Mexico

Somehow traveling by plane has a way of making things seem surreal upon arrival. It's just too fast I guess. One moment I was hanging out with my family on Bainbridge Island and the next I was stepping out of an airport into a muggy afternoon in Guadalajara with people speaking Spanish all around me.

First, the who, what, when, where, and why.

Who: (see pic below)
What: A service learning project through the University of Wisconsin medical school in partnership with the University of Guadalajara in which we carried out community health and wellness projects with local partners.
When: June 20-July 25
Where: Mexico, state of Jalisco in several small rural communities
Why: Our mission in two words was “aprender serviendo” or service learning. In greater detail, we had traveled to this part of Mexico to learn how to find out what matters to a community and how to assist in achieving said goals regarding health and wellness.




(Our team. L-R Me, Dora a nursing student who worked with us, Maria - our team leader and long time nurse/university professor, Joel a fellow medical student, Melissa a fellow med student, and Alyson a Spanish and Library sciences grad student who was with us for the first week and gave several talks on accessing free online medical literature.)

My plan here is to share a bit of what happened in each community and then tell a few choice stories.




(The church in Tepatitlan, a medium sized city we stayed in for several days before starting our project. It is also the location of the University we partnered with and where Maria lives.)




(A pastoral view of Tequililla.)


Tequililla:

This was the first community we traveled to and the one we stayed the longest at. During our two weeks in Tequililla we were housed with the local health promoter, Berta, and her family, which turned out to be a definite highlight.




(Berta and 2/4 of her children with our team. L-R Me, Berta, Melissa, Joel, Jorge, and Kary)


Upon arriving in Tequililla we held a town meeting of sorts where we outlined what areas we (three medical students) had experience in, asked what projects the town was interested in, and came up with an itinerary together. Before going to Mexico we had talked with Maria and she related several ideas the community had passed on to her (as she had been working with them for over a year) but at the meeting the community seemed more interested in a different set of ideas. For example, I had put some time preparing to run a healthy cooking/nutrition series of classes but most of the people were more interested in a workshop on how to make soap. I guess I should have known that things always have a way of changing:)

So, what did we end up doing? A whole hodge-podge of things but in the end they all linked back to health and wellness somehow. One of those projects was renovating a dilapidated volleyball field and getting games going almost every evening. This single act ended up being one of the best things we participated in as the daily volleyball became a main avenue through which we came to know a great many people in the community, built trust, and ultimately increased interest and participation in the other projects. Volleyball is great because really anyone can play (you don’t have to be in the best shape) and we always had mixed teams of all ages and both sexes.




(Volleyball!)


As this was a farming community in planting season people would work all day. This meant we had to do our programming later in the evening. For example, we would show up at the volleyball field around 6:30pm and start playing. People would gather over the next hours and we would play until dark (around 8pm) at which point we would transfer to our evening event from 8pm-9/10pm.

These other events were variable and consisted of:

- Salsa dance classes (Joel and Melissa are great dancers and no one knew how to dance salsa there – they all dance Banda instead and later taught us a bit of it!)
- Yoga classes (Melissa and I had experience in this)
- A basic bike maintenance class (I had worked in a shop for 6 years and Joel knew some as well)
- A more traditional health talk (which then prompted several personal visits as family members of individuals too sick to attend wanted us to visit their loved ones at home)
- An artisan soap-making workshop combined with a game to teach how infections spread and a demonstration of the most missed spots during hand washing
- Star gazing via telescopes we had brought
- Volleyball and soccer tournaments




(Preparing for the telescope workshop that night by spying on people working and cows. The telescopes invert the image and the kids got a huge kick out of seeing all the cows "upside down":)


The soccer tournament was particularly exciting. The day it was planned for dawned gray and it soon began to rain. We arrived at the field at the appointed hour and found a few kids already gathered. When we inquired if they still wanted to play the answer was a resounding, “Si como no, no somos de azucar!” or, “Yes, of course, we’re not made of sugar!” And so it was on. The rain continued and by the final match the dirt field had become a mud pit. Joel and I felt like ungainly giants almost unable to change direction on the slick surface. Much of the community came out to watch from a covered area and after the game Joel had the idea, after everyone else had cleared off the field, to run and slide on his stomach. We did it at the same time and right after all the other kids ran back on to the field and started sliding as well. We did a mass group slide for the cameras and came off the field laughing and smiling. It was a special moment; you could almost feel the excitement and happiness emanating from those involved.

(Post trip note: Alejandro, one of Berta’s sons who helped us on many projects and refereed the soccer tournament, informed us over facebook that the community has continued to hold soccer and volleyball tournaments after we left – awesome!)




(After the soccer tournement:)


While walking around the community during the day we noticed that there seemed to be a lot of people smoking. Could we do anything in this regard? I thought back to training I had received during my Americorps year on how to develop a smoking cessation plan and based on that I worked with Berta to develop a “Quit Plan” that she could use help her fellow community members who wanted to stop smoking. The plan attacks smoking as both a chemical addiction and a social addiction. For the chemical part we discussed the proper use of nicotine patches and I researched where to get them and the price. But even without the patches having a plan can help and thus we spent most of our time on the social addiction.

One starts by designating a quit date several weeks in the future and making sure everyone knows about it. Then, it is important to break the link between smoking and daily events. For example, if you smoke a cigarette with coffee every morning, for the next 3-4 weeks before your quit date you will have to drink your coffee and then wait for 15-20 minutes before smoking your cigarette (outside). Doing this with the other “linked smoking events” in your day will make quitting easier as you won’t be constantly thinking about cigarettes as you go through your daily activities. However, assuming you won’t have any desire to smoke is not reasonable and thus one also must prepare several emergency strategies such as taking 5 deep breaths, chewing on gum, etc. to deal with strong cravings.

Before leaving Tequililla I pretended I was a patient to help familiarize Berta with the material and also ran one cessation session for two co-workers who wanted to quit smoking. Their quit date was August 8th and I hope they had success. This was a project that had potential to be of real use long after we are gone and I am hopeful it will be so.

Switching topics, a few pics of one of my favorite things – food:)




(The kitchen with us at breakfast, my favorite room in the house:) There was always much laughter, great food and good conversation when we gathered there.)




(Joel grinding up corn kernels for later use in making handmade tortillas. The food overall was spectacular. I like Mexican food in the states but down there is the real deal! Nothing like a taco with handmade tortilla, special local sausage, avacado and freshly prepared salsa - yum!)




(A typical, yet amazing, breakfast. This was one was made on a wood-burning stove. Sweet-potato, gorditas (a thick patty of tortilla dough with beans or cheese inside, avacado, and cheese. We finished things off with mangos (not pictured))

As we spent the most time in Tequililla it proved the most rewarding for me as we really got to know people in the community. Our second week there we had lunch invitations at a different house every day!




Presa de Barajas

This was our second stop and we only stayed in Presa for about 4 days (Presa means “reservoir” in English). Our first night there we were invited to the Quinceñera of a relative of the people we stayed with (a “Quinceñera” is the huge 15-year-old birthday bash that marks when a girl transfers to being a young woman) . They were frying a great number of items in hot oil (tortillas, chicken, nopales (cactus)) and more) and even though it was 11pm and we were pretty full we had to eat so as not to insult. From there we were asked to participate in karaoke and we all three gave our best shot at a Linkin Park song which must have sounded pretty bad but was, I think, a goodwill gesture that earned us some community points:)

That night we were shown to our lodging, a formerly nice house that had not been lived in for the past 10 years. Our first evening the power shorted out (and while trying to fix it the family who owned it almost caught the box on fire before giving up!), then the water stopped flowing to everywhere except the shower head, and during the night I heard scratching in a cupboard and opened it to find three mice staring at me with a look of, “what are you doing here, this is our house now.” All that being said it provided a roof over our heads (albeit leaky) and we made due without too many problems; we just had to get creative, use our headlamps, and take freezing showers:)

So what did we work on in Presa? Four days wasn’t much time, but like Tequililla we held a meeting, came up with a plan, and by running around 3 activities per day we were able to fit in quite a bit! The citizens of Presa were very eager to participate as much as possible. Many of the activities were the same (salsa, health talk, yoga, volleyball, soap making) but there were a few differences.

One of these was turning the peanut chicken cooking idea into a community event. We did this and incorporated local vegetables such as keleite (a local green-leafed vegetable much like spinach). The reception here was mixed, some liked it a lot, others (including many kids) not so much. Compared to the food that is typically eaten our meal had way more vegetables, way less salt, and a completely new flavor so I couldn’t have expected it to be a taste-bud success:) Many of the adults though were interested by the fact that it would be a good meal for those with diabetes or those looking to prevent it.




(Part of our cook-off team for making peanut chicken.)



Las Jicamas


This was our final community and we only spent 3 days here (and no nights as it was so rural and remote that Maria was of the opinion we would be bitten by snakes or scorpions and die and therefore wouldn’t let us stay).

Our main project was to turn a messy storeroom into a library. This had been identified as a project the community was interested in by a UW group that had traveled to the site the previous January. The room designated for the library already had a great number of books but no one had been able to get shelves, organize, paint the room etc. We enlisted the help of numerous local kids and over the course of several days we, well, you’ll just have to see what happened below!




(The building on the left was a former school storeroom (inside view below) that was designated for remaking as a library.)




(Inside the room.)




(After!)




(Melissa had the great of idea of doing a tree mural where the leaves were handprints from kids from the community!)


The area around Las Jicamas has many nopales (a special kind of cactus that provides both a vegetable and a fruit). One can eat the new paddles (boiled and cut up in a salad with tomato, cilantro and onion, or grilled whole) or the fruit that gives rise to the flower. The fruit itself is quite juicy (almost watermelon texture) but with a unique (and delicious!) flavor all it’s own. There are quite a few seeds but they are easy to eat and swallow. Extracting the fruit can be tricky though as it is encased in a thick outer covering full of small spines that are almost impossible to remove from ones skin.




(A nopale or cactus. This plant provides a great deal of food. The new pads are cleaned of spines cooked and eaten and the little ovals you see are the fruit which are called "tunas".)




(Preparing the tuna. First you have to rub it in the grass to remove the many hair-like spines, next cut off the ends and then slice it vertically to remove the fruit.) Then enjoy!




And now some adventures/stories:

1. Under the Rock

On one of the open days we had in Tequililla I decided I was going to hike to the farthest off huge hill/small mountain I could see from the farm and climb it. I reckoned it would take about an hour to an hour and a half to make it up and the same back. No one wanted to go with me so I set off by myself with a nalgene of water, my camera and two bananas. For some reason the hill didn’t seem to be getting any closer for the longest time but after 2.5 hours I finally made it to the top. There were probably going to think I had been killed by narco-traffikers as my faulty time/distance estimate meant I would be getting back about 2 hours after I had told them (and they did end up thinking I had gotten lost/abducted or been killed even though we were in a safe area of the country. But, that isn’t the point of this story.) Once on top I had a strong urge to defacate and figured I would just pry up a rock, go under that, and no one would ever know. I found a suitable candidate and after lifting it up I was about sink down into battle position when I spotted some movement. Looking closer I saw it was a scorpion! It was small, about an inch long, but I had heard the smallest ones are the most poisoness – yikes! I got a stick and played with him some; his sting reaction was super fast! I threw a grub in at him and bam! A quick sting and the grub thrashed around for 15 seconds or so before remaining still. Eventually I reckoned I should leave the poor guy alone but it was my first scorpion and I was just so excited!


(My scorpion friend!)


2. Mad Cows


On the way back from playing with the scorpion I had to pass through a field of cows that had given me some dirty looks on the way out. This time they were on the other side of a fence but the fence was open at one spot a ways ahead of me so they could cross back over if they wanted. As I started to pass the herd several large ones took notice and began to moo vigorously. Soon the other 30 or so cows took note and began to moo and follow me. Now, they were still on the other side of the fence at this point but they would be able to cross over in about 100 feet when we reached the opening and this was not something I wanted to be around for. I picked up the pace and started fast walking. The cows increased their pace and matched me, coming closer to the fence and bellowing. Now I was getting worried, what was going on with these cows? There was no one else in sight. I stopped to see what they would do and they stopped too (where I took the pic you can see below). We were still a bit off from the opening and my plan was to sprint past and if they spilled onto my side and chased me I would try and hop the 4 foot barbwire fence and land on their original side. With this in mind I took off – and so did the cows! They were running right behind me on the other side of the fence and bellowing! For whatever reason they did not cross at the opening and we ran another quarter mile or so this way before their pasture ended and I escaped. Whew!




(The herd right after their initial bluff charge staring at me after I had stopped.



3. The Beach


I have already introduced you to Joel who is a fellow second year medical student (one of three of us on the trip). It turned out that one of Joel's uncles had moved to Mexico permanently 12 years ago. Joel had not seen him since he left Wisconsin but we were only a 5 hour bus ride from his house on the coast and he informed us he would be happy to have us come visit!




(Inside his canal-side house.)


Besides free lodging Joel's uncle graciously provided us with all the food we could eat. As his uncle happened to be a chef back in Wisconsin this turned out to be a mouth-watering experience twice per day.




(A seafood paella he prepared for us our first afternoon there!)




(One of the beaches we visited. This one had great waves for boogie boarding, which we did for hours on end.)




(Sunset at the beach. For the last rays we swam 100 feet offshore and bobbed up and down as the sun sank. The ocean seemed to be on fire.)




(Another shot)



4. The Burn


This story reaches back to the time we spent with Berta and her family. After trying so much good food they had prepared for us we decided to share something we know of. I used the same peanut-chicken recipe I cooked for my Ecuadorian host family and once again had to prepare the peanut sauce from scratch (peanut butter, milk, oil and chiles) as one cannot buy pre-made peanut sauce in Mexico.

Everything was going to plan and I decided to go to the bathroom quick before we served the meal. About two minutes after getting out of the bathroom I started to feel a burn that spread up inside my urethra (where the pee comes out in guys) that intensified quickly. What was going on? Did I have a rapid onset STI? I couldn’t think of anything that would have put me at risk… but the burning, it kept getting worse and worse. I tried to go to the bathroom again to see if I could “pee out” the problem but it only increased the pain. What was going on?! Then it hit me. The chiles! I had not washed my hands after splitting the chiles open (by hand in fact as I was in a hurry); I somehow must have self-contaminated myself and it had traveled up my urethra!

The meal turned out to be a hit but needless to say my enjoyment of it was tempered by the penile burning I was experiencing and that lasted a good 30-40 minutes.

Lesson. Be careful when mixing chiles and the use of bathrooms.

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So that’s all for now. I hope to have to my Guatemala experience out soon but in the meantime I’d love to hear from all of you!

Done with 1!

So, I was on the phone two weeks back with someone from AT&T to trouble shoot my internet (it had decided to tweak out during finals week and I didn't have time to deal with it then). At the end of our conversation she asked me if I was interested in bundling services, putting TV with phone and internet (as I only get internet right now). She went on about U-verse TV for a bit. When I replied I don't watch TV she was blown away. A brief pause was followed by, "then, what do you do?" The incredulity in her voice made me smile. Then I told her I ride bikes and climb trees.

Which is true, but what has been the real time consumer this past year was med school. And I am officially done with my first year!

The year finished out well. On reflection it was overall very enjoyable but there were definitely challenging sections. I think we (or maybe just me) often tend to review events in the past more kindly than they might have actually occurred so I reread some of my journal entries from throughout the year. There were indeed times when I was bummed out and frustrated but most entries ended on a hopeful note or at least attempted to find the positive. And being on the finished end sure does feel good!

I don't think I ever blogged about why I came out here to WI versus other options but it was based in large part that I felt this was the community I felt would best support and nurture me in becoming a compassionate and well-rounded physician. In other words, a gut feeling led to me taking a leap of faith. I thought and hoped it would be a good fit but wasn't 100% sure. Looking back though I think I made the right call. I have made new friends I hope to have for life, met and befriended mentors I admire greatly, become involved in more exciting service opportunities than I probably should have:), become even more fascinated and in awe regarding the inner workings of the human body, taken up a new fav sport (XC skiing!), and more.

What follows are some pics and stories from the past few weeks.




(My friend Tramanh and I in lab for the next to last time - the very last time was the test! As you can see we are both wearing our "nuerobiology" t-shirts, gifted to the entire class by our beloved nuero professor Big John. he really had us call him that too! the man is amazing. The blob on our shirts is a cross section through the brainstem - one of 10 levels we had to learn!)

After finals week I headed 5 hours north to the small town (approx. 2000 people) of Grantsburg where I did an "externship" for one week. To be honest I do not know the real difference between an internship and an externship but I do know I had an incredible experience and learned/reviewed loads of material. I also got to see how far I have to go in my training:) I was mainly working with Dr. Blaise Vitale who arrived in Grantsburg 20 years back through the National health service corps and has been there ever since. I got to stay in a very nice guest house right next to their lake-side home. I enjoyed several dinners with Dr. Vitale and his wife and two kids, got beat up in ping pong by his youngest child Teddy, and overall was made to feel extremely welcome.




(First morning before clinic looking out at the lake in front of where I was staying.)

On Monday (first day in clinic) I got to stitch up a patient that Dr. Vitale had removed a mole from (my first stitching on a live human ever!), learned to start an IV, was part of an emotional patient visit concerning a man who was struggling with his recent terminal cancer diagnosis, and then stayed the night on call. The last item is because G-burg is so small the family docs and PAs cover the ER (there are no dedicated ER physicians) and Dr. Vitale gets "call" once a week. Essentially he has to be at the hospital the whole night in case anyone comes in. I was informed as we started that if lots of patients came in I would have a "black cloud" and if it was light I had a "white cloud." We saw patients up till about 11pm and then went to bed. Everytime I heard a noise in the call room I woke up expecting the phone to ring but it never did. Not a single call the whole night! I was a termed a big white clouder which I wasn't too happy about but I guess for most people this is a good thing.

The following day I got to scrub in to surgery to see an endoscopy (where they stick a tube with a camera down someone's mouth and you see the image on a TV - it was awesome!). The second procedure I observed was a hemorrhoidectomy or removal of someone's hemorrhoids. I'll spare you the details but if possible I would suggest you avoid getting bad hemorrhoids. Over the lunch hour I had some free time and decided to go run around outside. I didn't have running shoes but there seemed to be lots of grass, the sun was shining, so I went for it. Turns out the hospital is surrounded by a golf course and I found a nice green to do some yoga and handstands on. This also happened to be in front of the pro-shop and after awhile a manager came out. He informed me I couldn't keep doing yoga on his green which I kinda figured but was nice enough to help me find some grass that I could use in the future. We chatted for awhile and by the end of the conversation he offered me a free round of golf with free clubs rental. I never got to take him up on it but man, the people up there were very nice.

That evening I accompanied Dr. Vitale to the local softball field for a team work night getting everything ready for the season. Dr. V has become very involved outside just medicine and it was neat to see how he had integrated into the community. I think I would like to do something similar in the future. That night, as I had the first night I arrived as well, I did a P90X workout with Dr. V in his basement. For those that haven't heard of P90X it's a series of workouts on DVD that range from "chest and back" to "kenpo" (martial arts cardio basically) to the "ab-ripper" to "power yoga". I've always been skeptical of workout DVDs but these kicked my butt! It was also a fun bonding time and even Teddy got in on a few of the workouts.


Wednesday was a long one. At the hospital at 8am to see the admitted patients, clinic 9-5, then sports physicals for local kids from 5-8pm. Two cool things that came from doing the physicals is I now feel much more comfortable with hernia checks and also learned the real reason you get asked to turn your head and cough. It's not to elicit a special cough or anything but merely so you don't cough in the person who is checking's face! Earlier in the day I had the chance to feel an actual inguinal hernia so I had the comparison to go on. Dr. V also found me a few heart murmurs to listen to. I've still got a long way to go on auscultation.

Thursday was a normal clinic day but after clinic I helped put in Dr. V's dock with him and Teddy. After the installation I took their kayak around some islands out on the lake as the sun faded into a sorbet spread of orange pink and purple above the lake. Sadly no pics.

My final day in clinic included learning several new procedures. I was able to inject over an abscess we tried to drain and froze off precancerous facial growths from a patient with a liquid nitrogen "gun" of sorts. During one patient visit a knock sounded on the door. Dr. Vitaled opened it and a concerned looking nurse from the operating room informed him she needed a moment. I went out as well.

"Dr. Vitale... we have a very rare surgery we want Michael to see."

It wasn't an emergency after all!

This brings me to one of the coolest parts about being in Grantsburg. I was the "new person." In a big teaching hospital med students are a dime a dozen but up in G-burg they don't get too many and thus everyone wanted to meet the new student, other providers frequently came by to show me interesting cases, people wanted to know all about me and there was a even a sign above my little student desk on the first day welcoming me! I felt like a rock-star to be honest. The fact that everyone there loved to teach made for a truly ideal learning environment.

Anyhow, back to the story. What they wanted me to see was called a gallstone ileus. Basically what happened was the person's gallbladder stuck to their small intestine, a hole wore through both the gallbladder and small intestine, then several gallstones popped through the hole and traveled down the small intestine a ways before getting stuck. The surgeon had to go in and find what he termed a spot where, "a sausage meets up with a noodle" or the spot where the block has caused a build up behind it so one section is enlarged while the small intestine following the blockage is much smaller. He found it alright, twice in fact! (as there ended up being two stones he had to remove). The picture below is of the larger of the two stones.




(The larger of the two gallstones. Crazy looking huh? This one, as you can measure by the scalpel next to it, was over 3 cm across!)


My time on Grantsburg in a clinical environment with such great teachers was just what I needed after a year largely buried in the books.

After my externship I had the weekend open. My plan was to camp and bike for two days before heading back to Madison. I found some sweet trails up past Cable in Northern Wisconsin. Pics below:




("The Wall" basically the entire side of a ravine that had been covered with slabs of rock. Great fun to ride!)




(A post ride self pic)


Next day I headed towards Madison but rode some trails half way back with my friend Tom.


(At an overlook from one of the mounds.)




(The so called "plumber's crack" trail feature.)


Since Sunday I've been back in Madison doing things like laundry and cleaning my apartment that got pushed aside during finals. I've also been preparing to go to Mexico and Guatemala this summer and thus have in the past few days eaten cactus and learned about other traditional foods of Jalisco for the nutrition/cooking classes we will run in Mexico, been instructed in how to make soap, and learned how to build/focus a telescope (all pertain to projects we will be doing in Jalisco). Concerning the telescope session (last night) as we were being taught by an astronomy grad student we also were able to use the main university telescope to look at venus, saturn, and the moon! My favorite image was either the rings of saturn (you could really see them!) or the craters on the moon.

Well, that's all now. I get back to WA May 30th and if you're in the area give me a call!

Warm regards to all.

Winter/Spring

Wow, its been awhile.

i know it's spring but i wanted to share how my big ski race went back in february. in a nutshell awesome. i didnt place too high but i did finish the whole 50K and in my goal time of under 4 hours (3:57 something).




(Myself and a few med school friends/fellow skiers, L-R me, Gabe, and Nate)




(A pic from the start. Over close to 10,000 participated in the event!)


lessons duly noted:


1) the birkie is hilly - i had been warned of hills but didnt really appreciate that until i started. the problem with these hills is you go up, expend a ton of energy, and then you're down the back side so fast you have start climbing again before you know what happened. bring on the lactic acid!

2) skate skiing uses your whole body - this was helpfully pointed out to me when my abdominal muscles started cramping around 35K:)

3) I am still a fairly inept descender - my lack of descending skills was not helped by the fact that my wave, wave ten - the absolute last, had to contend with descents that had been carved into tracks where one could not really turn well or slow down. i crashed big time on a sketchy corner to the raucous cheering of numerous heckling bystanders who had trekked into the woods with lots of alcohol and set up camp on the biggest downhills. as i tried to get going my boot wasnt quite in and i went down again. at this point one lady offered to help me while her companion offered a shot of hard liqueur.


right after the birkie things got warm so no more skiing. but, this made for some great tree climbing weather. i hadnt been up a tree since i went apple harvesting in the fall and it was great to get back out there.

we just finished up spring break a few weeks back which i used part of to visit my good friend Luke in Washington DC. Luke and I met the first day of orientation at PLU and even though life has taken us to different parts of the world/country we've stayed in touch. I had never been to DC (or any other part of the east coast for that matter) and had a great time exploring the capital, relaxing, cooking and eating delicious food, exercising and playing copious ping pong.




(Me, Luke and Marci in front of the capitol building)




(They had lots of trees with flowers. This is one of them. I was there for the cheery blossoms as well which were quite spectacular.)




(At the WWII memorial which was one of the most interesting to me.)



now im back in our final block, just 3 more weeks. one event of note is i ran my first ever solo MEDiC clinic recently (the one i co-coordinate on saturday morning/afternoons for uninsured people with acute medical conditions) and it went ok! while we are an acute care clinic in name we are seeing lots of patients with chronic conditions manifesting acutely as they have no other source of care. we have also been seeing a plethora of individuals for dental concerns. we have a few referrals each month but the need greatly overwhelms the supply. im not sure how the mouth was determined not to be a part of one's body for insurance purposes but it's terribly vexing for us and our patients. one man came to us for severe tooth decay and abscess that are causing him sufficient pain that he is taking multiple over the counter pain meds just to get through the day. the kicker? he's a US veteran, gets his care at the VA, but they don't do dental. dah!


oh, and i guess i didnt tell everyone this yet. while mtn biking in the trails by my house i fell hard off a jump and broke my left distal radius (colles fracture).




(me with cast)



JUST KIDDING! we had a workshop for M1s and M2s to learn a variety of skills. i participated in casting and learning how to suture on pigs feet. it was a blast, i could have sat there for hours perfecting the different suturing techniques but i reckon there will be more time for this in the future.

this past sunday the MEDiC council (team that runs free clinics for uninsured of our community) went to do a ropes course to build comraderie and have fun. i think both were accomplished in great measure. having a warm sunny spring day was a definite bonus.




(this cable bridge was tricky to balance on as the cables werent too tight. without some belay tension i think i would have fallen off. the exciting part of this one for me was to get up to the bridge. they didnt have the right rope so i got to climb the angled tree you can see in the left of the image up to the start with no rope! Thy needed someone to do this as the rope ladder normally used to start the challenge was stuck up on the other side that i am heading towards.)




(this was a high ropes challenge where you had to lean in and support your partner or you both would fall. or at least fall sooner as everyone fell eventually:)




(chris and i going for it!)




(our MEDiC team!)


while this final school block has been lighter on the course work i have kept quite busy due in large part to the transfer of leadership for various groups. Joining the MEDiC council has been a big part of this. In addition, myself, Anst and 3 other M1s will be running the Global Health Interest Group (GHIG) next year and we've already been dreaming up cool events. one i hope to run is a workshop to teach how to make thin and thick blood smears and then diagnose malaria by light microscopy. i was introduced to this in Ecuador by Manuel and think other students would find it fascinating.

Also keeping me on my toes has been the ramp up preparing to go to mexico and guatemala this summer. ive solidified travel plans and will be back in seattle may 30- june 20 then mexico june 20-july 25 and guatemala july 25-august 7. in mexico i will based in a small rural community called Tequililla in the state of Jalisco. in theory i will be working with community members in a series of nutrition/cooking classes much like i did with operation front line the year past in seattle. however, the cooking methods, food available (i heard nopales or cactus is a main veggie - anyone have any good nopale recipes by chance?), and manner of acquiring food will all be totally new so i envision i will be doing more learning than teaching to say the least.

well, that is all for now!

Polar Plunge and more

Hi all,

Life has been far busier for me this semester. This is due in large part to my getting involved with a number of new projects, a few of which I will tell you about. Overall though, life is good

The biggest news is I became a part of the MEDiC council for the rest of this year and into next. What does this mean? Well, the MEDiC coucil consists of UW health sciences students (mainly med) who work together to run 6 clinics in Madison for uninsured people seeking acute medical care. We can't offer extensive services/followup but we can deal with more mundane issues and we also have numerous connections around Madison to refer our patients too. My specific role is as a clinic co-coodinator for one of the 6 clinics. The clinic I am based at runs every saturday 8-1pm and we see a large number of Spanish speaking patients. The basic premise is that students in teams of two interview and examine patients to the best of their ability before reporting to an attending physician. They then come up with a treatment plan and all go back in to discuss options with the patient. As a coordinator I make sure all the students and docs show up, orient everyone, help connect patients with referrals, write up a report, and trouble shoot the many unforeseen events that always seem to come up. I have been training for the past month and should start on my own come some time next month. In some regards the position is similar to my role as a patient navigator in Americorps but I do less direct service in this position and more enabling of others to serve. So far it has been great!

On the physical side of things I have been training for a 50K cross country ski race. The date for this is next Saturday and I couldn't be more excited. My goal at this point is to finish before they call the race. Never having skied of any sort until this season the learning curve has been steep but I feel more or less ready:)

Another endeavor has been planning out events for this summer. On the agenda so far is spending a week in northern WI working with a rural family doc, assisting several communities in Jalisco, Mexico with a variety of community wellness projects for 4-6 weeks, and co-leading a team of UW health sciences students and doctors to run medical caravans in a remote part of Guatemala through a partnership with a local mission for two weeks. More on all those in the future.

As alluded to in the email I sent out I also participated in a Polar Plunge to raise money for special olympics in WI. Please see pics below. In total friends and family helped me to raise $225; the highest total on my team - thank you to all who donated!




(Our med school team - Dr. Bucky's Hyperthermics. the name was supposed to be a joke, hyperthermic means very warm which is exactly what we were not:)




(We had been standing out in line, waiting to jump, for a good 15 minutes at this point and were pretty well chilled. I was jumping up and down to try and stay warm. It was snowing a bit too but luckily not real windy. For anyone wondering, the shape on my left chest was meant to be a rough outline of where we learned our hearts are.)




(Jumping. The hole in the ice had been cleared out away from the shore so we had to walk around, jump in, swim a bit and then clamber out on some stairs they had put in.)




(The feeling can only be described as instant numbness of all body peripheral tissue. And massive cremaster muscle action. I was the first one out of the water which meant I was also the first one in the...)




(...hot-tub. Or, rather, luke-warm tub, but it was way better than the lake!)




(Our team after.)


Switching topics, I recently wrote a short piece on an experience I had while working in clinic. It was for submission to an annually published compilation called "Chicken Soup for the UW Medical Student Soul" and I have pasted it in below for anyone interested.

----------------------------------------
YAWNING - Michael Wauters, M1

“Hey Michael, this looks like a good one for you. Forty-six-year-old Latino man complaining of frequent urination and testicular pain.”

I was at GPP, the acronym for generalist partners program, where first and second year medical students get an introduction to clinical medicine through the opportunity to work with a local general practitioner once or twice a month.

I glanced at my watch before entering the room, it was getting towards 7pm, the end of our evening clinic, this would be our last patient and I was ready to get home and get some food. My GPP introduced me, as is his style, checking that the patient was OK with talking to a student first.

As I sat down on the stool across from the man, Ricardo we will call him, he tried to stifle a yawn with limited success. I inquired what had brought him to the clinic and he replied in short phrases. A minute passed and there was another suppressed yawn. Why was he so tired? After 5 or 10 minutes I had run out of questions I thought applicable but something just seemed off with his manner. Another yawn escaped.

“How many hours have you been sleeping per night on average?” I inquired.
“Five,” came the quick reply
“Do you feel that is sufficient for you?” I asked.
“No.” A brief silence ensued.
“And what is causing you to only get 5 hours of sleep?”
“My wife has died.”

I was not expecting to hear this. This man was in his forties. I wondered for a second if perhaps my Spanish had failed me and I had misunderstood. I asked again to clarify but there had been no misunderstanding, his partner was gone. I offered condolences. They seemed to lie there on the floor, squirming around, not quite adequate, not really reaching Ricardo. I felt torn between asking more and not wanting to stab into a wound I could see was hurting him profoundly. I had never been in this situation before. I took a middle road, not asking directly about his wife’s passing but how he is coping, what life is like now. I found out he was having trouble keeping it all together with no real support system in Madison and two high school age daughters to care for. He was still reticent in response. I inquired if he had been able to talk with someone about what had happened; he had not. Nor did he want to talk to our clinic psychologist.

I left the room to present the case. Frequent urination, no change in hunger, etc… and, his wife died a few weeks back. My doc was as stunned as I was. Then he added some bad news to mine. Blood work he had ordered on a hunch was back and the results were not good, an elevated blood sugar sufficiently high to diagnose Ricardo as diabetic.

The doctor and I returned to the room. Upon further questioning we found out Ricardo’s wife had passed away from swine flu. At this admission, he began to cry, trying to hide it some, until that became useless. We tried our best to console him and offered again the opportunity to talk with people at the clinic. He declined once more. After talking about his wife’s passing, we then had to inform him he was diabetic. It just didn’t seem fair; this man was already suffering enough. His initial reaction was incredulity; he didn’t believe us. The doctor had to repeat himself. We explained the basics and figured out a plan for Ricardo to return for follow-up care. However, it would be almost a month before he could see the diabetic educator. I stayed in the room after the doctor had left to explain a little more about what diabetes is and some of the basic nutritional steps he could start with to help improve his health given his newly diagnosed chronic condition.

After the visit, as I watched him walk down the empty clinic hallway, I could only imagine the pain and loneliness he was feeling. Reflecting back, I honestly wonder how much help we had been that evening. But then I envision, what if he had not come to clinic at all? His body would have continued to ail from the diabetes and he would have not had a chance to let out what had been on his mind night and day. It’s true, he declined further help, but I hope a seed was planted, that he knows there are other people who care about him, who are willing to help when he is ready. As a first year medical student my ability to diagnosis disease or design a treatment plan is almost nil. However, that evening with Ricardo reminded me that I do have something to offer, something that we all have, the ability to care about others.

I still think about Ricardo often and I hope he is healing, inside and out.

Reflections on the first 1/8 of Medical School

Hi there, it's been awhile since I checked in but better late than never! Life has been good in Madison. One semester down I feel I made the right decision. This is due to many factors but key ones are:

1) Finding several caring mentors amongst the faculty and a plethora of inspiring and kind peers.
2) A schedule that while quite busy has allowed sufficient time for me to keep up to some degree several activities that I most enjoy (exercise, cooking, and a little reading and journaling)
3) The opportunity to get away from the books and actually help people! Highlights include working at several student run clinics for the uninsured and helping provide vaccinations at a mass H1N1 clinic.

Bonus items: Harvesting apples from the copious apple trees in my neighborhood, great biking and skiing, and being able to use my truck for more freezer space because it is so cold!

For the Holidays we had two weeks off and I spent all of it back in WA with family and friends. My brothers and I had a blast climbing trees, making and throwing spears, trail running, damming a small stream with sticks and leaves, and shooting lego launchers. The highlight was a trip to the WA coast where we constructed a huge log fort to "resist" the ocean! See pics below:




(Our builder team minus me. Yes, with only 5 people we lifted all those logs into position:)




(The three brothers and the sea.)


Now I am back in Madison. We just started up the second semester and from what I've seen so far it looks to be another action-packed round of learning. The big news this time around is we started anatomy and today I was introduced to my team's cadaver. Let's just say it's probably best you're not sitting next to me right now as the smell just wouldn't come off in the shower... Just kidding, the odor isn't that bad as they use different chemicals than in the past and the room is very well ventilated.

Wishing you all the best in 2010,

Michael

Milwaukee Vaccine Clinic + more

After finishing up round two of exams last week I was facing a weekend free of studying and no plans - awesome! But what to do?

As fortune would have it I had received an email calling for volunteers to help with a mass vaccine clinic in Milwaukee that was to be held on Saturday. That sounded like just the kind of thing I was looking for! A great mix of service and learning. I recruited several like-minded classmates and we drove the 1.5 hours to Webster Middle School in Milwaukee yesterday morning to help vaccinate people against H1N1.




(Our team at lunch, L-R Anst, Anna, myself, and Tramanh)


Now, I must confess that I had never actually vaccinated anyone before arriving to supposedly do just that. I had done a little blood drawing in Ecuador but that was a quite a while ago and didn't involve screaming needle-mortified young children. So, you could say I was a bit nervous. Then, the very first patient that came to the vaccinator (a local EMT) who had agreed to teach me turned out to be a screaming needle-mortified young boy. Kinda reminded me of myself actually (I had a deathly fear of needles stage during childhood for those who don't know). His cries of terror reverberated across the school gym and it took two grown women to hold him semi-still. The EMT somehow succeeded on his still moving target and I found myself hoping I would get more tranquil patients to start with...

And then it was my turn. Luckily my first patient was a calm adult and there were no problems but my third patient was a terrified young girl who although she didn't really physically flail about, she did cry and scream a fair bit. However, I got her vaccinated without messing up or hurting her and from that point on my confidence started to grow.

An hour later a father and his two adolescent kids approached my station. The father seemed quite nervous. "So, is this going to hurt a lot? You're a pro right, you know what you're doing?" I responded with a, "I've been at this for a bit, don't you worry; the last lady said she didn't even feel it." Luckily he didn't ask me to clarify what a "little bit" meant and all went smoothly:) The rest of our time helping was a blur of constant and exciting work. I met one older gentleman who was a fighter jet pilot in WWII and even flew escort missions for B-24 bombers (the plane my grandfather was a radio operator in during the war!) Small world moment for sure.




(Our team including Dr. Cindy Haq, an amazing person and doctor who supervised us for the day with me holding up an example of the signs we used to bring the next person in line to our station.)


After a late lunch Dr. Haq noted that the crowds had wound down and suggested we go explore the lake-shore of Milwaukee as things were well under control. We took her up on the offer and headed for downtown.

During our wanderings we came across a new science center/museum/aquarium that was having a free admissions day. We had fun pretending to be kids again with my favorite highlight being the sturgeon touch tank!

After arriving back in Madison Anst, Tramanh and I all spent the evening cooking, eating, talking - it was great! Anst made a Haitian inspired fish dish while I cooked up a bunch of veggies in a soysauce/brown sugar/cornstarch/ginger sauce which we had over rice. I also made an apple crisp from the huge store of apples I still have from harvesting a few weeks pack. Tramanh was blown away that young males such as ourselves could cook things that tasted so good! (Thanks mom for the instruction:)




(The cooks)




(The food)




(Enjoying the meal!)

Today was spent on chores/errands as well as a couple of hours with my young mentee Steven. For those of you that don't remember (or never knew) I am part of a youth mentorship program through the med school and this was the first time Steven and I hung out just the two of us. We cooked up chocolate milk french toast with strawberries (and of course ate copious amounts of it) and then went mountain biking. I think (and hope) he had a good time and noted he seemed much more talkative on the drive back versus when we came to my house. I look forward to more adventures with him in the future.

So that about wraps it up. I hope you are well - keep me posted on what's up in your lives if you can!