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."

Worth the Walk

Highlight of the day: I bought two mugs for 50 pesos at a small shop in downtown Cholula. It's almost bad when things are so cheap, because I keep convincing myself to buy more. From jewelry to blankets to everything in between, today was a successful day for shopping.

The view from the church was
beautiful.  People were out flying kites and
 enjoying the weekend with family.

     This weekend was relaxing and exactly what I needed. Friday evening we went to a nice sushi restaurant in the "new" Puebla. Saturday, Savannah, Alex, and I went out to breakfast at a restaurant nearby called Las Quekas. I had an omelette for the first time since I have been here. That plus the freshly squeezed juice made for a great way to start the day.

     After taking a few hours to get some sun, we all decided to go to the mall again. I was craving chicken fingers, so we went to Chili's. The movie Jurassic World also just came out, so we really wanted to watch it. We were all crossing our fingers as the movie started hoping that the movie actually was in English. Lucky for us, we purchased tickets to an English showing with Spanish subtitles!

     Today Savannah and I went to Karma Bagels, a great restaurant though it is a bit of a walk. After walking all that way, we decided to stay out and explore some more. Lunch turned into a four hour walk. We finally made the trek up to the church as well! It wasn't really that bad since there was a breeze, and the view was completely worth it!

Better than Grey's

Highlight of the day: A 2 year old boy had to get his blood drawn, and his dad stepped out for a minute. One of the nurses asked me to hold the boy's hand to help him relax. It was nice being able to comfort a small child in a scary situation. 

     Today reminded me of an episode on Grey's Anatomy. From the beginning of the day, Savannah and I were running around following a resident, Doctor Hugo. He had a 36 hour shift, which was normal at the hospital. He was running around like crazy to get everything done on time, so it meant a  lot of labs and tests. Dr. Hugo had to go from floor to floor, from office to office, just to get signatures or approval. It was a very fast paced day.

     A patient was brought in by ambulance, and that was when things really started getting crazy. There were almost 10 doctors and nurses working on a child to get him stable. He came in and was not breathing on his own, nor did he have a pulse. Shortly after his arrival, his heart started beating again. I'm not exactly sure what happened because there were so many people talking at the same time while alarms were sounding. It was definitely an experience, and way more intense than anything I've ever seen on TV!

"Now What'll"

Highlight of the day: While riding with Dr. Casas to the pediatric hospital, Savannah and I were quizzed on the pronunciation of particular Spanish words. The words he was quizzing us on were Náhuatl, and Dr. Casas explained that Náhuatl was the language of the Aztecs. After hearing about the Náhuatl influence on Spanish for years, I finally understand that the language is not "now what'll." Even better, the my understanding of the backgrounds to words such as elote, corn in english, has finally clicked!

     Today was day one again. It was my first day at El Hospital para el Niño Poblano, a pediatric hospital in Puebla. It is a government funded hospital that operates under Seguro Popular, a type of insurance in Mexico. It was opened in the 1990s and was recently renovated and reopened earlier this year. They have about 90 beds in the hospital, and there are over 30 specialties represented throughout the staff.

     We weren't there for very long, so I haven't learned much about how the hospital functions yet. I do know I will be shadowing residents in the Emergency Room. We were told that the ER is always hectic, and I'm excited for the hustle and bustle tomorrow!