Monthly Archives: June 2015

Between the Zoque and Tzotzil

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My first morning in Tuxtla, Tio Milton was back bright and early to take Valeria and I to los miradores del Cañón del Sumidero, a winding road up the mountain with glorious views of the canyon below. This area is linked to the Chiapa people, who occupied the Central Valley area before the arrival of the Spanish. Their main settlement was in Chiapa de Corzo near the canyon, with a fortified area higher up for protection from invasions. The Chiapa fiercely resisted Spanish conquest for years, with their last refuge in the fortified area, now known as the archeological site of the Ruins of Berlin. When the Spanish took over the main city in 1528, the Chiapa still retained their stronghold until 1535. Legend has it that when this last fortification fell, the remaining Chiapa committed collective suicide by jumping into the canyon. Since then, the canyon has served as a boundary marker between the Zoque and Tzotzil peoples.

Miradores del Canon de Sumidero

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We then passed a relaxing afternoon wandering the streets of San Cristobal de las Casas (whose name in the Tzotzil and Tzeltal languages is Jovel, or “the place in the clouds”), visiting churches dating from 1528 and admiring Valeria’s haggling skills with the feria artists.

Iglesia del Carmen

For lunch, Milton treated us at Los Jardines de San Cristobal, a sprawling restaurant renowned for el buffet that gave me a chance to sample all Tuxtla’s favourite comidas: la sopa de chipilín, el cochito adobado, pollo con mole, platanos fritos, dulces de calabaza. To drink: el tascalate, a mix of corn, cocoa, achiote, cinnamon, and sugar (that I am slightly addicted to).

Valeria, Milton, y tascalate!
Jardines de San Cristobel

Jardines de San Cristobal

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The following weekend, Valeria and I returned to el Cañón, but this time, from abajo (below)! In the 39°C weather, Valeria and I and the other SCOPE students attempted to stay cool (ha!) by guzzling Chiapa de Corzo’s renowned pozol, an indigenous chiapeneco drink made from ground roasted white corn that is then mixed by hand with water, cocoa, and pochotl:

Pozol

We then rented a boat and spent the day exploring Chiapa de Corzo and el río Grijalva, keeping our hands safely inside the boat as we snapped photos of some of Grijalva’s more intimidating residents…

Sandra (SCOPE student from Colombia), yo, Valeria, y Diego (from Tuxtla)
La lancha

Diego and Valeria can be frightening 😉 but they’re not whom I’m referring to…
Cañón del Sumidero

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Faces in this photograph are as amazed as they appear!
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Baby crocodiles!!!
Crocodilitos

Iguane

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Endangered American river crocodiles
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The Shrine of the Virgin Guadalupe in La Cueva de Colores (Cave of Colors), named for the filtration of magnesium, potassium and other minerals which colour the walls pink
Guadalupe

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The walls of the Canyon stretch up over 1000m
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Cascada Árbol de Navidad (Christmas Tree Waterfall): the “branches” of the Árbol are made by deposits from the waterfall which are then covered in moss.
Arbol Navidad
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Chicoasén Dam, one of many hidroeléctricas that provide power to 70% of Mexico (take note of the snack boat ready for service!)
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Snacky boat

Worn out and heading home
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***EDIT*** A month later, when Josh joined me in Chiapas, we returned to the Cañón and found that the cocodrilos were feeling even more photogenic this visit… we saw over 10 crocodiles in 2 hours!!
Baby cocos!
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A Day in the Life of el Estudiante Sarita

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• The alarm goes off at 6:15AM. Normally, I do not hear the alarm at first because it is set to the soothing sounds of birds chirping, but since there are nightingales that chirp all night outside my window, this is not very helpful. I should probably change my alarm.

• Go into the bathroom to try and coax the shower to (a) get at least quasi-warm and (b) provide at least a trickle of flow. If this is not possible, I can always wash my hair in the sink.

• Dress in my all-white uniform that I have actually come to quite like wearing, for several reasons:
1. Although it seemed insane to me to wear pants and a long jacket in +39C weather, you would be so hot no matter what you wore that at least in long pants, you’re not sticking to yourself (/the 19 Mexicans crammed into the bus next to you) with sweat.
2. Scrubs material is way cooler than dress pants.
3. I never have to think about what to wear in the morning, hallelujah!!!
4. From Day 1, I have never felt out of place in the hospital, even though I’m a different race, a different culture, and speak a different language. When I walk down the street, all anyone sees is yet another medical student dressed all in white.

Uniforme!

• Go downstairs for breakfast, which normally consists of a literal (yes, Phil Cook) heap of local fruit: mango, papaya, bananas, and cantalope. Once, for a special treat, they gave me imported apples 😛 Other breakfast essentials include coffee (from a local coffee finca) and tortillas. This morning, I tried to be helpful and prepare everything myself, but apparently committed a gross error: the minute Ubel walked into the room, he looked at my plate, aghast, “Sara, you didn’t warm up your tortilla?” When Magali walked into the room, he turned to her immediately, “Sarita is eating tortillas that were not warmed up.” “Sarita, ¿por qué?” she gasped, horrified.

Canadians, please take note: YOU ALWAYS WARM UP THE TORTILLAS.

Breakfast

• Get driven to the hospital by Ubel, where we talk about Canadian politics (all of Mexico will be well aware of my views on Mr. Harper by the time I leave!), compare prices between our countries (“Un coche es barato o caro? Guayaba es barato o caro?”), and learn English swears (please take note that it was not I who initiated the latter!)

Calle al hospital

• Report to la Pediatria for rounds at 8AM. Unlike las Urgencias, la hospitalización pediátrica contains about 20 beds, with only 2 patients in a room – and the rooms have doors that close! Of the 20 patients we saw, nearly half had severe fevers that were in the process of being diagnosed as either Dengue or Chikungunya, two mosquito-borne viruses that are endemic in this area. On the other side of the ward is a single large ward for los Lactantes (nursing babies), with 15 cribs arranged in a large circle around a central nursing desk. Dengue and Chikungunya are also problems in these infants, as is malnutirition, food-borne illnesses such as Salmonella, hydrocephalus (increased fluid in the brain), and encephalitis (inflammation of the brain usually due to a virus).

• Rounds are finished by about 11AM, at which point I either talk to other students about differences between our medical schools, discuss differences in healthcare policy between our countries with la Doctora, or spend some time researching the topic I’ll be asked to discuss during the afternoon Neuro consults.

• At noon, I leave for lunch. Sometimes, Ubel packs me a little lunch, which is always exciting because it has the potential to be absolutely anything. Once it was leftover pancakes folded around leftover salad, and once it was a hotdog and mayonnaise sandwich (and honestly, both were delicious!) Otherwise, I either walk to the cafeteria outside the Walmart across the street for gringas or quesadillas, or I walk to the OXXO and buy a yummy but bizarre sandwich that always insists on hiding some kind of pickled veggie. I usually eat in the hospital lunch room with Lizeth, one of the student SCOPE coordinators in Tuxtla, who has been my tour guide/translator/lunch buddy/general lifesaver!

Walmart parking lot

Family-run booths selling everything from tamales to Jell-O outside the hospital
Tiendas del hospital

Unas gringa para una gringa!
Gringas

• Between 3-5PM, I join the neuropediatrician for external consults. Each consult is about 30 minutes long, during which time I try to follow along as the neuropediatrician takes a detailed birth history and history of presenting illness (that 95% of the time is some kind of seizure) and then be alert to the very subtle look given by the neuropediatrician that is my cue to take the patient to the other room and perform the neuro exam.

I am now conducting the neuro exams on all the patients, which is alternately amusing, educational, and bien pinche dificile. Performing neuro exams on kids in general is hard (they think you testing their reflexes is hilarious, and therefore refuse to go limp because they’re too busy giggling); performing neuro exams on kids with severe disabilities is very hard (when a child cannot respond to their name, it is hard to communicate that you would like them to follow the movements of a little bell using only their eyes and nothing else); and performing neuro exams on severely disabled kids IN SPANISH? Let’s just say I am sharply honing every single non-verbal communication skill I possess!

I both greatly respect, am severely intimidated by, and don’t always agree with the neuropediatrician whom I am fortunate enough to work with for the month. While I often think that in Canada, we don’t expect enough of kids, I think there must be a happy medium between our two worlds. Here, I’ve seen suspicion of neurological damage when a 13-year old boy was asked what season it was and he responded (very appropriately, I thought!), “Summer.” The doctor paused, looked at him gravely, and then intoned, “What day is solstice, young man? Solstice occurs on June 21. Therefore, we still have three days of spring.”

So perhaps I too have neurological damage. 😛

However, whatever I may think about this doctor’s bedside manner, I am in awe of the patience and generosity of time he shows to me. At the end of the first day, it was already 5PM and I was ready to thank him and leave, when he asked, “Oh – do you need to leave immediately?” I turned to find him setting up his laptop where he had a presentation on hipertensión endocraneal ready to go, and launched into a mini-lecture. Every day after that, he has given me a subject to research for the next day (anything from classification of seizures to pathological reflexes to UMN lesions), and once consults are done for the day, he asks me to present what I’ve found while he adds in any missing information. He is intimidating enough that I would never dare slack off and not do the research, but there is also something very endearing about how much he wants to teach me that puts me at ease with him. I’ve also made him laugh twice, which I consider a supreme accomplishment!

• Around 5:30PM, I walk back outside into the blinding heat and catch my combi just across the street. Comfortably inconspicuous in my white uniform (which miraculously, even in rainy season and even with riding a crammed combi, somehow isn’t black by the end of the day!), I wedge myself between a nursing mother and an impeccably suited gentleman, and pass my 6 pesos up to the driver. I know I’ll barely have my foot in the door at home before Magali will be insisting I eat something and Valeria will be telling me where we’re going out that night, so I savour my half hour of solitude (well, as alone as you can be when you’re in the back of a truck with 19* other Mexicans) and look forward to whatever the evening will bring!

Combi-ridin’ combi-ridin’
19 of us and room for more!

Evening view from my front door
Sunset at home

*I didn’t want to publish false information in this blog, so I made a point to count the gente in the combi with me today.

“Plan” is a 4-letter word

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If my time in Mexico has taught me anything in the first week, it is to accept that initial plans ultimately look nothing like reality.

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When I first received my exchange placement, it was in the department of Neurology, which had been one of my chosen fields. When I was given the name of the doctor I would be shadowing for the month, I saw that my department was now Pediatric Neurology – different, but still within the realm of what I was anticipating. When I arrived at the hospital on Monday morning, crisp and shiny in the requisite all-white uniform, I was told to report to Pediatric Neurology consults from 3-5PM; but in the morning, to report to Las Urgencias — aka the ER.

Ready for anything… except perhaps what came next.
First Day!

Within ten minutes, I was at the bedside of an unconscious patient in the Shock room. “Hiciste un chest tube antes, si?” asked the ER resident (You’ve put in a chest tube before, right?) I think I literally laughed in his face, as I assured him most emphatically, “Uh… non!” I watched with shock and awe as the resident took an endotracheal tube and began sawing off a portion with his scalpel. “We don’t have the resources here to buy chest tubes, so we have to make do with what we have,” he explained as he made notches in one end and tied off the balloon valves. “It’s not the best chest tube, but the most important thing is to save the patient’s life.”

He counted ribs, numbed the area with Lidocaine, and made his cut. “Venaquí,” he instructed me, holding out a sterile glove for me to slip on. “You can feel where to insert it?” Suspended in disbelief, I watched myself wiggle my finger in between the patient’s ribs, trying to find the space to insert the life-saving tube that would drain the fluid and blood from around his lungs. The resident deftly placed stitches, clamped the tube, inserted it through the cut – and immediately, a gush of frothing pink fluid poured out. This patient had a massive hemothorax (immediate evacuation of over 1L of blood after insertion of tube thoracostomy), requiring urgent surgery.

And thus began my introduction to Mexican medicine. Las Urgencias is a chaotic series of hallways lined with stretcher beds, with la Sala de Choque (the Shock room) as a separate salita with four beds for patients in shock. In Choque, urgent minor surgeries (like our thoracostomy) and CPR are performed, comatose patients are held, and in the middle of it all, a bespectacled senior doctor sits on a stool, ceaselessly churning out reports on a typewriter.

In the next few days in Las Urgencias, I attempted to take blood from a patient using a rubber glove as a tourniquet while transferring the blood into a test tube because vacuum tubes are not available; did an assessment on a comatose patient we were later told was pronounced brain dead; and correctly diagnosed a man with COPD from a distance (and only finding out later that the “EPOC” written on his chart was Spanish for COPD!)

I also spent many, many hours straining to just hear the doctor’s report. Not only is the noise level in Urgencias quite deafening at times, but I could not quite get used to the affect of the ER doctors… They would be lecturing a patient or delivering notes to their resident, when suddenly, with zero change in tone and definitely not even the slightest indication of eye contact (literally, they can have their back to you), they would be asking me a question on what process was contributing to the patient’s renal failure. I could not decide what was most challenging: knowing the answer to the medical question, understanding their rapidfire Spanish, or just frickin’ knowing when they were even talking to me!

For those reasons, I approached the exchange program about changing my placement. I loved the variety of cases I was seeing in Las Urgencias, but I had to admit that the atmosphere was not the most conducive to my learning. A senior Neuro student advised me to try and procure a placement with a Doctora in Pediatrics who was apparently “muy amable y tiene mucha pacienca con los estudiantes,” which was exactly what I needed!

Thus, from Neurology (in which I was interested but had no experience)
to Emergency (in which I had a glimpse of experience but little interest)
to Pediatrics (in which I have neither experience nor interest)…

Who knows where I’ll end up next!

But I’ll keep you posted ☺

Hospital Chiapas Nos Une

¡Bienvenida a Chiapas!

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After 13 hours of travel, I was speechlessly excited to look out my window and finally see my final destination. My first impression of Tuxtla was intensely green… In a rainforest rambling into jungles, in the middle of rainy season, with bright hot days and warm rain every evening, Tuxtla was putting out its finest for me. I disembarked, felt my hair grow 12x larger with the humidity, and walked into the terminal to find a smiling girl and man waving a homemade sign: “Bienvenida a Chiapas, Sara!”

Bienvenida!

My host family consists of Valeria, a first year medical student from Tuxtla, her brother Diego, sister Aránzazú (Zuzu), mamá Magali, papá Ubel, and crazy baby chiahuahua Toretto. Vale and her uncle Milton drove me to my new home for the month — past palmas and taquerias, fig trees and combis screeching to a halt, roadside tamal stands and the Mexican version of Squeegee-kids (except instead of Squeegeeing your car, they carry boxes selling everything from gum to newspapers; and instead of kids, they’re very respectable adults… it’s actually quite handy, like a little supermarket that comes walking past your car at every red light).

The minute we walked in the door, Magali kissed me and proclaimed, “Bienvenida a tu casa, Sarita!” This family is the type that not only says “Make yourself at home,” but actually expects you to do so. Within the hour, Valeria, Zuzu, and I had walked to the tienda, bought 8 different bags of chips (to make sure I tried all the different flavours), and were curled up on the couch to have a movie night, while Toretto licked my toes in a hostly fashion (and later stole my sock, which we have yet to find).

view from my bedroom balcony:
Bedroom balcony

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One of my first evenings, Valeria and her best friend Valeria (convenient to only have to learn so many new names) took me to la Parque de Marimba, where every single night there are live marimba bands and dancing! Afterwards, they instructed me in the art of both drinking michelada (beer, lime juice, and piquante seasonings) and in the art of shamelessly asking waiters for the nearly-untouched tapas platters leftover on other patrons’ tables 😛

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Parque de Marimba

Michelada

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The next evening, all the other SCOPE members took me out for Zoque pizza at a beautiful pizza place on the other end of town, where we impromptly become part of the birthday party going on next to us and were given free cake, as well as a free jarra of tascalate from the restaurant owners:
SCOPE & Zoque pizza!

Afterwards, however, the SCOPE team witnessed my most essential experience so far (/who are we kidding, most essential experience, punto.)

MIS PRIMEROS TACOS MEXICANOS.

PRIMERO TACO

Neurology knowledge will come. International trade relations will be analysed. But at least now I know I am truly in Mexico.

MIrador de Tuxtla

There’s (yet another) adventure…

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When I received the email from my exchange coordinator informing me that my accommodations had been changed from a private student apartment to living with a host family, I felt like things were finally falling into place for this trip. As evidenced by our adventures through Europe, I have found that the absolute best way to travel is to plan your travels around people, rather than places. Therefore, getting to live with a family during my time in Mexico promised to make this opportunity into something even more amazing than I had originally thought!

Happy FB news

But before getting acquainted with my new Mexican family, I first had to actually make it to Mexico… resulting, like all good trips should, in a travel adventure!

Josh and I rolled into Fargo around midnight, giving us plenty of time to hit up Buffalo Wild Wings before crashing into bed with the alarm set for 4AM in order to catch my 6AM flight out of Fargo. After an unreal goodbye with mi Josué in the airport, I was attempting to nap on the plane when I was suddenly awoken by cries of, “He’s collapsed! Somebody help! There is a medical emergency!”

An elderly gentleman had collapsed in the aisle of the plane right behind me, and the flight attendants came running with oxygen. They then made that announcement I truly thought occurred only in movies, “Is there any medical personnel aboard the aircraft?” I underwent a brief panicked ethical dilemma trying to figure out if I was responsible to try to do something if there was nobody else on board, but thankfully a very capable-looking doctor came bustling down the aisle of the plane. The attendants informed the plane that the pilot was on standby waiting for confirmation from the doctor about whether an emergency landing would be required. After a very confusing many minutes, the announcement was made that an emergency landing would not be required, but upon landing in Atlanta, paramedics still immediately boarded our plane and escorted the gentleman off.

After all that excitement, I was thankful for my long and relaxing layover in Atlanta, where I ate some very salty and fried things for breakfast before boarding my flight to Mexico City. Now, generally airports don’t fluster me, not even renowned massively huge airports like D.F. What flustered me was seeing that I had exactly one hour to both clear Customs and make my connecting flight to Tuxtla… and what panicked me was walking off the plane and into what I originally thought was the ground floor arena for a sold-out U2 concert, but was actually the “line” for Customs.

I stood in this line (read: at the back of a massive room filled with a massive amount of people, with the tiny Customs officials barely visible at the far other end) and anxiously chewed my nails to bits until finally asking the gentleman next to me if this was the only “line” to be in. I got the feeling that he had been stewing over things for awhile, because he immediately launched into a tirade against inefficient Mexican airport authorities who make tax-paying residents still stand in this line because they aren’t officially Mexican citizens, even though citizens barely ever fly so having a separate line for them is a horrific waste of resources… and then told me to try just getting into the Diplomats line. I had literally nothing to lose but a possible flight connection, so into the Diplomats line I went, behind a gaggle of Aerolíneas Mexicanas flight personnel and many dignified señoras in wheelchairs.

And I confess: upon arriving at the front of the line and being sternly confronted by the Customs official, who demanded to know what I thought I was doing in this line without proper paperwork, I shamelessly took full advantage of my confused-single-white-girl status and stammered many things about flights and information given to me and -insert pleading eyes here- … and was impatiently waved through Customs with time to spare.

(You get the idea)

Except for the small fact that my flight to Tuxtla was not listed on a single departure board. The first airport personnel I asked about my flight gave me a disgusted look and told me I was already at the gate (FYI, when I asked her this, I was definitely standing in front of a bank machine). The second person I asked pointed me towards the opposite end of the airport and said it would be posted there. Upon speed-walking the 20 minutes to the other end of the airport, the third person I asked informed me that obviously, it was Gate E2… which happened to be back where I had started from. Although, since my flight was still not on any Departures board, I consider it sheer magic that this person at least knew what I was talking about.

If at this point I wasn’t yet sufficiently aware of the fact that I was in truly in Mexico, I boarded the plane to Tuxtla only to have the man in front of me turn on his iPod speakers to blast the entire plane with marimba music. When the smiling flight attendant asked if he had headphones, he replied, “Well, I do… but then nobody else would be able to hear it!”

Bienvenidos a Mexico… the fun has just begun!

Bienvenidos a Chiapas!