11/23/11
Because Thursday was Thanksgiving and we are getting ready to head back to Oaxaca for our last week in Mexico, we only had one day of fieldwork this week. We spent Monday and Tuesday in class learning about the different types of domestic violence. These lectures mostly focused on the theme of equality as a form of preventing future cases of domestic violence.
On Wednesday, we traveled to a nearby high school to discuss this issue with 15-16 year olds. Normally, we spend all of Thursday and Friday preparing these presentations but since we didn’t have that option this week, we were forced to present the information without an outline. Also, we were unexpectedly divided into four groups with the boys only speaking with boys and the girls only speaking with girls. Surprisingly, the presentation went very well. They were also very fun because we were able to progress off the desires of the crowd. I enjoyed it because it really challenged my Spanish since I had to discuss topics without preparing what I was going to say.
During the presentation we did an activity where the men were to draw and write thing that define men physically, socially, sexually, and so on. Next, the men did the same thing for defining a woman. At the end we explained how most of the topics on the man poster were also present on the woman poster. For example, both men and women are strong, smart, independent, sensitive, and so on. We then further discussed the theme of equality by switching the two posters, man and women, with two posters from a female class. This showed that the social identities of women and men were similar between both genders and, when thought described on paper, both genders are very similar. We used this activity to show the classes that there are no defining characteristics that make one gender better than the other and we are all equal. Next, we tied equality into domestic violence and the lack of equality as a risk factor for domestic abuse. In the end the kids had a lot of fun and were surprised by the hidden message of the activity. The presentation was a great experience and one of my favorite presentations that we have given.
11/16/2011
Today we woke up early and went to the local village of Chila to experience a community where tropical diseases are a big threat. We split into three groups and each group went to a different location to find and learn more about mosquitoes, specifically the anopheles mosquito that transfers Malaria. My group went to a nearby lagoon.
At the lagoon, our instructor found and told us about each stage of a mosquito’s life. First we found eggs, which were located all around the edges of the lagoon in the brush. Next, we looked at the larva. There are four stages of mosquito larva and the way you can tell an anopheles mosquito from another larva is that anopheles larva lay horizontally on the surface of the water. Next, we located mosquitoes in their next stage in life, pupa. This stage right before adulthood and is when a mosquito starts to look like the insect we are all well aware of. Once adults, mosquitoes only return to the lagoon to nurture their eggs. Otherwise, mosquitoes will hang out in refuges till the night, when they can bite more victims. Therefore, to see the adult mosquito we went to a different location where some deep dark wells where mosquitoes would commonly hang out. We saw several adult mosquitoes and even caught a few to get a closer look.
11/17/2011
We started off today’s brigade by meeting some of the tropical disease control team in the area. Next, the team took us to a nearby house where they fumigated the house with an insecticide. Normally, when a case of the disease is found, the tropical disease control team will come in and fumigate that house and up to ten houses beyond where the infected case was. The biggest problem with these tropical diseases is that a healthy insect must first bite an infected person in order to carry and transfer the disease to others. Therefore, when a case becomes present, the entire area must be fumigated and the sick patient must be kept under a net away from insects at all times.
After the demonstration we split into our groups again to go find chinche bugs, which transmit the disease Chagas. We went to a house in the community that was known to have over 30 chinches in the surrounding area. In fact, the little boy that lives there with his family was infected with Chagas when he was only two years old. Fortunately, the boy, who is now seven, has been asymptomatic, but his symptoms could develop at any moment. We fortunately didn’t find any chinches but the instructor showed us all the common places these bugs like to hide.
Finally, we finished out the day looking for more mosquitoes, but we focused on mosquitoes that transfer the disease Dengue. The mosquitoes that transfer Dengue are called Aedis Aegipty and they are a little different than the anopheles mosquito. Aedis mosquito larva prefer to grow on the walls of still water, like water tanks or flower pots. They also are different than anopheles in that the larva are underwater and will zigzag up to the surface to breathe. We went to two different houses that had these types of larva in their water tanks. Our instructor explained to us how the residence must change their water every four days and need to cover these tanks so know mosquitoes can get in to lay their eggs.
11/18/2011
For our last day working on tropical diseases, we took all our newly learned knowledge and experience and gave a presentation to women in the Opportunidades program. For those of you that don’t remember, Opportunidades is a program that will pay for your medical expenses as long as you attend doctor consults and prevention seminars each month. We put a lot of time into our presentation, which was a little different because the women that attended could not read or write. We gave a small oral presentation and then preformed skits involving the audience to keep them interested. The experience was really great and, at the end, the women seemed very appreciative and interested in the prevention that we were emphasizing.
11/10/2011
Today we spent the day visiting midwives houses. These are very interesting because practically everywhere in the US, babies are now born in hospitals, not houses. This tradition is slowly becoming less popular now in Mexico because of the implementation of Seguro Popular, the universal health system in Mexico. Seguro Popular covers all births and birthing consults so there is really no reason to go to a midwife’s house anymore. Especially since the patient must pay a midwife for their services. What’s interesting is that the cost of the birth is dependant on the sex of the child. Because men are more valued in this culture, it costs twice as much if you have a boy compared to a girl. They believe that boys can work more and earn back that money. It seems like this case is slowly being diminished and rightfully so, as men and women are now earning equal roles in society.
Most midwives have been practicing this skill for so long that they can even tell the sex of the baby just by the orientation of the baby in the mother’s stomach. She told us that if the mother’s stomach is rounded, then it usually means it is a girl, and if the stomach is pointed in front, it usually means it is a boy. I wonder how accurate this method is? She also told us that some midwives can look at the placenta and not only tell how many more kids the woman will have, but also what sex they will be.
The process of having your baby at a midwife’s house starts with a limpia to rid the woman of any evils. Next, if the woman’s contractions are progressing fast enough, she will drink a tea that helps the contractions and birthing process occur faster. Last, the woman will have her baby and finish with an herbal bath to cleanse her body. Without the herbal bath, the woman risks having bacteria and contaminated air sit in her uterine cavity, which could cause problems in the future.
11/11/2011
Friday we went to a nearby public school to give a presentation about methods of contraception to a class. We spent most of our free time throughout the week organizing our presentation so it would be fun but still get across the information that we wanted them to know. We had a class of about 35 students ranging from ages 13-16. Surprisingly, the kids were very involved in the presentation, especially the boys in the group. We got the kids involved by playing jeopardy and having challenges where the students would have to put a condom on a banana or place a contraceptive patch in the correct location. I was in charge of presenting on injections, which are very common in Mexico. At the end we spent about a half hour answering questions, which was the best part of the entire presentation. When kids ask questions its cause they have an interest in the answer and it let us know that kids weren’t bored with our presentation.
In preparing for this presentation I noticed there are many differences with preference of contraceptive between Mexico and the US. In the US, pills and condoms are the most common used contraceptive methods. This is not the case in Mexico because of their cultural perceptions. First, men don’t like to use condoms because it is a simple of non-affection. Men usually where I condom during one night stands and if a man were to where a condom, their wife would commonly think they were sleeping with someone else. Also, talking about sexual relations is very taboo in Mexican culture. Therefore, people don’t like to show or do anything sex related in public. This is the issue with pills for young women because they would have to hide pills from their parents. In Mexico, the injection or the implant into the arm are the most common methods of contraception. These two methods are hardly ever used in the US.
11/2/2011
Today there was no clinic because it was a national holiday celebrating Dia de los Muertos.
11/3/2011
For my first day in this new clinic I was placed with Doctora Adriana. She was very kind and really pushed me to get the most out of my experience. She introduced me as Dr. Jason from the US to every patient and then asked the patients to tell me what was bothering them. After they told me their issues, she would have me ask the patients questions and answer any of their questions. It put a lot of pressure on me because I am limited in my Spanish medical vocabulary and general medical knowledge, but it forced me to learn fast. After my attempt at a consultation, the doctor would jump in and finish, while explaining to the patient and me the proper protocol for each patient’s situation.
The most interesting case of the day was a couple that was expecting their first baby in 2 months. The husband was HIV positive and there was concern for the baby. Some tests were run on the mother and the developing baby, and we were happy to hear that the baby was HIV negative and normal. Although, the doctor still suggested the woman have a C-section to decrease the stress on the baby, just in case there were any other issues we were missing.
Another case involved a woman who has been having digestive issues and blood in her stool for the past couple of months. Again, Dra. Adriana had me lead the consultation, except this time I didn’t feel like I was thrown into the deep end because of my previous experience with a similar case in my first clinic. I listened and touched the woman’s stomach, pinpointing where her pain was. Next, I performed percussions on the stomach, which clarified my suspicions that the woman had an intestinal infection. It turns out I was right, so we prescribed the woman with some antibiotics and scheduled to see her again in two weeks.
11/4/2011
I think I impressed the doctor when I made the proper diagnosis on the patient with an intestinal infection the day before because today she had me lead all the consultations. Unfortunately, the day was full of pregnant women consultations and I had little experience in this type of situation. I struggled with the first consultation and wasn’t very thorough so the doctor jumped in and assisted me.
After the first patient left, the doctor then showed me the proper procedure for a pregnancy consultation: the proper way to measure the uterus, how to listen to the babies heart, and how to feel for the position of the baby in the woman’s stomach. She also explained to me that one of the biggest causes of fetus/baby death is from infection of the vagina, intestines, or urinary tract. It is, therefore, important to ask every pregnant woman 7 questions: 1) Have you had an intestinal/vaginal/urinary infection before? 2) Have you had the flue or fever recently? 3) Are you having any vaginal bleeding? 4) Does it bother you when you urinate? 5) Have you had any vaginal discharge? 6) Does your abdomen feel uncomfortably hard? 7) Have your feet been swollen? From that moment on I was able to run the consultations with no troubles and the experience was really self-motivating because I was truly a doctor for a day.
10/26/11
Unfortunately, my day at CS Huayapam was very uneventful. The doctor wasn’t feeling good, so he refused to let us observe his consultations. Therefore, we spent the entire day helping the nurses. I would check the patient’s weight and height and then take their blood pressure. I went through this process with about 8 patients and then there was nothing else to do. Although all these tasks are good practice and I was happy to help, I was hoping to learn more about medicine and observe the doctor-patient interaction.
10/27/11
My next day at CS Huayapam was similar to the day before. After performing a few blood pressures, my partner and I decided to follow the dentist so we would at least see something different. Although I am not interested in dentistry, it was interesting to see the differences between Mexico and the US. Again, I felt like the technology was hindering the care that is seen in the US. Most patients have to go without anesthetics and the tooth filling is the old metal filling that isn’t seen in the US anymore. The experience was interesting and it was very nice of the dentist to allow us to watch.
10/28/11
The doctor again refused to let us observe his consultations, but my partner and I were determined to get the most of our experience. We started off the day helping the nurses again and I taught my partner how to check a patient’s blood pressure. Next, we asked the psychologists if we could observe one of her consultations. She let us observe as she helped a patient who was having issues with her Opportunidades. After the consultation the doctor explained to us that the most important part about being a psychologist is to listen to the patient. Then the psychologist told us that they often have to try giving the patient another perspective of the situation. Another thing she told us, which is similar in the US, is that most psychological issues can be traced back to some parental problems as a child. We made the best of the experience, but I am looking forward to getting back into medicine at next weeks clinic.
10/12/2011
For my first day I was assigned to the surgery department. Here, me and about six other students in my program followed along with the residence and doctors as they went bed to bed presenting each patient’s case. A resident would explain the patient’s case and then the doctor would ask us all questions about the surgical procedure.
After rounds we went into two surgeries. The first surgery was a gallbladder removal, which I have already seen in the US. The big difference between the two surgeries is that in the US they did the surgery Laparoscopically, meaning they did the surgery with only sticking little tools and a video camera in the patient. The one I saw here was more invasive because they had to cut the person open and then do the surgery by hand. The patient had several big gallstones that had to be removed along with the gallbladder.
The second surgery I saw was much more complicated. The patient previously had some complications from an appendectomy and then had to have his ascending colon removed. The surgery I saw today was the attachment of the patient’s small intestine to patient’s transverse colon. The patient went six months with a bag acting as his ascending colon.
One of the more interesting things about surgery in Mexico is the way they perform anesthesia on the patient. In the US, the universal consensus is to use general anesthesia to put the patient in an unconscious state, which means a ventilator must be used to control the patient’s breathing. In Mexico they more commonly use regional anesthesia to block off a portion of the body, leaving control of breathing in the patient’s hands. For both of these surgeries the patients were given regional anesthesia by injecting anesthetics into the epidural area of the spine. I am unsure of their reasons for doing this but perhaps it is a financial reason.
Later that night, a few of my fellow students and I came back to spend some time in the OBGYN department. Here I not only had the opportunity to see live births and C-sections, but also got to learn about neonatal care once the baby is out. Once the baby is out of the womb, there are a series of observations that the nurse will make in order to determine the baby’s gestational age. For example, the smoother the bottom of the baby’s foot, the younger the baby is. Babies born premature often have smooth feet with zero wrinkles. Another example is the floppiness of the ears. The floppier the ears are, the later the baby is in its development. Once the baby’s gestational age is determined the baby must get a vitamin K shot to help with the clotting of the blood in the umbilical cord, and antibiotic eye drops to prevent the transfer of any bacteria as the baby exits the womb.
Something interesting that I noticed when watching my second C-section was that all incisions for a C-section in Mexico are vertical. In the US they are horizontal. The reason for this is it is easier to get the baby out of a vertical cut then a horizontal one. In the US, they use a horizontal incision because the scar is more aesthetically pleasing. It is easier to hide a horizontal scar at the waste than a vertical scar up the person’s stomach. The hospital I was working at was a hospital that covered the general public so aesthetics weren’t much of a concern to them.
10/13/2011
After returning home at 1am from working in the OBGYN department all night, we had to be back at the hospital in the surgery department at 7am for class. The class was a presentation on the surgeries that were going to be occurring that day. Today there was only one surgery, a pancreatic cancer surgery, so the majority of the presentation was on the different ways to go about the surgery. Unfortunately, the surgery was scheduled for later that evening and we were unable to see it, but we did take good notes on the entire process.
After class we went on rounds and examined the patients that we saw receive surgery the day before. I felt like rounds were much more beneficial this time after going to class in the morning because we had a little more understanding on the general process of surgery. Once rounds were done there were no surgeries to view so we spent the rest of the day practicing laparoscopic surgery on a simulator that they had. The technique was completely awkward at first but after 3 or so tries we were all starting to become experts.
10/14/2011
The next day in Hospital Civil I was placed in the OBGYN department once again. I was excited to return because this was probably the happiest department in the entire hospital. We started off the day by seeing a vertical birth, which is a new process for birthing that is being tested. In Mexico, they choose women to have a vertical birth based on a lottery system and then evaluate the outcome compared to the general birthing position. A vertical birth is where the woman is placed in a standing position so that gravity can assist in the birthing process. This procedure is becoming more and more popular all over Latin America, and from what I witnessed it seemed a lot easier.
After seeing the real birth, I ran to another room to see a C-section. This C-section was the same as the others I have seen except before they closed the woman up, they placed an Intrauterine Device (IUD) in her uterus. An IUD is a t-shaped device that releases birth control hormones and last for about 5 years. This was an important procedure to witness because overpopulation is a serious issue in Mexico.
We spent the rest of the day watching a hysterectomy. This is a very serious procedure where they remove the woman’s uterus. In this case, the woman had several tumors growing in the uterus and, since she was done having children, it was best that it be removed. This was an elaborate procedure because the uterus had to be removed from the cervix and the two fallopian tubes. They also had to carefully cut off the round ligament attachments on each side of the uterus. But the biggest thing I learned from this procedure was the importance of being thorough and following surgical protocol. As the surgery was coming to and end and the surgeons where closing the incisions, the nurses began to count all their tools, gauze, towels, and any other tools they used to make sure everything was accounted for. It turns out that one small towel was missing and nowhere to be found. After spending several minutes searching the operating room, the towel was finally found inside the incision, where it was placed to clean up some blood. The surgeons then had to cut a few stitches they already made in order to remove the piece of cloth. Everything worked out in the end, but it could have been a disaster if that towel was not accounted for.
10/19/2011
The next day I was back at the hospital at 7am for surgery class. Today’s class was much more interesting because we were learning about hand surgeries. The reason I am interested in hand surgeries is because my dad was in a work-related accident that chopped off one of his fingers and left the rest of the fingers really beat up. After a quick debate they decided to reattach my dad’s finger and to this day we debate whether that was the right call. After three surgeries, although attached, my dad’s finger has limited movement, is constantly sore, and aches when the temperature is slightly cold. In class we learned that the goal of hand surgery is to conserve utilization and function for the longest time. They also told us that in Mexico they will only consider reattachment if the finger has 3 factors that are met: the finger must still be receiving blood, the segment being reattached is small, and the person is young enough where they can heal easier and the risk is more worth the attempt. My dad would have qualified for the first two factors, but is obviously to old for qualify for the last one. I if they would have just amputated the finger here in Mexico.
After class we headed to the surgery room for a busy day of surgery. We saw three surgeries that day: a gallbladder removal, a broken femur reconstruction, and a finger amputation. All of these surgeries were happening simultaneously so I obviously spent the majority of my time watching the hand surgery. The gallbladder surgery was similar to the one I saw earlier that week so I spent little time in there. The femur reconstruction, on the other hand, was very interesting because it required some carpenter-like skills to mount a steel rod to the patient’s leg. But my emotional attachment to the hand surgery had me drawn to that surgery for almost the entire time.
After explaining my story to the surgeon he even let me sit right next to him, only a foot away from the hand being worked on. I am grateful for that experience because seeing how intricate and complex the hand is makes me more amazed at the ability of my dad’s doctor to reattach my dad’s finger. Unfortunately, this patient wasn’t so lucky. He had already had his pinky finger removed and after trying to save his ring finger, they had to amputate it today. The surgery made me think about the amazing medical advancements that are going to be available in the future and how medicine is never finite. We will always learn new things about the body and its reactions to stress and medicine is always evolving.
10/20/2011
I spent the next day in a specialties department, oncology. The day started off a little scary because we watched a 7-year-old boy have a tumor removed from his shoulder. It was scary because the boy was so young, but the good news was that the tumor was not cancerous. The surgery was really quick and the boy was awake and fine in his room within a half hour.
The next surgery was much more serious. The woman had kidney cancer and had to have a Lumbotomy to have it removed. The woman’s left kidney was about three times as big as her right and she was showing all the signs of kidney cancer: blood in urine, abnormal growth of kidney, and pain while urinating. One of the surgeons showed us how we could feel the big solid kidney by pushing on the woman’s back and then feeling the kidney in the front. It felt like a grapefruit lodged in the woman’s abdomen. The surgeons then used anesthesia to knock the woman out; but, surprisingly, the woman had a bad reaction and went into cardiac arrest. The nurses rushed us out saying it was an emergency so we hugged the window looking at the patient with concern. The doctors performed several minutes of CPR and then brought in the Defibrillator. After about ten minutes of constant CPR the woman, finally became stable and was okay. It was a relief to see the woman was fine but the doctors agreed that she was in no condition to have surgery so, although she was alive, she was in for more problems in the future.
Since the Lumbotomy was cut short and there were no more surgeries in oncology, I went over to the surgery department to see the installation of a ureteric stent. This was another interesting surgery for me because I have seen the same surgery in the US, but again, it was very different because of the different technology in Mexico. In the US, they use Ureteroscopy, which uses cameras and tools placed through the urethra to perform the procedure. Although it sounds rough, this procedure is very simple and involves no cutting or long hours of recovery. The surgery in Mexico didn’t have this option and they instead had to cut the patient open, find the ureter, and then place the ureteric stent manually.
10/21/2011
Today was a medical holiday for most the doctors that work in Hospital Civil so we were given the day off. Overall, my experience at hospital civil was full of excitement and new experiences, but it also helped to confirm my suspicions that surgery isn’t my cup of tea. I’m looking forward to returning to a clinic where I will feel more in my element.
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