More medical reflections, and the real Salar.

This is the end of Bolivia.

It's been a good eight weeks - interesting to see a different way of practicing medicine in the hospital, fun to improve my spanish a lot, exciting to be able to travel around the country seeing some amazing things, and memorable for meeting engaging and interesting people..

Some more thoughts on medicine here;

There is a strange kind of 'caste' system in Bolivia. The country is almost frozen in between the typical way of life which has been lived out for centuries, and trying to modernize into a country able to interact with the world on a global level. Because of this there are two types of people here - the people from the 'campo' (countryside), who are more traditional folk, and then the more modernized urban people. The 'campesinos' dress in traditional multi-coloured clothing, work the land all day, are missing most of their teeth following a lifetime of sugary food and dentist avoidance, and they often speak only quechua or aymara (two tribal languages here). By contrast the urban people dress in American clothing, drive cars or motorbikes and will speak Spanish with the occasional English word. Obviously this is a big generalisation, and a majority of people are somewhere in between.

When different people come to the hospital it can be quite sad to see the way in which they are treated. Most of the doctors come from the 'urbanized' people, and unfortunately they can have a certain amount of pride and self-importance in the work that they do. When the campesinos come in to see the doctor it seems like they are treated with even less respect that usual; as if they don't understand what's happening, and as if "they should just be quiet and listen to the doctor who knows best". I'm not sure whether I have been influenced by the doctors views, or whether it really is the case - but it does seem like they lack understanding. Often they will come in and simply tell the doctor what is wrong, then ask them for a pill to make it better; there is no exchanging of information, listening to questions or advice, or accepting any solution other than a magic medication. It seems like it can be hard for both sides - the doctor feels like the patient isn't understanding and won't cooperate with any treatment or advice, and the patient feels like the doctor is holding back the medication which could so easily make all their illnesses better.

There are definitely benefits to the healthcare here compared to home as well. Patients don't need to be referred to a specialist and then be kept waiting for months. They turn up to the hospital at 7am, ask to see whichever doctor they think they need, and then sit and wait until they're seen (usually by 11 or 12). If the doctor decides that they need an x-ray or other investigation then they send them off down the corridor to get it, and then bring the results straight back to them. If any follow-up is needed then they'll tell the patient to drop in again in a couple of days. One morning I was in a consultation with a traumatologist. His last patient had a fractured wrist which had been badly repaired. The doctor happened to be driving into town after his surgery, so he offered to take the patient and her mother into the city where he could operate to fix her hand before he had lunch. I can't see that happening at home!

Away from the hospital - this is my 'holiday' week in Bolivia. And we finally made it to the salt flats!

Our mode of transport for three days at the Salar de Uyuni.

Probably Bolivia’s most famous tourist attraction; it’s around 4,000 square miles of salt, going down 150m deep. I think it’s the largest deposit of salt in the world. If that wasn’t enough excitement, then the surrounding area was also where Quantum of Solace (007) was filmed. Wow.

Salt flats.

The five volunteers at the hospital.

We arrived in Uyuni late in the day on Friday, after a bus and train combo down through Bolivia, and started our tour on Saturday morning. The classic tour is 3 days and 2 nights, although because it’s so popular then everything you see is packed with other 4WD cars and gringos wearing ridiculous alpaca hats and taking photos of everything, just like me. This couldn’t really be helped though, so we tried to just ignore the crowds and enjoy the scenery.

Salt piles ready to be eaten.

Isla del pescado - hundreds of cacti
in the middle of all the salt.

Day one was the only day on the actual salt flats (Salar). We visited the town where they process the salt, and then onto the salt flats – driving for an hour or two on a completely straight line, without seeming to move anywhere since our only point of reference was the distant mountains on the periphery of the salt. We stopped for lunch in the middle of the white expanse; some barbecued llama. Then was the chance to take some photos of the area – all sorts of bizarre photo opportunities since perspective is completely confused on the salt.

Some cacti as high as 10m.
All very spiky.

Sunset on the salt from the roof of
our car.

After lunch we visited the Isla del Pescado – an island in the middle of the salt (originally the salt was a sea, which then evaporated to leave all the salt..). The island was full of gigantic cacti – up to 10m high. Amazing to see such huge plants growing in the middle of a seemingly uninhabitable environment – apparently it takes 3 years of no rain to kill them off. The first day ended with watching the sun set over the salt, then driving another hour to a salt hotel – a building made completely out of salt. It was surprisingly warm (once the sun goes down here the temperature plummets. Our whole weekend was spent between 3669 and 5000m above sea level, so in the dark we needed as many layers as possible, whereas during the daytime we were sweating in the car, and applying factor 30 regularly).

Day two was spent off the salt. We started by visiting some volcanic rocks, which was like a giant playground. It's funny how in the UK if you visit historic geographical wonders or precious tourist attractions the chances are you'll be forced to look at it from a distance, behind a rope, whereas here we were positively encouraged to go climbing over everything.

Flamingoes on the lagoon.

'Flamingo' pose.

After the rocks we drove past 5 lagoons - each one filled with various flamingoes. They're funny to watch - they just stand there on one leg, which looks like it isn't strong enough to support anything, let alone a fully grown penguin.

After lunch we moved on to some more giant rocks. This time the main attraction was a 'rock tree', which was a rock that looked like a tree. Surprisingly we weren't allowed to climb on this one, but we did enjoy climbing all over the rocks around it.

The 'rock tree'. A rock shaped by the
wind over the decades..

The 'coloured lagoon'. Red because of
the algae and vitamins and things.
This is also why flamingoes are reddish.

After this we went to a larger lagoon known as the laguna colorada - 'coloured lagoon'. This was a strange red colour, apparently because of the different algae and vitamins and things that are in the water. The flamingoes eat from this lake, and apparently that's why flamingoes are pink! Fascinating. It looked a little bit like a giant lake of tomato soup. I didn't try any so can't confirm or deny that.

The evening was spent in another hotel, shivering away trying to absorb all the warmth from cups of tea, until we finally went to bed at the healthy time of 9pm.

The natural hot springs, 7am.

The geysers going full steam.

Day three began at 4.30am, in order to maximise the day. We started off by visiting some geysers as the sun came up - big natural jets of steam flowing out of the earth. Even better though was the hot springs that came afterwards. It was fantastic to sink into some hot water and escape the cold air. The ground surrounding the pool was still covered in little slivers of ice from the night before, and getting out again in order to get changed was not pleasant!
By now we were right down in the south west corner of Bolivia, on the border with Chile. The rest of the day was mainly a drive back up to Uyuni, enjoying the scenery and the occasional herd of llamas strolling by.

We arrived in Uyuni in the early evening, before getting another overnight train up north again. This wouldn't be Bolivia if there wasn't a strike involved, and we had to spend the day in Oruro before being able to catch a bus home to Cochabamba that evening. Tremendous experience.

The end of Bolivia.

I'm off to La Paz shortly, where I'll spend a few days before flying to Miami early Saturday morning on the first leg of the journey home.. It's been good Bolivia, hasta luego.