July 16, 2017; The Adjustment Period
I am currently on day three of having dinner cooked for me by new friends in Mexico. No offense to Chicagoans, but I have never experienced hospitality like this in my life. Nearly everyone I’ve met has offered to have me over to their house, or to have a coffee or dinner. I am especially grateful for these invitations since I am in a country where I don’t know anyone and am not fluent in the language. This extreme hospitality also has the added effect of making me feel like an imbecile in this category, all of my manners seem to pale in comparison. Is bringing a store bought dessert over enough or should I learn to make soufflés?
There have been a lot of things to get used to in Cuernavaca, and it is hard to not compare things here to Chicago. This is particularly true with elements of public health, since I have only studied and worked in public health in Chicago. One thing I find interesting is the diversity of types of homes in the neighborhoods. In Chicago, health related statistics are often recorded by neighborhood. There is a large amount of variability in these statistics, even between neighborhoods that are only a few blocks or miles apart. In Cuernavaca, the neighborhoods have a variety of types of homes. Often, you can assume the social status of the owner based on the amount of security. Gate, barbed wire, and a guard dog? That’s a newer home. However, these home are next to smaller homes with less security, and down the road there are tin roof houses with just a fence. Eventually the road is unpaved and the tiny homes just stand in the middle of a grassy patch. It seems as though it would be harder to develop generalized statistics about the people living in these neighborhoods, because they have such different lifestyles and accessibility to health care services.
Another part of the equation is the source of income for many of the people in Cuernavaca. The streets are lined with tiendas with people offering various services and goods. There are little shops for groceries, clothes laundering, and plenty of homemade foods. There are also lots of people who will set up tents or tables to sell food or artisanal goods on the street. There are also markets set up daily or weekly where people gather to sell their goods. Many of these people receive health insurance through Seguro Popular, which is public health insurance funded by national and state governments. This health insurance is used mostly by people who are self-employed or who work in the informal sector. It is also a requirement for the project that I am working on that the patients use Seguro Popular insurance, since this sector of people may be less likely to have received regular Pap smears and HPV tests in the recommended 3 year intervals.
Economic standing is very important in understanding the health and wellness of a population, and low economic standing is a deterrent to access to health and wellness services. I am very interested to learn more about the other barriers to effective healthcare in a society that offers public health insurance and is moving towards universal coverage, since there are still obstacles to overcome to ensure this often-marginalized group receives fair and effective medical treatment.
The Adventure Begins
My first week in Cuernavaca is coming to an end and it has been quite the whirlwind. I have been very fortunate that this first week has been filled with meeting wonderful people and experiences that I know will be helpful for my future career in public health. Although there have been bouts of homesickness and the language barrier has led to an embarrassing amount of time on Duolingo and watching How I Met Your Mother in Spanish, I know I’m having an experience that will be beneficial for years to come.
The first week here was packed, with the first day including an overview of the project I’ll be working on and an extensive tour of the lab where they test samples. This project is currently recruiting 10,000 participants who will be screened for HPV. If they are positive, then they will be asked to participate in 18 months of follow-up. The laboratory we toured explained the various processes that the samples go through to determine if they are positive for HPV and particularly for strains 16 and 18, which are linked to cervical cancer. Each team member gave incredible detail about the process that they use for testing the samples, and then reassured me that no, I would not be responsible for anything that technical during my time there. It was a huge relief.
Wednesday and Thursday included site visits to a local health center where nurses from the Instituto Nacional de Salud Publica are recruiting participants for the study. On Wednesday, we went door to door in the neighborhood, asking women if they were eligible and interested in participating in the study. This was a fascinating experience from a public health perspective because the women we talked to were so willing to discuss their medical history with unknown medical professionals who showed up at their door. It was also interesting as a traveler to get to see a neighborhood and the different kinds of homes and living situations.
Thursday, I went with the nursing team as they went to the homes of women who had participated in the study and received an abnormal Pap smear result. We went to their homes to inform them and ask that they continue participation in the study by coming in for a colposcopy. Since the nurses suspected that a lot of the women wouldn’t show up for the exam, they were all given the same appointment time. This has been one of the most interesting things to see, how difficult it can be to reach people for follow-up for their appointments. The solution is just going straight to the source in their homes to make sure they receive the results of their examination.
It is incredible how many new experiences I’ve come across in just this first week in Mexico. Now it’s off to Acapulco, hasta luego!