I am a fourth-year medical student at McGill University.  I found out about PACEMD through the website in the course of a Google search for International EM and electives.  I had actually seen a blurb about the rotation on the SAEM website earlier, but forgot all about it until a vacation in Chiapas and Oaxaca left me squirming for more time in Mexico. I decided to use some of my fourth-year elective time to work on my measly medical Spanish. The PACEMD rotation seemed perfect since it combined formal language instruction with immersion in an ED setting.

     One of the most striking aspects of my time here has been the extraordinary warmth I’ve felt at home, in the hospital, and in San Miguel. I walked into a family on arrival. Michael Page was here from Grand Rapids, MI with his wife Emery and three fabulous kids. My first hours included cuddling with children, then running off to a bullfight, dinner, and an evening of Negro Modelo and Pila Seca (the official PACEMD band). When I woke up for my first Spanish lesson with Lilia Galeana the next morning, I felt I had been here for the full month already.

      Michael served as welcome-wagon those first days, as I later would for the residents who arrived toward the end of the week. He took me down to the hospital, gave me the tour and introduced me all around. The hospital is the Health Ministry (civil) Hospital of San Miguel. Most patients are without insurance and many come from the surrounding pueblos. The majority of cases I saw were febrile kids, women in labor, or people with minor trauma. Yet, almost daily, I saw something that will forever stick in my mind: The farmer who ran around for a year with an unstable T10 fracture, until he couldn’t feel his legs; the little girl with the radius fracture and true-blue sclera; the village idiot whose diabetic foot was saved when the villagers decided they couldn’t stand the smell anymore, and banded together to ship him over ten hours, by farm truck to the hospital.

     The hospital is a small operation and the pace can get quite slow, particularly in the afternoons. As a result, I spent a good deal of my time there just talking to the staff- about everything from the structure of nursing certification in Mexico to the years craziest trauma cases. This was actually some of the best Spanish training I could have had. I found everyone at the hospital to be very enthusiastic about our presence there, and incredibly patient with our halting attempts to learn the language and culture.

     It is always difficult to quantify an increase in language skills, but I can say that by the end of my first week I already felt comfortable with basic history-taking and could understand at least 75% of what was being said in the hospital. At the end of the rotation my grammar is as atrocious as ever, but my ability to express myself in Spanish has dramatically improved. This may be due in part to the conversation and repetition-based model of language instruction that Lilia uses (also used by the US Foreign Service) in the 1.5-2 hours a day that we are with her. My experience is that this method really gets you talking. The more grammatically minded may be frustrated by the lack of didactic instruction, and at times I certainly felt myself pining for rules to hang onto. The bottom line is that I have come out of the rotation conversant.

     Being at the hospital itself is an experience in Spanish immersion. It should be understood that the rotation as a whole is not. People who are interested in roughing it in the Third World may be disappointed by San Miguel, which is more like Mexico for Dummies. Its a charming colonial town with a fabulous night-life and safe, if cobbled, streets. It has a large community of US-expats - both retired and not - and things are set up accordingly: there are Cybex-equipped gyms, one ton of Salsa and art classes, and quite decent expresso downtown. Accommodation during the rotation is with other residents in a large and comfortable house about a 20 minute walk (or $2 cab ride) from downtown. Luz cleans and does laundry daily, while Suzanna cooks mega-breakfasts and stocks the fridge with dinner. Lilia’s Spanish lessons are daily in the living room, and if Haywood is around, you’ll probably spend a decent amount of time in the nearby hot-springs (even if he isn’t, you can and should go soak). In short, it’s always something like summer in SMA, and as long as you remember to use bottled water to brush your teeth, the living is easy. I had a fabulous time during my month there, and look forward to visiting again soon.