June 10, 2013: Eu tem aula tudo dia. I have class all day.

Today began with class and ended with class...and had class in between. I started out with a class at Santa Casa with Isadora. She had a presentation first about cardiology. Though I did not understand very well because she speaks so quickly, I think she did a great job and it seemed like the teacher did as well. This class was very small, less than ten students, and after Isa's presentation listened to a short lecture by the teacher about diagnosing depression. I did understand more of this part, but the teacher spoke much more slowly and had very helpful slides. Later in the day I really appreciated this teacher because she seemed very interested in her subject which was not the case with all the teachers I saw. Then, after lecture, the class went to a different part of the hospital called Ambulatorio. This is similar to Urgent Care in the United States but I think it is also used as a doctors office. Every Monday, Wednesday, and Friday, the students each attend patients here and the professor (the same one who just gave the lecture and is a doctor at the hospital) then reviews their assessment and gives any necessary prescriptions or a bigger examination. I really enjoyed this patient contact and, though it was difficult to understand what the patient Isadora and I were attending was saying, it was very interesting to see the medical history papers the man brought with him. He brought recent chest x-rays and lab results, receipts from all of his doctor visits, and many past instructions. Our patient was back for a follow up visit and doing very well. In the end, the doctor asked him to return one more time in six months just to be sure he remains healthy.

I think I look pretty Brazilian here...just saying. Also, The teacher is the blond kneeling in the front (SO young!). Isadora is standing to my right.

After a wonderful lunch at Isadora's grandmother's home, we returned to class, but this time at PUC. We spent the rest of the day there learning about Pathology, writing a prognosis, and Medical Ethics. What specifically we learned I am not sure as I really do not understand much, but it was interesting to see the interactions between the students and the professors and meet many of Isadora's friends. Everyone wants to know about me and what I am doing there. It has been a little tricky to describe since I am just observing PUC this week, but I do my best and usually in the end, the Brazilians try to speak English and I try to speak Portuguese. A couple of different people told me how much they loved the United States. One guy even showed me his membership card for the NRA of the US (yes, the NRA...I was surprised haha). He loves the United States even though he has never been there and in a few years he hopes to do his residency there. If you ask him where he want to go, he simply replies that it does not matter because the whole country is great. Oppositely, another guy told me how worried he was to go to the United States. He explained that whenever he thought of what it would  be liked, he did not like it because he has always thought that Americans are cold and hate all foreigners. He said that he did not think anyone would help him or want him there. Hopefully, he believes me when I told him that most of us do have hearts and are interested in expanding our horizons as well as those of others. I cannot imagine if I came to Brazil only to be received with coldness, discrimination, and impatience. I have been received with open arms and so much patience. Maybe sometime I can return the favor. Finally, around 10:20 PM I arrived at home and got to eat dinner. I was so thankful because my host mother made my favorite dinner just for me. Even warmed up it was DELICIOUS :)

June 9, 2013: Cha do Alvaro and a little bit of reflection

This is a newer section of Goiania where Marina and Bruno live.

At almost halfway through my experience, I am really enjoying my time here. I am learning so many invaluable things and I can only imagine how much more I will learn in the second half.

I had a very interesting experience at mass this morning. Since I planned to attend the Cha do Alvaro (Alvaro's baby shower) in the evening and we normally attend mass at 7:00 PM, I had to go mass in the morning. Thaynara told me that mass began at 11:00 AM. So, at 10:55 Thaynara dropped me off at the church and I went inside to find a seat. It was very crowded just as it normally is but the priest was at the front already. Thinking I was just a few minutes late, I sat down and tried to look at the flier and figure out what was going on. Then, the cantor stood up and led the congregation in a round of Happy Birthday, just as usually happens at the END of mass. At that moment, I began to get a little suspicious. Once the singing was done, the priest gave the final blessing and everyone started leaving...oh dear. Finally I figured out that the mass began at 10:00 AM....

Marina (and Alvaro) and I at the baby shower. Everyone is eager to meet baby Alvaro sometime soon!

Mara, Marina, and I at the party

Lovely deserts and beautiful decorations

This evening, I attended the Cha do Alvaro. Some of the friends, Marina and Bruno, I have here from last year are having a baby and I was invited to the baby shower. It was really nice to see my friends and celebrate Alvaro's upcoming birth. Just as expected, the party was great and attended by only women, just as is traditional in the United States. It was nice to think of babies again after not working at Maternidade Nascer Cidadao for one week already! I definitely miss it. Though I am really enjoying learning other things and getting to know how medical school here works, I really appreciated the hands on learning I was afforded at Maternidade Nascer Cidadao. However, I have been able to think about what I have learned and compare it to what I have heard about other maternity hospitals as well. If I did not already explain,  Maternidade Nascer Cidadao is probably one of the most poor hospitals in Goiania. It is a public hospital so all patients there are served for free. Brazil's health care system provides free public health care for all citizens. If a person is not satisfied with the public health care that is available, he or she can pay to have private health care which is usually of better quality. Usually doctors here are part of both systems; they work in a public environment and are paid a meager salary by the government while also working in a private hospital or having their own private practice. Therefore, there is a public-private divide in the system that is readily apparent and which affects both the doctors and the patients. Marina plans to have Alvaro at a private hospital where how much you pay determines the room you are in and the amenities the room has. It sounds like a hotel! Also, I have heard that private maternity hospitals like this are much more willing to give women pain medication. This is because they are able to pay for it, while at hospitals like Maternidade Nascer Cidadao, pain medication for women in labor is seen as a luxury that almost never can be afforded. There, the patients even have to bring their own pillows, paper towel, and toilet paper. 

June 7, 2013: PUC Tour and Festa Junina

Today my morning began by leaving the house at 7:00 AM to spend some time with Professor Vera, the woman who is now helping me organize my time here (she was the professor of the social services class I attended Wednesday). She is a professor at PUC, but recently Vera has also become a professor for the other university, UFG, as well. She teaches on the UFG campus in Cidade de Goias though, not in Goiania. This morning I went with Vera around Goiania to organize her documents with the university and officially secure her position in Cidade de Goias. It was great to just ride in the car around some parts of Goiania that I have not seen before. The city really is beautiful in some parts and when you are on the outskirts you can see the rolling fields of soy beans, corn, and sugar cane and rising hills in the distance. Then, Professor Vera and I went to PUC for me to have a tour. Though I have already attended two classes there, I really enjoyed the tour of PUC and the students that I met. They were very nice and welcoming and all so impressed that I am learning Portuguese. My tour guide Isabela, a third year medical student and the daughter of the director of the medical school, will also be my guide next week. The plan is for me to attend some of her classes and go to the hospital, Santa Casa with her for clinical classes as well. Today I saw the laboratory which houses the animated mannequins for the medical students to learn proper medical techniques and procedures. Isabela said she really enjoyed when her classes were in the lab because all the students practice. On top of that, she said that when the mannequins just will not do, they even practice on each other! Next I saw a theater where the students do presentations, and after that, Isabela and I walked one block to the anatomy lab, where there are some lovely smelling human remains for the students to study. These bodies were SO old. Well, I am not sure of the age of the person when they died but I mean old as in they are black and dusty! There were also a lot of jars with different organs in them, including a brain and several pieces of other brains, a heart, and a kidney. Some jars had fetuses at different stages of development too.

My forro dance lesson from Luiz

At night, Thaynara and Karen and I went to a party called Festa Junina. This is a kind of party that happens every weekend in June. Sometimes, the people dress up like hillbillies to attend! It is so funny because everyone wears plaid and cowboy boots and cowboy hats. There is a lot of dancing with sertanejo music and some more old fashioned music as well. There is also a lot of food there that is traditional here, like pohmona (a corn and cheese dish that is cooked in a corn husk) and caldo (a type of soup). This Festa Junina was called Asclepiao. It was hosted by the UFG Medicina course and so I really enjoyed seeing all the people that I have met so far attending UFG Medicina events like Inter UFG. It was so much fun to see everyone and learn how to do the dances. I even got to meet Bonnie, an exchange student from Hong Kong! She speaks English very well but does not know any Portuguese. It was so interesting to hear about her experiences and thoughts about Goiania. We both are on an amazing journey here, but it was funny for me to hear that she thinks Goiania is a small city. I just laughed because to me it seems huge! To put things in perspective: Hong Kong--7,000,000 people; Goiania--1,800,000 people, Hillsdale and Alma together--might have almost 20,000 people!

The two pictures above show the traditional dance that I learned. Everyone stands in a big circle and there is an announcer who calls out the direction you have to go and it is crazy! Bonnie and I shared a partner and laughed the entire time.

Thaynara and Pracilla and I

Fernanda and I

Thaynara and I

 

Karen and Thaynara (I live in their house.)

June 5, 2013: Spanish and Social Services

Today at PUC I attended social services class in the social services college. It too began at 7:00 AM, but having gotten more sleep last night than I did the night before, this was not such a challenge. Also, it was much smaller and more diverse than the class in the medical school, having about fifteen students with a variety of ages. However, there was only one male in the class, whereas yesterday the class had a pretty equal male to female ratio. After the teacher introduced me to the class, everyone said their name for me and then I was given the opportunity to practice my Portuguese and speak to the class myself! I basically repeated what the teacher already told them about me (name, age, that I am a pre med student, where I am from) but everyone understood what I was saying so I would say it went pretty well. Also, this class which meets only on Wednesday mornings always has a little breakfast together during class which includes coffee and bread and fruit and cake! So far so good, right?

Now, you might be wondering why the title of this post is called "Spanish and Social Services." Shouldn't it be "Portuguese" or "Brazilians"? Well, no, it shouldn't be. This is because today in social services class we watched a movie called Segunda-Feira ao Sol. I was so excited when it was turned on because all of the previews before the menu were in English with Portuguese subtitles. Then the menu came and someone pressed the play button and everything changed.... The movie was in SPANISH! Haha! Oh my! I was watching a movie in Spanish with Portuguese subtitles. At least the filming seemed nice and I could catch some of the jokes...other than that though, I have no idea what happened in that movie. It was definitely an interesting experience. The class was very nice and even tried to change it to have the talking in English but that option was not offered...there was only Spanish.

 
Later in the day, Karin and Thaynara, my host sisters, were trying to decide where to go to dinner. One wanted to go to a Mexican restaurant and the other to a Barbeque restaurant. It was up to me to decide. It was only once we arrived at the Mexican place that I realized how fitting it was to eat there, yet again bringing Spanish into my day. I guess after being here for one month it was good to mix it up a little!

June 4, 2013: PUC and Santa Casa

Now that I am finished with my internship at Maternidade Nascer Cidadao, I am filling my time having experiences in other hospital settings and even taking more time to see what university life is like here. Goiania has many universities but the two I have had contact with are UFG, the Universidade Federal de Goias, and PUC, Pontifica Universidade Catolica de Goias. UFG is the university which my host sisters attend and it is the university at which the interns in Maternidade Nascer Cidadao study as well. It is public. Today I sat in on a class at PUC, which is private. The class was for fourth year medical students and it had about thirty students. The students were broken into groups to discuss approaches to caring for a patient with symptoms the professor listed on the board. Then, after discussion, the professor called on students to speak to the class about certain  aspects of the care which their group decided was best. The next class was about formatting the mandatory health care plans cities in Brazil are required to have. Most of the students did not seem to think this class was very important, but I wish I was able to understand more of the professor's lecture! From what I did understand, I think the teacher was talking about the difficulties that cities have faced in the past and possible approaches for remedying them in the future. I should also point out that the professor who is organizing my experiences now just dropped me off in the class with the students. Again, it was a case of total immersion, but at least this time the students speak English and were all very kind and curious to know everything about me.

After class (which began at 7:00 AM!), around 10:30 AM, I went with two other students to PUC's hospital, Santa Casa to observe two small surgeries. I liked this experience quite a bit and was very surprised how patient the doctor/professor was in teaching the students to perform these surgeries themselves, while also being mindful of the patient's needs as well. We also stopped by the OR and happened to have the opportunity to watch the majority of a Renalectomy (removal of one of the kidneys). Once the kidney was removed, the doctor even opened it to show us how full of kidney stones it was!

Following a lovely lunch in one of the other student's homes, we went back to the OR for the afternoon and watched a rare surgery called a fistula. A fistula is when an artery is connected to a vein. Though this is usually a birth defect, it can be created surgically in a patient's arm when necessary to more easily facilitate dialysis. This surgery, though very small, took a very long time and required three doctors, as many hands are necessary to hold all the instruments and make the tiny stitches to hold the artery and the vein together once they are freed from their normal positions in the arm. This surgery was very interesting to watch, however, I did not like it as much as the smaller surgeries, and in comparison to obstetrics, it is much less exciting.

June 2, 2013: Final day of Inter UFG

VAMOS MEDICINA, VAMOS MEDICINA, 

VAMOS MEDICINA!!!!

This is what happened when the med students found out they won...everyone flooded the Shuttlecock court and the cheering lasted for almost half an hour!

Parabens!!! Congratulations to Medicina for a great fight to win the sports section of the Inter UFG tournament today. All the athletes came together to beat the other departments by only five points! Though no one could quite explain how the scoring worked, I think each game that was played won a certain number of points depending on the score at the end and whether the team won or lost. However it worked, Medicina had the most points at the end and thus won Inter UFG for the seventh year in a row (that is the whole life of the tournament actually)! Today in the finals we watched handball, futsal, shuttlecock (I have never seen that game before but it was pretty cool…), and beach volleyball. In the end, I would say that Medicina did very well and definitely had the loudest fans. Something very interesting that was pointed out to me when Medicina won was that the med students all study and work all day and sometimes night too, then, when it comes to competitions like Inter UFG, still are able to have the most energy and win the most games, despite having the least amount of time to practice or sleep. This also applies for Madrasta (Medicina’s band) too. Madrasta has the largest number of participants and the least amount of time to practice and sleep, but in the end is able to produce the best sound and have so much fun doing it! Interesting.

May 31 and June 1, 2013: My days off

Cantor Marcello Barra

Since I am switching hospitals beginning on Monday, this weekend I was able to relax a little and visit some friends I have here in Goiania from my trip here last summer. It was so great to be able to see them and catch up. One of them is a famous musician here so I visited his music studio and got to sit in while he and his guitarist chose songs for his upcoming concert. It was excellent!

On Saturday morning, I went to work with Dr. Mauro (I stayed in his home last year). He is a pediatric neurosurgeon and had one surgery. Here is a summary:

•        Patient: 10 yr. old Aline Mendes de Jesus, female, otherwise in good health and mentally stable
•        Problem: Brain abscess in right frontal and temporal lobes
•        Cause: SINUSITIS
•        Surgery: patient arrived in OR; anesthesiologist put her to sleep; Dr. Mauro shaved a small rectangle of  hair off (4cm by 6cm) just above her right eye; he injected some saline under the skin to stretch it out a little and loosen it from the bone; 4cm incision was made; a large crank was used to drill into the skull, making a hole about 1.5cm across; a 3mm wide tube was inserted into the brain to find the abscess; about 3/4 cup of fluid was drained from the abscess (color of vegetable oil almost but the consistency of water); saline was injected into the brain to clean the location of the abscess; the skin was stitched together (about 10 stitches); anesthesia reduced and removed
•        Observations: not very much blood, the girl was very small and I thought maybe 7 years old, the patient's x-rays were not on paper because it is very expensive so they are only on CD and therefore Dr. Mauro had to find the abscess from memory
•        *side note: I talked to the anesthesiologist about working at Maternidade Nascer Cidadão and he said the medicine they practice there is like war medicine because they are so poor. I was very taken aback because it is not good but it is not horrible! But this man had worked there too so I am sure he saw more than I did.

Samba

Then for lunch, we went to a Samba restaurant to hear a local Samba singer. She was great and very popular among the patrons of the restaurant. Although some people were dancing, fortunately for me, I did not have to put my newly-learned Samba skills to work and was spared an infinite amount of embarrassment! After that we walked through the Feira da Luna, a street fair similar to the one in which my host parents work on Sundays. It too is very big and has food, clothes, shoes, and more. Everyone it seems likes to go to these. Right now, chemise shirts are a very popular item there because the main actress in one of the soap operas wears them all the time (Soap operas here are not like those in the United States. They are very popular, are with the best actors, and are on at night so the people are home from work to watch them.).

Senhor Barra

Lila and Mara

Senhor Barra and Dr. Mauro