Altamirano, a demi-heaven in this Adventure

I arrived in Altamirano last Sunday not knowing what I was going to do, where I was going to live, if the town had hotels or much more. But I guess that is part of the adventure. Altamirano is a small dust town of mostly one-story buildings with little to its reputation besides its propinquity to Ocosingo (gateway to San Cristobal to the East and Palenque to the Northwest) AND if you search google for it, its research from the hospital here. There are three hotels, ranging from ten to fifteen dollars per night, several panaderias (bread stores), a central market and several chicken-beans-or-rice restaurants. Naturally, being thrifty to the point of stupidity, I chose the 10 dollar hotel (well, it is difficult to say if the more expensive ones - perhaps the 1 star one – would have made a difference. Needless to say, I had a room with a bathroom and supposedly hot water which I shared with over a dozen cockroaches (until I murdered them all!!!) . Oooh Ooh ha ha ha!

The following morning, I walked to the hospital and was welcomed into the doctors’ quarters and after a wonderful breakfast, went to meet the Sister in charge who with some worry and hesitation allowed me to stay for my three months. Yay! The hospital is a beautifully designed series of buildings connected by a covered walkway lined with huge flowers and gardens. It has an operating room, a delivery room and maternity suite, a pediatric wing and a neonatal wing and five consult rooms. I started my day in surgery for a suspected appendicitis which turned out to be ascaris lumbricoides. We removed over a pound of pencil-sized worms from this man’s intestines and I got my first gross exposure to the ubiquity of parasitosis here. In the afternoon, we removed a large necrotic area of skin from a young man who had been bitten by what is suspected to be a spider. I do not plan to use more detail for what is most likely viewed as fairly disgusting.

We work from 9 to 2 and then from 5 to 7 hospital time. The hospital does not honor daylight savings because the indigenous people do not either. Therefore, 9am hospital time is 10 am Mexico time and 11 am back home in New York. The dormitories here consist of a ranch house with one side for women and the other side for men. My quarters has 3 beds in my room and two other rooms connected. It is quite comfortable and tranquil here when I try to forget the fact that a tarantula was found in someone’s bed on my first night here. They kept it in a jar to show everyone. Sorry, no picture! The kitchen staff cooks for the doctors and the hospital workers. It is usually some variety of eggs for breakfast and then an assortment of beans, rice, pasta, cheese, tortillas, and chicken or ham for the other meals. We eat together in a dining room/ living room/library area and I am quickly making new friends. The doctors here range in age from 24 to their mid-thirties. No one speaks English, which is of obvious frustration and benefit to me, and everyone is very friendly and helpful.

I have spent the rest of my week in consults with several different doctors. We work together a lot better than I’ve seen in the states. The nurses are all indigenous women who speak Spanish and Tzeltal, the local dialect spoken by at least 75% of our patients. It is, in fact, unusual to me to see nurses smiling and doctors joking around so much but it makes the day go so much faster. Everyone says good morning and good afternoon, the patients are in general very grateful, thanking and shaking our hands as they leave, and the sisters oversee the hospital’s daily matters without intruding too much. One sister even is our anesthesiologist (quite a funny site to see an old nun with a tube in her ear that goes down the patient’s esophagus to listen to the heart sounds intubating and administering anesthesia!) This one doctor, Juan, likes to speak the patients in English when he is with me, saying “Sit down” and “What the problem?”

I have seen a lot of gastritis, a consequence of their diet of coffee and very spicy foods, parasitosis, and then unusual lumps, bumps, and bites. I have been working hard to learn the names of medicines and medical terms in Spanish and I am already at the point where I am doing the interview and the physical as well as occasionally writing the note. It is likely that in another week I will start seeing patients on my own. We have a lab with a range of capabilities, ultrasound, and basic radiography. What we are lacking, diagnostic capabilities now viewed as necessities in the US, like Computer Tomography, are frustratingly noted in my head when I think of them as informative. But that is why I came down here; to learn medicine without them. There was a day not too long ago when Aortic Aneurysms and tumors were hypothesized to be present and found only post-mortem. Surely we have gained a lot in our medical approach as we have integrated technology but we have lost a lot as well. There was a day when doctors ran around the hospital doing their own blood smears and lab tests, palpating and percussing their patients bodies and often learning as much as we learn after waiting for our blind CTs and chemical function tests to come back. In gaining and losing, just like how we try to save time, we end up roughly where we started. Maybe by improving my clinical diagnostic skills, I can wind up a little ahead, even in the busy emergency room. At least, that is my hope.

Los Medicos