Tuesday, May 14, 2013

El primer día en las clínicas

Today started out fine and normal until we actually made it to the university (UAQ). First, we thought that we had only been scheduled to observe and work in one clinic from 8:30am until 2pm. However, we were very surprised to find out that we would actually be in TWO clinics with a lunch break in between, leaving us with a full 12-hour day. Second, there was a bit of miscommunication about the meeting time for Ryan, our pre-PT student, so he didn't even show up at UAQ until 8:50am since he thought we were meeting at 9am instead of 8:30am. The combination of finding out we were staying in clinics longer plus being late to leave left Nanci (and me, to be honest) a little stressed. But at 8:55am we were on our way. We dropped Mary and Ryan off at another UAQ campus specifically for the physical therapy and sports sciences schools and then headed to our first clinic, Clínica Santa Bárbara.

We met the clinic's nurse manager, Isabel, who then gave us a tour of the facility. We then learned that the clinic was more of a mini-hospital with many different departments, including surgery, urgent care, optical, dental, a general medical/surgical in-patient floor, rehab, etc. After the tour, Isabel, Nanci and I split the group up to work in different departments. Sarah, Heather, and Hannah went to Urgencias (urgent care), Elli M. and Katie were assigned to Hospitalización (in-patient med/surg), and Ellie B. headed over to Cirugía (surgery). Nanci and I decided we could float between the different units to supervise but decided to accompany the girls that were heading to Urgencias first. All of the girls and I were very surprised when they were all thrown right into helping out. They started an IV right away on a patient who was in for urgency with the inability to void. The IV was very interesting because the drip rate was calculated in the nurse's head. When they went to break a glass ampule that held a medication, I also asked Nanci if they had a special needle with a filter to avoid getting glass shards in the syringe, since that's what we use in the U.S. She replied that no, they don't, and they just have to be really careful when opening the ampules. 

After starting the IV for the patient and getting some meds, they transferred her to a different room with other urgent care patients. The students were told to take vital signs on all four of the urgent care patients, watch and change their IV bags, and that they would administer medicine as needed. Nanci told me that while it's "required" to take temperature as part of taking vital signs, often in Mexico they don't have thermometers and therefore don't "really" take a person's temperature. It was so interesting to stop and think about how much we take simple things for granted, such as thermometers. Temperature can indicate when something is happening but you can't necessarily see it, such as infection. 

All of the staff, both nurses and doctors, were so supportive and kind to us. They pulled us into various procedures and even had us help out. We were all able to watch one of the doctors form a cast for a sprained ankle and Heather was able to help hold the leg in place while the doctor applied the molding and bandages. Hannah was shown how to remove stitches from a patient's stomach by another of the physicians and he even just had her finish the whole procedure up. At one point, we all found ourselves with a physician who was going to clean an abscess via irrigation on a patient's abdomen. This abscess was a result of an appendix removal a couple of weeks prior and the patient's current visit to urgent care was for irrigation and dressing change. At first, we all thought we were just observing. Then he had Sarah remove the dressing and packing and we knew we were there to be more like his assistants! The doctor used a syringe and needle to irrigate the abscess and then handed it to each of us to have a turn! He then had the nurse slather a gauze in soap and proceeded to scrub the entire abscess, again handing it to us to have a turn! After each of us cleaned using soapy gauze and irrigated with the syringe and needle, the doctor had us TOUCH THE INSIDE OF THE ABSCESS (with our gloved hands). It was incredibly cool to do, and the doctor went on to explain the different parts of the body we were touching - such as fat, where the muscle was, where the peritoneal cavity was in relation to the layers, etc. 

When Nanci found out that I had never started an IV on an actual person before and had only practiced on our school's mannequins, she was determined to have me practice right then and there. She found one of the male nurses, César, who worked in the surgery area but didn't have any patients and had let Ellie B. practice on him earlier. I was so nervous and initially said no to his offer. After prodding from Nanci and assurance from César, Nanci, and Isabel that he was very calm and would be fine, I decided to give it a shot. It was so strange, these nurses (including the manager!) being at work and taking time and supplies to have me practice starting an IV. At first I tried close to his hand by his wrist and just couldn't get it - his veins were impossible to see and I could hardly feel where exactly they even were. Nanci suggested I try in the antecubital region so I applied the tourniquet and was able to more easily palpate a vein. On my first attempt in that spot, I was able to get flashback and successfully set up an IV drip of normal saline! The whole time Nanci, Isabel, and César were encouraging me and helping me feel empowered to do the procedure. When I was successful, the feeling was absolutely amazing! My confidence level was definitely boosted. 

We then set out around 2pm to get some lunch. At first we tried to go to a steakhouse buffet that Ruth had told the van driver to go to, but after determining that it was too expensive for us (about $16 per person) we headed over to VIPS, which is very similar to a Denny's. It was a mix of traditional Mexican food and American food (hamburgers, sandwiches, fries, etc.) and we were so famished that we inhaled everything that was set in front of us. We were somewhat drained from our busy morning, but the two hour lunch break and food revived us for our afternoon/evening at the other clinic, Clínica Santa Rosa Jaureguí. 

This clinic turned out to be a lot smaller than the Santa Bárbara clinic but we found out that it has nearly just as many different departments. One of the doctors, who is also the main clinic coordinator, took us on a tour of the clinic and showed us how there is one room for each unit. Many of the people who seek services there drive from surrounding communities since there are no ambulances that operate in the area. For this reason, and the fact that it is located in a small community, the clinic itself is smaller. However, the physician noted that the clinic is undergoing a few renovations as part of a large project and hopes that this will better serve the communities. She mentioned that there is a lot of violence and other risky behaviors on part of the adolescents and young adults (teenage pregnancy, fights, alcohol and drug use, etc.) and they hope to incorporate preventive classes in the community (schools, churches, etc.). 

After the tour, we split the group into groups again. Katie, Heather, and Hannah were assigned to the dental unit (since dentistry is part of nursing in Mexico) and Elli M., Ellie B., and Sarah went to the general urgent care/check-up area. I first went with the latter group and talked with one of the nurses who expounded on information regarding the clinic. I then proceeded to join the dental group, where we were able to observe a tooth extraction due to a granuloma on the tooth. It was funny because when the dentist pulled the tooth out, he put it in a little plastic mouse container for Katie to hand to the patient. We learned that instead of a tooth fairy, Mexican children put their lost teeth under their bed for un ratón (a rat) named "Miguelito" to come and leave money. When the dentist pulled out this older gentleman's tooth, he proceeded to jokingly give him the same little pink "Miguelito the rat" container that he gives children who can leave it in exchange for money. It was so cute! We also observed a cleaning done in attempt to eradicate an infectious bacteria from the tooth, which was also very interesting. 

After those patients, the dental unit closed and we went to join the other girls. To our surprise, we found them practicing IV starts ON EACH OTHER! This is very much against our school's rules back home for liability reasons, but the nurses suggested we do it to practice (since this is how they learn and practice in school) and we're not in our little skills lab so we all said, why not? Nanci offered up her antecubital region for me to start an IV as well as her deltoid muscle to try an IM injection and I succeeded at both! Confidence level boosted yet again! I think we all felt a little more confident in ourselves walking out of that clinic after practicing on one another in a safe place with lots of support and supervision from the Mexican nurses. 

We headed back to the university and all decided we deserved some helado (ice cream) after our long day of hard work. We walked over to a Burger King a few blocks away, ate our sweet treats together while jabbering about how much fun we had the whole day, and then parted ways to head home. It was by far one of the most exciting days here in Mexico and I'm looking forward to doing it all over again. I'm also so grateful to have had this experience to prepare me for my more advanced nursing clinicals that are coming up in the fall. My goal was to start at least one IV while being here and I'm so happy I already got the chance to do so today! I'm sure there will be many more opportunities as the month progresses and we work with patients in the hospitals. Tomorrow we head back to the same clinics and I'm really looking forward to seeing what more we can experience while being there!


  1. VERY cool experiences! So excited for you! Those doctors and nurses sound wonderful and "bent" on giving you hands on experiences!!

  2. Sounds like you're getting some great experience! Kind of crazy how different things are between countries! So glad you are documenting this!