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Centro Medico Humberto Parra(CMHP), is a non-profit medical clinic established in 2001 by American doctors Dr. Susan Hou and Dr. Mark Molitch and Bolivian doctor Dr. Douglas Villarroel. Located in the rain forest in eastern Bolivia, 72 miles outside of the country's largest city, Santa Cruz de la Sierra, Centro Medico is a community clinic with the goal of improving the health and overall quality of life of the surrounding communities by providing first-rate medical care and other health services. It is the only free medical clinic in the surrounding 40,000 person area. The Daniels Hamant Foundation of River Forest, IL funds and helps manage Centro Medico. The Daniels Hamant Foundation relies exclusively on private donations, and the Centro Medico Humberto Parra is heavily dependent on volunteer physicians and healthcare workers from the US and Bolivia.

History
After Dr. Villarroel, an Endocrinologist, contacted Dr. Hou, Professor of Medicine and Director of the Renal Transplant Program at Loyola University Medical Center, about performing his own renal biopsy, the two became friends. Villarroel later contacted Hou about arranging the first liver transplant in Bolivia for an eleven-year-old girl named Indira. After successfully sending a Bolivian surgical team to train with an American surgeon, the transplant was performed, giving Villarroel and Hou the idea to start a free medical clinic in the South American country. Soon staff were seeing 100 patients a day and distributing free medicine to Bolivians in need.

Currently, the clinic serves more than 3,000 patients a year with a staff made up of local Bolivian doctors and nurses, as well as medical students, residents, and visiting doctors through partnerships with Loyola University Medical Center in Maywood, Illinois and Northwestern University Medical Center in Chicago, Illinois.

Past Projects
Iodine deficiency is the most widespread cause of preventive mental impairment. In the 1980's Bolivia had one of the most severe iodine deficiency problems in the world, so severe that the WHO and UNICEF teamed up with the Bolivian government to implement the Universal Salt Iodization program in 1983. However, over two decades have passed since the iodization program was implemented and there have been no follow up assessments of the national population's iodine levels. As a college junior at Lake Forest College in Lake Forest, IL, Lavinia Sinitean, spent the summer of 2006 at Centro Medico investigating iodine levels of the local population as part of the Iodine Deficiency Project. Lavinia's project aimed to evaluate the iodine status and prevalence of iodine deficiency in Centro Medico's communities. For 3 months Sinitean collected urine and blood samples, which were later analyzed at Northwestern University. Sinitean reports having significant program support from clinic staff and lots of interest from the local communities.

In 2003, in conjunction with Dave Sears' Emergency Medicine Program, US volunteer Becky Laks developed a first aid training for local community members, most of whom had never been taught how to respond to medical emergencies. Since most of Centro Medico's communities are situated in semi-isolated, rural areas somewhat far from Centro Medico or other healthcare facilities, it was critical that locals learn how to handle emergency situations. Laks delivered the training, which consisted of two 4-hour sessions, to 6 Centro Medico communities. The training covered everything from keeping wounds clean to treating 1st and 2nd degree burns to more urgent situations such as snake bites, preventing shock, making a make-shift cast and doing CPR. Community members were given first aid manuals to homes to share with family members. Two weeks after the trainings were held, a local man was bit by a poisonous snake. He survived the incident, in no small part due to the help he received from a neighbor who had attended the first aid training.

Northwestern Medical student and Centro Medico Volunteer Julia Chu decided to do her MPH final requirement at Centro Medico. Since Chu had a special interest in women's health, specifically in maternal and perinatal morbidity and mortality, she researched birth spacing in Centro Medico's surrounding communities. While planning her project, she learned that short intervals - less than two years - between pregnancies had been associated with increased maternal and perinatal morbidity and mortality. Additionally, she also learned that women in rural areas in Bolivia only want 2 to 3 children in their lifetime but in reality have 5 to 6 children over a relatively short period of time. She then developed a survey that explored rural women's attitudes toward birth spacing and contraceptive use. Her studied aimed to investigate whether limited access to contraception, lack of sex education and cultural factors can explain why rural women commonly have more children than they desire.

Chu's research did show that women in the clinic area have more children than they desire or have children spaced too closely together. The women see this as a normal part of life. As the women in Julia's study put it, they would have waited longer in between pregnancies but got pregnant, so what could they have done? Often the women in her study did not use birth control. Their reasons for not using birth control included lack of education on birth control methods and their side effects, inconsistent access to contraceptives and being part of a culture that is accepting of having many children over a short period of time. The Bolivian government provides birth control, but it is not as easy as it sounds. Frequently government programs at local health posts only give a one-month supply at each visit. Inclement weather and bad road conditions often make it difficult to return to the post every month. In addition, the selection is usually limited to birth control pills or Depo-Provera injections. Sometimes the supplies even run out, causing poor patients to pay out-of-pocket at the local pharmacy or simply go without birth control.

In 2005, first year volunteer Northwestern medical student Jason Oppenheimer took action when he noticed that few local kids spent time reading and many never passed elementary education levels. Families were too poor to buy books, and the local school only went up to 5th grade. So he decided, "If the students can't afford books - give them books. If their parents can't help them in their home - find them an environment where the more advanced students can tutor those in need of assistance. If the students can't afford to go to Buena Vista for a secondary education - give them the opportunity to move their education forward at the clinic. With a generous donation of textbooks from Alfonso Cortez, a good friend of Clinic Director Dr. Douglas Villarroel, Oppenheimer formed Centro Medico's children's library, "La Hoguera," Spanish for "the hearth." Jason hoped that it would be a place where students would come after school to supplement their learning and a place for children to pass the time with a book while their parents visited the clinic. During his final two weeks of volunteering at Centro Medico, children started to come to La Hoguera.

Malnutrition is one of the leading health challenges at the clinic and most often affects young children and pregnant women. In 2003, Centro Medico volunteer Becky Laks decided to start the Centro Medico Nutrition Program which aimed to educate Centro Medico patients on nutrition and healthy eating. In addition, since energy-dense but nutrient-poor diets are common among Centro Medico's poor communities, she also started a multivitamin project. The program regularly distributed vitamin and mineral supplements to clinic patients, specifically young children.

Current Projects
Instituted in 2000, the Millennium Development Goals target factors that can affect the health of a nation, such as disease, hunger, illiteracy, and poverty. Included in this plan are goals of improving maternal health and reducing child mortality; accordingly, these are two of the most important issues faced by citizens of Bolivia. For non-pregnant women under the age of 59, SUMI, a national insurance program, covers PAP smears and family planning services. However, many of the common screening tests familiar to us in the United States are not covered or affordable for the women of Bolivia. Mammograms cost $25-95 US dollars which proves to be too much money for many of the women that we treat at CMHP. Bone density scans for osteoporosis screening come at a huge cost to the Bolivian patient of almost $200 US. We have fortunately found yearly campaigns that fund these services, allowing us to bring a new level of care to our female patients. In order to identify our female patients in need of these services, one of our med-student volunteers, Katie Burns, developed a guideline for PAP, mammogram, and DEXA screening as well as a chart to record past and future results. This information, as well as patient answers to questions such as "family history of breast or ovarian cancer" and "age of menarche and menopause" are permanently placed in each patient's chart by the front desk staff; this serves as a record of the patient's past screening tests and also alerts the doctor if a new study is needed. As of May 2013, over 20 women have received their osteoporosis screening and over 50 have had their annual PAPs thanks to our new program.

Much of parasite prevention is relatively simple and straightforward. It requires taking one dose of anti-parasite medication (albendazole) once every six months. In the past, parents routinely came to the clinic with their children and list off the symptoms of stomach parasites, better known as "bichos." Our doctors would then administer the anti-parasite medication. Gretchen Myers, a volunteer nurse, developed the program in 2008, with some help from a local hospital and health education center. The program continued, and subsequently flourished under the guidance of Alice Baumgartner when she became a coordinator in 2010. It has flourished since. CMHP volunteers have been going to local schools and administering this treatment to all students. Most importantly, education is incorporated to the children on parasite prevention and hand washing. Children are weighed and their heights are measured to screen for both malnutrition and obesity. In 2013, dental care was added due to the tooth disease that is abundant and this program gave us good exposure to the kids. Tooth brushes are given to all of the children we treat for parasites.

Cervical cancer is a major concern in Bolivia and all over the world. It is the second most common cancer among women worldwide and strikes more than 490,000 women each year. Women in developing countries are disproportionately affected; more than 80% of deaths due to cervical cancer occur among women in developing nations. Bolivia has one of the highest rates of cervical cancer in the world. Centro Medico is fortunately able to test patients for cervical cancer in partnership with a hospital in Santa Cruz. They are able to process our results within a week, and then we can treat whatever is found. We also have agreements with local gynecologists and oncologists who will follow up with any of our clinic patients found to have an abnormal result. In collaboration with the Women's Health project, we are able to document these results in the patient's charts to improve the likelihood of follow-up and maintaining screening in the future.

Diabetes and hypertension are foremost health concerns in Bolivia, particularly in the department of Santa Cruz where Centro Medico is located. A striking 11% of the local population has diabetes compared to 8% of the population in US. 22% of the local population have high blood pressure. Centro Medico is trying to address this problem through our Diabetes and Hypertension Chronic Care Program. Diabetes and hypertension are serious, chronic diseases that need constant maintenance. Poorly managed diabetes can lead to strokes, blindness, heart disease, kidney failure, foot amputations and nerve damage. Untreated hypertension puts patients at risk for heart attacks, strokes, and atherosclerosis.

We are very aware of these problems and follow our diabetic and hypertensive patients every month to promote medication and lifestyle compliance. We also have our health promoters out in the communities regularly checking patient's blood sugars and pressures to help promote good control. Unfortunately, many of the local villagers do not manage their diabetes or hypertension on a consistent and long-term basis. Villagers have undergone foot amputations, lost their sight and suffered heart attacks and strokes. Due to extreme poverty, poor diet and lack of health education, the morbidity of diabetes and hypertension among the local rural population is increasing. Families commonly live at a subsistence level with an average income of around $40 per month, and the typical diet consists of low-cost foods that are energy-dense but nutrient-poor. In addition, many patients suffering from diabetes or hypertension know little about their diseases and often believe that they can be cured with a single trip to the doctor or dose of medicine. As clinic founder, Dr. Susan Hou, says, 'We have found that people don't understand what it means to have a chronic disease. They tend to have very short-term concerns that make it difficult to think long-term.'

Chagas is a disease of poverty and most often afflicts populations like the one served by Centro Medico. Chagas is a chronic disease that commonly causes heart and gastrointestinal problems which are often further complicated by other health conditions. Over half the population served by Centro Medico has tested positive for Chagas. Many of the clinic's families are at risk of contracting chagas because the "vinchuca," the insect that carries the parasite that causes Chagas, lives in the thatched roofs and in the cracks of the earthen walls commonly found in the homes of Centro Medico's families. Centro Medico's Chagas Project works to prevent the spread of Chagas through education. The program emphasizes sleeping in an area enclosed by mosquito nets, educating women on the risks of transmission of Chagas' to their babies, and building future homes with materials that are inhospitable to the venchuca. Besides education alone, we are also now able to refer patients to governmental treatment programs, designed to prevent future complications that can come from chronic Chagas infection.