Vocab Lesson: Puebla Style

I've been studying Spanish basically all of my life, but it's pretty safe to say that you don't learn words specific to different dialects in Spanish classes. Here are the top local words and phrases I had to learn and found useful during my time in Puebla:

Barbacoa: Specially cooked pork
Cemitas: Sandwiches with fried meat and (possibly) very spicy peppers
Chilaquiles: A breakfast dish of tortilla chips (and sometimes chicken) and a sauce made of either green or red peppers
Milanesa: Breaded meat fillets (any type of meat)
A la Parrilla: Charcoal grilled meat (any type of meat)
La Recta: An important highway that connects Cholula and Puebla
Sale: Okay
La UDLA: This is how taxi drivers referred to UDLAP
Zócalo: Town square

Full Circle

Highlight of the trip: I never imagined I would become so close with Savannah, DJ, and Alex. Now we have inside jokes and shared memories to last a lifetime. 

DJ was crazy for wearing a
long sleeve shirt on such a
hot day!

     We finished our trip just like we started it: breakfast at La Antigua. Savannah and I walked to our bittersweet breakfast looking forward to the meal but sad to leave. We even sat at the same table we did the first day we went to breakfast. Now, we knew what the items on the menu meant! I had the best chilaquiles I have ever tasted. Of course I would find really good food the last day we were there.

     After breakfast, we went to Dr. Bandala's house for a cookout. There was an abundance of food: hamburgers, hotdogs, watermelon, french fries, and guacamole. Dr. Bandala is apparently known for his drinks, and he made us some mojitos and also tinto de verano, a drink made with wine and cranberry juice. We tried a little bit of everything before chowing down on the dessert, chocolate tres leches cake. We decided to enjoy the sunny day and procrastinate packing up our stuff, so we sat outside and played card games for hours. It was a great way to spend our last afternoon in Mexico.

     The month flew by so quickly. It seems like we just got here. I cannot believe I am already back in the United States and thinking about getting back to work. I learned so much during my month in Mexico. From understanding more about health care, to increasing my speed when I speak Spanish, to appreciating cultural differences even more, I gained a lot more knowledge than I had hoped. I am sad to be at home and not have any travel plans in my near future, but I guess I do have to go back to classes at some point if I plan on graduating on time!

     I'll have to keep finding innovative ways to practice my Spanish, and I hope I keep in touch with friends I made in Mexico. I will remember this trip to Mexico for the rest of my life. I can only hope I find the time to return in a couple of years to travel and explore even more! As for now, I'm off to make some homemade ice cream with the bottle of Mexican vanilla! Wish me luck!

Every Minute Counts

Highlight of the day: There was a thank you banquet lunch for the study abroad students, and the food was great. There was a salad with bell peppers and tomatoes, and it was amazing. I put this onion mixture on it, not realizing how spicy it was. Just when I thought I was getting used to the spicy food, I was wrong again!

The medical "mail chute" was  awesome!

     There weren't any surgeries today, at least not before we left. I spent the day in the Emergency Room, and it was really interesting to compare it to the hectic ER at Hospital para el Niño Poblano. At Hospital Angeles, there were fewer beds in the ER, and of course the hospital was not limited to children. Possibly the coolest thing I have seen since we have been here was a chute for things to be sent to and from the ER. Lab results and medications could be sent through a tube, similar to the tube at the drive-thru in a bank. I was told that it is really helpful because then no one has to travel from a different floor or across the building in a time-sensitive situation.

This is one of the four
 observation rooms. There
were also three consultation
 rooms.  

    The patients in the ER today were easily diagnosed and mostly in observation rooms. A man, about 60 years old, fell and hit his head early this morning. He was diagnosed with vertigo and being observed while test results came back. A young woman, about 25, came in with a likely allergic reaction. Her arms were red, swollen, and splotchy. She also felt tightness in her throat. She was given a steroid injection to reduce the symptoms, and they were waiting for insurance approval to send her to the allergist for further testing.

These beds were for emergent patients. Today there weren't
any! There was also a pediatric room with smaller beds. 

     Right before I left, there was a boy about 13 years old who was rushed into surgery. In the ER, there are two operating rooms. The boy's parents were frantically filling out paperwork at the nurses desk, so the surgery could begin as soon as possible. Other than the entrance of the surgical patient, the day was pretty relaxed. I didn't mind the slow pace because all the doctors and nurses wanted to talk to me. We talked about Mexico, the United States, medical schools, private vs. public hospitals, and many more things. The best part is that they wanted to talk to me in Spanish. A lot of people here like to practice their English, so it was nice to only use Spanish for a few hours! It's hard to practice speaking Spanish at home, so every little bit I get to practice helps a lot.

 

19,000 Words

Highlight of the day: Spending the afternoon and evening with Savannah and Alexa exploring downtown Puebla was perfect. I loved getting to see the city again, and we each chose something fun to do. My pick was going on a bus tour of Puebla. 

A picture is worth a thousand words, right? That means my adventures today were worth 19,000 words. That's a pretty successful day! Unfortunately, I don't remember the stories and facts about the places we visited, but I can still appreciate the beauty.

Let me Check my Schedule

Dinner was delicious.

Highlight of the day: Savannah and I walked to the Zócalo for dinner. I had Mole Poblano and she had Chile en Nogada. We shared both dishes, and it was by far the best meal I have had in Puebla!

    This morning I was counting down the minutes until I could put on my sterile scrubs, cap, mask, and booties. I was so excited to cross the barrier and be on the surgical floor. Today our first surgery was a hysterectomy. The patient had a uterine polyp and was constantly having uterine bleeding and was having difficulty getting pregnant. She may also have been anemic, but the best course of action was to remove the polyp and see if the patient improved. The polyp was removed and sent to a lab to be examined more closely. The procedure was over almost as fast as it started. There weren't even any stitches!

   The second surgery was an arthroscopic rotator cuff repair. The procedure took about two and a half hours, which the surgeons said was good time. Dr. Chavaz was the leading surgeon, and a resident was assisting with the procedure as well. The patient was in the "silla de playa" or "beach chair" position for optimal visualization of the shoulder during surgery. There were three portals for the medical instruments, and the key to a good arthroscopic surgery is to have good portals. If the portals are in good places, it is easy to maneuver and complete the surgery quickly. If the portals are not aligned correctly, the surgery becomes much more difficult and there is more of a chance that the surgery will turn into an open surgery.

The OR used for the rotator cuff repair.

     The most interesting thing I noticed today was that surgeries done with magnifying cameras can be very helpful to both the doctors and the patients, but they can also be time consuming. In the rotator cuff repair, the surgeons spent most of the surgery working with placing stitches inside the shoulder. Every movement has to be really precise, and the doctor has to look at a screen to see what he or she is doing. Fun fact: males have to have a screen 180 degrees to perform at their best in laparoscopic surgeries while women are able to have the screen about 270 degrees away and still perform at the same level. I am impressed with how much can be done with such small surgical instruments.

    I don't think I could ever get tired of saying: "I'll let you know when I'm out of surgery," or "surgery ran a bit late today." It's so much fun getting to see the action! I hope we get to see some more surgeries before we leave.

Pure Ecstasy

Highlight of the day: After the surgeries were over, Savannah and I joined the Dr. Hayfeld, his wife, and the anesthesiologist for a snack. They ordered us "ecstasy juice," which was basically just a mixture of fresh fruits, but jokes were still made about the drug, ecstasy, as well. 
    
     I have to be honest here: I was beyond nervous to watch a surgery. I had never been inside the operating room and not been the patient on the table. I had butterflies in my stomach, but once the first cut was made, I knew I wanted to be in that room. Dr. Hayfeld made the environment really comfortable for us. He spoke English, but I tried to speak to him in Spanish as much as I could. Sometimes it is hard when doctors speak English, because they want to practice their English as much as I want to practice my Spanish. Dr. Hayfeld played upbeat music during the procedure. While we were waiting to go in, Savannah and I heard classical music coming out of an OR for a cesarean section. Music seemed to be a big part of each doctor's OR.

The vacuum looking device
was used for the liposuction.

      The first surgery was a lipectomy on an older man around 60 years old. The surgery itself took less than 30 minutes from the first cut to the last stitch. I was surprised it went by so quickly.  Before I knew it, the next patient was entering the room. This patient was in his early twenties, and he was getting liposuction done on his chest. The fat in his chest settled unevenly, so he wanted it removed. This surgery took a little bit longer, but Dr. Hayfeld found it much more boring. He said he liked surgeries with more blood and that were more of a challenge. He has about four or five liposuctions a month, which I thought was pretty low considering he works at a private hospital. Dr. Hayfeld told me and Savannah that he used to work at a public hospital, and there he performed almost no elective surgeries.

I gave DJ my camera at dinner
and we had a photoshoot. 

     At Hospital Puebla, there is a decent amount of medical tourism. Often it is cheaper to go abroad to receive a treatment if insurance in the United States will not cover it. In the northern states of Mexico, medical tourism is much more prevalent because of the proximity to the United States. Dr. Hayfeld and his wife were telling us that sometimes tourists have bad surgeries by doctors who pose as plastic surgeons or another specialty to receive money. This has become a serious problem in Mexico. We were all discussing this at a doctors' only cafe outside the doctors' dressing rooms. The doctors can order any food or drink they want, and they don't have to pay for it! This is a prime example of the differences between public and private hospitals. The doctors are revered, and the work is much more relaxed. Dr. Hayfeld said he performs two to three short surgeries a day or maybe one long surgery. He is given plenty of time to rest, and he really seems to enjoy his job. I hope one day I find a specialty I love as much as he loves plastic surgery. 

     After we got back, Savannah and I got lunch at UDLAP and then met up with the guys to walk around and get dinner. I apparently have a problem because I can't stop buying things when we go out. Today my purchase was a 500 mL bottle of Mexican vanilla. I'm so excited to go home and make a homemade vanilla cake!

Where the Air Gets Thin

The altitude was about three times as
high as at Appalachian State.

Highlight of the day: Breakfast was beyond words. I got huevos a la mexicana (Mexican eggs) at a little restaurant at the campgrounds. They were scrambled eggs with tomatoes and onions sautéed and mixed in. Nothing hits the spot quite like scrambled eggs with some vegetables and a nice cup of hot chamomile tea in the morning. 

DJ makes impressive fires.

     This weekend, DJ, Alex, Savannah and I went to the extinct volcano, La Malinche, to camp. I don't know how well you could consider it camping, because we stayed in a fully furnished cabin at IMSS Centro Vacional La Malintzi with electricity, a refrigerator, air conditioning, and more. We had to make our own fires to stay warm, and DJ was really good at that! We bought bundles of wood at a small store in the park. We went through 12 bundles of wood to keep the fire going as long as possible!
   

I got a cup of hot coffee
for about 50 cents to warm up.

     We were really lucky because Dr. Bandala, Alex and DJ's professor here at UDLAP, drove us to the park. If he didn't take us, we would have possibly had to take multiple buses and taxis (probably very confusing and a little overwhelming). Dr. Bandala's daughter, Alexa, came along and spent the weekend with us as well. It was nice having someone who understood everything and could take care of the little details for us! We accidentally took all back roads getting to the park, so it took twice as long as it should have. It was the "scenic" route, so the delay was definitely worth the extra time. The countryside of Mexico was beautiful with the rolling hills, mountains, volcanoes, cities, and towns all in view.

Some locals told us to come
look  at the poisonous
red mushroom.

    Finally, we made it to La Malintzi, and we put all of our things in our cabin. We brought a decent amount of food, but there was a restaurant on site as well, so we made some meals and sat down at the restaurant for others. We were told that the hike to the top took between eight and ten hours to complete. Since that didn't sound too appealing to us, we decided to try the shorter hike (between three to four hours). However, the hike was not as easy as I thought it would be. I'm not really sure why I thought it would be easy to hike up a volcano. The oxygen kept getting thinner, and the hike was basically uphill the entire way. I'm sure the view from the top would have been beautiful, but it was too difficult for me, Savannah, and DJ. We decided to hang back and walk slowly to take in the beauty. I'm glad we decided to not go too far, because it started pouring! Luckily we had decided to head back to the park when we heard thunder, so we made it to a little restaurant just before the pouring started.

  

We found DJ a new car!

     Once we were all down from the volcano, we decided to head back to our cabin to dry off and warm up. We played card games, listened to music, and made dinner in the cabin over the fire. Not having any cell service or internet access for a while was really refreshing. We all just hung out and got to be off the grid for about 24 hours. It was exactly the relaxing getaway I needed. I would definitely do something similar to this weekend again, just at a much lower altitude!

Breaks were very necessary on the hike.

I Found My Twin

Highlight of the day: Savannah and I must have been spending too much time together, because we have started answering questions at the same time and finishing each others sentences. Everyone always asks us if we are sisters, and now I see why!

     I knew it was going to be an interesting day from the start when Savannah and I were asked at breakfast to evaluate chairs based on their design, comfort, and stability. From there, we went to Hospital Puebla for a few hours. The hospital is private, so it is more difficult to simply shadow doctors. We had to get permission from many department heads before starting our time there, so we will really start shadowing on Monday.

The plastic surgery office - AKA the best office in the hospital

     While we were there, a doctor named Andrés showed us around. He really loved the fifth floor of the building because on that floor was the plastic surgery office. Andrés explained to us that the private hospitals are very different from public hospitals in Mexico. In private hospitals, the staff caters to the patients much more than in the public hospitals. There are about 220 doctors' offices, and then other doctors work on the floors where patients stay. The hospital has ten floors. The first floor houses the emergency room, cafeteria, pharmacy, and main offices. The second floor is the surgical floor. Floors 3-4 are filled with rooms for admitted patients. Floors 5-10 are doctors offices of different specialties. With so many different doctors, almost any specialty you can think of can be found at Hospital Puebla.

     After our tour was over and we had talked with many different employees, we headed back to Cholula. We are going back on Monday to spend more time in the hospital and hopefully see some surgeries; today was mostly just introductions. Since we were done so early, Savannah and I decided to walk into downtown Cholula. The best way to describe our afternoon is with pictures:

First, we stopped at a coffee shop and took in the views and
the refreshing breeze on the upper terrace.

After walking into little shops and even a local farmer's market,
we decided to explore the Zócalo (the center of Cholula).

After browsing artisan stands, we decided
 to go to the Convent of San Gabriel. 

Also in the convent was the Royal Chapel. This
is a picture of the back of the altar. The entire
church was decorated very ornately.

The church and convent were beautiful and very large!

Next it was time for a snack on the way back. We'd been
walking around for about four hours at this point. 

There is a really cute crepe place in downtown Cholula which
sells a "crepe of the day" for less than $2 USD. Today it was
raspberry and delicious!

     After five hours of walking, shopping, and eating, I was exhausted. Getting to spend time exploring Mexico was 100% worth the fatigue I was feeling. Now it's time to rest up for our last full weekend here!   

Back to the Beginning

Highlight of the day: I got an ultrasound on my arm to see how the muscles, tendons, and ligaments moved. It was so cool being able to watch how everything was working underneath my skin!

     Today I was reminded of what first made me love medicine. Seeing the athletes come in with painful injuries and watching the doctors help the athletes to keep going through their pain was one of the greatest things I've seen so far. I didn't give medicine much of a thought until I had suffered multiple injuries from dancing when I was younger. I am still grateful the teams of doctors and nurses who worked to get me back in tip-top shape. Now there is something about working with athletes that always gets me really excited!

     The first appointment today was for a girl who had been accepted to UDLAP on a sports scholarship for track. For her admission to be complete, she needed to be evaluated to determine her health condition. The evaluation included a strength test, flexibility test, knee laxity test, lung function test, and maximum oxygen consumption test. All of these tests came back normal, so she was given a clean bill of health to join the athletic department at UDLAP.

     An interesting patient today was a student with a contracted muscle in her leg. She presented with leg pain when stretching and straightening her leg, but the pain was not constant. Using the ultrasound, the doctors were able to locate where the muscle was injured and locate the referred pain. She was sent to physical therapy for three days and told to rest. Many student athletes have pulled muscles or strained ligaments due to overuse and dehydration. If the athletes all rested as they were told, many would not have complications later on. However, it is common for the athletes to keep pushing their bodies because of an upcoming game, tournament, or competition. Many athletes are thinking about their short term goals instead of their long term goals! For me, when I realized that I needed to think long term, I realized medicine was what really excited me.

It's Getting Physical

Highlight of the day: I can't recall ever waking up to a hailstorm, but today I was taking a nap and woke up to pellets hitting my window. Savannah and I ran around closing windows on our floor to try to stop the water and hail from getting inside. I'm hoping it'll stop soon, or else we'll have to get dinner delivered.

The physical therapy facility was really nice. I would
not mind going to physical therapy appointments here!

     Today we actually spent the day at UDLAP. We went to the Centro Integral de Rehabilitación. We spent most of our time today in the physical therapy portion of the center. They primarily see athletes, but other students and even non-students can come to the facility. On average, they see 30 patients a day. Right now, there are less patients because it is summer. Although there are many athletes still at school training, most of the practices are only for American football and soccer. It is common for other athletes to stay at school over the summer to pick up extra classes, but they are not necessarily training or practicing right now. Many of the patients have common athletic injuries: knee problems from overuse, shin splints, and back pain. One of the physical therapists told me that knee injuries were likely the most common of all the injuries they saw at UDLAP. They also see patients who are recovering from surgeries and need physical therapy to regain their strength and motility.

There was plenty of equipment, and
the space was really clean.

     The facility is relatively new and very spacious. The old facility was much smaller, but now there is room for four examination tables, a treadmill, an area for assisted walking, private examination rooms, and many stationary bikes. The new facilities are top of the line, and they have access to technologically advanced treatments. Physical therapy didn't gain a lot of popularity in Mexico until fairly recently, so there is still a lot of progress that needs to be made for Mexico to become top ranked in physical therapy. Next door to the physical therapy building is a gym specifically for recovering athletes. There are trainers in the gym who help athletes perform exercises correctly to aid in their recovery. (Apparently Alex and DJ tried to work out in the athlete-training-only gym and were told they had to leave!)

LLLT and Electrotherapy
equipment

     The entire Centro Integral de Rehabilitación includes three sections: the clinic, the physical therapy center, and the gym. The communication between the three parts is essential to the functionality of the program at UDLAP and to the timely recovery of the athlete. For example, the doctor will send a patient with muscular pain to receive low level laser therapy (LLLT) to stimulate cell function of the mitochondria. The physical therapist will follow the instructions sent by the doctor, and once the patient has shown improvement, the physical therapist will send the patient to the gym to increase their strength. All three sections use the same computer system to track the patients' progress and monitor changes. By having the doctor so close to the physical therapist and to the athletic trainers, it is easy for a doctor to run over and assess a situation if something occurs. It seems like a great system, and I'm looking forward to seeing more of what the doctors do tomorrow!

La Araña Pequeñita

Highlight of the day: We went to Alex and DJ's dorm to watch the basketball game, and when we got inside the building, there was a bunny sitting on top of a bush. He was really soft and sweet. Petting such a cute little animal on campus was pretty awesome!

   It is always a busy day at El Hospital para el Niño Poblano. We spent the day shadowing Dr. Hugo again. Today we were in a different section of the emergency department.  The emergency room is separated into different sections: shock rooms, observation rooms (for patients they are not sure how to treat yet), and pre-hospitalization rooms (for patients who are going to be admitted soon). Also on the bottom floor of the hospital are the medical labs, tests such as x-rays, MRIs, CT scans, and other offices. The rooms for the specific tests are all painted to make the environment more welcoming to the kids.

     There was a girl admitted today who was only 33 days old. She had surgery on her gastrointestinal organs, because some of her tissues were fused at birth. She had a bag inserted in her stomach that will be removed in a month or so if she maintains good health, but she had to be admitted because she was having surgical complications. There seem to be a lot of transferred patients at El Hospital para el Niño Poblano because it is the most specialized pediatric hospital in the country. 

     On the other hand, sometimes patients have to be transferred to other hospitals nearby because they are too old or large for the hospital. Today there was a patient who was 17 years old and was diagnosed with leukemia. He was average size for his age, but since the hospital is geared toward small children, he could be better treated at a hospital geared towards adults. There were even some younger children, six or seven years old, who were suggested to transfer to a different hospital in Puebla, because their cases were not severe or specialized enough for their age group to necessitate a hospitalization at El Hospital para el Niño Poblano.

     Overall, I really enjoyed my time at El Hospital para el Niño Poblano. I enjoyed getting to watch different tests in progress, getting to learn more about cancer, and especially getting to see how doctors care for such little people. The "tiny humans" are so delicate and need a lot of care  and attention that older patients do not require. From holding a child's hand while getting blood drawn to singing "la pequeñita araña" (the itsy bitsy spider), there is always someone who could use more attention. Pediatric medicine is an entirely different type of medicine than family practice. Pediatric medicine is a little bit of everything, but everything is for the "tiny humans."