CFHI Clinical Rotation in Tarija, Bolivia

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Hello All! I am writing about my fourth year clinical rotation (international elective) I did in Tarija, Bolivia. It was an excellent learning experience and CFHI did a wonderful job with organizing the rotation and homestay. The homestay portion was excellent and the host family was very nice and hospitable. I enjoyed their friendliness and our daily conversations helped me to better improve my Spanish language skills. Ever since I was a premed student, I wanted to do an elective with CFHI because I had heard such good things about it. I finally had the opportunity to do it in my last year of med school recently. I would highly recommend this organization and its electives to students I learned a lot about the health care system of Bolivia as well as about the universal health care that exists there currently.

Students participate in clinical rotations at general public health clinics throughout Tarija. In Bolivia, current priorities include providing basic health care to more women and children, expanding immunizations, and dealing with the problems of diarrhea and tuberculosis which are leading causes of death amongst children. For the first two weeks of the rotation, we primarily worked in Villa Avaroa, a center for general public health facility located within the immediate outskirts of Tarija. Many of the women and children hailed from nearby rural communities and underserved areas of Tarija. It was pretty evident that much of the patient population comprised of the lower socio-economic groups of Tarija. The second half of the rotation involved primarily working in the Hospital of San Lorenzo, which is a smaller town or “pueblo” located approximately thirty minutes from Tarija. This hospital also served the locally underserved area of San Lorenzo and surrounding communities.

The lack of sanitation and hygiene were prevalent among patients and their families as was evident by their clothes and body odor. We saw several infants and children with advanced dental caries and infections due to lack of basic dental hygiene. Many patients came from impoverished backgrounds and living conditions. Transportation from the rural countryside to larger cities for health care can be an issue for many residents of the “el campo” (the countryside). Residents of nearby countryside communities often make several trips to health care facilities in a given year, but those in the further rural areas cannot make it. There are small health care teams that will make monthly trips to various rural communities for the rendering of basic health care services. We participated in two of these trips to different communities in the rural areas, and it was a very unique to have this experience and I definitely learned a lot. These rural communities are quite far by driving distance and the team of health care providers included the physician, a nurse, the driver, and the medical students. I remember one day in which we saw seven children from one family, ages 14 to 3. They all had pediculosis and were suffering from the common cold. They lived in huddled conditions in a small, two room house in the hills of the countryside with an outhouse for a bathroom and very limited access to any city resources.

We also learned in depth about the different clinical pathologies that are prevalent in Southern Bolivia, such as Chagas disease, tuberculosis, and parasitosis. In the first two weeks of the program, there was a strong focus on Chagas disease, an infectious disease that is a major cause of death and disability in South America. According to the CDC, an estimated 8 to 11 million people in Mexico, Central America, and South America are currently infected with Chagas. It is an infection which is often symptom-free and can be life-threatening if left untreated. We participated in prevention and epidemiological programs as well as clinical rotations where we observed the various manifestations and stages of Chagas infection.

All in all, it was a wonderful learning experience and a great way to finish medical school. I am glad I explored this opportunity and I would highly recommend others to do an international rotation if they can.