Building healthy foundations
Travel south of the U.S. border to Merida, the capital of Mexico’s Yucatán Peninsula, and you’ll find many in serious need of basic health care. You’ll also find physicians and medical students from MSU who are working to change that.
For the past two years, faculty from MSU’s College of Osteopathic Medicine, led by Dean William Strampel, and in conjunction with the university’s Institute of International Health, have been working with leaders in the Yucatán’s health system to develop clinical programs that benefit the health of the area’s six million inhabitants.
MSU physician Jake Rowan moved to Merida to lead the on-site work necessary to best meet vital health needs, including the treatment of diabetes and kidney-related illnesses. Already 40 dialysis units and a hyperbaric chamber are up and running, and now the college is partnering to build Mexico’s first osteopathic clinic.
It’s all part of a plan that is laying a foundation for a healthier future by providing more and better health care to the people in and around Merida, while giving MSU medical students a healthy dose of first-hand experience.
Jake Rowan, DO, associate professor, College of Osteopathic Medicine and director of Medical Education–International Programs, Merida, Mexico
Jake Rowan packed up his family and moved to Merida, Mexico for a year to set up and run an MSU partnership to help teach medical students about global health issues and to provide high-quality heath care for the residents of this city. He spends his time working at Hospital General Agustín O´Horán.
In Mexico, hospitals are arranged by insurance coverage and ability to pay. Agustín O´Horán is the hospital in Merida that is designated for those without coverage and no means to pay. It is a very busy place where patients line up on the sidewalk for hours just to get into the emergency room. Resources are tight. It isn’t unusual for people to have to wait in the emergency room for two days or more on a gurney in the hallway.
Rowan’s “office” doubles as a treatment room where he, MSU medical student Travis Gordon, and other physicians treat patients. There is a hyperbaric chamber in the corner that MSU helped the hospital obtain that sees a constant stream of patients.
And while he may have a clear mission, he wants it to be clear that he is not on a mission.
“This isn’t mission work,” says Rowan. “This is an ongoing opportunity for medical students to come and learn. It is a collaborative effort that is beneficial to MSU, the College of Osteopathic Medicine, and the great people of Merida, Mexico.”
With a mega-watt smile and easy-going manner, Rowan gets excited when he talks about the program in Merida.
“From an educational standpoint, international health electives like this enhance the student experience by providing essential global health skills that are crucial in a globalized society,” he says. “This initiative expands the international reach of MSU, MSUCOM, and osteopathic medicine. The program also expands the university’s research opportunities. O'Horán Hospital and the research universities in and around Merida offer numerous areas in which we can collaborate with local partners to study our mutual interest in any number of fields including medicine, geology, agriculture, and many others.”
And what legacy does Rowan hope to leave behind in Merida?
“I hope that I’m totally insignificant and that the program continues on and no one cares or remembers who started it,” says Rowan. “I just want students to always be able to come and do research and learn and go on.”
Field note: Lessons in humility
Travis Gordon is a fourth-year medical student in the MSU College of Osteopathic Medicine
Traveling has always been my passion in life. Between MSU Study Abroad in South America, Peace Corps in Nicaragua, and many locations in between, I have learned much about life during these trips—self-reliance, adventure, beauty, and, above all, humility. While all of these have served to broaden my perspective in life, the latter has been a constant theme during this surgery rotation at the Hospital O´Horán in Merida, Mexico.
Being that this is the poorest hospital in the city, it is where those who cannot afford health care go for whatever problem they may have—most of which are life threatening and advanced far beyond a level to which most health care providers in the United States are accustomed.
Diabetic “feet,” which extend to the thigh with open, oozing ulcers are quite common. Gaping bed sores so deep they expose the bone are an everyday experience. Jaundice so bad some patients almost glow in the dark with bilirubin levels of 30-40 is not unheard of. Tuberculosis, a few young men cut by a machete —you name it, this hospital does its best to take care of it.
It is easy to feel powerless in the midst of such serious problems, hence, the lesson in humility. With exposure to such incredible pathologies and plenty of suturing experience, this was becoming an amazing experience, but at the end of the day I felt like I, as the “Estudiante Gringo,” was contributing nothing in return. But then I encountered an issue on the surgery floor for which I could actually be of some help: postoperative ileus, also known as constipation.
At a glance, constipation does not seem like a serious issue, but in fact, after a few weeks it can become life threatening. And nobody likes to deal with these patients, as it generally requires the use of enemas or, even more fun, digital rectal exams.
One day I decided to try my hand at some Osteopathic Manipulative Therapy (OMT) with a patient who had not gone to the bathroom in more than two weeks, despite the general pharmacological protocol. The treatment took about 10 minutes. I returned to see him the next morning and his visiting family member told me that a few hours after I left, he had to use the bed pan…three times.
It was extremely gratifying and finally I felt like I could actually do something for some of these patients that perhaps others could not. As such, this became a daily job for me: seek out the patients with abdominal issues likely related to constipation and, well, make them poop.
As another goal of mine in this rotation was to demonstrate the principles of osteopathic medicine and teach whatever I could, this inclination for OMT fit the bill. Surgery residents started asking me about what I was doing and even helped me perform OMT on patients.
As their curiosity grew, so did my reputation in these pooping matters. Before I knew it, I was saddled with the nickname, Dr. PooPoo, to which I could only be much obliged. Soon I will return to Traverse City, Michigan, to finish up my medical education with incredible memories, unique medical experiences, and unfortunately, a nickname that probably will not go away for some time. As I said, it has been a humbling experience.