It was the dawn, 5 am, when I woke up to the sound of two cars screech and crash into each other. I jumped out of bed, a little frightened but aware of what happened, stepped outside and looked down from my second story patio to see shaken people walk out of their crumple metal cans and motocycle and foot patrol cops came flooding from all areas. People in the hotel across the street from me were taking pictures from their windows. This is an all too common sight; last weekend an accident on the same intersection during the night claimed 2 lives.
In the centro historico, where I live, all the streets are one way only and the street light flash red during the night and wee hours of the morning. According to a taxi driver, the law states motorists do not need to stop at red lights if there are no cars around. Driving in Oaxaca is dangerous- streets are poorly paved and narrow, no respect for other cars or pedestrians, and speeding is common. Dr. Tenorio, our medical director in Oaxaca, says his main concern for student safety isn't kidnappings or assault: its the fact that every day, there is at least one pedestrian fatality due to automobile accidents. Most people don't think of car accidents as a public health concern, even though they are the leading cause of death for Americans between the age 15 and 25. Think about this next time your buddy decides to drive home buzzed.
------- Post Script 11:30pm- Another car accident just happened, this time, involving alcohol. What are the odd of two crashes within 24 hours of each other?-----
On a lighter note, OMG, freakin' Noahs ark almost landed in Oaxaca today. I had been locked in my room all morning and afternoon, reading and writing my midterm paper ,when around 4:30 pm, big fat raindrops started to fall, and then it came down hard for 40 mins. Flash flood alert! I stepped outside me room to take these photos,
Centro de Salud Santa Cruz Xoxocotlan - October 1-10, 2008
This week had been work, work, work! This was the last week at our first clinical rotation site. Alexa and I really enjoyed our time at Centro de Salud Xoxo (ho-ho) and we are bummed to leave. We became good friends with the nurses, the physicians, the nutritionist and the other workers. Dr. Raymundo Murguia was our preceptor for the majority of our time there. He is a really great person; as a physician, he is thoughtful and thorough, and as a person, he is really caring and energetic. The first day of clinic, we drank a shot of mezcal together! But sometimes we felt a little uncomfortable with certain behaviors. For example, he has a prosthetic leg and in order to not have him stand up from his chair when I have a question, I will kneel beside him at his desk. While I ask the question, he would caress my cheek or brush my hair, which would be major sexual harrassment back in the States. It is not meant as being sexually forward- at no point did Alexa and I think he was doing so- but is part of the machisto culture. We are young women, lower ranking in the health care strata, and he feels a sort of tenderness or affection towards us. We are nice looking, we are excited about medicine, and he finds it endearing. But if you know me, you know I have a hard time with male dominance bullshit- it took a lot for me to not be offended.
Ugh, back to work on my midterm. We have entirely too much work this week. I cannot wait till weekend...again...5 days away.
When we weren't in consultation with Dr. Ray, we went on vaccination campaigns! AWWW YEAH, PUBLIC HEALTH ROCKS MY SOCKS! This is the motor of public health-going out into the community to educate about health and prevent illness on a mass scale. Every couple of months, a team from the clinic goes out into the public schools to give vaccinations and other preventative measures. A group of clinic workers hopped on the back of a truck, drove to the rural colonias (or regions) of Xoxo, and did a thorough job of reaching all target children. Alexa went on a tetanus vaccination campaign in Colonia Los Angeles (which BTW is at the foot of the mountain where Monte Alban is!) and I went on a anti-parasitic and vitamins campaign in Colonia Rufino Tamayo. Kids were given a small bottle of albendazol, an antiparastic treatment, and federally sponsored vitamins and minerals to supplement their nutrition. We had to make sure all the children drank the bottle of albendazol in front of us- some kids loved the taste of it, claiming it tasted like coconut, banana, strawberry, while a few kids were gagging and needed to chase it with fruit juice in order to keep it down. Oh, one kids spit on me on accident- he was gagging and ran out of the room to throw it up and started spewing near me!
So here were the highlights of my time at Xoxo- Reader Discretion Advised!
- Learning procedures. I learned how to: administer intermuscular and subcutaneous injections; perform and teach patients to perform a breast exam; perform a thorough general exam of the eyes, nose, ears, mouth, teeth, throat, neck, abdomen, feets and legs; determine the developmental stage of a fetus, find its heart beat and determine what position its in; and finally, how to interpret laboratory results for infection, anemia, diabetes and renal failure.
-Observing procedures- Pap smear (papanicolao in Spanish) and pelvic exam on a woman with a pelvic inflammatory infection (aka: white liquid spewing from what may be her uterus, since we were at her cervix and it was still coming out); suturing of a stabbing wound in the rib cage of a arma blanca (domestic violence)
- I was impressed with the high rates of diabetes. I knew it was a problem, but geez, its monumental! Feet exams are important to see if diabetes is affecting circulation. Diabetic feet are characterized by edema (swelling), uneven or discolored skin on the calves and feet, bed sore type wound that health slowly, little or no pulse in feet, and in the late stages, tough and hard black or purple skin on the feet. Also, diabetes is the leading cause of blindess in the world- Oaxaca is no exception. Retinopathy occurs when excess amounts of glucose (aka uncontrolled diabetes) cause the tiny veins in your eye to burst , causing blurring vision, and later, causing your retina to seperate from the macula causing permanent blindness. Crazy.
- There is little education on hygiene. This gets is where it gets a little gross. Cleaniness is important to be healthy, such as in this case. We had a 17 year old pregnant woman come in who had a UTI and vaginal infection for what appeared to be months according to her lab results. UTI was caused by a long term vaginal infection that wasn't treated. The vagina is a great place for bacteria to grow- its warm, moist, and dark. When bacteria begin to grow on the surface, it can enter the urethra by wiping forward after going to the bathroom or by sexual intercourse, causing urinary tract infections or worse. A lot of things cause vaginal infections and UTI, but sexual activity is a main contributor, and we talked to her about hygeine practices to prevent more UTIs. She brushed her teeth once a day (which was a lie), bathed every other day (I doubt it) and changed her clothes every other day. While there may be a socioeconomic factor playing into certain hygiene rituals, but poorer people than her are cleaner than this. After talking to Dr. Ray about hygiene education, and after a few more clinic visits, it became clear that genital hygiene is not addressed as part of general hygiene.
- Echoing on this past case, education about hygiene comes from the parents, and there is a lot of shame in talking about sex between parents and children. Dra. Gloria, another physician at Xoxo, said she will get young girls come in for a visit, worried because they think they injured themselves "there" because they are bleeding. Seriously, that still exists. Another case of this was when a mother brought in her 8, almost 9, year old daughter who was complaining about pain in her left chest. After talking to the young girl and examining her chest, we noticed her left nipple was sprouting. Her mother began menarc (her first menstruation) at age 12, so this little girl was beginning puberty, since the first menstruation is towards the end of puberty for girls. I understand the mothers concern, but couldn't the mother have looked at her own childs breast?
- Another woman, in her 40's with 3 children, did not know how to do a self breast exam (SBE's). No problem, a lot of women dont know, but she was embarassed to touch her own breasts and refused the exam. Alexa and I were going to show her how to do it, the male physician wasnt not going to adminsiter it, but regardless, she refused. Okay, you breast fed 3 kids, and you are ashamed to touch your breasts? I guess this shouldnt really surprise me, since people are shameful of their bodies in the USA too, but when breast cancer is the most prevalent and deadly cancer for this population, it is very frustrating that these cultural nuances get in the way of effective preventative measures.
So far, I have really enjoyed the primary clinic setting. As of yet, I still want to be in primary care and this experience got me more excited about prevention and treatment of illness. But next week I begin at Hospital Civil, a large general hospital with many specialties. I am most excited about oncology, general surgery, OB/GYN, and internal medicine.
Ugh, back to work on my midterm. We have entirely too much work this week. I cannot wait till weekend...again...5 days away.
