El Consultorio

31 Enero 2012

Briefly as an overview, for this pediatric rotation, I’m spending 1 week in infectious disease in La Paz (capital), one week in the El Alto, about an hour away working with more indigenous populations (particularly the Aymara), and the following 2 weeks back in La Paz in pulmonology and nephrology.

The first two days in Hospital Del Nino so far have been pretty good.   I work with one of the infectious disease attendings who is a great teacher and lets me do the interview and physical exams.  The first day we saw patients in El Consultorio, which is an in-hospital clinic.  We saw cases of diarrhea, vulvovaginitis, HIV, diarrhea, and a couple well child checks.  The visits are similar in some ways to the US but there are key differences due to the fact that the population and cultures served here are so different.  For example, some groups in Bolivia still believe the sun revolves around the earth.  My preceptor therefore adjusts treatment plans so they work with those beliefs rather than against them.  Illiteracy, poverty, and lower levels of education lend their problems as well.  Some mothers stop all fluids when a child has diarrhea, even though the child needs fluids the most.   Surprisingly, my preceptor at one point prescribed a placebo of vitamins to a boy came in with stable, non-specific nipple pain x1 year.  Everything about the history and exam was normal, but there were significant social stresses going on (mom in hospital critically ill, father left, living with aunt).  The thinking is that having something to take home from the appointment along with the reassurance is more emotionally satisfying (he’ll follow up in a couple weeks to see if it works).  Also, formula feeding causes many problems in Bolivia from a pediatric infectious disease standpoint.  To provide formula for your child you must first decontaminate the water (by boiling), use that water to disinfect the bottles, measure appropriately the amount of formula, and then use it immediately because it spoils.   Many families can’t do this and the children get sick.  Bolivia has one of the highest child mortality rate in South America, at about 54 deaths under 5 per 1000.