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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..

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It’s been shaping up to be a bit of a weird week – as everyone that’s been following on Bogota Surgery knows – it was a rapid change of gears from neurosurgery to thoracics this week.. (and everyone knows how much I enjoy interviewing surgeons from my home specialty). But during this week – the same name keeps cropping up in conversations – Dr. Edgard Eduardo Gutierrez, and that’s when I realized that while we’ve mentioned him from time to time on the Bogota blog – he’s never really gotten proper face time, here at home at Cartagena Surgery.

Of course, my loyal readers of Hidden Gem already know Dr. Gutierrez – since he’s profiled in my book, but let me introduce him to the rest of the world** – since it seems all of Bogota is talking about him.. (okay, to be fair – the Bogota thoracic surgery community).

** since this is long overdue **

First off, I have to say that Dr. Edgard Eduardo Gutierrez Puente has got to be one of the most easy-going, good-natured people I’ve ever met – Which explains why I ended up following him on his rounds through out the hospitals of Cartagena one sunny day.. (or how he ended up hosting some gringa nurse who spoke really bad Spanish). He’d been nice enough to review cases with me – and have me in the OR one day at Medi-help after I’d practically accosted him in the hallway.. Then as we were leaving the operating room, he turned at me with a long stream of spanish over his shoulder ending in “aqui o vamos conmigo?” I missed the whole preceeding paragraph, but caught “or go with me?”

That was it – he was stuck with me. And it was definitely out of the goodness of his heart – and no other motive because, frankly, I don’t think Dr. Gutierrez:
a.) has time to think about medical tourism, or care about being in some first-time author’s book or b.) even knew why I was there..
So there he was, driving around with me, asking him questions the entire time, in my fractured, barely comprehensible, mish-moshed Spanish. But he’d patiently answer, and then wait for me to figure out what he’d said – and then we’d start all over again.

At the time, (he was one of my first interviews), I probably took his graciousness for granted – it’s only now after meeting, and interviewing, interviewing and interviewing my way through my second book, that I realize how kind he was to that naïve little nurse, wandering around a strange city, in a foreign country, writing a book that very few people are actually interested in.

But all of this, doesn’t really matter.. What matters is all the other things; all the qualities and skills I saw during the time I followed him around Cartagena, and its’ operating rooms.

It didn’t matter if we were in the upscale Medi-help clinic or the aged, struggling Universitario de Cartagena; he was kind, gentle and empathetic with all of his patients.

There are a lot of things I could say, and have said in my book about Dr. Gutierrez, his operating style, adherence to surgical protocols and overall dedication to his profession. But to me; his kindness and compassion said it all.

Update: 20 April 2011

Here are the top search terms for the blog this week:

Top Searches

doctor edgardo gutierrez puente, cartagena  colombia  real stste, what is overstenting, colombia cartagena edgar eduardo gutierrez puente, tourist attractions in colombia

– so I am glad to see Dr. Gutierrez get some well deserved recognition for all his hard work..  The blog was also one the featured daily blogs for wordpress yesterday – congratulations, Dr. Gutierrez!

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Just renewed my visa so I can continue working on my second book – a guide to surgical tourism in Bogota, Colombia.. I also have some updates for my Cartagena readers:

2011 Updates to Hidden Gem: A Guide to Surgical Tourism:

1. Dr. Hector Pulido, MD – transplant surgeon/ biliary surgeon is no longer medical director at Nuevo BocaGrande Hospital in Cartagena.. While he did a great job – including a brand-new ER, he missed actively performing surgery – so he has left administration, and Cartagena. He is now in Barrenquilla, operating to his heart’s content.

2. Dr. Francisco Holguin Rueda, MD – bariatric surgeon. Dr. Holguin no longer runs Medi-help. He has moved on from this venture and is now working on developing more clinics across Colombia. He still operates, (of course!) but divides his time between Bogota, Cartagena and all points in between.

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Cardiology takes another hit with recent news discussing the increase risk of death from inappropriate ICD discharges: ie. getting shocked when you don’t need it. This has been in the literature before, but I’m re-posting another article from Cardiosource for you. Probably not the best findings considering that the device manufacters paid for the study.

Inappropriate shocks from ICDs ‘common’ and lead to greater risk of deathCONTACT: Amanda Jekowsky, ajekowsk@acc.org 202-375-6645
January 24, 2011

Despite the benefits of therapy with implantable cardioverter-defibrillators (ICDs), inappropriate shocks from the devices are “common” and place patients at a greater mortality risk. These were the conclusions drawn by a Dutch research team that examined the incidence, predictors, and patient outcomes of inappropriate ICD shocks in a large, real-world patient population. Published in the February 1, 2011, issue of the Journal of the American College of Cardiology, the study showed that inappropriate ICD shocks were more than just painful and psychologically disturbing—they also impacted patient survival.

Implantable cardioverter-defibrillators—which provide an electric shock whenever they sense an abnormal heart rhythm—have shown to provide a “substantial and significant” mortality reduction for high-risk patients with cardiovascular disease, the authors wrote. However, realizing that the treatment “still has drawbacks,” the team decided to examine inappropriate shocks delivered in response to rhythms other than life-threatening ventricular tachycardia or ventricular fibrillation.

Seeking to evaluate ICD implantation outside the setting of a clinical trial, researchers from Leiden University Medical Center in the Netherlands examined the medical records of all patients who had an ICD implantation at the hospital from 1996 to 2006. Specifically, the team analyzed how often inappropriate shocks occurred, what characteristics were associated with inappropriate shocks, and how inappropriate shocks influenced patient outcomes. The team’s main follow-up period was 41 months (±18 months), but they also recorded data at one year and five years. Patients treated with an ICD met the international guidelines for ICD implantation developed by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology.

Of the 1,554 patients who had complete records, 13% (204) (95% confidence interval [CI]: 11% to 14%) experienced an inappropriate shock during the main follow-up period, which led to a total of 665 inappropriate shocks. The cumulative incidence of inappropriate shocks “steadily increased” across the extended follow-up period, reaching 18% of patients at 5 years (95% CI: 15% to 20%).

After conducting Cox proportional hazards regression, the team found that several factors independently predicted the occurrence of an inappropriate shock, including an age of younger than 70 years; a history of atrial fibrillation, nonischemic heart disease, or nonuse of statins; and the occurrence of appropriate shocks. The main cause of inappropriate shocks was misdiagnosis of supraventricular tachycardia, which occurred in 155 (76%) of the 204 patients.

In what the authors considered “the most important finding,” patients who experienced inappropriate shocks had a higher risk of all-cause mortality. A total of 298 (19%) patients died during the follow-up, and after adjusting for potential confounders, the research team found a 60% increased risk of death after experiencing a first inappropriate shock (hazard ratio [HR]: 1.6, 95% CI: 1.1 to 2.3; p = 0.01). The risk of mortality increased with each subsequent inappropriate shock, up to an HR of 3.7 after 5 inappropriate shocks.

According to study author Martin J. Schalij, M.D., Ph.D., the study’s finding that inappropriate ICD shocks impact mortality is a “serious issue” which necessitates “that greater efforts be made to lower the number of these shocks.” He notes that while two other analyses—both conducted as part of ICD clinical trials—have shown an association between inappropriate shocks and increased mortality, the current trial is the first to do so in a large, general-patient population.

“We need to make sure we are implanting ICDs in the appropriate patients, but often the patients that need ICDs most are also at risk of inappropriate shocks due to the misinterpretation of other fast heart rhythms that are not themselves lethal,” said Ralph G. Brindis, M.D., M.P.H., president of the American College of Cardiology and senior advisor for cardiovascular disease, Northern California Kaiser Permanente. “We suspect over time, increasing sophistication of the ICD programming will help minimize these episodes of inappropriate shocks.”

Reducing the number of inappropriate shocks may prove challenging, however. The researchers found that despite improved technology in ICDs, patients who underwent implantation between May 2004 and 2006 were at a greater risk of experiencing inappropriate shocks than those who received their ICD between 1996 and May 2004. Acknowledging this “paradox,” the authors wrote that evolving guidelines on who could receive ICDs may have caused more critical patients to receive the device in later years, ultimately increasing the number of inappropriate shocks experienced.

Although the researchers could not determine the exact cause of the increase, still more must be done to stymie this trend, noted Dr. Schalij. “It is not acceptable that so many patients suffer from inappropriate shocks,” he stated. “ICD therapy must be improved, through both patient-tailored programming of the devices and the development of superior algorithms to allow ICDs to better determine false alarms, such as supraventricular arrhythmias.”

The study authors reported they received research grants from GE Healthcare, Bristol-Myers Squibb Medical Imaging, St. Jude, Medtronic, Boston Scientific, Biotronik, and Edwards Lifesciences.

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