 Good morning. My name is Clara Caballero. I'm a third-year resident of Somalia in my country. I live in Bolivia. For those who don't know me, I've been here just for more than a month. I'll be staying here just two more weeks. I came for doing a servership in the retina clinic and it's good to know the people that I haven't met yet. Well, they wanted me to speak a little bit about what is going on with the eye hospital in my city and with the residency in my city. I would like you to apologize for my English mistakes because my English is not as good as I thought. Your English is a lot better than most of us. Thank you. I may have it distraught. Well, for those who don't know, my country is in South America. It's just the heart of South America. The name is Bolivia but now the name has been changed. It's officially known as the Plurinational State of Bolivia. It's a landlocked country located in the center of South America. It's a democratic republic and that is divided into nine departments. Its geography is barred from the peaks of the Andes in the west, which we took Dr. Muffin and Dr. Duffin, to the eastern lowlands and is situated within the Amazon basin. It is a developing country. Its main economic activities are agriculture, forestry, fishing, mining, and manufacturing goods such as textiles, clothing, refined metals, and refined petroleum. We have an estimated population of 10 million people, which is really multiethnic. The main language spoken is Spanish, although I didn't even know that we have 34 other indigenous languages that are official, which I didn't even know. The geography, Bolivia has a huge degree of biodiversity. It's considered one of the greatest in the world, as well as several other regions with such ecological subunits as the Al Altiplano. We have jungle, we have tropical rainforests, we have desert, we have everything. It's divided into three physiographic regions, the Andean region in which I live in. It's located above 3,000 meters of altitude with some of the highest spots in the Americas, such as the Sahama, which is for you, I don't know, meters for you is not that important, but it is like 21,000 and 462 feet, and the Imani, which is like 21,200 feet. For example, we have a picture there of Dr. Duffin and Dr. Mifflin when we took them to the Sahama. We live really high. We have the Subundian region and we have the Llanos, which is located below 1,312 feet meters above sea level. Here we have some pictures of the country that are visually into the night departments. We have a lot of mountains, and we have a lot of, this one is a picture of the languages that we speak in our country. La Paz is the city I live in. Its original name is Nuestra Señora de la Paz. It's the seat of the government of Bolivia. It's located in the western part of the country, in the apartment of the same name. It's an elevation of the city. It's roughly between 11,975 feet, and the city is built on the hills. We basically live on the hills, above sea level. It is the world's highest de facto capital city. The city is sitting above, surrounded by the high mountains of the Alti Plano. It's kind of in the hills, and it has a lot of variety in elevations. From 10,500 to 3,500 feet, it depends on where exactly are you standing on the hill. We have a picture here of our city. I think it's really beautiful. The mountains you see in the back is the Yamani. The mountains are always covered in the snow, but it doesn't snow in my city. I don't know why. We have some other pictures. Our city is in the mountains. If you see the orange arrow, it's exactly where I live in the city. I live kind of in the middle. We do have a stitching. No, no. I keep saying that I have too much oxygen here. But we can breathe there. We can. What happens with the banks, with the eye hospitals in my country? In 1920, Dr. Landa Lyon, he opened ophthalmology courses in clinic at the School of Medicine in La Paz. The eye hospital named Said in the city of La Paz in 1939 becomes the first eye hospital in Bolivia and in South America. Dr. Liz Landa was the first director and founder in the Bolivian state, and he was awarded with Condor de los Andes, which is a great award in my country for that contribution. In 1950, Dr. Aníseto Solárez creates the Bolivian Society of Prevention of Blindness, and in 1957, it's created the Bolivian Institute of Blindness. But what are the ophthalmological disorders in Bolivian Andes? Actually, in Bolivia, 78% of our habitants live above 6,561 feet, and 50% live above 11,481 feet, so we really live up high. The average is about 12,467 feet. The air is thin and clear with low humidity and allows for more sunlight of the solar spectrum. That's why instead the heat diffusion is really low, so people are burning in the sun and in the shade they freeze. That's why these factors, in addition to a racial influence, the skin color of the people, that's why we call ourselves the bronze race, is because of the color of our skin. But what is the, when we have to talk about pathology of the eye, we have presupposing factors of pathology in the eye because we have a higher level of solar radiation, infrared, visible ultraviolet, and cosmic radiation. We have a lot of exposure to the environment directly. We have exposure of the eye to hyperbaric apoptia, and acute and chronic and nutrition and altitude because we have a lot of malnutrition in my country. Now, the ophthalmological disorienting height that we have found that are more common are metropia with 40% of the people living in the highlands need glasses, often for myopia, astigmatism, and presbyopia. Conjunctivity is pigmentosa with high incidence of proliferation, reaching almost 90% of our children. They have these terrible conjunctivitis and they are always scrolling their eyes. Yeah, I have never seen it here. Yeah, and I do have a lot of it. It's a more than pigmentation, it's proliferation. We have been reckless. Yeah, yeah, we treat them with is the only way it helps because otherwise it continues and it's worse and basically they're kids. So we have to trust the parents. Yeah, we have been reckless. We have the region and we even have them in children from three to seven years, of course, in young and in adult. We have cataracts with high incidence of prevalence. It will have macular degeneration, which are the most we have to know what are the biggest causes of blindness in Bolivia. We have accidents and trauma as the first one. And it is because our workers do not have, they do not care much about the way they work. They just want to make some money. So they do not protect themselves as much as we would like to. We have infectious diseases. We have congenital disorders, cataract retinal detachment, glaucoma, and we have some people that is blind, but we don't know why exactly. Well, the hospital I work in is named Instituto Nacional de Automología. It's the first one that has been created in the country. It has now 39 years and it's divided into triage. We basically try to do the same thing as we do here. We have sub-specialties as retinal glaucoma, coloplastic deviatrics and escrobism and serial segment cornea refractive surgery. We have the Department of Community Services and the Department of Low Vision, which is really new and it's just starting. We count with a clinical laboratory, pharmacy, cardiologist, surgical area. We have a future optical implant. We do have patient hospitalization rooms. We admit the patients so they can stay in the hospital. We have the address for the webpage of our hospital. I've been reading all about it and the mission of my hospital is to provide qualified eye care committed to promote, improve, and rehabilitate the visual health in our population. And the vision of my hospital is to be in an integrated hospital to the community that can resolve all the problems with the highest technology that we can find. Here is a picture that I have found of the people that work in my hospital, if you see in the center. And now is the current director of my hospital, Dr. Joel Moya. The residency. We have residency of host technology in my country, in three cities in the country. In three departments, we have it in La Paz, Cochabamba, and Santa Cruz. In La Paz, for what I know, it's been like 35 years of ophthalmology residency. We have formed almost 75 ophthalmology specialists in the country, in the city. It takes three years to be an ophthalmology specialist. We have now three residents in the first year for residency in the second year and two residents in the first year. It varies because it depends basically on the government. They decide when they want two, when they want three, or when they want four residents in the specialty. Only three of the nine residents receive some kind of payment. The other ones they do not. Yeah, the payment comes from the government. We all have to do it now. We, in the past, they had to go three months to a rural area to do some community work. Now it's a year. And now I even heard that they're planning to make it three years for every single medical specialty in the country. For example, if traumatology takes four years, you have to go four years to a rural area to do some kind of work. Now that's what it's new for us, it's even new for me. I just found out that. I don't know how it will be approved until I finish. We do not have fellowship programs available in my country. We are divided by models. Residents of the first years do mostly optics and refraction. We do optics and refraction. And residents of the second and third year, we are divided by a specialty clinic in ophthalmology. We have session, bibliographic sessions, clinical cases, ruby articles, and presentations of research. We also do research ourselves. According to agreement side with the university, because we are part of the university, we have a methodology research course for our residents of the first year. We do research. It has to be prospective. We have to follow some guidelines in the city. First year, we do assist to the patients. We do take care of the patients. We see patients even do by ourselves. The first year residents, they take care of the general ophthalmology patients. The second year and the third year, we take care of the sub-specialities. In the residents, we cover the emergency service 24 hours and 30, all year long. And we do have to stay at the hospital. We cannot be on call. Do you have any questions? I know you do. At the beginning, from day number one. You do get surgery treatment? Yeah. We have a lot of work there. So day number one, if it happens to be that you're with a surgeon and he's in surgery, you just have to go there and help more. Do they turn a lot of surgery? Not as much as we would like, but it's getting better. So give me an idea. It depends on the resident. Because when you want to do surgery, you can ask for more surgery. You don't have, for example, you have to do 100 cataracts in order to be an specialist. We do not have that. So if you do want to be a surgeon, you can look for yourself to do more surgery. You can ask your professors to do it. For example, so far, I have done 40 other surgeries, but because I want to, I have some friends that they don't want to, that they can, they will say, okay, I want to learn, but it's not something I want to do. I want to be more like a general of the knowledge. It's not a surgeon. So it varies. A cornea specialist has cornea in my hospital, at least. But we can find somewhere, some other places to go and do it. Basically, yeah, because for example, I've chosen the United States by my friends, they go to Mexico and they go to Peru. Those are Puerto Rico. The three countries they chose to go, but I don't have, I just chose the United States. Notice that you didn't have neuro-opemology left to there? We do not have. We do not have the specialty of neuro-ophthalmology in the hospital. And I don't think that even in the whole country, yeah, it's something that is really missing. I have a friend that he really wants to do the fellowship in neuro-ophthalmology, where we have to go outside. We cannot do it inside a country.