Delicious

With only one weekend remaining to explore Bolivia, we opted to seek out an Andean foothill retreat spot in a town called Samaipata. Catching a taxi in Santa Cruz, and squeezing 6 adults into a station wagon (no seatbelts, clearly, and sitting on each other's laps), we embarked on a 3 hour journey through the jungle, through rolling green hills, alongside mountains (scary ones, at that), and finally to the foothills and Samaipata. It's a sleepy town, known mainly for its easy access to the Parque Amboro (Bolivia's stunning national park). Our cab driver took us on a few detours on the way to Samaipata, and it turned out that apparently he's some kind of mail man who delivers eggs and some unidentified concealed goods to various locations along the way. It was both frustrating and humorous at the time, since we had to stop every 20 minutes or so while we sweated it out in the stinky station wagon. I suppose there's no right to complain when a 3 hour cab ride costs 3 dollars per person. I'm still not over how cheap everything is. Every time we go out for a 'really nice meal,' the max cost is 6 or 7 dollars a person. Looking at prices in stores and restaurants is like discovering my toes again for the first time, only every day. Pretty exciting.



We drove through the sleepy town of Samaipata, past kids kicking soccer balls in the dusty streets, past families sitting together in their open-door homes, and finally through winding dirt roads to a lush green paradise called 'Finca La Vispera.' After hearing about this paradisiacal retreat hotel/bed and breakfast/heaven from previous clinic volunteers, and becoming intrigued by the story of the two Dutch owners with their quaint mini-Dutch village, I couldn't wait to get there. I had no idea what I was in for. Greeted by Peter, the owner of the village and an ex-psychologist/ piano tuner from Holland who decided to follow his dream and open an organic farm in the middle of nowhere Bolivia, he invited us to sit down for a gratis pitcher of fresh tea from the herb garden. At the open-air cafe overlooking the herb garden, fruit trees, birds frolicking in the bird bath, and an infinite view of the mountains, I chose the 'flora and fruta' tea and watched in awe as our waitress scurried to the herb garden to pick each herb by hand. The lunch menu was one of the most impressive and delicious things I have ever laid eyes on, with each dish sounding more fresh and flavorful than the last. I chose the french onion soup and garbanzo wrap (very American food, I know, but when you can't eat fresh veggies and fruit for a month for fear of amoebas and giardia you want all of the crude veggies/legumes you can get when they're organic and safe). Again my jaw dropped as I peered out at my waitress picking out each onion, collecting fruits, and delicately creating each meal one at a time. It took about 2 hours for our meals to be ready, but I would have waited ten. And I had no complaints about looking out at the lush scenery over tea, fresh fruit juice, and good conversation. Fresh bread came out first, followed by our appetizer of fresh Gouda cheese with homemade Mango Chutney. Without exaggerating I can say that the chutney is one of the most exciting things I've ever tasted. Nutty, mango-ey, spicy, totally indescribable- and in perfect combination with the freshest, creamiest gouda cheese. The next dish was a fresh olive tapenade on Chapati bread, also delicious even for one who is not a fan of olives. The main event was breathtaking. Onion soup, created with 5 different kinds of fresh organic onions from the garden- so savory and fresh that you could taste the fact that the onions were just picked. Next came my garbanzo wrap, which was essentially fresh hummus (my favorite!) with fresh cucumbers, cheese, fresh dill... This was a lot of food, but with three hours, nothing else to do, and fresh ingredients, who could resist.



After an afternoon of palatal delights, it felt refreshing to walk the twenty minutes into town from our farm to explore the small village. We walked through the markets and through the empty streets for a few hours imagining how quiet and peaceful it would be to live there, and then ended our evening with a cheap bottle of Malbec to be shared in the gazebo in the town's plaza. The stars were blazing, moon was bright, and we walked back to our finca with a tipsy leap in our steps. The best part of the day was yet to come; we knew that awaiting us was a fierce game of scrabble in the open-air cafe/lounge and a lovely deep sleep in our individual mosquito-net-covered beds (it's amazing how much you appreciate sleeping space when you finally get it!).



Monday morning we awoke refreshed and ready for a full day, but first we had to try out the organic breakfast options (obviously!), some different teas and fresh juices, and cafe con leche. It wasn't disappointing- the omelettes were brimming with freshly picked vegetables- cucumbers, tomatoes, sprouts, sesame seeds, nuts, mango chutney... and the freshly squeezed orange juice was unrivaled. They even packed us lunches for our day out, and each lunch included a half cucumber, half carrot, apple, banana, fresh gouda cheese sandwiches, and some nutty/chocolately bread-cake. Checking out of our heavenly hotel was another one of those 'discovering your toes' moments--- for the room, all of the meals and packed lunch, for the beautiful premises, hikes, and views from the finca-- we paid about twenty dollars each. And on top of it, I bonded with the owner Peter and was told that he and his wife are looking for a replacement owner as they reach their later years. If I ever pick up and leave my job or the U.S., you'll know where I went. I'm certain that I will return to this place at some point in my life, so whoever's interested in visiting paradise with me sometime I'd be happy to go back.



The next stop was El Fuerte, a recently excavated site of Incan ruins. I've spoken before about the driving situation being a bit precarious here, but I had no idea how close you can really come to the edge- both literally and figuratively- while driving here. Our trip began innocently as our taxi station wagon started down the winding dirt road, but quickly and without warning the roads became more narrow, the cliffs more steep, and the anxiety ever more prominent. There was room only for one car on the road, but throwing caution to the wind (and giving each of us a panic attack) my driver confidently sped around each turn. He chose to drive on the edge of the road, with only a few inches between the tires and the end of the road (and did I mention there was a steep drop?) I suppose the reasoning was that the other side of the road (also known as the Right side of the road, where you're supposed to drive) was full of small rocks and pebbles from the mountainside above. Honestly, I would have been okay with a bumpy, pebbly-ride, but he wasn't interested in my opinion. We ascended the mountain, and thirty minutes later (an eternity, especially for Amanda who's afraid of heights and Erin who has transportation anxiety), we were almost there but came upon a sign that said 'narrow road, room for one car only'. I would personally say that the sign belonged about 1500 feet below, when the road began, but whatever. This part was really steep and really curvy, and our manual-transmission station wagon was having some issues. We would start driving, stall, and then slowly roll down, keeping in mind that we rolled down straight backwards on a curvy road, meaning that when you look behind you it looks like you're rolling off the cliff. Which we almost did. So the driver continued to attempt this, continued to roll backwards, and in a near state of shock Erin got out of the car and decided to walk the rest of the way. Matt joined her to be chivalrous (and also for personal gain, since he values his life as well). Sticking it out in the car, and seriously terrified, I watched him rev up the engine again and really step on the gas. Thankfully we got up the steep hill, got to the top, and immediately forgot about the traumatic drive when the glorious view from the mountain came in sight. I had a few minutes to enjoy the view of rolling green hilly jungle- and I mean every shade of green- while we waited for Matt and Erin to meet us up there. Our hike to the ruins soon began, and it was a refreshing and lovely hike. I was grateful for the use of my legs, grateful for my life, and a bit shell-shocked once again when I reminded myself that I was hiking to Incan ruins in the jungles of Bolivia. The ruins were really impressive, and the history was pretty interesting as well. When they were discovered (late 1800's I think) the team of explorers thought that the ruins looked like a takeoff site for alient spacecraft, and there's apparently a 'spacecraft'-like object that sits below the 'take-off' site. Bizarre story, and clearly persuaded by some hallucinogenics, but for some time a group of people believed that this was the very site where aliens first landed on earth and began the human race. The hike down was great (except for when we got lost and had to re-trace our steps four times until a Bolivian family took pity on us and showed us the way), and we loaded into our taxi (we hired a taxi for the day for all of our trips, from Samaipata to El Fuerte to the Waterfall and then to Santa Cruz-- all for seven dollars a person! no joke!)



Next stop was the Cuevas, a spot with a beautiful hike and a waterfall. We picnicked with our fresh (although now very warm) packed lunches while overlooking the waterfall, and then ran bravely into to the refreshingly ice cold water and experienced that life-affirming feeling of breathtakingly cold waterfall water on your face. The whole day was delicious- the sun, the fresh food, the hikes, the ancient history- no other way to describe it but delicious. We drove back to Santa Cruz, admiring the cows and sheep on the side of the road, and the peacocks (yes, there were quite a few peacocks. apparently peacocks spread their wings when they're in love, new fact courtesy of Alejandro the cab driver). Back through the every-shade-of-green jungle, through foothills, and then watching as the foothills flattened, and then through it all watching a sunset, with small-town kids running home from school (they leave school at 6 pm because they have a 3 hour siesta in the middle of the day)... we got back to Santa Cruz refreshed, in love with Samaipata, and ready to get back to work.

I have much to say about this week at clinic, as well as having to go back and really write about Carnaval, Freddy's nieto's baptism, etc... so I'll do it once I'm back in the states. I leave tomorrow morning (still not really sinking in), and I'll be back in Chicago late Friday night (but knowing my luck flying in Bolivia, I'll believe it when I'm there). All I have to say about clinic this week is that it was another fascinating but sad week. I diagnosed Chagas heart disease, a murmur in a 9year old girl, saw cutaneous leishmaniasis, was told my fortune by a young man with edema and JVD (which I was proud to be the first to find) -- and by the way my fortune was a little disconcerting, talked to a woman about her personal history of domestic violence and gave her enough diabetes meds so she can follow through on her plan to leave her husband and go to Argentina, and had another woman break down and cry about the sadness in her life (I guess I have that effect on people. On top of it, on our Tuesday morning exploration of Hospital Japones almost had me exploding in anger at some of the ways patients were managed. The diagnosis of the week was Hemorrhagic Dengue fever, and despite the fact that the 17-year old girl with low platelets and hemorrhage could have any number of forty different things, they assumed Hemorrhagic Dengue and since she's not getting better they're planning on withdrawing ventilatory support (basically pulling the plug). And on top of it, she and another patient are in a regular 6-bed room (which is all they have) on ventilators. No such thing as ICU for vent patients, just in the room with the rest of the patients. The vents are really old, and they use vent modes that we don't even have anymore in the states (pointed out by Erin who's starting her pulmonary/critical care fellowship this June. The flavor of the week last week at Hospital Japones was Ischemic stroke, despite the fact that the patients' CT scans were clearly showing multiple lesions highly representative of toxoplasmosis and the patients were young and HIV positive (giving them obvious risk factors for toxo or another infectious or malignant cause rather than Ischemic stroke). Medically it has been really interesting to see how the hospital runs, how different things are, etc. Don't get me wrong- I have been impressed by some things, especially how they make do with so few resources and so few tests- but it's frustrating knowing the capacity our hospitals have to care for patients (even though our system is far from perfect), and seeing these patients really struggling to get by. Another example- if a patient can't afford medications, for example if he's in shock and needs pressors to increase his blood pressure, but his family can't pay for it, he won' t get the meds. They'll let him die, because there's no other option. Ventilatory support only happens if the family will pay, along with emergency surgery (Appendectomy for example, which if not performed expediently the patient can die). But things are also fairly corrupt, which we learned a bit about this week. We're hearing a lot lately about unnecessary surgeries being performed, and just last week there were 2 appendectomies in the same small town by the small surgeon. There would be about a 1 in a million chance that both patients actually had appendicitis, and it seems as though the town's health leaders may be in cahoots (sp?) with local surgeons to get unnecessary procedures done. The clinic pays for the surgeries, and it's a complicated mess to get some of the emergency procedures approved by the higher-ups, so often times the town leaders have the authority to okay something. It's complicated and probably not making sense, but I've learned a lot about local politics here, the politics of running a clinic effectively (if not efficiently), and all sorts of things that make a 'free clinic' seem a bit less romantic.

I have so much to say, so many thoughts that keep piling up, and I hope I have conveyed the depth and significance of this past month. I leave the country with a bit of a heavy heart, but grateful for the interesting and beautiful places I´ve seen and the lovely people I met- patients, doctors, students, other volunteers, etc. Thank you for being interested in what I have to say, and thank you for being supportive and wonderful friends. Can´t wait to see you soon!