While I have written several books about surgery and surgeons in Colombia, much of this information I’ve obtained from my research has been consigned to sitting on the shelves of various bookstores.
But, now with the help of Colombia Reports, I am hoping to change that. As I mentioned in a previous post, Colombia Reports.com and it’s founder, Adriaan Alsema have been amazingly supportive of my work, ever since they printed my first article on Cartagena in 2010.
Since returning to Colombia, I have kept in touch with Colombia Reports while we discussed ways to bring more of my research and work to the public. Colombia Reports is a perfect platform – because it serves a community of English-speaking (reading) individuals who are interested in/ and living in Colombia. With this in mind, Colombia Reports has created a new Health & Beauty section which will carry some of my interviews and evaluations.
It is an ideal partnership for me; it allows me to bring my information to the people who need it – and continue to do my work as an objective, and unbiased reviewer. We haven’t figured out all of the details yet – but I want to encourage all of my faithful readers to show Colombia Reports the same dedication that you’ve shown my tiny little blog, so that our ‘experiment’ in medical tourism reporting becomes a viable and continued part of Colombia Reports.
This is more important to me that ever – just yesterday as I was revisiting a surgeon I interviewed in the past (for a new updated article), I heard a tragic story that just broke my heart about a patient that was recently harmed by Dr. Alfredo Hoyos. (I am looking for the news articles to confirm the story.)
Now – as many of you remember, I interviewed Dr. Alfredo Hoyos back in 2011, and followed him to the operating room. Readers of the book know he received harsh criticism for both failure to adhere to standard practices of sterility and patient intra-operative safety (among other things.) I also called him out for claiming false credentials from several plastic surgery associations – and notified those agencies of those claims.. In the book, readers were strongly advised not to see Dr. Hoyos or his associates for care.
But – as I mentioned, my book is sitting lonely on a shelf, here in Bogotá – and in the warehouses of Amazon.com and other retailers.. So, people like that patient – didn’t have the critical information that they needed..
This is where Colombia Reports – and I hope to change all that. So in the coming weeks, I am re-visiting some of surgeons we talked to in 2011, and interviewing more (new) surgeons, more operating room visits..
Been a busy week – (Yea!) but now that it is the weekend, I have a chance to post some more pictures and talk about my day in the operating room with Dr. Gabriel Omar Ramos Orozco.
Despite living in a neighboring apartment, interviewing Dr. Ramos proved to be more difficult than anticipated. But after several weeks, I was able to catch up with the busy surgeon.
Outside of the operating room, he is a brash, young surgeon with an off-beat charm and quirky sense of humor. But inside the operating room, as he removes a large tumor with several cancerous implants, Dr. Gabriel Ramos Orozco is all business.
It’s different for me, as the interviewer to have this perspective. As much as I enjoy him as a friendly neighbor – it’s the serious surgeon that I prefer. It’s a side of him that is unexpected, and what finally wins me over.
Originally from San Luis Rio Colorado in the neighboring state of Sonora, Dr. Ramos now calls Mexicali home. Like most surgeons here, he has a staff position at a public hospital separate from his private practice. It is here at IMSS (Instituto Mexicano del Seguro Social) where Dr. Ramos operates on several patients during part of the extended interview.
During the cases, the patients received a combination of epidural analgesia and conscious sedation. While the anesthesiologist was not particularly involved or attentive to the patients during the cases, there was no intra-operative hypotension/ alterations in hemodynamic status or prolonged hypoxia.
Dr. Ramos reviewed patient films and medical charts prior to the procedures. Patients were prepped, positioned and draped appropriately. Surgical sterility was maintained during the cases. The first case is a fairly straight forward laparoscopic case – and everything proceeds rapidly, in an uncomplicated fashion. 45 minutes later, and the procedure is over – and Dr. Ramos is typing his operative note.
But the second case is not – and Dr. Ramos knows it going in..
The case is an extensive tumor resection, where Dr. Ramos painstakingly removes several areas of implants (or tumor tissue that has spread throughout the abdomen, separate from the original tumor).
The difference between being able to surgical remove all of the sites and being unable to remove all of the gross disease is the difference between a possible surgical ‘cure’ and a ‘de-bulking’ procedure, Dr. Ramos explains. As always, when entering these surgeries, Dr. Ramos and his team do everything possible to go for surgical eradication of disease. The patient will still need adjunctive therapy (chemotherapy) to treat any microscopic cancer cells, but the prognosis is better than in cases where gross disease is left behind*. During this surgery, after extended exploration – it looks like Dr. Ramos was able to get everything.
“It’s not pretty,” he admits, “but in these types of cases, aesthetics are the last priority,” [behind removing all the tumor]. Despite that – the aesthetics after this large surgery are not as worrisome as one might have imagined.
The patient will have a large abdominal scar – but nothing that differs from most surgical scars in the pre-laparoscopy era. [I admit I may be jaded in this respect after seeing so many surgeries] – It is several inches long, but there are no obvious defects, the scar is straight and neatly aligned at the conclusion of the case – and the umbilicus ”belly-button” was spared.
As I walk out of the hospital into the 95 degree heat at 11 o’clock at night – I admit surprise and revise my opinion of Dr. Ramos – he is better than I expected, (he is more than just the kid next door), and he deserves credit for such.
*This may happen due to the location of metastatic lesions – not all lesions are surgically removable. (Tumor tissue may attach to major blood vessels such as the abdominal aorta, or other tissue that cannot be removed without seriously compromising the patient.) In those cases, surgeons try to remove as much disease as possible – called ‘de-bulking’ knowing that they will have to leave tumor behind.
Now you can read Bogotá! for free in the Kindle lending library.. (I hope this inspires some generosity among critics for impoverished medical writers – leave some positive feedback about the book!!)
Fundacion Clinica Shaio - the first cardiac hospital in Colombia has recently unveiled the updated english-language version of their website, as part of an effort to aid international travelers, and attract medical tourists. As long time readers know, I spent quite a bit of time at Clinica Shaio, with the Doctors Santos, (and several others). Now as part of our new podcasting project – we will be sharing one of my favorite surgery videos from the operating room of Dr. Hernando Santos. (If you’ve spent time here at www.BogotaSurgery.org than this video will be familiar to you.) To my new readers from iTunes – welcome & enjoy!
Brief introduction to Dr. Hernando Santos, MD.
The ‘Mexicali project’ is different from any of the previous surgical tourism projects I’ve undertaken. For starters – since I am currently working full-time in Northern Arizona – I can’t just drop everything and move to Mexicali for several months, like I’ve done previously.
So I really am a tourist – just like you, while I am here. (I just plan to be a repeated one.) That’s a critical difference because one of the most important aspects of my writing is that in many ways, I am just like you. Or, at least a lot like many of the people reading my articles. The only difference is that I am a nurse with a lot of experience in surgery and medicine. But as a stranger in a stranger land? – well, I’m a novice, like many of the people who are considering traveling for health care.
I don’t speak Spanish – or at least not much. [It's one of the first things people assume about me, "Oh, you must speak Spanish", but they are wrong.] I am kind of learning a bit as I wander my way around different locations, which is fun – but I’ll never be fluent. That’s crucial when I am roaming around in a strange country – How well can I navigate? How safe is it for foreigners? Will I be able to find people to help me (get directions, find a restroom, etc.)
I’m not an adventurous person (actually, I am kind of a chicken.) - Many of you might be adventurers at heart, but I don’t want people to assume that medical travel is only for the daring or brave-hearted because I can be one of the meekest, mildest, most easily intimidated people you could ever meet. You might think that some of my recent travels would have made me more confident or brave – but that’s not really the case. I still get nervous going to unfamiliar places, reading maps, finding the right bus – so I understand how other people might feel (and for much of my travels – I’ve gone alone..) So I like to think that this is my own kind of litmus test – if “Cartagena Surgery” can manage to find her way around, then most of my readers will be able to also.
But this time, it’s a little different – I’m not traveling alone – I brought my husband this time – and he’s a big gringo too.. (okay, I’m five foot one, so I am a “little” gringo). He speaks even less ‘Spanglish’ than I do..But since he’s with me – I’ve changed the pace a little bit.. No 16 hour days this time. [During the Bogotá trip, I lost almost thirty pounds, because I was basically working or writing during all of my waking hours, and things like regular meals were pushed to the wayside.] So, now I am smelling the roses, so to speak – enjoying the local culture instead of breezing past most of it. Also, having my husband here helps me maintain perspective – of how others may see Mexicali. Not everyone gets excited by medical facilities and doctors’ offices.
So for now, I am planning to make several short trips to Mexicali – to fact-find and bring you information; about medicine, doctors, and facilities and some of the other things we encounter along the way.
Had a wonderful event to share my book with and thank all of the people who made it possible. (No surgeons, no book). It was wonderful to see everyone – and I want to thank all the surgeons – who literally came straight from surgery to give their support of this project. Some of the great friends I have made from all walks of life (outside the hospital) were also there – which means a great deal – I know that I live and breathe writing and surgery, but I also know that this is not true for most people.
That’s been the theme of all of my visits to Colombia; kindness, caring and support. So many people; from surgeons, nurses, to taxi cab drivers and even random strangers in passing have been kind to the little (sometimes lost) American.
About 1/3 complete on formatting the e-version. It’s a tedious job, but once it’s complete – it will give me the freedom to do instant book updates as needed.
Also hoping to translate the book into Spanish versions. It’s been difficult to find someone due to the technical/ medical language.
Now that the Bogotá project is essentially complete – I anticipate that this blog may change in focus – similar to Cartagena Surgery. There will be more of a focus on medical tourism and medical news, now that interviews will be few and far between. (Never done entirely.)
Met with the very nice Dr. Catalina Morales yesterday evening to talk about Plastic, Aesthetic and Reconstructive Surgery.. Oh – and did I mention hand and maxillofacial surgery..
She’s very enjoyable to interview because she’s one of those people who really finds pleasure in what she does.. She likes to help people with reconstructive surgery, and she enjoys the satisfaction her aesthetic practice gives her patients..
Planning to go to the OR with her today – so we will re-visit the smiling, talented Dr. Morales later this afternoon..
Update: In the operating room with Dr. Catalina Morales, at Clinica de Marly 7 May 2011
I also interviewed Dr. Casallas Gomez over at Santa Fe de Bogota, read about it in another post..
Attended the monthly thoracic surgery meeting led by Dr. Juan Carlos Garzon yesterday for case discussions.. Several interesting cases presented. More importantly, I met and set up interviews with the last few thoracic surgeons; Dr. Beltran and Dr. Rodolfo Barrios (that I hadn’t met previously). Should be an interesting week in the south end of the city..
On the topic of thoracic surgery - I am soliciting articles from thoracic surgeons, and other practitioners on the site – not just here in Bogota, but from around the world as part of the mission of the site. I’ve already had some great feedback from some American surgeons.
Over at cartagena surgery we are talking about the recent announcement by the International Diabetes Federation on treatment recommendations for diabetes including the endorsement of Bariatric Surgery.
Dr. Mauricio Largacha is an orthopedic surgeon specializing in shoulder and elbow surgery including arthroscopy, rotator cuff repair and joint replacement. I’ll be following him to the operating room this weekend – so check back in for more details..
For readers unfamiliar with orthopedic surgery – ankle and shoulder joint surgeries are a particular sub-specialty only practiced by a few orthopedic surgeons. Luckily for readers here – Dr. Largacha is the author of several of the most heavily used textbooks (and chapters in American medical textbooks) on both ankle and shoulder surgery.
Spent most of the day over at Hospital Santa Clara with Dr. Stella Martinez, thoracic surgeon.. Despite having three cases, Dr. Martinez apologized for the paucity of scheduled OR surgeries due to the upcoming religious holidays.. (Despite Bogota’s booming population – this is a familiar scene, repeated around the city – kind of like people putting off surgery until after Christmas..)
I’d been warned by several people about Hospital Santa Clara – it’s one of the poorer public facilities, but to be frank, despite the aging exterior, it beat out some of the homegrown facilities I’ve been to.. While it was obviously a less affluent facility; with a campus style layout, no CT scan, and a 1950′s feel; the hospital was clean, all of the equipment worked, much of it was new – courtesy of a new administration..
Dr. Martinez is impressive, both in and out of the operating room – with an extensive resume, and skill set. She’s currently the Director of the thoracic surgery residency program at Hospital Santa Clara, and she takes resident training seriously. She’s also interested, and active in research, and maintains a busy surgery practice at several facilities. There’s a lot more to say about this talented surgeon , but you’ll have to wait to read the rest.