Sightseeing in the age of Covid-19


While my headline in a little tongue- in -cheek In the spirit of the famous Colombian writer, Gabriel Garcia Marquez, our topic today is a bit more serious. I decided to spent yesterday downtown at some historic sites. As I may have mentioned in a previous post, Colombia has quite a few public holidays. Over 20 in fact, so at least once a month (and sometimes twice) there is a festival Monday, where offices and businesses are closed.

Yesterday was the Feast of the Sacred Heart. It was a lovely day, the ciclovias are open, and people are out. But this post is a little different than my usual posts on fantastic restaurants, delicious fruits, amazing natural beauty, indigenous cultures, artisanal crafts and life in Bogota. This is a post for people who want to know more about the hearts of Colombians.

A friend and I decided to go on a history tour with Descubre Bogota. Our guide was Jose Ayala, and our tour was about the some of the famous and ultimately tragic figures in Bogota’s history. I knew it would be sad, and I knew it would be hard to hear. I know because I come from a country that has it’s own painful past – and we often struggle to reconcile with it. We also struggle to change course, from “that’s the way it’s always been (no matter how ugly or unfair” to trying to do better, and move forward. Like Colombia, my country has faced a lot of upheaval that has only been exacerbated by the pandemic.

I’ve read quite a bit about Colombia in the past 12 years, but I still take every opportunity to learn more. I will never been an expert – I don’t have a poli-science bone anywhere in my body. But it doesn’t mean I can’t try and learn. It’s especially important for people from the United States, because many of us never step out of our bubble, yet would be mortally offended if a visitor from another country didn’t know who Abraham Lincoln, John Kennedy or George Washington was.

I don’t expect casual visitors to delve deep into Colombia’s past, but I do feel that they should try and get past all the narco stereotypes. They should know at least a little something about some of the people who represent what Colombia is/ was and can and will be. They should know that Colombians have many of the same ideals that we purport to represent. That seems like an easy concept, but after more than a decade of working / writing/ traveling here, I know that to many people it’s not.

But today we are going downtown to scratch the surface, just a little bit.

(I didn’t have my camera, just my phone so the pictures are not very good).

The first stop on our tour was the Museo National, where Jose talked about the 1000 days war, which occurred just at the beginning of the 20th century. At that time, the Museo Nacional was a fortress and prison.

Then we proceeded up to the former home of Jaime Garzon, who is a more recent entry in Colombia’s history. I’m adding several links about him for readers to learn more about him, if you are interested. He was journalist and political critic who specialized in political satire. He also played an important part as a political activist and peace negotiator who worked to free many of the FARCs hostages. It was this work that was believed to have led to his assignation. According to our guide (and several other sources), Garzon knew an attempt was to be made on his life, and (possibly) knew that he was going to be murdered in his car that day. (The possibly, is due to a couple of Spanish words I was unsure of during the tour). They say that he carried on with his scheduled activities to keep the assassins’ away from his home and family. The outpouring of grief among Colombians was immense, and overwhelming.

An homage to Jaime Garzon:

Jaime Garzon memorial webpage

Archives in national center

The next stop on our somber tour was to view some of the architecture of the area and to talk about how this particular style of architecture was developed to incorporate nature into the design. It was a pretty amazing building, built in a series of semi-circles (just above the stadium del Toros) but hard to get a photo that real demonstrated the effect up close. (I had noticed the building on the drive to the door, it’s pretty striking).

Much of the rest of the tour was devoted to Gaitan and the more traditional figures in Colombian figures. Jorge Eliecer Gaitan (not to be confused with the later politician of the 1980’s Luis Carlos Galan) was a polarizing figure in Colombian politics. A populist leader of the left, he was active in politics from the 1920’s until his assignation in 1948 outside his office building. He was a very skilled public speaker and drew extremely large crowds due to his fiery nature. Many believed he would be the next President of Colombia. His murder on April 9th, 1948 like that of John Kennedy in 1963, where the suspected assassin next made it to trial. Like John Kennedy’s murderer, Lee Harvey Oswald, the complete motivations of Juan Roa Sierra were never known, and there are multiple theories that link the murder to outside entities including Fidel Castro and the Soviet Union were behind the assignation. Others claim US involvement which is not such a far-fetched idea, given the now known history of US interference in Latin American affairs.

I’ve been looking for some English language information to link to, but please note, much of what I have found, particularly historical footage, shows a pretty obvious bias. Others are equally biased in other ways. I chose the one here because, because it’s one of the few in English that show Gaitan and let modern day views see his dynamic appeal.

His death set off a series of protests and riots called the Bogotazo that left between 500 to 3,000 people dead (figures vary) and parts of Bogota destroyed.

It also directly led to a ten year civil war called, “La Violencia.”

Obviously not a small topic – and covered by many many scholars, journalists and political analysts far better than I could.

There were several more stops – one being the Palace of Justice. This is a story that has been widely covered, pretty much everywhere, including the series ‘Narcos” that I personally detest. (I recommend watching Pablo: el Patron de Mal, if you want to watch that stuff.)

The last stop, outside the Palace of Justice in the Plaza Bolivar is the most pertinent for many people. It’s fairly quiet today, with a intermittent heavy rain. But it’s been witness to almost everything Jose talked about on the tour – and visible in most of the film footage – from the 1940s to last week. (Look thru the next several pictures and then click on some of the links and videos).

“Those who don’t remember the past, are condemned to repeat it.” We hear this quote endlessly recycled but we don’t talk about what it really means. It’s not about ONLY remembering the past, it’s about learning and moving away from the actions of the past. Yes, this requires knowing about our most painful chapters, whether it be a nation, a family or an individual. But it also requires changing course. Knowing is not enough – action is required.

That is what Colombia, the USA and so many nations have struggled with this last year – the realization that we need to change course, and then trying to find the path to do so.

Now I don’t have a strong opinion on the current Colombian protests – I don’t feel like I have a deep enough understanding of all of the issues to do so. But I do understand what’s we’ve been seeing.. It’s the same as what we saw last year at home.. We are watching a nation – and it’s citizens try and find their path forward – and I respect that.

For readers who would like to know more about the current protests in Colombia, I highly recommend the Colombia Calling podcast along with Colombia Reports.com

A long time gone..


Hello, everyone! It’s been a long time since I’ve even logged in here – and I won’t blame the pandemic. Well, it wasn’t entirely the pandemic.

As my previous subscribers know, I’ve been working and researching surgery, and medical travel options since 2010. It’s not just a passion, it’s something extremely serious to me (even though I am often very light-hearted over here!)

In late 2019, I finally took the leap to do what we all knew I needed to do. I always said, I’m just the researcher, I’m here to evaluate, I’m not here to run a medical travel company. But the longer I went around interviewing, observing and evaluating surgeons, hospitals and surgical practices, the more I realized that I was literally, the only person out there doing what I do. I was a one-woman Quality Assurance program; focused patient safety, and post-operative outcomes.

For everyone else, it’s just a job. It’s not that they were all heartless, hateful individuals – but they were not in a position to be able to care. They are travel agents, not medical providers (you’ve heard this part of the speech before) so they didn’t even know what they should be concerned about. You have to be aware of all the risks to understand them.

That’s not a dig at anyone, that’s a reality. If you aren’t trained and don’t have extensive experience in medicine and surgery, then you really aren’t qualified to be referring any potential patient/ client/ or even a friend to a surgeon. And even then – all that training doesn’t matter, if you don’t go thru the proper steps to fully evaluate someone.

A person can be a fantastic surgeon – maybe even your husband’s heart surgeon, but that doesn’t mean they know who the best surgeon is for your breast cancer. I might know some surgeons from around the hospital where I work – but if I don’t go into their operating room – and they are just a golfing partner, or a workplace acquaintance, then my recommendation really isn’t worth very much. A lot of medicine functions in exactly that. Referrals are made out of friendships, not merit.

It’s the same with a referral from a close friend. That isn’t because your friend isn’t a kind, caring person, but even if she had the exact same procedure that you want or need – her experience is not necessarily your experience. Great surgeons can have patients with terrible complications (often because they take care of sicker patients). Very mediocre, sloppy or unsafe surgeons can have good outcomes because if everyone they operated on died or had catastrophic complications, well, they (hopefully) wouldn’t be a surgeon for very long.

This is about training, techniques, protocols and odds rations. We have all run a red light, whether by accident,, because you were in a hurry or whatever. We don’t all get t-boned in the intersection, because sometimes we get lucky, and sometimes we get away with it.

But careful and safe drivers who pay attention, slow down when they seen the light turn yellow are much much less likely to run a red light, which in turn means that their risk of getting in that accident in the intersection is much less than someone else who routinely hits the gas when that light turns yellow.

What I do is look for the safe drivers. The people who do things the correct and proper way every single time. So that when you are unconscious, and powerless on that operating room, you don’t have to be lucky.

With that in mind, I started my own travel company in late 2019. I knew I would never get rich doing it – but I knew that I could really help some people. I set my personal goal at having a very small exclusive clientele – and having 5 to 10 clients per year for the first five years.

Now that doesn’t even cover overhead – so it means I’d be doing my “day job” for at least another decade. But that’s okay – not everything in life is about money. Sometimes it’s just about doing the job right and helping people, As a health care provider, that is something that I already do. This is just taking it to another level.

So – I opened the company, and our maiden voyage so to speak, I have four clients. (As part of quality control program to ensure that all the nonmedical aspects come together in a timely fashion, I had decided to do the first two years of operating as very small group travel. As a trial and error process to streamline the process (hotel, luggage, meals, sightseeing, all the things that go with traveling but are not related to patient safety). You can never make sure that all the logistics are perfect with out a couple trial runs. With that in mind, our first clients were offered our services as at fraction of the price. (My accountant was screaming and so was my wallet – but that’s just how it has to be sometimes.)

All that hard work paid off – not only did ALL of our clients get excellent care, they had a good time too! We saw off the last client just a week before Christmas 2019. It was exhausting, but I was exhilarated. I also realized that it was very unlikely that I’d ever make money doing this. To make money, I’d have to charge more, a lot more. So much of the money I collected went to enhance the client experience, that there was very little left over.

I wouldn’t make money the way other medical travel companies do – they make money two ways:

-sheer volume

-kickbacks on front/ and back end. They get paid by the hospitals, the providers and sometimes even by hotels, restaurants and such for steering the clients in a specific direction. A lot of times, they are actually a front for a hospital – b ut pretend to be an independent entity.

Obviously, my loyal readers know that this wouldn’t work for me. It violates everything I believe. In fact, it’s part of the mission statement on my “official” company page.

But in the meantime, Covid did happen. So I have had a year and a half to think about it. The company is closed, and I’,m at a decision point.. Carry on or shutter entirely.

Now this blog was undercover for about that long too – and that’s not a coincidence. That’s because I was worried that if people read this blog, and read about Colombian food, my various adventures and even just the random absurd little things that happen sometimes, that they wouldn’t think I was professional – and thus wouldn’t want to be a client.

But people are multi-faceted. You can be a nuclear physicist AND a mom. Electrical engineers play musical instruments. We all have the abilities, interests and talents to do more than one thing. So as I stayed inside, and watched the entire world stop, I had plenty of time to think, and make decisions about my own life and the life of my company.

My goals are the same. I want to come out of this pandemic and be able to help five to ten people each year.

My goals are the same, but my perceptions have changed. Now, I’m okay if it’s never more than five or ten people a year.

It’s okay that I won’t get wealthy doing this – and that I will never be able to surrender my day job. I don’t know if I could do that anyway – it’s too much a part of who I am. I just want to be able to help five or ten people every year without losing money. I’ll write off my time as being basically free – but I still need to make enough money to do all the nice things for the clients that I feel are important, and to be able to pay the people that help make it possible. That’s not an impossible goal, and I don’t feel it’s a foolish one. I’ve been fortunate in life, so I can decide to do something just because it makes me feel good. So that’s what I am doing.

And lastly, it’s okay if people seeing and reading this realize that I’m a person, a fully rounded person, who likes to take pictures, loves to travel, and to have new experiences. It’s okay if they know that I’m a cat lady, and I love to sew, especially dutch wax prints in bright colors. It’s even fine if they know I love to sing – but I’m always terribly off-key. It’s okay because I will be here to help the people who want my help. People who recognize my expertise and still see me as a professional (despite my singing) and not a servant. People who know me, friends, family and people who trust me, respect my abilities – and know that I will always put their health and safety first.

So, I’m back!

Miami plastic surgeon tied to multiple deaths


From the Miami Herald comes a terrifying story about a plastic surgery group tied to multiple patient deaths.  The surgical group which operated out of three different south Florida clinics are responsible for at least three deaths, including the recent death of a young woman from West Virginia, Heather Meadows, 29,  who had traveled to south Florida looking for cheap plastic surgery.

bandaid

In addition to this case, come reports that the group housed post-operative patients in a local horse stable.  The clinics; Encore Plastic Surgery in Hialeah, and two Miami clinics; Vanity Plastic Surgery and Spectrum Aesthetics have also been linked with multiple serious medical complications including the case of Nyosha Fowler who was comatose for 28 days after surgeons at the clinic accidentally perforated her intestine and then injected the fecally contaminated fluid into her sciatic nerve during a liposuction/ fat transfer procedure.  Ms. Fowler, who is lucky to be alive, is now permanently disabled and facing a two-million dollar medical bill for the life-saving care she received at an outside facility.

Now, Heather Meadow’s death has been ruled accidental, which is no comfort to her family or the numerous patients harmed by these surgeons. While the state of Florida has reprimanded two of the surgeons in the surgical group in the past, this hasn’t affected their practice, and the surgical clinics continue to accept new patients from across the United States and operate on unsuspecting clients.

money

Beauty, at any price?

While Florida state health officials issued an emergency restriction prohibiting one of the group’s surgeons, Dr. Osak Omulepu from operating, no charges have been made despite cell phone photographs documenting horrific conditions at the horse stables where patients were forced to stay while they recuperated from various procedures.  In fact, Dr. Osak Omulepu continues to have four star ratings on several online sites.  His license is listed as active on the Florida Medical Board, with no complaints listed under his profile page.  However, under the disciplinary actions page, there are eight separate listings that do not appear on his general profile.

One of these Complaints, (posted here) related to the death of a 31-year-old woman due to repeated liver perforation during liposuction.  The complaint also cites several other cases against the doctor and notes that Dr. Osak Omulepu is not a board certified plastic surgeon.  In fact, according to the complaints filed in March, the good doctor, holds no certification in any recognized medical specialty.

Related posts:

Plastic surgery safety & Buttloads of Pain

Patient satisfaction scores vs. clinical outcomes: The Yelp! approach to surgery

Is your ‘cosmetic surgeon’ really even a surgeon?

Patient Safety & Medical Tourism

Liposuction in a Myrtle Beach apartment

Cano Cristales in La Macarena


Cano Cristales

Cano Cristales

Just got back from a four-day trip to Cano Cristales – and it was fantastic.  I went with a Colombian travel company – which I think made the trip all the better.  (I am getting ready to go on another adventure trip with a foreign company – so when I get back – I will compare the two.)

The company offers a couple different trip options – but I thought the trip on a chartered plane directly from Medellin sounded the most interesting, so that’s what I chose.  There were 19 of us on the trip out from the airport in central Medellin (Enrique Olaya Herrera airport) – all Paisas (Medellin residents) except myself.  Immediately, all our my fellow travelers embraced me – as they were entrusted by the travel agent to ‘take care of the gringa’.  It was very endearing, actually.

getting on the plane

getting on the plane

There were several nurses on the trip – so we bonded right away..

With my travel companions

With my travel companions

The Airport at La Macarena in Meta, Colombia

The Airport at La Macarena in Meta, Colombia

So it was at little sad – when arrived and they mixed and subdivided our group with another smaller group – except that they all turned all be awesome too!

So I ended up as part of a group of six – (including our guide, Sergio).. For someone who wanted to learn more about Colombia, I couldn’t have created a better group.  In our little band, there was a biologist, a microbiologist, an anthropologist and a meteorologist – and it was all random.  Everyone was from Medellin and they had all come to enjoy the park.

with a group of Colombian experts

with a group of Colombian experts

On the River

After arriving, we headed down to the Guayabero river for a boat trip to the first part of the hike.

From our daily jaunts down the river – we then proceeded to have all kinds of fun – from 4 X4ing to the next trail, to long hikes from the plains into the jungle..  Stopped at multiple points of the river, to enjoy the sights and to swim in the cool waters.  (It’s high 90’s with 95% humidity – so the water felt great!)

As I mentioned in a previous post – I left my trusty Nikon (and polarized lenses) back at home so these photos don’t even begin to capture how beautiful it really is.

best800

Swimming in the river – 

One of the best times was swimming near a waterfall in the middle of a torrential downpour.. Unfortunately, my camera had already taken a bit of a swim downriver so I don’t have any photos.. (But I did manage to salvage the photos and the camera – with help from a bag of rice).

Cowboys!

on the way back to the river from the trail we got to see the traditional Colombian way of life here on the plains as the cowboys were rounding up their herd.

Just as we were walking to the boats – we saw a group of people staring at something on the ground. As we got closer, I saw that it was some kind of furred animal.  Was it a goat – I couldn’t tell.  I was initially reluctant to get closer – it looked half dead laying on the ground in the blazing sun, eyes dull and glassy.  But as I got closer, it started to move – and it wasn’t a goat or barnyard animal at all.

What the heck was it? I didn't know but it looked sick to me..

What the heck was it? I didn’t know but it looked sick to me..

It was a perezoso (or Sloth in English), which had wandered out of the nearby forest and was now lost.

The biologist in our group immediately organized the group to entice the animal on to a tree branch, to carry across the field, out of the heat and the sun into the forest.  (It felt about 20 degrees cooler when we got there.)  The animal perked up and quickly climbed up into a tree.  Because it’s coat matched the branches, it blended in perfectly.

Within just a few minutes, it was greeted by another sloth high in the tree.

Heavy Military Presence in the area

DSCN2003

Readers will quickly notice from the photos that there is a heavily military presence in the area.  Despite a history of mixed relations with the Colombian military  – including the discovery of a mass grave in 2010 with over 2,000 unknown corpses (and a history of some atrocities towards Colombian citizens), I am happy to see them.  I know I am ignorant and naive, but their presence in La Macarena makes me feel safer.  This area, in a lot of ways is kind of like Colombia’s own Vietnam conflict (in their own territory).  I feel bad talking to these soldiers who are far from their homes; I’ve met soldiers here from Cali, Boyaca, Bogota and all other points outside of Meta.  This is nothing like Bogota (obviously!) and it makes me sad for them.

soldiers

Do I feel better knowing they are around??

Most people from outside Colombia worry about the FARC, but right now – with the FARC in peace negotiations, paramilitaries like ELN and AUC are the bigger problem.  These violent groups clash with everyone who gets in their way; townspeople, the army, and even the FARC.  So anyone (like the Army) that keeps them at bay – is well, awesome!

You bet ya!

You bet ya!

DSCN1911

While both the governmental tour agency and the military officers I spoke with report that there has been minimal paramilitary activity in the La Macarena area for the last several years (8 to 10 years is what I was told), the Colombian state of Meta has an active area for paramilitary activities for the duration of the 50+ year conflict.  I found only one fairly recent report (August 2014) of paramilitary activity in other parts of Meta.  The majority of reports date back to 2006 – 2010, so it’s been fairly quiet lately.  Even so, it’s good to know that there are 2500 active duty soldiers in the area surrounding La Macarena.

Miguel (forefront) from the Colombian military patrols La Macarena

Miguel (forefront) from the Colombian military patrols La Macarena

It’s quiet enough that some of the soldiers spend time performing community activities, like helping paint the town, which is one of the local projects to enhance the image of La Macarena for tourists.

a soldier helps a young girl with the community painting project

a soldier helps a young girl with the community painting project

La Macarena: the town

Aside from the large military population, La Macarena is a small little village – with just a few paved streets at the center of town.  Most of the buildings are squat and square with a few second story and one tall four-story hotel tower..

We spent the evenings watching local entertainment – singers and dancers or enjoying a cervecita while playing tejo and enjoying the cool evening breeze.

In Capitol City


Long time readers know that I am addicted to the capital city of Colombia.  So there was no way that I wasn’t going to take a few days to head over to Bogotá the moment I had a chance.  I just got back – and before I head off on my adventure to La Macarena tomorrow, I thought I’d post an update.

Charlie’s Place

8D y 106-84

Usaquen

Since I was just stopping in for a few days, I decided to forgo renting my usual apartment.  It’s a good thing I did or I would have missed out on getting to know the folks over at Charlie’s Place, a boutique hotel and spa in Usaquen.

CharliesPlace

It’s probably not for everyone – people who want to be in the middle of the tourist areas of Bogotá should stick to La Candeleria.  Business travels on large expense accounts can head to the big-name chains.  But for people like me, who want to be in the north side of Bogotá, around Barrio Chico and Usaquen, Charlie’s Place is ideal.

With just 22 rooms, the hotel is very cozy and accommodating.  The manager, Wilson, is a Minnesota native and is delightfully charming and easy-going.  The rest of the staff including Daniela and Javier are equally polite, friendly and helpful.  (There’s a reason Charlie’s Place is consistently rated as excellent by Trip Advisor for the last several years.)  The best part is that the rates are fair and the service is excellent.

Once I was comfortably settled, it was time to get back out and enjoy the brisk weather.  (The weather is one of the reasons I love this city!)  My first stop was over at SaludCoop where the doctors and nurses were nice enough to answer some questions about the ongoing healthcare crisis.

The Colombian Public Health Care Crisis

Right now, the public health system, EPS and SaludCoop are going broke.  Basically, much of the money paid in by members of the health care cooperative has disappeared (been embezzled), leaving hospitals with bare cupboards.  Hospital staff are feeling the pinch as payroll arrives late, in diminished amounts, or in some cases, not at all.   (There are rumors that the money was funneled into the purchase of luxury apartments, fancy vacations and the like).  There have been some protests and work stoppages by health care workers, but unfortunately, the local unions have been unwilling to support their efforts.

Unfortunately, the government seems apathetic to the concerns of the healthcare workers and their patients. The Minister of Health, Alejandro Gaviria went so far as to say that the health care crisis was a “lie” in a recent press conference, following up on his previous twitter (June 2015) and blog comments (Feb 2015), even going so far as quoting Christopher Hitchens in his defense of the health care system.  Of course, no where in his statement does he talk about healthcare workers going without pay or operating rooms without suture.  But he’s not alone in his apathy.

Most of the local politicians  couldn’t even be bothered to show up to a legislative session on the issue.  Only 9 members of the House of representatives (out of 166) attended.

This financial travesty has wide-spread implications beyond just the public health sector (of hospitals and clinics throughout Colombia).  Many of the private facilities also rely on payments from the healthcare cooperative.  (Imagine if medicare went broke through criminal mismanagement – it would affect a lot more that general and county hospitals).  In many cases, these hospitals are forced to write off millions of dollars of nonpayment from the health cooperative.  In fact, one of the largest hospitals in Cali (a city of 2.5 million people) will be forced to shut it;s doors, mainly due to losses incurred from nonpayment by EPS and SaludCoop.  So it’s a huge mess that will probably only get worse without government intervention.

On the flip side of the Colombian Health Care Crisis and the declining peso (over 3200 pesos to the dollar this week) – Hospital Santa Fe de Bogotá  appears to be thriving.

Santa Fe de Bogota’s new emergency department

Yesterday evening I had the pleasure of a guided tour of the new Emergency department at Santa fe de Bogota with the current Chief of the Emergency Department (and trauma surgeon), Dr. Francisco Holguin.

Fans of the Bogota book know that I spent quite a bit of time at Santa Fe de Bogotá in the past – and that it is one the highest ranked facilities in all of Latin America, so it was fantastic to see all of the improvements.  (The ER was still under construction the last few times I was there).  The first thing I can say – It’s big! Big, spacious, brightly lit and airy (especially for an ER).  The is good work flow with several large workspaces for the doctors and nurses, instead of the typical traffic jams that occur in older facilities.  It’s on the same floor as diagnostics (CT scan, radiology), the operating rooms and the intensive care units which means that critically ill and injured patients can be rapidly transported to where ever the need to go.

The spacious department now has 56 beds with an overflow unit for critically ill patients.  Several specialists are on-call, in the ER and available 24 hours including orthopedics, trauma and internal medicine.  Downstairs from the main ER is the fast track – for all of the non-life-threatening general medicine problems.

After spending two days interviewing and talking to people about the SaludCoop problems and EPS – it was nice to leave Bogotá on such a nice note.

Taking it easy in Medellin


at UPB open air auditorium

at Universidad Nacional – Medellin  open air auditorium (The medellin campus is famed for the lush greenery)

So I am back in Medellin, Colombia for several weeks – but this trip is different from all of my previous visits.  It’s the first time I have come here without a specific purpose.  I’m not here to interview surgeons, attend surgical conferences or even ColombiaModa.

No Colombia Moda this year for me. :-(

No Colombia Moda this year for me. 😦

Medellin has become so familiar to me, that when I needed a nice tranquil space to work on a non-Colombia related project – I headed here to get away from the thousands of distractions of my stateside life.  While I am here, I am also determined to enjoy and explore more of Colombia since I have just seen the bare minimum of life and locales.  So next week, I heading off to one of Colombia’s best known natural wonders, Cano Cristales.

I’m going as part of a group (which is something I’ve never done before).  It’s sounds like it will be a great trip – flying to Meta, Colombia in a small plane – to a community with limited electricity and no cellphone or internet service.  That doesn’t sound like a big deal, but as I writer, I have gotten used to almost always having computer access – almost anywhere in the world.  So this will be a nice break from the ordinary for me.

I don’t have my trusty Nikon this time around, which is a shame since Cano Cristales is famed for its beauty but I will attempt to take some pictures with a tiny camera (that packs well).  It’s weird because I tend to lose my confidence when I don’t have my big, heavy camera.

Naked without my Nikon? Not a great visual, is it?

Naked without my Nikon? Not a great visual, is it?

La Tierra del Olvido (2015 version)

In the meantime, I will continue to work on my current projects, relax a bit and enjoy Colombia.  Carlos Vives, one of my favorite Colombian singers, along with Medellin natives Maluma and J. Balvin, have re-made one of Carlos Vives most popular songs as part of a Colombia tourism promotion. It’s lovely, lively and catching – and features several other well-known Colombian entertainers and Colombian landscapes – so I hope you enjoy.. (Thankfully, no Sofia Vergara!)

Reason #6


Reason # 6

Now this Florida story has botched written all over it – from start to finish..  It starts with an insecure man seeking ‘underground’ penile injections from an unlicensed person for penis enlargement.. and from there, it only goes downhill..

scalpel

From bad to worse..

After being deformed and defrauded by a scam artist named Nery Gonzalez who offered illegal, and dangerous ‘penile enhancement treatments’, the bargain-seeking Florida resident stumbled into the offices of another incompetent provider,Dr. Mark Schreiber, a plastic surgeon who lost his license several years ago after several botched plastic surgeries following initial investigations in the deaths of two of his patients.

Dr. Mark Schreibermultiple patient deaths, license revoked, but had a nice website

After the death of the second patient (also a penis enlargement case) in 2002, Florida revoked Dr. Schreiber’s license.  In 2008, he went to prison for practicing medicine (and operating on patients) without a license.

In the most recent case, the victim is now deformed, and unable to perform sexually due to his disfigurement.

Source article:

Clary, Michael (2015).  Penis ‘mutilated’ after surgery; ex-Boynton doctor from Tamarac accused.   Sun Sentinel, August 2015.

Related posts:

Just another reason for Latin American Surgery.com

Reason #146 – a cautionary tale

Plastic surgery safety & Buttloads of pain

Cement, Fix-a-flat and Superglue are not beauty aids

Is your surgeon really a doctor?

See the plastic surgery archives for even more articles.

Patient satisfaction scores vs. clinical outcomes: The Yelp! approach to surgery


Patient satisfaction and clinical outcomes

Like Kevin MD says, “Patient satisfaction can kill“.  I’ve now seen several dramatic examples of this up close and personal.  For readers who feel like they are in the dark – there is a new ‘trend’ in healthcare, which financially rewards hospitals and physicians based on patient satisfaction scores..  Politicos, lobbyists and professional “patient advocates” have heralded this approach as the second coming.  A lot of these advocates try to lump patient satisfaction in with patient autonomy and patient rights.

Patient satisfaction is not the same as patient rights.

But it isn’t the same – and it’s stupid to pretend it is.  People have the right to determine if they want treatment X or not.  But giving people a “line-item veto” power on associated activities is a lazy clinician’s practice and recipe for disaster. (Not only that – it victimizes the very population we are trying to protect.  Anyone who is a parent understands this concept, but any degree of ‘paternalism’ in medicine is now viewed in a very negative light).

Instead of a new enlightened period of patient empowerment, informed consent and respect for patient rights, we have lazy attitudes (clinicians) and temper tantrums (patients) driving our clinical practices.  Doctors would rather ‘give in’ on critically important items than spend time to repeatedly try to explain key concepts of care to increasingly demanding ‘consumers’.  Overburdened staff are happy to go along with anything that decreases a workload which has tripled with recent changes in documentation.

It’s been a clinical nightmare and an  unprecedented fiasco in patient mismanagement which has lead to a dramatic rise in medical complications, length of stay and patient suffering.  I know, from first-hand observation and it’s been difficult to watch.  Even worse, it’s like a runaway train.  No one seems willing to reach for the brakes as it careens out of control and off the cliff.   It doesn’t seem to matter that there is ample evidence that this practice actually harms patients – the idea remains popular with payors, public relations departments and patients alike.

I work in cardiothoracic surgery so I guess I’ve been sheltered from this mentality.  It took a while for this concept to trickle down from the more ‘concerge-friendly’ specialities which have a high rate of elective procedures.  (No one really has elective cardiac surgery – when we used the term, we mean it’s not an active emergency).    I was first confronted with this concept when I started writing about plastic surgery.  People sent me numerous emails to complain about some of my reviews.  They didn’t care if conditions were sanitary or even safe.  Poorly staffed facilities, office-based surgeries with improper anesthesia, or a high rate of infections and post-operative complications didn’t concern them.   “Doctors” with falsified credentials didn’t daunt their enthusiasm.  The people writing to me only cared about two things; the doctor’s “bedside manner” and the price.  (Price was an important factor because we were often talking about procedures not usually covered by health insurance).

What is more important: a great surgeon or a great-looking one?

What is more important: a great surgeon or a great-looking one?  Patient satisfaction scores are often based on relatively superficial factors such as attractiveness, charisma or even whether the hospital has catered meals or hardwood floors..

I thought it was disturbing at the time, but I chalked it up to a lack of knowledge on the part of the “consumers”.  They just assume that these problems won’t happen to them.  Complications happen to other people.

Consumer or patient?

But it is this concept as consumers versus patients that is so very damaging.  It’s okay to use Yelp! to choose a restaurant, to google a hair dresser or  use tripadvisor for a hotel.  It’s even okay to use Angie’s List to find someone to trim your hedges and mow the lawn.  That’s because in the worst case scenario  – consumers have an unpleasant experience – the wait staff is slow, the haircut is ackward, or the hotel is noisy.  Maybe the gardener is late or leaves cut grass all over the sidewalk.  But no one gets hurt, and certainly no one dies.. Not from a bad haircut..

This is a photograph from a famous trainwreck in my home town in Virginia in 1903.  Somehow, it seemed appropriate for today's discussion.

This is a photograph from a famous trainwreck in my home town in Virginia in 1903. Somehow, it seemed appropriate for today’s discussion.

The problem with the consumer concept is the idea that “the customer is always right” or that the customer always knows best.   This means that customers are not only choosing their doctors based on this type of superficial data but also dictating the care.

  This is where it gets dangerous.

Aortic Valve Replacement

Aortic Valve Replacement – photo by K. Eckland, 2012

In cardiac surgery, we’ve long had a saying, “Cardiac surgery is not a democracy.”  This means that the surgeon has the last word, and is the highest authority when it comes to the care of cardiac patients.  The surgeon’s wishes trump mine, the anesthesiologists, the nurses, and even the patients and the patients’ family.  That’s because most cardiac surgeons have decades of medical and surgical training in addition to their individual years of clinical practice.  Surgeons and their support staff (like myself) are expected to use evidence-based practice.  This means we prescribe, and perform treatments based on years of research, and based on published guidelines.  These guidelines and protocols are then personalized or altered to suit each patient’s individual needs.  (Needs, not wants).

One of the biggest examples of this principle is:  Ambulation after surgery

Nobody wants to get out of bed and walk after heart surgery.  We’d all love to nap all day, get limitless pain medication and wake up six weeks later, rested and restored to health.  But reality doesn’t work that way.  Patients who get up and move, and do so in the early periods after surgery – do dramatically better than patients that don’t.  They have less complications, and they actually feel better  than patients who are allowed to take a more leisurely approach to cardiac rehabilitation.  Even a day makes a difference so this is where most surgeons draw rank.  Walking is not an “optional” part of post-surgical care.

In the ten years that I have been working in cardiac surgery, in massive academic facilities, average size hospitals and even small community programs – the guiding principle has been up and out of bed – and most programs do this at a fairly rapid pace.  For uncomplicated patients (no major immediate surgical problems, or advanced heart failure), the gold standard is out of bed to the chair on the evening of surgery (for patients who return from the operating room by mid-afternoon) or by 6 am the next morning (patients that arrive later, or who take longer to awaken from anesthesia).   These patients then take their first walk on post-operative day one to the nursing station and back, (usually around 50 to 200 feet) before lunchtime as a prerequisite for being transferred out of the intensive care unit to the step-down unit that afternoon.    For these patients, walking is not up for discussion.  It is the clinical expectation and part of the ‘package’ that goes with the operation.  Patients walk.  Period.

The majority of these patients will be discharged home on post-operative day 4.  Some will go home on post-operative day 3.  Not only that – but they will feel relatively good and will be clinically/ physically and psychologically* ready to go home by that time.

*Families are another story – the stress and anxiety of heart surgery is often worse for loved ones than for the patient and often does not clinically correlate with the patient’s actual physical condition.

Clinical Scenario of patient care driven by patient satisfaction scores$$$

In comparison, at a private, up-scale facility where I recently visited, the desire to please and get good Yelp! scores trumps the principles of patient care.  To start with, all patients automatically receive heavy doses of narcotics immediately after extubation via pca (patient controlled analgesia).  In theory, the pca allows patients to receive medication without lengthy delays to control pain to a ‘reasonable’ level.  (It is not reasonable to expect to be pain-free after major surgery.)

Patient satisfaction promise #1: You will be pain-free after surgery

But this hospital promises pain-free and they do their darndest to deliver.  Patients get on average 6 to 8 milligrams of dilaudid (hydromorphone) every hour after surgery by pushing their pca.  (If you think, “hey, after sawing my chest apart – that sounds like a great idea” then you are at risk for what happens next..

Nurses at this facility love this policy because it means they don’t have to attend to the patient as often and can catch up on computer documentation, facebook or whatever since the patient will be medicating himself into a semi-comatose state over the next few hours.  Semi-comatose is not an exaggeration.

Neurologically, some of these patients will develop delirium and vivid hallucinations.  Others will become agitated and combative.   Others will simply become confused and sleepy.

Since narcotics cause respiratory depression, sometimes these patients become hypoxic after using the pca heavily despite the supposed safeguards (lockouts are usually set ridiculously high – and despite policies against it – visitors, family and staff will push the pca button, even when the patient isn’t asking for medication).    Sometimes, patients end up on bipap or even re-intubated.  More often, they are just asleep – which as I said, suits the staff fine because it’s a lot less work for them.

But for the patient, it’s lost time – and puts them at risk for even more complications.  These people should be getting up to the chair, or walking for the first time.  Walking promotes respiratory expansion, prevents blood pooling (in extremities) and helps restore gastric function.

Instead, they are sleeping.  They should be performing pulmonary toileting to clear out all the secretions that built up during their lengthy surgery and reduce the risk of a post-operative pneumonia.  Instead, their lungs are building up more secretions.

Soon, the patient will want some water, after the intense mouth drying effects of the ventilator and breathing tube.  But the powerful narcotics have completely shut down bowel function.  No bowel sounds, no activity.  Water means nausea and vomiting, and more medications.  In many patients, this can cause an ileus, which adds several more unpleasant days (with a nasogastric tube) to their hospital stay.  For a fraction of these patients – they may need an emergent operation for a bowel obstruction as fecal material forms into hard, unpassable blockages in the GI tract.  Either way, the gross overuse of narcotics in these patients negatively impacts two of the most basic principles of post-cardiac surgery rehabilitation: ambulation and pulmonary toileting, and leads to increased risks of major/ unnecessary complications.

Patients need pain control after surgery – without adequate pain control patients can’t do all the activities they need to as part of their rehabilitation.  Untreated pain can in itself lead to complications.  But this bazooka approach to pain management is inappropriate for the vast majority of patients – especially the narcotic-naive or frail elderly (that make up a large percentage of cardiac patients).

Chasing patient satisfaction scores and profits in American healthcare

Chasing patient satisfaction scores and profits in American healthcare

The bottom line for CEOs and Administrators – I’m not sure if fulfilling the promise of pain-free cardiac surgery results in increased patient satisfaction scores on post-hospital surveys.  Do patients who spent the first two days after their surgery in a narcotic haze but then spent four or five extra days in the hospital due to preventable complications rate the service as well as patients undergoing surgery in a traditional program (who go home on day #4)?  And even if it does result in high satisfaction scores, (like it apparently did at this facility) – Is it ethical or moral to sacrifice the patient’s actual health and well-being for a couple of gold stars on post-discharge questionnaires.

But this is just the first part of the sequelae created by hospital administrators in their intense desire to chase profits, business and customers.  (This facility has created a niche market for itself by promoting these customer satisfaction practices that appeal to people that would otherwise seek care at the internationally known large academic facilities in the nearby area).  We will talk about some of the other pitfalls of programs  and practices devoted to chasing patient satisfaction scores, instead of patient care.

Take home message:

The real kicker:  multiple studies like this one by Aiken et al., demonstrate that the best way to increase patient satisfaction is to give good care, as defined by our more traditional measures (good outcomes). Hospitals that were well organized, with high levels of nurse staffing, (low levels of burnout) and good work environments.  Patients are happier, safer and have less complications when the nurse: patient ratios are appropriate for the level of care**.   It was never really about the ‘perks’ but it’s easier / cheaper for administrators to add enhanced cable television and pay-per-view movies to patient rooms than to actually give a darn..

$$$ – At the facility that was dominated by concerns related to patient satisfaction scores (ie. Press Ganey scores), that had such a high rate of complications (and a higher than average mortality)?? All those doctors have excellent, yes, excellent Press Ganey scores.. because apparently giving unlimited narcotics makes up for unnecessary (and life-threatening) complications. [and because, as demonstrated by several of the references below, Press Ganey scores are far from a reliable indicator of care.

**CEOs take note: I said nurses, not “nursing staff”.  Contrary to popular belief, 2 or 3 nursing aids, patient care techs or other ‘ancillary’ staff does NOT equal one well-trained registered nurse.  While these ancillary positions are important for providing basic care like hygeine (bathing and toileting, repositioning) and recording vital signs, they can not substitute for a nursing assessment and physical examination.

That being said – if hospitals increased (doubled or tripled) the number of occupational and physical therapists on staff – patient length of stay, level of debility and hospital complications related to disability and immobility (pneumonias, deep vein thrombosis/ pulmonary embolism, falls, fractures and failure to thrive) would dramatically decrease.

Resources/ References and Additional Reading

The Eckland Effect – this isn’t the first time we touched on this discussion, though previous posts have been focused more on international medical tourism, rather than American hospitals.

Kevin MD blog – I don’t always agree with him, but it’s an excellent blog on American medicine from a physician’s perspective.  If you read only one article from this post, read the article cited above.

Why rating your doctor is bad for your health.  Forbes article, 2013.

Rice, 2015.  Bioethicists say patient-satisfaction surveys could lead to bad medicine. Modern Healthcare, June 4th, 2015.

Dr. Delucia & Dr. Sullivan (2012). “Seven things you may not know about Press Ganey statistics“. Emergency Physicians Monthly.  The pitfalls of Press Ganey.

Robbins, Alexandra (2015).  The problem with satisfied patients.  Atlantic Monthly, April 2015.  An excellent read.  Best quote of the article, “Patients can be very satisfied and dead in an hour.”  Authors noted that the most satisfied patients were most likely to die.

Aiken LH1, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Casbas MT, Tishelman C, Scott A,Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Sjetne IS, Smith HL, Kutney-Lee A.  (2012).  Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United StatesBMJ. 2012 Mar 20;344:e1717. doi: 10.1136/bmj.e1717.

Zgierska, Robago & Miller (2014).  Impact of patient satisfaction ratings on physicians and clinical care.  Patient Preference and Adherence.  Results from a 26 item survey on physician’s attitudes and behaviors regarding patient satisfaction ratings.

This article demonstrates equal analgesia with IV tramadol versus the much stronger opioid, morphine.  (For comparison, hydromorphone (dilaudid) is 10X stronger than morphine).

Grunkemeier, et. al. (2007).  The narcotic bowel syndrome: clinical features, pathophysiology and management.    Clinical gastroenterology and hepatology. 2007 Nov 11. 

Heading South!


It’s been a long hiatus as I’ve replenished Latin American Surgery’s coffers on a couple assignments over the last several months, but I will be back in the Southern hemisphere later this summer, and I am sure we will have a lot to talk about..

It’s an unfortunate reality that travel and travel writing costs money.  That, coupled with the long hours required in my “day job” mean that I do less writing and researching for the blogs than I’d like.  I was able to keep pace initially, but there was a point where it became a question of getting some sleep so I could work and pay my mortgage (and buy groceries) or continuing to churn pages for the blog.

on the runway at Colombia Moda 2104

on the runway at Colombia Moda 2104

After spending a lot of my resources working on a thoracic project this Spring over at the sister site, thoracics.org and working – it’s nice to be back here at Latin American Surgery.com

I’m going back to Medellin soon – and I look forward to taking all my readers with me.  (I wanted to travel to a couple other areas, but frankly, couldn’t afford it).  I won’t be attending Colombia Moda this year – but there is always someone to interview, health topics to talk about, cultural events explore or people and places to photograph.

I have a couple if ideas for some interesting articles, but we’ll have to wait to see how these ideas come together..  I hope it will be worth the wait..

Life in the fast lane: my most recent assignment


No medical tourism or Latin America this winter, but as my latest assignment finishes, it’s been an interesting journey!

New friends, new places, and new experiences!

Co-workers in the PACU

Co-workers in the PACU

I spent the last few months working in the intensive care unit on the trauma service at a large, busy trauma hospital outside of the nation’s capitol.  It wasn’t quite what I expected – for all of my world travels and travel nursing, I still tend to revert back to Chicago Hope in my mind sometimes.. This was a lot more like St. Elsewhere – meaning that as a person from a rural background, I always expect to be somewhat overwhelmed in larger facilities but by the first week, it was surprisingly familiar and kind of homey feeling.  Instead of a cast of thousands, and a sea of unknown faces, it become a daily chorus of ‘good mornings’ to a close-knit group of providers.  (I was there quite a bit, which probably helped).

the view from the call room

the view from the call room

But somethings were definitely different, and it was more than just monuments, politics and presidents, and the “newsworthy” aspect of some of our patients.

just outside the federal district - and a whole different world from cardiac surgery

the federal district – (and a whole different world from cardiac surgery!)

Crash course in major trauma

Running from the police seems to be a frequent requirement for some of our admissions.  Bad jokes aside, where cardiac surgery is planned, detailed and precise, the world of trauma is often chaos, tragedy and upheaval.  A split-second accident, or fall becomes a forever life altering event.  All of the ugly of the world; crime, abuse and assault comes to our door.  Innocence smashed, so often without any sense of rhyme, reason or fairness.  Working here makes me confront my mortality in a way I’ve never had to before.

Doctors in the ICU

Doctors in the ICU

Scheduled chaos

Sure, many people have unexpected heart attacks – even people we tend to think of being ‘low-risk” – and nonsmokers have no guarantee of avoiding a lung cancer diagnosis.  But, for the most part, that’s the beauty and elegance of cardiothoracic surgery – it’s a calculated, orderly world for those of us working in it.   Cardiac surgery feeds the math-loving, logistical and analytical side, while thoracic surgery with its cornucopia and ‘catch-all’ of chest pathophysiology is a never-ending journey of the Jules Verne variety.

As comforting as this can be, it can also become a hindrance if we stay in the familiar for too long.  Sure, it’s nice to have the experience, to know most of the answers, most of the time – but these brief glimpses outside cardiothoracic surgery are crucial for staying engaged, and involved in medicine.  Even if I feel silly or stupid at times, it’s important to continue to learn new things (and dredge up older knowledge that’s been unused for a while).

The good thing is that the essentials, and the principles of caring for people never really change even if the hospital, the staff, the city and the specialty service does.   I don’t know why that surprises me anymore, but it still does.

So now that the assignment is over – I am back home.  I am planning for my next big trip (Asia, this time for a big thoracic conference), catching up on medical journals, and  a bit of continuing education while awaiting my next assignment.

Until then – we’ll get back to our usual programming!

Obamacare, American medicine, medical tourism and what it means for me


I haven’t written in a while because I have been looking for a way to describe what’s been going on in healthcare.

the American healthcare system

the American healthcare system

As a provider

There has been a weird unhappy vibe in the  American hospitals these days.. It’s like nothing I’ve ever felt before in the last 15 years.  There has always been a collective feeling of frustration among providers; but it’s usually sat somewhat untended, like a slow cooker slowly simmering away..  These frustrations were related to our inability to provide the best for all of our patients, our frustration with the broken-ness of a health care system so rife with waste, yet with so little help for our vulnerable populations, and those in dire need.

It was manifested by occasion individual grumbling; during case management meetings, during conversations with faceless insurance companies as we explained yet again, why our patient:

a. really needed XYX treatment and

b. how it was actually more cost-effective in the long run..

But it was isolated for the most part, and the majority of providers still felt like they were helping people – and enjoyed the job satisfaction that went along with that..

It seems like a lot of that has changed over the past year.. I don’t know if it’s fear of coming changes, and the uncertainty that goes along with that..  But most providers are actually in favor of the Affordable Care Act – or the concept, anyway.  It’s something else, maybe the forced implementation of governmental changes like clunky and poorly functioning EMRs, the continual threats of “pay-for-performance” or a cummulative effect of all of the above, but many providers seem to have reached the breaking point in frustration.

For the first time that I can recall, a lot of really excellent physicians and other providers I know are just burned out to the point of complete mental and physical exhaustion.  People I’ve know for a long time, people I consider my mentors, my inspiration are talking about retiring early or leaving the field to do something else entirely.

It’s also the first time that I’ve ever seen doctors, nurses, and others as a collective to seem so broken in spirit.

Patients are people, not check box diagnoses

I am feeling a bit of it myself – a kernel of hopelessness that sparks in my heart.. a sinking feeling when I order a standard medication (but individualized for a specific patient/ condition) and enter in the computer – and receive a message telling me that dosage is not permitted.  A follow-up phone call with the pharmacist continues the charade.. Since it doesn’t fall into a specific category between two mandatory dosing schedules (for diagnoses that differ from what my patient has) then – they don’t know how to categorize it on the computer – and thus my patient can’t have it..  This makes no sense to me, I am following best practices, the current literature and evidence-based practice, but somehow my patient’s condition hasn’t been coded somewhere down in the pharmacy, so they won’t release the medication.  Too scared of the consequences I guess – or too apathetic to care that the medicine is for a real, living, breathing person and not a statistical table somewhere.

– and I argue the realities of this individual scenario but the bureaucratic mentality on the other end of the phone doesn’t care..  How am I supposed to do my job; to care and protect my patient in a system like this?  It’s only going to get worse as the government gets more and more involved in patient care.

What?  My patient isn’t a peg, it’s a person – and if this person doesn’t fit the pre-specified check box doesn’t matter to me  (in this specific instance)- what matters is that my patient keeps his leg (which he may not, if he doesn’t get this medication at the dosage I ordered in consultation with his surgeon).

As the consumer – losing my current plan

At the same time that this brokenness is affecting providers nationwide – I have fallen into the dilemma of many of my readers. As a locum tenems provider, I am self-insured.  My current plan, which was flexible, affordable and provided coverage which suited our needs (low monthly fee, low deductible, reasonable co-pay, and two free wellness checks a year) is being discontinued.  It was also a flexible plan that allowed my family and I to see providers nationally.  So if I was working in Texas for six months, I could see a doctor in Dallas. Or Massachusetts, or California, even back in my home state of Virginia.

Now, I am spending most of my days off on the phone and the internet – looking for a policy that doesn’t limit my coverage by location.  Most of the time, I can’t even find the correct phone numbers to talk to the right people.  The numbers listed online at the marketplace are incorrect, or out of service.  The representatives that I do speak to after being on hold for thirty minutes and routed through a computer automated system are sometimes nice, (often completely indifferent) but can’t answer my questions.

I do know that at a minimum my monthly expenditure for even the bronze “no frills” plans will double, and may even triple.  My deductible will also double or even triple, so in January, I will be literally paying two or three times what I paid last month (December) for a fraction of the services.

Paying a lot, and getting almost nothing in return

All of the new government approved plans are based on my home state – and some even limit coverage to my county only.  Since my county is rural – and the nearest major medical center is actually in a neighboring state, having one of these local plans is like being uninsured.  (Some representatives said they would cover out-of-area “life-threatening emergencies*”, but others weren’t sure).

this should be a significant concern for anyone in rural or limited medical access areas**.  For someone with my geographical needs, it’s become a major nightmare.   Even with the increased costs – I may still not have coverage for the majority of my time (for 2013 for example, I was home for a total of 1 month. In 2014, I was home for four months).  Since I can’t predict where I will be sent – I can’t pick a plan for another state.  Not only that – but even if I knew I was going to be posted to Indiana or somewhere like that – I am not allowed to buy a plan outside of my registered address.

No one knows the answers – and what they do know doesn’t sound good:

After another full day on the phone with representatives for the Healthcare Marketplace and different insurance providers, it looks like the answers are pretty ugly when they even know them.  Most of the representatives had no answers.  One of them even asked me, “Well, do you vote?”  They won’t even give a call back number or extension so that when they “accidentally” disconnect you during another of the “let me transfer you to another representative” spiel, you have to go thru the whole rigmarole all over again.

1.  If you have a plan that does not have out-of-network coverage – consider yourself uninsured if you become injured or have a medical emergency outside of your area (which may be as small as your county.)  The cheapest plan for two people on Blue Cross/Anthem/Blue Shield (my existing company) that offers out of network coverage is 594.00 a month (we paid 213.00 a month before).

2.  None of the plans cover medical tourism – even from companies that previously provided these options.  So, if you live in a county like mine (with no trauma center, and a tiny rural hospital) – you aren’t covered for the neighboring hospital in another area in an emergency.

Not only that – you can’t receive coverage for a non-urgent (elective) procedure for something like a knee replacement at another facility.  My town has one orthopedic surgeon (and he isn’t someone I’d ever chose to go to.)  Now I can’t go to Duke, UVA or another nearby facility – and they won’t pay for me to have the same treatment (at a fraction of the cost somewhere else like Bogotá.)

Here’s a typical example of what I’ve learned after several days/ weeks of reading & talking to representatives –

I’ll pay $5,112 in premiums with a $13,200 deductible with NO coverage of any conditions (except an annual physical and a flu shot) until I’ve put out a total of $18,300 (every year – not a one time deal).   Then the insurance will start to pick up the tab.. This is supposed to be affordable?  For whom?

And while some people will pay less in premiums based on their income level – they still have to come up with the $13,200 deductible.  How the heck is that supposed to work for someone making $30,000 a year?

So now we are calling all the other companies and reading, reading, reading all the fine print.  For now – it looks like I will paying an exorbitant amount for minimal coverage, and will need to rely on medical tourism for any non-urgent but essential treatment that either falls below my high deductible or isn’t even available in my home area.  Luckily, I am pretty healthy (but I am currently working in a trauma unit so I know how quick that can change) – but isn’t the whole point of insurance to prepare for the unexpected?

So what does that mean?

I don’t have the answers for everyon1e.. In fact, I don’t even have them for myself. But it may mean that I am better served by paying my premium and using medical tourism for all of my other (non-emergency) health care needs.  After all, $13,199.99 buys a lot of care in Colombia, Mexico and many of the other places I’ve researched and written about.

*And, if you survive – you may have to argue with some bureaucrat whether your illness was actually life-threatening or not.. I mean, it can always be argued that “how serious was it, really, if you made it home alive?”

** Limited access areas may include major cities.  For example, the city of Las Vegas has a very limited number of specialists.

Ebola and medical tourism


 

biohazard

There’s a new editorial over at the IMJT on Ebola, medical tourists and the medical travel industry.  In the article, “Ebola: a hot topic for the next medical tourism event?” by Ian Youngman, he explores the potential pitfalls from medical tourists who are seeking treatment overseas.  As an insurance expert, who makes his living by preparing for “What if?” scenarios, the author offers valuable insight on a topic that has provoked wide speculation and fear-mongering among the general media.

Mr. Youngman explores current medical screening at airports, the impact on current medical tourists as well as the potential impact of a global pandemic/panic on the medical tourism industry.  Mr. Youngman urges for a clear, reasoned and cohesive discussion and response from leaders in the medical tourism industry.

passport w money

Death of young patient raises questions of safety

IN other news, the BBC is reporting on the recent death of a 24 year old British medical tourist.  While the BBC article offers few details on the patient who died during a liposuction procedure in Thailand, a more in-depth report from the UK Mail reports that the woman stopped breathing after receiving anesthesia at the private medical clinic.  The article reports that this was a repeat visit for the patient, who had previously undergone another plastic surgery procedure at the clinic.

Now questions are being raised about the doctor’s qualifications to perform the procedure, as well as the lack of availability of life-saving medical equipment at the medical clinic.  The doctor at the clinic, Dr. Sombob Saensiri has been arrested while this case is being investigated.

Note: There are conflicting reports regarding the exact circumstances of this patient’s death.  An Asian story reports that the patient had returned after a recent surgery with complaints of a developing infection.

Related posts:  Plastic surgery safety archives

Plastic surgery safety: Know before you go radio interview

Is your cosmetic surgeon really even a surgeon?

Liposuction in a Myrtle Beach apartment

 

Story updates: Be care my friends, and Mexicali


It may have been a while since my last post, but I haven’t been idle.  In the last few weeks, I’ve traveled to Mexicali to check in, have some dental work done as well as attending professional conferences and working on my next locum tenens assignment.

Mexicali sign

First – some updates on Mexicali:

I don’t have photos to accompany these updates, but the new emergency department at Hospital General de Mexicali is big, beautiful and open for business.

I also met with both Carlo Bonfante and Dr. Carlos Ochoa to talk about some of the upcoming improvements to the Hospital de la Familia.  Nothing has been completed yet, but they have some big plans to improve services for local residents and medical tourists alike.  I’ll write more when I have the rest of the details.

I also had a chance to catch up with Dr. Horatio Ham (Bariatric surgeon) and Alejandro Ballestereos (Anesthesia).  Dr. Ham reports that Dr. Abril’s radio show has been revived as an internet radio program.

Sadly, Dr. Alberto Aceves, a well-known Mexicali bariatric surgeon died in a private plane crash back in June.

 

My Mexicali dentist: Dr. Luis Israel Quintana

 

Dr. Israel Quintana with one of his American patients

I don’t have dental insurance but I have a history of bruxism (grinding my teeth) so I am pretty fanatical about taking care of my teeth.  I’ve written before about the difficulties in reporting on dental tourism, as well as my previous experiences with Dr. Quintana, so when my dentist at my last locum assignment gave me a work estimate for almost eight thousand dollars!*,  I knew I needed to plan a trip to Mexicali before my next assignment.

photo (12)

I ended up having 12 fillings (no cavities but plenty of damage from grinding), as well as a root canal and a partial crown.  He also made me a new night guard since my old one obviously wasn’t preventing ongoing damage.  While several days in the dentist’s chair was no picnic, I had minimal discomfort and little damage to my wallet.  All told, the bill was less than 1300.  I still need some additional work, but the majority of my teeth are now taken care of.  I don’t have to worry about having a dental emergency while I am working a contract.

Dr. Quintana also reminded me that his office accepts most American insurance plans – with no co-pays or other payment required.

* My initial estimate in Dallas only covered work on four teeth.  The additional surface fillings were not included.

 

Story Update: Please be careful my friends!

baby

Baby making and Planet Hospital: Lots of money and no baby

Some readers may remember the sad story that I received from a childless couple last year.  The couple had contracted with Planet Hospital for surrogacy services after receiving devastating news on the birth of their only child.  The child had been born with a terminal disease (the child later died).  The couple also learned that due to a rare (and previously undetected) genetic condition, it was likely that any future children would also contract this disease.   The couple had started a blog to document their journey into surrogacy, but after several months, it devolved into a story of deception, with the couple being defrauded of thousands and thousands of dollars by one of Planet Hospital’s contracted facilities.

Recently, Planet Hospital and their surrogacy scams made the front page of the print edition of The New York Times.  The story by Tamar Lewin rips the mask off of Rudy Rupak, the shyster I told you about previously.  (I also wrote about his shady transplant tourism practices at the Examiner.com back in 2012).

Surprisingly, the “Medical Travel Quality Alliance,” a branch of the MTA that advocates for “self-regulation” of the medical tourism industry only seems to partially condemn the practice of tourism surrogacy and Rudy Rupak in their latest publications and newsletter.  Of course, anyone with even a few years experience covering medical tourism remembers that Rudy Rupak was the poster child for the medical tourism industry for many years, even after the first rumors of shady business practices emerged in 2010.  Mr. Rupak has since filed for bankrupcy, but knowing of some of the deals Planet Hospital was involved in, I think he should be in prison.

The second time is the charm!


My apologies to my dear readers for this late post.  I usually write about surgery and surgeons, but occasionally drift into other things..   I visited the new Clinica de Medellin facility in late July, but didn’t have time to write about it before now.

Dermatology

Just before travelling to Medellin to cover Colombia Moda and the ALAT conference, I developed a dermatology problem.  As my American readers know, getting an appointment with a specialist in the USA can often take several months.  In fact, I was given an appointment in early July for later this fall.

However, during my stay in Medellin, my dermatology condition continued, so I decided to give the Clinica de Medellin another try.  I had heard rumors about some re-organization of the medical travel division so I decided to use this as an opportunity to verify those rumors.  I am very pleased to report that after sending my initial email to the Clinica de Medellin requesting a consultation with a dermatologist that I received a reply that same day (from Adriana Henao – email: ahenao@correo.clinicamedellin.com.co).

The coördinator called me back to confirm my availability and to ask if I would be willing to go to a clinic at one of the other Clinica de Medellin campuses.   (She also asked about my level of Spanish fluency so she could direct me to the appropriate physician.)

By the next day, an appointment had been scheduled for the end of the week.

New clinic

The clinic was so new that when I gave the address to the cab driver, he merely raised an eyebrow before starting the car.  On arrival, he expressed surprise – and said, “This wasn’t there before.”  The Clinica de Medellin Sede Occidental is divided into a hospital and an outpatient clinic area.  The smell of fresh paint was still evident in the immaculate, and sparkling facility.

The officer at the information desk had me personally escorted to the correct clinic when he heard my American accent (and hesitant Spanish).  I waited about fifteen minutes before being escorted into the private office of Dra. Sara Gonzalez Trujillo.  She was very friendly and pleasant.  We reviewed my past medical history and current treatments before she examined me.  She explained the condition in-depth before writing several prescriptions and requesting a lab test.

She provided me with a full copy of my medical records to take to my upcoming appointment and gave me her contact information.

Total cost of consultation: less than $50.00

 

Lab:

The labs cost about 25.00.  After a quick lab draw, I was given a lab slip with my record number on it.  I later received an email with my login to access my results.  Since I was headed back to the states, I emailed my results to Dr. Gonzalez, who called me with additional treatment recommendations and an explanation of the results.

Since seeing Dr. Gonzalez, I have been using the medications as prescribed – and my condition has improved dramatically.

Follow-up:

I have been taking the medications as prescribed and it is getting better.  I will email Dr. Gonzalez after seeing the dermatologist here to give her an update.

 

To make an appointment with Clinica Medellin, click here.