Sustainable Bolivia/Vivo en Positivo Cochabamba, Bolivia June-August 2014

Transcription

1 George Ru, SKMC 17 Foerderer Grant Journal Sustainable Bolivia/Vivo en Positivo Cochabamba, Bolivia June-August 2014 Planning the trip: Upon enrolling in medical school, I knew that I wanted to spend my final summer abroad in a Latin American country. I majored in Spanish Language and Literature with a focus on Latin America, and had studied abroad in Argentina while in college, so I already had a strong knowledge of the region that I wanted to further explore. I strongly considered going back to Buenos Aires to work at one of the medical schools there, but ultimately decided that I wanted a different experience. Another requirement that I had for this summer was that I wanted to work in a public health setting. I understood that many students go abroad and shadow in clinics, but my main objective was to work at a non-profit organization focused on public health. I began to search the Internet and the Jefferson Study Abroad website for programs in South America that offered more than the traditional clinic shadowing. I found a lot of good programs in Ecuador, but Sustainable Bolivia and their partner organization, Vivo en Positivo seemed like a better match for me. In contrast to Argentina, which is one of the most developed countries in South America, Bolivia is one of the poorest countries in the continent. Therefore, I thought the experience would offer me a well-rounded insight into a different South American culture. Once I had been accepted into the Sustainable Bolivia program, I maintained contact via with the staff and they were very helpful in providing necessary information about traveling to Bolivia. They required a short application and a resume in Spanish so that they could

2 properly match me with a partner organization. I was initially concerned that I wouldn t be able to obtain any clinical experience, but it turned out to be very simple to find time to shadow different doctors in the clinics. I spent a total of 9 weeks in Bolivia: 8 weeks working with Vivo en Positivo in Cochabamba and 1 week traveling. Bolivia: Bolivia is a country with a very rich and interesting history and culture. Although Bolivia was the first South American country to declare independence in 1809, it took 16 years of war until Bolivia was able to fully separate from Spain in Bolivia is full of natural resources and the landscape is incredibly varied, with La Paz in the altiplano (Andes mountains), Santa Cruz de la Sierra in the rainforest, and Cochabamba and Sucre located in valleys. The country is divided into 9 departments: La Paz, Cochabamba, Santa Cruz, Pando, Beni, Oruro, Potosí, Chuquisaca, and Tarija. The main metropolitan and economic regions in the country are in Santa Cruz, La Paz, and Cochabamba. Bolivia is very unique in that 60-70% of the population is indigenous, mainly of Quechua or Aymara heritage. In 2005, Evo Morales, a coca farmer of Aymara descent, was elected as the first indigenous President of the country. Evo Morales is a member of the MAS (Movement Towards Socialism) party, and has implemented a variety of policies that reflect his socialist beliefs. Morales created a new constitution in 2009 that gave more rights to the indigenous population and included more socialist programs. In terms of health, the new constitution guarantees universal health care and subsidies for pregnant women, young children and the elderly. However, everyone that I worked with informed me that there is a serious lack of implementation with these policies and that universal health care is essentially nonexistent.

3 Sustainable Bolivia and Vivo en Positivo are based in Cochabamba, the fourth largest city in Bolivia, after Santa Cruz, El Alto, and La Paz. Cochabamba is often regarded as a middle ground between the extremes of Santa Cruz and La Paz. Santa Cruz is Bolivia s richest and most expensive city, located in the rainforest near Brazil with a very humid climate. La Paz is on the other side of the country in the Andes Mountains near Perú, where the climate is rather cold and dry year-round. Cochabamba sits in a valley in between these two cities (8 hour bus ride to La Paz, 12 hour bus ride to Santa Cruz) and has a very temperate climate. I was there in the winter and temperatures would often hit between F during the day and drop to the 40s at night and in the early morning. A major draw to Cochabamba is the food, as it is universally accepted throughout the country that Cochabambinos have the best cuisine in Bolivia. I found Cochabamba to be an incredibly relaxed and enjoyable city, where the people are friendly and generally very helpful. There are not a lot of tourist attractions in Cochabamba, so the few foreigners in the city are often volunteers. I thought this was a huge positive about the city because I was able to meet a lot of local Bolivians and fully immerse myself in the culture. Throughout my 9-week stay in Bolivia, I don t believe I encountered a single Bolivian with a Type A personality. This is a huge change from the USA where deadlines and schedules are top priority, but it is very easy to become accustomed to the Bolivian lifestyle. Vivo en Positivo: When I first started at Vivo en Positivo, I mainly worked with the Director of Volunteers, Paulina Rivas. Throughout my first week and a half, we talked about what I wanted out of the experience, and I began by helping out with administrative duties at first. After fully researching Vivo s mission and the history of HIV/AIDS in Bolivia, we developed a project that I worked on

4 for the rest of my time there. At Vivo and CDVIR-Cochabamba (the government-run sexual and maternal health clinic), there are peer educators who are living with HIV and help others recently diagnosed with the virus. The goal of the 6-month program is to make sure that the new patient knows all the information about how to live a healthy, long life with HIV through staying adherent with their medication. There are set themes for each meeting, which include learning about the law 3729 that protects those living with HIV/AIDS from discrimination, eating healthier, using condoms correctly, and other important topics. I originally wanted to analyze the social aspects of these patients in staying adherent to their medication. For example, I wanted to see how insurance costs, distance to health centers, and income level affected a patient s ability to stay adherent to their medication. However, we determined that 9 weeks was simply not enough time to build a relationship with the patients and construct a proper model. I then shifted my focus on analyzing the counseling program and my project ended up being an analysis on the effectiveness of these peer educators on different groups of patient s ability to stay adherent to their medication. My project essentially turned out to be a mini-research study, as I conducted a retrospective cohort study with about 50 patients. I also was able to shadow doctors that I worked with while they were in the clinic during some afternoons. Vivo en Positivo is located near the Cala Cala neighborhood in the northern section of the city. Generally speaking, the more north you go in Cochabamba, the richer the area. I lived about a mile away from the office, so I would take a truffi in the morning to get to work and also in the afternoon after lunch. I would often walk home before lunch and at the end of the day. My work schedules were 8:30 AM-12:30 PM and 2:30 PM-6:30 PM, but this was very flexible and was probably closer to 9-12, 3-6.

5 Homestay: My homestay family easily was the highlight of my trip and was a huge reason why I had such a great experience in Bolivia. I lived with a fairly young couple in their early 40s, who had children of 18, 15, and 10 years old. The family had taken about 4 or 5 volunteers in the past, so they were very careful with the food preparation and were incredibly helpful in giving me tips around the city. The parents worked from home making inflatables and also advertising, so there was almost always someone in the house. The house was a modest size, and the grandfather and aunt lived in a house on the same land. Lunches are the main meal of the day, and a typical plate consisted of rice/pasta, a meat (almost always chicken), and then vegetables. There were some days that we had soup or something different, but I ate a lot of chicken and rice. At my family, we rarely prepared another meal for dinner. Dinner was often a basket of bread with a variety of spreads; sometimes an egg or bologna was offered. This was definitely difficult to adjust to during the first week, but I found it to be pretty easy after that. This is also different at various host families, as I know some families had full meals for dinner. The family that I stayed with was a very close-knit family and spent a lot of time together. Everyone was present at almost every lunch and they often lasted hours because the whole family liked to stay and talk and tell jokes. My host family also did not know much English, which was really good for me because I wanted to improve my Spanish. I felt that most of my improvement in Spanish occurred in the house through talking with the family on a daily basis. Sustainable Bolivia has a solid network of host families, and there are some families that can take more than one volunteer. I would recommend that you request to be the only volunteer in a host family if improving Spanish is one of the main reasons why you re traveling abroad. Sustainable Bolivia also has 3 volunteer houses where people can stay. The main volunteer

6 house, Casa Principal, is where most of the staff stays and there are often events held throughout the week at this house. For example, I took a weekly drawing class and participated in a few charlas, which are talks/discussions led by a volunteer or member in the community on a topic they are passionate about. These volunteer houses are cheaper to live in, but they do not include food. In addition, English is almost always spoken while at the volunteer house, so I did not spend too much time at the houses during my first month because I wanted to first immerse myself in the family. Tips for living in Bolivia: Cochabamba is honestly a very easy city to live in, but here are a few important tips for the city and if you decide to travel: -It s winter in Cocha during out summer, but this means it s only cold when you wake up and at night. The break in the middle of the day was helpful because I found that I would have to change midday because it got pretty hot during the day. Bring a variety of different clothes and at least one warm jacket is necessary. I had a North Face that I wore on every trip outside of Cocha because it was very cold elsewhere. I also wish I brought some Under Armor or other layering type clothing because there are some cities (Uyuni) where layering is essential. During the 3-day tour of Uyuni I wore about 4-5 layers on top and 3-4 layers on bottom. -If you want to shadow in the clinic with a doctor, bring your white coat. I didn t bring mine and it was a hassle for the doctor to try to find an extra one for me. I didn t go to any locations where scrubs were necessary, but it wouldn t hurt to bring them. -There are lots of stray dogs in South America in general, so if you have never been to the region, this may be jarring to see at first. They are literally on any street and are normally pretty

7 complacent and shouldn t cause any problems. If they start barking or chasing you, just clap really loud or throw rocks. -Even though Cocha is in a valley, it is still over 8,000 feet above sea level (Philly is 39 feet above sea level). I only had issues with altitude while in La Paz (about 12,000 feet above sea level), but be prepared to drink a lot of water/bring a water bottle. The locals all chew coca leaves and you will surely be taught how to do this, and it is also rather helpful. -If you forget anything, ask your host family or other volunteers to take you to La Cancha. La Cancha is supposedly South America s largest outdoor market, and it is very awesome and overwhelming. A common thing that you will see in Bolivia is that all the stores on the same street sell the exact same items, so there are specific rows for clothes, electronics, artisan gifts, etc. Bolivia is so cheap to live in and I ended up buying a few shirts to work out in for about $2. -Make copies of everything. The Sustainable Bolivia main office will make a copy of your passport and a green card that you get when you enter the country, but I made extra copies just in case. The first Friday of every month is always a big celebration, and immigration police are known to frequent the bars to ask to see copies of your passport/visa. -The sun is pretty powerful so sunscreen could help. I never really used it walking around the city, but it was definitely necessary for when I traveled to Uyuni for the salt flats. -WiFi is rare. I was lucky in that both my host family and my work had solid WiFi signals, but this was definitely not the norm. I brought an old iphone, but found it to be pretty useless when I was out, so I just used my ipad while I was in the house to keep in contact. I had a Bolivian phone (old-school phones prior to flip phones) and this was useful to keep in contact with friends there. A Bolivian friend gave me their old phone, so I am not sure how much the actual phone costs, but a chip is about $5 and you buy credit as you use it.

8 Summary of expenses: Exchange rate: 6.94 bolivianos = 1 dollar Before Bolivia: Flight from DC to La Paz (via Miami, Lima, Santa Cruz) = $870 Flight from La Paz to Cochabamba (30/40 mins) = $40 Sustainable Bolivia costs = $550/month = $1100 Bolivian visa = $160 -Went to Bolivian consulate in DC because I am from around there, but this can be bought at airport Yellow fever vaccine + Jefferson travel medicine consult = $160 + $50 = $210 -Yellow fever vaccine is required by Bolivia, but no government official checked my actual vaccine card while I was there In Cocha: Truffi ride = 2 bolivianos/trip x 2 times a day = 4 bs/day (<$1/day) Food provided by homestay, but I did go out to eat as well: Bolivian restaurants = bolivianos ($1.5-3) Nicer restaurants = bolivianos ($7-10) Taxis = 8-10 bolivianos to go anywhere in the city during normal hours. 15 bolivianos to bus station, 15 bolivianos late at night, bolivianos to airport in Cochabamba (normally ~$1-1.50) Drawing class = 100 bolivianos (~$15)

9 Artisan gifts almost every tourist buys a sweater made from alpaca fur, and you will find many many many items made from alpaca. There is normally an upcharge when they see that you are a tourist but I was able to haggle a sweater down to 80 bolivianos (~$12) I bought a ton of gifts and ended up spending around $50 Trips: Sipe Sipe (Small town near Cocha for the Aymara New Year) = 50 bolivianos = ~$7 Sucre, Potosí Bus there and back = 200 bolivianos (~$30) Hostels (2 nights) = ~300 bolivianos (~$40) Mine tour in Potosí = 150 bolivianos (~$20) Copacabana Bus there and back = 180 bolivianos (~$25) Hostel (1 night) = 50 bolivianos (~$7) Various expenses/isla del Sol entrance fee = 200 bolivianos (~$30) Villa Tunari (Rainforest 3 hours outside Cocha) Shared truffi there and back = 70 bolivianos ($10) Hostel (1 night) = 50 bolivianos (~$7) Entrance fees into parks = 150 bolivianos (~$20) Uyuni 3 night, 4 day tour of salt flats, mountains, and lakes = 680 bolivianos (~$100) -Included driver, food, hotels, 4 wheel drive -Haggle this price! Easy for tourists who don t know the system to pay upwards of $200

10 Park entrance fees = 200 bolivianos (~$30) 12 hour bus to La Paz = 200 bolivianos (~$30) La Paz Hostel (2 nights) = 320 bolivianos ($45) Money-saving tips: -Haggle for everything. Most shop owners in the markets will tell you different prices if you don t look Bolivian. My host family was fair-skinned and blue eyes, and they often complained about getting charged more because people constantly think that they are tourists. When traveling, it is also very easy to haggle for the prices of trips and tours. -I regret taking a plane from La Paz to Cochabamba when I first arrived. Buses between La Paz and Cocha are a lot cheaper than the plane ($45 vs $15) -I took buses everywhere when I traveled. If you are traveling outside the department of Cochabamba, it will most likely be an overnight bus. These leave around 9/10 PM and get you to your destination in the early morning so you have a full day there. I often left Thursday night and took a bus home on Sunday night and always made it to work on Monday. I suppose buses are less safe but I never had a major issue with this. Roads are often unpaved and some routes run through the mountains, but in the middle of night you can t really see outside, so ignorance is bliss. -As I mentioned before, all shops on the same street probably sell the same items, so browse around and don t just buy the first thing you see. -A previous report from Bolivia mentioned that it was expensive to buy normal clothing, but I don t necessarily agree with that. There are definitely expensive stores with imported clothing,

11 but if you re okay with used clothing/thrift shop quality, there are a ton of stands for cheap clothes in La Cancha and throughout the city. -I used cash the whole time. I brought cash with me in my luggage, which can be risky, but I didn t want to bring my check card out with me all the time. I would advise taking cash because the ATMs are not always reliable and the exchange rate is a lot worse. Safety: I personally never felt unsafe in Cochabamba or in many other locations in Bolivia, but I recognize that I am a male and pretty tall for Bolivians (5 10; most Bolivian men were about and most girls were 5 2ish). -The area around the bus station/la Cancha late at night is shady, so I never hung around there. I only took taxis straight to the bus station and stayed in the station. Pick pocketers are known to be near the bus station, so just keep all your belongings on you. -A popular scam involves a tourist approaching you and asking you for help, and after a while, a fake police officer comes up and asks for ID. If you are unaware of this scam, the fake police officer will often take your bag and steal money or expensive items. This never happened to me, but I was always told that the way to avoid it is to ask for credentials or tell the police officer that you will walk with them to the police station. All police officers will wear the standard uniform and will never ask to take your bag. -Taxis are so cheap, so although walking everywhere is tempting, I simply took taxis late at night to avoid any issues

12 -Street protests are very common in Cocha. They tend to block off certain roads to cars and march for a little bit then just stay there for rest of the day. This was never an issue if you re walking everywhere, and was very interesting to watch. -Read Lonely Planet, Trip Advisor, WikiTravel for more tips because they were all really helpful. I traveled alone to Sucre and Potosí (against the advice of my family and coworkers), but I had no issue and read up on the unsafe areas. Photos! Aerial view of Cochabamba (from Cristo)

13 Plaza Colón in Cochabamba Vivo en Positivo office

14 CDVIR-Cochabamba My awesome host family

15 Street protest in Cochabamba Potosí (Mountain in background was mined for silver during colonial times)

16 Sucre (often called Bolivia s prettiest city) Isla del Sol

17 Copacabana Villa Tunari

18 Uyuni salt flats La Paz markets

19 Me with the nutritionists I worked with