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Posts Tagged ‘medical tourism in Mexicali’

Back in Mexicali but just for a few days – as I pack up the apartment and get ready for my next journey – to Texas, of all places!

As I mentioned before, leaving Mexicali is hard – it’s a city, and a people who get under your skin.  I’ve lived (and traveled to) a lot of places, but this has been the most bittersweet of all.

In the meantime – I am (finally!) finishing up the last bit of editing  – with much help from friends –  for the Mexicali guide to surgical tourism book.   I hope to have it finished – and available on-line for downloads before the end of the year.

I’ll post links and directions for interested readers once it is ready.

Mexicalisign

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Well – this book has gone through the first-pass round of editing.. Now it’s on to the second step (another round of editing) before final formating and publishing.  As I’ve mentioned previously – I will be offering free pdf downloads at multiple outlets for interested readers.  (I would love to be able to offer it as an e-book but it costs quite a bit to have it professionally converted – and my previous efforts to convert books to electronic formats were exercises in extreme frustration.)

I wanted to take a minute to thank my additional content contributors:

Dr. Joanna Calzada, MD and Dr. Cuauhtemoc Cairo Robles.

Their assistance and contributions have been invaluable!  Dr. Calzada absolutely threw herself into helping me uncover the life and history of Mexicali – and as a second-generation Mexicali resident – her input was amazing.  We crisscrossed the city several times to get information to include in the book for our readers.

with Dr. Joanna Calzada, MD – book contributor (life & culture of Mexicali)

Dr. Robles, a professor of architecture at the Universidad Autonoma Baja California, and expert on Mexicali architecture was equally outstanding.  Not only did I use several of his publications as references and resources on public buildings – but Dr. Robles stepped right in to offer photographs, stories and local history on all of the amazing houses and other buildings I fell in love with (such as Mexicali’s Graceland.)

Lastly, special thanks to Elizabeth A. Warren – who is currently editing my book.  She is my former college roommate (and thus has been editing my writing intermittently over the last 18 years.)  She is also an English teacher in Memphis, Tennessee where we attended college together.

I felt quite the poor friend when I offered her the ‘opportunity’ to edit my book for free – (since I am budget less at the moment.)  But, as always – Libby was up for the challenge.  (Let’s home my improper use of grammar doesn’t get the best of her.)

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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..

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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..

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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].

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Back in Mexicali after a week away at the nurse practitioner conference in Florida – and I am surprised by how much I missed the city.

a view of the city

To be sure, it lacks the glamour and sophistication of Bogotá, Medellin or Buenos Aires.  It doesn’t have the 500 years of history or Caribbean flavor that makes Cartagena such a vibrant city.  Yet – despite this, Mexicali remains the city by the fence – and the city that makes me want to stay on the Mexican side of the border.

Maybe it’s the casual friendliness of the city that grabs me, and embraces me.  The lack of pretension, the very earthiness of the barren,hard packed dirt and dusty surroundings draw me in – with the hidden pockets of Mexicali that beg to be explored.  Every brightly lit taco stand, the mom and pop establishments, and the upscale neighborhoods tucked away in tree-lined streets..

So, today after clinic, and rounds – we left the hospital and explored Mexicali – looking for photos to represent the Mexicali that I am coming to know, and which are often unseen by weekend tourists.

the main artery, which criss-cross the city

Having the good doc as a tour guide was an unexpected bonus – he knows the city so well, and was able to give background and insight into all of our destinations. Despite being from Sonora, he attended school here – making Mexicali very much his home.

as the capital of Baja California, there are numerous excellent educational facilities

I find taking city photos one of the more difficult aspects of writing.. Monuments aren’t all that exciting, and often the most interesting parts of cities aren’t the most photogenic ones..

This is one of Mexicali’s better known landmarks – the stadium used for bullfights.  The Mexicali sign is actually made of mirrored tile which glistens in the sun..

Mexicali landmark: Bullfighting stadium

We stopped by the Military base, because I have been fascinated by the military presence during the preparations for the elections – soldiers guard the electoral offices to prevent any sort of voting shenanigans.  (I’ll try to get a picture of the soldiers soon)

The good doctor laughs when I ask about military efforts and involvement abroad.  (Just because I’m not aware of the Mexican military overseas doesn’t mean they aren’t UN peacekeepers.. )  So I ask my questions about it and it is several minutes before he can stop laughing enough to even answer the question.  Funny, maybe.  But then – when you think of it kind of nice.  Mexico doesn’t attempt to police the world, and that’s okay..

“No, there’s no navy,” he laughs.. (Actually, there is a navy – which is also involved in trying to fight drug trafficking and gang activity).  But it’s nice that it’s apparently low-key enough that it doesn’t dominate the public’s attention.

Military base in Mexicali

Their primary function is more like our national guard – fighting against unrest (and now – narco-trafficking) at home.  Safeguarding elections and the general populace.  Keeping the border safe (yes – safe from all the violence endemic to satisfying the American thirst for drugs, and the underground importation of American weaponry).  I feel a little nervous taking pictures of the base, but no one seems to notice or approach me.  (My first attempts were semi-surreptitiously, but then, with encouragement, I got a little bolder.)

Today is the last day that the political candidates are allowed to campaign before the election, so we passed supporters for PRI (Enrique Pena) and PAN (Vasquez Mota).  I didn’t see anyone out there for AMLO or Quadri, but maybe they just weren’t as well represented.  After this – the candidates have to lay low for a few days so Mexican citizens can ‘reflect’ prior to the elections on Sunday.  That’s kind of a cool concept too – no endless barrage of media like the mega-campaigns at home.

Of course, I wish we could have a real workable multi-party system, so it’s not always a ‘lesser of two evils’ situation at home.  Maybe if we weren’t limited by having just two choices and two main parties – we might have more ‘shades of grey’ instead of all this extremism at both ends of the spectrum.. But it’s interesting to watch here, all the same, and I am glad that I have been here to experience it.

I hope I don’t alienate readers at home with my talk of politics – after all, I am not really a political animal, so ignore my musings, if you like..

In other news – it’s a bit frustrating when you have spent several months here – only that have the New York Times swoop down.. and all the doors that were closed to you (That’s you, Omar Dipp) suddenly burst open since they are a major news agency.  Of course, they had the mandatory patient testimonial,  – it was just the usual “medical tourism lite” style story that so often dominate the news.   Didn’t you just love the “nurses warm your hand…”  more like advertising than real journalism, but whatever..  (In fairness – I write a lot of “news lite” articles myself for outlets like Examiner.com which actually prefer this style, but those are usually 400 word pieces – and I’m not at the NYT, so of course, I am envious..

But it’s good for Mexicali – and all the hard-working doctors I’ve met here..  They certainly deserve the exposure!

Hopefully readers who want the real scoop on operating room conditions, doctors , etc.  will still know where to come for in-depth information..

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Haven’t had time to sit down and write about my trip to the operating room with Dr. Horacio Ham and Dr. Rafael Abril until now, but that’s okay because I am going back again on Saturday for a longer case at a different facility.  Nice surprise to find out that Dr. Octavio Campa was scheduled for anesthesia.  Both Dr. Ham and Dr. Abril told me that Dr. Campa is one their ‘short list’ of three or four preferred anesthesiologists.  That confirms my own impressions and observations and what several other surgeons have told me.

campa

Dr. Campa (left) and another anesthesiologist at Hispano Americano

That evening we were at Hispano – Americano which is a private hospital that happens to be located across the street from the private clinic offices of several of the doctors I have interviewed.  It was just a quick short case (like most laparoscopy cases) – but everything went beautifully.

As I’ve said before, Dr. Campa is an excellent anesthesiologist so he doesn’t tolerate any hemodynamic instability, or any of the other conditions that make me concerned about patients during surgery.

Dr. Ham  and Dr. Abril work well together – everything was according to protocols – patient sterilely prepped and draped, etc..

laparoscopy

laparoscopy with Dr. Ham & Dr. Abril

I really enjoy talking with the docs, who are both fluent in English – but I won’t get more of an interview with Dr. Abril until Saturday.

w/ Dr. Ham

with Dr. Horacio Ham in the operating room after the conclusion of a successful case

Then – on Wednesday night – I got to see another side of the Doctors Ham & Abril on the set of their radio show, Los Doctores.  They were interviewing the ‘good doctor’ on sympathetectomies for hyperhidrosis – so he invited me to come along.

Los Doctores invited me to participate in the show – but with my Spanish (everyone remembers the ‘pajina’ mispronunciation episode in Bogotá, right?)  I thought it was better if I stay on the sidelines instead of risking offending all of Mexicali..

Los Doctores

on the set of Los Doctores; left to right: Dr. Rafael Abril, Dr. Carlos Ochoa, Dr. Mario Bojorquez and Dr. Horacio Ham

It really wasn’t much like I expected; maybe because all of the doctors know each other pretty well, so it was a lot more relaxed, and fun than I expected.  Dr. Abril is the main host of the show, and he’s definitely got the pattern down; charming, witty and relaxed, but interesting and involved too.. (my Spanish surprises me at times – I understood most of his jokes…)  It’s an audience participation type show – so listeners email / text their questions during the show, which makes it interesting but prevents any break in the format, which is nice.  (Though I suppose a few crazy callers now and then would be entertaining.)

Dr. Ochoa did a great talk about sympathectomy and how life changing it can be for patients after surgery, and took several questions.  After meeting several patients pre and post-operatively for hyperhidrosis, I’d have to say that it’s true.  It’s one of those conditions (excessive palmar and underarm sweating) that you don’t think about if you don’t have – but certainly negatively affects sufferers.  I remember an English speaking patient in Colombia telling me about how embarrassing it was to shake hands -(she was a salesperson) and how offended people would get as she wiped off her hands before doing so.  She also had to wear old-fashioned dress shields so she wouldn’t have big underarm stains all the time..  This was in Bogota (not steamy hot Cartagena), which is known for it’s year-round fall like temperatures and incredibly stylish women so you can imagine a degree of her embarrassment.

It (bilateral sympathectomy) is also one of those procedures that hasn’t really caught on in the USA – I knew a couple people in Flagstaff who told me they had to travel to Houston (or was it Dallas?) to find a surgeon who performed the procedure..  So expect a more detailed article in the future for readers who want to know more.

Tomorrow, (technically later today) I head back to San Luis with the good doctor in the morning to see a couple of patients – then back to the hospital.. and then an interview with a general surgeon.. So it should be an interesting and fun day.

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