Archive for August, 2013

15
Aug
13

back to school

Most major universities and public schools came back into session for Fall term this week. At the BUAP Escuela de Medicina,  students are back from vacation and the halls buzz with anticipation as they arrange schedules and meet new professors for their classes in endocrinology, psychiatry, public health, nursing, and other specialties. Unlike in the U.S., medical school students here have a standard uniform: white pants, white shoes, and long lab coat-like white jackets. Embroidered patches on coat sleeves indicate the student’s speciality or course of training. Students at the BUAP Medical School come from surrounding Puebla communities, but also from states near and far: Veracruz, Estado de México, Morelos, among others. Their excitement is somewhat infectious, and though I would like more time here to work on my research and writing projects, it’s time to head back to Eugene for our return to Fall quarter classes. This is our MHIRT trainees’ last week and my last week in Puebla.

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15
Aug
13

three things to like about life in Puebla

(1) the public running track, great surface, 10km along Rio Atoyac — morning runs with area runners, walkers, and dog walkers; (2) fresh orange juice squeezed by hand and sold by street vendors for 10 pesos a (large) cup; (3) the shoe shine man! my brown boots have never looked so shiny — and for 20 pesos! 

03
Aug
13

mad institutions

the phrase i heard repeated in interviews with outpatient psychiatric patients the past few weeks was “estoy mal de la cabeza”. after a tour of the inpatient facilities at the major psychiatric hospital yesterday, the phrase that repeats in my mind is “mad institution”. decades-old, the white plaster buildings are peeling and greying in disrepair; the grounds are green and spacious but there is no planting or color to soften the landscape. locked gates separate men’s from women’s and chronic from acute patients’ dorms. about 250 inpatients are living here and while the hospital has capacity for 300+ inpatients, the overall feeling is of wasted human potential, of lives thrown away, sleeping away their days in a foggy space that is neither life nor death – between sedation, side effects of anti-psychotic drugs, enclosure, and abandonment. i am reminded of political theorist Georgio Agamben’s phrase “bare life”, although these are barely lives, people abandoned inside the cement walls and chain-linked fences of an institution overwhelmed by other forms of abandonment. apparently more than half the inpatients were brought to the hospital as children with developmental delays or “retraso mental” (mental retardation), not mental illness, but without other options for social services or community-level supports, families are left bereft of options and may feel abandonment is their only choice. the psychiatrist who gives us the tour of the facilities is head of outpatient clinical services, and his assessment of the inpatient services is that the nursing staff “don’t want to do any extra work” to create, for example, structured daily activities for the patients. he says “the view here is ‘medicate, inject, sedate'”. but i’m reluctant to blame the nurses, who probably feel overwhelmed with their daily responsibilities for administering meds, helping bathe, and otherwise attend to the basic minimum needs of the patients. i think the responsibility lies elsewhere… the hospital director, for example, could require his staff to build structured daily activities – art classes, physical activities, etc. – into hospital services. the public health system could develop community-level interventions, in schools, for example, to offer support for families of developmentally disabled children. absent such social interventions, the other tendency of hospital staff is to blame families for not “assuming the responsibility of their ill relative”. this critique is often leveled at families by psychiatrists in a way that seems insensitive to the burdens of caregiving, not to mention their gendered and class dimensions (most of the outpatients I have interviewed have mothers or fathers as key relative caregivers and many are resource-poor and without other options for support). there are so many ways that this situation could be remedied. but instead, lives waste away in a mad institutional delirium somewhere between psychosis and side effects, sedation and despair.