Saturday, January 24, 2009

Watching the sun set in the mountains of Valle.

My favorite tree in Valle.

The Woods: Valle de Bravo

From New Year’s Day until the following Sunday, I found myself secluded in the mountains of Valle del Bravo. While we were isolated in the forest, we still had the comforts of our own home and more: a wooden cabin with running water, a full kitchen and a fire place. There was also a housekeeper who cleaned and cooked for us. Her chilaquiles, or tortilla chips soaked in a green tomatillo sauce, topped with mounds of onions, cheese and cream, were phenomenal.

In the country, I remembered what it was like to breathe fresh, clean air. Since there were no lights, except for the few coming from far away ranches here and there, I was able to see millions of stars. The only sounds I heard were roosters, geese, other birds, dogs barking and animals moving through the woods. The trees surrounding us were extremely tall and thin. In the distance, I saw mountains beyond mountains. The climate was variable as it would reach the high seventies during the day and by night I was wearing a sweater and a jacket. Fortunately, we had a fireplace to provide us with heat during the cold nights.

On our last day there, I decided to take a nature walk. I started out going down the hill, following a dirt path that led to a stream. The water was ice-cold. After crossing the stream, and trying not to slip on the muddy rocks, I started up the other hill. I wandered along a skinny dirt path lined heavily with a variety of shrubs and plants. At the top of the other hill I came to an open field. The plants were browner and appeared as if they had been over exposed to the sun. To take in the moment, I sat down in the dry dirt. In front of me were tiny, green spiders making webs in the grass; it was impressive to see them walk from one blade to another. When I do not take the time to closely observe my surroundings, I often overlook the little things in life.

Spending time in Valle del Bravo also gave me the opportunity to do Tai Chi and yoga with the mountains as the background, the grass as the floor and a blue, sunny sky as the ceiling. In yoga class, our objective is to connect with the earth and the sky, but in a classroom it is all in our head. In nature, I did not have to imagine it, rather I experienced it. Connecting with nature brought equilibrium back to my mind and body. It made for a helpful transition back to the chaotic city. I can see why city people migrate to places like Valle del Bravo and Tepoztlan for the weekend.

Tuesday, January 6, 2009

The Holidays in Mexico

When Mexicans take a vacation, they take a vacation. Most people stop working around the 19th of December and are just now returning. As I thought I would be one of the later ones back, I went to work yesterday to find that no one was there. The offices will not be open until Wednesday.

Speaking of the holidays, I decided to pass New Year's Eve in Valle del Bravo, Mexico. That night I learned that Mexicans have many superstitions surrounding the new year.

1) If you beign the year in Mexico, you will finish the year in Mexico.
2) Eat 12 grapes after the clock strikes midnight. For each grape, you make one wish.
3) Wear red undergarments so that you will have good luck with love in the coming year.
4) Run with a suitcase -where, I am not sure -and you will travel.

And the list goes on.

Saturday, December 13, 2008


One Wednesday night, back in December, I decided to go to Tequisquiapan early Thursday morning. Spontaneity adds excitement to life. Caley and I had previously researched the popular vacation spot finding out that it was famous for its wine and cheese and spas with thermal waters. I imagined that we would arrive around noon, eat a nice lunch, relax in the thermal waters and finish off the night taste-testing regional wines and cheeses. Does not sound too bad, eh?

Three of my four expectations were met. We pulled into Tequisquiapan just before 12, dropped our stuff off at the hotel and went on to hunt for a place to eat. On a side street, near the plaza, we found a simple spot where we ate sopes, gorditas and quesadillas in a hole-in-the-wall restaurant. We left feeling satisfied and ready for a dip in the thermal waters.

Since Tequis is known for its thermal baths, we figured that any taxi driver would know where to take us. Just to make sure that he was not going to rip us off, we asked the owner of the hotel that my friends were staying in, where would be the best place to go. He gave us two recommendations. We mentioned them to the taxi driver and he knew right where they were.

On our way to the thermal baths, I pictured us sitting in hot springs in a valley somewhere passing away the afternoon under the hot, bright Mexican sun. My expectation could not have been more wrong. The taxi driver had taken us to an empty water park filled with Disney character- decorated trashcans. Only three of the pools were open: one being the kiddy pool. Only one water slide was functioning: the blue slide that the manager turned on for us. In shock, I asked the manager if there were any hot springs, or natural thermal waters in which we could swim. With a defensive look on his face, he reassured me that the water in the pools came from the mountains and was naturally warm. I did not argue.

As the sun went down, we headed back to the center of town to look for a restaurant that served wine and cheese. We found a quiet one overlooking the town square. First, we ordered the regional sparking wine that was accompanied by complementary baked provolone cheese in a rich tomato sauce. To follow, we tried a bottle of the local red wine to accent a sample cheese plate with three different types of fresh panela: plain, chipotle and epazote with jalopeño. As I am a huge fan of spicy foods, my favorite cheese was the queso panela with epazote and jalopeño. For the little that I know about judging wines, I truly enjoyed them both. Who would have known that Mexico produced good wine?

From the restaurant, I took a cab back to the bus station where a three and a half- hour ride back to the city was awaiting me. The last leg, the taxi ride to my apartment, was the highlight of the ride as I watched hundreds of people walking to the Basilica of Guadalupe with their statues or portraits of the Virgin of Guadalupe in hand (the following day was the day of the Virgin of Guadalupe). It was a cultural phenomenon that I had never seen before.

Friday, November 28, 2008

What am I doing here again?

Almost three months have passed, and I have yet to post a blog about my research. You are all probably wondering what I am doing here.

Original idea
I thought I would start by stating why I chose to research women with gestational diabetes. First, it is well known that pregnant women with gestational diabetes are instructed to follow a healthy diet with a primary focus on the reduction of the consumption of carbohydrates. They are also advised to exercise 30 minutes a day, five days a week with doctor’s permission. Thus, I hypothesized that if women could look at the disease like a red flag or a teaching point and make those proper lifestyle changes, then they could prevent themselves and their unborn-child from developing type 2 diabetes.

Coincidentally, the word on the street at the hospital’s annual meeting resonated with my objective: the prevention of type 2 diabetes starts in the womb. I guess the idea was not that original after all. However, there are still no studies that have researched gestational diabetes in a Mexican population from a qualitative approach.

Since 2000, diabetes mellitus (DM) has been controversially declared as the number one cause of death for women in Mexico. Nationally, 7.3% of women in Mexico are suffering from DM. The high rates of DM can be attributed to well-known risk factors such as obesity, as well as gestational diabetes mellitus (GDM), or diabetes during pregnancy. More sobering statistics show that for women of child-bearing age, between 20-29 years old, almost 50% are overweight or obese, while the percentage is as high as 70% for women 30-39 years old. Other risk factors include: family members with diabetes, Hispanic ethnicity, history of GDM or glucose intolerance, women 25 years and older, and women with children that weighed more than 4kg at birth. With all of that being said, the prevalence of GDM at the Instituto Nacional de Perinatología was 5.3% in 2007.

Definition of Gestational Diabetes Mellitus
GDM is defined as "carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.” (1) GDM is characterized by insulin resistance and the failure to produce adequate amounts of insulin; the hormone responsible for the up-take of glucose from the blood. While insulin resistance is a normal symptom in pregnancy, the pancreas should be able to compensate and produce more. Those women who can not produce the extra insulin are considered to have GDM.

1. Gabbe S. The gestational diabetes mellitus conference. Diabetes Care 1998; 21 Suppl 2: B1-2.

Objective and Methods
The purpose of my research is two-fold: 1) to evaluate the treatment program provided for women with gestational diabetes (Medical Nutrition Therapy Program) and 2) to help explain the phenomenon of gestational diabetes in a small group of women from a socio-cultural perspective where I will compare participants with good blood glucose control to women with poor control. I have chosen to take a sociological, qualitative approach to study diabetes because the disease is not just a biological manifestation, but psychological and sociological.

I will collect the information with a combination of in-depth interviews, questionnaires and by making observations. Since I cannot follow the patients to their homes to study how and why they do/do not follow their treatment plan, I will capture the data by asking them questions about their perceptions, knowledge and self-care practices surrounding dietary habits, glucose monitoring and physical activity. In addition, I will explore their level of diabetes-related knowledge and their perception of the care that they receive from INPer. Secondly, I will use the questionnaires to describe the demographics of the patients and to take a relatively larger sample (30 women) of how women adhere to their treatment plan. Lastly, I will observe dietitian consultations, patient visits with the endocrinologists and talks on diabetes for women recently diagnosed with the disease.

Evaluation of the Medical Nutrition Therapy Program
The dietitians and rotating-nutrition students base their diet consultations on the Medical Nutrition Therapy program designed for women with gestational diabetes. Due to a lack of resources, it is not the exact same MNT program that is applied in the US. However, all patients are given an individualized diet, as well as educational materials with a diet plan and recommendations for exercise. At the first visit, a nutritional history is taken of the patient. A diet is then constructed using the number of calories assigned by the endocrinologist, based on weeks of gestation and her pregestational weight. The patients are restricted to eating a diet with 42% carbohydrates (people without diabetes are allotted 50-60% of carbohydrates daily). The quantity of carbohydrates is broken up into fourths, where the patients are usually told to eat ¼ of their daily rations with breakfast, 2/4 with lunch (the biggest meal of the day) and ¼ with dinner. Also, they are told to follow a schedule for their meals and snacks. Lastly, women are taught the different food groups, how they should be combined and what portion sizes are.

The latest and greatest
Currently, I am applying the questionnaires with the help of one of the nurses. The process is slow but steady. I plan to have the 30 questionnaires finished before I go home in December. I continue to make observations on a weekly basis; jotting down anything from what I see and hear in the consultation rooms to the waiting areas. With respect to the interviews, we had our first patient this past Thursday. She was a great informant, as she only had to be asked one question and she would provide us with a 20 minute answer. Moreover, the information that she gave us supported the observations that I have been making over the past three months; I was quite excited.

Saturday, November 8, 2008

Day of the Dead, Nov. 1, 2

"Calaverita, calaverita!" demanded a young boy, dressed in plain clothes. I replied, "No te entiendo, mi amor." Two seconds later, he blurted out the word in English, "Candy!" Irma turned to me and reaffirmed what he had said, "The boy wants candy." She later explained that since calavera (skull) plays such a prominent role in Día de los Muertos (Day of the Dead) that it is the word for candy during the festivities.

Irma and I bundled up and went to the Zocalo, the historical center of Mexico City, on Saturday night to celebrate the first day of Día de los Muertos. They say that November 1st is designated to the young ones who have passed away, as their spirits come running back faster than the adults. We ploughed our way through the crowds, sipping on scalding, hot, fruity punch with sugar cane stirrers while admiring the ofrendas (offerings) displayed on the altars (altares). The offerings were filled with the deceased’s favorite foods and drinks, marigolds, candles, photographs, skulls and other ornaments. I was told that the candles are used to guide the souls by light, where as the purpose of the marigolds is to guide them by its strong, distinct scent.

On the second night, we layered up again and went down to Coyocan to see more ofrendas. There was one main offering that was put together to make a statement against the government's proposition to take down the tianguis, or independent street vendors. Coyocan is known for its bohemian ambience and its free-spirited artists who sell all sorts of arts and crafts. As there was only one offering, we walked around admiring the children’s' costumes instead. The tin man was by far my favorite. In the plaza, parents accompanied their children as they went around asking for calaveritas. In Mexico -I imagine for safety reasons-little ones go to public places to ask for candy, rather than door-to-door.

It was interesting to see how an old tradition of paying respect to the dead has survived over the years and has integrated into today's Americanized Mexican culture. For example, Pizza Hut had ofrendas. The food of choice at an ofrenda in the Zocalo was a hamburger and juice box. I would argue that the holiday has not lost its original meaning, rather it has adapted to the times, for good or for worse.

Lastly, I found Día de los Muertos to be very powerful, as people took the weekend to celebrate and reminisce about their loved ones who have moved on. It is not necessarily a time for mourning, but rather a weekend set aside to share memories, eat good food, bring families together and appreciate the temporary life here on earth and the eternal lives of our deceased loved ones.