The Day After Groundhog Day
I meant to write yesterday, but had some trouble with blogger.com. It seemed to be down the three times I tried to post.
I've commented several times about the poverty I have seen here in Bolivia and feel I need to add some more context. I see a lot of poverty in the Seattle medical world, and I saw it in Alaska and Idaho, as well. The US has plenty of poverty and illness directly attributable to poverty, but there is also a large group of people in the US who suffer more than they might from acute and chronic illnesses due to complete lack of a mechanism to pay for care. In the US, it is as though a large majority of those without health care know what they need, or at least where they need to go and how often, but the only option available is the emergency room. Still, that ER option is a big difference. Another difference is that the caliber of poverty I see in Bolivia extends to malnutrition. With exception, it is not often to find an underfed person in the US.
Bolivia also has a more distinct separation between the haves and have nots. There are plenty of wealthy people in the urban areas, and both La Paz and Sucre have a significant middle and upper-middle class that has access to many of the same luxuries that similar classes do in the US and Europe, as far as I can tell. Still, the sheer volume of poor people here is the largest difference I notice from the US. With over two thirds the country living below the adjusted poverty line, wealth affects health.
Today was my final day in the hospital, and I was a bit sad to finish. I am very ready to return home, but I have learned something every day in the hospital in Bolivia, about medicine and more. For certain, my appetite is whet for a similar experience in the future when I have more autonomy, more command of the language, and (unlikely) more time. I would love to return to Bolivia, both to work and to travel, and I very much hope to visit other regions of the world as a physician. During the past few years I have met several physicians who have spent extended periods working in other countries; some of these people worked through Doctors Without Borders. I don't know, yet, if such a longer commitment is something I will be able to make, but is on my radar screen.
I have been very happy with the CFHI program. It is well-organized, locally, and centrally in SF. The faculty were excellent, and clearly have been selected with care for their collective ability to teach and desire to do so. Only two of the five with whom I worked spoke some English, another understood a minimal amount, and two more or less only spoke Spanish. This turned out to be fine for me, and my previous trips to Mexico played a big part. It certainly helps that I had four years at DHS and two terms in college, but speaking was a distant third priority to reading and writing. I also would not have undertaken such an endeavor any earlier in my medical training, as it helps to have only one language to translate. The couple here from SF seemed to feel similarly. Both are PA's who work in Oakland, and though they speak less Spanish than I, they seemed to take as much fom their time here as I did. I feel bad for the two other participants, who were learning the new language of medicine in a language they did not understand. Not that twenty-two is too young to travel or to have this type of experience, but I believe that I had ten times the trip they did.
My homestay family has been gracious to a fault. Much like I plan to keep contact with some of the faculty, I expect that I will see members of this family some time in the future, either in Bolivia or the US. A revolving door of nieces and nephews that came to Tio Jorge's every day for lunch, and especially one nephew living with Jorge, all served as full-time concierge service for me, making my transition and movement once here very easy. Language class was challenging, and much like flossing or buying renter's insurance, it was well worth it in the end. The combination of homestay, weekly medical rotations, and language class made for a valuable month.
I've commented several times about the poverty I have seen here in Bolivia and feel I need to add some more context. I see a lot of poverty in the Seattle medical world, and I saw it in Alaska and Idaho, as well. The US has plenty of poverty and illness directly attributable to poverty, but there is also a large group of people in the US who suffer more than they might from acute and chronic illnesses due to complete lack of a mechanism to pay for care. In the US, it is as though a large majority of those without health care know what they need, or at least where they need to go and how often, but the only option available is the emergency room. Still, that ER option is a big difference. Another difference is that the caliber of poverty I see in Bolivia extends to malnutrition. With exception, it is not often to find an underfed person in the US.
Bolivia also has a more distinct separation between the haves and have nots. There are plenty of wealthy people in the urban areas, and both La Paz and Sucre have a significant middle and upper-middle class that has access to many of the same luxuries that similar classes do in the US and Europe, as far as I can tell. Still, the sheer volume of poor people here is the largest difference I notice from the US. With over two thirds the country living below the adjusted poverty line, wealth affects health.
Today was my final day in the hospital, and I was a bit sad to finish. I am very ready to return home, but I have learned something every day in the hospital in Bolivia, about medicine and more. For certain, my appetite is whet for a similar experience in the future when I have more autonomy, more command of the language, and (unlikely) more time. I would love to return to Bolivia, both to work and to travel, and I very much hope to visit other regions of the world as a physician. During the past few years I have met several physicians who have spent extended periods working in other countries; some of these people worked through Doctors Without Borders. I don't know, yet, if such a longer commitment is something I will be able to make, but is on my radar screen.
I have been very happy with the CFHI program. It is well-organized, locally, and centrally in SF. The faculty were excellent, and clearly have been selected with care for their collective ability to teach and desire to do so. Only two of the five with whom I worked spoke some English, another understood a minimal amount, and two more or less only spoke Spanish. This turned out to be fine for me, and my previous trips to Mexico played a big part. It certainly helps that I had four years at DHS and two terms in college, but speaking was a distant third priority to reading and writing. I also would not have undertaken such an endeavor any earlier in my medical training, as it helps to have only one language to translate. The couple here from SF seemed to feel similarly. Both are PA's who work in Oakland, and though they speak less Spanish than I, they seemed to take as much fom their time here as I did. I feel bad for the two other participants, who were learning the new language of medicine in a language they did not understand. Not that twenty-two is too young to travel or to have this type of experience, but I believe that I had ten times the trip they did.
My homestay family has been gracious to a fault. Much like I plan to keep contact with some of the faculty, I expect that I will see members of this family some time in the future, either in Bolivia or the US. A revolving door of nieces and nephews that came to Tio Jorge's every day for lunch, and especially one nephew living with Jorge, all served as full-time concierge service for me, making my transition and movement once here very easy. Language class was challenging, and much like flossing or buying renter's insurance, it was well worth it in the end. The combination of homestay, weekly medical rotations, and language class made for a valuable month.
posted by Aaron Clarke Shur @ 19:00
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