Living with Dignity: Paulina’s Journey Back Home

Paulina is from the central Bolivian town of Mizque, but due to her ill health has reluctantly moved to Cochabamba to live with her son and his family. She suffers from Chagas disease, a parasitic infection endemic to her home region. Up to one-third of people infected with Chagas develop heart failure and/or digestive disorders. Paulina is especially unlucky – her heart is weakened, and she underwent surgery last year for Chagasic megacolon. Now her esophagus is direly impacted as well, massively distended and unable to move food through to the stomach.

In early 2025, Paulina sought treatment at Hospital del Norte, a large municipal hospital opened about six years ago in Cochabamba, Bolivia. In July, Hospital del Norte was hosting a Solidarity Bridge General Surgery Mission Trip focused on esophageal conditions, so her case was proposed for surgery by a joint US/ Bolivian team. Her medical file was presented during a pre-travel gathering via Zoom between the local doctors and the mission team, including general surgeon Dr. Kinga Powers. Together, they reviewed Paulina’s complex medical history at length. For the mission team, it was both heartbreaking and a profound learning experience to witness the devastating effects of Chagas disease on Paulina and her community.

Paulina hoped for a surgery to “fix” her esophagus, much like the megacolon surgery in 2024 that had improved her ability to digest food. Unfortunately, the surgical procedure sometimes performed to restore function for patients with Chagasic megaesophagus was not likely to succeed in Paulina’s advanced case. The risks of reconstruction were simply too high given her weakened state and the level of tissue damage. Instead, Dr. Powers suggested inserting a gastrostomy tube to allow direct feeding into her stomach.

Because Paulina speaks Quechua, explanations had to be relayed through interpreters—sometimes from English to Spanish to Quechua. The accompaniment team, including missioner Ted Johnson and Puente de Solidaridad staff member Marcela Canedo, spent many hours with the family as they discerned this difficult decision over several days. Ted, who had been studying Bolivian Quechua for the past year, was able to connect with Paulina using a few phrases directly in her language, which the family deeply appreciated.

Surgery cannot always offer to cure disease, but it may still give patients improved quality of life. It is not always easy for patients to accept a procedure that is more palliative than curative. In this case, Paulina would have to give up most hope of being able to eat by mouth, and commit to caring for a permanent tube in her stomach. In such moments, the presence of our accompaniment team can be deeply comforting as patients navigate both medical realities and the emotions of their discernment process.

Mission team chaplain Ted Johnson shares, “Once Paulina and her family made the decision to have the feeding tube inserted, her total affect changed. She smiled and openly laughed. She talked. She got out of bed and walked.”

Paulina underwent the g-tube insertion procedure and was well enough to go home with her son three days after surgery—once the family had mastered the steps to use and care for the tube. Over the following month, Puente de Solidaridad social worker Paola Antezana checked in regularly with the family to monitor her progress and provide continued support with supplies and encouragement. Paulina attended regular checkups where the local doctors confirmed the g-tube site had healed well. As soon as she felt strong enough, and despite her son’s plea to stay in Cochabamba, Paulina moved back to her rural home in Mizque, determined to live out her days in her beloved community.