the advancement of black minorities in medicine, but it is not an exclusive organization. It just so happens that the majority of attendees at AMEC and members of SNMA are African-American students, residents, and attending physicians.


Next weekend in early May, I will actually be returning to Philly for a Neurology specific conference (American Academy of Neurology) which I was fortunate enough to have received a scholarship award to attend. I look forward to the opportunity to network further with neurologists (and aspiring neurologists like myself) in the city of Brotherly Love. This weekend is right before our Pediatrics clerkship exam so I will unlikely have much time to explore the city.

In late June, after my final clerkship of third year (Family Medicine), I will be flying to Jamaica to visit my mother's side of the family in rural Mandeville. My grandmother and great-aunts and uncles are excited to host me for a week. My sister will also be in Jamaica during this time, but at a resort in Montego Bay with her boyfriend, rather than on a farm with the rest of our family haha. We will have two very different experiences.

The day after I return to Chicago from Jamaica, I will fly to Japan for the RIKEN Center for Brain Science Summer Lecture program at the RIKEN Institute located right outside of Tokyo. I am beyond excited for this opportunity that I never thought I would have when I applied to the program earlier this year. I will post another blog entry about these experiences down the road.


Thanks so much for reading! :)

Third year clerkship reflections (Internal Medicine, Psychiatry, OB/GYN)

Since my last entry, I've completed the Internal Medicine, Psychiatry and Obstetrics & Gynecology clerkships. I will do a (somewhat) brief reflection for each. Currently, I am on the Pediatrics clerkship and will end the year with Family Medicine.

Internal Medicine

On IM, I was excited to pre-round on and present my patients every day. I woke up every day at 4AM and arrived at the hospital at 6 to pre-round. We usually rounded as a team with our attending at 8 or 9, and afterwards we'd spend the afternoon calling consults, following up on labs/imaging/other orders, and attending lectures.

Photo from here

One of our most interesting patients was a middle-aged woman who was a direct admission to our service from her primary care physician. She presented with intermittent episodes of confusion. These episodes of confusion were really interfering with her quality of life. She would forget where she even was sometimes and what she was doing there (i.e. in the passenger's seat of the family car, at family events, and even in her doctor's office during a visit). She had a history of hypothyroidism, multiple vascular risk factors, heart failure, and many other things. Now she was found to have elevated levels of ammonia WITHOUT liver disease or medication use, two things that would most commonly cause hepatic encephalopathy. She’s a very interesting case. When the senior resident did a physical exam, she had very obvious asterixis (subtle flapping of the hands when the arms are held out in front of the body; indicative of elevated ammonia levels). We initially sent for a liver ultrasound, but that came back normal except for some heterogeneity (which means some fat), but nothing serious.

So after much more workup and everything coming back negative, we then considered a genetic cause of her elevated ammonia levels. One of the neurology attendings wanted to send for a work-up of OTC (ornithine transcarbamylase) deficiency, an enzyme in the urea cycle. Usually these urea cycle enzyme deficiencies present early in life, but in rare cases they can present later on. Call me a weirdo but this got me excited. I mean, I felt terrible that our patient was so distressed about her medical issues, especially this relatively new one now of confusion. We had no idea what was going on with her at the time, but I have to admit that the mystery of her condition had me enthralled. (Months later we learned that her hyperammonemia was due to a splenorenal shunt, which had not previously been seen on imaging).

One other thing I loved about Medicine was the opportunity to interact with and speak to so many different teams in the hospital – physical therapy, social work, nursing, other medical specialties, nutrition, speech pathology… I truly enjoyed getting their perspectives on the patient because we all bring our own expertise and skillsets to the table.

Psychiatry

Psychiatry was my most relaxed rotation. It was nice because I was able to accomplish quite a few of my personal goals outside of my clerkship duties (i.e. preparing to apply for away rotations, reading for pleasure, working on research projects, setting up meetings, etc). At times, though, it was a little annoying because it was such a drastic change from the fast pace of Medicine.

I enjoyed speaking with patients about their mental concerns. I saw patients with schizophrenia, bipolar disorder (and having active manic episodes), major depression, suicidal ideation, and much more. Psychiatry isn't heavy all of the time though. My attending and I had a few humorous encounters on the consult-liaison service at the VA hospital. One of these encounters is described below:

Photo from here

One of the general medicine teams consulted us because their patient, Mr. J, an older white man with a history of bipolar disorder, reported sleeping only 11 hours in the past 9 days. He was also found wandering into other patients' rooms and trying to initiate a conversation about Jesus. When we spoke with Mr. J, he said that he felt energetic and "alive" without sleep. My attending replied, "Well, Mr. J, you won't be alive for much longer if you continue to deprive yourself of sleep." Mr. J was sitting on the edge of the bed and listening to my attending. He had very dark circles and swelling around his eyes, and he was easily distracted during our discussion. He spoke with a strong Chicago accent. One moment we were speaking about adjusting his medications, and the next moment he started singing a song about red balloons. Our encounters with Mr. J were always entertaining, and oftentimes I had to refrain from laughing out loud at his antics and jokes. At one point in the discussion, Mr. J tried to defend his lack of sleep: "Albert Einstein was a genius, and he only got 4 hours of sleep in one YEAR." Mr. J spoke strongly, but one could tell that he wasn't completely serious; he had a little smirk in the corner of his mouth. I couldn't help myself. I was standing off to the side and tried to hide my laughter, but I couldn't suppress it any longer. My attending started chuckling as well, "I'm pretty sure that's not true...No, I'm certain it's not. It's impossible." We shared a few more laughs before finalizing the changes we would make to his sleep and bipolar disorder medications. His sleep improved over the next few days.

I enjoyed the Psychiatry clerkship overall and I have a newfound appreciation for this field, but I don’t know if I can work with depressed, schizophrenic, anxious, and suicidal patients for the rest of my life. The things we talk about with these patients (i.e. suicidal ideation, abuse) are very heavy, and I don’t know if I can take that home with me every day. I felt sad a lot on this rotation. It pushed me to reflect even more often than I normally do.

Obstetrics & Gynecology:

The six weeks I spent on the OB/GYN rotation were quite interesting and unlike any other specialty we are required to rotate through. The six weeks are divvied up into three 2-week assignments.

I spent the first two weeks on the Benign Gynecology service. Here, we saw the "bread and butter" of OB/GYN: conditions such as endometriosis, pelvic pain, dysmenorrhea, fibroids, etc, and surgeries/procedures like hysterectomies (removal of the uterus), myomectomies (removal of fibroids), and dilation and curettages (aka D&Cs, which were often done to remove fetal tissue from the uterus of a woman who had unfortunately suffered a spontaneous abortion). Many more conditions are seen and procedures done; this list just scratches the surface.

I spent the next two weeks on the Ambulatory service. I attended different clinics which consisted mainly of routine gynecology and obstetric visits. I did see a few interesting cases, such as a Bartholin's cyst on a woman's labia minora that would soon undergo marsupialization (a special procedure to ensure that the cyst would not recur). I also saw a woman my own age who was recently diagnosed with hypothalamic secondary amenorrhea. She didn't have a period for the majority of her life, and only recently underwent a workup for her amenorrhea. All imaging and tests did not find any abnormalities, so she was given this diagnosis of exclusion: hypothalamic secondary amenorrhea. Currently, she is taking birth control pills which help stimulate a normal menstrual cycle for her.

I spent the last two weeks on the overnight Labor & Delivery service (11PM-7AM). It was tough adjusting my sleep schedule, and to be frank, I hated the hours. Things were pretty slow, and I only saw one vaginal delivery and one C-section for the entire two weeks (the other medical student also saw one vaginal delivery and one C-section).

I enjoyed helping with the vaginal delivery though. The patient was in her late-20s and having her first child. Her husband was at the bedside whispering words of encouragement into her ear as she screamed with each contraction. The delivery room was crowded with several nurses, two residents, the attending, myself, and the patient's husband. The patient initially struggled so much with pushing that our attending wanted to proceed with a C-section. I didn't want the patient to have a C-section. She was only 28 years old, having her first child, and yes, she may have been bad at pushing but she just needed more encouragement. She didn't need a C-section and its associated complications in the future. I then personally assumed the responsibility of making sure that our patient would have a vaginal delivery. 

Photo from here

During the next contraction I yelled, "PUSH, Mrs. C, you can DO it!" Everyone stared at me. The nurses weren't as loud as I was, and the husband was simply whispering in her ear. I was holding her left leg.

"AGGHHH!" Mrs. C responded to my shout with a huge push.

"Good!" Our attending said in surprise. "Make the rest of your pushes exactly like that one!"

"Take a deep breath, and push again, HARD this time!" I yelled. "YOU GOT THIS!" I probably sounded like a maniac but I didn't care. Mrs. C was responding well to my shouts, and the baby was on his way out into the world. 

We continued like this for a bit longer until the baby boy finally popped out. He was immediately given to the Pediatric team. My resident then fanned me over to deliver the placenta. It was incredible.

Brief reflections on third year so far (Surgery, Pediatric Radiology, Neurology)

I am nearly halfway through my third year of medical school and I am thoroughly enjoying it thus far. My head is no longer buried in a textbook for several hours every single day. I actually get to interact and connect with patients and their families, which I absolutely love. So far I've completed Surgery, Neurology, a Pediatric Radiology elective, and I am halfway through my Internal Medicine clerkship. Next spring I will have Psychiatry, OB/GYN, Pediatrics, and Family Medicine (in that order). 

The learning curve was very steep during Surgery, which was my first clerkship of the year. I didn't enjoy this clerkship. I didn't like being in the OR (at all), I grew tired of waking up at 3:30 every day to get to the hospital by 5 to pre-round on my patient(s) for our 6:30 rounds. I hated that rounds were so short, and there weren't many learning opportunities for students to grow (I never once presented a patient to an attending on rounds). When I started Neurology after what felt like 2 months of torture on Surgery, I fell in love all over again with the field. I have officially decided to pursue a career in Neurology.

After Neurology I completed a Pediatric Radiology elective for one month and currently I am on my Internal Medicine clerkship, which I am loving so far. Why? Because there's no OR time, I get to wake up later because rounds usually aren't until 8:30/9, I present to attendings and consistently receive constructive feedback, and I'm able to see a variety of patients, some with very unique medical conditions. For example, we had a patient with no history of liver disease who presented with elevated levels of ammonia that were causing episodes of confusion; unfortunately, no one knew what was wrong with her, but some lab results strongly suggested that she had a rare genetic condition. We had another patient who presented with swelling of his penis; the Infectious Disease team believed that he had a very rare sexually transmitted infection. Last year there were only 7 known documented cases of this particular STI in the United States.

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One of my more notable encounters was with a gentle 20-year-old female patient during my Neurology clerkship. (Personally identifying information and certain details of this encounter have been changed to protect the patient. Names have been omitted). She was transferred from an outside hospital to Loyola after giving birth to her newborn baby son and having a couple of seizures shortly after the birth. At the first hospital, she was found to have a bleed in the right side of her brain. This provoked several unprecedented seizures and some residual weakness on the left side of her body. Prior to delivery at the previous hospital, an epidural was placed for her pain. Unfortunately, due to her scoliosis, several attempts were made to properly place the epidural between the vertebral bodies of her lower spine. These multiple attempts left her with a small tear in the lining of her subarachnoid space. This space contains the cerebrospinal fluid (CSF), which bathes the spinal cord. We believe that minimal amounts of CSF leaking through the small tear in the lining of her subarachnoid space caused a decrease in intracranial pressure, and likely led to a slight downward shift of her brain tissue, causing the tearing of blood vessels. This brain bleed was identified on a CT scan.

Our primary goals were to treat her headaches (which occurred due to the CSF leaks and decreased intracranial pressure), seizures (which started for the first time in her life after she gave birth), and the brain bleed (we needed to monitor it). To treat her headaches, our plan was to consult the anesthesia team to place a “blood patch” over the torn lining of her subarachnoid space in order to halt the CSF leaks. For her seizures, we started her on continuous 24-hour electroencephalography (EEG) monitoring to closely watch the electrical activity of her brain and ensure that the seizures would not recur. As for her brain bleed, which initiated her seizures, we watched her closely for any change in symptoms or physical examination findings that would indicate repeat imaging of her brain.

Understandably, she was anxious about the complexity of her medical concerns and was ultimately afraid that another seizure would occur. During rounds each morning, she and her boyfriend asked many questions about the seizures and how they tied into everything else that was going on with her neurologically. After rounds and completing my notes, I would return to her room to ask how she was feeling and if she had any concerns or questions. She and her boyfriend had a few, and her mother had many. Her parents were from Mexico and spoke little English. Her father stopped by briefly every day to check in on her, but oftentimes had to quickly return to work. During rounds, our nurse practitioner helped interpret the etiology and pathophysiology of the patient's condition to the mother. When I returned to the room in the afternoon, the mother began asking me the same questions we’d just clarified that morning.

It was during my interaction with this patient, her boyfriend and her parents that I came to realize the profound confusion and anxiety that can accompany encounters with patients and their loved ones who do not have a basic understanding of conditions that our healthcare teams see on a regular basis. I cannot forget the deep concern and fear on her mother's face as she repeated the questions she’d asked earlier on rounds: “Que causó el sangramiento en el cerebro de mi hija?” [What caused my daughter’s brain bleed?], “Por qué tiene dolor de cabeza?” [Why does she have headaches?] “Las convulsiones volverán a occurir?” [Are the seizures going to happen again?].

This patient's medical narrative was complex, thus her mother’s numerous questions were understandable. She and her boyfriend’s questions were brief, and though still concerned, they seemed to have a better grasp of the situation. However, because of the language barrier, the patient's mother still had gaps in her understanding. I was determined to help her grasp what was going on. I answered her questions carefully in Spanish, giving as much detail as was necessary about the pathophysiologies of her daughter's pertinent symptoms (headaches and seizures).

I found it incredibly gratifying to clarify the patient's medical conditions to her and her family during what was a confusing and anxiety-inducing time for all of them. She was terrified that the seizures would recur. I felt that it was a privilege to be present with her during this time of distress. I clarified what was going on, took her hand in my own, and reassured her that, after our discussions on rounds with the attending, everything was going to be ok.

As a physician-in-training, I am learning the tremendous difference that love, deep empathy, and genuine concern can make in patient care. I believe that medicine is about seeing one’s family in others and treating them as such. It is important to value the culture, background, and ideals of patients and their families. Without mutual respect and understanding, endeavors to bring about positive impacts are futile. I believe that the central goal of medicine is to reach and effectively treat individuals in need with an attitude of patience, gentleness, and kindness; this goal describes the basis for my drive to become a physician.

Fall Break in Iceland

This wasn't our exact route, but here's a rough idea
of the road trip we took around the island.

Photo from: http://www.misswanderlust.ca/category/iceland/

Several of my Loyola classmates and I spent our Fall break in Iceland. We rented two cars and went on a road trip around the island, spending each night in a different hostel in different cities/towns.

Reason for going to Iceland? To take a break from our demanding studies to see the majestic beauty of this country, and it truly was majestic. We saw waterfalls (I can’t even count how many), geysers, hot springs, a glacier, several black sand beaches, and much more.

We experienced nearly every weather pattern during our stay, including snow (a blizzard), pouring rain, and powerful winds. On our trip to Dalvik in the North, we hit a winter snowstorm in the mountains, and we passed two cars that were overturned just off the road. It was horrifying to see. It didn’t look as though there were any deaths, thankfully, but we couldn’t imagine having such a traumatic experience in a foreign country.

Thankfully, we arrived safely to and from all of our destinations, and we have returned home.

The beginning of the trip, quite frankly, was stressful. Out of the 9 of us, WOW Air (which, by the way, is an airline that I do not recommend to ANYONE) did not load FOUR of our luggages. They were left behind in Chicago, and the four of us did not have our own changes of clothes, toiletries and other necessities for most of our trip. FOUR OUT OF NINE. We did not find out that our luggage was left behind in Chicago until about 2 days after our arrival.

We finally retrieved our luggage at the airport after not having it for nearly 5 full days. I spoke to another woman at the Baggage Service desk who said that on her flight from Baltimore, WOW Air left behind the luggage of many people on that plane as well. She said she was never flying with them again. I too am never flying with WOW Air again. I don’t think I will ever understand how an airline can be so incredibly irresponsible. This is a level of incompetence that I have never before experienced (or heard of!) on my previous travels.

The luggage situation was stressful but I was still grateful to be in such a beautiful place. I spent my 24th birthday in Iceland with wonderful classmates who made the experience a great one.

Our original plan was to drive around the entire island, but a bridge collapse and poor road conditions on the way to Vagnsstaðir (in the South) forced us to change our plans, cancel our booking at the hostel in that town, and instead travel back the way we came in the North.

Here’s a very quick rundown of the things we saw:

 Sunday – Arrived in Keflavik (airport), drove to Reykjavik (the capital), grabbed some food and explored the city little bit (as well as other attractions on our way to our first hostel in Saeberg): the church, Leiff Erikkson statue (given as a gift to Iceland from the U.S.), a waterfall, and Deildartunguhver (no idea how to pronounce that), Europe's most powerful hot spring.

Monday – On the way to our next hostel in Akureyri (AH-KOO-RAY-REE: not 100% sure if this is the correct pronunciation haha, but we’ve been calling it this the entire trip), we stopped at Húnaþing vestra to admire the pillar rocks, grabbed lunch at a homely restaurant (the seafood soup was delicious), stopped at a black sand beach where we saw jellyfish stuck in the sand, seals, another waterfall, and a huge, picturesque rock (whose significance we don’t know).

That night we grabbed dinner in Akureyri at Fish and Chips. Some of us ordered fermented shark :O The meat was very slippery; it was hard to eat it on its own, so it's typically consumed with Brennivin, a special type of Icelandic vodka.

Tuesday – On Tuesday, we stayed in Akureyri for a bit to grab coffee, check out the local gift shop, and visit a small botanical garden before heading out to Reyðarfjörður (one of the locals taught us how to pronounce this town correctly, but we forgot it, so we continue to call it by the much easier and endearing name: Rey-ferger-burger). On our way to Reyðarfjörður, we stopped at Myvatn Nature Baths for a dip, smaller hot springs (which all smell like sulfur [rotten eggs]; some of the showers in the hostels also smell like eggs because they’re geothermally heated), and we explored the entrance to a cave (where a couple of us swore a love scene in Game of Thrones took place).

Wednesday – The hostel we stayed at in Reydarfjordur has the best view and accommodating owners! The hostel was actually a huge house with an amazing view of the mountains:

That morning we grabbed coffee and some breakfast at a local shop. I was craving scrambled eggs, so I ordered an egg and cheese sandwich with white garlic sauce. Once I received it, I saw that the eggs were cut up pieces of hard boiled eggs, the cheese was not melted, and the garlic tasted a little strange in the sandwich. Once our server set my plate down in front of me, one of my classmates started sniffing wildly and looking all around him. “What smells like sulfur? Do you guys smell that?” We just stared at him. “It smells like eggs. It’s following us everywhere!”

Dettifoss 

Solheimajokull glacier 

 

On our way to the next hostel in Dalvik, we went to see the most powerful waterfall in Europe (Dettifoss) and another waterfall. On this day alone we drove through a blizzard and pouring rain in the mountains. After the second waterfall we decided to head straight to the hostel for fear of the weather getting worse.

Thursday – Four of us left early to drop off one of our classmates at the airport (~6 hour drive) and pick up the luggage that WOW Air left behind in Chicago. For the rest of the day we drove around the Golden Circle to see geysers and another waterfall :) That night some of us went out in Reykjavik 😊

Friday – On our way to the small village of Vik, we saw an old Icelandic house made of stone and grass roofs (built years and years ago), a tall waterfall (Skogafoss) that you can see from the top after walking 527 steps, the Solheimajokull glacier(!), and a black sand beach, Reynisfjara, Iceland’s most dangerous beach (bottom right). 

Skogafoss 

Saturday – Headed back to the Keflavik airport from Vik

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Shortcomings of the trip:

Gas. We spent hundreds of dollars on gas this week. They charge per liter, not per gallon like in the U.S. A gallon has 3.78 L. On average, gas prices are 204 Kronas (which is about $2). So to fill up our tank, we’d have to spend around $100 (split 3-5 ways, depending on how many people are in the car). 

Prices. Iceland is expensive. We'd spend around $12-15 just for a burger. The fancier meals could be as much as $50. On average, if you want a good, fulfilling meal, even at the places that aren't fancy, you’d have to spend around $20-30. Other things: coffee/chocolate (~$6), regular, plain, no-name brand woman’s T-shirt ($12), a pair of thin, plain socks ($10), hot dog (~$4-6), etc. You get the idea. The cost of things is ridiculous because wages are higher over there. (Income taxes are also significantly higher as well).

Trip highlights:

The beautiful sights. You might be able to see bits and pieces of the incredible landscape in other places, but Iceland has it all.

The warm, friendly people we were able to meet (from Iceland and other countries). At one of our hostels we actually met two sisters who are from Peoria, IL, nearby our own homes. The diversity of the tourists was amazing. Most of the tourists visiting Iceland were Asian, but there were many others from Europe and the states. 

It was wonderful spending a week in one of the most beautiful countries in the world with 8 other enthusiastic, fun-loving medical students.

Thanks for reading :)

Takk fyrir! (“Thank you!”)

June 2017: A Month Volunteering and Studying in Bolivia

I spent the month of June as a student/volunteer with Sustainable Bolivia, an organization located in Cochabamba that offers Spanish and Quechua classes, and is partnered with many non-profits in Cochabamba and surrounding areas. Sustainable Bolivia hosts volunteers from all over the world. Throughout my trip I met volunteers from all over the U.S., as well as France, the UK, Norway, Australia, Italy, and Argentina.

Mano a Mano Bolivia ("Hand in Hand" Bolivia)

Photo taken from here

I lived with a homestay family, took Spanish and Quechua classes, and volunteered for the non-profit Mano a Mano Bolivia (MMB). MMB is committed to serving marginal populations and improving conditions in the sectors of health, education and road infrastructure in Bolivia.  Bolivia is the poorest country in South America with the highest rates of illiteracy, school dropouts, and maternal and infant mortality. There is also a shortage of doctors and nurses. In his book "Bolivia in Focus: A Guide to the People, Politics, and Culture", Robert Werner shares, “At 6.6 doctors and 3.4 nurses per 10,000 people, Bolivia’s health staff is about half the Latin American average....there is a geographical imbalance, with many urban areas having sufficient staff of doctors (but still a shortage of nurses) but too few of both in rural areas" (76). MMB’s efforts to address these issues are incredible. The picture below shows what MMB has accomplished thus far since they were founded in the early 1990s. I’ll give a few examples: 

• 158 Centros de Salud (health centers/clinics) have been constructed and established
• 59 schools have been constructed and established
• Over 37,000 patients have been seen in day/mobile clinics (what they call "jornadas") across the country (this does not include the patients seen in the health centers)
• 45 disadvantaged Bolivian students have been awarded a scholarship through Proyecto Soñar (Project Dream) to continue their education in a career of their choosing

My Volunteer Duties

It has been an honor working with Mano a Mano this month. During my first week, I met the office staff (which includes physicians, architects, engineers, project coordinators, a photographer, and others). My primary role as a volunteer was to assist with a few different projects:

• I helped set up for and organize el “Curso de Enfermería” (a course that MMB hosts for nurses from all across Bolivia for continued certification). At the end of the course, participants were asked to complete a survey about their experience. I organized the survey responses into a spreadsheet, making it easily accessible for Mano a Mano to analyze responses for quality improvement of the course.

• I volunteered at one of Mano a Mano’s clinics in La Maica Central, a rural community located about 45 minutes away by trufi from the center of Cochabamba. I helped organize medications in the pharmacy, fetched a few things here and there for the doctors as they examined and consulted with their patients, checked some patients into the computer system, and assisted a couple of doctors on their trips to set up day clinics and visit homebound elderly in nearby communities (that are a bit more resource-poor than La Maica Central). 

One of the odontologists attending to a Tsimane
patient in TIPNIS, Beni Department

• I joined three Bolivian doctors (one general physician and two odontologists, specialists in the structure and diseases of teeth) on a trip to TIPNIS (Territorio Indígena y Parque Nacional Isiboro Secure), an Amazonian Indigenous community located about an hour jet ride away from the center of Cochabamba. We were in the community for two days (6/17-6/18). On Saturday we arrived in the morning, set up clinic, and tended to about 60 patients throughout the day. On Sunday we continued seeing patients, and in the later morning the odontologists held an educational session with the community about proper tooth brushing. This session was translated to Tsimane by a member of the community.

• Upon returning home, I plan to continue a couple of small virtual projects for Mano a Mano, including translating a few documents and recording a voice-over for a publicity video for the organization.  

I had a wonderful experience working with MMB, but I hope to return with more medical training under my belt. I have only completed my first year of medical school; needless to say, I don't know enough to properly tend to a patient. During my fourth year, I would like to return to Bolivia to continue working with the marginalized communities across the nation that Mano a Mano is committed to serving.

Common sicknesses

The most common conditions seen in the clinic (La Maica Central) were fevers, colds, diarrhea (due primarily to parasitic infections and the water), tuberculosis, and UTIs (urinary tract infections). In TIPNIS, all of these illnesses were seen as well, but there were more cases of parasitic infection. We also tended to many with severe teeth damage and children with fungal skin infections.

Things I didn't like about my immersion experience

Streets of Cochabamba.
Photo taken from here

I'll open up my reflection on this experience to general negative impressions, then I'll end on a good note and talk about what I loved. Okay, first thing that comes to mind: the aggressive driving and lack of adherence to safety regulations on the road. Many cars also do not even have seat belts. When I got into a taxi for the first time with one of my friends, I automatically searched for the seat belt. She watched me look around frantically for a while then asked with a laugh, "Is this the first time you've been to a developing country?" I laughed off her teasing and realized that a lot of vehicles I've been in during my previous trips to the developing world also lacked seat belts: Guatemala, Jamaica, Panama.... (or perhaps this was mainly the case just in the cars I'd been in. Still....very dangerous).

The crazy driving on the streets of these countries is also similar to what I've seen in Bolivia this past month, but the aggression of many drivers bothered me much more this time around because I almost died four times (seriously): twice I was almost run over by cars that did not yield for me as I crossed the street (I quickly learned that pedestrians do not get the right away), once in a taxi with a young driver who nearly hit another vehicle as he weaved in and out of lanes like a maniac, and once in a trufi (mini-bus) with an elderly driver who I was convinced had no peripheral vision. He too almost collided with another car. The lack of safety on the roads became infuriating to me after a few weeks. Needless to say, there have been tragic stories in the news about people who lost their lives because of the insane driving.

One other dislike that comes to mind is the audacity of some men to use the bathroom out in the open (in the bushes, by a tree, etc). I witnessed this one too many times and was disgusted. I remember seeing a man instruct his son (who was young, probably about 5 years old) to pee by a telephone pole in front of traffic! I couldn't help but give the father a searing glare. "Seriously?" I wanted to say to him. "You're teaching your son that public indecency is okay and that he can use the bathroom wherever he wants whenever he wants? That's what dogs do!" I just walked past them, silently judging the father, but mostly the culture surrounding this indecency because clearly, many men were not taught properly.

Lastly, I wouldn't say this is something I didn't like, but I certainly found it strange (because I don't do it myself): it is common to cook and eat every single part of an animal. Recently, my Spanish instructor explained that many Bolivians eat the intestines, liver, kidneys, tongue, feet, heart, testicles, and even BRAINS of certain animals (chickens, cows, pigs, etc). (This isn't a complete list). I was shocked. "En serio?" (Really?) was all I could say when she finished listing the different parts that are typically cooked. "Siii," she responded, and continued describing how "rico" (delicious) these parts taste when they're cooked well. 

Things I loved about my immersion experience

Bolivia has a very interesting history and a beautiful culture. I'm very grateful I was afforded this opportunity to be immersed in it for a month. 

Me and one of my homestay sisters
out dancing

• My homestay family. I lived with two parents, two sisters, and a grandfather. I grew close to everyone, especially one of my sisters who introduced me to her friends and invited me out with them. My family and I had conversations about everything under the sun - Bolivian culture (especially in Cochabamba), religion, my hair, previous volunteers who lived with them, Evo Morales (Bolivia's president), medical school, and much more. My homestay mom was an incredible cook.

Pique macho made by my homestay
sister (who is on the right)

The food. My favorite Bolivian dish is Pique macho, which consists of boiled eggs (that are cut in half and decorate the outside of the dish), small pieces of beef, potatoes, onions, locotes (bell peppers), mustard, and mayonnaise. Other popular dishes include Picante de lengua ("spicy tongue"; I haven't tried it), charque de llama (llama meat; haven't tried this either), salteñas (which are delicious and stuffed with whatever you want, including vegetables, meat, eggs, etc), quinoa (a grain crop), and picante de pollo ("spicy chicken").

• Talking to Bolivians about my hair. I found myself answering the same questions repeatedly about my braids, including, "Por cuánto tiempo te duran? Cuánto tiempo se tarda en hacerlas? Cómo las lavas? Cuánto te costó hacerlas? Cómo las mantienes? Cómo es tu pelo natural?" etc. (How long do they last? How long does it take to get them done? How do you wash them? How much did it cost you to get it done? How do you maintain them? What is your natural hair like?) I didn’t mind answering these questions. I really appreciated their interest in my hair, which is an important part of me. Whenever I’ve gone abroad to Latin America I have certainly experienced more curiosity and appreciation from people about my type of hair than I do from non-African Americans back home in the states, ironically.

This is a brief snapshot of what we learned in one of my Quechua
classes. Here were went over a few common verbs (left of board)
and how to say baby, boy/girl, man/woman,
and elderly man/elderly woman.

• Learning Quechua. I learned the basics of Quechua in private one-on-one classes during my short time here. Quechua is the most widely spoken Indigenous language in Bolivia, and it has had a strong influence on Bolivian Spanish, especially in Cochabamba. Many speak “Quechuañol”. Many primary schools in Cochabamba are also teaching kids the basics of this Indigenous language (I’m not sure about the rest of the country). Recent medical school graduates are even required by the government to serve and continue training in rural communities to learn the more commonly spoken Indigenous languages (Quechua, Aymara, and Guaraní, but mainly Quechua) before they begin practicing elsewhere.

I didn’t find Quechua terribly difficult to learn, since its structure is in many ways like English. What I did find hard was getting used to seeing long words/sentences that are short words/sentences in English (i.e. kimsa chunka iskayniyuq means 32, Qam Cochabambamanta kankichu? means Are you from Cochabamba? etc). It just takes practice. 

As I'm returning home I’ve been worrying about losing a chunk of what I learned. After searching online I was only able to find a few Quechua speakers (native and non-native) in the Chicago area with whom I could continue practicing. While in Cochabamba, I wanted to learn the basics to communicate with some of the patients in the rural clinic I volunteered with. The physicians regularly encounter Quechua speaking patients who don't speak much Spanish (particularly the elderly). By the end of my trip I could only speak the very very basics. When I return to Bolivia I hope to be able to have full conversations with native Quechua speakers.

~*~*~

There is much more that I loved about the trip, but I don't want to write a book on here. I hope to return to continue working with Sustainable Bolivia and Mano a Mano. There is so much more to learn and contribute. I'm beyond grateful for this opportunity.

Plans for the rest of my "last full" summer

For the remainder of my summer vacation in July, I'll be back in the Chicago area chilling and working on a few things here and there, including a mini-project with one of Loyola's neurologists, catching up with a bunch of friends and family on FT and Skype, hanging out with friends in the Chicago area, watching Netflix, and reading reading reading. I don't want to even think about starting second year at this moment. I'm not ready to get hit with a ton of bricks yet.

Thanks for reading! :)