From Columbia 3: MetroSalud

Danielle is spending five weeks in Medellin, Colombia working on a research project involving tobacco exposure in pregnancy. The project involves two surveys: one targeted to prenatal care providers and one for pregnant patients in four different medical institutions throughout the city. She will blog about her experience here at OHSU StudentSpeak.  Learn more.

 Wednesday afternoon took me to work at El Salvador, one of several clinics run by MetroSalud. The organization comprises a network of 35 clinics and 9 hospitals, all publicly-funded,  throughout Medellin. MetroSalud’s sites largely serve a low income population, and are generally located in the city’s poorest areas.

I spent a few hours that day with Dra. Lina Montoya, assisting with her prenatal appointments. I immediately felt the difference between working at one of MetroSalud’s centers from working in a large academic hospital (Hospital General de Medellin). Besides the fact that there were not six other residents/students surrounding me and not everything was a talking point when examining a patient, El Salvador had a much different ambiance.

Dra. Lina seemed calm and relaxed, and left her door open during each visit. She spoke to each patient like a dear family member and affectionately called the pregnant ones “gorda” (which is not offensive in this culture). I have been blown away by the average age of the patients I have seen working at MetroSalud. Most have been under 18, and 15 seems to be a common age for the initiation of motherhood in this population. Tiny girls who you would not think could even get pregnant strolled in, sometimes accompanied with their young mother who appeared as though they also had given birth at an early age. I didn’t get the vibe among these patients that teenage pregnancy carried quite the stigma in their community as it does in the US, although Dra. Lina was well aware of and took into account the biological and emotional risks associated with early motherhood. It almost felt like the norm. Talking to Dra. Lina, I found out that MetroSalud offers free contraception methods through a program called Sol y Luna, including the pill, implanon, and even the IUD. Are these girls not taking advantage of these services because a) they want to get pregnant, b) they have not taken the time to schedule the visit, or c) they do not know about these services? The answer is probably more complex than any of these options. Part of me wants to crush up some estrogen and progestin and sprinkle it in the water here, though that might be sort of inhumane.

I am looking forward to seeing more of MetroSalud’s sites and continuing with patient surveys (which ask about their knowledge of  and exposure to tobacco in pregnancy). Dr. Bernardo Agudelo, my liaison at Nacer, graciously gifted me the assistance of two other medical students from la Universidad de Antioquia, Tatiana and Laura, who will help me in survey distribution. Phew!

Spanish lesson for those in the medical field (or those that are just interested in learning lady-health related words in another language):

Prolapse: desprendimiento
Rounds: la ronda
Progress note: nota de evaluación
Cyst: quiste
IgG: IgG (it’s the same, but it sounds so different!)
Cervix: cuello
Bowel movements: RHA (ruidos hidroaereos)
Contraception: planificación
Migraine: jaqueca, migraña
Tubal ligation: ligadura de trompas
Breasts: mamas
Clue cells: Células guías (for Natalie)
Due date: FPP (fecha probable de parto)
Big belly: barrigota (not an official medical term)
Pap smear: Papanicolaou (for my sister, who loves this word)