Thursday, March 27, 2008
Today has been the best clinical week in my opinion. We're traveling with the public health teams here in Puerto Escondido to outlying communities to learn about the programs that are being undertaken in Oaxaca to reduce the numbers of Malaria and Dengue. Since the program was started in 1999, the number of malaria cases in this region has gone down from 20,000 to 250. Seriously remarkable!
Mexico has one of the most extensive public health programs in the world. In this state alone of Oaxaca, they employ more than 3000 workers not including the administration and coordination officers.
We followed officers who work with the initiative called Patio Limpio. In this program, the officers visit every house in the state to assess the cleanliness of the area to prevent tropical disease carried by arthropod vectors. This includes dengue (Aedes aegyptis - mosquito), malaria (Anopheles vivax - mosquito), and Chagas disease (triatomes).
Although the cases of malaria have decreased in the region, dengue is becoming more prevalent (ick). A. aegyptis likes to stick around the house so the cleanliness and lack of stagnant water is a huge deterrent to keeping these bugs away.
Monday - stayed at the Jurisdicción de Puerto Escondido to see the malaria laboratory that they have there. The lab techs identify the cases of malaria with microscopes using slides sent in by volunteers in the community. Each community has a "notificante." When someone is sick or has symptoms that could indicate malaria, they visit the notificate who takes a blood sample which is then sent to the lab to verify whether or not it was malaria. The interesting this is that the notificante gives a precautionary dose of chloroquine as soon as the symptoms are suspicious and when the case is verified, the full dosage is given. They taught is how to identify malaria using the microscope and showed us the various stages of the parasite's life cycle. Not going to lie, it was kind of nice because the lab was air conditioned and it was the first time that I had been in air-conditioning while in Puerto Escondido.
Tuesday - One of the community workers took us to a small town called Tometal to show us a house that had cases of both dengue and malaria. They had also seen the bugs that transmit Chagas in their home, but luckily no one had been infected. The reason that I like this week is that we get the chance to talk to the people in the communities to ask them what they think of the program and the services available to them. The officer who took us out into the country was really nice and decide to give us a mini-tour. He took us to buy watermelon where I got a bunch of mangoes for free because there are so many that they can't get rid of them and don't eat them... (no way!!!) anyways, he also took us to see some iguanas or something (random) and to a point that is a great lookout over Puerto and has some religious memorials.
Wednesday - We went to learn about how they educate people on the Patio Limpio program. We went to a couple of houses with some of the officers here in Puerto. It was interesting because in the first house we went to we found A. aegyptis larva inside of a water feeder for one of their roosters that they forgot was there. There were also some in the water tank that they use to conserve water. In many parts of Oaxaca, they only get water one day a week. Therefore, people save it in tanks. Well, of course this is the perfect breeding ground for mosquitoes if it isn't kept clean or treated. They rate each of the houses according to how well they follow the plan. When they find a house that has problems they always return within one to one and a half months to check up on how well they are following the suggestions. They don't tell people when they're going to return because they want them to do it all the time and not only when the health officers come. Afterwards, we went out into the country again because after there has a been a case of dengue or malaria they spray insecticide as a ring around the house so that those mosquitoes that carry the disease can't spread. They told me that they used to spray everything but it wasn't working very well which is when they decided to start community capacity building programs instead. Pretty awesome! Especially because the newer programs that involve the community have been much more effective.
Thursday - Today was a very awesome day. We went out to meet a woman that is the health capacitor of her small town of 120 people. She gets together with the women of the community to set up programs for the health of the families. It's amazing that in her town there have been no cases of malaria or dengue and none of the children are malnourished (not so in Puerto Escondido). She was a very cool lady and explained how she works to set things up for the community. While we were in the community, people were amazed that we had come from the US to their small farms pretty much in the middle of nowhere. We were like local celebrities. We got free bananas from the store (the best I've EVER had btw) and Aureliana made us a delicious lunch of chicken soup•. very, very fresh chicken soup!
Thursday, March 20, 2008
Well, for the past 3 days, I've been feeling pretty cruddy. Haven't really done much other than lay around and feel nauseated. I'm starting to feel a little better right now so I think I'm going to go to the beach to hang out for a little while, but will probably take a taxi to get there.
Sigh... it stinks being sick.
Monday, March 17, 2008
Sunday, March 9, 2008
That night, Rebecca and I decided to go to the Rodeo which came to town. We didn't know that the tickets were going to be pretty expensive (well not really but $15 is a lot in Mexico!) but we found out that the rodeo was very long and that there was a concert afterwards by a pretty famous Cumbia band called La Apuesta. We really enjoyed it and I saw my first rodeo in Mexico and the first one that I remember clearly.
The next day we just relaxed around Puerto Escondido, and in the afternoon we went to a place called Roca Blanca that is another beach that is nearby. It was beautiful! Rebecca and I climbed some rocks to be able to get to a deserted beach on the other side which was awesome. Climbing over the rocks was kind of scary thought because I went on the water side which was dumb because the waves kept splashing into me. We just spent time with the family and enjoyed a nice time on the beach. Unfortunately, as soon as the sun began to set, the mosquitoes came out and in about 3 minutes gave me a ton of bites on my ankles :(
Friday, March 7, 2008
Thursday and Friday I spent my time in the Sala de Urgencias (or the Emergency Room). I mostly shadowed the two interns that work there. They were both really nice; it was pretty cool to see how a smaller community emergency room works after working at the one by my house (in
Thursday was pretty chill. It really wasn't that busy. The stuff that we saw was mostly stuff that you see on a normal basis in
Friday was VERY busy. First, I saw a woman who came in with labor pains whose baby had his umbilical cord wrapped around his head. They were examining her when suddenly an ambulance came in.
Two small brothers had been poisoned by what, they didn't know. I had never seen this before. It was very devastating to see two young boys so incredibly sick. I can't even fathom what the mother was going through to have both of her sons obviously struggling to even breathe. They were screaming in terror and pain, having trouble breathing, and salivating. They immediately took the smaller boy to the trauma room because he was in much worse condition, but the older boy (and by older I mean three years old) was simply taken to a regular emergency room bed without a monitor or anything like that.
I stayed with the older boy pretty much the entire time. He was absolute terrified (for obvious reason) and kept trying to remove his NG tube which could not have been comfortable at all. In some ways, they were not prepared for such an emergency. For example, the intern gave him the NG three different times because of various issues. There was also sanitation problems with not everyone wearing gloves all the time. Also, it kind of felt like there were too many doctors in the room. (Three attendings + two residents + two interns + many nurses), but overall, they did a good job. The boys were stabilized when I left. Mostly, I was just there to help with holding the young boys legs, making sure he got enough oxygen, talking to him to help calm him down, things like that. Pretty simple, but every little bit helps.
One of the residents was really great. When I told her that I was a student, she explained everything that was going on and when through the basic steps of doing a basic pediatric examination. She was from DF (
Oh, also here are some pictures of the hospital. I made sure that the faces of all the patients were covered or not visible in the pictures to maintain privacy although there aren't any laws that are actually enforced of the type in
Thursday, March 6, 2008
Today, after being at the hosp ital, Rebecca and I decided to go ahead and get lunch in Pochutla instead of riding back hungry to Puerto Escondido. Well, we went to a small taco place across the street from the hospital where we saw some of the doctors that we had shadowed. For only $1.50, I got two two chicken and onion tacos with tortillas made just for me, and two helpings of rice and beans. Amazingly delicious and very affordable.
Kind of on a whim, we decided to take a colectivo to a small beach town in between Pochutla and Puerto Escondido. A colectivo is a pickup truck that has a little canopy in the back with wooden benches. People pile into them to get to various places quickly and cheaply. You ride with all sorts of people from school children, vaqueros (cowboys), and little old ladies to chickens and construction tools. You just hop on a knock on the window when you get off and they tell you how much it cost. I'll have to take a picture of one before I leave.
Well, anyway we went to a turtle conservation aquarium where you can see various types of turtles native to
We saw many kinds of turtles and even a seal. Apparently, this seal is a cold-water seal that somehow found its way to
We stopped by a natural cosmetic products coop that was created for the people in the town. They use natural and organic things found in the area and with help from the Body Shop they were able to create this great little store where you can get various products pretty inexpensively.
Then we walked to Playa Mazunte. I have to tell you that it is absolutely gorgeous. There are little cabanas lining the side of the beach, but other than that, it is very tranquil and beautiful. We enjoyed ourselves, rolled our hospital khakis up and got a little wet. We also got some snacks to enjoy on the beach as we laid on the rocks to dry off.
In Rebecca's Lonely Planet book, they talked of an awesome sunset spot called Punta Cometa. It is a 30 minute hike to the top, but it is so worth it. This adorable blackish-brown doggie came with us the whole way and made sure that we got there ^^ The forest there was kind of dry because it is the dry season, but it was nice see more green. There were also these HUGE cacti when we got to the top. We sat on Punta Cometa and watched the sunset. We didn't have a flashlight to get back so we left before we wanted to and as we were walking back the sunset just got better and better, but we made sure to turn around to get more pictures.
It was kind of an issue getting a colectivo back to the carretera (highway), but when we got there we chatted with a taxi driver until our bus got there. People in
Got back at 9pm, had an awesome dinner cooked by our host mother.
All in all, an amazing day and definitely worth getting my khakis filthy!
Wednesday, March 5, 2008
Yesterday, I saw my first baby being born! It was a caesarean section. One difference was that it was transverse instead of longitudinal. (That means they cut up and down instead of horizontally like they normally do in the
Today, I saw a vaginal birth. Here, they pretty much cut an episiotomy for all of the births. This is contrary to what is common practice in the
I don't know if I mentioned that Pochutla is the farthest clinical site that we go to because it is 1 1/2 hour away by bus. It kind of stinks to have to walk 1/2 hour to the bus stop and ride for 1.5 hour and then do the same on the way back, but luckily we only do that this week. Other than that, I really like this hosp ital and wouldn't mind spending more time there.
Spanish class again. same time. This time we worked on subjuntive. I'm pretty rusty on some parts of it, so I'm glad that we're going over it again. It makes me think more about it when I speak and I want to get to the point again where I don't have to think about it.
Immediately after, we went to Restaurante Liza's which is the place that we've been going to pretty much every day at 5pm. It's really chill and the bartender Andrés is a really good guy. Apparently, he's a hardcore firefighter in