And then I Saw the Cookie Monster in the Lobby

**Warning: this post is slightly gruesome.

This week's clinical placement has been awesome. Spanish has become a bit easier to understand, and the doctor this week let us work more with the patients rather than just observe. I have been practicing how to do a full head-to-toe nursing assessment in Spanish. Bonnie and I were paired together with the doctor this week. Bonnie has been teaching me the assessment she learns in Physician's Assistant school. In the previous weeks, I have been by myself with the doctor.  The doctor this week was especially awesome at explaining everything going on with the patients. She spoke slowly and did her best to use different/simple adjectives to describe what was going on with the patient.

On top of all of this goodness, we received a wide variety of patients with different needs. Previously, most of my patients have been pregnant women (which isn't exactly my favorite area to study). This week was nuts. Here are some of my highlights from each day.

Day 1: Focusing on how to assess the patient in Spanish. Healthcare providers want to sound confident in all that they do, however the language barrier can make this difficult to do so. Bonnie and I have been practicing different phrases to get us through our physical assessment. Our most interesting patient of the day fractured his humerus 12 years ago and never received any sort of treatment. Two tendons in that area are cut. His arm still works, he is just relying on his arm muscles for movement.

Day 2: We had a type 2 diabetic patient come in with a wound on her big toe. In nursing school, we are constantly stressing over wound care for diabetics since their wounds do not heal as easily or quickly as healthier people. Also, they are more prone to infections due to having higher sugar concentrations in their blood (bacteria loves sugar). Bonnie and I took the patient to a separate room to clean and bandage her wound. It was a blast!

Day 3: I was paired with a new doctor this day. One of our patients came in with multiple facial fractures on her nose and forehead. Underneath her eyes were puffy, possibly indicating some trauma to the brain. During her assessment, we found out that she is a victim of spousal abuse. The doctor left the room for a while, leaving me to ask her more questions about her history. I found out that she had three children with this man, starting at the age of 17. The abuse began shortly after and has continued. She is 31 now. She says calling the police helps but he always ends up coming back. She lives with her mother and sister with the children, but wherever she moves he ends up finding her. The doctor ended up sending her to the nearest hospital, with paperwork indicating that this involves the legal system. Now that she has concrete evidence that she has been abused, hopefully some sort of change could happen. This day was really tough to get through.

Day 4: I was able to clean out another wound and give some penicillin to an older lady who crashed into a bike. It felt really cool to do this on my own, I am so lucky that the doctor trusted me to do this.

Day 5: This was my favorite day. A man came in with a fairly severe injury to his eyelid due to a car accident that had happened the day before. When I was able to get into the patient's room, I saw the nurse scraping out tiny glass shards and dirt, and Bonnie holding up a light so that the nurse could see. Down here, the luxury of rapid-acting pain medications aren't always the option, so I was able to jump in and hold the guy's hand while he was in pain. I just told him to squeeze my hand as tight as he could to get his mind off of what was happening. Later, we were able to give him some lidocaine before the doctor came in to give him stitches. I was able to sit next to the doctor while she stitched him right back up. I thought it was the coolest thing ever. I was so excited for the rest of the day to see what I saw. The whole procedure cost him 35 pesos.

When we were all done, I come out of the room only to find a man in a giant cookie monster suit. Only goes to show that you never know what is coming up next!

La Clinica

What Happens:
During the week, we go to clinical from 8 am to noon. We do not get a lot of hands-on experience, however we learn a lot of medical terminology just listening to the doctors explain to the patient what is going on with him/her. The patient comes in for their scheduled appointment, and checks in with the nurse. The nurse takes their vitals and history and prepares all the information for the doctor. The nurse determines whether or not it is important for the patient to go in and see the doctor, and if so, the patient is sent to the doctor's office. The doctor then diagnoses the patient. This portion takes about  (patients 20-30 minutes, compared to our American 10 minutes of doctor time).

What I Have Seen:
Most of the patients that have come in (from my perspective) have been young, pregnant women in need of a check up. Also, the mandatory vaccinations are different here than in the United States. Varicella (chicken pox) is not required here, for example. The medical professionals here are also concerned about Chagas disease. Chagas disease is spread by insects and does not show any symptoms until later in life. Luckily, I have not had any patients with this, but every clinic I go to there seems to be some sort of public service announcement concerning Chagas.

How This is Funded:
Seguro Popular and Oportunidades: these programs pay for the patient to come in to see the doctor. Oportunidades has the whole family volunteer in the community to "pay back".

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I am feeling extremely comfortable living in Puerto and doing my best to fully embrace the "no pasa nada" lifestyle. Yvonne, Bonnie, Rosie and I are still exploring the town and finding new adventures. Tonight Yvonne, Bonnie, and I tried pozole de pollo. It rocked. This week we only have Spanish class for three days (instead of five) so we are planning on doing lots of exploring/beach-ing then!

Tuesday Ten

So far I have been in Puerto Escondido for about a week and a half. I am having an awesome time soaking up the sun and getting to know everyone around me. I already feel like I have lived here for a while since I can be really independent, and the town is small enough that it becomes difficult to go somewhere without running into someone we know!

Here are the top ten things going on right now!

11. Working in the Clinics - Most of my patients are pregnant women coming in for a check up. I find it really interesting that many of these women are very similar in age to me. Here's a pic of the doctor letting me play "doctor": 

22.  Spanish classes – still really tough.  It is much easier for me to get around here with my Spanish, though. Medical Spanish has been a nice transition since most of the English and Spanish words are similar, but finding the correct verbs to put itself together has proven to be difficult!

33. The beaches – I somehow end up at the beach everyday. This week Bonnie, Rosie, Yvonne, and I have been meeting there during our lunch break before we have to go home to eat. The water is bright blue and salty. One of the beaches makes me feel like I am in the opening scene of “Grease”.

44. My host family’s cooking – as I mentioned before, the grandmother cooks the best Mexican food I have ever had. I come home for lunch everyday excited about what is going to fill my stomach next. So far, the chile relleno is my favorite!

55.  Zicatela – where we go out at night. Most of the tourists stay in this area, and all the best bars are down here. It is really fun to have most of the town in one spot to celebrate the end of the day!

66. The artwork down here – it totally rocks. Period. I love all of the colors. These two pictures are murals from a frozen yogurt shop in Zicatela. 

77.  Mercado – this is the big market near my house. It is always hustling and bustling with people selling flowers, fish, and anything else you may fancy!

88. The Perfect Ice Cream Weather – it’s hot over here. Everyone is constantly coated with a layer of sweat. It is pretty miserable at first, but it makes eating ice cream that much more enjoyable!

99. The Wildlife – I met a horse the other day. I started taking pictures of him and he just came right up to me and let me pet him!

110.  The Sky – We have been getting a little bit of rain down here, and it is awesome watching the storm roll in. It is still really warm out when it rains, so the rain feels refreshing. We are also getting some incredible sunsets over here. 

Sana Sana

I made it to the clinic safe and sound! Thanks for all the good vibes sent my way! It only took me a colectivo (basically a cab that takes multiple groups of people where they need to go, except it looks more like a truck - pictures to come!) and a taxi to get there the first time!

The clinic I have worked in this week is fairly small, containing two doctors and two nurses to run the entire show. The first hour of the day I work with the nurses taking vitals. All of the vitals are done manually and all of the paperwork done by the nurse is handwritten. At the University of Michigan Hospital, we do everything with machines and computers, so this had been my greatest culture shock thus far.

Once that hour has passed, I work with the doctor for the next three. The doctor I have been paired with this week sees about 10-18 patients per day. Most of our patients consist of pregnant women coming in for a check up. I have been able to listen to their baby's heartbeat and feel how the baby is positioned inside the womb. Everything we did in this clinic felt similar to my OB class, just this time everything is in Spanish. I help the doctor out by filling out some paperwork, but other than that, I spend most of my time trying to figure out what the patient and doctor and saying to each other. Over here, the patient-doctor relationship is extremely casual. Also, since the doctor does not see too many patients within a day, he is able to spend more time with each of them. Sometimes families will come in all together, and he will check them out all in one appointment. The doctor does not speak much English, but he still tries to explain everything to me.

My Spanish is getting slightly better, I spent at least 75% of the day translating from Spanish to English in my brain. Between that and the heat, I am exhausted by the end of each day. Lucky for me, when the scheduled portion of the day is done, Bonnie, Yvonne, and Rosie (the three other volunteers on the trip with me), are always ready to do something fun! Yesterday we ate gelato then went to go see a movie on the beach! One of the hotels puts this event on every Wednesday night. This week they showed "When Harry Met Sally." It was the ultimate girls night. Tonight, Rosie and I ended the afternoon on the beach.

Sorry no pictures this time, just wanted to give an update on what life has been like here so far. I'm living in paradise!

You Had Me at "Hello"

For the month of May, I will be working with Child Family Health International (CFHI) in Puerto Escondido. Our specific program takes health students and health professionals abroad to volunteer and observe local clinics and take medical Spanish classes. CFHI set us up with a local school called "Oasis" that doubles as a language and surf school. My local coordinator runs the language school (where we take Spanish classes with her) and her husband runs the surf school. I am on this trip with three other women, two in P.A. school, and one applying to medical school. So far the four of us make a solid team. As a true Wolverine, I would like to think I have mastered the true art of work and play with my peers. These past few days have been full of adventure, and I am so excited for the weeks to come.

Wherever you go, GO BLUE!

I flew into Puerto Escondido midday on Saturday. I was exhausted from the traveling and the heat. Lucky for me, I was soon greeted by my beautiful host family. I live with a woman, her daughter, and her grandson. The grandson is four years old and full of energy. He loves running into my room and jumping on my bed! His mom helps me with my Spanish and tells me where all the fun places in town are. The grandmother cooks the best food I have ever had (sorry Mom, Jorge, and Juanita). 

The grandmother just casually whipped this up for me for breakfast. The best part is, almost all the food here is naturally gluten free! WOOHOO! 

For Sunday morning, I had already made plans with my local coordinator's husband to take surf lessons. I have had minimal previous surf experience (I know, I am poor excuse for a San Diegan), so I took this chance to get back out there. 

This is the view from the top of the stairs that overlook the beach. At the bottom of the steps, the surf awaits! 

I had a blast surfing! I felt like I was flying! I am still really bad at it, but I hope to practice every weekend that I am here! 

All in all, I just so happen to land in paradise. I really did not think there was any place better than San Diego, but I was wrong. I love being under the sun and living in a small enough community so that I could walk everywhere. Most of the locals have lived here all their lives, so most people know each other. I feel very safe in this town. 

As for the work portion of this trip, I started my medical Spanish classes today. It was really tough getting back into the swing of things. My Spanish is incredibly poor, but improving daily. The language portion will be a challenge for me during this trip, but I am up for it!

Tomorrow morning, the four of us begin working in our respective clinics with a mentor. I plan on pure chaos. This will be the first time we travel outside of Puerto Escondido and we have do it alone. Also, (my fellow nursing peers can agree with me) the first day of clinical is usually nuts. And on top of that, it will all be in another language. So amidst the chaos, in typical-Maggie fashion, I plan to make a good story out of it. I'll keep you posted! :)