Story updates: Be care my friends, and Mexicali


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

Mexicali sign

First – some updates on Mexicali:

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

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

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

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

 

My Mexicali dentist: Dr. Luis Israel Quintana

 

Dr. Israel Quintana with one of his American patients

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

photo (12)

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

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

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

 

Story Update: Please be careful my friends!

baby

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

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

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

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

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Mexicali updates: October 2013


Here is some updated information from my recent visit to Mexicali for the Mexicali Summit (Cumbre de turismo Medico):

New Cath facility

Hospital Almater opened their new cardiac catheterization laboratory as part of their long-standing plans to build a ‘chest pain’ center.  The first cardiac cath in the new facility was scheduled to be performed October 18th, 2013.

During a discussion with the owner of Hospital Almater, at the Cumbre, I asked for permission for an ‘official’ tour of the new cath facility so I will have additional details for readers.  My request was denied.

Hopefully, I will be able to provide more information about the cath lab as well as the continued development of the ‘chest pain’ on a future visit to Mexicali.

Loss of full-time heart surgeon/ heart surgery program 

Mexicali has lost its only full-time cardiac surgeon.

Mexicali has lost its only full-time cardiac surgeon.

Several local physicians have reported that Dr. Cuauhtemoc Vasquez is no longer functioning as Mexicali’s only full-time cardiovascular surgeon.  His cardiac surgery program at Issstecali has closed (due to financial reasons), and he is no longer operating at the various facilities in town.  It is a huge loss of the city of a million residents.  Baja California residents will have to travel to Tijuana for surgery – while Imperial Valley residents will continue to travel to San Diego or Los Angeles for cardiac surgery services.

Salud Longevidad

During my visit, I was also invited to visit Salud Longevidad, a new clinic that is the brainchild of Dr.  Jorge Gallegos.  He created the clinic as a place for many of the local therapists and alternative/ complementary medicine practitioners to provide their services.  He likes to joke that he created the centro de medicina alternativa as a way to personally fight of the aging process, so “I will be young forever,” he explains with a smile.

The unassuming, nondescript exterior hides a spacious and elegant interior.  The clinic offers multiple treatments including various types of massage (and couples massage), water therapy, high colonics, magnetic therapies – and other varieties of “alternative” therapies.

The fifteen suite clinic also features a hyperbaric chamber.  Now, this is a treatment I can appreciate since there is a large volume of research on the benefits of hyperbaric oxygen therapy for wound healing and other medical applications outside of the ‘bends’ or complications from scuba diving for which the therapy is best known for*.  It also happens to be one of the nicest, most modern chambers that I have ever seen.  The majority of other chambers I have visited are either former military equipment or vintage models.

Dr. Juan Fernando Medrano, a medical doctor who also serves as the head of medical tourism at the Hospital de la Familia was gracious enough to invite me for a tour, and to watch one of his sessions at the new clinic.  He recently finished training as a medical aesthetic physician, and now performs platelet rich plasma (PRP) treatments (among other procedures).

Salud Longevidad is located on Av. Francisco Javier Mina #200 in Zona Centro (across the street from the parque de Mariachis).

For more information about Dr. Medrano and the PRP – please read my recent article at Examiner.com.

* Hyperbaric oxygen is best known for its use in treating ‘the bends” or complications from rapid decompression (rising to the surface too quickly) in scuba divers.

I have included a limited selection of medical literature on hyperbaric therapy.   However, I also want to caution readers when researching medical information, particularly when reading Chinese journals which have been recently discredited for widescale/ widespread fraud.

References

Egito JG, Abboud CS, Oliveira AP, Máximo CA, Montenegro CM, Amato VL, Bammann R, Farsky PS. (2013).  Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery.  Einstein (Sao Paulo). 2013 Sep;11(3):345-349. English, Portuguese.

While many readers know that I have a background in cardiac surgery – where mediastinitis is a serious/ dreaded complication – I hesitate to embrace these findings too enthusiastically due to the very small sample size (of 18 patients over 2 years).

Cao H, Ju K, Zhong L, Meng T. (2013).  Efficacy of hyperbaric oxygen treatment for depression in the convalescent stage following cerebral hemorrhage.  Exp Ther Med. 2013 Jun;5(6):1609-1612. Epub 2013 Apr 2. A small (60 patient) study looking at the effects of hyperbaric oxygen on depression in patients following cerebral hemmorhage (hemorrhagic stroke).

de Nadai TR, Daniel RF, de Nadai MN, da Rocha JJ, Féres O. (2013).  Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report. J Med Case Rep. 2013 Jun 27;7(1):167. doi: 10.1186/1752-1947-7-167. Did hyperbaric oxygen help?

Delasotta LA, Hanflik A, Bicking G, Mannella WJ.  (2013).  Hyperbaric oxygen for osteomyelitis in a compromised host.  Open Orthop J. 2013 May 3;7:114-7.  Research suggesting hyperbaric oxygen may be helpful in treating serious orthopedic infections in patients with impaired wound healing.

Recommended reading:

Chantelau EA.  (2013)  Benefits of hyperbaric oxygen still doubtful.    Dtsch Arztebl Int. 2013 May;110(21):372. doi: 10.3238/arz9tebl.2013.0372a. No abstract available.  A letter in which the author presents evidence suggesting that any attempt to conclusively state the benefits of hyperbaric oxygen therapy is premature/ misguided (at best.)

Spending the day with Dr. Gabriel Ramos, Oncology Surgeon


Spent the day in the operating rooms with one of my favorite Mexican surgeons, Dr. Gabriel Ramos Orozco.  Dr. Ramos is an oncology surgeon with offices in Mexicali (Baja California) and his hometown of San Luis Rio del Colorado in Sonora, Mexico.

Dr. Gabriel Ramos Orozco, Oncology Surgeon

Dr. Gabriel Ramos Orozco, Oncology Surgeon

In the operating room with Dr. Gabriel Ramos

We spent the day in his hometown – first at the Hospital Santa Margarita, where he performed a laparoscopic cholecystectomy, and then in his offices seeing patients.

In the operating room

In the operating room – photos edited to preserve patient privacy

Hospital Santa Marta

The hospital itself was a small intimate clinic.  The operating rooms were small but well-equipped.  We were joined by Dr. Campa, an excellent anesthesiologist and another general surgeon.  While the anesthesia equipment was dated, all of the equipment was functional.  At one point, the sensors for cardiac monitoring and oxymetry readings malfunctioned but within seconds a backup monitor was attached.  (This is a frequent occurrence in most hospitals around the world and the USA because the sensors that connect to the patient with gel are cheap disposable and somewhat fragile.)

There were several monitors dedicated to laparoscopy with good display quality.  The operating rooms had ample light and functioned well. Overall the clinic was very clean.

ramos surgery

The surgery itself proceeded in classic fashion.  The patient was positioned appropriately and safely before being prepped and draped in sterile fashion.  Since the surgery itself was of short duration, anti-embolic / DVT prophylaxis was not required but was still applied.  (Note:  in Mexico, these stockings are of limited utility – and for more lengthy procedures, TEDS or electronic squeezing devices are usually applied.)

The surgery itself was under an hour, with no bleeding or other complications. The patient was then transferred to the post-operative care area for monitored recovery from general anesthesia.

Dr. Ramos performs laparoscopic surgery

Dr. Ramos performs laparoscopic surgery

In the clinic

It was an interesting day – because he sees a diverse mix of patients.  As a general surgeon, he also operates for many of the classic indications, so there were several patients who saw Dr. Ramos for post-operative visits after appendectomies, cholecystomies (gallbladder removal) and the like.  There was also a mix of patients with more serious conditions like colon, testicular and breast cancers.  His patients were a cross section of people, from the United States and Mexico alike.

International patients

Some of these patients came for the lower cost of treatment here in Mexico, but others came due to the dearth of specialty physicians like oncology surgeons in places like Yuma and Las Vegas.  Many of these international patients spoke Spanish, or brought translators with them since Dr. Ramos is primarily Spanish speaking.

Since D. Ramos is not well-known outside of Mexico, many of these patients were referred by word-of-mouth, by former patients, friends and family.

Then it was back to the hospital twice to visit his patient post-operative.  She was resting comfortably and doing well.  It is this level of service that draws patients to his clinic both here and in central Mexicali.

This winter, Dr. Ramos returns to school so to speak – as he will be spending several months in Barcelona, Spain and Colombia learning new techniques such as uni-port laparoscopy.  He will then be able to offer these state-of-the-art treatments to his patients back here at home; whether these patients come from northern Mexico or other parts of the globe.

Highly Recommended:  Excellent surgeon with well-coordinated team.  However, patients requiring more extensive surgery (large tumor surgeries/ cytoreductive surgery) should request Dr. Ramos perform surgery in the larger Mexicali facilities for better access to advanced and specialized support services like hemodialysis etc. for sicker/ higher risk patients. 

However, the level of care was appropriate at this facility for this procedure, which is rated as low-risk.  (i.e. generally healthy patient, with straight-forward procedure)

as the mercury soars..


into the 110’s (and higher) it’s been an interesting week in Mexicali.  I’ve definitely entered new territory in my book writing venture.  In the last books, I basically didn’t see the forest for the trees – meaning that even as I raced around, and enjoyed the cities I was living in – I didn’t include any of the information about the cities themselves.. Just the surgeons, and surgery.

In retrospect – I think that was a mistake.  While I know the beautiful multifaceted Bogotá, my readers don’t.  At the time, I didn’t want to duplicate the efforts of the many talented travel writers out there.  But on consideration – living in a city is so much different from visiting one.   It takes months to see and fully appreciate the nuance of many locations – especially cities..  Anyone can talk about the historic church built in 19 whatever, but it takes time and familiarity to see the beauty of Mexicali’s Graceland, or the changing canvas of the UABC museum.  It takes time to collect the stories that bring the city to life.  So now, I am trying to do that – in a small fashion with everything I’ve collected since coming here in March.

I am not Frommer’s.. I am more like his awkward, quirky little cousin. I don’t have the manpower or the resources to talk about the hundreds of restaurants here (more than 100 Chinese restaurants alone!) but I can tell you some of my favorite places; for a casual lunch with friends, or a night on the town.  I can’t give exhaustive listings on all there is to see and do in this thriving city, but I can show you the heart of it.  I can tell you about the things that make Mexicali more than just spot in the hard-baked earth; the things that make this city real, and make it a fascinating place to be.  I can make your stay; whether just a few days, weeks or months; interesting and informative.

It’s been a fascinating and amazing journey to discover these ‘pockets of life’ and living history – and now that I am outside my realm (of medicine and surgery) one that would have been impossible without the numerous people who have embraced me, and shared their wisdom.  (It’s becoming quite the list – and I’ll share it with you all soon.)

But I certainly hope that my future readers enjoy the journey as much as I have.

How’s the book coming?


I was in the United States most of last week (at my reunion) but I didn’t stop working.  While a reunion may not seem like the most ideal situation for a medical writer – it’s actually a great opportunity to talk to people and get their opinions about health care, medicine and surgery.  After the first few minutes of catching up – talk naturally turns to everyday life, and for many of us – ‘everyday life’ involves worrying about the health of our families.. Also, many of my classmates – and old friends have been some of my biggest supporters of the blog (and my other work) so it was good to get some critical feedback.

Bret Harte class reunion

The book is coming along – almost continuous writing at this point.  While I (always!) want more interviews with more surgeons, I am now at the point where I am filling in some gaps  – talking about the city of Mexicali itself.  So I am visiting museums, archives, and talking to residents about Mexicali so I can provide a more complete picture to readers.  Right now, I would really like some information about 1920’s -30’s Mexicali – I can find a lot of interesting stuff about Tijuana, but Mexicali is proving more elusive.

It’s a bit of a change from my usual research – finding out about decades old scandals (even local haunted houses), visiting restaurants and nightclubs, but it’s been a lot of fun., even if it seems frivolous or silly at times.  I hope readers enjoy this glimpse into Mexicali’s rich history as much as I have.

Finished the cover – which to me, is critical at this point.  (I use the cover to inspire me when it comes to the less than thrilling stage of copy editing) so I am posting an image here.

cover for the new book

Meeting with an architect later this week – to learn about, and write about some of the variety of styles here in Mexicali.  (There is such a surprising array – I thought it would be nice for readers to have a chance to know a bit more.)

Now there’s one house I’ve dubbed “Mexicali’s Graceland.”  I don’t know why Graceland comes to mind every time I go past this home (it looks nothing like Elvis’ home in Memphis) but the term has stuck.  I am hoping to get some of the history on this house because it just looks like a place where even the walls have stories to tell.

The pictures aren’t the most flattering – but I’ll post one so you can tell me what you think.  (It’s actually far more lovely in person – with the contrast between the pink walls and the white scrollwork, as well as some of the more classic design features.) I guess my imagination tends to run away with me – with images of grandeur and elegant ladies sipping champagne in the marbled halls of the past – but then – most of my usual writing is technical in nature, so I have few outlets for my creativity.

Mexicali’s Graceland

Meeting with my co-writer today to go back to the archives..

Mexicali book: New co-author


As much as I have adored working with my previous co-author, Dr. Albert Klein, PharmD on two previous editions – it just wasn’t practical for this title.  He’s now living and working in North Carolina, whereas – I don’t know when (and if) I’ll be returning to my beloved southern Virginia, which makes this sort of collaboration more difficult.  Also, Dr. Klein, (by the nature of his background) is more of an expert on Colombian history, culture and Bogotá life than the rest of Latin America.  (I always feel that the best way to get a glimpse of life is through the eyes of those who have lived it.)

But I do want to sincerely thank Albert for everything – (without him, I might not have been brave enough to publish at all!)  It’s been a pleasure working with him – both on the books and in the hospital, so hopefully we can collaborate again in the future (Medellin, perhaps?)

In the meantime, I have a new co-author for the latest book, the ‘mini-gem’ guide to Mexicali.  While it’s a more breezy style book compared to my other offerings, I still feel very fortunate to have enlisted some local assistance for the sections on culture, Mexicali life and local color.  The input has been invaluable for me during the writing process – and will prove to be the same for readers, (I hope!)

I am also hoping to get a few additional contributors for other sections of the book to talk about issues in their respective areas of expertise.  (It may be free but that doesn’t mean it shouldn’t be a quality product and a good read.)   It’s not a done deal – and it may be difficult due to everyone’s busy schedules etc – but I am hoping it all comes together.

Once I get all of the specifics nailed down  – I’ll post more about it here.

The rest of the book is going well – I am probably about 75% complete (and then the dreaded editing process!!)  Depending on how horrible editing is – and time limitations – determines whether or not the Mexicali book becomes a e-book.  (I find the e-book conversion process endlessly frustrating, particularly for a die-hard fan of footnotes like myself.)

Mexicali book update


The service is quiet so I am spending the day writing and working on the Mexicali book.  For new readers, I would like to explain that the Mexicali book is a little different from my previous offerings.  This is not an exhaustive compilation of surgeons and facilities in Mexicali, as frankly, I do not have the time or resources to accomplish such a task at this point in time.

Like all my books, it is a labor of love, but differs in that it highlights some of the best, and worst of Mexicali and medical tourism in this city.  So instead of interviewing and observing hundreds of surgeons, it highlights the limited number of physicians who agreed to participate in this project.

As such, no plans are being made to market this book commercially. Instead, I plan to offer it as a free pdf download for interested readers.  I will also be offering a full color soft-bound edition (at cost) for people interested in the many full color photographs of surgeons and surgery in Mexicali.  I will be placing the soft-bound edition on Amazon.com for interested persons.  Unfortunately, the cost of producing such a book (color photos) in limited runs is fairly expensive, so I apologize in advance to readers – but as I said – it’s a labor of love, and I won’t make a dime off of it.  I can only hope that if readers enjoy this book, they will consider purchasing one of my longer, more detailed books on medical tourism (such as the Bogotá book.)

More information will be forthcoming as I get further and further towards completion of this project.