If I had Chagas, would I want to know?

It’s been six weeks with the study running and we have 89 patients already.  The main difficulty is finding age-matched controls, ie many 60-year olds are in the hospital with Chagas heart disease, but there aren’t many healthy 60-year olds walking around here.  The average Bolivian life expectancy is 66 years.  To think my father is already a few years older than that.

Today one of the friendliest patients came back for her results of the Chagas and diabetes (HbA1C) we ran.  Both were positive- surprises to her.  I’m not keen on breaking bad news, and I’m certainly not keen doing so in Spanish.  We were sitting on two mini stools I set up in the empty end of the hall.  She just sat there, speechless, tears welling in her eyes.  It took me a long time, but finally I just grabbed her hand and held it.  I started to offer bite-size medical advice, watching it fall on empty ears.  So instead I offered to pray together, and this she heard, as if she had been waiting the whole time for it.  So we sat outside praying in our different languages.

Our study is simply to identify a blood biomarker related to the heart disease of Chagas, which could in the future identify those at risk for cardiac complications.  We don’t do much for our current patients, but the Chagas blood test is very expensive.  Patients appreciate the opportunity to have it for free and ask to bring the whole family for it.   However with Chagas, it is unclear if people gain much from the diagnosis.  Treatment is not widely available in Bolivia, furthermore it’s unknown if treatment actually benefits adults (a large 5-year study is underway now). 

Will knowing she has Chagas help her?   Maybe she will go to the doctor sooner if she has symptoms, and start heart failure medication earlier if need be.  Or maybe when Chagas meds are available here she can take them, and they may prove helpful.  But maybe this diagnosis will linger over her head for years.  I pray it’s not that last one.

Uñas Pintadas

"You kind look like you're 16... and posting this to 

MySpace... except you're smiling"

-Jackie on my photo

So in Santa Cruz city, many of the people pay attention to their looks.  High heels wobble down the poorly constructed sidewalks, and residents come in every morning wearing make-up and earrings which match their nicely fitted scrub tops.

Another thing that is "in" is the fourth nail.  It's the accent nail, the spicy zest.  Most people get their nails done in the market, by other Bolivians.  Since I've always loved doing my own nails, I just took some old polish and gave it a shot.  Jackie and I certainly don't fit in here perfectly, and will likely just end up killing this trend, but here's my best attempt.

Day at the Park

The trees are starting to get weighed
down with the spring fruits

Santa Cruz is the biggest city in Bolivia, so we decided to check out it’s biggest park, Parque Urbano.  It took us 3 different bus/shared taxi services until we realized we were completely lost, and just forked out the $2 for a taxi.  It’s spring here, turning summer soon, so everyone was out.

Not pictured, but mangos are coming into season.  Unripe ones are currently littering the streets.  In a couple months we will be having mango smoothies everyday...!

Jackie and I will rent these next time

you wouldn't guess I was writing
"thank you" notes by that face

boys practicing for a break dancing competition

Lots of couples, a large bear and wandering dog

Fixing the House

The hot water went out.  I could live with cold water- I half expected it when I moved to Bolivia.  But we are paying for gas (all $1/month for unlimited gas, not sure how that works profitably), so after a week of hoping some strapping handyman would just show up, we decided to fix it.  And we did it with the Spanish instructions!  It's actually quite simple.

For all you (future) homeowners out there, did you know the hot water heater hosts an ever-burning flame under the tank?  To light it: set the dial, hold down a button to release more gas (on ours, not sure if on all), and position a lit match to where the gas exits... and voila!   Learning more life skills here every day.

fuzzy feet

I'm already sweating
in these

So Nate and I were walking home to the “hotel” (it’s hard to for me call anything costing $20/night a hotel and not a hostel) through the streets of La Paz last week.  We turn the corner and there is a big blue tarp laid out with fluffy masses.  Intrigued, we walked past staring, and the little old man literally jumped on the opportunity to reel us back.

It was all alpaca goods which he made, ranging from hats to strange table covers to an oversized slipper to put both feet in while working at a desk.  The wrinkles from many smiles came out as the man enthusiastically adorned us with everything he had to sell.  He was too cute and Nate couldn’t help but fall in love with this hardworking old man.  So for 125 Bolivianos ($17, we didn’t even bargain since it made his night), we walked away with a new pair of alpaca slippers!  Possibly the worst item to have in scorching Santa Cruz, but they will serve me well in NYC.  The asymmetry gives them character and brings the good memory back.

Really good quality!
Inside lined with a soft wooly fur

Churrasco

So Jackie and I decided that it was about time we put our grilling pit to some use so we hosted a churrasco last weekend.  It’s the type of food party done (think bbq, but more standardized), and so we enlisted the help of Omar and Percy (new Bolivian administrator here). 

Our only friends here are coworkers (or the people we pay, ie shopowners), so we invited the team of lab techs and coordinators.  Jackie went out and bought tons of meat and some drinks with Omar, while Nate and I went to the market and bought two large grocery bags of veggies and a cake for about $25. 

yuca, salad, and guacamole

For starters everyone ate churripan, which is simply a Bolivian sausage in a roll.  The classic salad was used- tomato and red onions dressed with balsamic, and Jackie tossed in some cucumbers (threw everyone off haha).  We boiled yuca-which is basically a starchy root, think potato- for a filler.  Percy made a hot sauce by blending tomato, hot peppers (locoto), and some spices.  Malasa made her famous guacamole to set out with some chips.  Omar was grillmaster and made some delicious meat, marinated in a mash of oregano, basil, oil, grilling salt, and pepper.  Delicious!

Happy Jackie

Percy and Jackie with yuca

Nate and Andrecito

Malasa and Lisbeth being silly

Nate-in-Bolivia!

Nate came to visit me!  So happy to have gotten the chance to show him around and hear his Espanish improve.  We spent 4 days around Amazonian Santa Cruz (he admitted, it’s not the greatest tourist city but we’ve carved ourselves a pretty darn good life here) and then 5 days in the Andean city, La Paz.  I convinced him to pitch a story on the coca leaf from the perspective here- part of the ancient culture turned terrible drug by Westerners.

This isn't an exercise in the artistic use of diminishing size;
Nate just towers over everyone here
(wait to see him try and fit into a Bolivian kayak...!)

Didn’t realize how much I missed him and home until he just left a few hours ago.  Upset and alone riding back from the Santa Cruz airport, I saw a man walking and weaving through the cars selling 3 dustpans (not the brushes, just the pan) for $3.  Just as I am wondering who would ever buy a dustpan off the street, the taxi next to us looks happily surprised and takes one!  Guess it's a successful business model here?  I have a lot more to learn and a lot more to go, and Jackie is waiting for me at the hospital to help with the patients!

lexicologita

n. a little bit of lexicology (Spanglish)

If you have the chance, read Steven Pinker’s work on the fascinating influence that language has to structure our world, and vise versa.  It’s fun learning Spanish as I pick up nuances of words and language.  Anyways, here’s a reason why I am enchanted with and enamored by Spanish:

I love small things.  Cute spoons, little cups, bite size pastries, mini magnets, you name it.  In Spanish, every noun can be easily turned into a smaller version by adding “-ito” or “-ita” to the end of the word.

“Viejos” = old people, an insult I was told not to use à “Viejitos” = the endearing old couple in our study

“Doctora” = what I am not à  “Doctorita” = the playful way some of the patients address me

“poco” = a little bit à “poquito” = a littler bit à “poquitito” = the littlest bit possible (I use this word a lot when trying to mooch haha)