Feeds:
Posts
Comments

Archive for the ‘Medical tourism in Mexicali’ Category

Dr. Enrique Davalos Ruiz, Neurosurgeon

Spent the morning in the operating room with Dr. Davalos.  As we discussed in a previous post, Dr. Davalos is one of just a few neurosurgeons here in Mexico to specialize in both adult and pediatric neurosurgery procedures.  He performs a wide range of procedures such surgery for cerebral tumors, spinal bifida, hydrocephalus, trauma, spinal surgery and epilepsy.  But one of the procedures he is best-known for here in Mexicali is the surgical repair of craniosynostosis.  However, if you’ve ever watched this intricate procedure – ‘repair’ really isn’t the word that comes to mind to describe the procedure.  ‘Rebuild’ is much more appropriate.

Craniosynostosis is a congenital cranial deformity caused by the premature fusion of the cranial sutures.  (These sutures allow for the babies head to be slightly compressed during natural childbirth).  Many new moms can attest that their neonate’s head was temporarily ‘squashed’ looking at birth, but normalize over the first few days as the bones relax into their natural position.  In normal development, these sutures (or ridges where the bones come together) are not yet fused  – and fuse over the first few months of life.

When the bones that comprise the skull fuse early, it can result in a significant cranial abnormality.  (Luckily, in most cases of [primary] craniosynostosis – the patient’s brain functions normally despite this.)

To treat this surgically, Dr. Davalos had to essentially rebuild part of the skull (the coronal sections of the parietal and frontal bones).   He did this by removing and reshaping the skull in separate sections and then rejoining the pieces to conform to a more natural shape.  (As a someone who sews, it reminded me of lacing a corset to get curved shaping).   In a child of this age – the bones should fuse/ heal within approximately six weeks – with no long term limitations for activities.

Sterility was maintained during the case, and everything proceeded in a rapid and appropriate fashion.  Anesthesia was proficient during the case, with excellent hemodynamic stability and oxygenation.

Dr. Davalos beveling a portion of the skull

Dr. Enrique Davalos Ruiz, MD

Pediatric and Adult Neurosurgery specialist

Calle B No 248

entre Av. Reforma and Obregon

Zona Centro

Mexicali, B. C.

Advertisements

Read Full Post »

Interesting day today – as I travelled across a wide range of specialties in just a few short blocks.  I started out this afternoon in thoracic surgery with the good doc seeing patients in clinic, then off to IMSS to watch a Whipple procedure (pancreatoduodenectomy) with Dr. Gabriel Ramos.   (The Whipple procedure would be the ‘open heart’ surgery of the general/ oncology surgery specialty – it’s a complex, complicated and involved procedure – so, naturally, I loved every minute of it!)

Dr. Gabriel Ramos & Dr. Maria Rivera

Some of you will recognize the absolutely delightful Dr. Maria Rivera from one of our pictures last week (on facebook) – in which she was an absolute stunner.

Not an everyday photo – but then that case was pretty breathtaking too – (when I finish writing about it, I will post a link.)

Dr. Elias Garcia Flores, who I met briefly last week was there too.. (Of course, I didn’t recognize him since he had a mask on this time.)

Unfortunately, I couldn’t stay because I had a previous appointment to interview Dr. Enrique Davalos Ruiz, a local neurosurgeon.  He turned out to very charming and interesting..

He’s the only neurosurgeon specializing in pediatric and adult neurosurgeon for all of Baja California and Sonora.  (I’ll write more about him soon – I am hoping to head to the operating room with him next week.) He’s pretty busy working at IMSS and Hospital General de Mexicali, in addition to private practice but he didn’t seem to mind taking time to talk to me.

Read Full Post »

This post is a little overdue since I was out of town for a few days.. I missed the 115 degree temps and I missed Mexicali too..

Dr. Juzaino (left) and Dr. Rivera

Usually, I go to surgery after I’ve spoken to the surgeon, and talked to them for a while but in this case – I had heard of Dr. Juzaino (after all – he practices at Hospital General de Mexicali) but couldn’t find a way to contact him – he’s not in the yellow pages, and no one seemed to have his number..

So I just hung out and waited for him when I saw his name on the surgery schedule. He was supernice, and invited me to stay and watch his femoral – popliteal bypass surgery.  Case went beautifully – leg fully revascularized at the end of the case.   Patient was awake during the case but appeared very comfortable.

intern during surgery

There was a beautiful intern in the surgery – her face was just luminous so I couldn’t resist taking a picture.  Unfortunately, I didn’t get her name, and no one recognizes her because of the mask – so I am hoping some one from the OR recognizes her here.. I’d like to send her a copy of the picture.. (and get permission to post it..)

Saw Lupita Dominguez – who in the role of nursing instructor that day.  She is always so delightful – I need to get a picture of her with out the mask so all of you can see her -besides being an outstanding nurse, and nursing instructor,  she is just the friendliest, sweetest person with cute freckles to boot.. (I am very envious of people with freckles..)

On another note entirely, here’s some more information about the ethical implications of transplant tourism for my interested readers as follow up to my Examiner.com article.  It’s a video of lectures by one of the leading ethicists and transplant surgeons, Dr. Delmonico.. (yes, like the steak.)

Read Full Post »

As I mentioned in a post earlier this week, the New York Times article  by Jennifer Medina has really gotten Mexicali officials to sit up and take notice.  The NYT article was just one part of a ‘medical tourism plan’ outlined by the mayor of Mexicali and other government officials.

turismo medico

city of Mexicali

Right now the outline consists of several points:

1. Guide to medical services – they have published a book with the names and addresses of surgeons interested in participating in medical tourism.

2. Transportation – mainly by automobile and buses.  The medical tourism lane at the border was part of this.

3. A plan for a 32 block medical tourism zone.

A good start, and it shows forethought – but as I listened to their outline it prompted my own (humble) suggestions:

1. Medical guide – make this a ‘real’ guide not a phone book of surgeons and providers offering their services.  It should be comprehensive, and offer more than just names and addresses, ideally written as an independent review.. But then take the risk that maybe everything, and every service won’t come out shining..   (Admittedly, this is something I understand the best).

2. Transportation – consider approaching Volaris or another carrier to offer direct flights once or twice a week from Las Vegas, Dallas and Los Angeles.  Right now there are no direct flights from Mexicali to the United States.  By offering direct flights – Mexicali could be much more competitive with both Tijuana and Las Vegas (which is pursuing its own medical tourism strategy to make Las Vegas a medical tourism destination.)  This would play to Mexicali’s two biggest strengths:

1.  It’s proximity to the United States

2.  It’s reputation as a ‘safe’ destination in comparison to Tijuana and other border cities which have their own medical tourism ideas..

It would also open up Mexicali to a much wider market since both Dallas and Los Angeles is a hub for several American carriers serving Canada and the USA.

2. Consider changing the 32 block ‘medical tourism zone’ into one large facility offering dedicated service lines.  While all the small private hospitals in Mexicali will hate this idea – instead of fighting over patients, they would have the advantage of having one large facility with pooled resources.

This would also address the weaknesses of medical tourism in Mexicali: Right now each facility has five (or two) ICU beds, and just 10 or so post-operative beds.  It would also eliminate some of the waste caused by the costly duplication of services – since each hospital currently struggles to offer CT scans, cath facilities and other costly equipment.  As part of a long-range plan – this would better enable the providers and facilities in Mexicali to seek outside accreditation/ and certification of programs and service lines, which in turn would attract more patients.

In the meantime, participating hospitals could convert to specialty facilities (ie. an orthopedic hospital, and plastic surgery center etc.) while the new facility is being built.  This would also reduce the stress on doctors traveling all over town to see just one or two patients at each facility.. If medical tourism really gets going here – these doctors are going to need as much time as they can get; caring for patients..

The centralized large hospital would also enable people like Dr. Vasquez to really get his cardiac surgery program off the ground.  More specialized ancillary services like physical and rehabilitative services would also be pooled and would improve the quality of services in the city, for everyone, including the people of Mexicali who also suffer from the lack of large, comprehensive facilities.   This also brings me to my next point –

3.  Since the city and government of Mexicali is involved in the project – there needs to be a clear and comprehensive plan about how the revenue from this project is going to serve the people of Mexicali.  After all – their tax dollars are helping to fund this ingress into medical tourism, so they need to get something out of it.. Like a PET scanner or some other service that doesn’t currently exist in Mexicali.

4. Don’t forget the rest of Baja – there are an awful lot of retirees and such living in southern Baja – so make sure they know about what your city has to offer.  These people need hip replacements, heart surgery and a whole spectrum of services that are very limited in their geographic area.  Give them a reason to come to Mexicali instead of Ensenada or Tijuana by courting their business.

If anyone from Mexicali reads this post – I hope they can see my suggestions, in the spirit that they are given.  Mexicali has a lot of opportunity here, and the potential to be a great place for a wide range of medical tourism – not just bariatrics and plastic surgery, but they need more comprehensive, and long-range strategies to put their plans into action.

Today was a great example of how much the city has accomplished by working together – with a little more work, and a lot of vision – Mexicali could really go far, and provide great services to more than just a bunch of gringos..

Read Full Post »

Had an amazing day yesterday – one of those days that reminds you how much we can do in medicine when we all work together.  I am hoping to write it up as a case study – if not – I will tell you more about it here.  (The patient was exceedingly gracious when I asked permission.)

But this morning, I was back in the operating room with Dr. Cuauhtemoc Vasquez.  (If he is tired of me – he sure doesn’t let on..)

I finally had the opportunity to get some of the pictures I’ve been trying to get on every visit to his OR – to show readers the heart, and the pulse of cardiac surgery..

There’s a running joke in Mexicali – if you need help in the operating room, any operating room, in any of the hospitals in the city; just holler for Lupita because she’s always there.

Introducing Lupita Dominguez, surgical nurse

All kidding aside on the popularity of the name “Lupita” among operating room personnel, there is just one Lupita that I would like to talk about today,  Lupita Dominguez, who is Dr. Vasquez’s surgical nurse.  In the months, and the numerous occasions that I have been a guest in Dr. Vasquez’s operating room, I’ve had the opportunity to observe and appreciate the hard-working Lupita.

Lupita Dominguez with Dr. Vasquez

Teacher, Coordinator and Mind-Reader

Most people don’t know it – but Lupita has the hardest job in the operating room, and probably (in Mexico) the most poorly paid.   They say a good scrub nurse has the instrument in the surgeon’s hand before he knows he needs it – and from what I’ve seen, that’s Lupita.  She’s here an hour earlier than the rest of the surgical team, getting everything ready, and she’ll be here after everyone else escorts the patient to the intensive care unit.

Here she is, a blur of motion as she takes care of everyone at the operating room table

As I watch again today, she is ‘running the table’ and anticipating the needs of not just one demanding cardiac surgeon, and an additional surgeon, but also one surgical intern, and another student.  With all of these people crowded at the table, she still has to follow the surgery, anticipate everyone’s needs and keep track of all the instruments and supplies in use.  In the midst of this maelström, the scrub nurse has to ensure that everyone else maintains sterility while preventing surgical instruments from being knocked to the floor, or otherwise misplaced (a difficult task at times).

Here she is demonstrating how to correctly load the needle, and pass sharp instruments

She’s forever in motion which has made taking the few photos of her a difficult endeavor; She’s shaving ice for cardioplegia, while listening to the circulator, adjusting the OR lights, and gently guiding the apprentices.  She’s so gentle in her teaching methods that the student doesn’t even realize she’s being led, and relaxes enough to learn.  This is no easy task, particularly since it’s just the beginning of the July, and while bright-eyed, pleasant and enthusiastic, the new surgical resident is inexperienced.  Her own student nurse, is two parts shy, but helpful enough that near the end of the case, (and the first time since I’ve known her), Lupita actually stops for a moment and flashes me a wave when she sees the camera faced in her direction.  I’m surprised, but I manage to capture it.

a very rare moment – Lupita takes a millisecond to say hello

She is endlessly busy, but ever uncomplaining – even when a scheduled surgery takes an unexpected turn and extends to twelve or even fourteen hours.  Bladder straining perhaps, baby-sitter calling, but Lupita never complains.  She’s not unique in that – scrub nurses around the world endure long hours, tired feet and legs, hungry bellies, full bladders, and aching backs as they complete their days in the operating room.  But she does it with good nature and grace.

Lupita assisting Dr. Vasquez during surgery

The surgical nurse

In the United States, this important job has been lost to nursing, a casualty of the ongoing shortage.  Positions such as scrub nurse and others like it have been frequently replaced with technicians who require less training and thus, less compensation that nurses.  Maybe the nursing profession doesn’t mourn the loss; but I do.

as you can see – here she is, ‘behind the scenes’ so to speak..

But in Mexico, and many other locations, this position remains the exclusive domain of the nurse.  Nurses such as Lupita, spend three years studying general nursing in college, before completing an (optional) additional year of training for a specialty such as the operating room.  After completing this training, these nurses spend yet another year in public service.

The idea of the public service requirement is honorable yet almost ironic (to me)  at times, since the majority of nurses in Mexico will spent their careers in public facilities, and by definition (in my mind at least), nursing is an occupation almost entirely devoted to the service and care of others.

Working conditions vary but some constants

Depending on the country, the culture, and the facility; conditions may vary; nurses may get short breaks, or be relieved during particularly long cases.   The only constant is the cold, and the hard floors, and rickety stepstools[1].  While the nurses here tell me that the workday is only seven hours long – I’ve been in the operating room with these ladies before, and watched a supposed ‘seven-hour’ day stretch to fifteen.   But it is just part of being a nurse.

[Usually I tell people when I am writing about them – but on this instance – there was never an opportunity.. but she (and all the nurses in the OR with Dr. Vasquez) certainly deserve mention.]


[1] Temperatures are set lower in cardiac surgery rooms.  Why the stepstools always seem rickety, I have no idea.

Read Full Post »

Busy day yesterday – spent the morning shift with Jose Luis Barron over at Mexicali General..  Then raced over to Hospital de la Familia for a couple of general and bariatric cases.

The first case was with the ever charming Drs. Horatio Ham, and Rafael Abril (who we’ve talked about before.)  with the always competent Dr. Campa as the anesthesiologist.   (Seriously – Dr. Campa always does an excellent job.)

Then as we prepared to enter the second case – the director of the hospital asked if I would like to meet Dr. Marco Sarinana G. and his partner, Dr. Joel Ramos..  well, of course.. (Dr. Sarinana’s name has a tilde over the first n – but try coaxing that out this antique keyboard..)

So off to the operating room with these three fellows.  (This isn’t my usual protocol for interviewing surgeons, etc. but sometimes it works out this way.)  Their practice is called Mexicali Obesity Solutions.

Dr. Marco Sarinana and Dr. Joel Ramos, Bariatric surgeons

Dr. Alejandro Ballesteros was the anesthesiologist for the case – and everything proceeded nicely.

After that – it was evening, and time to write everything down!

Today should be another great day – heading to IMSS with Dr. Gabriel Ramos for a big case..

Read Full Post »

It’s a busy Sunday in Mexicali – presidential elections are today, so I am going to try to get some pictures of the nearest polling station later.. In the meantime, I am spending the day catching up on my writing..

a polling station in Mexicali

Lots to write about – just haven’t had the time..  Friday morning was the intern graduation which marks the end of their intern year – as they advance in their residencies.. Didn’t get a lot of pictures since I was at the back of the room, and frankly, unwilling to butt ahead of proud parents to get good pics.. This was their day, not mine and I was pleased that I was invited.

I did get a couple of good pictures of my ‘hermanito’ Lalo and Gloria after the event.  (I’ve adopted Lalo as my ‘kid’ brother.. Not sure how he feels about – but he’s pretty easy-going so he probably just thinks it’s a silly gringa thing, and probably it is..)

Dr. ‘Lalo” Gutierrez with his parents

Lalo’s parents were sitting in the row ahead of me, so of course, I introduced myself and said hello.. (They were probably a little bewildered by this middle-aged gringa talking about their son in atrocious Spanish) but I figured they might be curious about the same gringa that posts pictures of Lalo on the internet.. I also feel that it’s important to take time and tell people the ‘good things’ in life.  (Like what a great person their son has turned out to be..)

Same thing for Gloria.. She is such a hard-worker, and yet, always willing to help out.. “Gloria can you help me walk this patient?”  It’s not even her patient, (and a lot of people would say – it’s not our jobs to walk patients) but the patient needs to get out of bed – I am here, and I need some help (with IV poles, pleurovacs, etc.)  and Gloria never hesitates.. that to me – is the hallmark of an excellent provider, that the patient comes first .. She still has several years to go, but I have confidence in her.

She throws herself into her rotations.. When she was on thoracics, she wanted to learn.. and she didn’t mind learning from a nurse (which is HUGE here, in my experience.)

Dr. Gloria Ayala (right) and her mother

She wasn’t sure that her mom would be able to be there – (she works long hours as a cook for a baseball team) but luckily she made it!

Met a pediatric cardiologist and his wife, a pediatrician.. Amazing because the first thing they said is, “We want nurse practitioners in our NICU,” so maybe NPs in Mexico will become a reality.. Heard there is an NP from San Francisco over at Hospital Hispano Americano but haven’t had the pleasure of meeting her.  (I’d love to exchange notes with her.)

I spent the remainder of the day in the operating room of Dr. Ernesto Romero Fonseca, an orthopedic surgeon specializing in trauma.  I don’t know what it is about Orthopedics, but the docs are always so “laid back”, and just so darn pleasant to be around.  Dr. Romero and his resident are no exception.

[“Laid back” is probably the wrong term – there is nothing casual about his approach to surgery but I haven’t had my second cup of coffee yet, so my vocabulary is a bit limited.. ]  Once I finish editing ‘patient bits’ I’ll post a photo..

Then it was off to clinic with the Professor.

Saturday, I spent the day in the operating room with Dr. Vasquez at Hospital de la Familia. He teased me about the colors of the surgical drapes,(green at Hospital de la Familia), so I guess he liked my article about the impact of color on medical photography.  (Though, truthfully, I take photos of surgeons, not operations..)

Since the NYT article* came out a few days ago – things have changed here in Mexicali.  People don’t seem to think the book is such a far-fetched idea anymore.  I’m hopeful this means I’ll get more response from some of the doctors.  (Right now, for every 15 I contact – I might get two replies, and one interview..)

Planning for my last day with the Professor  – makes me sad because I’ve had such a great time, (and learned a tremendous amount) but it has been wonderful.  Besides, I will be starting classes soon – and will be moving to my next location (and another great professor.)

Professor Ochoa and Dr. Vasquez

But I do have to say – that he has been a great professor, and I think, a good friend.  He let me steer my education at times (hey – can I learn more about X..) but always kept me studying, reading and writing.  He took time away from his regular life, and his other duties as a professor of other students (residents, interns etc.) to read my assignments, make suggestions and corrections when necessary.    and lastly, he tolerated a lot with good grace and humor.  Atrocious Spanish, (probably) some outlandish ideas and attitudes about patient care (I am a nurse, after all), a lot of chatter (one of my patient care things), endless questions…  especially, “donde estas?” when I was lost – again.

So as I wrap up my studies to spend the last few weeks concentrating on the book, and getting the last interviews, I want to thank Dr. Carlos Ochoa for his endless patience, and for giving me this opportunity.  I also want to thank all the interns (now residents) for welcoming me on rounds, the great doctors at Hospital General..  Thanks to Dr. Ivan for always welcoming me to the ER, and Dr. Joanna for welcoming me to her hospital.  All these people didn’t have to be so nice – but they were, and I appreciate it.

* Not my article [ I wish it were – since I have a lot to say on the topic].

Read Full Post »

Older Posts »