"esta bueno"

some pretty great and pretty right american just wrote to me "i hope there comes a time when your stories don't feel like burdens that only you can carry."

right before that a bolivian told me in his despedida (goodbye) to me " que te vayas bien que te pisas un tren que te dejas ancho como un sarten. " that you go well, that the train smashes into you and that it leaves u wide and flat like a frying pan. it's a little harsh on first sound. however,i'm told it's a saying and it's a good thing. i just kept thinking of the train smashing into me and me dieing on impact. in english we do say "break a leg". i guess they are both to say that i hope the very best for you but instead i say the very worst to you to not jinx it.

15 mintues before I received the american saying, and 15 minutes after the Bolivian dicho, i traveled home in taxi by night and thought man, more or less, for the first time in my young life, i feel at peace with some part of my communication.

in 8 months i have sent home a lot of stories. the writing has been my processing and the receiving has been another's challenge. i have frustrated/fascinated myself and others. believe me or not, but i have learned VERY WELL (like almost to a surprising extent to me) how to communicate where i am with the people and within the things here that i experience. it comes at weird times and in weird ways, but i feel the difference.
it's weird to not talk to people from home, and then all of a sudden be talking, and then to follow hey what's up with something really pesado, complicado (heavy, complicated).. we know that we are worlds apart and i think its more the impossibility of the mixing of the worlds and finding the way to tell the difference rather than not wanting to tell or not trusting to tell the real truth.

some things happened while i was here. but i look at them and always will look at them as the challenges, the realities, the things i never knew and had i blinked at a different moment, never would have realized. anyways i feel peace for all the strange heavy things that happenen, will happen ..the tough things.. the unspeakable...the things that maybe had to pass for me to realize or enlighten or sympathize or communicate or trust in my communication and realization.

with my friends and family at distance, i haven't yet transitioned from story to telling. i told the american dont worry i wont come home a mess and i won't ask her to clean up after me. i told the bolivian... man i really hope that train doesn't hit me. now i think, but man if it does (or for however many times it already has,) i have it in me to bounce back. then i'll recount the history... not as a burden but instead to even out the weight a little.

this is what it's about right?

"Ay, que se muera"

i'm not gonna go into medicine. i promise myself i'll never go to medical school. however, if i did, i'd go into geriatrics or really any field keen on palliative care. p.c.=treatment that recognizes boundaries, admit defeats, confirms that their are not always cures and concentrates on easing, calming the quality of life the patient has left.

yesterday i wrote my last update to the bosses. today already i am writing them a new email. it reads as follows. it's the follow up to the dialysis saga. i leave july 9th.. we'll see how many more there will be.
---

Hola amigos,
Last night Doogs told me Vaca Diez decided dialysis patient needs dialysis up until she leaves. Plan last night was dialysis sessions this week (however many needed) and from there we buy her a plane ticket. If I understand correctly she had hongos (fungus) in her catheter and the dialysis last week was not effective.

I just talked to patient (she answered the phone) and patient's daughter. Liliana told me her mom has changed her mind about the Argentina plan. She doesn't want to go. Even if this means her death, she wishes to die at home with her family around her.

Please let me know if there is anything else we can do for her, to meet her wishes and help her be comfortable if that is possible. I'll catch Doogs in the morning and follow up with the fam depending on what he says.

Thanks
Rachel
ps. I plan to go visit the patient in her home next Sunday.

--
alright i've learned to do good things. but all along i've learned the foundation. the foundation never admits defeat. the foundation doesnt believe in boundaries or limits. the foundation thinks that helicopters are the answer to road blocks and argentina is the answer to a failing kidney we cant transplant and a failing body we cant afford to dialize. since i've been here the foundation has never once engaged a palliative care conversation. i just learned this word so i'm probably pretty valiant to be the one starting it. however, i hear what the patient is saying. for the very least, that's why i'm here.

1.5 months ago this is the patient that broke me. i wanted to help the patient survive. now i'd be equally honored to help her meet her wishes.

Posi, Posichanco

the latest with the dialysis

or i guess me coming to terms with "giving everything you've got" to help another.

before giving was a requirement
its what i did cause thats what we do

and then when i had the patient on my floor

and rewoke at 3 am to take out the IV
i kinda got it.

what up friends. my blog should just hang out with my mind and my dreams, but due to its gran flojeracidad (laziness) i'll recount the headlines, you ask the details

1. Sloths. super cool. hung out with Monti in Montero while eating a Picole. At that time i was feeling pretty good because the day before i had slept from 3pm to 7am and pretty sad because i had just said goodbye to my last 7 months. not bad. also the Sloth... it seemed to really be living it up. it was chillin on corner end plaza chewing away at branch ends... every once in a while it took a break to take a wide sweeping view of its background surroundings.. then chomping resumed.

2. the saga of dialysis. i may have mentioned our renal failure patient and how my bro treated her for 3 weeks with diuretics (fluid removal) and how i am quite sensitive and have a heart that beats really fast (i have a pulse 30x that of all my friends) and a feeling in my heart that sometimes hurts. i think of things like families, and histories and economic situations and comfort and choices. docs think of the balance of water and minerals and a body's assisted drive to stay alive.

on tuesday i got back the lab results. one hour later i had a doc read them and knew we were in "ohhh shiittt" mode. i called the patient and the first call was unsuccessful. sometimes patients forget that spending 20Bs and stopping whatever they are doing to travel from campo (jungle) to city (bolivian miami) might be worth the bother. the second call i whipped out my newly perfected directness, alluded to untimely and uncomfortable death akin to that experienced by lethal injection, and the next thing i received was a prompt destination and ETA.

6:30 pm bundled (scarf and hat) swollen yet lucid patient arrives. By 7 Doogs had broken out the "look lady this happened to me. it's not all over. i had your disease and i am 15 years of health and counting. you are in bad shape now but if we devote the time and you commit to your future, we can get you through." we drew blood for Sodium and Potassium (to find out really how sick she was) and Doogs was done.

8 pm. this was the first patient i had brought back to the house. i forgot it's the Scruz mansion for a reason. it felt strange... Nico and I ran upstairs. We threw down some mattresses, some sheets, some comforters, some pillows. we set up patient camp planta baja (ground floor). we bundled the patient once again, this time in a more comfortable resting position. The ISI gringos, who had just sat down to a royal meal, asked Liliana the daughter if she wanted some pasta. Lilana asked me, as I was waiting the half hour for the lab results to come back, for some panuelas (adult diapers).

9:45pm lab results arrive. I call Doogs with the number 7.4 and hear Potassium is sky high. This is the point at which a heart can stop... a physical reaction mimicking lethal injection. Doogs response elevated "ohhh shhiit" mode. But he was good... he called his nurse and guided her to the cure.

11pm. Liceth the best licenciada (nurse practitioner) ever arrives at the Mansion. Ibyana and I assist in the creation of IV Souvenir Lamp Pole Fluid holder numero uno. 2 IV bags run, gluconato de sodio injected and the directions for Raquelita to close IV bags (so her blood didnt run up the IV?) and remove IV line in approximately 3 hours were given. ISI Americans think this is "really cool."Resident American Nephorologist with 30 years of experience in this type of care went to bed three hours ago.

2 am. What up IV that's still drippin and earnest Lilana that is still holding strong.
3 am. IV removal successful. Theoretically, Potassium burst averted. Heart noted to be functioning.

Wednesday
9:30am. At Institute of the Kidney we arrive. Dialysis begun. Repeat peritonitis discovered. Really cloudy dark diffusion (waste removal) observed. A few mean looks from the Peritoneal Dialysis nurse wondering "what have we done with this patient!"

3pm. I have returned home. Liliana daughter has my number. I fall asleep at my computer. 4:30 pm I awake to 4 missed dialysis calls and think "Man, if i was sleeping and Dialy patient died..."

5pm. Institute of Kidney, everything ok... meds bought, bills canceled.

6:30 pm. Despedida goodbye with Maggie American volunteer (1st at the clinic, on her 6th return). I think i wrote a text msg that said "Man,I feel like a wreck."

9:30pm. Patient released from Dialysis and directed to come back tomorrow. Peritonitis treated but repeat dialysis needed. Patient goes to Tia's home, I to mine.

Thurs. 7:30 am. Dialysis. Lilana looking good. She changed her purse. The new one was cute. I needed to head to Palacios for my last two days as jungle clinic Coordinator. Daughter tells me all cool, she and nurse give me release.

11:00 am. What up Palacios. Me, feeling good but tired, a lil sick.

2:30 pm. Lavitusmanos (the new coordinator) manual driving lesson.

3:00 pm. I'm a little warm and flushed and I get the "uh you're more than a lil sick" eyes from Sharon (she nursed me through Dengue).

3:15pm. Slumber, minor night sweats, not too shabby rest until Friday 7am.

Friday was great. That lots of sleep really helped. I said goodbye to the clinic. I waved to the trees where the monkeys reside. Kinda crazy, I know. And now i'm lightheaded. There's more... I'll revisit soon.

Monito vea, monito haga

halo there friends, what is happening in your neighborhood lately?

all's well in my neck of the woods. it's winter here so the crickets/frogs/sounding incests are at their very peak of noise production. that and the wind makes for quite the nice soundtrack. it shall be hitting stores soon.

heyyyyy guess who saw monkeys? i probably didn't share with any of you my long term bolivian jungle goals, but now you know that they totally involved monkeys. i do live in the middle of the jungle, literally. and yes the men strolling by on horses are on their way to hunt tigers. anyways to cut a story short, i hadn't yet seen any monkeys. the other day i realized i was leaving and because i hear them ALL the time, the seeing of the monkeys was on the top of my must dos. the two monkey sounds that occupy my environment are 1. the big burly roar (which i suspect comes from the big burly variety) 2. ooo ooo ahhh ahhh (the cute and lively, very similar to cartoon version)

i've been on lots of accompanied jungle walks. with the lack of my time left, i decided a solo trip was needed. i've heard the monkeys are curious and don't fear noise but tend to shy away from large groups. i took off down the forest path (aka latest forest destruction road) and took in my surroundings. it's fascinating how fascinating trees (and the flying of neon green yellow parrot friends) becomes if you pay it some really focused concentration.

This bolivian jungle consists of palm trees, motocou (a thinner more palm frommy variety), the tall old wise trees (the only tree in the forest sacrificed in slash and burn), Bibosi (the best hugging tree eva), all filled in by the unnamed out of control jungle growth. about mid way down the road i heard some Motocou rumbles. I stopped en plano esquina, plain path corner, and listened. Most normal americans who haven't lived in the bolivian jungle for the past few months probably would have been really quiet and busted out the tippy toes. i guess by now i've realized this one, me, is not so normal. i heard the ooo ooo ahh, i saw the palm fronds bounce up and down and i knew the real monkey hunt had begun. from there i pretty much chilled for the next half hour to hour... whistling and making cool imitative soundings, jumping around a lil bit, doing a little yoga/tai chi/"i'm interacting with monkeys" stretch sequence... and the rest is golden. you may find this hard to picture, but i think after dengue, deportation, political blockade... i've hopefully prepped you well. Monkey see monkey do is no joke. These little guys were great. I saw the little gray, black face variety. The first dude came out to give a peak (emerged from the heavy fronds to where i could see him) and from there, with my combined whistling, jumping, hooting, the rest of his forest friends followed. i prob saw about 6 in total and a larger darker a variety tree climbing in the distance. i stayed a while and as the sun started to set i returned American and thought "oh oh what happens if these monkeys really get curious... how close with they come?" after that, i soaked in the sights, said my goodbyes and jogged away.

basically 1st monkey sighting was a crazy success. I was stoked... I had definitely been waiting and the end result may have been greater than i had imagined. now I have one more reason to come back, for I know the monkeys totally would be my friends. Mumi told me, hey maybe next time they'll invite you back to their place. Ha ha.. that Mumi:).

oh yeah... we have this funny ISI (young catholic med students and docs and doc's wife nurse and priest) group visiting for the past 2 weeks. they are way more nutty and completely different than any group we've had. They are 9 Americans in total and they are here for "cultural immersion." the first week they were here our Palacios region was under intense political blockade. Anyways suffice to say they are silly nervous english speaking stomach sick a bit culturally unaware Ameri-cans. This is all fine and dandy because we all have our ways and we all have our rights to travel. Yesterday one of the group members said "Hey guys, did you hear today we get to see the Mayans?" Basically they are really into saying the words "indigenous people" and some genius thinks this part of the world was once inhabited my Mayans. It's cool America is geographically unlucky and when are world is flat we can't expect anyone to see it round. As always, I played along to the Mayan gig well. They wanted to see some Mayan paintings while they were here so this week at the clinic we collected a smattering of little kid "Mayan" artwork. the mayan kids had a blast with ISI's crayons and markers and the Americans can write home, "That's right honey, I was culturally immersed." A win, win situation:). Except for maybe the graves of the real Mayans.

Thank the world because it has monkeys.
RScout

Jefa Spice

hey hey judies... 7 month point yep wow:). it wouldnt be so impressive if everyday weren't so intensely insane absurdly hilarious and delightfully bolivian, but hey:). so i have not many words to coherently place but a few thoughts from me to me to you:

i've mastered the difference between jungle and rain forest. my life here has been jungle (out of control growth), where as rain forest would have been a piece of yummy dulce de leche torta ( with a canopy tree covering so thick no light ever touches the ground)

i will miss Picolo (the ice cream that made me love ice cream) and Picole the best leche fruit or vanilla flavored Popsicles in all the world.. .Sold in Montero across from the plaza. Def. add to your list of To Dos before you die. You might see a sloth too and that would just be cute.

I'll never forget the position of clinic caretaker. it seems we have this person to save us from bats (this has been an added job req. of late... we are doing some construction and living with lots of holes in lots of walls) anddd to cut the lawn. again, we live in the jungle. so the lawn means out of control control. so the job consists of a good 12 hours every day maintaining a jungle that regrows as fast as it is chopped. oh yes also the tool available for jungle control is 1. machete 2. tiny tiny electrical lawnmower.. that's right.. it has an extension chord. they want me to buy a new one, but i figured this little coordinator bought a fridge and a mattress and 4 new wheels, so i might pass it on to the next lil piggy.

so it's set that i am leaving now. so besides normal clinic coordinating life and patients and life and death and stuff like that, there is an added sadness and sweetness to all my interactions.my buddies are bummed and don't really believe i am leaving or quite why. i probably feel about the same but amazingly relieved my life will have a little distance of a little of this for a while.

Our "Star patient'.. we call him this because good attitudes are good and extra great names for extra annoying people make them all that more bearable. La Strella is Don Subirana who has nothing and no one and got in a machete accident which lead to his since 3 reconstructive urethra surgeries. Anyways he tracked me down yesterday and took me aside to ask very privately... "Will you sell my kidney for me?" I said NO! and then he asked, well will you at least take it back to the States for me and try there? Oye... que tipa. He told me he had sold everything he owned, the last being house.. His doc told him his kidney esta SANITO.. super healthy... and he came to me because it's all he has left to sell.

We had another ataxia patient yesterday. This time 23 years old, with a much more debilitating presentation than the last and a family history that spells bad news. His father, bro and sis have the same disease. His sis is in a wheelchair and her mom told me, through tears, that her limbs are starting to look like sticks.

I don't think i mentioned Adam and I went on a trip!? Uh, if i mentioned, Adam was here.. 3 weeks being a Docy out at the clinic. Basically he was fab with the patients, cares a lot, looks up everything, loves to ask me to come into translate just so he can say "This is my sis. She's younger than me." Ha ha, what a cutie. Oh yeah he also treated me, 2.2 times. Anyways I don't know if he'll make it to be a doc, but he'd be a damn good one one day. He says we may work together one day... I said, belligerently, I don't want to work for you! He said.. don't worry honey, you'd probably be running the place. I know docs are cool and respectable when they are good but not anymore important than anyone else you meet on the camino. What up organizational level... props to you!

I want to say Adam and I went to Oruro. We chilled at juice bars and I fell in love with every man in a suit. They wear suits there. Every where. Everyone. They look quite smashing and I think it's quite a lovely way to be. We took a series of four pictures (currently displayed on Picassa) of school children and their teacher doing the twist and shout. THey live in the Altiplano , its freezing, they can't point to the US on a map, but man do they do a cute Topnotes dance numba. Adam reminded that in juice and suits, these people were living it up, what's not to love. Oh yeah.. and cakes. man Oruro may be one of the coolest places on earth. everyone and their mother are buying cakes and walking through really crowded really busy market streets AND carrying cakes... cakes without cake boxes. At the same time, they love to say hello. And I mean they'd pretty much fall over and break their mother's backs if they don't utter a hello. This makes for lots of "HEy friends, whats up, how do you pass, beautiful weather." Even when Adam and I were doubled over from car sickness and altitude nausea the passer bys were still saying AMIGOS... como estan?

CUte. Even when I'm throwing up I'm accustomed to have a good attitude. Oh yeah and a monkey stole my camera. Well mono probably didn't steal it just borrowed it with no chance of giving it back. I went on an fun waterfall SUV adventure.. it tooks hours and we were crazy deep in the jungle.. but in the end we found gorgeous green rock formation pools and cascades that went up and up forever. Within the adventure my camera that has been with me for so many great sights bid me adeui. I was sad but then I remembered it was 1. sweet i had a camera in the first place 2. monkeys have way better perspective points that i do 3. if some campesino fam finds that shiny gray magic maker they can hopefully pay for their sick kid's hopsital bill or maybe their oldests' university. SOooo it's all ok in the end.

Love you kids, keep on reading those rainbows

Raqui

Problemas de Corazon

They say a man shouldn't cry or that he should bite back his tears because "boys don't cry" (especially not in baseball). I think they should change that saying. A man should totally cry, he should just go outside to do it.

I scribbled this in my notebook 5 minutes before I went to tell a person about the options of life and death (oh yeah and the options are kinda like a life that is half death (dialysis) or a life with undetermined expiration (the bandaid of diaeresis until medicine functions no more). Within the whole life saving medical field, I realize the importance of such chats. I think I'd respect those that chat'em well. By now I more or less understand the medicine. I understand the docs like life. I know the fam needs to hear the options and hearing it changes their world.

In these 5 minutes of prep I was crying inside. I wanted to tell the fam how much I'd come to love them and how I am just as scared as them. I wanted to tell them the American docs are yes, Americans, and yes really great looking and yes they dreamed of this scenario from dubbed tv... BUT that they are not magicians. And that yes, we Americans in general and even more in comparison to them have lots of money, but that we'll never have enough to save this particular patient.

Then I went into the consult room and sucked it up. And I said and translated what we needed to say. And I said it while caring but while being "manly" and not balling. And while I was in the room with patient I thought of my conversation with Mike and what it means when we say "I'd come to love them." Anyways the daughter has chubby cheeks and chubby arms and really telling eyes but a really really really way stronger than me heart and mind. I felt super weak and unprepared. I told someone else this story and they responsed: " I am heisitant to say it.. you are too sensitive - I'm not sure I'd like anyone else to do such a life-and-death talk. Bien hecho, chiquita."

Well done, I hope. Exhausted, worn, but also really good and proud, I feel.

Como no?

I'm 22, I know. I'm 22 and I'd like to call it a retirement.

May 26, 9:26 PM, email to THE Foundation

Hi all,

I´m writing to let you know I would like to pass on the coordinator position at the end of June. I´ve had a fantastic experience here. I think this clinic is awesome and provides an amazing amount for an amazing amount of people. This experience has been super influential on me and has inspired me to want to pursue further studies in non-profit management and development.

I feel I have put everything I could into doing this job well and I hope I´ve done a good job. At the same time, I have been overwhelmed by 6 straight months of non'stop work. I realized this when I had dengue and emotionally and physically I am realizing this again (hopefully without a repeat medical case). I´m also sensitive and my heart is starting to feel a bit raw. As you all know, the coordinator job is challenging. Of late, financial issues have been the most draining on me.This experience has taught me this is the kind of work I want to do in my life. I want to gain the experience and knowledge to really make a difference.

I hope to always be connected to this clinic and connected to Bolivia. I would love to re-visit this experience again when I have the skills and energy to make a real impact. For now I want to help facilitate the transition to the next coordinators. I´m working on some new forms, will draft a working training manual and will devote myself and Maria to pass on (in writing) everything we know.

I´m still in it heart and soul, my heart and soul are just tired.

Abrazos,
Rachel
__________

I think the American founders already knew. They know this job is untenable. They know that when dengue and deportation are vacations, 'burn out' is the trifecta perfecta. For all it's worth, my email took my Bolivian Jefe Dougman by surprise. I love him a lot (because everyone is loveable when you get to know what makes them shine) and I have enjoyed working and learning with him. This last month will be hard. I will be sad to go. He asked me in a Skype conversation from the States last night why I hadn't talked to him about this. I said, "because Douglas, in 6 months, you never gave me the chance." I told the truth. I care about people and no matter how frustrated I was, I care about him. Every Monday and Tuesday morning I enter the office to see Doug stressed and overworked, and almost always on the onset of depression if we add the foundations work to the mesa. If I were ever feeling stressed and overworked and overwhelmed, the last thing I wanted to do was tell him... just the other day he showed his shaking fingers...how effective would it be if we were both temblando juntos?

When Jefe comes to the clinic, I love it. I am always energized by his spirit and passion. On the Mondays and Tuesdays we have no money. On Mondays and Tuesday the sustainability of a chronic care institution that provides specialization and surgery yet has NO MONEY, drives us nutz and keeps us humble (and by that I mean internalizing a lot of pain and defeat).

This week my brother and I had the life and death talk with the dialysis patient we've been following (the one Susan found). We said her body seemed ok, but inside was failing. We discussed Argentina (where she has a daughter and could move to receive dialysis covered by the State). We discussed the limits of our treatments here in the clinic and how we can attempt to help for now but no one knows how long the help will make a difference. I made the band-aid analogy in spanish. In waiting rooms, during dialysis, while communicating and coordinating their care back and forth to palacios, I got to know this mother and daughter. The daughter is my age. At 22 she is dealing with the unimaginable. This was my first life and death talk. That I've heard. That I've thought about. And that I've given. My reality of understanding her situation, and the situation of all the patients we help, is only a very very very tiny piece of the weight of hers. When they left the room I sat with my brother. It took less than the closing of the door, for me to break down and cry. And I mean CRY. I know what we are doing is good. Maybe every consult, every treatment, every chat makes a difference. Maybe we involve ourselves in things that might be more natural, less difficult, less complicated and introduced to false hope, than if we leave them alone.

I realized about this position that the coordinator is stressed so that everyone else can be happy, can learn and treat patients in ways that they'll probably never forget. In my 6 months of being challenged and being overwhelmed and acting as Indiana Jonesina, every single volunteer has told me they had amazing time and has thanked me for helping make the experience possible. I've been told that people can tell the job is stressful but that "externally I handle it well." Damn external shells. I bet my shell is still not transparent. However, when I stopped being able to feel the difference inside, I new it was time to move on. I tried to tell Bossman it doesn't mean i didn't love this experience, give to this experience and learn from he and his clinic any less.

Autonomia carajo!

Now it is May and what has happened? hello friends and families. some say time flies. i say it bursts like a synapse with many bright colors, some strong smells and vivid flash backs-forwards-sides, with no communication between the explosions.

4th of May 2008
ahhh the date that will be forever known as Bolivian un-independence. In your CNN and NYTimes surfing of late, you've probably gotten a good glimpse of the Bolivian red yellow green flag. You may have heard that Bolivia is a poor lil country, robbed of a coastline and reigned by 173 presidents in 193 years.On Sunday I would say the rich whitish urban elite (meaning few) made their modern concrete move to smash and conquer the pobrecito indian rural campesino majority (meaning many). Evo tried to start the revolution from the bottom up... flipping over the bottom of the last 150 years of oppression. Unfortunately his indigenous social movement doesn't have any money nor business sense. On Sunday Santa Cruz de la Sierra, the region with ALL the natural resources and foreign investment, voted themselves Autonomia. The YES votes tallied more than a 87% margin. All the 'No' voters had two choices: get beat in the streets or get fooled by churrasco chancito (pig feast) dinners. Let's just say one can suspect not too many "No" voting potentials made it to the polling booths.

So that was the big day. Founder Woman Super added on a few days to her trip to stay as an International Observer. Have people heard that foreginers do this during contested elections as a citizen's kindness and as a fill in for Jimmy Carter when he can't make a personal appearance? All remained more or less calm inside the city. The news and the stories from friends were pretty horrendous: blockades, clashes, giant sticks with nails on the ends, stones, fists and feet, Guinda our nurse from Yapacani calling to tell us "The houses are burning." They really, really were. That all happened night before to day of. By night fall the Autonomistas took over the main plaza to have a gigantic celebratory drink dance and music filled celebration. We were there. In the gringo Irish Pub we drank some Bock and ate some Pique Macho. I may have been quiet about it but I did remember to recognize the contrasts.

the Friday before before:
One of these Thursdays before this Friday I spent in the jungle. I feel I may have dangerously messed with the hands of God. The sense it makes is nonsensical. Basically there is this young39 yr old man with Mitral St,enosis. Mitral Stenosis is a valvular heart disease that narrows the orifice of the mitral valve which day by day narrows ones possibilities for continued oxygen, blood flow, and life. The Solidarity Bridge is this non-profit organization that popped out of the wood work to offer free hearts, widen lives, and all that jazz. Anyways I got the green light from Solidarity Bridge on day Wed, took a field trip to the middle of the jungle to find the patient on Thursday, went to the city and waited and waited and waited on Friday. Javier de San Juan de Palometillas was a no-show. I never actually got to talk to him. I found his tiny hut, met his really dirty really tiny children and talked with his really sweet really innocent wife. "Ya ya doctora" is how she responded to my flash explanation of 1. valvular heart disease 2. importance of operation 3. immediate plan to get her husband evaluted, scanned, units of blood collected and SYNAPSE into surgery the following Monday or Tuesday. Her "ya ya doctora"s got increasingly less believable as her physical reaction became more and more real, heart-breaking, reality slapping by the minute. Javier works out in the Chaco to support his 4 young girls and 1 wife. They have nothing. He works when his heart feels ok. The wife was glad this week he was feeling ok and was working and will bring home something. We didn't talk about recovery time or how the family was gonna survive when their father went through the recuperation period of don't walk, don't talk, don't cough, don't lift more than 3 pounds. We also didn't talk about what will happen when this family doesn't have a father at all. I gotta hand it to ya God.... you have some tough work.

Ohhh yeah and the other heart patient, 61 yr old mitral stinosis A-Fib currently coagulated by us... is in pending surgery tambien. Every time she sees me all she can think of to say is "Miiiissss Raaaaaaaachhhelll. Mi angelita." Man man man, I wish I had never seen that Touched by and Angel CBS show where the presence of an angel didn't necessarily mean a life saved.

One Monday-Wednesday, Thursday May Day and then Fri Sat jungle clinic
And then this part their is really no way to start. The end will be when I see you next. Hmmm clinic drama is as follows: We met this 8 year old patient with the first name Bill Clinton Last name Sebollas Roca. His dad liked the way it sounds. And then Susan(Founder Super Woman) called the "contact Al Gore" number when we learned of the inconveniencing truth that these autonimista possibly racist land owners are trying to buy out the clinic land (26 acres of 150 acres of preservation) to cut down the forest, eliminate the clinic and start planting and farming a whole lot of pesticide laden sugar cane. Kinda nutz I know. They offered our clinic founders new land and the promise to rebuild our clinic anew, as is, but in a different location. This is all we talked about for a good 5 days. Susan wanted to go to the press, call the environmentalists, chain us and all of our patients to the trees. The contract was to be signed on Tuesday. It's now Friday and some exciting dramatic news stories have no follow-up. Oh yeah I also think this is not some random accident. It's too hard to explain Autonomia and Coilla Camba but I think this is an extremely strong and blatant racist move... that fights the Evo bottom up social revolution.. and displays a smack-down come back of serious oppression.

Oh yeah and we dont' have any money. Like seriously, NO money. We=the foundation. Yeettttt the founders were here so we started $280 a day dialysis to save a kidney failure diabetic, discussed buying a new lawn mower (right now our care taker maintains the clearing of 3 acres of jungle with a ELECTRIC POWERED lawn mower with tiny tiny cutting blade and a really long extension chord) for $500, shopped for printers/fax to total $600, met with our Knee Guy who needs an $8,000 operation so if TAL VEZ, maybbbeeeeeeeeee, someone can save his leg.

Yeahhhh maybe I'll become a business consultant. It sounds horrible but I'm starting think that's the only way to save the world. Money is the problem, when u have it, when u don't have it, when u think u might want it. When your rich you get blind-sided and can't pay for enough breast augmentations or when your rich and you get blind-sided and don't realize no matter how much you earn you'll never have enough to save and help all the people in the world whose needs meet your attention. If the rich are blind and the poor are too seeing, what does that make me?

Silly doctors. I hope they help me diagnose my synapses when I get enough distance from this intense, non-stop, incomprehensible, heightened comprehensive, experience. I think if I were really a nut-job and really untrustworthy, I would understand less and maybe not feel at all.

6 pesitos por favor

a note to those who read: please read this with a spanish speaker by your side. as to not annoy you and as to understand me, if either of these be possible.

what the date is/ abril '08

Gritz Vaca Viviana

Viviana Vaca Ortiz

24/y old f. changed voice. 6 años. uno en cincuenta mil. Lo peor era las ultimas 5 meses. Can´t straighten her finger (meaning hold it still long enough) to touch the finger of the doctor. ¨Yaaaaaah¨. Approach the desk to take some datos for her clinica historia. ´´Ya senorita puedes volver a tu asiento¨ Podemos quedar aqui? As she plants herself against the wall and against the wooden framed painting behind her. It´s just that I´m dizzy. I have fear of the stairs. I don´t want to subir them.

Result: genetics (dominant gene). ¨Atrophia Cerebral.¨ Cerebral Atrophy con SCA. No treatment. What do neurologists do? ¨Yaaaaaah.¨Name things for which there is usually no cure. Doug did some research. MRI´s are expensive. And why gastar when no hay nada que hacer? We gave her some Ambien. 30 days trial. Now she´s gonna sleep all the time?

Bekka wanted to take her out for juice. I thought about thinking about crying. And then there´s reality, which star medical student Mayoka delivered to her as she sat in a chair al ladito de the waiting room.

Spanish. Medicine. People skills. A entonces mi camiseta dice Verano Experienca de 2004? ¨Yes, Summer Experience 2004. it´s from a summer camp in the United States. From the Edmonds Park and Recreation. A summer camp is where kids go to pasear y disfrutar su tiempo libre cuando no haya escuela.¨ Competence. $. Dollares American. Relationships. Follow-through. One in 50 thoussand. the generic name for Ambien is Zolpidem.

Tramites Fase Uno

quick notes on today:

Cenetrop took my blood. They are the only center that is "Immigration certified". yeah that's right blood for bolivia. i guess this happens to make sure i don't introduce any disease the country doesn't already have? i did have a nice conversation with a woman who was getting dengue blood tested. we bonded over platelets.

Interpol took my picture without me knowing (I walked into the Police Office of Foreigners to meet not my lawyer but my lawyer's helper) Upon my arrival lawyer's helper said to Official Man "es ella" translation: "That's her.. quick take a photo." Then in a more prepared state they took my mug shot followed by a sweet lateral view.

I learned briefly from my lawyer's helper that we are applying for me to obtain Permanent Residency for 1 year. I have only 30 days but i see the tramiting (paper processing) in action, so i think all is cool.

Tomorow lawyer's helper says "she will call me for the morning. together we will report to Petropaca (another Police office.. this is a placer name because at the moment I can't place which of the many police departments i have to report to).

yep.

Casate Raquelita... mas facil, mas rapido y conveniente

There comes a time when you realize how cool is a Jelly Fish -- how vibrant are its colors and how out of this world are its shapes. At about this same time you also realize it took you 20 minutes, of driving real fast on a major American highway, to put on your seat belt.

Since my last Blob I got voluntary kicked out of my latin american country of choice. After four intense months in Bolivia, I passed four predetermined, present and profound days in my country of origin. I hadn’t been ready to go back and I wouldn’t have been ready had the Heads decided I must stay. It’s cool that when I return to my country of origin, for good, only then will it become one of my countries of choice.

Quick notes on Miami: Concentrated chillin/calling/pleading/explaining and getting stamped. The Department of Homeland Security, mannn do they have a tough job. Just because every legit office on the Bolivian and American side tells you: “No.” and Officer Hudson of the Deferred Inspections sector of the Miami Airport tells you “"Girl, if y'all did this in my country I'd deport you and definitely not accept you coming back. When yas in the Bolivian jail don't come crying to me.”….giving up hope is not justified. . Gigantic glossy photos of George Bush in the entrance of a sterile office space make any experience extra special.

If you are ever bummed about the world think about this: one morn in Miami I ran into a lady (literally.. i was running around in Village of Palmetto Bay) and I asked her for directions to a park. basically she was pretty stoked to see me and help me. she told me "wow you're a pretty little pod. what a nice complexion you have. where do you come from?" these were nice questions and compliments as I had not been given nor asked such things before. when i actually lived in the states no one EVER said this to me. Oh yes and I think maybe she was expecting the response of “Mars.”

Also old people are great. Go to Miami Beach one day and watch for the wrinkled pot-bellied oldies in their speedos (males) and their onsey’s (pear shaped females). They will be tan. Walking their morning walk. oblvious to the world around them. And. Happy.

Break downs come and Break downs go

I got into Miami at 6 am Thursday March26. I arrived at the plush house of the fam of a friend at 7:30 am. I was on the phone being passed from office to office for the next four hours. Then I visited Officer Hudson. Then I returned home and needed to take a quick nap. I awoke to further bureaucratic directions. Then the business day ended and I took a swim. Finally I took a trip to the Bolivian Consulate to meet one Senor Javier the Consul General and this was rei successful.

I have a new job. (Senor Javier just also happens to be in the the health helping out his poor country business. Of course Javier has a Sillas de Reudas program. He's a very nice guy collecting and sending wheelchairs to his country of origin for those in need. He has a connection in La Paz that sends him name + location +need and he sends them a wheelchair from the states. He would like to extend the program throughout the country. I am gonna work with him through Santa Cruz and hopefully Cochabamba. Basically this means ANYONE needing a wheelchair (if I/we can find them), in due time is gonna get one.

I have an Objeto Determinado visa for 30 days. When I got back to SCruz I promise him I would turn my papers into a lawyer (a LEGIT lawyer, an immigration lawyer) and begin the process of obtaining a 1 yr work visa. He says I can't leave the country for 40 days and need to focus on this tranmites in that time. When I got back, I half did this. Ie. My boss promised me everything will be ok. I believed him the first time…. so now I will bug him every week about it, no tameness accepted.

I have been really illegal for 4 months. The advice that I got to come to Bolivia with nothing, and then to begin to work having only a tourist visa was very illegal. Senor Javier said I was not only enganado (tricked, screwed over) by the lawyer that didnt do the papers, but from the very beginning he said that I and we the foundation were working illegally. You dudes know I’m always happy to help. If this helps the foundation know the process and the Miami contact to do things legally in the future, I can be a happy princess chicken.

Senor Javier at first told me my infraction was large and there might be no helping (it seemed at first that the infraction put the Foundation in danger too). Then we got to chatting and he got on the phone with the Director of Immigration in the USA then in Santa Cruz. We're cleared on both ends. As directed, I acted very calm going through the airport and did not cause any trouble nor ask any questions. If I have any problems before my 30 days are up I was told to go to Senor Altamirana. He’s a dude in S Cruz.

Basically my being and thinking in Miami is one more part to the movie. i jumped in the pool of the mansion where i residing in Miami and then re-created in my mind the Paul Simon sound tracked Royal Tenenbaums underwater scene. I seriously wish my brain were always filming, or my physical would film as I do the directing. The scene in the Deferred Inspections office of Homeland Security (with Office Hudson my new favorite gigantic African American woman who has a really giant gun and could crush me in a nano second) is one of my current favs. and the other in the Consulate office when 4 different phones in 4 different rooms kept ringing in a place where there are only 2 workers and 1 phone line… another great.

cool well i'm stoked to be back. i'm really appreciative of the privilege I have to have such problems and usually come out ok. because i know if i were any other, i'd be jailed, stamped and sealed. talking to people around me in pretty much every office i've been in (people with drugs in their tummy, or emergency medical crises of which that can't afford to fix here), really helps place me in perspective--- not that i usually feel i allow myself to dabble too far.

love is interesting

Hay que...

Friends,

I’ve recounted how my experience has been overwhelming, bone-breaking (those of you that did a little research on Denguito recognize the entendre) and challenging in that crazy –this is Rachel thriving- way. I’ve forgotten to relay the awes, smiles, laughs and jokes that allow me to experience myself and my world in ways different than my previously known expression. Basically I think about leaving this job because it’s crazy and unfair. But when I realize leaving this job would mean leaving so many people and places and interactions I now know and love, I stop with such thinking.

This could just be the roller coaster speaking but ya gotta know that I love this place. I love every crazy thing that happens and how my mind has become so crazed and so accustomed to every roll that comes. At this moment in time I understand Bolivian logic (or logical American working in Bolivia) better than I understand Obama’s race and USofA’s recession.

I almost got deported on Friday night. No joke. The streets were processing Jesus’s crucifixion. There was this roof, there were Mike and I exploring the wrong place at the wrong time, unidentified and apparently in the end on my part, undocumented as a working citizen. After hours and hoops and bureaucracy and lots of Bolivians coming to my rescue, the police were still pretty set on me being “irregular.” You never ever think in a crazy country like this that a meeting with the police could ever lead to anything more than a sweet little cash-money exchange. I was joking with the Interpol police that deal with foreigners about computer solitaire, Mike wanted to order our new friends a round of pizza, I was whistling… anywhooo the deal is that I won’t write too many more details here. Something happened, or rather didn’t happen, with my visa. I’m not really sure my stance yet but Monday morn at 9 am I’ll be chilling with these police again. Hopefully I’ll be staying in this country and continuing with my work and continuing to not flinch at well ANYTHING (that is until I have time to process and then just flinch uncontrollably at inappropriate times…but will whistle when it’s all over, so it’s ok).

Well back to my good news: I’m basically here in an audition to be Ms. Indiana Jones. Not Indiana Jones’ Mrs. because that would be incredibly unsatisfying and genderingly limited. I want to be (and based on my adventures thus far I might already be) living the tales of Indiana Jonesina. i just have to figure out how to wear white in dusty situations and not get dirty. Thus far I’m a big failure at this.

Why do I love Bolivia and why to the American Docs that meet me here think that I have gone crazy (ie. “gone Bolivian")?

Exhibit A: The other day I was in a taxi with three volunteers. We were stopped in traffic when suddenly something forceful and loud collided into the back end of the car. From my position I couldn’t see anything but a helmet peaking over the trunk of the vehicle. The doctor volunteer in the front seat put her hands to her head and shouted fearfully “OH Shit!” The loud noise seemed to be getting louder and louder and a forceful contact with the car became constant. The taxi driver didn’t seem affected and the two other volunteers to my right side didn’t seem to know what was going on. Processing all of this information my mind immediately jumped to the following conclusion: A helmeted man with a chainsaw is currently stealing our bumper. We are stopped in traffic. I am in Bolivia. This is an unguarded vulnerable bumper moment. The taxi driver must just know this happens and must also know that you don’t mess with helmeted chainsaw men; One should probably just let them do their thing. I figured I should probably follow the taxistas lead and stay calm and stay put. Then the chain saw noise got louder and louder and my mind jumped to “uh oh I think something from the backside of our taxi is going to blow up… I am getting out of the taxi NOW! I exited the taxi to learn that a helmeted man on a Moto had crashed his motorcycle under our car, he was still on the moto with the motor running. Essentially helmeted man was being rammed further and further underneath the car. In the end: The moto man was ok. He was wearing a helmet which is really really amazing because usually the riders of motos are 12 day old babies, Cholitas (indigenous women in skirts) barely holding on, and a young teenage boy driver, all of whom are unhelmeted. Anyways we helped Moto man out from under the car, turned off his motor, asked him if he was ok and stood back while he gathered himself, turned back on his Moto and sped off through traffic.

Exhibit B: Most things in Bolivia take a really really really long time to do. Akin to me unexplainably almost getting deported on Friday, Bolivia is really wound in bureaucracy hierarchy authoritarianism and corruption. Anywhoo it usually a little bit annoys me when I have to go pay a bill at a hospital and it ends up taking 4 hours because I have to visit 10 offices, sometimes the same office two or three times, to receive signatures, stamps, photocopies, seals.. etc etc.. to get the authorization to get the confirmation that I paid a freakin bill. Oh yeah and throughout all of this you have to have connections and make friends, or your stamps and line waiting and time will be worth NOTHING.

Anywhooo… every once in a while things in Bolivia work out just perfectly and I couldn’t be more delighted. Like day when my horn on the SUV broke and I was bummed because driving without a horn here is pretty much impossible. Anywhoo I was told to find an electrista so Mike did that but they told him it was cost $60 American dollars and we’d have to come back after lunch. I don’t have too many hours in city before I take off for campo life again so I decided to look for a different electrista. I went driving down the car repair street looking for the appropriate store. A dude caught my eye and looked excited to help me so I pulled over. I told him about the horn, I popped the engine, he fiddled with some things, ran off to get a fuse, did some stuff with copper wire, replaced a part, Honk HONk and five Bolivianos later and I was on my way. This same day I needed to get a key copied and also not knowing where to do this started wandering a random block for a key copying place. I walked past this tiny greasy man working next to a tiny greasy wooden tool box. I noticed underneath some more grease a “I Copy Keys" sign.” This time 4 Bolivianos and 2 minutes later I had my new copied key. He copied it by hand so I was skeptical but still pretty stoked.

Moral of the story: The key worked fabulously. So don’t be skeptical by a greasy man a hand made sign and a moment when u give the man the original key and he starts to search through a box of a million unlabeled already cut other keys and u think he’s gonna lose it or just sell u some random other key and very possibly have mixed up your original key with the others.

The horn sounded fabulous at first but in the end didn’t work out so splendidly. On my two hour drive to the Campo the horn honked like a dream. I was delighted and certainly honking it up. A few days later there was a small fire underneath the trunk where the motor and fuse box live and after some confusion and non-functioning horns, lights and other things… we discovered that all the cables connected to the fuse box had been burnt threw and threw. We were out in the middle of nowhere as always but luckily two nice clinic patients did some burnt wire cutting and not burnt wire taping and with this temp job we made it back to the city safe and sound. The bill at the car dealership to fix this mess was $70. Soooo street electristas are cute but they are all about sketchy recreated bad fuses with copper wire. I still think 5 Bs was a sweet deal though.

Exhibit C: could be the 22 hour bus ride I just took to nowhere (well to somewhere) to wait all night in a huge line of semis and double decker buses to realize at the break of dawn there was a gigantic irreparable gaping hole in the road that because we were in the middle of no where would not be repaired any time soon. My first thought (cuz I still am American) was to turn around (admit defeat and go the 8 hrs back to the city). Not a Bolivian in the 3 miles of cars blocked up on either side shared this idea. Instead a bunch of men went to work with machetes to cut down the forest that surrounded the hole on each side to create a new road. This new pathway worked for about three gigantic semis packed with a herd of 20 cows each.. and then the new road looked about the same as the gigantic hole we began with. But again, stress, frustration, fear, no need. These situations are my favorite where I can hop out of my car or my double decker bus to survey the situation, chat with the people, stand and be with my hands on my hips (just like my Dad always did in any obstacle situation). Phew…..

I could go on and on. Do I have flawed logic? The Americans (you inlcuded) think so. I survive here and learn and enjoy through it. I stress only in the actual non stressful situations. Like when I get annoyed with American doctors or think I work too much or work all day (which sometimes includes sitting with caskets of patients that didn’t make it through surgery) and then come home to questions like “What are we gonna do for dinner?” It’s a strange life. But it’s an ok one. When they tell me they are gonna deport me… I don’t believe them.. or at the very least I feel like in some screwy way there will be some line-waiting, wire taping, smile because u learn to love the absurdity, way to keep the adventures coming.

CentroGrande

On the phone the other day my mom said to me “Rae, you describe your last three months like they were your last three years.” I don’t think I had a very good response. All I could think of was… hmmm, is this good or bad? This week out at the jungle I realized one added detail, I’ve been here FOUR months… and who knows if I remember the last three (in whatever time measurement they be).

I’ve talked about in this blob before how my experience with jungle city medical SUV commercial has been: Do, Complete, Conceptualize, Sleep a lil and Do it all again. Last time I was in the Bolivia I learned my silly sensitive soul got the best of me and is the most of me. I felt as I lived in the States I got used to my select surroundings of picket fences and non-dreaded non- street dogs. When I left on Thanksgiving day last year I was really stoked about road trip hats, wooden boats, Madonna dance parties, the reality of my life cutely paired with my state postliberal arts graduation.

Well folks on day 1 of Marzo 2008 the intensity of profound perceptive “I DO care” hit me again. Maybe its because I live in Bolivia. Maybe its because this time it was someone I really knew. Maybe it’s because I’m not a doctor and nobody is just a patient to me. Maybe it’s because I don’t know medicine but I know pained eyes and tubes and nodules connected to every part of the body. Maybe it’s because I have no idea how to resuscitate but at the end of the day I’m responsible for making sure a really crazy number of hearts are still beating.

I just realized four months have passed. I realized day one the work would never stop. I realized month four I get the same level annoyed with babysitting doctors as I get dealing with bone and body hurting patients and those that ask for a lot a lot a lot of help but then don’t comply when it’s offered.

Zoilo (the father of two of the girls from Palacios that I live with in SCruz mansion) fell off his horse yesterday morning in the campo. He rushed himself to the clinic where it appeared on first look that my favorite man of Palacios had simply broken his nose. He was bleeding like no other but a lil gauze and pressure and fall clean-up and the docs told me he’d be a-ok. I like to trust The Docs but again without medical knowledge, only buddy knowledge, I insisted we take extra care. I had a lil chat with Zoilo while he was all gauzed up and he seemed to be doing well. He was preoccupied about his horse and a lil worried about an intense pain in his chest but other than that still really good people as we say.

Less that 20 minutes later I was rushing him to the hospital. “Rushing” down a rain destroyed mud road a good half hour from the highway which is another half hour away from the nearest hospital. “Rushing” was the blood from his nose and mouth that god damnit why was it in such a hurry? “Rushing” were all the thoughts in my head—acquired medical, non-medical, emotional, physical, you name it. One doesn’t die from a broken nose, right?

I can’t place you in my world. You probably don’t want to be placed in it. Zoilo didn’t die. Even if I transfer him to a Santa Cruz hospital today, the likely hood of him dieing is slim. It hit me this day that all these people, 2 hours from the city, 1 hour from the closest barely functioning hospital, die in emergent situations. There is no other choice. Even if you make it to the hospital you bleed out on the Emergency Room floor by the time you wait for the doctor to 1. pay attention to you 2. write the prescription for the drugs you need which you have to LEAVE the hospital to go and buy 3. get the life or death xray you need (to determine whether you need to go into IMMEDIATE surgery) for which on Saturday you have to wait for Me (or whoever else would normally be me in this situation) to drive down random streets of Portachuello to encounter the house of the WITHOUT A TELEPHONE man that you personally ask to take and hopefully read the xray.

It’s a lot. I’m 22 years old. Four months have passed and I’m still 22. When I focus on the job I think I’m gonna go crazy because that’s what it is. But when I focus on the patients, who have names, and families, and worries and realities connected to their world, their resources, their knowledge, I revert to being emotionally raw (just like the first time I developed in this “developing” world.) It makes me like the job more and be more thankful for what I’m doing. It makes the job that much harder and that much more constant. Doctors get callous. One Doc told me to appropriate medical separation. They see patients. They see medicine. They see life, and death when their skills can’t save it. Another Doc told me that when I start seeing the same, it’s my time to leave.

It’s been 4 months. My self-proclaimed “I NEED a one week vacation” starts as soon as I post this Blob and go and buy my ticket to Cochabamba.

yyy la vuelta

Heeyyyy. We’ve been over my Dengue, my revolutions and revelations. I know.. BOOORING! Fret not. I’m going to steer this Blob back to where we started.

Feeling well blood-plateletted, I returned to the jungle grind this week. As all Wednesday mornings go, I rallied the troops at 7 am to start the next –from city to campo (countryside)- medical adventure. In one SUV enter 8 people and their overnight bags, tons of meds, groceries, hartos litros of potable water and my VIP guitar. The important task of careful cd or Ipod playlist choosing transposes and… we’re off! Driving here is a trip. My favorite is the constant back seat commentary from the newbie Americans. “Heyyy Raquel…digamos (do we say) that here in the Bolivs the red lights do not apply?. Just like everything else, I learn as I go and YEP I’d get in a lot of accidents if I didn’t learn quickly which red lights do and do not apply.

It’s always fun to get back to the clinic. Life is way more than tranquilo out in the jungle. Wait I fantasize. On the way to the clinic and deep inside the jungle… life is prob pretty tranquil. But in the spot that they cleared out for clinic, docs, impatient patients, emergencies, trauma and drama, alter the ambient just a bit. Have I explained yet about my dual existence? Jungle (Wed morn thru Sat afternoon) - tranquil surroundings, people who have never seen doctors in their life, silly bursting at the seams clinic. City (Sun thru Tues) – carbon-copy contrast to jungle life. Santa Cruz is the plastic-surgery fancy car shiny mall new money Miami of Bolivia. In the private city clinic (the pride of my Bolivian doc and boss—and where I meet campo patients every Mon and Tues for further care) my joke is that when I finish with this job my bono bonus will be the same as everybody else’s… new breasts, new nose and why not? sure, throw in a new tummy. My joke in the Campo is ha ha, uhhhhhhhh you have cancer and need chemotherapy and we would have to close our clinic to pay for it. Uhhh your gonna die kinda soon. Luckily you don’t know what cancer is and you think there was a strong wind, a stronger rain, and that your bones hurt as a result. The doc gave you some aspirina and now we’re all smiling as a result. ~? Not all patients’ interactions are like that. Cancer and chemo of course are worst case scenario. We also help save people in a moments notice… without them ever knowing what would have happened had in that moment we hadn’t been there.

Each week clinic arrival is kinda just like the movies. Up pulls the white man in the modern SUV to save the day. No kidding, it’s only half like that. The travel is as follows: 1 hr of traffic and road construction autonomia, 40 min of amazing scenery, 20 min of Palacios’ bumpy/muddy/often flooded road. Getting there is always a happy moment. 1. I can breath a sigh of relief that we arrived safely. 2. It’s the jungle for goodness sake. It’s cool to roll up and see the awaiting Micros, taxis, a horse or two (the mixed transport by which the patients come). And the welcome back greetings with our clinic buddies are always warm and loving. My post-dengue return made it all that much sweeter.

Ok readers here’s the agenda for next Blob.

n Character profile of “clinica buddies.” Character profile of life actors in general

n Realization of how my life is akin to a taxi driver. But not at all in the chauffer or even transport sense.

n Realization of what my deal is about context. In language, jokes and how I live my life

n How I am getting really excited about the movie I’m gonna make one day. How when I walk down the street all I can think about are fascinating slow contextually without context movie scenes. And how I feel that I might be living inside the movie right now.

n This weeks’ story about how the clinic’s horse has disappeared/was stolen (we had two), the casero clinic caretaker/security/fix it man announced his resignation, how Dona Maria is a nut job and her words can’t be trusted for anything, how the Nuns did an unexplained emergency appendix operation on one of our patients (and did 4 more that night on not our patients), how the lab tech we have just “doesn’t show up” for three days, how the Portacheulo doctors we work with are also problematic no shows, how the Founders just announced construction plans to build a $110,000 new dormitory to “accommodate the gringos”, how I don’t get how a non-profit in financial and personal crisis can be SOOOO disconnected from the real-world……..how little Jefa Boss Rach has lots of important conversation about work, ethics, life, feelings, passion, shame, respect.

And I love you all.

ps.

scripted post: when my grandmother was in the hospital with breast cancer, laying in her hospital bed hooked to an IV, the first thing she told my visiting mother was "lucy, i've been trying to tell them, they just don't listen. my arm is not hungry anymore! "

moral of the story: it's in my blood.

"Raquelita, despierta!!!

What is a wakeup to me, you probably already know. No one wants to hear “Dengue has been good for me.” It’s trite for me to say my fall helped me to feel the ground. Nonetheless, I want to let everybody I do know what could, could have and is happening to me. I know how it feels when I write to you. I also know how it feels to live my life (especially now after being knocked over the head long enough to be forced to process). I still don’t know, although I’ve got a few good incites, on how it might feel to receive my scattered, stoic, flippant smatterings of updates.

I’m sorry to have worried you. (Not about the worry that was in-order but more the build up worry my stories create). I’m sorry to convey really important things flip and on the flip side. I’m sorry that something about me comes across as dangerous and too accommodating to unacceptable life measures. I feel the love and the reality-check. However I have to say that what I write is not crrrrazy different from how I am living. I am as aware enough about my situations to deal with them as they come, and YES to tell the details LATER. Don’t worry, I l haven’t changed. I will always be hyper-aware. Yes I take worry and risk and envelop it in adventure, jokes, uniqueness and possibly a semi-sick fascination with the struggle of survival. I am only as disconnected to make it through to the next day, knowing all the way through exactly how much my connections are worth.

The Dengue allowed me, made me and everything around me STOP. Instead of 1 besito (little kiss goodbye, I got 8 from one person.. por si caso just to make sure. All of a sudden a really fast, really stressed, really productive world went quiet. Planted in my bed my accomplishments went from trying to micromanage a non-profit poor people’s HMO to trying really hard to animate the stricken eyes and pulse of my number one patient.

Dengue or not, we all are existing in drastically different worlds. I try to convey where and how I inhabit foreign spaces and places while recognizing the gravity of existences and at the same time sharing the not-so-different (roll with, bounce back, entertain the ride) Rachel approach. Dengue wasn’t a joke but you better believe I was joking the whole way through. Yeah there were times to worry. I worried, I cried, twice I think. But yeah I feel proud for the most part that I was the one making sure my doctors (and frightened onlookers) didn’t get too stressed out and learned and felt the experience (on many levels) as much as I did. I was told “Man you’re Dengue sucks… but jeez are you entertaining and enjoyable through it.”

So this is the deal.. I’m not some crazed egotistic comedian/tale teller who ignores reality and feeds off the hilarious disconnection. As I struggle through the Dengue, or get harassed by cops, or understand realities I would wish didn’t exist to understand, my jokes, my suppressed worry, fright and meta-commentary ARE my experience. They aren’t to dupe, divert, dismay. I told jokes in my Dengue cama bed to keep me (and later us) going. I’m never existing in this world alone, so the reverberated smiles and energy of those around me got me to the re energized smiling and energetic state I’m in now.

I’m all better, platelets are up, the Dengue got the beat down. Dengue can strike again (there are 4 types), and worse on the repeat, this I know. Thank you for your support, and how u give when I don’t know I need it. Thanks that this life is kickin… and yes I taunt it, and yes I think I have it all under control, and yes I’ll keep telling you to try not to worry. Understand me as much as I don’t understand myself. Disconnected from you or myself I am not. I am gonna try to think more and have quiet without the Dengue and have balance and circular strength unity cuz that’s what it’s all about.

Ps. I really like memoirs.. i always have. So, I'm practicing. It's ok that I'm as fascinated by the writing as fascinated/mystified as you all are by the result.

A lil song to the tune of the Dengue

hello dearly beloved,
here's a little song i rewrote. based on the diddy "both hands" by Ani Difranco.

my version "Dos Medicos" tells of my last lil adventure (Sat night to the ongoing recovery of today) no worries about the details. i was sick. pretty sick. we were worried. yep a lil worried. but now i am on the blissful and carefully monitored road to recovery. in post-acute stable condition Dengue Fever i am: 1. amazed at the security of my medical care (with the bolivian connections and the american volunteers i am as taken care of as i will ever be) 2. incredibly educated on one more lovely detail of life 3. wiser beyond my years once once again 4.humbled and rooted by the reality of it all 5. thankful to be alive

Dos Medicos

I am walking
out in the jungle
and I am visited by the aedes aegypto
mosquito again
and I am getting the Dengue fever
and it can't let it go
but I will get through...
a tourniquet test behind the dark curtains
and the open door
on the second floor
he’s looking for many petechiae
to see how long our coordinator can last
and dos medicos
I need dos medicos
oh, I can't open my eyes

I am counting
platelets in your body
I am reading about Dengue
And how few have died
How few have died

I am watching your pulse rise and fall
like the cells of my life,
and the pain of it all .
and your bones have been my breakpoint
and your flesh has been my fall
I am waiting for DEET
to offer up my keep
ohh dos medicos
*I need dos medicos
oh I can't open my eyes

but in eachother's hearts we grew less and less small
and eventually the laboratorio couldn't explain it all
and I'm recording our history now on the clinica wall
and eventually Dr. Douglas will come
and solucionar it all

I am walking
out in the jungle
and I am visited by the aedes aegypto
mosquito again
and I am NOT getting the Dengue fever
and I can't let it know
that I will get through...
So now use dos medicos
please use dos medicos
so you can open your eyes
I am counting
platelets in your body
I am singing about Dengue
and how we survived
I am singing about Dengue and how we survived

paso a paso

heyyyyahh,
here's to letting you all know that all is a-ok. sorry for the lil' lapse. i haven't been in town, had enough time, nor felt grounded enough to write a real blog. my current "grounded" state shifts between planted and floating at all times. my equilibrium hasn't balanced quite yet.

everything is going well but i've been feeling stressed lately with the incredible weight of it all. my shoulders are creeping dangerously above ear level, so yes, i'm a little tense at best. the job is amazing and at the end of the day if i can focus on the small successes, that warm cozy feeling should envelope me inside. unfortunately i don't work like that. when you present me with a task, i see the task in 3-D plus an unlimited montage of invisible sides (first simplicity then history, social context, future, bureaucracy, heir achy, challenge). this makes for a long day (a given) and my mind and go-getterness makes it even longer.

Scenario: 1 lil jungle clinic. cute. friendly. open. lots of poor jungle people. cute. friendly. open. a service that asks for nothing and gives everything. a clientel that asks for everything and gives nothing. lots of docs...smart. little to no staff, social work, accounting, standards, policies... really stupid.

Centro Medico Humberto Parra is a cool place, and an even cooler idea. As far as I observed, we give the shirts off our backs. We're they're for the people in moments of need--- the gravity of need scale is completely open. We do this and it makes some people feel good about themselves. It makes some sick people actually better. We also do this and it makes some people, who need to replace the shirts, re-energize the backs, and make sure this process happens over and over again, feel really proud but really exhausted. It makes some strong, visionary people say to themselves pretty much everyday "Op. I do think I've gone cross-eyed." Oh yeah, the some people is Staff Member Me.

So that's about where I'm at. It's hard to explain. There be--- 100 patients half in great need status, half in "I take advantage of anything given for free" status. 4 American docs who know a lot and complete immediate tasks. 1 Bolivian doc who knows a little but attends to a lot. 1 nurse who is non-licensed but passionate, giving, and culturally knowledgeable. and then there is me.. for, no joke, EVERYTHING else. Meds, resources, logistics, patient follow up, patient politics, patient need, emergencies, hospitalization, exam transfer... (list length undetermined).

last week I chatted with Don Julio (president of all the Centro Med health groups serves). he told me two interesting things. 1. when researching how to socially classify the people we help he offered this standard: Bueno. Normal. Malo. Good, Normal, Bad.. those three words soon will determine who can pay, who can help, and who needs us the foundation to cover it all. 2. Don Julio ( an amazing wordsmith by my standards) also told me: "You people are like cows. You share a really giant organ." Cows have big hearts. According to Don Julio (despite the struggle and the confusion I feel everyday) apparently I do too.

The Americans are cute. They call me La Jefa (the boss lady) or La Jefa Spice (the boss lady Sporty Spice) and support me in a lot that I do. They can't really help most of the time but they seem to respect their time is but a glimpse into this reality. The Bolivians are also cool. They do their part and do it well. The exhaustion is that no one else but me is there to experience it all. I feel like I'm always working. I basically always am. The good news is that I've had some distraction (half Boliv half American), I really like Regaeeton, I've been playing a lot of guitar and sharing my voice and finger pickings with others. I'm working on balancing Gringo and more permanent life here. Cambas (Santa Cruz people) are funny.

Carnival is coming. It starts tomorrow. American Founders One (and hopefully Two..Dr. Molitch was not let on the plane from Miami because his yellow fever card was not written in Spanish) arrive in a half hour. 5 more Gringos arrive tomorrow (there are already 5 here). Again this all sounds fine but the more people, the more questions and planning and 24/7 WORK for me. Ps. we don't have enough beds, enough work spaces, enough car seats for this many people. The founders will be here. I haven't done much to solucionize (word in Spanish) cuz I want them to face the facts.

I wrote a really serious agenda to discuss with Founders (Number 1, Number 2 and Bolivian). It covers everything from "this is great to this is totally unsustainable to I am willing to work and give to you but your gotta make some changes to make my work and giving supportable." I plan to call a meeting for an organization that in 7 years has never paused the helping to make efficient and and standardize the help that we give.

I'll let you know if I'm successfully in getting them to pause to discuss such things. They tell me step by step and cool it Gringita Coordinator girl. I agree. But if my legacy here can be to make 1 or two tiny changes that makes the next person's job (and the Bolivians I work closest with) a little less head-splitting at the end of the day, I'm gonna try.

Ok I'm gonna go relax. And play guitar. Or get a call and have to go pick up the founder. But either way music (my own or de Reggaeton) will lead the way. Well one way travel... until the Founder (really prestigious American Med Head) is sitting next to me.

Love biggg hugs.

You Say ya Want a Revolution...

hi kids and baby goats,

I hope all State Side is sunny up. I’ve heard it might be cold there, REALLY cold, so I also hope everyone is drinking their Cocoa with Marsh mellows. But not the mini-marsh ones because if you live in MN those don’t count. Right now I am drinking some re hydration salts so we’re even in the substances ya don’t really want to be drinking game.

So a minute ago while awaking and elevating myself from my bed, I had all the brilliant intentions to blog my latest revelations, revolutions and rotations. Now that I’m sitting up and facing the computer I’m feeling a bit more flushed and suckered of energy/spirit than expected soooo here be the short and sweet:

Revelation: When it rains, it POURS. Or atleast if I remember correctly I think it’s been a pretty heavy cats and dogs since yesterday at 5 pm. And yes, I write literally of falling rain. I woke up asking myself the question (in Spanish) "on what ocean am I floating?" This might be a bad sign in a landlocked country butttt hopefully the jungle roots and mango growth will soak it all up. Oh yeah and there was totally a lightning and thunder loud and bright enough to have possibly have hit my bed. Be glad I’m not a horse cause I was spooked.

Revolution: OK, sooo my week out at Palacios jungle clinic was a bit rough. I have survived or am in processing of surviving, so no worries on the thinking about worrying. i´m getting over a lil sick stuff, a lil delirium, a lil sweating it out then shivering it away. more details later. i think i´m up the up and up. i had currently forgot the reading of a normal body temperature.. but i think today i´m gonna remember. As of last eve i´m back in city and coming back to reality.

The fun details basically went down like this:
Wed: A good day. Fun not rough. 9am- We arrive almost to jungle where workers have created an open canal about 3 Km before reaching the clinic. I park our auto behind the 2 patient Mini-buses and we begin the trek by foot. Patients are pretty into their free Gringo care so they are willing to hike out… hypertensive, enfartic, one-legged, an all. The gringo docs loved this… walking down a jungle road with groceries and stethoscopes in hand. That’s what we at the Foundation like to call Creating Memories☺ (aka I just made that up). Anywhoo I made half the trek and of course was into it but then of course cuz I’m coordinator and have additional (can be replaced by ALL) responsibilities I got to join Miguel in the horse drawn buggy to do cooler things. I think we may have moved at a slower pace though because 1. The horses are skinny and 2. Damnnnn it’s hot here. 3. Miguel told me it was because Number 1 (the horses are named #1 and #2) is lazy. I didn’t believe him. Anyways his 1 yr old son Miguelito is now my buddy, so the trip was a success.

Anyways so that was fun times.. I got a little sun burn and then put some DEET bug repellent on and then my skin acted like a crazy reactionary… butt just a little burning sensation and a lil extra red and a few docs monitoring me with some trace lines and all was swell.

Thursday morn to Sat afternoon: I guess the sprinted mile of the story would be: Raquel now has a ficha (chart) at the clinic. It was not half bad times. The American docs were incredibly attentive and careful and the Bolivian docs wanted to admit me to hospitals and stick things in my arms and give me lots of drugs (luckily we didn’t let them do that). I was kind of out of it most of the time but in retrospect it’s a good study in what’s what with the med care.

We don’t really know what happened but basically I had a very high elevated temperature, a pressurized headache, the hot colds, the sweats and shakes, the your in a sick state blood pressure and pulse...all the elements for a red faced, bleary eyed and headed me. As we all know it’s rough to be sick, and sometimes a lil more rough to be sick in the jungle.. but my peeps were good and stayed strong right along with me.

My blood tests were normal so we don’t think it was any of the Big Names in tropical diseases. Yesterday I inherited an added stomach bother which we are now blindly treating. Although it’s not really helping me build strength my temp is down and controlled this is GOOD, I’m force feeding liquids also GOOD, and I’m on Mandarin Fushia terrorist alert level should anything begin to go down hill again.

So, yes when I say I’m fine, I’m living enough to say it. Tranquilo, no mas.

Dangit in all that I didn’t get to my great Revolution story.

Round Two Revolution: I can’t remember what night but who knew delirium could be so awfully satisfactory? Basically I was feeling like my world must be ending and this pressure in my head must need to explode at some point. I left my 4 bunk bed room at 2 am to recline on some wicker furniture for a change of scenery. As I approached the wicker furn with my crazy temp and crazy head pressure I decided that I must start the Revolution. In retrospect, the Revolution was to be a mix of social and medical revolt. I was on this course of revolution-starting for three hours. At 5 am my entire body was suddenly covered in lakes of sweat and during some intense shaking I noticed my head pressure was gone. I couldn’t have been a happier cookie. I knew the Revolution had come. Later I couldn’t have been a colder cookie for the lakes cooled off very quickly.. but still interesting times.

I told this story to the docs in the morning and they immediately had me in consult. So yes I was very sick but mannnn besides the whole jungle thing, what a better place to be cared for?

Rotation: Of course I kinda had to work throughout all of this sweat, shiv, and delirium. Today I’m resting up more or less with a few tid bits here and there. I wanna go to a soccer game and if rains subside this will make me feel better. Yesterday in the middle of a night I got a call from a patient with a posib. dying old mother. I felt bad that I couldn’t jump out of bed to help her but I’m also starting to think there’s gotta be some limit to the craziness. I can be strong, but I gotta have the reserve to do it… yes yes?

Kiss, hug. Until the next jump:)

Ya, Con Anima y Ganas:)

The other day I was running down a dirt jungle road. And a different other day I was laying in my bed staring out an open jungle window. Both of these times I was REAL excited. Within these moments I realized the amazingness of my surroundings, physically and experientially. I also realized that what I see is not always what there be. Basically the point of my circumvention is to state that one day soon I am determined to spot a monkey in a tree and not have it fly away. So far each excited monkey spotting has actually been a false monkey yet real (in the end equally cool and more colorful) bird spotting. Do you get me? Lions, tigers and bears, not yet. Monkeys, yes, but they are hiding from me. Birds and super cool guide owls galore. Oh yes and speaking of spots, my extended torso area has been invaded by red dot aliens. I asked the Docs… and they said besides my rare sensitive and overly active blood vesseled skin condition (that they think is cool cuz you can draw the letter D on my back and it stays a clear D for a record amount of time), I’m gonna be ok.

So how’s the job going? I sat down to blog it up on Jan 7th to pronounce my one month survival point (and to reward myself a shiny #1 Best Crazy trophy). It turns out several minor emergencies prevented me from posting my excitement and awe at that particular moment.. Side linguistic note: Urgency seems to come up a lot in my daily responsibilities. The word emergency yes still means the same thing but is dealt with (by me) on a much more tranquil, matter of fact manner than I EVER would have imagined.

All in all, everything is going well. Let’s just say, in a short time I’ve learned a long distance and I’m in buen camino (good road) to discover more. I can’t remember (through ambulance trips, patient deaths, political blockades and holiday break) whether or not this past Wed-Sat was my first full week out at the clinic (jungle/Palacios). I’m pretty sure it was. After the break I received my new group of Medical Gringos. They are a small, good and valiant crew made up of 1 retired doc of maybe 70 plus years, two 4th yr med students, and one non-medical volunteer. (We would have more but the current political situation has prevented other less valiant volunteers and their Universities from permitting travel to question mark Bolivia at this time). This group’s level of Spanish is high which makes for a pleasant and consistently immersive experience for all. I know it’s really hard to explain and really hard for you to imagine what it is that I actually do here. It doesn’t make sense but pretty much everything that goes on I coordinate and pretty much any decision that needs to be made (besides the medical diagnosis) I control. In relationship to the Medical Gringo groups I pretty much always feel like I am the mama of 8 or more kids. I drive, I announce the time and manner of departure and arrival, and I give the directions, field the questions and deliver the answers as best as I can. Not only to the Medical Gringos but to pretty much everyone connected to the clinic (besides Boss Man Dr. Doug) I am the “Si, se puede” Yes you can or No you can’t” authority extraordinaire. My job does have a lot of power and responsibility but unfortunately everyone assumes that I have the answers and solutions to everything, no matter if the problem discussed is my personal responsibility or even related to my short time here, or not. This is a constant challenge but as all manageable in that crazy way.

The jungle clinic week was good. Friday was another “If I survived this I can survive anything” day. 100 plus patients, 1 urgent surgery, 1 emergency surgery, 1 straight up emergency and ZERO minutes of phone credit (for god knows what reason) made for an action packed day. Horse and buggy is quite the invention. Telephone technology still leaves a bit to be desired. Things at the clinic are kinda basket case at the moment. I’m stuck with an empty pharmacy, poor and unpredictable community organization (of the villages scheduled to come--- Thurs we had 10 patients. Fri we had 120. The number of doctors scheduled was exactly the same.), and lots of questions that lead to the expectation that I will fix it all. Head honcho Dona Maria (the listed above tasks are in her job description, not mine) is leaving for vacation on Monday…good timesJ. It’s always a bit stressful but I do my best to keep my cool, guide and help people when I can, take on extra work if my time allows and tattle troubles to Boss man and Stateside Founders (ie. I’m not supposed to be an authority figure in this manner). With the energy I have left, I leave the rest to fate and jungle tranquility.

Oh yeah and the social world in Palacios (jungle clinic) is well set. It’s common for the Gringo Clinic Volunteers to play scheduled volleyball, basketball and futbol games for night time activities with the entire village. We had our first fulbito game (soccer on a cement court) Thursday night. For the game I “estrellanar”ed (used for the first time) my new zapatillas, indoor soccer shoes I bought with buddy Zoila in the market. It was a pretty fabulous time and all of Palacios is quite surprised that their new gringita Coordinadora is no foreigner to the fulbito skills. The residents of Palacios have some mighty skills themselves. Anywhoo Wed. night Basket, Thursday night Fulbito, Friday night reunite all at the “neighborhood bar” aka the palm roof mud hut on the dirt road to the clinic. It is some dude’s house with the words Bilar painted on the side. I hear when people arrive he happily brings out a table and serves some cerveza beer and all have a great time.

My patient and hospital work in the city (Mondays and Tuesdays) is going well as well. I’ve streamlined my operations a bit (and am well on the way to making buddies with all the right people) so those days are equally busy and fun when I can take a moment to dance and enjoy through them. I’m getting into the Camba (the Santa Cruz) way and have totally realized if you expect to get work done you have to put in an equal amount of concentrated play time (jokes, gossip, chat, saltena eating and juice drinking). It’s sort of like people here in the tropics need to be warmed up first (don’t ask me why, it’s the hott hott summer here) before they are willing to entertain work ideas. Now that I’ve got the job more or less down, and have made a peace pact with the always emergent craziness… my next goal is to start my life life here. I’m scoping out some friends and will do my best to animate and explore when the “work” day is over. I have offers to go out dancing, explore the city and the upcoming carnival celebrations. I haven’t really felt like I have much time outside of work but hopefully soon I’ll feel comfortable enough to take on the extra social challenge. I’ve received lots of Coordinator Survival advice from Bolivians and past-Coordinators. The recurring theme seems to be separate myself from work (this includes the gringos who come and go) and find something in Santa Cruz that’s for my enjoyment and distraction. My time in the city is short but I’m all about finding a balance between work and play. So far I’ve had two café dates with a friend, and 1 evening of Carnival procession with Tesoro (super sweet and helpful secretary at Galene-clinic in city). It’s a small start, but paso a paso (step by step) I’m always on my way.

Love and lots of it. Happy stateside and Go Barack! Or I haven’t read the news in a few days, is he still in style?