Mexicali, Baja California (Mexico)
We’ve back in the city of Mexicali on the California – Mexico border to interview Dr. Carlos Cesar Ochoa Gaxiola as part of the first of a planned series of video casts. You may remember Dr. Ochoa from our first encounter back in November 2011. He’s the personable, friendly thoracic surgeon for this city of approximately 900,000 residents. At that time, we talked with Dr. Ochoa about his love for thoracic surgery, and what he’s seen in his local practice since moving to Mexicali after finishing his training just over a year & a half ago.
Now we’ve returned to spend more time with Dr. Ochoa; to see his practice and more of his day-to-day life in Mexicali as the sole thoracic surgeon. We’re also planning to talk to Dr. Ochoa about medical tourism, and what potential patients need to know before coming to Mexicali. He greets me with the standard kiss on the cheek and a smile, before saying “Listo? Let’s go!” We’re off and running for the rest of the afternoon and far into the night. Our first stop is to see several patients at Hospital Alamater, and then the operating room for a VATS procedure.
He is joined in the operating room by Dr. Cuauhtemoc Vasquez, the newest and only full-time cardiac surgeon in Mexicali. They frequently work together during cases. In fact, that morning, Dr. Ochoa assisted in two cases with Dr. Vasquez, a combined coronary bypass/ mitral valve replacement case and a an aortic valve replacement.
Of course, I took the opportunity to speak with Dr. Vasquez at length as well, as he was a bit of a captive audience. At 32, he is just beginning his career as a cardiac surgeon, here in Mexicali. He is experiencing his first frustrations as well; working in the first full-time cardiac surgery program in the city, which is still in its infancy, and at times there is a shortage of cases. This doesn’t curb his enthusiasm for surgery, however and we spend several minutes discussing several current issues in cardiology and cardiac surgery. He is well informed and a good conversationalist as we debate recent developments such as TAVI, carotid stenting and other quasi-surgical procedures and long-term outcomes.
We also discuss the costs of health care in Mexicali in comparison to care just a few short kilometers north, in California. He estimates that the total cost of bypass surgery (including hospital stay) in Mexicali is just $4500 – 5000 (US dollars). As readers know, the total cost of an uncomplicated bypass surgery in the USA often exceeds $100,000.
Hmm.. Looks like I may have to investigate Dr. Vasquez’s operating room on a subsequent visit – so I can report back to readers here. But for now, we return to the case at hand, and Dr. Ochoa.
The Hospital Alamater is the most exclusive private hospital in the city, and it shows. Sparkling marble tile greets visitors, and patients enjoy attractive- appearing (and quiet!) private rooms. The entire hospital is very clean, and nursing staff wears the formal pressed white scrub uniforms, with the supervisory nurse wearing the nursing cap of yesteryear with special modifications to comply with sanitary requirements of today.
The operating rooms are modern and well-lit. Anesthesia equipment is new, and fully functional. The anesthesiologist is in attendance at all times. The hemodynamic monitors are visible to the surgeon at all times, and none of the essential alarms have been silenced or altered. The anesthesiologist demonstrates ease and skill at using a double lumen ETT for intubation, which in my experience as an observer, is in itself, impressive. (You would be surprised by how often problems with dual lumen ETT intubation delays surgery.)
Surgical staff complete comprehensive surgical scrubs and surgical sterility is maintained during the case. The patient is well-scrubbed in preparation for surgery with a betadine solution after being positioned safely and correctly to prevent intra-operative injury or tissue damage. Then the patient is draped appropriately.
The anesthesiologist places a thoracic epidural prior to the initiation of the case for post-operative pain control. The video equipment for the case is modern with a large viewing screen. All the ports are complete, and the thoracoscope is new and fully functioning.
Dr. Ochoa demonstrates excellent surgical skill and the case (VATS with wedge resection and pleural biopsy) proceeds easily, without incident. The patient is hemodynamically stable during the entire case with minimal blood loss.
Following surgery, the patient is transferred to the PACU (previously called the recovery room) for a post-operative chest radiograph. Dr. Ochoa re-evaluates the patient in the PACU before we leave the hospital and proceed to our next stop.
Recommended. Surgical Apgar: 8
 There is another cardiac surgeon from Tijuana who sees patients in her clinic in Mexicali prior to sending patients to Tijuana, a larger city in the state of Baja California. As the Mexicali surgery program is just a few months old, many potential patients are unaware of its existence.
 ‘Bypass surgery’ is an abbreviation for coronary artery bypass grafting (CABG) aka ‘open-heart surgery.’ A ‘triple’ or ‘quadruple’ bypass refers to the number of bypass grafts placed during the procedure.
 If you have read any of my previous publications, you will know that this is NOT always the case, and I have witnessed several cases (at other locations) of unattended anesthesia during surgery, or the use poorly functioning out-dated equipment.
 During a later visit with the patient, the patient reported excellent analgesia (pain relief) with the epidural and minimal adjuvant anti-inflammatories.