Written by Susan Klosterman, 2014 Missioner Hi everyone! We are just finishing up our journey in Cochabamba. So far we have completed 5 implants, and are about to do our final checks on our patients. All of the cases have been complex and filled with challenges, but we have found strength and support in each other.

Monday morning our task was to get through customs with all of our supplies/equipment, and survive the high altitudes of La Paz after a sleepless night. We were so happy to see the smiling faces of Carlos and Jose at the airport. After that we came directly to the hospital and did our first implant, a CRT-D upgrade. We were hesitant to start the trip off with a complex procedure, but nonetheless agreed after reviewing the patient history. Cathy, Marian, and I have never worked together as a team, but you would never know that as we worked seamlessly on our first case.

Our first case yesterday was by far our most rewarding. The patient already had three leads in one vein, and we needed to add an additional two to properly upgrade the device. Local doctor Benjo Gareca was particularly helpful in getting access into the vein, and it was a true collaborative effort. He has great skills from implanting pacemakers, and we really enjoyed working with him and the perspective he brought. Not to mention he did everything with a smile on his face, a true pleasure to work with.

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The patients here are far and away the sickest and most complex I have ever seen. I think our shortest case has been over two hours, and the longest was over five. This, coupled with the growing pains of working without all the resources we are used to, has been a struggle. But our determined personalities have led to positive patient outcomes. When we see our patients and their families during rounds after implant, it makes all our efforts worth it.

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