Mas de cirugia y medicina interna

In surgery yesterday I was able to see surgery on a woman who had a tumor in her neck. The doctors cut into her neck, tried to avoid her carotid artery (sometimes unsuccessfully), and cut out the tumor. 

Tumor cut from the right side of the neck

After, I watched virtual surgery. The doctors performed a splenectomy on a little girl using laparoscopy. It was pretty neat! Why they preformed the surgery, I am not sure.

Today I was in internal medicine. It is a more depressing part of the hospital. One man has an autoimmune disease. His skin is covered with scabs and open wounds. The doctors keep netting around his bed and collected blood today for analysis. 

In the bed next to him is a 27 year old woman who is married with three kids. She was having problems back in February but the doctors told her she was fine. After several months and many different misdiagnosis, including anemia, the doctors finally determined it she had Leukemia. Last month she was able to undergo chemotherapy and is going through rehab now. Her story sounded like it could have been on House. She is so pale but looks strong. It's a very different place, internal medicine.

AVISO: this blog contains graphic pictures

For the past two weeks I have been working in clinics. This week they moved me, and two others, to Hospital Civil. There are four general places there: surgery, intensive care, emergency, and gynecology. The last two days Kirstin and I have been in surgery. We start the first hour with the residents as they do rounds on the post-surgery patients. After, we head to the surgical rooms to watch the surgeries. The doctors are very friendly, patient, and work to help you understand what is going on. The rooms are always full of doctors, nurses, students, and others to talk to.

Kirstin and I all scrubbed for surgery

The first surgery we saw was of an 11 year old girl. She had a fistula just above her right ear. The doctors inserted a catheter, stitched the fistula to the catheter, and melted/cut it out. 

Fistula removal in process

The second surgery was for a 78 year old woman. She had a hip replacement some years back but the metal inserts had become disconnected from her leg. The doctors went in, pulled out the old and put in new plates. It takes a lot of work to do that! The doctors had a hard time putting in new plates because they could not get them to fit just right.

Burning/cutting in to the femur

That would be her femur

Screwing it all down

Tools of the trade: screwdriver, hammer, wicked looking wrench

 Today they operated on a 50 year old man. His radius was shorter than his ulna due to a past accident and as a result he did not have full motion of his wrist. The doctors cut into his side, took a piece of bone from his ribs, and after braking the ulna placed the rib bone piece into his arm. They then screwed in a metal plate to hold it all together. After his arm was stitched together they screwed a joint into his arm and hand (through the skin!) to prevent him from being able to move it. They said they would not remove it for two months. 

Putting his ulna back together

On a slightly less grotesque note: Oaxaca is getting ready for the Gualaguetza! There is now a whole street set up with circus rides and food stalls! 

A blog so big it should have been made into 3

I went on more tours around Oaxaca today. It started with visiting a HUGE Tule tree which happens to not really be a Tule tree because those don't exist. The tree is over 2000 years old and was named by the Aztecs who conquered the area. It is over 50m in diameter.

Montezuma Cypress

 We then took a very long drive to the Hierve el Agua. I snapped a few pictures from the van along the way.

Hierve el agua is a natural calcium and sulfur spring. The water is not really boiling, nor is it hot. The way in which it comes out of the ground makes it appear as if it is boiling so that is where the name comes from.

A spring at Hierve el agua

A pool created by the spring

The calcium in the water stains the rocks white. This makes it took like a water fall (when really it isn't). 

Las cascadas

Sitting at the edge of the world

Enjoying the cool water on a hot day

After Hierve el agua we went to another ancient city called Mitla. The city was taken over by the Spanish and destroyed save but one section of a palace. This was to remind the people that their gods were not as strong as the Spanish god. 

The remaining section of the palace

 This is an original building. No acts of preservation were done by the people prior to the 20th century but the building remained intact due to the construction. There are a lot of tremors in the area and the Zapotecs developed a way of dry construction (without mortar) that made the buildings flexible. What they did was place the stones so that there were still small holes between them and when there was a tremor the rocks were able to move freely. 

The original building had red painting on it. The rocks are still stained a light pink from where the were decorated. The red in the picture is from recent restoration to show what it may have looked like.

From the front

Courtyard of the palace

The dry construction

Inside the palace

 The Spanish built a church on top of one of the destroyed sections of the palace. This was to show their dominance over the Zapotec gods. 

After Mitla we went to a textile place where they made rugs. The family that ran the place was of Zapotec origin and still spoke the native tongue (as well as Spanish and English). They talked to us how they cleaned the wool, prepared it, spun it, and dyed it.

The tools of the trade

 They then showed us their method of weaving rugs and several completed rugs. 

The tree of life

After returning back to town I wandered around the Zocalo looking for food and water. I also ran into a clown, fireworks, and a parade. It was pretty awesome! The parade was a demonstration for the Guelaguetza which is a big celebration held at the end of July every year in honor of Benito Juarez. The celebration starts on Monday with two more festivals on the following Saturdays. The name, guelaguetza, comes from a Zapotec work meaning "mutual offering." The celebration focuses on tradition dances, dress, and customs from the different regions of Oaxaca. This year marks the 80 year anniversary of the festival.  

Posing with parade dancers

Posing with a parade dancer

Seguros y Churros

Last night we learned about the healthcare system in Mexico. There are four basic segments and it is all run by the government - healthcare is a deemed a right, not a privilege. In the clinics where I work, the healthcare people have is called Seguro Popular. There are no co-pays, no costs for check ups, lab work, or surgeries. Patients may have to pay for some medications but that is rare. Oportunidades is a form of healthcare that branches from Seguro Popular. It actually costs families money to have, however, if patients check in every 6 months then the government helps cover the cost. A family can only have Oportunidades if they have children (and the children are attending school - school is not a requirement here). 

The other forms of healthcare include: ISSSTE which is for government workers, ISSFAM is for military personnel and their families, and IMSS which is your basic healthcare for the working class and does come with a cost. Usually the employer pays half the cost and the employee pays the other half. If the employee does not want to have to pay for IMSS they may always opt to have Seguro Popular but the healthcare provided is not as good.  

 

I snapped some shots of town on my way to the bus stop this morning. Early mornings and when it is raining are the best times to be out because no one else is. Usually the streets are packed with cars and the sidewalks with people.

The only form of green within a kilo of my place.

At the end of the day I went to a local bakery with some friends: Laura, Taylor, and Kirsten. It was fresh baked and some of it still warm! Sooo good.

It did not just rain today, it poured! And for several hours too.

Taylor and Kirsten (whimp)

Did I mention people do not like rain here? When it rains they go hide and try to wait it out. Normally this square is crowded with all sorts of life. Instead you can see people huddling in the door way of the church (there is a clown on the far right). We definitely felt like tourists when walking around.

Zocalo in the rain

 Eventually we decided to take for cover too and ended up in a sandwich shop. One of the wares included chocolate covered churros. This one is for you, Dad:

Chocolate covered churros and stuffed donos at Tito's

I was moved to a new hospital this week. It is much less exciting but is more intensive. I work with Dr. Francisco Lopez. He is constantly asking me questions about diagnosis and recommendations for the patients. Today he had me write his notes for him on the computer. It was a little degrading when he reworked half of it but I am learning.

Dr. Francisco going over a lab report with his patients

 When walking home from the bus stop I got mixed in with a large group of people. It turned out I was following a funeral procession that took up the entire street! 

Funeral Procession

 While waiting for the head doctor, Dra. Maggaldi, to come talk to us we played Manzanas con Manzanas. It was a lot of fun - even though we did not know 2/3rds of the words!

Manzanas con Manzanas

At the end of our day we wandered around the Zocalo, which is the main trading hub of the city. It is a big touristy area with people playing music and trying to sell you crafts. Did I mention my camera is dying? A slow painful death. I would like to apologize now for the poor quality of pictures you will see from now on.

Zocalo

Race Day and Monte Albán

This morning my family and I woke up early to participate in a race. It was a 5K around the main square of the city. It was a lot of fun, free, and I earned a shirt! Afterwords my group and I went on an all day tour of Monte Albán and some surround pueblos. 

Sunblock warriors! 

Tour guide with the Albán tree

Monte Albán is located just outside the city and is the ruins of a Zapotec and Mixteca culture. The name for the site is Spanish: Monte for mountain and Albán meaning white. There are trees that cover the hill called Trompillos and in the Spring white flowers bloom on them.

Over looking the complex

 Monte Albán is spread across four mountains. The Zapotecs were the first to live in the region and actually spent 50 years flattening the tops of the mountains by removing the dirt. They built their temples on the top of the mountains. This was also the place that the elites lived. The lower classes built their houses carved into the sides of the mountains.

A Zapotec sundial 

Wood carvings

After Monte Albán we went to two pueblos. The pueblos are home to artisan families. Oaxaca is known for its wood carvings, black pottery, and woven rugs. At the pueblos entire families work together to produce the final product. The first pueblo focused on wood carvings. The wood used is taken from the Trompillo trees. The trees are classified as either male or female depending on their size. When first cut the wood is very soft and easy for the carvers to work with but hardens with time. Once harden the painters follow the lines of the wood to finish the product.

An old Dominican church we passed on the way to the next pueblo. There were two quinceañeras occurring while we were there.  

There are a lot of tremors in the area. One, several decades ago, caused half the pillars and the ceiling to collapse.

We stopped for lunch at this 'all-you-can-eat' restaurant. They serve food that is traditional all over Qaxaca. 

Soupa de Qaxaca

This soup is a Qaxacan specialty. It has corn, squash, green beans, spinach, and tastes rica!

Barro negro

The final place we went to specialized in black pottery. Traditionally chunks of rock were allowed to soak in water for a month. After becoming soft they were formed into the desired shapes with a hand wheel. There were then placed in a helm for 17 hours. These pots were then used to carry and store water. Today, the pots are more ornamental. A few decades ago a technique used to make these pots appear shiny was developed here.