A Special "Hola" for Daniel, Jonathan, and Will

The most touching account described by Daniel, Jonathan, and Will about their experience last summer at Burn Center Viedma involved a little girl named Vivianna. While it’s rightfully their story to tell, we were privy to recent developments in her saga, and wanted to share these new revelations, along with some special video footage, with our founders.

Vivianna was three years old when pushed into an open flame by an older sibling last June. The accident occurred in a remote Indian village in the Bolivian countryside miles from the nearest hospital. As she fell backwards into the fire, her dress ignited and singed her back and buttocks. Because of the seclusion of her village, she lay without medical attention for three days. Once rumor of her accident reached Cochabamba, a medical missionary set out by helicopter to airlift her to Burn Center Viedma. Upon her arrival, Daniel, Jonathan, and Will watched in awe as Dr. Romero and company stripped all layers of tissue from her back down to her musculature, and grafted skin from all over her body to cover her exposed injury. We recently learned from Vivianna’s current care taker that the boy who pushed her into the fire was banished from her village. Unfortunately, we also learned that the village elders met and decided not to allow the now four year old Vivianna to return. Consequently, she is in the care of an American couple volunteering in Cochabamba. She’s learned to speak Spanish in lieu of her native language, and visits the burn center daily for physical therapy to ensure the elasticity of the grafted skin on her back. From what we’ve seen of her she’s nothing but smiles, and from what her care takers say, she’s a bundle of unbridled energy and mischief.

The Birth of a Churango Prodigy

Anyone who knows Jim is aware of his incredible prowess on the guitar, but apparently this talent is limited to six-stringed instruments. In this clip, Pablo, a fifteen year old boy who is recovering from burns on his chest and arms, does his best to instruct Jim on the finer points of playing the Churango, a ten stringed instrument. While Jim gives it the old “med-school” try, it’s obvious that Pablo is the superior Churango player. Sorry Jim, the video doesn’t lie.

The Discomforts of Home

Regardless of the perils faced during the course of a long and stressful day, one always has the comfort of a hot shower to look forward to; a few minutes of warmth and solace in which to forget about the day’s trials and tribulations. As if life at the burn center wasn’t uncomfortable enough, the children can’t even depend on a warm soak to sooth their misfortunes. Instead, their weekly bath consists of a lawn chair and a bucket of water. This footage is of Sarah, a four year old girl who was burned on her forehead when her brother tipped a boiling pot of water onto her and her older sister Maribel. Consistent with most events for the children at the burn center, her bath is obviously very traumatic. One thing that the camera doesn’t capture is the violence with which Sarah is shivering throughout the process. During her bath, we discovered that towels and baby shampoo are two luxuries the center is forced to do without. As is visible in this clip, they use hand soap to wash Sarah, and then dry her with bed sheets.

"Country Boy"

Last Friday, the burn center was transformed into a trauma surgery room. We gasped as we watched Dr. Romero unwrap a 12 year old boys right leg. It was obvious this was no burn victim. His skin had been ripped to shreds, and every muscle in his thigh was exposed. With our well developed "Spanglish" we were able to decipher the word "Vaca" meaning cow which was the demise of this young man. He was mauled by a long horn while working on his family's farm. Because his diet consisted of the typical rice and potatoes of a poor Bolivian family he had absolutely no fat on his legs. Because his condition was very fragile, it was vital that Dr. Romero knew the exact state of his health. At this moment Dr. Romero turned to us and asked MS4BCV to provide the finances for his lab work in hopes of his survival throughout the weekend- only $25. We are able to see first hand how every single dollar counts down here. Someone's sacrifice saved this young man's life. Yesterday we saw him, and he was alert, infection free and stable. We are waiting until Friday in hopes that he will be strong enough to survive surgery.

El Presidente

Evo, named after Evo Morales the current president of Bolivia , was recently mentioned by the girls in one of their blogs. While the girls continue to do an outstanding job serving children like Evo, we have returned home, and now have the capacity to upload the numerous videos we shot at the burn center. This in mind, I thought it only appropriate to share the impact that Evo had on our experience in Cochabamba.

Two years old, he lay flat on his stomach with his right arm and leg tied to his crib to prevent him from rolling on his back. He was sedated to alleviate the pain of the burns he suffered on his butt, and the debridement that followed to expedite their healing. Although the exact cause of his burns was never revealed, it was speculated that they were a result of a custom of burning a child’s rear-end with coals to quell the onset of diarrhea. He had been abandoned by both his mother and father, and was under the supervision of his two uncles at the time of his injury. Aside from his burns, he was severely malnourished. He was covered by what could best be described as a tent of blankets constructed to keep him warm while preventing direct contact with his exposed burns.

Our first day at Burn Center Viedma, the sight of his hazy brown eyes peering up at us from beneath this heap of covers was overwhelming. All that he wished to say, but was yet unable, was written with the mastery of Whitman in the expressions on his face. In each wrinkle of his brow and twist of his lip I saw the fear, frustration, hunger, pain, and solitude that defined his brief existence. Yet as my eyes began to water and I started to slip into hopelessness, he extended his tiny hand and wrapped it around my finger. With this gesture, Evo introduced me to reality. His simple touch made all that was composed within the poignant expressions of his face tangible. Once accepted as concrete, hopelessness gave way to empowerment. "We can help you", I thought silently to myself.

The day of our departure from Cochabamba we stopped at the burn center to say goodbye to the children. Fully recovered and fifteen pounds heavier, Evo was found alone playing on the floor. Grasping the same finger he had three weeks prior, he led me on a walk through the halls of the hospital. The agony that had previously been portrayed on his gaunt face was replaced by smiles and demands for more food. Yet the time came to say goodbye, and I led him back to where I found him earlier in the day. I gave him a hug, said so long, sat him down and turned to walk away. I fought looking back with every ounce of my judgment, yet as I rounded the corner it was unavoidable. Two outstretched arms, a face furrowed with disapproval, and tears streaming down his chubby cheeks. It’s an image that’s burned into my psyche. I was abandoning him, much as his mother and father had, and although our brief presence in his life harbored a fraction of the influence of a parent, the statement in his expression will haunt me forever.

The Great Fidel!

Fidel is a 10 year old boy who has been waiting since march for reconstructive surgery on his horribly scared face. Physicians from wake forest put in a skin expander in march and it was on wednesday that Dr. Romero performed his reconstructive surgery. This gave him skin that looked as if it had never been burned on his lower face and neck. Today when we arrived at the burn center we realized how much this young boy has been through already in his life. Not only was he burned, lives in an orphanage, but he is now undergoing even more surgery in hopes of a normal life one day. We know that the strength that these children possess come from a source that we will never understand. These kids have no insurance, no family, minimal hygeine, and they undergo traumas and insecurites that we would never survive. It really makes us greatful for the life we have been given. This confirms our mission to help those who have greater needs than our own.

Toys, Toys, Toys!

Every day we discover things that we wouldn't think twice about that are needed here. Anai is about 3 years old and her surgery on Friday was a big wake up call for us. The worst part of the surgery was not that she woke up twice during it crying for her mother, but that her surgery could have been prevented. After she was burned on her arms, her parents neglected to take her to physical therapy or to make her wear her burn suit so that she could heal properly. She developed awful scars and her skin was like leather. Her arm was permanently bent so that she could no longer use it. Now, Anai has to have even more surgery to try and fix her arm so that she is not disabled. This morning we walked into the burn center and immediately wanted to see how she was doing. We saw her laying flat on her back with both of her arms tied to the crib so that she cannot tear off her bandages from surgery. She has no entertainment except for the white ceilings and the nurses who can occasionally talk to her. This is where we are helping, not only with our time, but with the things that this fundraiser has allowed us to purchase. We are buying toys, blankets, and things for the kids who are confined to their cribs until their skin has healed. It is a great joy when you see how easy it is to make their lives a little better.

We are not in Kansas, Toto!

Over the last three days, we have seen many surgeries ranging from minor to life-threatening. On our first day in the hospital, we met a 15 month old boy who had fallen into a fire of hot coals. Unable to get himself out, he lay burning as his intoxicated parents neglected to notice. His palms are destroyed by deep third degree burns exposing the muscles, and his hands may have to be amputated. Second and third degree burns cover his body and the right half of his face. We are scheduled to participate in skin graft surgery tomorrow in an attempt to recover the skin on his face, eyelid and ear.

On the other side of the operating room door, there are two of our favorite children. Natalia and Evo are about the same age and equally bossy. They have become as much of a part of the burn center as the nurses and doctors. Both came in malnourished and frail. Now, they are plump, full of spirit and always looking for a hand to hold. They make us forget about the suffering that fills each room until we hear the whimpering and crying of a new patient who has just come out of surgery calling for his mother. The children are left with only white coats to attempt to comfort them. Parents are no where to be found due to the strict visitation rules and the inability to afford the stay in the city while their child is undergoing treatment.

Within the first week at the hospital, we have already noticed "luxury" items that the children desperately need since they share the same few toys and are confined to their beds for most of the day. Next week, we will head to the Concha, or market, to shop for items that will put smiles on these sad faces.

I feel like I'm at home!

We arrived this weekend to Cochabamba after many crazy adventures in the airport: such as 24 hours of travel time, almost missing our flight, altitude sickness and getting off the plane in rainbows and capris only to find out it's 32 degrees in La Paz (see picture). Now that we are here, we think it is well worth the journey. After getting off the plane standing in the wrong customs line, the first thing we thought we were asked was "were you chewing?" We had no idea what the woman meant - it was at that moment that we knew we were no longer in America. Later, that same day, Jessica slept on the sidewalk next to the taxis and due to the altitude sickness, Ashley stated that she felt "right at home" being the only blond in the airport of Bolivians. We think that we were suffering from a lack of sleep after we tried to get on wrong plane twice, making our flight 5 minutes before take-off.

Enough about travel. Today was our first day at the burn center. At this moment, we really felt as though our trip had begun. These children are a different kind of beautiful. We almost forget the language barrier because these children just need someone to hold their hand. We are just skimming the surface of what we are going to learn about these children, and we have already decided that we want to take them all home with us. Today, we helped put the compression suits on the children and tried to show them that we were there to help. There were lots of tears and smiles, and we are so excited to see what the next three weeks hold. As we learn, you will learn.

We've Reached a Decision

After two weeks spent assessing the needs of Burn Center Viedma, we’ve reached a decision on how to best utilize the funds that were so generously donated to MS4BCV. One of the most startling aspects of surgery at the burn center is the lack of reliable equipment to monitor vital signs during the course of an operation. The current monitor cuts in and out of service, and the validity of the data it presents when functional is questionable at best. Given that anesthetizing children is an extremely delicate pursuit, and the majority of children must be put under general anesthesia, the absence of adequate equipment for monitoring vital signs makes surgery at the burn center an extremely risky endeavor. Many times the only way the anesthesiologist knows for certain that the child’s heart is still beating is to use a stethoscope. Further more, if a child’s heart was to stop during a surgery, the OR lacks a defibrillator, which greatly inhibits the ability to resuscitate. Although Dr. Romero and staff are well aware of these inadequacies, they are unable to acquire new equipment since the hospital is federally funded. Currently the government has deemed other areas of health care in Bolivia a priority, so the burn center continues to go without. Sadly, it is the children who suffer, and pay the price in preventable scarring or deformities due to rushed procedures, infections due to delayed surgeries, or in some cases death.

Based on these observations, and input from our predecessors, we felt the best way for MS4BCV to uphold our mission of service to Burn Center Viedma was to purchase a new monitor complete with EKG and defibrillator for the OR. Given our lack of knowledge concerning this equipment, we enlisted the help of Dr. Luis Quiroga, a family practitioner who received his medical training at the University of Cincinnati and who practiced in Ohio for over thirty years. We accompanied Dr. Quiroga to numerous medical supply stores throughout the city until we found the equipment that met our requirements. He has guaranteed us that we have chosen the best monitor possible. We would again like to thank all those who so generously donated to this cause so that a purchase of this magnitude could be made. Because of your generosity, lives will be saved.

Dr. Romero

Growing up in a medical family, I was constantly reminded that medicine is a pursuit of the heart more so than the mind. Dr. Romero has been the director and chief surgeon of Burn Center Viedma for over twenty years. Although he continues to explore and improve his craft, the dedication that has defined his tenure in such a traumatic and stressful position has undoubtedly been driven by his heart. At sixty-five years of age, he has obvious aches and pains. Currently he is unable to lift his left shoulder above forty-five degrees, suffers from gastric ulcers, and today was battling a bout of gastroenteritis. Even while vomiting between surgeries he refused to concede his position of responsibility. Following this morning’s procedures, one of which was a debridement of the third degree burns suffered by an eighteen month old baby, we found an exhausted and dehydrated Dr. Romero seated next to the child’s crib. Of all that Dr. Romero has taught Jason, Jim, and I over the past few weeks, perhaps the most significant lesson is further evidence that medicine truly is a pursuit of the heart.

Staff Lunch

Written by Jason Rogers

Siesta, according to Webster’s Dictionary, is a mid day rest, and according to Cochabambans it is a reason to make lunch the most important meal of the day. Not long into our Bolivian excursion, did we realize that lunch, not dinner, is the most important event of the day. Lunch is a very leisurely meal in this country and as Americans we have to occupy ourselves with various activities to avoid the nap that is also a staple of many Latinos. Most businesses seem to shut down from the hours of noon to about 4 to ensure that everyone has ample time to siesta.

The above noted, putting together a lunch for the enter Burn Center Viedma staff was a goal of ours from the first day we arrived. Being able to invite the staff to a lunch shows our support of their work and further, their acceptance of our invitation means that they have also accepted us into their group. With the help of Cindy, we were able to set up such a lunch with the hospital staff and, interestingly enough, we left the choice of food up to the locals.

This past Monday we had the lunch and it went wonderfully. We (note: whenever I say “we” spoke to Dr. Romero I mean we smiled and nodded with some occasional Spanglish, the actually speaking/translating was done by Cindy Jackson, thanks!!) were able to tell Dr. Romero about the enormous support that the University of South Carolina School of Medicine had generated for his burn center in Cochabamba. The meal was a popular Bolivian dish called “picante de pollo y lengua” and included Tongue, Chicken, and freeze dried potatoes among other things, and of course some more smiling, nodding, and the obligatory acceptance of second helpings (I later realized that I was the only one suckered into second helpings of Tongue). Throughout the meal Dr. Romero was able to communicate to us some major equipment and personnel issues that he deals with day to day. First off the government only allows him to have the use of an anesthesiologist for three hours every morning, and when that time is up the day’s procedures are too. He stated that if he had access to a full time anesthesiologist he could operate all day instead of just in the morning. Dr. Romero also expressed concern that we would think of his techniques as “barbaric.” In fact, we were very impressed with his innovation and adaptation to working with a low budget and lack of certain tools that he described as “essential” in an American operating room. By the lunch’s end we had decided that buying a patient monitor for the OR would be a very worthy use of MS4bcv’s funds. As of now, patients’ vitals are not precisely known which is potentially detrimental to the well-being of any patient.

Thanks to our midday meal with the hospital staff, we were able to strengthen the relationship between the burn center and the USC SOM community. We received lots of thanks from Dr. Romero for our interest in his burn center and the fundraising efforts of everyone back home.

Lunch at El Cristo

We were up early our first Saturday in Cochabamba to take the children staying at Viedma Burn Center’s extended care home for a picnic at the Cristo. Those staying at the home are still recovering from significant and disfiguring burns, but do not require continued hospitalization. Each has been away from their family for many months, and in some cases years. A few have been abandoned by their parents due to their marred appearance or the expense of medical bills for the treatment of their burns. During our excursion we had an incredible time with all of them, and were touched by the way, in the absence of their immediate families, they functioned as a family unit. We continue to be amazed by their resiliency, and have been deeply moved by their ability to maintain their child-like innocence and energy amid such harrowing circumstances.

All Alone

When you step into the hall of Burn Center Viedma you immediately hear the sound of the children; a hodgepodge of laughing, crying, and an occasional scream. As you round the corner, you are met by those who are healthy enough to be out of their beds. After navigating their greetings of hugs, “holas” and their IV poles you see those who are still recovering from their most recent surgeries. In the midst of their pain they manage to conjure a smile and give a high five. The most tragic aspect of their experience at the Burn Center is not the anguish caused by their burns, the trauma of their surgeries, or the pain that follows, but the absence of their parents to comfort them. Except for the nurses, who are constantly pricking them with needles and hooking them up to their IVs, they are all alone. Every so often you hear one cry out for mama and its almost unbearable.

First Two Days

I’m sitting in an internet cafe at the moment. We’ve got about 30 minutes to kill until we have to meet some people for lunch. The kids at the hospital have been truly inspiring so far. Its impressive how they can be so brave at their age. Especially when you consider that every story is tragic. There is one little girl, Erlinda, who is about 10 years old, and she’s got a beautiful smile, but she spends much of here time crying out for home and a mother who has abandoned her. She was supposed to go home a couple weeks ago, but her parents haven’t returned for her and the bill remains unpaid. So she waits in limbo at the hospital. Eventually, she will be moved to an orphanage if the parents don t show up.
Such abandonment is not uncommon. Another boy, Fidel, was similarly rejected by his family. When his face was horribly disfigured, his parents dropped him off at the burn center saying they no longer wanted him. At twelve years old, there is no question he understands his circumstances, and I cannot fathom the emotional impact it must have on him. Facial disfigurement is unquestionably one of the most traumatizing injuries, and the fact that his parents have compounded his suffering by subjecting him to their ignorance and cruelty, makes his story one of the most heart wrenching we have yet encountered. He will live at the burn center for a little while, and will eventually also be moved to the orphanage.
There is another small infant named Jevo, whom the nurses call “el presidente” as he shares his name with the president of Bolivia. He spends all day lying on his stomach underneath a small tent because he parents held hot coals to his buttocks in an effort to cure his diarrhea. This is a treatment encouraged by village witch doctors, and such burns are frequently seen here.
Viviana is an orphan whose father abondoned the family, and who’s mother was beaten to death. She is from a village in the jungle, and the whole backside of her body was burned when a boy there intentionally pushed her into a fire. As punishment, the boy, at 14 years old, was banished from the village and sent into the jungle. Viviana made it to Cochabamba carried in a hammock. These are just a few of the stories that these kids have to tell. As you can imagine, it has been a very moving experience so far, and we are only into day two. This afternoon we will be following an ER resident. This was an unexpected opportunity, but should be interesting. Dr. Quiroga, who had practiced in Cincinnati for 25 years before moving home to his native Bolivia, oversees several residents and offered to let us shadow them as much as we would like. He said that the ER here is frequently filled up with shootings, stabbings, and other traumas that in great part characterize existence in large third world cities where poverty and violence are a fact of life.
Our days are filling up. Yesterday, however, we did make it down to the gym. We were able to buy a one month membership for just under 30 dollars. Exercising at altitude is incredibly taxing. I will hopefully come back home in much better shape than when I arrived. Its hard to believe how cheap everything is here. You can get a filet mignon at a nice restaurant for less than 5 dollars. Suffice to say, we are eating well. One of the most fascinating qualities about Bolivia is the apparent lack of laws, or, more accurately, law enforcement. There are no police cars. We occasionally see police officers, but they don’t do much but stand around. Many are armed with nothing more than moderately sized wooden batons, that have become chipped and worn over the years. So, as you can imagine, the driving conditions are unbelievable. Stoplights are a recent addition to Bolivian infrastructure, but they appear to be mere suggestions. Most people just slow down at a red light, look both ways, then proceed right on through. There are also no traffic lanes. It really is a free for all. Our host, Cindy, informed us that the right of way goes to the person who has the more intense stare. Most incredible, though, is that I have yet to see one single fender bender. So for the most part I think we are safe. We either walk or take a taxi almost everywhere, however, yesterday we did take a bus. We were all crammed into an old school bus and I spent much of the trip pushed up against a woman who was breast feeding.
The trip so far has been amazing. The education we are receiving is truly priceless. I welcome the coming weeks with an open mind and a sense of adventure.

We Made It!

Our lay-over in La Paz began at 5:30am after a flight from Miami that lasted the night. We spent the first portion of our stay getting through customs, acquiring our bags, and checking them once again for our flight to Cochabamba scheduled to depart at 7:50pm. We then hunkered down on the cold tile floors to catch up on the sleep we had missed the night before. After a few cups of Coca tea, a couple of meals from the Burger King, and a pep-talk from some Irish travelers (who coincidently had recently acquired their MDs) we decided to venture into the city. Apparently the only traffic regulation in Bolivia is to drive as fast as possible at oncoming cars. Although Jason was pumping his "back seat brake", it didn't seem to slow us down, and we continued to fly toward the city. Once we arrived, we had just enough time to peruse the goods at the witches market, visit San Francisco Cathedral, and inhale enough exhaust fumes to make Al Gore weep. We didn't experience any altitude sickness until we ran across four lanes of highway to get what our cab driver described as the "perfect" picture of La Paz. At eight-thirty last night we arrived safely in Cochabamba only to discover that my backpack had not made it, although one exactly like mine had. Jason had noticed the potential for this mix-up to occur in La Paz given that I and fellow traveler Erin O’Brien had the same backpack. He had warned Erin, who had navigated customs before we had, NOT TO GRAB THE WRONG BAG! Unfortunately Ms. O’Brien has a hard time taking advice, so Jim, Jason and I used her Suave "two-in-one" conditioner/shampoo for our shower this morning. In any event, we made it safely, and our focus has now shifted to our mission of service at Viedma Burn Center. We all feel so blessed to have this opportunity, and are so excited to get started tomorrow.

Day of Departure

Contrary to traditional decorum, its gentlemen first for the summer 2008 internship for MS4BCV. Over the past few months our predecessors and illustrious founders have cultivated our anticipation with heartwarming tales of heroism and courage, but now our time is at hand. We depart today armed with backpacks, passports, and proof of yellow fever vaccinations. Our first test will come 12,000 feet above the sea in the oxygen starved elevations of lofty La Paz as we wait for our connecting flight to Cochabamba. If we are to reach our final destination, we must first brave the altitude sickness that undoubtedly awaits us. Rumor has it that a coffee shop on the main level in front of American Airlines serves a remedy of coca tea that will ensure our survival. This rumor, however, is yet to be confirmed.

Alpaca Scarf Fundraiser a Tremendous Success!

Written by Will Bynum
Saturday, 15 March 2008

Thanks to the incredibly generous donations of family, friends, fellow students, and colleagues, we raised nearly $6,600 and gave out 225 scarves in return! We have been overwhelmed by the amount of monetary and moral support that we have received and feel blessed to be surrounded by such supportive and giving people.

We are currently working with Dr. Romero and the Viedma staff to make our first donation, which will most likely be an anesthesiology monitor to be used in a 2nd operating room currently under development.

This will allow the anesthesiologists and surgeons to perform safer operations and will directly enhance the quality of the care offered to the children treated at the burn center.
The machine, if purchased in South America, will cost approximately $3,000, therefore leaving a significant amount of money still to be donated. We will update you as soon as we make further plans for the remaining amount!

MS4BCV Gains Official Endorsement from USC SOM

Written by Will Bynum
Friday, 14 March 2008

At a recent meeting with Dr. Don DiPette, Dean of the USC School of Medicine, MS4BCV was granted with an official endorsement as an organization that the school supports.

Our proposal to Dr. DiPette included requests for the appointment of a faculty advisor and the establishment of an official summer program and a 4th year elective, both of which will be joint efforts between the Viedma Burn Center, MS4BCV, and the USC SOM.

Plans to establish the summer program are well under way, and the development of a 4th year elective is still in the preliminary, information-gathering stage.

Inaugural MS4BCV Summer Internship

Written by Will Bynum
Friday, 14 March 2008
Jason Rogers, Peter Loper, Jim Ford, Jessica McCutcheon, Ashley Smith, and Lauren Crosby will travel to Cochabamba this summer and will work alongside Dr. Romero and the Viedma staff during two three-week sessions.

The six students have already become very involved in the activities of MS4BCV and will take the reigns of the organization upon returning from Bolivia. We hope to expand from six students over two three-week sessions this summer to 15 students over five three week sessions during the summer of 2009. Cindy Jackson, founder of Burn Care International, Inc (NPO) will serve as the liaison for the summer internship.