Monday, December 16, 2013

Why Bolivia? Sutton's Law in Action!

When I supervise medical students or resident physicians, I always discuss with them the fundamental truth behind what we do as doctors:

There are only two reasons a patient comes to a doctor: they have pain or fear, or both.
Providing a neutral perspective for a patient's needs, this truth offers doctors a mindful way to maintain compassion and empathy even when fatigued or struggling with a difficult patient interaction.

When one steps back and considers the statement it may seem obvious. And thus it can be an example of Sutton's Law.

Willie Sutton, a famous twentieth-century American bank robber, when asked why he robbed banks, reportedly said:

"Because that's where the money is!"
The reply stated the obvious, and with that came Sutton's Law, an idea now central to medical training and referenced throughout the social sciences -- when assessing a problem, first consider the obvious, and test to confirm or rule that out before considering more esoteric and less likely diagnoses.

Thus Sutton's Law can explain why the AAVia Foundation for the Health of Bolivian Children needs your help.

Bolivia, like the banks robbed by Willie Sutton, is where the "money" is, or rather where the pain and fear for patients is abundant.

Work we support in Bolivia is to lessen the pain and fear that patients and families may have. Being the poorest country in South America means Bolivia has limited resources for medical care, so there is a lot of pain to ease and fear to settle.

Next month, the AAVia Foundation will have a team in La Paz to study the work being done there and the opportunities for Americans to help.

Please help us in this effort.

Joining us on the foundation's Facebook page means you can easily follow the exciting efforts we have planned.

And your donations will empower the foundation in its work.

Consider our trip in January as us casing the bank so we can rob Bolivian's of their pain and fear.

Willie Sutton lives -- and we are him!

--Timothy Malia, MD
Co-founder and Vice President of the AAVia Foundation for the Health of Bolivian Children
December 16, 2013

Monday, January 14, 2013

Mountains & Forests, Sand & Salt: Bolivia's Natural Beauty

At the AAVia Foundation for the Health of Bolivian Children, we often point out challenges faced by impoverished Bolivian children needing medical care. And we support our colleague starting a center for infants and children with colo-rectal problems who need high-level care or face life-long risk of problems and complications. But there is a lot more to Bolivia than poverty and barriers to medical care.

On a map, Bolivia looks small because it borders Brazil, one of the world's largest countries, but Bolivia is actually as big as the states of Texas and California combined! And Bolivia has remarkable diversity: Amazonian rain forests; savannas; mountain valleys; high peaks; Titicaca, the world's highest navigable lake; and even the world's largest salt flat which lies remotely at 12,000 ft (3600 m) elevation!

This tourism clip from Bolivia is worth a watch if you want to get a taste of the land's and its people's majesty. Enjoy.

And, remember, "Bolivia ¡te espera!"

--Timothy Malia, MD
Co-founder, AAVia Foundation for the Health of Bolivian Children
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Saturday, January 5, 2013

Can Technology Help Bolivian Patient-Doctor Relationship?

Where does trust, communication, accountability--and technology--fit in the AAVia journey?

Medical care depends on trust, communication and accountability as those attributes support the relationship between patient and provider. This remains as true today as in ancient Greece when Hippocrates (460BC-370BC) established the early foundation of modern medicine.

Technology, however, adds another factor to the equation today. When used well, it leverages information so patient and provider can make good decisions and monitor care to improve health. But the risk remains that technology can be a barrier between the two parties, or replace one of the three primary attributes--in either case, a grave error.

A new medical technology should only be part of care if it improves the patient-doctor relationship and is both easy to use and effective.

I just learned of  a non-invasive test (that is, no poke or needle stick to get blood) that rapidly checks for anemia and may pass muster for the above criteria. It is designed to be reasonable for use in poor, rural, under-developed areas of the world.

I read an interview with the lead researcher, Myshkin Ingawale, on the TED blog and then watched the related TED video.

The new portable technology (ToucHb) would allow community health workers to assess patients for anemia, help them get proper care, and then monitor if the treatment is working. Since the test is non-invasive, patients do not have to fear pain or bleeding.

It would support the trust patients have for a community health worker, facilitate communication about anemia and the treatments, and allow for accountability as treatment effectiveness can be documented.

I don't know if the ToucHb itself will ever play a part in the efforts of the AAVia Foundation for the Health of Bolivian Children; but I can say our inaugural project depends on properly balancing modern technology with proper medical care based on a strong patient-doctor relationship.

Our Bolivian partner, Dr. Edwin Dolz, is a pediatric surgeon who is establishing the Centro Nacional de Patología Colorectal Pediátrica in the Hospital Arco Iris, a charity hospital in La Paz, Bolivia.

The goal for the center is to provide excellent medical assessment and treatment, including skilled surgical care using appropriate medical technology when needed, for children having severe intestinal problems. When an infant or young child has Hirschsprung's Disease or congenital colon malformations, they and their families suffer greatly without proper medical care. But the cost of care is a barrier for impoverished Bolivian families; thus leading to long-term health complications for the child, and greater stress for the family.

With our support, children will have access to both medical technology and better health otherwise unavailable to them--and the trust, communication, and accountability between our Bolivian partners and their patients will be ever stronger!

--Timothy Malia, MD
Co-founder, AAVia Foundation for the Health of Bolivian Children
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Thursday, January 3, 2013

Highlights for December 2012

This past month has been filled with new, wonderful things for the AAVia Foundation! In future posts I will be sharing more details and information, but for now, the highlights:

  • We returned from a trip to Bolivia, where we had the opportunity to speak with doctors, nurses, parents, and children about the help that is needed.
  • We began this blog, which will become our place to talk with you about the foundation, Bolivia, and how all of us can make a difference.
  • Last but not least, we have added lots of new material to our website, including Pictures and more information about Our Project.

Our Facebook and Twitter pages have day-to-day updates, and our YouTube channel will have new videos soon. Join us on any of these sites to keep following the AAVia journey!

-Mackenzie Malia
Co-Founder, AAVia Foundation for the Health of Bolivian Children

Wednesday, January 2, 2013

Our Blog: Warm in December, Cold in June

Welcome to the first blog post for the AAVia Foundation. We look forward to posting about our activities, stories of our experiences, news reports, updates from our Bolivian partners, and whatever else we can imagine. Our hope is this will help readers better understand our motivation to support efforts in Bolivia for children's health.

Today, however, I wish to point to great poetry, specifically Robert Frost (1874-1963) and a poem he wrote about one hundred years ago, The Mountain (1915)

Frost was a Pulitzer Prize winner and the first poet asked to read at a presidential inauguration when John Kennedy invited him in 1960. He used his life in New England to color his poetry with natural world imagery and colloquial speech which related to common-man life both literally and metaphorically. His work is a major part of how rural American life of the early twentieth century will forever be remembered.

While most may recall Frost's poem The Road Not Taken ("Two roads diverged in a yellow wood ... I took the one less traveled by, And that has made all the difference."), we were drawn to The Mountain and from it found the name of our blog: Warm in December, Cold in June, as it reflects where we are and where we hope to go.

In the poem, a man is visiting a town which sits in the shadow of a mountain. As he hikes toward the mountain he meets a local farmer who is walking with an ox and cart. The conversation which follows relates how the mountain's size limits the growth of the town and that there are stories of a spring at the top which is "almost like a fountain," and which feeds a brook that flows down the mountain. The brook is storied as being "always cold in summer, warm in winter." The old man, though he has lived there a long time, has never climbed the mountain or seen the spring but he encourages the visitor to consider ways to climb the summit.

Later, the visitor tries to learn more about the brook and the water's temperature when he asks:

"Warm in December, cold in June, you say?"

And the old man replies (with what I imagine is a slow, heavy rural New England accent and dry humor):

"I don't suppose the water's changed at all.
You and I know enough to know it's warm
Compared with cold, and cold compared with warm.
But all the fun's in how you say a thing"
The poem winds down with no finality as the farmer turns to continue walking with his ox and cart. We never know if the visitor hikes the mountain finding the brook and its spring, or simply returns to the town where he started.

So goes life. We travel, sometimes to places that are "held in the shadow" of something grand like a mountain. We meet locals who encourage us to hike and explore new places. We ask questions and learn from the locals, understanding more of their past and possibilities for the future. But those possibilities are never certain and the reality that will unfold is only determined by what we choose to do next.

That defines the AAVia Foundation for the Health of Bolivian Children at this juncture. 

Bolivia lies in the southern hemisphere where, yes, the weather is warmer in December and colder in June. The peaks of the Andes Mountains dominate the geography. And we are learning from the locals so we may understand possibilities and choose our actions to better shape the future as we all climb the summit which lies before us.

--Timothy Malia, MD
Join the AAVia journey on our Facebook page, too!