Down to 5 Lives

After camp, Erica, Leah and I went to Samaipata in the mountains to decompress for a bit while the rest of the crew headed back to the States. I had never traveled with someone with diabetes before and both Erica and Leah have it. I learned quite a bit on how to manage diabetes while abroad.

Every night before going to bed, Erica and Leah made sure to have some honey around in case they went low, which seemed quite often since we spent a lot of time hiking during the day. They would wake up in the middle of the night with a shaking body and just eat spoons of honey to get their blood sugar level back up higher. On our hikes, we made sure to bring the jar of honey, which is a lot lighter than bringing liters of coke and juice. After Erica told me of an emergency she had while hiking, I was a little worried for the both of them. However, I ended up with the medical emergency.

Erica, Leah, Steve a guy from Ireland we met, and I hiked up the surrounding mountains to see some waterfalls. We chose to forgo obtaining a guide because we thought with the four of us, and a hand-drawn map of the hike, we could figure out the trail. Sadly that was not the case. We found the waterfalls with no problems, but after hiking to the top of the mountain, we could not find the rest of the trail. Instead, we chose to make our own trail down the mountain. Unfortunately, my foot slipped on a rock that fell off the mountain as I followed it down head first. Steve later told me that he just saw this body falling down towards him and didn't know what was going on. Thankfully, my face hit a rock, and stopped my continued free fall. Surprisingly, I didn't break anything and only ended up with bruises, a bloody nose, and a swollen face. When Erica finally reached me, she asked what else hurt besides my face. I told her my knees hurt as well and asked her to get off of them since she was sitting on them while tending to my bloody face. Once the shock wore off, my nose felt like stinging ants had just crawled up it. Thankfully, Leah caught up to us to give me some ibuprofen to help with the pain.


Making our way down the mountain proved to be extremely difficult since we literally had to slide on our butts and stomachs to get down the really steep parts. Steve became my hero and supported me down especially since he thought I had suffered a slight concussion; my wobbly walking almost threw me off the mountain a second time. Many times on the hike down, Erica just cussed at the world since we weren't sure we would ever make it safely down. As the injured one, I tried to calm everyone down, maybe I was still in a state of shock. We really could have benefited from having a machete to cut down the branches and plants in the way or our new trail. We tried to yell for help to the worker men down below tending to their fields, but instead, they just chose to watch us slide around.

After 2 hours hiking down, we hit ground and took a bus to the hospital. I'm not sure I need overseas health insurance when my hospital visit only cost me $1.50. The doctor checked my nose, and because I don't really have a nose to begin with, I didn't break it. He gave me 3 different drugs which only cost $6 in total. Two weeks later now, my nose has healed and all the swelling and black and blue color is gone.

Leah left to go back to the States and Erica came with me to Cochabamba. Erica hasn't had any problems with her diabetes here although, she did drop a bottle of insulin on the floor and now needs more, which she can only get back in Santa Cruz. Whenever she does need insulin, she tells me that she needs to "shoot up", which I find funny.

The other accident I should mention involved a car crash in Santa Cruz. I sat in the back seat as Yanira who is blind in one eye from diabetes, drove me, Lourdes and Maggie in the rain to a home visit. Yanira drove right through the roundabout without looking the other way for oncoming traffic and hit a car heading in the perpendicular direction. She didn't want to stop to talk to the lady she just hit.However, so many cars honked at her because her light was about to fall off, that she finally got out of the car and yelled at the other woman for hitting her car. After exchanging phone numbers, we threw her front light in the back seat and headed off to the home visit. Maggie tried to get a taxi there since none of us wanted to get back in the car, but Yanira insisted on getting us there in her now beat up car, while still blind in one eye on that rainy day.

More Outreach Efforts

Before camp, we worked on outreach efforts in the community since only half the group could attend the Tarija camp due to the unexpected lower attendance of campers due to political issues.

One day, we visited a local center for malnourished children and educated the care takers on the symptoms of diabetes as well as checked the children's blood sugar level. This gave me practice using a glucometer. One child had a high blood sugar level, but the care takers believe that since he is new to the center, he has not been properly fed and cared for. A local doctor went to visit the next day to make sure the child was ok.

On another day, we visited a local orphanage with 120 kids to educate the "mothers" about the symptoms of diabetes and test any children who might have symptoms. I felt like we were trying to find a needle in a haystack, but the education part was important. The orphanage divided itself up into 11 houses with 1 mother in each and kids of varying ages occupying each house. I rather liked the setup, which made each house seem more like a home and family setting complete with its own kitchen. The mothers and kids surprised me with their knowledge of diabetes symptoms which include, frequent urination, constant thirst, drastic weight loss, constant hunger, and fatigue. I didn't even know the symptoms of diabetes before becoming involved in this project.

Maggie, Lourdes and I made other home visits. As a result of one, Maggie miraculously made it on Bolivian television to discuss the symptoms of diabetes with Carlos, a 15 yr old boy with diabetes who is also deaf and mute. We met him and his family the day before the tv interview. He is the most animated child I have ever met and partly because he needs to over express himself to communicate without an oral language. I enjoyed being around his peppiness. Somehow the family already had a scheduled tv interview and invited Maggie to join them.

We also visited Fabiola's family on the outskirts of the city. A taxi dropped us off at a local bus stop on a dirt road and the father picked us up and we bused over to their house. Fabiola is 12 and has had diabetes for 10 years. She is well-educated and seems in control of her condition, but seems to be under the constant watchful eye of her father. Her father is overwhelming to be around and I enjoyed watching Fabiola open up at camp without him there. At the end of camp, she didn't want to go home at all, and sadly avoided her father on the last day. Despite this, the father could not thank us enough for the homevisit as well as for the incredible happiness he saw in his daughter.

Our final home visit was to Laura Christina's house. She is 15 years old and such a sincere and sweet girl whose mother is her best friend. Unfortunately, the parents had to obtain second jobs and work longer hours to pay for the additional cost of some of the insulin. Thankfully, Nino Feliz offers test strips and some of the insulin for free. We learned how concerned the parents are when she sleeps at night. For the most part, parents are most concerned when their child goes low on their blood sugar than when they go high. This is in part because they can see the physical differences when the blood sugar is low and they are not able to wake up their child. However, continual high blood sugar can lead to severe future complications.

On another day, we organized a focus group of parents and kids to learn more about their needs. Instead of taking advantage of a Saturday night in Santa Cruz, I stayed up very late writing up focus group questions with Maggie and Erica. From the focus group, I'm thrilled that the parents had a chance to have their fears about camp resolved for the most part, and meet other parents. I even watched as the parents exchanged numbers to create their own support group, which seems to be a much needed element to supporting the parents. Based on the momentum in the room, I expect the parents to bond together to educate local schools about the needs of their children and rally the government for more healthcare support.

Despite being the oldest volunteer since the program is more geared towards college students and recent grads, I enjoyed spending NYE as well as working with the other volunteers. One of the funniest and most endearing comments came from Anna who said to me on the last day, "June, I am so glad you came. I hope that in 12 years, when I am as old as you, that I can be just as spunky. You give me hope that I have a future." I felt my age at the moment, but understood what she was trying to say and she tried to reclarify after too. I may have been the oldest volunteer by a decade, but I also was one of the spunkier ones around.

Cuban Influence

To better understand the healthcare system in Bolivia, we partnered with Ayenida who is the director of hospital networks containing 5 provinces with 57 hospitals; she administrates all of them. Before camp, she took Maggie, Lourdes and me on a tour of one of her provinces. We visited a couple of hospitals and I was surprised to learn that mother mortality while giving birth is extremely high. Many mothers prefer to give birth at home since they are often scared of hospitals. As a result, when they deliver at home, they do not take out the placenta and therefore develop an infection and die.

Just as mothers fear going to the hospital to deliver, many diabetics fear taking insulin because they associate the insulin with complications that can occur with diabetes. Pablo a 29 year old with Type I ended up with a kidney transplant and Yanira has gone blind in one eye. When Yanira's mother died of complications related to diabetes, her father blamed it on the insulin. He refused to allow Yanira to continue taking insulin until she finally lost an eye. Doctors finally convinced him otherwise to allow her to continue her insulin treatment. Other complications of diabetes include foot ulcers and amputations. Although diabetes requires out of pocket costs, general healthcare is more affordable.

Interestingly, Castro is supporting Bolivia's healthcare system by providing funding for new hospitals as well as loaning Cuban doctors to Bolivia. Some local doctors are not thrilled with the influx of Cuban doctors because of the cultural differences as well as a few complications under Cuban doctor care. But due to Castro's generosity, healthcare is more widely available.

Morales has recently implemented government paid health insurance for all children until 5 years of age and for adults older than 59 years old. For those in between in age, the hospitals in some provinces provide free healthcare or health care visits for only $1.50. Cuba's money is helping pay for these costs, but I'm not sure how affordable healthcare is in other regions.

Diabetes Camp-Happy and Hopeful

Camp remains much of a blur because of the constant activity watching over the kids, getting them from one educational activity to the next, participating in the fun stuff, checking their blood sugars and organizing the rally event with Danielle and Aubrey.

For the rally, we set up 7 events with 7 transition events for 7 teams to compete. The activities ranged from finding lemons in heaps of flour while using only your face to filling up a bucket of water using only the cup in your mouth. Surprisingly, despite the complicated logistics, the event went smoothly and everyone had a fabulous time. We even had a few people throwing water balloons at the campers as they worked each activity.


Other days, we played capture the flag and “find the gringo” in which a few of the monitors hid around the campsite at night and then each team had to go find them. Steve hid under a bunch of sticks on the muddy ground and only 1 group found him mainly because none of us thought anyone would be crazy enough to hide there.

The rest of the time, the campers attended educational activities. Because my group was younger, we missed out on a lot of the leadership youth empowerment sessions in which each camper sets out objectives for the year related to diabetes. Instead, we focused on acting out plays related to diabetes, took advantage of teachable moments throughout the day, and learned a little more about managing diabetes. Our group even created our own song and dance to represent our group number 2, which I can not remember anymore.




The parents attended on the last day to reunite with their kids. For many of the children, they had never left home before, even for a slumber party, because of their diabetes. The parents put a lot of faith and trust in us to be able to hand over their child to complete strangers for a few nights for the first time in their lives. Some parents insisted on calling Kendra's phone number demanding to speak to their child just to make sure she was still alive. Despite having 90 total people at camp with 90% of them diabetic, we encountered no emergencies. A miracle to say the least.

Upon witnessing their children dance the line dances we had taught them, many of the parents told me that they have never seen their kid so happy and alive. I teared up with them as they told me this. They thanked me profusely for the broad smile they saw and secretly told me that they also enjoyed their brief vacation of not having to wake up in the middle of the night to check on and worry about their child.



Highlights for me included:
Watching Maria Lizeth open up and feel a part of the community. She was quite shy at the beginning and did not participate in the activities with the other girls. This is the first time many of the campers have met another person with diabetes. Creating a sense of community clearly provided much needed support and by the end, she had made lasting friendships and even bonded with Stan the Stent Graft.

Hearing Naomi's father's question on whether Naomi could have children later in life; he has been worried about her future. He asked Joe who has had diabetes for 47 years if she could have children. When he said yes, the father broke down in tears of relief and joy. I broke down crying upon hearing this show of love and concern. I had paid Naomi's family a home visit earlier and was so impressed with her maturity not to mention perfect posture. She is such a wonderful child with a bright future and loving family.

Reading the older campers' testimonials. The older kids each wrote something about what they gained from being at camp or what they have learned. Some said it saved their lives and gave them hope that they have a future. Even Katrina, who is so thin she could barely walk, appeared happy and hopeful and healthier than when we had first met her at her home.

Final highlight, making connections with the girls despite my poor Spanish skills and becoming a part of their lives. I miss them all already.

Diabetes Camp-Blood Sugar Checks

All in all, about 60 youth ranging in age from 8 to 25 attended the diabetes youth camp. They came from all socioeconomic backgrounds and various experience and years managing diabetes. We took over 5 cabins, at a local campsite, for each of the various age groups. I, Maggie, and Lorena, from La Paz who also has diabetes, managed nine 12 to 14 yr old girls. We needed all three monitors for all that was required of us.

Very excitable girls greeted me. The very first thing we did after introductions was to check everyone's blood sugar level. Although, the girls only check their levels twice a day, once in the morning and once at night due to costs of the strips, we had them check about 6x a day. With my minimal training testing a couple kid's blood sugar levels at the malnourished children's center, I set out to help.

Their levels were surprisingly, or not, all over the map. One girl's level was even over 400 whereas a normal blood sugar range for someone without diabetes is 80 to 120. Our schedule for the rest of the camp was to check the blood sugar levels at 7:30 am, 10:30am, noon, 2:30pm, 6:00pm, 10:30pm and 1am, and 3am if they were low. Thankfully, we had enough test strips, lancets, alcohol swabs and insulin to last all four days for everyone.

After a lot of exercise, their blood sugar level would drop quite a bit and I often had to keep careful watch of Anihi who almost passed out twice after too much exercise, something her body was just not use to doing. At one check, I fumbled checking her blood sugar level as Maggie kept her conscious and Jairo helped me finish it. We gave her coke and cookies to raise her level. After just a minute of drinking the coke, she suddenly perked up and was ready to play again. I had to keep her seated so that her body had time to recover. After that, I felt like I had been given a tremendous amount of responsibility with very little training.


Due to my inexperience, another volunteer showed me and 3 others, who have no experience with needles and syringes, how to put air in the insulin bottles and then how to draw out the correct amounts as well as how to draw up 2 different types of insulin with one syringe. After that tutorial, I was able to competently teach the kids as well as the local endocrinologist assigned to my group, who didn't seem to be all together there, the proper method.

Checking the girl's blood sugar level at night provided me the most peace. I would enter into each of their rooms while they slept and prick their finger to check their level. If it was low, I would wake them up and give them coke and crackers to eat. I then had to check their level again 15 min later. If it was still low, I had to give them more to eat. Then, Lorena would check their level again at 3am to make sure it was okay. The night I had off, poor Maggie was up all night checking blood sugars because all the kids were low. I guess they had way too much exercise that day.

Where to inject insulin is often an issue since the girls have their favorite places. However, by always injecting in the same places, the skin becomes hard. We encouraged them to try other places despite their fear. We taught them ways to roll their arms against their knees to get a better angle to inject in the fatty area. They learned from each other as well. I, also, learned greatly from them too and enjoyed the vicarious as well as interactive role that I played. Fun stuff to be written about later.

Good vs Evil NGOs

After being in Bolivia for the last week, I have learned so much about good vs evil NGOs. AYUDA had organized 2 camps, one in Tarija and the other in Santa Cruz. However, due to an evil NGO, we lost quite a few kids from the Tarija camp. Apparently, and granted I only know this through what I have been told by the local doctors, one of the most prominent diabetes NGOs in this country, name withheld on purpose, is corrupt. They sell their medical device and pharma donations to the locals, and they threatened to withdraw supplies from some families if they attended our camp. So, due to the lower attendance of 20 individuals, we did not send the entire volunteer team out to work the Tarija camp. Instead, the rest of us worked on community outreach. Both efforts though have really changed lives.

From the Tarija camp group, I learned about 17yr old Virgina who was just diagnosed with Diabetes on December 1st. She no longer thought she had a future. She figured that she would work out in the field and die soon after because of her condition. She didn't want to come to camp either, but Patricia, one of the local doctors and director of Fundacion Vida Plena, convinced her otherwise. At camp, Virginia constantly asked questions about diabetes and just thrived to learn more. At the end, she told everyone that she feels like camp changed her life. She is now well-informed and ready to live life again. She touched so many hearts and made everyone feel like we have made a difference in such a short time.

Today on our home visits, one group met Aya, a 10 yr old girl who has not taken any insulin since she was diagnosed 2 years ago. It's a miracle she is still alive, but I've been told that there is a honeymoon period associated with Type I diabetes when the pancreas still produces some insulin. During the home visit, the volunteers checked her blood sugar and found it at 588, extremely high. After an hour of talking with the mom and Aya regarding the importance of insulin to survive, the family gave in to learning more. Anna, Danielle and Marco taught her how to check her blood sugar with a glucometer they gave her, how to measure insulin, and how to inject herself. Surprisingly, she did it all by herself and corrected her blood sugar level with an injection. We plan to continue the education at camp and look to Nino Feliz for on-going support of supplies.

Finally, I learned about Katrina a 17 yr old malnourished girl. Another group went to visit her and learned that she is unable to eat. Whenever she does, she throws up because her body rejects the food. As a result, she never takes rapid insulin that is used to correct for food. She only uses the baseline insulin. Additionally, she does not have much family support and seems to have been abandoned by different family members. She didn't really want to come to camp, and I think we have convinced her to so that we can continue to support her.

Although some of these family situations seem really difficult to encounter, we were reminded to always stay peppy and keep our spirits up at camp. The campers do not want our pity and would like to be treated just like normal kids because they are kids first. Camp starts Thursday and I can not be more excited to reunite with the kids I have met already as well as to meet the ones I have not yet. We are expecting a high turnout of about 60 kids.

Economics of Managing Diabetes in Bolivia

Diabetes remains one of the major health care issues facing the US health care system affecting almost 8% of Americans and that number continues to increase as obesity increases. Two types of diabetes exist: Type 1 diabetes occurs primarily in children and young adults when the body's immune system destroys the pancreatic beta cells that produce insulin; this is about 5-10% of all diabetes cases; the rest are Type II that starts off with an inability of the body to utilize the insulin produced. Type I diabetes is caused by damage to the immune system although it is still unclear how and Type II is often associated with family history, older age, obesity, physical inactivity and impaired glucose metabolism. Although less prevalent, Type I tends to be more serious since it onsets at a young age and requires injections of insulin for life.

Right before New Year's, I flew down to Bolivia to begin work at a Diabetes education youth camp. I partnered with a US based organization, AYUDA, out of DC. I found them while reviewing the globalgiving.com site focused on international NGOs to which you could donate money. I noticed that AYUDA had a program starting in Bolivia in January and so I decided to send Kendra, the Director of Volunteers Programs, an e-mail to see if I could join them then. After a simple email and a quick phone call, and without asking for references, money, or my resume, Kendra invited me down. I just needed to get a flight there from Nicaragua and she would take care of my accommodations. I asked her much later why she invited me down to work with children on such blind faith, and she said that she just received a good vibe from our conversation. Good enough for me. I wish all my interviews could go that well. In the end though, I did take the time and recruited some funding from Medtronic to support the camp.

So, why Bolivia? The prevalence of Type I diabetes is not necessarily higher in Bolivia, but due to lack of funding, education, and supplies, Type I diabetes can be so costly as to result in death for many children. Ayuda focuses on Latin America and has partnered with the local NGOs Nino Feliz and Fundacion Vida Plena to host 2 youth camps in Bolivia. They have previously hosted camps in Ecuador for the past 8 years, and are starting a camp in the Dominican Republic later this year.

The camp with which I will work begins on Thursday and in the meantime, I have been working on community outreach efforts. To better understand diabetes in Bolivia and how it affects children and families, I went on 3 home visits one day. The three families were very different. I first met Naomi who was the oldest and most mature 8 yr old I have ever met. She took good care of her condition and the whole family changed their diet to accommodate her change in diet. At times during the visit, I felt like the parents just wanted an opportunity to voice out their frustrations with the school that doesn't understand or support her condition, the cost of supplies, and the lack of information and a support group for families. The family overall seemed well-informed and was interested in the Medtronic insulin pump that one of the volunteers used. Bolivia still does not have access to insulin pumps, but does use glucose monitors. This family received their glucose monitor from the NGO for free although they still have to pay $70 for each vial of rapid insulin Lispro.

The next family included 9 yr old Fabiana whose family seemed very well off based partly on their 4 well dressed toy dogs. Also, their bathroom was more elegant than any room in my house could ever be. Due to their economic status, they do not receive donations from the local NGO. Instead, her aunt who is also diabetic sends over her insulin from Spain. But the mom still has to pay almost a $1 for each blood sugar test strip. Her mom seemed most concerned with her daughter's inability to realize that she is low on blood sugar. I saw them again today, and apparently Fabiana did not wake-up because her blood sugar level was 21, very low, and so the family had to force some honey, I think, into her cheek. She is okay now. We plan to really educate Fabiana on the importance of checking her blood sugar levels and understanding how to best manage her condition at the camp.

The third family included Moises a very tall 14 yr old boy. He has such a laid back attitude and we immediately hit it off. He even IM's me during the day now. He receives all his supplies free of charge from Nino Feliz. He is very well educated and has no issues playing soccer because he takes care of his blood sugar levels and makes sure to take himself out if he isn't feeling well. Without the donations of the local NGOs, I'm not sure how his family could afford to treat his condition.


The cost of managing diabetes is outrageously high since the government does not provide any support. On average, for a month's supply of diabetes products, 1 vial of Regular (R) insulin (cheapest type) costs $20, 2 vials of NPH (baseline) insulin costs $40, using urine strips to measure blood sugar (not ideal) costs $7 otherwise a family would pay $60 for glucose meter strips assuming people only check 2x a day when they should check more. In total at $67 for the month for just basic supplies, this is about 80% of an average monthly salary for one person in Cochabamba, Bolivia. Some tricks of the trade to check blood sugar if you have no other means include peeing outside to see if ants come because there is sugar, or pissing in the hot exhaust pipe of a car to see if you can smell burnt sugar. I guess people have to get creative to survive. One older Boliviano I met obtains his supplies through medical insurance, but not everyone has this. Still, he pays the $1 for each blood sugar test strip and therefore at least $60 each month.

To better understand the needs of the families I also helped organize a focus group today that I will write about later since it is 1:30am for me.