Shannon Costello

‘Agotada’ is a great word for exhausted.  I don’t quite know if they are related words, but ‘gota’ is drop, as in drop of water.  I imagine something that has been squeezed dry…

I’ve been wanting to describe the consulting room where I work with Dave.  I estimate that it is about 13 by 13 feet, with a tile floor.  There are also similar tiles (floor sized), halfway up the wall.  The rest is painted white except for a cream strip at the very top of the wall.  It is not neatly painted.  There is a large window that one can open, but no screen.  There are some light cream curtains over the window.  There is a small bathroom built into one corner of the room.  It has the typical shower head positioned over the drain in the floor, a toilet, and small sink.  The toilet is flushed by pulling a thin rope that hangs down above it.  The doors and window trim are a dark brown wood that is smeared and speckled with whitish paint.  The floors are cleaned daily, but the dust from the streets is such that even in sneakers one finds one’s self slipping a little as one walks on the floors. 

In the room there is a small desk with two drawers.  The desk has seen better days.  There is a small white table with a drawer and cabinet.  The drawer does not open and the whole thing is somewhat battered.  There is a desk chair on wheels.  We have two consulting chairs.  They are the type of wooden chair that one might see on someone’s deck, lots of slats nailed onto a wooden frame.  They were painted a bright seventies sort of green, which has faded almost completely in spots where the wood has been scraped bare.  I sit in the chair that has the missing slat, but there are enough other slats to sit reasonably comfortably. 

All papers, audiogram euipment, hearing aid paraphanelia are crowded on the desk and table.  There is not enough room to really be organized.  It is harder on Dave as well because he doesn’t have a nurse to organize things for him.  I take over some of that- calling patients in, seating them, etc., but I leave the organizing to him for the most part. 

It is odd to think back to a normal examining room in the states- all the drawers and cabinets one could want, lots of flat surfaces to store things.  There is a suitcase or two behind the desk where Dave sits.

We have some plastic chairs out in the hall where people can sit while they are waiting.  The noise has been really frustrating for Dave when he tries to do audiograms.  The material in the walls and floors and the bareness of everything in the rooms and halls makes for lots of echoes.  And all the people waiting out in the hall to see us or the other doctors make a lot of noise.  We ask them to be quite but it is hard, of course.  And all the motorcycles passing by make tons of noise.  Today a rooster was somewhere nearby, and he also interfered. 

A hearing aid had a short today, and Dave didn’t have the proper tools to fix it.  He was pretty frustrated, and the people were so hopeful.  We think it is ok now.  He gave me a few trouble shooting tips in case anyone comes back with questions after he leaves tomorrow for Maryland.  People keep calling me ‘doctora’…I sound knowledgeable, but I am merely parroting what I hear in another language.  This could make for some tricky situations next week. 

They had some problems in the operating room today with equipment.  That’s another interesting comparison.  I was in the recovery room translating patient charts into Spanish for the night nurses.  The door is kept open- it opens onto a small patio.  (I am being inturrupted by a small boy who would probably like to chat.  I asked him how he was doing and he said fine, but he is reading over my shoulder now.  Hmmmm…there’s another one.)  So the room is open to the air.  Through the windows one can see an old truck parked by the window and one of those stone fences with broken glass cemented on top to keep people out.  Or in I suppose.  The whole thing just looks very primitive. 

Yesterday and today were the sorts of days where we finally got lunch at 2.  Yesterday I didn’t leave until 6:30 or so, when I went back to my room, curled up in the dark (remember it’s winter here) and cried.  I could do the same today, but perhaps not in the internet cafe.  I did sleep well last night, though.  I am very intimidated in some interpreting situations…like when I just don’t know the words.  The perfectionist in me struggles.  Wait until next week when I’m out of my audiological comfort zone. 

I was thinking about normal life, where I have a school compartment and a house-cleaning compartment, and a writing compartment….here I have one big compartment, Bolivia, and everything else is squooshed over to the side.  Culture shock.  Profound culture shock.  But at least I’m processing it some. 

Today a woman was explaining her grandson’s problems and she broke down in tears.  Peoples’ fears remind me how I feel about doctors.  I feel fear when I’m there, and I see that same fear on their faces.  Have I mentioned that one of my favorite lines is when a patient smiles at the doctor after a hearing test and tells him she heard everything?  Irony in action. 

I heard some in our group walked past a recently chopped off cow head in the street.  Butchering fascinates me; I’d like to see a cow head, but surgery scares me.  They tell us to make sure we eat if we have to go in there, and that we leave before we faint if we feel sick.  I haven’t been in there yet.  I may not need to, depending on who is around.  I guess if I’m asked I should at least try it so I know how long I can hack it.  Ooo…wrong expression, accidentally.  I hear the hardest part is the smell of burning flesh…so much I don’t know about surgery. 

Ok, so tonight I’m heading back to the room…maybe I won’t cry.  Tomorrow we leave bright and early for a four-hour drive to Samaipata, where there are some Inca ruins- El fuerte.  It is in the foothills, just inside Amboro National Park.  So we will be pure tourists for the weekend.  There are all kinds of activities scheduled for the evenings next week, including a demonstration of local instruments.  I’m looking forward to that. 

There is a catholic priest in town that everyone talks about.  He is greatly loved by his people because of all he has done for the town- perhaps I mentioned him before.  I was talking to someone about him today.  Not to raise issues that will make certain people criticize short term missions trips, but that makes a big statement…coming here from another country and spending the rest of your life in a small unknown town in Bolivia.  I bet that’s a bigger statment than what my two weeks here will make.  I also talked to a school principal who, nearing retirement, makes 450 bolivianos a month.  I was embarrassed to tell him my salary.  Two people told me about relatives who work in Spain…apparently a lot of people from here do that.  And another woman told me about how she lost 3 of her nine children- one at one and a half years, one at 3 months, and another at 21 days.

So I don’t know about internet access this weekend, but that’s ok.  Weekdays are the really happening times around here.  Last night I didn’t write because I was busy being tired and weepy…too much energy to head to an internet cafe.  Hey, one of the surgeons was so tired she came back on one of the motorbike taxis.  She was cheered when she arrived safely back at the hotel.  On the way here one of the taxis passed us…the passenger had a large window frame resting on his lap.  So much to handle….

I think there is a Spanish movie called ‘Hay un grito en tu silencio’- there’s a cry in your silence.  It kind of expresses things in some ways. 

Thanks for the e-mails…I appreciate reminders that my normal life exists.  I’m sorry I felt too tired to respond to them tonight.  I’m not even sure why…today didn’t seem that hard…

Until next time…

We saw the monkey this morning while walking to the hospital.  The hospital is about 6 or 7 blocks from where we are staying.  The people here are very nice about offering rides.  They showed up the first couple of days to drive us in, but have been willing to accomodate our desire to walk.  So there really is a monkey living on the plaza, a cute little monkey, with orangey fur.  I did not actually take a picture, since there was no point in taking a picture of a smudge of fur way up among the leaves.  I have taken about 40 pictures so far, I think.  I think my numbers may be somewhere in between CJ and his sister Kelly.  But they are both artists, and I am merely documenting.

Today on our post-lunch walk through town we saw the sloth.  Once I knew what to look for I found a couple more.  They are about the size of a medium-sized dog, gray and white, and very slothful.  The pastor, Carlos, told me that sometimes people outside of town catch them and sell them for pets, but that they die quickly in captivity.  There are a lot of geckos around our hotel as well, which one can catch and hold until they are relatively calm.

Have I mentioned that the motorcycles that constantly pass by are taxis?  I have seen four people on one at once, but I hear the record is five.  Hopefully I didn´t already say that.  I find I´m still reeling a little bit…I feel like I don´t quite know what I have written and that I will be very glad to be able to look back at it and figure out what I was thinking.  I remember telling a couple of teachers at school (my partners in writing) that I felt it took me about ten years to process Mexico.

I do keep comparing our (CJ and I) trip to Spain-  I really didn´t talk to people there (not that they wanted to; it was a city).  This kind of trip is much cooler.  We were invited to a soccer game last night, but it didn´t start until ten.  One of the surgeries did not finish until after 8 or 9pm last night.  Talk about being tired (for them, I mean).  They have been completing about 3-4 surgeries today.  Some of them are very small, but the one last night (a hernia) was quite complicated.

Today we fitted 3 hearing aids and saw 8 more patients.  Tomorrow we are scheduled to fit 5 more hearing aids, but we will do it in a group format.  That is easier because people get to see each other struggling with the same things they are struggling with.  It is harder than you might think to learn how to put a hearing aid on and how to take care of it.  It is supposed to take about a week to get comfortable with it.  That includes getting used to hearing again…and your family has to get used to talking more softly.  I am slowly learning that some of the communication problems have to do with the fact that, while the patients are not hearing me properly, they have developed the ability to act like they hear.  So I get confused when I ask a patient which ear they hear better from and they start telling me about their husband’s car accident.  There are other complicated things.  Because they have trouble hearing I sit directly in front of them and speak loudly and clearly.  But if I point to my right ear when I am referring to their right ear, they often think I am referring to their left ear.  I have learned that I should just point to their ear.

There is something a little heart-wrenching about seeing how nervous people are even for a hearing exam…though I am the same way for most doctor´s exams.  I am working at saying things to ease them.  I see the importance of touch here as well.  That nervousness is worse in a little kid when the doctor is talking about taking out his tonsils.

I have befriended a little girl (7 years) whose mother cleans in the hospital.  She sometimes appears at the examining room window or door, and she usually finds me anytime I leave the room.  She was in the group I played frisbee with yesterday.  I don´t know if I said that I got some of them to sing me the Bolivian national anthem…I can´t remember.  Since school is out, I think she is pretty bored.  I asked her to bring some books tomorrow and she can teach me to read.  She is a bit more direct about how I talk funny.  I get to practice using ´vos´ with her instead of ´tú´.

Another sort of wrenching line that runs through my head is that of the 17-year-old boy I met who had spent a few years in the US.  I asked him what country he preferred and he didn´t know, but then he said he would do anything to get back to the US.  I just keep hearing him saying that.

I got the contact information of a young woman whose son has a hernia (he´s about four).  She is studying to be a school teacher- math, no less.  I have enjoyed all the chances I have had to talk to teachers and students.

I made sure I looked up how to say ´tissue´(as in scar tissue) last night.  There was one moment yesterday when not knowing that sort of froze me.  ´Switch´has been one of the most useful words I have learned so far- ´palenquita´.

Did I mention that the power went off yesterday morning?  I suggested that our morning song ought to be ´We are walking in the Light of God´, which I was able to teach in English and Spanish.  It´s a very easy chorus.  Funny how this is supposed to be an alone sort of activity, writing like this, but I´m sitting here in this noisy cafe….this is a different one from the usual- right across the street from our hotel.

Besides the surgeries and hearing consultations, we have seen well over a hundred patients so far…I don´t include today´s statistics, which I haven´t finished collecting yet.

I´m still too hyper to stop talking.  I talk all day, half the night…but I was feeling a little fuzzy today.  Perhaps a little more sleep is in order.  I haven´t gone running yet, I think I´ll wait until after dinner.  Noone else wants to go, and it´s getting dark right now, but it will be- just kidding, mom!

What else should I say?  Meat markets are wild…I saw the biggest squash I have ever seen today…a motorcycle just went by, followed by a horse, followed by a car.  Typical.

I think I´m ready to end here.  Despite some of the little kids who were running around with jackets on (they are used to hotter weather?), it is pretty hot and sweaty sitting here.  And I should see what everyone else is up to.  They did make a deal they wouldn´t start any surgeries after 3 today.  Oh, and we had salteñas for lunch today.  They are so, so good…

Of course you all think the title means ‘lazy’ but it actually refers to the local sloth that lives on the plaza. Unfortunately I haven’t caught a glimpse of him yet, but I am really, really hoping. Dave saw him on the first day- he has pictures to prove it. I am starting to believe I am here. The weird anthills are helpful for that. We saw one today about the size of a basketball, 20 feet up a tree. I saw a butterfly that looked unfamiliar, but the local pastor told me they migrate from Canada, which made it seem a lot less special.

I have given up worrying about looking like a tourist. We walk through the town, see a chicken, and feel that we simply have to snap a picture. Today I took a picture of a store front with a table out on the sidewalk that was piled high with raw chickens, ready for the pot. No they weren’t covered. The local pastor asked if we were concerned about bacteria, but I said it had more to do with culture shock than anything else. Apparently, by the way, there is no term for culture shock in Spanish. However, he knew what ’shock’ meant, so no big deal.

We took an hour walk through town this afternoon, about five of us and the pastor. I serve as interpreter, because the pastor is very interested in talking to as many people as he can. He took us by the creek and talked to us about pollution. He said that Bolivians sometimes feel that they don’t need to worry about pollution so much because of the United States attitude towards pollution. I think he was referring to things like us not going along with the Kyoto treaty, etc. Of course one of the team members was from Vermont and hastened to assure him that there are definitely Americans who care about pollution. He also told us about a protest that happened here 6 months ago. The people from the country-about 40,00 of them- staged a massive protest and came down one of the roads into town, but the townspeople came out with about 200 rifles and so they detoured. I’ve heard that the political situation is much more stable around here, though. And the next elections aren’t until December or so. I’m guessing that protest was around the time of the referendum.

I suppose you can tell from all these peripheral details that I’m feeling pretty good about life at this point. I LOVE interpreting. I feel intensely useful while I’m doing it, and for the most part I am doing it well. Some people are harder to understand with others, and the fact that I have been working mostly with patients who are hard of hearing further complicates things. I am getting good at explaining how an audiogram works, and today I interpreted while Dave counseled two people who were receiving a hearing aid for the first time. One of them was a woman of about 46 years…she looked so much older it was shocking to hear she was that young. It was nice to see them smile as they explained that the volume was great. Imagine being able to hear well after struggling for so long. As one patient who we were not able to help said, it is hard to live like that.

They have done a few surgeries, but I have not been anywhere near the operating room. Besides working with the audiologist, I have done some running around, ok, floating (my doom), between a couple of other consulting rooms. The audiogram takes about ten minutes, so once the patients are fairly started, I speed down the hall to make sure the other doctors still have interpreters. I guess I just like being popular.

It is hard to measure motives sometimes. I want to do things for the right reasons, and not so other people will think I’m a good person. But then I want people to be happy with me…I helped wash the dinner dishes last night, and I’m sure I was hoping other people would notice and be impressed….what a wretched woman I am….

Yesterday, the first day, was a long day. We got to the hospital at around 8 and worked until about 7. I took about 10 minutes for lunch, including the time I took to walk to the room where lunch was served and back. Very satisfying work, though. Wayne mentioned at dinner that we can’t keep up that pace the whole trip, though, or we will burn ourselves out. Today just happened to be easier. Most people cleared out by noon and only a few came back in the afternoon. But I just realized it is about 5:30 already. I guess we worked a fair amount anyway. The doctors would like to be busier, though.

Well, I’d better stop now…..

Ok, here we go again. I know you will all think I do nothing but access the internet, but I am actually waiting for about half the team to finish what they are doing on other computers. Melanie and I are the only ones with bolivianos right now, so we need to be here.

I hadn’t thought aobut all the work it takes to set up a hospital. The hospital we are working in is a result of a last-minute switch, which is why we are in Portachuelo. The hospital is one story, partially air-conditioned. (I guess the OR has to be kept cool.) The rest of the building has windows without glass. The building is not fully finished. Today we dropped off stuff and started figuring how we are going to set things up, who is going to do what, who is going to try to translate what.

I spent a long time interpreting a rather intense conversation between a local pastor and Dave, the audiologist. It was all about theology, infant baptism, the problems of the Bolivian church here, etc. I felt a bit drained afterwards, but excited. I really am feeling comfortable with Spanish down here. In conversations I am understanding a good 90% of what I hear and I seem to be able to get my meaning across. I still can never decide if I’m thinking in Spanish or not.

We look forward to going to bed early tonight! We were going to go to church, but I think the pastor had a medical emergency and it was cancelled. Hopefully we can get to a Bolivian church next week.

The first night was definitely the worst.  We were unable to stay up later than 6pm- we were soooo tired.  But then I woke up at 1 in the morning and had real trouble getting to sleep.  What is culture shock, anyway?  At that time I figured I could define it as “psychological trauma caused as a result of finding oneself in a culture different from one’s own.” 

Part of me is still having trouble accepting that I am in Bolivia.  If someone had told me that I was actually in Argentina, it would have been just as easy to believe.  Shouldn’t there have been at least a bump when we went over the equator or something?  Anyway, clearly I’m not in the states. 

In Spain it was pretty easy to fit in, or at least not stand out.  Here it is impossible.  Everyone stares at me.  And some people make comments besides that.  I don’t mind ignoring a younger guy that makes comments, but it was a bit shocking to have, say, a seventy-year old grin familiarly and ask (using the informal!) how I was. 

Crossing the street was an experience in Santa Cruz.  There are some traffic lights, usually on sign posts on the street corners, but traffic just seems to flow, and honk, and flow.  I’m sure it is nothing like China, for example.  The volume of traffic is not nearly the same.  Still, there’s a technique for pedestrians.  The experts step into the street, leaving passing cars an inch or so, and cross as soon as there is a gap.  It’s hard to express.  I guess the biggest difference is the space everyone leaves each other.  It’s almost worse in a car, when you are so close to the car in the next lane.  If you are a moped in between the two…no seatbelts, by the way.  Not all the honking is for traffic.  I think taxis honk to signal that they are available.  And I think there is some honking just to honk. 

I had a salteña for breakfast yesterday.  It was yummy…MUCH less spicy than the ones I tried.  Can’t wait to try making them again. 

Back to culture shock.  It is helping me to make comparisons.  For example, last week I was walking down Thunder Hill Road and I accidentally made eye contact with a young man who was singing to himself.  Something about the exchange made me nervous, but I had a grocery bag with milk in it- I figured I could give him a wack if necessary.  After I crossed the street and walked a bit further, I chanced a look back.  He was standing there, staring in my direction.  So, ok, I’ve dealt with that kind of thing before.  So I don’t need to mind too much when the group of young males that we walk past let each other know that there are tourists with pretty faces passing by. 

The character of the streets would change so suddenly.  On one block there would be a tile-like pavement with shop windows displaying expensive brand name stuff.  Then all of a sudden the sidewalk would be dirt, with a couple of adolescent boys sitting their giggling while their friend urinated against the wall.  Walk faster.  Watch pockets. 

In any case, we survived the city, and it really was a neat experience. 

Francis, the full-time Bolivia missionary for Medical Ministry International, came to get us at around noon.  His wife cooked lunch for us (traditional Dominican meal) and we played with his daughter and talked to whoever was in the house.  One of the guys there took Melanie and I for a walk.  That neighborhood had a residential town feel rather than a city feel.  Night was falling as we came back.  I caught a lizard (no big deal, he was pretty gentle), and we saw an owl.  There are always lots of dogs roaming around. 

The plane with the rest of the team was supposed to arrive at 9:30pm, and we arrived at the airport right on time.  But with various delays, we waited 4 hours before everyone finally got through customs.  It was particularly hard on the welcoming committee from Portachuelo (where we are based).  I talked and talked and talked.  Lots of Spanish practice.  It was much harder on Melanie, who doesn’t know Spanish.  Please pray that I will be wise in what I say…in some ways it is harder to know the language- more responsibility. 

At 3:00 or so in the morning we were driving along when the motor of the vehicle we were in began to overheat.  There were 5 of us in the vehicle.  So there I am, in the wee hours of the morning, giving Melanie a Spanish lesson.  A car pulled up in front of us.  The driver had the biggest knife I’ve ever seen someone carrying casually.  !!!  Francis said it was probably because he was a taxi driver.  !!! 

A man came by and said to Francis that there were thieves in the area and we should be careful.  Francis thanked him profusely.  Ten minutes later it ocurred to me to translate that for Melanie.  She had had no idea. 

The Residencial where we are staying is quite nice.  I am sharing a room with Melanie.  The room has two beds- with blankets, joy!- a big window with curtains (a safety pin suffices to hold them closed), and door that locks.  We also have a table and a coat rack to hang towels, etc.  I enjoyed my 5 hours of sleep.  Our room opens on a large patio with tropical trees and hammocks.  The bathroom is similar in setup to the one we had in the hotel room.  Ominously, there was only one knob for the water….but it warmed up after awhile.  I think the electric shower heads just take longer to heat up the water. 

I had yogurt, toast, and an orange for breakfast, and then some of us set up to walk around the town.  They lost me here in the internet cafe.  That’s ok, I’m just across the plaza from the Residencial.  We will eat lunch at 12:30 and then have our orientation meeting at 2, after which we will go to the hospital to get set up.  There has been talk of me visiting a teacher training school or talking with some musicians.  The people have been very, very welcoming. 

I guess that is about it for now.  This cafe is filled with people, mostly young boys, all looking to play games.  A number of them are clustered around my chair…perhaps they are watching my neighbors playing?  In any case, this is a public blog. 

I should mention that this is really replacing any journal that I might keep.  I only brought a pad of paper, and this blog is a piece of my life that I can hang onto.  I’m hanging on!!! 

Well, here I am, seeing South America from an internet café at a cost of 3 Bolivianos per hour.  I get 7 bolivianos for every dollar.  I won´t dwell on the loooong plane flight, except to say that I met the most interesting people and had fun using Spanish to get through customs- not at all the arduous task one might expect. 

I must take a moment to describe the bathroom in our (Melanie, a nursing student and I) hotel room.  It is a very small room with a window that provides a great view of the construction work going on in multiple floors of the building next door, with no curtain to obstruct our view.  We hung a towel to rectify that situation. 

The light is a bit scary- it buzzes dreadfully at first, then pauses, and then starts again, getting progressively louder and louder….The room is small- I think if I stretched out my arms as far as they would go lengthwise I could probably touch both walls.  And there is no shower stall.  The electric shower head (supposed to heat the water right in the head- my preliminary tests have yet to prove that) is positioned right above the drain in the floor.   The toilet paper is also smaller and tougher. 

But the room is clean and has a working toilet.   And new experiences are definitely broadening.  The towels and sheets were folded in fancy ways I could not have imagined. 

The most challenging thing for me so far has been that I find myself having to talk in Spanish when I would rather not.  So far today we have gotten a map of the town, gotten money and food, and even found our way back to our hotel.  And I found a used book store.  I paid roughly $4-5 for each book.  (The book store is a good example of me not wanting to talk.  I made myself ask for recommendations for Bolivian novels and also about a specific title I was unable to locate in the US.)  Now we are back out again, having eaten our first complete meal (we tried for authentic Santa Cruz but ended up with very good Italian).  After we finish here we will head for a small park and the supermarket, purely to satisfy my curiousity.  We will probably buy a snack to last us through the dinner area, as walking around at night may be a little more than even our tough constitutions can handle.  Oh, and once I come down off my adrenalin rush I will probably find that I am very tired.  I probably got about 4 fitful hours of sleep on the plane. 

Tomorrow we are supposed to meet up with Francis, our project director, for lunch.  The rest of the team is also supposed to arrive tomorrow. 

I find myself a little nervous about eating.  I take a bite and think “I took a bite.   I´m sick!”  It helps make praying for the meal more meaningful and not just a mealtime ritual.  I really do want God to bless the food to my body…

In honor of this trip I spent time yesterday and today preparing this recipe.

Salteñas are the Bolivian version of empanadas, which come from Argentina. The story is that a woman from Salta, Argentina moved to Bolvia and made a version that was so good it is still a hit today. Mothers would send their kids to buy empanadas from La Salteña, the woman from Salta. Rumor has it that they are so popular that McDonald’s was unable to compete with them and closed down. I will be on the lookout for McDonald’s. And for salteñas.

I had high hopes for this recipe. The concept of things wrapped in dough and baked appeals to me in general. The recipe also reads as if it were translated (not too carefully) from Spanish, which lends an air of authenticity. I thirded the recipe. Even so, a third of a cup of cayenne pepper is a lot. I think it is possible that the salteñas I made tasted really good underneath all that spice. And that whole thing about eating something with fat in it to help ease the burn is all well and good, but somehow the burn got on the outside of my lips too, so recovery took awhile.

I look forward to trying to recipe again someday with a lot less cayenne.

The starting salary for a first-year teacher in Howard County is somewhere around $40,000. In Bolivia teachers earn about $1000, a typical income. Of course some things cost less, but not always. In the late 90’s massive protests were sparked when the government’s attempt to grant control of the water system to a foreign company resulted in monthly water bills of $20-$30. Imagine if a quarter of your income was going to pay your water bill…

The first day of winter was June 21, and students do get some time off for winter vacation. In Montero winter vacation started about a week early because of swine flu. Catholic religious instruction used to be mandatory in the schools (before 1967 being non-Catholic was illegal), but is now optional. Most of the country is still Catholic, though indigenous religious traditions have been blended in.

I will be in Bolivia until July 11. I am hoping to post every so often…