August 2009 Archives

Reflections of past, present and future.

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Jan. 10, 2009 - Jan. 12, 2009: Days 7-9

Over the last few days of our trip, we engaged in a range of new adventures - from zip-lining hundreds of feet atop a vast valley to swimming beneath a towering waterfall to exploring Victoria City for souvenirs.

On our drive back to Matamoros, we again encountered intimidating tanks rolling past us, but this time, they numbered in the hundreds and occupied the entire right lane for endless miles into the distance. They drove by only a few feet away from our van and carried numerous gunmen - some of whom even had their rifles pointed towards our direction. I eased my apprehension by sleeping the majority of the way, or maybe I was just really exhausted. In any case, the tanks made for a memorable conclusion to what has proved to be an enlightening journey full of notable challenges and self-discovery.

As the group of us boarded the plane out of the Brownsville airport - now, as a group of friends with numerous shared memories - I spent some time reflecting on all that I had seen and experienced.

Throughout my journey, I found myself struggling with my inability to provide sustained comfort and treatment to those in need. It frustrates me that even in a world where technological advancements and medical breakthroughs have become common occurrences rather than rarities, there still remains so much we cannot do - so many basic needs that remain unmet, so many individuals who continue to lack good health or any means to attain it. Making quality healthcare affordable and available to all continues to be an elusive goal, but its resolution relies on more than just formulating plans and hoping for its realization - it will take revitalized action and the sustained efforts of many.

A new age of globalization is already upon us, marking unprecedented exchanges of people, ideas and resources. The world has become, in many ways, less distant and more accessible. As much as it has and continues to expedite the spread of technology, business, and efforts towards global cooperation, it also means the more rapid spread of disease - as the recent swine flu outbreak can attest to. Issues that used to only affect one part of the world can now have widespread, global ramifications. We are now more than ever intertwined with the fates of one another and we can no longer be defined solely by the nation in which we reside - the actions of one nation inevitably affects us all - as members of the global society. In the betterment of the human race, we are only as strong as our weakest members. To this end, our health and our abilities to sustain it must be regarded as fundamental rights and must be considered as some of the highest priorities of any responsible government.

It will take more than the work of a single nation to mediate global disparities in healthcare - it must be a far-reaching, global initiative. It will require the implementation of multinational task forces to reform healthcare models that do not work and to set up minimum standards for efficient and effective healthcare delivery. Someday, when I have amassed the knowledge, the resources and the level of expertise to do so, I hope to play my part in reaching these ends.

Recently, I read an article entitled "To Hell with Good Intentions" by Monsignor Ivan Illich that led me to question and reflect upon my actions and behavior while service learning in Mexico.

This controversial article proposes that there is an atmosphere of hypocrisy prevailing in America. In particular, Monsignor Illich attacks those American "do-gooders" who feel as though they are sacrificing their time, money and energy in order to "save" or "serve" the underprivileged in Mexico - or for that matter, any developing nation. He identifies these acts of "service" as idealistic and offensive, stating that nobody is helped by these "good intentions". These volunteers, by imposing pretentious values onto underprivileged individuals, are merely creating disorder, because they "do not understand what they are doing or what people think of them". When this happens, they are no longer serving others in a reciprocal relationship, but rather, doing service unto others who become hindered by their efforts.

There is some truth to these statements: when individuals "blindly" serve others solely for the sake of fulfilling some "personal legacy" or to satisfy their own needs for "personal empowerment" while disregarding the attitudes and views of those they serve, they may be hurting rather than helping. Perhaps, effective and beneficial service should stem from a thorough understanding of the problem through the community's perspective, along with a careful consideration of the values among different cultures and different individuals, so that solutions can be found to appropriately respond to these differences.

It is important to remember that although bettering humanity may be the overarching intent of service, good intentions do not always lead to "good" outcomes that are beneficial to both server and receiver. Service should be focused on providing for the needs of the receiver, with the benefits provided to servers constituting byproducts of the good they provide to others.

In this light, I can understand Monsignor Illich's concerns and even find elements of his criticism relevant to my own experiences in Mexico. On numerous occasions, I felt as though I was intruding on the lives of those I was hoping to treat, or that I was forcing my own values and standards on others who did not desire them, or that I was somehow compromising the pride of those I wished to help for my own personal benefit. How can I, a 20-year old student with few "real-life" experiences, even begin to understand the needs and problems of people who live very differently from myself, let alone try to solve them? In many ways, I likely benefited more from my experiences than the patients themselves. I do not know if my "good intentions" achieved the purpose I hoped they would.

But as long as we keep striving to understand and striving to serve those who need it the most, I cannot see the bad of possessing "good intentions". It is when we no longer have these good intentions, when we no longer have any desire to serve, when we, as a society, lack those individuals who are willing to give the time and money and energy to help others, that humanity truly suffers. It is not solely in the fulfillment of the goals of service that makes it great, but in the process of trying to achieve them. If we never stop trying, then we never really give up on the dream. And as long as the dream of service is alive, then we have not settled for the status quo, and we open ourselves up to actively provide change for the better - only then can we collectively build a brighter tomorrow.

Clinic Day 4: la Meza

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Jan. 9, 2009 - Day 6

The drive to la Meza takes about two hours, but in spite of the length, I enjoyed myself. I was able to listen to peaceful music while admiring the deep blue sky, eclipsed occasionally by towering mountains and fluffy clouds.

La Meza is a small and dusty village, which I quickly discovered to house spectacular views of the surrounding mountain ranges. After setting up clinic at the local church, we immediately set off to triage the first group of patients waiting for our services. I took blood pressures and pulses, gently moving two fingers down the ridge of the thumb to mark my spot and adding sustained pressure to the side of the patient's wrist as I had been taught.

I remember just a few days ago when I was struggling to find a pulse on a middle-aged man with a thick, leathery layer of skin over his wrists. I remember my frustration at feeling only silence rather than the pounding beneath my fingertips, when it was so easy to find it on my own wrist, and my feelings of ineptitude as I tried to work quickly to minimize any discomfort for the patient. Dr. Mendoza had patiently taken me aside to show me his full-proof "pulse-finding method", stressing the amount of pressure I needed to exert on the patient's wrist. Although seemingly foreign just a few days ago, these triage skills now felt natural and comfortable. I was even given the chance to diagnose one of the patients. Though it was a relatively simple case of rheumatoid arthritis, I was still able to suggest ibuprofen as the drug of choice and fill out the patient's prescription - quite an honor for an aspiring doctor.

One of the patients we met today was an 83-year old woman who I accompanied throughout the clinic and with whom I actually held a conversation. She was in wonderful health for her age - no history of high blood pressure, no diabetes - just the beginnings of arthritis and the stiffening of a few joints on her fingers, but nothing to warrant alarm. I learned she had lived in town all her life and that housework now comprised the better part of her days. Her wrinkled face creased into a smile as she chattered about her family, and I could tell by the concern shown her by her fellow residents, that she was a well-respected force in her village.

Class in the only school house in la Meza ended around 11 today, and soon, huge, eager crowds of school children dressed in their uniforms gathered by the church to peek in at the commotion inside. To their delight, I offered them handfuls and handfuls of fruit candy, stressing that they share with others. Unfortunately, the boys would not share with the girls or vice versa, so it was up to me to mediate these disputes by a fair distribution process. I can still see their bright-eyed faces and hear their excited cries, and I can't help but smile when I remember their joy; it's a fond memory I hope to keep for a long while.

A group of young girls were especially memorable. The eldest, with her younger sister and their neighbor in tow, came up to greet me. After learning my name, the three pulled me along by the hand, and led me to their peers outside - all the while keeping up a chorus of "se llama xiaoxiao" ~ "her name is xiaoxiao" as they introduced me to their group of friends. From then on, I was prone to hearing strings of "xiaoxiao, xiaoxiao, xiaoxiao" by an enthusiastic group of followers as I walked around clinic, much to my amusement.

As clinic day came to a close, we enjoyed some local food made fresh by appreciative townspeople, after which, Dr. Mendoza explained we had one last patient to see - a man with a case so rare and extensive that none of us had ever seen anything like it before and may never see again.

While embarking on the short walk to visit our patient, Dr. Mendoza explained to us the seriousness of the patient's condition and prepared us for the visual image we would soon witness. Because the door of the house was only a foot or so wide, our group shuffled one by one to enter the cramped home and struggled to make room for each other.

It took a good while before my eyes adjusted to the dimly lit room, a harsh contrast to the sunlight outside. As I took in the room around me - containing two small but neatly made up beds, a few pieces of furniture along with some picture frames on the wall - I inhaled the overwhelming odor of urine and sweat that seemed to permeate the room and add to its dank and musty qualities. Finally, I could make out the man's right foot, which he rested on the dirt floor. It was unmistakable and strangely inhuman - huge and swollen with grotesque, reddened ulcer sores leaking pus on the side of his skin. The entire leg was swollen to at least twice the size of the other and appeared to consist of hardened patches of leathery-looking skin.

We learned that the man has a mycetoma, a chronic, inflammatory and subcutaneous granuloma caused by some fungus or bacteria that enters the skin via a traumatic event - in his case, a large cut he received almost 20 years ago while working in the fields. Also called a pie de madura, this condition most often affects the foot and develops into multiple nodules. His is one of three total cases in this region, and Dr. Mendoza had promised to check back on our patient a few months ago to further assess his condition. While his mycetoma had remained nearly stagnant for years, it now caused the man considerable pain and had recently started oozing pus, spreading patches of hardened, bulging skin in multiple regions up his leg. Unfortunately, the only treatment at this point involves amputation and replacement with a prosthetic limb.

Our group watched in amazement as Dr. Mendoza applied antibiotics to the affected region and tried to convince our patient to accept surgery. He explained that if the man does not go through with treatment now, future intervention would require amputation up to the knee, an invasive procedure that would leave him disabled for the rest of his life.

The situation was difficult for all of us to watch. The man still has to provide for his family, and continues to engage in work involving strenuous physical labor on a daily basis. It is no surprise he wants to hold out on amputation for as long as possible so that he can continue to work. Unable to force any action on the man, Dr. Mendoza could only provide his medical expertise and the promise of a future visit. After the man's wife thanked us for our visit, we left the house in silence, saddened by the seriousness of the man's condition and by our inability to do anything about it.

Clinic Day 3: San Lorenzo and Blue Lagoon

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Jan. 8, 2009 - Day 5

After a satisfying breakfast of coffee, freshly squeezed orange juice, and eggs with potatoes and green pepper, we made our way down to San Lorenzo for our third day of clinic. Though the drive was comparably short, I enjoyed it for its rustic qualities and spent my time observing the different animals roaming the dirt road. I counted at least two donkeys, a few horses, and several herds of cattle - a few of which managed to stop traffic to our amusement.

Today, we continued to observe the now familiar cases of gripa ~ fever, allergies, hypertension and diabetes in the patients we triaged, along with the occasional parasitic infection and cataract. After offering handfuls of candy, vitamins and toothbrushes to the village children, more and more crowded by the church windows - each curious about our work. Some even flocked in and out the door numerous times, hoping for more treats, which I was happy to provide.

Later this afternoon, we made the trek to the Blue Lagoon, a hidden spring known only to locals. The drive took us through a barren field of tall grasses surrounded by distant mountain ranges. For the rest of the trip, we hiked across a narrow brook dotted with natural stepping-stones and down a rocky cliff that presented plenty of opportunities for one misstep to result in a violent tumble to the depths below. But despite this omnipresent risk, I found myself breathing in the gentle sweetness of the air around me and listening to the soothing serenade of a faraway waterfall, and I felt more at peace with myself than I had in a long time - finally able to enjoy the moment for what it was.

Actually entering the lagoon at the bottom of the cliff involves stepping through unexpectedly slimy mud hidden beneath a layer of murky water. I was completely unprepared when my feet sank into the thick gooeyness, surrounded by globs that seemed to envelop my every step and prevent me from gaining proper balance. Swimming was my only option to avoid the uncertainty of the darkness below, so I spent the rest of the time floating in the balmy waters of the lagoon. With the surrounding cliff and trees giving the impression of a secluded sanctuary, it was the perfect remedy for the hot afternoon sun.

On one side of the cliff, there is a mossy rock that juts out into the lagoon, and some of us decided it would be fun to use it to climb up the side of the cliff where several locations appeared promising for jumping into the water below.

You have to push yourself up onto the rock with quite a bit of force; then, using your knee to prevent slippage, proceed to climb up the rock by resting on your stomach and edging your body forward. Then you must find little notches and branches to help support your climb, a task made difficult by mud-caked feet and wet, moss-encased granite.
To make it to the top, you have to take some leaps of faith - believing that your lower body won't crumple beneath you, trusting that the flimsy-looking branch in front of you will somehow still manage to support your weight.

I decided a height of about 15 feet above the water would be enough of a thrill for me. Standing up on the slippery rock, staring down at the shimmering turquoise water below - much too far below, it seemed - made my legs shake the first time. As I stood there, with my knees buckled beneath me and my heart pounding abnormally fast, I realized I could not climb my way back down without seriously injuring myself, which made me sincerely regret my decision to climb. Images of me losing my balance and tumbling down the side or severely bruising myself on the way down by jumping too close to the cliff, raced through my mind.

But in the end, I just took a deep breath, propelled myself forward, and jumped.
I hit the water harshly the first time and experienced the unpleasant sensation of water rushing into my nose, but nonetheless, it was exhilarating. The second time was much easier, and the third time, almost natural.

I think this is the case for a lot of things. Sometimes, we just need to take the risk - a calculated one, of course - and let go of the fears and inhibitions that hold us back in order to reach much greater heights. Perhaps it is the struggle to the top that makes it worth reaching. Perhaps it takes embracing new challenges and the uncertainties and complexities of life in order to live it fully, as it was meant to be lived.

Clinic Day 2: San Vicente

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Jan. 7, 2009 - Day 4

A sharp and obnoxious chatter -like a persistent, childish giggle - woke me up this morning. I was rather confused by the noise at first until I discovered its source to be the early morning antics of the hotel's resident parrot. He is a tiny, bright-green feathered fellow with well-developed vocal cords and a particular affinity for attention. He would constantly howl at our group from afar, only to stare silently at us once we got closer - as if to feign innocence while showing off his long feathers through a repertoire of fancy tricks. Throughout our trip, we all found him to be quite entertaining though nonetheless an annoyance in the early morning hours.

After a breakfast interrupted by numerous outbursts from our parrot friend, we made the drive up the mountains to San Vicente, enjoying panoramic vistas all the way. We passed rolling hills and valleys of leafy trees before a backdrop of crisp blue sky and fluffy clouds. Aside from the rumbling lull of the van on the winding, pebbled road, the view outside - speckled occasionally with the morning sun peeking through the mature trees - was peaceful and surreal.

San Vicente is more rural a village than San Juanito. Small, shack-like dwellings, fenced by crude slabs of wood and wire, comprise the majority of the housing here. The village is located on a cliff overlooking a valley that expands towards the horizon, encompassing a multitude of grasses and colorful homes before converging with far-away mountain ranges amidst the morning haze.

We passed by villagers hard at work in their backyard gardens alongside horses, sheep, and cattle. Dogs and chickens wandered freely beside us on the rock-covered streets lined with the occasional shrub or fruit tree.

An elderly woman with long, flowing white hair and drowning in an oversized jean jacket greeted us at the door of a faded blue church, the site of our clinic. Our group of three students took the lead in registration and triage. After measuring her blood pressure, pulse, respiratory frequency and temperature, I carefully listened to her lungs with the stethoscope hung around my neck and made a note of her weight. At barely 85 pounds without her jacket, her bony shoulder blades poked out beneath her thin shirt and her fragile legs were visible as thin sticks as she walked with a slight limp.

Dr. Lauda performed a quick medical history and discussed the old woman's case with us. Our patient had recently suffered a fall while tending to her animals, most likely due to her worsening osteoporosis. Given the harsh conditions of the mountain climate and the scarcity of dairy products in this region, the diagnosis did not come as a surprise to any of us. As we held the woman's coat in front of her for privacy, Dr. Lauda worked quickly to secure a wrap over her hip and lower back. Surgery is expensive and inaccessible in this region of Mexico, Dr. Lauda explained, so our patient will require someone to wrap her body for the rest of her life. I stared in awe at this old lady, who was still working so hard to support her family, despite the pain she undoubtedly felt with every movement. Before she walked away, she gratefully embraced each of us, and wished us well on our journeys ahead.

Our second patient of the day presented with the beginnings of what appeared to be a cold, but Dr. Mendoza noticed she also had a well-developed cataract in one eye. He made an effort to explain to us his thought process and his conversation with the patient. A couple of us were given the opportunity to more closely examine her eye - each of us using the scope in turn to stare intently at the cloudy layer of glutinous tissue covering her right lens. After taking my turn, I looked around at my fellow students - each of whom, like me, was carefully observing our patient's notable features as Dr. Mendoza pointed them out to us. We checked the color of the mucus in her nose to examine the source of her running nose - pale signified an allergic reaction, red signified a cold - and determined the flexibility of her joints to detect early signs of arthritis. With each exam, our patient began to look more and more uncomfortable. She stared shyly at us with a look of embarrassment and waited patiently as we discussed her medical conditions in a language she could not understand.

I realize the need for observing patients in this manner for the sake of learning, but I feel ashamed to have put her in this position - to have made her feel like some sort of specimen to be poked and prodded for our educational benefit. As I gently advanced the otoscope into her ear canal, I made every effort to explain - albeit in broken Spanish - the purpose of my efforts. I made sure to say thank you and repeat how sorry I was to inflict any uncomfort onto her, apologizing for having to repeat an exam already performed by Dr. Mendoza. And when her eyes met mine during our group discussions in English, I made sure to smile at our patient, hoping it would - at the very least - relieve her of some anxiety.

A couple we met today, an elderly man and his wife, were especially memorable. Both have worked in physical labor their entire lives, lifting heavy objects as part of their daily routine. Their thick clothing was stained with a layer of grime and marked by large patches of frayed cloth, and their dusty shoes had worn thin with soles that would hardly offer protection against the sharp and rocky terrain in which they lived. But their faces, though covered by a layer of dust and sweat and marred by sun and wind, could not hide the crinkles of their smiles nor the kindness in their eyes.

The old man was nearly blind from cataracts. As I accompanied him to the triage area, my arm underneath his for support, he recalled the numerous negative experiences with doctors he has met before, doctors who have abused their authority and prescribed expensive medications and procedures that have worsened rather than treated some of his conditions. Dr. Mendoza tried to allay his understandable distrust of doctors, and to complicate matters even more, discovered that besides his cataracts, the man also had a long list of other illnesses: high blood pressure, diabetes, gastritis, and rasping lung sounds that seemed to indicate a serious lung condition like bronchitis, making it difficult for him to take full breaths. Worse still, Dr. Mendoza found a hardening of the tympanic membrane in both ears, an indication our patient would soon be deaf as well.

I desperately wished there was more I could do to ease their suffering. But realizing that I am still an undergraduate student with no experience in treating patients, all I could do was fill out their prescription and hand them their medications while clearly specifying their recommended dosages. As I watched the two walk away together, each supporting the other on the rocky ground outside, I couldn't help but feel an overwhelming sense of helplessness - frustrated at my utter inability to do any more to help the old couple. Medicines may work, but only for a brief 15 days - the extent of the pills we can offer each patient. And 15 days is not enough to treat conditions like his or to prevent their occurrence in others. No miracle pill or procedure can cure the conditions in which these villagers live or deal with the medical issues they face on a daily basis. I can only hope that someday, when I have acquired the knowledge and the experience and the resources to do so, I will really be able to make a difference.

After clinic, a local family cooked lunch for our group. They filled their kitchen table with massive platefuls of tortillas, noodles, beans and rice. It wasn't a delicious or expensive meal by any means, but I think we all enjoyed it. The family had clearly spent a lot of time in setting up and preparing a home-cooked meal simply for our benefit - so that we could all enjoy a comfortable place to sit and plenty of good food to eat. As I continue my journey, I never cease to be touched by the kindness of those who have so little, yet give so much of themselves.

Clinic Day 1: San Juanito

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Jan. 6, 2009 - Day 3

I woke up early this morning for a morning run with a few other girls. The temperature was surprisingly chilly as the sun peeked out near the horizon, which made for an invigorating run. We circled the plaza - then decided to wander down some of the side streets. At one point, we found our path blocked by a large group of intimidating dogs that seemed to capitalize on our apprehension by barking ferociously. The early morning activity of the plaza - the busy street sweepers, the elderly couples on their morning strolls, the stores and street vendors beginning to open for the day as the light glinted off the tops of towering trees, and the hazy mountain ranges in the far-off distance - made for a lovely backdrop against the pounding of each step on the dusty, pebble-lined streets.

It took a good few hours driving on rocky terrain the entire way to arrive at San Juanito, a tiny village situated amidst rolling hills. We stumbled out of the van into a swirl of hot dust to set up clinic at the local church, a well-kept, canary yellow-hued building that clearly constituted the heart and life of the village. A long line of eager patients had already gathered to see us. I would be starting off the day registering patients, which I took as the perfect opportunity to improve upon my waning Spanish-speaking skills.

Together comprising an entire spectrum of ages, each patient grabbed a numbered card and waited anxiously in the hot sun, while I, with my clipboard and pen in hand, attempted to ask each a series of questions - from their name and age to current medications and chief complaints. This seemingly simple task was in actuality quite a challenge. Not only did I need to ask my questions in a way that made logical sense to the patient - and in Spanish for that matter, but also, I had to be able to process his or her quick-paced and occasionally mumbled replies in a meaningful way, which sometimes required looking up a word or two in my dictionary and the use of multiple creative hand gestures on both our parts.

Claudia, Dr. Mendoza's niece, spoke no English but was nonetheless, always willing to help. At first, I kept asking "¿Tiene algunas alergias o problemas con medicinas?" ~ "Do you have any allergies or problems with medicine?", a question that made sense to me, but only yielded looks of confusion in the patients I asked. Instead, Claudia recommended I ask "¿Le hace daño algún medicamento?" ~ "Does any medication cause harm to you?", which immediately prompted a look of comprehension and most importantly, an actual response.

Throughout my interactions, I was constantly reminded of what Dr. Mendoza had stressed on our first night in Matamoros about the importance of communication. He explained that because we would be working in rural villages where healthcare access is limited and medication in short supply, the majority of the patients we encounter would be rather ignorant of medical terminology or health concerns, making clarity critically important. Accurate diagnosis and proper treatment stem from a thorough assessment of the patient's particular situation, which ultimately depends on effective and thorough communication between patient and caregiver.

But I found that no matter how terrible my Spanish likely sounded and however many verb tenses I likely mis-conjugated, treating each patient with a smile went a long way. I was amazed by their patience towards my repeated clarification questions - a true testament that a smile and a willingness to listen can break down any language barrier.

During the short interludes between patients, I visited often with a few of the families sitting nearby the church and offered small pieces of candy to the children. Each lit up with a shy smile at the sight of the sweets, and I soon found myself stared at by numerous curious faces through the windows and doorway.

I also had the opportunity to witness Dr. Mendoza's masterful diagnosis of multiple patients, many of whom had gastritis complicated by a diet consisting largely of spicy salsas and flour tortillas. Antacids can treat this condition temporarily, but Dr. Mendoza explained that what looks to be a simple case of gastritis can quickly take a turn for the worse and may result in severe reflux disease or cancer if left untreated. A change in eating habits is necessary to prevent, or at least slow the onset of these consequences.

I met a woman who arrived with her two young sons - her face covered in a layer of rough, leathery skin likely a result of spending years under the harsh sun without skin protection. She presented with heel pain and deep "manchas" (marks) on her feet and abdomen, a symptom indicative of a deep parasitic infection. After another careful examination of her heel area, Dr. Mendoza quickly assessed the source of her heel pain - the result of bone growth on the side of her calcaneous bone, worsened by friction from walking.

During diagnosis, I could not help but notice that the woman's sandals were covered in a layer of grime, and her toes were caked with dried mud - understandably so from the dust outside. It is no wonder that infections like hers are so prevalent in many of these rural areas. Moisture, humidity and dirty conditions complicated by a lack of fresh and clean sources of water become breeding grounds for these diseases. I wish there was some way to do more to attack the source of these issues rather than just attempting to treat their effects.

But despite these feelings of helplessness, I was thoroughly touched by how grateful these patients were for the little I could do for them. Some shook my hands, others embraced me - each looked up to me with such deep kindness and respect that I felt almost embarrassed to accept it. I had merely offered my empathy.

Later today, our group took a collective walk around Jaumave. Everything is so colorful here - houses are pinks and purples, greens and blues, and trees are decorated with wrap-around strings of colored plastic. The townspeople are not rich but their happiness and their love for each other is so evident. There is a real sense of community and cohesiveness here that is scarce found elsewhere. I think there is a lot to learn.

Jaumave

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Jan. 5, 2009 - Day 2

I woke up this morning, still not used to brushing my teeth with bottled water or tossing used toilet paper in the trash rather than flushing it. But these minor bathroom inconveniences were nowhere near as unpleasant as I had imagined.

Breakfast was at La Regio's where we all enjoyed incredibly flaky and buttery cornmeal biscuits with jam, made even better with eggs and freshly squeezed orange juice - along with what I quickly understood to be the obligatory tortillas and salsa that come with every meal. But what strikes me most about breakfast here is how much time people devote to it. Breakfast isn't a "hurry up and eat as quickly as possible to start off your day" type of affair like it is in the States, but more of a means to ease into the day and reconnect with friends and family. There is a certain simplicity and pace to life here that I find enchanting and very agreeable.

With our stomachs full, we embarked on the 5-hour long drive to Jaumave, where we will stay for the next few days. The length of the drive gave me plenty of time to enjoy the sights of the Mexican countryside. We passed by majestic mountain ranges and valleys, and barren, desolate fields dotted with the occasional cactus or palm tree. The land seemed to stretch on and on for endless miles into the distance. Passing by the numerous residences scattered along the road made me acutely aware of the conditions in many of the rural towns and villages in Mexico - conditions I had never before seen first-hand. Tiny, colorful, one-room houses built of nothing more than corrugated steel or pieces of cardboard and wood leaning against each other, the occasional fence consisting of irregular-shaped sticks and rusted wire, the children running barefoot with mud-covered clothing, livestock freely roaming the dusty streets - all are images that will remain with me for years to come.

Jaumave is a tiny village with perhaps 200 residents, consisting of a 5 or 6-block radius centered at three small, park-like plazas. It's the kind of town where it's common to see children playing soccer on the streets to the delight of fearless dog packs, couples snuggled on plaza benches while fruit sellers try to steer shoppers their way, and small, family-owned ice cream shops and bakeries lining the narrow sidewalks.

During triage training tonight, we learned how to accurately take pulses, temperature readings, and blood pressure measurements and discussed the main health concerns we will likely encounter during clinic - everything ranging from parasitic infections to hypertension to UTIs. After taking vital signs on each other for practice and amassing numerous mosquito bites, our group headed out for milkshakes at "la Cabana", a small but charming outdoor restaurant owned by Fernando, one of the few residents here who speak English. Topped with frothy cream and sprinkled with cinnamon and nutmeg, it was the perfect treat to end the day.

Into the Unknown: Arriving in Matamoros, Mexico

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Jan. 4, 2009 - Day 1

The flight to Houston this morning was scheduled for 6:40 AM, meaning I had to get up at 4 in the morning - quite a feat for a college student on a much-needed winter break. Our crew left Minneapolis later than expected, delayed by the long de-icing process (how I love Minnesota winters!) to embark on what I hoped to be an eye-opening and perhaps, life-changing adventure.

I've always enjoyed plane rides. I like the anticipation of take-off, the soft and gentle lull of the plane as it traverses blue skies, the feeling of being invincible - far from the problems that affect the world below, and the relief of a solid landing. But even more than these simple pleasures, plane rides seem to reinforce my optimistic nature. No matter how dreary the day, the sun is always shining up here - a reminder that no matter what kind of day I'm having or what defeat or shortcoming I'm facing, I can find a way to get through it. Perhaps the key to solving our "problems" simply involves looking at them from a different perspective - seeing the bigger picture. Clouds inevitably get in our way, but we must never forget what is behind them, because when the darkness passes, we can once again renew our hopes for brighter days ahead.

At Houston, we boarded a tiny connecting flight to the Brownsville airport, truly the smallest airport I've ever been in, with all of two terminals. But the weather was wonderful, 80's and sunny - something I will miss when I return to Minnesota in a week or so.

Upon arrival, our group met Dr. Mendoza and the rest of the medical team with students from around the country. After loading up the vans, we were ready to cross the border where vehicles are stopped at a random basis for search and seizure. Ours was one of the lucky few able to experience this intimidating encounter. With a gunman situated in a frighteningly large tank and armed guards standing less than a foot away, none of us had actually been in this type of situation before - except maybe vicariously through TV and movies. Fortunately, there were no major issues, and we were able to acquire entry permits and exchange money fairly smoothly.

On the way to Matamoros, we encountered yet another tank patrolling the streets. Dr. Mendoza attempted to ease our apprehensiveness by explaining the current drug situation in Mexico. Apparently, Mexico's newly inaugurated government, as part of their revitalized effort to crack down on drug cartels, are instituting a much larger military presence, as a way to offer reassurance to the public as much as to intimidate drug traffickers and deter crime - I think it's working, at least in this latter pursuit.

We arrived at Dr. Mendoza's church in Matamoros, where we would spend the night. Our initial meeting was a much more enlightening experience than I could have hoped for. Dr. Mendoza began with "medicine is an art form", a profound statement I began to understand more fully only as the week progressed. He said that the most effective physicians are the ones who utilize all their senses to diagnose and treat a patient. Medicine requires careful and constant observation: everything from how the patient walks to how the patient smells may be critical for an accurate diagnosis. This depiction is worth reflecting on. However much technology improves, at the core, medicine remains very much a human endeavor, with its successful implementation contingent on an unwavering devotion to patient care and an astute intuition acquired through years of experience. Dr. Mendoza commented that during clinic, all we will have available to us will be a simple blood glucose measuring device, blood pressure cuffs and stethoscopes - the most basic of medical tools - which led me to think about the important roles advanced technology now plays in health care. There is no denying that technology in the form of impressive machinery and new medications has done much to help the human condition and continues to save lives everyday, but it doesn't always lead to the right diagnosis nor does it always produce the desired outcome. The physician still has to exercise judgment on a case-by-case basis. I can't help but wonder whether the doctors in these rural villages, unable to rely on the constant onslaught of technology, know more about the human body and how to treat its complications than some of the most prestigious doctors working in the most technologically advanced hospitals.

After the meeting, our group of fifteen made the trek over to the nearby and quite modern shopping mall where numerous curious onlookers stared openly at us - I don't think they're used to seeing large groups of American students around. For dinner, I ordered my meal completely in Spanish for the first time. Using a mix of (most likely) grammatically incorrect phrases learned in high school and some exaggerated hand gestures, I was able to get my point across to servers who seemed slightly amused by our group's incompetence. At least the fajitas were delicious, complete with ridiculously spicy salsa and chips - a satisfying end to a long day.

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