Salar de Uyuni (Salt Flats of Uyuni)

I have now seen the sun set over 12,500 kilometers of pure salt.

The salt flats of Uyuni are one of the most spectacular natural formations that I have ever witnessed. Surrounded by mountains, the Salar appears to be a giant lake of salt that at parts goes down more than 50 meters. Currently they use the salt for commercial production (to be used in food) and also to build Salt hotels on the flats for tourists.

(view photos HERE)

http://www.facebook.com/media/set/?set=a.10150332206411718.393655.504936717&l=02fe39fa9e&type=1


We took a bus from La Paz overnight thursday night (about a 12 hour bus ride down to Uyuni). The first 7 hours or so were perfectly nice and smooth, but then things took a turn for the worse, as the road became unbearably bumpy. The rattling of the bus sounded like a machine gun, but I was actually able to turn the experience positive as I simply imagined that I was in a massage chair and that helped ease the pain for a bit. As we neared Uyuni the windows completely iced up, and thus when we actually arrived no one wanted to get out of their cozy blanketed seats. The town was basically dead at 7:30 in the morning and we rushed to find our company in the freezing cold. The town clearly was clearly built around tourism as the main street was lined with tour agencies -- one of which was ours. We ate breakfast and then met our guide (and the three Brazilian ladies who would join our group), loaded up the jeep and headed out.

The first stop on our journey was the "train cemetery," which was exactly how it sounds -- a graveyard of rusted old decaying trains. By itself it probably would have been a pretty cool sight, but unfortunately it was absolutely littered with tourists clamoring to get a photo of themselves standing on top of the train, and thus it lost a little bit of it's appeal.

Our next stop was the salt flat itself, which was overwhelmingly expansive. Everywhere you looked was miles and miles of white, flat ground. We took our standard tourist photos (including several trick photos that used the hindered depth perception) and then headed on to the salt hotel where we ate our lunch. We then drove for about 2 hours all the way across the flats towards the base of the volcano Tunupa where our hotel was located. We drove over several different formations of the salt, including salt formed into thousands of tiny cylinders that poked up, beautiful hexagonal formations, and my personal favorite, salt with a two inch layer of water on top which reflected the surrounding mountains with absolutely perfect clarity.

When we approached the land at the base of the volcano, as if we weren't already in a strange enough dream world, we saw a flock of pink flamingos posing outside our window. The flamingos were so majestic and composed that I had to remind myself that no... these pink creatures weren't actually a normal sight...

We arrived at our hotel, unloaded our gear and then walked around to take pictures. The town seemed to be built with simple stones stacked on one another, and in one of these stone enclosures we found a pack of llamas, of which we took about 1,000 pictures of (for your convenience I've eliminated a lot of these pictures from the facebook album). We returned to the hotel for coffee (and a game of hearts to pass the time) and then dinner, which was soup, spaghetti, bread and a bottle of wine. When we had each had enough wine to warm us up a bit and make us a little sleepy, we put on a few more jackets and our gloves, scarves and hats and headed to bed (the nights there got absolutely freezing and our hotel had no heating).

The next day we woke up to watch the sunrise over the mountains and then headed out to the volcano. We walked to a cave where Incan mummies were buried and then had a chance to hike up to a viewpoint, where we had fantastic views of the flats and of the volcano itself. Next we drove over to Isla del Pescado (fish Island) which was another bizzare sight -- a small fish-shaped island absolutely covered in cacti.

As we drove back to catch our bus in Uyuni, we were able to pause for a bit to watch a spectacular sunset over the salt flats.

I definitely caught the travel bug on this trip, as I feel like there is so much of this world that I have yet to explore. I also was once again reminded (and overwhelmed) by the absolute beauty and diversity of landscape that Bolivia has to offer. From miles and miles of salt to volcanoes to the world's highest lake, to incan ruins to cities like La Paz, there is so much to see here.

Speaking of, on somewhat of a whim we decided that tomorrow we will embark to climb (literally climb) Mount Huayna Potosí. It will be a two day trek, hiking to high camp tomorrow, going to sleep around 6 pm and then beggining a 6 hour trek to the summit at 1 am. We'll hopefully be able to observe the sunset from the peak, which is situated at 6,080 meters (19,947 feet) -- higher than Mount Everest Base camp. It's going to be one of the toughest hikes of my life... But I am so pumped. After all, when will I ever get another chance like this?

As they say... When in Bolivia....

General Pediatrics with Dr. Tejerina (and Patch Adams!)

Last week I was with Dr. Tejerina in the general pediatrics ward. She is a fantastic teacher and is extremely enthusiastic about the work that she does which is fantastic to witness. She works incredibly well with kids and you can easily tell how much she loves young people.

On a normal day I would help her take notes on the patients and also help interview the patients' mothers about 4 things: how the kids are eating, if their vaccines were up to date, how they were born (normal birth, c section, etc.) and how they were growing (is their height/weight, etc. normal). Tejerina deals a lot with Down Syndrome patients, and she taught me how to identify a few early signals, including the lack of a joint in the pinky finger, a line dividing the big toe from the others, heart problems (present in about 50% of Down patients) along with the basic signal of slow development.

Tejerina also dealt a lot with intoxications/poisons, and on our second day we say three different patients with three different poisons. One was an iron pill intoxication (they're used as supplements for pregnant mothers and are easily mistaken for M&M's), another was pesticides and the other was a calculator battery stuck in the kids nose. On this day I also helped translate an english textbook that described these intoxications.

The third day was specifically dedicated to Down patients, and I watched Tejerina advise a distressed and panicked couple who had a baby with Down that the diagnosis "opened a door to a beautiful new world", and that if diagnosed early enough, the hospital can help speed development as fast as possible so the child will have as normal a life as was possible.

On the first day we only saw a few patients as Patch Adams (the real guy that the movie is based off of) visited the hospital and so we ran to try and see him. He was dressed ridiculously (see above picture) and he really seemed to be able to connect well with the kids. He gave a talk in which he described his hospital which was free of charge, that required no insurance and that paid all of it's workers (from custodians to doctors) just $300 a month. For forty years, he "paid to be a doctor". While his talk was relatively broad and spoke of generalities like love and care (and was also painfully anti-american) I really do respect what he's done with his hospital and what he continues to do all around the world. He preached compassion and patient connection in hospitals, also saying that "the saddest thing that was last in the US medical world was the house call."

Photos for Last Post!

Here they are:

http://www.facebook.com/media/set/?set=a.10150331954481718.393564.504936717&l=c8a3cd1408&type=1

Enjoy!

Día de La Paz and The World's Most Dangerous Road

This past Saturday, the 16th of July was "La Paz Day", a day to celebrate the citizens and culture of La Paz. Most of the festivities went on the night before, however, and so at around 6:30 Friday night we went out to the main street of La Paz, El Prado, to observe the celebrations. The street was packed with people, and we saw many groups of Paceñas (citizens of La Paz) marching by with bands playing and lots of people watching. I tried Anticucho (beef heart kabobs) and a special drink that is really only served on holidiays that is made with Singani (a grape brandy – national drink of Bolivia) warm milk and egg whites. We also grabbed ice cream and watched as many cebras (people who man the crosswalks dressed literally from head to toe as Zebras) ran past. We headed down to the Stadium where there was a pretty cool Bolivian band playing and a really large crowd all drinking and celebrating. Unfortunately we couldn’t stay out too late because we had to get up early the next morning to go on the bikes.

On Saturday we woke up early (around 6:30) and had breakfast at Alexander café before heading out on our drive to El Cumbre (Spanish for the Summit) where we began the most dangerous road bike trek. Our guide was a really cool guy from Asheville named Phil – he was also a stereotypical Asheville native (long hair, scraggly beard, had been doing outdoor activities since early high school). He and the Spanish speaking guide, Javier, were in charge of 14 of us bikers on our trip (from all over the world, but most spoke English). After arriving at El Cumbre and receiving our helmets, gloves and bikes, our guides went through the safety speech and then procured a bottle of a clear liquid which Phil informed us was basically straight alcohol. It was a tradition that in order to guarantee safe passage on the trek to Coroico one must make an offering to the god Pachamama – which entailed splashing a bit of the vile liquid on the ground and our front tire, as well as touching a bit to our lips before passing it along to the next traveler. We started the trek at 4700 meters (15,419 feet) and first biked downhill on a smooth paved road for 63 km (almost 40 miles). We really flew down this part (which was extremely fun) probably going close to 40 to 50 mph and we passed several buses and cars along the way. This was a great opportunity for us to get used to handling the bikes before we got on the World’s Most Dangerous Road. The road itself is really no longer much in use beyond for tourist bike trips (there is a new, much safer road from La Paz to Coroico), but there was still the occasional local who drives the road to get to their house in one of the villages that’s located along the road. It’s a gravel road that at times can be pretty wide, yet also at times can be so narrow that a single minivan uses up most of the space of the road. There are lots of sharp, blind turns without any barriers between you and a 250-meter straight cliff drop (see example image above).

We began the trek on the old road still above the clouds, as all we really see out in the horizon is white mist. Much to our dismay, our guide informed us that this road is the only one in Bolivia where traffic drives on the left side of the road (so that the driver can see the cliff edge outside his own window) and so he tells us to stay on the left side (close to the cliff edge) in order to avoid a possible collision. After our first segment of road my hands felt numb from my death grip on my brakes. However little by little I become more and more confident of my ability, and begin to ease off of the brakes a bit more as we finally passed underneath the clouds into a phenomenally lush green mountainside. We took the trek in small segments, pausing to drink water, double check that everyone was still with us, and for the guides to tell us a quick anecdote about the segment of road that we were approaching (along with any safety tips they had for us). We consistently flew by roadside crucifixes and monuments, just in case we needed a reminder of exactly what was at stake for each of us. To be completely honest, however, I was so focused on the techniques of safe riding and on the safest path (with the fewest loose rocks) that I never really had time to be too terrified of how close I was to the edge. As we got lower and lower in altitude we shed layers, and the scenery became even greener and lusher. We passed directly under a few waterfalls, and adrenaline and an appreciation for the unbelievable beauty of the surroundings replaced the fear that I had felt previously. I really didn’t want the ride to end when it was all said and done. We finished at an animal refuge that had rescued mistreated animals that had been taken captive from the wild and sold on the black market (i.e. pick pocket monkeys). There we had a beer, all we can eat pasta buffet and a fantastic swim in their pool (which was exactly what my body needed after the long ride). Then the four of us who had bought the zipline tickets were taken to get our gear and then drove back up the road to the first zipline departure point. We zipped over huge valleys over 1500 meters total (three segments of 484, 505 and 587 meters, respectively) and got to speeds of over 85km/hr (about 52 mph). (click here for a video of the zipline we did). We then met up with the rest of the group for the ride back to La Paz.

The bus ride back actually was almost more terrifying than the bikes down, as we traveled back up the exact same road to see the views we had missed on the way down. I will admit, it was incredibly beautiful and I once again realized just how gorgeous of a country Bolivia is.

This weekend I think we plan to spend a few days at the Bolivian Salt flats, which are supposed to be amazing. I will post pictures from this weekend sometime later this week (I got a cd of video and photos from our bike trip for free along with a t-shirt).

Best wishes!
Whitaker

Servicio De Los Adolescentes

Last week I spent my clinical rotations in a clinic for Adolescents in Mira Flores, a neighborhood on the outskirts of La Paz. Most of the patients come from the surrounding neighborhoods as apparently in order to get an appointment at a hospital one must first get a check up at a local clinic (like this one) and then be referred to a hospital. The clinic serves boys and girls from ages 10-25 with any problem that they might have, however the most frequent cases are adolescent mothers who come in to check on their babies or to get help for any illness they might have.

One of the main goals of the clinic is education. They hold classes for pregnant mothers on how to take care of themselves during their pregnancy and their babies after birth, as well as knitting classes (Christine and I sat in on one of these classes during one of the days). They also empower youth leaders to go and inform the youth of the area about forms of birth control to prevent teenage pregnancy. We worked with Dr. Santivañez, a fantastic doctor and even better teacher (it's interesting how the two professions seem to go hand and hand) and we could tell right away how much each patient really respected her. Her office is small and very cold filled with a desk, a filing cabinet, and an exam table. There is also a small dirty bathroom where the patients can change (and take urine tests). The walls are painted yellow so it is not difficult to notice the permanent line of ants that crawl in a line around the window every day (it never seems to bother Dr. Santivañez). The office was not very hygienic at all (particularly using USA hopsital standards), as they used the same sheet for every examination (which even had a small bloodstain already on it) and there was dirt all over the floors.

During our time at the clinic we took patients' blood pressure, learned how to feel the baby in the mother's stomach, listened for the fetal heartbeat and placenta sounds as well as measured the height of their stomachs. By the end of the week we were experts at this. As I said before, we mostly saw pregnant adolescents, and they all seemed much older than the age on their chart, both physically and emotionally.

On our first day we saw a girl who was pregnant with her second child at the age of 16 which I found very interesting. Even more difficult to believe was that she had listed her pregnancies as "planned". When I asked Dr. Santivañez about this, she said that although not common, this occassionally occurred here in La Paz. She gave a hypothetical situation of a girl in a poor family with 8 kids that struggled to give each child enough food -- an extremely tough existence. Along comes a man who gives this girl an opportunity to escape from this tough life through the possibility of beginning another family. She takes this opportunity, becomes pregnant and hopes that maybe this other life will be better. Unfortunately, according to Dr. Santivañez, what these girls fail to realize is that from that moment on they become "slaves" to this new family and household, unable to get any education or to ever escape the obligation of providing for this new family. It's a vicious cycle that can exist in many of the poorer families of La Paz.

All in all it was a fascinating insight and experience.

Tomorrow I'll hopefully post about this past weekend and my adventures on the "World's Most Dangerous Road"!

Hasta Mañana!
Whitaker

My Bolivian Guitar! (and a quick cultural/political note)

Yesterday I bought an authentic Bolivian guitar here in La Paz and so I wanted to first share a few pictures of it (above)

And also, just a quick observation that I've found interesting so far is that warnings that Bolivians disapprove of the United States and it's people have been pretty much entirely untrue. Ever since Evo Morales has taken office the governments of Bolivia and the US have not gotten along well, however I've not once noticed any hostility towards Americans from the citizens of La Paz since I've been here. In fact, when the Bolivians I've interacted with so far (from taxi drivers to doctors to young patients of all socioeconomic backgrounds) have found out that I'm from the US, they've reacted with "how beutiful!" or "I hear it's wonderful" or "I would love to travel there some day". While I definitely don't think one can take these statements so far as to say that Bolvians love Americans, are jealous of America, or would trade their culture for ours, so far it has at least meant that there isn't an overwhelming sense of hostility towards the States and its people. Of course, I've only been in La Paz (a very industrialized, developed city) and haven't yet interacted much with the more rural, indigenous people of Bolivia (who come from Aymara or Quechua backgrounds).

Copacabana and Lake Titicaca

Hello all!

This past weekend the two other girls in my CFHI program, a Scottish medical student named Scott (that I met at the hospital) and myself traveled by bus to Lake Titicaca.

To see pictures from the trip I'm describing below (along with a few of my room in La Paz) check out my facebook album here:

this is the address in case that link doesn't work:

http://www.facebook.com/media/set/?set=a.10150319656536718.389908.504936717&l=0ee0ac8671

We woke up early and got to the cemetery (where the public transit buses leave) at about 7:15, took a scenic bus ride down to Titicaca (had to stop to cross a strait) and arrived at Copacabana at around 11:30. The first thing we did when we arrived was check out the Mudejar Cathedral which has the famous statue of the Virgen de Candelaria – to which come pilgrims from both Bolivia and Peru. We then ate a fresh trout lunch (trout is farmed in the lake, so this was extremely fresh) down by the beach with a great view. A precious little kid joined us for a while – he clearly loved the attention of tourists. After lunch we hopped on a boat for an hour and a half ride to the south part of the island (the town of Yumani). We hiked upwards for a good 30 or 40 minutes and then found our hostel where we had reserved a very nice four person room with a shower, breakfast and beautiful view all for about $11 (Overall including 4 meals, all travel expenses, the hostel and any extra purchases, the weekend cost us each about $40 -- just another example of how cheap things are here). We walked up to the top of a nearby hill to watch the gorgeous sunset over the rest of the island. The snow-capped mountains in the background turned a beautiful pink and purple color as the sun set. After we were satisfied with the thousands of pictures we took (I edited the facebook album to include only my favorites -- which is clearly still an overwhelming number of pictures...) we came back down and ate another fresh fish dish, this time by candlelight (while possibly for romantic atmosphere, it was more likely for lack of electricity), joined by two other English speaking travelers, a man from India named Ali (who we hiked with the following day) and a student from a school in Boston. We ended up going to bed around 9:30 (who knows the last time I went to bed that early…) because everything was already dark and cold on the island.

The next morning we woke up and had breakfast at our hostel and then were joined by Ali to walk the length of the island. On the walk we had some amazing views of the lake and the surrounding lands. It was very hard to resist taking thousands of pictures because everywhere I looked it seemed like there was a new beautiful view with bright colors that I wanted to capture. It took us about 3.5 hours to walk the length of the island, and then we headed backwards via a different route to the northern port of Cha’llampampa where we took a second boat back to the south. There we ate lunch and then took the last boat back to Copacabana. We tried to take a bus immediately back to La Paz but they told us that they only had space on their final bus that left at 7 (tough traveling back on a Sunday -- lots of tourists taking weekend trips) but this actually ended up giving us a fantastic opportunity to see an unbelievably gorgeous sunset from some Incan site on a hill overlooking Copacabana. We got back to La Paz late that night and crashed. All in all it was a fantastic weekend and a great exposure to the beauty of the lake and Bolivia as a whole.

This week I'm at El Servicio de los Adolescentes, a health clinic for boys and girls from ages 10-25. I will update some information about that experience in the next day or so.

With love from Bolvia!
Whitaker

Estoy Aquí!

It's Wednesday, July 6th and all is pretty quiet here in La Paz right now because from about 12-3 most Bolivians return home for a big lunch and the ciesta (city-wide rest). The seasons are reversed south of the equator so we're currently in the beginnings of the winter season -- That plus the fact that La Paz sits at almost 12,000 feet elevation (for a reference, the peak of Mount Mitchell sits at 6,684 feet) makes for some very cold temperatures, particularly at night. Unfortunately my homestay doesn't have heating (many of the residents of the building are afraid of the dangers of gas heating) and so I have to bundle up before I go to bed. During the day, if the sun is out it's warm enough for jeans and a jacket, but at night it can get down to below freezing. My homestay is in a fantastic area of town -- right on a main avenue (avenida Arce). It's a nice cozy apartment that my host mom, her son, a girl from Germany, and myself will be sharing for the next six weeks. On my first day (sunday), some of the CFHI participants from the month before were still in town, and so I walked around and explored the city with them for a bit. La Paz is a very hilly city and thus walking even a block uphill got me extremely winded early on due to the lack of oxygen at this altitude.

The food here has so far been very good. I'm still not quite used to the way that Bolivians (and most Latin Americans) have their meals: big breakfast, even bigger lunch, and then very small dinner. Through the program I'm provided breakfast and lunch at my homestay, and every lunch so far my host mom has piled on the food -- once again, something that I'm not used to. It's really interesting how it works, however, as meals here (particularly lunch) are huge social and family gathering times, even during the normal work week. I also think in practice, having a small dinner helps to keep weight down a lot.

In terms of my clinical rotations, this week I'm at el Hospital del Niño, shadowing Dra. Riveros in the Oncology and Genetics ward. Given that it's a pediatrics hospital, all of the patients in the ward are younger than 15 or so, and some are even new borns who were born with some form of cancer. This particular rotation has been much more observation based as there's not much hands on treatment experience one can participate in in Oncology. One observation that I've noticed is that although this is one of the better pediatric hospitals here in La Paz, the building is pretty run-down and the supplies are few, particularly compared to US standards. I also noticed that hospital visits can definitely be a family affair here, as many of the kids we saw in the hospital had both parents, all siblings and occasionally even grandparents there with them.

That's about all I have for now. This weekend a group of us might head to the beautiful Lake Titicaca, via Copacabana and La Isla del Sol, so I'll be sure to report back on that when I get a chance.

Hasta Luego!
Whitaker

First Post!

Hello! I just created this blog to document my experiences over the next six weeks in La Paz. I'm heading to bed now, in the morning I'll be getting on a plane and in less than 24 hours I'll be in Bolivia! Buenos noches!