Opening Doors Through Social Medicine in Bolivia
“You have to be fearless,” she said. As I listened to the words of the nurse, I realized that this moment will never happen again. The patient waiting for me to puncture his vein will never smile at me again. The encouraging words from the pair to calmly continue will never again be spoken. That moment was mine to have and mine to conquer despite my uncertainties, so I proceeded knowing that it was another experience in Bolivia that will seep within and forever be apart of me.
I was sent by my host organization, Foundation for Sustainable Development, to work with a NGO named the Instituto para el Desarrollo Humano. IDH is an institution that works to develop social and preventative medicine while promoting gender equity and basic human rights for the HIV/AIDS community in Bolivia. As part of my experience, it is required that I create a sustainable project that aids the institution in fulfilling their purposes. I dedicated my time to creating two projects that had both educational and preventive components in order to increase the likelihood of sustainability.
The first project dealt with the idea that education should begin in the home. Sexuality is a culturally taboo topic in Bolivia, so the theme is not discussed openly in the household. As a result, the youth of Bolivia are forced to sustain their curiosity by exploration and often contract sexually transmitted diseases from their first sexual encounter. IDH began a new program titled “Opening Doors” that promotes sexual education in the school system. They have created teaching manuals that are distributed to the Ministries of Education and guide teachers in various lessons about sexual health and HIV/AIDS. This has proven to be an effective measure, so IDH has initiated a new guide with the focus on sexuality.
In addition to the guides for the school system, we thought it imperative to create booklets specifically for the parents in order to complement the information that will be provided by the manuals. In this manner, the parents will feel a better sense of control and understanding of the information that will be given to their children. The pamphlets provide tips on how to tackle the difficult themes and offer assurance to help ease the parents in the discussions.
My roles were to research techniques and create the booklets for the program. The pamphlet was well received by the IDH team and the program coordinator anticipated great results from the booklets. It was a satisfying experience to view a final product and know that it will remain within the homes of Bolivia long after I depart.
My second project involved collaborating with another NGO that dealt with HIV prevention. CEADES is a NGO based in Cochabamba, Bolivia that has formed a platform to conduct research that will aid in the development of new protocols and treatments for HIV patients co-infected with Chagas and tuberculosis in Cochabamba. They were in need of new participants from the community in order to continue with their objectives, so I introduced them to IDH to examine the possibility of a partnership.
Their current study was centered specifically in HIV patients co-infected with Chagas. I decided to create an adjunct study that would test for additional co-infections of Hepatitis B and HTLV-1 in order to increase the benefits for IDH patients. As part of the Foundation for Sustainable Development internship, I had the opportunity to obtain funding through writing a grant to my foundation.
I invested months in preparing the information, stabilizing community support, and gaining the interest of leading research companies in Bolivia. My study was going to be the first related to the co-infection of HTLV-1 in HIV patients in Bolivia. I was anxious to view the final product of my hard work until I received the final committee decision. My project was denied.
I reflected on the various meetings that I initiated, the numerous calls I made to verify information, the constant conferences that I held with my directors to alleviate doubts and concerns, and the planning that I arranged between IDH and CEADES so that everything was clear and in order.
With one letter it fell apart. What was most challenging for me was to finally respond to the various ignored emails that I would not be able to contribute to the study. From that experience, I learned that it is acceptable for an individual to feel broken, but one can not remain at that state.
I focused the remainder of my time on a resolution. We concluded that I would become the liaison between IDH and CEADES to set up the Chagas study in the medical consultation office of IDH. The study will continue for six months after my departure date. In this way, CEADES will increase data collection and IDH patients will receive benefits from the study.
The patients benefited from the free diagnosis of Chagas as well as the additional tests that were performed free of charge. The additional tests included: a physical examination with a focus on the cardiovascular and neurologic systems, a complete neurological exam including a mini-mental status exam, a fundoscopic (examination of the interior of the eye) exam, and a pupillometry exam (examination of the pupils), an EKG, and an X-ray. These procedures provided a clearer analysis of how Chagas affects the immune system and the progression of AIDS.
After planning and organizing, the study was successfully set up in our office and I was able to assist in the various tests. In each session, we asked for a urine and blood sample from the patient and quickly proceeded to the CEADES lab to process and analyze the samples. Because I have previous research experience, I was permitted to perform the various lab tests. The lab results in addition to the results of the various performed exams are transferred to the patient’s primary physician in order to improve the quality of care between the patient and doctor.
During my internship with IDH, I established an additional internship with LABIMED, a diagnostic clinic on the University campus of San Simon. Once a week, I analyzed the CD4 count and viral load in the blood plasma of HIV patients. After I established a strong relation with my research professor and his staff, I gained the confidence to ask for more responsibility. I thought it would be interesting to learn how to extract blood samples. In this way, I would not only be apart of the analysis process, but I would be able to have a slightly more intimate connection to the sample. The samples were no longer just blood plasma. They had a name, they had a smile, and they had a story.
The nurses eagerly welcomed me and taught me the basics with eloquent patience, a patience that is not easily found in the States. The patients smiled and waited as I nervously entered their vein. “You have to be fearless, Alejandra,” the nurse stated to me as I struggled with my first vein. She had no idea that she summed up my experience with one phrase.
I tried to pretend. In the first collaborative meeting that I arranged with the medical professionals, I pretended that the sweat droplets gleaming on my forehead were due to the imaginary heat in the conference room. When I was asked to lead one of the neurological tests on the patients, I pretended that the increase in my heart rate was due to the altitude difference.
Yet, when the needle was passed to me to for the first time to extract a blood sample, there was no pretending. I was afraid. I could not pretend that I was not terrified to puncture the patient, yet I was not going to allow my apprehension to overwhelm me. I learned to use fear. It has the ability to hinder or evoke true talents and I plan to use my lifetime mastering that skill that was I first recognized in Bolivia.
The Christianson Grant allowed me to learn from the little moments while working abroad. I learned that time can be created; there is always time for tea and laughter and that it is always better to listen than to speak. I learned that patience is beautiful and flexibility is vital; that moments pass and never repeat themselves; and that family is essential and should always be valued. Most of all, I learned that working abroad strips you to your core and exposes your inner self to the world as you succumb to your surroundings. The personal change that results from the experience is priceless and I am forever grateful to have started mine while living in Bolivia.
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