Bolivia September 1st - 11th

Monday 1st Sept.
The big challenge today was to get an extension on our visa so we took the 106 Taxi to El Prado, to the immigration department and after supplying the with photocopies of the front page of our passports and our Bolivian visa page at 0800 it was a simple matter of a 90 day extension stamp at no etra cost. This was very pleasing so soon we were back on the road to the supermarket to buy food for the week and caught a taxi back to Tiraque from San Carlos Catholic Church which cost 10 B´s per person. By the time we got to Tiraque which was about 1600, it was too late to carry on to the Aid Post so we booked into the hotel at 50 B´s a room and waited until morning.
Tuesday 2nd Sept
We found out quite early that it was possible to get a taxi to K´aspiKancha which even the taxi drivers described to us as being Alta Alta )very high). None the less we loaded our two boxes of medications into the back of the taxi and 40 minutes later we were at the small aid post which has service for 1500 people which seemed to be at the highest elevation we had been to this far. Unfortunately, noone was there and the sign on the door said ¨Back Tommorrow¨´, but fortunately we found this before the taxi left so we took the taxi back down again and waited until the next day.
Wednesday 3rd Sept.
Now we have a date and time to talk to the Mayor which is 0730 on Thursday which means there is no point going up thousands of feet to the health centre as we would be unable to make the meeting the next morning as the road to the health post has no regular traffic on it and is 12 long kms from Tiraque so we took the taxi back to Cochabamba which then give us the chance to get plaster of Paris immobilsation for Bronni due to her rolling her ankle 6 days earlier with ongoing pain and slow improvement. While we were in Cochabamba we got XRays as well for her ankle and foot in a very quick time in a very busy hospital of Tiquipaya and I was happy to find no fractures. The plaster still needed to be applied to make her foot comfortable.
Thursday 4th September
Very kindly Abrahm had agreed to come to the meeting with us at 0730 so at 0600 we were leaving the house to drive there in his work vehicle as he as (representative of Water for People) also needed some discussions with the Mayor. The meeting was attended by the mayor and vice mayor and they were both very happy for Troppodoc to become involved in the province of Tiraque with a population of almost 24000 people and 11 health posts staffed by axillary nurses. Our role is mostly to work at primary car level, helping mothers in the villages to deliver babies safely, to assist the axillary nurses delivery the babies in the health posts safely, to support general medical services in the health posts and to assist if needed in Tiraque Hospital with the limited obstetric facility there. In so much as in the hospital there is no obstetric surgical facility, neither Caesarian section nor forceps extraction and several times a month women are transported an hour away to Punata into the next province for surgical delivery. I plan for Troppodoc to have a vehicle and be on 24 hour call for village baby deliveries and health post assistance. In addition to this I hope to do teaching to the axillary nurses in the health post and the Doctors and nurses in the hospital so the optimal outcome can be achieved in Tiraque hospital for every mother having a baby. The hospital and vice mayor requested some surgical instruments to facilitate C sections and possibility of forceps and Ventouse extraction. Currently I am waiting for the mayor to write a letter confirming all this to take to the Board of Trustees.
One again there was not enough time (one afternoon) to go to the Health post at K´aspiKancha so we sent the medicines on the the village of Koari and took a taxi back to Cochabamba to find a pair of crutches for Bronni and a plaster boot.
Friday 5th September
Having 3 days at our disposal with no clinics and not wanting to stroll around Cochabamba we caught a 7 hour bus trip to La Paz (30 B´s) and took a taxi to the Cemeterio (10 B´S) and a mini van to Lake Titicaca, 3814 mts above sea level and the tourist town of Copacabana. This mini van took 4 hours and we arrived just before dark.
Saturday 6th Sept
Relaxing in this picturesque town on the shore of the lake, catching up with emails and I was trying hard to ignore the painful grimicing of Bronni as she walked on the cobbled stone roadway. Forunately we have medicines for pain. Tomorrow morning we will be back on the bus for the 4 part, 12 hour trip back to Cochabamba to start another week in the mountains in the aid post of Koari.
Just a brief mention of the stunning scenery in that 12 hours of travel through spectacular countryside crossing mountain saddles of 4500 mts (higher than Mount Cook) in land which is farmed with Llamas sheep cattle and very hardy Bolivian people on which appears to be vast expanses of very stoney ground. This is a trip I would recommend for future volunteers and it can also be done inexpensively by plane but much would be missed.

Sept 7th
Back in a taxi heading towards work at Koari. Able to find a taxi that goes direct there, destination Totora and costing 15 B´s. We arrived to find Dr Rosby, who is one of six Dr´s working in 6 different health posts in the Tiraque area. She is newly graduated and studying for specialist exams in the available free time that she has. This is the first warm day that we have had in Koari. Finding out more information from this Doctor is good as she has limited English although she is only at the health post for 4 weeks before taking a week off as well as this she works only from Monday morning to Friday morning before travelling to Tiraque hospital.
Sept 8th
A little busier today but only seeing 12 patients while the nurse was away in Tiraque collecting more vaccine. There are lots of sore eyes in this area as almost nobody wears sun glasses and throughout Winter there is strong sun here at 36oo mts above sea level, and strong wind.
Sept 9th
We first meet this morning a 70 year old lady with a considerable part of her nose eaten away by cancer or infection. She lives not far from the clinic with what appears to be a couple of family members. She has been offered treatment in Cochabamba, presumably excision and radiation but she is unable to afford the cost and there is noone in Cochabamba with whom to stay with while undergoing treatment. This problem has been with her for 4 years and I look forward to showing some photographs of her to specialists in New Zealand. A few more patients and we head off to Tiraque to get more food supplies as this community of 2,000
has no shop and no telephone access to anywhere. We managed to make it back at night just before dark as the wind chill factor was biting very deep.
Sept 10th
12 patients seen again. Eye problems, pregnancy problems, back problems and dental problems. On Friday more of the same before heading to Tiraque to interact with Doctors at the hospital and find out what shortages of equipment they have. This is an interesting cottage hospital for 25,000 with a delivery suite, but no operating theatre, XRay or laboratory.
Sept 11th
Spent the day visiting a paddock high in the mountains where the locals transform tussock country at 3500 mts to potato growing fields with a serious slope on them. Long day watching 4 Bullock teams plugh, break up the soil with planters and fertilizers behind them, all and all 30 plus people to plough and plant an alpine field.

Thursday 27th August 2009

This is our final full day at Sanka Yani . We saw at least 35 people here and the walked the two hours up the hill to see the two year old with the draining neck abscess. We were in two minds all the way up the hill as to what to do with this boy as we were expected at Tiraque Hospital and back to Cochabamba on the weekend. We would like to have organised appropriate followup for his abcess and dressing, however when we got to his house the door was closed and locked and we were bewildered as to where he could be. We kicked around for a while and finally decided there was nothing to be gained in waiting so knocked on the neighbours door as we were departing, Happily our patients mother was there with the children.. The abcess incision cut was rapidly healing and no further infection was present to cause him problems, so we changed the dressing and asked the Mother to remove it in two days time. We then retraced our steps down the hill to our remaining patients. Abdominal colic, abdominal pain from reflux, eye pain from infection, repeated vomiting, vaginal candida infections, hypotensive headaches, abdominal worms, lower respiratory infections, waxy ears, osteoarthritis of knees, appendix pain, were some of the problems seen that day.   Into the night people were knocking on the door as they knew we were leaving the next day.

.

Friday 28th August

Soon we were at the hospital and participating in the obstetric/gynaecological clinc, doing ultrasound examinations of mostly antinatal mothers.

First we need to do some research as to the infant and maternal mortality/ caesarian rates and poor neo natal outcomes problems in this province of   40,000 people. Other than the Mayor in his overall supervisory capacity there appears to be no one in charge of healthcare for this area.

In the afternoon we headed back to Cochabamba to revisit Susana and Abrahm.

Saturday relaxing and Sunday was watching their children participating in local street dancing with hundreds of other children in a junior remake of the previous religious celebration two weeks ago.

 

Monday 31st. August

We have talked over with Susana and Abrahm the childbirthing idea and hope to talk more with the Mayor and the hospital director to see if this would be a benefit to the health service in this province.