fingersticks

As I was popping out a piece of Eclipse gum that Misa brought down for me (the gum here isn't as good hehe), I managed to slice the pad on the tip of my middle finger.  Ouch!  Immediately, I surrounded the cut with my two thumbs and started squeezing out a blob of blood into a red droplet, ever growing and challenging its own surface tension.  What?!  My normal reaction (though unhygienic) was always to instantly start sucking and applying pressure. Why was I here milking out my own blood?

Fingersticks.  We just spent a week doing over 130 fingersticks in our patients who returned for a scheduled test.  

When we were trying out the lancets, I spent a good few
minutes trying to stick myself to test our glucose machine,
with the needle threatening to pierce my skin but too
cowardly to plunge it in.  Eventually, I just went for my palm.

What are fingersticks?  It's what some diabetics do multiple times daily, as capillary blood (particularly from the fingertips, as compared to the less sensitive palm) gives a quite accurate measure of blood sugar.

These little buggers are painful!  I'd suffer other things gladly over a fingerstick. The fingertip has one of the highest concentrations of nerves (others include the tongue and erogenous zones), and thus painful stimuli are PAINFUL.  

These are similar to the lancets we use here.
The picture doesn't do justice to how solid
 and unneccesarily long that needle is...
...compared to a fingertip at least!

It's a strange sensation to open a relatively thick needle, cringe myself, and plunge it as fast as possible into the soft fingerpad of an innocent person, only to know that seconds later I will plead "I'm really sorry!  I know that hurt!".  The funny thing is, when done right the pain is instantaneous, but shocking and intense.  Half the people can handle it, but half almost jump out of their chair in pain, and watch cautiously with dread as you milk a drop of blood out.

Anyhow, I'm glad to be done with the week of fingersticks.  One medical procedure I will be happy to pass off anyday!

Bolivia’s Minerals: Na+

The backpacker’s favorite natural wonder of Bolivia?  Salar de Uyuni, or the Salt Flats.  It’s one of the biggest salt mines in the world, what used to be part of the ocean but then got cut off by tectonic movements which created the Andes Mountains.

let me tell you what makes a lucrative business here- cocaine.
this would be worth a million.  instead, this salt is likely ~$50

just reach down and scoop it up

 Here, salt is mined by hand.  It’s not a lucrative industry at all, and the salt flats are protected land so people cant use machinery.  They shovel little piles which are then taken, shoveled onto a hot plate to dry, and then packaged by hand.  Iodine is added to prevent goiters!  A small baggie, enough to refill the table salt multiple times over, goes for about a quarter.

Not far away exists a lithium mine, and Bolivia has the largest supply of lithium, which is indeed a lucrative material.  However, they are currently lacking the technology to mine it properly.  Also, you can learn how Potosi, Bolivia, used to be one of the richest cities in the world with it’s silver being mined by the Spaniards, but now there’s not much left.  Potosi used to have one of the world's largest mints, and the sign (PTSI superimposed on each other) may have been the start of the modern $ sign!

The salt mines are everyone’s favorite place to 

Misa came!  And blew me away!

play with perspective.  The land is incredibly flat (and bright!), so you can go to different dimensions with the lack of diminishing perspective. 

that's one big apple!

I love seeing Japanese people who represent the epitome of their
culture. This group brought a huge set of action figures, and took
pictures of another person fighting with them.  He wore a wig,
bright clothing, and parachute pants.  Wish I had those pictures!

Misa Travels Bolivia!

It’s always fresh to see a new perspective- and luckily Misa could leave her 2 kiddos with her husband and my mom for 10 days to come visit (thanks!).  We began in La Paz, one of the two capitals, and an area representing the stereotypical Bolivia or the western Andean plateau.  The people are mostly indigenous and have their own food and customs.

On our bus tour, we learned these shocking statistics: 36% of the population is under 14, whereas less than 5% are over 65.  The average woman has 3.5 children (total fertility rate or TFR).  Compare this to the U.S., where 20% are under 14, and 13% are over 65, where the TFR is 1.89 (to be a replaceable population it must be 2.1).

These are "cholas", or the typical Bolivian women.  They wear
bowler hats (brought over from England) as well as pleated
skirts, embroidered tops, and shawls.  And two long braids!

Misa in the bowler hat and awayo.  Most women
carry everything from their crops to their babies
in awayos tied around their backs

We have TONS of fresh juice available in Bolivia,
but what Misa could not get enough of was this
pineapple juice.  She raves about it!

Great candlelight dinner.  Minutes later, the power went out in
this small town briefly, and it really was candlelight...

Street Dogs are standard.  This is quite
possibly the cutest dog I have ever seen.
It's funny how indifferent they can be.

the markets with fruits brought in locally are found in all
cities and towns.  always make a colorful photo

in Santa Cruz, tropical plants = big leaves!

       In Bolivia, Zebra direct traffic!  We tried to ask them what they were doing, but they just shoo-ed us along

the service industry

My dad had a sour face on for the first 20 minutes while
waiting for his beer. The place was filled with smoking
advertising and ashtrays, and the smell lingered.

Bolivia does a lot of things well, particularly considering their lower GDP and possible corruption throughout the government and such.  Everyone here can agree that service, however, is not one of them.  Particularly when it comes to restaurants.  I'll just leave one tale, from my sister and dad's last night in Bolivia (more on them soon!).

 We stopped in a Peruvian restaurant to look at the menu, which was mostly seafood.  They listed two chicken dishes on the extensive printed menu, both of which were not available.  My sister was already a bit queezy for seafood, so we decided to pass it up.  The lady followed us out of the restaurant, then explained that if we all wanted chicken, she would run to the store to get it!  Talk about bending over backwards for business!

We went to a place called "Fridays", that looked exactly like the American TGIF.  It even had a slogan "every day is Friday", and Jackie joked about the Bolivian version, EDIF.  

--> On the menu was a bunch of pasta dishes along with dishes like "Friday's Sandwich  and with no explanation.  When asked about it, the waiter was like "you know, it's bread, with meat.  And cheese...  It's really good."

--> Also on the menu was "Panini".  No description, nor could the waiter describe it.

--> I asked what the piña colada was like.  He described it as "you know, pineapple, and like... whiskey.  Yeah, it's blended"  (thankfully they used a drink book to make it without whiskey, but it was definitely not blended)

--> Our drink orders sat on slips of paper on the counter for literally 20 minutes, until I turned around and asked the bartender if he could at least open the beer for my dad.  He had no other customers.

The funniest thing about this bill is the it's listed in order that 

they were made. Beer, mixed drink, 4 main dishes, then the 

other 2 drinks.  Total of $40- can't complain I guess.

--> Misa's and Jackie's drink order was confused twice before they even started to make anything.

--> The food came out by some lady from the kitchen.  Then our silverware.  Then a few minutes later our bread.  Then a five minutes later some parmesan cheese.  Surprise!

-->  The sauce was great, but the lasagna and ravioli were notably microwaved.

--> The waiter gave me his phone number on a slip of paper under the bill.

At least we all left with a good laugh!

Tiburcia Gets a Pacemaker

Through some fantastic donations of a collaborating cardiologist and the group Kids for World Health (http://kfwhtrek.org/ - if kids can save lives with their spare change, so can you!), a previous researcher got a few pacemakers and cables to distribute to our neediest patients.  Note that all of our patients are the neediest- in the public hospital some barely have enough to cover the $8/day charge for the hospital bed and meals.

I met Tiburcia in one of the cardiology clinics at the hospital.  She had spend a year searching for a pacemaker, as she had Chagas related heart disease.  Not the common heart failure, but rather it affected her heart's conduction system (sick sinus syndrome exacerbated at night likely due to increased vagal tone, as shown on a 24 hour holter with numerous rhythm disturbances).

Tiburcia, me, daughter Alicia, and Dr. Vela
it's as if they smiled all morning until the camera came out

We set everything up with our collaborating surgeon, Dr. Vela, and I accompanied her on all the pre-op visits.  On February 22, I was gowned and watched patiently in the OR.  The generator, to make pulses for the hearts contraction, is placed just under the skin and the wires are threaded into the heart through veins. Her veins are incredibly thin (it took 6 sticks to draw our samples) so implanting the wires was difficult, possibly also due to their anatomy.   Instead of the normal 45 minutes, the surgery took 2.5 hours.  The whole time she was under only local anesthesia (general anesthesia not needed and could be fatal with her heart condition), and I cringed with every cringe she had.  Surgery is not for me.  The left side didn't work out, so they had to cut into the right side and start trying again. And much alternating between breath holding and daydreaming on my part, it was successfully placed and tested.  As basically the patient advocate, I was sent out to tell the family what post-op meds to purchase.  I walked out, fully masked and gowned, to all her children anxiously waiting.  And I told them she was fine and the surgery was successful, albeit with aforementioned complications which were resolved.  When I walked back into the OR, I was wearing a huge smile.  "I feel like a doctor".

Tiburcia is doing well post-operatively, and gave permission to share her details with others.  Thank you to all the collaborators and especially contributing kids out there- you have made 6 children quite like yourselves very happy : )

Campo!

Our friend Omar took us out to his campo, or basically farm.  It's about an hour outside the city, and it's maintained by a man and his family who live there for free.  Fantastic day to get away and relax.  Many thanks to Omar and his family!

singani is the local liquor of grapes

I'd have to say this is a first!  I'm wildly inefficient at this,
one guy filled a bucket faster than I would have filled the cup

starting off the morning right
ambrosia = singani, fresh milk, sugar
a little foamy, and what I could get
myself to drink was delicious

Guadalupe, Omar's Argentinian girlfriend, sports her Argentinian
hat in a field of soy.  Soy is actually one of the biggest crops here,
despite it not really being part of the diet. 

animal farm!  without the politics. could have played all day

I walked around this field for a while and stared down a horned bull.  Just tried not to make anyone mad.

we took a horse and buggy tour

favorite picture of the day

Emi Awards

So sometimes Jackie and I happen upon some free time.  Luckily for us, there are a few movie shops in a 2-block radius of our apartment.  Of course we aren't talking Blockbuster (oh the days!), or K-Mercado, or even RedBox.  We are talking about the "Peliculas Rodrigo" and Movie Car with Big Trunk Outside Mexican Restaurant, for lack of a better name.  From what I can tell, Peliculas Rodrigo consists of an older woman who sits on the curb with a stack of 50 movies, who once helped me break my big bill to buy a phone card.  When we went to watch Lincoln she sold us, Jackie's computer said "Do you want to put something on this blank disc?".  No, no we would like Lincoln actually.  So since then she has been stamping the CDs with "Peliculas Rodrigo" to exchange if that happens again.  Hence, we know this mobile human of a shop has a name!

not sure why I took a photo of "Peliculas
 Rodrigo" 4 months ago..  probably
had something to do with that cake

they go for aboue $1-2 dollars each, depending on your
mass purchasing and bargaining

Now do realize that I have some moral objections to pirated discs.  But they only go so far.  And honestly, there is no real place to buy a movie here, because it would be a market for me on a feeling-guilty day and one other rich and overly-conscientious (or more likely naive) tourist.  Jackie and I have supported the industry at the movie theatre here, mostly in English with subtitles, which go for about $8/movie or $10 for 3D.

Anyways, so Jackie and I recently attempted all the movies (and failed).  Can we stop with all the ridiculously long movies?  There is a continuous Oscar Movie Marathon at AMC theatres every year (note this shameless plug for Nate's 2011 article), not sure how you lasted through this willingly Daryl hehe.  Here's my take on everything this year, and no big spoilers:

LINCOLN:  Due to aforementioned delay, I'll get back to you on this...  Ever since watching Daniel Day Lewis in his low-cut attire running around the beautiful wilderness in Last of the Mohicans, I am a fan of all his work. 

SILVER LININGS PLAYBOOK:  Didn't strike my fancy at all.  Maybe because the whole time I was thought how annoying Katniss Everdeen (played by Jennifer Lawrence in Hunger Games) is  as a protagonist.  Long.

ARGO:  Kudos, Ben Affleck.  Hope to see more from you.  Way to bring history to life.  Also, it's a relatively shorter film with a plotline!

LIFE OF PI:  Didn't love the book, but Ang Lee did do stunning creating the Ocean as a beautiful/terrifying/interactive third player in this story.  He actually interviewed Steven Callahan, a man who was lost at see on a raft for 76 days, to bring more reality to the emotional experience.  Not a "must see" (wouldn't necessarily call any of these that), but if you are going to it's a must see in 3D!  Fabulous cinematography.

AMOUR (disclaimer: I've only seen half so far):  Maybe some of this was lost in translation (French movie with Spanish subtitles), but just was very long and depressing.  It could use more plot to portray this theme...  So today I went to see a patient who was on her way out of the hospital, post the same event.  I found her lying backwards on her bed, cramped into the corner, staring off into space. Her husband came around, smiling and genuinely excited to take her home, and she barely reacted except to lightly push him away.  I asked him about the house, which he replied would be fine for her condition (not by American standards, but this is Bolivia).  The whole clash of attitudes broke my heart, and I had to leave, not to mention I had nothing to say.  If that was the point of Amour, to make us terribly uncomfortably aware of our often inevitable weaknesses, vulnerabilities, and demise, then it succeeded.

LES MISERABLES:  Total bias that I love the songs.  Had a hard time watching it with Hollywood celebs (Gladiator, Hathaway, Mama Mia girl with unplaceably strange face, and Wolverine in Les Mis?!?) though, which was disappointing.  But overall it was put together nicely.

DJANGO UNCHAINED:  Haven't seen it yet, but I'm not really a Tarantino fan...

ZERO DARK THIRY:  Interesting job spinning the tedious and almost miraculous work of finding Bin Ladin into a coherent plot.  A little long, but informative about the general environment that side of the world.

BEASTS OF THE SOUTHERN WILD
Fantastic(al)!  Hands down my favorite.  Please watch this.  Shocking and touching.  These alien yet loveable characters will steal your heart, and it's incredible to think only the main character was cast via a casting call and the movie ran on a shoestring budget.  Thank you, no longer unknown directors/producers, for making a solidly wonderful movie for 2012.