Skip to content

Winter has definitely arrived!!!

June 6, 2012

The cold air has settled over the city and we’re all growing accustomed to wearing three sweaters, a scarf or two and gloves when we go out! Despite the cold air, we’ve enjoyed a number of activities over the past few days….thankfully many indoors!

On Monday 6/4 we had morning classes and enjoyed a guest lecture by a Christian physician who is Uruguayan of Armenian descent.  Dr. Papatian spoke to us for about an hour about how his faith impacts the practice of medicine in Uruguay and why he chose medicine as a career. He encouraged all of us to think carefully about our motivations for each and every action and about how we will use our education to serve others. He used the example of Paul on the road to Damascus who responded to Jesus with two questions: (1) Who are you Lord? and (2) What would you have me do?

I think that we were all very touched by his kindness and sincerity and by the stories he told of how he made choices early in his life that have affected how he lives and works today. He is an inspiration and we look forward to participating with him and other christian medical professionals and Uruguayan Christians in an outreach to homeless people in need of medical care through a mobile medical outreach called Projecto America.

That evening we gathered in the student loft to watch a very intense movie called “The Official Story”. This movie won an Oscar for best foreign film in 1983. It’s the story of one Argentine family struggling with whether their adopted child was one of the appropriated children of the “disappeared” political prisoners…moving, sobering, disturbing…and an excellent history lesson before we travel to Buenos Aires next weekend.

Tuesday 6/5 started with a trip to the port to get Yellow Fever shots. These immunizations are not absolutely required, but recommended for travelers to Brazil and that’s where we’re headed in just a few days! Class the rest of the day and lots of activity in the Casa kitchen that evening as students cooked dinner and then launched into a Harry Potter marathon….while doing homework….how do they do that?

Wednesday 6/6. Every Wednesday students spend all morning in observation. Nine students headed to Hospital de Clinicas and the four Speech Path students went to Escuela Roosevelt. They’ve had excellent experiences and I will ask them to post comments to this post that describe some of the interesting things they’ve seen and done.

This afternoon we headed to the Uruguayan National Art Museum to see art painted by well known Uruguayan Artists and a display of unusual photographs of a man walking sideways up trees or buildings or sleeping on the ocean floor…all of this provided plenty of opportunity for the Core course students to talk about the sense of “identity” of individuals and community! Wimon Walker does a really good job of teaching his courses with a Latin American flavor and this allows the students to integrate all they’re seeing into what they’re doing in class.

(Famous painting below copyright in public domain…Blanes…painting of victims of a Yellow Fever outbreak in BA)

Painting by Juan Manuel Blanes
Episodio de la Fiebre Amarilla


From → Uncategorized

  1. Zach Davis permalink

    My time in Montevideo so far has been full of learning experiences and general excitement. Perhaps the most important of these have been my opportunities to shadow and tour the various hospitals in the city. Last Wednesday, May 30th, myself and two other students got to follow around a small team of medical students and their attending at Hospital de Clinicas as they attempted to diagnose a lady that had been admitted to the hospital earlier that week. It was like an episode of House, but without all of the lupus and drug addiction. Though my ability to decipher their medical Spanish was very limited, I was able to learn a lot about the diagnostic process and how a good doctor interacts with his or her patients. A week later we rotated to the cardiology department at Hospital de Clinicas. We were lucky enough to be paired with doctors who spoke excellent English, and our schedule coincided with a very interesting catheter ablation procedure that the team was performing that morning. Several doctors were eager to explain the physiology and anatomy behind the operation to us, and I felt like a member of the hospital team for those few hours.
    Those two mornings in particular have contributed to my understanding of healthcare administration in general, but our tours of the rest of Hospital de Clinicas as well as the private British Hospital have provided interesting insights into how the system works in Uruguay. It is no secret that the system in the United States will be undergoing dramatic changes in our near future, and I plan to be thoroughly educated on how other developed countries have tackled the problem of healthcare. In conjunction with our Global Healthcare class, these experiences have definitely given me a hands-on perspective of the medical field that I aim to be a part of someday.
    During our downtime, we have been lucky enough to learn about Uruguayan culture and the country’s rich history. This includes several stops at various art museums around the city, a scenic bus tour, walks through the crowded ferria street markets, and even a World Cup elimination round soccer game. One of my goals is to become fluent in Spanish, and I’ve definitely had lots of opportunities to practice that. This is the longest that I’ve been out of the country at a given time, so it has been a huge adjustment! I’m so glad I’m here though and it has been nothing short of incredible.

  2. My experience in Uruguay so far has been a very enriching one. We have spent our observation days in the public hospital in Montevideo, Hospital de Clinicas. This huge facility has 18 floors of patients, plus a sublevel containing the ER. The first week of observation I spent on the 11th floor making rounds with a doctor, resident, and several medical students. Clinicas is a teaching hospital and has a medical school on one of the floors, so residents and medical students do much of the work, while under close watch of a physician.
    The second week of observation I spent on two different floors. First, we went to obstetrics and sat in on consultations with pregnant women. We saw one woman with tuberculosis, and another who refused to quit smoking for the good of her baby. We then went up to the 13th floor, which contained an array of cases. We spent the majority of our time here observing a spinal tap and the insertion of a central venous catheter. This man also had AIDS. To do these two procedures, the man’s bed was wheeled into a small windowed room on the outside of the main treatment room containing the other patients. One resident told us that the windows of this room are often open, and birds fly through. Despite the areas of crumbling wall and dirty floors, the medical staff at Clinicas is exceptional. They know what they are doing, and have deep care for all their patients. They recognize that their facility is not exactly state of the art, but they continue to work hard and provide quality care to their patients.

  3. The students studying communication science and disorders have the opportunity to experience two different locations in Montevideo that provide the kinds of services we will be providing. Last Friday, we got to spend the morning observing at the children’s hospital. The section of the hospital we worked with handles disorders or difficulties in voice, speech and language, swallowing and feeding, and audiology. They serve a great amount of patients daily, a variety of which we saw the day we were there. We saw newborns with various issues including sucking/feeding difficulties and one with a cleft palate. We saw two young children, both with cerebral palsy, who were with their caregivers receiving check-ups regarding feeding. One of these was a boy with a feeding tube, and one was a girl who is fed orally but is currently having swallowing difficulties, and the clinicians were requesting further swallow studies for her. With both of these children, I found it interesting that there were teams of consultants working together and discussing the children’s medical records, current status, etc. After observing this system, I really liked the way it worked and the intense, individual attention that each client received because of it. The collaborative efforts of everyone involved allowed for discussion about each patient, as well as varied opinions or areas of expertise.
    I also enjoyed seeing how many students were present at the hospital, working among the professionals and getting experience. The program for an education in speech-language pathology is different in Uruguay, and students are engaged in clinical involvement much earlier on in the school process. Because of this, it seemed that students felt comfortable being in that setting and that they are receiving good experience through spending so much time there. Two students that we saw towards the end of our time were working with a boy doing language therapy based largely on playing and on his interests. This was intriguing to hear about and I would have liked to spend more time there watching the session and observing how this approach works. The thing I probably enjoyed observing the most was the last part of our time there, when we watched a young three-year-old girl’s language assessment. Seeing the ways that the students administering the test got to interact with the child made me eager to work in this area. Because I am interested in language development, it was exciting to see a little glimpse of this realm of therapy and to think about what kinds of intervention they might be planning to start with for this little girl.
    The second location we have visited, which we will be returning to every Wednesday for the rest of our time here, is a school for children with severe disabilities, Escuela Roosevelt. The main disability being served at this site is cerebral palsy. Students eligible for enrollment in the school are those with significant motor difficulties. The majority of the children are in wheelchairs, and many of them are non-verbal or have very little communication ability. Services such as physical and occupational therapy are being provided to the students, and although there is no speech-language pathologist, a large amount of focus is still placed on developing and improving communication skills. This work is mostly being done by the teachers, along with the love and care that teachers provide to each student, as most of them come from unstable homes. The main theme I heard throughout our first day at the school when speaking to the different teachers and other service providers, was that the most important thing is communicating love to the children by treating them with patience and kindness, and trying to help them better communicate. It was actually quite moving to observe the patience and compassion that all of the teachers showed to the students.
    There was definitely not a huge pool of apparent resources available to the teachers. Classrooms were fairly empty, containing only the bare minimum. The use of technology seemed to be extremely scarce, but based on conversations with the teachers, this is not by choice. They simply do not have the resources to do everything they would like to be able to do, such as provide adequate communication devices for students that could be taught to use them and greatly enhance communication ability. The teachers clearly try their best to give each student the individual attention he/she needs, but this is difficult under the circumstances. With the lack of resources, only so much progress can be made. However, teachers are providing the best intervention they can by trying to increase communication ability. This is being done in different ways depending on the classroom and the level of each individual student.
    Our first day at the school, one thing I found interesting and a bit surprising was the high student-to-teacher ratio. Each class has an average of around ten students, with only one teacher in the room (there are five classes, and students are divided by level of ability and functionality rather than by age). It was, therefore, no problem when we returned the next week, and the teachers seemed appreciative to have our help. The four students were split up into different classrooms, and we each spent time observing a few of the students and making notes on their behavior, as well as thinking of some ideas for helping them during the remainder of our visits. I was completely thrilled by getting to work with the students in the classroom I was in, talking to them and playing with them (all in Spanish!), and getting to know the teacher a little bit. The whole experience felt like a glimpse of the future and what I will get to be doing as a speech-language pathologist, and it only got me more excited for that.
    Overall, I was extremely impressed by and appreciative of everyone’s acceptance of our presence at both locations. At the hospital, not only did they welcome us, but also graciously embraced us and gave us every opportunity for exposure that they could, just within the few hours we were there. This showed me that they clearly place high emphasis on learning and giving students experience to the system and how everything works. And at the school, we were not only taken in without question, but also were appreciated for the help we could provide while we were there.

  4. Alex Clendening permalink

    Last Wednesday I got the opportunity to experience some of the aspects of the medical school here in Uruguay that are so immensely different than ours in the United States. Here, eight years for completion of medical school is the norm, whereas it is only four years in the United States. Also, a major difference is the cost of medical school, with the Uruguayan medical schools being free. Yet another difference is the admission process that medical schools have. As I am currently going through the application process in the US, I realize how competitive it is and how hard it is to get in. However, in Uruguay almost anyone can simply sign up for medical school and will get in. There is a difference though because most of their matriculated applicants end up dropping out through the long eight year period, whereas those in the United States usually are kept in medical school either by their own desire or through assistance from the school. Just as there is as much difference in the medical schools, there is a different process for graduating. This is where my personal experience was last week at the Hospital de Clinicas. To attain graduation of medical school, students undergo a clinical interaction with a patient. This consists of many questions aimed towards diagnosis and takes about forty-five minutes of discussion between the doctor and the patient. While this is happening, the other members of the graduating class are observing the experience and grading the student on their questioning technique and their overall interaction with the patient. After the diagnostic period, the doctor presents the results of the discussion to the rest of the class and is once again graded on their diagnosis of the patient’s condition. In our case, I believe the patient we saw had a form of autoimmune disorder, specifically some type of lupus. The patient exhibited a rash over the arms and legs which was an indication of this, but the major determinant was the blood tests that came back with very high levels of white blood cells. I was able to pick this up through my limited knowledge of spanish, but it was a very rewarding experience. In fact, I believe this patient-doctor interaction is one of the most important aspects of medicine. I was happy to see this tested in the medical students here, and I hope that there is a similar system set up in the United States. This first day of observation gave me the opportunity to experience a completely different side of the medical profession, and it encouraged me become a doctor similar to the Uruguayans; that is, I want to put my relationship with my patients in the forefront of my responsibilities.
    Whereas my first shadowing experience was quite different from the something in the United States, the procedure I saw yesterday was very similar to one I had seen in the United States. I got the opportunity to see a heart catheterization where a patient had their tachycardic arrhythmia fixed through applying electromagnetic waves to a pinpointed location on an area of the heart. This was very similar to a procedure I had seen at the hospital in my hometown except for one major difference that seems to be a norm of the healthcare system here. This attitude that every doctor seems to have is one of calmness and tranquility. No one is in a rush, and people spend time talking to everyone that they know and see throughout the hospital. Due to this attitude, many procedures take quite a while, as was the case with the heart catheterization we saw. We were there starting at 8:15 (the patient already being there) and by the time we had to go at 11:30, the patient was still in the operating room. However, this contributes to the patient-doctor interaction that seemed so important last week. This is one advantage they appear to have over us here in Uruguay. They spend more time and more emotional energy with their patient and seem much more genuinely interested in their life. I believe many of our doctors should adopt these same practices. Most often when I shadow doctors in Texas, it is apparent that they view the patients as more of a job than an actual person. However here this is much different. Through these shadowing experiences, I have already gotten the opportunity to see what kind of doctor I want to be. Put simply, I would like to be a hybrid of an American and a Uruguayan. I want to be able to invest in my patients and still be able to see many of them in a day’s time.

  5. Kate Winsor permalink

    While living in Montevideo our group has had the privilege to shadow and observe at the Hospital de Clínicas. Hospital de Clínicas is the largest public hospital in Uruguay and according to many of the physicians that I have talked to in my experience at the hospital, it is the worst of the public hospitals. The first thing that two of the doctors I met told me was that of all the hospitals in Montevideo, Hospital de Clínicas was in the worst condition. Last week while observing a spinal tap procedure in an enclosed balcony, a doctor who spoke very clear English explained that they did the best with what they have. The balcony, which was used to perform minor procedures, doubled as a place to hang drying laundry and according to the doctor, sometimes birds would fly in there while they were trying to do procedures. Despite their difficulties, the doctors at Hospital de Clínicas provide exceptional care to their patients.
    Hospital de Clínicas is a teaching hospital that is connected to a medical school. It is very similar to Parkland Hospital that we toured in Dallas before departing to Uruguay. In our first week of observations my group followed a team of doctors working in the internal medicine clinics. From what I observed the hospital seemed to function very similar to a teaching hospital in the United States. They had interns and residents, who had finished with medical school and worked under the observation of the doctors at the hospital. One of the residents in the group had very good English and explained that first year residents must work in internal medicine and after their first year they are able to move into specialties. The resident that we were talking to was planning on specializing in Rumetology. Something that surprised me was that two of the doctors that we met had traveled from other countries in South America to study in Uruguay. One of the interns was from Ecuador and one of the residents was from Bolivia. The health care system of Uruguay is more developed than many of the systems in the other countries of South America.
    Though we are doing our shadowing at Hospital de Clínicas, we were also able to tour the British Hospital in Montevideo. Hospital de Clínicas is a public hospital that provides medical care to people who fall under the public section of Uruguayan health care. The people in the public section on the Uruguayan health care system are usually very poor. The British Hospital treats people in the opposite end of the spectrum in that have private health insurance. The British Hospital is virtually the only hospital available for those with private insurance. Hospital de Clínicas is the largest of the public hospitals but there are many other public hospitals within Uruguay that people in the can go to. The British Hospital was much smaller than Hospital de Clínicas, due to the differences in the amount of people that the private and public sections of health care cover. The British Hospital was very different from Hospital de Clínicas. The patient wards at the British Hospital seemed more like a hotel than a hospital; a stark contrast to the eight patients per room at Hospital de Clínicas. It is very interesting to see that even though everyone in Uruguay has health care available, the level of health care provided to each of the different groups is much different.
    One of the biggest differences between Parkland Hospital and the Hospital de Clínicas is the security and patient privacy. When we toured Parkland we were not able to see any patients or even walk down certain hallways because of patient privacy laws. The observations and shadowing that we have done at Hospital de Clínicas would not be possible in the United States. All of the doctors that we met at Hospital de Clínicas were very eager to help us learn. Though some of were very confused about who we were and why we had come to Uruguay, they all showed us as much as they could that would enhance our learning while observing at the hospital. When we met the head of Neurology he very eagerly invited us to come observe him but unfortunately we didn’t have time. I was very thankful that the doctors at Hospital de Clínicas were so eager to share and help us to learn.
    One of the biggest challenges I have found in observing is the language barrier. Though I have already learned a lot of Spanish during this trip, I have not learned nearly enough to understand the doctor-patient interactions. Our first week of observations many of the doctors that we were with spoke very good English and were able to explain the basics of what was going on to us. The second week of observations the doctors did not know any English so our group had to rely on our limited Spanish. We were able to figure out the basics of what was wrong with each patient but we were often left confused about the details of each case.
    Overall, I have felt that my experience of shadowing at the Hospital de Clínicas has been very educational. I have found it very interesting to compare the similarities and differences of the health care systems of the United States and Uruguay. I am very excited to continue shadowing for the next four weeks while I am in Montevideo.

  6. Alaina Wolf permalink

    The Roosevelt school was fairly small and from what we saw, there were not very many resources in the classrooms. In order to be enrolled in the school the children had to have some sort of motor disabilities. Most of the students had Cerebral Palsy, but there were also students with Spina Bifida, Cystic Fibrosis and some even had signs of Autism. Those who could not walk had wheel chairs that seemed to be provided by the school. In the mornings the teachers provided academic activities and in the afternoons there were more hands on activities such as; cooking, gardening, and art projects. While we were there was a music class in session where they worked on teaching the kids rhythm.
    In each of the classrooms there was one teacher to at least 10 kids. Even though almost every teacher that we met made a point to express how different each kid is and how they need such different teaching techniques, you have to wonder if that is even possible. Much of their teaching was group based. We didn’t see much of the specific activities but what we could see were the teachers working on joint attention and increasing their basic knowledge as much as possible.
    On the second day that we observed we were able to choose a specific classroom and sit down with the kids. The young girl that I sat down with has Cerebral Palsy. She is in a wheel chair and cannot speak although she can understand most of what’s going on around her. At first, I didn’t know what she was capable so I just observed her, but she had no way of communicating with me. The teacher gave one sheet of paper, but she had no pencil to write with. I had a pen to take notes with so I passed it to her. She immediately began to write everything that the teacher had written on the board. The boy sitting next to her would ask her questions and she could nod to show her answer, but she could obviously only say yes or no. When she was finished writing everything that was on the board, I asked her to write her name and she smiled and immediately got to work. Even though it took her longer than most to write because of her disease, she was very exact and when she would mess up on a letter she would cross out the word and start over completely. By the end of our visit, I “met” her whole family and even her boyfriend through her drawing pictures of them and writing their names.

  7. The Hospital de Clinicas is truly a teaching hospital. In our experience so far, the doctors we have met all demonstrate a commitment to teaching students in their hospital and over the world. Our first trip to the hospital, a general practitioner who has been our contact gave us a tour of almost every floor, speaking with other doctors to allow us into the wards and to see the facilities. This past Wednesday, Zach, Alex, and I watched a heart catheterization operation. About halfway through the operation, one of the important heads of the cardiology unit walked into the room, saw us, and immediately began explaining the operation in perfect English, as it was pretty obvious that we had not understood the Spanish up to that point. The doctor drew us a picture, frequently asking, “You understand?”
    One of the clearest examples of the hospital’s focus on teaching occurred the Wednesday before last. We shadowed a doctor who, in House style, hosted a contest between the medical students. We observed as one med student consulted with a patient for twenty minutes and then had a set time to diagnose the patient. The student presented her findings, and the doctor took an hour to give feedback.
    Though the hospital needs repairs and a good cleaning, the staff has been very gracious and helpful to us. They have extended their welcome and teaching to our group, showing us that they highly value the education of students interested in medicine.

  8. In observing Hospital de Clinicas, one of the public teaching hospitals in Montevideo, I have had the opportunity to understand and see firsthand the clinical care that the people of Montevideo are receiving through their public hospital system. Arriving on the first day for observation, I was quite nervous for what I was about to experience, especially since my Spanish was not very good. We broke up into groups of three and were sent off to different areas of the hospital. My group’s first destination was the clinics, which are for people who cannot afford health care but can go here to receive free consultations and medications. In a room roughly the size of a typical classroom was 10 beds, each having a sheet for privacy but everyone was still able to hear most of the conversation that were going on with other patients. Though their sense of privacy was next to none, people who could not afford health care were getting to consult with intelligent doctors who could possibly save their life or help them considerably for free. Many of the doctors were well aware of the ruggedness and the need of reconstruction for the hospital, yet they saw hope in the hospital staff and their ability to care for the people of Montevideo. Being a teaching hospital, many people from all over South America come to Hospital de Clinicas for their residency because their staff is well known for being equipped to teach the next generation of doctors in South America. Knowing this definitely gave me a more positive perspective on how I viewed the hospital.
    Having observed only twice at the Hospital de Clinicas, I feel like I have already seen so much more than I would have been able to in the United States. With the United States having such tight regulations on patient’s rights to security, it is very limited as to what outsiders can see and know about the patients. But here it is a completely different story. In the clinic, almost 5 medical professionals ranging from interns to doctors greet the patient and have a 10 minute consultation with them. After, they all stepped out and talked with each other about the next steps they should take to treat that patient. They were able to translate the basics of what each consultation went over since we did not understand many of the medical terms in Spanish. They told us how many of the patients had been there for over 3 months because they are waiting for x-rays and labs to get back so the doctors can prescribe them medicine or whatever other care they need. This slow process keeps many patients in the hospital for long durations and many were voicing their complaints about having to wait for weeks to even get an x-ray done. We continued to greet every patient in the room, each having quite different reasons for being there. The last patient we greeted needed a biopsy which we got to observe. Their process of small operations, like a biopsy, was quite different than what I have experienced when having a biopsy done. All of their supplies are double wrapped in brown paper to ensure sanitation of the instruments and gauze used for this procedure. There was a head doctor instructing a resident who was performing the biopsy. Using this collaborative method, the resident was able to practice what they had learned, but still had a safety net in case they needed it. This was very interesting to watch and watching the doctors work as a team made me see how this hospital really is a great teaching hospital.
    The second time we came to observe, my group got to listen to consultations with pregnant women and the doctors. This was really interesting but sad because we got to listen (or tried to because it was all in Spanish) to multiple women talk with doctors about their concerns with their pregnancies. We got to see a pregnant woman who had tuberculosis, a pregnant woman who smoked daily, and many other sad cases of pregnancies in which the fetus will most likely be affected. The doctor that was trying to translate this to us made it seem like these stories were very common among the Uruguayan population which was quite sad. The next area that we went to was another clinic-type setting where multiple people were in the same room with various diseases or conditions that needed treatment. There was a man there who had AIDS and needed to have a spinal tap and central venous catheter inserted into his neck. These are both very scary procedures and this patient did not have any family with him. It was hard watching him deal with the coldness of the enclosed balcony area that was made into a temporary procedure room and attempted to stay still though he was obviously in tremendous pain. Watching this procedure was nothing that I had ever seen before. The preparation was very carefully done, but I was a little concerned with the environment of the procedure room. Only 10 feet away from the other patients, this patient was wheeled into an adjacent room in which laundry was hung on a string and nurses told us that birds sometimes fly in and out. This would NOT be acceptable in the United States. The doctors were well aware of that but they had nothing better to offer. They made sure to be very sanitary and keep everything as sterile as they could like they would if they were in a state of the art procedure room. After the patient had his spinal tap procedure, they immediately put him on his back and began to prepare for the central venous catheterization into his neck. This procedure had a lot of blood and was difficult to watch, yet I could not seem to keep my eyes off. As eight of us are standing around this patient, I looked at him and saw the horror in his eyes. It must be hard for these patients to have so many people watch and observe their misfortune, but if they can get these procedures done for free and also allow medical students to learn and practice as they are working to become doctors, then they do not have much to lose, as sad of a statement as that may be.
    It’s easy to overlook the humanity of these patients that are in this hospital and after watching this procedure, I really felt like that is something very important to the people of this hospital. Sure, they invited complete strangers into their procedure room along with the medical students, but you could see that the patient-doctor relationship was strong and the patient was able to hold onto the doctor when crying out in pain and didn’t have any family there for support. This is what makes Hospital de Clinicas work. Their want to have strong relationships with their patients ensures them that though the process may be slow, they are doing the best that they can with what resources they have. Overall, this experience has completely changed by view of the public hospitals and I will definitely carry this with me in my training as a nurse.

  9. Josh Hill permalink

    We have gotten the opportunity to shadow at the Hospital de Clinicas on Wednesday mornings. The Hospital de Clinicas is the largest hospital in Uruguay. It is a university hospital that is staffed by many students from the medical school. In fact one of the 23 floors in Hospital de Clinicas is dedicated to the medical school. The hospital officially opened on September 21, 1953.
    We have now been to the hospital three times. The first time we took a lengthy tour all around the hospital. We visited many of the floors. The higher we got in the hospital, the worse conditions there were. Many of the walls were crumbling. Some places we even saw what appeared to be mold.

    The next time we came, two others and me shadowed at the cardiology department. The cardiology department was significantly nicer than the rest of the hospital. There were freshly painted hallways and nicer rooms. We got to see some doctors put in a heart stint into a patient. The Wednesday after that I was moved to a ward that contained older women, it contained about 12 patients with conditions from schizophrenia to pneumonia. I really enjoyed getting to talk to some of the interns about their hospital and their country.

    One thing that one said to me that really stood out was that though he hated the conditions in which they were working, and said that the building was crumbling and awful this place contained great minds. It doesn’t matter the condition of the building, as long as there are healthcare providers committed to providing excellent care.

  10. Colton McCoy permalink

    I had a few presumptions when I entered through the wide doors of Hospital de Clinicas, the largest public hospital in Uruguay. The doors were marked with the decay of crumbling paint, there were massive swarms of people, and the floors were a filthy black color in places; this was more or less what I had expected. After all they couldn’t possibly be expected to out-perform the United States. Or could they? I came to find that despite its inferior aesthetics Hospital de Clinicas challenged the predispositions I had about Uruguayan health care.
    After we made our way through the doors on the first shadowing day, we were greeted by the very amiable Dr. Perazza. He was extremely interested in giving us the best possible look at his hospital, so the nine of us ACU students were split into groups of three and were thrown right into the Uruguay health care system by being able to observe doctors from different disciplines. My group had the privilege to shadow on the 2nd floor, cardiology.
    Because the privacy laws in Uruguay are far more lenient than in the U.S., we were able to walk right into the surgery viewing room. The operating room was spotless with state-of-the-art equipment, which was a stark contrast to the underfunded examining rooms that we had seen elsewhere in the hospital. In the two and a half hours we were there we were able to observe an Angioplasty, or stent insertion. One of the doctors with better English explained the entire procedure by drawing a detailed diagram on a sheet of blank printer paper for all of us to see. The doctors were extremely well prepared, and that became evident as the procedure went by without a hitch. For some reason this surprised me. I guess in my mind I had expected the doctors to be less than excellent, but the care that the patients received was just that, excellent.
    The next week, I shadowed alone during internal medicine rounds on the 11th floor. I followed a group of female doctors around as they cared for their patients on a cold winter’s day in a hospital that lacked a central heating system. I saw everything from bladder cancer to sores caused by diabetes. The story was the same here as it was on the cardiology floor, the doctors were extremely invested in the lives of their patients, and genuinely cared about making them better. One thing that was very noticeable however was that the doctors didn’t seem to be in a hurry to do much of anything. It wasn’t uncommon for us to sit around talking (or attempting to talk because it was in Spanish) for 15 minutes or so while drinking Mate, the national drink of Uruguay. This seemed strange to me because the hospital appeared to be very busy, nonetheless we made it around to every patient on the 11th floor before it was time for me to leave.
    Before boarding the plane to Uruguay we were able to get a tour of Parkland Hospital in Dallas. It appeared to be a very technologically advanced hospital, we saw high-tech MRI machines, heart monitor systems, and the whole hospital was on electronic records. The strangest part of all of this is that the U.S. health care system has comparable outcomes to the system in Uruguay despite the obvious discrepancy in technology. I am looking forward to more shadowing opportunities so that I may further investigate this phenomenon.

  11. At the Escuela Roosevelt we each split into our own classrooms where we will spend the rest of our observations, in my class I mainly worked with a kid that suffers from a form of Autism, and he also has a sleeping disorder. The teacher told me that a lot of times he can only stay awake for a few hours during the day because he stays up all night. This teacher has worked specifically with him to help him begin to be able to communicate, because he had not been able to before. As I worked with him and watched the teacher interact with him she would give him prompts of what he should and shouldn’t do. He was eating an apple and he would try to pick it up off the plate with his mouth which is not sociably acceptable, so she was telling him no and prompting him to use his hand and only get one piece of apple at a time. He would do this for awhile and then he would forget after a little while and start going back to trying to eat the apple off of the plate with his mouth. At one point he put some apple in his mouth and chewed it for a little bit then spit it out, so the teacher took it away. She took it away because she was trying to teach him that by spitting the apple out he was insinuating that he didn’t want to eat anymore apple. The teacher then went on to give him other activities to do that would prompt him to use his fine motor skills and his communication skills. He did very well with these activities until he started getting tired. Then he got to where he didn’t want to do anything. She explained to me that he had only gotten 3 hours of sleep the night before and she didn’t want him to go to sleep yet so she was going to try and get him to do one more activity. She moved all the kids to sit around the table and got out a car that she had them passing back and forth to each other. During this activity she had all of the kids working on joint attention with each other and this activity was fitting for the needs of every kid in her class.
    The Escuela Roosevelt was not what I had expected when it comes to who they served. I had thought it would be more of a preschool setting for younger children but it actually has students up to the age of 18. I imagined the school would be an enclosed school in a small rural area, but it was actually in an old country home, it had a therapy pool that had been donated to them. They also had a gym where they would have recess and music class; the new wood floor had also been donated.
    The rest of the observation time I just observed the teacher and how she worked with each student individually to fit each students needs. It was obvious that this teacher truly cared for the children in her classroom and she loved them as her own. Each kid was in a wheelchair and required a lot of assistance with most of their tasks. She had to have a lot of patience with each child and with the activities she did with them. One of the things I learned from her was that the most important thing these children need is love and kindness. She taught me that as I graduate and start my career I need to remember that these children need patience and they need to be loved.

  12. Shadowing Experience at Hospital de Clinicas
    The last two Wednesdays that we have shadowed the doctors at the hospital have been extremely rewarding to me. I have never been in that kind of a situation before where I am able to learn from doctors and see the patients first hand. Even if I had had some kind of internship before in America, there is no way I would be able to see the things I have and get a tour in extreme detail of the hospital like I have been able to in Montevideo.
    Last week my group of three was assigned to shadow in the Cardiology unit. We had the head doctor in charge of the entire unit explain the steps of placing a stint in one of the major arteries of the heart. This was incredible to me! The way that he explained it to us was so detailed including him drawing me a picture and answering all of my questions! Luckily, he spoke very good English so I was able to understand all of it. We spent three hours in the Cardiology unit observing two or three patients; all of them were elderly patients, who I guess are more likely to have heart problems. One thing I notice about this situation is that all of the doctors were fairly relaxed; no one seemed to be in a rush to hurry and get more patients through. There were about four doctors just sitting in the room with us sipping Mate and chatting about various issues.
    This Wednesday I was assigned to work with the nurses on the eleventh floor in the clinics. I cannot even describe how much I loved this! It made me partly wish I were still a Nursing student. The nurses spoke just as much English as I do Spanish so it was very interesting for me. I honestly have not been in a situation where I have been less in control of what was happening. I literally had no person there to interpret for three hours so I was forced to focus on my Spanish and listen extremely carefully to what I was being told. The three nurses I was with were very funny, and they absolutely loved the patient they were working with that was evident. Some of the patients that had been there for months had deep relationships with them. I admired how the nurses treated everyone with such care even though the facility was definitely sub par. While I was with them we checked on a few diabetic patients and helped change an old man with colon cancers diaper. It was so sad to watch because he was extremely frail and only had a little while to live.
    Overall, I have enjoyed the experience, this entire trip has been a wonderful adventure but the main thing I feel will really serve me well later in life is the work we are doing and observing in the hospital. I have no idea if I want to work in a medical setting when I get my Family Studies degree, but I love having the option and being exposed to this kind of lifestyle in advance is truly helpful!

  13. Denysha Taylor permalink

    One of the most memorable experiences I will take home from Uruguay is the close-hand observations that my fellow SLP classmates and I participated in while we were here. On Wednesday we visited a small public school in Montevideo called Escuela Roosevelt . From the outside it looked like a typical school, but on the inside it was far from what I expected. This school was for students with motor difficulties, so most of the students had cerebral palsy. Upon viewing our first classroom, I saw many students with students with severe difficulties and were unable to speak verbally, some not even with gestures. Almost immediately I thought of my cousin Devin, who’s had the same difficulties since birth. To my surprise, however, it was only recently i learned that Devin has an effective communication system, so I knew it was possible for these students to develop one as well. Unfortunately, my aunt, over the years, has had a lot of help from Speech Pathologists whereas this school had none. Technology resources were also hard for the school to find. The school was funded by donations and lacked workbooks, toys, and enough teachers. Some of which had as many as fifteen disabled students in a classroom. Despite these hardships, the school made up for it with a great staff. The teachers in each classrooms were innovative and flexible. Since the students are at different levels with different subjects, there is a separate plan for each of her students. One my favorite strategies was seeing a texture book. The student she worked with has hypersensitivity and she used the different textures in the book to teach him new words or concepts. Another special case I saw was a student who had sleep disorder and tended to stay awake on weekends and fall asleep in class. But his teacher had developed several strategies to keep him awake and focused long enough to learn new things. Before we left, we also attended their music class. The students loved it and the music teacher was so patient with all of them. We were also able to see part of the staff meeting which included a psychiatrist, a physical therapist, and a nutritionist all working together as one speech pathologist.
    The following Friday we visited a children’s hospital. Speech pathologists actually had a varied amount of responsibilities there. Everything from therapy, assessment and diagnosis, and research in voice, swallowing, hearing, speech and language. It didn’t take us long to get involved and we actually stood in on consultations and an assessment. I was excited to see how the speech pathologists worked together and discussed ways to help the client. Students in Uruguay are blessed to have such early exposure to the field and I was happy to be a part of that There were two particular cases that were kind of sad. A little girl with cerebral palsy that was being taken care of by her mother while the father had a job in a different town. Unfortunately the work had become too stressful for the mother and she left. The father tried to care for his daughter as best he could on his own. We able to watch him feed to evaluate her difficulties. It was wonderful to spend a semester learning so many things about your field and see them come to life in a consultation rather than reading about it from a textbook. It’s difficult to see a parent try so hard to care for their child but it just isn’t enough.
    Afterwards one of the ladies took us to see more of the clinic. We saw the rehabilitation site and hearing screening site. We went inside the maternity wards, and newborns sometimes have motor skill difficulty and tend to aspirate when feeding. The mothers were being taught how to feed and watch their babies to keep track of their feeding. Before we left, we saw an assessment of a little girl about two or three years old. I’m surprised she didn’t get nervous with all those people in that little dollhouse with her! Again, I love seeing face-to-face examples of we learn in class. Needless to say our day was pretty packed, but it was so incredible!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: