1. El Mundo de Esuchando Jordan Keys, MS4

2. Mexico
FACTS:
Estados Unidos Mexicanos (United Mexican States) is the official name.
Comprised of 31 states.
Population of about 127, 017, 000 million people in 2015.
Mexico City is its capital .
My international rotation was done in the state of Hidalgo in the city of Pachuca de Soto.

3. Pachuca de Soto, Hidalgo, Mexico
FACTS:
Pachuca de Soto is the capital city of the state of Hidalgo.
My host school was the Autonomous University of Hidalgo which was founded in 1869.
A famous monument in Pachuca was the Reloj Monumental that commemorated the 100th anniversary of Mexico’s Independence.
Reloj Monumental was located near my hotel Gran Indenpendica in the Plaza Independencia.

4. Hospital del Nino DIF
I rotated in the Hospital del Nino DIF Hidalgo’s Hematology-Oncology Pediatric Department.
It is the largest pediatric hospital in the state of Hidalgo.
The Hem-Onc department was a 20 bed facility that had 6 dedicated isolation rooms.

5. ¿ Qué Haciendo Aqui? Objectives
Understand how health care differs from that in the United States.
Gain an understanding of conditions that affect the pediatric population in Mexico.
Develop a better appreciation for Mexican culture.

6. My Purpose
I wanted to see how much I could learn despite not being fluent in Spanish.
This international rotation would provide me the opportunity to step outside of my comfort zone by myself.
I wanted to know if there were any differences in how medical treatment was done in Mexico compared to the United States.
Improve my cultural competency towards the Latino community so that I can better serve them as a physician in the United States.

7. A Day In the Hem-Onc Department
Rounds began promptly at 7 AM.
The rounding team consisted of a dietician, a pharmacist, a nurse, 2-3 residents (R1-R3s), the attending, and myself.
In the mornings, we would round with two different oncologist and one hematologist on their respective patients.
Rounds were often conducted by the third year resident (R3) presenting the patient to the attending.
After morning rounds were concluded, Doctor Violeta and I would go collect blood samples and take them to the laboratory on the first floor.
We would also do in person consults to specialists, transport patients to get X-rays/CTs done, and attend noon conferences.
Around 3 PM, afternoon rounds would begin with one oncologist and one hematologist that were different from the morning attendings.
More laboratory runs.
Dismissal at 5 PM.
Doctora Violeta Baños, a first year resident

8. Profound Clinical/Academic Experience
First, blood samples were sometimes drawn without gloves, and if gloves were used they were often utilized as make-shift tourniquets. I never got an answer as to why things were done this way, but I suspected that gloves were an expensive commodity.
Second, was observing Doctor Baños’ work ethic. She would arrive to work at 4 AM to round on all of her patients. She had many hats that she would wear while at work. Not only was she the first year resident, but the phlebotomist, laboratory sample deliverer, point of contact for consults, and my guide through the hospital. Despite all of her responsibilities, she maintained such a happy, kind demeanor.
Last, while the hospital did have EMR, samples had to be taken to the laboratory by the resident and results were hand-written in record-keeping books. Eventually, these results were translated to electronic records.

9. Profound Clinical/Academic Experience
During one of my days on service, I interviewed a pediatric surgeon, Doctora Alejandra Jimenez who informed me that while the Mexican government provided government funding for childrens’ medical needs, that funding had essentially been depleted.
As a result, thousands of children are turned away because they cannot afford to pay for their treatment. Moreover, families sometimes must sell assests to pay their child’s medical bills. However, more often than not parents lose their jobs caring for ill children, especially children with cancer.
When asked what could be done to retify this problem, she suggested that the government create jobs for its people so that they can provide for their families.

10. Profound Cultural Experience
Traveling to Mexico alone and knowing minimal Spanish was an experience in and of itself.
Learning how and where to get US dollars converted into pesos (Casas de cambio)
Climbing a pyramid in Puebla
Using public transportation such as taxis, combis, and Tuzobus to get to work.
Trying different foods like tortas, chilequiles, pastes, crickets.
Wearing all white uniforms to work instead of blue or green scrubs
Mexican culture is so warm, welcoming, and family-oriented! The doctors often greeted the nurses with kisses on the cheek.

11. Spicy flavored crickets
My work uniform
Chilequiles
Santuario de La Virgen de los Remedios Cholula Puebla

12. ¿ Qué Aprendiste?
Almost all of the children on the Hem-Onc service suffered from Acute Lymphoblastic Leukemia (ALL).
ALL is a common childhood cancer in Mexico and in the United States. It is also a very treatable cancer.
Treatment plans for the ALL patients were based on guidelines made in the United States.
Reading Spanish enabled me to understand the course of the patients’ medical treatment from their charts.
Listening on rounds helped me to understand treatment changes and improve my spoken Spanish.
Mexico needs more funding to provide healthcare to its children.

13. Healthcare for Children in Mexico
Universal health care was approved in Mexico in 2012 with Seguro Popular (SP) which provides insurance to people who do not have employment-based health insurance.
Most children are covered by this health insurance even though there are many other types of insurance.
SP covered vaccinations, comprehensive physical check-ups and diagnosis and treatment of acute intestinal and respiratory infections for children under 5 years old in 2006.
SP has since been expanded to cover more medical issues for children.

14. Resources http://www.who.int/countries/mex/en/