In Capitol City


Long time readers know that I am addicted to the capital city of Colombia.  So there was no way that I wasn’t going to take a few days to head over to Bogotá the moment I had a chance.  I just got back – and before I head off on my adventure to La Macarena tomorrow, I thought I’d post an update.

Charlie’s Place

8D y 106-84

Usaquen

Since I was just stopping in for a few days, I decided to forgo renting my usual apartment.  It’s a good thing I did or I would have missed out on getting to know the folks over at Charlie’s Place, a boutique hotel and spa in Usaquen.

CharliesPlace

It’s probably not for everyone – people who want to be in the middle of the tourist areas of Bogotá should stick to La Candeleria.  Business travels on large expense accounts can head to the big-name chains.  But for people like me, who want to be in the north side of Bogotá, around Barrio Chico and Usaquen, Charlie’s Place is ideal.

With just 22 rooms, the hotel is very cozy and accommodating.  The manager, Wilson, is a Minnesota native and is delightfully charming and easy-going.  The rest of the staff including Daniela and Javier are equally polite, friendly and helpful.  (There’s a reason Charlie’s Place is consistently rated as excellent by Trip Advisor for the last several years.)  The best part is that the rates are fair and the service is excellent.

Once I was comfortably settled, it was time to get back out and enjoy the brisk weather.  (The weather is one of the reasons I love this city!)  My first stop was over at SaludCoop where the doctors and nurses were nice enough to answer some questions about the ongoing healthcare crisis.

The Colombian Public Health Care Crisis

Right now, the public health system, EPS and SaludCoop are going broke.  Basically, much of the money paid in by members of the health care cooperative has disappeared (been embezzled), leaving hospitals with bare cupboards.  Hospital staff are feeling the pinch as payroll arrives late, in diminished amounts, or in some cases, not at all.   (There are rumors that the money was funneled into the purchase of luxury apartments, fancy vacations and the like).  There have been some protests and work stoppages by health care workers, but unfortunately, the local unions have been unwilling to support their efforts.

Unfortunately, the government seems apathetic to the concerns of the healthcare workers and their patients. The Minister of Health, Alejandro Gaviria went so far as to say that the health care crisis was a “lie” in a recent press conference, following up on his previous twitter (June 2015) and blog comments (Feb 2015), even going so far as quoting Christopher Hitchens in his defense of the health care system.  Of course, no where in his statement does he talk about healthcare workers going without pay or operating rooms without suture.  But he’s not alone in his apathy.

Most of the local politicians  couldn’t even be bothered to show up to a legislative session on the issue.  Only 9 members of the House of representatives (out of 166) attended.

This financial travesty has wide-spread implications beyond just the public health sector (of hospitals and clinics throughout Colombia).  Many of the private facilities also rely on payments from the healthcare cooperative.  (Imagine if medicare went broke through criminal mismanagement – it would affect a lot more that general and county hospitals).  In many cases, these hospitals are forced to write off millions of dollars of nonpayment from the health cooperative.  In fact, one of the largest hospitals in Cali (a city of 2.5 million people) will be forced to shut it;s doors, mainly due to losses incurred from nonpayment by EPS and SaludCoop.  So it’s a huge mess that will probably only get worse without government intervention.

On the flip side of the Colombian Health Care Crisis and the declining peso (over 3200 pesos to the dollar this week) – Hospital Santa Fe de Bogotá  appears to be thriving.

Santa Fe de Bogota’s new emergency department

Yesterday evening I had the pleasure of a guided tour of the new Emergency department at Santa fe de Bogota with the current Chief of the Emergency Department (and trauma surgeon), Dr. Francisco Holguin.

Fans of the Bogota book know that I spent quite a bit of time at Santa Fe de Bogotá in the past – and that it is one the highest ranked facilities in all of Latin America, so it was fantastic to see all of the improvements.  (The ER was still under construction the last few times I was there).  The first thing I can say – It’s big! Big, spacious, brightly lit and airy (especially for an ER).  The is good work flow with several large workspaces for the doctors and nurses, instead of the typical traffic jams that occur in older facilities.  It’s on the same floor as diagnostics (CT scan, radiology), the operating rooms and the intensive care units which means that critically ill and injured patients can be rapidly transported to where ever the need to go.

The spacious department now has 56 beds with an overflow unit for critically ill patients.  Several specialists are on-call, in the ER and available 24 hours including orthopedics, trauma and internal medicine.  Downstairs from the main ER is the fast track – for all of the non-life-threatening general medicine problems.

After spending two days interviewing and talking to people about the SaludCoop problems and EPS – it was nice to leave Bogotá on such a nice note.

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Checking in at Santa Fe de Bogota


After a year and a half – it was time to stop in at Santa Fe de Bogotá and see what was new.

Dr. Roosevelt Farjardo, MD (general surgeon) has been instrumental in implementing some of these new and exciting changes such as the ‘Virtual Hospital’ that I will be writing about (soon).  He was very nice about taking time to update me on some of his new programs at part of the Center for innovation in education and health.  Telemedicine is just the tip of the iceberg as far as some of the cool things they are doing.

Unfortunately, the same can’t be said of the International Patient Center  – or rather – I can’t report anything other than the fact that Ana Maria Gonzalez (the previous director) has left for a position in the United States and that Dr. Carolina Munoz has taken her place.

I was hoping to get some statistics and report back about some of the specialty programs for overseas travelers – but Alas!  I am unable to bring this information to you.  I waited over 70 minutes after my scheduled appointment with Dr. Munoz – and despite several calls from her staff, she never showed up and never attempted to reschedule.

I wish I could say this is an isolated incident – but I am afraid this is more like a clash of “cultures”.  I say this because I met with Dr. Munoz  previously; during the writing of the book (when she was the Director of the International Patient Center at rival Fundacion Cardioinfantil.)

At that time, (if I remember correctly, she introduced herself as a cardiac surgeon who had retired to “spend more time with her children.”)

Of course, my obvious question – was “oh, and how many children do you have?**”

I thought we were making polite conversation – because at the time, I was less familiar with Colombian customs, culture etc.   In reality, she was reminding me of her elevated stature in comparison to mine (as ‘just a nurse’).  Dense as I was – it became obvious as the interview progressed – as she made sure that I knew that she had replaced her rival (Ms. Ana Maria Gonzalez – RN) who had also worked at Fundacion Cardioinfantil in the past.  I’m sure she resented having to answer questions about the Executive Health Program and other aspects of their medical tourism program from someone she found to be inferior to herself.  (She made that pretty clear at that initial interview back in 2011).

So I guess it is no surprise that she didn’t bother to show up to our appointment this week – which is a shame, as I had looked forward to finding out more about the evolving International Patient Center at Santa Fe de Bogotá.

Luckily for me – there was another nurse there, Sandra Salazar – who could give me some basics.   She was delightful, helpful and dreadfully embarrassed about the whole thing.  She was even able to give me a list of some of the American insurance companies they have worked with in the past.  I had lots of questions about the HIPEC program, which she couldn’t answer – but she outlined the entire medical tourist process – and answered a lot of other questions.  She showed me how they streamline the process for their international patients, and the process for medical and surgical evaluations.

Now, there’s some good news for readers:  You aren’t nurses.  You are paying customers – so I am sure that Dr. Carolina Munoz will put aside any of her personal feelings (whatever they are) towards foreigners and will make time for you.

**The answer as none – as she is not married, and was not planning to be married in the foreseeable future.

Now when I am talking about culture – I am not strictly talking Colombia – America.  I am talking about Doctor – Nurse relations.  Watch some old Turner Classic Movies sometime and you will see what I mean..

Now I debated writing about this, but after talking with some other non-Colombians here in Bogotá, I felt it was important to pass it along because it illustrates quite a few things about my work:

1.  It’s not as easy as it looks (I spend a huge amount of time waiting..)

2.  Cultural differences can cause a lot of problems – so be prepared to be tolerant.

3.  If there is a chance that patients may get poor service – I want to know about it!  (And part of readers need to know about – is my experiences.)

Fundacion Santa Fe de Bogota ranks among the best in Latin America


Santa Fe de Bogotá ranked second in Latin America

In the most recent American Economics (AmericaEconomica), Fundacion Santa Fe de Bogotá ranked second in the category of “Capital Humano” coming in just behind Clinica Alemana, in Santiago, Chile.  Fundacion Santa Fe ranked #4 overall.

Capital Humano

This category ranks and measures the education, training and research among the staff of each facility, as well as on-going improvement projects and educational offerings.

Of course, it’s no surprise to readers of Hidden Gem that the surgeons over at Santa Fe de Bogotá excel at academic excellence.

Now – while we give Kudos to Santa Fe de Bogotá, as well as Hospital Israelita Albert Einstein (Brazil) and Clinica Alemana for their outstanding rankings – we remind readers that rankings aren’t always what they are cracked up to be.

AmericaEconomica, “The best hospitals and clinics in Latin America.”

Neurosurgery at Santa Fe de Bogota


Dr. Fernando Hakim Daccach (left), neurosurgery – Santa Fe de Bogota

As you can imagine, millions of pairs of eyes are turned towards Santa Fe de Bogota – and the department of Neurosurgery after the mayor of Bogotá, Gustavo Petro was admitted with a subdural hematoma, and subsequently underwent surgery.

Many people don’t know that Bogotá is actually the home to modern neurosurgery.  Dr. Salomon Hakim, one of the founders of modern neurosurgery and inventor of the Hakim shunt for hydrocephalus called Bogota home.  (Sadly, he died just last year.)

But neurosurgery in Colombia doesn’t begin or end with Dr. Salomon Hakim.  With five neurosurgery residency programs and over 150 practicing neurosurgeons in Bogotá – new innovations and treatments are being developed here everyday.

Many of these fine surgeons practice at Fundacion Santa Fe de Bogota such as Dr. Aristizabal – Chief of the Neurosurgery residency program, or Dr. Carlos Cure, Dr. Enrique Jimenez and Dr. Fernando Hakim .

Others such as Dr. Pedro Penagos or Dr. Juan Fernando Ramon are scattered throughout the city – treating brain cancers at the National Cancer Institute, or caring for the families of policemen at the Hospital de la Policia – and innovating in the field of neuronavigation.

While my heart goes out to the Mayor of Bogotá, and his family – hopefully the international media stories on his health will give some well-deserved attention to these fine (and humble) neurosurgeons.

 

References and additional information: Updated 17 June 2012

Gustavo Petro webpage

According to their website, they anticipate the mayor will be discharged home soon (in a statement dated today, June 17th.)  We are glad to hear he is making such a speedy recovery.

 

Now available in the Kindle Lending Library!


Now you can read Bogotá! for free in the Kindle lending library..  (I hope this inspires some generosity among critics for impoverished medical writers – leave some positive feedback about the book!!)

 

 

In the OR with Dr. Hakim


Had an interesting day with Dr. Fernando Hakim, Neurosurgeon, over at Santa Fe de Bogota, for a tumor resection.  A lot of the stereotypes are true; neurosurgery is a  precision-based specialty (not that the other specialties aren’t – but at least in most cases, there is a margin to work with**.) but some of them aren’t.. In this case, with a tumor pressing against the spinal cord – there is no margin to work with, no border area around the tumor, so to speak.. but then again this petty much describes a lot of neurosurgery.. requiring careful, painstaking process..something I would find inherently, and incredibly stressful – but Dr. Hakim and his team didn’t; they were focused, precise, but relaxed and well-coordinated with each other.. Definitely not the uptight, high stress stereotype.. (You’d think I would have known better – I’ve seen plenty of surgery, and some spine cases# before – but nothing of this magnitude, and as I’ve said before; neurosurgery is a bit of a final frontier)

(not to give you the wrong impression – surgery is always serious, this just wasn’t the melodrama that stereotypes/ stories sometimes suggest)

Dr. Fernando Hakim Daccach (left), neurosurgery

** ‘margin of tissue’ or area surrounding the tumor, not ‘margin of error’

# cartagena neuro cases were ‘back cases’ or spinal cases for chronic back problems..

Dr. Hakim, neurosurgeon using the OR microscope for precision work

To switch gears a bit, I met with Dr. Fabio Andres Mejia, a plastic surgeon specializing in rhinoplasty and breast procedures (augmentation/ reduction).  He’s a former fellow (and current member of the) Dr. Ralph Millard (Society) and has been in practice since 1998.
He’s no longer working three jobs or taking emergency plastic surgery calls all over the city – and is now focused solely on private practice (and having a livable schedule)

Dr. Jairo Ramirez and Dra. Stella Martinez


My early morning surgery plan fell apart – so I will try again next week. Met with Dr. Jairo Ramirez, MD, FACS over at Santa Fe de Bogota this morning. Dr. Ramirez is a vascular and thoracic surgeon, and the Chief of Vascular Surgery (at SF de B) but he reports the majority of his practice is the treatment of venous disease such as varicosities and venous stasis ulcers.

This afternoon, I met with Dra. Stella Martinez Jaramillo, (thoracic surgeon) and she is a fascinating lady. We had a great chat – and scheduled a day for me to see her in action..I am definitely looking forward to it.

Spoke with Dr. Javier Maldonado, cardiac surgeon on the phone today to set up an appointment next week over at Clinica Colombia. Now, I thought he completed some of his training in the USA but I could swear I heard soft traces of a southern accent – and Cleveland is a far cry from my native Virginia.. There must be a story there – or my overactive imagination.. I’ll keep you posted.