Disclaimer: So I have to admit that I did not actually look at the blog until this week (I know, I’m a horrible person and will never get into med school), and I wrote my entry before I read what was already posted. I think I misunderstood the purpose a little – I thought it was more reflection and less feedback. Since I already wrote it, I’m just going to post what I have. I’ll post again later with more specific feedback since that seems to be what everyone’s doing. Sorry it’s so long!
Centro de Salud – Xoxo
I spent the first week of the program at this clinic which is about 15 mins from the city center by bus. (I think it’s somewhat similar to a lot of the clinics that participate in the Patient Advocacy Program back home.) The first thing I noticed when Grace and I sat down to observe was the patients’ immediate comfort with the presence of two very young (somewhat useless) other people in the room. Most people greeted us with a “Buenos dias” and smile and then proceeded with the consultation without hesitation. I don’t recall anyone actually asking who we were or why we were there and only rarely did the doctor feel the need to explain. I guess there really is something to that white coat. I’ve shadowed doctors back home as well (with a white coat) and people would sometimes stare me down if the doctor didn’t immediately explain who I was. (Cultural Difference #1!) We asked the doctor about this and she basically said that the patients were used to having extra people in the room (other doctors, nurses etc.), so it’s not a big deal to them. I also found it interesting that the doctor did the admitting of new patients and started their charts (which sometimes required an hour of her time). This involved asking the patient’s name and address multiple times, asking about a laundry list of allergies, family history, pregnancies, etc. – things that may have been better recorded by an assistant if not a questionnaire (although not all the patients can read so some would obviously have to be oral). The doctor typed everything on a typewriter in full sentences which seemed like a waste of very precious time. Considering their level of training, as well as the need for skilled medical professionals in crowded clinics, I was surprised that the doctors were doing administrative tasks.
Another thing I found interesting at Xoxo was how tactile the practice of medicine was. Because they didn’t have all kinds of fancy equipment, a lot of their work involved just using their senses. In the week that we spent with her, Dra. Carolina used every sense (except for taste – that would be gross) when examining and diagnosing her patients. Maybe medicine is more or less the same in the US and I just hadn’t thought about that way before. Either way, it was exciting to see her check the progress of a pregnancy by literally feeling the head, back and legs of the baby with her hands instead of by doing an ultrasound. I don’t know much about how good her method was but it seemed good enough! It made me wonder just how necessary all of our high-cost, high-tech stuff is. I can’t cite any study specifically but I know from lots of anecdotal evidence that there’s something about a doctor’s touch that makes people feel better. When I got vague stomach aches as a little kid all the doctor had to do was examine me and I’d feel fine . . makes me wonder if patients back home are missing out on the placebo effect of actually being touched by the doctor . . food for thought. I noticed a few other cultural differences but I’m going to wait and see if the same issues come up with Dra. Margarita before I write about them because this entry is already too long.
CRIT (Centro de Rehabilitacion Infantil Teleton)
Organization and efficiency are two factors that I consider critical to the success of health care delivery through a system, program or facility. (Sadly, I think the US health care system is severely lacking in both but that’s another blog . . .) CRIT is the epitome of both. It’s a well-planned, well-organized facility with great use of technology and a level of coordination I have never seen before. The building itself is spacious, colorful and clean. It’s surrounded by grass, a playground, and a tent for fiestas. Different wings of the building are represented by different pictures (a saxophone, a rattle, etc.) . . . everything was clearly designed with children in mind. It’s a stark contrast from the sterile, white walls and corridors of most American hospitals. (I haven’t seen a children’s rehab facility in the US so I admit I can’t compare directly.) Patients’ cards are scanned as they arrive so that doctors and therapists know exactly who is in the building. Parents often shuttle their children from one type of therapy to the next and the facility seemed more or less paperless, so each doctor could just pull up each patient’s chart online. The online charts include a picture of the child and allow the doctor to see notes from all the other departments. Most of the doctors at CRIT seemed to know each other well and seemed to consult each other about particular cases pretty often via email or in the hallways. I got the sense that the medical staff was very much a team rather than a bunch of specialists who happened to be working in the same place. Along with that came the sense that they were really trying to treat and take care of the whole child and not just each little, individual problem. There was an article in The New York Times a while ago (I forget the title . . . ) about how the high number of specialists has changed the patient-doctor dynamic. It essentially told the story of a patient with several different but related illnesses and a different doctor for each. He felt that none of them got the big picture, and he was constantly being shuttled from one specialist to another without feeling that any one person was taking care of him. I got the sense that CRIT managed to overcome with problem by really putting a coordinated team of people behind each family, something I’d like to see more of back home.
On a personal level CRIT was both sad and inspiring. Seeing the staff and parents put so much time and care into helping their children was great. When I was playing with kids in the Peds Dept at Hospital Civil I found it hard to keep playing or talking with them if they didn’t respond much. At CRIT, many of patients are completely unresponsive, yet everyone continues to play and talk and sing to them as if they understood it all. I found myself watching the patients during the consultations – some would just sit like rag dolls, others would flail around, most would make noises and faces, their eyes were usually not fixed in one place (they would jet around the room especially towards the ceiling) – and I would wonder what was going on in their heads. What were they thinking? Were they even thinking? Some of them clearly were expressing emotions but others just seemed to be making faces randomly. Obviously seeing the kids is hard emotionally, but it also messes with your concept of what it means to be human. Philosophically it’s hard to distinguish a “mind” from a bundle of nerves in control of a body. It made me think back to some “theory of mind” stuff from psychology. I don’t really have any profound conclusion about this, but it’s something I found myself thinking about a lot.
Overall CRIT was very interesting, I enjoyed it (especially the last few days), and I think I got a lot out of it, but it’s not really the place to go if you want fast-paced, hands-on work.
Hospital Civil
I’m still trying to decide exactly how I feel about Hospital Civil. I was only there for a few days, so I don’t have much to say about it yet. My most distinct memory about it is that it isn’t well-ventilated and I found myself getting light-headed pretty often. It didn’t seem to bother anyone else (including patients with pneumonia) so maybe I was just being hypersensitive. I realize hospitals aren’t necessary pleasant places to work but it was frustrating to have to leave rounds periodically to get some fresh air and water. I’ll post more about this rotation some other time.
Traditional Medicine – La Curandera
Like the rest of the group, I was curious about the practice of traditional medicine and the role of the “curanderas” in Oaxaca today. Although for me, I think the whole concept was a little less novel because I’ve seen a lot of the same types of practices and figures in India and even among Indian immigrant communities in the US. My grandparents, who lived in rural Punjab for decades still hold on to a lot of their traditional remedies. And for being married to a doctor, my Mom is still surprisingly anti-modern medicine. She will always reach for the flax seeds before the ibuprofen. As a result I’ve grown up being treated with both homeopathic meds (which all taste like sugar pills to me, but sometimes they work!) and allopathic ones, getting blessed by spiritual healers, and carrying around all kinds of holy good luck charms (mostly to appease my grandmother). Having seen and done all that I was surprised that the traditional medicine we were introduced to didn’t involve more mysticism. Although there was a small room with a large crucifix for prayer, the basis of the medicine was clearly not religion but the plants and herbs themselves. The curanderas were very clear about what they could and could not treat. Of course, all of this could be the result of their relationship with the Centro de Salud next door, or the fact that they were presenting their work to Americans interested in allopathic medicine. While it was great to see the traditional healers and the allopathic doctors working together, the center for traditional medicine didn’t strike me as being typical. It seemed like the curandera that the people who went on the hike visited may have been more typical. But I don’t really have a sense of what an “authentic” curandera is so I could be totally wrong. All in all, it wasn’t exactly what I expected but definitely still interesting and worthwhile.
I promise to never post anything this long again.
- Sonia
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