Wednesday, September 2, 2009

la asunta: parte tres

I felt a bit out of my leauge a couple months ago when I arrived, for the first time, to La Asunta--a remote, under-developed pueblo in the Sud Yungas. And after spending more than an hour walking the dimly lit main avenue, asking unknown locals if they knew any of the UAC-CP students or graduates on my list, I recognized defeat and surrendered myself to the rustic hostal accommodations I had secured for $2.50 US.

But, as it always does, my luck changed almost immediately when I set off at 8am the next morning. Within an hour of running into Janneth Quispe on her way to work, I suddenly had all sorts of interview/visit opportunities. Perhaps one of the most exciting was a surprise--I learned that two 4th-year Nursing students from the College were doing internships at the hospital in La Asunta.

Me pictured with Estela and Veronica in front of the sign for La Asunta's Hospital.

Vernoica Quispe and Estela Mollo, both students from rural Bolivian communities, were awarded paid internships with USAID during the College's July/winter break. Their work was originally supposed to focus on a program for Leishmaniasis, but with limited trained staff available at the hospital, they quickly found themselves working with a variety of public health programs.

After a tour of the hospital, the two aspiring nurses guided me to the public health room where signs about common infectious diseases adorned the walls. As I sat with paper, pen, and voice recorder, poised to note their every word, they started to tell me about general nutrition (or lack thereof) in the countryside.

In La Asunta, they explained, people eat mostly carbohydrates. They supported this claim by listing the foods most commonly found in the daily diet: rice, plantain, pasta, and yuca. I admitted that I had noticed the overt absence of veggies and asked them why. "It costs more," Veronica said, adding that farmers in La Asunta are primarily dedicated to growing coca--a plant that has sucked the nutrients from the land and makes it difficult to grow other things.

Proudly donning their UAC-CP Nursing uniforms, Veronica and Estela stand in front of shelving that houses tupperware containers--each representing a patient actively being treated for Tuberculosis.

"In addition to poor nutrition," I started to ask, "what is one of the most common things you see here at the hospital?" They responded immediately and simultaneously: Niños. Children. They attend to a lot of children with diarrhea, digestive track infections, and respiratory problems--all of which stem from unsanitary living conditions.

"Do you see children die?" I inquired, calling to mind vague, but frightening statistics about the death rate of children under five-years-old in Bolivia. There was a noticeable pause before Estela responded carefully. "Not a lot, but it happens." She recalled the story of a woman who came to the hospital the previous week. After explaining that her small child had been sick with diarrhea for three days, the doctor went to check the young patient only to find that he had already died. "The mother didn't know it," Estela said, "but she brought her dead baby to the hospital."

All public health visits to homes in communities surrounding La Asunta must be recorded. In the log, Veronica and Estela note the names, ages, and relationships of people living in each household and the public health topics discussed at each visit.

In this case, as in many others, people live too far from the health centers to come for medical attention at a moment's notice. "Of course," Estela said, "we tell them, 'You must come to the hospital as soon as you notice a problem." But that isn't how it works. They have to wait until there is transportation--usually Friday and Saturday [market days in La Asunta]." In fact, Friday, Saturday, and Sunday are the busiest days at the hospital.

Because people can't come to the hospital, Veronica and Estela take the hospital to the people. They traveled up to 5 or 6 hours a day, visiting remote, rural households "after hours" when farming families can be found at home. In addition to visiting private homes, they also gave talks at rural schools and, every Thursday during the month, they hosted a radio talk show in La Asunta that was broadcast throughout the countryside (topics included: Leishmaniasis and Tuberculosis).

The women's ward in La Asunta's Hospital is sparse, to say the least. Because the entire town is without electricity from 11pm at night until 4pm the following afternoon (at which point a town-wide generator is turned on), women give birth by candlelight. Emergency operations are sometimes performed with help of an electrical generator.

It's common for people in the countryside to be skeptical of outsiders, modern medicine, and hospitals (quite frankly, after touring the hospital, I can't blame them!). But Veronica and Estela claimed to have no problem working with the gente of the rural sector. "They like that we talk to them; they listen to us, they trust us," Veronica said. "They ask about diseases and ask about the symptoms and what can happen to them. We are there to answer those questions and, in some cases, encourage them to get to the hospital immediately."

Part of the reason they are received well, they said, is because they are each fluent in their indigenous language--Vernoica speaks Aymara and Estela speaks Quechua. "Today, for example," Estela offered up, "a woman came here and nobody understood her, so I had to interpret. The doctor gave her a prescription and the woman went to the pharmacy [in town] to buy her medicine, but when she came to show me what she had purchased, I realized that the pharmacy had cheated her." It was because of her language abilities, Estela said, that she was able to help the Quechuan-speaking patient make sure she understood the prescribed dose and potential side effects. "It's beautiful to be bi-lingual," Vernoica added.

Both young women agreed that it had been a great experience for them to work at the hospital. "It makes me realize that I'm getting a good education; I can work alongside all the other trained professionals," Estela told me. Veronica agreed. "It's good preparation for us," she said. "And it's a good feeling to know that we are helping our people of the rural area."

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