Kallawaya – traditional holistic healer with a profound, centuries-old knowledge of natural medicine
The footsteps of the Kallawaya echo through the highlands of La Paz, Bolivia. These native Andean medicine men travel great distances – through the birthplace of the Incas, past massive stone monoliths of gods with glaring hand deformities – to heal the body and spirit of their people. As members of an Interplast team, we enter beneath the shadows of the monoliths and alongside the traditions of the local culture on our way to repair the hands of Bolivia’s children.
This inaugural trip to La Paz is a mixture of opportunities and challenges for Interplast, as well as for the individual team members. Our hopes to operate on as many children as possible are tempered by the limitations of any initial trip to a developing country – the logistic obstacles and the time needed to generate an awareness of Interplast’s presence and potential. We will help establish the international relationships with organizations and medical colleagues that will be the foundation for future Interplast trips here.
We are hand surgeons, anesthesiologists, nurses, hand therapists, a pediatrician, and a secretary/translator. One of the hand therapists is from Santa Cruz, Bolivia, the site of a previous Interplast trip. She will now be working with the hand therapist from Salt Lake City to treat the La Paz patients and teach the local therapists. This growing network of educated professionals is helping to address the issues of postoperative management and continuity of care that are particularly crucial in hand surgery.
We are mountain climbers and marathon runners, art enthusiasts and world travelers, parents and grandparents. A few of us have worked together, but the rest met for the first time in the airport in Miami en route to La Paz. Some have been on more than twenty Interplast trips, but others like myself are on our first trip. Many paths have brought us together in this faraway city.
HEALING HANDS
La Paz is nestled within a canyon at an elevation of 12,000 feet along the Andes highlands. The first view of the city from the canyon rim is expansive and breathtaking. As we descend through this unique city, an intricate array of surprises unfolds. The ornate architecture reflects the character of the people, emerging proudly and defiantly through veils of poverty.
During our bus ride from the airport to the hospital we learn that only 26 children are scheduled for evaluation in the Hospital del Niño. We had anticipated examining many more potential patients, for we know that we will have to turn some away; some may have conditions we would be unable to treat, or some may not be healthy enough to undergo surgery. However, this disappointing turnout is far overshadowed by the news that our equipment has been detained in customs at the airport, which may prevent us from doing any surgery. We do not understand why customs has confiscated our supplies; we probably never will. We are aware that Interplast and many other international medical volunteer groups commonly encounter such difficulties, but we fear that 26 waiting children may never get to have their hands fixed.
A few hours later we are in the Hospital del Niño clinic. Families are quiet in the waiting room, nervous with anticipation. For most of these children, Interplast offers the only hope of restoring hand function—which is critically important in a community where education is limited and manual skills are essential. Mothers carry the smaller children in colorful blankets on their backs. Shy children hold out their hands to be examined. Most of them speak native dialects, and my Irish-Italian New Jersey Spanish is unintelligible to them, no matter how loudly I speak. Our hosts help translate and bridge the gap between two disparate cultures in the hope of achieving our common goal.
We meet Fernando, Sebastian, and Joselyn; they have congenital deformities resulting in missing or nonfunctioning fingers. Ana has disabling nerve injuries sustained during childbirth. Bladomir and Maria have been badly burned, and Gabriella had trauma to her nerves and tendons that was not adequately treated. Much of their functional loss would have been prevented with appropriate treatment, and in many cases the deformities are now only partly correctable. The impact that these problems will have on these children’s lives is staggering.
We schedule 12 children for surgery. We are still trying to evaluate as many children as possible despite fearing that the problem in customs will prevent us from operating on them. Delays are compressing the surgery schedule. We explain to the parents that our time is limited and that their child’s ability to have surgery depends on the number and severity of the hand problems to be evaluated during the rest of the week.
Local news crews appear at the clinic to interview us for television and newspapers. Perhaps this coverage will raise awareness of our visit and attract more children to the clinic. When the cameras are gone, our hosts inform us that children from Cochabamba and Santa Cruz will be bused in during the next few days. Cochabamba is several hours away, and Santa Cruz is a day’s drive away. We eagerly await the arrival of these children that are traveling so far in the hope of having surgery.
Surgery that does not require the special equipment locked up in customs is scheduled for the first day. My first operation is on Alex, a 10-year-old boy who caught his finger in a slamming door when he was eighteen months old. This is the type of routine injury that a busy hand surgeon in the United States treats on a weekly basis. In this child, however, the injury has become debilitating. The fingertip is deformed and most of the nail is missing. One of the nerves has been cut, leading to an abnormal neuroma that sticks out through the skin, causing him excruciating pain and reluctance to use the hand. I excise the neuroma and abnormal nail bed as well as the nail shards that are growing against the skin at the tip. This is minor surgery for me but a chance at a life change for this small boy.
Customs continues to interfere with the fate of the children from La Paz. After Monday’s cases, we have an Interplast team meeting, and at the recommendation of the anesthesiologists decide to postpone surgery until our intraoperative monitoring equipment becomes available. Tuesday’s surgeries are cancelled. Until we can get our own equipment back, surgery will be indefinitely postponed. If we cannot get the equipment by the following day, members of the team will return home. Morale plummets.
As more children from the region arrive, they are scheduled for overnight admission prior to surgery. For many children ‘overnight’ turns into two or three nights due to the undetermined issue of the equipment and ever-changing operating room schedules. Bed-lined wards overflow with anxious children and hopeful parents. The Interplast team is here. The patients are now here. But there’s still no sign of our equipment.
By Tuesday there are more than 16 children in the hospital waiting for surgery. A 12-year-old boy named Alberto has lived his entire life with an extra thumb on his right hand, an easily fixable deformity. He takes his bed in the ward, like the others, knowing that he may not get to have surgery. His extra thumb is progressively dropping to a lower priority as the children with contracted wrists, nerve palsies, and minimally functional fingers fill the adjacent beds. He understands this but waits patiently. His smile is unwavering.
Somehow, with the clock ticking on Tuesday afternoon, the offices of the First Lady of Bolivia and the Minister of Health arrange to have our supplies released from customs, and the doors to the operating room reopen. By Wednesday we are running a 12-hour schedule in two operating rooms.
Word of our visit has now reached the entire country through the media reports. Busloads of children arrive from Cochabamba, Santa Cruz, and other faraway regions. The clinic becomes overwhelmed. While we operate on Wednesday, Dr. Gary Feldman, a pediatrician from Riverside, California, evaluates 87 children in the clinic. A rumor quickly spreads among the children that this jolly, gray-bearded man is Papa Noel (Santa Claus). I watch Gary interact with the children, and their response to him, and I begin to wonder if it’s true.
The clinic has become a triage unit. We will now evaluate at least 200 children during the week; there is no need to count anymore. Dr. Douglas Hutchinson, a hand surgeon from Salt Lake City, is the team leader with the ultimate responsibility for making the final decisions regarding surgery. Hutch labors over the decision of selecting the patients with the right balance of severe functional deficits and high improvement potential. Children with extra thumbs and other relatively mild deformities who have waited many hours, and in some cases days, must be turned away. There are no arguments, only tears. Entire families shake our hands and then gather their belongings to begin their journey home.
The remaining families are still waiting, shifting closer to the outside of the examining rooms. We are devastated by the need to say no to so many deserving people, but we have no choice; we do not have enough time to treat every patient. We never intended to break so many hearts, or to have our own hearts broken. Angel, a 2-year-old boy with no thumbs gets squeezed onto the operating room schedule for a pollicization, an operation in which the index finger is converted into an opposable thumb. He is the fourth child whom we have seen with this congenital disorder and the 25th and final patient to be placed on the week’s surgery schedule. The lines are still getting longer, but the operating rooms are full.
Time limitations force us to discharge some of the waiting children from the hospital. Their families also thank us. Hutch tells Alberto, the boy with the extra thumb who has now been in the hospital most of the week, that he cannot have surgery. The decision weighs heavily on Hutch, but Alberto accepts the news with composure. He waits for his mother, who will pick him up the next morning.
SEEING THE FUTURE
On the second afternoon in Bolivia, I go with the other two surgeons to meet Drs. Patricia Callisperis and Jorge Terrazas. Patricia is a pediatric orthopedic surgeon who runs a small government-funded rehabilitation hospital. Jorge, her cousin, is the only specialty-trained orthopedic hand surgeon in Bolivia. He left La Paz to train in Brazil but has since returned to help the people in his community. The two cousins have taken on the challenge of building an operating suite in the rehabilitation hospital.
Because of a Bolivian law prohibiting relatives from working together in the same government building, Jorge cannot be officially employed by the hospital. Instead, he will work there free of charge, taking care of the needy children of La Paz. At the time of our visit, they are waiting to find out the results of the bacterial cultures taken to confirm the sterility of the operating room. The immediate future of the operating room will rely upon the results of these tests, but the project’s destiny is driven by the dedication of these two impressive and charismatic people.
The hospital is a plain white cement building, a project of the heart struggling to survive despite limited funding. A small courtyard is lined with roses. The colorful flowers provide a stark contrast with the crumbling cement buildings surrounding the hospital and the gray cliff backdrop. The founder of the hospital is buried inside the building, inseparable from her dreams. Her casket lies behind a wall with a framed print of Jesus, below which lies the inscription “el amigo que nunca se cae” (‘the friend who never falls’).
Patricia tells us that the hospital is actually ‘home’ for 22 patients. They are not the rehabilitation patients whom we anticipated. They are all children from the countryside who were born with congenital deformities and left at the doorstep of the rehabilitation center “to wait for God to take them away.” This is not what the doctors had pictured for their hospital either, but they continue to do vocational work with these children, teaching crafts and providing remedial education with the hope of giving them a role in society.
Jorge welcomes us to his home after our tour of the rehabilitation hospital. Our arrival surprises his wife, who balances their two small children while putting together snacks and drinks to help us feel welcome. Our discussion with Jorge turns to ways that we can work together to help the children of La Paz. We learn that many of the injuries and congenital deformities that we treat routinely in the United States are left untreated in Bolivia due to lack of funding and expertise.
Jorge is a one-man tertiary center. Many of the patients that he evaluates have already missed the window of opportunity for optimal care. Some deformities are no longer operable, and others require multiple complicated operations to treat what was once more easily fixed. We review his photographs of patients with complicated hand injuries from machinery accidents and electrical burns, sharing our thoughts on surgical repair options.
During the week we become friends with our Bolivian colleagues. We operate with Jorge and Dr. Adán Gutiérrez, a local plastic surgeon from Oruro, Bolivia. We learn the Spanish names for the surgical instruments (even our Canadian team member, who applies a French accent to the new vocabulary). We develop growing respect for the Bolivian nurses, people who are on salary and are not getting paid any more for staying into the evening to operate with us. By the end of the week, Americans and Bolivians have united as a single team, colleagues with a mutual respect. We speak about the reality of what we will accomplish during future trips to La Paz.
SUMMONING THE SPIRITS
On the last day of surgery, the schedule is again cut short by customs issues. We must get our equipment packed and back through the airport by mid-afternoon in order to ship it back to the United States.
We listen to the flowing rhythms of the antara panpipes and small charango guitars as we operate. We eat meat-filled pastries called salteñas between cases. Dionysio, the van driver, collects the leftovers for the children in his neighborhood.
Gabriella, a 7-year-old girl with a brachial plexus injury from childbirth, cannot extend her wrist or thumb. We transfer two functioning tendons to the back of her wrist in order to restore this absent motion. The last cases in the two operating rooms finish almost simultaneously. I feel a sudden sadness, realizing that our week of operating in La Paz is over.
Out of the corner of my eye I see the nurses getting ready for an additional case next door. Alberto’s mother hasn’t been able to pick him up yet, and Hutch can do his surgery under local anesthesia while the rest of the team packs the equipment. Alberto is finally getting rid of his extra thumb. He and Hutch go into the room smiling and come out smiling.
On our last evening in Bolivia we pass along the mesa overlooking La Paz. The lights of the city twinkle below us like a bowl full of stars. The week has been a whirlwind, and I am only starting to absorb the emotional effects of the experience. I traveled to Bolivia to heal the hands of its children, but I have found myself enriched by the people and their culture. In the course of the week, in the footsteps of the Kallawaya, my spirit has been healed.
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