Illimani (6462 m) in the city of La Paz (3100-4100 m)

Close to 2 million people live in the city of La Paz, Bolivia, a modern bowl-shaped city surrounded by mountains, with altitudes ranging from 3100 m to 4100 m above sea level. The airport, located at 4000 mt, is enveloped by close to 600.000 inhabitants. The local mean barometric pressure at IPPA is around 490 mmHg (65% that of sea level). The partial pressure of oxygen molecules (PIO2) = 94mmHg is 1/3 less than at sea level. Similarly, mean arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCo2) are 1/3 and 1/4 less respectively.

Twenty years ago, medicine in the Bolivian Andean region was practiced according to sea level standards. Most physicians returned from sea-level training, applying their up-to-date knowledge to high altitude residents encountering varied problems in doing so. At the same time, few scientific expeditions from abroad arrived, making only short period observations in basic physiology, with approach to clinical problems, partly due to the fact that at the time scarce comfortable living installations, such as good hotels and others, were available.

Given the difficulty of attaining reliable data on altitude related pathologies, Dr. Gustavo Zubieta Castillo, a highly trained and experienced Bolivian physician, specialized in the field of cardio-respiratory physiology, created in 1970 "Clinica IPPA: del Instituto de Patologia de la Altura", an internationally prestigious medical Institute visited by important researchers from all over the world. IPPA includes four physicians, a nutritionist, a biotechnologist, and an International Affairs specialist, as well as support personnel. Most of the equipment and software is developed in the same Institute, making it a highly computerized and sophisticated medical Institute with on-line data acquisition.

IPPA also works as a clinic attending local residents - whose parameters and clinical problems differ from those at sea level. High altitude increased polycythemia is frequent and still creates much confusion. Patients are bled periodically, are given all kinds of treatment with different teas and even toxic drugs. The institution practices extensive testing in these patients, with blood tests, urine tests, chest X-rays, blood gases, spirometry, electrocardiogram, cardio- pulmonary stress tests, nitrogen washout, ventilation studies, oxygen dissociation curves, and others. The gained experience helps managing increased polycythemia and all cardio-pulmonary disease at high altitude much better.

Dr. Gustavo Zubieta Castillo received training in cardiac physiology in the "Instituto de Cardiologia" in Mexico. He worked for many years as Professor of Physiology at the Universidad Mayor de San Andres in La Paz, Bolivia. In 1968, he was nominated as a visiting professor to the Pulmonary Department of the University of Tulane in New Orleans-Louisiana, (USA).

Among Dr. Zubieta's publishings is the Triple Hypoxia Syndrome in which he observes that increased polycythemia patients suffer from time to time hypoxic crisis. In other words these patients are suffering from three hypoxias: 1)High altitude hypoxia; 2)Increased polycythemia; 3) superimposed hypoxia of pulmonary inflammation, temporary and reversible by oxygen administration. Some patients arrive to consultation with PaO2 as low as 30 mmHg. These facts led to the description of the "acute" reversible polycythemia at high altitude.

Another important paper,"Iatrogenia at high altitude" was published. It refers to iatrogenia caused by malpractice on polycythemics with toxic drugs in the hope of "destroying" excessive red blood cells, ignoring completely the etiopathogenesis of this disease, causing several hundreds of these patients to become severely ill and even die.

The book entitled HIGH ALTITUDE PATHOLOGY AT 12000 FT. containing the above information was the first Bolivian medical book published in English in 1989.

Attention is concentrated on the diagnosis and treatment of high altitude disease and cardio-pulmonary disease at high altitude. The experience gained in 26 years is capital for the people living and arriving to high altitude.

In 1986, Loren McIntyre from the National Geographic Institute visited IPPA and included his interview in the article "The High Andes" of the "National Geographic Magazine" in April 1987. As a result many letters arrived from all over the world. Some were quite curious and anecdotic. For example: one was from an American with "pectus excavatum" (a congenital depressed chest deformity), who wondered if by arriving to high altitude his "chest would inflate".

Another much more bizarre letter, was from a man who claimed to be an astronaut who wanted to include studies about high altitude adaptation in his research project for his future trip to space. After a couple of letters and a phone call from the Bolivian Embassy in Washington D.C., we were informed that he had no connection whatsoever with NASA, and that he was not to be taken seriously.

This Institute tries to cooperate in the study of the broad universe of high altitude problems with many questions to be solved, with knowledge, inventiveness and work. This is why it is open to all criticism, cooperation and discussion. Finally, it is dedicated, to all those "short of breath at high altitude".

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