La Brigada

Today was our first day of medical brigades, and according to Dr. Sevilla, it was the healthiest community that we will encounter during this week. This is mostly d/t the fact that they are only a 45 minute drive to the closest “city.” Many of the communities that we will be visiting are much more secluded with an even decreased access to health care in comparison.

Driving up the mountain, one of the most poignant pictures is of the garbage dump covered in scavengers, both human and vulture picking through the discards of the larger towns below in hopes of finding valuables. The smell of course assaults you, but I feel that the continual presence of this is a much more memorable image. Although, many have tried to move the “basurero” away from the small town, much of the efforts have been met with pure apathy.

In the town, fortunately, many of the other public health efforts have been successful. The majority of the residents of the town have chimneys instead of stoves so that the smoke of their cooking fires billows outside rather than into their homes and their lungs. The improvement in the health of these families has been substantial as they have seen a dramatic decrease in morbidities such as asthma and COPD. Additionally, there has been a significant decrease in the carbon monoxide poisoning seen.

One patient I had sticks to my mind tonight. She was an 80-year-old woman who came in due to a cough that she had had for years and pain in her bones (“dolor de los huesos.”) With her simply attempting to walk in, it was obvious that something was very wrong. Her protuberant belly preceded her as she was guided toward our small little station in the loud classroom. The cough she had had for years, but what bothered her most was the pain in her bones. As much as I attempted to redirect her toward her cough she had for years or her history of ovarian cancer, my attempts were futile as she continually insisted that the other brigade had checked her out and she was “fine.” Soon enough, as much as I attempted to speak to her and offer some sort of treatment for her bone pain in hopes of delving deeper into the root of her problems (recurrent ovarian cancer? Carcinomatous TB?), she left. Even now, I am left with the question of what could I have done differently and how has the discontinuity of care between the multiple brigade groups entering this community has affected the long-term outcome of her health. It is completely unclear to me why they decided that she was "fine," and what sort of tools they used. Did they ultrasound her belly? Did they perform a PPD? Sometimes, you feel like there is only so much you can do.... and it makes you feel a little small.

Honduras

Going to Honduras for my Family Medicine Rotation through the ENLACE program! 1 week brigade and 3 weeks in Tegucigalpa! Can't wait :)

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Brigadas! (Tropical Medicine Community Trips)

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!

Montezuma's Revenge

Montezuma's Revenge is what is referred to by tourist's who visit México and experience stomach problems. The name is derived from Montezume III the ruler of the Aztez empire that was defeated by the Spanish conquitador Cortés.

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.

Rave

Went to an all night dance party last night... it was amazing. Amazing DJ, everyone dancing on the beach under the stars, fire spinners... what more could you ask for??? The atmosphere was so accepting and fun that no one had any inhibitions to dance. It was great to dance without worrying about all the people around you. I hope there's another one this week so we can go again and stay until dawn.

Mercado, un Rodeo, una Roca Blanca, y un Incendio

Yesterday, we got up early in the morning to go to the market because Becky was leaving that afternoon and wanted to do some last-minute shopping. Rebecca and I went with Lori and Becky's host mom and sister. It was a lot of fun checking out the local market for all of the great food and handicrafts etc. One cool thing is that we went to two small stores next to the market to buy café and chocolate. I got some homemade chocolate that is very tasty and very very dark. It's great!

I fell asleep after getting back which was great to rest during the middle of the day. I took a much deserved siesta. That evening, I went with Lori and her host mom and sister to a Mayan wedding that they had heard about that was happening on the beach. It started one hour after they had said (of course) but it was pretty cool to see the beginning of it. The "novios" came in on a boat from the ocean and they were dressed in their wedding clothes which were beautiful. They did some prayers where they prayed to the Houses of the North, East, South, and West.

Suddenly, Marie Carmen decided that we should leave because of the dinner. It's a good thing we did because when we climbed back up from the beach there was a big fire with trucks and everything! It was pretty scary, but I wasn't so scared to not be able to snap some pictures. The brush around Playa Manzanillo is pretty dry, so I wasn't really that surprised that it was on fire. I'm glad that we left when we did though, because it could have been much scarier.

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 :(

Urgencias

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 Munster, Indiana).

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 Mexico. Pregnancy, accidents, infections, etc. One thing that I saw that was pretty interesting was a woman came in with a relatively large mass in her breast. They weren't sure if it was a cyst or a tumor, but they won't know what it is until they do either a biopsy or an X-ray. Other than that there were a couple of women in labor, a bladder infection, and a broken leg.

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 (Mexico City or Districto Federal) doing her four months of service at a rural hosp ital that is required of all residents in Mexico. I can tell that I am understand more Spanish all of the time, but it was very hard for me at times because people would ask me for stuff, but I wouldn't know what it was. Although I speak pretty fluently, there are many vocab words that I still need to learn especially medical ones. I learned that the hard way.

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 Mexico. I also made sure to ask consent first.

Atardecer maravilloso, Tortugas, y Playitas

I decided to do the afternoon of today separate because we did something completely different, and then add the work at the hospital in the morning to the post tomorrow.

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 Mexico. The little pueblito of Mazunte (pop. 450) used to be dependent on hunting turtles. This was outlawed in 1990 and various coop and sustainable development projects were started in the town to offset this huge blow to the towns economic stability. This turtle park brings in many tourists to the area which help the economy and bring more recognition to its amazing beaches and vistas.

We saw many kinds of turtles and even a seal. Apparently, this seal is a cold-water seal that somehow found its way to Mexico. It was found on a beach poor thing and they decided to bring him to the aquarium until they can figure out waht to do with him. He's just a little guy, but he seemed really confused of why he couldn't get out of his tank :( They had HUGE marine turtles and various kinds of desert turtles too (are those tortoises? not sure). They also some turtle babies to help in the conservation efforts. So cute!

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 Mexico are jus so friendly. They love to talk to people and ask tons of questions. It's a great way to practice Spanish.

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!