2008 Bolivian Mission Journal

We are now celebrating our tenth anniversary of the mission. During the summer of 1997 I went to a mission fair on the campus of Western Carolina University. Like a beacon of light from the cloudless sky, I was led to a booth conducted by the Andean Rural Health Mission. I told the man who was in the booth that I wanted to go to Bolivia. Quite frankly, I don’t know why I said Bolivia. It just came out of my mouth. Quite frankly, I was hoping to go to Belize, where they speak English and have some fantastic archeological sites. The following Monday, a person from the mission called me to confirm that I wanted to go to Bolivia and asked if I spoke Spanish. At that point I spoke no Spanish and she tried to convince me to go with one of their work teams to Haiti or Central America. I said I wanted to go to Bolivia. Really, my knowledge of Bolivia was limited to the movie, “Butch Cassidy and the Sundance Kid.” I told her I wanted to go for a month and I asked how many volunteers went for that long. She answered that most go for a week. Then I said that I thought I could raise a lot of money and she said that they would try to find a translator for Joanna and me. I don’t believe in coincidences as all of our meetings are set by God. Here in the US, we are too preoccupied to notice these “coincidences,” but in Bolivia the bringing together of seemingly unrelated people is remarkable. Our translator was taking a two year leave of absence from her successful accounting practice in Atlanta. She was considering a career in medicine, but she was unsure of her choice. After working with us she decided to go into medicine and later received a full scholarship to the prestigious Johns Hopkins School of Medicine. She has been back to Montero two times with our group and will be joining us for the last time as a student this year. On one of those visits, she met the leader of the University of Mississippi group, Robert Wicks, and subsequently he enrolled in Johns Hopkins also. Many of our partners in Bolivia have come to us in unusual ways, but the hand of God is always visible. We now have a foster home, help with feeding programs and medical and dental clinics. We own a carpentry shop, help with home building, church construction and we have donated thousands of Bibles during the previous ten years. This year we will have groups coming from Ole Miss, (11), The University of North Carolina at Asheville, (16) and 15 medical students from Johns Hopkins, in addition to the 13 people coming from Highlands. Speaking of coincidences, the faculty advisor from UNC-A was chosen because she is fluent in Spanish, but she worked in the department of environmental health. Linda Block’s email address included the phrase, “leadprevention.” I had always been interested in checking the children for lead poisoning as there is no good disposal of batteries or anything else for that matter. Now one of our big projects will be the testing of 1000 children for lead levels in their blood.

This is the second year for severe flooding in the lowlands of Bolivia. We helped with the flood relief by providing $10,000 for basic housing in Beni where the flooding was the worst, but I felt badly that I did not visit the flooded areas. This year I want to visit the devastated areas and see if we can play a greater, more direct role. We could take our mobile medical clinics there and do some feeding of the poor. I have one week in Bolivia before the first group comes from UNC-A. Then 26 people come at the same time. That will be the largest group we have had in Montero at the same time. I look forward to seeing how our partners, who have been helpful for ten years, will step forward and help out. The Rotary Club has been our main partner, but several of the local hospitals, clinics and individuals have been very important to our mission and have allowed us to do so much in such a short period of time. Over these ten amazing years we have donated over $1,000,000 worth of medical supplies and equipment and trained medical personnel. We have built many houses for the poor, constructed schoolhouses and clinics in addition to building and supporting the foster home where orphan and abandoned children now have a chance to become productive adults. I have no doubt, due to all the “coincidences” that have occurred in only 10 years, that something special will happen to some of our boys. In the meantime, I will be satisfied that they are being protected, fed and educated. What happens next is in God’s hands and with His guidance, we will be led in the right directions to further His goals on this planet.

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Thursday, February 21, 2008

It is Thursday and we have arrived once again. It was a nice day to travel yesterday, but I understand it is cold and snowy in Highlands today. It is amazing how many times the weather is really bad on the day before or the day after we travel. Another of those coincidences again. The temperature was 88 degrees when we arrived and that is a fairly cool day here in summer. We left Miami two hours late due to a mechanical problem, but I am glad to be here as I really thought we would not be able to leave at all last night. Going through customs was a breeze, which is unusual. The only people they checked were the local Bolivians. Perhaps the local government has seen the drop in North American volunteers coming to this area due to the negative tone of the Evo Morales rule in La Paz. The people in the lowlands do not like him or his government but they are welcoming us with a lack of suspicion. Last year going through customs was an ordeal. We were met by several of the Rotarians and Dr. Dardo Chavez. Joanna came to Montero in Herman Landivar’s SUV and I came “home” to the Pinocho in the car of Jesus Plata, the Rotary Club president. We discussed several pressing issues on the way to Montero from the airport as we drove on the new four lane highway, or at least on the soon to be completed four lane highway. It has only been two years since they started the improvement to the road and by the look of it, it won’t be finished soon. My thoughts last year were correct as they haven’t planned very well. They seem to build and then repair the mistakes in drainage that were obvious to me as we drove by last year. They are putting in the drains now that should have been placed before they laid down the road. There are no markers for lane changes, or anything to indicate that there is an approaching hole other than a pile of dirt. You just have to know. I wonder how many accidents have occurred in the last year on this stretch of road. On the other hand, it is amazing how few accidents we see in general in Bolivia with all the seemingly dangerous places there are with little or no barriers. Clearly the people are more careful and there are no trial lawyers here as we know in the USA. Bolivians are, generally speaking, very careful. There are no insurance companies to bail them out if one is unfortunate enough to have an accident.

We spent most of the siesta unpacking. I have the extra work of unpacking the stuff I leave here every year. I leave my computer printer, all the other electronic devices, hair dryers and other things I never use at home like fishing hats with mosquito netting, audio-visual equipment for movies and slide shows and the like. Cell phones are always a lot of fun. Generally the batteries won’t charge after being left in a box for 10 months. Also the chips need to be changed as the phone number is cancelled if the phone is not used for six months. Perhaps I should pay someone to use the phone every once in a while so I don’t have to go through the process of getting a new chip every year. After unpacking I went out to fix the phones. The process is always the same. I can get the chip in one store, the batteries in another and the phone cards in yet a third. After getting the new phone numbers, one for me, one for Joanna and a third for the group that needs it the most, called “the blue phone” I get business cards made to distribute to my friends and contacts. Last year I went to the same place, but it is now under new management. I could order 100 cards last year, but now I had to order 200 which was their minimum. Also they won’t be ready for a week (next day last year) and, of course, they were more expensive. I got a new cartridge for the printer, and some food for light lunches, as the Pinocho won’t serve lunch and dinner until the group arrives next week. Of course today, having arrived two hours later than usual, they fixed us a three-course lunch which they brought to our room. I love this place!

One observation I had as I shopped was that there were fewer people in the stores and not a single store that I visited, including the supermarket, had enough money in the till to make change for a hundred dollar bill. Normally making change for that amount is no problem. Dr. Patzi mentioned that the people here might not want to take dollars as the currency is falling. Imagine that! The Boliviano is going UP on the almighty dollar! That should give us all cause for concern.

In the evening Joanna and I went to the Rotary Club meeting. I always try to come on Thursday, the day of the meeting as this club is our partner in many projects and very important to the mission and me. I think they are getting tired of some of the projects that continue on and on like the foster home and the carpentry shop. Most projects are finished in a specified period of time, but our foster home and the carpentry shop will go on for years. We will need to find someone or group to be the administrator of these projects as the interest is and has been waning and that is not good. The well-being of too many children is at risk. The family that is in the home has not had a rest for several years, and while the work is not hard, it is a 24-hour a day job. We will visit the home tomorrow. For dinner we had roast pig. Back home that would be a real event, but here this type of meal is quite typical, at least for the well-to-do. It was very good, served with rice, salad and potatoes. It might be common here but it was a real treat for me.

About midway through the program, my lack of sleep caught up with me. I practically fell asleep during the meeting and did actually fall asleep quickly when we returned to the Pinocho.

Friday, February 22, 2008

It rained all night and I had no idea, sleeping comfortably the whole night. By morning there was only a light drizzle, but I nearly slipped on the slick tiles near the dinning room. The owner apologized for the paucity of the fruit they had for our breakfast, but for us, the papaya, mangoes and pineapple were a tropical treat and they were so good. You can’t get fruit tasting like this in non-tropical areas. Unfortunately, we import the fruit green and let it ripen. Nothing tastes as good as tree ripened fruit. The lack of fruit was due to the flooding again this year. While it was not as bad here in Montero, to the north and in the mountains where most of the fruit trees grow, the flooding has been worse than last year and I remember people telling me that it was the worst they had ever experienced.

Following breakfast I went to the Rotary Club to do some planning for the groups that will come and then Joanna and I went to the foster home. The place looked in good repair, not like last year when it was so wet that nothing could be planted and the grass couldn’t be cut. As we turned the corner to the home, corn, in various degrees of growth and other vegetables could be seen growing. Once inside the complex, we saw our old friends, the dogs, and several new additions to the animal population. There were four new cats and at least one new dog. The mother dog looked so thin and tired, we thought she might be dead, lying still in the grass near the driveway. She has had a hard life having puppies all the time. We need to spay and neuter these pets and guard dogs.

In the home, the boys were all in the study room taking their English classes. Their English is much better, but their pronunciation is still poor. They would all become fluent quickly if they had the chance to come to the US or other English speaking country. The new home we built last year stands unoccupied. This is a shame and may be another indicator why we need to change the administration. I can’t believe that a family couldn’t be found to work here and take some of the burden from Irma and Pedro, the house parents. The work is difficult, but all the money earned could be saved as the food is free and there is no cost for the house. It is as difficult to save money here as it is in the US, but it would be, at least possible for these people. In a normal job here in Bolivia, you would go from day to day just earning enough to survive and never have a chance to save. After the English lesson we walked around the grounds and looked at the garden more closely. The ground is fertile here needing little or no fertilizer due to the floods and all the dirt is alluvial with no rocks. The fact that the soil has no rocks is good for the garden but not good for the roads. Once again the road to the home was very bad due to ruts from the traffic, but the places where we put rock in last year were very good. I told the boys we would bring them some baseball gloves and balls tomorrow and we left for another meeting at 12:30.

Our friend and director of the laboratory here came to see us at the Pinocho. All the equipment we brought seven years ago is still in working order. The new laboratory equipment in the US is so technical that it is outdated in a few years and needs to be replaced at a great cost. Here, everything needs to be repaired as there are no new parts for these old machines, but they keep plugging along. The technicians here, whether for this type of medical analyzers, or for automobiles and other machines, must be smart and resourceful or they are out of business. She gave us another side of the many stories that we have already heard about the economy, the foster home and many other issues and soon we will know first hand what the reality is. The Children’s hospital has been taken over by Cuban doctors, supplied by Hugo Chaves of Venezuela who provided the money and Fidel Castro of Cuba who provided the doctors. Everyone says the care is horrible, but it is free. Also the hospital looks better from the outside. I will visit it early next week and see if our students can go there to observe. I think it would be good for them to see a totally different sort of medicine, not that what they will see here is anything like the hospitals back home. The General Hospital, of course was run by crooks and the economy was bad, according to Terri. That I have already observed to be true.

Saturday, February 23, 2008

We slept in a bit today and now we feel well acclimated to the area after the trip. Even though there is only one-hour time difference, the trip is still long and difficult. Following breakfast we went to the boy’s home and distributed the baseball gloves and we began to play the first baseball game in Montero. The boys are so one handed that they tried to put the gloves on the right hand and then throw the ball with the gloved hand. None were left landed that I can tell, although I did bring a left-handed glove just in case. They had a plastic bat that they had used before and the men in the carpentry shop used for a pattern to make a wooden bat. Baseball is a difficult game to explain even if one were fluent in Spanish as the rules are complex. Since they are trying to learn English, I thought that I would explain as much as I could in that tongue, but I resorted to Spanish quickly, although many words are the same in both languages, e.g. pitcher, batter, catcher, etc. Pablo is a great athlete and he was able to throw and catch right away, but all the children wanted to bat. Playing the field is not very interesting and soon the boys were sitting on the ground or going off to play other games. They tried to stop the ball with their feet as soccer is their familiar game. Several of the new boys could throw very well, but catching was a problem. The gloves are stiff and they will improve with age as will their skills. The game was just getting good when it was interrupted by rain. It has not rained hard or rained all day, but it has rained every day since we have been here. As we left we drove by the plaza and it was obvious that something was going to happen by the activity going on there, but we went home for lunch and didn’t linger. We usually watch CNN on the TV but I decided to surf through the channels and found my old friend Aldo Pena singing and I recognized the plaza when the camera went to a distant shot. I took two of the young men who are children of the owners and told them I would introduce them to Aldo Pena who is quite famous for his singing and composing and we shot off in the car to the plaza. As we walked up to the gazebo where the program was taking place, Aldo saw me and greeted me by name. He asked me to say a few words for the camera but, at this point, didn’t know what the program was about, so I said I was happy to be back in Montero and that Aldo was a great singer. As the time went by, it was obvious that the event was a fundraiser for the poor folks that lost everything in the floods to the north of us in Beni. I was hoping to go there to see the situation for myself, but it is quite far away and difficult to travel there due to the floods right now. Last year the flooding was much worse here in Montero, but it is actually worse in Beni this year due to all the rain in the mountains. Three rivers run into the lowlands there, one from here and two from the mountains to the north of here. I have seen photos of the capital city Trinidad and it is completely underwater. When they began to ask for donations, I made a donation and gave bills to my companions to donate also. People drove by with bags of clothes which were collected. Then I remembered seeing a large truck earlier filled with bags that I thought were garbage. Now it dawned on me that they were picking up donated food and clothes. It made me feel that my small donations were very small, indeed. It reminded me of the story of the widow’s mite in Matthew. I am sure we will augment our donation when we find a suitable recipient organization. Apparently, the government is doing very little, as Beni is one of the four districts that has made it known that they want out of Evo Morales’ Bolivia. I danced with some of the Red Cross volunteer women, and when we returned to the Pinocho, the owners greeted us as champions! They had seen the event on TV.

From the look of this photo, you would have thought these boys had played baseball all their life, but this was the first time they ever had a baseball glove on their hand

The rain continued and the rest of the afternoon was spent reading and doing small tasks such as communicating by Internet with our friends and groups that will be coming soon. They have wifi at the Pinocho, but I cannot send emails, only receive. I did finally find an Internet café open and responded to all the letters I had read. Tomorrow we will return to the boys’ home to eat lunch and continue the baseball game, and then go to the market to see what has happened to the prices and check out the quality and quantity of the produce and then attend one or two different church services.

Sunday, February 24, 2008

The rain interrupted our game again, but the improvement was impressive. The boys were dressed in different colored uniforms so it was green against red. The hitting is much better than the fielding, but eventually we made three outs and changed sides. We managed about two innings before the rains came. We had planned to have lunch at the home and, as usual, we sat in the place of honor. The mother cooks, serves and doesn’t eat with us or the other boys. I don’t know what it would be like in a normal home but this bothers me as she acts like a servant, not the mother or a member of the family. Quite frankly, I think the older boys could do some of the serving, or even more such as washing the dishes.

The football team (soccer) is actually good in Montero this year and there was a game this afternoon. We made arrangements for the boys to go and we added two of the boys from the Pinocho and their father, who is the husband of the administrator. All dressed in red, we piled into the two pickup trucks and met at the stadium. The field was in bad shape from all the rain, but I know I could maintain the field better than this. Before the game two boys came out with a blanket, a cup and a bucket and tried to remove some of the water from the many holes in the turf. There is no drainage! Some sand and drainage tiles would solve the problem. Then some new grass seed and fertilizer would improve the situation. The game began with our side controlling the game, but midway through the first half, the score was still 0-0. They had an aging, but big center who was very physical, but our team had two wings that were much faster than their men. This finally turned the game as we scored twice to their one goal. The second half was sloppy as the field took its toll. Our first goal was a long shot that bounced funny and eluded the goalie. They had a penalty kick for a score and we followed with two great goals to finish the game at 5-2. At the end the police needed to interfere between the referees and the visiting coach. All in all, it was a good game with lots of excitement despite the wet field. The boys enjoyed the event and that was the important part.

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Monday, February 25, 2008

This was another one of those difficult days. After all the fun and joy of yesterday, I suppose this was to be expected. First we went to the boys’ home. The lathe I brought two years ago lost its speed adjustment feature. I tried to fix it and after taking the electrical aspect apart and then putting it all back together, I inserted the mandrel, the heavy metal rod on which you put the wood to be turned. The lathe suddenly ran with such speed that the mandrel flew out, twisted on to the floor. If I had been standing to my right or one of the boys had been there, it could have killed or at least maimed one of us. Fortunately for me none of those things happened but this machine is inoperable. Perhaps we can ship another part from the USA but this equipment does not exist here. I am sure someone put the plug into the 220 outlet, ruining the speed control mechanism. After the English lessons the boys came out to the field anxious to play baseball. I tried to organize them moving from first to second, etc, until everyone batted. Others came late and wanted to fit in but they only added to the confusion. Soon, many feelings were hurt and emotions easily came out with quarrelling and even fights. They all seem so tense and angry this year. I feel that one of the new boys may be to blame as he seems to be the center of most of the problems, but he is so small. He never gives an inch even after being well trounced by the older boys. Irma, the housemother, is tired and depressed and much of the problem stems from her inability to provide the love and attention to all these boys. I fear we may have to change the family and that may be the first thing the new administration has to do when they start soon. Speaking of terminations, only the chief of the carpentry shop was at work today. All these workers are new and he stated that on Mondays, usually no one shows up for work. Back home this usually means that they are hung over. The original plan for the shop was for it to furnish the funds to maintain the foster home so we wouldn’t have to provide the finances for the home indefinitely. However, it has lost money every year. My idea at this point is to lease out the facility, as it has some of the best equipment in the town, and we would be sure to have some income. Unless someone has a better idea, that is what I will suggest.

After lunch I was to meet with the people at the Children’s Hospital, but they had gone to Santa Cruz, even though Dr. Chavez and I had an appointment. This is the hospital that has been taken over by the Cuban doctors. I thought it would be interesting to see how it is run and how qualified the doctors were. Perhaps this will not be possible. After that visit I got some emails about the instrument we will use to check the soil for lead and other heavy metal contaminants. Apparently this equipment contains a small amount of radioactive cesium. (So do all the smoke detectors you can buy at the hardware store) I, unfortunately, wrote the director of the Institute of Science and Nuclear Technology that it had milligrams rather than micrograms, one thousand times less, of the radioactive element and that became a big problem. I know nothing about this machine and I wrote the letter by memory. Still, I knew it had micrograms. I just wrote it incorrectly. With my bad Spanish and his bad English, I think we solved the problem on the phone and on the Internet. We still need an organization here to certify that they will be responsible for the machine for the two weeks or less that it will be here. I am sure Dr. Chavez will do that.

In the evening I went to the Rotary Club to discuss the foster home management problem. We signed an agreement to let a church that has experience with this type of home run the facility for two years with an option to continue for eight more years if they are successful. This is a church with which I am familiar. In fact we are doing a small microfinance project with them at this time. All the money will continue to be funneled through the Rotary Club and the church’s benefit, as far as I can tell, will be that this home will become their biggest such facility in the area and a resource for bringing more children, orphans and abandoned, into a safe environment. I met a former exchange student, Sarah at the meeting. She was gravely injured in an accident that killed another exchange student here five years ago. Her name was Etta Turner and two eating centers are named for her in Montero. Sarah is currently working with the Etta Turner Center that, hopefully, will run the big microfinance program next year, for which we have a Matching Grant in the works right now. She has been in China learning the ins and outs of microfinance for the last six months and she will be here for two more years. She is a remarkable, beautiful young lady. I can’t believe she would return to a place where she almost lost her life and be willing to give so much more to this community. She will be my partner in the tennis match tomorrow night. I try to get a little exercise every Tuesday night playing tennis with my doctor friends. After today, I think I deserve a little diversion. The only real pleasure of this day was seeing the four kittens at the foster home.

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Tuesday, February 26, 2008

I awoke in the middle of the night with the noise of heavy rain on the roof of our room. I have never heard the rain this loud in all the years I have been here and that was over the rumble of the air conditioner. The one thing we don’t need here is more rain.

This was the day set aside to finish the things left undone yesterday and Friday. Most of the day was spent on getting our permit to bring the heavy metal testing machine into the country. Because it contains 10 micro curies of cadmium 109, we need to go through a huge bureaucratic mess even though the director, a very nice man, said that it would be a formality because the amount of radiation was very small. He emailed the form and it took all morning to find the correct information to fill in the blanks. We both faxed and emailed the returns to him and he made some corrections and suggestions for us to resubmit the application. As it was noon, we took a break to finish after lunch. Starting the process again at 2PM, we made the changes and submitted the proposal once again. He said it was nearly correct, but the forms needed to be sent to La Paz by courier as they needed the originals! The flight leaves from Greenville, SC tomorrow and they can’t bring the machine without the permit. Finally he said he would send the permit TOMORROW. The machine could not be delivered to Asheville until the permit arrived but the company made an exception as they had a copy of the forms we had sent in and believed that the permit would be, finally, delivered. I am glad I was here in Bolivia, but now I wish I had come a week earlier. It probably wouldn’t have made any difference as things are always left to the last moment when it becomes an emergency.

During the time between my visits to the clinic where the forms were filled out, I went to the Children’s Hospital to see if we could use the facility for the medical students who would come later. Even the Cubans warmly welcomed me. I was told that they would not let me see anything at the hospital. My doctor friends also said that no one would go there, even though it is free, but I found the place busy, well run, and clean. I think my friends need to see reality rather than what they wish to see. A decision would be made at a later time and reported to me as to whether they would like to join our teaching effort. This was a positive sign in a few days of disappointing results and much rain. I was not able to go to the boy’s home for lack of time so I spent the rest of the short time left before lunch getting a haircut and filling the pickup with gas. It cost 178 Bolivianos to fill the tank, or about $24 dollars. I spent most of the early afternoon visiting the other location that we will use for the med students and where I had planned to go last week before our planning session at the first clinic lasted all afternoon. There is no way you can utilize your time here as in the US and it takes a little time to adjust to the cultural changes. A visit becomes a social event with the coffee, soft drinks and food. Joanna and I visited the CLEM office, a small clinic for women and children where we decided we could use to do some lead testing in the afternoon sometime next week. The visit took several hours.

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Wednesday, February 27, 2008

As usual, there was intermittent rain throughout the day. This is just enough to keep everything wet and muddy. We went to the foster home, having not been there yesterday and found the boys working in the garden, planting the seeds that we had brought. I immediately joined them while Joanna went to the house to teach English. The soil was soft, not rock hard as it was after the rain last year and the sun baked it like a brick. Some of the boys cleared the weeds and a few planted the seeds. I planted at first and then took over from one of the boys who was weeding. Soon a shower moistened the ground, good for the seeds, but it ended our work. Shortly, the rain ceased and we were able to play a little game of catch, teaching the position of the mitt to catch the ball thrown in different areas. These hand movements are intuitive to those who have played all their lives, but these boys “catch” a ground ball with their feet and then pick it up. Pablo is the best athlete in the group. We played a game of catch where you step back one step after each catch and a dropped ball is an “out.” Eventually we were quite far apart when he finally dropped the third ball. Three outs! Then the player needed to change gloves with another boy. All the boys had shared the gloves and somewhat begrudgingly, gave up the glove to the next player. I was so proud of Pablo, having played the game for at least fifteen minutes while the others watched. He wouldn’t give up the mitt. Finally he relinquished, but went off to sulk. This was the first time I had ever seen this happy child act in this fashion and I really didn’t understand his behavior as he had done so well. This type of behavior will improve when the other gloves arrive and every boy has one.

Soon it was time to leave, after I had a conversation with the two foster parents who are fearful of the administration change. This may result in their leaving, but I told them they have my backing, but I am not in control. Several issues were discussed that have been bothering them as they have little contact with the Rotary Club who should have been involved with these issues before. Following lunch I went to a small church, Church of Nazarene, where we have helped with small projects for five years. They are in charge of a feeding program funded by the American charity, Compassion USA. Compassion provides the money for food and administration, but not for building. In the past, when I provided money, the projects were started and finished rapidly. This is important for our groups, as it is nice to see the progress in the short time the groups are here. Our mission will fund about $2500 to build the last of several classrooms that we have built in the past. The classrooms are used to teach the children after they eat as they all go to school only four hours a day. Since feeding children and the poor in general, and educating children are the main concerns of our mission, this project fits our goals perfectly.

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Thursday, February 28, 2008

Dr. Dardo Chaves, and I brought our pickups (actually they are both his) to carry the luggage and we hired a microbus to pick up the group from UNC-A. This is the first, I hope, of many trips to the south of the border for a new program, Mountains to the World. This program was funded by a grant from a former Highlander David Sweat, to give students an alternative to the normal spring break and give them experience in a Latin American country. Since David knew me and was familiar with the mission, it was suggested that they contact our group to see if they could come with us this year. This year their main focus will be the lead testing project. We have enough kits to check 1000 children and hair samples, soil, water and environmental surfaces will be tested for lead and other heavy metals. Those samples will be tested in the laboratory in Asheville. I have no idea if there is a problem with this element that can cause fetal death, low birth weight, hyperactivity, low IQ and anemia in children, and hypertension and heart disease in adults in addition to countless other illnesses and symptoms. Some of the students want to teach dancing and music in addition to visiting the orphanages and hospitals. The plane was on time, but our group did not emerge from the customs for a long time. I feared that they had held up our monitors we had brought, but, alas, one of the students had not obtained a visa and had forgotten her forms, so all this had to be done before she could enter the country. Finally we were able to take our bags to the waiting trucks. None of the bags were checked by customs, so our initial experience was not a fluke. It had been cloudy all day and raining hard on and off, with no let up in the precipitation for the first time this trip. It rained hard the whole day. Fortunately we had tarps to cover the baggage. We arrived back at the Pinocho and unpacked. The students mostly wanted to live with families and the Rotarians found beds for nine of them. The rest made their home for the next week in the Pinocho. Lunch and dinner will now be served at the hotel in addition to the usual breakfast. Joanna and I will go from skimpy sandwiches to a full spread of meats, vegetables, rice, potatoes, and dessert.

In the afternoon we all went to the different venues of work in the same bus that had brought the group from the airport. The rain had let up but it was still drizzling when we finally approached the road to the foster home. Since the bus could not get through the muddy road, all the people got out of the bus and got in the pickup for the final journey to the foster home. Those in the back of the pickup had an exciting, albeit, short trip. Last year we made such journeys to the campo to hold mobile clinics and the roads were this bad or worse and the trips were for 50 miles or more. This was a cakewalk. Unfortunately, the gate was locked and no one answered the bell. The boys always go to school in the afternoon so it was no surprise that they were not there. I suppose the parents took this opportunity to take a break from the place. After our blunted visit to the home, we retraced our steps and then visited two more locations and finished our visits at the Cruz Roja Clinic where a small gathering was held to hear about the lead project and gather support for the project. The minister of health for the district was there and she threw her weight behind the project. Dardo had obviously done his homework to get all these important people here for this meeting. No one had heard of lead poisoning before. Linda Block, the faculty leader of the group had a slide show she had given in Mexico. When she heard who would be there, she grabbed her flash drive, I brought my computer, and Danny Ortiz brought the clinic’s projector, and in less than

Linda Block demonstrates the Niton XRF lead and heavy metal tester

30 minutes we were ready to perform the slide show. It is amazing what can be done in this age of electronics. The ability to get the permit for the machine was another example. We were able to communicate in two languages in two continents for two days completing a task that would have taken weeks in “the olden days.” The newspapers and the television media were there so everyone will know about our project in a few days. After the meeting we had a few minutes to rest before the Rotary Meeting. The Gringos definitely outnumbered the Rotarian hosts. The lead project was again explained and following the meeting, the students went to their beds tired and ready for sleep after a long day. By the way, they never did look at the paperwork for the machine that had the small amount of radioactivity. I was not surprised by the lack of communication with the different levels of government. At least we had copies of the needed documents in case they had looked.

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Friday, February 29, 2008

I woke ready to begin the lead project. We had a meeting with the leaders of the Etta Turner Center at 9AM. We explained the project to them and told them of the benefits to the children and the community as a whole for this project. There is in reality, very little treatment for the children, but prevention of disease is cheap. Treatment of disease, in general, is expensive and only available for the lucky few who can afford it and with lead in particular it is very expensive. We don’t know if there is a problem here until we test the children. In the US lead is mainly in paint. Here no one painted their homes in the era of lead paint so that will not be a problem; however other sources of the metal are common here, e.g. mining and industry in general and poor disposal of batteries and other garbage. They finally seemed to agree to the project, subjecting the youngest of their children to be tested. At 10:30 we went to the Villa Cochabamba clinic to demonstrate the technique of lead testing. After ascertaining that the controls were in the correct range, we tested one of the students who had a slightly elevated level of lead in her blood. We then tested several of the Bolivian nurses and they, too, had elevated levels. I suggested we check the alcohol that we were using to clean the fingers before taking the sample of blood, suspecting that this might be the source of false elevated levels. Sure enough, it had the highest level of all. Using a different kind of alcohol to cleanse the finger for the test, the results were lower, but not zero as they should be. I checked the tap water and it was high also. The test was not approved to check substances other than blood, but I am concerned with these levels. This is the same alcohol that is sold in stores for medical purposes, but also it is consumed by people looking for a cheap drunk. These unfortunate people may be at risk of lead poisoning. Three ounces can be bought for less than a quarter. We broke for lunch and then returned to visit a local school near the mercado to check our first patients. It was an interesting afternoon. The children’s classrooms were isolated from the other parts of the school. At first the little ones were reluctant to have their fingers pricked, but when they found they would be rewarded with a balloon, most were persuaded to have the test done. The girls all were tested, but several of the boys resisted and we didn’t press the issue to test them all. All children had some lead and one had a high level. In all, twenty five children were tested. Two nurses drew the blood and two students performed the tests. Data were collected and it was quite well coordinated, considering it was the first time, with the work we had done before having forms ready and the teaching sessions for the health care workers. They will continue the project after we leave. I think the lead is coming from the gasoline, although Bolivia supposedly removed lead from

The nurse takes a sample of blood as the other children watch. Most of the children were very cooperative and brave.

the gasoline in the 1980’s. Even small children are passengers on the motorcycles, which spew out fumes at alarming rates. Tomorrow we will check some homes and then go to an industrial area near the sugar factory. Unfortunately, while we were busy doing the blood tests, a student and Linda were checking soil samples outside, and that student’s camera disappeared. Only the nurses, the children and the teachers were present in that room. I know people in the police and they will check into this theft. This was a birthday present for this student, which was given in advance of her birthday next week. For her, and us, this was a real tragedy. Several of the students went to the orphanage and several more never made it to the orphanage that is near the market. They got engrossed in the lure of the mercado and got lost. At least they had an experience even if it wasn’t the one they had planned.

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Saturday, March 01, 2008

We received the results of the lead tests that the nurses performed after we returned last night. The actual test in the machine takes three minutes, but with three nurses taking blood samples the ability of the machine to cope is quickly overwhelmed. There is no way to speed up the machine; therefore the nurses did the tests in the clinic at night. They seem very dedicated to this project already. Three results were in the high region and one in the critical area, over 20-micrograms/ deciliter. The lead group went out to check the home of the child who had such a high level and found no lead there. They need to check 20 homes to have enough information to come to some conclusions, and hair and water samples, in addition to soil and fish need to be taken home to UNCA for analysis.
I think I already know the answer, but it is dangerous to jump to conclusions. The air that we breathe is contaminated by lead from the gasoline. The translator, and our friend, Daniel Ortiz lives most of the time in Santa Cruz. There are fewer motorbikes there and the cars and taxis generally run on natural gas which has less or no lead. Although the levels we have found so far might not make the children sick, it could affect their potential IQ and cause premature mortality when they are older. Apparently adding ethanol to gasoline to boost octane is nothing new. In the 1920-30, blended gasoline with alcohol was common at 15-20%. Prohibition and a cheaper form of gasoline additive, tetraethyl lead, or THL came along and replaced the more expensive ethanol. The industry thought the level in gasoline would not hurt the public, but children living near the expressways in big cities developed many problems similar to those in children, and adults, living in mining

The UNC-A students plant seeds in the garden.

communities or smelters of metals which included lead. Since our preliminary tests don’t find lead in the soils, it is probably the fumes from the cars. Only a few developed countries still have leaded fuel, like Indonesia, and they will soon fade it out, but many undeveloped countries still have lead. Since 1980, Bolivia is not supposed to have lead in the gasoline. Since the ministry of health is interested in our project, perhaps something can be done to hasten the elimination of this toxic element from the gasoline, if that is the cause, and thus, the air. While they were checking the homes for lead, the rest of the group went to the foster home to plant seeds, play baseball and soccer. We played a spirited game of soccer in the mud and rain. The Bolivians (the children) against us (the adults) which ended in a tie, 2-2. I played goalie for our side and managed to stop a ball with my face and right shoulder. Right away I noticed the smell of feces and, unfortunately, the taste. I didn’t swallow my saliva until I had a chance to wash my mouth out with clean water and mouthwash. All the boys were on their best behavior. When there are more people around to play with the children, there seems to be less fighting as no one feels left out. Little Lorenzo, the newest boy who fights a lot, scored a goal and that made him feel really good. Later when we were playing catch with the Asheville students, to show them how it should look, I asked Lorenzo to throw to BJ, who by now was quite far away from me. He threw a perfect ball to him. Others came into the game and we had a large circle of players throwing from one to another. They all want to bat. That comes easily, but catching and throwing are the keys to the game.

After lunch we all went into different directions. Some went to the hospital to see births and did get to see a Cesarean section, some went to the resort, Las Lagunas, others just walked around the city, while some rested, especially the group of three Highlanders who arrived this morning. Joanna had met Steve Hott, Michelle Hott and Jessica Connor, all of whom have been here before.

Wilder and Fredy play catch

In the evening, I unpacked the new suitcases and repaired the two monitors that had some internal parts come loose during the flights. The students and one of their leaders went off to Santa Cruz to see a concert. They went with Daniel in whom I have the greatest trust. Still, they won’t be back until 1 or 2 AM and like a good parent, I will worry until I hear them return.

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Sunday, March 2, 2008

Today was an interesting day, as most seem to be here during the mission. After breakfast we visited the Dios Es Amor Church which is always a treat for me. This is the church where we had the feeding program several years ago, feeding up to 2000 people at a meal. Immediately we were recognized and announced to the members, who had noticed us also. Even though it was the Queshua service, the language of the Incas, the only words I understood in the service were, “We need two thousand dollars more to purchase the land for our new church in Portachuelo,” which was spoken in Spanish. I am quite sure the pastor said those words in Spanish for my benefit. Their church is still in the process of being finished even as they are beginning a new church in that nearby city. (Portachuelo is actually more than 500 years old, but still a very small town) I was impressed that they are moving ahead with such a project before their church is actually finished.

Joanna and I went to a birthday gathering in Santa Cruz while the students from UNC-A went their various ways to Buena Vista, about 50 miles to the north, to Las Lagunas, the resort with the giant pool, to the hospital, to the foster home and some just walked around talking to people randomly on the streets. There are many Spanish speakers in the group giving them the confidence to venture out. I was concerned about their going to Santa Cruz last night, but they all returned safe and sound and did so again this afternoon. Perhaps I have been too protective of the groups in the past.

Following the lunch in Santa Cruz, our host took us to a movie theater, the largest I have ever seen. There were ten different theaters within the huge building with shops and restaurants in the complex. There may be bigger theaters somewhere, but I have never seen one like this. We saw the “Bucket List,” which was in English, with Spanish subtitles. It was a very good movie with Jack Nicholson and Morgan Freeman. It is worth seeing even if you don’t like movies. Returning back to the Pinocho just in time for dinner, eating is a full time job here, we ate and then planned the following week’s activities. Our construction project is at the comedor at the Nazarene Church and other projects involve the hospital, the foster home and orphanage, home visits with the visiting nurses and the lead project. I called several of my friends to set up meetings with the water authority and the leaders of the government to help us obtain the information and samples we need to complete the project. One week is not enough time to do such an important project. We spent the evening into the night completing the consent forms in Spanish and making lists and procedures. Much of this should have been done back in Asheville. Finally, around midnight, I managed to go to bed and breakfast is at 7:30. Like last year I will be spending much of my time as a taxi driver.

Monday, March 03, 2008

My belief that I was to be a taxi driver today was a sound one. The first group left for the hospital at 8AM. I met the medical doctors on rounds and introduced the students to them, but they wanted to see deliveries again. On the way to the delivery suite, we met Enrique Escharagay, a quite well known TB specialist who has chosen to stay here in Montero with his meager office rather than going to almost anywhere else to practice. I am trying to obtain a Gates Foundation grant for his office and work. TB is a terrible problem here. At 8:30AM the construction group led by Steve Hott went to the small church to begin the classroom. By the end of the day, he, his wife Michelle, several students and two Bolivians had finished 5 courses of bricks around the whole place. Another group was led to the foster home by Joanna and I took Laura, whose lead project is a major focus of the trip, to the supermarket to buy notebooks, plastic spoons to collect soil samples, plastic bottles and other things she needed. I went across the street to buy a measuring cup which was not available in the supermarket and some distilled water from a laboratory run by friends. This came in a liter bag, like IV fluids. Because the director of the lab is a friend, they would not charge me. We need six more liters so I will offer money and take nothing less than “yes” for an answer when I return tomorrow. We returned to the Pinocho to pick up the rest of the lead team and off we went to the Villa Cochabamba to pick up the nurses that have been so gratefully donated for our efforts. We were late by this time and I thought I knew approximately where the school we were to visit was, but the nurse giving me directions led me back to where I had just come. Eventually we went around the block a few times and came out where I was intending to go originally. I have found several shortcuts, or at least routes that avoid traffic, over the years, but she made me go in all the really congested areas. Eventually arriving in the area called Guabira, we again made a wrong turn and continued to go the wrong way down one-way streets. It became apparent to me that she had walked these streets, but never had driven on them. When one is walking, there are no one way streets. Finally, as we arrived, at the school, we met the health director who had just started to leave, giving up on us I am sure. Over the years I have developed a reputation for being on time. I hope I don’t lose that over the next few weeks as it took a long time to change the behavior of these very nice, but tardy people. We managed to check the walls and floors of the school for lead and other heavy metals, and found none. The children, however, had moderately elevated levels as we have found everywhere else thus far. We were able to check about 20 before the school let out for lunch. The parents who came to pick up their children were very happy to have them tested. I have always found that the parents are happy to have tests done on their children if it has anything to do with their health. One mother wanted to be tested, so we did her out of courtesy. Adults and older children generally will be negative for lead, as she was and I checked her for diabetes also which was also negative.

After another wonderful lunch we met with the sub-prefect (there are nine districts in Bolivia and each has a prefect. There is a sub-prefect in each of the “counties” in the district). He knows everyone who is important and he made us an appointment with the chief of the water department called COSMOL. That would take place at 5PM. We went back into the outskirts of the town to meet up with the other parts of the team that were checking houses, which takes a long time, and the children in those houses. It only takes a short period of time to check the children and most never cry. The balloon given as a gift for their pain and suffering always seems to be enough to make them happy. As I have noted from the first year of the mission, the poorest children are the bravest.

The children happily playing with their balloons after the tests

Soon it was time for us to meet the water people at COSMOL and off we went leaving the others behind. I was not sure I could find them again, but there are several in the group who speak Spanish well and there were three nurses who know the way around these parts like the back of their hands. Without their help, who knows who would have the confidence in us to let us do this kind of work? The meeting was interesting to me. They showed us how they check the water and the results. There are 9 wells scattered about the city that are over 200 meters deep. The water from each well is checked every six months and the data was there for anyone to see. Actually it looked too good for me as there were no abnormal reading ever! Even in the USA it is impossible to be perfect all the time. We got permission to check the wells and also we were given a computerized map of the water system showing the type of pipe, the oldest being cement and the newest being PVC, and when the pipes were last repaired and the size of the pipe. It was really quite impressive. I left Laura and Danny (to translate) at the office as I returned to the group I had left behind. Just as the sun was beginning to set, I found them. They had just finished the last house. At dinner, the hospital group reported that they had not seen much. The hospital has had such bad administration that, I think, the people have lost trust in the place. At least the ceilings that had fallen down last year were repaired. The construction team had completed several more courses of bricks. I like this kind of work as you can measure your progress from day to day. The temperature was OK as it was overcast and threatening to rain all day but actually rained only enough to keep the temperature down and the dust under control. The men at the COSMOL agreed with me that there is still lead in the gasoline even though it was supposed to be eliminated almost ten years ago. However, we have found little in the soil where it would usually remain for years. However, it never rains like this in any place other than the tropics and it may have been washed away. All the people, including me, have no real proof that there is lead in the gasoline, but everyone I have talked to suspects that it does. Since we can’t take a sample back in the airplane, we might never know.

It is not uncommon to see livestock just walking around in the city. One of these sheep is hairless, breed for this condition because of the heat. Inbreeding has brought out the hairy gene in his sibling which can make life miserable in this heat.

Everyone was a bit concerned about the politics here with Evo Morales, the president, doing all sorts of weird things and trying to have a populist movement to redistribute the land to the poor, but today I saw in the newspaper that there is a possibility of war between Venezuela, Ecuador and Columbia. Who would have thought it? The people here have no interest in fighting, but, if pushed, they might resort to conflict, especially if the government tries to take away their land. The nature of the two different areas, the mountains versus the tropics, is vast. In the mountains, the farm land has been cultivated for thousands of years, while here in the tropics, only since the malaria has been reduced by insect control has the land been able to be cultivated in an efficient manner. Also sugar cane, Soya, and cattle need to be raised in large farms to be efficient. Small farms cannot afford the large equipment to reap the crops. Mountain crops are often maintained by hand in small farms. Evo also wants to stop exporting crops, to keep the food in the country and thus keeping the price down. Again, this hurts the tropics and helps the mountain people. The oil and gas are all in the tropical area and it is closer to export it to Brazil and Chile than it is to send it to the Alto Plano. I think he will be out of office before he can institute such foolish policies.

Tuesday, March 04, 2008

This was a pretty good day. After taking everyone where they needed to go and some now get there on their own, I was able to go to the foster home for the first time in several days. The new lathe had to come in separate pieces as it was too heavy to come in one piece. The largest part is here but it is useless until the other parts arrive in the few weeks. In the meantime, we are cutting up the wood parts, drilling them and inserting the metal tubes. All this can be done in anticipation of the arrival of the rest of the machine later this month. Then the pen making will be rapid. The three oldest boys worked with me, Pedro, Fredy and Wilder until I needed to pick up the lead testing group at 10:30AM. Pedro said he would take the students and Joanna back to the Pinocho. That relieved me of one more thing. Fortunately for me the lead group was close by, but I didn’t know exactly where they were. I got directions and found the school, 12th de Abril quite quickly, albeit, over some really bad roads. They were set up in a new classroom with an unfinished roof and bricks for a floor. Thankfully it was not raining. About 20% of the children have elevated lead levels which is a very high percentage for the USA where only 1 or 2 % is normal. We left there and went to the comedor, the feeding center, where we are doing the building project. There we checked 25 more children with similar results. When the samples are tested in Asheville, we will have a better idea of the source of the lead, but currently, the dirt, paint and other surfaces have not shown a significant amount of lead. Water will be tested back home as we don’t have the technology to do that here.

Following lunch, I told the lead project group that I would take them to their first place and then I had other plans. I didn’t know that the first place would be “over the river and through the woods…” literally. I had been the general area before, but I had never passed the dike like area previously, and if I had gone there before, I would have stopped and turned around. The elevated structure was, indeed, a dike. There was a river beyond which, from the look of it, floods frequently. Beyond that were a series of brick making kilns and holes that fill with flood waters, leaving behind the clay which can be mined, made into mud bricks and baked in the drier season to make the bricks that everyone uses to build their houses or other buildings. It is amazing how the raw materials are brought to the area by the rivers. There is the sand in the big rivers, and clay in these shallow low lands that need the flooding to replace the material that is dug out every year and used to make the ubiquitous bricks. Then there is the fuel that bakes the bricks. This is also renewable as they use wood to stoke the fires. That process should create the possibility of contaminating the air with many toxic substances. I left the researchers and the nurses, but, needless to say I arrived back at the Pinocho more than an hour late. I really thought the ride through one river and down some roads to the houses of the workers that live there was an interesting one, to be sure.

After lunch and completing my taxi duties, Joanna and I went to a nearby town, Portachuelo, with a few of the students, just to get away for a bit and buy some honey products to sell back home. The skin cream is well known by our volunteers to be as good as any similar product found in the USA. Upon returning we ate dinner and then I was called to come to a “brief” meeting at the Rotary House to hear the final reading of the legal document pertaining to the administration of the boy’s home. The meeting was important but the discussion of every little detail is boring to me. Finally everyone seemed to be in accord with the document as written. The major issues were the fact that this group is a protestant evangelical organization and the boys have all been brought up as Catholics. They stated that they would not try to convert anyone at least until they came of age and that we didn’t want any older boys to come in from the outside, only those who grow up within our home. That decided, I left to play tennis, but two of the persons present at the meeting were my prospective tennis partners.

I warmed up with young man who was a son of one of the doctors with whom I play.
Eventually, everyone arrived and we had a good game. I have been asked to help one of the boys in the tennis program get enough money to pay for a trip to La Paz to play in a tournament. I came up with the idea to sell some of the racquets I have brought to help defray the cost of the trip. The racquets that were donated by the Mountain Laurel Tennis Club are older models but are very modern to the people here.

Wednesday, March 5, 2008

Wednesdays are always fun as we usually work only half a day and go to Santa Cruz for shopping and go to a restaurant. After my taxi trips and taking a few photos, a big group went to the boy’s home. I did the pen project with the same three boys and a fourth, Marcelo, entered into the fun and was trained by the other boys. As in the past, the drilling of the wood blanks and the gluing and inserting of the tubes are the easiest part of the pen making process and the boys do this task well. Following about one hour of that work, we played baseball, using a light ball that was obtained from McDonalds and brought here last year. The boys can hit well, but no one wants to play in the field. Due to that fact, I decided to stop hitting and let the boys play soccer. One of the boys got the plastic bat and the light ball and tried to hit it into our group of soccer players. I told him to stop three times and finally he hit one of the boys in the head with the ball. Fortunately, it was this light, whiffle type ball instead of a real baseball or it could have been a tragedy. Instead it was a learning experience. I took to bat and ball from the boy and took him to the garden. I don’t know what was going through his mind as we walked, in silence. We were in the garden alone and I told him to pull some weeds and then we talked about the incident. Walking back to the house, my arm around him, he seemed relieved and I hope he will remember to be more careful. This child has had problems in the past, and despite his size, he is a crybaby when the others fight back and he is teased even by the little kids. I worry what he might do, especially when the children use machetes to cut the grass.

Every group was in a position to be picked up in a logical order and all were ready for a little relief when I arrived at the respective sites. We have been working hard in the various areas. The classroom has four walls and is about ready for the roof and the floor. Tomorrow the students will carry sand into the structure to level the floor and then bricks will be laid, and then, finally, cement will cover the bricks and the building will be finished. The doorframe and windows were inserted as well.

The lead project is coming along well with samples taken from all the sites to see if there is lead in the city water wells, in the pipes or in the houses. We continue to find about 20% children with elevated levels. The latest source for lead exposure seems to the bronze faucets where older children are able to put their mouths on the metal take a drink. The smallest children cannot reach up that high.

Off to Santa Cruz we went after lunch. It was good for me not to have to drive. Having been so many times to the big city recently, I went to the camera district to see if I could find a similar camera as the one stolen earlier this week at the school. We do have a lead on the theft as one of the students saw a young boy playing with a camera, but the likelihood of recovering the camera is slight.

Having spent most of the afternoon on the quest for the camera, I didn’t have time to do anything else until I finally got the group together at the main plaza and took the bus to the Casa Camba restaurant, one of the favorite places for students to go for dinner and dancing. The restaurant didn’t disappoint. We asked all the nurses who had helped with the lead project to come and we paid for another bus to bring them to the restaurant after work. They arrived about five minutes after we did and we had a table of 35 people including the bus drivers. We ate and danced until we were tired and returned to the confines of the Pinocho for a well-deserved sleep.

Thursday, March 6, 2008

I had a tight schedule this day as we began the day with a photo opportunity loading a small truck with a chlorine solution that makes even bad water safe to drink. Almost since the day we arrived I have been working with a pastor from Beni, the area to the north where they have had flooding for the second year. We purchased $5000 worth of the chemical that will serve 200 people for three months. Hopefully then the situation will improve and families can return to a normal life with safe water options. We also donated $2500 for basic food such as rice and cooking oil. This was all photographed not so much for our glory, but to document that this money and things were donated. Pastor Dennis will email photos from Beni when he delivers and distributes the items. That will complete the cycle that maintains trust in this area. This type of checks and balances has worked well for Dr. Chavez and I am happy to learn from this successful administrator.

I dropped off the lead work team at a classroom and another meeting of the lead crewmembers was planned for 5PM this afternoon. Food and drinks would be served by these kind people in appreciation of our contribution to their mission work.

During the meeting on Tuesday evening the new administrators of the home wanted me to see the project they run in Buena Vista. It is a home for drug addicts and alcoholics. As we drove into the property, I recognized it as a property I looked at in 2001 as a possible purchase for a home in Bolivia. Obviously, I didn’t buy the land then, as it did not fit into what I thought the mission would become. Immediately it was obvious that this facility was well run and that is what we need in the boy’s home. The last part of their addiction treatment has the persons going to a home of a couple without children. The addicts have to work to earn money or they don’t get fed and they don’t have electricity if they can’t pay the bills. Many leave, and that is that! I think this group of couples will be the source of families to work in our home. There will always be a source of families from which to choose, so our home will not be left without foster parents. We had lunch in the town of Buena Vista in a restaurant on the square. Since last year the roads have been bricked and the area is just beautiful. It is a small and tranquil town. I bought some coffee beans and raw chocolate to sell at the summer’s auction at a shop on the main plaza. Traveling with me were the president of Rotary and his exchange student from Japan. I could understand her Spanish as well as North American’s speaking Spanish. As a second language, the syntax and speed of speaking make it easier to understand. We talked about food, topography and the cultural differences between our three countries.

I made it back to Montero just in time to pick up the group to do the lead project in a nearby eating center. I did the blood samples and when we finished with the children, I checked the blood pressure and blood glucose of the mothers of the children. Our monitors that we purchased for this function worked very well. Tomorrow we will take several monitors to the Guarani Community to do the lead study and a screening of the adult Indians there. This year we are much more organized with no carbon required printed forms which creates a duplicate for the patient and a copy for us in addition to the vital sign machines that will allow all the students to be involved. Blood sugars will also be performed with the handheld machines that are very easy to use.

I planned to rest for a few minutes before my 5 o’clock meeting at the construction site when it began to rain hard again. It has been raining all week on and off. No one has seen the Southern Cross, which is a shame for those who have crossed the equator for the first time. It cannot be seen on our side of the equator. It is the equivalent of our North Star. I got a call that they were waiting for me and I felt a bit indignant as I was not yet late. It is very difficult to be on time with a group this big as there is always someone who isn’t ready when it is time to leave. I drove to the church in the rain and it was obvious they could work no more in this downpour. The people of the church wanted to show their appreciation for our

Lauren Wingo, Lydia Doll, Kassidy Heffner, Steve and Michelle Hott and Jessica Connor have nearly completed the last classroom of the feeding center

contribution and work on the classroom so they had a little party for the workers and me. So far I have not laid the first brick although I did bring a few wheelbarrows of sand to the site. We had coffee, tea and a variety of locally made breads followed by a wonderfully moist, sweet cake. I generally don’t like cake as it is too dry for my taste, but the cakes are moist due to jell-o like fillings and fruit between the layers. The rain stopped as we were finished eating and Steve Hott jokingly said that we could begin to work again and one of the Bolivian workers got up to do so. We laughed and decided the workday was ended and we went home. The pastor invited us to church at 10AM on Sunday which was good as the Penial Church had asked us to be there on Sunday at 9AM. Later I got a call from the pastor of the church that Danny’s brother is building to be there at 8PM. Since this project will soon be finished, we will need another small project to fill our building needs in the coming weeks and that church may be the site. Our Sunday church card is now filled.

In the evening we attended the Rotary Club where Ashley performed an example of clogging, which used to be the famous dance of the mountains of North Carolina. She still teaches this type of dance but the center of clogging has long since left the mountains to other areas where it has increased in popularity. It is hard to think of Highlands in the 70’s without thinking about Helen’s Barn and clogging on Saturday night. Now both are gone.

Friday, March 7, 2008

The lead project is into the home stretch, at least as far as the home visits are concerned. The machine which contains the radioactive material needs to return with the UNC-A group and it is the most important part of those visits. The Niton XRF can detect elemental metals just by applying the machine to the surface and is good for paint, china, metal and practically any surface material. How it works, I do not know, but it is amazing! It reads out the percentage of metals in order of their content as long as it is out of the predetermined range. Lead shows up as well as iron, zinc, arsenic and some elements that I didn’t remember from chemistry. Thankfully, no chemicals are turning up in dangerous amounts aside from a few sources of lead, mostly in the brass faucets. Brass is not used for that reason in the US for plumbing, but many older, quite expensive fixtures were made of bronze. I know I used to have some bronze fittings in my house before we replumbed the house in the 1980’s. After dropping off a few people again, I visited the foster home and continued the drilling of wood for the pens. I don’t remember where I put the rest of the parts of the lathe, but I hope they come with Eugenia Green and Michelle Main who come tonight. I didn’t put them on the list of priorities because I thought the old lathe still functioned. An electrician is coming later and maybe he can fix the velocity regulator and then we will have two, which was the original idea. I really thought the lathe parts were in the group of suitcases brought by the UNC-A group and I hope they weren’t removed to make room for something else. Then they won’t come until next year!

After lunch we tried to go to the Guarani Community. The main road is being repaired but it is paved and created no problems. The dirt road that we turned into was bumpy but not a problem. After driving about 10 Km on this road we came to the path to the Guarani
Community and the gate was locked. I understand that there are two reasons for locking the gate. One is that the bridges are washed out. In that case, we will never be able to enter the community during this trip. The other is that they don’t want people using the road when it is muddy as the tires make so many ruts that the road can be ruined for several months. I hope the latter is the case. I knew another route to the community so we backtracked to the main road and took the road to that goes by Las Lagunas, the resort. A cry rose up from the ranks to go there instead of doing the lead tests but I wanted to do testing on the children in the campo, the country. The road was not good but it was passable. Finally we came to an end of the road. I asked a man whether we could go to the Guarani Community and he said the road was not passable. Then I heard him speak to his wife and I recognized the Guarani language and asked him if the Guarani lived here. He said, “We are all Guarani.” Apparently we fell upon one of the three Guarani Communities that dot the landscape in this part of Bolivia. I told him what we could do, checking the adults for diabetes and hypertension, and the children for lead. Since we were there, I thought

Everyone ready to go to the Guarani Community

we might as well do something. Soon there were about 20 children waiting in line to get their fingers stuck all without crying. Even the toddlers didn’t cry. How they know to be stoic at this young age, I do not know, but this has been my experience in all my years here in Bolivia. As the other children in the city, the levels were slightly elevated but not alarmingly so. All fell between 5 and 8 micrograms/deciliter. While these levels are elevated, they probably won’t effect development of the brain. Still any lead will eventually cause premature death from a variety of medical problems, including heart disease and hypertension. The community did have a central water system and there were the ubiquitous brass faucets in the home and in the yard. We returned to the Pinocho feeling that we were lucky to go to such a remote area and return without getting stuck.

In the evening Joanna and I went to a meeting of the Civic Community of Montero, a group of mainly women who perform volunteer work in Montero. After many speeches, they finally gave four women awards for their volunteer work. Joanna was one of the four. She is a professional volunteer in Highlands as well but it is nice to get some recognition of her efforts here as well.

Joanna and three other volunteers receive their awards

As soon as she received her award, Herman and I left for the airport to pick up Maria Eugenia Green and Michelle Main at the airport. Once again the plane was late in arriving. Since there is no landing in La Paz on the night flight, the problem had to be in Miami. When they finally arrived they told the tale of waiting on the tarmac for several hours with mechanical problems. They thought the flight would be cancelled but finally they took off, delaying the arrival by an hour and a half. More groups are arriving tomorrow when we will have the most people at one time in Montero in the history of the mission.

Saturday, March 08, 2008

This turned out to be a day I will not soon forget and, unfortunately, not for a good reason. The AA flight was late again, this time by 1:45 minutes. After loading the two buses with luggage and people, there were 26 total, we headed to Montero. The two buses left just before me and I followed in the truck in which I carried Elaine Clark of Ole Miss, Shannon Shea, a senior at Johns Hopkins, and Robert Wicks who developed not only this group from Johns Hopkins, but initiated the first group from the University of Mississippi in 2005. Just before we got to the roundabout at the south side of Warnes, the town next to Montero, a crowd had gathered and two or three automobiles were in front of us. It was apparent there had been an accident. I asked Shannon, whose Spanish was much better than mine, to go and see if we could be of some help. She returned to tell us that one man was dead and another injured. I wondered how she could be so sure about the one who was dead, as she had been gone for only a few seconds. We identified ourselves as medical personnel and they waved us toward the accident site. One man was in pain with an obvious broken leg. The unfortunate one had been a motorcycle taxi driver. The bike apparently fell in the mud and pools of water that had collected in this part of the road and he was run over by a truck. I won’t describe the scene further, but the image is ingrained in my mind to the smallest detail and I don’t think it will soon be erased. We helped put the injured man on a stretcher and offered to place him in our truck, but he would have had to have been placed sideways with two or more people in the back of the pickup to hold the stretcher to be sure he didn’t fall out. It would have worked but a bigger truck was close at hand and they let us pass and loaded him in the other truck. Soon, traffic was moving next to the dead man as if nothing had happened. Traffic would have been backed up for miles in the US until the body had been properly removed. Death is more commonplace here. I hope his family will be all right and I am praying for them right now.

By the time we reached the Pinocho, lunch was being served. Luckily none of the others witnessed the accident, being only minutes ahead of the tragedy. I warned the crowd about using the motorcycle taxis as many of the UNC-A students have used them.

The rain continued to fall and we decided to go to the foster home, as we really couldn’t do anything else. The road was horrible having been traveled many times while muddy. The ruts were deep and they caused the passengers to lurch back and forth. Finally we arrived and there was no welcome by the boys or the numerous dogs. The rain was that bad keeping the boys inside and the dogs under the eaves to protect themselves from the rain. Normally, if there is a chance to play outside, the boys take it. We all went inside to play with the kids and there was no outcry to go outside to play baseball or soccer. I took some to the carpentry shop to continue the drilling of holes in the wood for pens. Fredy was proud to be able to do this quite well all by himself. He does try to drill too fast causing some of the wood pieces to break. Of course, he didn’t think it was his fault, but that is OK as there are a lot of wood pieces. Mostly we have guaycan and tajibo wood at the present time. Both are fine woods for pens and furniture. The adults and one 8 year old inserted the brass tubes covered with epoxy into the drilled pieces of wood, so these will be ready when the rest of the lathe parts arrive, or when we are able to fix the old lathe. We have a lot of pieces ready for the lathe when all the pieces finally arrive. The boys and I can hardly wait!

Lauren Hodges and I collect water samples from the river. The main flow of the river is in the middle, but this river was filled from one side to the other just two days later.

Lauren Hodges, who is doing the lead project as part of her schoolwork, needed to collect some water samples from the nearby canal and the big river, Rio Piray, that carries water from the mountains to the Amazon basin, through Beni. Quite frankly, the canal near the boy’s home is the real reason why I decided to fund this project in the first place. It is very nasty, draining water from the whole city of Montero. We collected the sample from the canal first to gain experience, as we would need to obtain our river sample from the Eisenhower Bridge over the river Piray that is some 200 feet below the bridge. We had some string that Irma allowed us to use. We were able to collect water with a plastic bottle that would fill only partially and we needed to get three samples to fill a quart bottle. Driving to the big river some ten miles away, we parked by the bridge and began to walk to the bridge, as there was a traffic jam as no one was allowed to cross the bridge. There was a dirt road off to the left just before the bridge and we decided to take it and see if we could obtain a sample from the river’s edge. The road, like all others, was in bad shape. Being so close to the river it was very wet and slippery. I spotted a path to the river and stopped in the middle of the path, not being too worried that another car would need to pass. We were able to collect a sample using the same technique, as the water level was so high the water was right up to the bank where we were. Normally, we would be several meters from the river’s edge and this could have been quicksand as it had been recently deposited. The path we took was covered with large leg bones of cattle. How they got there, I can only guess. We collected our samples and returned to the truck. The road was so slippery that we fell into the roadside ditch even though we were traveling very slowly. Finally we were able to retrace our steps and return to the main road. Traffic on our side of the road was blocked allowing us to travel back to Montero without any other cars on the road. We later found out that the road on the other side of the bridge had washed out on the southbound part of the road.

On returning to the boy’s home to pick up the rest of the students and Joanna, we made the road even worse. This part of the road must be filled with stone. Apparently this is private property, but they have to give us access. Improving the road should not be an issue, as the repairs would make their property more valuable. They say this will be fixed by Monday for the birthday party at the home. Personally, I don’t think having a party at the home is a good idea because of the road.

In the evening I showed the movie, “Wit,” a story about a woman with ovarian cancer. We show this movie to hospice volunteers to show they how not to interact with patients and I showed this to the med students to show them how not to be a doctor. There was no empathy from the doctors and only at the end did the nurse really get emotionally involved. There is nothing wrong with being empathetic with your patients. Some of my fondest memories of patient care were not about saving lives, but making the transition to the next life easier and less frightening. That is a trip you can only take once and practice doesn’t make perfect. I hope these young students will become “real” doctors, not just smart ones. Having seen the movie, which recalled the death of my mother from cancer and the badly mutilated taxi driver, I got emotional trying to explain how a good doctor becomes involved with the whole patient, not just the disease that the patient has. Actually, maybe this will be a good thing for them to see a mature doctor able to feel pain and sadness and show emotion even after a movie. These are human emotions needed to care for human patients. Tomorrow they will all go to Samiapata, an archeological site about four hours away. Some of the students from Ole Miss have tried to go there twice before, but were unable to get there due to the weather. One of the bridges was washed out earlier in the week, but two students from UNCA were able to get there today, making the trip to Samiapata, at least, a possibility.

Sunday, March 09, 2008

Steve and Michelle Hott left this morning and the UNC-A group will leave tonight. There are two different time sequences that work here all the time but are more apparent when one gets ready to leave. On one hand the time seems to go by so fast that it feels like you just got here and on the other, when you add up all the things you have accomplished, it seems like you have been here for months. It is difficult to explain and I think it needs to be experienced first hand, but everyone who comes here feels the same thing.

I went to the Pineal Church with Eugenia Green at 9AM, followed by a service at the Nazarene Church where we built the classroom. I would meet up with the pastor again later in the day when we went to the soccer game at the stadium, two blocks from the church. Following lunch I had to collect fish samples from my fishing friend Herman who said he is working all the time except when he is fishing. Yesterday, as we went to the river to collect the water samples, we passed his farm and I saw three or four men fishing in the small pond and he said he was one of them. He caught several fish that they use for bait to catch big ones. I had to skin and filet the fish and they were the toughest fish I had ever cleaned. I don’t know how the other fish digest these fish. In addition to the tough skin, they also have poisonous spines. I got two other samples from his freezer at his house. These samples were dated, and the name of the river where they were caught was recorded. This concluded the project as far as collection of the food, water and soil samples. The blood collection from the children will continue for some months to come.

After lunch the soccer players from UNCA wanted to see a football game so off we went, keeping one eye on the clock, as they had to leave shortly after the game and the other on the weather. It looked like rain all day but it only drizzled a little. The field came into play as the home team was out played by the visitors for most of the game, but the only score came on a penalty kick resulting from a dubious call and our team lost 1-0. The bad field made the outcome in doubt until the final whistle. Bad weather or a bad field can be a great equalizer in many sports.

After the last supper, the group left for the airport tired and ready to return home. I went to the market to buy two last minute soccer t-shirts for one of the students and they were off in the bus. Finding a plastic bag filled with souvenirs in the lobby after the group left, we raced after the bus to give the contents to the owner, but, alas, they had too much of a head start and we will need to bring these things to Asheville in April when we return. If that was all they left behind, I will feel that we did well. Tomorrow begins the five rotations at the various clinics and hospitals with the medical students. I hope it goes well as I will have to rely on my friends to make this work well. After coming all this way, these students deserve a good experience and I cannot be with all of them.

Monday, March10, 2008

I awoke at 4AM with stomach pains and diarrhea. Perhaps the Popsicle I ate at the soccer match was the cause, but who knows? If that be the case, however, all the students on the plane that left last night may have the same problem and that would not be good. While I was awake I heard the rain falling hard again and I worry about the lunch at the boy’s home. The rain continued through breakfast but all the groups were able to go to their five destinations. Two groups walked to the work places that were nearby, Dr. Patzi took one group to the hospital and taxis took the remaining two groups to their respective locations. I needed to talk to the TB doctor about a Gates Foundation grant so I went to the General Hospital to talk to him to see what he has done so far and see how the students were faring. He has been writing me about his plans and I have given him some advice about how to proceed. Apparently he has gathered a coalition of civic groups, one being the organization that gave Joanna the award last week and has talked to an architect and engineer about the building. He and I both agree that the process needs to proceed without the “help” of governmental agencies. The sad state of the hospital is an indication of how graft and corruption can sap a program. To obtain a grant, I told him, our project needs to be self-sustaining and be something new and different so it can be an example for other third world clinics to emulate. All third world countries have similar problems in dealing with TB and other diseases and they have to contend with corruption, either open, as it is here, or hidden. We need for all our money to go to help the poor people and not end up in the pockets of some bureaurcrat's pocket. Dr. Esheraguy is an honest man who also has knowledge about how things work here. Dr. Chavez, one of our partners, is another. Both could have left and found better paying jobs elsewhere, but decided to stay and make a difference here. After this group leaves and I have more time, we will get together, perhaps with a few important people and talk more. The process may take a year or more.

Due to the weather, I decided to see if everyone got to where they needed to be. I knew from experience that the two clinics would be quiet as the patients and some of the employees can’t get to work in this kind of weather. The roads were full of water but the roads near the Red Cross clinic were rivers. At least 18 inches of running water was flowing by the clinic. There were only a few patients so I made sure the students were able to look at some specimens of parasites that they may never see again if they practice in an urban area. The group from Johns Hopkins is very diverse, talented, intelligent and interesting which did not surprise me in the least. Two were from China, one from Italy, one from Viet Nam and one was born in Africa. Many different geographic areas of the US were also represented. All the students had arrived at their proper areas and several of the Ole Miss students joined them on their rounds. They are getting along well, as they are not that far apart in their studies. The rest of the college students went to the boy’s home with the Highlands’ volunteers in the pouring rain. The canal near the home is the main exit point for all the rain that falls on Montero. Now I know why these roads in a fairly unpopulated area of the city were paved last year ahead of more traveled roads in the center of the city, as they act as a drain for all this water. The canal is obviously the lowest part of the town save the brick making area further to the north, which we visited last week. That place must be under many feet of water today, replenishing the clay again. We drove over roads that were completely under water. Only a few high spots were visible. I knew where the road was but the students must have thought we were crazy! We finally reached the home and soon everyone was busy playing with the boys. Just before noon I left to pick up some of the students at the Pinocho and the rest got in the microbus to take them to the foster home for my birthday celebration. I told the driver that we would meet him where the paved road met the dirt road, as this was not covered by water when I left 30 minutes ago. I made it to the predetermined site and found it covered with several feet of water. I took the group I had brought to the home and called the driver to meet me near a hospital that was higher and out of the water to pick up the rest of the people. It took two more trips through the raging water to get all the people to the home. While the water was on the road, it actually was less dangerous as there was no slipping and the ruts were filed in making the road smooth, although we all felt like it was an adventure with water up to the floorboards of the truck. One mentioned that it was like a ride at Disney World and he felt he should get a snow cone as a reward after he arrived at the destination. The party finally commenced with a few songs from the boys and we feasted on the chicken dinner with yuca, rice, carrots and fried bananas. For dessert we had the two cakes we had picked up and brought back with the second group. There was plenty left for tomorrow and the evening meal. The rain slacked off during the meal enough so that the boys wanted to play outside. At first we played catch, as several in the group were former baseball players. We were able to show them how to throw and catch. Soon, however, a soccer ball appeared and a game commenced on the wet field. There were several puddles that the ball always seemed to find. The students and the boys were falling in the mud, often on purpose and soon everyone was soaked, the boys much more so than the rest. All their uniforms we bought last year were completely covered with muddy water. At least they had changed out of their new clothes they had worn for the party. Finally we left, taking everyone in two trucks full of people to the bus, the dirty people were relegated to the back of the truck for transport, as I didn’t want them fouling the bus. Originally we had come in four truckloads, with 22 people in the last trip. I think they all had a great time and no one was injured, which was a miracle considering some of the falls playing football.

We had time to bathe and change clothes before the next party at the Rotary Club. The clubhouse is owned by the club, unlike in most of the richer countries of the world where the space is rented. Perhaps that is why we have money left over to support missions like this one. At any rate, there is a space large enough to play basketball, if they played that sport here. There is a deck on the second floor where the meetings can be held if the weather is good, a smaller room across from the deck area with air-conditioning and the office where the fulltime secretary works.

The explosion of purple dust actually took me by surprise as the piñata flies apart

Herman and I had brought ice to cool the soft drinks and beer to the club earlier in the day. We filled two large cement tubs made for this purpose with the ice that came in pieces two meters long and about 10 inches square. These tubs would easily hold 200 liter bottles of drinks each. We arrived in two vehicles, which made three trips each. No one had to sit in the bed of the truck this time having set a personal record of 22 people in the truck on the last trip from the foster home. There was a live band, plenty of people and good food. Most of the people were at first hesitant to dance but soon practically everyone was dancing despite the heat. For Bolivia, it was actually cool, but very humid. Finally a piñata was brought out with a Styrofoam image of me with an American flag hat and an “autonomia” flag and a special autonomia shirt. This part of Bolivia doesn’t want to succeed from Bolivia but they want to be in control of their own government, thus the term, “autonomia.” I hit the piñata on the bottom and purple dust came out along with several “prizes.” The people dove in without regard for safety or getting the purple dust all over their clothes trying to get a candy bar or other items.

The explosion of purple dust actually took me by surprise as the piñata flies apart
I opened the presents that had been brought while the band continued to play and we danced until midnight. The students all walked home in a group, the rain having stopped for a while and arrived at the Pinocho at the same time that I arrived with the truck. I think a good time was had by all. I know I did.

Tuesday, March 11, 2008

The rain continued but lightly as the groups went to their respective places. So far the program is working well and the good Lord is blessing us with some very interesting cases. One rarity was a breech twin birth. This was the first birth these students ever saw and they couldn’t have known how rare it was to witness such a birth. Practically all twins are born by Cesarean section now, even here, and all breach births are surgically managed, as the risks are just too high to handle vaginally. The problem that can arise is that the two chins get caught one against the other and neither baby can be born. The second baby has to be delivered first over the first one with forceps which is a very difficult task, indeed. They witnessed a miracle and didn’t know it! Every day they see Chagas disease, dengue and parasites that they will probably never see again, but it is a good experience. I am, of course, gratified that they are all happy and I am proud of my friends who are making all this possible with their help.

In the afternoon, the groups went on house calls or conducted a screening clinic for adults where the students checked the blood pressures, oxygen levels in the blood and blood glucose for diabetes. To those who had problems, we gave advice about lifestyle changes to lessen the problem and the worst were referred to clinics and doctors. Screening clinics like this one are not performed by any other group other than ours, to my knowledge, here in Bolivia. The term “screening clinic” doesn’t seem to have any meaning to the medical people here. I may reserve two of the vital sign monitors to be used for this purpose in future years rather than giving them to the hospitals.

At the same time I took several med students to the Catholic Hospital in Portachuelo, which is on the other side of the Eisenhower Bridge. One lane was open and we were fortunate enough to get across quickly. The mother superior, a very thankful and gracious lady, met us. I have to admit that I have fallen in love with this marvelous woman over the years. It is always a joy to be in her presence, and my wife thinks so too. We set up the monitors we were donating to the hospital and they all functioned perfectly. We attached the monitor to one of the doctors to show all the features. I think we were all pleased with the reactions from the hospital staff. This kind of reaction makes it easy for us to work hard to raise money to keep the mission going. When we returned, the river was even higher than before filling the river from bank to bank. This is the river where we had collected the water sample just two days before. I would have been frightened to collect the sample today as one misstep would mean certain death. Many people were watching from the riverbank as the army was trying to fill the area near the base of the bridge with sand, but as soon as they put the sand in it was carried away by the force of the water. I have to think that this amount of rain was not a common event even in this part of the world where heavy rains occur frequently. Rains like this one coming on the heels of many smaller rains is a disaster and eventually all this water will end up in Beni where we recently sent our aid, adding insult to injury. Today I received word that the money we sent last year to build houses was finally all spent and four houses were built on stilts and many more families received tarps to offer them basic shelter. I hope they can withstand this inundation.

Lauren Zeitels takes the Madre’s blood pressure, while Trang Minh Vu looks on. Another doctor checks his oxygen level as another gets his heart monitored.

After some delay at the bridge, we rushed back for dinner and then I went to Rotary for the final signing of the document turning over the administration of the foster home to the Mision Global Peniel Association. This event was apparently news worthy enough to bring out two TV channels and a reporter. With all this rain, I would have thought there would have been something more news worthy. Unfortunately five children have been drowned or killed in mudslides so far due to the floods.

Wednesday, March 12, 2008

Finally we had a day without rain. It was overcast and cool with winds from the south. That usually means a few days of clear skies will come and then get hot for the first time this trip. The various medical student groups went to the five work areas and today we brought a monitor to the children’s hospital which was one of the five areas. We came unannounced, as I really don’t want all the fanfare we usually attract when we come to deliver expensive equipment. The nurses were happy to have the equipment and decided to put it in the neonatal area where the sickest children usually are present, but the monitor is portable so it can easily be moved to any place in the hospital.

Shannon Shea, a senior at Johns Hopkins stands behind the nurse at the children’s hospital as other nurses doctors and med students look on

I returned to the Pinocho and picked up the work crew from Ole Miss, a few of whom have really worked hard on the classroom project. I helped put some cement in the floor and then left to do some chores that needed to be done. Having little time to do what I need to do, or want to do, I decided to spend a little time with my wife. She, too, has been busy scheduling home visits with the visiting nurses and teaching English at the foster home. Also, she keeps track of where I am supposed to be most of the time. We ended up at the mercado looking for material for some projects and decided to have me fitted for a suit as we might be invited to a wedding in April, only if the date can be changed to have the wedding before we leave. It would be an honor to have someone change the date of their wedding just to accommodate our coming, but it seems like a major task. Just in case, however, we need some formal dress. After purchasing some fabric we went upstairs in the market where there are at least 25 different booths of people sewing, most of whom were men. We chose one who had a selection of suits that looked fairly much like the type I wanted. I was measured and the bill came to about $50. I decided to get a pair of pants made to replace my tuxedo pants that I bought when I was 18 years old, in high school. Over the years they seem to have shrunk somewhat and are becoming uncomfortable during the rare occasions when I am required to wear a tux. Describing how the satin stripe on the pant leg should look required my best Spanish. I wonder how the pants will look! For only $10 I am not terribly concerned if they don’t come out correctly.

After lunch, and our discussion of the cases the group saw in the morning (which we do after every lunch and dinner) I decided to drive out to the Eisenhower Bridge to see the river. It was down at least four feet from the last visit yesterday and one could see the sand again in the middle of the riverbed. Unfortunately the river had dug a channel near to the opposite side of the bridge undermining even further the base of the structure. Where the river used to be straight, or nearly so, there is now a deep bay where the bank has been worn away. This bay, which is now about a half mile across, will need to be filled in completely to save the bridge, in my opinion. The dirt has been washed away from the roadside on the opposite side from where we stood. The traffic has been halted and we walked to the bridge, having come only to watch and take photos. I wish I had a photo of the river when it was so high yesterday. We returned to the hotel just in time to leave, in the other direction, thank God, to go to Santa Cruz with our groups. Having spent all of my time last week looking for a camera for Lauren, the student from UNCA whose cameral was stolen, this time I did some shopping for the mission. I took the opportunity to buy some gems of Bolivanita, or ametrine, a stone unique to Bolivia. The same mineral of citrine and amethyst are combined in the same stone and if cut properly, it can be very beautiful with one side purple and the other golden or honey colored. I bought one large stone cut in the shape of a heart. I hope it will bring a substantial bid at the summer auction. These will be set by local jewelers in Highlands.

We had dinner at the Brazilian restaurant where Joanna and I had previously attended a birthday party earlier in the month. The students were happy with the choice having been to the Casa Camba on the way back from Samiapata on Sunday. It was good that they had gone there then as three bridges have been washed out on the road to the archeological site since this rain began. The food was good, as usual, even having a sufficient variety of pastas and vegetables to suit our vegetarian volunteer, Jessica Connor who is leaving tomorrow. She has been working mostly on the classroom and is seriously thinking about building a patio at her home with the experience she has developed during the building project. I told myself tonight that I would not eat as much as I did last week, and I don’t think I did, but I still ate too much. Even the desserts are difficult to resist. Including the drivers our bill came to just over $400, or about $10 per person. While this is cheap by our standards, $400 is a yearly wage for a skilled worker here in this country and certainly it would take several years to save enough money to enjoy such a meal with as many friends as this. Everything must be kept in perspective. The trip home was very short as I slept most of the way.

Thursday, March 13, 2008

Feeling like I didn’t need to eat for the next week, I ate a bit of fruit and yogurt for breakfast and took some of the workers to their sites. Dardo had made an appointment with me to show me what the needs were for the Cruz Roja clinic. This clinic has been a work in progress since I arrived 10 years ago. He gave me his vision of the building showing me the maternity ward that he hoped to open two years ago. The private rooms that will pay for the rest of the free deliveries were all single bed rooms while the charity patients will labor and recover in wards. Space for volunteers to live while they work in Montero was also allocated. This would be good for students and doctors that come here to learn the culture and the systems of these clinics and the TB program. Then they can take that knowledge to other countries. He needs 286 windows costing $3350 or about $11 per window. Also three more rooms need to be added before the building is complete costing another $6600. I will see how much more we will have in the bank after the extra expense of the aid to Beni. Also the groups from UNCA and Johns Hopkins have not paid yet needing invoices before checks can be made and sent. That amounts to nearly $10,000 that cannot be spent right away. I have sent an invoice to UNCA but who knows when that check will arrive? In addition to those funds, a special offering has been sent to the mission for the flooding in Beni. I don’t know how much that will be.

On the way home from the clinic the truck stopped. I had been noticing a sizzling noise after our short drives and looked at the motor twice and saw water from the road evaporating on the motor. I wondered why I had not heard this before as we have been in small lakes many times this week. I fiddled with the battery terminals that we found to be corroded. The truck started up again only to stop again and again. Finally a few taxi drivers helped after a suggestion to help us from Eugenia who was driving with me. We cleaned out the terminals with a knife this time and they ran off with the bolt that closes the piece of lead on the terminal and got a replacement that was not corroded. Returning in about ten minutes, we replaced the parts and the truck started up immediately. Can you imagine that one can buy a single bolt or screw in a store that only sells nuts and bolts? I called Dardo when we reached the Pinocho and he discovered that the water and oil were both on empty. No wonder we smelled an odor and there was that sizzling noise when we stopped. The motor could have been ruined. I don’t know if the motor had a fail safe mechanism that stopped the motor when it was too hot, or the battery was actually the problem and it was an act of God that stopped the automobile before the heat ruined the engine. I prefer to believe the latter, but I really think the former is more likely. In any case, the oil gage and heat gauges didn’t work.

We were supposed to go to the public hospital in Portachuelo Thursday afternoon to deliver more monitors, but it seemed hopeless to try to cross the bridge with all the news of the destruction of this very important structure. Most of the agricultural produce grown in the tropics that is transported to the mountains and then to export through the port in Chile travel over this road and bridge. Conversely, the fruits and vegetables grown in Cochabamba come to the tropics on the same road. The destruction of this structure would be an economic disaster for the whole country. Instead we went to the CLEM clinic and did another screening clinic for diabetes and hypertension. Shannon Shea had conducted a screening clinic at the Guabira health center on Tuesday and after the results were in today, she explained to the patients whose results were elevated what could be done. Some diabetics were high enough to require treatment right away. One who had a sugar of over 400 was given prescriptions and told to return to the clinic for follow up in one month. I hope she follows through as she has lost a lot of weight and doesn’t feel well. The few children that were at the clinic were tested for lead and they had the same moderately elevated levels that we have been seeing. None were in the bad range, but none were in the very good range either.

In the evening we went to Exponorte, a county fair like exposition where I paid for the Rotary Club to have their meeting, as they have been gracious enough to invite all our guests and volunteers over the last ten years without charge. I am sure we have been served a thousand meals in those years with never a complaint or mention of cost. I was happy to pay for the Rotarians and their spouses and our volunteers. Our wonderful meal was enjoyed by all in this festive atmosphere and the modest bill of $200 was paid out of the money I earn selling firewood in the fall and winter. Alan Marsh and I enjoy the exercise required from cutting and chopping wood and the result is the ability to make this kind of gesture a few times a year in Montero and help pay for gas (no small expense) for the truck and incidental repairs. Exponorte is a cacophony of noise from every direction. There are carnival rides and games, dance bands, restaurants, shops and exhibitions. The rains cancelled the first two days but the weather is cooperating today. The grounds are surprisingly dry. I left soon after dinner but many stayed and enjoyed the exhibitions and rides before returning home. They tell me the fair doesn’t get jumping until after midnight. I have never seen it jumping.

Friday, March 14, 2008

Dardo picked up the truck to have it serviced. It was a miracle that the truck didn’t stall while we were in the “rivers” going to the foster home on Monday or in the campo going to the Guarani. I wouldn’t have known what was wrong and no one could have come to help us for the muddy roads. He uses water instead of antifreeze in the radiator so it is easy to replace, but I wonder where it all went. There doesn’t seem to be a leak and there is no oil under the truck when I move it in the morning. It is a miracle the engine wasn’t ruined. We have put a lot of hard miles on this vehicle in the last few weeks. We delivered most of the equipment we had brought for the general hospital. As usual they were happy to receive all these things that our local hospitals and those in Baltimore have donated. Most of these things are items that have gone out of date but are still useful. Once again we came unannounced to avoid the media, but today was Father’s Day in Bolivia and Dr. Patzi and other doctors that teach the students were still there and helped make sure the items got to the right places where they could be used to treat the poor. I made sure that the administration knows that these things are for those who cannot afford to pay and that we would stop giving to this institution if these rules were not followed. Then I brought the work crew to the church project which included one of the med students who wanted to experience a little manual labor for a change of pace. As for me, I still have not laid a single brick, but I understand why a med student would want to do this kind of work.

The nearly finished classroom at the Nazarene Church feeding and learning program. The program director of Compassion, Luis Zalazar just happened to be there at the time and is pictured on the right next to the wife of the pastor and his daughter

In the afternoon we got a call from Robert Wicks and Edith Dietz, both medical students at Johns Hopkins, who went to a small clinic in Palacios, a town not far from Portachuelo. They said the bridge was OK and they had no trouble crossing it in the morning. Edith had volunteered at this clinic for a year and was anxious to return there. We decided to do our screening clinic there without their knowing we were coming. That never kept us from having a successful clinic before so we left with high hopes. Edith had given me directions and we found the clinic with little difficulty. However, it was literally in the middle of nowhere. Apparently someone had donated land in a large estate and they built the clinic there. All the care is free, but they built the clinic in the middle of the land instead on the edge of the estate. The clinic specializes in the diagnosis and treatment of diabetes and hypertension, but the clinic also has visiting dentists and eye doctors. Since this place is so isolated we were only able to screen the few patients that happened to be there at the time. Normally people come out of the wilderness when they find out about our services, but there are no people around here. The town is at least 5Km away and to call it a town is an exaggeration. We passed through it on the way to the clinic and it had a soccer field and little else. I screened four children that were the sons and daughter of the man who guards and cleans the clinic and the grounds. Once again, they had modestly elevated lead levels. I explained about the faucets, as they seem to be the main source of the lead. There is very little gasoline used here so my fears of leaded gas seem to be evaporating as fast as the water after a rainless week since Monday.

We packed up our equipment and left hoping to screen a few people in the town, but it was nearly 5PM when we got there and we decided to go home right away, as the bridge might still be a problem. Since we picked up the people who had gone with Edith in the morning, we had 13 people in the truck on the way home. We arrived to a traffic stoppage several kilometers from the bridge and soon found out that no one had been able to pass over the bridge since 3 PM. One of my friends from Montero was stuck in the same line. As night fell I felt we might at last get to see the Southern Cross, but alas, some clouds developed on the horizon right where it would have been and the constellation was obscured. A month has passed and I have not seen it once. Apparently they were putting rock filled screen boxes into the base of the bridge in hopes of saving it until the dry season comes when major work can be done. It was dark when we were finally able to get to the bridge so we couldn’t see how bad it really was. In the newspaper the next day we could see that the road at the approach to the bridge was actually undermined by the water and this is where we had driven the night before. I fear this major artery will soon be lost. After waiting all that time to cross the bridge, we found the traffic bumper to bumper all the way to the tollbooth which is just this side of Montero. I couldn’t believe that they wouldn’t try to have the traffic exit as fast as possible by allowing the trucks and cars to pass without collecting the fee, but they didn’t think that way. After we finally paid our toll, we met the traffic from the Exponorte that was just beginning to get busy, and finally, when we came to the main plaza, the Catholic Church was having a celebration for the beginning of Semana Santa, Holy Week. A drive that I have made in 20 minutes took over 4 hours.

I arrived with the group just in time to eat and run to the airport to collect our last group of volunteers, five adults from Highlands and Cashiers. I had received an email that their flight had been cancelled but I didn’t know which part was cancelled. I eventually found out that the Atlanta to Miami flight was cancelled and I had no message on whether they had made other arrangements to get to Miami. I went to the airport in case they actually did arrive. Luckily, Nick Pressler’s father used to work for Delta and a flight to Ft. Lauderdale was made with a connecting taxi drive to Miami at breakneck speeds. The Russian taxi driver told them he had to be aggressively defensive in driving up to 90 miles per hour to get them to the airport just in time. Of course, the flight was late again, but only about 20 minutes. It was fortunate that they arrived at all. Unpacking their bags I found none of the lathe parts that we needed to complete the pens. I know I packed them and they are either still in my office where I left them in a suitcase, or they are still in Asheville where they were forgotten. I am crestfallen, but Jamie Rold, an electrician from Highlands found a replacement part for the other lathe and had it sent to Bolivia by FedEx. He said it should arrive by Monday. I guess he doesn’t know about Bolivia. We will see. (In the end of April as I review the journal, the part has not yet arrived)

Saturday, March 15, 2008

Having completed the week with all the different sites in the town and not having rain for four days, we started off to the Guarani Community with sandwiches made by the kitchen at the Pinocho. A picnic type lunch with mystery sandwiches is always a thrill for me and I look forward to it with great anticipation. However, first we have to get there. The first hurdle was passed when the gate was unlocked. That didn’t mean that the bridges wouldn’t be washed out but we proceeded cautiously. There were several muddy areas that we managed to get through and we were glad that no trucks were able to destroy the road as these areas were difficult enough as they were. This group of medical students didn’t seem to react with the same degree of glee that was shown by the UNCA group when they went through similar mud pits. Worry was a better description of their emotion. Finally we arrived at the deep river just before the community. Most got out and walked across the wooden bridge that spanned the river as the rest of us forded the river. I had done this many times before but this was the deepest the stream had been. Water splashed over the hood and onto the windshield but the vehicle managed to find the other side of the bank. A beautiful morning was filled with unusual highly colored birds and cloudless blue skies. The temperature was moderate for Bolivia and the winds of the last few days had died down to a gentle cooling breeze. As soon as we arrived, one of the elders rang the bell and soon the whole village was assembled at the schoolhouse. We split up the group into children between 2 and 5 and then the adults. We screened the children for lead after explaining the project, and the adults for diabetes and high blood pressure. By now, everyone knew what to do and the screenings went smoothly except for the fact that I couldn’t find the red notebook we use to tabulate the lead results. I realized that I had left it on the table in Palacios. I will have to visit that clinic again! Perhaps I can pick it up when we finally deliver the monitors to the other hospital next week. We tested 19 children in the high-risk age group and got similar results once again. Most were between 5 and 8 and a few were in the 3 range. Not one of the children cried and none refused to be tested. Toys, pencils and candy were awarded the ones who were tested and what we had left over we gave to the young lady who wrote down the names of the children for us to distribute to the rest of the children. They were so overwhelmed that they knocked her down off the porch we had constructed three years ago. Fortunately she was not injured, but our intent was to honor her and reward her for her work for us. I hope she felt so honored after her treatment by the children. After we packed up our equipment, there was time for a soccer game with the local kids. We played to a 2-2 tie.
The ball was actually volleyball, so we have an excuse to return with the new group that arrived yesterday to bring a real soccer ball next week.

On the way home we stopped under a tree to eat lunch. I feigned that the truck had run out of gas, but I was soon found out. These medical students are too smart. We ate our sandwiches which were made on a hoagie roll and contained beef, carrots, asparagus, cheese, tomatoes, pickles and cucumbers. Mayonnaise, ketchup and mustard were all included in the box along with iced drinks forks and small plastic containers of pineapple. Everyone thought it was the best sandwich they had ever eaten, but one must take into account that it was hot, the day was beautiful and we were hungry. I did think it to be very good myself. Since we were very close to Las Lagunas and it was a nice day we decided to go to the resort. I knew a short cut to the resort, having been lost here several years before and finally finding the main road which went directly by Las Lagunas. Taking the turn off the familiar path, I was soon inclined to back up and return the way we came. This road had been open during the flood and trucks had made the first part of the road very difficult making deep ruts. Not only that, a parked car near the mud pit was a harbinger of impassibility. Despite these bad omens, we decided to carry on, as there was nowhere to turn around. We got stuck briefly one time and everyone needed to exit the truck and push. Whether the pushing helped or the lightened load, who knows, but we were soon on our way again. The road winded around more than I remembered and soon we were back at the same place we had visited last week. I gave them the last of our soft drinks, asked directions to the main road and soon we found our way to the resort. Due to the poor economy, the place was practically empty. We played some beach volleyball and went to the pool. Actually there are four pools about the size of a football field each. One was closed for cleaning and the water in the one we swam in looked a bit murky. After a few hours we returned to the hotel for lunch having had quite an adventure for our last day. While doing our lead testing, I discovered that our book with all of our results in it was gone. I have to think that I left it in Palacio, so I will have to return there to retrieve it. If the bridge does not fail, I will retrieve it when we bring the monitors to the public hospital in Portachuelo next week. I hope it is there as all our data is in that book.

After dinner we went to the church where we will construct the roof and floor next week. Marie Wicks played the keyboard doing a Beethoven piece she performed in the Teen Miss Mississippi contest, that she won, and Michelle Main did her religious skits with Danny translating for her. We all sang songs for hours and we finally left at about 10:30.

Many of the students celebrated their last night by going to Exponorte, but I decided to catch up on the journal. None had returned when I finally went to bed at 12:30AM.

Jim Delancey, from Ole Miss and Trang Vu tested the children for lead. Trang is from Viet Nam and the campo reminded her of her former country

Sunday, March 16, 2008

I arose at 6:30 to send the Johns Hopkins group off in a microbus to the airport. I had hoped my contacts here would make their trip a successful one and I think they had both a learning experience and a good time. That combination is hard to beat. Learning should be fun if you like to be challenged. These students didn’t disappoint me in the least. What an interesting and diverse group!

Michelle had made a connection with the deaf-mute church we had visited last year and we went there at 9AM. We found that that congregation had left and a new Compassion church, similar to the one where we built the last classroom near the stadium, had taken its place. It was filled with children who were thrilled with the hat skit made famous by Martha Rodenbeck in past years. Michelle had her own twist to it and all the Highlands folks wore the hats while Eugenia translated. We all had a good time and the message was real. After church we listened to the pastor’s plan for the church. He needs to double the size of the feeding hall and add more classrooms. I have to admit, God brings us to the places that help feed children and teach them also. Good nutrition, good education and spiritual guidance are the pathway out of this cycle of poverty and ignorance. Most of these children were born to single mothers and there are hundreds of them. I can’t help but think that this is God’s plan for our mission, feeding and educating children. I told the pastor to write his plans out with his vision and costs and we will see what we can do next year. In the meantime we can supply the church with Bibles.

Michelle captivates the children with her skits

Next we stopped by the Dios Es Amor Church where we had done so much before. The church grows every year and our friends still remember us fondly and we them. I had to meet Dr. Plata at 9:25AM and I know how punctual he is. We rushed through hellos and goodbyes and at 9:27 I received a call as we left the church. Of course it was Dr. Plata. We arrived at the Global Mision Pineal Church at the correct time, but instead of a meeting we were told have a seat and that they were blessed to have a special speaker from Argentina. As was usual with this church, we sang for 45 minutes and then both of the pastors of the church spoke, with a few references to our foster home. This was to introduce us to the congregation and let them know that their church would be involved its administration. The congregation applauded so they seemed to like the idea. Finally the dynamic, young visiting pastor began to speak. After about 30 minutes they asked people to come forward to receive the spirit and be healed. I have seen this in movies and on TV, but I have never experienced it in person before, even though I have been to spiritual healing services before. He would whisper in the person’s ear and then his voice would crescendo to a higher level and finally the person, with their arms raised to the heavens, would begin to tremble and then faint. The pastor of the church stood behind the people being blessed, knowing that this would be the result. After about seven people were lying on the floor in various stages of recovery, I whispered to Dr. Plata, “Do you do this in the Catholic Church,” and he said, “No!” I asked him if he thought it was real, as it looked very convincing to me and he said, “I don’t know.” At that point the pastor pointed his finger at me and asked me to close my eyes and raise my arms. I am quite sure the combination of raising the arms with eyes closed and the anxiety of the moment could cause people to faint. He put his hand over my heart and I could feel the power of the moment, but I did not faint. A traditionally dressed Kolla woman was next and she, too, did not faint. We were the only ones. She did come away from the experience with tears running down her cheeks. After I gave my testimony about the way the mission began, which is at the beginning of this missive, the pastor came to me and called me a man of the Spirit, which I took as a compliment. I do freely admit to the power of the moment.

The lathe equipment did not arrive in the suitcases brought on Friday with the Highlands group, but the baseball gloves and bats did. We took a duffle bag full of equipment to the home and distributed the items to the boys. Now each boy has his own glove. We used old tires for bases as the bricks we had used before were hard on the feet. The Gringos played the field while we let them bat. I think showing them how the game works did more for their learning than all my teaching before. They even learned to return to the base when a fly ball is caught, which is a difficult concept to learn. After we played until they were tired we played football, but the game was short lived which is very unusual. Several of the boys are sick and Pablo, the best athlete, sprained his ankle so not many were playing at the beginning and it was hot.

The Ole Miss group left at 6PM after a really good trip and experience. I got an e-mail from one the next day expressing his gratitude for allowing them to come and letting me know that they arrived safely home. This place has the ability to change lives and I wonder what will happen in these young people’s lives. The mission should be proud to be a part of shaping young people’s lives.

Monday, March 17, 2008

It has been a week since the big rain and we have had four days of sunny weather. Now there is dust and the dirt roads are hard as bricks, the mud having been baked in the sun. There were a few clouds in the sky in the morning but these had cleared by noon. The new group decided to begin work at 7:30 at the church to take advantage of the cooler temperature. All the Bolivians arrived at the same time as we and soon we were leveling the floor and laying bricks. I had a meeting with the psychologist at 9:00AM along with Joanna and Maria Eugenia. We discussed her findings on the boys in the foster home. Every psychologist has done the evaluations before but none has ever told us anything, resulting in the same work being done over and over without any real information being used to help the boys. Dr. Plata found this girl who is just out of school and did all this for free. Apparently this type of work is part of the repayment for school tuition paid by the state and I suspect the other psychologists were just putting in their time doing all this before. She impressed us so that we wanted to hire her for $300 per month, which was her suggestion, and she would work every morning, five days a week. Several children have learning disabilities and one has a speech impediment. Actually he speaks English with better phonics than Spanish. We also discussed how things seem to disappear as we have provided many books, language tapes and other things that are no longer there. We suggested that each teacher have his/her own locked cabinet to store their equipment. An inventory would be taken tomorrow before the new administration begins. A dinner to celebrate the new group taking over would take place tomorrow. Also Joanna and I need to renew our visas tomorrow and that was discussed also. I said there was 13 kilos of meat left over from my birthday party, frozen in Herman’s freezer. We could use that so the meal would be practically free. Just then Pedro, the housefather, came to the Rotary House and he picked up the meat and bought charcoal and vegetables with $12 that I gave him. Dinner for 35 for about 34 cents a piece. I love Bolivia!

I had planned to go to Portachuelo tomorrow, but because of the dinner tomorrow, and the experience with the bridge over the weekend, I decided to deliver the monitors in the afternoon and try to go to Palacios also. We tried to call the clinic many times but their phone didn’t work so I didn’t know for sure if the notebook was really there. We crossed the bridge without trouble. The traffic was one way, as part of the road on the approach to the bridge on the north side was gone but we had luck and went directly across. I took some manuals to the first hospital as I only gave them the service manuals and not the directions on how to use the monitors. Then we went to the government hospital. They did not have to hear an explanation about why we did not arrive last Thursday. They already knew that it was nearly impossible for us to cross the bridge then. We set up the monitors and taught them how to use them. One of the doctors was at the General Hospital as a resident two years ago when we donated the same type of monitor and he was familiar with them. He was one of the better residents that I had met there. I felt very comfortable that he would teach the others on the proper use of these valuable resources.

One cardiac monitor and one vital sign monitor are donated to the hospital in Portachuelo

Soon we were on the way to Palacios. It is funny when you know where you are going, you seem to get there faster. Soon we were on the right road, with a family we met at the crossroad, in the back of the truck with all their shopping items. They had, amongst their purchases, two five-liter cans of alcohol which they use as fuel to cook, or, at least, that is what they said. Looking at them, I believed them. Soon we had left the “bustling” town of Palacios, 250 inhabitants, where we had dropped off our passengers and were on the private road to the clinic in the middle of nowhere. Crossing the bridge, just before the clinic, we could see how high the water had been just a week before by the cut in the sandy banks and the detritus left on the brush and trees lining the river. Unlike the other shallow wide rivers we usually see, this one was deep and narrow and lined with trees and shrubs. That is the difference. Plato wrote in 450 B.C. that the consequence of cutting the trees close to a river is erosion and eventual disaster. No one listened then and no one is listening now. We found the book at the clinic, which was a great relief to me as it contained all the data from the first two weeks of the lead project.

Soon we were on the road to Montero and up ahead we saw a line of trucks and cars. Mostly there were trucks as when the trucks begin to move, the cars advance in the other lane as the traffic is in one direction only and fill in the spaces between the slowly accelerating trucks. If I were a truck driver, I would be upset by these cars getting in front of me, but I have to admit, I did the same. After only a wait of 15 minutes we were in Montero and there was no delay at the toll both or the church at the plaza.

At dinner the construction crew reported that they had finished three fourths of the floor and had begun to work on the walls. Even now the temperature is 85 degrees and the humidity is rising. Now this is typical Bolivian weather, but it is the first example of it we have had the whole trip due to all the rain. Tomorrow will be very hot with probably afternoon showers. Thankfully we are working in the shade of the church roof. Tomorrow I need to send two workers to the first project to finish the roof and the rest to the new church work site. Joanna and I will go to Santa Cruz to renew the visas and buy Bibles and I hope to finally do some building myself tomorrow. It has been over a month and I have not laid a single brick.

Mike Harris, Dwight Bryant, J. T. Schandolph, Nick Pressler and Jamie Rold working on the floor of the church. Jamie, with the shovel, really did most of the hard work.

Tuesday, March 18, 2007

Our string of good weather has continued. I took two workers to the Church of the Nazarene to work on the roof and three to the new church project. I don’t know what they call the church, but we call it “Danny’s Church,” even though his parents run it and he really has nothing to do with it other than playing the guitar or the keyboard at the services when he is there. I laid a few bricks and then we went to Santa Cruz to renew our passports as they only gave us a 30-day visa. They said it would be easy to renew the visa here, but I was skeptical. We were pleasantly surprised how easy it was, needing only a photocopy of the passport and the original visa page and it was done. It made me wonder why they made us waste a day going to Santa Cruz to do such a simple thing. We took Ireneo, one of the boys, who apparently has a speech impediment, to a speech therapist. He was happy to have all the attention. The other boys tease him about his speech and he retaliates with fighting. Although he is larger than all the boys except his brother, Fredy, he is a crybaby if the other person gets the best of him. There is still a lot of anger in these boys. It comes out during football games and baseball way too often.

Joanna wanted to buy some things for the auction and I wanted to buy some Bibles for the new Compassion church and Danny’s church. I chose 50 Bibles and 20 children’s pictorial Bibles, which cost three times as much as the full Bibles. I went to pay with dollars and they would only give me 7.31 Bolivianos for each dollar. They didn’t want to take dollars at all! What a sad day for our currency when the once mighty dollar is not accepted in BOLIVIA! Their currency is stronger than ours. In the last two years the dollar has fallen 15% against the Boliviano. I went to the plaza and changed my $500 into Bolivianos and got 7.41 which saved us enough to buy two more Bibles. Unfortunately we got to the bookstore right after they closed for siesta. Having to eat in Santa Cruz is not a terrible thing as they have many fine and inexpensive restaurants; therefore, having to wait until after siesta to get the Bibles was not unpleasant. We found a small restaurant near the plaza and added it to our list of good places to eat. We picked up the Bibles right after 3:30 when siesta ends and headed back to Montero. I was happy to have done all our business in Portachuelo yesterday or we would have missed that appointment again. On returning home to the Pinocho I put together the last shipment of things for the General Hospital in Montero and I discovered that the heart cable for the cardiac monitor were missing. I was worried that the last monitor might be lacking some parts, as there are at least ten things that hook up to the machine. I think everything was present when we came so we probably gave a bag with those leads in it with one of the small monitors that does not have cardiac monitoring in Portachuelo. I will have to visit there one more time to see if we did, indeed, do that. With little rain, the bridge repairs should be progressing well, but I am still uneasy about going there and getting stuck on the other side of the river like last week. I don’t have much time to waste and going to Santa Cruz today to get the visa was enough time wasted for me.

At 7:30 we had a meeting at the Rotary Club to discuss financial matters concerning the foster home. This meeting was supposed to be a dinner meeting with the new administrators at the foster home. They suggested the time and place for this meeting, but today they said they could not come due to a conflict with some father’s day event at their church. Since we didn’t have food as we expected, and we had told the Pinocho that we would not be eating there this night, we then had to find a place to eat. There are not many safe restaurants in which to eat in Montero, unlike Santa Cruz. We finally went to a restaurant run by some Rotary friends of mine, which specializes in quail and steak. We all enjoyed the all you can eat meal and asked for two more quail and one piece of steak. They brought us eight more quail and four more pieces of meat. Of course, we had to eat all of the food. More or less bloated, we made it home at about 11:00PM.

Wednesday, March 19, 2008

This was one of those days where everything came out as planned. We went to Danny’s Church (the actual name is The Shalom Church) and started on the walls, the floor having been finished yesterday. I love laying brick. There is something primordial doing a type of construction that has not really changed in the last 5000 years. It ties me to the historical past and brings me into the time of the Bible, the Odyssey and the Iliad, all books that have great meaning for me. Because of the shade of the building, the roof having been finished earlier last Sunday, we were able to work hard and completed as much as we could do by only 10:30 leaving time to go to the hospital with the rest of the items brought by the Johns Hoskins group and our last monitor, minus the cardiac cable. Since most of these cables are interchangeable, they might have an old one that might fit this monitor. It was Father’ Day and all of our doctor friends were there which would be an unusual event on most other days. We were met with many “Feliz dia del Padre’s” as we entered with all our suitcases. We put all the things in the administrator’s meeting room and left quickly as it was already lunchtime. Still, I was one chore ahead of my schedule for the day and we needed to be back for lunch and our weekly trip to Santa Cruz.

We had planned to go to the Swiss Restaurant for one of our person’s birthday, paid by one of the other volunteers, but that restaurant was full due to Father’s Day; therefore, we had to find another place in which to dine after shopping. Only the best restaurants take reservations and all these were booked when we called from Montero. We decide that we would go early and trust our luck and find a place after shopping. We picked up the alpaca things that Joanna had bought yesterday and they still hadn’t made a complete bill. We will have to return in another week to get the bill, as we need an accurate account for the auction. I am sure we will probably need to buy more when she returns. Very smart of them. We had a huge box of alpaca items from children’s clothes to sweaters and ruananas. This kind of wool is one of the best in the world. While that business was being performed, I took several of the group to change money in the market. This is usually easy, legal and quick. Today several men approached us which always makes me a little nervous. Usually only one person will come to you at a time or others will leave when you finally decide who will change the money. We set the exchange price and changed odd lots of money. One had $100 but wanted only $30 in Bolivianos and $70 in dollars and one wanted $80 in Bolivianos. I can do math in my head if the numbers are somewhat normal, like $100 is 745 Bolivianos if the exchange is 7.45 but odd numbers are not easy. We were shorted 70 Bolivianos but didn’t realize it. Having gone to a little craft mall down the street, three police came in and asked to see the money. They must have had an eye on the men because they knew we were cheated. They counted the money and discovered we were about $10 short. I had checked the money and knew none were counterfeit and at first I thought maybe our bill was a fake. Returning to the plaza to identify the men with the police escort, we quickly found the men and they fled, disappearing into the shops and crowd. It is hard to imagine that they can stay in business long cheating people out of only $10. While the police looked for the men, another man waved to me to come into his office. He had just gotten a call from the cheater and he wanted to make things right. Without much fuss he asked how much money we were out and gave me the 70 Bolivianos. I was satisfied at this point, and having lost a lot of time, I was ready to move on, but the police wanted to know who gave me the money and wanted to arrest someone. I pointed out the man who also quickly disappeared. While the police looked for him, we disappeared to our previous place of business. In all the years I have exchanged money on the street, I have never had a problem like this. In other countries, money changers will run off with your money, give you false bills, either counterfeit or cheaper bills from another country, or other scams I have not yet seen, but the money changers here are usually honest. Most of them I have seen and used for years.

We found a new restaurant called Michelangelo’s, which was an Italian restaurant. I have passed this place many times before but it didn’t look like much from the outside so we never tried it before. The interior was like a maze with small rooms going every which way, but it had a lot of atmosphere and turned out to be a very fine restaurant. I was happy to have been able to try a new one and it is not far from the plaza, easily within walking distance. This was one of the hottest days we have had this year and I was glad we only had to work half a day.

Thursday, March 20, 2008

We went out to the boy’s home and played baseball most of the morning. The boys have discovered that baseball is not a very interesting sport all the time and some didn’t want to play unless they could bat all the time. Also, they didn’t like being called “out” after hitting such a good ball that was caught “on the fly.” Some, however, are getting the hang of the game. Unfortunately, they are the same boys that are good at everything else. I would be nice if some were very good at football and some at baseball while others might be good at the computer, etc.

We all got quite tired, hot and sweaty in a hurry and left at noon. In the afternoon I had planned to finally get Internet for the home and I had set aside this afternoon to do that. I took some to the church to work and Danny, the Bolivian man who has helped us so much, went with me. Of all the afternoons I could have chosen, this was the only one in the whole year that the office was closed due to the Good Friday holiday tomorrow. We did find out that they would be open on Saturday morning. I will do it then after going to the jail. I went to the Rotary Club to do some business with the secretary, but she too was gone. I looked all over town for her as I needed to make some airline reservations for next week and there was no time to lose. Finally she called me, having seen my truck parked outside the door of the club when she returned and I rushed over to the building. Completing that task, I returned to the church with the rest of our group to celebrate Father’s Day at Danny’s church. After a short but nice service, we rushed home, showered and changed and went to the Nazarene Church for another service. Both churches put off their Father’s Day celebrations until tonight in order to have us present. We received small gifts and were honored to have some district supervisors present at both services. At the last church, the children provided entertainment demonstrating native folk dances. I think we were all charmed. Several of the group are feeling a little sick and we returned to the Pinocho for an early evening of rest.

Friday, March 21, 2008

I was awakened with thunder in the night. With the air-conditioning, I don’t usually hear thunder, so this strike was close by. Although there was rain, when there is lightening here, it doesn’t rain for very long. When we went to breakfast the ground was already dry and only a few puddles in the street gave evidence to the rain in the night.

This is Good Friday. This is a day unlike any other in Latin America. Almost all of the stores are closed all day; however, we found the market busier than ever. We bought apples, peaches and bananas for the little girl’s home and proceeded to the orphanage to put up the “push me pull you” apparatus I bought at Lowe’s before we came. Every year we need to repair a few items at the playground we built in 2000 for the orphanage. The girl at the gate recognized us right away and opened the doors for the truck. Needing a few more things, I walked to the market to buy several bolts that were missing from the apparatus. It was so hot, I took a motorcycle taxi back to the girl’s home even though it was only a short walk. The heat can really take the starch out of you quickly.

The girls happily play on the new apparatus as the old one is still in use on the left

After spending some time with the little girls, we returned to the Pinocho for lunch. We had fish for lunch, which is a tradition in Latin America on Good Friday. This is usually the only time we get to eat seafood while in the landlocked nation of Bolivia. This fish was a pacu and it is one of the best tasting fish you can find anywhere. It is a boney fish, however, and even after removing the main part of the skeleton it still has little “Y” bones in the upper half of the fillets. This presents a problem for those who like a boneless piece of fish, but the flavor makes it all worthwhile.

After lunch I went to the foster home to play soccer with the boys. It was sooooo hot, even the boys didn’t want to play. I have never seen them so lethargic! After a while, seeing no chance for improvement, we went to play on the playground where it was cooler in partial shade. Like last year the boys created new games using soccer balls and a Frisbee left by the Ole Miss students. They suddenly had renewed energy and seemed to have a better time than they had playing soccer. Soon the afternoon time passed away and it was time to prepare for the procession.

The boys had renewed energy playing in the partial shade of the playground

If you have never been to a Latin American country for Good Friday, you have really missed something. At 5:30PM they begin to read from the Bible about the events leading up to the crucifixion. Jesus came before Pilate, Peter denies Jesus three times as the cock crows. Jesus is flogged and he is crucified. Just as Jesus dies on the cross, there was a loud thunderclap. There had been sound effects to fit the Passion play, so I was confused if this were a sound effect or real thunder. It had looked like rain and there was even a little drizzle. Soon it became apparent it was real. The sky opened and down came the rain. This was not unlike the representation in the movies at the time of Jesus’ death. The dignitaries who had the seats for the play used the chairs for umbrellas. To the south I could see clear sky so I figured the rain would only last a few minutes. Soon all were running for cover as the lightening and thunder were far too close for comfort. Almost an hour passed before the rain let up enough to venture out into open spaces again. The procession began right after the sun had set which was, in reality, about the time Jesus actually died. The effigy of the Virgin Mary came out of the church first followed by the casket with Jesus within. It is a grand show every year and different also. Last year there were young men dressed as Roman guards surrounding the casket while this year there were real soldiers in the Bolivian army carrying their assault weapons. I liked it better last year. We walked with the procession to the south, toward the Pinocho until the procession turned to the right and we walked straight to the Pinocho a few blocks further down. Wet and tired from the heat of the day, we gathered back in the courtyard to eat the sandwiches carefully made by the cooks. Since we knew we would be late getting in and we wanted the employees to enjoy the procession also, we had them make sandwiches instead of a full meal. Actually most thought the sandwiches were very good. There were three types all on the homemade bread we all have come to love. Chicken, beef and cheese with tomatoes and pickles, but some had fried eggplant, carrots, asparagus, zucchini and all sorts of other things one wouldn’t ordinarily think to put on a sandwich, but might in the future because they were so good. The ubiquitous avocado replaced mayonnaise to provide moisture and taste.

After the rain, the procession was about to begin from the main Catholic Church at the plaza just as the sun set behind the church

Saturday, March 22, 2008

This was a very busy day. We went to the jail at 8:00AM sharp and Dr. Plata was already there. He has been faithful to service the jail for many years never missing a Saturday there for vacations or even when his father died. He is a dedicated man. Entering the exam room we see the medicine cabinet we bought filled with medicine and tools, like the glucometers, stethoscope and other medical instruments that we have provided. Looking around the jail there have been several improvements that we also have provided. The cells all have ventilation now and the main cellblock has been enlarged about four feet wider to provide a walkway along the whole block, giving room for an old cooler for drinks and water. This is a little thing, but for these men and women, this is a major improvement. We saw several patients but not as many as usual. I think the added ventilation and the extra room have caused the inmate’s health to improve. We bought a few things that the prisoners make to earn a few dollars. The best thing was a plastic tractor made completely from old plastic bottles that otherwise would have ended up in the landfill. After we left we brought two big bags of empty bottles to the jail. After they were screened to be sure they contained no contraband, they were given to the man who makes the trucks and tractors and he was very happy to get them. Normally it takes two weeks to make a truck due to the time it takes to get the “raw materials” to make one. Now he says the two we ordered would be ready in two days.

One of the plastic tractors made by one of the inmates from old soda bottles

We returned to the Pinocho as Pedro was arriving with the boys from the foster home. We always like to bring the boys here and they look forward to coming for an entire year. The main question they ask is, “When are we going to the pool?” in perfect English. We left for Las Lagunas with clouds in the sky, but somewhat cooler than yesterday. The boys always have a great time here. The first time we came we were so concerned about one of the boys drowning. There are no lifeguards here. Our fears were soon quelled as all the boys either knew how to swim or picked it up immediately. I think the main factor keeping people from swimming is fear of the water. None of these boys is afraid of the water.

We returned from the pool and immediately went to the girl’s orphanage to finish putting in the swing supports that are really heavy duty and will never need to be replaced like the ones they make here by welding a ring of steel to a long bolt. At the Pinocho, at the same time, Joanna Dwight and Jamie colored the Easter eggs. J. T. Schandolph, Nick Pressler and I had drilled some of the holes yesterday but the drill ran out of power. I charged the battery all night and still we only were able to drill three holes before it lost its charge again. We returned to the orphanage about an hour later to show the movie, “Happy Feet.” It was still hot and the power was supposed to be turned off if the town did not conserve electricity. Thankfully there was no blackout, or even a brownout. The girls enjoyed the projected version as there are no movies here in Montero and their television is a very small one. It was a real treat for all of them and us also. This is another thing we do every year and the girls look forward to it as well. We have been so busy that we have not been able to do the little things that bring such joy to both our volunteers and the people we serve. Now we are fitting them all into such a small amount of time.

We returned to the Pinocho for dinner at 9:00PM. The dinner was scheduled to be late as to not be interrupted by the blackout, which didn’t occur. The meals continue to be so incredible. Just thinking about how they care for us here makes me want to tell you more about this little hotel. When we first came ten years ago the hotel was a work in progress. Every year they would add another floor, or put another room here, change some rooms around, always improving the place. Finally, two years ago there was nothing left to do and then they started to add things that made life more pleasant. Native art was added to the walls, new phones were added and this year there is wifi for connecting to the Internet. The food has always been excellent and the variety incredible. We have dessert twice daily and we have been here three months in the past without ever having the same thing twice. Also the presentation is so artistic, especially considering the vegetables. The imagination of the owner’s wife to do such things is beyond belief. I think she should make a cookbook and I have suggested that to her, but she is too shy to even consider such an idea. The administrator is as good a concierge as you will find even at the finest hotels. She has a phone list of all the important people and places in the surrounding cities and we have used her many times to make reservations. It is such a comfort to be in a place like this one. It allows us to be more productive. I remember fondly, when I had my heart attack and was recovering at the hospital, and they brought me meals. I was the envy not only of the other patients, but the staff as well. No one ate as well as I did, and there was plenty of food left over to share with the nurses who often congregated in my room at break time who especially liked the desserts.

Easter Sunday, March 23, 2008

We slept in and had breakfast at 9:00AM. Afterwards we drove to the foster home for our annual Easter egg hunt. The boys stayed in the study room as we hid the eggs. The older boys knew what to expect and found the most eggs, while the new boys, who had no experience with such things, didn’t know what to expect and found only a few. The second time we hid the eggs, however, they were on even ground with the rest and found a lot more. We had fewer eggs each time we hid the them, as some were found broken and sent immediately to the kitchen for rapid consumption and a few were so well hidden as to be lost forever until an animal finds them. We started with 95 and finished with 75 eggs in good condition and about 10 were lost. There is a lizard here that eats eggs. It comes out at night and will find those we couldn’t find. Nothing is wasted in Bolivia.

We had lunch which consisted of the meat not used at my birthday party at the Rotary Club. There were thirteen kilos, or 28 pounds left over and we prepared about a third of it today. The rest will be used for the dinner to celebrate the new administration, which keeps getting put off to a later date. Soon we will be gone, so I hope it happens quickly. The meat was cooked over a charcoal fire on a grill. The cooking was done in the garage as it looked like rain earlier, but we were lucky and there was only a drizzle. The meat was tougher than the usual meat here in Bolivia. The flavor is good but you can’t eat much before your jaw is sore. This helps keep the calories down. I don’t remember the meat being this tough at the birthday party so we must have used the best cuts then. We also had rice with cheese, beans and potato salad which was especially good. Since there are so few volunteers at this time, we all ate together in the dining room. That was important to me. Soon after eating the boys went for siesta and we left to enjoy siesta also. This was the first time I can remember actually trying to sleep during siesta the whole trip.

During our siesta I worked on a few words for the Easter service later in the night. Since the poor need to work every day to earn their daily bread, most of the churches have their services in the evening. Most of us took the free time to check e-mails and check the scores of the NCAA Basketball Tournament. North Carolina won their game by 30 points and looks like a champion, but as yet, untested.

After dinner we left for the church that we are building. This was the first service since the floor was finished and it made a great deal of difference. Several of the women of the church thanked us because they no longer will need to step in the mud to pray and praise and their chairs don’t sink into the dirt. The service is like an aerobic lesson. There was a lot of singing and dancing, or at least a lot of jumping up and down. Even in the heat, it felt good to move around that much. I gave my Easter message and then we really had a dance that reminded me of the Jewish dance, the hora. There was no lack of energy expended and no one seemed to be tired at the end. The older of the two pastors danced with the most vigor and never seemed to lose his breath. After an hour and a half we finally said our goodbyes with the hugs with the men and kisses on the cheek for the women. Easter had come to an end, but it signaled a new beginning for each of us, free from sin once more, made clean in the blood of Jesus.

Monday, March 24, 2008

The day broke with a gentle breeze and sunny skies. I knew from experience it would be a mild day, for Bolivia. The maximum temperature was 85 degrees. I took the workers to the church and I went to a meeting at the sugar hospital, Guabira. Every year they ask me for money for equipment. I don’t mind being asked as they have given the medical care for the foster home for free since we donated the anesthesia equipment five years ago. It didn’t take them long to produce the letter acknowledging the gift and the offering of free service to the boys. That was two administrators ago. Now they want $2500 a year for the care for the boys. That is not really bad considering that we presently have fourteen boys there and several more are on the way. After the meeting I went to the Rotary Club to talk to Mercy, the secretary about this and confirm the tickets to Cochabamba tomorrow. She told me we had to go to Santa Cruz to pay for the tickets in person. They wouldn’t take a credit card over the phone. Since one of the offices was in a place I felt I could safely drive to in the city, we went in the truck instead of a taxi. Again, what a waste of time to do something that could be done on the phone or on a computer. We arrived at the office of AeroSur and practically had to wake the secretary up. We were told we had to go to another office, nearby. Here again is evidence of wasteful business practices. We came to the office and soon found that our reservations had been cancelled because we had not paid for the tickets in person within 24 hours. They supposed that we would drive to Santa Cruz on Easter! Luckily, there were five seats available for the flights we wanted, but they asked that we confirm the return passage seats when we get to Cochabamba! It is only two days off and we will only be there two days and one night. What a way to run a business! No wonder the previous airline, Lloyd Air Boliviano, which treated passengers the same way, went broke last year. I considered ourselves lucky to get the tickets and off we went to Montero again. I got into town just in time to eat and go to Portachuelo to do the lead testing again. Here almost every child cried before getting stuck for the samples. We had full support from the administrator of the day care center who was off to Santa Cruz himself for a meeting and he offered us his office with air-conditioning for our tests. Before long it was 5:30 and we had tested 23 children for lead and several adults for diabetes. One child had a level of 11.1, which is fairly high. According to her mother, she likes to put all things in her mouth. The mother was given some advice from me and the two doctors who were working with us. They were very interested to learn about the project and to have the opportunity to do something new. Returning to the Pinocho, we met two women from USAID who are checking up on the clinics to see if they are getting results from the money and equipment they have provided over the years. Evo Morales had tried to expel this group, having accused them of spying for the United States. I wonder why the US would waste their time and limited resources for espionage on spying on Bolivia. Also on the way home we saw several military events to mark the anniversary of the loss of their port to Chile over 150 years ago. The former governments tried to lessen the impact of this event as it happened so long ago and it was a defeat. No one celebrates defeats! This is another of Evo Morales’ egomaniacal wishes to have the port back. If Bolivia goes to war with Chile over this port, over the mountains and down to the sea, it would be catastrophic for Bolivia. Perhaps he is smart as a fox and will use the threat to bargain for a free port or some compensation that might be paid by Chile just to make Evo go away. If that is his reasoning, he is, indeed smart, but I don’t think he thinks that way. At any rate, the port would only help the Alto Plano and give the rest of Bolivia even more reasons to leave the country and form a new one. I hope and pray this does not happen. There is a vote on autonomy for the lowland districts in May. If this passes there may be a conflict here that surely could undo everything we have done over the past ten years. It is easy to breakdown but so hard to build up.

Over dinner Dr. Plata and I talked about the finances of the home and the carpentry shop. His sister-in –law, who is an accountant, was present. She said the books for both the foster home and the carpentry shop were totally incomplete and impossible to know where the money went. For my part, I know how much money we spend per year for the home and I am satisfied with the $15,000 we spend and I think we get a lot for our buck. Exactly where it went is not a concern for me. The carpentry shop is another matter. The men get paid whether they work or not. That is no way to run a business. She felt, as do I, that the shop, if run properly, could support the foster home all by itself. With the new administration and many changes, I hope my dream will become a reality, that the shop will, indeed, support the foster home. After the meeting, we met the pastor from the Peniel Church who just happened to be driving by. Dr. Plata invited him to his office for a chat about all the things we had just talked about. This was another of the many “coincidences” that happen all the time here. I feel good about the changes that are occurring. We all live and learn.

Tuesday, March 25, 2008

We arose at 4:30AM to go to the airport at 6:15 to catch a plane to Cochabamba for a visit to another place in Bolivia. Cochabamba is approximately the same elevation as Highlands and, therefore, cooler than Montero, but not as cool as the Alto Plano which is about 14,000 above sea level. The mountains look very much like Franklin with rounded tops and the city is completely surrounded by mountains. It is like a little Alto Plano, smaller by far and not as high up. There are no snow-capped mountains like in La Paz. The airport is in the city and we were in our hotel within 30 minutes after landing. This is the way travel should be. Only four hours ago we were waking in Montero. We left the hotel to walk around the Prado, which is basically the new section of town. It does not have a plaza in the true meaning of the word, but there is a beautifully cared for strip of green grass and palm trees running down the entire length of two to three miles. After exploring the area where we reside, we walked to the old square which is historic and was built in colonial days about 350 years ago. Here one finds museums and historical buildings and also little shops selling anything from paper goods to lottery tickets. Only a few blocks away is one of the old mercados where practically anything can be bought from food to musical instruments. We walked around there for a while until we all felt a bit sick smelling the mixtures of cooking food, fruit and vegetables and just old garbage. We took a cab to the smaller market near the bus depot that sells crafts, musical instruments and alpaca goods. Even after being there quite a long time and feeling tired from our early awakening, we looked at out watches and it was only 10:30. Siesta would look good today! Joanna had to do some shopping for the auction so the men left and looked around and got something to drink. Returning to the market some 45 minutes later we found Joanna still shopping. I looked around and bought some old Bolivian currency from the inflationary period. 100,000 Peso notes could be bought for one Boliviano. Then the men got in the swing of things and began to buy some other items. Soon it was time to return to the hotel to deposit our purchases and find a place to eat lunch. We were all hungry as we left before breakfast and the roll we got to eat on the plane was not up to our usual standard breakfast at the Pinocho. We did find an excellent restaurant that had been recommended to us by Dr. Patzi right on the Prado, no more than a ten-minute walk from our hotel. Walking was a joy as the temperature was in the low 80’s rather than the 90’s and 100’s we have been suffering in Montero.

After lunch we went to the Palacio Portales, a house built by a very rich man who made his fortune from tin mines at the turn of the last century in Oruro. He never actually lived in the house, dying before it was completed, but I am glad some people did have this much money to leave something for future generations to see. All the things in this palace were brought from Europe and shipped here, completing the building in 1912. Senor Patino also built a summer residence just outside the city that we will visit tomorrow. The house looked very European with the square brick architecture so commonly seen there. Actually there was a mix of various types of architecture taking the best of several and combining them here. For someone who knows about such things, this would be a very interesting place to study. We discovered that the recent past president, Carlos Mesa would be speaking here tonight and we were invited to come to the talk. We walked around the town with the final destination being the botanical gardens. We thought this would be a grand example of tropical plants and it did have potential, but it had gone to seed, literally and figuratively. There were a few signs indicating the names of the interesting plants and trees, but my garden looks better than this place. Seeing how well kept the Prado was, we were really expecting something much nicer. This was our first disappointment in Cochabamba.

In the evening we returned to the Palacio Portales to see the President. I was waiting in line to buy his books when he walked in by himself. I had seen pictures of him before and viewed him on television, but I really didn’t think it was he as there was no one giving him any mind. I bought the books and could have had him autograph them if I had had the initiative to ask if he was the president. I turned around and when I looked back, he was gone. We arrived on time and we had seats as the rest of the guests continued to arrive. There were no police, no checks of bags or of person. Nothing! Can you imagine this type of event in the US with no protection? Wouldn’t our ex-presidents like this instead of having security all the time when you just want to be left alone? The talk was interesting stressing the respect for human life, property and security. It sounds a little like our Declaration of Independence. Human rights were a big issue with attention to equality in opportunity in education and work. Spiritual rights were also mentioned. All this is counter to the direction the country is now being taken under Evo Morales who is giving preference to his tribe of mountain folks who know nothing, or very little of the people who don’t live in the Alto Plano. I do certainly agree that these indigenous people, who are the remnants of the Inca Empire, have generally been left out by previous governments, but fairness to all is important. We left when they began to show the video of the president, having a copy of it in the book we bought and the video, if shown in its entirety, was 110 minutes long and it was already past 9PM. We had dinner in the “party district,” but on a Tuesday night it was not very busy. We dined at a Chinese restaurant and came to the conclusion that most of them in all of the places in the world we have eaten were basically the same. Although the area was quite devoid of people, there was a birthday party for a teenager with exchange students at the next table. They were quite noisy, but having fun. Many were speaking in English as a common language, but I think several were from Scandinavia and a few from North America. The rest of the restaurant was empty.

Wednesday, March 26, 2008

We walked around the Prado until 10AM and then rented a cab for the day. He charged 30 Bolivianos an hour, or about $4. Nick Pressler rode in the back of the hatchback while the rest of us sat comfortably in the rest of the seats. Having seen the giant statue of Jesus on our walks, we now drove to the mountain on which He resides. This statue resembles the one in Rio de Janeiro but this one is only 20 years old and two meters taller. Also it was built and engineered by Bolivians while the one in Rio was built by Frenchmen, or at least, that is what our guide told us. The sun was just right for us to get photos of Jesus as the sun was rising behind Him giving the allusion of a halo around his head. Several others were waiting for the right moment to get a photo of the same effect.

From the mountain we could see a golf course and since Nick is a golf pro, we decided to visit the Country Club of Cochabamba on our way back to the city. The club was as unbelievable as the statue of Jesus. The greens were neat and well manicured. There was a nice pool and several racquetball courts outside, but inside there were four more plus courts for tennis, volleyball and soccer. Outside there were several more tennis courts including one for tournaments complete with a viewing area. The courts were all crushed brick similar to Roland Garros in Paris. I asked about the fees and that was the really big surprise. Membership is $7000 and dues are $25 per month or one can get a monthly membership for $100 per month. What a deal! There were also big playgrounds for children, a regulation soccer field and many other amenities we didn’t have time to see. We next visited the archaeology museum in the center of the old district. The building was on a corner and was previously a bank in the old days complete with a vault. The exhibitions were quite well done showing mummies of wealthy Inca Indians buried many centuries ago. The bodies were wrapped in rope in the fetal position. There were the tools and implements they used thousands of years ago and many did not look much different from the homemade bowls one can see being used today. Bows and arrows and other weapons were exhibited and these looked very much like the ones you might see in Greek or Roman museums. These implements were developed independently, by different cultures using what was on hand to achieve the same purpose and came up with the basically same design.

We returned to the cab and visited the summer home of Sr. Simon Patino. The estate was enormous and I don’t think we discovered the full extent of it driving in the place. This house is still owned and used by the heirs of Simon, but people are welcome to visit and walk around the gardens. As disappointing as the botanical gardens were yesterday, this place made up for it in the opposite extreme. The gardens and pools were spectacular and well maintained by the crew that was evident everywhere. Trees and plants were all identified and there were pools full of fish in addition to the wonderful view of the surrounding mountains.

Dwight Bryant, Nick Pressler, Joanna and Jamie Rold at the pool by the side of the mansion house. The entire structure was made of cement, made to look like wood.

In awe of the outside, we knocked on the door and were given a free tour of the house. Most of the original furniture was still present; however the use of the various rooms has changed over time. As the palace was all constructed from imported wood, marble and wallpaper, so was this house, built in the style of a fine country estate in Europe. Unlike the other palace, this one was actually occupied by the by the owner before he died. Apparently the materials were imported not because similar items, especially the wood, could not be obtained in Bolivia, but because the road systems were so poor that the fine woods now available could not be harvested and brought to these places. I can’t even imagine how expensive building these houses must have been. In a way, it is a little like Highlands-Cashiers, where everything has to be brought in from somewhere else, adding to the cost.

We tried to find another museum, but being a little tired from the altitude and the travel, we decided to return to the airport, hoping to catch an earlier flight to Santa Cruz. Unfortunately there was another flight one hour after ours, but none before. We spent two hours in the airport eating dinner and reflecting on what we had seen in two short days. I think we accomplished a variety of things and met the president, even if he was not still in office. That is not too bad for a two-day trip.

When I got back, I got such a surprise when I checked my e-mail. One of the girls from UNC-A had received several calls pertaining to a lost bag. She, apparently, had no recollection about losing a bag, but emailed me all the same. It is and has been at the airport in Santa Cruz since the 29th of February. The lost bag! The one I have been seeking for a month. I am certain this has the missing lathe parts. I will need to return to the airport again tomorrow.

Thursday, March 27, 2008

Following breakfast and bringing the volunteers to the work site for the last time, I drove to the airport and claimed the baggage. All of our bags should have had a tag with our home address and the Pinocho logo on the other side of the tag. Either this one didn’t have this tag or it fell off. Fortunately it did have the name and phone number of the girl who brought it for the group. I gave them a copy of the email and my cards from the mission for identification and was handed the bag right away. The process took less time than the visa renewal process last week. I was able to return and help with laying bricks at the church. It was a good thing I returned when I did, as the men understood the new foreman to say that the opening for the window frame needed to be narrower and they had closed the gap by about two inches. At this rate there would soon be an arch I asked the man if that was his intent and he said, “No.” The last three rows of bricks needed to be adjusted which only took a few minutes. Later, after the mortar had set up, this process would have taken hours. The sun was bearing down on the side of the church where we were working so Nick let me get up on the scaffold to continue his side of the wall while Jamie continued to work on his side of the window opening. The next day he could not work due to the sunburn that went right through his shirt and pants. Fortunately for me I received no such burn, apparently from lack of time in the sun. They were pouring the cement columns at the front of the church to support the ceiling and then they can finish bricking the front of the church later when we are gone.

I was so anxious to begin the lathe work at the foster home that I almost forgot about the lead testing commitment at the Etta Turner Center in the Pampa section of Montero. After lunch I picked up the nurses from the clinic and we went to the feeding center, but no one knew we were coming. I set up the visit in Portachuelo, but the nurses said they would set up the visits to the Pampas and Minero. Nothing had been done. We talked to the administrator and found that this center really has very little connection with the original Etta Center in Montero. There had been no communication between the two comedores as I expected there would be. We went next door to the children’s day care center and asked them if they would be interested in having the lead testing done at their institution and the administrator was very interested. She was to let the parents know and we could return next Friday. Since this only took about an hour, I was able to go to the home and set up the lathe. All the pieces, thankfully, were there and it was assembled quickly. I made a few pieces to see how it worked. Because of the transformer the speed of rotation was a bit slower than I am used to, but this speed will be great for the less experienced boys as they learn how to use the machine. It is more forgiving at the slower speed.

In the evening I had two meetings that required my presence. The others in the group went to Expoforest, an event in Santa Cruz that I would like to visit on Saturday. This is an exposition of forest products from paper to wood and everything in between, including nuts, coffee and goods made from leather and other forest materials. Meanwhile I went to the meeting at the Rotary Club to discuss the finances of the foster home and the carpentry shop. (again!) The meeting began at 7:00 PM. There was a great deal of discussion. The accountant had given us a general financial statement for the home as it now functions and one with the second house involved. She tried to make the numbers look as bad as she could for the second house as there seems to be a feeling that this house is a bad idea. In my mind, the second home is essential to the foster home. The older boys now are sent off just when they are most valuable to teach the younger boys valuable lesions, not only in school, but also in life in general. Just think how little you would have learned if it had not been for peer interaction and help. Also the concept of a home, rather than an orphanage where the children are set out into the world at a predetermined time, has not set in. One of the ways to continue funding for this place after I am gone and perhaps the mission fails, is for the graduates to help fund the home because they saw what their lives might have been without it. If they leave, they will not give this place the credit it deserves. Also, whether the boys that left come back or not, I want the second home to begin functioning ASAP! The house parents need the help and the boys nearing the age to be sent off again need to stay. I brought up the inconsistencies in the financial report. There were no costs for medical care for just the one home, and $45,000 a year for two. The support from the government was the same for both homes, even though the projected number of children went from 14 now to 45 later. I feel the mission can support the home to the tune of $25,000 a year with little effort on our part. That number, in my opinion, will be sufficient. Dr. Plata, who is very concerned about the project, asked quite bluntly, “What will happen when you are not here? You will not live forever.” This is a good point and I have always thought that the mission would continue in my absence through the efforts of those who have been touched by the work we have done. Surely someone will have to step up and do more. I am confident someone will do so. Also the original plan was for the carpentry shop to fund the project. This, the accountant thought possible with good management, something we don’t have now.

At the actual Rotary meeting, I met a man from Samiapata who wants to set up a center for teenaged boys and girls who are alcoholics and drug addicts. Dennis, a self-proclaimed hippy, lost a leg in an accident while working in the Peace Corps. Living 10 years in India and other exotic places, he developed a love for meditation. He feels this is the way to help addicts. Having been able to meditate all my life, I know the power of this technique. Some of my first memories as a child are my experiences with meditation. Of course, at the time, I didn’t know what I was doing. There are a lot of different ways to try to treat addictions and none of them works very well. Perhaps his method will have some success. He wants to try to get a Rotary Matching Grant to pay for solar electricity, as there is no electrical power where he wants to build the project in Samiapata and he needs help in other areas as well. As we talked, he mentioned that he had lived ten years in Panama. I asked where and he said he lived in David. My first venture into mission work was with The Rotary Foundation when we began the Polio Plus program. Our project was in David and he knew the few people that I remembered from my visit fifteen years ago. What a small world it is. He gave a speech on meditation after the meeting and I could understand all he said. It is amazing how I can understand foreigners speaking Spanish better than I can native speakers. It is probably because they speak slower, with fewer accents and use syntax more like English from force of habit. At any rate, I enjoyed the talk and the members also asked a lot of questions, indicating some interest. I think I will enjoy working with Dennis in trying to obtain a Matching Grant.

Friday, March 28, 2008

This is the last day for Dwight, Nick and Jamie. Tonight I will go to the airport and drop them off and pick up our last volunteer, Felicia Gasca. She worked with me this past summer in the ER as she thinks she might like to go to medical school. She has received a scholarship to any school in Florida for undergraduate work so she must have some talent. She is a junior in her school in Daytona Beach, Florida.

We went to the boy’s home for the last time with this group and mostly made pens and prepared the wood for future pen making. The process is a lengthy one with many steps. The boys like to use the lathe, but there is more to the pens than that. A man came having a few pieces of interesting tropical wood. He had pieces of morado, a fine dark brown wood and pecana negra, a tan wood with dark lines. Both are softer wood than the tajibo we have been using and I bought all he had. From this wood we can make hundreds of pens. The first step is cutting the wood into long square pieces. These are then cut to the correct length. This work I delegate to the adult workers. It is far too dangerous for small-inexperienced hands. These pieces are drilled using a drill press and a special holder that helps center the wood for drilling. This is the process at which Fredy is so good, but the other boys, Wilder and Pablo can do it well also. Then brass metal tubes are inserted and glued into the wood. This has to be done properly or the wood breaks when it is turned. This is happening about every third piece of wood now and the problem may be the old glue we are using, or the bad technique the boys use to insert the tubes. I have seen them do it poorly. Unfortunately, the one who does it poorly is not always the one who breaks the wood and, thus, a lesson is not learned. The tubes can be used over again so nothing is lost except the time and the wood. Buying the expensive woods in the US would be a problem, but all this wood I bought was 40 Bolivianos or about $5.00. The ends of the wood then need to be trimmed to the exact length of the tubes. This process is done with the drill press and uses a special bit made expressly for this purpose. If done poorly, the pen pieces won’t fit properly if at all. Finally the wood is ready for the lathe. After the pieces are worked, sanded and polished, the pen can be assembled. Even the small children can do that part and the finished product really looks good. Examples of these pens can be seen on our website. www.highlandsbolivianmission.com and purchased there as well.

In the afternoon, the men decided to rest, all having a sinus infection that has not yet responded to antibiotics and that could be a problem when they fly tonight. I also have bronchitis that is aggravated by the dust in the carpentry shop and the general foul air in Montero. Perhaps all of our illnesses are secondary to the pollutants and not from an infection. While the rest of the men rested, I went to Minero for another lead screen program. Minero is about 50 Km from Montero and is a small town about the size of Portachuelo or Buena Vista, but not nearly as nice as either of the two other towns. We went to a daycare center and soon tested 26 children who had slightly higher levels that the other places we have checked. One had a level of 12 micrograms/deciliter and this was confirmed by a recheck of the specimen. The average was about 7.5 which was one or two points higher than the other locations. There is a big sugar cane factory here but that shouldn’t put lead into the air. I am considering paying these fine nurses who work at the Villa Cochabamba Clinic $1000 to continue the work and go to Oruro and Potosi where tin mines are located and other metals are mined as well. Lead levels could be very high in such areas.

On returning to the Pinocho we had our “last supper” and off we went to the airport for the fourth time in four days. It had been raining earlier and I really feared driving on these dangerous roads in the rain where the little light I have from the headlights would reflect away from me and make the road very dark. Fortunately, the rain held off and the new lights I installed into the headlamps were somewhat better but not much. I left the men off and waited for Felicia to clear customs and returned to Montero. We have only ten more days until the end of this year’s mission. I look forward to returning home, but it also is a time of regret because we love it so much here. My lungs, on the other hand, will enjoy the cool, clean air of Highlands and spring is my favorite time of year in the mountains.

Saturday, March 29, 2008

Felicia was up before the rest of us. There is no jet lag as we are now on the same time as Highlands. We are in fall here with the days getting shorter as they lengthen on the other side of the equator. We are so close to the equator that the change in the length of the day is hardly noticeable. At the equator, days and nights are the same every day of the year.
After breakfast we ventured to the foster home. After saying hello to the boys and the staff, I headed to the shop while Joanna and Felicia played with the boys. Even though the day was cool by Bolivian standards and Felicia is from Florida, she was not accustomed to the heat and couldn’t work long without resting. She eventually came to the shop and helped to make the wood blanks with the boys. Soon she will be making pens, too. Felicia’s father is Mexican and she speaks Spanish well. Due to the wood splitting because of poor gluing technique, we only made three pens, but we made many more pieces ready for the lathe and some of the morado and pecana negra will be ready tomorrow after the glue dries completely. I have made pens from morado before and I know how the wood behaves, but pecana negra will be a new experience.

We went to Expoforest in the afternoon. This will be our last trip to Santa Cruz leaving next Wednesday afternoon open to do other more needed projects, as we have been to Santa Cruz so many times in the past few weeks. The last week in Bolivia, for me, is the most difficult as people I have never seen come looking for help with their projects. We responded to one request for help this week with a donation of tennis racquets to the physical education program for all the secondary schools in Montero. The Mountain Laurel Tennis Club in Highlands had given the racquets to the mission. These racquets, if purchased here, which cannot be done because they don’t exist here, would have cost about $250 a piece, or about $2000. I hope some of these students will be as good as the young man that got a racquet last year and was playing in a tournament in La Paz earlier in the month. The school that requested help with their computer program gave me their projected costs yesterday also, and the TB doctor I have helped over the years got his laptop computer this morning as he is going to the Dominican Republic tomorrow and needs a better computer than the IBM laptop I gave him six years ago. The battery in the old one has failed and he has to use connected to electricity, which defeats the purpose of a portable computer and the screen fades out from time to time. The foster home will get to use the old one after Danny erases the programs and makes it as up to date as it can get. If the boys ruin it, it is no great loss, but I hope it will last a long time. I think I have a spare battery and a more sophisticated hard drive that will fit this machine at home. With any luck it will and then it will be portable again, also.

As for Expoforest, I was very disappointed. There were fewer exhibits than last year and those that were present were not as good. Some fine furniture was present but the depth and scope of the exhibits was not there. In the past there had been many wood carvers and today there were none. Gone was the competition for the best product made of wood that produced many interesting chairs, tables, benches, artwork and other items that were very interesting. At least there was a carved snake made with a chain saw using a thin tree trunk that was about 30 feet long. The scales were carefully cut into the wood with the saw. That exhibit also had a few other interesting pieces of art, but that was the only really interesting one in my opinion. I was thinking of getting our pen project involved in this fair next year but now I am not so sure. The most interesting part of the show was the exhibition of tropical tree seeds. This was a new exhibit and fascinating in the way seeds propagate their respective species. Most were huge seedpods, much larger than anything I have ever seen before. Brazil nuts are actually the size of cocoanuts with the faceted seeds that we see packed into these balls, but there were seeds the size of bowling balls and some of the pods were three feet long. How these evolved like this is amazing. Many, I am sure, provide food for animals and the seeds are dropped in the feces to other nearby areas, thus spreading the area where the trees can be grown.

Fredy cleans up as Wilder and Nick sand a pen barrel. Dwight looks on with approval.

In the evening we went to the Suiza Restaurant again. I tried a new Chardonnay wine thinking we could bring this one home for the wine tasting. Unfortunately I did not check the price before ordering it. The wine cost more than the rest of the meal put together. It was a good wine, but not that good. Still, for five people we dined in a fine restaurant for $20 a person and with a normal table wine it would have been only half that much. Felicia had several firsts: Her first escargot and her first fried calamari. She didn’t want to try the llama or the ostrich or she would have had many more “firsts.” Two new things at one time are sufficient.

Sunday, March 30, 2008

Since most of the churches meet in the evening, we slept in a bit and left for the foster home at 10:00 AM. The first news was that one of the boys “escaped” at the catechism practice last night. Wilder, my best pen maker, left to go to his aunt’s house. He has always been a poor student, smart but not really trying in school. He worked well with the boys yesterday and suddenly for no apparent reason, became withdrawn. That type of behavior is not unusual with these boys who have been through so much so I didn’t make much of it. His aunt used to beat him and cut him on the face causing a big scar. Why he wants to go back there, I don’t know. There is little we can do if he does not want to come back and his aunt is willing to accept him. The psychologist says this happens all the time at orphanages, but this is the first time this has happened here since Fredy left three times four years ago. Of course, Fredy came back and is happy he did. Earning 15 Bolivianos, about $2, is tempting to boys at this age, but without education, he will be making $2 a day ten years from now. For me, every time we get a child who is good at making the pens, off he goes. I hope the praise I gave him yesterday when he was making pens didn’t give him the confidence to go out on his own. We did make a few pens, five in fact, using the new wood that I bought a few days ago. They were spectacular! I love the deep brown color of the morado and the pecana negra is a tan wood with deep brown bands like a tiger that has a translucent, almost gemstone appearance when polished.

After the pen making we played soccer for a short period of time as the heat was fierce again. There were some clouds indicating impending rain, but none fell. In the afternoon we took the boys to another soccer match. The field was in much better condition. Before the game a man was praised for donating a riding mower to the stadium. I don’t now what they used before but the field was now in playable condition. It is amazing what can be done when you have to do it and have the proper equipment. Remember that the league threatened to remove this stadium from playing games if the field wasn’t improved. Our field at the foster home was better than this one, and our lawnmower probably was better than theirs, even though it is a push mower. Unfortunately the match was poorly played due to the heat. The last part of the first half had a lot of action and both teams scored one goal. The second half was lethargic and just before the end of the game the team from La Paz scored a goal, as our team didn’t get back on defense. In the closing minutes Montero tried harder but it was too late. The final score was 2-1.

In the evening I went to several churches with Felicia to deliver books, gifts from Martha Rodenbeck, to the respective pastors of the churches. We ended up at the Dios Es Amor church where we had done the feeding programs several years ago. I always get a good feeling when I enter this church. I remember so many of the women who took time off from their work to feed the poor, hardly being out of that category themselves and several worked in the market serving food for profit as their way of making a living. What a sacrifice! Some of these old women are only chest high to me, but they all look noble and proud. We sang for over an hour and then had a sermon, without notes for another hour. Shortly past 10PM we got up to leave and the pastor gave us a special blessing for all the work we have done in Montero. The sermon had been about the leper cured by Jesus. He was asked why the man had leprosy and He answered, “So I could cure him for the glory of God.” I responded that our work was done only for the glory of God and there was a round of applause. All that singing made me hoarse and tired. Sleep came easily.

Monday, March 31, 2008

I finally went to Cotas, the phone company, to see about getting a landline installed at the foster home to get Internet there. They said they would have a schedule of fees tomorrow and we could make a decision. Later we went to the foster home again and played with the boys, made pens and played a little soccer, doing only a few. We talked about Wilder mostly and none of the boys seemed all that concerned. I hope he will return when he comes to his senses.

In the afternoon I went to the medical clinic to see patients for the first time. Quite frankly, I haven’t had the time to do this before now and Felicia wants to be a doctor so I thought it would be good for her to see me work in an office setting. One of our “patients” was Pablo, now, my best pen maker. The psychologist came with him as he wanted to join Wilder and get a job, leaving the home. Pablo is an excellent student and good at all he does. I told him that he has choices. He can take drugs or not take drugs. He could drink alcohol or not. He could study hard or not. Then I showed him my office at the clinic. It was air-conditioned and nice. Wilder, on the other hand, will be working in a field making a few dollars a day. I think that made him change his mind, although I don’t think he was really serious about leaving the home. I think when one boy does something the others want to try the same thing. Hopefully no one else will leave. Perhaps getting Internet will keep some of them in the educational environment.

In the evening I went to the Shalom church (Danny’s Church) for them to thank us for the work and the donation we made to them. Joanna and Felicia stayed home due the heat and the fact that they are both magnets for insects and in the night with the lights at the church, there are plenty of insects. It was a simple night with everyone giving their thanks in their own words for what our contribution has done for them in relation to this church. It was a moving night followed by empanadas and cake. I was stuffed having eaten just before I came. I was able to be home by 9PM and worked several hours writing evaluations of the students from Johns Hopkins. I only finished half of them.

Tuesday, April 01, 2008

The first item in the day was to return to Cotas to see what it would cost to get a phone line and Internet at the foster home. By becoming an associate of Cotas, we could get a phone line for $1500. This number was told to me a few years ago, so I was not surprised. After talking to a few more people at the office, they sent a man with us to go to the Rotary Club, as they will ultimately pay the bills. After more talk, the agent said since the Rotary Club was already an associate of the phone company, they could add a line for only 165 Bolivanos, or about $20 as opposed to the home becoming an associate member for $1500. After all this time we find we can do what I wanted to do for such a small amount. There will be a connection fee of $275 which is also reasonable.

After the phone discussion I went to the foster home and the skies opened up just as I approached the gate to the Hogar. Pedro had just arrived ahead of me and he got soaking wet opening the gate for me. Thunder and lightening occurred while we made a few pens and rain came through the roof of the carpentry shop. Finally I left at noon and I expected
to go to the supermarket to buy dog and cat food. When I drove over the bridge I saw dirt graded into the middle of the road where we paid $1000 to have rock put there last year. This was the best part of the road and now they have ruined it! When this happens the top becomes muddy and the hard dirt under the mud does not allow the tires to dig in deep enough to stay on the road. Dr. Patzi in this very place was driving along and just slid off the road into the roadside ditch. Even knowing this, I proceeded forward knowing that I had four-wheel drive that Dr. Patzi didn’t have. Since I couldn’t drive on the center of the road where it used to be flat, I drove to one side of the pile of dirt and immediately slid into the ditch. I put the car into four-wheel drive to no avail. Soon I was perpendicular to the road with no option but to move forward and try to back up and begin over again. Soon I was really stuck. I called the Hogar and in a few minutes a truckload of carpenters and Pedro came and pushed me out of the ditch. I was able to make the rest of the trip on the road as, by this time, it had stopped raining and the mud was getting less slippery. I was so angry that someone would grade the road like this and make it practically impassible. I think they did this to take the dirt and rock, my rock, to put on the road further up the road where the floods had carried the dirt toward the drainage canal. Maybe by next year they will fix the road like it was before, which was fine. I was able to make several passages on this road in the rain with 18 inches of water covering this same road on my birthday. Now I couldn’t navigate it after a brief shower. What a shame.

By the time I got back I was late for lunch and my shoes were covered with mud and my slacks were filthy. I had to change clothes to go to the clinic. I feared that no one would be able to come to the clinic because of the flood but there were several interesting patients. One was a man with diabetes. Last week his sugar was 400, but today it was 526. I asked him all sorts of questions and he had no dizziness, dry mouth, blurred vision or any other symptoms commonly found with an elevated blood sugar. His friend who came with him said he works eight to ten hours a day and seems quite normal. Normally people will be in the hospital with such elevated numbers. Another man came in with abdominal pain and jaundice. I did an abdominal ultrasound with the machine we bought for the clinic four years ago. Immediately I found stones in the gall bladder. I am not an expert in ultrasound, but this was something that just jumped out on the screen. I made a picture for him and suggested that he see a surgeon at the General Hospital where we gave the laparoscopic surgery equipment three years ago. He looked depressed and I guessed that he didn’t have the money for an operation, but his condition is grave and possibly fatal if he doesn’t have an operation. Then a young man came in with a laceration on his foot. He had the foot bandaged with his shirt, but blood drained all over the floor. I thought maybe he had had a terrible accident on a motorcycle as the bleeding was really terrible, but he said he had stepped on a piece of glass that went right through his shoe. The cut was not that big, but he had obviously cut a small skin artery. We repaired his laceration with the suture trays and thread we had brought last year. Unfortunately the only suture material we had was either very thin or gut, which is not very durable. In Bolivia you use what you have and hope for the best. Felicia and I went to the market on the way home to buy the pet food.

At 7PM we went to the Rotary Club to discuss the Foster home administration and covered much of the same material we had covered last week. Finally at 8PM the group from the Global Mision Peniel came in to join the discussion. I was happy to see that they were willing to try to raise money to help fill the deficit predicted by the accountant when the second home is finally opened. Their feeling was that it would be easy to raise money for children. Our organization was pledged to fill the gap and we will if necessary. We can always focus our attention on the home and give less to other causes, but it is nice to see the new organization willing to fundraise as we have done for so long. The Rotary Club here has only recently even suggested that they could raise some money. The long term funding for the home is still in doubt unless we develop a very large endowment fund.

Wednesday, April 02, 2008

I awoke to the tinkle, tinkle of rain hitting the gutter. Not a hard rain, but the kind of rain that usually lasts all day. I had hoped to go to the church to lay some brick with Felicia so she can say she did this and see how it is done, but there was no way we could do that even under the roof. Instead two pediatricians picked me up to visit a small boy with a very serious disease, spinal muscular atrophy. This is the most common neurological disease that kills children, although the two cases I have seen have both been here. It is a genetic disease, a recessive gene, which destroys the same nerves in the spine that polio does. It is a progressive disease that usually kills by the second year of life. The doctors wanted me to see him, as he is the only child on home respirator therapy in Bolivia. His room was something like a shrine, brightly decorated and clean. There was an oxymeter and a small portable respirator at the head of the bed. The mother is basically on call for his care 24 hours a day. One of the beanie babies we had given to the children’s hospital last year was hanging on the medicine cabinet, filled with medicine, feeding tubes and respirator equipment. Apparently he was in the hospital when we gave these toys last year. That was when this boy was given his diagnosis. No hospital room was better equipped than this room. Fortunately this family was wealthy enough to put forth this kind of effort to keep their son alive. I donated some powerful antibiotics that I had brought in case one of our volunteers got sick to the boy’s doctors. Generally these children get pneumonia several times a year and the antibiotics may prove useful.

The cute boy with the worst form of spinal muscular atrophy

I went to the carpentry shop to continue teaching the boys to make the pens. I will be gone for a year in only a few days and there is so little time. We made a few corkscrews in addition to the pens and due to the rain; there was no question of playing football or baseball. I took the old way home by the drainage canal. It is a poorly kept dirt road that is always drivable as long as it is not used often. The bricks that Robbie Forrester, Eddie Ingram and I put here three years ago to fill holes are still there and making the journey safe and possible. The only problem on this path is falling in to the drainage canal instead of a small ditch, like yesterday, if one is unfortunate enough to slide off the road. Fortunately there is no pile of dirt on this road.

We went to Santa Cruz in the afternoon for the final time to pick up the painting by Angel Blanco and do a few chores we had hoped to accomplish last Saturday when we were here, but all the places we visited were closed. Unfortunately, there was a blockade on the main road making it impossible to enter the city. This was a rally for the Autonomia vote in May. People need to register to be able to vote and the deadline is next week. To pass the time waiting for the streets to clear, we went to a supermarket to buy cheese and meat for our pizzas that we will make on Friday night. We had to buy a Styrofoam cooler to keep the food cool while we finished our chores and went to dinner. When we finally got to the center of the city, many of the shops we needed to go to were closed again as the employees either were part of the demonstration or were let off work as no one could enter the city to come to the shops. At one we only needed to pick up a sales slip so we know what we paid for the items we bought there several weeks ago and our efforts to pick it up have been thwarted. Frustrated we did what we could and went to dinner. Fortunately, Angel Blanco was waiting for us and gave us the painting. It is a depiction of three horses running in a storm. The painting is 3 feet by 4 feet and it fit in the taxi only by having the edge propped over the back seat where Joanna and I sat lying to one side as to not dent the picture with our heads. After the painting dries completely, it will have to be removed from the frame and rolled up and inserted in a tube for transport back to Highlands.

Thursday, April 03, 2008

This was one of those days that make you glad that you decided to start and maintain a mission and glad you spend all that time working to raise money. First I went to the church, Shalom, to build for the last time. The pastor and I have become good friends and he is literally building the church himself, brick by brick. I have told you before that I find building with bricks something that connects me with thousands of years of history and I explained to him why I like to do this. We worked for several hours in the cool weather, overcast with strong wind. The wind was so strong that you had to place several bricks on top of one another to prevent some from being blown away. (This is an old bricklayer’s joke) It felt good to be working with this man doing something I like to do. I worked for two hours and never broke a sweat. What a difference from a few days ago before the rain! Suddenly Andreas disappeared with the wheelbarrow only to reappear a few minutes later with the wheelbarrow laden with empanadas and drinks that his family sells at the nearby college. This money supports the home and the church. Quickly he returned, wheelbarrow empty and minus his wife and daughter who stayed at the college to sell their wares. He continued working with me until I needed to leave to go to the school ceremony. The pastor and I have become close and saying our first of many good-byes was difficult.

At 10:30 we all went to a ceremony at the school where we were about to present a check for $1500 to buy computers and begin a class for learning this very necessary technology. All the students in the whole school came and brought signs indicating their thanks for the contribution. It almost brought me to tears. One boy gave a speech and I thought that he might be a politician one day. He was an accomplished speaker at his young age of 10. There is potential here that can become something special if it has the help and support that every child should have, but few get in this country. Soon the schools are to receive computers from the government paid for by the petrodollars that Bolivia is earning selling their ample supplies of gas and oil. I hope our small contribution will help their program be better and include the Internet.

In the afternoon we returned to the clinic for what we thought would be the last time. Our last patient had a huge lipoma on her left shoulder and another one near her neck. A lipoma is a benign fatty tumor. I told her I could remove the one on her shoulder but not the one on the neck as it was too close to many critical parts including nerves, lung and major blood vessels. The suture trays I had left before were here but I was not sure of the sterility, as they were not wrapped in paper and plastic like we sterilize them back home. Also I did not have sterile gloves and the clinic uses nonsterile gloves wiped with iodine to clean for surgery. I knew we had gloves, prep kits and two sterile procedure trays at the Pinocho so I delayed the surgery until tomorrow morning. My free day was quickly being filled with more things. I like to keep the last day free for all the things that inevitably come up.

In the evening we all went to the foster home for the new group to see and did an inventory of the things at the hogar. The new man who will be taking care of the new building and the older boys was there giving me a good feeling that it would be open soon and the boys that went to Santa Cruz will be returning before long. Also there are several boys that will soon be old enough to go to the new building and they will not be sent to an orphanage. Immediately following that meeting we all went to the weekly Rotary meeting that was held at a local restaurant owned by a fellow Rotarian. This restaurant specializes in quail and it is one of our favorite places to go if the Pinocho doesn’t serve dinner. That doesn’t happen very often and I am happy that Teresa doesn’t have to slave over a stove for just the three of us who are here right now. She has been very gracious to serve us when we are so few, but we are more than just guests to the staff here after all these years. They are more to me than just owners of the hotel. We have had their son at our house and met him in Spain when we visited there several years ago. Having friends is the most important part of living, in my opinion, and the most interesting part also. The meeting mainly concerned the introduction of the various people taking over the administration of the home, including Danny who will be the new computer teacher and our last good-bye speeches. At the end of the meeting they announced that Joanna Baumrucker’s name would grace the new daycare center being built in the Pampa de la Madre barrio in Montero. I suppose that fact will cost the mission in the end, but at the present I have told them we would donate $7,500 for equipment as a group in Europe is paying for the building costs. This is a very nice recognition of the work she has put into the mission for ten years. Our anniversary is being graced by many different organizations. This is really the difference in our mission from most other missions who have a sole purpose in mind when they come. This is also the benefit of coming to the same place year after year. Making contacts allows you to expand the mission into many different areas. Only God knows where we will go to next and I mean that quite literally.

It was an honor to have all the children come to the ceremony for us.

Friday, April 4, 2008

We woke early to be able to do all the things we had planned and now we had the early morning surgery. We went to the clinic with all our things for the surgery. Unfortunately I had given away all my 71/2 sized gloves and had only 81/2 gloves at my disposal. These would have to do but they were two sizes too large for my hands. The patient was not there at 8:30 so I saw two of the nurses at the clinic. It is a bit sad that they don’t trust their own doctors as the questions were quite simple and the doctors here would have been competent to answer them. Then again, perhaps in this closed environment, they didn’t want to discuss their problems with the local doctors. Our surgical patient came fifteen minutes late, with all apologies and we quickly prepped her for the minor surgery.

After anesthesia with lidocaine an incision was made over the large lipoma. The cut was smaller than the tumor as I hoped to remove it like delivering a baby, making the smallest incision possible to remove the tumor. The fat of a lipoma is different from that of normal fat and I rapidly got into the tumor fat. With my finger I was able to get around the tumor and remove it from the wound, but the base of the tumor was connected to the other site in the neck. This was good and bad all at once. I was able to remove a lot of the neck tumor through this incision, but finally I could pull no more of the tumor out through the incision I had made and I was causing the patient a lot of pain, as the area where the rest of the tumor was had no anesthesia. I cut the tumor as close to the base as I could and closed the wound. I am always amazed by how few blood vessels one encounters with these lipomas. I once removed a 2.2 pound one in my office and this one was 1/3 as big. Her shoulder looked normal after the operation, aside from the sutures. The nurses at the clinic would remove these in a week to ten days.

I changed clothes and went to the foster home picking up Joanna on the way. Felicia and Joanna taught the boys English while I continued with the pen project. The little boys want to help so badly. I let them sand but they are far too young to use the lathe or even the drill press. All these things are potentially dangerous and I don’t want them to learn the hard way. The foreman in the shop is minus a thumb and he should be a reminder of how dangerous these machines can be. Fortunately for us, he lost it in a previous work site.

In the afternoon I went for our last lead-testing project. The nurses had done another testing at a new school since I was last with them. This I could tell from the book we have for all the data. We went to the kindergarten where we had talked to the director last week. Many parents were there with the children, but the place was closed and no one was inside. Evo Morales was in the mercado region giving out computers today and perhaps she went there to pick up one for her school. At any rate, we set up the testing in the bed of the truck as to not miss an opportunity to get more data. All the children were in the good range and there were only seven so the clinic didn’t last long.

We returned to the Mercado, where the clinic was located, but we were unable to enter the area as it was blocked off for security reasons. When Evo comes to Montero, he visits this area because it is quite large and also because his people, those from the mountains, live and work there. The mercado is completely run by the mountain people, the Kollas. These people are the hard working mountain Indian tribes that the Cambas don’t like. They don’t like them for all the reasons I do like them. They are intelligent and work hard. They came here with nothing or very little and they now own all this market area. The locals are just jealous. In a generation or two, these people will be just like the Cambas. The climate will change their dress which now, with the women at least, consists of multiple petticoats under their traditional dresses. Their “suitcases” are multicolored blankets that sometimes contain all their worldly goods including, sometimes, a baby. These are amazing people and the ones I came to love during our feeding projects. We couldn’t get too close with our truck due to the security (unlike our experience with ex-president Mesa last week) and suddenly a helicopter flew over head and Evo Morales was gone, back to the mountains. Meanwhile the three 18 wheel trucks filled with computers and printers were being systematically emptied and the goods given to the teachers and their students. This was not exactly a great way to distribute all these computers, but it was an effective political move. Whether these computers will be used as intended, or even installed properly is the weak link in this giveaway. Eventually we ended up back in the Villa Cochabamba Clinic for our last meeting to acknowledge our contribution to the clinics and to Montero and the surrounding areas as well. Dardo Chavez is an astute man who knows everything about our mission as he lends us Danny to help with our mission and all the other groups that use his clinics as well. He is a real ambassador for this place and one of the reasons he gets so much help from mission groups all over the world. Danny is learning German so he can help those groups who speak German too. A Japanese group will arrive next week. This is a busy place, but I think they like our group the best, or at least they make us feel that way. I hope all the groups that come have the same feeling.

Following the ceremony at the Villa Cochabamba we rushed off to the home of Herman and Gringa Landivar to prepare pizzas and get ready for the movie. Every year, as a gesture of appreciation on our part, we have an evening of pizza, popcorn and a movie for our friends and those who were important to our mission at this house. The house is in the center of the town and it is big enough to accommodate 20-30 guests. A bed sheet was already stretched perfectly across a sliding glass door to be used as a screen for the film. Hino, the house servant, has done this enough times to do it correctly by himself. All the cheese we bought a few days ago was shredded and the pizza dough baked and ready for the toppings. Fortunately it was cool so the heat in the kitchen even felt good. I set up the projector and the DVD player and showed the tape of the 2007 All Male Beauty Pageant, one of our fundraisers that brought in about $22,000 for the mission last September, just to see if the projector worked correctly. I have two speakers that need 110 volts so I need to bring a transformer to make the show happen. The rest of the equipment can use either 220 or 110. Next year I hope to purchase new speakers so I can leave the 30-pound transformer in my room at the Pinocho. I do like to use 110 to charge my computer and other electronic equipment as I think the expensive chargers last longer using the weaker current, at least they don’t get as hot. Everything worked well and the Pageant DVD would be over by 8PM when the main feature would be shown. We had several movies from which to choose and the crowd decided to watch Harry Potter. Since no one had seen any of the previous episodes, I thought they would be lost and I think they were. The books have been very complex and interesting and the movies follow the plot as well as can be expected when one condenses an 800-page book into 120 minutes, but jumping in at the second to last episode is not a good idea. Everyone made their own pizza with choices of shrimp, olives, ham, sausage, onions, peppers, salami and, of course, one or more of the five different cheeses we bought. The movie may have been difficult to follow but the food and company was great. This will be the last time we see most of these people present until next year.

Saturday, April 5, 2008

El ultimo dia. This day is always is a day always filled with a variety of emotions. We first went to the jail. Felicia had not seen this place before and like almost everyone else that comes here for the first time, she was frightened. First we have to pass through a crowded area where the guards live. The living conditions here are far worse than the worst jail in the US and these are the guards! Then you have to walk through a narrow walkway that is damp, dark and dank where the gate is locked. The guard here was new and didn’t recognize me, but our friend and trustee, Hugo came to the gate and we were quickly let in. Her fear quickly dissolved when she made contact with the prisoners. We checked a few sick patients and then suddenly the jail went silent. This place usually is a bustle of activity. Last night at the pizza dinner, Dr. Plata told me that I needed to come to the prison today as they planned a ceremony for our group and our contribution to the jail. We walked out of the exam room into the jail yard where all the prisoners were gathered in a large circle. When we entered the circle the inmates began to applaud. The mission pays the bills and I get the credit. We pay for all the medicines and for the improvements that made this place at least inhabitable. They gave me a plaque for our contribution, a plaque that really means a lot to me. Can you imagine how difficult it would be to have a plaque made if you were in prison?

Hugo, the trustee, Dr. Plata and me at the prison ceremony

Following the moving ceremony at the jail, Felicia and I went back to the Pinocho to pick up Joanna and go to the foster home for the last time this year. Joanna played with the boys and taught English while I went to the carpentry shop for the last time. Felicia went back and forth between the two places. After making the last of the pens that I will be taking home, we played our last soccer game. Pedro played one goalie and I played the other. It was cool enough that the boys tried hard. The new boy who came only yesterday was not very coordinated with his feet, as though he had never played football before. He tried hard and Hiber, one of the boys who was sent to Santa Cruz to an orphanage three years ago, played as he did the last time. He tried to get the younger boys involved and tried his best to get the new boy involved also. After about an hour, the final score was 2-2. That was a good way to end the day with a draw.

We were having lunch at the Pinocho for all the boys. I drove most of them to the hotel and Pedro came with the last of the boys, his wife and the psychologist. The meal was fantastic as usual. They pulled out all the stops to serve us a great “last supper.”

A sample of the last supper with the boys at the Pinocho

The boys ate like they had never eaten before. I have eaten at the boy’s home plenty of times and the food has always been very good. I guess the variety was the only real difference. It made me feel good to see all the boys eating until they could eat no more. For dessert, there was pineapple cooked with brown sugar and covered with vanilla ice cream. All the boys had seconds. How they ate any more after the lunch, I will never know. After several hours the boys finally left and we began to pack. I leave a lot of things here at the hotel. The ability to do that is just another reason why this place is different and something special to the mission. The only bad thing about the Pinocho are the pillows which are very hard. Joanna bought two soft new ones and they are in the new suitcase that is now in storage along with the other two. Every year it seems we have more things in storage. Yesterday I took two suitcases to the Villa Cochabamba filled with two of the vital sign monitors and the equipment for the lead testing project. All these things can be used by other groups if they find the need. Therefore, we have five boxes and suitcases here in Bolivia, waiting for our return. Being able to leave all this behind makes our mission charged and ready to go when we hit the ground. There is no time wasted and time is the only thing you can’t get more of in life. We finished packing which included taking the batteries out of the cell phones. This is done by design as many people try to call me the last day to try to get something. The people who are honest and have good projects don’t wait to the last minute to ask. Most of our projects, in fact, have begun by people or groups coming to us asking for help. For that reason, I am always open to at least hearing about new potential projects. The help for Beni, the tennis racquets for the public schools and the computer gift for the school are examples of projects that happened because someone came to us with a plan. At any rate we went to the dinner at Herman’s where many of our friends were gathered. This was the second evening we were at Herman’s, who is a good friend, but his work has occupied his time the last few years and I have hardly seen him until these last two nights. One of these days I will have more time and his work will fall to his children and we can spend more time fishing and doing good things for the people of Montero like we did when we first came to this place. That was a time when our mission was not as broad and he was only raising chickens and eggs. Now, with the price of sugar cane as high as it is, he is very busy at the farm and I have very little free time to do anything aside from the mission work. After many more farewells we left early to get a good night sleep as we needed to be up at 5:30AM to go to the airport for our return flight.

An overview:

After an uneventful flight to Miami and then to Atlanta, the longest part of the journey seemed to be the last part of the journey: the drive from the airport to home in Scaly Mountain. I am often asked if I am not afraid to go to Bolivia and I reply by saying that, “Yes, I am frightened to go to Bolivia. I have to go through Atlanta to get to the airport.”
I usually try to find a common thread that reveals the hand of God working through us or on us. This year the boys at the foster home are the obvious choice for seeing and feeling the hand of God. Last year we worked with the Global Peniel Mission Church with the micro-finance project. This year, quite independently, they were chosen to be administrators of the home. I knew all the persons related to the change in administration, which made the conversion simple for me, even though it seemed to take forever to actually make the change. I knew and trusted them. Within a week they had chosen a man to live at the home with the older boys and help with the running of the foster home. This will give the foster parents a chance to get a well-deserved vacation. A home for the cook and yard man, will be built on the property or nearby on land across the drainage canal. The problem with the cook in the past was that the remoteness of the home was such that the cook spent most of her income on taxi rides to get to work and when the weather was bad, the taxis wouldn’t drive on the roads to the home. The home built nearby would solve two problems: no need for transportation and the cook/yard person would have a place to live, thus saving money on both counts. The boys continue to be angry and God knows they all have been through hell before coming to the home. We now have a full time psychologist who is willing to work five days a week with the boys. Our computer teacher was lazy and didn’t come every week causing the boys to basically be in the same level of competence as they were a year ago. We now have hired Daniel, our friend for many years, who is finishing up his college degree and will work every Saturday without fail. He is very reliable. He also speaks English well and will help the English program by teaching computer in English. To top it all off, he can teach piano and the guitar. I don’t know how long he can work for us or even the clinic, as he has so many talents that he will surely move on to a better job, but for now he is working to improve the lives of the boys and I know he will be in touch with me frequently about the home. The last important change will be the Internet connection for the home. When it is completed, I will be able to correspond frequently with the boys and they can have pen pals in the US, which will improve their English in addition to making friends all over the world. The Internet can be the most important tool in learning, but it can also be a dangerous thing if there is not enough oversight. With the new people in place, I feel there will be plenty of oversight.

The mission in general is transforming from a Highlands oriented mission to a worldwide mission. Over the previous years we have had people come from five foreign countries, but this year alone we had students from China, Africa, Viet Nam, India and Italy and a volunteer who was born in Sweden. Highlands people were only 20% of the volunteers. Groups from UNC-Asheville, Ole Miss and Johns Hopkins made up the other 80%. The basic mission of providing medical help to the Bolivians and helping to feed the poor and educate children has not changed, but the delivery of that care has really changed over the years. We are becoming an educational site for several universities and I only see that role enlarging in the future. There is a group of students from Harvard Medical School wanting to come when the logistics can be worked out. The other part of our mission is to educate North Americans about the way the vast majority of citizens of this earth actually live. We are very lucky to have been born in the USA and I do mean lucky. The only difference from one being born in the poorest area of El Alto or being born in the richest section of Palo Alto is just pure luck. The poorest person here has so many advantages over the hard working poor here. One of the things I have learned reading material from other third world places is that all you have to do is change the names of the places and the story is the same. Parasites, chronic illnesses that we do not have, like Chagas disease, malaria and other mosquito borne diseases, malnutrition and anemia. All these things are so common in the third world and they have so little medical equipment to care for these basic problems. We spend fortunes on end of life care, cancer, heart disease and stroke. We get yearly physicals that find disease early and we have treatments that prolong life that are only dreams in the third world. Still, the biggest problem in the world today is over population and it is in the poorest countries where the population is growing the fastest. What will happen when the common diseases are conquered and their average life spans compare to ours? If the birth rates don’t come down our planet is doomed. There is a common accepted fact that the world’s population will double by 2040. I can’t imagine what the price of food and oil will be by then if that really comes true. This is not something that needs to happen and we should do all we can to help prevent such a jump in the population. The best way to impact the high level of infant and maternal mortality is to prevent some of those births in the first place. Our mission has always supported clinics here in Montero that teach and support birth control, even in this heavily Catholic country. We do not support abortion and I have never even heard of one being performed here, but there is a vast difference between birth control; and abortion although they often get confused and combined. When we came to Montero in 1998, the population was about 60,000. Now there are 120,000 people living here. The infrastructure of roads, schools water and sewer just can’t keep up with that kind of growth. There are improvements every year and there would be more if it were not for corruption and incompetence in the government, but that problem exists everywhere and is certainly not unique to the third world. I have rambled on perhaps a bit too much but these things need to be said. Our mission is focused on helping others and we do a lot with the little we have. We will have several fundraisers this summer as always and I hope you can come and see first hand what we are doing and see our wonderful team of volunteers working to make the lives of many Bolivians a bit better.

I hope you will spend some time reading and thinking about the following reflections from the Johns Hopkins medical students. They spent a good deal of their precious time writing these insightful missives. These people and many like them will be the doctors of the future. If they are all like these students, our medical care and health will be in good hands.

JOHNS HOPKINS MEDICAL SCHOOL STUDENT REFLECTIONS

Shannon Shea
March 30, 2008

Returning to Bolivia during my fourth year of medical school was a very special experience for me. So much of my decision to pursue a career in medicine is based upon experiences I had and people I met while serving as a volunteer in Bolivia. A very prominent figure along my road to medicine was Dr. John Baumrucker and having another chance to work with him was very welcome as I am about to end one step in my medical education and begin another. I am confident that it will not be the last time that we will find ourselves working together in Montero. I am excited about the evolution of my role as my medical and public health knowledge and experience grow.
Each time I return to Bolivia I am reenergized to make the most of the opportunities I have been afforded simply because I was born in the United States. So much is taken for granted in our country and a healthy dose of perspective is seldom unwelcome or unnecessary. I am reminded that I have a responsibility to use my gifts to help those to whom less has been given. At the same time, it is important to recognize and appreciate the knowledge and initiative of the Bolivian people. They have many wonderful ideas about how to address the very complex problems they face and keeping that in mind as I continue to work with them will be critical for success and sustainability.
I thoroughly enjoyed sharing my home away from home with a new group of future medical professionals. It was gratifying to see the first year students so engaged in tours of the various medical facilities, morning rounds, observing in the operating room, home visits, and screening programs. I was encouraged that I was able to help them learn to use some of the instruments of their chosen profession and was able to explain some of the disease processes we encountered as well as offer some insight into the contrast between what they were observing in Bolivia and what they will see in Baltimore.
I particularly enjoyed going on home visits this time around. The last time I had this opportunity was during Dr. John’s first visit to Montero when I served as his translator. At that time, I had only recently admitted to myself that medicine might be something I was interested in studying. Now, with the added perspective acquired during nearly four years of medical school and a year studying public health, I was able to more fully appreciate the importance of the work being done in the clinics of Montero. If a child slips through the cracks in Montero and does not get vaccinations, vitamin supplementation, or support to avoid malnutrition, it is certainly not due to a lack of trying on the part of the health care professionals in town.
The Villacochabamba clinic was very familiar to me from my days as a volunteer in that neighborhood. I was there at least twice weekly throughout my first year in Bolivia taking girls from the Hogar Sagrado Corazon to see the local doctors and dentists. The clinic has grown a bit since my time and has a lot of new facilities, particularly for ophthalmology and optometry needs. The Tuberculosis program in Montero is so effective that other clinics throughout the country have sent people to observe Villacochabamba’s methods. The commitment to this program by the health care professionals is truly inspiring. If a patient does not come to the clinic to take their medications, then a predetermined health care professional will actually go to that patient’s home and deliver the medication and observe the patient taking it. Another important project run by this clinic is the water testing and treatment program. The goal is to have potable water for all of Montero’s inhabitants. I was impressed by the scope and effectiveness of this public health intervention. The neighborhood clinic with which I was so familiar impressed me anew now that I have a framework in which to critically appraise their efforts. There is still much work to be done in Montero, Bolivia and elsewhere, but I am optimistic about the future knowing that there are talented people dedicating themselves to this important work.

Richard Pollock
March 30, 2008
Reflection of my time in Bolivia

The only way I know how to write this paper is write about certain experiences or events that stick out in my mind, still today as poignant as would be a pungent smell. I remember driving from the Santa Cruz airport, on that rainy road looking at the tens of people blocking the path, my eyes traveling from the crowd, to the wreck, to the man that would never ride again. I remember needing all my might to hold back tears as you, Dr. John, broke out in emotion after the movie “Wit”. My eyes still well up thinking about the power of seeing a doctor react with tears, especially as you urged us to simply listen to our patients. We aren’t just supposed to heal, we need to act as comforters during the scary times as well. I remember the experience of fording a river in that chunky bus, adrenaline pumping at every curve as we climbed further into the mountains on our way to the Incan ruins in Samaipata. The views were incredible; it’s no wonder the Incans and others found a greater sense of religion in these higher places. I remember being offered hot chocolate at one of the clinics during my first day, drinking it, and then worrying whether I shouldn’t have done that for fear of getting worms. Thinking about it now, I feel kind of ashamed that I even thought about it, considering it was boiled water. If anything, this trip has made me want to become more fearless, not for myself but for others. Being cautious about my health is a good thing, but past a certain extent it becomes selfish, and needing to become more selfless is something this trip taught me. I remember the soccer games, first with the orphan boys of Montero, then with the children from the Guarani village. The games just seemed to integrate markedly different peoples so quickly and easily; during the game, everyone acts like a kid. I remember the girls orphanage, and girls being so open and welcoming towards us, wanting us to read to them and playing with our cameras and our hair…then us regretting that they did when we heard they all had lice. We all took showers, checked each other’s hair, and our scalps all became incredibly more itchy, if only for a few hours. I remember learning the difference between a male and a female in an ultrasound, the difference being a turtle and a hamburger, respectively. I remember hearing Metallica and ABBA at Cruz Roja and thinking that, prior to coming to Bolivia, I thought it would simply be a poor man’s version of America: People would share similar musical tastes, similar sports interests, and similar culture. I left thinking I could not have been more wrong or ethnocentric, the Third World is definitely a different world. I remember learning from an intern named Claudia the three main ailments seen at the General Hospital: Chagas, Leishmaniasis, and malaria, the last of which surprised me. Following my experience at the General Hospital, I remember my anger at the fact that Chagas disease will affect 70 percent of Bolivia’s population and thinking the world was really screwed up if billions goes into research in the United States for surgical outcomes and very little goes into researching a cure for a disease that affects entire countries. It angers me that, through no fault of a person, an insect can come in the middle of the night, when we are most helpless, and infect someone with life-threatening diseases like Chagas and malaria. There’s a certain degree of unfairness to infectious diseases that really irks me, and I have to wonder if this is a field that is calling out to me. This feeling unlike anything I have had before, I credit to my time in Bolivia. And last, I will always remember the bow and arrow I bought in Santa Cruz. Thank you, Dr. Baumrucker, for letting me make these unforgettable memories.

Trang Vu
March 30, 2008

On our second day in Bolivia, Dr. Baumrucker had arranged for us to travel up to the mountainous region called Samaipata where there was a famous Incan ruin called El Fuerte. The trip started out as a typical tourist adventure, but as we drove on farther and deeper into the Bolivian countryside, I found myself undergoing a very emotional journey of my own.
Looking out at the scenery as we drove past, I noticed more and more how much the Bolivian countryside reminded me of Vietnam, my native country. There were so many parallels between the two landscapes: the lonely palm trees in the middle of a field, the big shaggy mango trees in the muddy front yards, the small boxy houses with the open porches, the free-roaming chickens, and the thatched huts. For everyone else on the bus, these sights may have been new, interesting or disturbing - a stark reminder that they were no longer in America. For me though, these sights brought a sad and deep sense of nostalgia. I had not only seen these things before; I had lived it.
I was born in a small rural village in the southern tip of Vietnam. My family and I lived in a thatched house my father built with his own hands. The floor was packed dirt, the bed was made from slabs of wood, and we sold gasoline out of glass bottles to supplement my parents’ teacher salaries. I, like many of the children I met in Bolivia, walked barefoot and played in the mud. Now, my family and I live in a four-bedroom house in the suburbs of Maryland. I have gone from a simple country girl growing up in a third world country to a first year medical student from Johns Hopkins. Not only that, I was going to another third world country to volunteer.
This realization almost brought me to tears. I wanted to cry out of gratefulness and awe for how much my life has changed and how far I have come from my humble beginnings. I know that without luck and God’s blessings, I easily could still be living in Vietnam, probably married and struggling to feed my children. My life would be nothing like I know it to be today. Also, I wanted to cry because I felt like I was coming full circle with my life. I have not only been able to grow out of an impoverished childhood and achieve my dreams, but also to return and help those who share similar disadvantages as I once had. This has been a dream of mine for many years; it was my initial inspiration to become a doctor. Sitting on that bus on the dusty road to Samaipata, I realized I have come so close to achieving my dreams.
Granted, Bolivia is not exactly Vietnam, but it has just as many economic and political problems as Vietnam, and just as many poor and suffering people. I also knew that as a first year medical student with little experience, my contributions would be miniscule in the grand scheme of things. But I still felt so happy and empowered by simply being there in Bolivia and being able to help in whatever small ways that I could. Small steps at a time, I told myself.
Bolivia was my first medical mission, but I know it won’t be my last. I have learned so much during my stay in Bolivia – how the medical system is ran, its inherent flaws, its inspiring programs. More importantly, however, I came away with a greater appreciation for the enormous generosity and dedication for those who have devoted their lives to the betterment of others. In particular, I was moved and amazed by the wonderful achievements Dr. Baumrucker has managed in Montero and beyond. I cannot even imagine how many lives he has touched and how profoundly he has touched them, but I know the answer is lots. During my brief stay in Bolivia, I noticed that he never took a day off, even on his birthday. He always had something to do for everyday, whether it was running a free health screening or donating cardiac monitors to hospitals. No one could question his passion, which was to help sick and needy people as much as he could. This is something that I hope someday, I could do myself.

Adam Iddriss
Bolivia Reflection

Traveling to Bolivia has been a truly rewarding spring break which integrated my interests in medicine, service, and international studies. Through my time in Bolivia, I have been able to observe healthcare practices of a developing country, participate in health interventions, and interact with the Bolivian culture. What follows are some notable moments from the trip that I took away:
Medical Equipment
When our group visited the private clinic, I expected to see something similar to the breast augmentations that had been reported by the group who had spent the day there the previous day. Instead, we were taken on a thorough tour of the hospital and showed their equipment. My background is in bioengineering and I have done a number of clinical engineering and bioinstrumentation projects repairing medical devices and equipment. I was surprised to see the state-of-the-art equipment, such as the bili light for administering phototherapy for jaundiced babies, the commuted tomography scanner, and ultrasound machine, all at one location. Moreover, as the week progressed, I used the private clinic as a point of reference from which to compare the equipment at the clinics and general hospital, which serves more underserved populations and had correspondingly inferior technology.
Home Visits and Community Medicine
The home visits also proved to be fulfilling experiences. I went on two rounds of home visits with our group. We were able to go to several houses and meet with families, weigh babies, administer vaccines, and check the nutritional progress of several babies. At first, I thought it was going to be difficult obtaining permission of different families to let such a big group of strangers into their homes. Fortunately, the community health worker was excellent and coercing families to let us in and gathering their documents. I enjoyed interacting with the families as we went around the neighborhood. Everyone seemed so welcoming and genuinely happy to see us.
The community health infrastructure I witnessed in Montero was very impressive. Any system that uses volunteers from the community as health advocates is an excellent example of an appropriate intervention to improve health. The community volunteers probably already have a relationship with the families they are visiting. Thus, they are much more likely to be able to have an effect in their community by promoting health and nutrition to their friends, compared to a person with no relationship to the families. I was also impressed by the tuberculosis service at Cruz Roja. Developing a sustainable program that is able achieve the success of the tuberculosis prevention program is a substantial accomplishment, particularly in an area with such limited resources.
Culture
Observing and interacting in the cultural aspects of Bolivia, including music, food, language, and history, was wonderfully exciting. I was pleasantly surprised by the accommodations and especially the food (that chocolate cake was unbelievably tasty ). In addition, Exponorte was an interesting dose of Bolivian culture.
Conclusions
I chose to pursue a career in medicine because I wanted to make tangible differences in my community. During the first year at Hopkins, while there has been a lot of focus on the basic sciences, the clinical aspects of medicine have not been emphasized. I enjoyed my time in Bolivia, in part, because it refreshed my passion for clinical medicine. Reflecting back on my experiences in Bolivia, I am grateful for the people I have met, the places I visited, the foods I ate, and the opportunity to practice my Spanish and obtain direct exposure to global medicine. My time in Bolivia will not soon be forgotten.

Bolivia Reflection By Stephen Juraschek

The week was a full one. I went to four hospitals and four clinics. I visited maternity wards, an emergency department, an operating room, hospital laboratories, delivered equipment to needy hospitals, and went to a boy’s foster home and girl’s orphanage. I was also able to participate in three health screenings for glucose, lead, and other abnormal vital signs. The week was one of observing how healthcare was delivered in a third world country as well as one of serving indigents with fundamental health necessities. I saw firsthand the effects of poverty on access to health care and good nutrition as well as the ramifications of lacking preventative measures and health education.
One of the most impressive sites I visited were the tuberculosis and maternity clinics – Cruz Roja, Clem, and Villa Cochabamba. These clinics were run by an individual named Dardo Chavez, who had international training in public health and preventative medicine and had even worked for World Health Organization. Dardo effectively managed these TB clinics, mobilizing volunteer community health workers to follow up on TB patients to ensure treatment compliance. Moreover, his clinics maintained accurate records of the locations of patients and stage of disease. Overall his clinics boasted a one hundred percent compliance rate and served as a model for TB clinics throughout South America. In addition to treating TB, the clinics focused on caring for pregnant women, female adolescents, and children under the age of five. The clinic employed several travel nurses that would do home visits to examine children and women. This was an effective means of engendering trust among people in the community and encouraging them to go to the clinics for care. This was a wise financial move too. Last year the government began compensating health professionals for care provided to pregnant women and children under age five. Tuberculosis has also received a lot of international support for treatment projects. Thus, Dardo at least theoretically received monetary compensation for the services shown to patients through his clinic.
I was also impressed by the role political administrators played in the execution of healthcare. The current president is quite socialist and encouraged the aforementioned compensation for pregnant women and infants. He also authorized Cuban doctors to come and practice medicine in Bolivia. These doctors were provided by Fidel Castro and paid for by Hugo Chavez, president of Venezuela as a propaganda mechanism. This move although intended to improve healthcare was met by resistance from Bolivian doctors, who questioned their credentials and tended to lean toward the right. Furthermore, it cut into their financial base, stealing their patients since the Cuban doctors could provide free services.
Another concept-breaking discovery was the underutilization of healthcare in Bolivia. My initial thought was that healthcare was lacking due to inadequate resources and that people were trying to receive care but could not due to insufficient equipment. Although this was true in many cases, a number of the clinics I visited were empty during the day. Doctors frequently were done with patients before lunchtime. The reason for this was that people were not taking advantage of existing resources due to lack of money. The cost of visiting a doctor for a routine check up or for a minor condition was too high for the average Bolivian. As a result, individuals only went to the doctor in cases of extreme need. This affected the overall health of Bolivians in multiple ways. Patients would frequently present with advanced conditions of often preventable disease. Furthermore, patients suffered from lack of education on proper nutrition and self-care. Prevention, the most economical treatment, was often the first thing sacrificed due to lack of fiscal recourses.
The most important lesson I learned from this trip, however, was the power of a few individuals to make a difference. I was impressed by Dr. John’s personal sacrifice on behalf of others. As an experienced physician there is much he could be doing to advance his own career both fiscally and professionally, yet he chose to spend his time working in an undistinguished, small town in Bolivia, and despite being merely one individual he was able to do so much to improve health services and give people hope. During the past week, I too received a taste for this noble work. Seeing the appreciation of San Jose Obrero hospital administrators, when we presented used vital sign monitors demonstrated the tremendous impact of small donations. Giving out eyeglasses and clothes in the Guarani village while testing people’s glucose levels, possessed a unique value that transcended all the fiscal and professional achievements one could obtain. For me this trip rekindled a joy in helping others, one of the prime motivators for me to enter the field of medicine. It also opened my eyes to see the many simple ways that I can participate in helping others live meaningful lives. I am truly grateful for the experience my trip to Bolivia afforded me and believe I have left positively changed. The experience there will go with me throughout my future medical practice both in the United States and in other third world countries to which I will go on missions to serve needy indigents in the future.

Lauren Zeitels

The opportunity to observe and participate in the Bolivian healthcare system at the level of home visits, community clinics, and hospitals broadened my understanding of healthcare delivery. The observation that struck me most about the Bolivian healthcare system is its commitment to prenatal, infant, and young child care through the SUMI program. This stands in sharp contrast to the United States where the elderly have the greatest access to care through Medicare and many children remain uninsured and without adequate healthcare. The importance of SUMI was highlighted by my visits to the Cruz Roja and the Villa Cochabamba. While the heavy rains made it difficult to reach the Cruz Roja, the patients who made the journey were all covered by SUMI. In addition to receiving proper medical care, these women and children were educated not only about common childhood maladies, their signs and symptoms, and how to seek the necessary care, but also about proper nutrition and vaccinations in an effort to promote preventative care.
This commitment to preventative care was even more strongly highlighted by the home visits I joined with a nurse and student volunteer at the Villa Cochabamba. Armed with addresses and histories for families with children under the age of one, we hiked throughout one of the neighborhoods served by the clinic. Often the homes were difficult to find as houses were not well marked and small dirt roads led to even smaller dirt roads, but the nurse located each family’s home. Each child visited was weighed, and their weight was recorded alongside any and all health details discussed with the family. Most of the information focused on proper nutrition of both mother and child as well as the importance of regular pap smears for mothers. Furthermore, vaccines were administered to those children who had just passed their first birthday. Home visits illustrated the nurses’ dedication to their patients as well as the clinic’s commitment to preventative medicine. Not only did each pregnant mother and child under the age of five have access to healthcare, but they were actively engaged in the healthcare system and educated about ways to avoid disease.
It was clear that both clinics have recognized the importance of preventative care and embraced it as the cornerstone of their approach to healthcare. It was striking that a place with few resources would choose to use them on preventative care, because although preventative care stretches the healthcare dollar farther, it does not demonstrate the immediate success of later interventions. The preventative care focus on pregnant women and young children fits the countries needs as girls are often impregnated at young ages and out of wedlock. Meeting the young mothers on home visits illustrated the difficulties they face in rearing and providing for their children. They found the extra support afforded by neighborhood clinics invaluable.
While the SUMI program greatly enhances medical care for pregnant women and children, it affords no assistance to other members of society. For all the information on diseases that strike in infancy and infant nutrition, I saw none that addressed chronic conditions or diseases such as hypertension, diabetes, or cancer. While these diseases may not be as prominent in Bolivia as the United States, our screening clinics identified individuals with blood sugar levels and blood pressures well above normal. Hopefully as resources increase, Bolivia will be able to address these issues wit the same emphasis on preventative care that is given during the first few years of life.

Spring Break 2008- Bolivia
Bridget Wild

We each had different reasons for going to Bolivia. Some of us had ambitions of delivering medical care, equipment, and some sort of relief. We all knew we were receiving medical elective credit, so presumably we were to learn something clinical, too. However, for those of us with ambitions of someday being involved in international health efforts or even domestic health policy, the health care providers in Montero are hard at work implementing many comprehensive medical programs from which the most developed countries like the US should learn.
It is an understatement to say that Bolivia’s medical technology is behind the average American hospital. Surgeries are performed on tables that look like something from a museum on patients who are awake. Pediatric wards are full of metal cribs with no other aesthetic reminder that it is a place for children. Physicians rely heavily on intuition for diagnostics with the nearest CT scanner being over an hour away and most clinics operating with basic in house labs. Literally 48 hours after cramming for a neuroscience test including a clinical correlation about the dangers of using gentamicin we rounded with physicians who use it almost exclusively as an antibiotic at the general hospital. When asked about the antibiotic explicitly, the doctor said he knew of the risks of vestibular damage, but that gentamicin was the most affordable and available drug. Many conversations went this way; the doctors knew all the modern medical information, but were limited and made the most with what was available.
To call these perceived disparities shortcomings of Bolivian healthcare would be a sad oversight of their huge victories. In many ways, their doctors’ efforts were impressive as they learned to pay attention to patients’ reported symptoms and basic metabolic/blood labs to make complex medical plans. Even more impressive, this third world country is investing some of the few resources they have in public health and preventative health efforts.
In Montero, every home is visited by a traveling nurse at least every three months. All children under the age of 5 are weighed and vaccinated. Children regularly falling below the growth curve are referred to a local feeding program where mothers learn how to make soy products go far while the children eat healthy meals. This proactive approach to primary care has long-term benefits as it prevents expensive and dangerous diseases in a highly susceptible population. While it would be easy to funnel what little health resources they have into crisis and acute intervention, Montero’s doctors have recognized that such emergencies can be avoided and higher quality of life provided. Other programs help further cover medical expenses of pregnant women and young children. In the US the 40 million uninsured have no such programs to fall back on. Instead, they lean heavily on emergency departments to provide primary care. Not only does this tax the emergency department lowering the quality and swiftness of acute care, but it means many people do not seek medical attention until what would have been a minor illness or disease has progressed to a painful and complicated prognosis. Looking beyond the question of insurance and payment, the way medical care is brought to the people where they are in Montero is to be commended as it creates a more trusting relationship between provider and patient at the same time as caring for populations who would not have the luxury of time to get to a clinic.
A recurring theme in Bolivian medicine was to create community around health. Tuberculosis is a common disease in the poor communities and requires aggressive and consistent treatment for over 6 months to be successfully cleared. Knowing that many people had barriers preventing compliance, one clinic created a program that provided emotional support, social events, and regular check-ins to make sure doses were taken every day. Patients who failed to come pick up their meds were called and someone hand delivered them. Patients felt empowered and cared for at the same time, and the program reports 100% compliance.
As I think through the many examples of programs demonstrating commitment to creating a better baseline of health in the community, I question what my own role in international medicine should be in the future. While perhaps too few in number, Bolivia’s native doctors were competent. Should we be sending foreign doctors to make up for the deficit, or committing to help train more Bolivians as nurses, assistants, and physicians? In considering the lack of antibiotics, equipment, and facilities, should we be donating the needed supplies or committing to developing cheaper methods? There is a hard balance to strike between meeting immediate needs and investing in a sustainable future. Whether thinking domestically or internationally, I will deliberately consider my role as a medical student and someday physician in striking this balance from now on.

Bolivia Reflection
Lara Kovel

As a medical student in my first year of classes, there are entire weeks where I do not see a patient. It is easy to lose track of why I spend entire weekends studying for one exam when I am so isolated from patient encounters. Traveling to Bolivia was the perfect spring break for me– I tested blood pressure and glucose levels, gave vaccines to young children, listened to heart and lung sounds, and I even explained in Spanish the results of screening tests to the patients. We spent every morning shadowing at a different hospital or clinic in Montero and every afternoon performing free screening clinics or donating equipment to hospitals in need. I really appreciate all of my time in Bolivia, and I am already eager to return.
Driving into Montero from the airport, the first thing that we saw was a fatal car accident. It had been the rainy season in Santa Cruz for several weeks by the time we arrived, so the already tenuous roads were in even worse condition. Without the same equipment and technology to respond to accidents that we have, there was nothing to do for one motorcyclist by the time the doctor arrived. Driving through the streets of Montero, a small city of about 100,000 people, you would notice the lack of street signs, and stop signs, and traffic lights. Every intersection seems like an accident waiting to happen, though the Bolivians seem to know which direction has the right of way. Once we got to the hotel and unpacked, we set out to explore the rainy streets of Montero. It was interesting to see on every block an empty pharmacy and a doctor’s office advertising a primary care physician. The underutilization in Bolivia seemed to be ubiquitous because the poverty is so overwhelming and the people are not educated about the resources available to them.
One of my favorite parts of this trip was seeing the boys’ foster home, designed and managed by Dr. John. Construction for the boys’ home started in 2001, and now it is an entire compound with a home for the boys, a carpentry shop, and a large soccer field. Before that time there was no place for the orphaned boys of Montero, who were usually abandoned and forced to fend for themselves on the streets. At the home, there are fourteen boys ranging from age 8 to 14 who have weekly computer and English lessons while learning farming skills and other trades like carpentry. I enjoyed seeing the pen-making project, which is a way the boys can earn money for their college educations. It was also great to throw around some baseball with Freddy, one of the older boys. Later in the week, we also spent a few hours at the girls’ orphanage, which houses 120 girls ranging from babies to teenagers. We were quickly greeted by scores of smiling girls, eager for attention and some playtime with older people. I had brought a stethoscope in case we could do some physical exams, which did not work out, but I soon had a line of girls waiting for me to listen to their hearts and lungs. I listened to each one, using my limited experience to listen for abnormalities, though these girls were more interested in hugs and kind words than the current status of their health. Afterwards, two young girls named Maribel and Janet, aged about 7 or 8, insisted on giving us a tour of the orphanage and the animal yard. It was hard to leave these bright and enthusiastic girls who survived without a family and lived with so little. Before we left, we met with the US volunteers who talked with us about sponsoring a child. Thirty US dollars was all it took to help feed and clothe one of their many charges for one year. It is amazing how much more our money can do in Bolivia than in the United States. I signed up to sponsor Janet, who I had already met, and I cannot wait to get my first letter from her so I can send something back.
The General Hospital was where we started our morning shadowing, and it was interesting to see how different the conditions were from our Hopkins’ hospital. Rain was leaking through the ceilings in certain places, and some patients were packed in four to a room. The maternity ward was filled to capacity with 8 fully pregnant women waiting to deliver. The first thing that we did was rounds with Dr. Patzi, and we were amazed at how much diagnosing they do with the physical exam and history. Without the reliable tests and state-of-the-art laboratory methods, the physicians were much more hands on than I have seen with US doctors. One of the most amazing things that I saw on this trip was a baby being delivered. We saw both a vaginal delivery and a cesarean section of an 18-year old preeclamptic patient.
After the general hospital, we toured several free clinics in the area including Villa Cochabamba and Cruz Roja or the Red Cross. These clinics had several programs that they executed very well, and they saw many patients for free or for whatever they could pay. One of the remarkable programs was the tuberculosis clinic. This program had to date obtained 100% compliance, which they accomplished by setting up a board with daily medications for each patient to pick up at any time, 24 hours a day. Also impressive was the extensive home visit system they carry out. The nurses keep track of 40,000 of the city’s 100,000 people, the poorest of the poor who cannot even afford a taxi to get to the clinic. The clinic’s staff monitors the children to keep them up to date on their vaccines, and they follow cases of at-risk pregnancies and malnourished children. Both Villa Cochabamba and Cruz Roja are run by Dardo Chavez, who keeps the clinics well staffed and has lots of plans for expansion. At Cruz Roja, we walked out in the barrio for home visits with one of the nurses. For each of the six families, we weighed the children to see how they were doing for their age group. One of the families had a four-year old girl whose weight placed her in the moderately malnourished category. We gave her family iron supplements and vitamins to take every day to help her to gain some weight. These home visits were a great part of the health care system in Bolivia, and I really enjoyed seeing the nurses in action.
This week for me has not only been a chance to see patients and learn more clinical skills, but also a very inspiring glimpse into the life of a very dedicated physician. Dr. John Baumrucker has been working in Bolivia for over ten years now, and his mission has had a great impact on the community. Wherever he sees a need, he finds a way to fulfill it. I hope that I can be as dedicated as him in my own career, and I hope to continue to learn from his example.

Ashley Campbell
3/30/08

Reflections on a Bolivian Mission

Spring Break, Bolivia 2008. A nine-day whirlwind through a culture, a landscape, a small town, and a health system in a developing country.

As one of 14 first year medical students on the trip, I arrived feeling exhausted from just finishing exams in Neuroscience and months of cramming a relentless flow of information into my head. I left feeling reinvigorated by the passion to learn medicine. Even though our contribution was short lasting and small, the work that we did was rewarding and eye opening.

In Montero, we had the opportunity to tour a number of different medical institutions, including the General Hospital, the Children’s Hospital, La Villa Cochabamba (a small non-profit outreach clinic), and Clinica Norte (a private clinic). It was at these places that we got to see some fascinating cases, as well as a real sense of what the health care system was like. My experience showed me how profoundly different healthcare is in developing countries. While there are many intelligent and dedicated physicians, it is not enough to sustain a standard of care that Americans are used to. The technology, medical supplies, medications, facilities, and money are simply not easily accessible or even available. Diseases that would be easily treated or even preventable in the United States become the death sentence of many.

I remember a woman who came in with a history of seven years of untreated hypertension. She had massive pleural effusions, a severely hypertrophic heart, and pitted edema in her legs. I watched as she sat propped up in her hospital bed struggling to breathe despite having an oxygen tube. She was almost certainly also suffering from Chagas disease, which affects the heart and visceral parasympathetic system. While she was only 42 years old and had nine children, it was pretty clear that her time was coming to an end. I knew that had she been in the United States, her symptoms would have been treated long before she presented to the hospital in this condition. But for her, life was centered on a farm in a remote village where coming to find health care was no simple task.

I also remember a 5-year-old child with an abscess on his hip. It had initially been a scrape from a fall in the playground, that had now progressed to a huge pus-filled sore that was so painful he could not walk. When asked what was being done for him, I learned that the infecting organism had not yet been identified because the mother had not yet taken the sample to the lab to be tested. In Bolivia, instead of all medical tests being ordered and executed within the hospital, they are often outsourced to the families to take care of. As one can imagine, this often leads to delays and inefficiencies. Thus, for treatment, this boy was being given a whole range of antibiotics and medications, including gentamicin, which can lead to devastating toxicity to auditory and vestibular function.

What perhaps impressed me most in Montero was the amount of investment on the part of the government in preventative care for children. At La Clinica Villa Cochabamba, there was a remarkable surveillance system in place of over 40,000 people. As a way of monitoring the health of children and families in the area, there were 5 nurses who went on several house calls everyday. On these house calls, they weighed and measured the height of the children, updated their vaccinations, and inquired about their vitamin intake. If the children were underweight or had other health concerns, they were earmarked for future follow-up by the clinic. This system represented an impressive effort by public health officials and the government to combat childhood mortality, a huge problem for developing countries.

The work that Dr. Baumrucker has done in Bolivia is inspiring. By investing his time and talents in a small community in Bolivia, he has made a difference in a countless number of lives. Dr. Baumrucker is no longer a foreigner in Montero—instead, the community has embraced his efforts and his contributions. While we were there, it was clear that he has become integrated as a well-respected member of the community, his home away from home.

As I begin my career in medicine, I have many decisions to make: what will be my specialty? Will I have a research focus? Will I want to practice in an urban or rural setting? And most importantly, what will be the difference that I make? As I come away from this trip, I find myself with only more questions but at least convinced of one thing. While I do not know what the most effective way of helping distribute medical care to developing countries is, I know that I want to help. In whatever specialty I choose to enter, I hope that it is one that will provide me with skills that I can export abroad at least a few weeks out of the year.

James Chen
Remembering Bolivia
There are so many moments in life that are unpredictable and unforeseen, so many elements of our journeys that turn out differently than what we initially imagine – and it is these experiences that sometimes carry the greatest sense of wonder when we reflect upon them. As I look back upon this medical mission trip to Bolivia, that is exactly the kind of feeling that I have. In my mind, I had so many questions about what the week would be like, so many imagined images patched together from Robert’s stories of past trips and little snippets about Bolivia that I had searched up on Google. But before I knew it, I was already stepping out of the plane into the airport at Santa Cruz and breathing my first breath of Bolivian air, ready to face the realities of a country that was far from the realm of Hopkins Medical School.
I remember still, the comically harrowing drive up the mountain to La Fuerte on roads that had clearly survived the worst of an exciting rain season. The scenery was beautiful, open, and vast – it certainly looked and felt as if I was somewhere far away from home. All varieties of dogs ran along the roads, blending into the masses of people mingling at the local markets. Ornate houses rose up in the mountainside, a reminder of the wealth that contrasted so starkly with the rundown residences strewn so frequently along the sides of the street. In Montero, I remember the central square that bustled with so much life during the day, the motorcycle taxis that navigated their way narrowly between pedestrians and cars, traffic law that had never seen the limits of traffic lights, and of course the Pinocho that I called home for a week. In the clinics, I was met by only the kindest courtesy from the physicians and saw what the art of medicine looked like in a land so different than the United States. I was surprised by the system of home visits that so many of the local clinics utilized to reach out to their patients, because it is something that this generation of American medicine has long abandoned. That level of human caring is a great testament to the heart of the Bolivian people and I was definitely reminded by many of these interactions of what it meant to a doctor for your patient.
To see that goodness in the people made it such a meaningful opportunity to then give back to them personally at the health screening clinics throughout the week. I had picked up only a few simple Spanish phrases here and there (just enough to tell patients that the glucose test would pinch a little bit and how say hello and thank you) but despite this, I remember being only met with smiles and understanding. “Valiente” was one of those words that I had learned for all the young children who held out their fingers bravely to be pricked for the lead testing and I recall vividly how few of them shed any tears. At the general hospital, I was in the maternity ward one morning and had the privilege of being present for several child deliveries. There was one mother that was struggling with the pain of the labor process and I felt so helpless in not knowing her language, not being able to comfort her in the normal ways that I knew how. I reached out and held her hand, not sure of what else I could do, and minutes later, her child was finally delivered under the expert guidance of the resident. A great smile rose across the mother’s face and it showed me that the art of healing transcends the barriers of language and culture that can otherwise separate people. It was a meaningful process to be a part of and I am so glad to have seen it in the context of the Bolivian healthcare system.
Aside from the clinical immersion, the humanistic and cultural elements of the week were among the greatest parts of this medical mission experience. I don’t know how many other times in my life I will have the chance to play soccer with orphaned boys, to splash around in water and mud and grass, and to wildly cheer “Gol!!!!” after one of my young teammates scored on my classmate of the opposing team. I am also not sure when I will find myself riding on the back of a 4 by 4 truck through collections of flood water surrounded by huge fields of sugar cane, with the wind rushing past my hair and nothing but blue sky above me. It was an adventure unlike any I could have easily imagined and I will always remember my week in Bolivia as such.
There are so many reasons why I decided to come to medical school, but among them was the idea that medicine provides a route through which one can give back to those who have so much less than us. Against the rigors of classes, exams, and all the pressures to succeed academically during these first years of medical school, you inevitably forget some part of that important driving force in your life direction. Being a part of this trip opened my eyes again to that part of medicine by showing me the tremendous impact that a doctor can provide to others, particularly if you have the courage to seek out those in need. All of the things I saw and did, all the lessons and lives that I encountered during this trip to Bolivia will always be a treasure along the path of my first year in medical. These are stories that I will not soon forget and I can only hope that one day I can provide as meaningful an experience to other students who aspire to learn the meaning of being a true physician.

ROSS MCMILLAN

In my mind I can vividly remember sitting at the dinner table at the Hotel Pinocho during one of the first evenings of our trip. As I devoured my plantains and eagerly awaited the tres leches cake, I sat attentively listening to Shannon explain why she chose to return to Bolivia again and again. “They don’t have much,” she explained, “but that doesn’t mean that they are poor.” That sentiment was later echoed by Dr. Baumrucker when he relayed that, “the Bolivian people will literally give you the clothes off of their back; even though it isn’t much, they will give what they have.” We often live by materialistic standards of wealth: houses, cars, expensive clothing. Therefore at times we forget the love for all mankind that binds humanity. I learned more about the practice of medicine in this one week than I had during any week prior to that in medical school. Yet, what made the trip to Montero, Bolivia meaningful were the people of the country. The selfless attitudes of the Bolivian people, especially the doctors that we shadowed and the patients that we treated, helped to reassess my own reasons for wanting to be a doctor. Ultimately, I was forced to look beyond the science of medicine and focus on selflessness and patient care.
As a student from the United States, I was surprised of how welcoming the patients in Bolivia are of students. Often when I shadow in the United States, I am introduced as student doctor or simply doctor because the patients are extremely skeptical of a student who is involved in their care. Furthermore, a superhuman efficiency and precision are required from American doctors, a precision that can’t be matched by even the most tenured physicians, let alone medical students. However, the Bolivians are appreciative of any healthcare that they can receive. During a health screening at a Belgian mission where approximately 100-150 people arrived to get their height, weight, temperature, heart rate, blood glucose, and blood pressure taken, we as students were all practicing techniques that we had just learned a day in advance. We stuck the patients mercilessly with glucometers and fumbled with their blood pressure cuffs. To compound the problem, most of the medical students could not speak Spanish and were unable to communicate the significance of the medical numbers given. Still, we were met with nothing but smiles and an appreciation for the work that we did, however mistake filled it was. More so than anything else, they just wanted to be treated.
Aside from the interactive clinical experiences, I took a very keen interest in my brief introduction to the Bolivian Healthcare System and utilization. I believe that there are vast improvements that need to be made to the Bolivian Health care system. First and foremost, a more precise account of the population’s medical records must be kept, especially for the children. One morning, my classmate Lauren Zeitels and I volunteered at the Villa Cochabamba clinic, one of the three public clinics responsible for serving the needs of the community. Each is responsible for sending nurses into the community to update the health census statistics of a certain segment of the community and address the medical concerns of pregnant women and children under five. Lauren, the nurse, the nurse’s apprentice and I trekked across miles of weather beaten roads and flooded walkways to check on these patients. When we reached our destinations, half of the patients had moved or been displaced with no clue as to their current destination. While the nurses did a fantastic job of informing the young women and caring for their children, the method was inefficient. Furthermore, what is to happen to the children after their sixth birthday? Is their health forgotten until they themselves become pregnant? All are interesting public health questions that I would love to study at some length.
In addition to a lack in organization of the system, the Bolivian communities were in need of doctors to attend to their health care needs and interpret the data that we and other clinics might provide for them. The government has measures in place to help allay this problem, a problem that I discussed at length while shadowing a physician at the Children’s Hospital. Currently after their 5th year of medical school and first year of residency, medical students are required to spend six months as a physician in a rural community. This is invaluable to these communities, as it provides doctors to patients that have a dire need for their services. Yet, this is only a band aide to the gaping problem. These doctors need some incentive to stay in the rural communities rather than returning to the metropolises of Santa Cruz and Sucre.
I feel that Bolivia needs a health care system that can meet the vivacity and the energy of its people, a people that accepted me and the other American students wholeheartedly. They opened their homes and their lives to my care. I saw emergency surgeries, Chagas infectious disease patients, a burn victim, and ambulatory medicine in action, all from doctors and interns that were patient to teach me despite the language barrier. Furthermore, the patients were optimistic beyond measure. I only hope that I am able, at some point in time, to address their public health measures just as their system helped to expose me to the field of medicine.
There is a similarity in healthcare between Bolivia and the United States. Bolivia has a shortage of general practitioners that are willing to meet the needs of the poor, just as does the United States. Clinica Norte, one of the five clinics that we were able to visit, is a private clinic that accepts only paying customers. When speaking to one of the physicians there, I was informed there are some days that they have very few patients, as few as 6 to 12. However, later during that afternoon I had the opportunity to attend a health screening at a Belgian Mission. The people were extremely appreciative of our services, just as all of the Bolivian patients had been. However, some had extremely glucose levels and others injuries that could not be attended to by medical students. They were in need of doctors to attend to their health care needs and interpret the data that we had provided for them. The government has measures in place to help allay this problem. Currently after their 5th year of medical school and first year of residency, medical students are required to spend six months as a physician in a rural community. This is invaluable to these communities, as it provides doctors to patients that have a dire need for their services. Yet, this is only a band aide to gaping problem. These doctors need some incentive to stay in the rural communities rather than returning to the metropolises of Santa Cruz and Sucre to earn wealth and luxury.

Daniel Q. Sun

We arrived in Bolivia at the end of a raining season that was stretching well into March. Stepping off the plane, the only thing I knew about South America was from the magic realism of Gabriel García Márquez and Isabel Allende. I had wondered what Bolivia would be like; whether it would resemble the Macondo of Márquez or the Chilean slums of Allende. The rain, therefore, seemed like a fitting welcome to a land of lush green and bleak poverty.
In the town of Montero, population 90 000, there was a general hospital, a children’s hospital, a few private clinics, and several community clinics. Each represented a unique cross section of Montero and Bolivia, and offered a unique perspective on medical care in the developing world. I remember rounding on the general surgery service at the public hospital, where appendicitis, abscesses, and gallstones made up the majority of the cases. My interested was particularly piqued by a case of a psoas abscess in a young man. At first, I was very perplexed about how, with no prior history of surgery, an abscess could form in one of the deepest muscles in our body. It turned out that the abscess started superficially in the skin and due to malnutrition, it spread into this young man’s psoas major muscle. Seeing this case reminded me of the cruelly synergistic effects of crushing poverty and ill health, where one builds on the other to form an almost unbreakable vicious cycle.
At the same time, there were also many encouraging signs for optimism and hope. I was particularly impressed by Dr. Dardo’s Cochabamba Clinic, which offers primary care to pregnant women and infants. It has managed to institute several innovative and effective programs in improving public health, including a TB treatment program that boasts 100% compliance and cure rates, as well as a house visit program to track the health of local children and distribute vaccines and vitamins. These preventive health measures seemed both cost effective and highly successful, and indeed could serve as a model for the effective delivery of primary care in many other places. Another example is Dr. Baumrucker’s medical mission. It was eye opening to see surgeries being done on patients who are only under local anesthesia due to the lack of effective monitoring equipment for general anesthesia. Simply by bringing medical supplies, from the most routine such as gauze and scrubs, to the more sophisticated such as vitals monitors, Dr. Baumrucker is single handedly improving the practice of medicine in Montero and the surrounding area.
On one sunny day, after the rains have stopped, we traveled along miles of dirt roads with our suitcases of medical equipment to a Guaraní village, which is one of the major indigenous populations in Bolivia. As we did blood pressure and blood glucose screening for the village, I saw the infamous mud-walled and thatched roof huts in which the Guaraní lived. The thatched roofs are an ideal habitat for bugs that transmit Chagas disease. These bugs are called assassin bugs and they descend at night, while the inhabitants are asleep, to suck blood in the lip area. During this process, the person is infected by the parasite trypanosoma cruzi. The victim remains asymptomatic for decades, after which systemic conditions such as cardiomyopathy develop and frequently lead to congestive heart failure. There is no effective treatment. The story of this disease exemplifies the problem of health care in developing countries. There is no economic incentive for pharmaceutical companies to develop treatments since the disease only afflicts those that grow up in thatched houses – the poorest of the poor. Furthermore, developing countries such as Bolivia have no resources to combat this disease or treat its victims. Indeed, most Guaraní kids are infected by the time they reach adolescence.
In Bolivia, I saw both Márquez’s Macondo and Allende’s slums. However, I also saw the beautiful spirit of South America and the poignancy of the human condition regardless of wealth or health.

Lorenza Frisoni

I have never seen a real malnourished infant before. You can often see pictures of these babies on the cover of Time magazine denouncing the existence of hunger in the world. These pictures are always able to produce a sense of guilt in those of us who see them because of the “shame” we feel from all the abundance and excess we are used to. I saw one of these malnourished children in a clinic in Montero, Bolivia and I was certainly not prepared for it.

I soon realized that the cover of Time magazine showing pictures of starving children is a reality in several areas of the world. I have been told that in Bolivia, children die of three major causes: respiratory infections, diarrhea and malnutrition. Respiratory infections are aggravated by the unfriendly climate, diarrhea is mainly due to the lack of clean water, and malnutrition is common because of the pervasive poverty. In regards to starvation, the more I think about it, the more disturbing I find it because the cause is so basic and elemental: the simple lack of food. For me it was a powerful experience since I believe during my pediatric rotation in the US, I will be facing the opposite problem, epidemic obesity. I somehow still feel extremely sorry and I am still struggling with whom or what is responsible for tragedies of this kind.

The baby was very pale and emaciated. He must have not weighed more than 2 kg although I am not sure about the age. He was so dehydrated and the skin was so thin and transparent that I could see every vessel in his body. His mouth was almost completely covered with a fungal infection, a condition that was likely contributing to his poor intake. The mother belonged to one of the indigenous populations of Bolivia and had carried the baby to the clinic in a typical Quechua shawl. As soon as the mother had unwrapped the garment and put the baby on the bed the doctor said, “Esto bebe va a morir”-this baby is going to die. It was difficult to follow the conversation because the mother was speaking an indigenous dialect that was not really Spanish so I cannot comment on the details of the child’s past medical history. I believe that no matter what the details may have been, ultimately they were not important. Public health intervention, sexual education, better health care structures that reach the most remote populations living in the mountains seem all necessary measures although it is difficult to know which a country like Bolivia needs first.

I enjoyed my visit to Bolivia very much. I see this experience as a preparation for unexpected situations and to the infinitely sad realities of disease in children and adults.

Reflection on 2008 Spring Break experience with the Highlands Bolivia Mission in Montero, Bolivia by Edith Dietz

One afternoon in Montero when half of the group left for a health screening at a nearby community center, a small group of us (Bridget, Lorenza, Ashley, and I) decided to head over to the General Hospital (the regional municipal hospital) and see if we could find anything interesting happening there. We figured we might at least find a mother giving birth or we could visit with patients. Since we brought along some surgical materials to donate to the hospital, we first went to the surgery department, and somewhere along the way I recognized Claudia, one of the interns at the hospital who I had met the previous day.
When we asked her if we could observe in the labor and delivery area, she took it upon herself to lead us there, find any women in labor, teach us how to feel for fetal orientation, listen for the fetal heartbeat, and measure the fundal height. I knew that she was doing her rotation in internal medicine, so it was surprising that she could take the time to teach us clinical skills in a separate area of the hospital.
Since none of the patients were quite ready to deliver, she gave us a tour of the rest of the obstetrics section of the hospital—the room for women recovering from vaginal births, another room for those who had had C-sections, the room where they do D&C, and the room for women hospitalized because of high risk pregnancies. We stopped and held a baby, talked to the mothers about how they were feeling, and asked about the reason for their C-sections. Coming from an environment where people’s health information is heavily protected (for the most part), it was amazing that we could just walk into the ward and women would happily discuss their health condition with us in close proximity to other patients.
As we ran after trying to keep up, Claudia explained that the Montero hospital was suffering from the effects of immigration on a strained health system—large numbers of people are moving into Santa Cruz for jobs so the tertiary care centers there are overfilled. As a result, people from Montero rely on secondary care centers which don’t have the diagnostic tools or specialists needed to give them adequate care. She lamented the lack of preventive care in Bolivia and the advanced state of disease with which many patients present. After we had spent two non-stop hours with her touring different areas of the hospital, we learned that this was the afternoon after an overnight call! She was indefatigable. She stayed to wait around for the lab results of a patient with severe liver dysfunction, introduced us to the patient, and explained the lab results to us. As we were discussing his case, she noticed that his O2 saturation was dangerously low and ran to get her colleagues for help. She shared with us her frustration regarding the lackadaisical attitude of some of her colleagues who were just sitting in the next room drinking tea, while no one was monitoring the patients. Truthfully, we had seen very few other medical personnel while following her around the hospital.
That afternoon with Claudia was incredibly enriching only because we had been lucky enough to have crossed paths with someone who was energetic and excited to teach. That was, in fact, the key to the entire trip and will probably be the key to my entire medical education. The opportunity to spend the week working with medical personnel was available only because Dr. Baumrucker has a passion for teaching and recognized the importance of exposing students to other medical systems. Claudia happened to be one of the more energetic teachers I’ve ever had, but more importantly she was enthusiastic about sharing her knowledge and expertise with us. She explained all the cases thoroughly and made sure to ask if we had any questions. She loved her job and it was clear that she felt pride sharing it with us even though she could identify a number of short-comings with the Bolivian health care system.

Robert Wicks
Bolivia Reflection

Albert Schweitzer once stated, “The only ones among you who will be really happy are those who will have sought and found how to serve.” This trip was the fourth time for me to travel to Bolivia, and each time I visit that small town of Montero, I never cease to learn something new about what it means to be a physician serving the community. This year was especially meaningful for me, since I was able to share my experiences with my younger sister, Marie, who traveled to Bolivia during the same week with the University of Mississippi group.
I first visited Montero, Bolivia in the spring of 2004 with a friend from the University of Mississippi. Six hours after we arrived at the Viru Viru International airport in Santa Cruz, the physician with whom we were volunteering, Dr. John Baumrucker, suffered a major heart attack. I, having limited medical knowledge, did not know how to proceed. I gave him a glass of water and a waitress at the restaurant gave him several aspirins. He then called a local physician. Dr. Baumrucker was rushed to a small hospital and given an EKG, using the very equipment he had donated. He was then whisked to Santa Cruz for the placement of a stent. Never had I seen such a great outpouring of support as what occurred over the next few days. Everyone from businessmen and white-coated physicians to day laborers came to his bedside to pray and wish him a rapid recovery. This one man, who devoted three months of his life a year to serving others through medicine, was able to influence an entire community, and they were overjoyed to reciprocate his care during this time of need.
This year, I wanted to impart some of the knowledge learned from my previous experiences to my fellow medical school students. When I first sent out an email last December asking if any students would be interested in attending a medical mission to Bolivia, I was overwhelmed by the response. Eventually, the number was narrowed down to fifteen. I found it humorous at first that these fifteen students would trust me to bring them down to Bolivia with only a tentative schedule and little information on what projects they would be doing. However, I knew that this was an experience that they would not regret because they would see a side of medicine not found in the United States. William Faulkner once said, “To understand the world, you must first understand a place like Mississippi.” Over the past few years, I have learned that the same thing can be said of Bolivia.
Returning to Bolivia for the fourth time, however, does not mean that I, personally, did not learn anything from the trip. Two observations that I made during the program clearly expanded my medical education in ways that were not possible had I never returned. The first lesson I learned was about the dire plight of a disease I had only heard of in previous trips, Chagas disease. The eventually fatal disease has infected 8-11 million people throughout Central and South America, but it is rarely seen in the US. Chagas disease is a protozoan spread by insects, known as kissing bugs, that live in thatched roofs. The bugs bite at night and spread the protozoan via their feces. Once the protozoa infect the body, they differentiate and lead to the death of neurons in the autonomic nervous system in the intestines and heart. This loss of enervation leads to the clinical symptoms of an enlarged heart and/or digestive tract. The number of patients who had enlarged hearts in the hospital was astounding. One physician said that 80% of the individuals whom he sees in the emergency room test positive for being exposed to Chagas. Thirty percent of those testing positive will develop the disease. These numbers show the plight of a disease that is truly neglected by the developed world.
The second valuable lesson I learned was while visiting a clinic on the outskirts of Montero, Villa Cochabamba. The director of the clinic, Dr. Dardo Chavez, showed that even in a resource-limited setting, a world-class clinic can be found. Villa Cochabamba provides medical services, tuberculosis treatment, vaccination programs, and an eye-care. The clinic has won multiple national and international awards for its programs. One of the most outstanding projects available is a community health program, where each healthcare worker is assigned to keep track of one surrounding neighborhood. The health workers keep a file on each family in their perspective neighborhood. They then travel by foot to every home to ensure that the children of the families are well nourished and have received the proper vaccinations. The program has been tremendously successful and has been implemented in health clinics throughout Bolivia and other parts of South America. Another very successful project is the tuberculosis treatment program. The TB treatment center has a calendar on the wall with envelopes that contains assigned pills for every patient in the community being treated for TB. The patient must come to treatment center each week to collect their assigned pills. If they miss picking up the pills, community health workers will locate them in the community to ensure that the patients complete the treatment. Ensuring that all patients who begin treatment complete it greatly reduces the chance of the TB bacteria becoming resistant to the medications. The TB treatment program had a 100% success rate in the previous year.
As I become a physician, I hope to encompass the lessons I have learned in Bolivia into both my own medical practices and future medical missions abroad. I also hope that the experiences my fellow medical students have encountered during this trip will lead them to devote time to service of their community and the world, once they become physicians. The lessons learned in Bolivia are invaluable. Speaking about Helen Keller, Dr. James Johnson of the World Health Organization once stated, “I think she knew that to truly understand the human condition, you must be in the conditions under which people live and struggle.” I think my time in Bolivia has allowed me to walk at least a few steps in these kind people’s shoes.

Even medical students need to let go and have fun now and then