Wabash Blogs Health Care in Chiapas
 

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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.

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/)