Practising paeds in Mexico

Ben Hope finds that an attachment abroad can be enlightening

Earlier this year I was able to spend part of my clinical training in Mexico under a scheme operated by the International Federation of Medical Students Association (IFMSA). SINESP is the Mexican branch of the federation. Although I landed at the dead of night, one of SINESP's representatives was at the airport to meet me. He carried my luggage to his car and drove me to a house that had been bought for use by foreign students. This welcome was typical, and over the next four weeks hospitality often sparkled, making me ashamed of London's "there's no business like my business" cold shoulder.

My boss, however, a consultant paediatrician, was less concerned with niceties. He "suggested" - in other words, "if you don't agree I won't sign your bit of paper" - that I join the on-call team, starting at seven in the morning and checking sick children until lunchtime the next day. He was humourless and formal. Con- sultant personality, I increasingly suspect, is global. I found my team, already flagging in the mid-morning heat, resting their chins on a large table under a feeble fan. Papers to be memorised were strewn about; international tomes of protocol lay prone with split spines, the largest served as pillows. The exhausted crew greeted me with scant interest. Certainly no one leapt up to show me the ropes.

Tableau of underfunded health care

In the background was the tableau of under-funded health care that I had waited many years to behold: moaning sick on trolleys, bloodstained linen in disarray, indwelling syringes taped to infant forearms in place of venflons. Temperatures were being taken, abdomens felt, and mothers being reassured. I went to where the action was and introduced myself. Seizing the key words of my colleague's reply, I tried to construct a patient history: 7 month old boy, shaking in the night, mother doesn't have a thermometer, nor a husband. She'll be 16 soon, does she know she needs to give the baby more to eat?

The Mexican students are in their sixth year, and they are working hard, propping up the state health system like house officers in the United Kingdom did in the past. Their derisory wage will not start to dribble out of the state's piggy bank until next year when they will be sent to clinics, often single handed, random, and far flung. Only those who can pull strings will get city jobs. Over frijoles and tortillas in the staff canteen - someone's seen to it that I don't have to pay anything - a favourite game goes like this:

"Tell us again how much you will earn next year, after only five years of study?"

I round the figure into a US dollar equivalent, money everyone knows about.

"Are there too many doctors or too few? Bueno, we're coming to England."

Then I am saying something about debts, rain, tax, shoebox living, traffic, and it's falling on deaf ears and sounding lame to mine. Let's talk about American doctors, though, those broadly disparaged gringos from across the arid border. Now they make bucks.

I feel like a useful supernumerary

The outpatient clinics in the Hospital Universitario are the busiest I have ever seen. "Do not attends" do not matter as the gap will be filled not by coffee but by one of the many families who have journeyed and queued in expectation of 10 minutes' trained attention. For the first time since I gave up volunteer work I feel like a useful supernumerary. I handle some basic cases and when the consultant tells me things they are pertinent rather than impertinent. The learning environment is not ideal, as I know and can infer so little about the lives of the babies and their families. It would be foolish to underestimate the difficulty of doing medicine well in a language you speak weakly. But there is a steep learning curve and I would not be back in a district general hospital in England for all the tequila in Chihuahua.

My hosts take me out at night when I am not dozing on a Merck manual or watching diazepam infusions. The city is spread out and navigable by five-lane highways whose tarmac is heat polished and gleaming, and tyres squeal at 30 km/h. The feeling of being in a movie is with me frequently. The behaviour on the streets is good, the drinking mod- erate and often non-alcoholic. The discos are expensive and nondescript, but up in the hills that surround the city there are open air bars with bands singing heartfelt homages to giantkiller bandit rebels. I learn about Pancho Villa and American aggression.

It wasn't all work

Best of all are the weekends and the week of Easter holidays that I have incorporated into this attachment. I have made friends who are climbers, and they take me to tropical mountains and cliffs by the Pacific. I swim in the wild sea, eat fish, and revise paeds.

This month of my clinical training was packed with incident and discovery, based in a modern teaching hospital that runs as economically as possible so it can offer the right stuff when it needs to. I did not see at first hand the poverty with which millions of Mexicans struggle, but I did see children with chronic conditions receiving inferior treatment because there was no money for anything else. I now have a basic medical vocabulary in Spanish and will be back in Latin America as soon as possible.

For more useful information, contact: Hospital Universitario, Dr Jose E Gonzalez, Av. Madero y Gonzalitos, Monterrey, NL, Mexico
hospitaluni@infosel.net.mx

Ben Hope, final year medical student, Royal Free and University College Medical School
Email: Benjaminhope@hotmail.com


studentBMJ 2000;08:395-434 November ISSN 0966-6494