A better view on Mexican health care and the current state of my life.

Ok so my last post about the Hospitals here was a bit bitter. I'm finding that most of my issues at the hospital are all due to one individual. You see you have to deal with stupid people no matter where you work. So the truth about the system here is that its actually getting better. I don't remember if I explained before but all the public hospitals and clinics work by the same standards as in the states. The guys who wrote the standards for Mexico learned from The Joint Commission which is the group that does most of the certifying of hospitals in the US. But they do still do things differently. They find ways to reach the standards without all the cost. Now the Government is requiring even the private hospitals to follow the same standards in able to become certified by them. Its not quite a requirement yet to get this certification but its obvious that soon enough it will be. The small private hospital I work for is trying hard to comply with these standards. My original Job description was as an assistance to this process. But I quickly learned that without earned trust and respect my word counted for nothing regardless of my experience. I requested and have received a new Job description which will basically put me as a supervisor or in the states what was seen as a Head Charge Nurse. They are also finally giving me the orientation and time of learning on the floor that I requested. I have already spent a couple weeks on one of the normal units, and in the ER. My next steps are to learn the ins and outs of ICU, OR, and the Nursery. The person that I struggle to work with, due to her ethics, will be my work partner once I'm done with my training. This will pose as a major hurdle for me but its not something I cant handle. Some of our first steps to help us reach the standards will be better documentation, and education for the nursing staff. These are things I have been pushing for since the first day and will still take some time to finish but I can see a bright future for our hospital and many others. The director of our hospital is also the director of an association of about 20 private hospitals all over our state. His plan is for all of us to work together and standardize our efforts. Meaning that the paperwork and process of all the hospitals will be the same. This will be a huge effort but I think its an excellent goal. As I have said before as far as treatment and education of the doctors here its fairly equal to the states. One of the biggest differences that was hard for me at first is that nurses do less here and doctors do more. I see the benefits to this but being a nurse who loved the technical procedures it was a little bitter for me at first. But  the patients love it.

As a quick update on our family and home life, obviously Im still working my 40 hours a week at the hospital and I teach English about 6 hours a week. We figured out we would actually be saving money if my husband stayed at home with our girls and teaches a few hours of Spanish every week on the side. Day care for three kids at the cheapest place we could find was costing us more than our rent, and as is usually the case with parents they just were not up to our standards. My husband is starting a bit of a freelance project with these Spanish classes. Basically we have some friends down here who have to learn and soon. There is an international medical program down here. The first two years of their classes are mainly in English  but the last two years are all Spanish. So he has put together and program and will be starting with his first three students on Monday. We looked around at prices and we are basically charging half of what all the schools or other programs are charging. The down falls to our program is that we don't offer any type of certificate. The upside is that its real communication Spanish with a cultural twist. He plans on adding in common phrases and such that people wouldn't learn from a more structured class. Its basically the same idea that is behind my English lessons. So far my students love it so we are hoping his catches on. So things are going pretty good for us at the moment and my girls are all growing strong, healthy and smart. Really life is good. God has been very good to us and is constantly providing for each new step in our lives.

Adapting, accepting, but not completely giving up

So after looking for a different job I find that I'm doing as well as I prob can do at the moment. Also, during my time of looking, my work changed my job description into something I like a lot more. I will now be a co-supervisor and will be working on the floor a lot more. If you remember from my last post one of my complaints was that I hadn't even seen a patient or used a stethoscope in many weeks.  I have only done the new work two day but they were the best two days I have had since Iv been their. So I am trying to adapt to the frustrations I feel about my job and the system at the hospital. Some of the changes I wanted to make and that I suggested are now being implemented. They are ideas I had that people argued tooth and nail against about a month ago. Now someone else has suggested the exact thing (a doctor) and it is going through.  I am going to just have to humble myself and accept that when I give ideas for change that I will most likely never get credit for them. With that in mind I do plan to still offer advise on changes that should be made and keep a low profile. I hope to prove to them with this new job profile that I am a good nurse and someone that they can accept ideas from.

I realize in the last post that I didn't mention much about the level of skill in the hospital and just grumped about the system for change. I want to be clear that the education level for nurses and doctors is excellent here. The are well informed and are good at their jobs.

There are a few things about the lax system that are helpful even. I was sick last week and one of the doctors noticed. He brought me to his office and gave me antibiotics for free. We often get free stuff like pads of paper, pens, even medication from drug reps that come through the hospital.

I am recieveing full benefits so that is also a plus. Any job I found that would pay me more for teaching wouldn't give me benefits. I really do want to adapt to life here. I know that we don't have any time limit for living here and that its for life. So I'm doing my best to accept things and at the same time keep my morals and beliefs. We shall see how that goes. Some days its so easy to live here I wonder why I'm such a grump about it. But other days it is truly a challenge and one I'm not sure I'm up to. Im pretty sure that no matter where I was to raise my family life would show up with its struggles. What I have to remember on a daily basis is that I'm blessed with three beautiful healthy daughters and a husband who helps me 100%. There really isn't much more you can ask for in life. God is good and always will be no matter how much of a grump I decide to be. But I'm sure I will hear from him more clearly once I accept my situation for what it is.

Well my girls just woke up so I need to go take them to the park. Have a great week everyone.

The inside scoop on Hospitals in Mexico

First of all I have to remind you I'm by no means and expert on this considering this is the first hospital I have worked in. But I do ask our new nurses where they worked before and what it was like. It seems to me that we are the norm as far as private hospitals go. The only place that is more standardized like I am use to is the IMSS.  The other thing about the nursing jobs here is that the pay is so very low. Most nurses get no more than 4-5,000p a month. I am getting more than that because I entered at a supervisor level. The nurses at the IMSS get 7,000 a pay check and only work three twelve hour  shifts per week. Which is way more money and way less hours than me. My plan is to go sign up for a job at an IMSS but apparently it takes years to get accepted into one of the positions.
Basically when you walk into my hospital it is beautiful. It reminds you of a hotel but with nurses stations. The nurses are well educated in school but once they are out the hospitals do not maintain a proper continuing education program. This is something I have been pushing for since I got into the hospital. No one seems to understand the importance of it. Or like many people have told me the higher ups are just afraid to give to much education to the lower positions. This is not only in the hospitals but pretty much is the rule in the work force here. To be honest the only personal experience I have in the states is in Hospitals and the last one was a teaching hospital so this totally rubs me the wrong way. Im going to do my best to keep this post objective and not go into my rants. So here I wont explain how utterly important it is for continuing education in health care.

Since October I have tried to encourage changes such as continued education, starting an orientation program for new nurses, placing resources for the nurses at the nursing stating (drug books, references on processes, an easier and safer documentation practice, etc.) And everything I try to implement gets denied. I am basically not being allowed to do what they told me they hired me for. Finally I asked for a job description because my position was completely made up. I was getting sick of wasting my time trying to plan and implement things when I was always held up and denied at the last min. I had no idea what the heck they wanted me to do from day to day. Now I am a Supervisor B, with basically administrative duties. To explain it best Im doing all the crappy paperwork that the head nurse doesn't have time to do.

The worse part about all of this is that the things they do focus on are so silly. They are insane about the dress code. For example I have gotten "talked to" like three times for my presentation. The first time was because apparently I wasn't using enough bleach on my uniforms. Then it was that I don't paint my shoes enough and the looked dirty. They were clean but scuffed, here you have to wear the old school leather white nursing shoes. Can I hear a Blech from any nurses out there. This last time I was told that my little fly always were to messy and I need to start putting gel in my hair. And don't get me started on my tregas earrings. Basically the supervisor in charge of checking this sort of thing was ticked off because I explained to her that she was doing something illegal and when she argued with me about it I brought it to the head nurse. What was she doing  you might ask. Well in health care we write with pen only in the charts. This is so that nothing can ever be erased. If you make a mistake here you are suppose to put (parenthesis) around it and rewrite what you wanted. One day I found some nurses taking pieces of tape and ripping off what they had written and writing over it. I very nicely explained to them that this is the same as using white out and is illegal. A short time later one of them told me that the Supervisor does it all the time. YIKES!!! So the same nurse who walks around sending people home for scuffed shoes and fly aways thinks its ok to falsefi documents as long as you cant tell. Yes that is what she told me when I confronted her about it. That the nurses shouldn't do it because when they do it its ugly but when she does it it looks nice and you cant even tell she did it. Sigh!!!!!!!!!!!

To be honest a lot of the problems within the private hospitals here (and yes I have asked around) is the chain of command or lack of use of it. For example the above mentioned Supervisor is no more than a supervisor. But many of the changes I have wanted to make the head nurse thought were valid and could work. This of course was when I as alone in her office with her. But when we would bring it to the Supervisor meetings I would be immediately shut down by this supervisor. And worst of all the head nurse would immediately agree her. Basically if it comes out of my mouth they quickly scruntch up their lips and shake their heads no.

Also the horrible communication. They are giving us a course on Lean Healthcare which is a system of organization and communication from Japan. We used this system at the last hospital I worked at in the states and it was great. But to be honest with the way things are here its next to impossible to implement any of it. We have no intranet, all the supervisors of nursing and the head nurse use the same email address, there is no calender of events or meetings. You usually don't know about a meeting until like 10min before hand. Mind you most of this kind of thing doesn't really reach the patient but turns out to be a horrible working environment. And happy nurses make happy patients.

The few suggestions of mine that have been put into place they are sure to wait a few weeks after I suggest it and then suggest it as if it were their idea. This also is very common in all the workforce down here. There is no since of encouragement to employees who do have good ideas. They are to afraid you will raise up above them. Again this is so hard for me to swallow because the hospital I came from encouraged growth. I never push this kind of thing or try to make sure everyone knows the idea came from me. This is because I know they all know and there really isnt any point anyway. I have finally given up on giving any ideas for the betterment of anything. I realize that if I do they will just get turned down. I have resigned to just doing what they ask of me and no more. My husband made it very clear that this is what is expected here. And Im finding its true. The supervisor I mentioned above has back off quite a bit. This all makes me so sad because I have so much to offer and instead Im organizing the charts of discharged patients and doing secretary work.

Actually I may even look into another teaching job next week that will be the same pay but half the hours. I'm pretty sure I wont get seguro or Infonavit and because of this I have to discuss it more with my husband. But as excited as I was to put my nursing uniform on I think its not where I should be. I haven't even touched a stethoscope in over a month. Athough I hate the job hopping, I guess its ok because Im still learning so much about the work force here in Mexico which is nothing like where I grew up. I had one job from the time I was 16-18 at a nursing home (thats a long time for a teenager). Then another job from the time I was 18-21 at a hospital until I moved to St. Louis to go to school.Thats when I worked at Barns and had that job from the time I was 21-28 when I moved to Mexico. I have almost had more jobs in two years than I did in over ten years of working in the states. I know there isn't a perfect job and the grass isn't always greener, but I think its time to start being a realist and accept that maybe nursing isn't what I should be doing down here right now anyway. I do want to apply at the IMS and maybe even in Tepa. But for now if I can make the same amount of money but have more time with my kids maybe I should be teaching.

Love letter to my girls

So an old friend of the family created this really cute site for moms. I haven't had as much time as Id like to read on it but what I have had time for I have loved. I felt so  privileged when she asked me to write a love letter to my girls for her to post during her Feb postings. So here is the link. I think that lots of  my mommy readers will really enjoy this encouraging page.

http://bestlife4moms.weebly.com/3/post/2012/02/love-letters-from-mom-amanda-s-mexico-feb-23-2012.html?

Experiencing IMS in the city

Yesterday was my first real experience with the free public health system here in the city. Let me tell you its much worse here than in the small town of Tepatitlan. For my job I have to have a carta justificante when I miss work for an illness. And the letter must come from the IMS not from a private doctor. So although it was obvious that my girls had the pox and I couldn't bring them to the daycare I still had to go to the IMS clinic. I was there from 9-12 waiting. Basically they didn't explain everything to me well and even with my probing questions they were reluctant to fill me in on the whole process. By the grace of God the director of our day care showed up (hoping to get vaccinated against the pox) and she got the full information for me. Here is how it works. We are part of the evening shift appointments. People can start showing up at any time for these slots. The appointments don't actually start until 2pm. But if you wait till then to go there may be so many people already that you wont get an appointment that day. But we were there at 15 min till 9am and the lady seriously thought I would wait from then until 2pm. That is virtually impossible with three kids. Not only that by the time I got fed up and left at 1200 there were only two people there for the evening shift appointments. So I'm thinking if we ever do have to get something from that doctor again (for work, or day care) then we will show up at like one and have to wait until 3 or 330 for our appointment.  During the time we waited we managed to see the dentist who spoke English to my girls and confirmed we have no cavities. YEAH for that one. We will be visiting the dentist in another 6months for the fluoride application. The only thing I felt was missing there was education. Maybe they didn't do it because I still had my work uniform on. Usually the IMS clinic is better about educating the patient. The dentist is not as full and basically you just show up and they check you out. They actually came over to me and asked me if I wanted the check up from them while I waited for the other office.  We almost got the babies flu vaccine but I gave up waiting before that happened. I'm kinda pinching myself for that one. But after three hours there with three girls I was done and so were the girls. We ended up going through the ER and getting Tylenol and my letter from there. I have since lost that letter which I'm also kicking myself for. We also ended up getting an Antibiotic because the oldest on has infections in lesions. The whole experience was pretty horrible and I'm pretty sure we will never use the doctor there unless its absolutely necessary. I'm still glad we have Seguro in case we ever need hospitalization because there is no way we can afford a private hospital. And also the ER was pretty quick and we got free care and medication. Right now the girls are playing well and so far the baby hasn't shown any signs of contracting it from them. I hope if she is going to get it that she gets it soon. I feel like Im leaving something out of the informative part of this post so as always if there are any questions Id be happy to answer them.

Whats in the Headlines

I have been wanting to start this as a series of blogs. I hope I can get one out each week. The idea here is to show those of you who do not live here that we are not living in a dangerous, third world, ignorant country. The people here live happy lives and think about a lot of the same issues as the people in the states and other countries. Mexican culture is that slow change is better than quick change and although in most cases this drives me up the wall I have also seen that it works a lot of the time. So here is the first of my Whats in the Headlines posts. Basically almost daily I grab a free edition called Publimetro. Publimetro from what I understand started here in Mexico but is now one of the larges world wide free publications. There are about four free news publications here in town but I have found this one to be the most unbiased and one that covers all issues from public to private, from government to famous people, and they even give a reasonable area to what is going on with all the drug stuff. The thing I like is that with each of these issues they lay out the facts. They don't over or under so any of it. For each article I'm not going to go into to much detail as far as this blog goes, but if I post about an article and you want to hear more on that specific topic I could write a second post about it, as always just let me know.

Wednesday 11 of January 2012
The Cathedral is suffering with time. With continual traffic and mistreatment from people the cathedral which is an important symbolic for the city is falling apart. So far they have only managed to raise 10% of the cost to renovate. This is truly a beautiful building but the paper is saying that their is much work to be done. They believe the work will not be completed until after the middle of February . Its going to cost10,000 pesos most of which will be paid by the secretary of culture.

Explaining the paranoia: Specialist talk about why people believe in rumors that are found in the internet. Basically the week before someone spread rumors about kidnappings from a government school. Almost  a third of people kept their kids home from school Monday threw Friday the following week. From the first day the state of Jalisco and the City was stating that their was no proof and no missing children reports. In the end it all proved to be rumors but now people are concerned as to why this rumor started and why so many people believed it even when officials where saying otherwise. 

Thursday the 12 of January 2012
Asking the internet about sex: Publimetro did a poll asking teenagers who the talked to about sex. The options were parents, teachers and the internet. A whoping 67% said they got their answers online, which isn't surprising but at the same time sad and scary. 25% said they asked their parents. I'm curious to how this would pan out in the states. And 18% said they asked their teachers. They noted that pregnancies cause 6% of drop outs during grade school and junior high in Jalisco. Within Jalisco their were 69,800 pregnancies in 2011, out of those 18,882 were under the age of 19. But here is the good thing about all this. This  information hit the front page of the news paper and talked about how the government is determined to have more education for teenagers about the subject. Although this may seem a little late I'm just glad they are taking note and planning on changing. Along with that they are trying to educate the public which is number one for change.

Thousands run to the federal office to register their voting card on the last day available. Ok there is not much to say here but laugh. And really I think the same thing happens in the states.

100 kilos of marijuana was confiscated inside a packing company.


Obviously there is a lot more in each paper but this is what is being placed on the front page.

Also one of the days I received an extra free booklet made by the Secretary of communications and transportation. It was a drivers manual. I'm not sure how many of you remember the manual you use to study for your drivers test but more or less it was the same. It also had stickers you could put on your car that said: Don't message while driving, Don't drive when your tired, Don't obstruct handicapped entrances, I have kids and pets in my back seat (the picture of the kid has a seat-belt), And I'm a responsible driver (again the picture has a man with a seat belt). Yeah for trying to make driving and streets safer here in Mexico. Im sure not a lot of people actually took the time to read the booklet but like I said educating the public is the first step to change and I think Mexico is well on its way to becoming a better place to be.

Hope you enjoyed and see you next week. ;)

Our first Three Kings day

Every year we eat rosca and comment on how cute the little dolls are. Many times the holiday has been explained to me, but I just never took the time to start the traditions. This year I took the girls to Soriana on Jan 5th to buy our rosca. I told them we would leave it out on the table and see if the three kings like rosca. They also each put one shoe under the tree in hopes that the kings might leave them something. Because it was kind of short notice and because we also do Christmas and Santa, the kings only brought them a piece of candy. But it was a big one. They also left pistachios for Issac and I and a sucker for the baby. When they woke up they got to eat rosca and thankfully both the big girls ended up with the doll. (no fighting) Joslins teacher had asked if we had some to send a piece for her to school because they were going to discuss it in class. I packed a piece away for her and sent it with her. I also made them some abualita hot coco that morning. It was kind of a lot to do on a school/work day but if its only once a year I think we can handle it. Plus once again I feel like it helps them to remember why we even celebrate this time of year. Today I finally got all my Christmas stuff put away and my house back in its original order. Usually I put Christmas stuff away the 1st or 2nd of Jan to start out the year fresh but I do believe I can let this slide and hey as long as its done in January its still the beginning of the new year right. Its been so great to have time today to catch up on my blogging and to clean my house and spend time with my girls. The only bad thing about having Sunday be my only day off is that we have been missing church. Hopefully soon Issac can get Sundays off also to help me drag all the girls in there.