Summer Clinical in Pachuca Mexico Thomas J Stolz

Summer Clinical in Pachuca, Mexico Thomas J Stolz Jr

Areas of focus 1 2 Gain an understanding of the Mexican healthcare system as it compares to the American Healthcare System Work on clinical Spanish • Focus on the Emergency setting • Focus on patient interview 3 Improve clinical skills through hands on approach

Clinical Rotation site: Pachuca, Mexico Capitol of the State of Hidalgo (3 Million population).

UAEH

Medical education in Mexico • 4 years education • 2 years of didactics, but much more clinical in first years • 2 years of rotations • 1 intern year • 1 social service year • After social service Doctors can become general practitioner or pursue a residency

Hospital General de Pachuca • Hospital funding and patient population • Secretariat of Health’s Seguro Popular – Funded by federal government • Unemployed • Clinical experience • Most busy hospital • 16 beds in the open trauma room • 40+ more patients in hallway • Lack of basic supplies • Worked in Emergency • Clinical Highlight • Running compression on coding patient • Auscultation of pneumonia • Placing NG tube

IMSS Hospital • Hospital funding and patient population • Instituto Mexicano del Seguro Social - Funded equally by the employee, employer and the federal government • Employed citizens • Clinical experience • Significantly nicer than public hospital • Medication and equipment more readily available • Separate areas for trauma and critical care • Worked in Emergency • Clinical Highlight • Stitching up patients hand post crushing accident • Rhabdomyolysis case • Severe gangrenous infection wound cleaning

DIF Hidalgo – Hospital del nino • Hospital description • Completely government funded. • Children • Clinical experience • By far the nicest hospital • EMR • Worked in Peds onc / Surgery • Clinical highlight • Identifying a case of Intussusception by Ultra sound imaging • Participating in Ileum anastomoses

Mexico vs USA Comparisons % population with health coverage Predominant form of health coverage % GDP used on health coverage Life expectancy All cause mortality (per 100, 000) Number of Doctors per 1000 Mexico United States 92. 3 % 90. 9% Government-funded Private Insurance 6. 2% 16. 4% 74. 4 years 78. 8 years 946. 1 (#34 of 34) 826. 1 (#27 of 34) 2. 2 2. 5

Top causes of Death (Mexico) Cause Percent Diseases of the heart 16. 0 Diabetes mellitus 14. 5 Stroke 5. 5 Interpersonal violence 5. 4 Cirrhosis of liver 4. 1 COPD 3. 8 Lower respiratory infection 3. 4 Hypertensive heart disease 3. 4 Road injury 2. 5 Nephritis, nephrotic syndrome and nephrosis 2. 3

Top causes of Death (USA) Cause Percent Diseases of the heart 23. 4 Malignant Neoplasm 22. 5 Chronic lower respiratory diseases 5. 6 Accidents (unintentional injuries) 5. 2 Cerebrovascular diseases 5. 1 Alzheimer's disease 3. 6 Diabetes mellitus 2. 9 Influenza and pneumonia 2. 1 Nephritis, nephrotic syndrome and nephrosis 1. 8 Intentional self-harm (suicide) 1. 6

Final observations • • Clinical guidelines of practice are comparable between US and Mexico. However major differences seen were: • Practitioners are much more lax with their decision making and following EBM • Lack of EMR makes tracing of medical malpractice much harder • Lack of adequate supplies makes care much more difficult in certain settings • Lack of equipment (CT, MRI) makes Mexican practitioners much more dependent on clinical skills