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.

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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

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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!

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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

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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!)

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.

Crazy days!


It’s been a couple crazy, busy days here in Medellin.  I have a bit of a backlog of posts – from a day learning to finger crochet in a group crochet class, the festival of flowers, a visit to Clinica Medellin Occidente and the ALAT conference.  It will take me a little while to post everything before heading home in just a few short days.

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The ALAT conference was fantastic.  In addition to numerous wonderful, learned speakers from all over Latin America, it was a great chance to connect with innovative thoracic surgeons from practices all around the world.  We also re-connected with surgeons we’ve interviewed in the past – to hear what they have been doing since my last visit.

One of these surgeons was Dr. Andres Jimenez at Fundacion Santa Fe de Bogotá (SFdeB).  As astute readers of the Bogotá books may remember, our encounters haven’t always been as collegial as they could have been.   However, he did grant me an interview, and permit my ingress into the operating room.  To my surprise, I found that while he was a hesitant interviewee, he was also a promising young surgeon.

With that in mind, I re-connected with Dr. Jimenez briefly to ask about the program.  Dr. Jimenez reports that they have started a lung transplant program and recently performed his first lung transplant at SFdeB.

Dr. Carlos Carvajal (right)

Dr. Carlos Carvajal (right)

Dr. Carlos Carvajal, who was a thoracic surgery fellow when we first interviewed him – is now a practicing thoracic surgeon at Hospital Santa Clara in downtown Bogotá.

Dr. Ricardo Buitrago continues his work in robotic surgery at Clinica de Marly.  Caught up with Dr. Luis Torres, the young and charming thoracic surgeon from Clinica Palermo.

But the biggest surprise at all – was the twinkling brown eyes of Dr. Cristian Anuz Martinez.  (The twinkling brown eyes above a surgical mask are all I remembered from my 2012 trip to the operating room with Dr. Frnando Bello in Santa Cruz, Bolivia).

with Dr. Cristian Anuz Martinez

with Dr. Cristian Anuz Martinez

We spent some time over coffee talking about the current state of cardiothoracic surgery in Bolivia, his private practice and his colleagues.

The conference itself was phenomenal – the amount and range of topics covered – from sleep medicine, tuberculosis, critical care medicine and pulmonology in addition to thoracic surgery.

The Festival of Flowers

The festival of flowers, one of the largest events in Medellin also started August 1st.  The event which is expected to draw 19,000 visitors to Medellin this year – celebrates the floral industry of Antioquia with ten days of events.  The events are staggered through out the city and include musical concerts, singing contests, parades, flora displays, children’s events and arts.

 

 

Festival of Flowers displays in Plaza Mayor

Festival of Flowers displays in Plaza Mayor

Tomorrow: Clinica de Medellin – Second time is the charm!

Street of Dreams – Calle 49


el centro map with shopping districts outlined

el centro map with shopping districts outlined -high resolution

During Colombia Moda, I met several American business people looking for more information about fabric and textiles than the small booths could provide.  Many of them wanted to go out and see the fabrics, some of the shops and the factories but no one thought to take them to see any of these things.  All of the people I met were first-time visitors to Medellin (and some may never be back).  I can’t help with factory tours (I’d like to see those myself) but I do live nearby, so I thought maybe I could help provide some information for future visitors to this fair city. Since I thought wandering around El Centro as a first-time visitor without a guide might be a little daunting, this post might help people feel more comfortable. So I spent all day Saturday wandering around the district  – to take pictures and be able to provide more information to people interested in finding fabrics and materials while in Medellin.

A note about Fabric shopping in Medellin: If you are looking for super cheap – crazy bargains, you probably won’t find them here.  But you will find a huge array of all kinds of fabric – most of it made right here in the city.  For someone like myself who is sometimes (okay, frequently) frustrated by the lack of floor space given to apparel fabrics in the United States – (where it seems like 90% of fabric is for quilting and such), it’s still a bonanza.

Also, while it isn’t made in the USA (which is increasingly rare, I know) – I still feel a bit of loyalty towards buying locally sourced items – even if Medellin is that source. Still interested?  Good.

How to get here – the real Medellin

The best fabric and general shopping in  Medellin isn’t in the fancy malls of El Poblado and Enviagado.  It’s in the busy, teeming streets of El Centro.  El Centro is also where many of the most famous tourist attractions are, so if you are interested in seeing some of the famous architecture, the Botero collection (at the Museo de Antioquia) – you can do that too.  El Poblado and Enviagado are the rich, sanitized versions of Medellin – so if you have friends that aren’t interested in shopping but would like to see more of Medellin – this is a trip to take them on…

1.  Taxi – if you want to take a taxi, ask him to take you to the Plaza Botero.  It’s a few streets away from your destination, but it’s a nice central space – especially good if you are meeting friends or other visitors.

2.  Metro Train –  the metro train is cheap, clean and quite reliable.  It’s also a good way to see a bit of the city.  Take the (blue line) train to either Parque Berrio station or the San Antonio station.  San Antonio is closer to shopping, but Parque Berrio puts you right at the Plaza.  (For more information about the Metro, see this helpful article at Medellin Living).

Get a map –  Now, I know this is a digital age, but sometimes a paper map is just easier.. Safer too because it makes you less of a target for thieves who prey on upscale tourists for all of our fancy electronic devices.

tourist kiosk with maps

tourist kiosk with maps

There are several of these kiosks located in/ around Plaza Botero and around the Parque Berrio station.  Just ask for a map “Mapa, por favor” and they will be happy to provide you with a free map of Medellin.  I used this same map for reference for the shopping areas, to make it easy for visitors to recognize where to go.

Navigating the city Places like Medellin and Bogotá are particularly easy to navigate because streets use numbers, not names for the most part.  (Once you get used to the system – our system of street naming in the USA seems needlessly confusing.) Everything is basically on a grid – Calles run in one direction and are abbreviated as Cll.  Carreras run in a perpendicular direction and are often abbreviated as Cr. It makes locating a business very easy.  For example, my favorite fabric store in Medellin is Textiles El Faison – and their address is Calle 49 #53 – 101.  This means that they are located on Calle 49, about 101 meters from the cross-street, Carerra 53.

Now that you are here – with your map Walk south towards Calle 49.  (To orient yourself – remember that Medellin is set in the foothills.  If you start walking uphill, you are heading East (the wrong direction) – towards the financial center of Medellin (near where I usually stay). On Calle 49 – turn West (or downwards on a very slight grade)  The next several streets will be crammed with shops filled with all kinds of sewing related items – thread stores, fabric stores, sewing machine repair etc.

Sewing machine repair and sales

Sewing machine repair and sales

Many of the shops look tiny compared to JoAnn’s or the big craft stores you may be used to.  Sometimes they are tiny – but sometimes, it’s just the entrance to a larger indoor mall.

Entrance to one of the small fabric markets

Entrance to one of the small fabric markets

Fabric

Now, the fabric stores line Calle 49 and many of the cross-streets.. But sometimes notions can be a bit trickier to track down.  A lot of tiny shops sell just one product – like elastic or ribbon trims, buttons and the like.

small shop in an indoor fabric mini-mall selling thread

small shop in an indoor fabric mini-mall (Shanghai) off calle 49 selling thread

elastics and trims

elastics and trims

As I mentioned before, my favorite fabric store from my wandering on Saturday – is Textiles El Faison.  It’s a big store, and not quite as claustrophobic feeling as some of the smaller shops.  (When the shops are crowded, and the fabric piled to the ceilings, I get a bit closed in feeling in some of the smaller shops..) Not that this would prevent me – if I saw ‘the fabric’ there.

many shops are small but piled high with fabric

many shops are small but piled high with fabric

Lots of great stuff- but limited luggage space, so I move on to the next ones.

as you can see - the width of the store is pretty narrow, maybe 12 feet in total. Now add ten customers and I get a bit 'crowded' feeling

as you can see – the width of the store is pretty narrow, maybe 12 feet in total. Now add ten customers and I get a bit ‘crowded’ feeling

But for general browsing, or to see fabric in a shop more like what most of us are used to – Textiles El Faison is a well-lit two story shop.   Jaime Sosa is the manager there – and he is very nice and helpful.  My photos are a bit blurry because I was relying on my small phone (an older model) because I don’t like lugging my fancy Nikon down to El Centro).

Jaiime Sosa

Jaiime Sosa

Here’s the address for people who want to skip the adventures and go straight to his shop:

Textiles El Faison Calle 49 No 53 – 101 Medellin

displays piled high with fabric

displays piled high with fabric

But that’s not the only great place.. I really liked Portofino Textil too.. It’s located on the ground floor of a little textile mall.  (It’s a very interesting mall – about half the shops sell custom printed fabrics).

One of the malls for custom printed fabric

One of the malls for custom printed fabric

I was trying to cover a lot of ground, so I didn’t stop in and get all the details on custom printing – even though I saw little storefronts printing the fabric during my wandering.  (Maybe I will get a chance to go back and ask some questions.)  Custom may be the wrong word since most of it seems to be more like “Small lot pop prints” but at one shop, I did see a customer hand over a jump drive filled with images for printing).  But some of the other shops / kiosks didn’t look to have computers just their own style of pop prints (justin beiber, popular artists, other cool designs).

small storefront.. the lady in the blue tank is printing custom fabric

small storefront.. the lady in the blue tank is printing custom fabric

Portofino IMG_1881 Portofino has more of a warehouse feel  –  and a two meter minimum.  Fabric is priced by the kilogram.  I couldn’t resist one of the fabrics there – and my two meters of this lightweight lycra was 0.7kg in total.  For an example on prices – the tag on the bolt said 45,000 per kilogram but advertised a discount.. After the discount, my fabric total 27,156.  tax added a bit – for a total of 28,350 for my two meters of a 60 inch (or there about width).   According to today’s exchange rate – that’s about $15.35 (or around 7.50 a yard since a meter is a couple of inches more.)  So, like I said – not a crazy, amazing deal – except that I love the fabric, it was made right here, and it’s certainly not something I’d find at Hancocks or Joanns (if we even had one in my town). It’s actually located under another fabric store but I found it to have better selection, and salespeople that were very helpful and friendly. (Fabien was particularly nice – and patient with my limited Spanish).

I just couldn't resist..

I just couldn’t resist..

Portfino Textil #162  Carrera 53 No. 49 – 68 Medellin There were quite a few other shops – so you will just have to make you way down Calle 49 and find your own favorites. Patterns Pattern magazines can be especially hard to find – but when you do find them – they are a great deal.. Most pattern books contain anywhere from 20 to 200 patterns.  It depends on the magazine.  My favorites are Bianca, Quili and the more simply named Patrones.  Bianca has a lot of the patterns that are hard to find in the United States – like an extended variety of swimwear, lingerie and exercise apparel.  They also have a great assortment of patterns made for the new stretchy fabrics; lycra blends and modal.

Magazines containing 10 - 40 different patterns

Magazines containing 10 – 40 different patterns

Patrones is a grand brand because it has copies of a lot of the designs by major labels.  Want to wear your own Dolce & Gabbana? Then patrones is the magazine for you.  Sometimes you can find the magazines at larger newsstands or bookstores like Panoamericano.  Some of the patterns in Patrones are pretty intricate and instructions are limited (and in Spanish) but at 4,000 to 10,000 pesos (2.25 to about 6 dollars) a book – if you are an experienced sewer it is still quite the find.) patterns2 Now – for patterns on Calle 49 – the best place to go is – this little shop..

the place to buy patterns

the place to buy patterns Calle 49 #53 – 14

The place is tiny, so you have to ask to see the pattern books (or point, if necessary.)  They don’t have long aisles to browse like some of the bigger bookstores.  But the owner is very sweet – and they have a large array of titles available.

some of the patterns available at this small shop

some of the patterns available at this small shop

Yarns

Now, Medellin has that ‘perpetual spring’ climate we have been talking about, so I didn’t find as many places offering the bulky and superbulky yarns that I love.  Quite a few thread stores offered the smaller crochet threads and yarns similar to Lily’s Sugar N’ Cream but since I am on a superbulky yarn kick – I will keep looking..   I did see a couple, but shame on me because I didn’t write down exact addresses or take pictures (but since one of them is on a street close to home, I may venture out later this week – when I’ve exhausted my current supply and get some pics.)

yarns

yarns

Now before you head out for your shopping adventure  – review a few things to make your shopping more enjoyable and safe.  

In Medellin – alone or not quite ready to venture into El Centro by yourself?

I am always up and willing to lend a hand – if I am in the city.  (It’s a good guess if I am blogging about Medellin, then you can find me here.)  You can always call me/ text me at 301-706-3929 (If I am not in Colombia, I won’t answer) or email me at k.eckland@gmail.com I’d be happy to arrange to get together for a day tour of the shopping areas.  We can check out museums, eat some tasty street food, buy local produce, window shop – or hunt down that one special piece of fabric you’ve been waiting for..

If you don’t catch me on this trip – I’ll be back.. I’ll definitely be back for Colombia Moda 2015, so if you come a few days early (in July) we can have some fun.

Under Une Canal


Now that it’s over, I can say it’s been another wonderful week at Colombia Moda:  I met Miss Colombia (she seems sweet) and took a picture of the President of the Republic..

santos

 

Didn’t get to meet President Santos, but maybe someday.  (I promise not to talk politics.)

Miss Colombia, Paula Vega of Atlantico region (Barranquilla)

Miss Colombia, Paula Vega of Atlantico region (Barranquilla)

Luis Martin

I even say hello to one of the models (since we were heading down the hallway) and we had a nice conversation.  It’s funny – I guess I always get intimidated by people taller than me, etc.. and I guess sometimes the expectation is just that models aren’t that nice.. But nothing could be farther from the truth.  Luis Martin – a local model from a neighborhood here in Medellin was very nice, sweet and pleasant.  It must be weird for him – I mean, his face is really familiar to me – after two years of seeing it thru my lens..

 

Luis Martin, model and a nice kid

Luis Martin, model and a nice kid

I wish we hadn’t be racing down a hallway – I would have liked to get a photo because he looks better in his own clothes..(Better sense of style).  Anyway, I thought it was nice of him to make conversation with a random gringa.. (We talked about Virginia of all things).  So – I wish him the best luck, and hope he makes the cover of Vogue one of these days.

Last day of Moda

Yesterday was the last day at Colombia Moda, and I don’t have enough nice things to say about all of the photographers and videographers there.  They are the reason I came back this year.  Instead of treating me as an outsider, they have always been welcoming and kind.

the orange backpack shows where I sit during the runways

the orange backpack shows where I sit during the runways

This year it was great to be back and see old friends like Stiven and Fredrico.  I didn’t see some of the wonderful people from last year, like Estaban who kept me in laughter and good humor even when every bone in my body ached from long hours in contorted positions.

Always great to see Stiven

Always great to see Stiven

This year, I have to give special thanks and words of gratitude to the videographers of Une Canal (Channel One) of Medellin.  Une Canal is the public television station for the city and during fashion week, they record live from the runway so it can be seen on big screens outside (so people without access to the runway itself can see it as it happens.)  That means they are at every single catwalk – always smiling, joking and being friendly even while setting up cameras, untangling cables etc…

The Videographers of Une Canal

That’s the handsome Juan Carlos, the charming Danilo Gallego and the ever kind Hernan.  For the entire fashion week, they allowed (and encouraged) me to take one of the plum floor positions beneath their cameras – in the dead center position of the runway.

Danilo Gallego of Une Canal

Danilo Gallego of Une Canal

People with better equipment than my starter Nikon can take sitting positions and even rise up on the press bleachers, but without this prime spot on the floor – I’d have been toast.  I never would have been able to capture 1/10th of the images that I’ve used in my recent articles.

I’d love to do a real (in-depth) articles on the videographers and photographers here at Moda, but it looks like I’ve already been scooped which I think it really cool.  Yesterday, the reporter from Une canal turned the tables of the videographers and interviewed them before one of the runways.

Danilo is interviewed for a segment on Une Canal

Danilo is interviewed for a segment on Une Canal

I am hoping to see Juan Carlos, Danilo and Stiven at some future events here in Medellin before I leave in August..  If not – I’ll see you next year!

Colombia Moda and Examiner.com


leonisa26

Colombia Moda is over, and I am exhausted..  Sorting through several thousands of photos while writing articles about fashion collections has to be done in as timely a manner as possible, which doesn’t leave much time for sleep!

The good thing about writing for the Examiner.com is that they don’t give me any deadlines or article requirements.  I write about what I want – and submit it as fast as I can.  But there is no editor to nag me for specific lines so I feel free to focus on writing about the fashion that I like, or that I think is important.

I don’t write about Gef France because I think it’s boring.  I do cover Studio F if only because it is so immensely popular here – though I prefer the more daring and creative (and often smaller) lines.

But while I continue to gulp coffee and sort photos (even though my eyes are so tired I’m not sure if the photo is blurry or it’s just me, I wanted to give my readers links to my most recent articles (and photos) at Examiner.com

Lenonisa Runway

Agua Bandita and Onda de Mar – the Agua bandita photos are disappointing – the lighting was terrible.  (I thought that was me too – but then several photographers grumbled about substandard lighting and showed me their photos..)  They even called out during the runway to get better light..

Ipanema by Paradizia

Nonstop Runway: Faride Ramos

Nonstop Runway designer trio

Beverly Hills by Carmen Belissa

Studio F

I also talked to some Americans I met at the expo.  They seemed a little overwhelmed and lost – as they looked for textile manufacturers to produce fabric samples for use in their designs.  I bet they would have liked my textile/ fabric city tour idea.

I have a couple of articles I am still working on – and then it will be back to normal here at Latin American Surgery.  The ALAT conference (thoracic surgeons from all over Latin America) will be here in Medellin next week, so we will be back to some surgical topics soon.

Crochet, crafts and traditional arts in Colombia


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One of my latest crochet projects – American flag scarf

Since learning some basic crochet (very basic) from my (very patient) roommate, Iris in Cartagena, I have continued to crochet.  I find it’s an excellent activity for all the waiting that goes along with travel.  I crochet in the car when we drive from assignment to assignment.

Hat and scarf

Hat and scarf

I need to learn some new stitches but I am getting a lot of practice with my basic stitch.   I have switched to a very large crochet hook (15mm or an “S” hook) and cuddly soft bulky yarns (types 5 and 6).  It makes it easier to see when I make errors and it works up quickly.  Plus, the yarn is so plush and soft feeling.

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I made a couple things for my friend’s new baby in Bogota.

My tiny model wearing the first hat I made

My tiny model wearing the first hat I made

 

So when I went to see her – I spent an afternoon in Chapinero checking out the yarn situation.  I was in a large bookstore in Chapinero when I met Ligia Morena Vega.  I was looking at some new sewing pattern magazines (since I am a sewer who crochets) and she was buying crochet magazines.

So I asked her if she knew where I could find some yarns in the neighborhood.. Not only did she know – she took me with her to meet the proprietors and learn more about the crafting classes offered.

That’s one of the things I’ve noticed in Colombia – pull out a crochet hook or start asking about crochet, and instantly you make friends.  I was on the bus to the airport in Rionegro when this happened the first time.  (It’s a long bus ride to Medellin, so I pulled out my crochet..)  Very quickly I made friends with several women  on the bus as we talked crochet.

 

with Ligia, shopping for yarn in Bogota

with Ligia, shopping for yarn in Bogota

Ligia crochets professionally.  She was buying magazines to use as catalogs for customers who want custom-made clothing, including formal style and elegant ankle length dresses.    Ligia’s husband runs a coffee and chocolate shop nearby on Calle 57 and Carrera 16 – so I will have to stop in and visit on my next trip to Bogotá (and get some pictures of her latest crochet creations too!)

We walked a few blocks to a short street, Calle 56 (with Carrera 13) where there are several stores selling a variety of yarns.  While there was a lot of Red Heart and Lion Brand (especially the Homespun USA – my favorite, at home), I was able to find some beautiful yarns that are made right in Bogotá.

I fell in love with some of the yarns from Lanas Arvi.

Lanas Arvi

One of the yarns is a beautiful tan and turquoise mix..

some of my new Colombian yarn.. with my gigantic crochet hook.

some of my new Colombian yarn.. with my gigantic crochet hook.

It’s destined to be a scarf.. This time I might even keep it.  So far, I have gifted away everything I’ve made with the exception of a camera lens bag..

Several of the shops offer crochet and knitting classes.  Todos Lanas and Almacen Mutifibras even print the class schedules on the back of their receipts.

The prices are about the same as Wal-mart (since JoAnn’s and some of the craft stores mark up the yarns quite a bit.)  I also bought two small skeins of a lovely dark purple to make a gift for a friend – and two small skeins of a variegated yarn with the bright yellow, blue and red of the Colombian flag..   All of the other yellow/ blue / red yarns were sold out just about everywhere we looked.  Several owners told us that between Colombian Independence Day (today) and the World Cup – they haven’t been able to keep any of the patriotic colors in stock for the last month.

Embajada de la Coca

During my visit to Bogotá – we sampled some delicious Andean style cuisine at the Embajada de la Coca.  (To read my article on the experience, click here.)

welcome to Embajada de la Coca

welcome to Embajada de la Coca

Meet the artist: Isabella Klein

The next day, I spent the afternoon visiting the Klein family.  If the name sounds familiar – it’s because one the sons, Albert Klein, PharmD is a close friend and my co-writer on several of the Hidden Gem titles.  (The Kleins are a talented family; the younger son, Alex plays piano with the Bogotá Philharmonic Orchestra and the daughter, A. J. is an occasional model.)

(For more about the Bogotá Philharmonic – read this post by a blogger from the University of Texas at Austin.)

His mother, Isabella works as a professional translator as well as teaching English.  But that’s just her job – art is her life.  She works in multiple platforms – mixed media, paintings, photography and artisan crafts.

On today’s visit – we talked about some of her craft work as well as the large craft fairs here in Colombia.  We discussed my ideas for ‘artisan craft style tours‘ where visitors could learn more about the crafting process and Indigenous cultures of Colombia.

She showed me some of her more recent projects – making decorative wooden boxes.  Instead of using the traditional Colombian patterns, she designs her own.

Some of the wooden boxes designed by Isabella Klein

Some of the wooden boxes designed by Isabella Klein

Her mixed media paints are arresting to look at.  Unfortunately, I was too busy admiring them to take any pictures..

But I do have a couple more pictures of the boxes.

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I think the next box is just fantastic.. It’s a design that just catches the eye.  I like the combination of blues.

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For a portfolio of some of Isabella Klein’s work – click here.

After too few days – it was time to say goodbye to my Bogota friends (new and old) and head back to Medellin to prepare for Colombia Moda..

with dear friends, Camila and Flavita.

with dear friends, Camila and Flavita.

Of course – it wasn’t all bad – these lovely ladies were at the airport in Rionegro to greet me..  The Aguardiente Girls!!

Welcome to Medellin!

Welcome to Medellin!

 

The Eckland Effect


It’s been a while since I’ve written – but sometimes between maintaining two blogs, a series on health for Examiner.com, answering emails from potential medical tourists, traveling and working long hours on assignment – I sometimes feel a bit like a candle burning at both ends.

But I am happy to report – that I recently completed my latest assignment and am back home in my native Virginia (for a few days) before heading back to Colombia.

I’ll spend the next couple days getting ready; contacting potential interviewees, researching articles,

Colombia flag

The downside of frequent extended travel is the piling up of all the inevitable errands and hassles.  Sometimes its just stuff like sorting through a couple of months of mail, but other times it’s paying property taxes (in person because I live in a small town) or renewing my driver’s license (now good until 2022!)

But now that we’re all caught up – we can get back to work (and writing!)

The Profiteer Model

Several interesting articles and posts have been written about medical tourism lately. We will talk about some of the other issues in future posts but today, I wanted to share this article by Stacy Hsu from the Tampai Times.  This article takes issue with the “Profiteer’ model of many so-called “Medical Tourism” hospitals and clinics.

VIP Medicine

As we’ve mentioned in previous posts, the idea of exclusive hospitals designed solely for the wealthy foreigner is both a noxious and popular one.  To many people, the idea of a resort-like or decadent atmosphere that caters to the every whim of the monied tourist or “Club Medicine” is a charmed one. VIP/ Executive health programs thrive around the world – from the hallowed halls of academic medicine like  John Hopkins, the Cleveland Clinic to the Planet Hospital branded facilities around the world.

Much of the medical tourism industry has been based on this context.  Programs are advertised on the basis of desirable location, gourmet cuisine menus, luxurious accommodations and nightly turn down service; not surgical skill or publishable clinical outcomes.  No one hypes a short-length of stay or low re-admission rate when catered meals, high-speed internet and cable television are part of the selling points.

money pills

VIP versus Concierge: Not entirely the same

Don’t want to travel?  But want your health care needs catered to?  There are whole branches of primary care practices (ie. the “Royal Pains” practices) that are now based on this principle.  On the surface, it doesn’t sound like much – patients pay extra money to have their doctor actually give them the time and attention they deserve* (during visits, phone calls and emails) but in reality, it can very quickly turn into something else as this ‘bonus’ pay approach changes the patient – provider relationship.

But “concierge medicine” as it is called in primary care medicine is a far cry from the VIP and Executive programs offered as part of medical tourism programs.  In concierge medicine, patients still have a long-term and established relationship with their physician – and it is this relationship that can actually improve health care outcomes along with patient satisfaction.  That’s because having more time with your family doctor means that s/he will spend more time answering questions and explaining care to patients. In turn, the patient is more likely to fill their prescriptions, take their medications and otherwise follow this doctor’s instructions.

*Instead of delegating more personalized care to people like me; the nurse practitioner (NP) or physician assistant (PA) which is more commonly done in standard medical offices.

But is ego-tickling medicine good for your health? 

According to the scant amount of existing research, the answer is often no, when we are talking about short-term patient-provider relationships like the one-day executive physical or the spa style surgery service.  In fact, patients often receive unnecessary and even potentially harmful, expensive tests and procedures (like the famed “Full body CT”).

I liken it to “The emperor’s new clothes” syndrome, where the patient is seen more as a consumer / purchaser of goods than a person seeking health services.  In this scenario, the healthcare provider is more concerned with keeping the customer satisfied than explaining why many of these tests and procedures are not necessary or may even be harmful.

Remember: First do no harm!

The customer is always right!

These contradictory objectives may become a conflict when the needed health advice isn’t what the patient wants to hear*.

Not even the humble fools dare tell the emperor the truth.

Not even the humble fools dare tell the emperor the truth.

The ‘Eckland Effect’

But it looks like this may be changing.  Several new research projects as well as recent articles are showing a move towards data collection and measurement of objective outcomes in regards to medical tourism.  Instead of patient satisfaction surveys, researchers are asking about the incidence of complications.

Other organizations are talking about implementing more accountability, transparency and formal accreditation for medical tourism programs and facilities.  Of course, accreditation is only as valuable as the organization offering it.

*Certainly this dynamic was at play in the care and death of pop star Michael Jackson under the care of Dr. Conrad Murray.

Additional articles for interested readers:

Al-Lamki, L. (2011).  Medical Tourism: Beneficence or maleficence? SQU Med J Nov 2011, 11(4): 444-447.  This is an excellent editorial that offers a concise overview of many of the ethical issues we have discussed here at Latin American Surgery including brain drain, transplant tourism, quality assurance, continuity-of-care and the overall impact of medical tourism on local communities.

In a related article, ” A European perspective on medical tourism: the need for a knowledge base” Carrera & Lunt (2010) argued for the urgent need for record-keeping  and statistical data collection in the medical tourism industry.  While this article is not available for free on-line, a related presentation by the authors is available here.

For readers interested in learning more about the correlation between patient satisfaction and clinical outcomes, I encourage you to read the works of JJ Fenton.

Fenton JJ, Jerant AF, Bertakis KD, Franks P. (2012).  The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality.  Arch Intern Med. 2012 Mar 12;172(5):405-11. doi: 10.1001/archinternmed.2011.1662. Epub 2012 Feb 13.  This study in particular is a must read:  in this study, Fenton et al. followed a group of more than 36,000 patients and found that high patient satisfaction was correlated with increased health costs, greater rates of inpatient admissions to the hospital and a higher overall mortality.  Fenton et al have also conducted several additional studies examining the relationship between patient satisfaction and quality of care.  The findings of these study question the utility of new programs linking patient satisfaction with provider compensation (ie. pay-for-performance) and question the commonly held beliefs that patient satisfaction = high quality care.  It may be that the best care comes at a price:  unhappy patients.  But then again, isn’t not a popularity contest – or at least, it shouldn’t be.

Medscape subscribers can also view a series of articles on this topic including an inteview with Dr. Fenton on his body of work.  Medscape has a series of articles examining both sides of the argument linking patient satisfaction with provider compensation.

Patient satisfaction is overrated – an excellent editorial about the cost to patients (in health and money) related to demands for ‘patient satisfaction”.

Days of Summer


cautionary tale for my on-line friends in another botched surgery case in Florida.

Let the buyer beware:

In the most recent case, four individuals have been arrested for impersonating surgeons and operating an unlicensed surgery clinic. According to the media reports, only one of the four people charged is a licensed physician, nurse or other trained healthcare provider – but that didn’t stop them from performing major operations such as liposuction and abdominoplasty procedures on their unknowing patients.  While Dr. William Marrocco* was the doctor on record for the clinic – patients report that he wasn’t the one operating!

scalpel

Unlike many of the ‘chop shops” we’ve written about that take place in garages, motels and private ‘parties’, in this scenario, unwary consumers were duped by a savvy group of criminals who had owned and operated the “Health and Beauty Cosmetic Surgery” clinic in downtown West Palm Beach.

*The good doctor Marrocco remains a legally licensed doctor in the state of Florida – though interestingly enough – he does not have prescriptive privileges.  One the Florida Department of Health website, Dr. Marrocco (whose secondary address corresponds with the clinic address) reports active licenses in Virginia, Pennsylvania, Michigan, Indiana and Nebraska.

But let’s check it out… so I did my own preliminary online search –

Virginia: No records found.  No active or past licensees (expired in the last five years) found.  So he may have had one – but not recently.

Pennsylvania: William Charles Marrocco held a license in Pennsylvania for a brief two-year period between 1998 to 2000. This includes his period of medical residency training at Temple University Hospital.

Michigan: Three expired licenses – one for student status (resident) and one as a pharmacist.

Indiana: Dr. Marrocco was a licensed plastic surgeon in the state of Indiana from 2000 to 2011 and has a notation “reinstatement pending‘.  Maybe Dr. Marracco is planning on heading back to Indiana – where his license remains unblemished – despite the scandal surrounding the 2003  death of his wife after he performed liposuction on her).  License # 01052282A

Nebraska:  Expired, license #2909, educational license permit (training) affiliated with Indiana University

Jorge Nayib Alarcon Zambrano – (one of the individuals charged) is listed as a member of the Colombian Society of Plastic Surgeons – from Cali, Colombia.  So he may be a trained surgeon, just not a very good one (and not licensed in the United States).

Licensing isn’t everything..

Kind of goes to show some of the pitfalls of relying on licensing boards for consumer protection.  Dr. William Marrocco was a licensed plastic surgeon, but that’s little consolation for many patients at that West Palm Beach clinic.

In fairness to Dr. William Marrocco, Jorge Alarcon and the other individuals in the case – they have been charged with multiple counts, but have not been convicted of any crime.  Until that time, they remain innocent until proven guilty.

Apologies to my loyal readers for the long lapse in posts but my plate has been pretty full.  But I will be finishing my latest assignment in a few weeks and starting a couple of new projects for the summer months.

airplane3

I applied for and received a new assignment from Examiner.com to expand my focus to include more than just health topics.  Now I will be able to write more articles focusing on life and culture in Latin America.

Colombia Moda 2014

To kick-start my new assignment, I have applied to attend Colombia Moda 2014.

(official image from Colombia Moda / Inexmoda)

As many of you already know, I was able to attend last year – and got a fascinating glimpse into the fashion industry and the future of both fashion and consumerism.

Last year’s speakers were promoting the concept of “re-shoring” and changing from the traditional ‘seasonal’ lines and collections to an ongoing, evolving fashion line with new designs and items being designed, developed and sold to the public in shorter mini cycles.

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This year – I’ll be able to cover all of this – along with interviews with individual designers, fashion lines and the Colombian fashion and textile industry.  (Last year, my articles were focused on the role between fashion and plastic surgery).

Fashion is so intrinsic to Colombian life, and many parts of Latin America, so I am really excited about it.  It plays such an important role in the economic, social and an even personal lives of many Colombians.

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I won’t have an assistant this year – but I am getting a new lens for the event (I will be journalist/ photographer for the event).

After Colombia Moda, I will be flipping back and forth between writing about culture and my ‘usual’ medicine and health storylines.

I will be staying in Colombia for several weeks as well as covering the Latin American Association of Thoracics (ALAT) conference at the end of July.   It’s one of the biggest international conferences in thoracic medicine/ surgery with many of the legends of thoracic surgery planning to be in attendance.

Sponsors del Congreso ALAT 2014

In August, I’ll be heading across the globe to interview the head of an innovative surgical program.

I’ll be checking in along the way – and posting photos, interviews and articles as I go.

 

On the Streets of Cartagena


After a couple of super serious posts – It’s time to change the pace, back to the colorful life of Cartagena..  When we aren’t in Sincelejo, I’ve had a considerable amount of free time to enjoy the city.

Iris and I have had some great adventures (particularly gastronomic ones), but I have also spent a lot of time roaming around on my own, trying to make the city my home.

So I thought I would introduce some of the nice people I’ve met on my daily walks around the city. I don’t have photos of everyone, but I thought I would share the ones I do have..

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With Aristedes

 

(According to this picture, the  rumors are true – at least the part about my looks)

I almost didn’t post this picture of Aristedes Ayala and I – just because I look pretty awful but that would be a disservice to Aristedes, who has been a good friend while I’ve been here.  We’ve hung out various afternoons while he’s practiced his English with me.  I’ve tried to impart my southern accent during our lessons along with key American and southern idiomatic phrases, but I am not sure how successful I was.

But then again, it seems like my own accent has started to fade away from disuse.  (I have tried very hard to speak very clearly, and not to use colloquial phrases when I talk to non-native English speakers over the last few years – and I think I might have been a bit too successful.)

Gustavo

Gustavo

This is Gustavo.  He sells aromatic coffees, gum and stuff like that – one of the streets near my home, in a shady spot by the beach – so I see him almost everyday.  (I also have a slight gum addiction).

Gustavo is an interesting guy – he’s worked here near the beach in Cartagena for ten years – so he’s seen a lot of interesting and crazy things, particularly on holiday weekends when the beach is packed with tourists.

Prior to that, Gustavo, who is from here in Bolivar, worked in Agriculture in the coffee sector.

Miguel

Miguel

Miguel is a nice young kid I met who works for Aguilar as one of the delivery drivers (so he has what I consider to be an ‘essential’ job here in Cartagena).  I don’t know if the city of Cartagena issues badges for expedited travel during states of emergency like we had at the hospital in St Thomas, (USVI) but he should probably get one.  I can’t even image how life might grind to a halt if alcohol was suddenly absent from all the bars, restaurants and fancy hotels.

 

Willie

Willie

Willie is one of the vendors who works on the busy touristy zone in Bocagrande.  He sells a lot of the Colombian craft items.

Willie with his wares

Willie with his wares

Since I have been working on my first mochilla, we talk about my progress sometimes.  (I’ve made a lot of progress on my latest trip to Sincelejo).

making progress on my Colombian bag

making progress on my Colombian bag

Then there’s this guy.  I don’t know his name, so I will call him Juan Carlos (which is one of my favorite names).  Imagine my surprise to see that he has been here at the military base every day watching over me (which is across the street from my apartment).  I never even noticed him until today.

Meet Juan Carlos

Meet Juan Carlos

So I asked Juan Rodriguez (at the base) to introduce me – and he did.

Officer Rodriguez

Officer Rodriguez

I know the military here has a bad reputation (particularly for past misdeeds) but all of my encounters with them have been pleasant, professional and friendly.

I always feel safer when they are around.

Manuel

Manuel

Manuel sells jewelry and beads on the beach – but he was happy to make time for a short chat.

I didn’t get the names of some of the other vendors I spent a couple of afternoons chatting with.  (I wasn’t shopping – just passing the time).

Cartagena playa 015

 

I joked with this guy about being from Bucaramanga (he’s not, BTW) because I have the female shoe shopping fantasy about Bucaramanga.

Selling shoes

Selling shoes

 

I always imagine it would be a shoe paradise for me – lots and lots of shoes in small sizes!  (I wear a what is a child’s size shoe in the USA so it’s hard to find shoes without cartoons on them at home.)

Now  – that I think would be a great tourism opportunity – “Shoe Shopping Excursions”.  I’d be more than happy to sign up for a weekend trip to Bucaramanga to find at least one pair of comfortable shoes that actually fit!

I’ve actually tried to enlist my good friend Camila in a do-it-yourself shopping adventure, but to no avail.  (She’s expecting a baby soon which has put a damper on major excursions – but hey – a new baby isn’t so bad..)  She’s be the perfect accomplice because she used to own an upscale clothing boutique so she is very knowledgeable about the quality of leather, clothing, shoes and other apparel items.  She also has excellent taste.  (I have gringo taste which is nothing to brag about – so I accept all help offered.)

I dread shoe shopping at home because it’s an exercise in frustration and is often accompanied by tears..

But maybe I can enlist some of my fantastically fashionable Bogotanas on my next visit..

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This nice kid was just hanging out, outside Juan Valdez – but he was happy to let me take his picture..

Cartagena playa 019

Now I don’t have a photo of one of my favorite people here in Cartagena.  His name is Juan Fernandez and he repairs shoes along one of my exercise routes.  He’s about 60 and from a small town outside Cartagena, though he has lived here for about 40 years.  I always stop and chat with him for at least a few minutes, and he always greets me by name.

When we both have a little more time, we talk about philosophy, life in Colombia and our shared experiences.  I look forward to seeing him – and he always asks about my adventures in Sincelejo.

Now I know I talked about some of the things I don’t like about Colombia in a recent post –  but it’s people like Juan Fernandez that make me love Colombia so much.  Just nice people – who are happy to talk to a stranger, make her feel at home and pass the time.

End of the road


I know many people were not thrilled about my latest post, “What I don’t like about Colombia,” but I felt it was a fair question (posed by a reader) and it deserved an honest answer.  Whitewashing my opinions / experiences and perspectives or painting a pretty picture does a disservice to this beautiful country and its people.

Colombia, like any country – has its beauty, its strengths, its joys and its share of problems.  Ignoring issues because they may appear less than favorable undermines my integrity and the integrity of my work.

So I apologize if I have offended anyone, particularly any of the wonderful people who have graciously extended hospitality and friendship to me.  That was not my intention.  But I cannot apologize for sharing my perspectives as an outsider looking in.

As my time here in Cartagena and Sincelejo comes to a close – I hope that my readers, colleagues and friends can appreciate my experiences for what they are, my experiences.

Last week in Sincelejo

My last week in Sincelejo was a bittersweet one.  Sweet because we had two coronary cases but bitter because it was sad knowing this was the last time I would see everyone.

Anita, Patricia and Estebes

These three ladies have made all the difference in my operating room experiences here, and I am grateful for that.  I have really enjoyed getting to know them – and I feel sad at the thought that I may never see them again.

Raquel (right) and Anita, the instrumentadors

Raquel (right) and Anita, the instrumentadors

I am really going to miss Patricia and her perpetually sunny nature, easy smiles and ready laughter.  She was so sweet to introduce me to her son so I would have an escort and companion if I wanted to go out dancing.

Patricia and Estebes, circulating nurses

Patricia and Estebes, circulating nurses

I will miss Estebes, who always seems to go out of her way to help me.  She is always there to adjust the light, offer a stool or anything else that might make it easier for me while I am peering into one of the dark tunnels of someone’s leg.

with Estebes

with Estebes

Anita, too, has wonderful.  I feel like we have also had some fun, working at the ‘back’ of the table.  I’ve tried not to be in her way – and to actually be somewhat helpful.  (I’ve probably failed at this – but she has been very sweet and has never made me feel unwelcome.)  She’s also extremely knowledgeable about surgery so it’s good to have her there.  It’s hard to feel nervous with Anita watching over me.  Or when I need a third hand – she is always there – even while managing everything at the top of the table too.

barbosa 045

Tuesday

We arrived in Sincelejo this morning for surgery this afternoon.   I did a fitting with Dr. Barbosa and his new headlamp apparatus so I could fit the final piece of Velcro.  It’s not the prettiest thing in the world, but it’s functional and fully washable.  (The previous headlamp anchor is an uncovered foam that crumbles with washing).  I added a border to the old one as well, and repaired it the best I could, so he would be able to swap them out as needed.  I hope he liked it – despite its ‘ugly duckling’ appearance.  I thought it would be a nice gesture since he has done so much for me – and I don’t know how to say “Thank You.”

Dr. Barbosa models his new headgear.

Dr. Barbosa models his new headgear.

 

The patient only needs one small segment of vein – so Dr. Barbosa decided it would be a good time for me to learn open saphenectomy.  (I think I have convinced him on the soundness of my theory of learning the principles of saphenectomy, especially with my argument on the need to know for emergency cases.)

performing a saphenectomy

performing a saphenectomy

It was amazingly fast and essentially a bloodless field.  Since everything is open before you, it is easy to ligate and clip all of the collaterals.  I was surprised by how quickly I was able to free the vein.  Closure didn’t take much longer than normal because even though it was an ‘open saphenectomy’ since it was only one graft it wasn’t that long of an incision.

I am glad I had an opportunity to try it because it certainly gave me more confidence than I would have had if I was expected to learn it during an emergency case.  I also felt it gave me a better feel for the anatomy – because it’s all laid out in front of you. (It doesn’t matter how much you read or study a textbook – people are ‘never’ completely textbook, and ‘real’ anatomy looks different from the pretty drawing in my Grey’s Anatomy, especially when you are peering down a dark tunnel tract.)

Wednesday

The patient from yesterday is doing well.  The morning chest x-ray showed significant atelectasis but the patient was hemodynamically stable and without other complications.  I reviewed post-operative teaching (pulmonary toileting, ambulation) with the patient and explained that due to underlying COPD, he needed to be more aggressive in pulmonary toileting, and post- operative exercises.

Just a nurse?  I don’t think so…. But you are only a doctor.

Today a doctor attempted to insult me by stating, “You aren’t a doctor.” (Don’t worry, dear readers – it wasn’t Dr. B – I think he ‘gets” me.)  It made me want to laugh out loud but I managed to restrain myself since I was scrubbed in at the time.  Of course I’m not a doctor – and thank the lord that I am a nurse!  I never have and never will want to be anything else!

I feel sorry for someone so limited that they can’t see all that is missing from their life because they are “just a doctor.”  They are just a doctor, but I am fortunate enough to be a nurse!  I get to be everything that they can’t.  For him, the people who come to us for help are just patients – part of an endless cycle of work, a means to pay the bills, buy a big house and have the status that being a doctor brings.

But for me, well, I am not usually overly religious in my speech but there is no other way to describe it but to say, I am blessed. I do feel it’s a ‘calling’ of sorts.   I am blessed with the opportunity to care for these people, each one unique; with their own hopes, dreams and rich histories.  I have the privilege of being one of the people alongside the family and friends who cares for them.  I am lucky enough to be invited to share in that care.  The patients may leave the hospital, but they never leave my heart.

I am so much more than just a nurse to my patients; I am a teacher, a friend, a source of comfort and compassion during a life-changing experience.  I am the one who holds their hands when they are frightened – and the person who brings a smile to their face when they think they will never smile again.

Just a nurse?

Just a nurse?

I am a little bit social worker, a tiny little angel, a physical therapist, a cheerleader and friend, and even to many, their favorite ‘doctor’.  Often, I am the one they feel comfortable talking to – I am the one they bring their questions and concerns to.  Usually, I am the one they trust – to tell them to truth and to assist them on their journey back to health.  And, that sir, is a privilege you may never know.

To my surgeons, I am the extra right hand they didn’t know they needed.  I am always where I am needed – often behind the scenes, taking care of small issues so the surgeon can continue to do the things he needs to do – namely operate.  I am someone to bounce ideas off of – someone to teach (and wants to learn).  I am the very best resident a surgeon will ever have.

To the other doctors (who may have limited experience with cardiac surgery patients), the ones who are willing to admit it – I am an advisor, a teacher and a trusted colleague.

To my nursing colleagues – I am a mentor, a teacher and someone willing to listen to their concerns.  I know their jobs and I know their intrinsic value.  I know their talents – even if you don’t.  I never shrug off a nurse’s concerns, and that has saved lives.  If the nurse caring for the patient comes to me and says, “I don’t know what it is but something isn’t right,” than I know that something isn’t right.  And together, we figure it out and make it better.  I know that these nurses, the ones you dismiss – they have hopes and dreams too – and they take pride in excelling in their job.  If they don’t know something, it’s not for a lack of trying – it’s for want of a mentor.

Ever Luis, one of my favorite floor nurses

Ever Luis, one of my favorite floor nurses

And yet – there is still more to this nurse – I am an investigator, a researcher and a bit of a detective.  But you sir, are only a doctor.

In today’s case, the patient needed two grafts.  Dr. B started the initial incisions (I was off by a centimeter yesterday on my initial incision, so I think he lost confidence in my skills – I was worried about avoiding the patients more superficial varices.)  I am a little afraid of jumping in too quickly and harming the patient – so I am cautious in making my initial incisions – but once that’s done, I feel like I am in familiar territory.  I looked at my case log after the surgery – and it seems incredible for me that I’ve only had eight cases because it feels like I’ve been doing it for longer – parts of the procedure feel almost automatic now.  I wish it was 25 or 3o cases but the service just isn’t that busy.  I knew that would be the case when I came here – so I am grateful for the eight cases.  Eight is still more than none, and none is how many cases I was getting back at home.  (It’s that tired cliché – everyone wants someone with experience but no one wants to give a person a chance to get experience.)

I am still hoping that future employers will take my willingness and eagerness to train into consideration and offer me a chance even though I am a locum tenens provider.  I have just been burned too many times in permanent positions to risk taking another one in hopes that they will fulfill their promises to train me.

Thursday

No surgery today but a full clinic!  It was a good day in clinic because I got to see all the post-operative patients from our previous surgeries, and it was just a bit heart wrenching.  But then again, I am always a big sap for my patients.

All the patients seemed so happy to see me – and I was so happy to see all of them too!

Everyone looked really good, and I was impressed by their questions and attentiveness during the appointments.  My patients knew all of their medications by name, and were eager to discuss this and other post-operative instructions they received at the time of discharge.  (Usually it seems like people forget a lot of what we talk about in the hospital – but I think my horrible gringa accent sticks in their minds).

The only disappointing aspect, was seeing one of our patients (who had been really fragile pre-operatively) amble in.  She looked great – and said she felt pretty good, (other than the usual sternal soreness) but one of her leg incisions had partially dehisced.  (Luckily it was a very small skip incision and the patient had been fastidious about cleaning it as directed).  The wound was very clean, with no signs of infection.  It was healing well by secondary intention but I was disappointed in myself that the wound closure didn’t hold up.

After clinic – we headed back home.  All the while, I was thinking of how I will miss Sincelejo.  I will miss my friends, my patients and Clinica Santa Maria.  I will miss the chance to work with Dr. Barbosa – who was always such a great teacher, even if we didn’t always see eye-to-eye.  Most of all, I will miss Iris, who has been my best friend, confident and colleague during this journey.  I will miss working with her – I honestly think that between the two of us, we could be a force to change the world (or at least cardiac surgery) for the better.

From the bottom of my heart, I sincerely say, Thank you Iris, Thank you Dr. Barbosa, Thank you, Estebes, Anita and Patricia – and thank you Dr. Salgua for having me here among all of us – and making me part of the team.  I will miss you all.

Dr. Salgua Feris

Dr. Salgua Feris

So what don’t you like about Colombia?


This question comes from a recent email by one of our loyal readers.. (It may have been sarcastic, but I’ll answer it honestly and candidly.)

So,  what don’t you like about Colombia?

Fair enough, but let me preface the discussion by saying that EVERY SINGLE THING that I mention below also exists in the United States.  So I won’t pretend that my country is some kind of gender utopia.  It’s not – In fact, the “war on women” has been waged between political parties and in headlines of newspapers all over the United States.  My home state of Virginia, along with Texas has been some of the worst offenders on this front..

Still… Due to the overwhelming machismo here – the things that bother me the most in Colombia  somehow manage to be extremely pervasive, sometimes subtle yet face-slappingly* shocking at the same time.

1. You are never more than your looks.  Sure, everyone knows that unfortunately, attractiveness, particularly female attractiveness is the unspoken prerequisite for career success in the United States.  But it tends to remain unspoken, highly illegal and in the background for most of us.

It is one of the biggest ways that males here (Colombia) are able to maintain authority and superiority and subjugate women.  Too many people buy** into it – so even women who hate it are forced to conform to survive (professionally, financially).

It’s different here – and it’s probably the main reason I haven’t chosen to call Colombia my long term home.  It’s never in the background here, and it never fades away.  It doesn’t matter whether you’ve known someone here for five minutes or five years – you are still being judged by your looks.  It doesn’t matter what your background is, your skillset or your intelligence.

Men (who are the majority rule here) won’t even hear what comes out of your mouth if you don’t meet the “minimal attractiveness” levels.  It’s almost like a physical disability – as if they literally can’t hear you.

a PhD in physics?  Sorry, sweetie - I can't hear you.. Maybe after you get some breast implants..

a PhD in physics? Sorry, sweetie – I can’t hear you.. Maybe after you get some breast implants..

Not only that – but in general, Men here judge harshly.  If you aren’t a supermodel, with large (or enhanced) curves – then you are lacking.  Not only that – but they will be certain to inform you that you are lacking (using during your initial introduction, and probably every single subsequent meeting thereafter.)

(Obviously – this doesn’t apply to ever single male in Colombia, but it’s still quite prevalent even among the better educated upper classes).

Even if you are beautiful – your time for professional and career success is limited.  Maybe you have some cellulite, or your breasts aren’t perky enough – or you’ve had the gall to age.

So as you can image, as a chubby, woman over 30, who has never, ever been “mistaken” for a model even on my very best days as a young ingénue, this constant spoken criticism is extremely disheartening.  Not only that – but it makes it extremely hard to get any work done.

2. Don’t ever attempt to discuss any of this with male Colombians.   While women here talk about these issues often and express their feelings towards these attitudes of male machismo, don’t bother trying to address these issues with male Colombians.  (Sure, there is always the odd exception – usually a more cosmopolitan man who has lived outside South America at some point, but it’s not common.)  As I said before, ‘selective deafness’ comes into play.  Not only that – even when having a so-called polite conversation (on American customs, polite behaviors etc.) attempting to explain (to people planning to visit the USA) that these behaviors may be perceived negatively in the United States, will be dismissed.  Very often this will also result in comments such as “you are just jealous of the beauty of Colombian women.”  This comment was made in response to a discussion about the fact that calling an American woman ‘gordita’ (chubby/ fat) or ‘vieja’ (old) may impede abilities to make friends and have serious repercussions, particularly if it occurs in the workplace.

It will also get you labeled as a lesbian.

an aging lesbian speaks out

an aging ‘lesbian’ speaks out

3. Aggressive homophobia, particularly in the coastal areas of Colombia.  Despite the fact that an estimated 8% of the population identifies as gay, homosexuality remains a big taboo in many parts of Colombia.

While Bogotanos and residents of more cosmopolitan cities like Medellin and Cali tend to express more tolerant / accepting attitudes regarding an individual’s sexuality – this is not the case in places like Cartagena.  (Costenos have a reputation for being less than sophisticated.  There is even a Colombian version of the “Beverly Hill-Billies” which features several Costenos living in Bogota). Homophobic slurs are extremely common in every day speech.

Like their American ‘redneck’ stereotype counterparts – many Costenos are bigoted, biased and intolerant of others.  This includes the darker-skinned Costeno residents, and gay people.  While I try to keep my mouth shut for the most part, (even though it pains me) when I hear the blatant racism / homophobia – on the one occasion when I objected to hearing the repeated use of an extremely ugly Spanish pejorative for gay people  (akin to the American slur of “faggot”), I was literally shouted down for my audacity in attempting to censor his “bible given” right to spew hate.

Even the sly suggestion that a particular apartment is in a “gay neighborhood” is enough to prompt something akin to panic, and further discussions on moving/ selling said apartment.

Of course, this sort of bigotry happens in the USA – and everyone knows that.  But I would like to think that a lot has changed in the last ten years in that the majority of Americans are not only tolerant of gay individuals but support their right to equality under the law, the right to pursue personal happiness and to get married and have families. Even the majority of Southerners***.

So now you have a unattractive, middle-age lesbian in Colombia.  Try and imagine how this impedes daily interactions.  Oh, did I mention that I am also considered a slut.

4. Rampant Slut shaming.

So if you have committed any of the faux paxs listed above, don’t be surprised at what comes next, namely Slut Shaming.  Especially if this “puta gringa” has also committed the unforgivable sin of also learning the names of the Building porter or the person who sells you gum (daily) or other members of Cartagena’s “lower class.”  It’s not something as simple as good manners – it’s because you are a slut and are sleeping with all of them.

In a country where married men openly brag about their numerous sexual conquests, ‘amigitas’ and secret families are common, women are still placed within the narrow confines of the “Madonna/ slut” paradigm.  As a married foreigner who often travels solo due to financial concerns, the lack of my husband’s physical presence makes me even more of a target for this labelling.

Women here are supposed to dedicate long hours, and thousands of dollars in pursuit of ‘sexy’; wearing tight, short revealing clothes, tilting around on high heels while attempting to balance outsized breasts with generously rounded bottoms – yet maintain an ‘inner purity’ that prohibits open and frank conversations about gender issues.  The end result of this – is that men are able to strictly control the financial and economic mobility of women in a society that castigates outliers.

So I am fairly certain that my candid response to this question won’t go unpunished.  I probably should have stuck to easy answers.

ie. What don’t you like about Colombia?  Answer: FARC/ paramilitaries.

But then, I don’t have run-ins with paramilitaries on a daily basis..

So what does this mean?

Does it mean that this slutty, unattractive, lesbian gringa should give up any hopes of doing business in Colombia?  AKA “Gringa GO HOME” (as has been suggested on multiple occasions).  Or should I fire up my time machine, emerge as a fresh 20 something, head directly to the nearest plastic surgeon and keep my damned mouth shut?  Should I wear tighter clothes, stilt like heels and hope to blend in?

Maybe it is time for me to go home – and return when I can remember and enjoy the thousands of things I LOVE about Colombia; the cool air of Bogota, the richness of a country with an in the amazing array of natural wonders and geographic splendor, the overwhelming variety of fresh fruits and vegetables, the joy of learning to Salsa, the cultural depth of a country with over 500 years of history, the incredible variety of friendly, and interesting people I meet on any given day (machismo not withstanding).

But don’t worry – nothing can get me down for long – and I will return to the beautiful, wonderful, culturally rich Colombia very soon.

Notes:

* Yes, I made that word up, but that’s how I often feel as I confront these issues every single day here.

** Literally.  It’s one of the reasons plastic surgery is such big business here.

*** Before readers get upset that I am “propagating the American redneck stereotype”, consider this – I say this as a self-proclaimed ‘redneck southerner’ who happens to express a ‘Live and Let live” philosophy towards others. That being said – my experiences in Colombia – are mine, and I don’t attempt to speak for, or represent anyone else’s experiences here.  If anything – I hope your experiences (as a female) in Colombia have been different.

Additional articles on related topics

This study compares eating disordered behavior and plastic surgery rates in the USA and Colombia.

Gender, eating habits and body practices in Medellin, Colombia – article by Ana Maria Ochoa.

Narco-aesthetics: How Colombia’s drug trade constructed female ‘beauty’ – article by Mimi Yagoub

Life in Plastic – it’s fantastic! about the culture of plastic surgery in Latin America (specifically Cali, Colombia) and the link to narco-trafficking.

LA Times article: A Scathing Attack on Culture of Machismo.

Acid attacks show the face of machismo in Colombia

Earning a living is the biggest obstacle for Colombian women.

Colombia: Human Rights Situation of the LGBT Population: Shadow Report Submitted to the United Nations Human Rights Committee (2010).  While laws were passed to protect the human rights of the LGBT community in 2011, the situation remains precarious for the LGBT community particularly in rural areas.

U.S. groups file briefs in Colombia marriage case. (4/14/2014).

Bogota mayor invites residents to come out of the closet.

Women on Waves resources: promoting women’s rights internationally. Provides practical, not philosophical information for women in a multi-lingual site on women’s health & gender issues.

Women on Web: women’s health information – multi-lingal site.

Featured Image courtesy of Sodahead.com