Oh, Mexico

The crashing surf provides mood music for the the hermit crabs scuttling passive-aggressively under banana leaves here at Mar de Jade, some hour’s drive south of Puerto Vallarta on the coast of Mexico. I share this space – campus is far too prosaic a word for this place, and estate smacks too strongly of cruel capitalism – with students and guests from around the United States.

The owner/proprietor/guru/storyteller-in-chief is an MD, MPH from los Estados Unidos who came to this area some decades ago to help build a public health infrastructure for the locals, who were (and still are) sorely in need. The zen retreat at which I stay doubles as housing for volunteers at the clinic that she still runs every Monday, Wednesday and Friday, providing free consults from doctors who donate their time. I went with them and found that I wasn’t entirely underfoot: taking blood pressure remains instinctive after my summers at Hopkins, and tough as the language barrier may be, a ready smile still puts most patients at ease while the doctor collects a history.

Still, I was struck by the differences between the “Mar de Jade Clinica Campesina” and the clinics I’ve frequented myself over the years. Few Americans would voluntarily tread into a doctor’s office with an open-air waiting room covered only by a trellis and vines, replete with flies and a noisy children’s program on the other side of the courtyard – certainly it’s not what we imagine as we debate the future of healthcare in this election. White lab coats are a distant myth to us as we usher the next patient into our semi-private exam rooms. The most high-tech tools available in the exam rooms are tiny flashlights for measuring pupil dilation, with reflex hammers a close second. One patient presented with an epidermal infection that we would have lanced but for lack of a scalpel. Women crowd the line outside the room containing the newly installed sonogram, and our OB/GYN, on loan from a Kaiser Permanente hospital in California, rushes madly through the patients in an effort to make sure no one goes home unseen.

Our patients are unfazed by the five to six gringos facing them in each examination room. We are frequently introduced by the English-speaking volunteer doctors as “mis collegas” – their colleagues – and are allowed to watch, certainly to speak during, most of the more prosaic procedures.

I am struck by the unwieldiness of the translation process. Though our doctors are conversant in Spanish, the histories are taken slowly for reasons both cultural and linguistic, as the doctors tiptoe their way through unfamiliar medical foliage in asking and then are faced with speedy yet meandering responses from the patients. I’ve been impressed everywhere in Mexico with the locals’ unapologetic belief in the importance of a good story, and the case interviews are no exception: sometimes we hear about a family member’s death for ten minutes before we finish the examination and call in the next patient. Having just read “The Spirit Catches You and You Fall Down”, though, and faced with a paucity of medical resources, it occurs to me that an authoritative tone and an attentive ear are the most consistent medications we have available to dispense. I hope they help.

Whether they do or not, the clinic does have more modern techniques available. The lab tech comes in a couple of times each week to collect blood samples for analysis, and we can refer patients for ECGs or X-rays. These are all expensive, though, and even $50 US is an unreasonable sum to expect from the far from well-to-do patients who line the walls of the waiting room. The familiar battery of multi-syllabic medicines is available here as in the US, though the attenuated supply is hard to believe.

Lunch is hamburgers, known to all of us, in our newfound wry Mexican style, as “the American food.” We munch away and mainline lukewarm fruit punch as we debate the merits of allowing our interpreters to converse with the patients themselves and then relate the gist of the exchange back to the doctor. It’s not HHS-recommended procedure and there’s always the chance that we’re missing important nuances, but it seems to get the job done and it certainly puts the patients at ease, so no one feels too strongly about changing the process.

The line dwindles and our shoulders slump as the day draws to a close. We hop back in the truck to return to Mar de Jade and compare notes: doctors from the US and Canada, medical students from the South, post-bac students from the West Coast, and a PA and assorted others, including yours truly, the representative Baltimoron.