1. Pioneers of Pachuca
Kyle Gillett
Feb. 2017

2. About Pachuca, Mexico
Capitol of the State of Hidalgo (3 Million population).
Exchange program through Universidad de Hidalgo (UAEH)
First group of KUMC students to go during February

3. About Pachuca Hospitals
Hospital Obstetrico
main obstetric hospital in Pachuca
Most days spent here
Private hospital
Higher pay for doctors, more expensive
Surgeries common here

4. Topic of interest
I did not know what specific topics to look at before going to Mexico.
I thought about writing about the dietary health and access to exercise equipment and/or access to sports fields or parks. I felt these would contrast well with the USA. I also enjoy these aspects of preventative medicine.
While working at the hospital there were a few aspects of OB care that I noticed were very different. Namely, these things were C- sections and prenatal care for non- high risk pregnancies. Thus, I didn’t have a specific rationale behind topic choice.
Learning point: “sometimes less is more”.

5. OB care in Pachuca Less resources in general C sections rates lower
Lots of minor differences (i.e. vertical skin incisions)
Normal to have VBAC (Vaginal birth after C section)
All patients labor in same room “Toco”

6. Routine Care Fetal monitoring in very few pregnancies
This helps control cost without increasing risk much
Less stringent protection from litigation needed
Common to listen to heart at short intervals, feel for contractions
Less prevention in general. Less vaccines, less procedures
Sometimes only one prenatal checkup at hospital before delivery
Other checkups at locations other than hospital
Highest risk pregnancies sent to general hospital where there is ability to treat other medical conditions
Pushing emphasized. Maneuvers such as McRoberts and suprapubic pressure used often. Drugs used less often. No epidurals given (at this hospital).

7. Learning points / conclusions
Interventions
Individual – continuity of care would help the individual avoid health problems even without preventative medicine budget
Community – More emphasis on vaccination and avoiding pollutants, state or regional emphasis on preventative medicine
Systemic – Better use of resources, more non-pharmacological, non-invasive solutions
In summary, main learning points.
How to be more judicious using resources, especially during obstetric care
Effect of emphasis on preventative medicine
Better Spanish language skills

8. Clinical Experience Example
Public hospitals very busy. Hard to find space. Privacy not valued as much, especially over access to care.
The medical budget in Mexico can be difficult so we were told there is not enough spent on preventative medicine.
For example – no screening colonoscopies
Although there is still room for improvement, I appreciate the emphasis on preventative medicine in the United States.

9. Cultural experience
I really enjoyed watching the feral dogs in Mexico. They reminded me of dogs in Nepal. Most people ignored them but some people fed them. They would form packs and often sleep and base their “territory” near a safe area with easy food access.
Photos by me: Feral royalty

10. Happy journey Photo by Brandon at Aztec pyramids
*References included below pictures