Tag Archives: medicine

Thanksgiving and Frida Kahlo, Hospitals and Recovery

It’s Thanksgiving Day 2014. I’m at Duke Regional Hospital in Durham, North Carolina recovering from knee replacement surgery in a hospital bed that reclines to any position at the touch of a finger. In the past twenty-four hours, Frida Kahlo has often entered my mind.

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Mostly because she did such a miraculous job of hiding her pain and her deformity when medicine at the time did not offer sophisticated drugs or surgical techniques. She adorned herself in jewelry and costumes to focus attention to her upper body.

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Mostly because I want to look “normal” just like she did. Friends will come to visit today with good cheer, turkey and mashed potatoes in hand. My bandaged leg is under a blanket, my lipstick is applied.

Mostly because having surgery is a solitary experience, even surrounded by flowers, accompanied by Facebook, family and friends who are with me in this virtual world. Frida did not have Facebook and WhatsApp to connect her. She had her imagination and insights.

She reached out to connect by looking in the mirror that still hangs above her recovery bed in Casa Azul, paintbrush and canvas in hand, sketchbook and pencil in hand, to express her feelings about life, death, politics and Diego.

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I have my knitting at hand, my dreams rumbling around in my mind and my plans for the new year formulating.

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When I left Mexico City last week to return to North Carolina for this surgery, I kept the image of Frida on her bed with me. Her effigy was draped in an indigo shawl reflected in the mirror above.

My knee will heal and the pain will subside. This is more than a hope. It is knowledge that my care team led by Dr. Rhett Hallows, a Duke orthopedic surgeon, is expert. Afterall, I did interview four surgeons in September!

Today, one day after the procedure, I used day-glow pink, duct-taped crutches  to walk my first three hundred and one steps down the hospital corridor. The goal was three hundred, but my friend Mary Ann said, go on, you can do one more. So, I did.

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I am reclined in my hospital bed ready to welcome visitors. I give thanks for the gift of life as it presents itself each day, each moment a different experience and not as I predicted.

It is a perfect day for giving thanks, to my family and friends, to the strangers who care for me, and to Frida’s memory, a woman who endured hardship and pain. Frida is a model for what it means to transcend, create and live large.

Happy Thanksgiving, everyone. I am grateful you are a part of my life.

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Looking for Frida Kahlo and Diego Rivera Art History Study Tour, April or July 2015.

UK Medical Student Talks About Health Care in Teotitlan del Valle, Oaxaca

Edd Morris grew up in the United Kingdom (UK) on the Wales-England border.  He just finished medical school in London, England, and decided to return to a Spanish-speaking country to volunteer in a community service project before going on to a two-year hospital residency back home.  He has a passion for people and community health.  When he contacted us about coming to Oaxaca, we helped place him in the Teotitlan del Valle public health clinic. Here is his story.

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“I’ve always wanted be a General Practitioner (that’s what we call Family Doctors in the UK) and so I thought it would be an incredible opportunity to volunteer in a community clinic in rural Mexico.

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[Photo above left: Doctora Elizabet, clinic director, with Edd Morris.  Photo above right: Edd with patient and Dr. Jonas.}

I’ve been here for a month, working alongside the doctors and nurses of the Teotitlan de Valle Centro de Salud. I’ve observed consultations and undertaken my own, too.  I’ve accompanied the nurses on a community vaccination drive, And, I’ve dressed a lot of wounds and ulcers!

One programme here really caught my imagination. It’s called Oportunidades, and it’s a national social support system offered by the Mexican state.

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[Photo above, left to right: Ms. Mayra, administrative manager, Dra. Elizabet, Edd Morris, Dra. Guadalupe]

Through Oportunidades, disadvantaged families can receive financial support from the Mexican Government, as long as they fully participate according to the plan.

There are different strands to the programme — the children in the family must attend school and the head of the household is required to go to seminars about healthy living, for example.

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[Photo above left: Edd with village community service in-take volunteer, and above right, with nursing staff.]

Healthcare is a crucial aspect. Everybody who participates in Oportunidades  must attend a six-month health check with a doctor, and children must be up-to-date with all their vaccines. Doctors should bring up relevant issues at every health check-up.  For example, it is important to discuss pregnancy prevention with adolescents.

In Teotitlan, Oportunidaes participants are also asked to take part in group exercise. I went running with the men’s group last Thursday, then we played a 60-minute soccer match (it was exhausting — I was the one who almost needed medical help when the game ended!)

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[Photo above left, Edd with Dr. Pablo, and right, with Norma Hawthorne]

Families who demonstrate their engagement with the Oportunidades programme then receive financial support from the government. The money is paid directly to the bank account of head of the household – effectively wiping out any diversion of funds.

What’s even more impressive is that the role of head-of-household is always delegated to a woman. Mexican research has shown that when a woman receives the money, she’s much more likely to spend it on her family and children – exactly those the programme is meant to support.

Oportunidades is a really impressive programme and the doctors tell me that it’s been successful at breaking the cycle of poverty. Like any large-scale initiative, it’s not perfect or infallible, but it’s one of the things which really impressed me with healthcare in Mexico.”

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[Public health messages throughout the town help educate people about health prevention, including dental care, diabetes, heart and respiratory illness, and more.]

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Edd Morris leaves Teotitlan del Valle, Oaxaca, on June 18, 2014.  When he returns to London, he will begin work at Queen Elizabeth Hospital, London  which serves a diverse, low-income population.  He receives his official medical degree from St. Georges, University of London (www.sgul.ac.uk) in two weeks. Edd remarked about what a rich, meaningful and culturally diverse experience this has been to have a direct connection with the local population.  What he learned will help prepare him for the next step in his profession. From all accounts, everyone he has come in contact with has enjoyed knowing, working with and hosting him here.  When are you coming back? was a question I heard all day.

We are accepting applications for volunteers to serve in the public health clinic for 2014 and 2015.  You must be a student in a baccalaureate or masters degree program in the following fields: nursing, medicine, physician assistant, and be a Spanish speaker with at least one-year of university level language skills.  If you are interested, please contact us.

 

Best Medical Care in Mexico City and Oaxaca

Where to get the best medical care in Mexico and in Oaxaca, has been foremost on my mind for the last month. Here are recommendations.

We are still reeling from Suzie’s accident on February 20, when the guide/driver of the car she was riding in hit a concrete barricade on the way to Teotihuacan. The UNESCO World Heritage site in the Estado de Mexico, is about 30 miles northeast of Mexico City. On impact, Suzie suffered a traumatic head injury and went into a coma.  The ambulance took her to an public emergency clinic (not hospital) in Coacalco de Berriozobal, located between the pyramids and the city. They were poorly equipped to handle this type of trauma and it took us hours to get her moved to receive proper care.

Best Hospitals in Mexico City

  1. ABC Hospital Observatorio Campus. Telephone for Emergencies, 55-5230 8161. American British Cowdray Hospital is known to have the best medical facilities in the entire country. It is accredited by the Joint Commission International. Doctors and staff are bilingual. Emergency medicine is top-notch. This is where you want to be to get attention you deserve as a human being.
  2. Angeles Hospital, Agrarismo 208, Col. Escandon, Mexico City, Del Miguel Hidalgo C.P. 11800, Tel. 5516 9900. Elena Hanna says she got great treatment here for an emergency and doctors/staff speak English.

Best Medical Care in Oaxaca City, Mexico 

After the accident and in preparation for upcoming workshops, I am now requiring that all Oaxaca Cultural Navigator LLC workshop participants have health/accident/emergency evacuation insurance coverage. I recommend the same for you.

Then, because it is essential to know, I researched the best emergency and general medical care available in Oaxaca City, asking Oaxaqueños and long-time ex-pat residents. Here is what I found out to share with you.

Best Hospitals in Oaxaca City

  1. Hospital del Valle, Eucaliptos 401, Colonia Reforma, Oaxaca, Oaxaca.  (951) 515-2563

  2. Hospital Reforma, Calle Reforma 613 near Humboldt,, Oaxaca, Oaxaca, (951) 516-0989

  3. Clinica Hospital Carmen, Abasolo 215, Oaxaca, Oaxaca, (951) 516-0027
  4. Clinica Las Rosas for ophthalmology, Las Rosas 308, Colonia Reforma, Oaxaca, (951)513-9030

Best Doctors in Oaxaca City

  1. Javier Guzman, M.D.,  Sabinos 204, Colonia Reforma, Cell: 044 (951) 548-1245, general surgery, diagnostics
  2. Alberto Zamacona, M.D., Libres 610, Oaxaca, Oaxaca, (951) 513-6422 and (951) 130-8730, general practitioner, bilingual
  3. Ramon Mondragon, M.D., on Pino Suarez, (951) 514-2306, (951) 515-7259 and (951) 547-0054, cardiology

Best Dentists in Oaxaca City

  1. Dr. Rafael Medina, Cielo 203, Lomas del Creston, Oaxaca, phone: 52 951 513 9520. His partner is Dr. Edgar Barroso who specializes in crowns and root canals, recommended by Leslie Larson.
  2. Dr. Angel Gomez, recommended by Tom Holloway.
  3. Dr. Daniel Tenorio, Abasolo, recommended by Jo Ann and Tom Feher.

 

Please contribute to this list by adding  a comment about “the best” from your experience!

I want to add these BESTS: neurosurgeon, dentist, oncologist, dermatologist, and any other fields you think would help people seeking high quality health care and emergency treatment in Oaxaca.  Thank you.

Travelers Note: It may be worthwhile to consider making your own list of best emergency medical facilities and doctors wherever you are traveling to next. Accidents happen and you don’t want to be caught by surprise or without enough time to respond quickly. When I go to Barcelona and Fes next autumn, I intend to do just this!

Suzie Update: Her brother tells me she is being moved to a long-term care facility that helps people with her kind of injury. She is opening her eyes and moving her feet and remains in a semi-coma. Suzie is a Licensed Clinical Social Worker employed at University of North Carolina at Chapel Hill student health services where she worked with students. Talented and loved.

 

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.

 

 

Getting Sick in Mexico: Precautions, Remedies and Reassurances

Getting sick in Mexico is something people don’t write about much.  But, every traveler and even residents can be periodically affected.  Our U.S. sanitation practices are super vigilant, many often think to the extreme.  We have a public health awareness imbedded into our culture.  Mr. Clean in everywhere.  The New York Times recently published Let’s Dirty Up Our Diets (or there’s nothing wrong with a little good, clean dirt in our food).  We don’t have much, if any, and perhaps this is what makes us less resistant and more vulnerable to international travel.

The kind of “being sick” I’m talking about is not the common head cold that we often pick up on airplanes or what’s known in Oaxaca as La Grippa (influenza).   I’m talking about the gut-wrenching, vomiting and diarrhea kind of sick that knocks you over and wipes you out, tethering you to a bathroom for 24-36 hours.  I’ve been this kind of sick in Mexico even after being here a while.  Mexicans get this, too.

I’ve avoided writing about this for the almost six years I’ve had this blog.  It’s not a pleasant topic and I don’t want people to think that Mexico is dirty and unsafe.  It is just different here.  Mexico is not exactly the Third World nor is it the First World.  There is incredible prosperity here and also abject poverty.  Poverty and lack of public health education breeds disease.  In rural public health clinics, even basic hand-washing is not a universal practice.

With lack of infrastructure and poor water quality, everyone who can afford it will drink and cook (and brush teeth) with bottled and purified water.  If they can’t afford it and are smart, they will boil water that comes from the local water sources.  Tap water is a No-No.

Tourists crave fresh fruits and vegetables.  They must be washed very carefully, peeled with clean knives and treated with drops of disinfectant.   That means we must know our food preparer, and even then, it’s iffy.  Sin lechuga, no lettuce, I tell our workshop participants, unless you are in a highly respected establishment (hotel, restaurant) that caters to tourists, and sometimes … even then …  We are particularly vulnerable at street stalls and small cafes where food preparers take the money and also prepare the food without hand washing in between.

Precautions.  Let this be a word of warming:  Be aware of what you are touching.  Those nasty germs travel quickly from hand to mouth (or eyes or nose).

  • Buttons on the ATM
  • Door handles (in and out of taxis, especially) and hand rails
  • Shaking hands (a common respectful practice here)
  • Handling money
  • Arm rests on buses
  • Canned soda tops
  • Counters and any other surfaces
  • Touching objects at flea markets
  • Baggage handlers
  • Et cetera!  You get the picture.

Now, I’m not trying to scare you.  I’m trying to raise your awareness.  It’s not possible to avoid touching everything but it IS important to be conscious and diligently keep your Hand Sanitizer handy and use it liberally.  Any time you are in a public place you are vulnerable.  Until we eat a little more dirt in our food and build up our immune system, I would rely on the hand sanitizer.

Mexico no longer dispenses the anti-bacterial Ciprofloxicino (we know it as Cipro) over the counter.  You need a prescription for it.  Thus, if you have not come prepared with your own medication that you have gotten in your home country as a precaution, then you must see a local doctor who will prescribe.

Many pharmacies (Ahorro in Oaxaca, 20 de Noviembre a block from the Zocalo  or in Puebla, Farmacias Similares, 10 Oriente #4) have a Doc-in-the-Box clinic right next door.   Here, you wait in line (often less than 10 minutes) until you can be seen and interviewed about your ailments.  You might even be asked to undergo a more thorough examination that includes getting on an exam table, having your blood pressure taken, and listening to your vitals.  Only then will the doctor give you a prescription that can be filled immediately.

Now, the trick is, when you are tethered to the toilet, how do you get to the doctor to get an Rx?  You might have to send a surrogate.  But no doctor will write a script for someone who is not there.  So, becoming an actor or actress to be there and translate the symptoms takes on even more import.   If a friend or relative can’t do this, then come prepared and bring your own meds with you!

Remedies  (for vomiting, diarrhea, stomach ache):  THIS IS NOT MEDICAL ADVICE–only public health information with dosages prescribed by a Mexican physician!

  1. Ciprofloxino (antibacterial)—a seven-day series
  2. Meclizina/piriodoxina—3 pills daily for 2 days for nausea
  3. Clonixinato delisina butilhioscina, 3 pills daily for 2 days for stomach ache
  4. Plenty of fluids, preferably electrolytes to stay hydrated

The doctor’s visit will cost about 30 pesos.  In today’s dollars, that’s $2.16 USD.  Three prescriptions and three bottles of electrolytes cost 240 pesos or $17.29 USD.

Reassurances

This IS something you can deal with if it happens to you.  It will set you back a couple of days, but you will recover with good medicine.  And, Mexico is worth it!