Post-trip blog 2

Continuing from my last post, I noticed that the U.S. is extremely EXPENSIVE. We are rich, rich country. Food here costs twice as much as anywhere in Mexico, however it's also twice as rich in nutrients (and fat). While driving home, I noticed that streets and building are well maintained in relation to Mexico. But I feel as though, there's a loss in cultural and artistic nature. Oaxacan building are very Victorian, and the streets look as through they have inlaid stone. Also, people in Oaxaca walk around a lot, and I really like that. However in the U.S., everyone uses cars to get to where they need to go, regardless of social class or economic status. In general, there's a lot of waste and resource use in the U.S., which I haven't seen in other countries in the world. I feel like there should be more emphasis on conservation and redistribution of resources in order to conserve our environment and maximize the potential of what we have. We as Americans don't care because we don't have to face the reality of limited resources, as other countries do; however, I don't think it's an excuse to excessively waste the blessings that we have. For example, instead of spending money on military endeavors and health care litigation we could spend it on education and community based health care programs. We could build the social services of our country, which tend to lag behind countries with less than half of our GDP. I find it ridiculous that people buy large SUVs, when there's literally no petroleum left for other countries to use for development. Why is it that our gas prices don't reflect the reality of the scarcity of petroleum? It is because Americans just don't want to pay for it like everyone else? Or how much food we consume and throw away (speaking for myself here also), when children in Africa, India, Mexico, and many other countries are starving. Even through all my criticism, I LOVE the U.S. because we have freedoms and resources, which many other countries don't have. We were built on principles of equality and human justice, and we work hard to preserve that. No country is perfect, but I feel as though we're miles ahead of other countries in that respect. I'm proud to be an American, which is why I can't stand to see injustices within my own country.

Post-trip blog 1: Reverse Culture Shock

Post-trip blog 1: Reverse Culture Shock

Coming back to the U.S., was definitely a culture shock. Adela told us that we would be going through some major reverse-culture shock after the trip, but I didn't really believe her. I thought,"How could I be in culture shock, if I'm just returning home? If anything I would be glad to live in familiarity again." Was I wrong. As I write this, I miss Oaxaca SO much. The U.S. seems extremely foreign to me, and I'm noticing things here, that I've never noticed before. The first thing I noticed was the attitude of most people. American culture tends to be less service oriented than other countries. For example, when I was at Burger King, the only thing employees really do is take your order and warm up you food. They don't serve you, give you napkins, or ask If you need anything else. It seems like they really don't care about what they do, if anything they hate being there (which I can understand because they're most likely underpaid and underinsured..however I'm sure people in Mexico are too). The entire experience was impersonal and I didn't like it. In contrast, cafe's and restaurants in Oaxaca (even fast food restaurants) are very personalized. The waiters love to have conversations and get to know you; they see if you're comfortable and check up on you from time to time. If you want something else, they're really happy to assist. This level of service isn't confined to restaurants, it's in every part of Oaxacan culture. It doesn't matter if your in a bus station, an airport, or a market, people are genuinely interested in helping, being friendly, and building relationships.

Being back in the U.S., I feel like culture of America is centered around being independent and impersonal. Everyone is in their own world, doing their own thing. For example, when I was walking through the airport, the majority of people were irritated or stressed. They wouldn't look and smile or say hi. Even when I smiled at people, they seemed to look confused or ignored it. This level of independence has formed a culture in which human being are socially unaware of each other. It seems (I might be being harsh here) that American culture is selfish. However, don't get me wrong. I know not all Americans are like this. Many Americans are great people, who like to meet new people, build relationships, and expand their horizons. Actually, most Americans that I've met, who are interested in new people and relationships, are those that I meet in foreign countries, or on foreign flights. They love to find out about other cultures, beliefs, and customs. I feel like they have more of an understanding of the world and can better tolerate difference and diversity, which is why I think it's so essential to travel and live in other countries. I've lived in America my whole life, and after being in Oaxaca I think that I used to be extremely closed minded. Now, I want to start a conversation with everyone; especially people from different countries or states. I want to learn their perspectives, views, and experiences. I feel as though, everyone can teach me something useful; something that can inspire me and improve my life. I no longer feel that I know everything in my closed little world. I want to travel more and do more programs through CFHI because there's a WHOLE WORLD out there, and the amount of lessons and experiences to be gained are ENDLESS.

My biggest fear is reverting back to the way I was. I don't want to be satisfied with my microenvironment; shielded from the rest of the world. I don't want to lose my diverse life experiences, and the relationships I've gained in Mexico. I want to travel the world. To meet great surgeons and physicians from different cities and countries, who can each teach me something different. I want to keep using the skills I've learned and develop them further so I can mature as a person, and ultimately be a socially aware physician capable of contributing to his community in extraordinary ways.

Side note and Oaxaca review

While reading about cultural factors which act as barriers to Latinos in the West, I realized that great doctors are those that take ingenious means to deliver the best quality health care to their patient; even if it means learning foreign cultural values, learning a new language, or living abroad for months. What separates a mediocre doctor from a great one, is that great doctors are constantly looking for new ways to delivery the best quality of health care to their patient, even if it means doing a rain dance before a consult. As long as that rain dance can increase compliance and patient satisfaction, it's worth it... no matter how weird it may seem. I also look it at it from a business perspective. If I'm a corporation, in order to have maximum receptivity for my product, I need to deliver the highest quality product on the market; my product must satisfy the consumer over any other product available. Same applies to health care. I want my patients to be the most satisfied patients in the world. If I'm selling health care, it's going to be the highest quality health care around!

Last words of the program:

I'm going to miss all the friends that I've made through this program (except the one's that live near me because we'll be hanging out over break!). Hopefully, I'll see them all in the future, as my colleagues in the medical profession. I saw a lot of good qualities in all of them, and it would be a privilege to work with them in the future.

Oaxaca was an amazing place to learn culture, emotional intelligence, and the practice of medicine. The city is beautiful in its architecture, culture, and people. I will definitely return here as a vacationer, and maybe even as a researcher. I want to improve my Spanish so that the next time I come I can explore and communicate a lot more.

The UCD/CFHI Oaxaca program was amazing. It has matured me as a person. I feel that I'm more self aware, which has lead me to be more culturally humble and socially aware. I want to increase my skills in emotional intelligence, and serve the underserved as I have never done before. I highly recommend this program to students in the pursuit of medicine because it will teach them valuable skills they can use in every part of their future career, as well as in every aspect of their life; whether it's in marriage, business ventures, or medical consultations. I feel that the most important way this program contributes to the world is that it empowers the individual to reach their potential by motivating them to go out and serve the underserved. At least for me, I really feel compelled to get involved in community development projects tied in with health care. I know that in order to keep the skills and lessons I've learned in Oaxaca, I have to involve myself in public health projects. Another thing this program revealed to me, is my love and passion for medicine. I watched tons of surgeries and I was enamored by every one of them. I want to be a surgeon, who has the technical expertise for complex procedures, true empathy and compassion to serve his patients, and a major contributor to the development of his community. Lastly, this program allowed me to meet amazing faculty, which have guided ( and continue to guide) my personal growth and development in a positive direction. I hope that Adela will be my mentor for the rest of my life; she's a great person and has the insight to really bring out the best qualities in her students. She and other doctors I've met on this program (especially Dr. German Tenorio) have helped me form an image of the type of person and doctor I want to be; I can now put my efforts into a concrete direction. With this program now over, I say "adieu!"

Last experiences in Oaxaca

My experience in Oaxaca is coming to a close. I'm in my last week here and I'm really sad. Unfortunately, I wont be able to post anything big until I get back to the States, due to the fact that I'm swamped in my final essays.

I'll quickly go over some aspects of what I did in the last week!

I saw one surgery this week, which was quite interesting. A 12 year old girl needed ligament correction because her foot was incorrectly oriented. The surgery was extremely simple, and it took about 20 minutes to complete. Dr. Rene cut the ligaments and restitched it in the correct orientation. It was an extremely simple surgery, which I enjoyed.

Unfortunately, it was also my last day at Hospital ISSSTE, and I was extremely sad. I did not want to say bye to Dr. Rene because he taught me so much and we've built such a great relationship. He was always happy to have me around. However, I took his contact information and we parted ways :(. He told me to keep in touch, incase he ever wanted to visit California. I'm glad that I was able to spend 4 weeks of this quarter, rotating with him. I learned how far empathy can take a health care practitioner in his ability to deliver care. Watching Dr. Rene interact with his patients is a priceless learning experience, and it gave me real time exposure to empathetic and socially aware health care. I learned a lot and I loved it. Hopefully, I can improve my emotional intelligence skills to his level, as well as Dr. Tenorio's.

Blog 32

Blog 32: 11/17/08-11/19/08

This is my second week in Puerto, it's a bit more relaxed than the first week. Our brigades are officially over, and the program(in Puerto) is mostly lecture based from here on out. However, we're doing something on Thursday. I have yet to find out what it is.

Professora Yvette gave me a book over the weekend called The Man Behind the Mask. It's the memoirs of an orthopedic surgeon who was able to obtain great success and respect in his life. The book was literally sent to me from God because it's exactly the journey I hope to be going through soon. Anyways, from the few chapters I've read, the author had one trait that allowed him surpass his struggle and reach the goals he wanted. It was his love for what he was pursuing. He had a genuine passion for medicine, which permeated throughout his being and allowed him to deal with all his problems (financial, social, and educational). This passion allowed him to survive the rigors of medical school, marriage, children, residency, and his fellowships. I know I have that passion within me, but I want to feel it as he did. I want to immerse myself as he did. He would spend hours moonlighting, rotating, and studying literature in the areas of his interest. With passion, any goal is obtainable; it changes life from being directionless to something with a purpose. I feel that one of the greatest accomplishments in life is to find one's passion, whether it's being an astronaut, race-car driver, doctor, or a chef. It allows one to surpass the struggle, learn from it, and become a better person.

The pursuit of medicine is an amazing struggle. Even this early in the game I've been forced to face faults and inner demons which I never knew existed. I noticed that my drive to become a doctor had the potential to make me a jealous and a bitter person. If I wasn't constantly paranoid about the current state of my character, I may have continued down that path. Luckily, I was vigilant enough to stop any feelings of negativity from entering my soul. I'm not too sure where I acquired this paranoia, however it's extremely beneficial to me. I want to see myself as a person who can carry dignity and respect in interactions with others, as many great physicians are able to. I wish to be a physician who's only concerned for the well being of his patient. I don't want to be going down this arduous path to full-fill my ego, to gain pride, or money because none of those things are worth a moment of my life. Dr. Rene Valesquez, Dr. Flores, and Dr. Soy are all doctors who are free of ego, pride, or greed. They truly care for their patients, and you would never guess they were the experts in their field because they showed no arrogance or superiority to others. They had the respect of their patients, not due to their expertise in surgical skill, but because of their genuine ability to care.

Blog 31

Blog 31: 11/12/08-11/14/08

For the rest of this week, I was mostly on brigades. It was a pretty educational experience; we learned about Paludismo (malaria), dengue fever, and chagas, which are epidemiological problems in rural areas around Puerto. The diseases are spread through insect vectors; chagas is spread through a type of beetle called
Chinche (rhodnius prolixus), while dengue and malaria are spread through certain species of mosquito. The brigades were pretty tough, physically because the weather was really hot and humid, and there were tons of bugs everywhere. Rural areas (mostly located in the hills), are NOT easy places to live due to the terrain, weather, and sanitation. We went to people's houses in the these rural areas with entomologists employed by Oaxaca's health system.

I give these guys a lot of props because their job is not easy. They have to go to people's houses in many different areas and districts to look for the presence of mosquitos and chinche, as well as certain conditions favorable to their colonization. The entomologists do their work in this crazy hot weather in full uniform (hardhat, full sleeved shirts, khakis, and thick vest). Many times they have to goto houses located in the middle of rural jungle-forests, and other very hard to reach places. They also have to make sure people infected with any of these diseases comply with the treatments given to them. Definitely not easy work.

During the brigades we were able to ride in the beds of pick-up trucks, which was a really awesome. It probably wasn't the safest thing in the world. lol. It felt like a roller coaster ride, and I would do it again if I could. The entomologists need the All-Wheel drive trucks for the mountainous terrain of these rural areas.

We did our first bridage, the Chagas brigade, on Wednesday. We went to a rural, jungle hill region of Puerto, where Chagas was a problem. We inspected a few local houses to see if there were Chinche or an environment conducive to Chinche. The first house we saw was really dirty and a mess; also, it was completely open to the outside jungle. There were chickens, roosters, and dogs walking in and out of rooms. The furniture was a mess, and there were things sloppily piled into corners. Messy conditions are perfect for Chinche beetles because they prefer to hide under anything they can find. Also, the beetles don't attack people or animals when they're awake, they generally wait till people sleep and come out at night when they can feed without being noticed. When the Chinche does feed on a human it defecates into the cavity that it fed from. It's the feces of the Chinche that contains the Chagas parasite. When people itch or scratch the bite (usually a 3cm lesion), they spread the feces into their bloodstream, which is how the parasite enters the body.

I don't blame these people for the conditions of their houses because it's a result of their economic condition. Their houses are really old or poorly made; there's a lack of windows and the floors are made of dirt. New furniture and amenities are probably too expensive for most of these people, and they must do with whatever they have or whatever they can find. It's really unfortunate. The entomologists main advice for prevention of Chagas is to keep things washed and orderly because even though these people are poor, they can keep their houses clean. Education and awareness are really the best method of prevention because most of these people don't know about the disease or how it's spread. The main problem with Chagas is that the symptoms (maybe they'll feel some headaches or eye pain earlier on) don't surface until 15-25 years after infection. If it isn't treated within 6 months of infection, it cannot be cured. Many people within the rural population die of Chagas (causes heart failure, strokes etc.) in their 50s-60s, and usually didn't know that they were bitten 25 years earlier. The disease can be diagnosed through a microscopy of a blood sample, where the parasite can be seen.

The Dengue and Malaria brigades that took place on Thursday and Friday were pretty fun. Again, we had to get to secluded houses in rural country side hills via pick-up truck. Due to the fact the that main vector of transmission for both these diseases is mosquitos, cleanliness of the house isn't the main factor as a conducive environment. Instead there is a great focus on puddles, empty containers that can carry water, and wells. Any stagnant water, or areas where water can collect or stagnate after rains, will most likely be a breeding ground for mosquitos. This was a big problem in the first house we went to. The yard had wells and water bowls for chickens, all of which had mosquito larvae. Mosquito life-cycle is on average 11 days, however it can be much shorter with increased amounts of heat (5-6 days). Due to their short life-cycles, they can reproduce quick, and in containers as small as bottle caps. An important prevention technique is to remove containers and keep the yard orderly and clean. Regularly changing drinking water for chickens is also important. Wells or water basins should contain larvae killing chemicals, and the chemicals should be changed every 8 days to be effective (In the case of this house, the chemicals weren't changed for over 30 days...not good). The best way to prevent the incidence and prevalence of Paludismo and Dengue is to find ways to control mosquito population, which can only be done through educating the local population. There aren't enough men employed by the health system to clean up Puerto's districts, so all the work must be done by the local populations; therefore, compliance to health system guidelines is the real limiting factor in these rural areas.

There are two different species of mosquito that are of concern in the area. The Anopheles species carries Paludismo, while the A. aegypti species carries Dengue. You can distinguish between the two species by looking at the larvae. Anapheles larvae are suspended on the surface of a liquid horizontally (they lack a respiratory siphon), as apposed to the A. Aegypti larvae which are suspended vertically (they have a respiratory siphon). Also, the A. aegypti has a pair of striped legs, which distinguishes it from other mosquitos. The prevention for these two mosquitos are the same, which is cleaning up any stagnant water that could serve as a place of reproduction.

Dengue fever is caused by a blood-born virus that is transferred by a mosquito vector from an infected person to another. The entomologists were saying that A. aegypti are now being born with dengue already in them... SCARY stuff. Being that dengue is caused by a virus, it's untreatable, and you have to hope your immune system can fight it off. There are two forms of dengue, classic and hemorrhaging. The most dangerous form, Hemorrhaging dengue, is characterized by a bleeding from the eyes, nose, and internally; it has a high rate of mortality. Classic is a lesser form characterized by a fever and sensitivity to light (hemorrhaging also has this symptom). The virus causes bleeding by attacking platelets, which prevents the body from being able to clot (indicated by a platelet count lower than 100,000). Victims are usually hospitalized and can receive blood transfusions to compensate for the blood loss.

Paludismo, or Malaria, is caused by a parasite (Plasmodium vivax) that is transferred from one person to another via mosquito vector. The parasites multiply within and killing red blood cells, ultimately resulting in anemia. Symptoms include fever, shivering, and vomiting. Both sicknesses, Dengue and Malaria, can be detected by blood sample microscopy.

The first line of prevention, set up by the system of health, is the appointment of community volunteers. The community volunteers are respected members of the community who are appointed to take blood samples of everyone who has a fever or exhibits any symptoms of sickness. The blood sample is then sent to a Centro De Salud so it can be examined for Malaria, Chagas, or Dengue. My group met with Luis, a volunteer, who has been collecting blood samples for his community for over 30 years. He has this box full of slides and small needlelike devices meant to prick the skin. The Centros restock his supplies every so often. After pricking the skin, he collects a drop of blood and smears it on the slide. People whose samples are taken are then logged onto small charts or records. He's also given medications to distribute to people diagnosed with Malaria (Chloroquina and Primaquina). Community volunteers are extremely effective because they're trusted by their community and are easily accessible. Also, they're given pretty sweet benefits, such as free basic health care, and 50% off of surgeries.

I think that Oaxaca's system of health is doing a great job in fighting these diseases. By focusing on prevention and putting more effort into involving the local communities, they're able to prevent further incidence and prevalence. Prevention is definitely the most effective technique, especially considering the lack of resources and funding that the state can provide for those who are victimized by these diseases. Medication for Malaria and Chagas is expensive, and the state of Oaxaca simply can't provide enough for everyone to be treated. I think the main issue is compliance, due to the culture surrounding these areas. Unfortunately, in these rural areas the women do all the work and it's up to them to clean up all the stagnant water, yards, and houses. The men are extremely lazy and unconcerned of the situation, which is attributed to their machismo attitudes. One entomologist made the joke, that if there's a scorpion on the same hammock that a man is lying on, he's so lazy that he'll tell his wife to get the antidote because he's too lazy to move out of the way or to kill it. Being that women already have so much work to do, it's hard to believe that they make much more time for prevention efforts.

I learned a lot about these rural communities. Epidemiologically, they have more problems with communicable disease than other populations, due to their low socioeconomic status. It's really important to educate and increase awareness in these areas in order to fight the prevalence of diseases such as Malaria, Dengue, and Chagas. Salud Oaxaca's medical entomologists increase awareness by inspections and assessments of local living conditions and pest populations. I admire these men because they genuinely want to help these people improve their quality of life; it's the only explanation for why they would work in such harsh conditions and travel to isolated areas in order to deliver health care. They love the people they serve, and the people trust and love the, which is an essential quality for doctors to have as well. Luis, the community volunteer we met, with was telling us that the local people carry a deep respect for these entomologists and their work. I'm simply amazed at the level of dedication and selflessness that exists within these men!
I'll keep everyone posted more often about my adventures through Puerto! Salamz.

Blog 30

Blog 30: 08/11/08-10/11/08

Sorry, I havent been able to post for a while. I've been in Puerto Escondido this week, and the internet is pretty slow. Also with all the things I've been doing, posting everyday is near impossible. I will however, summarize my experiences for the week.

Our class took a charter bus from Oaxaca City to Puerto Escondido last Saturday (08/11/04). It was an 8 hour excursion, through twisty mountain roads, and amazing views. Luckily, I took Dramamine so I didn't get motion sickness in the bus. The mountain views are really nice; it's very similar driving to Lake Tahoe. Mexico has a beautiful countryside filled with mountain forests, lakes, waterfalls, and rivers.

We arrived at our hostel Casarmar, in Puerto, at about 5-6 p.m. My apartment is on the second floor, and I share it with Nick and Ricky; they're pretty cool guys. It has 2 bedrooms, a full bath, a livingroom, and a kitchen; luckily its REALLY clean. The beach is right out in front, but unfortunately the rip currents are too strong for us to swim in it. However, a beach we could swim at is only a 5-10 min walk along Zicatela. La Punta, Zicatela is the part of the city we're in. In Zicatela, there's a bunch of markets, with AMAZING sea food. I've had some excellent fish here, and the best thing of all is that it's cheap (60-80 pesos for fish, rice, and a salad). I think I've eaten fish here almost everyday this week. I can't get enough of it because it's just too tender and fresh. My favorite type of fish is called Pescado Empanizado, which is a fried and breaded fish filet; with spicy chipotle sauce is simply to die for.

This month in Puerto there's a huge surf competition, and there's surfers from around the world who come to participate. The waves here are pretty clean, and break well for surfing. Also, the water is really warm, being that Puerto is near the equator, which makes swimming and surfing really fun. The weather here is also amazing, due to the city's closeness to the equator.

Puerto is a bit more humid and warm than Oaxaca, however, not enough to cause annoyance. In the day it can get pretty hot...I would say 90s-100s. The evenings are about 72-78 degrees. The sunsets are amazing to watch because the sun, which emanates hues of orange and purple, drops over the horizon of the ocean. The evenings and nights are characterized by nice temperatures and ocean breezes; it's extremely pleasant, similar to Hawaii and other tropical locations. At around 6 p.m, during the sunset, I like to pull up a sunbathing chair, read a book, and surf the internet. I feel like I'm in paradise...which isn't good, lol, because I can't get any work done!!!

On monday, I took surf lessons in Playa La Punta (the beach near where I live). Me, Massud, and Ricky went to Oasis Surf Academy at around 12:30 p.m. to meet up with our surf instructor and get some boards. The lesson started off on the beach, with the instructor showing us how to position our bodies on the board, how to stand up on the board, and how to move our weight around. After that, we got into the water and hit some smaller waves. The smaller waves are harder to get up on, and it took me a while to even knee surf (stand up on my knees). Throughout the lesson the instructor would push our board as a wave came, so that we had enough momentum to catch it. I didn't like that thought, I wanted to do it on my own. After getting used to some smaller waves, we swam nearer to the rocks and further into the ocean. The rocks create perfect wave breaks for surfing. An important skill in surfing is to know what type of wave to catch because many waves aren't ideal to surf on; the way a wave breaks determines how good of a wave it is. I learned that the hard way because I would try to surf every wave, and I wasn't able to stand on any of them. You have to look for the wave that will start to break near your position in the ocean. A lot of surfing is about patience. It's about waiting and deciding to use the energy you invested in paddling out to catch the right wave that will allow you to stand and ride it. Also, it's important in surfing to be a strong swimmer because paddling takes a LOT of energy, especially because you have to do it for most waves you want to catch. Paddling against the ocean waves is NOT easy, water gets your face, and you're dead tired by the time you're out at sea (at least for me). However you realize all the effort and patience worth it when you're able to catch that one wave. The wave that allows you to stand proudly on top of it. The wave that makes you feel like a conquerer and a champion. The wave that is the culmination of all your hard work and willpower. The wave is your reward, and because you worked so hard for it, it tastes sweeter than anything else. Standing on top of a wave is unlike anything I've ever done. That surf lesson, made me fall in love with surfing and the ocean. It's a deep and spiritual experience, in which many life lessons can be learned.

In surfing, there are a lot of parallels to life. It takes hard work, and a LOT of willpower to receive a reward. I spent all day paddling and swimming to catch ONE wave, but that ONE wave made the entire experience meaningful and rewarding. Life is a lot like that. We spend years on end studying in school and working toward a goal, which for me is becoming a surgeon. The moment I become a surgeon, or even the moment I get into medical school, will be the culmination of all my effort and hard work; it will derive its meaning from the struggle I went through to get to that point. While struggling to surf, I learned a lot of skills I need in order to be a successful surfer. I learned that I have to watch for the right wave, and be patient. I have to perfect my balance and technique, in order to even stand on the board during that perfect wave. The struggle of surfing teaches one how to surf, this also applies to life. In life, it's the struggle that we mature from, and learn the essential lessons that will ultimately improve us as human beings, and ultimately help us to reach our goals. I came out of that surf lesson knowing more about myself and my relationship to the physical world, than I did coming into it. I learned that in the struggle for all goals, there's an internal component to this whole process, which will manifest itself in the physical world, and allow me to obtain success. However, the only way to develop yourself and your relationship to the world is to struggle and work hard; to put yourself in unique situations where lessons can be learned. I think the reason I learned so much can be attributed to my drive to learn lessons from everything I can do; which is the result of a realization I had last week. I realize that there really are life lessons and parallels in any experience one goes through.

Blog 29

Blog 29: 11/04/08-11/06/08

My rotations this week were awesome. The cirugia (surgery) department in ISSSTE has been consistently amazing. The orthopedic surgeons are great, and are really interesting in helping me understand what's going on. They really make an effort to help me learn the concepts and see the procedures during surgical intervention. I regularly rotate with Dr. Rene Velasquez de la Rosa (Traumatologo y Orthopedia) who's probably the coolest doctor I've met in Mexico... I'm EXTREMELY lucky. I've seen about 6 surgeries this week, which involved an ankle (tovillo), spine, and knee. I'll go through the cases, and reflect on my experiences with Dr. Claudio (another orthopedic surgeon) and Dr. Rene.

11/04/08

Today, I watched Dr. Claudio and Dr. Hector operate because Dr. Rene only operates on Thursday and Friday. Unfortunately, Dr. Rene thought that I wouldn't be interested, and directed me to Dr. Claudio. Looking back, I wish I sat through Dr. Rene's consults instead; I want to get a feel for the whole surgical process, from consult to recovery. I think it was kind of miscommunication on my part, mainly due to my limitations in Spanish. However, it wasn't a big deal because I still really enjoyed the ankle surgery. Next time, I'm going to request to sit in on more of Dr. Rene's consults which are awesome because he makes the experience really enjoyable for the patient. His consults reflect all the components of emotional intelligence that I've learned in class, which is what makes them so essential for me to see and learn from.

The few consults that I've done with Dr. Rene have been really awesome. It's VERY apparent that his patient's LOVE him. I think it's a result of his genuine interest in their well-being, and of course emotional intelligence. He's always talks to patients with respect, care, and empathy. His specific style of interaction is characterized by humor, friendship, and nonchalance; it works really well. He really jokes around with his patients, asks about their day, what they like to do etc...things that don't necessarily relate to their condition. He has more of a genuine interest in their life and their personality. The patient also asks about the Dr.'s life in return, and get to know about him also. Through his style of interaction, relationships he has with people turn into bonds of friendship. In essence, the consult room is really a place for him to socialize and build a meaningful relationship with his patient. My first consult was with a woman who was going to undergo a spinal operation in a few days. We met her in the hallway, and walked with her to the room. As soon as the she came in, Dr. Rene started joking around. she was laughing a lot, and was in a really good mood. She didn't seem particularly stressed or distraught about her impending surgery. I got the impression that she really trusted Dr. Rene. In sum, he knows how to change the traditionally stressful experience of surgery, in to one free of worry and fear. The secret to his success is his ability to form bonds of friendship with his patients. I hope to go on more of his consults and observe him in action.

Returning to today's rotation...I watched Dr. Claudio perform an open reduction surgery on a fractured ankle. He internally fixed the fracture by using torneos (screws) and plaqas (plates). The ankle fractured in 3 places, which required the use of a plate in one fracture site, and direct input of screws in the others. The most interesting part of the surgery, was how he drilled the plate in. He (with the help of Dr. Hector), lined up the 2 parts of bone and stuck a plate on it. The plate has spaces for screws to fit through, so Dr. Claudio drilled through the spaces in order to form grooves inside the bone for the screws fit into. Thereafter, he put in the torneos with a screwdriver. Seven torneos were put in total, in order to obtain a maximum amount of structural rigidity in the construct.

Dr. Claudio was really nice, and it really helped that he knew a bit of English. What made my rotation with Dr. Claudio priceless, was his inherent interest in trying to help me understand the concepts of the procedure. For example, I found out that screws and plates must be oriented on the bone to achieve maximum rigidity and tightness around the fracture in order for proper healing to occur. If they're are gaps or looseness, then the fracture fragments may slide around, therefore prolonging healing or resulting in improper healing. After the surgery, he asked about where I was from and what my schedule was like, and he really wanted me to come back and rotate with him. However, due to the fact that I'm rotating with Dr. Rene, it wouldn't be possible to do both. These rotations are simply incredible.

11/05/08-11/06/08

In the past 2 days, I've seen 2 spine surgeries and a protesis of the rodilla (prosthetic knee transplant).
The spine surgeries are quicker. They generally involve the input of a styrofoam-like synthetic disc, in the place of the original disc. Most of the spinal conditions are characterized by the deterioration of the discs between lumbar vertebrae, which usually results from "Black" disc disease or a disc "hernia". First, Dr. Rene always enters from lower back with a cauderizer or knife, and stops when he finds the disc. He then proceeds to use a unique clipping tool to remove peices of the deteriorating disc tissue. Once all the disc tissue is removed, he puts a synthetic disc in its place. Lastly, the patient is resealed with stitches and the surgery is done. It's simple and quick.

The protesis of the knee was definitely one of the coolest surgeries I've seen. It's much more complicated and requires more time and resources. A 69 year old female had a knee condition that required the input of a prosthetic knee. There were MANY parts to this surgery, so it's going to be hard for me to go through every detail, but I will go over the major parts. The bones in the knee were shaped by the usage of many unique tools, mainly saws and adapters to the saw. The shaping was done to accommodate the placement of the prosthetic knee parts to fit on the original bone, kind of like legos. First, the adapters that were drilled into the knee. These adapters had spaces that exposed the part of the knee that needed to be sawed off. The saw was put through the space and it shaved off bone at different angles. Once shaped, certain parts of the knee had grooved holes drilled into them. The purpose of these grooved holes were to help accommodate the prosthetic pieces to fit in their respective areas. There was a smooth Prosthetic bit made for the femoral part of the joint; it was a contoured piece of metal. For the tibial part of the joint, there was a flat metal platform that would accommodate a plastic spacer meant to slide along the metal femoral peice during motion. All the bits were cemented to the joint by a unique compound (it smelled like paint remover!). The compound was fluid at first so that it could be shaped and applied to the synthetic bits and the bone before bonding occurred. During bonding, it hardened quickly through an exothermic reaction (i held some extra cement in my hand and it was really really hot!). The application of the cement had to be precise because you don't want the synthetic bits to move from their intended positions. It was an amazing surgery, characterized by a lot of hammering, drilling, and sawing. I never thought that it was possible to shave parts of the knee and add prosthetic pieces to restore joint movement... It's really mind blowing how far we've come. This surgery is definitely an example of how technology in health is improving people's lives.

I really love rotating with Dr. Rene Velasquez. It's a very personal experience, and I'm able to really benefit from the amount of attention he's able to give. By following him around, I'm able to see all the aspects of a surgeon's profession. I've learned that it's not just about going into the O.R. and performing a procedure. It's much more than that. It's about gaining the trust and respect of your patients so that you can give them the best care possible. The only way to give the best care is to build a meaningful relationship with your patient, otherwise it's hard to empathize and look at them as a human being. Dr. Rene has an amazing quality, where he can form bonds fast and I'm 100 percent sure it's through his practice and usage of emotional intelligence. I don't think it's something he learned in a class, like me; I think it came from the years of experience and his love for what he does.

Another thing that I really admire about Dr. Rene is that he makes sure the patients family is happy and content with his care as well. For example, after a spinal surgery on a woman, the first thing we did was to go to the waiting room and meet with her family. He made sure her husband wasn't worried, and assured him that everything was fine. In another case, we waited for a patient's husband for 15 minutes in the waiting room, instead of just leaving or assuming he'll find out the post-operative status, one way or another. He treats everyone with a sense of humor, respect, and empathy that builds an environment of trust and security around him. People trust him and are really satisfied with his care. When random patient's in the hospital ask him questions, he makes sure they're directed to the right department or people. Many people are concerned, he can see that and behave accordingly. He's definitely a great representation of how doctor's should be. I hope to be a lot like him!

Blog 28

Blog 28: 04/11/08

I learned something extremely key today. However, due to its intuitive nature It is extremely hard to regurgitate it; but, it is too important for me not to try. It was an great epiphany, the magnitude of which I cannot describe. It was amazing because I was speaking from the heart, and realizations were flowing out of me like an endless, gushing river. It was knowledge which, up until know, hadn't presented itself in the forefront of my consciousness. The experience was an amazing high of energy, motivation, and gratitude. The final product was the realization of an essential personal truth, which I'm sure will let me spread my wings and soar through this amazing journey called life. First, I will introduce the context of the situation which lead up to this realization.

The morning was pretty relaxed. I ate breakfast at 9, and took a nap till 10:30. Around 10:35 I left the house to get my laptop charger fixed because the chord was hyper-extended, and it wouldn't charge my laptop anymore. After I dropped the chord off to Adonai(an apple certified store), I went to Cafe Los Cuiles with Justin and surfed the internet for a bit. At 2:00 p.m., I went home and had comida. I met some old homestays of my familia who were from Portland, Oregon; they were going to tour Sierras. After they left, I went to Cafe Italiano, and studied a bit with Jennifer. We ended up talking about our backgrounds, which was really interesting because they contrasted so much from each other. I'll have to make a completely separate post about that experience. I had Spanish class from 5-7p.m., which was fun because I learned how to give commands. After class, I went to Cafe Brujula to do research for my paper and read assigned articles. At this Cafe, at 8 p.m.,
is where my epiphany began!

In Cafe Brujula, I decided to call my friend Shuja through my Skype VoIP. Our conversation was about medical school. I think I called him because was thinking about medical school earlier that day, and was getting a little nervous and anxious. He asked me how the Oaxaca program was so far, and I told him that I was getting a little bored with the program, and my blog; I told Jennifer the same thing before. Although I was enamored with my surgical rotations, I was beginning to have problems extracting relevant lessons from my experience. Don't get me wrong though, orthopedic surgeries are still AMAZING, and I'm as giddy as ever watching them. But writing about cases and specific pathological details of certain conditions is something I'll learn in medical school. I feel like there's a greater lesson I need to learn before I can really appreciate the specifics of medicine. The realization came through the development of my blog. The blog posts of my rotations started to become regurgitation of case facts, instead of something more important. I stopped paying attention to the real lesson...How has this experience changed me? What have I gained from this experience? Has it matured me? Can I think on a new level? How does this effect the quality of life of the patient? Did I pay attention to how the doctor interacted with the patient? Why was the doctor interested in being a surgeon? Can I apply what I've learned through this experience to other situations in the future? The pathology and treatment of conditions is extremely interesting, but I know I'll learn all this stuff in medical school. I'm young, and at this point in my life it's essential to learn lessons that would allow me to mature, develop wisdom, and and force me to think in new ways. Lessons that present-day doctors have already learned before entering medical school. I realized that current doctors have skills to think on an abstract plane, and can use their minds in creative and new ways. Technical skills are only one aspect of medicine. I think I'm getting the idea of what it means to be a doctor now; it requires abstract critical thinking skills, wisdom, insight, which are learned through tough but deep life experiences; life experiences that force one to look for a deeper meaning than what's present in the obvious details.

However, I'm not downplaying the significance of my rotations. They've matured me in great ways. They've exposed me to medicine in a way I've never experienced before. It's served it's purpose in showing me that I wanted to be a doctor, and that I would love to be a surgeon for the rest of my life. Watching surgeries, excites me so much, and I get rushes every time I watch them. I would spend all day if I could in the O.R. However, I want to stop watching, and start contributing and getting involved. I think I need to approach my surgical rotations in a very analytical way. A approach that would allow me to understand what surgery is all about as an overall field. Also, I need to supplement my rotational experiences, with experiences that have nothing to do with surgery or medicine, in order to gain new insight and perspectives.

I also realized that, you don't want to be stuck in your comfort zone, because prevents you learning, changing, and gaining new perspectives. When things become boring and comfortable it's because learning has ceased. In fact, I realized the more random and interesting situations I throw myself into, the more I can learn different skills and lessons. If I'm in the same environment, it becomes a comfort zone because you gain familiarity with everything, and the rate of learning decreases substantially. Whether I intern at a construction site or at NASA, there are essential life lessons in each scenario. Doctors are able to extract the deeper meanings behind situations, which ultimately allows them to use more skills and improve their ability to give care to their patients. I feel as though medical schools look for people who are able to learn something beneficial from everything they do. Extracting meaning from experiences results in the development of critical thinking, analysis, and increased reasoning abilities; it forces one to understand the situation or context in more dimensions. It's an essential skill, and I'm going to practice thinking this way, by chancing the way I observe everything. I'm going to ask myself what did I learn from this experience? Why did I feel a particular way? How can I use what I've learned in the future? By thinking this way, development as a better person and physician is endless; it has no limits.

I asked Imran Khan, who's a really close friends with one of my best friend's Shuja, about what activities I should do in order to get admission to medical school being that he was recently admitted into medical school himself. So he went on to tell me his personal experiences. He was a student defender in the student judicial committee at his undergraduate school. The experience wasn't a clinical or research experience, however, he was able to gain useful skills and lessons that he could apply in being doctor. In his experience, many times he had to defend students that he knew were cheating, but it was his duty to defend them. It also applies to taking care of patient because doctors have to offer health care to patients, even if the doctor perceives the patient to have moral corruption. It made him an applicant with a diverse skill set, who able to bring his diverse experiences and use them in ways others couldn't. I feel that's why he was able to get into medical school. He told me about this before I started the program, and I only really understood what he was talking after going through experiences in this program. It's important to have diverse experiences, in order to have unique skills that will allow you to approach situations and problems differently and more effectively.

I think it takes a lot of maturity to know why one want's to become doctor. Through my rotational experiences, I'm slowly getting a handle on the reason I want to become a doctor. The more rotations I go through, the more it strengthens my resolve and reason to pursue the medical path. Hopefully, i'll come to a point where I can easily express that reason, and it doesn't exist just as a feeling.

The main point of this program is to give the premedical student a new perspective in their approach to medicine because medicine isn't just grounded in technical skills, human physiology, and problem solving. There's a human aspect to it, and it requires diversified life experiences that can provide the motivation for true empathy and awareness of those in need. The program is meant to mature the premed student, and prepare him/her for the journey through medical school, residency, and practice.

Blog 27

Blog 27: 10/27/08

My third day at Hospital ISSSTE was amazing because I was finally transferred to surgery. Also, I was lucky enough to see a spinal surgery. To get the transfer, I went to talk to the administration, which was an interesting experience in itself.

At 8 a.m., I went to the administrative teaching office, which assigns students to various rotations around the hospital. At ISSSTE, the system is very regulated and permission is needed for students to change departments, and must be assigned specific doctors to rotate with; unlike Civil, where students can pretty much show up anywhere, as long as they have a proper identification. At the office, I wasn't able to speak a word of Spanish, I think it was just one of those morning where my brain wouldn't function. The only thing I could communicate was that I wanted to rotate in cirugia (surgery). After a lot of talking (none of which I understood), the secretary assigned a lady for me to follow. I followed the lady to a department that said Cirugia and Medica Interno (you can guess what those mean). She told me to ask for Dr. Eric Martinez, when I reached the department. So I asked for Dr. Eric Martinez, and he wasn't there today, so I was told to ask Dr. Victor Cruz about what I should do. Dr. Victor Cruz was a really nice guy, unfortunately I couldn't understand a word he was saying, and vice-versa. He took me to this room with two other doctors. This is where it gets funny. Dr. Cruz said something to do the doctors, and left. So, I was in an office with these two doctors, and I had no idea where I was, who I was supposed to follow, or where I was supposed to go. The lady doctor started talking to me, and I through she told me to enter one of the rooms in the hallway. So, I went outside and entered a room with a patient in it. The patient was confused and had no idea what I was doing in the room. What made things worse was that I couldn't understand a word the patient was saying. So I was waiting in his room for 10 minutes, and the patient's son told me to go outside to get a face mask. When, I went outside the male doctor who was in the office told me to follow him, and we ended up going to his consult room, which was two floors down. So as it turned out, I wasn't supposed to go into any of the rooms in Medica Interno, instead they just wanted me to wait for one of them to finish their paper work. So...not knowing good Spanish can make for interesting experiences and funny stories! I feel kind of bad because the patient, probably had no idea what was going on.

I'm starting to like ISSSTE more than Civil because my rotation is more personalized. It's just me and one doctor, and I follow him through his surgeries. The doctor is an orthopedic surgeon (title in mexico: Traumatologo); his name is Dr. Rene Velazquez. I'm really lucky to be shadowing him because he's a really nice guy, who's able to get along with everyone. His people skills are amazing. He also, really goes out of his way to make sure that I'm having fun and get to see really interesting stuff.

Today's case was really cool. Dr. Velazquez operated on a 33 year old woman, who had a "black disc" (deteriorating disc?) which was causing her problems (my guess a lot of pain). The surgery was especially interesting. Dr. Velazquez was learning how to do a new procedure from another orthopedic surgeon named Dr. Pepe. Dr. Pepe owned or worked for a company (www.lixus-spine.com) that developed special plastic spacers (and other orthopedic equipment), which would tie together and rigidify the vertebra that had the black disc in between. Dr. Velazquez entered the woman's back with a cauderizer. He kept going deeper, until we saw the vertebral arches. Dr. Velazquez used a special X-shaped tool to separate the vertebral arches of the two different vertebrae. Thereafter, there was an x-shaped space between the vertebral arches, where the x-shaped plastic spacer was placed. The plastic spacer was secured between the vertebra using this special rope that tied around the vertebral arches. The lady was then resealed. The deteriorating black disc could no longer act as a proper spacer, causing the spinal vertebra to start touching. It was a pretty simple procedure, meant to separate the vertebra that were touching and causing pain.

I really thank God for my experiences today. I was assigned to a really friendly surgeon, who was happy to have me with him. It did wonders for my learning and observational experiences. Dr. Pepe spoke English, and he was super happy to explain the procedure he taught to Dr. Velazquez; he ended up giving me his e-mail and card, and told me that next time I was in Mexico City, I should call him to check out his orthopedic company. Both surgeons were really impressed with my videos and pictures, and wanted it on C.D.. During the surgery Dr. Pepe wanted me to take a bunch of pictures of his equipment and how it looked inside the body, so I have some really cool viewing angles on photo. I'm going to continue my rotation with Dr. Velazquez next week, so I should see some pretty cool stuff. What's really interesting is that he's going to let me view him interacting in the consult room, as well as in the operating room in order for me to get a full understanding of the surgical profession. He also told me, I could come into the O.R. anytime I wanted, even if he wasn't there, and introduced me to Dr. Venacio Rodriguez, the head Anesthesiologist. Now I have full surgery observation access at ISSSTE! Kudos to the Oaxaca Program!

One more thing: ISSSTE's operating facilities are better funded than Civil. There is more surgical equipment available, and more resources are used during surgery (such as more sheets and coverings on the patient). There are less people in the O.R. which makes the viewing experience more personalized. It's better maintained, and the rooms are much cleaner. It was easy to see how good insurance, can get the patient better resources for care. The difference between ISSSTE and Seguro Popular is pretty big in terms of quality of care.

Blog 26

Blog 26: 10/30/08

My second day at Hospital ISSSTE was tough. In the ICU, being aggressive takes a lot of energy, and after a while I couldn't keep asking the doctors and med school students to explain every little thing. To really learn in that environment, you need to have the requisite knowledge they teach you in medical school. So I decided I'm going to switch to cirugia(surgery) tomorrow, or at least gynecology. Overall, it was a pretty relaxed day. One thing that I don't like about ISSSTE is how hard it is to move from one department to the other. I have to go to the administrative department and get permission (which is contingent on if the lady is even there that day) in order to move from ICU to surgery.

On a side note, one thing I noticed about Hospital ISSSTE is that it's pretty well funded. They have pretty good landscaping, and the hospital is relatively well taken care of, especially in comparison to Hospital Civil.

So far, my favorite rotation has been through the surgery department of Hospital Civil. It's very easy to switch rooms or departments to find what I wanted to see. And most days there were tons of interesting surgeries going on. I'm trying to get Hospital Civil to be my last rotation on this trip, but it's extremely sought after by the other students, so the only thing I can really do is pray. I'll definitely start going on the weekends to see surgeries, being that I don't have many more chances to be there, before and after Puerto Escondido. Also, there's a ton of work to do before this quarter ends. I have a 10 page individual research paper, a 10 page group research paper, and a final paper....YIKES. I've got to jump on that horse quick or else it's not going to get done.

Comida was good today. At Becari, many home-stays made tamales, and luckily there was manteca-free tamales for me to eat. It was really good, and I was pretty satisfied. Dia de los muertos (Day of the Dead) is coming up, and there were little kids dressed up as skeletons and zombies. They performed a dance for our group, which was pretty cute. Dia de los muertos are actually two days in Mexican culture. The two days are dedicated to honoring dead children and adult family members once a year, by making them altars. In Mexico, they actually celebrate the dead instead of mourning them, which is really interesting. The rituals and customs are derived from pre-Spanish cultures, and combined with Catholicism. It's going to be on Friday and Saturday, so I'll definitely take pictures and keep everyone posted. I'll also keep everyone posted about my surgery experiences tomorrow. Salamz.

Blog 25

Blog 25: 10/29/08

It was my first day at Hospital ISSSTE, which is a hospital dedicated to serving government employees such as public school teachers, administrators, etc. It's a very nice hospital, located only a few blocks away from Hospital Civil (General Hospital of Oaxaca). My first rotation was in the emergency department/Intensive care.
Unfortunately, by the time we got there, all the patients were stabilized and referred to their relative departments. There wasn't much to do. Rotating through the ER is very different than through the O.R. or primary care units.

ER has a lot more stress associated with it. A lot of patients come in with unknown problems, and need to be stabilized immediately. Because today wasn't such a busy day, the residents were using it to really relax; they looked really worn out, probably because most of them were on a 36 hour rotation. It was a really interesting and valuable rotation for me because I learned a lot about myself, and how I would need to change in order to take what I wanted from the experience.

Unlike in the other departments, it was much harder to learn in emergency care. Everything is fast-paced and people don't have the time or energy to stop and teach. It was really frustrating because I was having a hard time getting what I wanted out of the situation. I was used to having doctors taking the time to really explain the patient's problems, and answer questions that I asked. Many times In surgeries, doctors explained to me what was going on, many times without me even asking questions. Due to time and attention constraints present in the ER, I really had to change my strategy to learn. In order to learn, I realized I would have to be more proactive and persistent. The residents weren't just going to wait for me follow them around and ask questions. I would have to be more aggressive. So, I changed my approach and tagged along with any residents I could find. I didn't wait around for them to notice that I had questions, instead I asked questions as they were working and walking around. Any free time they had, I would swoop in with questions that I needed answered. The residents didn't mind my approach at all, and were really willing to explain things when I took the initiative to ask. Many times they didn't fully answer my questions, so I would just ask the person later, or ask someone else.

I learned a lot from the experience because it forced me to learn adaption skills for that environment. In this particular environment, where there's no time and a lot of stress, the only way to benefit is to be proactive and go after what you want. No one has the time to notice what you want or need. Hopefully, I step it up a notch tommorrow and get even more out of the ER. I want to practice my new found skills. However, I also realize that being this aggressive may not fair well in other contexts, such as in the O.R.; instead it might be interpreted as something else, and serve as a great annoyance to surgeons and surgical residents. The lesson I took away from this experience is that it's important to adapt one's approach to learning, based on the context of their environment. Being proactive takes energy, but I'm really looking foreword to my rotation tomorrow!

Blog 24

Blog 24: 10/24/08

he surgeries I saw today have topped all of the other surgeries I have seen on this trip so far. God was looking out for me because the line up today was ALL orthopedic; as opposed to the last two days where I didn't have any. I was pumped on adrenaline all day. I'm pretty sure found my calling. I've never been so excited about watching anything in my life. I HAVE to be!!....no, I'm GOING to be an orthopedic surgeon!

In the operating room, my obsession must have been apparent because the residents where taking extra measures to let me see what was going on. They moved me near the surgical table and let me look over their shoulders while they hammered away. I'm sure they could see my enthusiasm by my constant facial expression of astonishment (I would've screamed if I could). In that room, I felt, what I like to call, a "surgical high" (I'm a dork I know). I was in a complete state of euphoria, and I could've stayed in that room for another 9 hours. Alexa and I, asked the attending surgeon (Dr.Zapien) questions after the first surgery and he invited us to other his surgeries of the day. We were really lucky. A lot of props go to Alexa because she really helped me understand what was going on in the first two surgeries.

The first operation was on a 7 month old girl. The tendons and ligaments in her feet were congenitally abnormal, causing her feet to be tilted to their sides and pointed downwards. To correct this, they had to cut her tendons and ligaments, and re-stitch them in a way which reoriented her feet into their proper orientations. The surgeon was going to specifically cut the tendon from the posterior tibia. They also removed the extra membrane which was around her tendons and ligaments (not sure why?)This was probably the most focus intensive surgery of the day. I could tell the surgeons were under great pressure because children are extremely hard to operate on because their tissues are small and look different compared to adults. Operations requires more precise cutting, time-constraints are different, and vitals are more essential. Complications can have negative developmental effects on the child, and even death.

The second surgery, which was a much simpler procedure, was a fractured elbow. The patient was a 10-12 year old boy, who probably fractured his elbow through some physical activity. The surgeon made a cavity into his elbow, and reoriented his bones into their proper positions. Thereafter, the surgeon (which was actually a resident) drilled two screws through the elbow (my guess is to keep the bones in their proper positions while they heal). Lastly, he re-stitched the elbow, and the surgery was done. It was really simple.
I don't think there was an attending present for that surgery. It seemed like one resident was teaching another. They kept taking out the clavias(screws) and re-drilling them into the same part of the arm. My guess was the resident's first time doing the operation, and he was having a bit of trouble getting the screws into the right spots. In fact, they kept calling a senior resident as a reference. But, I suppose that's how you learn to do surgery!

The last, and most EPIC, AMAZING, and INGENIOUS surgery to EVER take place (at least for me), was a femoral reconstruction surgery. A 22 year old girl had a motorcycle accident that resulted in a major fracture of her femur; her bone was broken into 2 main pieces and the area of trauma was shattered like glass They hung her leg up to a pole, and at the fracture site it bended 45 degrees, when normally that area of the leg shouldn't bend at all...crazy stuff.
The surgeon started by entering the site of her fracture, using cauterizer (similar to in radical surgeries, but on her leg). It was weird to see a huge bone like the femur to exist in pieces within the leg. The surgeon, separated the pieces of bone to reveal the interior of the femur. He took a unique hand-drill, and started removing the interior of the bone. Another incision was made at the top of the hip where they drilled another hole through the femur. Eventually, there was a hole that ran from the fracture site all the way to top of the hip. The surgeon inserted a long metal tube that ran through the tunnel made through the medulla of the femur (there was a lot of hammering for this part). Thereafter, the metal tube was visible at the end of the femur where the fracture was, as well as the end where the hip incision was made. The surgeons then took the pieces of fractured bone and pieced them together around the visible part of the metal tube (located at the trauma site), and used a metal tie-rod to hold the pieces together. After that, they drilled screws through the surface of her femur longitudinally so it permeated the metal tube and exited on the other-side of the bone. The longitudinal screws were meant to hold the metal-bone construct together. The surgery was indescribably amazing
She reminded me of a super-hero named Wolverine from the comic book series X-Men because this character had a metal skeleton.

I had a really amazing experience. It was my favorite rotation in Oaxaca thus far, and it's hard for me to believe I'll see anything cooler. However, I have yet to see an open heart surgery and a neurosurgery, so I'll keep my mind open. I have a feeling that neurosurgeries are also an amazing experience. One thing I know for sure though, is that surgery is definitely my path.

I still can't believe that I saw three orthopedic surgeries in one day, I could not have lucked out more. A real benefit was that I was able to watch two of the surgeries, with the same set of surgeons, and due to the fact that they've seen me before (yesterday, and the day before) they're pretty relaxed about letting me get close. They also gave me their e-mails, so I could e-mail them pictures of the surgeries and ask questions about anything I didn't understand. I talked to the attending surgeon at the end of the surgery, Dr. Zapien, he was really friendly and willing to answer my questions. Definitely a great experience. When I get back to the bay area, I'm interested in finding research that exposes me to surgical methods and techniques, and other aspects of the process also.

Blog 23 - Competition

Blog Entry 23: 10/23/08

I learned a really important lesson today. I've defined what competition means to me, and how I can use it to my advantage. I think it really improved my opinion of certain people I used to look down on, and me realize goals through their perspective. By integrating my morals, what I want, and how other's perceive competition, I've created my own definition, which I think will serve me extremely well on my way medical school, and throughout the rest of my life.
Competition was a concept that I've only recently come to address. And until now, I've never consciously identified what it means to me. What I found was that I subconsciously defined it as process of defeating everyone else by any means necessary to achieve a goal. Motivation to compete would come from hopes and efforts in the failure of others; it also meant having hatred and jealousy when witnessing the success of others. This internal definition kept me away from competing in many things because it went against my values and morals. However, I changed my perspective by observing some students on this program.
Initially, I saw some other students spending disproportionate amounts of time with the professor, as well as going on some really awesome rotations. I framed their actions in the context of my old definition of competition, which built resentment in my heart. I felt that their intentions were to step on others to get what they want. I viewed them as my cold, heartless, and selfish; people that I have to beat. However, I was able to identify the condition of my heart, and I didn't like what I saw.
Our perceptions are colored by our beliefs and principles (Thank you emotional intelligence lectures!). It turned out my perceptions of these students were a result of my flawed belief of competition. I found that a little part of me wanted to have all the cool rotations to myself, and that others shouldn't benefit as much I should. I really didn't like thinking that at all, and it wasn't something I wanted to exist as a part of my personality. So, I thought about it in a different way, in other words I reframed it so that I could understand the perspective of these proactive students.
By reframing and putting myself in their shoes (Thanks again emotional intelligence lectures!!), I began to understand and respect them. In fact, I ended up respecting them a lot. I noticed that these are students who were motivated enough to take the initiative to try obtain what they were interested and passionate about. They weren't going to wait around for something amazing to fall into their lap. That's also something I've come to realize about life in general, things aren't going to come to you, you have to go proactively find it. I think I trace my old perspective to the way I was raised. Everything was pretty much handed to me, and I never had to proactively seek much of anything. When I didn't see amazing stuff falling into my lap as usual, I became stressed out. I saw other students benefitting, by being proactive... something I didn't understand at first. This program actually taught me otherwise, which is what makes the experience priceless. It's an essential life skill for anything one wants to accomplish.
I realized that it wasn't the intent of these students to take something away from me, instead it was to seek out something they wanted. My new definition of competition incorporates that. If everyone benefits that's great, but the reality of life is that there are goals that many people may have, but only a few people can obtain them. These goals are obtained by people who take the initiative to go seek it out. Their intent isn't to prevent others from getting to the goal, in fact, they're unconcerned with that. It's more of an internal struggle with yourself to go and get what you want because you realize it's not going to just be given to you. And people who proactively seek things out, deserve the rewards of that. I respect people like that, and they've really motivated me to do the same. By this definition, the success of others should inspire one to strive and learn from the success of others. It should build respect for those you see succeed and obtain a certain goal. At least, that's what it has done for me.

Blog Entry 22

Blog Entry 22: 10/22/08

In this post, I'll be going over my second day of Hospital Civil, which took place last week. I rotated through the operating room with Samantha. It was pretty fun.

I was able to watch my first orthopedic surgery, and I must say... IT WAS AWESOMEEEEEE!!!!!!

The patient was a male, who had an open fracture of the tibia as a result of trauma. The orthopedic surgeons were operating on his leg, 36 hours from the time the trauma took place. The patient wasn't fully anesthetized for the procedure, due to the fact that it was a regionalized procedure.
It started out with the anesthesiologist numbing the skin around the patient's L4 vertebra with litocane. Then he inserted a negative pressure injection/catheter through the muscle, into the spinal cord. If we saw the catheter fall out, it meant they weren't in the right area. The anesthesiologist inserted a thin needle to penetrate the spinal tissue (similar to a spinal tap). He drew out some spinal fluid, and put in the anesthesia. The process is a general process of anesthesia for most of the surgeries that I've seen.
After the patient was anesthetized, the orthopedic resident was using a needle to find the joint in the ankle. He inserted 2 screws, one in his tibia and one in his joint. At the end of the surgery there were 5 screws total around the ankle and in the tibia. They drilled the screws, above and below the fracture in order to line up the fractured areas of the tibia. They lined up the screws on both sides of the fracture, with other metal bits. The whole contraption was extremely rigid, and it managed to line up both parts of the fractured tibia, so that they would heal symmetrically. It was LITERALLY the coolest surgery I have ever seen!!!!!!!!!!!!
I loved this surgery because it was very technical. It was amazing that they used a simple power drill, to drill screws into the tibia. The procedure stimulated my mind spatially; in my head, I could see the different parts of the bone lining up when the screws were lined together. It's just amazing to me that we could fix the body using screws and power-drills. I've decided I want to be an orthopedic surgeon. Orthopedic surgery forces the surgeon to use their spatial intelligence, ingenuity and knowledge of the bones and leverage, in order to design different mechanical structures to fix fractures. It' extremely creative because every fracture is unique, and there are an infinite number of ways a fracture can act and look. It was a simple surgery, but I LOVED IT. I HAVE TO BE AN ORTHOPEDIC SURGEON!!!!!!!!!!!! If a kid breaks his arm playing football, I want to be the guy to fix it :).

Blog Entry 21

Blog entry 21: 10/21/08

Sorry, I haven't posted a while. Midterms just ended, and I was enjoying the week. Dra. Adela left on Sunday, I'm going to miss her because she's really easy to get along with and was always willing to hang out. One thing that I respect (it also kind of scares me) about Adela is that she's SUPER perceptive. For any future students of hers, DO NOT think she's oblivious to anything; I guarantee she can read you like a book. I'm sure she read me like a book, YIKES. But these qualities make her a good professor who can recognize potential... hopefully she saw some in me. I'm just hoping, I didn't do anything stupid in front of her without noticing (probably did :P). As of now, Dra. Melnikow is taking her place.
I was able to talk to Dra. Melnikow about the medical school process, and she has some really awesome perspectives. She really helped me understand certain pathways I could take in applying for medical school. She's a real asset to this program
I'm going to talk about my first rotation at Hospital Civil, which started last week.
So far, Hospital Civil is my favorite rotation. I'm probably going to come back here for my last 2 weeks. The first day started out in Pediatrics. I'll talk about all of the cases.
The first case was a three year old boy who had fractures through his humerus, ulna and radius. In Mexico, three years of age is the most common age for fractures. However in the U.S., we see the most fractures occur in ages 16 years and up. The contrast exists because car accidents cause the most bone injuries in the U.S.; Why? because most people are able to afford a car, and can start driving at 16. On the other hand, in Mexico, we see fractures mostly in children, occurring from sports and physical activity. Adults tend to walk instead. It was interesting to see the boy's x-rays. His humerus was completely fractured through and displaced. He didn't have a cast, and his arm was suspended by a system of pullies which served to reorient his bones into their proper positions. Luckily, the boy didn't suffer from medial nerve or muscle damage, and we knew that because he was able to move his hands and fingers.
Side note: We rotated with Dr. Jacobo Lopez Garcia. This Doctor LOVED my group (Me, Nick, and Alexa). He oriented the rotation as if we were real medical students. We weren't told what conditions the kids had. Instead, the doctor would give us symptoms and clues, and expected us to figure out what was wrong. After we figured out what was wrong, he would explain the conditions in depth. We would go over pathology, risk factors, and treatments. It was AWESOME. It really helped that he was able to speak a lot of English.
Our second case was a 14 year old boy who contracted Pneumonia. The boy was brought in by a resident who thought it was asthma. After running tests, the doctor found out the boy's problem wasn't asthma at all, it was pneumonia. Pneumonia is characterized by fever, cough, and respiratory weezing. Dr. Garcia showed us different x-ray angles, which indicated a mucous obstruction (called atelectasia) in the boy's bronchii. The doctor said that if the atelectasias are really bad, a surgeon might have to endoscopically wash the brochii with sterile water. Fortunately, the boy didn't need an endoscopy, and recovered with Penicillin. However, if after 3 days, they didn't see a recovery, the antibiotic is changed to another one.
Dr. Jacobo gave us some public health information on the usage of Penicillin to treat local strains of Pneumonia. Due to the over-usage and availibility of antibiotics in Mexico, 30% of Pneumonia is resistant to Penicillin (very high) as opposed to 10% in the U.S.
The third case we saw was a 3-4 year old boy with a brain tumor. The tumor was a cyst, which is a soft-tissue type of tumor. Doctor's knew the boy had a brain tumor because he suffered from headaches, vomiting and dizziness; these symptoms indicate problems in the brain. There was a lack of fever, and other symptoms traditionally associated with infections. The surgeons removed the cyst, however the boy still had headaches and vomiting, which indicated another problem. We found out that complications in the surgery resulted in the contraction of meningitis. This explained the residual symptoms. The boy had to be put into isolation, so the other children didn't get exposed to meningitis. Apparently, surgically complicated infections were quite common in the hospital.
Dr. Jacobo asked me what types of antibiotics should be used to treat the infection. Initially, I said ciproflaxin (which I assumed to be a powerful antibiotic). He said we could'nt use ciproflaxin because it acts as a growth plate inhibitor in children, using it would result in developmental complications. Then I said Amoxycilin, but he corrected me again. Amoxycilin is unable to penetrate to the meninges, due to the inflammation. The antibiotic we could use, was called cefalosperinas (and vancomycin) because it could penetrate the meninges with no developmental side-effects.
Dr. Jacobo said, In Mexico, for kids 5 yrs or less pneumonococcus can cause meningitis because patients cannot afford to buy the vaccine that would prevent it. In the case of this boy, pneumonococcus caused the secondary infection in his meninges. Other major symptoms after the surgery included: Edema of the brain in the surgical area, and an abscess(a collection of puss); together, these symptoms caused thrombosis (blockage of veins and arteries). The child was at serious risk for brain damage!!!
The fourth case, was a 5 yr old boy. He came in with headaches, vomiting, and couldn't swallow. These symptoms were a result of a tumor occurring in his mesencaphalon. Unlike a cyst, this was a solid mass of tissue. The mass of tissue caused hydrocephaly by blocking the drainage of of the C.S.F. in the ventricles. We saw that the ventricular cavity became larger, due to the build-up of C.S.F., resulting in intercranial hypertension. Due to the compression of the brain, from C.S.F. build-up, the patient could no longer talk. His gloseopharyngeal nerves were affected by the tumor, which is why couldn't swallow; these nerves innervate the muscles responsible for swallowing in the mouth. The boy is in need of surgery. Surgical intervention would include a shunt, which would drain extra C.S.F to the gut, in order to eliminate hydrocephaly; they would also remove the tumor.
The fifth case, was really interesting. A 13 yr olds girl had two unrelated problems. Her head was proportionately bigger than the rest of her body, due to congenital hydrocephaly. She also had a frontal fracture in her cranium from trauma. There was a hemorrhage lesion due to to the trauma of the fracture. Compared to the last case, the congenital hydrocephaly had less of an effect on this girl. The girl had hydrocephaly since she was born, and her cranium was extended in response to the larger ventricular lakes. Due to her larger cranium, her brain was not compressed, which is why she was relatively asymptomatic compared to our last case.
The sixth case (the most interesting case of the day) was a 6 year old male with an inflamed kidney. The doctor made the boy drink a phase-contrast solution in order to highlight the problem associated with his kidneys. We saw what was wrong by examining the boy's x-rays. He had a congenital valve failure in his bladder. Due to the faulty valves, the bladder was unable seal the ureters, and urine would go back and build up in the ureters and kidneys. Doctors were able to diagnose the problem due to the frequency of urinary tract infections. The boy had problems with valves associated with both kidneys. One kidney was severly damaged, and would only function at 25%, which the doctor termed as hydronephrosis or acute kidney failure. The second kidney was still functioning, however, in a short period of time would have also gone into failure. On the x-ray, we saw one of the kidneys taking up the phase-contast solution (it was bright), while the other failed kidney could not reabsorb the solution (it was dark). The functioning ureter and kidney, were both very inflamed. The boy required surgical intervention.
Surgical intervention would shunt the ureter to the gut, and the extra urine would be excreted from his gut. Also, the boy's valves would be replaced with plastic valves. With this procedure, the failed kidney should return to 75% functioning capacity, while the other kidney would remain at 100%. It was an extremely interesting case.
The last case of the day (I loved this case because Dr. Jacobo gave me the unofficial title of doctor, for my ability to diagnose it on my own). It was an 8 yr old girl, with dark bruises/spots all over her legs and arms. She didn't have a fever or any symptoms associated with an infection. I concluded, that the only reason she would bruise is due to a problem with her platelets (platelets bind together to form clots, and unexplained bruising or internal bleeding indicates a problem with platelets). I assumed it was some type of autoimmune disease... turned out I was right. There are two possible problems associated with platelets. One type is associated with abnormal platelet aggregation (function), while the other is a low count. A normal platelet count in the blood is 200k-400k, this girl had 7000-8000. The doctor told me that her immune system was attacking her platelets, which would explain the low counts. The repercussions are serious. The girl could eventually have hemorrhaging in her brain, GI tract, and Urinal tract, which together is called idiopathic trombocitopenica aguda (trying saying it fast). Platelets are produced in the medulla osea (bone marrow), along with RBCs (red blood cells), and WBCs (white blood cells). I thought the problem could be a form of leukemia, but Dr. Jacobo told me that Leukemia affects only RBCs and WBCs.
The girl was going to be treated with Prednisone, a cortico-steriod (can diffuse through plasma membranes) that acts as an immunosuppresor (the doctor said it also stimulates platelet formation from the bone marrow). The side-effects are more hair growth, psychosis, cataract formation, osteopenia( precursor to osteoporosis), and osteoporosis. What's more interesting is that the treatment is a permanent cure. Apparently, when the body cells are exposed to higher levels of platelets, over time, they start to recognize them. Therefore, autoimmune response goes down permanently. That's really intense!
Reflections...
This rotation was the best I've had yet, mainly due to the doctor. Dr. Jacobo Garcia was an amazing guy, who had the interest and patience to teach Me, Nick, and Alexa. In fact, he wanted us to comeback, and I really want to. So far, this is the most I've learned about diseases and treatment in comparison to all the other rotations I've done. Dr. Jacobo is like a walking medical textbook. I still don't know WHY he liked us so much, but I'm glad he did. Pediatrics seems really interesting, but I feel really bad for a lot of these kids. I saw some kids in a great deal of pain (especially the boy with meningitis), and it really hit me emotionally. Serving children is extremely important because they deserve the chance to experience a long and healthy life. They deserve the chance to find themselves and reach their potential.
Pediatrics, as in other primary care fields, is based in problem solving. That's probably why it's so interesting. I think it's more fulfilling than other fields because you're helping children improve their quality of life.