Calling all fashionistas!


map Medellin

While many of you know that Medellin isn’t my favorite city in Colombia – it does have its own attractions.  I am not talking about the spectacularly breath-taking ride up to Parque Arvi on the metro cable or the Botero museum.

It’s the shopping – Medellin is the New York of Colombia and much of Latin America.  As home to Colombia Moda and the Colombian textile industry, the array of shopping opportunities are mind-boggling.  Most tourist guides will direct you to the upscale, brand name only shopping malls in the wealthier enclaves like El Poblado.  While these malls are worth seeing, I advise visitors to go in the guise of a museum-seeking tourist.

indoor flower garden at upscale mall in Medellin

indoor flower garden at upscale mall in Medellin (El Poblado district)

That is to say – go to look (at the sculptured gardens, majestic views and boutique brands) and maybe for a light lunch at one of the elegant eateries but save your cash for the real shopping mecca, in El Centro.  Wear comfortable shoes – and plan to finish shopping before 6 pm..

To get here:  Take the Metro (train) to Station San Antonio.  That will put you in the center of the shopping district.

Biggest Open Air Shopping District in Latin America

Don't worry, honey.. I stayed safely outside of this shop dedicated to crochet

Don’t worry, honey.. I stayed safely outside of this shop dedicated to crochet

At least, according to the banner hanging over one of the cobbled pedestrian streets.  But it seems pretty accurate as I wander street after street of an amazing array of goods.. If it isn’t here – than you won’t find it in Colombia.

photo (1)

Since it’s not Buenos Aires (Argentina), yes – they have sizes larger than SIX.

 

There are streets filled with row after row of sidewalk vendors selling a multitude of items.  A whole street devoted to shoes.. Sidewalk vendors selling ornamental sandals with adjacent stores sell every kind of shoe ever made..

sandals

Just one of the many, many displays of sandals in the shopping district of El Centro

Street after street with store after store of Shoes.. Appliances.. Clothing.. Cosmetics.. Electronics.. DVDs.. Porn…  Lingerie.. Hats.  Costume Jewelry.  Fabric. Ribbons.  Yarn..  Several stores filled to the brim with beads.  Pastry and cake shops.  Any kind of soccer (futbol) jersey you could ever want (and not because it’s the world cup – these stores are always here.)

Whole malls (centro commercials) for bridal wear.. Others filled with row after row of beauty salons.

Dollar stores for all the items you forgot to pack.. Luggage stores for extra space to bring back your fabulous finds..

About the only thing I didn’t see was a street devoted to mascotas (pets) but that’s probably just because I didn’t wander far enough.

You can find almost anything here!

You can find almost anything here!

 

Calling all Colombian travel agencies!   Fashion and textile guided tours

Add this to my wish list for Colombian tourism businesses –  or other ways to make Colombia accessible to tourists on a whole new level.  For people who are familiar with Colombia, the tours would just be a nice, relaxing way to have someone else take care of the details…  Not everyone lives in El Centro and has the ability to walk a few streets right into the commercial heart of the city.

But for first-time visitors; wives of travelling businessmen or people unfamiliar with this part of the city – a guided tour to the heart of Medellin’s fashion district would be absolutely essential, particularly as the area gets kind of sketchy after 6 pm.  Tours for fashion sewers, crafters and knitters along with general shopping and factory tours just sounds like a fun way to spend a day.  Throw in a typical Colombian lunch (not the enormous banda paisa but something featuring all of the great local fruits and vegetables) and a mixed group of tourists (Colombians, and foreigners from several nations) as well as a knowledgeable, bilingual guide  – and I think there would be a line of people ready to sign up..

I think it would go along with my dream trip to Bucaramanga for a weekend guided factory tour and shoe-shopping adventure.

Alas!  I am not a marketing genius – just a lover of fashion, sewing and crochet.  But just for fun – I am going to add a survey here where readers can let me know what they think of this idea..  If I get enough interested responses – I’ll pass it along to someone in the tourism industry.

Proexport advertises Shopping Tours but they are short on details..

If you are interested in a personal beauty consultant – and shopping.. a bit pricey but here’s the link.  (link is a bit short on details too..)

Fashion Tourism Survey

 Tips for Shopping in El Centro:

– Wear comfortable shoes

– Don’t bring extras: jewelry, cameras, smart phones.  (This is a high crime area).

– Bring mainly small bills: 2ooo, 5000 and 10,000 peso bills.  It’s problematic to pay for a 3,000 peso purchase with a 50 mil bill for shopkeepers and may be impossible for outside vendors.

– keep your belongings secure – I recommend a zippered purse.  Backpacks should be worn on the front.  Messenger bags work for me – so I can keep the strap across my chest, and the bag close to my body.

– Try not to be too loud and (gringo-ey) in El Centro.. While most Colombians like Americans, in this instance, you don’t want to attract too much attention.

– Be prepared to leave by 6 pm – and don’t stay in El Centro after dark unless you are with a native paisa (person from Medellin).  It is easy to get lost – and dangerous at night.

In general, use commonsense – have fun and good luck on your shopping adventures!

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Is it safe to fly after surgery?


Long haul flights are a health risk for everyone

While the risks of prolonged immobility and pulmonary embolism with long distance travel are well-known, many potential patients are unaware of the increased risks of thromboembolism after surgery.

Increased risks in specialized populations

People with a personal or family history of previous blood clots (PE or DVT), women on oral contraceptives, and patients who have undergone orthopedic surgery are some of the people at greatest risk.

Increased risk after surgery + Long trips

The heightened risk of thromboembolism or blood clots may persist for weeks after surgery.  When combined with long-haul flights, the risk increases exponentially.

In fact, these risks are one of the reasons I began investigating medical tourism options in the Americas – as an alternative to 18 hour flights to Asia and India.

Want to reduce your risk – Follow the instructions in your in-flight magazine

Guidelines and airline in-flight magazines promote the practice of in-flight exercise to reduce this risk – but few have investigated the risks of thromboembolism in post-surgical patients by modes of transportation: car travel versus air travel.

airplane3

But, is it safe to fly after surgery?

This spring, Dr. Stephen Cassivi, a thoracic surgeon at the world-famous Mayo Clinic in Minnesota tried to answer that question with a presentation of data at the  the annual meeting of the American Association for Thoracic Surgery.

This question takes on additional significance when talking about patients who have had lung surgeries.  Some of these patients require oxygen in the post-operative period, and the effects of changes in altitude* (while widely speculated about) with air travel, have never been studied in this population.

Now, Dr. Cassivi and his research team, say yes – it is safe.  Mayo Clinic is home t0 one of the most robust medical travel services in the United States for both domestic and international medical tourists.

After following hundreds of patients post-operatively and comparing their mode of transportation  – Dr. Cassivi concludes that the risks posed by automobile travel and air travel after surgery are about the same.

Additional reading

For more information on deep vein thrombosis, pulmonary embolism and safe travel, read my examiner article here.

AATS poster presentation abstract:

Safety of Air Travel in the Immediate Postoperative Period Following Anatomic Pulmonary Resection
*Stephen D. Cassivi, Karlyn E. Pierson, Bettie J. Lechtenberg, *Mark S. Allen, Dennis A. Wigle, *Francis C. Nichols, III, K. Robert Shen, *Claude Deschamps
Mayo Clinic, Rochester, MN

Schwarz T, Siegert G, Oettler W, et al. Venous Thrombosis After Long-haul Flights.  Arch Intern Med. 2003;163(22):2759-2764. doi:10.1001/archinte.163.22.2759 .  This is some of the definitive work that discussed the risk of long flights with blood clots in the traveling population due to prolonged immobility.

*Most flights are pressurized to an altitude of around 8,000 feet – which is the same level as Bogotá, Colombia.  This is higher than Flagstaff, AZ, Lake Tahoe, Nevada, Denver, Colorado or Mexico City, D.F.  – all of which are locations where some visitors feel physical effects from the altitude (headaches, fatigue, dyspnea, or air hunger.  In extreme (and rare) cases, people can develop cerebral edema or other life-threatening complications at these altitudes**.

** Severe effects like cerebral edema are much more common at extreme altitudes such as the Base Camp of Mt. Everest but have occurred in susceptible individuals at lower levels.

Going home..


After a whirlwind three months that included trips to Chile, Bolivia and different cities in Colombia, I am getting ready to come home in a few days.  As always, leaving Bogotá is bittersweet.  I miss my friends, and my family but I will also miss the city and all of the nice people I’ve met here.

I am posting a map of Colombia, so even though I’ve taken several trips – you can see that I haven’t really explored the country at all. (I’ve posted little push pins on the areas I have visited.)  I excluded Facativa and some of the closer towns since they are really just suburbs of Bogotá, and it would just clutter the map.

Map of Colombia, courtesy of Google Earth

As you can see – I haven’t explored the southern part of Colombia, or the pacific coast at all.  My Atlantic adventures have been confined to Cartagena.  So, I guess this means, I still have a lot of work cut out for me on my next visit(s).

map showing central Colombia

But I hope that readers have enjoyed reading about my travels, the people I’ve met and the things I’ve seen.  Now – I know this is a medical/ surgery blog but since much of the surgery I write about is in this part of the world, I think that including some of my experiences is relevant/ interesting for people who read the blog.  Once I get back home, I’ll post some more articles on medical quality control and standards – and more of my usual dry fare.

Back to Bogota


After stuffing myself with lechona and tamal tolidense, swimming in the fresh crisp water of one of the local fincas, enjoying the controlled chaos of the market in Lerida and being overwhelmed by the tragedy of Armero – it was time to head back home to Bogotá.

Since it was Sunday, the roads were almost deserted, so we made it home in a fraction of the time it took to travel in the other direction. So much so, that we had plenty of time to stop and look around at more sites on the way home.

I got some great pictures of the drive – heading up into the cool mountains.

the valley below

One of the more interesting places we passed once we returned to Cundinamarca was Guaduas.  Guaduas is a small city of about 30,000 that was the birthplace and home of one of Colombia’s most famous women (no, not Shakira but “La Pola”.)

The city was founded in 1572 and was a well-used and frequent stop for travelers from Bogotá to more outlying areas like Tolima.  Now one of its main claims to fame is Policarpa Salavarrieta or “La Pola” as she is known.  Her likeness and name currently adorn a local bakery in Guaduas.

Ms. Salavarrieta (1795 – 1817)  is considered one of Colombia’s heroes (or heroine) for her role in the Colombian revolution.  She is the only female to be honored on Colombian currency (in multiple different designations over the years.)  She currently decorates the 10,000 peso bill, but was also on coinage in the past.

After being orphaned by a smallpox outbreak, she moved to Bogotá where she was able to sneak in and out of Bogotá (which had tight security under the Royalist regime).

She was a seamstress who used her sewing talents to gain access to the homes of staunch Royalists and eavesdrop on their conversations.  She also stole documents and spied on military officers and recruited others to the revolutionary cause.

Unfortunately, after the capture of one of her fellow revolutionaries, she was arrested, tried and executed along with her lover and several others on November 14, 1817.  She was reportedly defiant even as she was led to the firing squad, and refused to keep her back to her executioners – turning around to face them as they shot her to death.

To commemorate her actions to assist the revolutionary efforts, in the late 1960’s, the Colombian government designated her birthday as “Day of the Colombian Woman.”

After learning more about La Pola from my guide, we continued to Faca (Facativa), a city just outside Bogotá to visit one of the fincas that used to be in the family.  Faca is best known for its native roots, and the many indigenous carvings, paintings and sculptures that were found during archeological excavations.  Faca is primarily a farm town – and is surrounded by several large fincas with livestock and different agricultural products including flower cultivation.

From there – we cruised on into Bogotá; where as much as I enjoyed my journeys, it felt great to be home.

Afternoon at the finca, and a day at the market


We spent Saturday exploring Lerida and cruising around.

Ready for adventure

We stopped at several roadside stops to buy some local fruit before heading off to La Gaviota, a local finca owned by a Brazilian woman.

buying papayas

We bought some delicious sugar mangos, along with some sweet papayas and mandarins.

enjoying sugar mangos

La Gaviota, a finca in Tolima

Now, there are two kinds of fincas in Colombia; working fincas and pure vacation fincas.  A working finca is usually a farm or an orchard – often owned by a city resident but managed locally.  This allows people who live and work in Bogota to have a get-away place that also brings in income.

one of the lakes at La Gaviota

Some of these fincas have been in peoples’ families for generations and produce much of the fruit and livestock products (dairy, meat etc) that are sold in Colombia.

Other fincas are pure recreational homes, and as such, are primarily owned by wealthier Colombians though this is not always the case.  Fincas vary from modest cabin style affairs to elaborate, ornate mansions with swimming pools, tennis courts and private fully stocked ponds.  Since most working people can’t stay at their finca very often, many owners rent out their fincas part-time.  Such was the case with the lovely La Gaviota.

the pool, surrounded by fruit trees

The entire property has been planted with fruits and trees native to Brazil and the staff encourages visitors to sample the many exotic varieties.

Yaca, a fruit native to Brazil

There is a swimming pool, and several lakes stocked with fish.  There is also a hotel, and a restaurant, where they will prepare your fresh catch.  Like many of the numerous fincas that dot the landscape here, they welcome travelers and offer services at reasonable rates.  So we spent the sunny afternoon at the pool.

The next day, we went to the market in Lerida.   We bought some more ‘tipica’ or traditional Tolidense food called lechona from a very nice young man who helps his grandmother.

young man selling lechona

While I vary from vegetarianism to veganism in the states, I never hesitate to try another delicious typical dish when I am traveling – and it was marvelous; warm, savory and flavorful.

There are several variations of lechona, which is stuffed pork but the Tolidense version uses a base of garbanzo beans for the stuffing and comes with a sweet-flavored bread stuffing called insulso on the side.

lechona

The grandmother, also invited us to come to her house where she had other tolidense specialities for sale, including tolidense tamales.

with grandmother

There were other vendors selling panela which is popular sugar product here in Colombia, (and other latin American countries.)  It’s a staple, a form of unrefined sugar produced at the local sugar cane factories in the region.  (I particularly like panela in my coffee and tea.)

panela

We met and purchased several tamales from another vendor in the market, a very nice woman who was very happy to pose for the camera.  I am ashamed to say that I forgot to write her name in my little notebook because my hands were full with all of our great purchases.

homemade tamales

in Lerida


in the mountains on the way to Tolima

Most Americans have limited exposure to Colombia, and Colombian life.  Other than media reports about drugs and violence, the majority of people’s opinions about the country have been formed by one quintessential little film of the mid-80’s…

“Romancing the Stone” – yeah, that’s right – the silly little romantic comedy with Kathleen Turner and Michael Douglas.  “Is this the bus to Cartagena?” is a line I’ve heard many, many times from people asking questions about my experiences here.

In general, like most things, Colombia is nothing like the movies.  Especially this one, since it was filmed in Veracruz, Mexico.

just outside Lerida at Sunset

But Lerida is that Colombia – the hot, humid, tropical Colombia that people think of after watching that movie.  It isn’t jungle-like here, of course,(that’s further south) but it’s an ancient city with stone buildings and some cobblestone streets interspersed among newer construction; but Lerida has the unrelenting heat and steaminess that people generally picture (and fail to find in Bogota.)  My guide tells me that the city wasn’t quite so hot – until most of the trees were removed when the streets were paved.  It makes sense since the neighboring cities (with thick tree-lined streets) are noticeably cooler.

It’s an interesting city – and more than just miles away from Bogotá – more like decades.  Life is a bit more traditional here, but that may be just the heat, and the ancient appearance of much of the buildings contributing to that perception.  Lerida was first ‘discovered’ in 1538 by Spanish conquistador Sebastián de Belalcazar who was amazed by the richness of the land, but it wasn’t officially ‘founded’ until 1777, which actually makes it technically one of the younger towns.  But as you wander the town, you see that people are still living in many of the original buildings – updated and modernized, of course.  But the original architecture with high ceiling and spacious rooms offers the advantages of cooler temperatures despite relentless sun.

As a mentioned in a previous post about Cali – motorcycles are the preferred method of travel in the warmer climes; relatively inexpensive, and good on gas – you see motorcycles just about everywhere you look; with entire families on bikes.

family on motorcycle in Lerida

Women in high heels, babies pressed between bodies, toddlers riding up front, even women riding ‘side-saddle’.

Coming from a society where motorcycles are used more as a statement than a viable mode of transportation; it takes a minute to adjust to the scene of so many bikes – it’s not a convention, they aren’t ‘bikers’, it’s just another day of running errands and going to work.

line of motorcycles

For more posts about my visits to Medellin, click here.

Road to Lerida, part II


As we pass into the valley, and the town of Honda, the whole topography changes.  It’s less West Virginia and more eastern Tennessee – in the summer.  The temperature has become hot and a bit humid.  The land is more flat, and as the land straightens out, so does traffic.  We can finally accelerate to 50km/h for the remainder of our journey.

drive to Santa Marta? no thanks..

(It’s this limited speed that makes the road signs for Cartagena and Barranquilla (1150+ km) so terrifying, yet correspond with other visitors stories about 20 hour bus rides).  But the view is so interesting, and I have great company, so it makes for a pleasant drive, especially once we escape the industrial traffic.

it be corn, but it’s not Iowa..

Even the mountains here in the valley are different, the ones that are visible in the landscape are more like hills, with exposed rock crevices.

My ‘guide’ for this trip just amazes me with the breadth and knowledge he has of this area of the country.  As we pass different outcroppings, and tiny towns – he knows a bit of folklore, facts of interest or history on each one of them.  We travel through places that seems a million miles and twenty years from the sophisticated enclaves of Medellin, Bogotá or Cali.

In the Colombian state of Tolima, we drive through the small city of Caldas.  This seemingly unimportant but bustling town is actually one of the more important towns in Colombia’s history.  When scientific explorers (Spanish) first came here they found an amazing bounty of plants, flowers and fruits.  Many of which are only found in Colombia.

They also found gold here (and in the neighboring towns such as Mariquita).  It was their treatment of the native population in pursuit of this shiny metal beneath the nearby mountains that led to a local uprising (and eventual revolution – leading to Colombia’s independence).

Modern day explorers also made important discoveries in this area of Tolima, near Caldas:  large pockets of natural gas.

In the next town, of Mariquita – gold mining both recently and in the past, has shaped the town.  It was the uprising here in Mariquita against the Spaniards and their gold mining efforts that shapes this town’s history.  Further gold exploration in more recent history has also caused problems – my guide tells me that the tunneling and excavations have caused major subsidence problems, with homes disappearing into sinkholes.  (As someone who lived in the Monongalia Mine area of West Virginia, I can well image the scene.)

Marquita is also home to a historic church – and the “Milagro senor de la ermita.”

Church services were actually in session when I arrived, so I didn’t many pictures.  (I took the one interior picture from a little alcove so I wouldn’t disturb services while my companions lit candles).

Church in Mariquita

The state of Tolima is famous for it’s tamales  – which have little in common with the Mexican version.  Mariquita itself is famous for having excellent tamales tolidense so we stopped at a place off on a side street which was recommended by the locals, called “El Tamalito” en San Sebastian de Mariquita.  The tamales were, indeed, delicious.

The owner, Mr. William Naffati has been making tamales for over 20 years.  He lived (and worked) in Bogotá for 40 years before coming back to Tolima (where his family is from) 2 years ago.  He states that he makes the ingredients for 200 tamales at a time, in huge metal VATS.

William Neffati, in the kitchen

He states that the secret to the rich flavor of the tamales is due to three key oils: chicken, pork and another which he’s keeping a secret for now.  Then the meats and vegetables are slow cooked for a minimum of four hours before final preparations.  He reports that during the course of a weekend he will prepare and sell over 1200 tamales.

Now this next part of our journey probably deserves its own post – but since I am using borrowed internet to post this – it will have to do.

Lastly, as the sky darkened we passed Armero, a ‘lost town’ that was destroyed in the November 1985 volcanic explosion that spewed rock and lava throughout the area.  The official death toll was 24,000 but locals estimate that it was higher.  As the lava rained down on the town – it burned and destroyed many of the buildings, and their charred and abandoned structures remain – as a memorial to the site.


My guide and my traveling companions know a great story about this town too.  As the volcano rained death down on the 29,000 residents of Armero, and a sea of mud/ sludge began to destroy the town, somehow, despite being in the center of the storm of rock and lava, the local hospital (which did sustain heavy damage) was spared.  Not a single one of the hospitalized patients (who were on the second or top floor of the building) were harmed.

what remains of the hospital today

I guess when you consider the devastation to the area, that would make the hospital of Armero the second miracle of our journey.   I’m not usually so sentimental, but looking at the town, it’s hard not to be.

Ruins at Armero

Unfortunately, it was getting dark as we came through, so I couldn’t get any photos. (But we came back through the next day – and I managed to get a few.)  We didn’t get out of the car because the structures are unaltered and are considered unsafe.  I would have loved to crawl around them a little bit, but I try to take good advice.

The guide

My guide for our trip is Mr. Alvaro Palacios, an adoption attorney.  Last year, when I was writing the Bogotá book, I was renting a room in one of the apartments  he and his wife own.  After being there for six months – we became pretty close.  Especially since once my roommates returned to their home countries, I was alone (sometimes lonely, when l had enough time to think about it) in the apartment.

Mr. Alvaro Palacios

But they always made me feel safe and secure in the fact, that they were next door, and that someone would notice if I didn’t show up one day*.  So I came to very much enjoy talking with the Palacios, their daughter, Camila and their son, Alvaro who was a medical student at the time.

Dr. Alvaro Palacio

In fact, that’s the reason they’ve invited me along – we are heading to Lerida to visit their son who is doing his intern year at the hospital here.  (In Colombia, all doctors have to do a ‘social service’ year working and training in underserved areas.)