A Stranger in a Strange Land

by chelseajin

My friend once told me that life is like walking through a valley towards the horizon. You start out wanting to reach the end, but there are a lot of distractions or pit stops on the way, that often you never reach the horizon, but stop somewhere along the road. The idea was that life is a long journey with these intended goals, but sometimes they’re never ending and thus impossible to reach. After all, can you really call the horizon a destination? The stops along the way are supposed to be satisfying in their own ways.
So I’m on what you’d call a huge detour. I’m spending my year off between 2nd and 3rd year in Arizona volunteering at a rural health clinic.

The difference in geography and culture is enormous. I can’t even believe that we have 1 President, and not several divided by time zones. Coming from New York, everything in Arizona is noticeably wider, slower, and drier. The residential streets are seriously 4-5 cars wide, with “suicide left  turns” needed to make it across. And while one might think the consistent 90-100 degree weather would kill off life, I’m amazed (and disgusted) to see anthills nearly a foot in diameter and grasshopper 3-4 inches long.

Green arrow points to one of at least 10 huge anthills
http://www.washingtonpost.com/wp-dyn/content/gallery/2009/09/24/GA2009092403264.html
Horse Lubber grasshopper

The relentless sun makes you realize that you really are just a bag of water. I started on foot to explore the neighborhood, and within 10 minutes my entire back was wet and I was horribly thirsty. Back home, I couldn’t finish a water bottle without feeling sick. Here, I was constantly looking for a water fountain or cafe and treated it as if I were a nursing baby. I’ll stand here for 5 minutes drinking, thank you, and I’ll refill my water bottle, double thank you.

Once I covered some of the shopping district, I headed for the University of Arizona. I’ve never been in a large university before, and walking through the University of Arizona made me realize how small-town my own NY college was in some ways. The campus is really like its own sovereign nation. I think this chart immediately came up in my head (minus the numbers) as I used my phone as a GPS. It’s already ridiculous I had to use a GPS because I got lost as soon I put one step inside campus bounds.

CCNY/Sophie Davis
University of Arizona
>16,000 students (let’s say 400 in Sophie Davis)
-35 acres
-Dry campus
-book store and various coffee spots.
~39,200 students
-380 acres
-Bars are part of campus (what?!)
-lots of chain restaurants, urban outfitters, boutiques, etc.

I’ll have a picture of some more relevant items soon, but the Mobile Health Program is housed in a truck that goes to certain rural and under-served sites in the area. Tucson, Arizona is a mere few hours from Mexico. This one fact brings to mind all kinds of healthcare issues because of the proximity to the border. The clinic serves underinsured or uninsured people. From what I’ve seen so far, it looks like undocumented immigrants are the main patient population.

The clinic has been in service for over 10 years, started by Dr. Augusto Ortiz and his wife, Martha Ortiz. I’ve been told that in the beginning, he examined patients in his car. Now we have a large truck that is specially outfitted with 2 exam rooms.

The clinic team serves several different sites (on a complicated schedule which I have yet to memorize), and is advertised heavily by a Promontora, a community health advocate.

Breech Pregnancies

http://rajivpharma.blogspot.com/2010/08/breech-baby.html

I got my first taste of action with some Obstetrics patients. We had two pregnant women come in for checkups. Both spoke primarily Spanish and were unsure if their babies were in breech position or not.

“Breech babies” are fetuses whose feet are pointing downwards. Head injury or oxygen deprivation to the baby are prominent concerns and complications during a breech delivery.

worrybomb.com/2008/11/17/moxibustion/

We discussed how to manage a possible breech patient. Oftentimes,the fetus would turn on it’s own.  By about 36 weeks, if the fetus still hasn’t come to an optimal position, a physician can attempt to externally rotate the baby. During this time, the patient can also try moxibustion, basically putting an herbal cigar on the 5th digit of the feet. Although efficacy of the technique seems unclear, it’s noninvasive and many are convinced that it’s helpful.

Placing an IUD
We also saw one woman who wanted to get an Intrauterine Device (IUD) placed. An IUD is a form of long-term contraception.

ldysinger.stjohnsem.edu/thm_544_marriage/08_fertility/05_contraception.htm

It is a T-shaped piece of plastic which releases hormones, preventing egg fertilization from occurring. The patient was a woman who had had her first child with the clinic, a great example of continuity of care within a small community. It’s pretty cool to see how far technology has come. In this case, contraceptive technology started with the most primitive forms of condoms, then probably medicine herbs. An IUD seems like a transition between the cruder tools of old and a more elegant process in the future.

As a medical student on a small team, I wasn’t exactly sure of my role. Would I get to conduct a history? (Would I be able to without native speaking Spanish skills and in a sensitive environment regarding pregnancies?) Just like any animal placed in an unfamiliar environment, I became hyper-observant. The nurse, attending, and resident were taking notes on patients by drawing boxes next to tasks they had to complete. I started off just writing in general comments on my sheet because I didn’t know if I’d get to give a Glucose Loading Test. Turns out that keeping good notes in any situation is a must, because after chart review, they asked me to keep tabs on all the tasks they had discussed.

Some dry reading, but we’ll see what happens.

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