Pachuca is the capital of the state of Hidalgo, and is about an hour and a half northeast of Mexico City.

It is in the mountains (elevation 7,979 ft; for comparison, Wichita’s elevation is 1,299 ft). Thus, the temperature is mild Pachuca even during the summer. In the summer, average highs are around 70F (lows are Debra Diepenbrock in the upper 40s) and they receive ~2.7 inches of rain per month. Why Here? • Wanted to gain clinical experience internationally, preferably in a Spanish‐speaking country since I speak the language. • Central America would be cheaper travel than Spain or South America • Originally planned to go to Honduras, but my proposed mentor wasn’t going to be there at the right time • Pachuca was suggested because of prior relationship between KUMC and UAEH (Universidad Autonoma del Estado de Hidalgo) • I accepted, and I’m so glad I did –it was a wonderful experience that I would highly recommend to anyone considering it! The buses were crowded! Very pretty walk between buses Plaza Juarez

La Ciudad The City Gorgeous sunrises! Surrounded by mountains View from my apartment building Colorful houses in Pachuca

Más de La Ciudad More of The City Their Dinoparque was fun! Mineral del Monte, also known as Real del Monte (don’t ask me why) is a mining village close to Pachuca. It is apparently the site of the first soccer team in Mexico (see picture to right), and also claims to be the home of pastes (next slide), which are a small pastry stuffed with a variety of fillings, and which were brought to Pachuca by Cornish mine workers. If I could do it again, I’d spend the whole day here instead of a Got to try on a mining hat couple hours (and not when it’s raining)! Soccer field (yes, it is flooded)

Real del Monte

Mining equipment Chalupas & Boing Torta & Jarritos Quesadilla & Boing Paste

La Comida The Food Arrachera(?) & Lemonade (fizzy) Hospital del Niño DIF –main ISSSTE (Government Hospital) –main entrance entrance

Los Hospitales

Hospital del Niño DIF –main lobby The Hospitals Things I Saw • Patients • Procedures/Imaging • Thrombocytopenic purpura • Bone marrow aspiration • Acute lymphoblastic leukemia (several) • Neuroblastoma (new diagnosis) • Bone marrow biopsy • Ovarian cancer (post‐surgery) • Lumbar puncture/CSF • Heart murmur aspiration • Irregularly irregular heartbeat • MRI &CT • Acute pharyngotonsillitis & mesenteric adenitis • X‐rays • Sinking left parietal fracture with symmetric IUGR, perinatal asphyxia, recovered neonatal depression • Neurosurgery • Screw in hip • C‐sections • Tracheostomy, gastrostomy ‐ due to spinal muscular atrophy • Salpingectomy • Head trauma (fell while playing sports) • ECG • Bronchitis compatible with influenza‐type illness • Suspected head fracture post 1m fall ‐ actually just sutures haven't yet closed (1yo) Topics of Discussion • Kawasaki • Henoch‐Schonlein purpura • Calculation of solutions • When to use low, medium, or high liquid volume • Polymorphic erythema • Stevens‐Johnson Syndrome • Urticaria syndrome • Rheumatoid arthritis • Tumor lysis syndrome • ALL • Cranio‐encephalic trauma (Glasgow, Phillips criteria, etc.) Patient pre‐surgery Head X‐ray Sinking left parietal fracture Prepping the site! Mid‐surgery

Neurocirugía Neurosurgery All stitched up! 4yo, pharyngotonsillitis & mesenteric Bronchitis compatible with 1yo, suspected fracture – sutures haven’t closed adenitis influenza‐type illness

Otras fotos médicas Other medical pictures

Fellow students (Jenni, Yury) What Surprised Me • Differences in PPE • They rarely wore gloves unless a procedure required sterility (even when drawing blood)! • How chaotic the ED is • Beds were lining the hallway (no privacy), “waiting rooms” were used for patients who needed an IV but could sit in regular chairs, the few individual rooms seemed to be used only for procedures (such as ECGs) or possibly if a patient were contagious. • I found surgery really interesting • Since I’m deaf, I never considered surgery as a possible field to go into, but the neurosurgery & C‐sections I observed were fascinating, and I’d love to at least be able to observe and/or assist with some surgeries on occasion. • Everybody talks fast • I know some native Spanish speakers who speak fast, but I thought it was an individual thing…it’s not! Most of the people I interacted with spoke much faster than I’m used to, which makes it hard to understand when you’re deaf and the words blur together. • Much more affectionate • Kisses on the cheek when you meet someone and as you say hello and goodbye, very little personal space (both of which I knew about, but that’s different from experiencing it personally) What I Wish I’d Known • Medical students wear all white (shirts, pants, and shoes) • I learned this the afternoon before I flew out and had to buy a lot of new clothes. • Almost everything takes cash, not credit cards • I learned this after I arrived –I didn’t change near enough money at the airport, so I had to use an ATM at their supermarket. • It’s cooler than you’d think, and it rains a lot • Make sure to pack a jacket & rain gear (umbrella or raincoat, shoes that can get wet). • Bedding is not provided at the place I stayed (through UAEH) • I misunderstood the email –only a fitted sheet & a pillow were provided, not even a pillowcase, and certainly no blankets (I was glad I brought a couple light ones). • How to get around • Most of the buses in Pachuca have a standard route, but no standard schedule or stops –you have to flag them down and tell them where you want to get off. If you’re unsure if they go where you want to go, just ask –people are generally helpful! Overall Takeaways • This was an extremely valuable experience educationally –I learned a lot! • I’m so glad I got to go, and would love to go again sometime (there or somewhere else in Latin America)! • Before returning, I should practice Spanish more (both conversational and medical) so I’m more comfortable with both listening and speaking. • Keep an open mind about what you want to specialize in (I thought I ruled out surgery due to being deaf, but it’s really fascinating). • Try to plan as best you can so you’re reasonably prepared, but realize that sometimes you end up just needing to go with the flow or change plans, so don’t get too frustrated and enjoy the ride! Sources • Main entrance of Hospital del Nino DIF • http://www.hidalguia.com.mx/gobierno/2015/0212‐dif.htm • Main entrance of ISSSTE • http://www.elindipendientedehidalgo.com.mx/niega‐delegado‐crisis‐ financiera‐en‐issste/ • Colorful houses in Pachuca • https://community.giffgaff.com/t5/General‐Discussion/Mexican‐town‐ transformed/td‐p/17245784