There are a few visual guides around the clinic indicating some of the more imperative medical needs. This is a shadow box of the many methods of contraception offered in the clinic. On Monday of next week, Dr. Jonas is allowing us to put an implanon in a patient’s arm!
In many ways the clinic where we are working is similar to those of the US, but there are also some very staunch differences. For example, like medical offices in the US most of the doctors use computers for documentation purposes, but not EMR systems as most American clinics have (and all of them very soon!). The doctors use Microsoft Word documents and have files saved under each patient’s name in alphabetical order, copying and pasting previous visit notes with minimal changes in vital sign numbers, chief complaints, etc.
Also, the sanitation is extremely varied from that of the states. No one uses gloves to give injections, but they are used for other invasive procedures such as genitorectal exams and wound dressing changes. No bed sheets/clinic table papers are changed between patients, no ultrasound probes are cleaned, and otoscope tips are never thrown away or cleaned. Hands are rarely washed. Sterile water is taken from a filter in the sink in reusable bottles. Overall a very different sanitation culture. Not a bad thing, just a difference in regulations and expectations than we are taught in medical institutions in the US.
Today we talked to Dr. Jonas about some of the differences between medical cultures/words/treatments as well. We use many of the same drugs to treat the same problems: ranitidine [ranitidina] for indigestion, pravastatin [pravastatina] for hypercholesterolemia, loratadine [loratadina] for allergies, pentoxifylline [pentoxifilina] for venous insufficiency, nitrofurantoin [nitrofurantina] for UTI’s… with slight differences in word endings (often ending in an “a” in Spanish). We use many of the same words and methods for diagnostic purposes: placenta previa/accreta, lipoma, vitiligo, Naegel’s Rule for estimated date of delivery, childhood growth charts based on age/height/weight, age-based guidelines monitoring fine and gross motor skills, social skills, and language skills. But there are also drugs used that are not the same as those regulated by the FDA and many drugs that the people cannot afford because they are not generic. For example, we had a diabetic patient last week with paresthesias (burning/tingling) in her fingers. Normally one could treat with gabapentin/Neurontin or other neurologic drugs, but these were unavailable for miles around and not generic as in the States. Instead, the doctor prescribed a folic acid supplement in hopes of providing some relief via nerve conduction.
One very strong positive of Mexico’s health system over our own is the government’s implementation of a mechanism to ensure a standard of care throughout the provider system. Each person is given a book (Cartilla Nacional de Salud) that follows their medical care through their lifetime based on age and gender. It is given to the medical provider at each visit and necessary changes are made to ensure that the next provider that the patient sees is up-to-date on the patient’s health status. It follows past medical history, family history, social history, etc., among other topics relative to age and gender.
Above for women aged 20-59, following their reproductive health, recommended screenings, medical conditions, medications taken, etc.
Below for young men aged 9-20 following their past medical history and vaccination history.
Overall, we are learning a MULTITUDE every single day. The first week was tough. It took about 3-4 days to “tweak our ears” to begin understanding the language, much less learning a whole new language of medicine within that language. People at the clinic are already complementing us on how much our abilities to speak have improved over the past week. How exciting!! But even more exciting is what rolled into clinic on Friday… a man who fell off of his bicycle (borracho) and ripped some holes in his face that we got to practice our suturing skills on. A few pictures below! 🙂
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