After a week of EORs and lectures, 2 of my classmates and I headed from SF to Miami to Bolivia for our 6 week rotation abroad. Once we landed, I immediately felt the effects of the altitude. La Paz sits at 13,000ft above sea level! Cue SOB, slight tachycardia, and fatigue. 24 hours prior to our flight we started taking Acetazolamide (Diamox) for altitude sickness prevention.
If you remember your pharm, you’ll know it’s a carbonic anhydrase inhibitor/diuretic (read: not fun for long flights). Perhaps the strangest side effect we all felt was numbness/tingling which would begin suddenly in different parts—one foot, hands, eyelid, upper lip lol. After 2 days, we discontinued it & for the most part it did prevent altitude sickness, despite some mild headaches and shortness of breath. Nothing some mate tea couldn’t fix.
Its been 3 weeks since we landed, and I’ve been immersing myself in the culture and exploring as much as possible. I’ve been trying my best to document portions of my trip and rotation, but we’re often reminded not to have our phones out for safety and respect for the Bolivian culture. Duly noted.
As many of you know, this is my public health rotation. I’m in clinic half days, mainly because my public health preceptor is a doctor, so she takes me along on rounds & outpatient clinics. Its been interesting to see how diseases are managed but sometimes also very heartbreaking due to lack of resources. The rest of my time here is more focused on research.
So what exactly are you working on?
I’m working with a non-profit organization and their network of clinics to implement a novel type of health insurance in Bolivia targeted towards individuals of non-formal sector employment—such as small scale agricultural workers and street vendors who otherwise have no access to managed health insurance policies. According to studies, only 37.1% of Bolivians have health insurance, leaving the rest to pay out of pocket or not seek care at all—the latter being most common. Unfortunately, limited access to care affects the most vulnerable populations, and a catastrophic health expenditure often leads to a further fall into poverty, one in which individuals find it hard to recuperate from. With this health insurance, individuals are offered a policy with premiums relative to their income. The most common premium is ~10 US dollars/month for coverage of a household of 3.
So you might be thinking…how hard must it be to implement & adopt this? Low premiums…100% coverage for doctor’s visits and meds? Who wouldn’t sign up? Well..it's been a struggle. Insurance is not part of many people’s lives here; many would rather hedge their bets instead of pay a monthly premium for a service they may never use. This is where the public health aspects come into play--education, outreach, and other financial services offered through the non-profit.
How are your days spent?
It varies. For the most part I’m in the non-profit organization office in the mornings, followed by clinic in the afternoon. My daily assignments include creating/revising medical protocols, collecting and analyzing data regarding utilization of services, visiting clinics to ensure quality care, educating individuals about the importance of health insurance, and speaking with patients to see if there is anything we can do to improve services. I’m also working on designing a new aspect of the project which involves opening up the health insurance coverage to more individuals.
How do you like your MPH work compared to your clinical work?
For me, nothing compares to time spent in clinic/hospital. Spending time with patients, managing conditions/diseases, working on puzzling cases..this will always be the most exhilarating. I love medicine and connecting with people, so at times (especially when I'm doing data analysis or theoretical application) public health seems a bit distant. But, I know it is just as important and impacting lives at a large scale is a nice change from the one-on-one in clinic. It has been a wonderful experience thus far.
Alright, that's all! I have to go finish some assignments for this week which include plenty of data collection and analysis. In clinical news, I’ll be visiting a children’s hospital this week so I’ll keep you updated. Thanks for reading. Ciao!