University of Plymouth 2019

Physiotherapy, Merida Mexico

Tang Wah, ChristinaI chose Mexico because I had never been before and I was intrigued by the country.

I turned up at the hospital for the first time and thought it was quite small from the outside, but I was not surprised at how busy it was even for so early in the morning - and that was just the outside. 

Inside was teeming with patients and staff and there were more floors than you’d expect, so I did get lost for the first few days! 

I was quite surprised at the number of patients lying in hospital beds along the corridor who were waiting to be seen; many had drips and drains attached or were really frail and elderly. I’d never seen that many patients in a corridor before so I was a bit concerned. I later came to understand that they were still being attended to and I grew accustomed to it. 

My confidence in clinical reasoning improved significantly.

I became more confident assisting with treatment, rather than hesitating like I usually would. When it was quiet I visited other wards and spoke with hospital staff members who were interested in different approaches to treatment. 

Tang Wah, ChristinaI learnt a lot about the approach to pediatric physiotherapy and became more confident with the manual handling of limbs of young children. As a student physiotherapist, I'd often only seen or assisted with the treatment of adult patients, so this was a great opportunity. In particular, I learnt about the approach to premature babies; stimulating a sucking reflex and also stretching and manipulations for hip alignment.

I had to be resourceful when it came to patient positioning as they did not have adjustable plinths. I had to either use a step (as I’m quite short) when the patient was on the bed or treatment had to be performed in a seated position.

Tang Wah, ChristinaMy most memorable experience was up on the trauma and orthopaedic ward or what they called the ‘surgical ward’. I was providing passive stretching of an elderly double amputee. What struck me the most was the approach to pressure sores and the infection control of the wound. This patient had a massive pressure sore from his sacrum to the top of his lumbar spine. Pressure care management in Mexico is not as much of a focal point as it is back home. When I asked about his care, I was told that such care is referred to the nurses looking after him. I found this quite difficult to get to grips with because even as a physio student we are highly focused on prevention back home, even though it is not necessarily our area of expertise.

There was also a father in the same ward who was in a coma and unresponsive due to kidney failure. He had been in a coma for several weeks and his son was outside when we went to see him. Treatment involved a lot of passive stretching from the physios.

In the outpatient department, I assisted with the treatment of a patient who had bilateral pins and needles and was losing grip strength. Her treatment plan consisted of hand therapy prescribed by the doctor who sent the referral. But drawing on my clinical knowledge, I realised her symptoms could be coming from her cervical spine. I asked if I could use some manual therapy on her. It turned out her neck was quite stiff upon assessment and she had quite tense and short muscles. After my treatment, she reported her symptoms had decreased and were now unilateral.  

Tang Wah, ChristinaWith regards to physiotherapy approaches and practices, I feel physiotherapy in Mexico still has a lot of catching up to do. I was surprised that physiotherapists were not allowed to practice autonomously as we do in the UK, but instead a patient’s treatment is dictated by what the doctor has written on the patient’s referral.

When I spoke with Mexican physio students, I learnt that they study for three years, and take one year for placement. I felt that the Mexican students had a wealth of knowledge but were not given the opportunity to practice all that they had learnt.

From local hospital staff, I learnt that they are very open and really interested in the approach to physiotherapy back home. They were more than happy to explain local practices to me too. Within outpatients I learnt that they tend to be very hands-off with regards to MSK problems. However, they still take a holistic approach to the patient.

In the evenings and on the weekends, myself and the other students would either go to the mall for bowling, have Salsa Wednesdays or when we just wanted to have a quiet night in we could. 

Tang Wah, ChristinaWeekends were almost always spent away. I didn’t know that Mexico had so many small islands, and a weekend was definitely not enough!  We also visited the ruins in and around Merida, found cenotes and went shopping for artisanal gifts. Mexico is such a colourful country! The people are so friendly and the food (and coffee) was amazing!

If you have the chance to undertake an overseas placement, either before or after you qualify, definitely do it! It helps push you out of your comfort zone and builds your confidence.

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