Today we were back in the clinical setting at Hospital de Especialidades del Niño y la Mujer (HENM). This is a public hospital that specializes in pediatrics, gynecology, and obstetrics. Patients who come here have insurance and therefore do not pay for the services. For patients who can afford to pay more, they go to private hospitals, such as Médica Tec100 which I wrote about visiting last week Friday. I have REALLY been looking forward to today and tomorrow since labor and delivery (L&D) is my favorite unit and I hope to one day work on an L&D unit or in a neonatal intensive care unit (NICU). I've been so excited to see some births and hold some babies since coming to Mexico and finding out that we'd be going to this hospital!
We met at the university at 8am. Since Nanci has to be in Mexico City for today and tomorrow to get her visa approved for travel to the U.S., Ruth had another student join us named Marlen. We all piled into a UAQ van and headed over to HENM. Once we arrived, we were given a tour of the entire hospital, which had two buildings. In the first building, we went to Urgencias Pediátricas on the main level, which was an emergency unit only for pediatrics. We then headed up to the next level where on one side there was the NICU and intermediate / stepdown NICU. The other side of this floor had a mix of pediatric units, which included respiratory illnesses, oncology, dialysis, and internal medicine. On the third level, there was one side that had inpatient postpartum women who were accompanied by their babies if they were healthy. On the other side this floor, there were patients with various gynecological issues such as cancer, infection, etc. We then walked over to the other building that had a separate emergency area for laboring women. Further inside we were able to see the entrance to the L&D unit, in which both vaginal and Caesarean section births take place. In this area there was also a short-term postpartum area for women who were able to go home within hours of giving birth.
We split up into two groups, one going to the stepdown NICU unit and the other in the L&D unit. Mary went with the NICU group (Ellie B. and Hannah) while I went to L&D with Heather, Sarah, Katie, and Elli M. We got personal protective wear that included a disposable top and pants along with a mask, head covering, and shoe booties. It's interesting because here they have a step that goes from the changing room up into the unit so you can't forget to put on your shoe booties. You lift one foot up, put on the bootie, set that foot down on the other side of the step, and then put the other bootie on the other foot and cross completely through the doorway. It's a good way to ensure you have all the right stuff on because it makes you stop and think to consider what you're wearing!
When we were all dressed correctly and on the other side of the doorway with our protective wear, we were shown around the unit by the nurse manager, Gabriela. She showed us the rooms reserved for C-sections, general vaginal delivery, and abortions/miscarriages as well as the two labor areas and the one postpartum area for mothers and babies. It was interesting to note the differences between the OB units I've seen and had clinicals in in the U.S. compared to this unit. Family members are not allowed back in this unit and women are lined up right in a row to labor. Sometimes they also give birth right next to someone else, often without a curtain to separate the space they share. At one point, there was a woman giving birth crying out in pain and her "roommate" who was still laboring looked very nervous. In that instance and in several other situations I wanted to hold the woman's hand or offer encouragement as she gave birth, but I wasn't sure if that would be culturally appropriate in these situations. I'm still not sure if that would be welcomed by staff or patients and I wonder if social support during birthing is something that is culturally driven.
It was sweltering hot for the first hour or so being in that unit and I would guess that the temperature was somewhere in the 80s. I was sweating profusely and at one point while observing a C-section, two girls had to step out of the room and sit down. I don't think it was so much the actual surgery itself that put them over the edge, but the mixture of the heat, the overwhelming number of people moving around and in and out of the room, and wearing a stifling mask that was difficult to breathe through that made it easy to feel slightly faint. I realized how we take having air conditioning in a hospital for granted, seeing as how all the public hospitals and clinics we've observed in while here in Mexico don't have it. I can't imagine giving birth, something so strenuous and requiring so much energy, without at least a fan. We are fortunate to have such resources and I give so much credit to these hospitals' patients AND staff who stay and work in these facilities. Additionally, I noticed paper charting and typewriters all over the tables on the floor. I actually recorded four people (med students? nurses? doctors? a mix I think) at one table just typing away at their notes. All over the unit the sound of typing on the typewriters echoed. Again, I give the staff credit for their organization and skills in keeping track of and completing all their documentation without computers like we have in the U.S. I peeked at one of the charts and was so impressed to see the great detail documented through handwriting and typing by the hospital staff - SO much work with such little time since they juggle several patients at a time.
In all we saw about four C-sections and four vaginal deliveries - WAY more than what I saw during my half-semester OB clinical back home! It was very fast paced and women were just laboring and giving birth left and right! I loved watching the women get moved to the postpartum area and spend time with their tiny little newborns. After working so hard and going through so much pain (only C-sections got epidurals, from what I could see), it was great to see the moms bond with and love on their babies. However, I must admit, just like how I felt after my OB clinical back home, watching all that laboring and delivering made me cringe at the thought of myself going through that process. It's true that they say nurses / any health care worker make the worst patients because it will sure be awful to know exactly what's happening, what could happen, and what to expect when/if I find myself in a L&D unit as a patient!
We met back up with Mary, Ellie B. and Hannah and headed back to UAQ. Some of the girls went out to lunch at VIPS downtown for some American-type food while Sarah and I went to Express Arte Caffe to eat and have internet access at the same time. We enjoyed eating at a table just by the doors that offered a nice breeze that accompanied by the soft music made for a perfect afternoon. We had some great conversation while eating and then I worked on this blog post and she did some homework. It was soooo relaxing and perfect after constantly moving all morning / early afternoon in the L&D unit.
Elli M., Katie, and Heather met up with us at the cafe and I took them to a place downtown where that I had found that was really cool where I thought I would buy Husband a gift (note my extreme vagueness here since I don't want to ruin the surprise of what I got). They all thought the place was great, too, and proceeded to buy the same gift for their families back home. After I walked back to the house and got ready to go out with Mary and her friend Melissa, who she met during her first year in Querétaro.
Melissa picked us up around 7:45pm and took us to La Mariposa (The Butterfly), which is a cute little ice cream shop and restaurant with a 50s vibe. Mary had taken me there on Sunday night when we got some leches malteadas (milkshakes) and we ended up ordering the exact same thing this time around! Once again, it was so delicious and refreshing. The place was also air conditioned so I even got cold after drinking the my chocolate shake! We talked for a long time about what Melissa has been up to (she's an English teacher at a bilingual school here, she also teaches private English lessons to adults, she has recently bought a new car and started living on her own, her little sister's quinceñera that happened in February, etc.), what Mary's been up to, and introducing me and my life. Naturally, since she's an English speaker, the whole conversation was in English and I was super impressed with her. Apparently she studied in the U.S. for a year during high school as part of an exchange program and that sparked an interest and propelled her toward her current career teaching English at the elementary, middle, and high school level for Mexican students. She was a blast to talk to and get to know! Mary had told me that she had a lot of energy and she was definitely right! Melissa also brought Mary some gifts of traditional Mexican items and candies and even brought me some, too - too sweet of her :) We headed home, bid farewell to Melissa, and are now about to go to bed, considering we have another early morning and long day tomorrow again.
Hasta luego!
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