Day 6 - Day 1 on the Cruz Verde Norte Ambulancia

This morning Luis picked me up from Gloria's for my first day in the Ambulancia. Whilst waiting for the crews to arrive because someone had locked the ambulance keys inside the vehicle, we went for breakfast across the road, I had three chorizo tacos, which were far larger than expected and certainly filled a void.

When the crews arrived I was introduced to them and showed around the vehicles and the equipment they contained. I was then shown the Paramedico locker room and rest room where they had several beds for when the shift is quiet. Here I met Chris, another FREUC 5 student, but from South Africa who had already been here for two weeks. We got talking and decided to have a look around the local area at the various shops and food stalls whilst we waited for a shout. 

Immediately as we left the hospital the first call came in and surely we jumped in the ambulance for a very fast journey to a pedestrian who had been hit by a car. Upon arrival we found the patient to have pain in the right side of the chest, completing an examination using the acronym FLAPS (Feel, Look, Auscultate, Percuss, Search) I found that the right side most probably had a couple of fractured ribs. The air entry was equal bilaterally and there was no evidence of pneumothorax so the primary port of call for this patient was to check observations (which were all fine) and provide pain relief, which of course meant cannulation. The patient was then transferred to the emergency department where he was then handed over to the doctors for further assessment and treatment.

An hour or so passed before our second call came in, this time a cyclist that had been knocked off his bike. Again rushing to the scene the patient was sat upright with an obvious head injury. He had a deep laceration above the left eye and also a great deal of swelling above the cheek bone and around the eye. After taking observations at the scene, the patient was able to mobilise so after dressing the wound in the back of the ambulance, he was also transferred to the ED for further assessment and wound closure.

Again waiting around for a little while, a call came in, this time for a transfer to one of the other hospitals in the area for surgery. The patient had a fracture to the left tib/fib and was stable.

Myself and Chris decided to have a look at some of the local medical shops to see the price of medical equipment here. Unsurprisingly most was much cheaper, although some items such as stethoscopes and pulse oximeters were roughly the same. One of the stores we visited was more or less like a large Tesco, but instead of food on the shelves, you had supplies such as surgical equipment, sharps bins, cannulas, intravenous fluids and airway management equipment. The store even had some drugs that you could purchase off the shelf that at home would be considered controlled drugs and only available to registered health care professionals. 

After this I decided to get some food in a restaurant, and visit some local shops to buy a few things. I was able to easily communicate with the staff and can definitely say my Spanish has greatly improved since I have been here.

Day 5 - Day 3 in Cruz Verde Norte Urgencias

First thing in the morning I was met by Luis, who introduced himself and gave me my ambulance shirts and GMP lanyard, shortly after he left Arielle showed up to give me a second Spanish lesson. We went out for a coffee and she showed me where the local laundrette which unfortunately turned out to be closed.

In the afternoon I was back at Cruz Verde Norte Urgencias and this time none of the staff spoke any English, using what little Spanglish I knew I was still able to get very involved and despite the language barrier the staff were very accommodating (often using google translate to communicate). 

During the first hour or so we received an open fracture to the ankle, myself and one of the doctors cleaned the bone and wound before I was tasked to pin the patient down whilst the bones were realigned without analgesia. Upon realignment (and a lot of swearing) I then dressed the subsequent wound whilst we waited for a transfer for surgery.

Shortly after, a small girl arrived with a deep laceration to the chin, she was very agitated and would not allow anyone to treat her, more so when she saw the needles for the analgesia. Again I had to hold her down and stop her thrashing about whilst one of the doctors cleaned and sutured the wound.

Several more patients presented requiring suturing, mostly hands and fingers and as such I was allowed to crack on and do it myself, the most notable of which was a fingertip that had been partially amputated, and I was tasked with re-attaching it. (shown below).

My final job of the day was a cardiac arrest that was brought in by one of the ambulances. The middle aged female was asystolic on arrival and therefore I immediately commenced with compressions. Much like in England, the rhythm and a carotid pulse is checked every two minutes during resuscitation. The woman was intubated and after approximately six minutes of CPR we achieved ventricular tachycardia and subsequently a shock was delivered. We continued CPR for another three cycles when upon the rhythm check we found the patient to be in normal sinus rhythm. She was then attached to a ventilator where over the next fifteen minutes her observations seemed stable with a heart rate of around 80 and sats of 94% also with a radial pulse. Shortly after this she then deteriorated and re-arrested. After discussion with the family it was decided to stop all resuscitation attempts.

Tomorrow I start my first shift on the ambulance, so until then buenas noches.

(my fingertip reattachment)

Day 4 - Day 2 in Cruz Verde Norte Urgencias

Starting at 07:30 today was a little more interesting in the ED, we started the day with several trauma patients, most from motorcycle and car accidents. The doctor talked me through how to examine X-rays of the spine using the acronym ABCS (Alignment, Bones, Cartilage and Soft tissue) shortly following this we received a biker who had a Tibia and Fibula open fracture (xray shown above) which is a little more obvious on the x ray. 

Having a mass of trauma patients gave me the perfect opportunity to practice gaining IV access (cannulating) in order to give pain relief and fluids. To my surprise I have found out that Entonox is not available locally and NSAIDs and Morphine are often the primary source of pain relief.

As the day went on, more and more patients presented, often requiring suturing I took the opportunity to learn to suture myself. After watching a few times and being observed once, I was given the ok to suture without supervision. Using Lidocaine as a local analgesic and the suturing packs provided, I closed several large wounds to the arms and one to head.

In the Evening I met with Arielle, She took me for a coffee in one of the local cafes and to learn some Spanish, She then took me for a walk around the local area explaining some of the history of the buildings and the city. Back at Gloria's we discussed what to expect over the next few weeks before parting ways until tomorrow morning when my Spanish lessons continue.

On another note, I have been using the app Duolingo in order to learn some basics of Spanish. From my experience so far the app is great at teaching you to read in the language, ok for learning how to understand, but not so good at teaching you your pronunciation.

(Above: My first attempt at suturing the scalp)

Day 3 - Day 1 in Cruz Verde Norte Urgencias

Today was my first day working at Cruz Verde Norte in the emergency department. The morning for me started by getting an Uber to the hospital, this is known to be the safest form of transport in Guadalajara as the drivers details are recorded and you are given the price prior to booking.

On arrival I was met by the other staff at the nurses station, communication was a little difficult at first due to my lack of Spanish vocabulary, however one of the doctors in charge spoke very good English and was also very friendly.

It was a slow start to the morning, with about three patients presenting over the first three hours, I observed and learnt about suturing and was shown around and introduced to how the health care system works here.

The second part of the day was a  bit busier, the doctor let me take lead and assess one of the patients rushed in. In many ways this was a lot easier than most I saw throughout the day as there was no language barrier due to the fact the patient was unresponsive. 

After taking initial observations I gave my findings and my thoughts of a diagnosis to the doctor where he confirmed that I was correct. The elderly female was suffering from septic shock. As a result, due to her frailty, age and the fact that irreversible damage to the brain and tissues would have already occured, it was decided that we would give her fluids, oxygen and make her comfortable while we waited for transport to take her to the equivalent of palliative care, she passed away soon after.

After another Uber ride back to Gloria's followed by a short walk around some of the local streets I returned to another fantastic meal.

Day 2 - GMP Induction and More Exploring

Today started at 09:30, I was picked up by Arielle and taken to Hospital General de Zapopan to complete the necessary form to work in the hospitals. Following this we then traveled to Cruz Verde Zapopan Norte where I was introduced to some of the nurses and doctors I would be working with over the coming week.

We then had a little drive around the town, grabbing a drink on the way to purchase a sim card for my phone that would work in Mexico and to exchange the dollars I had with me for pesos. Arielle went through the do's and don'ts in Guadalajara and told me what to expect over the coming weeks.

Once dropped back at Gloria's (my host for the time i'm here) I decided to go out for lunch, so visited the same taco restaurant as I did for lunch yesterday, and for the first time practicing some "spanglish" managed to order my food with ease. After a little walk around the city and a haircut costing 80 peso (£3.26) I returned to Gloria's where she had prepared a lovely meal for me with her amazing homemade chili.

An early night for me tonight as I will be starting in the emergency department at 08:00 tomorrow.

Day 1 - Exploring Guadalajara

So, after my 27 hour journey and a 7 hour sleep I spent my first day exploring the city. In the morning I was introduced to Eithaar, who was on her last day of her two week radiology placement and kindly became my tour guide of the city. Walking across town viewing the sights and exploring the lesser touristy areas I realised how little Spanish I really knew and how important it would be to learn over the coming weeks. In total today we walked just shy of 24km (according to my phone). 

I originally was concerned that being Coeliac (gluten free) would make eating here very difficult, however after having my first experience of Mexican food, having chilaquiles en pollo for lunch and pastor y chorizo tacos for dinner I now know that this will be no issue at all. The one thing that has absolutely astounded me is the cost of food and drinks, a glass bottle of coke costs around 15 peso (about 60p) and my dinner 48 peso (just under £2)

All in all, today has been brilliant and having Eithaar around to show me the ropes and also my translator at times has made today an amazing introduction to the city.

Templo Expiatorio del Santisimo Sacramento

(this is approximately 30 seconds from where I am staying)

The Journey

After 27 hours of traveling I have finally arrived at my accommodation. It is worth noting, if you pay for extra leg room on a flight, that does not mean the seats are any wider, and being stuck between two larger fellas makes for an uncomfortable journey with a lack of sleep. Gloria, the person I am staying with is lovely and showed me the basics for tonight, I am looking forward to exploring the surroundings tomorrow before starting in the hospital on monday.

Intro

So here it is, i'm creating this blog to record my trip to Mexico. The aim of the trip, organised by Global Medical Projects is to gain experience on the front line whilst exploring a different culture.
I aim to update this blog daily, however I do not know what the availability of internet is like where I am going, so this may vary.

During my 5 weeks in Guadalajara I am aiming to complete around 325 hours of the 750 hours of clinical practice required to complete my Level 5 Diploma in First Response Emergency and Urgent Care.

In order to get to my destination, this saturday, from gatwick airport I have a 11hr 20m flight to Los angeles, a 3hr 23m stop followed by another flight to Guadalajara taking 3hr 13m.

More info on Global Medical Projects at: http://www.globalmedicalprojects.co.uk/