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.