Saturday January 5, 2019-Today we went to the Rio Grande communitaria hospital for a 5 ½ hr observation.  We are lucky to get this opportunity, thanks to Dr Enver , he works there, so got us in.  This hospital is very small, it has an ER and one ward, here were 7 patients on the medical ward, 6 adults (5 OB and one medical) and a baby with early sepsis.  It was hard for me to understand the nurse on the ward so Kylie and I read through the chart and was able to translate the spanish.  We did not understand some of the abbrevations.  Laura brought us almuerzo we went to observe in the ER. The nurses were making masks so we helped them.  We  noticed that the nurses wear masks when caring for the patients.  We were told to protect themselves especially that it is winter now.

One of the ER nurses gave us a tour of the OR, birthing room and PACU.  The equipment is not as modern as ours. 

After the tour, we got a GI bleeder in the ER with systolic pressure in the 60’s.  The ER nurse expertly placed an IV and started fluid, boy did that make a difference.  The ER doc consulted the internal medicine (IM) physician (who we know from the Corbana clinic).  The IM physician explained to the diagnosis with the patient  and I was able to follow in spanish, maybe because I am so familiar with the diagnosis.  The nurse drew the blood for analysis and gave the three tubes of blood to the patient’s brother who took these along with a form to the lab in Rio Grande, 10 minutes away as the hospital’s laboratory was closed (perhaps because of the holiday).  I noticed that the lab tubes were not labeled and they were not in a biohazard bag.  Some other differences I noticed

-The suction apparatus is much different

-There were four shared rooms and one single room.  A lady who lost a baby was sharing a room with 2 ladies who delivered babies.  I felt kinda sad for the lady who lost her baby. 

The nurses document all their notes on paper.

The doctors entered the orders in the computer and printed them.  However, when the computer was not working, the doctors typed the orders, yes using a typewriter.

The nurses rotate to both ER, OB, and the ward. They usually work 8 hours but during the holiday, they work 12 hr shifts and get 5 days off.  The nurses in the ER was super nice, and willing to show us how they do things here.  The visit was insightful just seeing how health care is delivered in rural Mexico. Having seeing what I did today in the hospital makes me very grateful for the resources that we have in the US and how fortunate we are.

We went back to Cacalotepec then back to Ernesto ‘s cafe for a mango smoothie.  After comida, we took a little siesta.  We then went to the public health department and did our diabetes teaching.  I started off the session, the group was divided in dyads and presented the AADE7 selfcare topics of healthy eating, being active, taking medication, problem solving , healthy coping, monitoring, and, risk reduction. I felt we did well and there were a lot of good audience questions. It also emphasized to me even more that the population here is low or no literacy, there are some with disabilities (such as blindness from diabetes), so one has to be very mindful of of this when providing education. I was able to conduct a short interview with the clients (with diabetes) after the education session. Evening well spent, everyone did an amazing job

Friday January 4, 2019-Today Dave drove us 50 minutes to Tututepec. Dave was our tour guide as we visited Palacio Nacional. There were murals on the wall depicting Mixteco, Chatino, and Afrolatino culture and heritage in this area. I felt so informed after this tour, thanks to Dave. We also visited the Catholic Church in town which used to be the old palace.

We had lunch at the “corner” restaurant /Comedor Cortes which is family run business.  For comida, we had delicious frijoles, tortilla( a given, served with every meal), chile rellenos and Jamaica (hibiscus) tea.

After the van stalled on us, Randy and Dave tried to troubleshoot but no luck. Dave had to get a mechanic from one town over who eventually fixed the problem.

In the meantime, we hung out in Cortes Comedor and had ice suckers, then eventually moved to the plaza where it was much cooler. 

We got back to Roca Blanca mission base in another van, thanks to Jesus and Chano late in the afternoon. We inhaled our afternoon meal (comida) and was able to make it to Manialtepec Lagoon for a bioluminescent boat tour.  While on the lake, we were surrounded by a mangrove, a lot of birds but no crocodiles on the lake, thank goodness. The boat took us out to the ocean where we had a coconut and  watch the sunset which was amazing.  The sunset here is beautiful. After the sun went down, we went to view the bioluminescencia.  All nine of us along with our driver Johnie jumped in the lake, the water was so refreshing.  We were very fortunate because the bioluminescent was  glowing, we had so much fun making streaks in the water to see the plankton.

What was really liberating was that while in the lake, there were no “selfies, “we all just have a special memory  of swimming in this phosphorescent lake in Mexico.

I enjoyed talking in Spanish to Johnie, he spoke slowly and clearly, I had no trouble understanding him.

We ended the evening by celebrating Eddie’s birthday with the happy birthday song in spanish and a tres leches cake.

We went to the village of San Martin today where we set up clinic in the Iglesia Cristiana Evangelica Mision Victoria.  We saw a total of 42 medical patients, adults and children.  Randy saw 6 physical therapy patients.  Jazmine and I break away to interview this 82 y.o. Chatino lady and her daughter about diabetes.  We had the interview in the kitchen which a separate single building beside the house.  The lady and her three daughters share the kitchen.  There is a wood fire inside, a corn tortilla stone and the ladies were making fresh tortilla.  They were very simple people but super nice.  The pastor’s wife made us chicken soup, the chayote was delicious.  This was a hot and tiring day for me.  Did a few consults with Laura interpreting for me. 

Once back in Cacalote, Laura and I conducted two more diabetes interviews at the clients’ homes. 

After dinner we went into el pueblo for snacks at the green shop.  We stop at a restaurant, greeted by a nice man who made us mango smoothie, a coconut,  and a bocadilla 

Today was very well spent, our team provided care to 42 clients!

We worked on our educational posters this morning.  We used the AADE7 framework for diabetes self-care, but everyone added their creative flare which was great to see.  We started our diabetes interview with the clients.  Jazmine did an amazing job at interpreting and to understand the nuances of this culture made her a good fit for this project.  Kylie and Brooke helped with the interviews too.  Randy saw some clients for physical therapy needs, Eddie did very well at interpreting, Jacquie, and Lindsey also helped/observed these sessions.

I got some insight from the clients today on how they are living with diabetes, pretty challenging.  This was very educational.  It is also very sad to see the devasting complications of diabetes.  I learned that in Oaxaca, it is a common belief that Moringa (a herb) can be used to treat diabetes either by using the seed to make a tea or eating the flower.  And people do use it.  I got to see what the Moringa tree looks like because Laura has one in her backyard.

The pm was spent learning about domestic violence in this community  from  someone’s personal experience and how advocacy began from this. 

Feliz año nuevo

After a tamale breakfast,  we went to the Roca Blanca beach.  It was very relaxing just watching the ocean, listening to the waves and bonding with the group.  We had cocos, agua limon, and delicious guacamole.  The ocean was so refreshing and the waves manageable as we swam in a protected area.  Some of us got to use surf boards. 

In the pm we went on a home visit in Rio Grande.  Rio Grande is a large town next to Cacalote, population in Rio is around 15, 000. Eddie, Lindsey, Brooke, Randy, and I visited this client. It was an eye opener to see where this client lives and how he faces life’s challenges fearlessly, and the community support for the “orphaned.”  It also made me reflect on social conditions and the impact on health. Why do some have so much and others little to nothing? Is it fair?

We dipped in the ocean then had a bonfire on the beach. Thanks to Laura and the Chano family for making this happen….Got an opportunity to bond with the group. Ismel, a local (and friend of Laura) joined us. Ismel who is a teacher works in a school in the village which is 8 hours away from Cacolote. Access to the village is not good due to lack of public transportation.

We have a lot to be grateful in 2018 and now look forward to 2019.

Chano and Vladimir got us to Roca Blanca Missions in Cacolote where Randy, Anya and I hooked up the gang. Laura Nelson who runs the clinic, was out doing home visits with the students. We had a nice lunch at La Casa Hogar, the orphanage that houses 8 kids.

Got to Huatulco today at 10am after an uneventful flight from Mexico City.  Touching down  aroused a feeling of being grateful to be here once again.  This is my third trip leading students to volunteer in a medical clinic, La Clinica Corbana in Cacalote, Oaxaca.  It’s exciting to have another experience with six nursing students-Eddie, Jazmine, Jacquie, Brooke, Lindsey, and Kylie. The cocos frios were the best thirst quencher in this hot and humid weather on the way to Cacolote. Chano and Vladimir got us to Cacolote where we hooked up the gang

Slept hard on this one, woke up upon approaching Mexico City only to be diverted to another airport due to fog. Thank you Eddie for keeping me in touch with the group and Laura for all your help…..Impatiently waiting to get to Oaxaca…