Far from the city of Cochabamba, sometimes a couple of hours walk from the last bus stop (because there is no road in) are several dozen health clinics where the nurses from todays class work. Where sometimes major trauma from auto accidents, where bites from venomous snakes, and where complicted labors occur and there is no ability to medicallly evacuate the patients.
Where there is only one doctor assigned and he is sometimes absent.
Upon these briefly trained people falls the responsibility of being sometimes the only medical professional for miles around, and for every medical need.
With these folks I walked thru an investigation of a disease outbreak, hidden within the routine patients they see every day. Cholera lurks in the northern section of town, and the first three cases show up, among the routine sore throats, tuberculosis, and pneumonia. I planted nine envelopes at desks in the classroom, and, as the nurses in those seats open them and read aloud the description of each of the 9 cases, I urge them to begin to suspect an emerging outbreak. With the Power Point, we re-arrange the data, and the pattern emerges. I praise their detective work and warn them to be vigalent. Epidemiology 101.
Next, I discussed (at Dr. Zegarras request) the Social Determinants of Health. I urged them to think beyond their clinic walls, to see how the source of water, how getting prenatal care, how drinking (“chicha” is a favorits alcohol here) and driving result in Bolivias high mortality statistics. In short, I urged them to also do Public Health.
But what they seemed most interested in was to hear the Gringo doctor sing a song from this “California” place. They asked for it. They got “Folsom Prison.” Bush and Cheney would replace waterboarding with my singing, if they could, but it sure broke the ice. I hope they rememmber the Public Health lessons more than my croaking.
Sex, Drugs, and Public Health 