Sightseeing in the age of Covid-19


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

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

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

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

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

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

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

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

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

An homage to Jaime Garzon:

Jaime Garzon memorial webpage

Archives in national center

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

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

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

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

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

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

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

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

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

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

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

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

A long time gone..


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-sheer volume

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

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

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

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

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

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

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

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

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

So, I’m back!

Miami plastic surgeon tied to multiple deaths


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

bandaid

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

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

money

Beauty, at any price?

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

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

Related posts:

Plastic surgery safety & Buttloads of Pain

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

Is your ‘cosmetic surgeon’ really even a surgeon?

Patient Safety & Medical Tourism

Liposuction in a Myrtle Beach apartment

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


Patient satisfaction and clinical outcomes

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

Patient satisfaction is not the same as patient rights.

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

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

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

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

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

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

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

Consumer or patient?

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

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

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

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

  This is where it gets dangerous.

Aortic Valve Replacement

Aortic Valve Replacement – photo by K. Eckland, 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chasing patient satisfaction scores and profits in American healthcare

Chasing patient satisfaction scores and profits in American healthcare

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

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

Take home message:

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

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

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

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

Resources/ References and Additional Reading

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

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

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

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

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

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

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

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

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

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

Heading South!


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

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

on the runway at Colombia Moda 2104

on the runway at Colombia Moda 2104

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

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

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

Life in the fast lane: my most recent assignment


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

New friends, new places, and new experiences!

Co-workers in the PACU

Co-workers in the PACU

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

the view from the call room

the view from the call room

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

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

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

Crash course in major trauma

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

Doctors in the ICU

Doctors in the ICU

Scheduled chaos

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

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

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

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

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

Street of Dreams – Calle 49


el centro map with shopping districts outlined

el centro map with shopping districts outlined -high resolution

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

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

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

How to get here – the real Medellin

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

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

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

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

tourist kiosk with maps

tourist kiosk with maps

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

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

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

Sewing machine repair and sales

Sewing machine repair and sales

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

Entrance to one of the small fabric markets

Entrance to one of the small fabric markets

Fabric

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

small shop in an indoor fabric mini-mall selling thread

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

elastics and trims

elastics and trims

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

many shops are small but piled high with fabric

many shops are small but piled high with fabric

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

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

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

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

Jaiime Sosa

Jaiime Sosa

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

Textiles El Faison Calle 49 No 53 – 101 Medellin

displays piled high with fabric

displays piled high with fabric

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

One of the malls for custom printed fabric

One of the malls for custom printed fabric

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

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

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

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

I just couldn't resist..

I just couldn’t resist..

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

Magazines containing 10 - 40 different patterns

Magazines containing 10 – 40 different patterns

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

the place to buy patterns

the place to buy patterns Calle 49 #53 – 14

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

some of the patterns available at this small shop

some of the patterns available at this small shop

Yarns

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

yarns

yarns

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

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

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

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

UN resolutions, ethics and big business


As I continue my journey home from the medical tourism trade show in Mexicali – I am reminded of the urgency of the need for industry regulation.  This reminder comes in the form, of a very nice Chinese woman in the Los Angeles Airport (LAX).

Woman soliciting signatures for United Nations petition against organ harvesting

Woman soliciting signatures for United Nations petition against organ harvesting

Now, in this photo she is talking to a traveler in the airport.  Sadly, he seemed to think she was trying to sell him something, instead of merely enlisting his aid against human rights atrocities.

(If you look close at the next photo, you can see her display).

organs (2)

I have blurred her features to preserve her privacy and safety.

We have talked about this topic before, in several previous posts, particularly when talking about transplant tourism: (with links to source articles within posts)

The Ethics of Transplant Tourism

Ethics 2

The Ugly side of Medical Tourism

But now – on the heels of a gathering dedicated to the business side of medical tourism (with nary a consideration for ethics or the need to establish a moral compass) this woman, her brochures and her sign remind me, yet again – why it is important for readers, and medical travelers to be informed.

Brochure

Brochure

But it’s not enough to be aware of the abuses and human rights violations.  It’s important that we, as consumers, service providers and yes, even as a writer, not contribute to companies, practices or services that help support the routine execution of other human beings in our own pursuit of health.  It is more than unethical – to me it is unthinkable.

So sign the petitions, research the issue  – and more importantly, research your medical tourism facilitators (travel agencies), and destinations.  Most of all – don’t buy an organ – no matter what.

Why quality of anesthesia matters: who is administering your anesthesia?


Now that Colombia Moda is over – let’s get back to the stuff that really matters.. Let’s warm up but reviewing some older posts for our newer readers.

Love, Life and Surgery in Latin America

I know some readers find some of my reporting dry and uninspired, particularly when talking about methodology, measurements and scales such as Surgical Apgar Scoring.  But the use of appropriate protocols, safety procedures and specialized personnel is crucial for continued patient safety.

There is a saying among medical professionals about our patients.. We want them all to be boring and routine.   That is what I strive for, for each and every one of my readers – safe, boring and routine.

Excitement and drama are only enjoyable when watching Grey’s Anatomy or other fictionalized medical dramas.  In real life, it means something has drastically and horribly gone awry.  Unlike many of its fictional counterparts – outcomes are not usually good.

In a not-so-sleepy hollow of upstate New York, a medical tragedy serves to illustrate this point, while also bringing up questions regarding the procedure.  While we don’t know the circumstances behind this case – (and don’t really want to…

View original post 1,047 more words

Bogota’s castle


Some of you may notice that I have temporarily changed my header – to show Bogotá’s castle.  I found it the other day as I wandered some of the carerras.  (Residents of Bogotá know that once you get into the single digit carerras – all logic and inference regarding standard directions goes out the window.)  Once you cross Carerra Septima (Cra. 7) the lovely city layout that makes Bogotá such an easy place to navigate changes into a labyrinth of twisting, winding streets reminiscent of San Francisco..

It’s part of what makes the city so interesting – and at times (such as yesterday, when I was making my way to an appointment) – a bit frustrating.  Just when you think you ‘know’ the city – you stumble upon something completely different from what you were expecting..

Not what I was expecting

The castle which is located at Cra 3 – 74 was the brainchild of Dr. Juan Osorio Morales and is called Castillo Mono Osorio.   While it has the appearance of antiquity, it’s actually only about 100 years old.

Bogotá’s castle

The creator, a local eccentric – was  Colombian cultural attaché to Brussels.   Upon his return to Bogotá, he spent the next twenty years creating the castle which later served as home to his own personal theater troupe.

Like the work of many unconventional artists, after his death the castle fell into disrepair until it was rescued in recent years by one of his descendents and repaired to its current state.

It currently houses several stores including a banquet space, a gift shop and a pharmacy.  Best of all – there is currently space for let.  A new, whimsical office, anyone?

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..

Canadians look towards medical tourism


In this story, several Canadian residents are suing the province of Alberta for the right to purchase private health insurance.  The Alberta resident who was interviewed in the story, explain that due to the prolonged wait times for medical treatment in his home country – he would like the right to pursue treatment in other countries.

One of the claimants explained that after being told that he would have to wait FIVE years for back surgery for debilitating back pain, he went to the United States for treatment.  On his return, his Canadian government refused to reimburse him for his medical treatment, stating that the treatment was available in Canada.

(BTW: the American price tag for surgery: $77,000)

Just another reason many North Americans are looking South for care.