Tuesday was our first day at Hospital del niño which opened its doors in 1972 and is the largest pediatric teaching hospital in Bolivia. The hospital is full of children and every ward is brightly decorated with large windows to let as much sunlight in as possible. We had the opportunity to tour through every department and even in that short time I was amazed by the complexity and rarity of the patient presentations.
Dr. Uribe is our preceptor through Child Family Health International (CFHI) for this month. She is an incredibly knowledgable and passionate pediatrician and gave us a short lecture during our first meeting on common health concerns for children here in La Paz. Pediatric medicine is very important in Bolivia because close to 45% of the population are under the age of 18. Among the most common health issues for children include malnutrition, TB, viral gastroenteritis and child abuse. The causes of mortality in children aged under 5, according to the Ministry of Health, are directly associated with poverty. Our first grand rounds presentation was focused on child abuse which is a very common problem in the city of La Paz. We learned that the culture to respect a child’s rights does not widely exist in Bolivia. Children are seen as their parent’s property and it is still considered normal to discipline children through physical abuse. Syndrome de Kempe or Battered Child Syndrome is a presentation seen often at Hospital del Niño. This syndrome refers to a behavior in which the child is exposed to different physical and/or sexual abuses, neglect or emotional misconduct and certain physical and emotional symptoms present.
We spent our first week in the Neumología (pulmonology) department with Dr. Salete who is possibly the kindest and most energetic pediatrician I’ve ever met. In addition to our time in the pulmonology ward we also had the incredible opportunity to observe and work with Dr. Salete in her outpatient clinic. She is one of the only doctors in La Paz who has special training to care for patients with Down’s Syndrome. During the outpatient clinics we were also able to observe very rare genetic conditions, such as Cornelia de Lange syndrome. Dr. Salete’s patience and exhaustive detail with every patient was inspiring. She took every possible opportunity to teach us and made us feel so valued.
My experience this week was such a rewarding and humbling time. There were so many patients with unique and meaningful stories however one in particular stood out to me as a very special case. Nitin and I met a young girl who was diagnosed with Neurofibromatosis type 1. Sadly, her mother and sister had both passed away from the same disease. Her father was the only one left to care for her. When we first met the young girl and her father, the sorrow that this genetic disorder had placed on their lives was palpable. Her presentation was severe and the reason for her most recent admission was a neurofibroma compressing her diaphragm making it very difficult for her to breath and a neurofibroma in her brain obstructing her ventricular outflow. The only treatment for this patient is to surgically remove the neurofibromas with no cure or certainty that more won’t grow. The case was an excellent learning opportunity for us but we felt heartbroken for the life of this patient and uncertainty of her future.
This week was also the commencement of our Spanish classes and our professora Jehny is incredible! Jehny has taught us so much in such a short amount of time. She took us on a walking tour yesterday of the markets and the Basilica de San Francisco and we were mesmerized by the intricate hand made Bolivian goods.
Having seen and learned so much in just one week, I cannot imagine what beauty lies ahead in the country of Bolivia!