Of the many changes I notice here the amount of young people one sees in the street is staggering. (old folks are rare)  Most of the population is below 25 and with so many older people dyiing before the age of 60 there is a marked outward appearance of the young.  This is noticable in the public hospital where Pediatrics and especially Pediatric Trauma make up a third of the hospital population. Every day I see more children with agricultural accidents, traffic accidents, burns, broken bones, infected wounds.   Unfortunately, many children suffer needless pain due to a lack of nurses and medicines. With one nurse to 8 or 10 children it is difficult to make sure that every order is carried out and every medicine give.  The nurses due a good job with what they have and are quite dedicated. The families usally stay in whole or in part near the hospital and will often take their meals with the children if they can be moved to hospial cafeteria..  The residents pretty much run the show in the hospital as the doctors spend most of their days with the private patients in their office or in surgery. I wish i could speak spanish better as i often have problems communicating techincal terms. Orders as well as notes are still all in paper....something many doctors miss in the US.   The other thing i notice is how rarely the attending doctors talk to the parents. I am not sure why this is so.