Category Archives: Tuxtla Gutierrez

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After finishing my official month at the hospital, I stayed on in Tuxtla for another ten days with my family, enjoying the freedom to sleep in, help out around the house, and await Josh’s arrival in Chiapas. After nearly five weeks of living on my own, I couldn’t quite wrap my head around the thought of living as a couple once again. My time alone in Tuxtla had taught me an incredible amount about myself that I simply would not have learned in the same way if I was traveling with someone else. From the seemingly mundane (but for me, actually quite revolutionary!) lesson of learning to appreciate and even enjoy technology, to the possibly life-altering opportunity of being forced to work in both the ER and Pediatrics, to the maddeningly frustrating yet impossibly proud moments of having to depend solely on my own Spanish skills for communication, to the terrifying yet indescribably rewarding moments of having to depend solely on my own social skills for friendship… Because of experiences like these, I’ve always found it incredibly valuable to spend some time apart from each other, continuing to build our individual lives, and then also adding all the new lessons and challenges learned as individuals to our shared married life.

But as amazing as travelling alone can be, and as amazing as married life can be, the truth is that the transition between the two can be tricky. However, the Tuxtlayork crew were incredible (as they tend to be) at immediately welcoming Josh into our group and planning a week full of activities to show off our beloved Chiapas. As the experienced Chiapeneca, I got to play hostess to Josh, instructing him in the art of combi-riding, introducing him to the wonders of the Cañón del Sumidero, and ensuring that he was well-versed in the flavours of Tuxtla, including my favourites of michelada and tascalate. With Tuxtlayork, we returned to Sancris for a final weekend, and from Sancris, left on a twelve-hour round trip to seek out some of Chiapas’ maravillas:

Sancris 4.0: Columbian arepas, Mercado de dulces, & Maya Vinic fairtrade coffee!
Arepas!!
Dulces
Yes, that’s a chingón of souvenirs!
Maya Vinic

Las cascadas de Agua Azul
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Agua Azul

Misol-Ha (where Josh beat us back to the bus by swimming across, rather than walking):
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Palenque: site of Mayan King Pakal’s legendary reign
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Site of torture and subsequent decapitation of criminals (yep, the torture seems gratuitous)
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With all our exchanges coming to an end around the same time, our final few days in Tuxtla were a blur of goodbye dinners and tearful hugs. We kept each other positive by talking about next summer – Sandra was going into her final year of medicine, so we decided a combination celebration/reunion was absolutely essential. The only question remaining is in which country it will be held!

Jammin’ … classic setlist of Radiohead, Romeo Santos, Fall Out Boy, and Heathen Eve originals
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Despedida 1.0 😦
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Marimba lessons from the experts
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Beautiful farewell dinner (complete with Mexican sushi!) with our host families
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Far sooner than I was ready for, it was our turn to be dropped off at the Tuxtla airport to catch our flight to Cancún and continue the next leg of our Mexican adventure. Thankfully, the airport was tiny enough that we could disregard all the PASSENGERS ONLY BEYOND THIS POINT warnings, and Valeria and Valeria escorted us with besos and a running photo-documentary all the way to the security checkpoint… at which point our final hugs were supervised by armed guards and the Valerias were then escorted back to the waiting area.

Despedida 2.0 😦 😦
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No es un adiós, es solamente un ¡Hasta pronto! a mi querida Chiapas.
And for the moment, es un ¡Hola! a Quintana Roo

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Tuxtlayork

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After a week settling into my new Mexican home, I was informed that another exchange student from Columbia would be arriving the next day, hosted by my host’s best friend (conveniently also named Valeria). As I tend to be, I was leery about introducing someone new into my comfortable Mexican life… but (as is so often the case), I should never have worried. Sandra “La Columbiana” arrived in full force the next morning, flooding Mexico with “usted” (the respectful form of address is used almost exclusively in Columbia, even between dating couples) and exclamations of “chiquitico” and “poquitico” (the Columbian diminutive form manages to be even more adorable than the standard Spanish diminutive).

Warm, generous, wildly affectionate and wickedly hilarious, Sandra was a welcome addition to my exchange experience. From our first day spent together exploring the many parks of Tuxtla, it was evident that the four of us fit comfortably together, and rarely a day or night passed without us going out for micheladas, going out dancing, or sleeping over at one of the Valeria’s houses.

La Marimba, Chiapas’ signature sound, de la Parque Chiapasonate   

Getting pulled into a sexy catwalk/dance contest hosted by a clown in the park. After some Ukrainian Baptist dance moves that I believe only thoroughly bewildered the crowd, La Canada won second place! My prize? A light-up hippo keychain and a heart balloon.    

The next week, we found out that one more exchange student would be joining Tuxtla for the summer – a chico from Venezuela who was studying medicine in España. We went to his SCOPE welcome dinner more out of curiosity than anything: he was a research student while the rest of us were clinical students, and he would be living on his own by the university campus instead of with a host family, so the expectation of seeing him regularly was low.

However, Andrés had the definition of buena onda, the Latino description for that indescribable quality possessed by truly genuine people that irresistibly attracts you to them. Impulsively, we invited him out with us the next night for more micheladas… which turned into a uninterrupted string of beautiful days and impossibly fun nights together.

In all the roads I have travelled, las cascadas de Aguacero is the most breathtakingly beautiful place I have ever seen   

Enjoying pollo asado for lunch after miraculously keeping it dry walking through the falls  

Reina de la cascada! 😛 (gracias a Valeria para encontrar mi corona jajaja)            

It wasn’t only the insane weekends spent dancing until 6AM in Sancris that made our time together unforgettable (although those certainly helped 😉 ). It was also the mornings after dancing, when we’d go out for breakfast empanadas at noon in the Mercado de los Dulces and argue about body image and health education in our respective countries. It was the long afternoons in Andrés’ apartment, watching Amityville Horror (not my choice, I assure you!!), eating Rockoleta chili suckers, and discussing our countries’ views on homosexuality, our own views on sexuality in general, and all the social/political/religious/personal elements that affect our relationships whether we want them to or not. It was sharing stories about taking night shift at the hospital, our agreements and disagreements regarding doctors’ bedside manner, our arguments about antibiotic use. It was the twelve hours round-trip to Palenque that we spent crammed in a combi together, careening through the jungle and tipping precariously over mountain cliffs, trying to sleep wrapped around each other like the canned tunafish we shared for supper on the road. It was the long afternoons spent lying on Valeria’s bed, sharing pictures from our incredible day and stupid memes on Whatsapp.

While out dancing at a club in Tuxtla, we got our photo taken for a local pop culture magazine. Apparently I’m a bigger deal in Mexico than in Winnipeg!

Sancris 2.0
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Afternoon sliding fun at Rancho Nuevo with new Sancris friends
  

Sancris 3.0: Midnight birthday celebrations with more wonderful new friends  

“Hay figuras…” Informative and hilarious guided tours through Las Grutas by local kids    

This is the golden reward of an exchange. Unlike, say, a conference, where you have the opportunity to talk to people of different backgrounds and cultures, but only for an isolated moment in time; an exchange gives you the gift of actually living and breathing and eating together in a real snapshot of your life. Having the gift of time allows you to spend time doing absolutely nothing together, thus cultivating a level of comfort that paves the ground for even more genuine conversations. And surprisingly, it is the in-between times, the times between ridiculous adventures and intense conversations, where you learn the unexpected things about yourself and others that you can both laugh at and challenge each other on.

We were five individuals of different ages, skin colours, faith backgrounds, language backgrounds, travel histories, sexuality, and definitions of family. One of us can’t handle spicy food. One of us doesn’t drink. One overuses antibiotics. One didn’t know what cystic fibrosis was. One of us was terrible with changes of plan. One was terrible with punctuality. We were all medical students, all determined to improve the health of our world around us in some way, with different resources at our fingertips, different supports at our back, different goals in front of us. And wherever we went next, we would all be immutably changed by our time spent together in Tuxtla Gutierrez, Chiapas, Mexico.

Valeria, Valeria, Sandra, y Andrés, como podría describir la importancia de su amistad en mi vida? De nuestros conversaciones, de las historias de sus vidas, del tiempo que pasamos juntos, he aprendido un chingón de cosas de ustedes que van a cambiar mi vida por siempre! Muchísimas gracias para desafiar mis pensamientos y me daban apoyo y amor cuando lo necesitaba. Tienen siempre una casa y una amiga loca en Canadá! Los quiero muchísimos, mis bebés, y los extraño. #Cancún2016!!

“UPED” is also a 4-letter word…

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I have a confession to make: I have no desire whatsoever to blog.

I feel so at home here in Tuxtla that it’s easy to forget I’m supposed to be a traveller. The truth is, I’m not travelling anymore – I have my home here, a job to go to every day, friends I can make plans with, public transit I’m comfortable taking, new cellphone chargers to buy when mine dies. It’s only when I consider blogging that I remember my time here is temporary, and as a result, I have been avoiding this blog like the plague.

However, with the month drawing to a close, it is becoming difficult to ignore the fact that I have another life in Canada, and when I return to that life, I know I’ll want these blog posts to remind me of my home in Mexico!

Centro medico

Let’s backtrack a minute to A Day in the Life of el Estudiante Sarita, and to that fateful comment posted by a faithful reader: “Your new position doesn’t make for as harrowing a blog post but it sounds much better for you – way to go on suggesting a switch.”

Now, let’s fast-forward to a week after I had comfortably settled into my routine in Pediatria. On Friday afternoon, after my regular debriefing with la Doctora, I kissed her good-bye and told her I’d see her on Monday, to which she responded, “Oh, I won’t be here on Monday – I’m leaving for holidays for the next 2 weeks!”

… say what?

I bemusedly contacted Lizeth, my exchange coordinator, informing her that my placement would need to change yet again, and somehow she worked rapid magic and found me a placement for the next week.

Remember my comment from my first week, about how I had little interest in Emergency and even less in Pediatrics? Well, the fates decided that I was giving up on both too soon, and I was to report the next work day to …
*drumroll please*

Las Urgencias Pediatricas Emergency Department (UPED).

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Note the makeshifts tent set up along the gates, where people sleep while waiting for news about their family members
Tents

Upon arrival, I was introduced to Miguel, an incredibly kind if incredibly fast-talking interno (Year 5 of 6 in Mexican medical education). Our introductions were suddenly interrupted by shouting behind us, as the doctor doing rounds engaged in a heated debate with a nurse and a resident regarding a discrepancy in patient care. I have never heard so many creative variations of groserías as I heard coming from that doctor’s mouth. As his tirade was winding down, Miguel nudged me. “Go introduce yourself to that loco,” he whispered. “That’s your supervising doctor.”

Hesitantly, I approached the doctor, who was, self-admittedly, completely loco and not one to mince words when he felt his staff was slacking off. But he was also an amazing doctor, devoted to his patients and passionate about improving their level of care and his staff’s skill level. He warmly greeted me, and instructed Miguel to provide me with every possible opportunity to learn during my time in UPED.

UPED

Miguel took this to heart and took me under his wing, immediately walking me through the process of how to take a patient history for new entries, how to fill out a lab req, and where to drop off blood samples (Quick reminder: This is all in Spanish. Oy vey, my ears were bleeding from trying so hard to listen and absorb everything!) However, as Miguel and I were taking down the patient history of a 6-year old with a ruptured appendix, there was another flurry of activity as the surgeon came striding into the ER – there was a 3-year old with a perforated intestine requiring even more emergent surgery, and I was informed that I was to accompany them into surgery.

I do not know how much more clearly I could have stated, “I HAVE NO CLINICAL EXPERIENCE IN SURGERY. I HAVE NEVER SEEN A SURGERY BEFORE.” Before I knew it, I was on the surgical ward, changing into Miguel’s borrowed surgical scrubs and frantically trying to listen to how I was to scrub my hands and what to do with the surgical booties and where to stand so I wouldn’t contaminate everything. The surgical resident was extremely personable if extremely brusque, and as he was unpacking the sterile trays, he showed me each instrument and told me its name. I tried to absorb as much as possible, but since he was only showing me everything once and since I was very clear that it was the first time in my life I had ever seen these things – in English OR Spanish – I was assuming this experience was more of a bonus teaching session.

Assume nothing. Behind us was the operating table with the tiny patient already anesthethized, and within minutes, the surgeon was on one side of the table, the resident on the other, and I, the first-year exchange student, was beside the resident as the instrumentist for the surgery.

Pardon my Spanish, but ¡¿QC?!

Long story short: They quickly realised I meant it when I said I had no surgical experience, and another resident was called in to act as instrumentist. Once the resident took over as instrumentist and I was able to simply observe the surgery (which was all I wanted to do in the first place!), I was in awe. This was (as I have mentioned many times!), the first surgery I have ever seen, and it was beautiful. Watching the surgeon delicately slice through each layer of tissue, cauterizing the edges of the cut to control the bleeding, that distinctive smell in the air, the metres of intestines that literally came ballooning out of the body once they were freed from their confined space… The human body is incredible, amazing, miraculous, and powerful, and to see it exposed so carefully was a true gift.

(Speaking of gifts, the surgery occurred on my sister’s birthday, and I kept wondering what her reaction would be if she were in the room :P)

Once the perforation was corrected by resectioning 20 cm of intestine (which were handed to me with the instructions, “Guardalo.”) and a stoma made in the side of the patient, the pinch-hitter resident and the surgeon left me and the original resident alone to sew up the incisions. And I kid you not – completely scrubbed up with only our eyes visible, standing on opposite sides of a draped patient with a gaping open abdomen, with my finger acting as an anchor for the stitches holding the abdominal wall together – the resident casually started to flirt with me. Oh, los Mexicanos!!

Once the incision was closed and cleaned, the resident left to chart and the nurse handed me a plastic bottle containing the 20 cm of intestine, and asked me to go prepare it in formaldehyde. I wandered into the hall, clutching my intestine bottle, and eventually found some very nice healthcare aides who took me to a jug of formaldehye sitting in the hallway and helped me syringe in enough to cover the sample. At this point, the resident had me fill out a Pathology report, then instructed me to go change. In the change room, juggling my borrowed scrubs, the Path report, the intestine, and a can of Coke the resident insisted on buying for me, I had a brief out-of-body experience and wanted to break into uncontrollable laughter.

Instead, I changed and met the resident in the ICU, where he proceeded to hand the intestine bottle to the patient’s mother, informed her that here was what had caused the problem, and pointed her to her daughter’s bed. He then turned to me and said, “Well, quieres una otra Coka?”

El tor de Chiapas

That was my first day in las Urgencias Pediatrias. And though I frantically reviewed and quizzed myself on all surgical instruments that night, I did not go back into the OR. Instead, the rest of my time in the hospital was spent finally being useful. I was comfortable enough with the layout of the hospital and in my lanugage skills to actually be able to type up patient charts, collect lab results, fill out reqs, and drop off samples at the lab, even understanding when there was an issue with one of the reqs and being able to correct it myself without having to bother an intern. The UPED staff were incredible to work with – so patient with my language skills and constantly finding things they could teach me how to do so I could do them myself. Los internos invited me to stay on for la guardia (night shift) one night, and it was very satisfying to be further included as a part of their team.

Friday was my last day in the hospital, and when one of the doctors found out, he started giving the interns a hard time, “Where’s her cake? It’s la canadiense’s last day, of course we need a cake!” I laughed it off as a joke, but sure enough, later in the day, Miguel came running in with a bakery box, and soon the entire UPED staff was gathered in the break room, toasting me as I cut the cake.

Gracias por el pastel, Dr. Keeven!

Los estimados doctores del UPED
UPED doctores

La buena gente del UPED 🙂
Internos de UPED

To make it a truly authentic Urgencias fiesta, after about 10 minutes of relaxing together, another doctor came running in, shouting, “There’s a head injury outside, the patient is seizuring!” With this, everyone shoved the last bite of cake in their mouth and bolted outside.

My time in Mexico has taught me too many things to count. But possibly the most surprising, and the most potentially life-changing, is that as much as I cannot believe I am about to admit this…

I love Peds. and I love Emerg.

And I have no idea where I will end up next!

Outside the hospital

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