Tag Archives: health care

Oaxaca Community Health Clinic is Learning Laboratory for U.S. Physician Assistant Students

When Meagan Parsons and Ben Cook arrived in Teotitlan del Valle, Oaxaca, three weeks ago to start their month-long public health clinic externship, they expected that people would be friendly and open since they had traveled before in Latin America.   They didn’t know quite what to expect about Mexico’s health care system.

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What the two physician assistant students from Methodist University in Fayetteville, NC, discovered was that

  • local resources were more advanced than they imagined,
  • the federal and state government funding and delivery of health care provides excellent continuity of care,
  • patients are more appreciative of the health care they receive compared with what they see in the United States,
  • there is no poly-pharmacy — meaning that patients are not over-medicated, and there are few if any drug interactions,
  • pharmaceuticals are free with a doctor’s prescription,
  • the types and choices of medicines dispensed are limited
  • there are few resources for state-of-the-art equipment, and
  • people here are hardworking and dedicated to doing things well, taking pride in what they do.

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After only a few days “on the job,” Meagan and Ben assisted in a labor and delivery, which was a highlight.  This primary care practice experience compares with a family medicine practice in the U.S. for which they receive academic credit as part of a clinical rotation

Some of the most common medical problems that present at the clinic are diabetes, hypertension, intestinal and respiratory infections.  Dr. Jonas Gutierrez explained that there is no breast or cervical cancer here.  Neither is there Dengue fever or malaria.  

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The clinic staff, which includes five primary care doctors (one assigned to each residential section of the village), a pediatrician, psychologist, dentist, nurses, a  social worker, and physician administrator who is also a surgeon, concentrate on preventive medicine through regular check-ups, health education, and administering vaccines.  Complicated labor and delivery cases are referred to the tertiary care hospital, as are critical cases.

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The doctors included Ben and Meagan in social activities, inviting them to lunches, sports events and family outings.  There was no relationship hierarchy.  

For a look into Meagan and Ben’s Oaxaca blog click here!

After the first few days, Meagan and Ben’s “ears turned on,” they began to hear the words and their Spanish improved, especially the medical terms that got bandied about.  Meagan says that she developed keener non-verbal skills and could begin to pick up cues given by patients, which will help her immensely when she returns to North Carolina.

Ben says he will take home the language and how to better relate to Hispanic culture.  He saw first-hand how everyone in the family is involved in health care decision-making, and this awareness will benefit him as he moves on in his career after December 2013 graduation.

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Academic advisor Deborah Morris, MD, PA-C, who came for a one-week site and supervision visit, talked with Meagan and Ben about developing a Spanish-language diabetes education pamphlet to leave behind for patients, since this is a pressing health care issue for the village. The content will include treatment choices, self-care, diet and nutrition, and exercises.  There will be lots of visuals to make it easy to understand.  The doctors will review the content and provide feedback before the document is ready to print.

Each of the doctors who Meagan and Ben worked with said the students were very helpful, learned a lot and so did they.  This was an excellent “intercambio” —   an opportunity for cultural exchange, mutual sharing, learning, and collaboration.

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Medical training in Mexico involves five years of study to become a family practice generalist M.D., plus a one year internship and one year of social service (medical education is paid for by the government and is nominal to students), for a total of seven years of education and service.  To become a specialist, doctors add an additional four years on to their education by doing a hospital residency.

Thank you to the doctors and nurses of the Centro de Salud, Teotitlan del Valle, Oaxaca, for welcoming students to the clinic to gain valuable experience, especially Clinic Director Dra. Elizabet Lopez Martinez, Dr. Jonas Gutierrez, Dr. Pablo Aredondo, Dr. Jesus Morales, Dr. Faustido Hernandez, Administradora Mayra Mendez, and Dra. Jessica Lopez. Thanks also to the Public Health Committee of Teotitlan del Valle, and to Deborah Morris, MD, PA-C, for facilitating this collaborative health care exchange.

Note:  All photo subjects gave their permission to be photographed.



Student Physician Assistants Volunteer in Oaxaca Village Public Health Clinic

Two students enrolled in the Physician Assistant program at Methodist University in Fayetteville, North Carolina, will do a one-month volunteer clinical residency at the public health clinic in Teotitlan del Valle, Oaxaca, this summer.  Meagan Parsons and Benjamin Cook, who will both graduate in December 2013, land in Oaxaca next week!  Needless to say, they are excited.

And, we are grateful for their service.  They will work alongside local doctors, nurses, and other clinicians to support delivery of primary health care services to a rural and growing village of 8,000 people.

For those of you who don’t know, Physician Assistants (PA’s) are master’s degree prepared health care professionals who are trained to practice as part of a physician-led team.   This is usually a two-year program that includes a first year of classroom coursework followed by a second year of clinical rotations.

Nurse Practitioners (master’s prepared nurses who provide direct patient care) and PA’s are meeting the demands of our U.S. health care system, especially in underserved areas where there is a lack of adequate medical services.   Immigrant populations who speak Spanish and have cultural impressions of a health care system that hasn’t always provided access to quality treatment benefit from these professional services.  

Meagan Parsons, Benjamin Cook and Professor Deborah Morris, M.D., P.A.

Meagan Parsons, Benjamin Cook and Professor Deborah Morris, M.D., P.A.

Both Ben and Meagan speak Spanish and the experience will give them a chance to improve their language skills and learn more about how health care is delivered in rural Mexico.  What they learn will help them translate the experience to their own professional goals to work in rural North Carolina communities after they graduate.

Meagan graduated from The University of North Carolina at Chapel Hill in 2009 with an undergraduate degree in biology and a minor in Spanish for health care professionals.  She worked as a nursing assistant in a pediatric surgical unit before she decided to go on for the P.A. degree.  This will be her first trip to Mexico and Meagan is eager for the immersion experience that she knows will give her a greater understanding for the emotional and cultural issues facing North Carolina’s immigrants.  When she graduates from Methodist, she plans to return to Rockingham County where she will practice in a small-scale rural community working with Spanish-speaking populations.

Ben Cook completed his undergraduate degree in human biology and Spanish from North Carolina State University in 2011.  He always wanted to pursue a medical career and he wanted more time to have a family and be involved with family life.  He feels that by becoming a P.A., he will have the best of both worlds.  He chose Methodist University because it has a high pass rate on the national certifying examination and there is a dedicated laboratory for student use.   Like most men who pursue a career in health care, Ben wants to go to work in either the Emergency Department or in Urgent Care where the fast-paced excitement prevails.  He feels the Oaxaca experience will give him better ways to connect with patients here in the U.S.

Deborah Morris, M.D., P.A., is the faculty member who supervises the cultural immersion program in Teotitlan del Valle for Methodist University.  She says this experience is essential for giving students a broader perspective of the world and the ways that health care is delivered in a system that is different than ours in the U.S. She says, There is a flow of people between Oaxaca and North Carolina.  It is helpful for students to have this experience to be more effective as P.A.’s.

For the village of Teotitlan del Valle, the students will trail and support the work of Mexican doctors, nurses, social workers, psychologists and dentists.  They will start out doing basic health assessments and physical diagnosis, assist in giving innoculations, and update handwritten medical records.  As they get to know the population and their needs, they will develop a health education project with local participation and input, that can be used for continuing health care improvement.  The biggest health care issues in Oaxaca are women’s and children’s health, pre-natal care, diabetes and its prevention, and cancer treatment.

Meagan and Ben will overlap with UNC Chapel Hill School of Nursing student Leonora Tisdale who arrived to volunteer in the clinic in early June.  I am so gratified to be able to organize this experience that benefits the students, the people of Teotitlan del Valle, and people here in the U.S. who will be better served as a result of Leonora, Meagan and Ben’s immersion.

I work with universities to place students in the health professions for a volunteer experience in the Teotitlan del Valle public health clinic. Please contact me for more information.



Nursing Student Volunteers in Oaxaca Public Health Clinic: Health Care Externships

Aside from organizing arts workshops in Oaxaca, Mexico, I also work with universities to place students pursuing a health care degree in the Teotitlan del Valle public health clinic for student exchange externship experiences.   I started doing this during the ten years I worked at The University of North Carolina at Chapel Hill School of Nursing.  This gives me a great deal of pleasure and personal satisfaction because of its positive impact on people.  This is international cultural and health care education that can change lives.

In a week from now, Leonora Tisdale, a thirty-two year old second degree nursing student at The University of North Carolina at Chapel Hill, will spend a month volunteering in the clinic, which serves the primary care needs of eight thousand residents, plus those who come from smaller villages nearby.


Leonora is bilingual, a trained doula, and holds an undergraduate degree from Guilford College.  She is interested in learning more about the medical culture of Mexico and its standard of care, maternal childbirth practices and women’s health.  After she returns, she will do a North Carolina clinical rotation at a rural clinic that serves immigrant families from Mexico and Central America.  Neither the professionals in or patients accessing the Teotitlan del Valle clinic speak much, if any, English.  This will give Leonora a perfect opportunity to build her medical Spanish vocabulary as she prepares for her nursing career.

When we met for coffee yesterday, Leonora said she is excited and energized.  She has prepared well by reading about Oaxaca health care needs:  the mental health issues around migration and being left behind, why indigenous women choose traditional birth methods, and the stigma of HIV-AIDS.  She wants to build relationships with the people who live in the village and learn the cultural nuances that one can only get by being there.  And, of course, she wants to eat all  seven Oaxaca moles (though, I suspect, not at the same time!).  At the end of her service, Leonora will write a reflection paper about her experience and I hope to publish it here.

One of the public health officials of the village tells me that better health care is a priority for Teotitecos.  The externships not only provide a cultural exchange, they give the clinic doctors, nurses, psychologist, and social worker clinical help in an overburdened system where the population is growing and there are not enough providers.  I explained to Leonora that diabetes occurrence is high in the region and there are health education opportunities working with local people to sustain programs around nutrition and exercise, and maternal and child health, and other chronic illnesses.

Students and/or university faculty members work with me directly to make the arrangements for student volunteer service. I facilitate the residency and make arrangements with those in the village.  Students work directly with their universities for academic credit, travel and insurance requirements.

At the end of June, two physician assistant students — Ben Cook and Meagan Parsons — from Methodist University in Fayetteville, NC, will begin their month-long externship at the Teotitlan del Valle clinic.  They will be joined by Professor Deborah Morris, MD, PA-C, who will be the on-site supervisor of their experience.

I welcome inquiries to arrange for spring break, winter intercession, and summer externships.   We ask that students be enrolled in a four-year academic institution, have at least one year of Spanish language proficiency to participate, be an excellent student, and participate as part of their academic experience for academic credit with the supervision (on-site or remotely) of a faculty member.

For more information, contact Norma Hawthorne at normahawthorne@mac.com  (copy and paste my email address into your email program if you can’t get the link to work.  It’s funky today!).

Oaxaca Healthcare: Free for the People

From personal experience I can tell you that tapping into the public health care system is low cost and easy if you are living or visiting in Oaxaca. This morning I presented myself at the Centro de Salud in Teotitlan del Valle with symptoms that I had pretty much determined via internet research were the cause of shingles.  I am not going to share photos with you!  And, this is not what I had intended to write about today, but here goes!

The clinic is a clean and modern building staffed with nurses and medical specialists, including gynecologists, pediatricians, psychologists, dentists, and social workers.

I took a seat along with about 15 people — men, women, children, babies — to wait our turn.  After the nurse in charge of intake took my name and age, she weighed me and measured my height.   The total wait before I saw the doctor was 40 minutes, about the same amount of time I can wait for an appointment in the U.S. that I have made months in advance.

After the diagnosis was confirmed, the doctor prescribed the necessary anti-viral and pain medications, which the on-site pharmacy dispensed immediately.  When I asked, the doctor said what I had was familiar here, too.  The medicine and office visit is free for local people.  For people who don’t live in the pueblo, the suggested donation is 20 pesos (that’s less than $2 USD).   I put 100 pesos (that’s about $8 USD) in the donation box.

My ailment will be treated over the course of five or six days.  I feel so much better now that I have pastillas (pills) in my system.  The doctor asked that I follow-up with him in six days to make sure I’m healing well.

Meanwhile, I suggest, if you are older than age 50 and  haven’t done so,  to get a shingles vaccination.

P.S. This summer physician assistant and nursing students from Methodist University in Fayetteville, NC, will do an externship here, learning how the Mexican healthcare system works. I organize this through the program leaders at the university, helping the students secure lodging and getting approvals for them to work in the clinic.  Today gave me a chance to see how the system works from the inside!  It’s very good.


Multicultural Learning Experience for U.S. Nursing Student in Oaxaca

“I loved it!”

Kathy Ray, a bachelor of science in nursing (BSN) student at the University of North Carolina at Chapel Hill, spent two weeks volunteering in the rural public health clinic in Teotitlan del Valle, Oaxaca.  The learning experience was invaluable.  She developed what will be, she is certain, lifelong professional relationships with local nurses and doctors.  She improved her Spanish language skills and she developed a greater appreciation for Mexico.

The village has one of the better-equipped clinics in the region and many patients from smaller villages are referred there for their primary care.  Because of that, the patient census on a given day can be high.  The clinic has two general practitioners, a pediatrician, a psychologist, social worker, nurses and a dentist assigned for patient care.  It serves 8,000 village residents plus people from more remote rural villages.  They welcomed Kathy Ray with open arms.

Kathy loved living in the village and volunteering there.  “It was the first time in my life I have been on my own,” she said.  “I got married young and started raising children when I was 22 years old.”  She had never been out of the U.S. before.

What Kathy Ray was able to accomplish in two short weeks

She started a fun Brazilian exercise program, called capoeira, for teens and pre-teens held in the central plaza in front of the church.  The exercises incorporate music, games, dance, acrobatics, and martial arts (it is non-violent, she explains).  The children loved it, and she got several repeat participants. (You can see examples on YouTube.)  Pre-teens and teens everywhere are at risk for early onset diabetes and fun exercise helps overcome the risks.

Kathy gave rubella, DPT, and hepatitis-B vaccinations to children and adults, and shadowed the ob-gyn doctor.  She learned hands-on techniques, and also shared ways that Carolina nurses are taught to give emotional caring and support to patients who are in medical crisis.

“The nurses and doctors are all very professional.  I was able to shadow the nurse who was in charge of vaccinations and the OB-GYN doctor who cared for pregnant women.  I learned the techniques for vaccinating infants, children and teens, and learned to read ultrasounds to identify gender.  It was great.”

Kathy is a mature and wise 39 year-old mother of teenagers.  This gave her the ability and perspective to become a peer professional.

She shared her perspectives about needed safety education materials

Even in the two short weeks that Kathy volunteered, she knows she made a difference.  She recommended that the clinic publish educational pamphlets for parents about unintentional accidents, including how parents can protect their children by encouraging the use of helmets, seatbelts, and to not to ride in the back of pick-up trucks (how many accidents happen).  Kathy saw she could influence and encourage safety education by reinforcing the message that “it only takes one person to make a difference.”

Kathy and I spent over an hour together in my office while she recounted her experiences during her two-week stay with a local family.  She has written about living in Teotitlan del Valle and being a volunteer nursing student on her blog: http://onceuponatimeinoaxaca.blogspot.com/

She has posted photos there, too.

Placing student nurses between their junior and senior years

For me, it has been such a delight to place nursing students in Oaxaca as part of a global study experience.  It has been four years since I started this program with the help of Federico Chavez Sosa.  And, it is beneficial for students to be volunteering in Mexico since many of our immigrants are from Spanish-speaking countries.  Teotitlan is perfect because it is safe, small, welcoming and we have a network of relationships there.  The village health professionals receive the benefit of smart, educated and dedicated nursing students to help.

“I was excited, but also nervous about going to Mexico on my own.  It turned out to be one of the best experiences of my life.  The relationships I developed will be life-long.  I loved the beautiful scenery, the visual imagery, the rolling farmland surrounded by mountains. And, I walked everywhere.”

“And, of course, Oaxaca Cultural Navigator was my bible.”

How did Kathy manage on a strict student budget?

She bought pre-cooked food at the local market, purchased prepared yogurt mixed with fresh fruit, cooked beans, rice, red pepper, and choyote squash in the house she was staying where she had kitchen privileges.  She drank the purified water and didn’t brush her teeth with tap water!  She didn’t get sick :)

“Every day, someone would come to the clinic with a frozen milky drink flavored with cinnamon (horchata) that we would all buy for 40 cents each.  That was a highlight of my day,” Kathy remembered with a smile.

Kathy will receive university credit for this experience after she writes and submits a paper under the guidelines of the global study program at the school of nursing.

Norma Hawthorne works with accredited schools of nursing to place talented student volunteers for two- to six-weeks in public health clinics in Oaxaca.  If you would like to discuss this opportunity for summer 2012, please contact me.  (The relationship must be with the university/college rather than with individual students.)