Hasta Luego, La Paz...

Today we wrapped up our trip with a traditional Bolivian Sunday: leisure start, long breakfast around the table together, and hosting a Parrillada (a big BBQ). Karola and Manuel invited their extended family as well as many of the doctors and physical therapists we met during our time in Bolivia. Currently, hours later, we are all still in food comas from the feast of pork, beef, fish, grilled vegetables, potatoes, corn on the cob, salads, and a fantastic fruit and custard dessert. It was a wonderful way to say goodbye and thank you to everyone who made our experience here so incredible. Tonight we are packing and prepping for a pre-sunrise departure to the airport in the morning.

Muchas, muchas gracias for your interest and support during our time here. We look forward to sharing more stories and pictures with you upon return!

Witches Market

Today was shopping day two! We had a liesurly start to the day with another wonderful breakfast. Karola and her husband had a wedding to attend, so we headed off to navigate the witches market on our own this time. We started the trip off with a tour of the San Fransico church which is virtually in the middle of the market. The church was beautiful, and included an alter decorated with gold from the Baroque period and cloisters filled with antique furniture and artwork. We even had a chance to sqeeze up the windy, narrow stone staircase to the roof and got some amazing views of the city! After our tour, we were ready to start bartering! We all had successful days at the market, complete with lunch at a fabulous restaurant where many of us had dishes made with quinoa, the traditional grain of Bolivia. We quickly stopped back at the house to drop off our purchases and then sped off with Karola to some local grocery stores to pick up some Bolivian goodies to bring home. By the time we got back to Karola's house we were officially pooped and decided to do a show and tell of all our purchases and top the night off with some pizza.

It's hard to believe that we only have one more day here!

Museum and Lake Titicaca

This morning we headed off to Karola´s father´s house that is a museum of her grandfather Cecilio Guzman de Rojas in La Paz.

He gave us a full tour of the works of art, and even allowed to take pictures of them.

The house was very ornate with a lot of hand carved wood. We then discussed the stories behind Cecilio Guzman de Rojas´ life while we had salteñas.

He also showed us work that he has done on computers, and the program www.Atamiri.cc. It allows you to talk to people in other languages because it translates the language that you write into the language that they write. It was very interesting and educational morning.

Karola´s mother, Ulla, then met up with us to head to Lake Titicaca. It was about a 1.5 hour drive. We arrived at a hotel on the water, Hotel Inca Utama. We went in and ordered trout, which we have all decided strongly resembles our salmon, but tastes better.

We toured one of the museums on the property that had a lot of ancient medicinal techniques including the usage of different herbs and rituals in the Bolivian culture.

The last room in the museum was a small stage used for offerings and coca leaf readings. There was a Callawalla who is also a Yatiri, which means that he is an herb healing doctor and also uses coca leaves to read the future. He told some of our fortunes using coca leaves which was very interesting to watch and observe. We then continued our tour around the complex which a lot of us compared to the Plimouth Plantation of Lake Titicaca, because they were indigenous people who were still practicing their weaving and boat making skills out of reeds.

The area was a replica of an traditional Incan lake village. While we were wandering the area, a thunderstorm rolled in, but luckily, we got in the cars fast enough to head away from the storm.

Afterwards we continued down the road for some more scenic shots and ended up in an area of the lake where we could see a small town in Peru. The lake was absolutely beautiful.

We then headed home to have dinner, catch up on emails, the blog, and rest as many of us are still recovering from our trip to Uyuni.

Hasta Manaña!!!

Trip to Uyuni

Our adventure started out bright and early on Tuesday morning when we left Karola's at 6:30am to head to the bus station in La Paz. We picked up a physical therpist friend of Karola's, Vilma, who joined us for the trip. From La Paz we took a bus to Oruro (about 3 hours away) and there visited a nursing home, Hogar la Sagrada Familia, run by catholic nuns. It is kept immacuately clean and many of the residents help out with daily tasks. We learned that the facility is subsided by the church and residents stay for free when there families could no longer support them. We used monetary donations there to by blankets for the facility, since the central heating was too expensive for them to use. After that we had lunch in Oruro and jumped on a 3:30pm train to Uyuni.

The train ride took about 8hrs and took us through a lot of the counrtyside of Bolivia and we saw a gorgeous sunset over the landscape. We arrived in Uyuni and went straight to bed at our hotel, Tonito Hotel. The hotel is run by friend's of Karola's, Mark from Amherst, MA and his wife, Sussie from Uyuni, Bolivia.

After breakfast at the hotel we took a short stroll through town to pick up sunglasses and water we started off on tour to the Salar de Uyuni. It began with a stop at the train cemetary, where old trains are left to rust away.

Then we headed into the Salar de Uyuni (which means place of salt of Uyuni). It is 12,000 sq kilometers of salt flats, all you could see for miles around was white salt. The lake had evaporated and the salt hardened. Underneath the salt was a lake filled with litheum, magnesium, potassium, and zinc. It was truly amazing to see white salt all around you for miles and miles. While at the salt flats we had lunch and hiked on one of the islands that was made up of coral with lots of wild cacti growing. We were able to witness a traditional offering to Pancha Mama and a ceremony to have one´s soul return to her. We all felt privileged to be part of such traditions.

After leaving the island, we stopped to take some fantastic pictures. The photos were possible because the background was all white so we were able to play with the size and depth of objects, it was a very fun experience and we all shared numerous laughs. We got to see the sunset and the longest shadows of ourselves we had ever seen. The day was truly amazing. Once back at the hotel we had fantastic pizzas to top off the night and taught CPR to Suzzie, the owner of the hotel.

We headed to the train that night and boarded for an overnight ride at midnight, which left most of us sleepy the next day. We arrived back in Oruro at 7am and grabbed a quick breakfast at a hotel and headed for our next adventure to the mine.

We were warmly greeted and given two presentations on how mines in general in Bolivia are run and how this specific mine was operated. We then all grabbed hard hats and headed to the mine sight. We gave a presentation to the miners on first aid, including CPR, the Heimlich, splinting after finger injuries, proper body mechanics for lifting and the importance of stretching and staying well hydrated. After sharing our information we assisted the miners in practicing what they had learned. We were then given the opportunity to learn about traditional mining beliefs and practices. We learned about Tio, the protector of the mine, and how the miners pay respect to him to ensure safety and good luck while working.

The exchange of information of current thinking of first aid and ancient mining beliefs and superstitions was an excellent comparison of our cultures. It was a fascinating experience for all. After our enlightening trip we headed back to the bus station for our journey back to La Paz. We were certainly a tired group, however had a much better appreciation for some of the deep routed beliefs in the Bolivian culture and a greater appreciation for how drastic the difference in landscape were across the country.

A Little Bit of Everything

Today we started off with observation of physical therapy treatments on 2 of Karola´s patients. It was interesting to see how she interacts with her patients and the type of manual skills that she uses. We were able to ask questions of both her and the patients.

We then walked to a Rehabilitation Hospital in La Paz. This hospital is for the working class who has insurance and for those we are retired. We met with the director of the hospital, she informed us of the aid that they are receiving from the Red Cross to help with covering the cost of prosthetics. The hospital also has future plans to be run by the government.

The head physical therapist then gave us a tour of their department. It included a hydrotherapy room, electrotherapy room, thermotherapy room, therapeutic exercise room, and an occupational therapy room. They see a lot of patients and often one physical therapist is working with over 3 patients at a time.

We then headed back to Karol´s for lunch. Her mom cooked baked chicken with vegetables and a chickpea salad for the vegetarians. It was then finished off with a fruit compote with vanilla ice cream.

We then raced to the Military Hospital to meet with Dr. Alfredo who is a surgeon there. Security was tighter at the hospital and we were required to where a mask due to the swine flu epidemic. He gave us a tour of the hospital and then had us meet up with the physical therapy department to have a tour of all the rehabilitation rooms. They had a very large pool that had a aquatic treadmill. Currently there is no water in it due to a heating problem.

After picking up the train tickets for tomorrows trip we then went to a prosthetics office. It is set up for individuals who do not have enough money to pay full price for their device. The people who work there all have a disability and this allows them to have a job and give back to others who are having difficulties similar to what they had. They also go to more rural areas to find individuals who need prosthetics and bring them back to the office in La Paz. Right now they make about 4 prosthetics a month, which is low, but they feel that this is due to the current economy and lack of knowledge that their facility exists. There was a therapy room that is run by the individuals and rooms to stay in while their device get mad and fitted correctly for them.

We then went to a small coffee place to have some tea, coffee, light dinner, and dessert for our evening. Afterwards we headed home to pack and get ready for our trip to Uyuni.

Well be back thursday with another update! Ciao Ciao!!!

Shopping Day!!!

Today we decided to lay low and take a break from the last few busy days and prepare for another busy week! We woke up casually and made ourselves a tasty little breakfast outside on the beautiful patio. We've all decided that the warmest summer we've ever had is our 2 weeks of winter in Bolivia, its definitely been nicer than expected!

After breakfast we headed out to do some shopping and take a little visit to the Witches Market. We were all very successful with buying fabulous jewelry, scarves, blankets, rugs, and much more (and plan to be successful once again when we take on shopping day #2 next Saturday)!

While we didnt make many purchases at the Witches Market, as we thought customs may have a little issue with 7 Llama fetuses making their way into the US. Sorry guys, I know youre all bummed. We all promise we found many other good options for you!

It was very interesting seeing the market itself though. Not only are there fetuses for purchase, but we learned that the true tradition with it is a ceremony that takes place when building a new home. Karola informed us that here in Bolivia, it is tradition that before the foundation is laid, the owner buries an offering consisting of a llama fetus, coca leaves, sugar cubes with customary symbols, herbs, strings of wool, paper money, confetti, and wine. By doing this you ensure prosperity and good luck with your new home. She said that it is thought to be so important that construction will literally stop and not continue until this has taken place. We were once again intriuged by the traditions and customs of this amazing country.

Once the shopping exhaustion had set in, we headed out for a traditional Bolivian lunch where we tasted a sweet dark beer (similar to Guinness but much lower alcohol content and much sweeter), and some fabulous roasted potatoes. Some of us tried the traditional dish called Wátia, which was seasoned steak, chicken, and pork that was cooked in tin containers buried in the ground and covered with lids and soil for many hours. It was served over plaintains, roasted potatoes, corn on the cob and a freeze-dried potato. It was quite literally a mountain of food.

The rest enjoyed another traditional trout dish served with rice and vegetables which was equally incredible!

Tonight we had a little team meeting to organize the rest of our final week here, and prepared "goodie bags"for PT's, Rehab Hospitals, Nursing Homes, and the Prosthetic Factory we will be visiting soon.

Thanks again for all the great comments...keep them coming as we all love to hear from you!
Adios!

Tiwanaku

This morning Meredith, Malia, and Meghan went for a run around Karola's house. They went up a very large hill and really felt the altitude and discussed that there are no hills this size back in Massachusetts.

As we begin most mornings we had breakfast and then packed a picnic lunch to bring with us to Tiwanaku, ruins that are near lake Titicaca in El Alto. Today was more of a tourist day then doing clinical care or educational visits since it is the weekend.

It was about a 2 hour drive to get to the ruins. Alot of the artifacts were no longer on display due to vandalism and lack of funding.

We all agreed that it was nice to be outside for a lot of the day and to learn more about the ancient history of Bolivia.

After walking around the ruins we headed back towards El Alto, stopping along the way to have lunch at a open space looking over Mtn. Illimani. Our picnic lunch was veggtable with rice noodles, and breads with assorted cheese. We all tried Batons (a type of milk chocolate that children eat).

We were then back on the road to La Paz. We drove around the city and saw so areas that we might go to in the next couple of days.

We spent the evening playing games, discussing our plans for the next couple of days, and making dinner together.

Being schooled...

At the end of the day today, we all agree that it has been one of the most educational days of the trip. We started with our usual delicious breakfast, threw on our scrubs, and headed to Hospital Obrero, a worker's hospital, one of the largest hospitals in La Paz.

Here we divided into small groups and entered the operating rooms where we witnessed everything from gall bladder removals to a femur fracture repair to an Achilles tendon repair to a varus (bow leg) deformity correction. Although we experienced different degrees of communication and sanitation during surgery, the mutual consensus was that the doctors, nurses and anesthesiologists knew how to have a good time!

After the morning at Hospital Obrero, we ran to grab a quick bite (saltenas--baked pastry shells filled with meat, potatoes, egg, raisins, olives and cumin; a common mid-morning Bolivian snack) before heading into another operating room at Clinica Alemana, the German hospital.

Here we took turns entering two by two into a very complicated repair of an ankle fracture. At this private hospital we immediately noticed the difference in sanitation, precautions taken, and up-to-date medical equipment compared to the OR's at Hospital Obrero. Everyone here was very welcoming; they even provided cookies and coke after the procedure.

Our post-op afternoon was filled with some relaxing down time, tea, and dessert in the

sunshine at Karola's. We then spent some time with Karola's friend, also a PT, and discussed the differences in patient care, expectations, and beliefs about disease and healing between Bolivia and the US. We also discussed how, as health care providers, we can connect with our patients in a meaningful and respectful way, balancing science and spirituality.

We wrapped up the night with another traditional Bolivian meal--sushi. :) It was delicious, but we are still being gentle to our GI systems and gradually weaning ourselves onto the typical Bolivian diet. Tomorrow we are looking forward to a day trip out of La Paz where we will explore some Inca ruins. We are also looking forward to seeing more comments from all of you, so please send us your thoughts and questions!

Hasta manana!

Senda Verde

Yesterday we drove to Senda Verda, an animal refuge located in Yungas. The trip started with a long ascent out of La Paz and we stopped at an area called La Cumbre to make a sacrafice of sugar to Pacha Mama (mother earth) because August is the month that she is hungry.
Here, at 19,000 feet, we had amazing views of the Andes Mountains. We were lucky to have very clear weather as it is often foggy in this area. As we descended the temperature rose and we began to see more vegetation, we could also see the Death Road winding along the side of the mountains. By the time we got to Senda Verde is was very hot! We has a late lunch of their homemade pasta and sauces, settled into our cabins, and then made our way to the pool. We encountered several animals roaming the refuge including: parrots, monkeys, hens, turtles, dogs, and an anteater. When we got to the pool, the owner warned us to put our valuables indoors because the monkeys enjoy playing with shiney objects, but didn't think that they would bother our towels or clothes. However, just as we got into the water, a monkey ran away with Meredith's water and sunscreen, Katies T-shirt, and Christen's sunglasses. Luckily, all items were retreived, and we were gathering all of our things to move indoors when another monkey ran away with Nikki's skirt. A few moments later we saw him swinging through the trees wearing it! Eventually it was returned, we decided we had experienced enough adventure at the pool, and we were invited to watch the bear feeding. Some of us even had a chance to feed nuts to the bear they had saved from a home in El Alto, which happened to be of the most endangered species in the world. We had a relaxing dinner of trout, played some games and then headed to our cabins for bed. Meg and Katie were brave enough to spend the night in the treehouse!
Today Malia, Meg, and Meredith started the day with a short run up the Death Road. For breakfast we had delicious quinoa and oatmeal pancakes and then we were on our way to Coroico, a small town about 30 minutes away from Senda Verde. There, we were given a tour of the hospital by the physical therapist. Despite being a very poor hospital, it was clean and the practicioners seemed passionate about their work. We were able to donate some diapers for the NICU, face masks, sheets and bandaids. We went to a German restaurant in Coroioco and then took a walk around the plaza. It is tradition that the women walk clockwise and the men walk counterclockwise around the plaza so they can meet. After our tour of the town we were back on the road to La Paz, it became much cloudier, so we we glad to have gotten so many pictures the day before.

Tomorrow there is a chance we will be seeing a surgery in the morning and then we will be off to the witches market!

Another beautiful day in La Paz!

Day 3 is done and we are officially pooped! Excited, but pooped! We went to two hospitals in La Paz this morning. First the Instituto de Gastroenterologia, which specializes in surgeries and treatment for GI issues. It was very interesting to see a specialty hospital that serves all populations in the area. We also got some interesting knowledge and a little show and tell in the lab...we'll save the details for those stomachs that can handle it when we get back. : )

After that we went to the Hospital General which is almost 10o years old. It had some pretty amazing buildings with lots of different treatments going on. We were able to tour almost the entire facility at both hospitals as well as meeting with the directors of both facilities. It was interesting to hear about how they run their version of a public general hospital that serves many patients for less than $2 a treatment. Hearing how they run things and seeing the facilities and patients was pretty amazing. It is amazing to see such a contrast in infection control and patient confidentiality standards between here and the U.S. We actually walked into a patient room while she was having an endoscopy, such an amazing experience, but one we would never have in the US. We were able to spend time in the PT department there and had a great time talking with their PT's about new ideas and ways that we go about treating our patients.

Next we came back to Karola's house for another amazing lunch made by her mother (what an incredible cook!!!). Its so nice to have a little break in the sun mid-day! Pretty much the

warmest winter days we've ever experienced!!! After a little down time we headed to another private PT clinic where we were able to see a whole other side of the practice. It was much more focused on energy techniques, alternative therapy, aesthetic therapy and much more. We even played around and did a little Aikido with some kids! (They were much better than us)

On our way home we went to a lookout point where we got some ABSOLUTELY AMAZING pictures of Mount Illimani, it was a great way to end the day.

After our busy busy day we headed to the market to pick up some things, then home for a great pasta dinner cooked by Karola, and now its off to bed to prepare for our overnight trip to Senda Verde tomorrow!

Hope everything is great at home for everyone and we'll be back on thursday!

Ciao Ciao!

segundo dia

I think we've all settled into life in Bolivia. We got to experience a little bit of everything today. We started off with a visit to the Hospital del Nino which is a community hospital for children. We started off in the oncology ward and were included in the medical rounds and then had a tour of the entire hospital. We brought some of the donated supplies to try and brighten the children's days and make life a little easier on the families. Unlike in the US, all of the medical supplies and medicine the families, which are often incredible poor, are paid for by the families.

It was hard seeing children who may not receive the best care because they could not afford it. We were also informed that many of the supplies and toys had to be locked up so the families and and even the staff would not steal them away from the patients. We passed around

Bandaids that were colored with cartoons which made many of the children smile.

After our visit to the hospital we drove to Karola's mother's house for a delicious lunch of fish, rice noodles and vegetables. We took a nice walk through the Valle de la Luna (moon vally) which is what is depicted in our pictures. The formations were made from a mud slide which then froze and was carved out by a river. The weather during the walk was so crazy compared to the weather at night, I think it changed about 50 degrees.

We got our first view of some physical therapy when we visited Karola's clinic. We observed passive ROM and stair training with crutches. It took all of our input to figure out how her patient would go down the stairs because there are no walls or railings at her stairs at school (no Americans with Disabilities Act here).

We finished up the day with a nice dinner at a cafe and some conversation and reflection on the day.

First day in La Paz

We arrived, a sleepy group, about 6am. As we drove through La Paz from the airport to Karola & Manuel's house we saw the sunrise over the mountains that surround the city. After a delicious breakfast and a little rest we headed out to the Devil's tooth mountain and to see more of the city. Then to the market for fresh fruits and veggies, and learned about the local produce.

We've had a relaxing evening at the house filled with cookies, coca tea, catching up and preparing for tomorrow's adventures!

Packing party before & after

Packing Party!

And the adventure begins. We're all gathered in Toni's kitchen making pizza after shoving tons of boxes of donated goods into 7 bags.

We leave in 42 hours out of Logan airport!