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Archive for the ‘Tourism’ Category

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.

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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

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As time flies at my current assignment –  I’ve begun planning for my next writing assignment – to Central America this spring.  It’s too early to nail down some of the specifics like housing, or begin making appointments for interviews – but it’s never to early to test out my equipment.

For each trip, as I gain more and more experience with the more technical aspects (photography and video), I’ve upgraded my cameras and other equipment.

With my first book – I didn’t know enough to even realize how ill-prepared I was – to capture the images and the moments that now serve as some of the most breathtaking and rewarding parts of my work.    I used a borrowed camera and didn’t even have a laptop – I spent all of my evenings in various internet cafes transcribing my notes.

Cartagena, Colombia

Some of my more lasting images – like the photo above, which served as the cover of the first edition of the Cartagena book were just luck.  My camera was a hit-or-miss affair – that sometimes worked, and sometimes didn’t.

But as I continued writing, and working – I learned from my mistakes.  One (borrowed) camera became (with the help of eBay), two cameras.  Then two cameras, and video..

More importantly, I learned to become more aggressive in my photo-taking.  Take ten – if you want one good one..  Lean in more to get the shot, use a stool (or two) if needed – and use the Zoom!  Stop worrying if you are annoying the surgeon* with photo-taking – and get in there to get the shot that matters.

photo from first Cartagena visit

photo from first Cartagena visit

Now the photo above – is a good example.. It’s edited (for patient privacy and such) but the unedited version shows the surgeon making his initial incision.   Of course, I got this photo due to an accommodating anesthesiologist who encouraged me to get in there and get close with my zoom lens.

vasquez

by the time I took this photo of Dr. Vasquez in Mexico, I had learned what I was doing (sort of).

Now, I will never be a professional photographer, which takes years of training – but I have now taken thousands and thousands of photos, so I am learning little by little.  I’ve also upgraded to better equipment – which allows me to experiment with different lens and manual settings such as shutter speed and light settings.

With my latest camera – I have been going out on every possible occasion to practice, practice, practice.   I had a three-day weekend, so we headed out-of-town for just that purpose – kind of “a photography adventure”.

Marti Gras 2013

Beads fly in the Marti Gras parade

Now, we’re in the south for my current assignment, so we thought it would be interesting to capture some images from the Marti Gras parades – lots of color, movement and an interesting cast of characters.

It’s easy to find some of the flaws in my photos, but it was good practice (and fun too!).

galveston 105

Now I love this next photo – I just think that this dancer (in the center) projects such confidence and star power..

Marti Gras stunner

But my very favorite, is probably this next one..

Marti Gras parade

My husband also likes this more formal composition from this weekend – away from the parades, beads and celebrations..

Bicycle built for two

But he’s a bit of a romantic, eh?

Hopefully, all this practice will serve me in good stead on my next writing project.  In the meantime, I’ll keep snapping away.

For more Marti Gras photos – see my slideshow..

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* Before, I was often SO timid that I was too shy/ embarrassed to get some of the photos I needed.  (If I hadn’t been so shy – and had just asked – I would have realized – that most of the time, (as long as you are not completely obnoxious – or bursting the flash all over the place) that most surgeons are pretty oblivious during surgery – because their focus is elsewhere (as it should be.)  So they don’t mind if you take tons of photos..  (Notably, I also only very rarely, use my flash in the operating room – because I do think that is very distracting! – and of course, I ALWAYS ask permission..)

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Spent the weekend in Buga (Valle de Cauca) – just outside of Cali.  I didn’t get any photos but it’s a beautiful little touristy town (and one of the oldest in Colombia so it has that ‘Cartagena feel’).  Buga is mainly known for a famous Basilica – blessed by a former pope that attracts three million people a year.

I spent most of Saturday in the office with one of Colombia’s hard working vascular surgeons, Dr. Jhon Jairo Berrio.  That Saturday he saw about 40 patients between his office in Tulua and his second office in Buga.

Dr. Jhon Berrio with his wife, Maria Victoria on a Sunday morning in Buga

The majority of patients were referred for venous problems (varicose veins, venous stasis disease) but there were a few patients with peripheral arterial disease as well.

I got a chance to meet his lovely family which includes his wife, Maria Victoria.  She is a dentist and they share a spacious office (with several exam rooms, X-ray, etc.) at the Buga location.

Sunday, he had multiple surgeries scheduled – but alas! I was scheduled to come here, to Medellin for a few days before returning to Bogotá.  However, it was still a good opportunity to see the doctor in action.

Toured the hospital in Tulua as well, which was formerly the Hospital Occidental.  As an interesting side note – this hospital was previously supported with funds from narco-trafficking.  When the government attempted to close the hospital – the outcry from local residents who rely on its services was deafening – and prevented it’s closure.   It was then converted to a state facility, but derives much of its technology and equipment from its previous financial backers generosity.

Cali (and surrounding areas) themselves were different from what I had anticipated; Cali is less sophisticated than Medellin or Bogotá – by still has its distinct charms.  The weather is definitely better than what I expected.  While hot, it was not oppressive and the promised afternoon breezes arrived from the mountains just as reported.  The visits to Tulua and Buga were a great way to experience life outside the big city.  (Sometimes when you are living in Bogotá – it feels more like London or other global cities.)

It is however, very much a tropical clime – the appearance of large numbers of motorcycles and scooters gives weight to this.  The bikes serve as affordable, convenient and economical transportation for large numbers of citizens in these communities.  It isn’t entirely uncommon to see an entire family; husband, wife and child on the back of one of these bikes.  While certainly dangerous – for many of the lower class – it is the most reasonable option.  It’s not uncommon to see riders with their pets or large packages in arms as they criss-cross the city.

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As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

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The service is quiet so I am spending the day writing and working on the Mexicali book.  For new readers, I would like to explain that the Mexicali book is a little different from my previous offerings.  This is not an exhaustive compilation of surgeons and facilities in Mexicali, as frankly, I do not have the time or resources to accomplish such a task at this point in time.

Like all my books, it is a labor of love, but differs in that it highlights some of the best, and worst of Mexicali and medical tourism in this city.  So instead of interviewing and observing hundreds of surgeons, it highlights the limited number of physicians who agreed to participate in this project.

As such, no plans are being made to market this book commercially. Instead, I plan to offer it as a free pdf download for interested readers.  I will also be offering a full color soft-bound edition (at cost) for people interested in the many full color photographs of surgeons and surgery in Mexicali.  I will be placing the soft-bound edition on Amazon.com for interested persons.  Unfortunately, the cost of producing such a book (color photos) in limited runs is fairly expensive, so I apologize in advance to readers – but as I said – it’s a labor of love, and I won’t make a dime off of it.  I can only hope that if readers enjoy this book, they will consider purchasing one of my longer, more detailed books on medical tourism (such as the Bogotá book.)

More information will be forthcoming as I get further and further towards completion of this project.

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Cancun on a hazy day

I was pleased but surprised when I received an email from Dr. Mario Gonzalez Cepeda, MD who is a plastic surgeon here at the Perfection clinic in central Cancun.  After speaking with Dr. Gonzalez briefly, we arranged for a meeting to talk about the future of surgery in Cancun and the creation of a medical complex catering to surgical specialties.

Dr. Gonzalez, and Luis Arturo Guillermo Irigoyen, MBA, CP, the CEO of Perfection Medical Group met with me to discuss their plans for the creation of a medical city.  Currently in the first stage of implementation, the team at Perfection envisions a free-standing private hospital offering medical tourists a range of specialty services including plastic, bariatric, orthopedic and cardiovascular surgery.  They already have strategies in place to attract well qualified (and English-speaking) providers and medical staff, and will be seeking international health care facility accreditation.

It sounds like an excellent plan to me.  While Dr. Gonzalez will be building a new hospital much of the other infrastructure essential to a successful medical tourism destination is already in place; Cancun is packed full with a wide range of hotels, from the more modestly priced to the elegant facilities such as Rui, Crystal and the Vista Americana.  The local airport already caters to international travelers and receives flights from several North American cities daily (with short flights in comparison to travel to Asia and India).  The surroundings are lush, welcoming and Hispano – Caribbean in flavor, with gorgeous white sand beaches and nearby Mayan ruins for visitors to explore.

Mr. Irigoyen gives an estimated timeline of two years until completion, so we will check back in soon and see how the project is progressing.

 Perfection Medical Group

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