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.

Advertisements

Crochet, crafts and traditional arts in Colombia


IMG_1768[1]

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.

IMG_1780[1]

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.

IMG_1816

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

IMG_1814

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.

dsigners

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.

sew

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..

aistedes 002

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..

Cartagena playa 012

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