Wabash Blogs Health Care in Chiapas -

July 24, 2008

lot's of updates and pictures

Sorry for not updating lately. A lot has been happening, including some med school stuff I’ve had to take care of in addition to stuff around San Cristobal. I’m making up for it though!

This is what Mayordomo officials dress like in the villages near San Cristobal.

    Last week I got started in the emergency unit of San Cristobal’s Regional Hospital. I was told things were going quite a bit slower than usual, but I was still able to see some interesting things. I was able to observe four surgeries on the first day. Two of them were cesarean sections, one was a trauma to a young girl’s femur and ankle, and the fourth was just local anesthesia to remove a cyst from an older woman’s foot. Honestly, this is the first summer I’ve witnessed a lot of stuff in person. I mean, I’ve seen this stuff on Discovery Health, but it’s much different in person. I have been pretty determined to be involved in medical issues tied to greater social problems through public health someday, but this really had me interested. One thing’s for sure: It didn’t make me sick. I was glad to have the opportunity because it confirmed my fascination with the human body and my desire to help cure its problems as a doctor. I wasn’t in the way, and in fact was able to help assist the surgeons a bit by handing things or directing the surgical lamps.
    Aside from this time in surgery, I spent a lot of time with the interns in the ER who shared the gloomy stories of days on end trapped in the hospital with only three or four hours to catch some sleep and freshen up. It’s not much different here than in the US. The biggest difference is that Mexican university students have to pick their career upon entrance, while I get four years to study and decide whether or not to apply to med school. They do a lot of combined class and clinical work throughout their education, something medical schools in the US have just recently realized can be more effective for students. That’s something I am particularly interested in as an applicant for med school. They were really interested in the way we do things up there in terms of education and medical school. They were also asking a lot about the healthcare system of the US. It got interesting when the physician's salary came up. It’s apparent to them that we make more money in the US, but I pointed out to them that our cost and standard of living is much higher. It’s like two different worlds. I am continuously amazed by how much Mexico can do with its federal hospitals and popular insurance program. While I know the quality of healthcare isn’t always the best, and it can be hard to find certain types of treatment, I am still surprised. I made it clear to them how much something can cost when you don’t have insurance or seek treatment for something insurance doesn’t cover. I mean, I spoke from experience when I shared the cost of getting braces...almost five or six times what it costs in Mexico. Pretty amazing.
    Aside from my medical experiences, I’ve been having a lot of fun soaking up the surroundings. I like to go out about everyday, at least for a walk. It sometimes seems colder inside than outside because of the concrete buildings. It has been fairly nice compared to the previous weeks with so much rain. Two weekends ago I visited San Andres Larrainzar, a community I was unfortunately not able to work in earlier this summer. It’s in a Zapatista region near the town of Oventic. I went with the language school where Brandon was teaching English and the director was able to get us a question and answer session with the Zapatistas in town. I asked about the supposed hospital that was newly constructed, though it seemed he wasn’t very interested. Being a part of the federal government, it came secondary to the clinic the autonomous communities had founded in another area. I wouldn’t expect the care to be as great though. The leader also shared the Zapatista concern with the organization of the city.  Being the community’s main church, there is a dispute between municipal and autonomous officials over how the city should be organized. The Zapatistas were trying to set up a market in a different place to give the church respect and create a park out of the area it currently occupies. It was pretty bad. I mean, I saw drunk people on the street in front of the church. I didn’t quite understand all of their argument, but I could see that it’s going to be hard to introduce any change. I honestly think that people really aren’t aware of the conflict between municipal and Zapatista officials, the two groups trying to govern the town. I think that people chose not to leave the central market for another area because they don’t want to risk losing money. I do find the Zapatista argument compelling though after visiting several communities with central parks near the church where families can take a Sunday afternoon stroll or listen to folk music.

The church and market in San Andres Larrainzar, near Oventic.  

    Last weekend I was able to visit Agua Azul, Mizol'ha, and Palenque. The first two places are waterfalls. They were beautiful and each had places where we could get in the water. I got some amazing pictures and really enjoyed swimming. We proceeded to the Mayan ruins at Palenque. I had just seen a play about the king Pakal here in San Cristobal, so I was excited to see his city again. I didn’t appreciate it as much when I last visited about five years ago. I was fascinated by the hieroglyphs and calendar especially. It’s amazing how much these people knew before any outside influences arrived. I got some amazing pictures, but unfortunately could only see a replica of his huge tomb in the temple of the inscriptions. He was king around 600 AD so this stuff was pretty old. I got a nice picture of the jade mask he was buried in. I think they found it in like seventy or more pieces but somehow managed to put it back together.

Brandon and I in front of the Temple of the Inscriptions at Palenque.

Jenna, a friend from Atlanta and I in front of the cascadas at Agua Azul.
    Just yesterday I made it over to the textile and traditional clothing museum of Sergio Castro. This is this amazing guy who has been in the region for over forty years working with indigenous communities to provide care for burns and other wounds, teach agricultural techniques, build schools, and bring potable water systems to small villages. He showed us all the traditional clothing of the seven Mayan language groups in Chiapas and then a slideshow of indigenous life and the work he has done. There were some particularly disturbing images of wounds you hardly see in the US. This man is a saint though: he provides his help free of any cost and works practically everyday. Next week I am going out with him to the villages to observe and help him. I am pretty excited but am nervous to see the wounds. He said that something like eight to ten severe burns occur in his territory every month. He follows up with these people to see that they recover. They usually occur in the home since food is cooked on the open flame in the middle of the floor, where people walk and children play. There’s a neat video about him you can see here: http://youtube.com/watch?v=sZIUIg3bWac.


Sergio Castro pointing out one kind of indigenous woman's dress in Chiapas.    

In addition to all of this, my Canadian friend Angela and I have been volunteering at a home for abused children. We are teaching some basic English and playing games with them. It’s a non-profit called El Reino de Los Niños (The kingdom of the children). A couple of the boys have mental handicaps so it’s been particularly challenging to learn the best way to work with them.  I've enjoyed it a lot.  Angela is a teacher, so I really benefit from having her help in planning stuff for the kids. Next week I am going to try to make instruments with them out of some cereal boxes, milk cartons, and soda bottles I’ve saved. I’ll let you know how that goes. 

Antonio, Angela, and Uriel at Reino de los Niños.  

Jonny, Uriel, and I at Reino de Los Niños.

Anyways, watch for more updates. This weekend I may get to see some distant family I’ve never met and attend a public health conference in Comitan. That’s the town my grandmother was born in.  I leave Chiapas in just 8 days.

This is a picture and Ana and I in the front of the cathedral.  She is a Chamula and assisted us with Tzotzil-Spanish translation when we helped at her village.  I frequently bump in to her.  She's on vacation from school and spends the days with her sisters and mother selling crafts in the central park of San Cristobal.

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July 03, 2008

Gynecology & Family Planning 101

Edit (13 July 2008): Since I wrote this post, I was able to get a picture with the nurse in family planning.  

 

A lot has happened in the last few days. This week I got registered with the General Hospital in San CristÛbal to serve as a volunteer and shadow some doctors. I am going to be here for the remainder of the month until I head home. Expect to hear about some interesting experiences. My first two days were filled with plenty of them.

First off, I spent three hours in the ultrasound clinic on Wednesday. We mostly saw pregnant women. The doc showed me how to palpate their stomachs and assess the baby’s position. We proceeded to using the ultrasound to check on the baby. Each ultrasound was a different case. One woman’s baby was in a transverse position, another had an abnormally large amount of amniotic fluid, and a third bed-ridden young lady seemed to have lost her baby. I was able to identify the sex of a couple of them. I also learned a lot of new Spanish medical terms in the process.

Later when they said they were going to put me in consultation, I thought maybe I’d just be seeing the common aches and sicknesses. I didn’t know I was going to be set up with a gynecologist in family planning for the rest of the week. Needless to say, I saw some new and interesting things. In fact, I didn’t imagine even having the ability to experience what I have. The first day was basically observation. Some couples came in looking for contraceptive methods, several women came in for pap smears, and others came in for routine checkups on their IUDs or hormonal implants. I really enjoyed the experience and it didn’t make me sick! †I think it made me more confident of my choice to pursue medicine. What I appreciated most were the reasons for family planning down here. The main two reasons used have to deal with the health of the woman and practical reasons like costs and education. Doctors are especially concerned for the health of sexually active teenage girls and want to ensure parents can give their children the food and education they need. This means helping families control pregnancy, especially in a society where abortion is greatly frowned upon. The federal government subsidizes most costs in the process too. Today I got to help take new patient medical histories and even got to explain the basic contraceptive methods offered at the hospital to a new patient.

I’ve noticed a lot of differences in terms of the female agency here. One patient told us how it is usually hard for indigenous women who don’t give birth to boys. Sometimes they’re abused by their husbands as a result. The need for labor in the communities causes problems like this. Sometimes American men shudder when thinking of the feminist movement up there, but I find it appalling that women down here are still fighting for the most basic rights and respect from men. Imagine a situation where a husband speaks for his wife during a basic consultation, or where a woman has to have her husband’s complete consent before any type of contraception. It usually depends on what the husband wishes in traditional society down here. It’s especially interesting, because everything is still very much in progress, and you can notice it every day. I enjoy watching social development and have really learned a lot about how it intertwines with public health and medicine. Next I'm going to be in the emergency and trauma area. Expect to hear more soon! Thanks for reading.†

This is a picture of the hospital's main entrance. †It's a segundo nivel health center. †Patients needing more treatment have to travel about 50 minutes to the state's capital, Tuxtla-Gutierrez. (http://flickr.com/photos/elizacole/)

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June 24, 2008

A great, but long day

A woman and her three boys.  Her outfit is common of this particular group of indigenous Chiapanecos from around Zinacantan I think.  

Today was much different from the last two weeks. I got to spend about 8 hours working in a small village about 45 minutes away from San Cristobal. I believe its name was Navenchauc. I may have mentioned before that the culture here is saturated with indigenous influences. Chiapas is the only state in Mexico where over 50% of the population identifies as indigenous. The people in this community largely spoke a Mayan dialect called Tzotzil. I knew three words in the language and somehow managed to use them all. I got a friendly grin when I was combining them with the Spanish I was speaking. It was amazing. By some fortune, with the connections I am making here, I was able to travel with a volunteer group of United States citizens providing international medical assistance. It appears that they worked with the government to augment support for one day in each community surrounding San Cristobal. They aren’t here for as long as I will be, but I will probably get to spend the rest of the week with them. I was happy to be able to use my Spanish to help. I usually had to go through a Spanish to Tzotil translator as well, so it became a bit of a puzzle to find out how people were hurting or what illnesses they were suffering from. I covered some history and basic questions with probably 100 people throughout the day. This isn’t something regular in the area, so we were a bit of a spectacle and more than 300 people probably got in line to see the docs. Just to give you an idea of what children experience here, especially under 6-7 years old: Often symptoms include loss of appetite, head colds, fevers, and diarrhea. I don’t think the people understand how important water is to their health. I tried to tell that to as many people as would understand me. Usually the cause of a lot of these problems is intestinal parasites. I’m wishing I had taken parisitology right about now…haha. I got to take some pictures finally, but they aren’t the best quality. I promise to get some more. I might be taking some patients blood pressures tomorrow, so that will be something new and exciting. I am still desperately waiting to see how the MCAT went. Scores were supposed to be released today at 5 pm, but so much for that. Look forward to more updates later this week!

Some info on the wall at the clinic tries to warn parents how to care for diarrhea in their children or of precautions to take during pregnancy, among other things.  

The group's makeshift pharmacy and people waiting for prescriptions.

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June 20, 2008

Lots of Thoughts

This is a long post since it’s been a while. Thanks for reading.

Over the last week, I was shadowing a doctor in his work on preventative measures to control the spread of disease in the area around San Cristóbal at ISSSTE. This is what I mentioned in my last post. I have been thinking about a lot more than just the shots I’ve watched nurses administer. In my biology classes at Wabash I learned about diseases and their transmission. In my political science and economics classes I learned about globalization and central power theory. In my history classes with Dr. Warner I learned about the history of Latin America, a part of the world rich in resources but prone to corruption. I learned about Mexico’s history and its relationship with the US over time. Here I can see first hand the problems that the developing world faces.

I guess what has affected me most, is hearing about border crossing and the implications it has on families, economics, and international politics. The mother of one child we vaccinated explained her concerns for her brother who had head the US to earn money. The people here are genuinely struggling to make a living. They leave behind families to seek better opportunities and more money. Here Mexicans work very hard but are short of employment. Even people with post-secondary degrees struggle to find jobs. The current Mexican government seems to be heading in the right direction, trying to make its actions more transparent to increase confidence and credibility. The government web pages are being revitalized and less money is being wasted on unnecessary things.

I’ve found myself at conflict here though because I tend to fall into idealism, and I have had to realize that there are several limiting factors that are going to keep parts of the world like this from developing very quickly. I guess one thing that is going to limit this over the next several decades is population growth. Here in Mexico, preventative health experts are facing serious problems. Weekly reports of diagnoses all over the country show that when vaccinations are available, Mexican health officials can generally control infectious agents causing tetanus, meningitis, gastroenteritis, poliomyelitis, and many other diseases. The government fortunately has the resources to administer vaccinations, but the realities of international relations prevent this from always happening. Countries like Korea and India are large producers of the vaccines that Mexico uses. Because of population growth, there are strict quotas on vaccination exports to countries like Mexico.

Today I was happy to hear from Dr. Castro that the Secretary of Health has started an effort to develop and produce vaccines and other biological agents for the control of disease. They are calling on Mexicans all around the world that work as research scientists and engineers to come back and help in an effort to protect Mexicans from preventable diseases. This made me think about a paper I wrote in Latin American history. My hope was that strong nationalism could help struggling Latin American countries advance and develop into countries with stronger economies, higher qualities of life, and honest politics. Now, I am by no means an expert on anything related to Latin American politics or Latin American history, but my liberal arts education (thanks to Wabash), has led me to make some interesting observations. This is an amazing way to create a sustainable industry within Mexico that could create more jobs, as well as provide for a demand that is seriously under supplied. It could prevent the spread the spread of disease and overtime cut down on the amount of financial resources expended in responding to outbreaks or on individual treatment. Maybe then, the efforts in place for social development in Mexico could become more effective; Goals for improving water supply and sanitation would become more realistic, for example. I grew up in a place where we don't have to worry about getting a parasite from drinking tap water. I grew up in an environment where I had the resources to get eyeglasses or dental care if I needed it.

These are small things we often take for granted. So as I mentioned, I feel nationalism could help these Latin American countries advance, but I also see a strong international awareness of the worlds problems as absolutely necessary. It’s going to be interesting to see how immigration is controlled over the next ten years, but my hopes are that whatever is done is sensitive to the reality facing Mexico, and I hope to see strong lines of communication and cooperation between our world’s leaders. Doctors here in Chiapas are very aware of the situation of the national government and international politics in terms of healthcare. That’s the kind of doctor I aspire to be. It’s amazing how much one person like Dr. Luis Castro can do. He and his team of vaccination techs do marvelous jobs in keeping people from getting sick, helping them obtain treatment when they are, and educating them on the resources they do have access to. These are the minds that are struggling to find solutions for Mexico.

It’s hard for me to get any pictures in the workplace, but I may be able to post some soon. On the weekends, I have been fortunate enough to make some trips. Last weekend I went with one doctor and his family to see a beautiful canyon just about an hour from San Cristobal. Here’s a photo of the scenery from last Sunday. Have a nice weekend. Next time you hear from me will hopefully be with news from my next experience at a newly built hospital in San Andes Larrainzar, a small community in the Tzotzil indigenous area. I will probably have some information to share with you regarding the Zapatistas you may have heard about in Chiapas. I am going to see a documentary about them tonight.

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June 11, 2008

Preventative Medicine Through Vaccination Brigades

I have been working for three days with the ISSSTE hospital in San Cristobal preventative medicine program. It’s a federally funded health center in San Cristobal that offers free healthcare.  I got to visit a school and spend time walking from house to house with a vaccination brigada.  Literally, these are vaccination brigades that are composed of a pair of vacunadores that visit patients and make sure they have all necessary vaccinations according to the national schedule for vaccination.  Sometimes it’s just checking records, but other times its actually visiting the home to give a vaccination.  These house calls are for kids from birth to 6 years.  

 

Just some observations and things I have yet to figure out:  I don’t understand why, but apparently a lot of people who are enrolled in the federal programs for free healthcare don’t take advantage of them.  The people I have been working with try really hard to stress the importance of preventative medicine, but sometimes people straight up refuse free vaccinations. I do admire their efforts and the way the vaccination schedule is promoted through cartillas that every registered newborn is given to keep track of their vaccination record (since the 1970s).   The vaccinations applied here are quite different from those given in the US, and as new vaccinations are developed the schedule tends to be updated or changed, so that can become a challenge.  For example, within the last five years, the schedule has changed about three times.  It also can be hard to apply vaccinations when a lot of kids are sick.  This is the rainy season and a lot of kids have fevers, coughs, and head colds.  Giving a kid a vaccination, especially a live one, under these conditions could be bad, so we haven’t had a lot of chances to vaccinate.

 

The preventative health program is headed by Dr. Luis Enrique Castro, a young doctor who recently completed public health training in Mexico City at the National Institute of Public Health.  It turns out that the Institute has a US accredited degree program for a masters in public health.  They work with the University of Guadalajara, which happens to have a degree program for US citizens in the med school.  While it’s not something I had really given consideration, I will most likely be applying there now.  Most classes are taught in English but I could get some really good clinical exposure in a Spanish-speaking environment in the third and fourth years of med school.  So far it’s looking very interesting!

 

This is just a small update of what’s been happening the last few days.  I might get to give some vaccinations next week, so I’ll keep you posted. 

 

The other night I got together with Brandon and Michael, and we came up with a list of some things we are currently liking about Mexico.  I’ll leave you with that!

 

Walking everywhere

Nutella on corn tortillas

Speaking Spanish all the time

The nice people, coworkers, bosses

Orienting ourselves by using the surrounding hills and mountains

Taquerías

Salsa dancing

The churches

No te Metas con Zohan

Chiles

Foreign perspective on US and International issues

Presidential election discussions in Spanish at the dinner table

The mealtimes

The marimba music

Sobremesa

Guacamole

The end of stomach problems

 

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June 05, 2008

Chiapas!

It’s only been a few days since last writing, but a lot has happened. Brandon and I spent a few days in Mexico City staying with my Aunt and Uncle. We were overwhelmed with Mexican hospitality. My cousins who are much older than me were really helpful despite their busy schedules with work and children. We got a tour of the central part of the city and then were taken out for tacos. We also spent one of the few days we were there at the pyramids just outside of the city. Teotihuacan is the name of the ancient city with ruins over 2000 years old. Don’t confuse these with the Aztecs who were around much later. The sun was high and bright as we climbed the pyramids of the sun and of the moon. We got some pretty nice pictures.

Also as part of that excursion, we stopped by the Plaza de las Tres Culturas (Plaza of the Three Cultures). These are the remains of what was one of the two major islands on in lake Texcoco, where the Aztec city, Tenochtitlan once existed. It’s named after three cultures because you see evidence of the indigenous remains, examples of Spanish colonialism, all surrounded by examples of modern Mexican culture. We also got to see the Basilica of Guadalupe, on the largest Catholic attractions in the Americas. This is something I highly recommend seeing if you are ever in Mexico City. Religion plays a large role in Mexican culture and the story behind the apparition of this particular Virgin says a lot about the Mexican people and their history.

I love the culture here because of the way it embraces the mixture of influences that make the people who they are today. You see examples on the street in artwork, crafts, language, clothing, etc. I’ve been speaking so much Spanish in just a few days that I’m already beginning to pick up so much more. It’s nice to gain comfort in speaking the language. The people you talk to and spend time with hear really teach you something you can’t get in the classroom. Languages take a lot of practice, and I am certain that for the next several weeks that’s exactly what I will be doing.

Today is Thursday the 5th of June and we arrived in Chiapas just last night. The environment is beautiful. The terrain is more mountainous and the vegetation more green than up around the city. Unfortunately for us, we arrived to experience the effects of a tropical storm that has affected the area. It’s kind of gloomy but last night the sun came out. We got settled in our sweet apartment and decided to head out to find some stuff we needed. We bought a couple food items and toiletries and ran into Michael Opiecionek on the street. If you don’t know Mike, he’s a student at Wabash too. He’s Polish, with only two semesters of Spanish under his belt, but he’s managed to get around perfectly for the last few weeks in San Cristobal de Las Casas, the town we are living in. It was funny because we also ran in Jorge Alejandro Diaz. He just finished his freshman year at Wabash and lives here. This was all coincidental and all within the first few hours we were here.

Just an hour ago, I met with the doctor who is organizing my summer projects. I’m getting started quickly and am pretty excited. I know the biggest challenge will be picking up the medical jargon in Spanish. Tomorrow morning I am going to bombarded with it in the doctor’s class here at the university. He deals with medical law, and apparently I’ll be presenting some stuff to the class later this summer on an issue of interest to me. I have yet to find out all the info, but it seems to be exciting. Monday I get to work with another doctor in his clinic. I’ll be meeting with him tonight to discuss what will be happening. Keep looking forward to more updates. I’m kind of unsure at this point but I am really excited to see what’s next.

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Much Still to Be Determined

This entry was written on June 1, 2006.

Well, I am on the plane as I am writing this. We’ve been experiencing a little turbulence, enough to keep me from sleeping, so I decided to type a little entry into my laptop to save for later.

I’ve been to México several times throughout my childhood, the last time being in the summer of 2005 just before leaving for freshman year at Wabash. I’ve experienced a lot and am pretty proud of the Mexican heritage I have. This will be the longest time I’ve been out of the US consecutively and I’ll probably be speaking español todo el tiempo, much more than I ever have at home. This is also the first time I’m traveling without my family.

Part of the excitement of traveling abroad without your parents is the amount of uncertainty. I’m not talking about traveling across borders with only a couple dollars in my pocket and a single bag containing the bare necessities. No, no, those of you who know me, know that that I would never travel like that. I’m referring to the amount of uncertainty I have about how I’m going to adapt to the situations I’ll be presented with. It’s not going to be a trip with a strict itinerary, but it’s focus is going to be my personal experience. I know what I want to accomplish, who I’ll be working with, and where I’ll be staying, but what I’ve learned at Wabash, is that you can plan all you want, but you have to be prepared for taking one of about a million possible paths or combinations of different paths to reach the goals you’ve set for yourself.

It’s going to be about the experience of making my own decisions about what to see, how to structure my time there, and make my own experience of the adventure. The Dill Grant gave me the opportunity to independently design the course of my stay abroad, along with the invaluable help of some very generous people who were interested in seeing me succeed. I’m excited about getting away, in some sense this is my ideal vacation. I won’t get to stay at a fancy resort and sit in the sun on the beach all day, but I’ll get some good time to make my own decisions, my own experiences, my own memories, and develop my own dreams for a career in medicine and the healthcare field.

As I write this summer with hopes of keeping you all informed, please be patient between posts. I will keep up my writing with consistent journal entries but it may sometimes be a couple of days before I can access a computer and post this stuff to the website. These entries aren’t just for the web, they’re something I hope to take seriously for my own benefit so I can reflect on my experiences as I look forward to the future. I’m sorry to break it to you, but if you didn’t already know, the telecommunications infrastructure widely prevalent in the United States is lacking in the global South, so my only access to the Internet will probably be through a local café. When I am in the field in some indigenous villages around San Cristobal I will likely have no access, but that is still to be determined.

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