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!
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