New UTMB PA school Clinical Rotation Begins

From left to right, Michael, Sandy, Patricia, Eliza, Max, Taylor, Nick, Chelsea, Carter, and Estuardo.

Yesterday Chelsea and Taylor arrived in Chichicastenango with their husbands, Carter and Nick, from a long weekend break in Antigua.  After taking the opportunity to explore the Sunday market for a few hours, we all met at the ACEBAR office for the official kickoff of the second University of Texas Medical Branch PA School clinical rotation

As with the last UTMB group, we began with a three hour clinic for a large handful of patients (17), at the ACEBAR office.  Most of the patients were ACEBAR scholarship recipients who for one reason or another missed a wellness exam during the first clinical rotation in January.  In addition, however, we also saw a few mothers of the scholarship students, as well as at least one follow-up visit – the one I sat in on was with a child who had a serious skin infection in January.

That’s not to say I didn’t talk, though, because working with a doctor doing an exam is always an irresistible opportunity for an anthropologist.  Indeed, there’s probably no other setting in which young – or old – women will speak more readily and honestly about their problems.  And of course their problems are as much or more about their family, social, or economic problems than about their health.

Taylor with a scholarship recipient

In fact, medical exams offer a remarkable window to the culture and pressures and traumas of children and families I’ve never met, or to learn more about children I’ve known for a long time.   So at a certain level it’s fun work for me, at least until some emotional saturation point is reached and it gets incrementally harder and more painful for me to listen to one after another story that underscores the trauma of poverty.

Sandy – our preceptor and gerontologist – is excited about the many herbal treatments available locally. This is a great addition to our treatment arsenal, particularly for patients who cannot afford high priced traditional pharmaceutical regimens.

While Chelsea was talking to one of the preceptors about how best to assist this patient, I kept chatting to the woman.  I discovered that she already has eight children, and is way less-than-thrilled about being pregnant again.  It became obvious to me that that this was yet another case of anxiety and depression.  (The next patient was also a women who had eight children – but who firmly stated she would not have any more).

Anyway, while the stories are interesting, the treatments are complicated in any cultural environment, and particularly one as poor and traumatized as this indigenous Maya population.  Many of the ailments and conditions defy treatment of any sort, while in many other cases there there’s just no resources for treating mental health or chronic conditions (the girl with the anxiety problem, for instance, also needs eyeglasses – and there’s simply no way she or we can afford them).

Chelsea with a scholarship recipient

The good news on this particular rotation is that our newest preceptor – Sandy – is very interested in herbal remedies, and has spent a good deal of time researching them.  I will talk more about what we hope to do with these treatments in future posts.  But in at least two cases today, she prescribed a tea made from “pericón,” which in the US is well-known as St. John’s Wort.  This is a very affordable treatment (a good part of the year it grows wild and can be picked, and the rest of the time can be bought very cheaply from herbalist pharmacies) for someone like this kid, and beyond a demonstrated therapeutic value provides a proactive treatment approach that at the very least presents some value as a placebo.

So it was a good first day and trial run, and the two preceptors and I were quite enchanted with both Chelsea and Taylor.  In fact our only complaint is that their husbands – Carter and Nick – who joined us at the clinic yesterday afternoon, had to go back to their jobs in the States early this morning, and are not able to stay with us for the full 3 week rotation.   But I’m sure our slightly-smaller-than-today group will have a good time over the course of the rotation as we work in diverse clinical settings – to include home visits to rural Maya families, nursing homes for men and women (they’re not co-ed here), and women’s exams and general consultations in three different Health Ministry “Centros de Salud.”

Stay tuned for more photos and commentary related to this clinical rotation ….