It Started with Carne Asada

This week started out with a BBQ at our house on Sunday and Chela made carne asada. I've never had carne asada this delicious. Maybe it was the atmosphere. Maybe it was because I had spent a few hours prior lying on the beach. I don't know, but it was fantastic. The whole family came over!

Familia Ramirez Moncada: Mayra, Oscar Jr, Oscar Sr

This week I spent my clinic time in Hospital General de Puerto Escondido. We each got to choose our specialty, so I chose Pediatrics. It was quite the combination. Dra. Gloria Ortiz & her resident are in charge of a NICU, inpatient, antepartum care, postpartum care, emergency, and outpatient. I couldn't believe it. Morning rounds began each day at 7:30am and I was there until a little after noon. I had nightly homework assignments to read about conditions, and I had to present on an 8yo with a glioma. In Spanish. During morning rounds. It was so hard! I couldn't possibly do it without the help of a script and she was great about it. I'm proud of myself for that.

I saw two births: one natural vaginal delivery and one C-section. Hospital births here are different than in the US. The providers don't really talk to the women. It's mechanical, necessary, routine. It was really strange during the C-section how invisible the patient was the entire time. I was able to show her her new 4.73kg (!!!) baby, we both cried and I wanted to hug her or something. It was sad and happy.

In the NICU there were three babies who had been born at home, far away from the hospital, who had experienced little or no prenatal care and birth trauma. One of them isn't going to make it for sure. It was going into septic shock and compensated metabolic acidosis on my last day there. A lot of children aren't named here right away. A lot of babies are born prematurely and have the odds stacked against them from conception. Doctors do what they can and really focus on education, respecting spirituality, and trying to integrate public health with every day life. The challenges are incredible.

As I've talked about before, there are two kinds of public health insurance: Seguro Popular and Oportunidades. They are both really focused on preventative medicine, and people have to show up once a month to get check ups. They have a booklet that must be signed:

Each age group and gender have different booklets. It's pretty neat! One thing that is very different here is the lack of follow-up. Once the patient is given a requisition for labs or and ultrasound, they have to return to the clinic for the results then bring them back to the doctor. There is definitely no EMR:

We also got to visit with a Partera/Curandera this week. She is about 90 years old, been birthing babies for 70 years! Women come to her in labor and she takes care of them. She has 11 of her own children, and had to deliver 2 by herself because her husband was at work. Wow. I had a tough time understanding her because she has very few teeth. With the help of an interpreter, we were able to understand the answers to our questions. One of her daughters lives in North Carolina and is the only one continuing on the tradition of being a curandera (healer). With the implementation of Seguro Popular, she is rarely used anymore and no one wants to succeed her role as partera. I still have mixed emotions about this. I love the connectedness with the earth and the role of a partera but I believe in hospitals. The jury is still out, I may never have an answer to this.

So last week I got stomach/intestines sick and this week I was homesick. I am much better now, but I had a few days where all I wanted was to be at home. It was strong, it was really tough to deal with.

Not much longer here though. I could indeed use a break from the heat and the mosquito bites.

Until next time!

Mangos Falling from the Sky!

Well hello again. It's been a few weeks. Didn't really mean for that to happen. So here's an update.

My third week was spent at the Centro de Salud in Bajos de Chila. It's a small town just north of Puerto Escondido. The preceptor there was incredible. She explained everything, asked questions, showed us lab results & asked us to interpret them, and let us examine every patient. I even got to help clean out a foot wound and attend the suturing of ped v. auto eyelid laceration. There were five of us in a room not much larger than my bathroom. It was not air conditioned. Talk about sweating!

Here I am in Bajos de Chila:

One really cool thing I got to do that week was go out to the schools with the dentist and teach kids how to brush their teeth. We gave them toothbrushes and taught them when to brush. I didn't get pictures, but supposedly someone is going to email me some. I doubt it, but at least I have the memories. I also got to wander around town on my last day there because the doctor was 2 hours late. That is quite common here. People just sit and wait, sometimes all day. So, while wandering the town I got some cool shots. There are about 11,000 inhabitants.

Here is a picture of me & Dra. Trinidad:

Thursday of that week we all went out with the head physician of the program here. She took us out to get tlayudas and talk about our experiences here. It was great! 

Saturday May 24 I headed about an hour south to a little town called Mazunte. $36 pesos for an air conditioned bus ride. Fell asleep listening to The Pixies and woke up just in time for my stop. I went to the National Turtle Conservation Museum/Aquarium. Every year there are thousands of turtles that show up to lay their eggs. They hatch, then those turtles come back later. Then I went shopping around town, ate lunch, then headed back to Puerto Escondido. Caught the bus on the side of the highway, but this time it was a locals commuter bus. The music was blasting, all the windows were open, and it was $30 pesos. All in all, a fun day.

That night there was a cultural fair at the Agencia Municipal across the street from my house. I listened to a choir and watched some traditional dance performed by kids.

I didn't stay too long since I had planned on taking my host family out to dinner to thank them for being totally awesome. We had pozole at Taqueria Rosy, THE pozole spot in Puerto. Then, of course, we went for gelato.

This is me and Chela, my host mom:

 Deniss, Chela's granddaughter

 Deniss & Citlaly, Chela's daughter/Deniss's mom

Alright, enough of that week. Gonna break this up into different posts...

¡Los perros se hablan Español!

Hóla amigos

Yes. It's true. The dogs speak Spanish. Ok, well they don't speak Spanish but you know what I mean. Speaking of dogs... they are a step above Panamanian dogs. There are plenty of on-leash pet dogs, but the mange-ridden-rabies-having-anorexic dogs far outnumber the pets. It's so sad to see and I can't bear to photograph them because I fear I will steal bits of their souls if I do.

Yvonne & I bought bikes here last week and so far the pedal arm thing has become detached twice. While I was riding. Ha! I have concierge service with the purchase so I called up the store and a mechanic came and fixed my bike today. Honestly, the bikes are pieces of junk so it's nice to have that service. It is also nice to have the bikes to ride around town, especially since we have baskets!

I started at a new clinic this week. I am in Barra de Colotepec (barra = where the river meets the ocean). It's a pretty, poor little town just outside of Puerto Escondido. Monday we saw 14 patients in 4 hours. It was pretty intense. Let me explain... families who have Seguro Popular (gov't issued health insurance) and Oportunidades (same but different) are required to go to the clinic once a month for a check up. So, we may see a family of four at one time. It's focused on preventative medicine, family planning, and community service. Yep, you read that right--families who receive Oportunidades must complete a certain number of community service hours per week. Obviously nothing is perfect and systems remain bureaucratic and corrupt. But it's definitely food for thought. I'm really enjoying clinic time. Patients are really interested in who the güera is (that's me) sitting next to the doc.

This week I've seen 2 cases of chicken pox (no varicella vacuna here!), a woman in active labor (she walked in 5cm dilated), parasitic diseases (Albendazole anyone?), and I got to write a few Rx's recetas in Spanish. Here's a photo of the Centro de Salud:

And the obligatory selfie:

The sun and humidity are fantastic substitutes for makeup :)

I finally (!!!) took the correct colectivo directly to the clinic today. It's a camineto, a pickup truck with a canopy, and it's pretty frightening! It's only 8 pesos ($0.60) one way. Took some photos during my morning commute:
Statue of Benito Juarez in Puerto Escondido (the cut out is so you can see where you are going!):

This is a shot out the back:

Today was an interesting day. I met up with Rodolfo, the Public Health Official for Barra de Colotepec. He gave me a lecture (en Español) about Dengue (clásico y hemorrágico). There is a public health campaign called "Patios Limpios" where an official goes to each house and checks for mosquito activity. People have huge tanques of water outside their homes and standing water is a breeding ground for mosquitos. So, he makes sure the water is clean (by putting in fish that eat mosquito larvae), the patios are clean, and that there are no high-risk areas of homes. I walked around with him today and he handed me the clipboard and I was in charge of recording the results of each visit!

Our first stop was to an abuelita. We sat and talked to her for about 30 minutes. She had tamales cooking on the outdoor griddle and she made sure we each had one. Honestly, it was the most delicious tamal I have EVER had. It was a tamal sordo, without filling, but the flavor was amazing:

I couldn't get a better picture because I didn't want to be rude. But you can see a bit of her in the background along with the oven/stove situation. She also had pineapple plants, a starfruit tree, and mango trees. You better believe she gave me a mango at the end of our visit!

Then another lady gave me plums (ciruelas). You can't say no...it's offensive. So, I gave the plums to the colectivo driver and the mango to La Doña. I don't have a talented enough digestive system to handle fruit just picked off the tree here and since I just went to the supermercado I didn't want to waste the fruit.

We went to one house with tons of farm animals:

And we ended the day with a full clipboard:

Here's a cute pic for my sister. These two kiddos could NOT get enough of my books. 

And I could not get enough of this damn adorable cat with gigantic orejas (ears on animals... oidos are ears on humans).

It's almost like they are weighing him down!!

My Spanish is improving day by day. I try to talk to as many people as possible. If I did that in the US, people would probably think I am weird. Friendliness is the rule, not the exception!

NO PASA NADA...the only other rule in Puerto.

Talk to you all soon enough.

Dogs in Restaurants & Babies in Bars

Hola amigos!

The weekend is over and I'm settling in for the night. Tomorrow I start at Barra de Colotepec clinic and I must be there promptly at 8am. Breakfast is at 7 and it takes about 10 minutes in the colectivo so I should be ok on time. I hate being late, but time has different meaning here. Stores open when they open. Everything moves a bit slower here. I have been acclimating to slow living over the past week and now I'm due at clinic at 8am every day this week, what a trip!

Friday evening after Spanish class Yvonne, Maggie, Rosie and I went to Playa Manzanillo for "happy hour"--being happy at the beach for about an hour! :) Later that night we ended up in the Zicatela at Kabbala--a club with cabanas on the beach. We saw giant waves and after 10:30pm it was ladies' night so we got free drinks. There were babies dancing to an American rock cover band. Weird to see babis in a bar! We stayed there for a while then went over to Sativa, another club. It was filled with surfers and it was roasting in there.

We danced and had some more drinks then went home. It was a blast! It also became quite apparent that we are living with Puerto royalty. Everyone knows this family. They are part of the original group of surfers that made Puerto a surf destination.

Saturday was Dia de las Madres in Mexico. It is a really big event, so we told our house mom that she could chill out this weekend and that we could fend for ourselves for meals. We started our day at El Cafecito for brunch then went up to Zona Centro for shopping. I bought two swim suits for $120MXN which works out to be $9.27 USD. CRAZY! Then we went up to the mercado and bought our house mom some flowers and then headed out for adventures. Across the street from where we live is the Agencia Municipal and they had a huge party set up for Dia de las Madres. There were tons of chairs, vendors, and a stage. We walked toward the Adoquin and I bought a pineapple paleta (popsicle) and had them dust it with some Tajin.

It was the perfect afternoon treat. Then we hung out at Rosarito's on the beach, ordered beers, and played a little in the water. The waves were frightening and apparently they were no good for surfing. The undertow was impressively strong. I had my first tlayuda and it was delicious. Apparently if you go to Oaxaca and don't have one, you've never really been to Oaxaca. It's a paper thin corn tortilla with queso Oaxaqueno and your choice of filling. I got veggie and it was delightful. I will definitely try more of these while I'm here.

After some sunning we went home to change. The Agencia Municipal was FULL of people! There were people on stage singing songs to their moms. It was so cute! We took a taxi back down to Zicatela and eventually met up with Rosie & Maggie at Bar Fly. Sativa was closed and Saturday night Bar Fly is the spot! Hung out there for a bit, then headed over to Kabbalah for Salsa night. You can't do Salsa in flip flops. Ok. Ok. I can't do Salsa in flip flops...or barefoot. I need some lessons!

Sunday started with random power outages. It was so sticky and hot and humid and intense that it was tough to sleep. Got motivated and went to Playa Carizalillo for an afternoon of sunning. We played in the water a bit and then sprawled out on beach towels for a snooze. Then I did my homework under the  palapa. It started pouring rain as I watched surfers catch waves. The four of us finished out a perfect weekend at a sweet little Italian joint on the Rinconada.

I just finished FaceTiming with Drew. It was good to see his face. I miss you babe!

Hope everyone is well and has also had a lovely weekend...

Hasta luego!