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Why Colombia for medical tourism/ surgical tourism?

Here are several of the reasons I have decided to focus on Colombia as one the emerging destinations for medical tourism:

1. It’s close to the United States (and North America): direct flights to several cities in Colombia are only 2 – 3 hours from Miami, Orlando and many other southern US cities.
This should be first and foremost in people’s minds – for more than just consumer comfort. Those coach-class seats can kill.
The risk of venous thromboembolism (VTE), a potentially fatal complication of air travel (and other stationary conditions) is very real; and this risk increases dramatically with flight duration. Flights to Asia can be anywhere from 16 to 20 hours – which is an endurance test for even the healthiest and heartiest of individuals.

This risk for DVT/ VTE which can lead to pulmonary embolism, and death is enhanced in elderly people, people with chronic diseases (diabetes, lung diseases, etc.), obesity and people who have recently had surgery.   Some data suggests this enhanced post-surgical risk may persist for up to 12 weeks. While there are treatments to prevent thromboembolism or blood clots, none of these strategies are fool-proof. (Some of these safety strategies for air travel are mentioned in the above attached links).

Proximity – Close to the USA/ North America:
-Cheaper flights (all the flights to Asia are in the thousands – and you shouldn’t be travelling alone)
– Shorter flight duration (safer, more comfortable)

2. Cost:
This includes medical travel costs as briefly mentioned above. Most cities in Colombia are relatively affordable for other travel accommodations (though this is sometimes included if medical tourism packages/ planning are used.) This is in addition to the known cost-savings of medical care outside of the United States, which is the main reason behind the popularity of medical tourism. For example, a recent CT scan at a local hospital cost around $250.00, versus several thousand.

For actual surgical procedures, the savings are much greater. Heart surgery in the USA ranges from $80,000 – 180,000.. of course, if you have good insurance – your costs are much lower.. If, of course, you have good insurance – and insurance doesn’t cover everything!
In Colombia, heart surgery costs around $12,000 – and most cardiac programs  (and other surgeons/ hospitals) here accept American insurance – so your 20% co-pay is going to be a lot more reasonable..

3. Similar culture, similar values, similar ideals – yes, the language is different (but many people and providers speak English) but the underlying primary core values, and core medical values are the same. This means, that while the US medical system is plagued with problems – some of these problems are related to our values such as the sanctity of life, and the preciousness of life.. That value is shared here – which is important – since that is not the case in many places – even western europe where medicine, surgery and expensive treatments are rationed, and sometimes denied – particularly to people over the age of 65.

Medical providers, nurses, and staff here care about their patients the same way, we do at home.. And arguably, in most cases, the doctor- patient relationship is a lot closer, and more personal here. Doctors want and expect patients to contact them – they give patients their email and cell phone numbers on their business cards, for just that reason, and they aren’t put out or annoyed if you use it.. (I know, I’ve been with doctors when patients call.)

4. Surgical proficiency, medical education, and available resources – this is the primarily reason I am currently here in Bogota, Colombia; the high level of skill and training among surgeons in Colombia. These doctors are professionals in the highest sense of the word, and have attended well-known, well-respected and accredited institutions. In many cases, these surgeons are at the forefront of emerging technologies, that are just now becoming popular in the USA.
As far as medical technology goes – many of the doctors, and hospitals I visited have the latest technology, which rivals if not beats what I’ve seen in the US. (Now, for those of you who have never stepped inside a rural hospital in the United States – you would be surprised at what resources they do and DON’T have.) Americans in general, and American medical professionals tend to view the world from this little bubble, thinking that we always have the latest and greatest – even when we know it’s not always true. It may have been true twenty years ago, but sadly, it’s not always true now.

Come back for part two – and we’ll discuss Why not India, why not Thailand.. (but in the meantime, here’s some food for thought)

* Antibiotic resistant infections of any sort (MRSA, VRE) are still fairly rare in Colombia.
Superbug Hits UK from Medical Tourism from India

Indian Resistant Bacteria from Medical Tourism

More articles/ links on SuperBug

Of course, to be fair, our own food supply contributes to this problem too..

Back in Cartagena

I’m back in Cartagena, where it all started.. I’ll be here for a while, taking in more of the local culture and reacquainting myself with the city.

cartagena 008

Unlike my previous visits – I am going to spend a little time outside of the operating room.

If you haven’t been to the site in a while – you’ll notice, neither have I.  Having a separate Cartagena page was becoming overwhelming, so I have been transitioning it all to a sister site, latinamericansurgery.com.

However, the sites aren’t completely similar.  I admit, we don’t have as many lively debates and outside contributions as before.   I also miss the opportunity to write about a wider range of topics outside of medical tourism but I am still trying to build my audience and I was worried that my site was actually a little too diverse to offer helpful information.  Much of it was scattered over multiple sections.  So you’ll notice that Latin American Surgery is a little more organized – though the volume of pages makes precise organization difficult.

I miss the dialogues we often had here at Cartagena Surgery.  We would often get great feedback from other health care providers, researchers and experts in the field.  It was a lot of fun, and I hope that more experts will start to write in on cardiovascular and other health topics.  In the meantime, I will just keep traveling, learning, working and writing.

I also continue to write about various health care topics over at Examiner.com so if you can’t find it here –  try searching the archives over at the Examiner.

Planned site merge

Notice of site merge:  since much of the content tends to run parallel – from medical tourism to medical information about medical conditions and treatment options – I am merging Cartagena Surgery content with Latin American surgery.

This will also include some of my more personal posts on photography, student life during various internships and other posts that give readers a better sense of the person behind the posts.  I debated for several months before initiating the large-scale move – (hundreds of posts), and it will take time to organize and arrange all of the new additions.  Hopefully, the addition of the posts is welcome to all of my long-term followers  – who can now find information on medical conditions  (aortic stenosis) and the doctors (cardiac surgeons) to treat it at the same place.

So if you are a fan or subscriber to Cartagena Surgery – please take a moment to head over to http://latinamericansurgery.com/ to sign up to continue to receive my posts.

Back to Colombia

So, if you’ve been by our sister site – the newly re-christened LatinAmericanSurgery.com then you will notice that I’ve taken an abrupt detour from our planned excursion into Panama.

It’s a long story, but suffice to say, I’ll be here in Medellin for the next several weeks..(Hopefully interviewing, talking to and writing about surgeons since that’s one of the things  I do best.)

It’s a religous holiday weekend so it’s been pretty quiet since we got here, but I expect my schedule will pick up in a few days. In the meantime, I am enjoying a lovely beginning to summer here while I prepare to contact local physicians.

flores 005

In other news – I finished the second half of a two-part series on “Lung surgery after cardiac stents” over at Examiner.com so if you get a chance, check it out.

I’ve also applied for special credentials to write outside of my usual area [health & medicine] over at Examiner.com for an upcoming fashion show.  I know it’s outside my expertise – but it’s the largest fashion venue in Colombia and I think it would be great to get some photos and talk about it on the blogs/ Examiner.com to give people a better chance to get to know Colombia, its art and culture. (and I’m not entirely ignorant about the world of fashion thanks to some undergraduate classes in costume studies at Dalhousie!)

So – I am keeping my fingers crossed that they won’t reject my application out of hand.. If they say yes – it’s a whole ‘nother application process to get a press pass into the fashion show.

We’re here – in Panama City, Panama starting what I hope turns out to be the latest installment in the Hidden Gem medical guide series..  (wow – #4 – can y’all believe it?!!)

firstday 003

In the meantime, as I interview surgeons, take notes, photographs and continue my research – I’ve made some changes to the Cartagena Surgery trio of websites..

To streamline and consolidate the medical tourism information – I’ve transferred quite a few of my posts about the Mexicali book over to the sister site – which has been renamed “Latin American Surgery” in honor of the expanding list of destinations that the series has begun to cover.  Bogotá Surgery just didn’t seem entirely accurate now that there are Hidden Gem guides to multiple destinations.

I’ll still be coming by the Cartagena site – to give some of my more informal impressions, and related stories about my adventures as well as our usual discussions on medicine and health.  After all – Cartagena Surgery and its readers have become like old friends; you know the ones who don’t laugh when you kick your shoes off and have a great big hole in the toe of your dress sock.. (and they don’t think any less of you for it either..)

I like to think that my readers here don’t mind my little side trips into photography, funky restaurants, haunted houses or the myriad of touristy things I venture into whether I am “on-location” or just preparing for the next trip.

I also like to think (and hope) that readers don’t mind my ‘down home’ discussions on medicine and health since I think that’s what is often missing in our healthcare conversations.. Just real honest, straight talk..   (even if sometimes I do get a bit up on my soapbox about some of the things that are frustrating about healthcare..)

So – I’ll still be here – to talk about the sweltering heat of the rainy season in Panama City, post my continuing photography efforts, and all the other things that go on down here.. I just hope you’ll still be reading.

New recommendations out of a recent conference in Austria as reported by the Heart.org.  This comes on the heels of the most recent changes in BMI recommendations, as we reported last month.

As reported by Steve Stiles over at the Heart.org,  in”Case made for metabolic bariatric-surgery eligibility criteria,”  new evidence and recommendations suggest that surgery should be done earlier in the course of the disease process (diabetes) in patients with lower BMIs.  Currently the BMI restriction criteria enforced in North America and Europe prevent the majority of diabetic patients from receiving gastric bypass surgery, which is the only proven ‘cure’ for diabetes.  That’s because the majority of type II diabetic patients are  overweight but not morbidly obese.

As reported previously on this site, Latin American bariatric surgeons have been at the forefront of the surgical treatment of diabetes.  Many of the surgeons previously interviewed for numerous projects here at Cartagena Surgery were involved in several early studies on the effects of surgery in moderate overweight patients with diabetes.

More interestingly, researchers at the conference are also suggesting possible gastric bypass procedures for patients with ‘pre-diabetes’ or patients with an hemoglobin A1c greater than 5.7 % but less than 6.5% (6.5% is the cut off for diagnosis of diabetes.)

This is wonderful news – it means committees and such are finally getting around to following all of the research that has been published and presented over the last ten years..  But then it just one more important step…

Call it by its name

So I have my own suggestion to doctors and researchers – and it’s one that I’ve made been – a nomenclature change.  We need to stop calling it “pre-diabetes”, because the name is a falsehood – and leads everyone (patients, nurses and doctors astray.)

– Greater than 95% of patients with ‘pre-diabetes’ will develop diabetes – so without a drastic intervention (far beyond diet and exercise)  it’s pretty much a certainty.

– Many of the devastating complications of diabetes develop during this so-called pre-diabetic period.

– Doctors are now recommending surgical treatment to cure this “pre” disease state.

So….  

if almost everyone who has ‘pre-diabetes’ gets diabetes, and it’s already causing damage PLUS we now recommend a pretty radical lifestyle change (surgical removal of most of the stomach) —> that sounds like a disease to me.  Call it early diabetes, call it diabetes with minimal elevation of lab values, but call it what it is….Diabetes..

This is critical because without this firm diagnosis:

insurance won’t pay for glucometers, medications, diabetic education, dietary counseling (or surgery for that matter).  That’s a lot of out-of-pocket expenses for our patients to bear, for something that is treated like a ‘maybe’.

– patients (and healthcare providers) alike won’t take it seriously..  Patients won’t understand how crucial it is to take firm control of glucose management, patients won’t be started on preventative regimens to prevent the related complications like renal failure, heart disease and limb ischemia.

– Patients may not receive important screening to prevent these complications – and we already know that at the time for formal diagnosis (usually SEVEN years after initial glucose derangements are seen) – these patients will already have proteinuria (a sign of kidney disease), retinopathies, vasculopathies and neuropathies..

I work with providers every day, and the sad fact is that too many of them (us) shrug their shoulders and say – yeah – he /she should eat better, get more exercise, shrug.. But they don’t treat the disease – they don’t start checking the glucose more often, they don’t start statin drugs, the don’t screen for heart disease and they don’t consult the specialists – the diabetic educators, the nutritionists, the endocrinologists – and yes, the bariatric surgeons…

Chances are if your doctors and your nurses don’t take it seriously; and don’t make a big deal out of it – and don’t talk to you, at length about what “pre-diabetes” IS and what it really means for your life and your health –

then neither will you.

For related content:  see the Diabetes & Bariatric tab

the Weight of a Nation: the obesity epidemic

Bariatric surgery and non-alcoholic fatty liver disease

The Pros & Cons of Bariatric Surgery

Gastric bypass to ‘cure’ diabetes goes mainstream

The lost of Las Vegas

Vintage Las Vegas

Desert Oasis or Roadside Toilet?

Gleaming neon, dazzling lights; glamorous yet slightly seedy, Las Vegas is the glittering rest stop on the otherwise lonely desert highway west.

all that glitters

all that glitters

Like it’s upscale and more mature big sister, Hollywood; Las Vegas attracts millions of visitors each year.  Many of these visitors come seeking fame and fortune.   Unlike the more illustrious fantasies of super-stardom on the silver screen and streets paved with gold, even the “Las Vegas dream” has a harder edge.

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‘Easy money’ is the lure of the city; but instead of striking it big, many of the fame seekers find themselves in the shady world of drugs, prostitution, porn or living on the streets..

Peg Entwistle  & John O’Brien

While Hollywood may be the birthplace of such romanticized tales of stripping and prostitution, ala “Striptease,” “Indecent Proposal” and “Pretty Woman” in real-life there are few happy endings for all the runaway erstwhile Julia Roberts.

As illustrated in the 1990’s novel (and film), “Leaving Las Vegas” even survival in Sin City is a mark of success.

Like Hollywood, the side streets and alleyways serve as a cautionary tale to wayward youth.  Homeless youths clutter the sidewalks of the Strip, sleeping in doorways or holding signs asking for help.

The Lost

Panhandling in downtown Las Vegas

Panhandling in downtown Las Vegas

Broken promises, forgotten youth

They are running from something; abusive or neglectful homes, impoverished or alcoholic families or perhaps something even darker, but today I am too disheartened to ask the specifics.

The four young adults are outside a casino, quiet, friendly and polite when I approach.  But their youth is almost an accusation against this modern world that has no place for them, outside of the gutters and the trash of our glaringly tacky, frantic shopping spree, free-for-all that has become the American economy.

Angelica Gaskin, Andrian Wack, Robert Gaskin and Ritchie Cunningham fight to survive on the streets of Las Vegas

Andrian Wack, Angelica Gaskin,  Robert Gaskin and Ritchie Cunningham fight to survive on the streets of Las Vegas

Angelica Gaskins, 20 wears a Pikachu cap and a brown hoodie.  Originally from Anaheim, California, she and her husband, Robert, along with the remaining members of the group narrowly avoid homelessness by panhandling  during the day and sharing a tiny room in a cheap hotel.  She explains their signs by saying, “We used to earn money by entertaining people with our signs, but now we aren’t allowed.”  New ordinances aimed at controlling the increasing number of homeless in Las Vegas have Angelica upset.

Andrian Wack, a twenty year old girl from northeast Ohio, whose pixie-ish freckles and fair complexion are marred by multiple facial piercings, fang-shaped incisors and skateboarder style shares this sentiment.

Robert Gaskins, 23 from upstate New York is pleasant but more subdued; only speaking up when introduced by his wife, whose face is shining with pride.    He stands close to her; giving support and protection from the unnamed demons she is running from.

At first glance, they seem an unlikely pairing but after a moment’s reflection – a good match, supporting each other.  It’s hard not to look at them, with a bit of painful cynicism brought on by maturity and experience.  What chance do they have to stay together, with all the obstacles they face?  One can only hope, for their sake, that “love is enough” since they don’t have much else.

Ritchie Cunningham, 23, “Yes, I swear that’s my name,” is an engaging young man with a shy smile, in a camouflage jacket.  He catches sight of my camera and readily recruits his friends; posing kneeling near the ground.    Unlike the others, he offers little information about his past, instead focusing the conversation on the future saying, “I want to get my GED soon.”

Walking away from this foursome, I can’t help but think about these damaged children.

The American Dream vs. “The Running Man”

It’ s no longer the ‘American dream’, it has degenerated into a winner-takes-all, survival-of-the-fittest endurance contest just to survive.   Now our younger generation has inherited our financial messes, our love of excess and fierce competitiveness and too many of them are just like Angelica, Andrian, Robert and Ritchie: shunted to the sidelines and pushed out of the game.

No job, no education, no future 

In my own immediate family, my mother was the first to go to college.  Her father was a successful business man from the “School of Hard Knocks” and their family was solidly middle class, if at the lower end.

No more dreams of success for future generations – just survival

When it came to the American dream, my in-laws are a typical portrait of America’s past.

While my father-in-law had limited education, and the family (of nine) often struggled to make ends meet – there was always hot food on the table, clothes on their backs and a roof over their head.  But that was in the aftermath of the second world war, and as an honorably discharged veteran, and skilled craftsman, there were always employers looking for someone willing to work hard.

It might have been the same for my husband, who was a modern-day version of the Loretta Lynn story.  After leaving high school at the age of 16 to work full-time in the local gold mine, he could have easily become an educational footnote – but still, the jobs were there; with decent wages and benefits for hard-working men with GEDs in hand**.   Luckily, he used his GED and the gold mine as part of his stepping stone to community college, university and eventually, a master’s degree..

But the path to success based on hard work, long hours and sheer effort no longer exists.

But what about the legions of high school dropouts within an era of grade inflation (and degree inflation)?

Unable to compete

In a generation of lowered expectations and easy A’ s which make a post-secondary education more obtainable (but even more expensive), and where even 10 dollar an hour jobs often require college educations – what will happen to people like Angelina and Andrian?

When “Do you want fries with that?” is no longer an option

What will happen to all of those who have been marginalized by their families and society for their entire lives?  Now that even the fast food industry is shunning them, it seems that the ‘working class’ / blue-collar life is out of reach.

Whatever the answer is – it’s not on a cardboard sign..  Good luck kids.. and good luck to everyone else out there..

** Of course, this all changed in the late 80’s and early 90’s as the mines closed, along with factories and plants across the United States as companies moved their workforces overseas, setting the foundation for today’s employment landscape.

Additional Information

Resources for homeless youth

Home sweet blog..

Readers –

My current assignment in Texas is coming to an end – so the blog content will be shifting back; less photography and more medical news.  I’d like to thank all my loyal readers for staying with me as I indulged my creative side for the last few months, and drifted away from our original foci.

But I hope, that for your part – it hasn’t all been eye-rolling, deep sighing, shoulder shrugging ‘tolerance’.  I hope that you have enjoyed the chance to connect on a more personal and less formal level.

That’s how I feel when I read other bloggers pages about photography, travel, sewing, art or any of the other interests that define me outside of nursing and health care.  I hope that you get that same sense of familiarity, of enjoyment when each of my blogs is posted.

If I can recreate that same, “I wonder what she has today?” anticipation that I feel when reading the Mexfiles, seeing the latest creations at the Renegade Seamstress or vicariously enjoying the tasty travels of Bunny and Pork  Belly; well, that’s success in its own right.

My blog certainly isn’t up to the caliber as the others I’ve enjoyed – but I think if I can get each of my subset of readers (photography fans and medical / health readers) to remain interested and engaged, even when I stray off topic..

with fellow Nurse practitioners in Texas

with fellow Nurse practitioners in Texas

These last few months, since returning from Colombia have been fun.  Figuring out photography and trying to get past point-and-shoot has been frustrating, frustrating, jaw clenching, foot stamping frustrating at times..

But – it’s good photography practice for my future writings, and it’s also a bit less strenuous.  Writing and posting research based articles (with relevant citations) can be a bit onerous after a long day in the hospital.. Tired eyes tend to make for more spelling errors..  I could just post less often when on assignment, I suppose..

Yet – I am always hesitant to leave the blog for too long because it has come to be a place for me to indulge my ‘nerdy’ side with a friendly audience.

The blog lets me address and talk about the issues in medicine and patient care, explore relevant medical discoveries and emerging research as well as passing on some of the information (and patient education) that I have gained as part of my years of taking care of people.  It lets me talk about all the nerd stuff that people at work don’t really sit around and talk about –

Like everyone else, they talk about families, finances, home life. Taking kids to soccer, going to church, socializing with friends, landscaping the lawn..   All good things, great community and friendly folks.. But it doesn’t fill that ‘Dora the Explorer’ inside me; or the inner Florence Nightingale.

It also doesn’t mesh with my family; the vagabond roving band of travelers that we are, so it is sometimes hard to relate.  I mean, right now, I live in a hotel, my ‘home base’ is a storage shed in another state – where we stop in and swap out clothes.. My husband and I are sometimes working in different states (or countries) for weeks or months at a time – so we aren’t the best candidates to join leagues or make long-term commitments.  All of it sounds wonderful but it sometimes makes us feel like outsiders looking in.

So I come here to wordpress; to enjoy Serapa, Nicephore’s diary, and the return of Miss Christina and all the other people I will never meet – but sure enjoying knowing about a little corner of their lives..  I hope it is the same for all of you.