Dia de los Muertos

I will never forget the sights and smells of Dia de los Muertos. Locals dressed in costumes, vendors, and tourists flooded Alcala at the beginning of the week. Banda music rang throughout the cobbled streets and people joyfully danced throughout the night. It was honestly a wonderful sight to see and experience.

Our group had the amazing opportunity to enter into the local alter making competition at the local cemetery, El Panteon General. We decided to honor the railroad workers who gave their lives to build the railroads.

We traveled to two different markets to buy the necessary materials for the altar—a local market in Teotitlan and El Mercado de Abastos in Oaxaca. The local market in Teotitlan was so beautiful. Golden, magenta, and purple flowers decorated the area. The fragrances of fresh bread, smoky incense, and sweet chocolate danced around in the air, mixing with the beautiful languages of Spanish and Zapotec. El Mercado de Abastos was also full of people, colors, smells, and sounds. However, there were a lot more Western influences—there was a specific section in the market filled with scary masks, props, and costumes.

Mercado in Teotitlan:

pan de muerto

Mercado de Abastos:

sugar skulls (calaveras)

We spent that night stringing manzanitas and peanuts together, de-stemming flowers, and creating/decorating a sugarcane arc. The next day, we stuffed all of the materials into taxis and rode to El Panteon General. The cemetery was huge but also very peaceful. The vibrant blue sky contrasted beautifully with the stones and trees. Many different families scuffled around carrying bundles of marigolds (among other flowers) and buckets of water.

We worked on our altar and tapete for a total of 8 hours or so. Everything came together very beautifully. Everyone helped each other out and worked together. It was a great bonding experience and I enjoyed every minute of it!

jason and maria practicing their presentation for our altar

our tapete

Later that night, we visited El Panteon General to see our altar as well as the others. It looked a lot different in the dark. However, the beauty remained the same. Rows of lit candles lined the walls and emitted an orange/yellow tint. The earthy scent of marigolds and incense drifted among the visitors who were packed into the hall.

We also visited a cemetery in a pueblo 20 minutes from the city (Panteon Atzompa). This was a lot more different. It was a lot more emotional to me. A live banda played on a stage at the corner of the cemetery. Light from the candles dotted the darkness and lit the faces of those remembering their loved ones. Although the upbeat banda music rang throughout the cemetery, it could not disguise the solemn atmosphere.

We all experience the pain of losing someone. However, we cope with it in many different ways. Participating in the traditions of Dia de los Muertos was a HUGE blessing and honor, and it was a beautiful experience.

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We ended up winning 2nd place in the competition!

Here are some pictures of the other altars:

HOME SWEET HOME

It’s been about 4 days since I returned back to the states. Oaxaca will forever hold a piece of my heart. 

On another note! I will be posting more updates about Dia de Los Muertos and Puerto Escondido soon!

7 days

until my amazing adventure in Oaxaca comes to an end.

6 months: An early passing

Karina and I had the blessed opportunity to visit the gynecology/labor and delivery unit at Hospital Civil on Thursday (211113). The unit was pretty different than the one that I visited at ISSSTE. The biggest difference was the number of patients at Hospital Civil—there were A LOT.

Everything was going smoothly. Karina and I witnessed the birth of a beautiful baby girl. We got to help the nurse dress her. She absolutely captivated us with every move she made. She spent her time squirming around in her pastel yellow pants and top or crying. It was mind-blowing to imagine that the little girl lying in front of me had only been on the earth for less than an hour!

The second labor that we witnessed ended very differently. The labor started off normally. The lift team transported the 18 year old mother to the delivery room and the nurses cleaned and prepared her. A few minutes later, I saw the frail dark body of a neonate with a 6 month gestational age. I let out a sharp gasp as the OBGYN handed the thin and delicate body into the arms of the pediatrician. Soft, weak cries echoed through the delivery room—then quite. A heavy blanket of seriousness descended upon the room; a small foreshadowing of the coming event. The doctor softly told the pediatrician to hand the baby over to her mother. That was when we knew—the baby wasn’t going to make it…

The mother tightly cradled her child against her breast and started sobbing— the pain in her heart overriding the pain from just giving birth. A weighty silence filled every crevice of the room, only to be broken by the distant cries of the other neonates and the sobbing of the woman. The head OBYN moved close to the woman and comforted her with a warm and gentle voice. He never left her side.

We later learned the circumstances of the woman’s birth. Her baby had massive amounts of fluid buildup within the brain and had a very low chance of survival. Furthermore, the mother had preeclampsia and, as a result, had hypertension. According to the head OBGYN, the two #1 causes of maternal deaths in Mexico are hypertension and hemorrhage.

It turns out that the women had discussed her situation with her doctor beforehand. The woman faced the hardest decision of her life—save her baby’s life or save her own. I can’t imagine half the pain that she went through making the decision that she did. Even though the baby was not full term, the baby was still hers and a part of her own flesh.

After this occurrence, I couldn’t help but wonder how I would handle a situation similar to what this woman experienced, as a mother. I acknowledge that my personality, situation, reasoning, motivations, and outlook vary from those of the woman. So, at this moment, I don’t have a definite answer.

Also, I couldn’t help but contemplate how I would address a situation like this as a doctor. A career in medicine includes situations where one must face death. If a time like this ever arises, I hope I could handle the situation with the similar respect and warmth that the OBGYN handled it with. I greatly admired the sensitivity and comfort that he offered to the woman while she grieved. The whole staff worked together to help the mother go through the grieving process.

Life is a beautiful but also fragile gift. My heart and prayers are with this incredibly strong woman and her family.

Hospital Civil (102413,102513)

A few students from my program and I started our third rotations at Hospital Civil starting October 24th. As soon as we arrived, we met with Dra. Mayda and she divided us up into pairs and assigned us to the various departments in the hospital. I was placed in the urgent care department—or urgencia.

Hospital Civil is the biggest public hospital here in Oaxaca and the hallways and corridors accurately depicted that.  As Dra. Mayda escorted us through the hospital to urgencia, I observed lines and lines of patients waiting to receive care. Doctors, nurses, security guards, and medical students flooded the labyrinthine hallways and corridors. When we finally reached the department, we joined a giant team of medical students, residents, and preceptors on their rotations/debriefing. It was reminiscent of the gynecology rotations that I observed at ISSSTE, but the speed, amount of activity, and movement was on a different level. The team formed multiple concentric circles around each patient’s bed and the medical student in charge of the patient presented everyone with a concise overview of patient while the rest flipped through their notes, wrote on their clipboards, or conversed with each other.

Fortunately, we met a resident, Karey, who was very caring and genuine! After the rotations, he let us look at a chest x-ray. He took the time to explain each element that a doctor looks for. His explanations of the anatomy of the pulmonary and coronary system reminded me a lot about an anatomy course that I took during my winter quarter at Davis. Karey also showed us how to use an EKG monitor and check blood glucose levels. He was very bright and made sure each of us understood the anatomy. It was a bit mind-blowing to think that he was the same age as me!

Being a non-native Spanish speaker, it was very difficult to keep up with the conversations between the doctors and students. Most of them were too focused and concentrated on their work (understandably) to give me a thorough answer to some of my questions.  To be honest, it was also intimidating to be around that many doctors and students. Many times, I found myself slipping back into a state of passivity. However, meeting Karey encouraged me to keep pushing through and keep asking questions.

Karey’s generosity and kindness inspired me to strive to do the same in the future. Since my conversation with Dr. Francisco during my rotations at Colonia America, I’ve been reflecting a lot on why I want to become a doctor. Of course, part of my reasoning involves caring for others, interacting with a wide variety of people, and putting some of my favorite subjects into practice. However, I’ve recently been thinking about clinical teaching/precepting in the future as well. After learning about public health, cultural competency, emotional intelligence, and a bunch of other topics (power of conversations, perceptions, etc.), I’ve realized how important it is to share this information with others. I think that this is especially true in a setting where diagnosis and treatment are at the forefront.

Alas, I must take things one step at a time. I still have to apply… yet, a girl can dream no?

A normal x-ray

An abnormal x-ray

My first EKG!

Hospital Psiquiatrico Cruz Del Sur

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Our class had the opportunity to visit Hospital Psiquiatrico Cruz Del Sur on Friday. We began the day with a presentation of the mission statement/goals of the hospital and the specific ways in which the hospital tried to cater their services to the patients. Their main goal was reintegrating their patients. Throughout the presentation, the administrator mentioned the lack of resources that the hospital had.  One of the students asked how the patients paid for their treatment at the facility.

Afterwards, we toured the hospital. We first looked through the cafeteria: a medium sized building with rows and rows of tables. There were plates of enfrijoladas (a fried fajita with beans in it), rice, and fruit. The nutritionist explained that the meals were individualized to meet the needs of the patients who had allergies or were diabetic. The 75 patients there received 3 meals—breakfast at 9am and dinner at 6pm. Their dinner is fairly light (like gelatin or yogurt). This 15 hour gap between dinner and breakfast posed a big problem for the patients. According to the hospital administrator, the hunger kept the patients up at night, so they had to receive medication to help them sleep. She described that there used to be extra land where they had guava and orange trees. However, the government took the land for other projects (none of which were finished).

We moved into the main courtyard. A placid but strange atmosphere blanketed the area. The attendant’s voice echoed across the gray cement and the lifeless grass. There was a building on the northeast side of the area that was supposed to be a rehabilitation center. However, the building was poorly built and therefore, not in use.

Many of us wanted to interact a lot more with the patients. Unfortunately though, the regulations changed a few days before our visit and thus limited us from doing so. Most of our interactions with the patients took place from afar or behind a metal fence. Nevertheless, they were one of the most meaningful encounters that I had. A veil of sadness covered the patient’s faces, but as we continued to talk to them, the sadness seemed to melt away—even if it was for only a moment. We talked to a man who aspired to start a support group for alcoholics. He explained how his own problems with alcoholism had hurt his family and how he wanted to help those who were facing the same problems as him.

There may have been a good reasons and intentions behind keeping us from fully interacting with the patients. After all, the hospital faced some safety issues between the patients and visitors in the past. However, it is also beneficial to have the patients interact with others as well. The main goal for the Hospital Psiquiatrico Cruz Del Sur was to reintegrate their patients back into society. I believe that effective reintegration also involves slowly exposing the patients to other members of the society.

The stigma against those with mental illnesses can be the hardest to fight. However, I realized that simple actions could also have such profound effects. Showing genuine interest in the patients as people and giving them the attention they deserved seemed to pull them out of that lifeless courtyard and into a world colored with love, hope, and life. Far too often, the stigma of mental illnesses (in both Mexico and the U.S.) veils our eyes from looking past the mental illness and into the hearts of those afflicted by them. The patients at the hospital were more than just the illness that they have. They each had their own struggles and histories. They were just like us.

ISSSTE

My second rotation took place at the Instituto de Servicio y Seguro Social para los Trabajadores del Estado, or simply put, ISSSTE. Compared to CS Col America, ISSSTE was very different.  Unlike Col America, ISSSTE is a hospital. Thus, it was a lot bigger and there were a lot more people—patients, doctors, medical students, residents, etc. The environment was also a lot more fast-paced.

We began the day with an hour long discussion about a case study about a boy who displayed symptoms of appendicitis as a result of amoebas. Then I joined the residents and medical students in the gynecology department while they made their rounds. Taylor and Wyatt went to surgery and Maya went to observe a C-section. Somehow, towards the end of the day, we all ended up meeting and observing a pediatrician clean and swaddle a newborn.

The fast-paced nature of the hospital is definitely evident during the rounds. All of the students, residents, and doctors would encircle the patient’s bed and then, a 10 minute session of rapid-fire questions and answers, conversations, and movement would commence.  A multitude of things would take place during that timeframe. One medical student would check the patient’s vitals while a resident would brief the head preceptor with the patient’s information. The others would intently scribble down information, converse with each other, or fetch certain medical instruments for the doctors.

Overall, I noticed that we had a lot more freedom at ISSSTE. Consequently, it also made it very easy for us to take a passive role. Many times, I found myself waiting for someone to direct me to a certain area or invite me to observe an interesting procedure. However, I realized that I can’t wait around for someone to guide me—especially in a hospital setting. I realized how important it was to be proactive, ask questions, and show interest in the work that the doctors and residents do.  Given my generally passive personality, I felt pretty uncomfortable reaching out to others. Nevertheless, doing so opened up a plethora of knowledge and opportunity. I was able to learn how to perform a checkup on a baby, and observe 4 births (1 natural, 3 Cesarean).  

Taylor, me, Wyatt, and Maya as we prepare to observe a natural birth.

A courtyard in ISSSTE

 

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On another note:  The miracle of life is beautiful. No amount of words can come close to describing the moment a mother sees her baby for the first time. Nor can it describe the expression on the father’s face as he holds his child in his arms. 

La Sierra Norte

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We left Quinta Real for La Sierra at the crack of dawn (Literally. It was still dark when Maya and I arrived.) It took us about half an hour to reach the casa for breakfast. There’s always something about the still and crisp air that envelopes you with peace and calmness.  The smell of pines and burning wood revived my senses…the chocolate con agua helped too!

After filling our stomachs with café, chocolate, and mountains of pan dulce, we headed to a house where they carved molinillos. The carpenter demonstrated his years of handicraft with exceptional finesse.  He rapidly transformed the baseball bat shaped block of wood into a sturdy yet beautiful frother.

Afterwards, we drove to our cabins in Capulalpam and had the awesome but also very difficult (the roads were very rocky and littered with potholes, plus the brakes on my bike were a bit sketch) opportunity to ride bikes around the town to the Templo de San Mateo. After touring the cathedral, we listened to the local youth band perform “My Heart Will Go On” and—let’s be real now—I teared up a bit.

Our next destination was el Centro de Herbolaria—a clinic that focused mostly on traditional healing. There, a majority of us received a limpia con huevo. Limpia in Spanish means cleansing and refers to an ancient spiritual practice that is used to clear physical, emotional, mental, and spiritual blockages.

My limpia:

The curandera started off by spraying my arms, neck, and stomach with the herbal water. Then she took an egg and gently rubbed it in small circular motions on the areas where she sprayed the water and along my entire body. Afterwards, she cracked the egg into a glass of water and proceeded to pat me with a bundle of herbs and use it to follow the contours of my body. Lastly, she spat alcohol on my belly, on my lower back, down my shirt, and finally on my belly. Observing the egg in the water, she firmly urged me “tranquilice, tranquilice”—“calm down, calm down.” She told me that I was stressed out and that coming to the sierras would help with the stress.

Overall, I thought that my limpia experience was very wonderful! The coolness of the room, the huevo, and the herbal water felt so refreshing against my sun-scorched skin.

We rode our bikes (once again) up unforgiving hills to a house that made tepache. It was quite interesting! It tasted somewhat like a Korean plum drink that my parents would give me to digest my food. To be honest though, I thought that the grapefruit soda tasted a lot better  :]

After refueling with tepache and other refreshments, we headed to las cuevas del arroyo. Hooray for spelunking! I was entranced by the whitish grey formations that glistened from the moisture. They seemed to almost glow from the occasional flash from our cameras and their shapes were very intricate and indicative of the beauty of nature. Although the slippery stones and small spaces made it a little difficult to trek through the cave, it was quite the adventure!

We had fish for la comida (although we ate at around 6pm) at a restaurant by a beautiful river. Sitting down and filling our stomachs was the best reward after a day packed with activities. After all, my numb legs needed a break.

I would say that the highlight of the day was zip-lining after comida. The distance was pretty short but it was such an amazing experience. It felt like I was flying (very cliché, but true!). The fresh piney air rushed against my face and danced through my hair. The sun was setting when it was my turn to go, so I remember seeing a flurry of lights.

We finished off the day with a bonfire, some bomb food (including smores with Maria’s cookies!), a live banda, and dancing.

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We woke up the next morning and ate breakfast at a place nestled amongst the tall trees of la sierra. After stuffing ourselves with delicious food, we got into the back of a truck and embarked on the best car ride of my life. We all stood up, breathing in the freezing air and dust, getting thrown about left and right, singing at the top of our lungs, and taking in the breathtaking scenery.

After about 45 minutes, we arrived at the cloud forest. The forest got its name because the moisture from low-flying clouds creates a perfect environment for the moss to grow. There were veils of moss on almost everything and floor of the forest was blanketed in greens and browns.

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Overall, my trip to la sierra was full of firsts and rife with experiences that I will never forget.

Updates and the White Coat

Hello friends! I am so sorry for this much delayed update! Why must I be so nit-picky when it comes to writing?? Last week, our teacher passed out our midterm prompts (4 total) and those have been taking up a good chunk of my time. I will post another entry later documenting my adventurous weekend in La Sierra Norte (Capulalpam and Ixtlan de Juarez), but for now, I will leave you all with an update on my first two weeks of clinic!

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These past 2 weeks have been amazing! Interning at CS Colonia America clinic opened my eyes to so many things. I experienced something new every day—palpating a fetus and listening to its heart, checking for circulation in diabetes patients, checking throats for irritation and inflammation, and looking at an ear infection were some of the things that I did.

A few things that I observed in clinic so far:

• Most of the patients that came to see my doctor were diabetic
• Many women get pregnant at a young age
• Not a lot of family planning/discussion about birth control
• The patient records and files are all on paper
• Some people travel VERY FAR to come to the clinic

During class, we talked a lot about the different factors that interact and influence Chicano/a health. These factors range from culture values and roles (machismo, familismo, confinanza, and others), psychology, social context, religion, environment, genetics, etc. They can influence how a patient communicates with their doctor, chooses when to go to the hospital, perceives/interprets his or her illness, and follows through with the care plan. For example, many people that I saw in clinic were hesitant to visit the doctor earlier because that would mean that they would need to take time off from work—their livelihood.

Surprisingly though, one of the most influential things that I learned this week wasn’t through examining a patient but rather, it was through a chat that I had with Dr. Francisco. It all started with a simple question—“when did you know you wanted to become a doctor?” My Spanish was pretty choppy and I had to dig through my brain to search for the correct words to formulate the question.  Once he registered my conglomeration of words and broken phrases, he began to tell me his story.

Dr. Francisco’s curiosity for medicine started when he was a boy. He lived in a very small and rural town near Puerto Escondido. A doctor from the town clinic would often eat at the comedor that his mother owned.  The doctor’s white coat always caught Dr. Francisco’s eye, and he grew up thinking that it looked fancy and become increasingly fascinated by it. The white coat eventually motivated him to go to medical school. After medical school, he served as the only doctor of a small town for 10 years. “Working at a clinic in a small town,” he told me with glimmering eyes and a grin, “gives you the opportunity to deeply connect with your patients and effectively treat them. Why? It’s because you get to know the whole family—the mother, father, children, grandma, grandpa, etc. You can visit their house to simply check their water storage for mosquitoes and then end up chatting with them about life. Not only do you get to familiarize yourself with your patients’ home environments, but you also get to familiarize yourself with their stories as well.”

Dr. Francisco’s bright eyes never dulled nor did his grin disappear as he recounted his life in that small town. Clearly, the amount of time and dedication that it took to care for all of the families and people in the town was arduous. Yet, he discovered a hidden pearl despite the mountains of paperwork and never-ending work hours. Its opalescence carefully knit within the folds of the white coat—easily overlooked. This “white coat” that Dr. Francisco was so fascinated with came to mean a lot more than just a showy garment. It transformed to represent the service that a doctor provides and the care and dedication put into treating a patient.

A doctor is more than just someone who tries to find out what’s wrong with a patient and then prescribes medicine. Although this type of care can alleviate symptoms, it does not do anything to help the patient in the long run, especially if he or she has a chronic illness. In order to get to the heart of treating an illness, a doctor must be willing to be a part of the patients’ lives and consider how cultural, social, psychological, and physical barriers could prevent them from getting better. A doctor must be able to be sensitive to his or her patients when formulating a care plan and also have the patience to listen to and answer any questions that they might have.

As I continue my journey in the field of health care, I will strive to keep these values tucked safely in my heart.

CS Col. America

Tomorrow, I will be starting my first clinical rotation at Centro de Salud Colonia America. My brain is jumbled with an amalgamation of questions and my heart is filled with excitement. Though, one thing is for sure. All of the glory goes to God for blessing me with this wonderful opportunity to learn more about medicine and His people in Oaxaca.