Long Journey Home, Nice People

Our lab shuts down for 3 weeks of holidays, so it’s vacation!  Luckily I was able to catch up with my sister and her kids in Orlando, then go home for Christmas with them.  So now, I am writing this on my 37^th hour of my 39-hour journey from Santa Cruz to Orlando (due to much bad luck and a missed Amtrak train).

In the last two days, a lot of people have paid it forward for me:  The taxi driver lowered the set airport fare for me.  The waiter told me he couldn’t substitute ham for chicken on a sandwich. then gave me both free of charge.  The station guard walked over to confirm I had correct change for my bus fare.  The man I flagged on the street gave me a 4-block ride to the Amtrak station (he wouldn’t accept my money, and unfortunately he drove a hair too slow).  The Amtrak station lady offered me free cookies and for one of her co-workers to drive me to a restaurant nearby.  The 2 different hispanic young men in a local restaurant in Miami both looked at me and offered a “Buen Provecho” (basically “enjoy your meal”), without even judging whether I could understand it or not.  My neighbor on the train offered up potato chips, her sandwhich, and a ride from the station if I needed one.  It's amazing how far a smile will get you.  I'll have to pay it forward, as well.

Grumpy from travel, I think of two things.  (1) When I asked my taxi driver, he said he has never left the province of Santa Cruz.  This is typical- no Lake Titicaca, no La Paz, and no salt flats in their lifetime, let alone another country.  (2) An 11 year-old girl we befriended once asked us “how long does it take to travel home?”.  She couldn’t understand our answer: ~18 hours (typical).  When her family moved across Bolivia from outside La Paz, it took 5 days of uncomfortable buses and terrible roads.  And if she ever wanted to return to see her old friends, it would take just as long.  But she will likely never have that opportunity.

Night out with Rosario

At the hotel where Evo Morales,
President of Bolivia, largely disapproved
of by Cruceñas, apparently stays

This is Rosario.  Rosario would likely define herself as a 61-year old mother of 3, a converted and strong Evangelical Christian, and a Cruceña (a person from Santa Cruz, more on this semi-feud later).  Months ago, I was making small chat with her while taking her EKG.  "My boyfriend is coming, so what kind of food should he eat here?" I asked.  Her eyes lit up, and she started raving about all the dishes here.  "You MUST come to a restaurant with me!  Yes yes come!  Here is my number, call me anytime and I'll pick you up."

So Jackie and I finally felt more relaxed with the project, and we figured we should call her up.  I've actually seen her in and out of her clinic appointments, gifting me with bread and earrings and a big smile every time.

I wish I could describe her better, but she is a riot.  She had her son pick us up, and they took us to a local restaurant with a wood grill and 50-gallon pots with the 3 typical dishes served for the night.  "No, not that, something less fatty and more meat!" she jokingly scorned the server picking out our meat hunk.

Los Tajibos is where the Queen of Spain stayed apparently.  It's decked out for the holidays, and starts at $205 per night.  Compare that with the hotel down our street (a nice area), starting at 250 Bolivianos, or $32

After dinner, she made her son drive us around town to all the fanciest hotels in Santa Cruz!  She also took us to the iconic restaurant here, but it is expensive so we just walked around it, snapping photos at her request and brushing off confused waiters.

Z is for Zebu

Oh no I might have eaten you! One day
I'll go veg, not for my new friend, but
for all the social implications the meat
 industry has on the world population

The zebu, or cebú in Spanish, is a friend of the cow family.  Originating from South Asia, he is known for his hump, his floppy ears, and his dewlap.  I looked "dewlap" up, it's the hanging flop from his neck.  Apparently, these beasts cost about 500 USD monthly in feed, which is about 1-2x the average monthly salary here.  I had some today at a grill with a family, the cut turned out to be pretty chewy but not bad.

After being imported to Brazil, they have spread throughout South America (and through Africa, at that) due to their resistance to heat.  I got two answers from googling "How did the zebu get his hump?" :
(1) The people of India selected out cows with increasingly higher
      humps, which could better stabilize yokes and other carried goods.
(2) It serves to store water, and was subject to natural evolution similar to the camel.
Neither site seemed particularly reliable, so if anyone wants to write something with real sources about zebu, please enlighten us.  I cringe at the thought of spreading unverified information, but the theories were both plausible enough.

the glittery ones win the prizes at the fair!
bonus academic exercise: so what's the evolutionary purpose of a dewlap?

pellagra

Every morning we check through the paper charts of the 20 men and 20 women inpatients looking for heart diseases to recruit.  In one of the smaller rooms of two, we read of a case of pellagra by alcoholism, a severe deficiency of niacin (Vitamin B3).  Pellagra is uncommon in the world today, since it only comes from very severe malnutrition, seen in some of the poorest third world or today from alcoholism or malabsorption from intestinal disease.  In the US, it was common in the South in the early 1900s, where the diet was mostly corn, but since the development of fortified food throughout the world, it is largely prevented.  It's classically learned as being a dementia, diarrhea, dermatitis, and eventually death if untreated.

So after we finished with patients at 4:30, we decided to check him out.  We walk in, spot an old disheveled man with spaghetti sauce all over his mouth and clothes, and hone in on him.  We manage to get his name, but cannot follow a single thing after that.  Makes sense that this be the alcoholic man with pellagra dementia.  We look to the other guy in the room, our age with blisters on both arms, and confirm with him that the old man is incomprehensible even to Spanish speakers.  The other man was 25 years old, who worked in garbage removal, and explained that he had an infection that spread and now covered both forearms.

Time for the charts.  Turns out the old man had tuberculosis meningitis (think high protein, low glucose in CSF) - don't worry parents this isn't at all as contagious as it sounds.  It was the young, relatable man who actually had fell to alcoholism, been brought in by a friend, and was being treated for pellagra dermatitis which was now superinfected.  On his extremely swollen feet, you could see clearly delineated blistering sun burns where his skin was exposed to the sun through his sandals (classic photosensitivity reaction).

After I asked to take a picture of his feet, he held out his bandaged
arms for another picture.  You can see the impressive line demarcating
where his neck was exposed to the sun, causing the rash and blisters 

This was almost a week after hiss
admission.  

Jackie and I were both chatting about how bizarre it was that this guy had such an extreme of malnutrition without other diseases first.  We were flipping through the labs, a quick task as he only had the money to pay for 4 basic labs.  On his blood count, he had anemia as expected.  And we saw it- MCV of 116.  Of course he would be folate/B12 deficient as well!  We quickly stopped Everth, the resident with the cute smirk, and reminded him the patient should be supplemented with these vitamins as well.  Sometimes it feels like we don't do much for the patient care here, so it felt good to put in that two cents.

Funny Money

Front, note the tape barely holding it together.
Pantaleon Dalence headed the Supreme court in the
late 1800s, and is considered the father of Bolivian Justice

I actually haven't seen a fake bill here.  But nevertheless each shopkeeper, taxi driver, and everyday person who functions by exchanges of money knows how to check for one.  And since a good portion of the bills here are old and ripped in half, I'm constantly doing so too.  When I asked someone how to tell, they let out the secret: his mustache moves!

Here's 20 Bolivianos, worth $3.  I hoard these for my daily purchases, since with the 50 or 100 bills you often find people don't have change.

Back.  The bill has a distinct texture, and you can
pick at the corner to make sure it's one sheet

Small letters outline the Banco Central,
but it's honestly too small for my eyes.
I matched the 39337175 before
accepting these two halves

In the watermark is a face, the number 20 to the left,  and the
strip to the right. On the left edge, see the red box is shadowed
in the yellow outline, proving the sides match perfectly

This man is showing off the 100Bs bill.
Exhibiting wealth with 300 Bs, worth US $40