Nurse Elizabeth

Here's another article from Elizabeth Niels, featured first in her hometown newspaper.
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Until last month, my only hands-on medical experience was my volunteer job at Oconomowoc Memorial Hospital during high school where I was what was once known as a candy striper. It was a simple little job. I spent most of my time trolling OMH's hushed hallways with my cart, distributing ice water in Styrofoam cups to patients. The toughest part was making sure the thin paper sheath securely covered the sipping end of each straw so that the water was germ-free. Not too hard.

Fast forward ten years to the rugged mountains of Bolivia, where one bright Bolivian morning, I am bumping down the road with my friend Dr. Moises, the on-staff physician at Unidad Académica Campesina de Carmen Pampa (UAC-CP). Dr. Moises divides his time between teaching and administrative work, but each Sunday he ventures out into the surrounding rural communities to do some "doctoring." Today I am along for the ride because I want to see Moises and the UAC-CP nursing students in action.

As we approach our destination, we come upon a group of women tending their coca fields. One of the women hurries over to explain that her son, the UAC-CP student that was to assist Dr. Moises for the day, will not be able to work. She's sorry, she says with her big Bolivian smile, but he just can't make it. As Moises's face falls, I entertain a moment of gratitude for our trusty telephone service in the States, where just a few quick phone calls to some other nurses-in-training would have easily remedied our situation.

But as it stands, there aren't any phones here. No worries, though, because Bolivians are masters at inventing creative solutions for problems like ours. So I wasn't surprised when, as we drove away, Moises turned to me and to ask if I know how to use a blood pressure cuff. He hardly waited for my answer, and I got the feeling that he didn't care whether I knew or not. I was all he had. I was to be the nurse for today.

In the village, I expected Dr. Moises to have a modestly appointed office where he'd see patients. No such luck. When we got there, we waited an hour for someone to find someone else who had a key for a single room somewhere in town that was to serve as the office for the day. Word of Moises's arrival quickly spread throughout the village while we waited. When the key was found, he and I hurried to set up our office -- quickly taping the measuring strip to the wall, organizing the note cards which listed the medical history of previous patients, unloading the rusty scale, etc. The line of patients outside the office grew from 2 people to 5 to 10 and more.

Finally, when our makeshift clinic was organized, I threw open the door to receive our first patient, an old cholita with two long black braids down her back and a skirt thick with pleats and petticoats. The dirt on her hands indicated she'd probably just walked in from her field. As the nurse, I was charged with measuring her height and weight as well as taking her temperature, heartbeat, breathing rate and blood pressure. I was relieved when she looked oblivious as I failed for the third time when I tried to use the blood pressure cuff.

Part way through my exam, I had her step on the scale, but her feet completely obstructed my view of dial. Move a little bit, I said, but then she just stepped right off the scale. No, no, no, I said, get on again and just move back a little bit. So she'd get back on but then she steeped right off again. After three or four times of her little dance, I realized that she had no idea of what she was doing. Chances were she'd never been weighed before. So I stepped on the scale to show her exactly where to place her feet. Timidly, she copied me and then held back her skirts and bent way down to look at the dial, too. Finally. That worked, and she gave me a big, more-or-less toothless grin.

I repeated the same drill with other patients of all ages and pretty soon I'd processed enough patients so there was a short line of them waiting to see Dr. Moises. Because our "clinic" was only one room, the waiting patients waiting for Moises had front-row seats to his examinations of their neighbors. They watched as he tested others' urine samples and gave injections, and they listened as he provided others' diagnoses. Privacy was not an option.

Patients visiting Moises that day suffered from everything from simple bladder infections to complicated abscesses, heart disease and more. The children that visited were all subjected to a heavy breathing test so Moises could check for tuberculosis, one of the main killers of young people in Bolivia, along with common diarrhea. Infant mortality is high in Bolivia as well. While we were sipping our Cokes earlier that morning, I’d asked Moises if he ever delivers babies. Not often, he said, because most rural Bolivian women give birth at home, either aided by a midwife or a friend or just alone. Amazingly, one student at the UAC-CP remembers when his mother gave birth to his little brother in a field and then walked right home. Like other Bolivian women, she was probably back working in the field two days later.

Moises also let me know that day that most folks come to him only as a last resort -– and only after they’ve visited their local shaman, called a Kallawaya. The Kallawaya, whose traditions date back many hundreds of years, believe that sickness is caused by an imbalanced life-force. To coax the body back into equilibrium, the Kallawaya combine herbal remedies, amulets and incantations in the Kallawaya language, derived from the language of the Inca. Only when these methods fail do many seek help from Western medicine. Moises says he’s accepted being the last resort, but he just wishes more people would come to see him when they first had trouble. The average Bolivian life expectancy is about 62.5 years.

Finally, after five intense hours, our last patient collected his machete, put on his old felt hat and left. We’d seen 24 patients that day and we were exhausted. As tokens of appreciation our little office was scattered with a dozen or so throw-pillow-sized bags of coca leaves meant for us to chew like tobacco. And even though neither Moises nor I liked the stuff, it was an honor to receive the hard-earned fruits of our patients' labors – mainly because we both knew it was all they had to give.

On the pock-marked road home a few hours later, we had to turn back to down after blew a tire, which Moises changed faster than I'd ever seen anyone do it. I asked him how often he loses a tire – is it about every six-months or so, perhaps? Nope, said Moises, it’s more like every six weeks. I laughed. I could only imagine the amount of creative solutions he's had to come up with each day. Forget about artists, I told him, the real creative geniuses are right here in Bolivia.