I have arrived in Puerto Escondido! After leaving my apartment in New York City at 3am, I touched down in Huatulco 12 hours later. I then took a taxi, about 1.5 hours and 800 pesos, to my homestay here in Puerto Escondido. The family I am living with is wonderful; the girls, two and seven years old, are adorable. The house is beautiful, with a kitchen and living room that have only three floor-to-ceiling walls, inviting in the songs of the birds and fresh air. It’s hot; a blazing paradise.
Dinner the first night with my Mexican family at Pizzeria, Mama’s Pizza, on Zicatela Beach. Margarita pizza with pesto: yummm! The restaurant is alive with surfers, here for the big waves heard crashing in the dark.
Yesterday, Sol, my mexican mom and local coordinator for CFHI, gave me a map (photo below), a phone, and a quick tour of the city, teaching me about the public transportation. I then met with the local doctor who coordinates the clinical sites; and, she shared with me important information about the local public health system and challenges. One program, Oportunidades, is a government-funded program that supports families of low socioeconomic status. Part of the program pays mothers as their children attend school and achieve higher levels of education… Interestingly, the program pays out more money for girls in school than boys in an effort to balance out an educational disparity between genders.
Today, I had my first day at clinic at the Centro de Salud Colonial Aeropuerto (just beyond the top left corner of map), a easy 10 minute and inexpensive 5 pesos bus ride away. I was observing mostly; and, that was what I felt most comfortable doing. Although I have many of the clinical skills, such as performing a Pap smear cervical cancer screening, I feel I still lack the language skills to converse with the patient in a manner that puts her at ease. I am glad I have the spanish lessons in the afternoon to focus on improving my ability to interact with patients naturally.
The doctor, Doctora Veronica, with whom I am going to be working with this first week was receptive to my suggestions and questions all day. Dr. Veronica and I saw one patient with a strange presentation of dermatitis just below the umbilicus. I had seen this before, as an allergy to the copper in the belt buckle; so, I quickly looked up the word for copper in spanish, and suggested it as a differential diagnosis not yet considered. Up to that point, with the first couple patients, I had only asked questions; so it was nice to feel as though I was bringing something more to the table. Continue reading Public health, clinic and Super Che→
Everyday this week has started before the sunrise… a nice time to travel, before the heat of the sun takes hold. I’ve enjoyed the early morning commute to 7am rounds at the Puerto Esondido General Hospital.
Puerto Escondido General Hospital, 6:45am
The Puerto Escondido General Hospital is a 30 bed hospital with one designated for gynecological patients, one for general surgery, and some private rooms for contact isolation patients; additionally, there is small pediatric unit.
Dra. Julia and me in the hospital courtyard
The local medical coordinator of Child Family Health International connected me with Dra. Julia, a wonderful hospitalist, who went out of her way every day to ensure my experience was as rich and action-packed as it could be! Two days this week I spent observing surgeries: c-sections, a femur repair after a gun shot wound, cholecystectomy, appendectomy, and an amputation of a diabetic great toe.
Prevelant all throughtout Mexico and the United States, type 2 diabetes is the culprit behind many of the ailments of the patients hospitalized in the Puerto Escondido hospital. Kidney disease, loss of vision, and ulcers — all a result of the chronic microvascular injury of poorly controlled blood glucose levels.
One woman, 53 years old, had been hospitalized for 7 days (likely much longer than would be afforded in any US hospital) after presenting with uncontrolled diabetes and an unstagable diabetic ulcer on her right great toe. After debreedment and days of antibiotic therapy, follow up x-rays revealed the infection was not responding to treatment. The surgeon and care team gathered during rounds on Friday to explain her options to her: amputate her toe now, or wait and amputate her entire food or even more after the inevitable spread of infection into the bones. She agrees to the surgery today, muttering, “Si doctor, entiendo” — yes doctor, i understand.
The tears in her eyes make reflect her coprehension of the impending surgery; but, I do not believe she understands how she got into situation. What led her, and countless others like her, to limb-sparing amputations? Although I do not know her story, I presume it includes poor nutritional options coupled with gaps in healthcare access, resources, screenings, education, and follow up. Continue reading A day in the life of the local Mexican hospital→
Just finished up a wonderful week traveling out to Baja de Chila, a quiet town 15 minutes north of Puerto Escondido. The drive in the mornings was beautiful, with the late-dawn mist rising between the mountains in the distance. The doctor with whom I worked this week was devoted to providing great care to her patients. The majority of her patients are suffering from chronic conditions such as hypertension, dyslipidemia, and diabetes. Additionally, she cares for many pregnant mothers and children of all ages. Between patients today, she taught me a couple different suturing techniques – for c-sections and other abdominal surgeries, traumatic lacerations, and a type of stitch that minimized the resulting scar.
It’s my last week in Puerto Escondido, and apparently it’s rainy season 🙂
All the packing materials provided by CFHI warned of rainy season during these summer months; but, up until this point, I was beginning to believe it was a farce — the weather has been beautiful! While my bathing suits hang-dry every night, my raincoat and umbrella have been nicely stowed under my bed. For the last 24 hours nothing has been dry! Continue reading Let it rain!→
I fear that my last post would discourage students from participating in Mexico trips in the summer. Do not hesitate!
While on the subjects of fear and Mexico trips… I have had both friends and family at home worry about my safety in Mexico, but after almost a month here talking with many travelers, it is clear to me that Puerto Escondido (and Oaxaca state as a whole) is a safe place to travel! Of course you have to use caution like you would in any place to which you are new, and it is important to check the local up-to-date travel advisories; however, do not read the headline news of Mexican drug wars and assume it has anything to do with the goings on of the areas in which CFHI’s programs are located. CFHI takes precautions, and will not send students into danger.
Puerto is a wonderful small city, and a major vacation spot for Mexicans (usually traveling from Mexico City). So, although there is the vacation-vibe to the beach-side parts of town, Spanish is spoken everywhere. Some restaurants have English menus; but, I always order in Spanish. It is important to me that I have the Spanish-immersion experience. Continue reading Picture perfect Puerto Escondido, hasta luego!→
Learning from the Locals - International Medicine 