Everybody's experience at PACE MedSpanish is unique, based on various factors . Here are some experiences that the MedSpanish students have has in the past...
Mackenzie Shribbs shares her MedSpanish experience
Dr. Hana CHOY M.D. PGY5 (EM/IM)
I had taken French in high school and a little in college. Learning any new language stopped abruptly upon entering medical school. Sometime, in the midst of my fourth year of residency, it dawned on me that Spanish would have been so much more useful than French. It was not until the fifth year of my residency that I decided to actually do something about that. I had very simple goals because I knew learning a language was difficult and practically impossible in the short four weeks I could spare. This program far exceeded my goals; frankly it pushed me beyond those goals, and I am glad for it. The clinical experience struck me more as an opportunity to observe medical practices in a different country. It also served as a reminder that I am nowhere near fluent in Spanish, particularly within a medical environment. And perhaps that is what pushed me to go beyond my goals. I had an amazing instructor. She tried very hard to not speak a lick of English to you, and while this can be frustrating at times, she knows and I know that is the best way to learn. She also is horribly optimistic. While I was thrilled to know how to conjugate some verbs in the present, a past tense, and a future tense, she was not satisfied until I had learned 5 more tenses (I think). Granted, I still have difficulty keeping them straight, but I think a good instructor is one who pushes her student beyond what the student believes is her capability. It had been a while since I had been in a classroom, let alone with my own private tutor, I had forgotten the importance of that until now. If I could afford it, in regards to cost and time, I would take this course again and again and again. I would bring my fiance, and he too would get classes from Ana or someone like her. The time with Mari Carmen, at the Red Cross, was fabulous! Having her go over all the equipment and vocabulary of the ambulance was perfect for a new learner and an emergency physician. Doing that at the very beginning of a beginner’s time here is just the right start.
SVJETLANA LOZO, OB/GYN PGY 3
During my Medical Spanish course at PACEMD I had a chance to observe and participate in Advanced Life Support in Obstetrics Course (ALSO). The course has been initially designed by University of Wisconsin Department of Family Medicine in 1991 and was shown to be a great success. American Academy of Family Physicians acquired ownership of the program in 1993. The aim of the program is to teach management of potential emergencies in perinatal period including but not limited to preecclampsia, ecclampsia, post partum hemorrhage, cardiac arrest and few others.
The course has gained its international reputation and currently has been administered in 47 countries, attempting to significantly decrease maternal mortality and morbidity around the globe.
As a third year obstetrics and gynecology resident, I decided to spent two weeks with PACE Med program and participate in Medical Spanish Program Module. During my stay in Mexico I had a chance to attend ALSO course. What I saw was impressive!
Level of organization, as well as depth of material that was explained in this course was excellent. Lectures that we given were detailed and yet short enough to keep everyone’s attention. Each lecture finished with question and answer session as well as practical lab. One of my favorites was lecture on management of Post Partum Hemorrhages. In USA we are lucky to have immediate access to large number of different medications as well as operating room and skilled stuff. In other parts of the world that might not be the case. Tricks like wrapping the body in the tight wrap or use of non-pneumatic anti-shock garment (NASG) was eyeopening for me.
The physicians that ran the course were possibly one of the most educated and skilled obstetricians and gynecologist that I have ever met. The atmosphere that course generated was an invigorating one.
At the end of the each day, there was wrap up session which was extremely beneficial for both lecturers and attendees. In these sessions effectiveness of the course was discussed as well as applicability of lecture material to daily practice. Even though the course was designed as American course, it is extremely applicable and educational to the doctors around the world.
Toward the end of the weekend course, as ob/gyn in training I was inspired. I was inspired to speak better spanish and have chance to better communicate with this amazing group of doctors. I was inspired to get more actively involved in international health and spread the knowledge and tools that we have in USA. Mostly, I was inspired to become active member of PACE Med Family and actively participate in their emergency care programs.
Lenny Noronha, MD, CME
Many thanks to the PACE team for organizing and coordinating a terrific MedSpanish program for me last week in San Miguel de Allende. I was fortunate to have one week to get away from my clinical, educational and administrative duties before starting Palliative Care fellowship this July. As a junior faculty member at the University of New Mexico Department of Internal Medicine, it was a great opportunity to work on practical skills and assess another system at the same time.
The curriculum allowed me to achieve my goals of practicing medical Spanish, learning about cultural attitudes toward end of life care and making contacts with local palliative care/hospice providers.
The first couple days of immersion were focused on exploring SMA and Guanajuato with the two medical students visiting from the USA. Dr. Hall, Blanca and the Flores family gave us a warm welcome. We were pleased with how easy it was to navigate the streets. It is very clean and safe. There was great music in the parks and diverse restaurants.
The tour of the Hospital “Felipe G. Dobarganes” on Monday April, 30 was my first of a healthcare facility in Mexico. The other visitors and I were impressed with the compliant line of patients that applied hand sanitizer on entering the front door. Surprisingly, hand hygiene did not appear as accessible between patient rooms (ED or inpatient). Some wards were completely open with curtains that could be pulled. Others, like obstetrics, had private rooms. The providers and staff were all very polite and approachable. They have the option of hand-written or typed (with a typewriter!) documentation for paper charts. Interestingly, morphine is not used in the hospital.
Post-operative and trauma-related pain is generally treated with NSAIDS, acetaminophen and occasionally Tramadol.
I was fortunate to meet Dr. Lula Tejeida – just before she departed for a month in Mexico City to advance her skills in Palliative Care. She is clearly a woman with a strong passion to develop a more robust set of clinical services for citizens on her return.
Later in the week, I was invited to join a dynamic group of nurses (including Dra. Lula’s sister Leticia), a physician and a bioethicist for a Thanatology conference in neighboring Querétaro. All were very kind and thoughtful. The program was my first exposure to the field. Though I didn’t catch all the jokes the visiting speaker made, I could follow the concepts of grief and bereavement and classic themes in modern Mexican culture. The timing of my visit was fortunate.
The next day, I accompanied Yolanda, a nurse with Hospice de San Miguel, on several home visits. Yolanda also works as an ER nurse at Felipe G. Dobarganes. The sequence of her interval history gathering and provision of resources came with a direct, yet caring style. She was very patient and sweet to explain the complex family dynamics of the patients so that I could understand the situations we entered. Even though the patients could receive medications covered by the national health insurance, occasionally family members will not get them from the pharmacy out of spite or other issues. The hospice team is able to obtain opiates (i.e. suboxone) for patients with severe pain.
The Spanish tutorial was less structured than most of the curricula I have been involved with, yet very helpful. Blanca had us a take a second assessment exam on arrival. It would have been helpful to review it together. Most of my conversational sessions were with Blanca were combined with Scott, a medical student at the same language level. We were given reasonable assignments to complete overnight. This worked out very well. Each day, capturing vocabulary and sentence structure became easier.
The home stay with the Flores family was sensational! Marina and Ernesto are very warm, generous and open-minded. They have been hosting students for nearly 20 years and understand the concerns of visitors with compassion. They understand some English, but do not speak any. They speak clear Spanish at a tempo learners can pick up quickly. Meals are tasty and guests have to fight off second helpings. Cooking with Marina was a blast. My single room had plenty of space, a comfortable bed and desk. I had a private bathroom. It was a short walk to many restaurants/bars and the PACE office. Two of their adult children live locally. One of their sons lives in New York.
All in all, it was better than expected and well worth the price!
The opportunity to learn about modern cultural aspects of Mexican health, family and immigration to the USA was very rich. Each of the parties mentioned in this narrative shared experiences and personal opinions openly. Issues surrounding end of life care were particularly useful to me. The entire team made me feel like a valued guest.
I strongly recommend this program to students, residents and faculty interested in improving their medical Spanish and understanding Mexican values toward health care.
Daniel V. Jereza, M.D. Family Practice PGYIII
Immersion into the real Mexican life is the best part of this whole experience. The people are very friendly. It is like revisiting the past. The whole experience is comparable to being drop off in the middle of the ocean with no choice but to swim for survival. I had no choice but to communicate in whatever little Spanish I knew and learned to be understood. It worked.
How useful did you find the classes?
The Spanish class further enforces what words and sentences I learned in the clinic. The instructors are flexible and adopt the classes based on your goals. Like myself, I do not expect to be fluent in Spanish in two weeks but at least I was able to communicate with the patient effectively.
Carie Chin-Garcia MS IV
The brigada trips (rural mobile health units) are outstanding experience for the MedSpanish student. The student would be most helpful and benefit most from the experience if their language ability is at least at the intermediate level. I worked several times with Dr. Nora. Her team included a driver/social worker and, a pick-up truck with supplies in the back on often bumpy, dirt roads to ranchos about 40-90 minutes away from the Centro de Salud. Students can see the schedule for the brigadas posted on the wall directly opposite the main entrance of the Centro de Salud.
Upon arriving to the destination, the MedSpanish student can ask how they would be most helpful, which could often mean grabbing some of the needed supplies out of the truck. Usually, there is a local person who organizes the day (i.e. sets up a table/chair/bed for exams; and makes a list people needing to be seen by the MD) The MedSpanish student can respectfully take initiative and bring in patients one at a time off the list from the outside area where patients are waiting, take blood pressures, check capillary blood glucoses, and perform all of the exams.
The physician has to fill out a significant amount of paperwork, so the ability to help on the part of the student is greatly appreciated. Patients have follow-up on diabetes, HTN; poor nutrition, and often need dental referrals. The MedSpanish student can obtain meds from the supply boxes if they are familiar with the names of the meds which can also greatly facilitate the visit. While the MD and student are working with patients, the nurse is often preparing to give vaccines and the driver/social worker is giving a lecture on a health topic (diabetes, diarrhea, nutrition) & may give supplements to the children. The MD may make referrals if necessary (i.e. 54 y.o. 7.c small, hard lump found in breast referred for mammography) Students can expect to see 20 patients; to sometimes go on side trips for home visits (very ill elderly or newborns needing blood tests); and to have varying facilities (i.e. someone’s porch & bedroom is designated “Salud” satellite clinic.)
SHERILYN WEBB, MD EMERGENCY MEDICINE (CME)
My experiences with MedSpanish/PACE-MD have been very positive. This is my third CME in San Miguel de Allende, although I was only able to stay for one week this time. 3 years ago,my husband (Physician Assistant-ER) and I spent 3 weeks here studying Spanish,working with the ED staff at the old hospital in El Centro, as well as the Cruz Roja. We worked on the ambulance during the last-ever Running of the Bulls during the annual “Sanmiguelada” --an exhilarating experience! I also attended the IFEM Conference in 2011, which was outstanding. Our time in San Miguel was so enjoyable that we subsequently bought a casa antigüa about 3 blocks from the Jardín, and have been remodeling since that time. As a result, I am staying in my own home. All of our neighbors speak only Spanish, as does our architect. We have immersed ourselves in the culture of our wonderfully friendly neighborhood, participating in posadas, fiestas, ofrendas, and neighborhood meetings.
We hope to live in San Miguel full time, eventually. Our previous clinical experience was excellent, although this time I am concentrating on classroom Spanish, and foregoing the clinical portion, due to time limitations and some burning questions about verb tenses. As I arrived, SMA was in full celebratory mode for La Candelaria. Parque Juarez was filled with flowers, music, and smiles. Walking the streets of San Miguel in the early morning hours to 152 Canal is an invigorating way to start each day, taking a different route each time, and watching the intriguing world of Mexico come to life. The new school building is nicely located, and well arranged for tutorials.The staff is smiling and helpful. Blanca is a wonderful teacher, with much patience and a delightful sense of humor. Marina's cooking class is not to be missed! I would definitely recommend this program to any healthcare provider, and plan to return as often as possible.
I am very grateful for the competence and kindness of the MedSpanish/PACE-MD staff !
MICHELLE HELLUMS, SUMMER PROGRAM
"Here is what a typical day was like for me in San Miguel: I would wake up in the beautiful Bed and Breakfast to the aroma of a traditional Mexican breakfast prepared by our talented cocinera Susana. Fellow MedSpanish students would gather around the kitchen table for the delicious meal, and afterward we would set off for either our Spanish lesson or clinical rotation.
Health sciences oriented spanish lessons are usually one-on-one instruction, and occasionally are conducted in small groups. Because the lessons provide individual attention, tailored to the student’s specific abilities and needs, there is no minimum knowledge of Spanish required prior to program enrollment. MedSpanish health sciences instructors help students make quick progress in conversational Spanish, and teach students the language skills needed to communicate in a health care setting.
MedSpanish students spend 4-5 hours each weekday in a clinical setting- typically at the Mexican Red Cross in response to ambulance service calls. La Cruz Roja responds to 95% of ambulance calls in Mexico.The team of EMT’s are eager to help students learn Spanish, and they allowed us to practice our developing language skills by interviewing patients and completing pre-hospital forms.
After hours, they showed us around town and introduced us to San Miguel’s nightlife. They are a great social circle for MedSpanish students. Other clinical opportunities often arise, such as the Brigadas moviles, which are Mobil health brigades that travel to the communities outside of San Miguel to provide medical consults and health promotion.
While San Miguel’s city center is rather affluent, the surrounding communities are very impoverished and provide a memorable experience to MedSpanish students outside of the Red Cross.
Justin Inslee, Pre-Pro Summer Program
¨Sometimes the best way to learn how to swim is to jump into the water."
While San Miguel has a significant English speaking community of ExPats, I felt well immersed into the Mexican culture. Truly, the experience is what you make if it in terms of choosing to eat in traditional restaurants and taking advantage of the night life with our friends from the La Cruz Roja Mexicana. We also made the effort to take up PACE MedSpanish on their advised weekend trips (Bernal and Guanajuato, to name a few) and planned one of our own to the beach of Ixtapa. Of course, we also had the resource of daily Spanish lessons, operated in small groups and occasionally one on one sessions. For these reasons, my Spanish progressed quite quickly.
I was especially excited to be part of the group at La Cruz Roja. My medical interests are in emergency medicine, sports medicine, and surgery, making the work with first response a wonderful opportunity. Frankly, we were exposed to a much more hands-on medical experience than we could have received in the United States. This gives the MedSpanish program a very innate and intimate value. The local volunteers, paramedics and operators became some of our best friends - several of whom I still communicate with to this day. We often would get together outside of work hours to go out on the town, experience the nightlife, and build camaraderie for the working day.
One of the other students and I joined in on a wilderness medicine weekend hosted by La Cruz Roja, where we camped out overnight in a remote area about an hour outside of San Miguel de Allende and competed in remote patient transport/stabilization drills, techniques for accessing remote locations (rope-scaling rocks, navigating pathways, etc.), physical fitness tests, and team-building exercises. We grilled meat over an open fire and ate it with fresh cheese and tortillas as we hung out around a bonfire - the best meal I had during my stay in Mexico.
I was also able to help on a mobile medical practice with Las Brigadas while they were advocating for women's health. I was able to help check vitals and conduct brief patient histories before each examination. We were also volunteers for a central plaza CPR community training day where we helped set up, tear down, and interact with community members throughout the event to deliver the instruction material. Needless to say, we were exposed to many facets of Mexican medical education, practice, and community engagement opportunities.
The value of working directly with Red Cross, getting exposure to global medicine practices, being part of the Mexican culture (both the lively and the laid back), and improving my Spanish cannot be overstated. The program delivers upon it's fundamental tenets incredibly well, offering students the chance to see medicine and Mexico in ways that they would otherwise not be able to."
Thomas Pre-Med Student
During my senior year of university I was hungry to find a healthcare-related opportunity outside of the United States in order to expand my clinical experience and improve my understanding of global and public health. A family friend introduced me to “Programa de Actualización Continua en Emergencias” (PACE), a humanitarian agency that provides healthcare solutions and training in emergency and community care in Mexico and Latin America. After speaking with Dr. Haywood Hall, CEO and president of PACE, I was convinced that the program would offer a once-in-a-lifetime invaluable experience. During the six-week summer program in San Miguel de Allende I would learn Spanish in both conversational and medical contexts through PACE's MedSpanish program and volunteer at the Red Cross Mexico and several local and rural clinics and hospitals.
In just four weeks I have experienced and learned more that I could have hoped for. My first two weeks in Mexico were spent learning basic life support and medical Spanish terminology. For the following two weeks I spent 50 hours at the Red Cross on call for emergency medical service. I confronted a plethora of injuries and illnesses including automobile accidents, knife lacerations and mental health issues. During a call I would take vitals, record patient histories and assist the EMTs.
I have also received 4 certifications including "Basic Life Support" from the American Heart Association in both Spanish and English and "Basic Life Support in Obstetrics" and "Helping Babies Breathe" in Spanish. During my second week I was offered the chance to teach midwives the Helping Babies Breathe course in Spanish. I jumped at this opportunity as I knew it would not only improve my Spanish skills but more importantly would allow me to make a positive impact in healthcare deprived communities. My comprehension of Spanish has gone from zero to conversational and stands to improve further. My fluency in three languages will allow me to reach and communicate effectively with more patients here in the United States and around the world. I am looking forward to the rest of my time here, especially teaching other healthcare-related classes to members of the local community. These experiences have reinforced my desire to become a doctor and to learn and teach as much as I possibly can.