I am not used to feeling so inept and I am not used to feeling so incapable. I feel better when I at least have the illusion of contributing and giving back as much (more) than I am taking. In truth, probably the most difficult thing about this experience has been making the adjustment to being so useless all of the time (I'll credit Erin with that statement). Like all things hard and difficult, I know that being in such a frustrating position is good for me - it forces me to relinquish control (at least a little) and it is humbling to be clueless all the time. Still, I haven't been the best at embracing this unfamiliar role - my emotional response has mostly been guilt.
There's the ridiculous, totally unjustified, outrageous guilt. The guilt for not knowing things that I haven't learned yet in school. Guilt for not knowing how to do things I have never done before. Guilt for dozing for an hour while the interns and the students are working so hard during the Guardias. Guilt for not speaking better Spanish. Guilt for chosing sleep and comfort over experiencing Mexico and partying with the students (it's Mexico, I should enjoy it and experience it. . but it's my bed and it's really not that nice or comfortable but I am so tired. .ahh sleep. . I guess I'm old).
Then there's the guilt that's slightly more founded. Like guilt for getting so much personal attention from the doctors, personal attention that the other students aren't receiving. There is the guilt for taking up learning time from the other students - for example, attending a birth that should be attended by a student. Guilt for getting all of the privelages of practicing medicine without having done the work of learning the information in class. The guilt of knowing that I will probably never be able to repay the kindness of the students, interns, and doctors here. Since these are all inherent components of the program, there's not really much I can do to change it, except choose to not participate, and then I would have to feel guilty about that.
And then there's the guilt that is born from participating in activities that conflict with medical ethics in the states, ethics of education, and my own personal ethics. For example, the cold truth is that we are studying in Mexico because, here, education of the student trumps the welfare of the patient (another Erin observation). Both Erin and I are untrained and unskilled in the art of delivering babies, and yet we have little to no oversight during the births we are attending. I am essentially trusted as a 'doctor' skilled in delivery. And for this I can feel some legitimate guilt. Early on in the month, I made a choice to go with the flow, to trust the judgement of those around me even if their choices were not consistent with my knowledge level, my comfort level, or my ethics.
Down here, you are called doctor once you enter medical school. Indeed, after Dr. Pacheco overheard me introduce myself as a student to one of his patients, he took me aside and told me that I need to embrace the role of doctor; I need to instill confidence in patients and introduce myself as a doctor, not as a student. Working with patients who think that I have the knowledge and experience to qualify me as doctor and doing nothing to dispell that misconception is seen as dishonest trickery in the moral code of medical schools in United States. It is almost equivalent to running an experiment on human subjects without their consent. Although it may not have the same tragic outcome as Tuskegee, it is understood as equally morally reprehensible.
Then there is the larger issue of patient rights and, at times, human rights. Doctors here treat their patients differently than doctors in the states treat their patients. The doctor-patient relationship is reminiscent of the more traditional doctor as omniscent patriach model that we have worked so hard to do away with in the states. At Materno-Infantil, doctors are all-knowing, and they refer to their patients as Queen, sweetie, child, little mama, even fatty. There is minimal attention paid to patient consent and patient agency in decision making is almost non-existent (information is routinely withheld from patients). Unnecessary, treatable pain is not immediately alleviated.
These things do not mesh with the way I strive to treat patients and people. I understand that most of this is either a cultural thing or a resources thing. It is clear that, except for one or two doctors, most of the people working in Materno-Infantil truly care about the patients and are passionate about providing excellent care to the poorest sector of Mexico. Of course remembering cultural differences helps to dissipate the horror at what I see as lack of respect, condescencion, and even cruelty to pateints. But cultural relativity can only carry me so far - at what point is something just simply not consistant with human rights? While I have yet to see something that grievous, it is an important question to ask, especially when I am expected to participate. Do I be in Rome and do as the Romans do, or do I do what I believe is right? Although I am loathe to admit it, my response has been somewhat inbetween. I have found myself treating the patients here slightly differently than I would treat the patients in the states. While no excuses should be made, a likely explanation is because I don't speak enough Spanish or know enough medicine to circumvent the established doctor-patient relationship.
There is a serious moral problem with us being down here. There is an element of this experience that feels unsettilingly colonial - as though the rich white girls from the United States are down here to learn (experiment, practice, improve themselves) on poor Mexicans since the poor Mexican patients don't matter as much as the rich white patients in the United States. Of That is a somewhat simplified way of looking at the situation. Erin and I are down here on an Intercambio, an exchange. An exchange (of ideas, of people, of experiences) implies that both parties have something worthwhile to offer and something to gain (and this is one reason I really like the philosophy behind an exchange - it's a true sharing of ideas that legitimizes both participants as educators and learners). And the doctors in the hospital are exceedingly proud of the technology they have, the wealth of knowledge and experience working at the hospital, the education they are giving to their students, and the excellent care they give to their patients. And they want to share this with us. They gave Erin three or more tours of the new wing of the hospital and took her picture with the governor of the state of Guanajuato. Erin and I were featured in the Mexican newspaper in an article explaining why we have come down here to learn (what Mexico has to offer that the United States doesn't). There seem to be motives behind so much of what we have done here. For example, I believe that the time we spent in Ultrasound was just to show us how advanced they are in the hospital. This is problematic as well - why is there a need to prove their achievements to two undereducated medical students? (Because we are from the United States).
Although we may not embrace this role, Erin and I are ambassadors (of a sort) from the United States. We are representatives of our home and we carry all of the baggage of the highly charged relationship between the USA and Mexico (and the rest of the world). Because of this, the third statement I make when I meet someone new is often anti-bush, anti-wall, and anti-Iraq war. Perhaps one positive element of our ignorance in all things baby is that it helps to even out the imbalance inherent in this troubled relationship of power. I think there is some amount of surprise when the doctors and students realize how little we know and pride and satisfaction at getting to educate the 'big doctors' from America.
Of course, the reality is that this experience is much more complicated than any one statement I've made. It's a mix of all of the above, plus a little and minus a little. There is so much history and experience that is woven into the roles we (Mexicans and Americans) are playing down here, that it is impossible to tease out any true meaning.
And with that, I relinquish my soap box.
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