09/27/2011
My first day at clinic was a little disappointing. My partner and I arrived bright and early at Centro de Salud San Felipe and met with the nurses as the Salud started to open and patients started to arrive. Unfortunately, there was a misunderstanding and the medical director, who we thought we would be shadowing, was no longer the director. We then waited for three hours for the new medical director to arrive. Sadly, she never came, which I have been told is common here in Mexico. Sometimes the doctor just doesn’t show up and the patients are just out of luck. So after a full day of awkward smiles at patients thinking my partner and I were the doctors, we went back home.
Turns out it was a better idea for us to switch clinics because of the medical director misunderstanding, so we went with our program’s medical director and visited our new clinic, Centro de Salud Pueblo Nuevo. It was a rough first day but it was a perfect chance for me to release my nerves and completely prepare for the better days that were yet to come.
Turns out it was a better idea for us to switch clinics because of the medical director misunderstanding, so we went with our program’s medical director and visited our new clinic, Centro de Salud Pueblo Nuevo. It was a rough first day but it was a perfect chance for me to release my nerves and completely prepare for the better days that were yet to come.
09/28/2011
I am now thankful for my rough first day because my mind had been wandering in uncertainty for this new experience I was about to have and that first day helped but my head back into a real context. Everyone seemed very nice at this new clinic. The environment was much more uplifting. The clinic was located in a little suburban area of the highway, unlike my old clinic that was in the mountains surrounded by weeds and only a few buildings. Also, there was a playground and grass right next to this new clinic.
After a little small talk with Doctora Coral, the doctor I was following, we jumped right into seeing patients. The center was promoting safe sex that day so most of our consults were about the different types of birth control and planned parenting. Apparently, there is a serious issue with too many births in the area, so they are trying to help families plan out how many children they want and then control it accordingly.
After Dra Coral and I got more comfortable with each other, she showed me the anatomical sights to listen to the heart and the lungs. She also showed me the different spots to listen to these organs on babies. From then on she told me to check everyone’s heart and lungs with my stethoscope because it takes listening to hundreds of healthy hearts in order to hear the difference in a bad heart. Next she showed me how to listen and feel the parts of a stomach in a check-up. We discussed the anatomical sight, known as Mcburney’s point, where the appendix is located and then she showed me how to palpate the kidneys. It was a very involved and interactive first day at Pueblo Nuevo.
After a little small talk with Doctora Coral, the doctor I was following, we jumped right into seeing patients. The center was promoting safe sex that day so most of our consults were about the different types of birth control and planned parenting. Apparently, there is a serious issue with too many births in the area, so they are trying to help families plan out how many children they want and then control it accordingly.
After Dra Coral and I got more comfortable with each other, she showed me the anatomical sights to listen to the heart and the lungs. She also showed me the different spots to listen to these organs on babies. From then on she told me to check everyone’s heart and lungs with my stethoscope because it takes listening to hundreds of healthy hearts in order to hear the difference in a bad heart. Next she showed me how to listen and feel the parts of a stomach in a check-up. We discussed the anatomical sight, known as Mcburney’s point, where the appendix is located and then she showed me how to palpate the kidneys. It was a very involved and interactive first day at Pueblo Nuevo.
09/30/2011
The first patient today was a long time diabetic, which is very common both in Mexico because of a slight genetic predisposition and their high starch concentrated diets. Dra Coral showed me how to check a diabetic’s feet, which is one of the most common complications with diabetes. We first checked between each toe for bacteria, which is a good sign of how healthy the feet are. Next, we checked the perfusion, return of blood, at the base of each toe and the heel by pressing firmly and then releasing. Last, we checked the dorsalis pedis artery for a pulse. This artery is located on the top of the foot slightly more medial then the centerline of the foot. After the feet it is important to check the patients eyes, which is another common spot of complication for diabetics.
The next patient was a 5-month-old baby girl just coming in for a check-up. Checking the baby’s heart and lungs was my favorite thing of the day cause the baby kept grabbing and hitting my stethoscope. It was very entertaining. The more important part of the check-up was listening to the advice the doctor gave the patient. For example, when feeding, offer the spoon to the baby sideways and not straight on. This prevents any accidents where if the baby were to lunge forward, they wouldn’t choke on the spoon. We also talked about the schedule for introducing different foods into the babies diet. For example, the baby shouldn’t have fruit till after two months and no meat until after 8 months.
The next patient was another diabetic, but the point of me writing about it was what the doctor asked me when the patient left. She asked me what color the patient’s eyes were. I curiously admitted I didn’t know and then she went on to explain to me the importance of really looking at the patient. She said noticing their mannerisms and physical emotion is the first evidence for making a diagnosis and when you look in the patient’s eyes, you make a trustworthy connection that enhances the doctor-patient interaction. So, from then on, Dra Coral would ask me what the color of each patient’s eyes when they left and I would answer.
At the end of that day I learned a little bit about Mexico’s system. After every doctors appointment the patient goes to the dentist, which is conveniently located in the same building. This is a way to try to make people go to the dentist because it isn’t as highly valued in Mexico and in the US. It’s actually a clever idea. I, myself, don’t like going to the dentist and would probably go more if I were forced to after I see the doctor.
The next patient was a 5-month-old baby girl just coming in for a check-up. Checking the baby’s heart and lungs was my favorite thing of the day cause the baby kept grabbing and hitting my stethoscope. It was very entertaining. The more important part of the check-up was listening to the advice the doctor gave the patient. For example, when feeding, offer the spoon to the baby sideways and not straight on. This prevents any accidents where if the baby were to lunge forward, they wouldn’t choke on the spoon. We also talked about the schedule for introducing different foods into the babies diet. For example, the baby shouldn’t have fruit till after two months and no meat until after 8 months.
The next patient was another diabetic, but the point of me writing about it was what the doctor asked me when the patient left. She asked me what color the patient’s eyes were. I curiously admitted I didn’t know and then she went on to explain to me the importance of really looking at the patient. She said noticing their mannerisms and physical emotion is the first evidence for making a diagnosis and when you look in the patient’s eyes, you make a trustworthy connection that enhances the doctor-patient interaction. So, from then on, Dra Coral would ask me what the color of each patient’s eyes when they left and I would answer.
At the end of that day I learned a little bit about Mexico’s system. After every doctors appointment the patient goes to the dentist, which is conveniently located in the same building. This is a way to try to make people go to the dentist because it isn’t as highly valued in Mexico and in the US. It’s actually a clever idea. I, myself, don’t like going to the dentist and would probably go more if I were forced to after I see the doctor.
10/05/2011
Our first patient of the day had just had a hysterectomy, which is the removal of the uterus, and she also was a borderline diabetic. Her blood glucose was a little high that day so we signed her up for a test to see if it was always high, or just high because she had a sugary snack before the visit. In the test the patient’s blood glucose is monitored for two hours after she takes a sugar pill. As the sugar pill is digested, her blood glucose should increase, but after 2 hours if her blood glucose hasn’t returned to normal, then she is insulin resistant and diabetic.
A lot of the time doctors make a diagnosis based on symptoms and medical history. For example, if you have a fever and are throwing up, then it’s probably the stomach flue, or if there is pressure around your eyes and you have gross fluids coming out of your nose, then is probably a sinus infection. This next case was fun because we made a diagnosis by auscultation, meaning listening to sounds of the body. Yes auscultation does refer to listening to the heart and lungs, which is done at almost every consult, but for this case we placed two fingers on the stomach and then hit those two fingers with the other hand to listen to the sound. Normally, the intestines and stomach have a lot of gas in them and will make a hollow sound when you perform this procedure. On the other hand, if you hear a thud sound, it probably means the intestines are swollen and inflamed. This was the case for this patient, who turned out to have an intestinal infection.
At clinic there are a lot of pregnant women who come in for a check-up. It is usually the same process where we make sure they are staying healthy and then we measure their uterus to see how far along they are. To measure the uterus we palpate the pubic bone and then measure up the body till we feel the fundus, which is the top of the uterus. Sadly, the patient we saw today was 12 weeks in and we were unable to measure the uterus, which is usually a sign that the seed didn’t take or the patient had a miscarriage. It’s wasn’t easy but it was Dra Coral’s obligation to tell the women that both these options are highly feasible and we need to do further testing to make sure. This was the first really emotional medical experience I have had in Mexico. All the other cases I have seen were issues, but none of them were traumatic. Although difficult, it is good to experience these types of situations because medicine isn’t always uplifting.
That evening I went to Hospital Carmen to see some surgeries with our program medical director, Doctora Magali. First, I watched a C-section for the first time in my life. Seeing a baby come out of another human being is a life changing experience and I will never look at a human being the same. Seeing this procedure elevated my respect for the process of growing up and the importance of life. I look forward to having my own child and I now have a glimpse of the moment that every father calls a miracle.
After seeing the C-section I was able to watch a prostate biopsy surgery. Interestingly, I have already seen this procedure in the US, but it was very different. In the US the procedure was quick and easy because, without getting into too much details, the technology was much more advanced. In Mexico, without going into too much detail, the procedure was very elaborate and painful. Also, the patient would probably be hospitalized for 3-4 days, unlike in the US where the patient left an hour later.
A lot of the time doctors make a diagnosis based on symptoms and medical history. For example, if you have a fever and are throwing up, then it’s probably the stomach flue, or if there is pressure around your eyes and you have gross fluids coming out of your nose, then is probably a sinus infection. This next case was fun because we made a diagnosis by auscultation, meaning listening to sounds of the body. Yes auscultation does refer to listening to the heart and lungs, which is done at almost every consult, but for this case we placed two fingers on the stomach and then hit those two fingers with the other hand to listen to the sound. Normally, the intestines and stomach have a lot of gas in them and will make a hollow sound when you perform this procedure. On the other hand, if you hear a thud sound, it probably means the intestines are swollen and inflamed. This was the case for this patient, who turned out to have an intestinal infection.
At clinic there are a lot of pregnant women who come in for a check-up. It is usually the same process where we make sure they are staying healthy and then we measure their uterus to see how far along they are. To measure the uterus we palpate the pubic bone and then measure up the body till we feel the fundus, which is the top of the uterus. Sadly, the patient we saw today was 12 weeks in and we were unable to measure the uterus, which is usually a sign that the seed didn’t take or the patient had a miscarriage. It’s wasn’t easy but it was Dra Coral’s obligation to tell the women that both these options are highly feasible and we need to do further testing to make sure. This was the first really emotional medical experience I have had in Mexico. All the other cases I have seen were issues, but none of them were traumatic. Although difficult, it is good to experience these types of situations because medicine isn’t always uplifting.
That evening I went to Hospital Carmen to see some surgeries with our program medical director, Doctora Magali. First, I watched a C-section for the first time in my life. Seeing a baby come out of another human being is a life changing experience and I will never look at a human being the same. Seeing this procedure elevated my respect for the process of growing up and the importance of life. I look forward to having my own child and I now have a glimpse of the moment that every father calls a miracle.
After seeing the C-section I was able to watch a prostate biopsy surgery. Interestingly, I have already seen this procedure in the US, but it was very different. In the US the procedure was quick and easy because, without getting into too much details, the technology was much more advanced. In Mexico, without going into too much detail, the procedure was very elaborate and painful. Also, the patient would probably be hospitalized for 3-4 days, unlike in the US where the patient left an hour later.
10/06/2011
Today was a day full of diabetic and hypertension patients, which are very common in Mexico. What I did learn that I wasn’t aware of is the Opportunidades Program. This is a program that people must qualify for based on income. If they qualify, they can receive assistance in their medication costs if they come once a month to see the doctor. This program becomes very important for people with chronic diseases that will probably be on medication for the rest of their lives, like diabetic and hypertensive patients. These types of patients must come on a scheduled date once a month in order to receive funding. At the end of the day, we checked in on a newborn baby that was born the previous night. We preformed a few reflex tests to see if everything was normal with the baby. For example, we would rub the babies cheek with our finger and the baby would turn its head and open its mouth, looking for food. Another reflex when we extended the baby’s arms in front of them and let go, the baby’s arms would tremble back close to its body. This reflex is because that is the position the baby has been in for all of its life and extending the arms is a foreign movement to the baby.
10/07/2011
My last day at CS Pueblo Nuevo we took the opportunity to interview Dra Coral on her opinion of Mexico’s health system. It was interesting because she said the system had dos caras, which means it has two faces. The good side of the system is that Mexico provides health insurance for all. The negative side of the system is that these services are free and available but people don’t take advantage of it. For example, at this clinic I have probably seen about 25 diabetics, but only one person was actually controlling his diabetics sufficiently. Dra Coral also told us of the corruption in the system. There are no direct records of where the government funding is going and she said that a lot of the time they don’t even receive money at their clinic, making it difficult to provide proper care.
After our interview we talked about a vitamin supplement, called acetofollicle. This vitamin is under debate whether or not it should be prescribed to all people. The vitamin is essential in proper cell growth and is primarily given to women who are pregnant. Dra Coral is one of those people who believe all people should have this vitamin and she, therefore, prescribes it to all her patients.
One of my favorite patients of all my time at this clinic was an 8-month-old baby girl. She was perfectly healthy and was just there for a check-up. We used the check-up to inform the mother of important tips to help the baby in her development. For example, we talked about the importance of tummy time, an exercise for the baby and also something I remember my cousins talking about with their own children. Apparently it is important to leave your baby on their stomach so they can learn to pick their head up. Once that is mastered the baby will extend its arms and lift its chest up. Then, before you know it, the baby will be crawling. This tummy time is an important aide in the child’s development.
I had a great experience and learned so much with Dra Coral at CS Pueblo Nuevo. She was a great mentor and I am grateful for her kindness and help. Next I am off to Hospital Civil where I will see more serious medical patients.
After our interview we talked about a vitamin supplement, called acetofollicle. This vitamin is under debate whether or not it should be prescribed to all people. The vitamin is essential in proper cell growth and is primarily given to women who are pregnant. Dra Coral is one of those people who believe all people should have this vitamin and she, therefore, prescribes it to all her patients.
One of my favorite patients of all my time at this clinic was an 8-month-old baby girl. She was perfectly healthy and was just there for a check-up. We used the check-up to inform the mother of important tips to help the baby in her development. For example, we talked about the importance of tummy time, an exercise for the baby and also something I remember my cousins talking about with their own children. Apparently it is important to leave your baby on their stomach so they can learn to pick their head up. Once that is mastered the baby will extend its arms and lift its chest up. Then, before you know it, the baby will be crawling. This tummy time is an important aide in the child’s development.
I had a great experience and learned so much with Dra Coral at CS Pueblo Nuevo. She was a great mentor and I am grateful for her kindness and help. Next I am off to Hospital Civil where I will see more serious medical patients.
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