As the projects continue to grow here in Bolivia, I unfortunately seem to have less and less time to update my blog. So, in recompense, I’ll provide an interesting, though tragic story to offset my usually drab entries.
Many of you may remember Dr. Stephen Hawthorne, an expat family physician from Chicago whom I worked with in rural Potosi during my first trip to Bolivia. When speaking to him last week about expanding our trauma initiative to the department of Potosi, he provided his strong affirmation through a very telling personal anecdote:
Dr. Stephen Hawthorne and his family at their house in the village of Yawisla, circa 2009
3 weeks ago, Dr. Hawthorne received a call at his new clinic in the city of Potosi. The call was from the head physician at the district hospital in Vitichi, a rural municipality about 2.5 hours from the city. The physician was calling to inform Dr. Hawthorne about a 55-year-old man who was being brought by ambulance from Vitichi to Potosi for further care. According to this doctor, the patient had fallen out of a tree while harvesting peaches, landed on his feet, and has since been unable to move his leg due to a broken bone.
As the afternoon passed, the patient arrived to Dr. Hawthorne’s outpatient clinic. Unfortunately, Dr. Hawthorne found the situation to be much graver than previously expected: upon initial evaluation, it was clear that the patient had in fact transected his spinal cord from a vertebral fracture caused by the fall, resulting in paralysis of his lower extremities. As many of you know, these injuries also affect the nerves going to the bladder, and the patient confirmed that he had not urinated since the accident…5 days prior. With low blood pressure and a bladder the size of a basketball, Dr. Hawthorne informed the ambulance driver that the patient needed to be transferred to the city’s general hospital after initial stabilization in the clinic. However, when Dr. Hawthorne had finished caring for the patient’s most pressing needs, the ambulance driver had already left the city for Vitichi and was not responding to any phone calls.
Unfortunately, this story does not finish with a simple “Dr. Hawthorne then called an ambulance who transported the patient to the hospital where he received care.” Dr. Hawthorne tried this method, but the local hospital’s ambulance was busy shuttling around hospital patients who needed a CT or MRI. (As an aside, since the hospital doesn’t have its own CT or MRI, it must transfer its inpatients to and from private imaging centers each day, preventing its use in prehospital care.) After waiting in vain and exhausting all other options, Dr. Hawthorne went to the hospital, waited for the ambulance to return, hijacked the ambulance, and finally transported this patient to the hospital 24 hours after his arrival to the clinic.
This tragic story ends in the same way as so many others in Bolivia: after admission to the hospital (and subsequent transfer to a private imaging center and then back to the hospital again), it was found that the patient had a blowout fracture of his 7th thoracic vertebrae with complete transection of his spinal cord. Unfortunately, this poor, uninsured farmer from a rural village was unable to afford the surgery that would allow him to at least be able to sit up and use a wheelchair, so he was sent back to his village in the same condition he arrived. One can only imagine how he will fight off the pressure ulcers and urinary track infections that will forever plague him as a paraplegic in a rural Bolivian village.
However tragic, this story demonstrates the incredible need for trauma and infrastructure development throughout rural Bolivia. The patient was initially improperly diagnosed – had there been suspicion for a possible spinal injury (which there must always be with this specific type of fall and impact), the patient would have been properly immobilized following his initial injury, possibly preventing the secondary complication of spinal cord transection. It also took 5 days for this patient to arrive at a hospital capable of diagnosing and caring for his injury; thankfully this patient had no life-threatening injuries or internal bleeding, otherwise he would not have survived to even make it to the city. And, finally, considering his final outcome, there is no system to care for patients following injury. This injury not only removes the patient from the family workforce, but requires others to leave their jobs in order to care for him. When the family is already struggling financially in a poor, rural village, this creates an incredible financial burden for the family that can rarely be sustained.
The country of Bolivia is broken up into 9 departments, of which the department of Potosi is the poorest and least developed. The city of Potosi is the department’s capital with a population of roughly 600,000.
Brief Project Update:
After speaking with Dr. Hawthorne, I flew down to Potosi for 24 hours to meet with directors of the hospital, Red Cross, police and police training academy, firemen, medical and nursing schools, and ministry of health. All individuals are incredibly excited for our initiative and have been busy organizing sessions for us to train their personnel. I was also invited to meet with the director of the ministry of health, who has asked for our official partnership in numerous development projects and is currently organizing for our course to be taught in all of the district/municipal hospitals in the department. I must express my sincerest gratitude for Dr. Hawthorne and his partner, Dr. Francisco Nina, who orchestrated all of these meetings and will be helping us train throughout the future. While our final month here is already entirely overbooked, we are incredibly grateful for the opportunity to serve the Bolivian people through these various avenues.
Steven J Schuetz 
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