Termales Los Volcanes

Posted on October 29, 2023 by K Eckland

It’s taking longer than I thought to find the video clips I have about driving in Colombia.. so we will defer that topic for now. Instead, let’s talk about something less death-defying and much more relaxing.. Hot springs!

I know I mentioned in my post about Santa Rosa de Cabal – how much I love hot springs.. Or maybe I mentioned it when I went to to Sulfur pools in Tocaima way back in 2010, but that would have been the earliest days of the blog.. I adored the hot springs in Paipa – but those too, I might not have mentioned since it was a client trip.

Anyway – I love hot springs! I love bathtubs, jacuzzis, swimming pools – all things water. It was so important that it was one of the determining factors when it came to purchasing my house in North Bogota. Was there a bathtub / was the bathroom large enough to install one? Now, the tub at my house isn’t some massive spa tub that uses hundreds of gallons of water. It’s just a regular old tub, but I sure do love it – especially when I can’t sleep, or the damp chill during the rainy season sets into my joints. Now the tub at my rental property is the supersized luxury type, but honestly, I’ve never used it – or the golden toilet.

*the bathtub at the Elvis Presley Graceland penthouse*

So if you’ve never been to the ‘termales’ or the hot springs but you enjoy a hot bath – just think of a swimming pool of nice, hot volcanically heated water, usually in a beautiful outdoor location. I’ve recently made it my personal goal to visit as many Colombian hot springs as possible. I read somewhere that Cundinamarca has 42 different hot springs alone, and that Colombia has 130+. I won’t get to all of them – and I don’t need to. (I can’t image enjoying hot springs in 100 degree weather, which rules out several). But with just a few days left before I head back to the United States for a month, we decided to start working on that top ten list I posted recently.

A mid-week day trip was perfect, so we decided to pick a location close to Bogota. We decided to go to Termales Los Volcanes in Macheta, Cundinamarca. Minimal traffic to navigate to get out of the city since it was a Tuesday, low weekday prices and no crowds at the springs.

We arrived early in the morning, around 730 am, while the weather was still cool and refreshing. We had a nice breakfast before jumping in the deliciously warm springs. There are two big pools, one much warmer than the other, and two smaller pools.

The hot springs are set against the lush green background, with a waterfall, cobblestone paths and lots of flowers. There is a small hotel on site, along with a restaurant, snack shop and spa. Since we were on a day trip, we didn’t need the hotel, but we checked it out anyway. Weekday rates start at 315,000 COP and include breakfast as well as hot springs entry. Weekend rates start at 415,000 COP.

Since we were just day trippers, it cost us 35,000 COP each to get in. The hot springs are open from 7 am to 11 pm most days. We enjoyed the pools for quite a few hours, along with breakfast, snacks, lunch, massages in the spa, and quick dunks in the icy waterfall before we headed back to the city. It was a lovely day – and even lovelier because Andres and I got to spent it together. (We do a lot of family activities with his parents, cousins, uncles etc., but we don’t always get to spend time together.) He’s a great co-pilot, co-conspirator and partner-in-crime for our adventures. We have a lot of very different interests but he’s definitely game for my hot springs challenge.

I got a bit of a sunburn despite lots of sunscreen – so I’d advise wearing a rashguard, like Andres did. Otherwise, it the entire day was a bit of joy..

Cali, Cali, Cali and the best AirBnB in Cali!

Posted on October 25, 2023 by K Eckland

Montenegro, Salento, Santa Rosa de Cabal and now, Cali, Colombia. We passed thru multiple states, ate lots of different things, took lots of pictures, hiked in the mountains, climbed lots of stairs and enjoyed the famous hot springs on our way to the grand city of Cali, Colombia.

So…. Cali is hot.. Not warm, but hot. Maybe not to everyone (I saw locals wearing sweaters and jackets) but it’s the kind of hot that makes me grouchy and miserable – and I know this! I’ve had plenty of miserable trips to sunny beach locations (and other places that heat seekers flock to – and I know what heat does to me). Add heat = instant bitch.

It was also the surprise visit for Andres and his daughter’s shared birthday weekend.

So I couldn’t let the heat get to me. I found a charming Airbnb home with a small swimming pool. The hosts were absolutely delightful, so I posted the link above, if you are planning a trip to Cali. It was in a nice neighborhood (but not a lot of stores or restaurants to walk to) right on the river. It was the perfect solution – we basically lived in the pool for much of the weekend. His daughter loved it, we had a good time, and I didn’t become a heat enraged monster.

House we rented in Cali, in private cul-de-sac
lovely elegant split level
Dining room and kitchen opened out to the pool/ BBQ area
BBQ area
living room
master bedroom
master bedroom
view from master bedroom

I don’t usually feature someone else’s rental on the blog – but this house made all the difference. It was spacious – charming.. We barbecued, we swam, we slept in the hammock by the pool. This house made all the difference for me – (and certainly for people who had to travel with me!)

But we didn’t stay in the house the entire time. We took a morning stroll down to the Parque de los Gatos and other Cali landmarks. Of course, I did manage to bow out of one afternoon adventure in the heat – to hang out by the pool and read a book. It was lovely! I also used the time to sneak out and get ice cream for the birthday folks..

I enjoyed the heck out of the pool.. I even stayed home to read a book by the pool while everyone else went out one afternoon
the Pool
BBQ birthday
Parque de los Gatos

I probably should talk about Cali and salsa dancing.. or salsa music, drink champus or the many other things that make Cali famous and noteworthy.

But I didn’t go and experience any of those things on this visit. (This is my second visit to Cali.)

Here’s an easy Recipe for Champus. It’s a tasty nonalcoholic drink made with tropical fruits. Lots of people say they drink it at room temperature, but we usually have it chilled.

At the end of our weekend, we returned to Bogota.. I drove for a good bit of the way – but I really don’t like driving in Bogota, so we switched off at Ibague, where we stopped for lunch, and to wait out traffic with some friends. (You don’t want to drive thru/ near Bogota during peak time – it can take 3 to 4 hours to cross the city if caught in peak traffic.) On one of my future posts – we are going to talk about Driving in Colombia. I know I mentioned that I received my driver’s license and motorcycle license this year but driving in Colombia particularly in the city of Bogota is worthy of a special note.

The charming and colorful town of Salento

Posted on October 5, 2023 by K Eckland

The trip has gone better than expected so far. In the last decade of so, I have developed a very poor heat tolerance – which makes traveling difficult sometimes. I feel overheated on a sunny day 70 degree day in Bogota (I have several fans installed at my house to the complete horror of my friends and neighbors.) Sometimes, I am sweating and overheating when my friends are putting on sweaters.. It’s kind of frustrating to deal with – but now I travel with my own fan, and ice packs. So, I was worried about traveling to the Eje Cafetero, because some areas are fairly warm, like Pereira but Andres was careful to plan most of our trip in the cooler areas. Not as cool as Manizales, which is my general comfort zone, but quite pleasant so far in our journey.

Salento is quite close to Valle de Cocora, and during our stay, the weather was cool, with rain overnight. Salento is one of those picture postcard towns, that as much as it’s a touristy place, it still manages to be charming, which was a pleasant surprise. (I am sure volume of tourists plays a big part – we were there during the week, just prior to school vacations (semana de receso) so while there were other tourists around, there weren’t any lines, nothing was crowded, merchants were pleasant, friendly and not at all pushy.

I like color – it’s one of my signatures in both interior design and fashion. I strongly believe that we should “live life in color” and I despite that all white cold, institutional look that is so popular these days. Same thing for grey, and beige schemes – which predominate in Bogota design. My own house in Bogota is a riot of color, and a color scheme that changes on a whim.

Salento is the same, rich with color – in the bright fashion of the coast, and the Caribbean versus the painted ladies of San Francisco. The other nice thing is that it isn’t just one or two streets – it’s the majority of the town.

colorful homes and businesses in Salento

We stayed at a lovely apartment hotel that was close to the center of town. We were able to walk everywhere. The apartment was well-appointed, and we could make our own breakfast in the morning. Our host, Mario was very nice and happy to accommodate our plans.

After we got settled, we walked downtown – and to the Mirador, which is a point above Salento that allows you to see the entire city below – once you climb the steps to get there. (There’s a less strenuous path to the Mirador, but I needed the exercise).

It’s 256 fairly steep steps, (less than half the steps of La Piedra del Penol, and only a quarter of the climb up Monserrate but it’s enough to make you breath pretty hard.

I found the actual city view a little underwhelming, but maybe I’ve been spoiled by all the beautiful Bogota vistas..

But once you reach the top, there is a trail that leads to another view point – and this one is breathtaking. Instead of city scapes, it’s a panaramic view of the valley and the mountains that surround Salento.

I could take a million pictures and probably never do it justice.. So here’s a couple more.. Just click on the image if you want to see the whole thing.

The older I get, the more I am awed by nature. It’s funny how that happens. Sometimes, I think that we need to see a lot of ugly to truly appreciate the beauty in the world.

On the way back, we did a little bit of shopping to celebrate Andres birthday – and so I could take pictures of some of the crafts. (I know, it’s in almost all my Colombia posts – but the different kind of artisanal art and indigenous and traditional craft here is so beautiful. I don’t need to buy it – because how many mochillas, bags, hats and other things does a person need? Then again – I do try to support local craft by buying it whenever I need a gift because why would you buy someone mass market crap when there is a plethora of beautiful handmade items that actually mean something out there.

(Not this time – this time Andres actually picked out the beautiful leather bag he wanted – and I’ll get a picture of it tomorrow.) But there is such a variety of so many lovely things, that I just can’t help but take pictures of it when they let me..

After that, we took some more pictures – found a nice restaurant before heading back to the hotel to sleep..

Tomorrow – Santa Rosa de Cabal and the thermal springs..

A surprise visit – to Eje Cafetero and Cali

Posted on October 4, 2023 by K Eckland

It’s been a bit since I’ve posted here, but the adventures continue. I spent some time in Pacho, Cundinamarca finishing up a manuscript for my second full length novel. Now that it’s done – I am in the tedious process of getting it edited and finding an illustrator.. Now, I am not the great American novelist and I have absolutely no illusions that I will find any mainstream sales success (no publicist, no large publishing house) but I have always believed that if you put in the time and effort to do something, finish it…

But, it was a relief to finally finish the book – and not have all the characters in my head all the time. That being said – there is always so much to do.. But we are taking a week to smell the roses and enjoy ourselves.. It’s a surprise visit for my significant other to see her daughter on her birthday. She lives in Cali – and she will be delighted to see her dad.

Since I’ve never been to the Cafetero or Coffee Region of Colombia, we decided to take a tour of it on our way to see her.

We left Bogota around 3:30 am.. We live in North Bogota, and our journey takes us south, so we have to cross the entire city first. (There isn’t a bypass though politicians have been promising one for the last 40 years.) By 4:30 we encountered traffic.. (If you haven’t been here – Bogota has a massive traffic problem – brought about by limited public transportation, a huge population of people who work on one side of Bogota and live on the other) and well, an exploding population, with a road system designed for a much smaller city. (In the 1990’s Bogota’s population was around 3 million, now in 2023 – we have close to that in Venezuelan immigrants with a total population of around 11 million).

But soon enough, we were on the open road.. Our first stop was Ibague in the Colombia state of Tolima. Culinary-wise, Tolima is best known for some of my favorites, Tamal tolimese and Lechona (stuffed roasted pig). (The links will take you to some older posts on these tasty Colombian dishes).

We stopped for some breakfast and a quick visit with family. (His, not mine, though I like to think of his large immediate family as mine). It was starting to get hot there by about 930 so I was glad when we hit the road again..

Now if you’ve never driven in Colombia – distances are very very deceiving. I recently got my Colombian driver’s license which requires you to take the full driving course to learn the Codigo de Transito, and clock your behind the wheel hours. Funny enough, I was rear ended while driving in the student car, which has massive green labels saying “student driver – keep back” – but that’s a story for another time.

The maximum speed limit in the country is 80 kilometers – but most of the time, you never get near it.. In the cities, the limiting factor is usually traffic – but in other areas, it’s the state of the roads themselves. There is always road construction. With a rainy and a dry season, you also get periodic flooding in some places.. Much of Colombia is high in the Andes mountains – with winding mountain roads – usually one lane in each direction. Add a couple of fuel trucker, semis (18 wheelers) and a whole bunch of motorcycles and cyclists – with people passing said fuel trucks, cyclists over double lines, on blind curves and all, you end up with an average speed of around 30 to 50 kilometers an hour.. (that’s less than 30 miles an hour for people like myself who weren’t raised on the metric system.) Sometimes it feels painfully slow.. But on highway 40 – it can feel dangerously fast..

*That time estimate is complete fiction..*

Unfortunately, due to the narrow roads, curves and such – I didn’t get many pictures of our drive – and it’s an unbelievably breathtakingly gorgeous drive.. You climb higher and higher in the mountains (which is delightfully refreshing with cool temperatures) with such a picturesque landscape, dotted here and there with fincas and small farms – but otherwise endless green trees, plants, grass and a wide open blue sky..

We continued on after a brief stop in Cajamarca (photo above) to Montenegro, where we spent the night. There are some cool things to see in Montenegro but we decided to relax a bit after getting up so early.

Sampled some coffee, walked around the plaza and swam in the pool. My companions were lights out asleep by about 730 that night. The next morning we headed off to the Valle de Cocora. If you’ve ever seen the kid’s animated movie. Encanto – it’s set in this part of Colombia..

*I love maps.. absolutely fascinate me, so of course – plenty of them in this post..*

The Valle de Cocora is part of the Los Nevados National Park and is located just outside of Salento. It’s famous for the large collection of Quindo Wax Palms, which are the tallest palm trees in the world. These palms are also part of the national identity of Colombia.

As part of the Nevados Mountain range, the palms are located at an elevation higher than Denver.. What does that mean, you ask? It means blissfully cool weather.. and lots of misty low clouds that drift in and out.

Today was the day that I realized that I am not a horse lover.. Not a horse hater either.. Wouldn’t want to knowingly eat one – and I used to get upset when they would sanction killing the wild mustangs when I lived in Nevada.

But I was never that pre-teen girl that was doing paint-by-number horse paints, or reading Black Beauty a million times (am I dating myself or what), and dreaming of owning a horse.. but I love animals in general, mainly feline varieties. Our neighbor used to graze horses in our yard when I was little in Virginia, and I have ridden before.. But not – horse crazy.

Ha.. So we decided to go on a “nice” horseback tour. I immediately felt uncomfortable, but hey – get back in the saddle right.. But it progressed to a freak out – and I ended up dismounting and walking (which is fine – I love a good walk/ hike). But it still surprised the heck out of me. I always feel like I am fearless.. Ha. Seabiscuit proved me so so wrong today..

Andres and his mom had a lovely time horseback riding.. Once my pulse went back to normal, and my feet were on level ground – I had a great time too..

We had a lovely lunch at a cute restaurant. The area is known for it’s fish (trout) dishes, so we each had a different trout preparation and shared..

Enjoying a little Club Colombia
High up in the Valle de Cocora
Andres mom enjoying trucha with mushrooms
Valle de Cocora is filled with amusements, tours, shops and selfie stations
Trucha with cerviche
Trucha with garlic butter
the classic Eje Cafetero jeep
Horse tack at the stables

Then it was time to set off for Salento.. But that’s another post.

Additional Links about destinations in this post:

Cocora Valley Jetsetter’s Guide

Visiting the place that inspired Encanto

Town hopping in the Cafetero

National Coffee Park in Montenegro

Kristin in Colombia again.

Posted on August 24, 2023 by K Eckland

Readers know that I am just not that cool – or up-to-date with social media etc.. As much as I hate to admit it, it’s a little bit after my demographic.. I am a bit too much Gen Z, and not enough today to be entirely natural with all of the online mediums. I still remember dating a informational systems major (see, even the name of the degree gives me away!) in college, and having him show me email for the first time. Of course, it was kind of a nerd messaging system then because it only worked on campus, and it only worked for people who had their own desktop computers, (which wasn’t very many of us.) Of course, less than two years later – everyone had a desktop and the internet was becoming “a thing” but it has quickly left me in the dust. It’s embarrassing since my mom (who is in her mid-80’s is more computer literate than I am.) Now, my dad – he refuses to use anything but a flip phone (he gets super irritated trying to learn the features of smart phones)- so we have a bit more in common there. It’s hard to realize that you have become dated, despite your best efforts. It comes along with no longer listening to the pop stations (as you find yourself twisting the dial to salsa channels, throw-back stations or even the dreaded talk news..)

So I am still working on my next podcast – but it’s a bit of a challenge – to avoid background noise – get past the fact that my voice sounds like That! and to avoid the same old trite soundbites. There are plenty of cooler, hipper IG perfect podcasters talking about Colombia. In fact, most of them have Gringa in their name. It’s one of the things I still argue about with my friends here.. They want me to be commercially successful – which is another thing I don’t quite understand about podcasts. I just want to be genuine. Not another bleach blonde bimbo “La Gringa………..” talking about the most instagram worthy photo locations, and such. I don’t want to show visitors to Colombia how to fake like they have experienced Colombian culture. In fact, I find that trite, annoying and a little bit offensive that all these little cuties (because they are all very cute versus my middle aged self) post pictures of a couple of famous Colombian destinations, a meal or two – and then declare that they have had the “Colombian experience.” I have becoming here since 2010, finally moved here permanently in 2019 – and I can tell you that I still haven’t finished my Colombian “experience.”

It’s not a hashmark to be checked – it’s a rich and vibrant country with a wealth of things to do, see and experience. Not everyone needs to move to Colombia to enjoy this beautiful country – but it would be wonderful if tourists could take more time to actually enjoy Colombia, instead of just finding the best photogenic angles of themselves in front of monuments that they haven’t even bothered to learn about. That’s kind of hard for even the most earnest tourists to do anything more profound when most of the “Gringa” podcasts out there are promoting exactly that sort of superficial garbage along with a “what happens in Colombia,” type attitude..

And I suppose I am supposed to say that that’s okay because vacations aren’t supposed to be educational lessons, etc.. etc.. But, I just can’t.

I am not the kind of person that would enjoy flying half-way around the world to fight over towel space on a crowded beach, or loungers at an expensive hotel. There’s no need too spend thousands of dollars to do that – especially if you are going to do it to the detriment of an actual opportunity to see something new – and learn something. Not only that – I think this trend of superficial tourism is so darn destructive. Travel is supposed to build bridges and be a cultural exchange – between the visitors and the inhabitants. The visitors learn about a new culture (and gain respect for it) and the inhabitants learn a bit about the people who come to visit. But that’s not happening anymore – or at least not in a way that builds bridges..

All over the globe, hordes of tourists are descending like locusts on social media featured hotspots.. And then they proceed to show their asses (literally and figuratively, in many cases) in a game of online one-upmanship before heading off to the next destination. And it’s making the inhabitants of these lovely places – places that people are racing to see – hate us. Luckily, the majority of people who come to Colombia aren’t going on narco tourism tours, or vandalizing national monuments. But they do litter in our national parks – and flout carefully constructed rules designed to protect the environment (like wearing lots of lotions, creams etc.) and going into the famous river of five colors. They also fail to respect locals – and continuous bring up sensitive topics. It’s not cute to probe or make jokes about a national wound, even if you see locals selling items related to it. Individuals who sell confederate flags do so to make a living – and that doesn’t make it collectively okay.

I know that as a person born in the United States that there are certain topics that are painful to me. Topics that are too large and complex to explain to a total stranger in a social setting. It hurts me to think about how the nation of my birth has failed us, in the past and continues to fight (and often fail) on issues that shouldn’t be so difficult. These things that are shameful to me, even though I have nothing to do with it. Many people from the United States, like myself don’t really want visitors asking about our civil rights legacy (George Floyd, Black Lives Matter, Slavery or racism in general) so why do we feel that it’s okay to throw other peoples’ hurts in their faces?

This has changed the way I look at a lot of people, people that I consider friends – as I watch them do this – even after I’ve asked them not too.. And they smile and grin while doing it – all the while thinking they are cute, funny or somehow original. Maybe this sounds trivial to some of my readers, but it has permanently changed the way I look / feel about these people.

So – maybe this so-call ‘gringa’ can be a bit of downer – because I don’t want to always talk about the shiny and superficial (sometimes, sure). But I also feel that I have an obligation – as a permanent resident here – to learn about my new home, expand my perspective, and learn to see things without that unique stain of ‘American superiority.” If you want to come on that journey with me – and I haven’t offended you too much with my opinions – please continue to join me on Kristin in Colombia..

The other apartment in North Bogota

Posted on June 21, 2023 by K Eckland

Last week, I wrote about my first interior design project and my love for the music of Carlos Vives. If that seems like a weird association – then you might need to read last week’s post.

After finishing the first apartment with Daniel Valderrama – who is the head of V & E design (where I am a partner), we started our next project, a few blocks away. While the first project was inspired by Colombian singer, Carlos Vives – the second apartment has a decidedly more North American feel..

Part of that is because of the unique way that V & E Design operates. It’s less of a “let us help you chose a new wallpaper,” then – “tell us what sorts of things you like – and then we will design something unique for you.”

So for our second apartment – we designed around the ideas of Elvis Presley and his Memphis estate, Graceland. The project is called, the We love Elvis! penthouse or the Elvis Apartment.

Here’s the kitchen door with a custom stained glass insert – if you want more of an idea of what we are talking about..

It’s a bigger apartment – with four bedrooms and three bathrooms – including an amazing gold bathroom. There is a fantastic open terrace and a smaller more private enclosed terrace too.

My niece in the golden bathroom – showing off the large jacuzzi tub.

Of course – if you want to see more pictures of the Elvis Apartment – you can see a wide variety on AirBNB.

We strayed a bit from my usual topics on Colombian culture and such – but we will pick back up on our usual topics soon. (Like the cuisine at El Chato – which is consistently rated at one of the best restaurants in Latin America and the world!)

I haven’t been there, yet.. I have included a link to the restaurant menu – if any of you want to give it a try and report back..

We Love Carlos Vives! The King of Colombian music..

Posted on June 14, 2023 by K Eckland

It’s been a while since I’ve had an opportunity to sit down and write but that doesn’t mean my adventures have stopped.. In fact, it was a little hectic for about six months. I have been working with an Interior Design firm doing specialty apartments.

The first apartment is the We Love Carlos Vives penthouse apartment. It’s an adorable apartment in the family friendly neighborhood of Cedritos in North Bogota. If you want all the hustle and bustle of downtown Bogota, then this isn’t the place for you. But if you are staying in Bogota, or working here – and want a nice, safe but lively (not noisy) neighborhood with restaurants, bars, grocery stores, banks, parks and shopping in close walking distance – this apartment may be ideal for you.

It has 3 bedrooms, 2 bathrooms and two large balconies with views of the city. It’s comfortably outfitted with modern amenities and decorated in rural Colombian style. It pays homage to one of Colombia’s greatest musical artists, Carlos Vives.

(If you’d like to rent the apartment – click here!

If you don’t know who Carlos Vives is – don’t worry! I have included some videos for your enjoyment!

https://player.pbs.org/viralplayer/3071811576/

He’s an amazing performer – and he (and artist Diomedes Diaz) popularized Colombian music around the world.

This link below plays his 20 most popular songs.. So click, relax and enjoy.. You can come back and read more about Carlos Vives, and the We Love Carlos Vives Apartment once you’ve immersed yourself in his music.

For many people outside of Colombia, he is best known for some of his collaborations – and for his song in the Disney movie, “Encanto”

Of course, if you really want to know about Carlos Vives, best to hear it from the man himself.. Here’s a brief interview.

Now that you love Carlos Vives’ music as much as I do – you might just enjoy the We Love Carlos Vives penthouse apartment.

I also made a little video.. It’s total amateur hour (because – yeah – I am a total amateur) and the music is nowhere as good as Carlos Vives, but here it is. I think the apartment is as colorful, charming and Colombian as the man himself..

I am going to try and get back to posting regularly – I’ve been traveling around Colombia recently – to the lovely coastal city of San Antero, to the pueblos of Cundinamarca, like Pacho and areas in between so I will post some pictures and descriptions soon.

Reason # 1 – and Holidays in Colombia

Posted on December 25, 2021 by K Eckland

Over the years, people have asked me the same question repeatedly. “Why, Colombia?” Different people have asked me this question for different reasons, about different things. Sometimes it’s Colombian people – government officials, surgeons and others, and they are asking in relation to my work in medical travel.

Sometimes, it’s my fellow North Americans asking for the same reason. Sometimes, it’s my co-workers in the USA, who want to know why I spend so much time here. Sometimes, it’s Colombians for the same reason. Sometimes, it’s just people who are curious.. There are many many reasons, and I won’t talk about them all today.. But..

The #1 reason I love Colombia, live in Colombia and promote Colombia and Colombian culture is: The People!

Obviously, people are unique, and there are good and bad people etc.. everywhere. But I have found my Colombian friends, acquaintances, neighbors, and even many many strangers to be some of the nicest, and kindest people I have encountered. I would have never been able to write the books, if that hadn’t have been the case. Before smart phones (and related technology), and speaking very minimal Spanish, I was able to navigate, research and write several books about this country, all due to the countless times absolute strangers helped me out, whether I was lost in the far part of town, needed to complete a task complicated by complex instructions, or just needed additional information. There was always someone that volunteered to help. Many of these people went on to become close friends, or colleagues. But sometimes, it was just a stranger on the bus who was giving me directions to where I needed to go.

Of course, there are nice and helpful people in the United States – I always tell people, that in general, “gringos” are friendly and welcoming to strangers. And the rest of the world, has no shortage of nice people either. But it’s more than that – here there is a sense of family and inclusion that we seem to have lost in the United States. When I was a child, during the holidays, families (like mine) always invited visitors, strangers, single people etc. to join us – and celebrate with us. But much of that sense of inclusion has diminished over the last several decades.

Where my parents would invite people to picnic with us at one of our soccer games, etc. my generation is more closed off – our immediate nuclear family becames a secret club. Instead of saying, “I can’t do lunch because of my child’s X activity, but would you like to sit in the stands with me so we can catch up?” people have become exclusionary – and often times, pretty darn proud of it. It becomes almost a badge of honor among young adults to start excluding even very close friends once you marry and had children.

It’s more like, “Look at how special I am – I have a spouse, and kids, [and thus don’t have time for you].” I am not the first to remark on this phenomena, there has been miles of articles, books and literature written about it. It ties in with the helicopter parenting and other childrearing trends that are more prevalent in North America. This anti-social, narcissistic trend probably isn’t entirely absent in Colombia – but it’s not common. So, in Colombia, at least, your friends with kids are still your friends and vice versa..

Thus, for someone like me – who likes to travel (and likes to travel alone) and live a very independent life – being able to maintain friendships with people, and being able to include them in my life and theirs, despite their childbearing status is important. (I love my friends, and even though I don’t have kids of my own, I enjoy being around children, especially when they get to that fun pre-teen age).

But during the holidays, these trends tend to be enhanced, which is why they talk about the depression and risk of suicide during the holidays – in the USA – because we have a lot of lonely people being left out of a lot of socializing for superficial reasons (like divorce, widowhood, or single status) even before the pandemic turned our world upside down.

But let me give you a recent example (just one of many many experiences I have had) and tell you about my Christmas – because maybe it’s better to just talk about actual events – instead of sociology theories..

Of course, let me acknowledge, that the Holidays in Colombia are a very special time anyway.. It’s not about a bunch of presents under the tree or buying a lot of stuff you don’t really need. Colombia is a Catholic nation – and religion is definitely part of it – but not overwhelmingly so. (I am not terribly religious – and none of it makes me uncomfortable here – which means something; when you consider that many times at home in the USA – I can’t get through a business meeting without someone feeling the need to invoke Jesus, repeatedly, in a lengthy and aggressive manner, whether or not it’s appropriate.)

Christmas, New Year’s and the Holiday season is a time to celebrate – with friends and family. It’s a time for homemade cooking, exchanging hugs, stories and spending time together. It’s gotten more complicated recently – but this year, everyone was vaccinated – and boosted – and several of us remained masked too (with doors and windows open for extra ventilation).

This year, 2021, my neighbors, the Gonzalez family invited me to join with their big, boisterous, lovely and sweet family for Christmas. I moved here in the middle of the pandemic – with strict lockdown rules in place – so I didn’t really know my neighbors well – only enough to share greetings in passing. We had exchanged holiday greetings and neighborly gifts (they gave me a lovely anchete (gift basket), and then they invited me to spend time with their family.

Look at this lovely anchete, filled with great things..

Side Note:

I learned a long time, when I first came to Colombia – to say yes to these opportunities. (When I was new to Colombia, I would often say no because I didn’t want to be “a bother”, or inconvenience anyone. I thought saying yes was bad manners – so sometimes, I turned down invitations to do things that I really wanted to do because I thought people were just inviting me to be nice – and again, I didn’t want to inconvenience them…. and then a nice Colombian girl I knew explained that by turning down invitations, people got the impression that I wasn’t interested in what they had to offer..

So I got over my uncomfortableness at feeling like I was “putting people out” and started saying Yes.. To just about everything… and it has made a heck of a difference – and I’ve had some amazing experiences and gotten to know some wonderful people).

So off we went to his brother’s house.. Both John and his brother were born in the atlantic coast of Colombia, even though they have spent most of their lives here in Bogota. So, in a salute to their costeno heritage, they were cooking some delicious cuts of meat – using a smoking technique called al trapo..

Don’t worry, while I may have been too busy enjoying myself and talking to everyone to take pictures of all the members of the Gonzalez family – I did manage to get lots of food pictures..

My neighbor is one of five siblings – and three still live in Bogota. He and his wife, Brenda have six grown children, who all live nearby.. So it was a fun gathering of some very nice people, who all love each other a lot. Mr. Gonzalez brother, Richard was doing the honors cooking the meat with one of Mr. Gonzalez’s sons.

So first you dampen a piece of linen or loosely woven cotton cloth in wine.. Red wine, preferably, but any wine will do. It just needs to be moist, not dripping.

Once the cloth has been moistened with wine, sprinkle coarse salt and some pepper on the cloth. Then place the meat in the center of the cloth. Roll the meat in the cloth, adding additional salt and pepper between layers.

Meat rolled in wine soaked cloth and tied with string

Then the meat roll is placed directly into the fire (on a wire rack over the flames)

Cook the meat for 20 to 30 minutes. When the roll is removed, it will look crusty and burnt, but it will be juicy and delicious inside. Cut the fabric and the strings.

After the covering has been removed, let the meat rest for five minutes before slicing and serving.

There was a bevy of other delicious things to eat.. I took pictures of some of my favorites

There was a delicious mango salad, with lettuce, pineapple pieces, mango chunks, and raisins. I don’t know what the dressing was – but it was delicous and mild enough not to overpower the delicate flavors in the salad.

Besides enjoying all the delicious food and drink, we had a lovely time. John and Brenda’s kids are a lively, good-natured bunch.. I wish I would have gotten more pictures at the time..

At midnight,, everyone including the sweet little grandkids gathering in the living room to watch the little ones open a few presents.

the grandbabies, enjoying some desserts..

Then we played some games, chatted and the adults enchanged secret friend gifts.. (They did charades during the gift exchange, so you had to guess who the gift was going to..) Danced a little bit – enjoyed some jokes.. and then it was time to go home..

All and all a lovely time, with a charming family, celebrating Christmas here in Colombia..

A day in Boyaca

Posted on December 23, 2021 by K Eckland

Big news dear readers.. It doesn’t entirely excuse my long absence but great news all the same.. After during a myriad of things during the last two years (like everyone else during this pandemic), I have finally received my Colombian visa. This allows me to stay in country for longer stretches. I am currently still back and forth quite a bit, while I supplement my income working in the USA, until my company can one day be self-supporting (if ever!) Right now, it’s still basically on pause – but hopefully that will change soon.

The pandemic has turned our lives upside down, but it’s also reminded us of what’s important. To me, it’s important for me to be here – and to continue to build my life here. Part of that is enjoying all the wonderful and beautiful things here – animals, flowers, nature, history.. and of course, FOOD. I’m not sophisticated enough to be a ‘foodie’ but I sure do like to try new flavors, tastes, fruits and vegetables.

I’d been feeling a bit hemmed in, with all the changes due to the pandemic, previous restrictions and missing my Sunday routine. So, I went on the internet and called a friend. Within a few minutes, we had booked a one day tour through several towns in Boyaca.

The tour we chose was through a group called Travel Experience VIP. Our tour guides were Nathalia and Alexandra and they were delightful and sweet. The trip cost 65,000 COP and included transport, snacks and a full day tour through several sites in the neighboring Colombian state of Boyaca. We had to pay for our lunch, a 5 mil trip insurance (for accidents etc.) and an optional nature hike (12 mil each). It was still a great deal – bus transport to Boyaca alone when we first looked at going on a trip to Villa de Leiva was 40,000 each way.

After we stopped for breakfast (included), we continued on to a dairy company. Boyaca is the home to the majority of Colombia’s dairy industry, so there were numerous dairy companies selling cheese, ice cream, milk and other dairy products. We stopped at this large well-known factory, to get some of the well-known cheese filled arapas. They were warm, and golden colored, and SO delicious that I was unable to get any pictures.

But I do have some more pictures of some of the cheeses and other products they sell. My favorite is a corn husk wrapped tamale style cheese filled delight called, “envueltos chavitos.” I like it because it’s not some greasy melted cheese mess. It’s made with a very dry crumbly style cheese that is so well mixed into the corn muffin tasting roll that you don’t see the cheese but it adds just a touch of sweet to what would otherwise be a plain corn muffin.

many of the dairy products made right on site -through the open door ,in the room behind the case.

this is the dessert case full of sweets..Bocadilla, araquipe, and my envueltos chavitos

a closer look at all the sweets you could ever want..

After we stopped to enjoy a delicious treat – back to the bus.. Now Colombian roads outside of major cities are really just rural lanes. Which is a nightmare if it’s a heavily travelled road – or a delight, if it’s a relaxing and sunny Sunday cruising in lovely rural farmland like our trip in Boyaca.. Green grass, farms, a small town here and there..

Then we were at our next stop, which was a sizable town, known mainly for it’s church.. Chiquinquira, I believe.. I am not a particularly churchy person, so I was happy to wander thru the small town square, and then get back on the bus. I later read about the poisoned bread incident back in the 1960’s, and well, that adds a bit more mystery to an otherwise kind of boring looking town..

The next stops were more fun..

As a middle-aged woman who likes to sew, crochet and take pictures, Raquira was definitely up my alley. (Did I mention that I have a cat, too?) Raquira is a totally cheesy tourist town, with cutesy little boutique hotels, coffee shops and romantic restaurants..

Now none of that particularly excites me.. But Raquira is also famous for artesanal crafts, particularly ceramics. And that does excite the craft loving part of me – the part that really really appreciates the effort involved in handmade goods – and Hecho en Colombia.. It’s also the me that is still trying to decorate my home – and doesn’t like that whole Ikea/ 2001 spaceship / antiseptic look. Ah, but limited space on the bus, so I mostly did take pictures, even though a lovely vase did follow me home.

yes, made in Colombia and painted by hand..

The streets were lined with shops, so there was plenty of different things to look at, admire or buy. We passed the ceramics factory, where large stacks of unpainted ceramic items just waited to be decorated.

Unlike many tourist places, the prices were very reasonable – and much less than what you would pay for the same items in Bogota. Maybe I’ll go back one day – with folks with a car.. so I can pick up a couple more pieces.. maybe one of the handmade pieces of furniture I saw… Or a planter for my growing garden. My friend had the same dilemma.

in Sutamarchan – home of Longaniza sausage

After the shopping excursion, it was time for lunch – and it turns out that Sutamarchan, Boyaca is also famous for a specific type of chorizo-type sausage called Longaniza. Now long time readers know that I just love, love, love picada – or that delicious mix of potatoes, sausages and other meats. (It has the morcilla or blood sausage that I love!). I wasn’t a big sausage eater before I came to Colombia, but it’s definitely something that I enjoy now.

yes, I love picada.. and it’s part of my own Sunday tradition.

That huge plate is a portion for one – but it was more than plenty for my friend and I. After our bellies were stuffed – it was time to go for the nature hike.. and believe me, I was ready for a nice long walk about after all that food.

on a nature hike to see the “blue” lakes

The next big stop was the historical city of Villa de Leiva (Leyva). It’s famous for being a preserved Colonial town, with cobbled streets etc. and stringent building codes against modern construction.

The main plaza in the town is the largest cobbled plaza in Colombia. The city is full of restaurants and charming boutique hotels. For a tourist town, the locals remained surprisingly friendly and welcoming. (Which is pretty amazing when you think about all the tourists that pass thru Villa de Leiva, especially in December, which is peak tourist season.)

Then it was time to start the drive home. On the way – now that night had fallen, we drove by an amazing holiday lights display that just went on and on.. It was charming.

Then we stopped at one last place so we could stock up on arapas with cheese so they would be fresh for breakfast (which they were). On the way back, the bus stopped close to our place, so we wouldn’t have to travel very far to get home. I’ve even posted the link for the coupon we used for our trip with Travel Experience VIP. Now enjoy!

I added lots of links to make it easy to find more information about the places and things mentioned in my post.

**I have a whole series of posts on my Sundays here:

Sundays in Cartagena

Sundays at Parque Arvi

Sundays in la Candaleria

Sundays in Antioquia

Sundays in Usaquen

Sundays for your health

Sundays in Bogota

Readers may notice that this blog has changed over the years – to be more culture and life and less surgery. I still love surgery and I am still committed to everything I’ve always talked about here; patient safety, quality, and excellent care – I’ve just decided not to talk about it here anymore. It’s at a different site., dedicated to all things medical so I am changing the name – but slowly, so people will have time to get used to the idea..

Cano Cristales in La Macarena

Posted on September 1, 2015 by K Eckland

Cano Cristales

Just got back from a four-day trip to Cano Cristales – and it was fantastic. I went with a Colombian travel company – which I think made the trip all the better. (I am getting ready to go on another adventure trip with a foreign company – so when I get back – I will compare the two.)

The company offers a couple different trip options – but I thought the trip on a chartered plane directly from Medellin sounded the most interesting, so that’s what I chose. There were 19 of us on the trip out from the airport in central Medellin (Enrique Olaya Herrera airport) – all Paisas (Medellin residents) except myself. Immediately, all our my fellow travelers embraced me – as they were entrusted by the travel agent to ‘take care of the gringa’. It was very endearing, actually.

getting on the plane

There were several nurses on the trip – so we bonded right away..

With my travel companions

The Airport at La Macarena in Meta, Colombia

So it was at little sad – when arrived and they mixed and subdivided our group with another smaller group – except that they all turned all be awesome too!

So I ended up as part of a group of six – (including our guide, Sergio).. For someone who wanted to learn more about Colombia, I couldn’t have created a better group. In our little band, there was a biologist, a microbiologist, an anthropologist and a meteorologist – and it was all random. Everyone was from Medellin and they had all come to enjoy the park.

with a group of Colombian experts

On the River

After arriving, we headed down to the Guayabero river for a boat trip to the first part of the hike.

Military partrolling for paramilitaries on the river

riverboats

From our daily jaunts down the river – we then proceeded to have all kinds of fun – from 4 X4ing to the next trail, to long hikes from the plains into the jungle.. Stopped at multiple points of the river, to enjoy the sights and to swim in the cool waters. (It’s high 90’s with 95% humidity – so the water felt great!)

Cano Cristales

As I mentioned in a previous post – I left my trusty Nikon (and polarized lenses) back at home so these photos don’t even begin to capture how beautiful it really is.

Swimming in the river –

One of the best times was swimming near a waterfall in the middle of a torrential downpour.. Unfortunately, my camera had already taken a bit of a swim downriver so I don’t have any photos.. (But I did manage to salvage the photos and the camera – with help from a bag of rice).

Cowboys!

on the way back to the river from the trail we got to see the traditional Colombian way of life here on the plains as the cowboys were rounding up their herd.

Just as we were walking to the boats – we saw a group of people staring at something on the ground. As we got closer, I saw that it was some kind of furred animal. Was it a goat – I couldn’t tell. I was initially reluctant to get closer – it looked half dead laying on the ground in the blazing sun, eyes dull and glassy. But as I got closer, it started to move – and it wasn’t a goat or barnyard animal at all.

What the heck was it? I didn’t know but it looked sick to me..

It was a perezoso (or Sloth in English), which had wandered out of the nearby forest and was now lost.

and then this “half-dead creature got up..

and walked to a nearby table..

The biologist in our group immediately organized the group to entice the animal on to a tree branch, to carry across the field, out of the heat and the sun into the forest. (It felt about 20 degrees cooler when we got there.) The animal perked up and quickly climbed up into a tree. Because it’s coat matched the branches, it blended in perfectly.

Within just a few minutes, it was greeted by another sloth high in the tree.

Heavy Military Presence in the area

Readers will quickly notice from the photos that there is a heavily military presence in the area. Despite a history of mixed relations with the Colombian military – including the discovery of a mass grave in 2010 with over 2,000 unknown corpses (and a history of some atrocities towards Colombian citizens), I am happy to see them. I know I am ignorant and naive, but their presence in La Macarena makes me feel safer. This area, in a lot of ways is kind of like Colombia’s own Vietnam conflict (in their own territory). I feel bad talking to these soldiers who are far from their homes; I’ve met soldiers here from Cali, Boyaca, Bogota and all other points outside of Meta. This is nothing like Bogota (obviously!) and it makes me sad for them.

Do I feel better knowing they are around??

Most people from outside Colombia worry about the FARC, but right now – with the FARC in peace negotiations, paramilitaries like ELN and AUC are the bigger problem. These violent groups clash with everyone who gets in their way; townspeople, the army, and even the FARC. So anyone (like the Army) that keeps them at bay – is well, awesome!

You bet ya!

While both the governmental tour agency and the military officers I spoke with report that there has been minimal paramilitary activity in the La Macarena area for the last several years (8 to 10 years is what I was told), the Colombian state of Meta has an active area for paramilitary activities for the duration of the 50+ year conflict. I found only one fairly recent report (August 2014) of paramilitary activity in other parts of Meta. The majority of reports date back to 2006 – 2010, so it’s been fairly quiet lately. Even so, it’s good to know that there are 2500 active duty soldiers in the area surrounding La Macarena.

Miguel (forefront) from the Colombian military patrols La Macarena

It’s quiet enough that some of the soldiers spend time performing community activities, like helping paint the town, which is one of the local projects to enhance the image of La Macarena for tourists.

a soldier helps a young girl with the community painting project

La Macarena: the town

Aside from the large military population, La Macarena is a small little village – with just a few paved streets at the center of town. Most of the buildings are squat and square with a few second story and one tall four-story hotel tower..

Of course I checked out the hospital

We spent the evenings watching local entertainment – singers and dancers or enjoying a cervecita while playing tejo and enjoying the cool evening breeze.

In Capitol City

Posted on August 27, 2015 by K Eckland

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.

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.

Taking it easy in Medellin

Posted on August 19, 2015 by K Eckland

at Universidad Nacional – Medellin open air auditorium (The medellin campus is famed for the lush greenery)

So I am back in Medellin, Colombia for several weeks – but this trip is different from all of my previous visits. It’s the first time I have come here without a specific purpose. I’m not here to interview surgeons, attend surgical conferences or even ColombiaModa.

No Colombia Moda this year for me. 😦

Medellin has become so familiar to me, that when I needed a nice tranquil space to work on a non-Colombia related project – I headed here to get away from the thousands of distractions of my stateside life. While I am here, I am also determined to enjoy and explore more of Colombia since I have just seen the bare minimum of life and locales. So next week, I heading off to one of Colombia’s best known natural wonders, Cano Cristales.

I’m going as part of a group (which is something I’ve never done before). It’s sounds like it will be a great trip – flying to Meta, Colombia in a small plane – to a community with limited electricity and no cellphone or internet service. That doesn’t sound like a big deal, but as I writer, I have gotten used to almost always having computer access – almost anywhere in the world. So this will be a nice break from the ordinary for me.

I don’t have my trusty Nikon this time around, which is a shame since Cano Cristales is famed for its beauty but I will attempt to take some pictures with a tiny camera (that packs well). It’s weird because I tend to lose my confidence when I don’t have my big, heavy camera.

Naked without my Nikon? Not a great visual, is it?

La Tierra del Olvido (2015 version)

In the meantime, I will continue to work on my current projects, relax a bit and enjoy Colombia. Carlos Vives, one of my favorite Colombian singers, along with Medellin natives Maluma and J. Balvin, have re-made one of Carlos Vives most popular songs as part of a Colombia tourism promotion. It’s lovely, lively and catching – and features several other well-known Colombian entertainers and Colombian landscapes – so I hope you enjoy.. (Thankfully, no Sofia Vergara!)

The second time is the charm!

Posted on September 18, 2014 by K Eckland

My apologies to my dear readers for this late post. I usually write about surgery and surgeons, but occasionally drift into other things.. I visited the new Clinica de Medellin facility in late July, but didn’t have time to write about it before now.

Dermatology

Just before travelling to Medellin to cover Colombia Moda and the ALAT conference, I developed a dermatology problem. As my American readers know, getting an appointment with a specialist in the USA can often take several months. In fact, I was given an appointment in early July for later this fall.

However, during my stay in Medellin, my dermatology condition continued, so I decided to give the Clinica de Medellin another try. I had heard rumors about some re-organization of the medical travel division so I decided to use this as an opportunity to verify those rumors. I am very pleased to report that after sending my initial email to the Clinica de Medellin requesting a consultation with a dermatologist that I received a reply that same day (from Adriana Henao – email: ahenao@correo.clinicamedellin.com.co).

The coördinator called me back to confirm my availability and to ask if I would be willing to go to a clinic at one of the other Clinica de Medellin campuses. (She also asked about my level of Spanish fluency so she could direct me to the appropriate physician.)

By the next day, an appointment had been scheduled for the end of the week.

New clinic

The clinic was so new that when I gave the address to the cab driver, he merely raised an eyebrow before starting the car. On arrival, he expressed surprise – and said, “This wasn’t there before.” The Clinica de Medellin Sede Occidental is divided into a hospital and an outpatient clinic area. The smell of fresh paint was still evident in the immaculate, and sparkling facility.

The officer at the information desk had me personally escorted to the correct clinic when he heard my American accent (and hesitant Spanish). I waited about fifteen minutes before being escorted into the private office of Dra. Sara Gonzalez Trujillo. She was very friendly and pleasant. We reviewed my past medical history and current treatments before she examined me. She explained the condition in-depth before writing several prescriptions and requesting a lab test.

She provided me with a full copy of my medical records to take to my upcoming appointment and gave me her contact information.

Total cost of consultation: less than $50.00

Lab:

The labs cost about 25.00. After a quick lab draw, I was given a lab slip with my record number on it. I later received an email with my login to access my results. Since I was headed back to the states, I emailed my results to Dr. Gonzalez, who called me with additional treatment recommendations and an explanation of the results.

Since seeing Dr. Gonzalez, I have been using the medications as prescribed – and my condition has improved dramatically.

Follow-up:

I have been taking the medications as prescribed and it is getting better. I will email Dr. Gonzalez after seeing the dermatologist here to give her an update.

To make an appointment with Clinica Medellin, click here.

Crazy days!

Posted on August 3, 2014 by K Eckland

It’s been a couple crazy, busy days here in Medellin. I have a bit of a backlog of posts – from a day learning to finger crochet in a group crochet class, the festival of flowers, a visit to Clinica Medellin Occidente and the ALAT conference. It will take me a little while to post everything before heading home in just a few short days.

The ALAT conference was fantastic. In addition to numerous wonderful, learned speakers from all over Latin America, it was a great chance to connect with innovative thoracic surgeons from practices all around the world. We also re-connected with surgeons we’ve interviewed in the past – to hear what they have been doing since my last visit.

One of these surgeons was Dr. Andres Jimenez at Fundacion Santa Fe de Bogotá (SFdeB). As astute readers of the Bogotá books may remember, our encounters haven’t always been as collegial as they could have been. However, he did grant me an interview, and permit my ingress into the operating room. To my surprise, I found that while he was a hesitant interviewee, he was also a promising young surgeon.

With that in mind, I re-connected with Dr. Jimenez briefly to ask about the program. Dr. Jimenez reports that they have started a lung transplant program and recently performed his first lung transplant at SFdeB.

Dr. Carlos Carvajal (right)

Dr. Carlos Carvajal, who was a thoracic surgery fellow when we first interviewed him – is now a practicing thoracic surgeon at Hospital Santa Clara in downtown Bogotá.

Dr. Ricardo Buitrago continues his work in robotic surgery at Clinica de Marly. Caught up with Dr. Luis Torres, the young and charming thoracic surgeon from Clinica Palermo.

But the biggest surprise at all – was the twinkling brown eyes of Dr. Cristian Anuz Martinez. (The twinkling brown eyes above a surgical mask are all I remembered from my 2012 trip to the operating room with Dr. Frnando Bello in Santa Cruz, Bolivia).

with Dr. Cristian Anuz Martinez

We spent some time over coffee talking about the current state of cardiothoracic surgery in Bolivia, his private practice and his colleagues.

The conference itself was phenomenal – the amount and range of topics covered – from sleep medicine, tuberculosis, critical care medicine and pulmonology in addition to thoracic surgery.

The Festival of Flowers

The festival of flowers, one of the largest events in Medellin also started August 1st. The event which is expected to draw 19,000 visitors to Medellin this year – celebrates the floral industry of Antioquia with ten days of events. The events are staggered through out the city and include musical concerts, singing contests, parades, flora displays, children’s events and arts.

Festival of Flowers displays in Plaza Mayor

Tomorrow: Clinica de Medellin – Second time is the charm!

Street of Dreams – Calle 49

Posted on July 28, 2014 by K Eckland

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

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

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

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 (Shanghai) off calle 49 selling thread

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

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

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

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

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

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

Portofino 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..

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

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.) Now – for patterns on Calle 49 – the best place to go is – this little shop..

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

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

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.

Under Une Canal

Posted on July 25, 2014 by K Eckland

Now that it’s over, I can say it’s been another wonderful week at Colombia Moda: I met Miss Colombia (she seems sweet) and took a picture of the President of the Republic..

Didn’t get to meet President Santos, but maybe someday. (I promise not to talk politics.)

Miss Colombia, Paula Vega of Atlantico region (Barranquilla)

Luis Martin

I even say hello to one of the models (since we were heading down the hallway) and we had a nice conversation. It’s funny – I guess I always get intimidated by people taller than me, etc.. and I guess sometimes the expectation is just that models aren’t that nice.. But nothing could be farther from the truth. Luis Martin – a local model from a neighborhood here in Medellin was very nice, sweet and pleasant. It must be weird for him – I mean, his face is really familiar to me – after two years of seeing it thru my lens..

Luis Martin, model and a nice kid

I wish we hadn’t be racing down a hallway – I would have liked to get a photo because he looks better in his own clothes..(Better sense of style). Anyway, I thought it was nice of him to make conversation with a random gringa.. (We talked about Virginia of all things). So – I wish him the best luck, and hope he makes the cover of Vogue one of these days.

Last day of Moda

Yesterday was the last day at Colombia Moda, and I don’t have enough nice things to say about all of the photographers and videographers there. They are the reason I came back this year. Instead of treating me as an outsider, they have always been welcoming and kind.

the orange backpack shows where I sit during the runways

This year it was great to be back and see old friends like Stiven and Fredrico. I didn’t see some of the wonderful people from last year, like Estaban who kept me in laughter and good humor even when every bone in my body ached from long hours in contorted positions.

Always great to see Stiven

This year, I have to give special thanks and words of gratitude to the videographers of Une Canal (Channel One) of Medellin. Une Canal is the public television station for the city and during fashion week, they record live from the runway so it can be seen on big screens outside (so people without access to the runway itself can see it as it happens.) That means they are at every single catwalk – always smiling, joking and being friendly even while setting up cameras, untangling cables etc…

The Videographers of Une Canal

That’s the handsome Juan Carlos, the charming Danilo Gallego and the ever kind Hernan. For the entire fashion week, they allowed (and encouraged) me to take one of the plum floor positions beneath their cameras – in the dead center position of the runway.

Danilo Gallego of Une Canal

People with better equipment than my starter Nikon can take sitting positions and even rise up on the press bleachers, but without this prime spot on the floor – I’d have been toast. I never would have been able to capture 1/10th of the images that I’ve used in my recent articles.

I’d love to do a real (in-depth) articles on the videographers and photographers here at Moda, but it looks like I’ve already been scooped which I think it really cool. Yesterday, the reporter from Une canal turned the tables of the videographers and interviewed them before one of the runways.

Danilo is interviewed for a segment on Une Canal

I am hoping to see Juan Carlos, Danilo and Stiven at some future events here in Medellin before I leave in August.. If not – I’ll see you next year!

Colombia Moda and Examiner.com

Posted on July 25, 2014 by K Eckland

Colombia Moda is over, and I am exhausted.. Sorting through several thousands of photos while writing articles about fashion collections has to be done in as timely a manner as possible, which doesn’t leave much time for sleep!

The good thing about writing for the Examiner.com is that they don’t give me any deadlines or article requirements. I write about what I want – and submit it as fast as I can. But there is no editor to nag me for specific lines so I feel free to focus on writing about the fashion that I like, or that I think is important.

I don’t write about Gef France because I think it’s boring. I do cover Studio F if only because it is so immensely popular here – though I prefer the more daring and creative (and often smaller) lines.

But while I continue to gulp coffee and sort photos (even though my eyes are so tired I’m not sure if the photo is blurry or it’s just me, I wanted to give my readers links to my most recent articles (and photos) at Examiner.com

Lenonisa Runway

Agua Bandita and Onda de Mar – the Agua bandita photos are disappointing – the lighting was terrible. (I thought that was me too – but then several photographers grumbled about substandard lighting and showed me their photos..) They even called out during the runway to get better light..

Ipanema by Paradizia

Nonstop Runway: Faride Ramos

Nonstop Runway designer trio

Beverly Hills by Carmen Belissa

Studio F

I also talked to some Americans I met at the expo. They seemed a little overwhelmed and lost – as they looked for textile manufacturers to produce fabric samples for use in their designs. I bet they would have liked my textile/ fabric city tour idea.

I have a couple of articles I am still working on – and then it will be back to normal here at Latin American Surgery. The ALAT conference (thoracic surgeons from all over Latin America) will be here in Medellin next week, so we will be back to some surgical topics soon.

Crochet, crafts and traditional arts in Colombia

Posted on July 20, 2014 by K Eckland

One of my latest crochet projects – American flag scarf

Since learning some basic crochet (very basic) from my (very patient) roommate, Iris in Cartagena, I have continued to crochet. I find it’s an excellent activity for all the waiting that goes along with travel. I crochet in the car when we drive from assignment to assignment.

Hat and scarf

I need to learn some new stitches but I am getting a lot of practice with my basic stitch. I have switched to a very large crochet hook (15mm or an “S” hook) and cuddly soft bulky yarns (types 5 and 6). It makes it easier to see when I make errors and it works up quickly. Plus, the yarn is so plush and soft feeling.

I made a couple things for my friend’s new baby in Bogota.

My tiny model wearing the first hat I made

So when I went to see her – I spent an afternoon in Chapinero checking out the yarn situation. I was in a large bookstore in Chapinero when I met Ligia Morena Vega. I was looking at some new sewing pattern magazines (since I am a sewer who crochets) and she was buying crochet magazines.

So I asked her if she knew where I could find some yarns in the neighborhood.. Not only did she know – she took me with her to meet the proprietors and learn more about the crafting classes offered.

That’s one of the things I’ve noticed in Colombia – pull out a crochet hook or start asking about crochet, and instantly you make friends. I was on the bus to the airport in Rionegro when this happened the first time. (It’s a long bus ride to Medellin, so I pulled out my crochet..) Very quickly I made friends with several women on the bus as we talked crochet.

with Ligia, shopping for yarn in Bogota

Ligia crochets professionally. She was buying magazines to use as catalogs for customers who want custom-made clothing, including formal style and elegant ankle length dresses. Ligia’s husband runs a coffee and chocolate shop nearby on Calle 57 and Carrera 16 – so I will have to stop in and visit on my next trip to Bogotá (and get some pictures of her latest crochet creations too!)

We walked a few blocks to a short street, Calle 56 (with Carrera 13) where there are several stores selling a variety of yarns. While there was a lot of Red Heart and Lion Brand (especially the Homespun USA – my favorite, at home), I was able to find some beautiful yarns that are made right in Bogotá.

I fell in love with some of the yarns from Lanas Arvi.

One of the yarns is a beautiful tan and turquoise mix..

some of my new Colombian yarn.. with my gigantic crochet hook.

It’s destined to be a scarf.. This time I might even keep it. So far, I have gifted away everything I’ve made with the exception of a camera lens bag..

Several of the shops offer crochet and knitting classes. Todos Lanas and Almacen Mutifibras even print the class schedules on the back of their receipts.

The prices are about the same as Wal-mart (since JoAnn’s and some of the craft stores mark up the yarns quite a bit.) I also bought two small skeins of a lovely dark purple to make a gift for a friend – and two small skeins of a variegated yarn with the bright yellow, blue and red of the Colombian flag.. All of the other yellow/ blue / red yarns were sold out just about everywhere we looked. Several owners told us that between Colombian Independence Day (today) and the World Cup – they haven’t been able to keep any of the patriotic colors in stock for the last month.

Embajada de la Coca

During my visit to Bogotá – we sampled some delicious Andean style cuisine at the Embajada de la Coca. (To read my article on the experience, click here.)

welcome to Embajada de la Coca

Meet the artist: Isabella Klein

The next day, I spent the afternoon visiting the Klein family. If the name sounds familiar – it’s because one the sons, Albert Klein, PharmD is a close friend and my co-writer on several of the Hidden Gem titles. (The Kleins are a talented family; the younger son, Alex plays piano with the Bogotá Philharmonic Orchestra and the daughter, A. J. is an occasional model.)

(For more about the Bogotá Philharmonic – read this post by a blogger from the University of Texas at Austin.)

His mother, Isabella works as a professional translator as well as teaching English. But that’s just her job – art is her life. She works in multiple platforms – mixed media, paintings, photography and artisan crafts.

On today’s visit – we talked about some of her craft work as well as the large craft fairs here in Colombia. We discussed my ideas for ‘artisan craft style tours‘ where visitors could learn more about the crafting process and Indigenous cultures of Colombia.

She showed me some of her more recent projects – making decorative wooden boxes. Instead of using the traditional Colombian patterns, she designs her own.

Some of the wooden boxes designed by Isabella Klein

Her mixed media paints are arresting to look at. Unfortunately, I was too busy admiring them to take any pictures..

But I do have a couple more pictures of the boxes.

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

For a portfolio of some of Isabella Klein’s work – click here.

After too few days – it was time to say goodbye to my Bogota friends (new and old) and head back to Medellin to prepare for Colombia Moda..

with dear friends, Camila and Flavita.

Of course – it wasn’t all bad – these lovely ladies were at the airport in Rionegro to greet me.. The Aguardiente Girls!!

Welcome to Medellin!

The Eckland Effect

Posted on July 8, 2014 by K Eckland

It’s been a while since I’ve written – but sometimes between maintaining two blogs, a series on health for Examiner.com, answering emails from potential medical tourists, traveling and working long hours on assignment – I sometimes feel a bit like a candle burning at both ends.

But I am happy to report – that I recently completed my latest assignment and am back home in my native Virginia (for a few days) before heading back to Colombia.

I’ll spend the next couple days getting ready; contacting potential interviewees, researching articles,

The downside of frequent extended travel is the piling up of all the inevitable errands and hassles. Sometimes its just stuff like sorting through a couple of months of mail, but other times it’s paying property taxes (in person because I live in a small town) or renewing my driver’s license (now good until 2022!)

But now that we’re all caught up – we can get back to work (and writing!)

The Profiteer Model

Several interesting articles and posts have been written about medical tourism lately. We will talk about some of the other issues in future posts but today, I wanted to share this article by Stacy Hsu from the Tampai Times. This article takes issue with the “Profiteer’ model of many so-called “Medical Tourism” hospitals and clinics.

VIP Medicine

As we’ve mentioned in previous posts, the idea of exclusive hospitals designed solely for the wealthy foreigner is both a noxious and popular one. To many people, the idea of a resort-like or decadent atmosphere that caters to the every whim of the monied tourist or “Club Medicine” is a charmed one. VIP/ Executive health programs thrive around the world – from the hallowed halls of academic medicine like John Hopkins, the Cleveland Clinic to the Planet Hospital branded facilities around the world.

Much of the medical tourism industry has been based on this context. Programs are advertised on the basis of desirable location, gourmet cuisine menus, luxurious accommodations and nightly turn down service; not surgical skill or publishable clinical outcomes. No one hypes a short-length of stay or low re-admission rate when catered meals, high-speed internet and cable television are part of the selling points.

VIP versus Concierge: Not entirely the same

Don’t want to travel? But want your health care needs catered to? There are whole branches of primary care practices (ie. the “Royal Pains” practices) that are now based on this principle. On the surface, it doesn’t sound like much – patients pay extra money to have their doctor actually give them the time and attention they deserve* (during visits, phone calls and emails) but in reality, it can very quickly turn into something else as this ‘bonus’ pay approach changes the patient – provider relationship.

But “concierge medicine” as it is called in primary care medicine is a far cry from the VIP and Executive programs offered as part of medical tourism programs. In concierge medicine, patients still have a long-term and established relationship with their physician – and it is this relationship that can actually improve health care outcomes along with patient satisfaction. That’s because having more time with your family doctor means that s/he will spend more time answering questions and explaining care to patients. In turn, the patient is more likely to fill their prescriptions, take their medications and otherwise follow this doctor’s instructions.

*Instead of delegating more personalized care to people like me; the nurse practitioner (NP) or physician assistant (PA) which is more commonly done in standard medical offices.

But is ego-tickling medicine good for your health?

According to the scant amount of existing research, the answer is often no, when we are talking about short-term patient-provider relationships like the one-day executive physical or the spa style surgery service. In fact, patients often receive unnecessary and even potentially harmful, expensive tests and procedures (like the famed “Full body CT”).

I liken it to “T he emperor’s new clothes” syndrome, where the patient is seen more as a consumer / purchaser of goods than a person seeking health services. In this scenario, the healthcare provider is more concerned with keeping the customer satisfied than explaining why many of these tests and procedures are not necessary or may even be harmful.

Remember: First do no harm!

The customer is always right!

These contradictory objectives may become a conflict when the needed health advice isn’t what the patient wants to hear*.

Not even the humble fools dare tell the emperor the truth.

The ‘Eckland Effect’

But it looks like this may be changing. Several new research projects as well as recent articles are showing a move towards data collection and measurement of objective outcomes in regards to medical tourism. Instead of patient satisfaction surveys, researchers are asking about the incidence of complications.

Other organizations are talking about implementing more accountability, transparency and formal accreditation for medical tourism programs and facilities. Of course, accreditation is only as valuable as the organization offering it.

*Certainly this dynamic was at play in the care and death of pop star Michael Jackson under the care of Dr. Conrad Murray.

Additional articles for interested readers:

Al-Lamki, L. (2011). Medical Tourism: Beneficence or maleficence? SQU Med J Nov 2011, 11(4): 444-447. This is an excellent editorial that offers a concise overview of many of the ethical issues we have discussed here at Latin American Surgery including brain drain, transplant tourism, quality assurance, continuity-of-care and the overall impact of medical tourism on local communities.

In a related article, ” A European perspective on medical tourism: the need for a knowledge base” Carrera & Lunt (2010) argued for the urgent need for record-keeping and statistical data collection in the medical tourism industry. While this article is not available for free on-line, a related presentation by the authors is available here.

For readers interested in learning more about the correlation between patient satisfaction and clinical outcomes, I encourage you to read the works of JJ Fenton.

Fenton JJ, Jerant AF, Bertakis KD, Franks P. (2012). The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012 Mar 12;172(5):405-11. doi: 10.1001/archinternmed.2011.1662. Epub 2012 Feb 13. This study in particular is a must read: in this study, Fenton et al. followed a group of more than 36,000 patients and found that high patient satisfaction was correlated with increased health costs, greater rates of inpatient admissions to the hospital and a higher overall mortality. Fenton et al have also conducted several additional studies examining the relationship between patient satisfaction and quality of care. The findings of these study question the utility of new programs linking patient satisfaction with provider compensation (ie. pay-for-performance) and question the commonly held beliefs that patient satisfaction = high quality care. It may be that the best care comes at a price: unhappy patients. But then again, isn’t not a popularity contest – or at least, it shouldn’t be.

Medscape subscribers can also view a series of articles on this topic including an inteview with Dr. Fenton on his body of work. Medscape has a series of articles examining both sides of the argument linking patient satisfaction with provider compensation.

Patient satisfaction is overrated – an excellent editorial about the cost to patients (in health and money) related to demands for ‘patient satisfaction”.

Days of Summer

Posted on June 15, 2014 by K Eckland

A cautionary tale for my on-line friends in another botched surgery case in Florida.

Let the buyer beware:

In the most recent case, four individuals have been arrested for impersonating surgeons and operating an unlicensed surgery clinic. According to the media reports, only one of the four people charged is a licensed physician, nurse or other trained healthcare provider – but that didn’t stop them from performing major operations such as liposuction and abdominoplasty procedures on their unknowing patients. While Dr. William Marrocco* was the doctor on record for the clinic – patients report that he wasn’t the one operating!

Unlike many of the ‘chop shops” we’ve written about that take place in garages, motels and private ‘parties’, in this scenario, unwary consumers were duped by a savvy group of criminals who had owned and operated the “Health and Beauty Cosmetic Surgery” clinic in downtown West Palm Beach.

*The good doctor Marrocco remains a legally licensed doctor in the state of Florida – though interestingly enough – he does not have prescriptive privileges. One the Florida Department of Health website, Dr. Marrocco (whose secondary address corresponds with the clinic address) reports active licenses in Virginia, Pennsylvania, Michigan, Indiana and Nebraska.

But let’s check it out… so I did my own preliminary online search –

Virginia: No records found. No active or past licensees (expired in the last five years) found. So he may have had one – but not recently.

Pennsylvania: William Charles Marrocco held a license in Pennsylvania for a brief two-year period between 1998 to 2000. This includes his period of medical residency training at Temple University Hospital.

Michigan: Three expired licenses – one for student status (resident) and one as a pharmacist.

Indiana: Dr. Marrocco was a licensed plastic surgeon in the state of Indiana from 2000 to 2011 and has a notation “reinstatement pending‘. Maybe Dr. Marracco is planning on heading back to Indiana – where his license remains unblemished – despite the scandal surrounding the 2003 death of his wife after he performed liposuction on her). License # 01052282A

Nebraska: Expired, license #2909, educational license permit (training) affiliated with Indiana University

Jorge Nayib Alarcon Zambrano – (one of the individuals charged) is listed as a member of the Colombian Society of Plastic Surgeons – from Cali, Colombia. So he may be a trained surgeon, just not a very good one (and not licensed in the United States).

Licensing isn’t everything..

Kind of goes to show some of the pitfalls of relying on licensing boards for consumer protection. Dr. William Marrocco was a licensed plastic surgeon, but that’s little consolation for many patients at that West Palm Beach clinic.

In fairness to Dr. William Marrocco, Jorge Alarcon and the other individuals in the case – they have been charged with multiple counts, but have not been convicted of any crime. Until that time, they remain innocent until proven guilty.

Apologies to my loyal readers for the long lapse in posts but my plate has been pretty full. But I will be finishing my latest assignment in a few weeks and starting a couple of new projects for the summer months.

I applied for and received a new assignment from Examiner.com to expand my focus to include more than just health topics. Now I will be able to write more articles focusing on life and culture in Latin America.

Colombia Moda 2014

To kick-start my new assignment, I have applied to attend Colombia Moda 2014.

(official image from Colombia Moda / Inexmoda)

As many of you already know, I was able to attend last year – and got a fascinating glimpse into the fashion industry and the future of both fashion and consumerism.

Last year’s speakers were promoting the concept of “re-shoring” and changing from the traditional ‘seasonal’ lines and collections to an ongoing, evolving fashion line with new designs and items being designed, developed and sold to the public in shorter mini cycles.

This year – I’ll be able to cover all of this – along with interviews with individual designers, fashion lines and the Colombian fashion and textile industry. (Last year, my articles were focused on the role between fashion and plastic surgery).

Fashion is so intrinsic to Colombian life, and many parts of Latin America, so I am really excited about it. It plays such an important role in the economic, social and an even personal lives of many Colombians.

I won’t have an assistant this year – but I am getting a new lens for the event (I will be journalist/ photographer for the event).

After Colombia Moda, I will be flipping back and forth between writing about culture and my ‘usual’ medicine and health storylines.

I will be staying in Colombia for several weeks as well as covering the Latin American Association of Thoracics (ALAT) conference at the end of July. It’s one of the biggest international conferences in thoracic medicine/ surgery with many of the legends of thoracic surgery planning to be in attendance.

In August, I’ll be heading across the globe to interview the head of an innovative surgical program.

I’ll be checking in along the way – and posting photos, interviews and articles as I go.

On the Streets of Cartagena

Posted on April 26, 2014 by K Eckland

After a couple of super serious posts – It’s time to change the pace, back to the colorful life of Cartagena.. When we aren’t in Sincelejo, I’ve had a considerable amount of free time to enjoy the city.

Iris and I have had some great adventures (particularly gastronomic ones), but I have also spent a lot of time roaming around on my own, trying to make the city my home.

So I thought I would introduce some of the nice people I’ve met on my daily walks around the city. I don’t have photos of everyone, but I thought I would share the ones I do have..

With Aristedes

(According to this picture, the rumors are true – at least the part about my looks)

I almost didn’t post this picture of Aristedes Ayala and I – just because I look pretty awful but that would be a disservice to Aristedes, who has been a good friend while I’ve been here. We’ve hung out various afternoons while he’s practiced his English with me. I’ve tried to impart my southern accent during our lessons along with key American and southern idiomatic phrases, but I am not sure how successful I was.

But then again, it seems like my own accent has started to fade away from disuse. (I have tried very hard to speak very clearly, and not to use colloquial phrases when I talk to non-native English speakers over the last few years – and I think I might have been a bit too successful.)

Gustavo

This is Gustavo. He sells aromatic coffees, gum and stuff like that – one of the streets near my home, in a shady spot by the beach – so I see him almost everyday. (I also have a slight gum addiction).

Gustavo is an interesting guy – he’s worked here near the beach in Cartagena for ten years – so he’s seen a lot of interesting and crazy things, particularly on holiday weekends when the beach is packed with tourists.

Prior to that, Gustavo, who is from here in Bolivar, worked in Agriculture in the coffee sector.

Miguel

Miguel is a nice young kid I met who works for Aguilar as one of the delivery drivers (so he has what I consider to be an ‘essential’ job here in Cartagena). I don’t know if the city of Cartagena issues badges for expedited travel during states of emergency like we had at the hospital in St Thomas, (USVI) but he should probably get one. I can’t even image how life might grind to a halt if alcohol was suddenly absent from all the bars, restaurants and fancy hotels.

Willie

Willie is one of the vendors who works on the busy touristy zone in Bocagrande. He sells a lot of the Colombian craft items.

Willie with his wares

Since I have been working on my first mochilla, we talk about my progress sometimes. (I’ve made a lot of progress on my latest trip to Sincelejo).

making progress on my Colombian bag

Then there’s this guy. I don’t know his name, so I will call him Juan Carlos (which is one of my favorite names). Imagine my surprise to see that he has been here at the military base every day watching over me (which is across the street from my apartment). I never even noticed him until today.

Meet Juan Carlos

So I asked Juan Rodriguez (at the base) to introduce me – and he did.

Officer Rodriguez

I know the military here has a bad reputation (particularly for past misdeeds) but all of my encounters with them have been pleasant, professional and friendly.

I always feel safer when they are around.

Manuel

Manuel sells jewelry and beads on the beach – but he was happy to make time for a short chat.

I didn’t get the names of some of the other vendors I spent a couple of afternoons chatting with. (I wasn’t shopping – just passing the time).

I joked with this guy about being from Bucaramanga (he’s not, BTW) because I have the female shoe shopping fantasy about Bucaramanga.

Selling shoes

I always imagine it would be a shoe paradise for me – lots and lots of shoes in small sizes! (I wear a what is a child’s size shoe in the USA so it’s hard to find shoes without cartoons on them at home.)

Now – that I think would be a great tourism opportunity – “Shoe Shopping Excursions”. I’d be more than happy to sign up for a weekend trip to Bucaramanga to find at least one pair of comfortable shoes that actually fit!

I’ve actually tried to enlist my good friend Camila in a do-it-yourself shopping adventure, but to no avail. (She’s expecting a baby soon which has put a damper on major excursions – but hey – a new baby isn’t so bad..) She’s be the perfect accomplice because she used to own an upscale clothing boutique so she is very knowledgeable about the quality of leather, clothing, shoes and other apparel items. She also has excellent taste. (I have gringo taste which is nothing to brag about – so I accept all help offered.)

I dread shoe shopping at home because it’s an exercise in frustration and is often accompanied by tears..

But maybe I can enlist some of my fantastically fashionable Bogotanas on my next visit..

This nice kid was just hanging out, outside Juan Valdez – but he was happy to let me take his picture..

Now I don’t have a photo of one of my favorite people here in Cartagena. His name is Juan Fernandez and he repairs shoes along one of my exercise routes. He’s about 60 and from a small town outside Cartagena, though he has lived here for about 40 years. I always stop and chat with him for at least a few minutes, and he always greets me by name.

When we both have a little more time, we talk about philosophy, life in Colombia and our shared experiences. I look forward to seeing him – and he always asks about my adventures in Sincelejo.

Now I know I talked about some of the things I don’t like about Colombia in a recent post – but it’s people like Juan Fernandez that make me love Colombia so much. Just nice people – who are happy to talk to a stranger, make her feel at home and pass the time.

End of the road

Posted on April 26, 2014 by K Eckland

I know many people were not thrilled about my latest post, “What I don’t like about Colombia,” but I felt it was a fair question (posed by a reader) and it deserved an honest answer. Whitewashing my opinions / experiences and perspectives or painting a pretty picture does a disservice to this beautiful country and its people.

Colombia, like any country – has its beauty, its strengths, its joys and its share of problems. Ignoring issues because they may appear less than favorable undermines my integrity and the integrity of my work.

So I apologize if I have offended anyone, particularly any of the wonderful people who have graciously extended hospitality and friendship to me. That was not my intention. But I cannot apologize for sharing my perspectives as an outsider looking in.

As my time here in Cartagena and Sincelejo comes to a close – I hope that my readers, colleagues and friends can appreciate my experiences for what they are, my experiences.

Last week in Sincelejo

My last week in Sincelejo was a bittersweet one. Sweet because we had two coronary cases but bitter because it was sad knowing this was the last time I would see everyone.

Anita, Patricia and Estebes

These three ladies have made all the difference in my operating room experiences here, and I am grateful for that. I have really enjoyed getting to know them – and I feel sad at the thought that I may never see them again.

Raquel (right) and Anita, the instrumentadors

I am really going to miss Patricia and her perpetually sunny nature, easy smiles and ready laughter. She was so sweet to introduce me to her son so I would have an escort and companion if I wanted to go out dancing.

Patricia and Estebes, circulating nurses

I will miss Estebes, who always seems to go out of her way to help me. She is always there to adjust the light, offer a stool or anything else that might make it easier for me while I am peering into one of the dark tunnels of someone’s leg.

with Estebes

Anita, too, has wonderful. I feel like we have also had some fun, working at the ‘back’ of the table. I’ve tried not to be in her way – and to actually be somewhat helpful. (I’ve probably failed at this – but she has been very sweet and has never made me feel unwelcome.) She’s also extremely knowledgeable about surgery so it’s good to have her there. It’s hard to feel nervous with Anita watching over me. Or when I need a third hand – she is always there – even while managing everything at the top of the table too.

Tuesday

We arrived in Sincelejo this morning for surgery this afternoon. I did a fitting with Dr. Barbosa and his new headlamp apparatus so I could fit the final piece of Velcro. It’s not the prettiest thing in the world, but it’s functional and fully washable. (The previous headlamp anchor is an uncovered foam that crumbles with washing). I added a border to the old one as well, and repaired it the best I could, so he would be able to swap them out as needed. I hope he liked it – despite its ‘ugly duckling’ appearance. I thought it would be a nice gesture since he has done so much for me – and I don’t know how to say “Thank You.”

Dr. Barbosa models his new headgear.

The patient only needs one small segment of vein – so Dr. Barbosa decided it would be a good time for me to learn open saphenectomy. (I think I have convinced him on the soundness of my theory of learning the principles of saphenectomy, especially with my argument on the need to know for emergency cases.)

performing a saphenectomy

It was amazingly fast and essentially a bloodless field. Since everything is open before you, it is easy to ligate and clip all of the collaterals. I was surprised by how quickly I was able to free the vein. Closure didn’t take much longer than normal because even though it was an ‘open saphenectomy’ since it was only one graft it wasn’t that long of an incision.

I am glad I had an opportunity to try it because it certainly gave me more confidence than I would have had if I was expected to learn it during an emergency case. I also felt it gave me a better feel for the anatomy – because it’s all laid out in front of you. (It doesn’t matter how much you read or study a textbook – people are ‘never’ completely textbook, and ‘real’ anatomy looks different from the pretty drawing in my Grey’s Anatomy, especially when you are peering down a dark tunnel tract.)

Wednesday

The patient from yesterday is doing well. The morning chest x-ray showed significant atelectasis but the patient was hemodynamically stable and without other complications. I reviewed post-operative teaching (pulmonary toileting, ambulation) with the patient and explained that due to underlying COPD, he needed to be more aggressive in pulmonary toileting, and post- operative exercises.

Just a nurse? I don’t think so…. But you are only a doctor.

Today a doctor attempted to insult me by stating, “You aren’t a doctor.” (Don’t worry, dear readers – it wasn’t Dr. B – I think he ‘gets” me.) It made me want to laugh out loud but I managed to restrain myself since I was scrubbed in at the time. Of course I’m not a doctor – and thank the lord that I am a nurse! I never have and never will want to be anything else!

I feel sorry for someone so limited that they can’t see all that is missing from their life because they are “just a doctor.” They are just a doctor, but I am fortunate enough to be a nurse! I get to be everything that they can’t. For him, the people who come to us for help are just patients – part of an endless cycle of work, a means to pay the bills, buy a big house and have the status that being a doctor brings.

But for me, well, I am not usually overly religious in my speech but there is no other way to describe it but to say, I am blessed. I do feel it’s a ‘calling’ of sorts. I am blessed with the opportunity to care for these people, each one unique; with their own hopes, dreams and rich histories. I have the privilege of being one of the people alongside the family and friends who cares for them. I am lucky enough to be invited to share in that care. The patients may leave the hospital, but they never leave my heart.

I am so much more than just a nurse to my patients; I am a teacher, a friend, a source of comfort and compassion during a life-changing experience. I am the one who holds their hands when they are frightened – and the person who brings a smile to their face when they think they will never smile again.

Just a nurse?

I am a little bit social worker, a tiny little angel, a physical therapist, a cheerleader and friend, and even to many, their favorite ‘doctor’. Often, I am the one they feel comfortable talking to – I am the one they bring their questions and concerns to. Usually, I am the one they trust – to tell them to truth and to assist them on their journey back to health. And, that sir, is a privilege you may never know.

To my surgeons, I am the extra right hand they didn’t know they needed. I am always where I am needed – often behind the scenes, taking care of small issues so the surgeon can continue to do the things he needs to do – namely operate. I am someone to bounce ideas off of – someone to teach (and wants to learn). I am the very best resident a surgeon will ever have.

To the other doctors (who may have limited experience with cardiac surgery patients), the ones who are willing to admit it – I am an advisor, a teacher and a trusted colleague.

To my nursing colleagues – I am a mentor, a teacher and someone willing to listen to their concerns. I know their jobs and I know their intrinsic value. I know their talents – even if you don’t. I never shrug off a nurse’s concerns, and that has saved lives. If the nurse caring for the patient comes to me and says, “I don’t know what it is but something isn’t right,” than I know that something isn’t right. And together, we figure it out and make it better. I know that these nurses, the ones you dismiss – they have hopes and dreams too – and they take pride in excelling in their job. If they don’t know something, it’s not for a lack of trying – it’s for want of a mentor.

Ever Luis, one of my favorite floor nurses

And yet – there is still more to this nurse – I am an investigator, a researcher and a bit of a detective. But you sir, are only a doctor.

In today’s case, the patient needed two grafts. Dr. B started the initial incisions (I was off by a centimeter yesterday on my initial incision, so I think he lost confidence in my skills – I was worried about avoiding the patients more superficial varices.) I am a little afraid of jumping in too quickly and harming the patient – so I am cautious in making my initial incisions – but once that’s done, I feel like I am in familiar territory. I looked at my case log after the surgery – and it seems incredible for me that I’ve only had eight cases because it feels like I’ve been doing it for longer – parts of the procedure feel almost automatic now. I wish it was 25 or 3o cases but the service just isn’t that busy. I knew that would be the case when I came here – so I am grateful for the eight cases. Eight is still more than none, and none is how many cases I was getting back at home. (It’s that tired cliché – everyone wants someone with experience but no one wants to give a person a chance to get experience.)

I am still hoping that future employers will take my willingness and eagerness to train into consideration and offer me a chance even though I am a locum tenens provider. I have just been burned too many times in permanent positions to risk taking another one in hopes that they will fulfill their promises to train me.

Thursday

No surgery today but a full clinic! It was a good day in clinic because I got to see all the post-operative patients from our previous surgeries, and it was just a bit heart wrenching. But then again, I am always a big sap for my patients.

All the patients seemed so happy to see me – and I was so happy to see all of them too!

Everyone looked really good, and I was impressed by their questions and attentiveness during the appointments. My patients knew all of their medications by name, and were eager to discuss this and other post-operative instructions they received at the time of discharge. (Usually it seems like people forget a lot of what we talk about in the hospital – but I think my horrible gringa accent sticks in their minds).

The only disappointing aspect, was seeing one of our patients (who had been really fragile pre-operatively) amble in. She looked great – and said she felt pretty good, (other than the usual sternal soreness) but one of her leg incisions had partially dehisced. (Luckily it was a very small skip incision and the patient had been fastidious about cleaning it as directed). The wound was very clean, with no signs of infection. It was healing well by secondary intention but I was disappointed in myself that the wound closure didn’t hold up.

After clinic – we headed back home. All the while, I was thinking of how I will miss Sincelejo. I will miss my friends, my patients and Clinica Santa Maria. I will miss the chance to work with Dr. Barbosa – who was always such a great teacher, even if we didn’t always see eye-to-eye. Most of all, I will miss Iris, who has been my best friend, confident and colleague during this journey. I will miss working with her – I honestly think that between the two of us, we could be a force to change the world (or at least cardiac surgery) for the better.

From the bottom of my heart, I sincerely say, Thank you Iris, Thank you Dr. Barbosa, Thank you, Estebes, Anita and Patricia – and thank you Dr. Salgua for having me here among all of us – and making me part of the team. I will miss you all.

Dr. Salgua Feris

So what don’t you like about Colombia?

Posted on April 25, 2014 by K Eckland

This question comes from a recent email by one of our loyal readers.. (It may have been sarcastic, but I’ll answer it honestly and candidly.)

So, what don’t you like about Colombia?

Fair enough, but let me preface the discussion by saying that EVERY SINGLE THING that I mention below also exists in the United States. So I won’t pretend that my country is some kind of gender utopia. It’s not – In fact, the “war on women” has been waged between political parties and in headlines of newspapers all over the United States. My home state of Virginia, along with Texas has been some of the worst offenders on this front..

Still… Due to the overwhelming machismo here – the things that bother me the most in Colombia somehow manage to be extremely pervasive, sometimes subtle yet face-slappingly* shocking at the same time.

1. You are never more than your looks. Sure, everyone knows that unfortunately, attractiveness, particularly female attractiveness is the unspoken prerequisite for career success in the United States. But it tends to remain unspoken, highly illegal and in the background for most of us.

It is one of the biggest ways that males here (Colombia) are able to maintain authority and superiority and subjugate women. Too many people buy** into it – so even women who hate it are forced to conform to survive (professionally, financially).

It’s different here – and it’s probably the main reason I haven’t chosen to call Colombia my long term home. It’s never in the background here, and it never fades away. It doesn’t matter whether you’ve known someone here for five minutes or five years – you are still being judged by your looks. It doesn’t matter what your background is, your skillset or your intelligence.

Men (who are the majority rule here) won’t even hear what comes out of your mouth if you don’t meet the “minimal attractiveness” levels. It’s almost like a physical disability – as if they literally can’t hear you.

a PhD in physics? Sorry, sweetie – I can’t hear you.. Maybe after you get some breast implants..

Not only that – but in general, Men here judge harshly. If you aren’t a supermodel, with large (or enhanced) curves – then you are lacking. Not only that – but they will be certain to inform you that you are lacking (using during your initial introduction, and probably every single subsequent meeting thereafter.)

(Obviously – this doesn’t apply to ever single male in Colombia, but it’s still quite prevalent even among the better educated upper classes).

Even if you are beautiful – your time for professional and career success is limited. Maybe you have some cellulite, or your breasts aren’t perky enough – or you’ve had the gall to age.

So as you can image, as a chubby, woman over 30, who has never, ever been “mistaken” for a model even on my very best days as a young ingénue, this constant spoken criticism is extremely disheartening. Not only that – but it makes it extremely hard to get any work done.

2. Don’t ever attempt to discuss any of this with male Colombians. While women here talk about these issues often and express their feelings towards these attitudes of male machismo, don’t bother trying to address these issues with male Colombians. (Sure, there is always the odd exception – usually a more cosmopolitan man who has lived outside South America at some point, but it’s not common.) As I said before, ‘selective deafness’ comes into play. Not only that – even when having a so-called polite conversation (on American customs, polite behaviors etc.) attempting to explain (to people planning to visit the USA) that these behaviors may be perceived negatively in the United States, will be dismissed. Very often this will also result in comments such as “you are just jealous of the beauty of Colombian women.” This comment was made in response to a discussion about the fact that calling an American woman ‘gordita’ (chubby/ fat) or ‘vieja’ (old) may impede abilities to make friends and have serious repercussions, particularly if it occurs in the workplace.

It will also get you labeled as a lesbian.

an aging ‘lesbian’ speaks out

3. Aggressive homophobia, particularly in the coastal areas of Colombia. Despite the fact that an estimated 8% of the population identifies as gay, homosexuality remains a big taboo in many parts of Colombia.

While Bogotanos and residents of more cosmopolitan cities like Medellin and Cali tend to express more tolerant / accepting attitudes regarding an individual’s sexuality – this is not the case in places like Cartagena. (Costenos have a reputation for being less than sophisticated. There is even a Colombian version of the “Beverly Hill-Billies” which features several Costenos living in Bogota). Homophobic slurs are extremely common in every day speech.

Like their American ‘redneck’ stereotype counterparts – many Costenos are bigoted, biased and intolerant of others. This includes the darker-skinned Costeno residents, and gay people. While I try to keep my mouth shut for the most part, (even though it pains me) when I hear the blatant racism / homophobia – on the one occasion when I objected to hearing the repeated use of an extremely ugly Spanish pejorative for gay people (akin to the American slur of “faggot”), I was literally shouted down for my audacity in attempting to censor his “bible given” right to spew hate.

Even the sly suggestion that a particular apartment is in a “gay neighborhood” is enough to prompt something akin to panic, and further discussions on moving/ selling said apartment.

Of course, this sort of bigotry happens in the USA – and everyone knows that. But I would like to think that a lot has changed in the last ten years in that the majority of Americans are not only tolerant of gay individuals but support their right to equality under the law, the right to pursue personal happiness and to get married and have families. Even the majority of Southerners***.

So now you have a unattractive, middle-age lesbian in Colombia. Try and imagine how this impedes daily interactions. Oh, did I mention that I am also considered a slut.

4. Rampant Slut shaming.

So if you have committed any of the faux paxs listed above, don’t be surprised at what comes next, namely Slut Shaming. Especially if this “puta gringa” has also committed the unforgivable sin of also learning the names of the Building porter or the person who sells you gum (daily) or other members of Cartagena’s “lower class.” It’s not something as simple as good manners – it’s because you are a slut and are sleeping with all of them.

In a country where married men openly brag about their numerous sexual conquests, ‘amigitas’ and secret families are common, women are still placed within the narrow confines of the “Madonna/ slut” paradigm. As a married foreigner who often travels solo due to financial concerns, the lack of my husband’s physical presence makes me even more of a target for this labelling.

Women here are supposed to dedicate long hours, and thousands of dollars in pursuit of ‘sexy’; wearing tight, short revealing clothes, tilting around on high heels while attempting to balance outsized breasts with generously rounded bottoms – yet maintain an ‘inner purity’ that prohibits open and frank conversations about gender issues. The end result of this – is that men are able to strictly control the financial and economic mobility of women in a society that castigates outliers.

So I am fairly certain that my candid response to this question won’t go unpunished. I probably should have stuck to easy answers.

ie. What don’t you like about Colombia? Answer: FARC/ paramilitaries.

But then, I don’t have run-ins with paramilitaries on a daily basis..

So what does this mean?

Does it mean that this slutty, unattractive, lesbian gringa should give up any hopes of doing business in Colombia? AKA “Gringa GO HOME” (as has been suggested on multiple occasions). Or should I fire up my time machine, emerge as a fresh 20 something, head directly to the nearest plastic surgeon and keep my damned mouth shut? Should I wear tighter clothes, stilt like heels and hope to blend in?

Maybe it is time for me to go home – and return when I can remember and enjoy the thousands of things I LOVE about Colombia; the cool air of Bogota, the richness of a country with an in the amazing array of natural wonders and geographic splendor, the overwhelming variety of fresh fruits and vegetables, the joy of learning to Salsa, the cultural depth of a country with over 500 years of history, the incredible variety of friendly, and interesting people I meet on any given day (machismo not withstanding).

But don’t worry – nothing can get me down for long – and I will return to the beautiful, wonderful, culturally rich Colombia very soon.

Notes:

* Yes, I made that word up, but that’s how I often feel as I confront these issues every single day here.

** Literally. It’s one of the reasons plastic surgery is such big business here.

*** Before readers get upset that I am “propagating the American redneck stereotype”, consider this – I say this as a self-proclaimed ‘redneck southerner’ who happens to express a ‘Live and Let live” philosophy towards others. That being said – my experiences in Colombia – are mine, and I don’t attempt to speak for, or represent anyone else’s experiences here. If anything – I hope your experiences (as a female) in Colombia have been different.

Additional articles on related topics

This study compares eating disordered behavior and plastic surgery rates in the USA and Colombia.

Gender, eating habits and body practices in Medellin, Colombia – article by Ana Maria Ochoa.

Narco-aesthetics: How Colombia’s drug trade constructed female ‘beauty’ – article by Mimi Yagoub

Life in Plastic – it’s fantastic! about the culture of plastic surgery in Latin America (specifically Cali, Colombia) and the link to narco-trafficking.

LA Times article: A Scathing Attack on Culture of Machismo.

Acid attacks show the face of machismo in Colombia

Earning a living is the biggest obstacle for Colombian women.

Colombia: Human Rights Situation of the LGBT Population: Shadow Report Submitted to the United Nations Human Rights Committee (2010). While laws were passed to protect the human rights of the LGBT community in 2011, the situation remains precarious for the LGBT community particularly in rural areas.

U.S. groups file briefs in Colombia marriage case. (4/14/2014).

Bogota mayor invites residents to come out of the closet.

Women on Waves resources: promoting women’s rights internationally. Provides practical, not philosophical information for women in a multi-lingual site on women’s health & gender issues.

Women on Web: women’s health information – multi-lingal site.

Featured Image courtesy of Sodahead.com

Made in Colombia

Posted on April 18, 2014 by K Eckland

The operating room may have stayed dark for the last several days, but that doesn’t mean it’s been a quiet holiday week here in Cartagena.

the quiet streets of last week are just a memory

The relaxed, fun atmosphere of the city – due to the tourists, the beaches, the clubs (and the Chivas!) is contagious. It’s impossible not to be affected by all the smiling, happy people out and around…

Adventures with Iris

Iris and I have had a fantastic week – wandering around the city and enjoying all that it has to offer. (I swear, my next book is going to be called, “Adventures with Iris” and I am going to chronicle all of our various escapades). But since she’s camera shy, it would be kind of a crazy book – with photos of me standing alone in all sorts of cool places..

Hanging out with Iris usually looks like this (as she hides from the camera). You can also see my new haircut from a recent ‘day of beauty’ with Iris.

We’ve been all over town, sampling various cuisine, drinking a micholada here and there, and enjoying the refreshing evenings that serve as a relief to the sultry heat of the day. We get along great so there is always something to talk about when we hang out.

Coconut water from the source

I have a bit of a routine here – in the early mornings (if I wake up early enough), I head out to walk along the beach for some exercise. By 7:30 or so – the sun, heat and humidity are already out in full force, and it’s time to head back indoors.

The rest of the morning is spent sewing, writing, reading, or crocheting.

After lunch it’s time for a siesta to pass the afternoon before the ocean breezes come to shore and cool off the city. (Without the daily afternoon cool down, I think the city would just be unbearable, particularly for someone like myself, who is unaccustomed to the heat. People from South Florida probably don’t even notice it.)

Visiting with Iris’ Colombian craft class

In the late afternoons – we head out for various activities..

at a recent Colombian cuisine and craft event in El Centro

Colombian crafts – continued

I am making a lot of progress on my first crochet project – the universal, ever popular ‘Colombian bag.’

Made in Colombia – the typical/ classic Colombian handbag, “Mochilla”

Of course, mine won’t be as fancy as these here (since it’s my first) but I did add a jazzy yellow stripe.

Colombian bag progress update

Avenida Brasil – More drama than the hair-pulling, cat-fighting “Dynasty” style dramas of the 1980’s. (That’s probably not their advertising slogan).

I also work on the bag some evenings while we watch “Avenida Brasil” which is one of the typical melodramatic (always crying or screaming) telenovelas on television. As the name implies, it’s actually a Brazilian show. It’s a bad stereotype of Latin American soap operas with tired story lines (everyone cheats – no one uses contraception, so everyone gets pregnant (but somehow never gets HIV). It has none of the substance of “El Patron” but it’s popular here, so I watch it. But maybe all soap operas are like this – I was never a big fan of the Young & the Restless or whatever…

For the last week of episodes: the wicked Carmina has been crying/ carrying on (and manipulating everyone) in every episode. She recently caught her husband, Tifon cheating on her with one of his old friends, Mona Lisa. But that’s no surprise to chronic watchers despite the fact that Mona Lisa just married another guy.. ( and Of course, Carmina has not only been cheating on Tifon for several years – but actually lives in a shared home with her amante, Max, his unsuspecting family, as well as her in-laws and her daughter (whose father is actually Max.)

Probably the only interesting story line for me is the serial polygamist. I don’t know the name of the character – but he’s suave and handsome in kind of a bland Argentine kind of way.. It’s like he just can’t help himself – as he marries woman after woman and maintains several separate lives. He was recently found out by his three wives (who were completely unaware of each other) – while dating and wooing a fourth woman. It’s only interesting to me in that he seems completely oblivious yet totally manipulating and calculating at the same time. It’s a common theme that reflects much of the ‘machismo‘ here.

Then there is Jorgita (Jorge), the son of Carmina and all of his trials and tribulations. Of course, he is in love with one woman, while dating and impregnating another. He’s supposed to be so wonderful and charming – but I find him quite revolting with all of his flashy jewelry and declarations of ardent amor.

Of course there are a myriad of other characters and story lines but this is probably enough to give an accurate depiction.

Hecho en Colombia

Handmade dress – about half way done

I’ve also been sewing a dress using some fabric and patterns I bought here. I altered the pattern (quite a bit) to make it more of my 1920’s style and on a whim – have been sewing it by hand.

One of my preliminary handsewn seams. (They are prettier when I finish).

Maybe when I get done – I can label it ‘Hecho en Colombia’ since I made it here in Cartagena using a Colombian sewing pattern, and Colombian fabric. (Both the pattern company and the fabric manufacturer are in Medellin.)

Iris has a perfectly fine Brother sewing machine – (I used it to create a new helmet guard for Dr. B’s helmet light) but I just felt like doing it by hand.

Dr. B’s new helmet liner

It’s a cushion made of fabric covered foam that keeps the metal frame that holds the surgical light from shifting or weighing too heavily on his head during surgery. It’s navy blue so it’s hard to see in the photos. It has velcro strips to affix it to the metal frame, and adjust for individual sizing.

photo showing Dr. B and his helmet light (and the old liner).

Haha.. Kind of funny how even sewing always circles back to surgery, isn’t it?

San Jacinto and taking the long way home

Posted on April 11, 2014 by K Eckland

As we left Sincelejo to return to Cartagena, I noticed that we made an unexpected turn away from our usual route. This was confirmed as we passed the fitness center on the other side of town and headed towards Corozal.

The department of Sucre as outlined in RED

“Ah, this will be my adventure today,” I said to myself. Sure enough – I kept quiet and enjoyed the change of scenery as we drove away from Sincelejo into a mountainous area that reminded me of my high school years in Angels Camp – Murphy’s area of California (Sierra Nevada foothills).

The terrain was dotted with trees interspersed with dry straw-colored grasses. Cattle grazed in pastures on either side of the small, winding two-lane highway.

As we drove through Corozal, I ventured to voice my suspicions. The good doctor laughed and confirmed that it was, indeed an ‘adventure’ designed for me – since he and Iris knew of my love of Colombian countryside.

the apple is just there for scale

First stop on our tour was for the famed avocados. (Indeed – these famous avocados have been the source of much amusement among the cardiac surgery team due to a previous episode involving a “bait and switch” by another team member (who ‘stole’ a bag of these avocados from the good doctor, and left behind a small bag of more ordinary avocados in their place.)

woven fabric made on traditional looms

We then passed into Bolivar –

Our next stop was San Jacinto, which is a town that is locally known for their artisanal crafts. (The Sucre – Bolivar regions are noted for many of their textile crafts. Some of the techniques date to the pre-Colombian era).

Having Iris as my tour guide was wonderful. As a certified artisanal artist of traditional Colombian crafts, Iris was able to give me a detailed explanation of each of the different types of craft making – including information about regional differences in weaving designs, colors used, and other traditional items.

(For more information about the processes used in this craft work, click here.)

Since I am in the midst of (very slowly) learning how to crochet one of the traditional Colombian bags – I can certainly appreciate the amount of time and skill that goes into crafting each of these individual items. There is no assembly line, factory floor or Made in China” labels here. (Yes, I looked).

As the road wound its way back to the fork where we usually take the other branch) we stop at our usual coffee shop. There we were greeted by a Palenque resident selling baked goods.

We bought a sweet, round ball of a popcorn(ish) treat called Alegra which contains corn with coconut and panela. She then came and sat with us and attempted to teach us to speak a few words of Palenque.

After our brief respite, we continued to the main highway to Cartagena and proceeded home. It took a little longer, but to me – it was well-worth it. Thank you, Iris and Dr. Barbosa for my unexpected surprise!

!Eres Absurdo!

Posted on April 11, 2014 by K Eckland

Eres Absurdo!

I’ve heard that several times since I’ve been here – but it’s not exactly as it sounds. It’s slang: like saying “goofy-footed” when referring to snowboarders. It means that I am left-handed, or left-hand dominant, since the operating room requires you to be somewhat ambidextrous.

So this week – that was one of the things I set out to do – to become more proficient with suturing with my right hand. It wasn’t as hard as I expected but I certainly don’t have the speed I have with my left hand (which sadly, isn’t that fast).

Monday

Today wasn’t a great day. Everything went well – harvested vein, closed incisions, in the operating room so it should have been another fantastic day – but…. I just a felt, a little lonely today, I guess. Or maybe lonely is the wrong term – since I live with three other people here in Sincelejo. I guess what I meant to say is it’s the first time I’ve really felt alone since I’ve been here – and it was kind of surprise to feel that way.

I guess because I am used to traveling frequently and in making unfamiliar surroundings my home that it came as an unexpected pang when I suddenly missed the camaraderie I have had at other hospitals. Everyone has been fantastic here – particularly Iris, who I consider to be a good friend, but it’s not quite the same.

My name is Kristin.. Kristina is someone else

Here in Colombia, many people struggle to pronounce my name so it’s usually simplified to “Kristina”. But that’s not me. Just like my name, I feel like a bit part of my personality just doesn’t translate into Spanish well. Not as a cultural metaphor or anything ‘deep’ like that – but literally. When something that you take for granted – like having an extensive vocabulary at your disposal, is redacted, it kind of changes how you express yourself. It also changes peoples’ perceptions of you.

Just for five minutes – I desperately wanted at least one person who really “knew” me to be there.

Dr. Barbosa is a fantastic teacher and a very intelligent and kind person – but we don’t have the kind of friendship that I had with either Dr. Embrey (in Virginia) or Dr. Ochoa (in Mexicali). Part of that is probably due to the fact that I just haven’t been here all that long. I worked with Dr. Embrey for almost three years. Dr. Ochoa and I were together five to six times a week for months.

The other part is Dr. Barbosa himself. Our perspectives are fairly different, so that tends to complicate things. He is always friendly but still a bit reserved with me. That might be due to the fact that I am still lacking fluency in Spanish. (I understand a heck of a lot more that I can speak – but even so, colloquial phrases and subtle nuances in speech are usually a complete mystery to me). So I miss most of the jokes in the operating room, or figure it out about five minutes too late to be part of the conversation.

But after a little while that feeling of intense ‘alone’ dissipated – and everything went back to normal, whatever that is.

Tuesday

This morning I went by the Cancer Institute of Sucre. I had written to them last week, but received no reply, so I decided to stop in. After about an hour, I was able to talk to one of the administrators but she said that I had to submit all my questions about their cancer treatment programs in writing, in advance. I explained that is not how it usually works, and left my card. I am sure that will be the last I hear from them. It’s a shame because the facility is beautiful, sparkling and new. They advertise a wide variety of cancer treatments including brachiotherapy and thoracic surgery so I would have liked to know more. (The website looks like something circa 1996, so it’s not really possible to get information from there.)

Another case today – another saphenectomy! But this one came with a potent reminder. While I still need practice, I feel more capable of performing the procedure that I did before. Things proceeded well, if slowly (still need a headlamp!) but then it turned out that the internal mammary wasn’t useable so Dr. Barbosa needed more vein conduit. Which he proceeded to harvest himself, in about five minutes. So – I still plenty to aim for.

The holiday week started mid-week, but I am still hopefully for a few new consults tomorrow. I know we probably won’t have any surgeries over the ‘Semana Santa” period, but I can’t help but keep my fingers crossed anyway.

Wednesday

Aortic valve replacement*** today. Dr. Salgua showed up early today – and looked pretty determined, so I decided just to stay out-of-the-way. I figured since it wasn’t a vein harvesting case, I shouldn’t make a fuss. After all, I am just a visitor here – and I’ll be leaving soon.

Not my best photo by far – but my favorite part of this surgery – placing the new aortic valve into position

Instead, I stayed behind the splash guard and took pictures – since aortic replacement is the “prettiest” of all cardiac surgeries. Unfortunately, my position was a little precarious, balanced in two steps – and still barely above the splash guard. So many of the best shots – ended up partially obscured. (But I don’t want to give up any more surgeries to get better photos.)

Received a consult from the cath lab today but surgery will probably be delayed due to the Easter week holiday. (The team is willing to operate 24/ 7 – but few else are.)

Both our patients from earlier this week are doing great. Monday’s patient passed me several times doing laps on the med-surg floor. He’ll probably go home tomorrow or Friday.

Thursday

No surgery scheduled for today. Rounded on the patients from this week and spent some time explaining medications, post-discharge instructions and other health information with the patients and their families. While I love the operating room – this is the part I enjoy the most: getting to know my patients, and getting to be part of their lives for just the briefest of moments. It is this time with patients – before and after surgery that makes them people, families – not legs or valves or bypasses. Without this part, I am not sure I would have the same satisfaction and gratification in my work*. I love seeing patients when they return to the clinic for their first post-operative visit – to see how good they look, and how much better many of them already feel.

This afternoon – was exactly that as one of my first patients returned to the clinic after surgery. The patient looked fantastic! All smiles, and stated that they already felt better.

After seeing patients in the clinic, we packed up and headed for home. Since we currently have no surgery scheduled for next week (Semana Santa), and our other consults are pending insurance authorization, I don’t know when or if I will be returning to Sincelejo before I depart for the United States.

*As I say this, ironically, I am hoping for a ‘straight surgery’ position for one of my future contracts, so I can refine/ improve my surgical skills for future contracts in different settings that encompass a variety of duties.

***More Aortic Valve articles, including my famous “Heinz 57” post can be found here:

Aortic Stenosis and Heinz 57 : (what is Aortic stenosis?)

Aortic Valve Replacement and the Elderly

Aortic Stenosis : More patients need surgery

Cardiac surgery and valvular heart disease: More than just TAVR

There is a whole separate section on TAVI/ TAVR.

Sincelejo Diaries, part 2

Posted on April 5, 2014 by K Eckland

Tuesday – We drove back from Cartagena this morning before heading to surgery in the afternoon for a bypass grafting case. For the first half of the way, I sat in the back and enjoyed looking out the window. It’s amazing how dry parts of Bolivar are.

The drought has been responsible for the deaths of over 20,000 farm animals here in Colombia. The small lakes are disappearing, from my first trip to Sincelejo to my most recent visit just a few weeks later. The trees and bushes besides the roadways are completely coated with layers of dust from passing vehicles. It gets greener as we pass into Sucre, but it’s a sad reminder of the devastating effects of climate change.

After stopping for breakfast along the way, where we met up with Dr. Melano, Iris went with Dr. Melano and I stayed with Dr. Barbosa. We talked about music mostly. At one point, a former patient from several years ago called, just to say hello. The patient had recently heard that Dr. Barbosa now had a surgery program in Sucre. (The patient had previously traveled to Cartagena from a small town in Sucre for surgery.)

Once we got to Sincelejo, we headed to the hospital to see our patient before surgery and go over any last-minute questions or concerns.

(Of course) I was worried about finding vein but we easily found good quality conduit. Dr. Salgua has been very nice about helping me with the saphenectomies. The team teases me because I have a difficult time pronouncing her name. We have a kind of system: While I finish closing the leg, she moves up the table to assist the surgeon in starting the grafts. Then when I finish wrapping the leg, I stay at the back of the table with the instrumentadora, learning the Spanish names for all the instruments. Once the chest is closed, she does a layer of fascia and I close the skin incision.

It’s a little crowded sometimes with the new instrumentadora learning the essentials of cardiac surgery, but the atmosphere at the back of the table is a lot different from the climate at the top. (Dr. B is always calm, pleasant and entertaining – but Dr. Salgua is almost completely silent the whole time). I am a lot quieter than my “out of OR self” when I am across the table from the surgeon too..

Wednesday – Another coronary case, on a fragile-ish patient (multiple co-morbidities including chronic kidney disease etc). It was a long case and I was a little worried the whole time but the patient did well. (I always worry about the frail patients).

I did okay too – performing a saphenectomy with Dr. Barbosa. The patient had a vein stripping procedure previously (on one leg only) so I wanted to be sure to get a good segment of vein on the remaining vein. I think Dr. Barbosa was worried about the quality of the conduit (because he kind of hovered – and didn’t relax until we started harvesting it.)

Skip harvesting

I wish I would have more opportunities to perform a traditional saphenectomy (one very long incision). I assisted on one several years ago – and I think if I had a chance to do a couple more, I would feel more comfortable skip harvesting. Of course, a headlamp would also help. (It’s kind of dark looking down the skip ‘tunnels’). Then once I’ve mastered skip harvesting, I think it’s just another small jump to endo-harvesting with a scope. I know a lot of people never bother learn to skip harvest, but I feel more comfortable building on the principles of open procedures first. I might need them in an emergency case which is kind of why I wished I had more open saphenectomy experience.

Thursday – Saw three patients in the clinic today. However, on reviewing the patient records and an intra-office echocardiogram, one of the patients definitely doesn’t need surgery at this point. (Asymptomatic with only moderate valvular disease). We were happy to let him know he didn’t need surgery even if that means fewer cases.

Two surgeries today. The first case was a bypass case for a patient with severe coronary disease and unstable angina. Dr. Salgua and I did the harvest. I think Dr. Barbosa is a little nervous about handing over the reins to me for harvest because he keeps a pretty close eye on me while I am doing it. But then again, it might be because I am a little overly cautious and hesitant at this point. If I didn’t have Dr. Salgua to look over my shoulder and encourage me onward, I’d put clips on everything and proceed at a snail’s pace to make sure I do it right. But since it’s still my first week, maybe I shouldn’t be so hard on myself.

On the other hand, he must think my suturing is pretty good, because he just trusts me to do it correctly.

The second case was a patient from last week, who developed a large (symptomatic) pleural effusion and cardiac effusion (no tamponade or hemodynamic instability) which is a pretty common surgical complication. The case proceeded well – I placed the chest tube, with Dr. Barbosa supervising. Dr. Barbosa performed the cardiac window portion of the procedure.

Sadly, one of our patients from last week died today. It was a fragile patient to begin with, and even though surgery proceeded well, the patient could never tolerate extubation and had to be re-intubated twice after initially doing well. From there, the patient continued to deteriorate.

Friday

Today we had a beautiful aortic valve surgery. This has always been one of my favorite cardiac procedures. Somehow its elegant in the way the new valve slides down the carefully coördinated sutures. (I don’t have pictures from this case – since I was first assisting – but I will post some from a previous case – so you can see what I mean).

Dr. Salgua worked an overnight shift, so I was at the top of the table – (and yes, noticeably quieter than normal.) I was surprised at how fast it seemed to go – but maybe that’s because everything went so smoothly. Or maybe because we’ve done a lot of coronaries lately, which is a much more tedious and time-consuming process.

Iris and I are working on a patient education process – as a way to improve the continuum of care for patients (particularly after discharge). I really enjoy working with Iris because I feel like we are always on the same page when it comes to patient care.

While it’s been a tiring week for the crew – I am, as always! exhilarated and happy to be here in Sincelejo. Just knowing it’s the end of another week (and I am that much closer to going home) has me feeling a little sad. But I guess I can’t stay forever, and I sure don’t want to take advantage of all the kindnesses that have been extended to me.

That being said:

At the end of every surgery, every day and every week in Sincelejo – I am grateful. Grateful to Dr. Barbosa for being such a willing and patient teacher – grateful to the operating room crew (especially Iris Castro and Dr. Salgua) and particularly grateful to all the kind and generous patients I have met and helped take care of*.

The medical mission

This week I had another inquiry about ‘medical missions’. I know people mean well when they ask about medical missions, or when they participate in these types of activities but…

Long time readers know my philosophy on this – don’t go overseas so you can pat yourself on the back over the ‘great deeds’ you performed ‘helping the poor’. It’s patronizing to the destination country and its inhabitants – and generally not very useful anyway. An awful lot of volunteers with real skills and talents go to waste on these so-called mission trips when their skills might be better served (in less exciting or glamorous ways) in free clinics in our own country.

But it does give everyone involved a chance to brag about how selfless and noble they have been; traveling thousands of miles, sleeping somewhere without 24/7 wi-fi (and who knows what other hardships).

Instead, change your orientation – and maybe challenge that assumption that everything you’ve learned about medicine, health care and taking care of people is better and superior. Open your eyes and be willing to learn what others have to teach you instead.

* I always opt for full disclosure and transparency with the patients. I introduce myself and explain that I am a studying with Dr. Barbosa, what my credentials and experience is to give them the opportunity to ‘opt out’.

Iris & Ximena

Posted on March 31, 2014 by K Eckland

Here in Cartagena, I have been fortunate enough to have two great roommates; Iris and Ximena.

Dr. Barbosa made all the arrangements for me, and I was a little nervous about bunking down with another nurse (we can be temperamental and territorial at times) but living with Iris has been absolutely wonderful.

I was kind of worried I’d be living with some young, possibly flighty nurse who might resent having a middle-age woman in her home, cramping her style. Instead, it’s like having an instant best friend and I love it.

For starters – we have a lot in common: we are both academically and professionally inclined. Iris is the perfusionist for Dr. Barbosa’s cardiac surgery service and is extremely knowledgeable.

Part of the machinery that makes up Iriis’ professional life: the heart-lung machine

(In Colombia, Perfusion is an advanced nursing degree. Iris obtained her master’s degrees in both critical care (National University) and Perfusion at (CES.). She is widely acknowledged as one of the best perfusionists (if not the best) in all of Colombia. Her peers frequently consult her seeking advice for a variety of surgical circumstances.

She is the only nurse to collaborate (and be listed on the cover) of a comprehensive Colombian textbook on Cardiology. Her name is listed along side such esteemed Colombian physicians as Pablo Guerra, Nestor Sandoval and Sergio Franco.

She also serves as a reviewing editor of several Colombian medical journals. Research articles are sent to Iris to review the methodology/ study design and overall quality. Articles she rejects will not be accepted for publication.

In her free time, it’s not unusual to find her reading the latest journal articles on cardiac surgery or working on presentations for the latest meeting or international conference on perfusion. In fact, she recently returned from the annual Colombian conference on cardiology and cardiac surgery in Medellin. She is equally enthusiastic about all aspects of nursing and the position and rights of women (nurses) in Colombia and in medical society in general.

She is particularly outspoken against much of the machismo that dominates life here. She is the one person I have learned to expect to never ask me the unpleasantly intrusive questions that seem to pass for almost introductory conversation here such as “Why don’t you have children? Don’t you want them? What does your husband think of that? Your husband permits you to be here [in Colombia] without him?”*

Even when we don’t agree on all issues, she never judges my opinions or thoughts. She endeavors to understand my reasoning instead. It’s refreshing.

This combination of intellect, insight and experience makes for a lot of interesting and engaging discussions in the evenings as we relax and enjoy the fragrant breezes that bring daily relief to the sweltering city.

A strong woman in a culture of machismo

Iris is also extremely forthright and independent (traits that also resonate with me.) She takes no ‘guff’ from anyone and lives how she pleases in a society that has a lot of difficulty accepting that (unmarried, no kids with Ximena as a part-time roommate.)

Even my professor, as charming and intelligent as he is, defaults into this kind of ‘macho’ thinking. He tells me he worries about Iris, as “she is all alone” without a man to protect her. He worries she is missing out on true happiness and is destined to be sad, alone. Nothing could be further from the truth.

Rather, Iris has chosen to defy tradition, and live life on her terms. She has friends, family and romantic attachments like anyone else. She just maintains both her privacy and her independence despite that, sort of like Elizabeth I of England.

It is sometimes hard as an outsider to understand why this attracts some much attention – a single woman living quietly in her own apartment. But then I think back to some of the comments I get from friends, acquaintances, co-workers and even strangers regarding locums life, and I realize, that as female professionals; whether the United States or Colombia, we still have a long way to go.

It’s just that as an American, I think I have fallen for the illusion of the possibility of female equality in way that women in other countries never have. (The irony is that at this moment in my home country, women’s rights; to reproductive, financial and professional freedom are being eroded more that any other time in recent history. Hard won battles of the 60’s and 70’s are being erased with nary an outcry.)

Here ‘paternalism’ rules the day – and no one pretends any different.

But there is more to Iris that a forthright, intelligent, independent individual. She is also a nurturer, a caregiver, a nurse in the very sense of the word.

What could be more nurturing that offering up her home to an unknown stranger from another land?

“Ximena”

Iris and the other members of her apartment complex have adopted a white and orange stray cat that answers to a variety of affectionate terms. One of these is “Nena”. One my first day here, I confused “Nena” as a shortened version of Ximena, so Ximena she is.

This straggly looking, mangy little ball of fluff is adored by the residents of the small apartment building. Typical of most cats, she is “owned” by none, but owns each neighbor in turn. But it was Iris who took up donations to get Ximena surgery she needed and routine veterinary care. All the residents share in the feeding and care of the street cat – including applying a cream to her healing surgical scar, but it is Iris whom Ximena usually seeks.

While most of the residents leave their doors open during the afternoons to invite Ximena in, Ximena is most often found either inside our apartment, or bellowing outside the door (on the rare occasions that is is closed.) She wanders in with the grace and arrogance that only a cat possesses.

She carries herself with a dignity that belies her ‘homeless’ state as to say she isn’t a vagabond but a seasoned traveler as she visits each apartment in turn – but always comes back to Iris to stay all afternoon and overnight.

Some of the neighbors our jealous of Ximena’s attention, but with our weekly journeys to Sincelejo, they always have an apportunity to host ‘Nena as their favored guest.

Iris loves to cook – and does so easily, deliciously. She embraces a healthy lifestyle filled with daily exercise and fresh fruit and vegetables.

salad made of exotic fruits

We talk about my love of Colombian food – and together one day in the kitchen, we make brevas. She tells me with a smile that she has never made them, but used to watch her grandmother cook them for a sweet tweet.

Boiling brevas: Photo by Camila

We savor the sugary treat, one breva at a time over the next several days.

In addition to learning how to perform saphenectomies from Dr. Barbosa, Iris is teaching me how to crochet. My first project will be one of the small bags that is in a style typical for Colombia. I think it is ironic that it seems easier to suture that it is to crochet.

But Iris is endlessly patient with me – and slowly, slowly as I unravel my mistakes and start again, I am making progress. She has a blogspot where she showcases her latest creations. She recently received national accreditation as a ‘native artist’ to participate in festivals and art fairs that specialize in traditional Colombia crafts.

Today, as we sit on the sofa, crocheting, we talk about plans for the Semana Santa (Easter Week). The secretarial staff in Sincelejo has vacation plans and wants to keep the office closed all week so she can visit a boyfriend in Medellin – but Iris and I think it should remain open for the patients. We plan to offer to staff the office, so that patients won’t have to wait a week to be seen. We will have to navigate and negotiate carefully and diplomatically to prevent causing any hard feelings but as Iris points out, it’s the right thing to do for the patients – and the doctors, and that’s what matters. (My motives are admittedly more self-serving: more clinic = more surgery.)

*This type of questioning is fairly pervasive throughout Colombia, and is often performed as part of introductory conversation. Once a taxi driver in Bogotá directed me to the nearest fertility clinic when I responded “No” to the question about children. He wasn’t rude, on the contrary, he thought he was being helpful.

** Iris prefers not to have her picture taken.

Sundays in Cartagena

Posted on March 30, 2014 by K Eckland

El Centro

Sundays in Cartagena are a bit different from Bogotá or Medellin. As a major tourist destination, Cartagena never really slows down the way other cities do in Colombia. In Bogotá, my neighborhood (Chico) was essentially deserted on Sundays. The only signs of life were on the streets closed for pedestrian walking. La Candeleria and Usaquen were the destinations of choice for Bogotanos who chose to stay in the city.

Instead the activities change – instead of business, the weekends are for boat trips to the Islands of Santa Rosario, long leisurely lunches, wandering around El Centro and looking at arts and native crafts, and walking along the beach. Tourists stroll along Bocagrande window shopping at designer storefronts, eating ice cream. The hotels host popular events in Castillogrande, and restaurants and bars feature the sports of the day, to standing room only crowds.

So today, after sleeping in a bit, Iris and I headed to El Centro for another leisurely stroll around El Centro. Sunday mornings are a nice time for this – the streets are still pretty quiet and not yet packed with tourists. (That comes later in the day.)

As we wandered down the tree-lined streets, I can’t help put take photos, even if I’ve photographed these same areas many times before. Somehow, every time I encounter the colorful buildings with the beautiful blossoms on the curving cobblestone streets, I am enchanted all over again.

After walking around the neighborhood and making our way up the wall, we headed to the nearest Juan Valdez..

After our leisurely coffee, we walked back home to escape the heat of the day. Now I am heading back out – to the beach.

The Sincelejo Diaries

Posted on March 30, 2014 by K Eckland

Sincelejo from the balcony

Since I have very limited wi-fi while in Sincelejo, I have been keeping a diary of my time on the cardiac surgery service of Dr. Cristian Barbosa. But then again, maybe I should explain why I am here.

I came to Colombia to learn how to perform skip harvesting saphenectomies with Dr. Barbosa. As I mentioned previously, we’ve kept in contact since we first met, and he was gracious enough to offer to teach me.

Before I ever left Virginia, it took a lot of paperwork and diplomacy, but we were able to secure administrative permissions for me to study sapheneous vein harvesting with Dr. Barbosa at the hospital in Sincelejo. While this isn’t medical tourism, I thought my readers might enjoy hearing about daily life as part of Dr. Barbosa’s cardiac surgery service.

Cardiac Surgery in Sucre, Colombia

outside the operating room

While the cardiac surgery program is located in Hospital Santa Maria, Dr. Barbosa and his team often travel to nearby hospitals and clinics to see new consultations. This program is the only program in the state of Sucre and patients come from all parts of the state.

Many of the patients come from tiny pueblos of a few hundred (or thousand people). Many others come from impoverished backgrounds. (Colombia has a tiered health care system with a national health care plan for people from lower socio-economic classes, kind of similar to the Medicaid concept.)

We arrive in Sincelejo on Monday, March 24^th in the evening. We have a busy day tomorrow and the doctor wants to get started early (without facing the 3 hour drive in the morning.)

En Familia

In Sincelejo, we live en familia, in a large airy apartment with big windows that overlook much of Sincelejo. There are four of us here, the surgeon, the anesthesiologist (who is Director of the program), the perfusionist and myself. Iris and I share a large room with a private balcony. Meals are shared and we usually travel as a group to the hospital and on errands.

After our arrival Monday evening, the doctor, the perfusionist and I head to the largest grocery store and shopping center in town. We shop as a family, picking out fruit, arepa corn flour, coffee and other essentials. We then head to the food court. (They are treating me to Corral, due to my proclaimed love of Corral’s famed hamburgers).

It sounds like it could be uncomfortable – this domestic scene with my boss and the cardiac surgery team, but surprisingly it isn’t. Iris, the perfusionist (and my roommate both here and in Cartagena) always says they are a “cardiac surgery family,” and it feels that way – in a comforting, cozy way.

I joke and call Dr. Barbosa, “Papa” as he is the natural father figure of the group, and somehow it feels appropriate.

‘Papa’ of our cardiac surgery team

25 March 2014 – Tuesday

Today we travelled to Corozal to see two consultations in the intensive care unit. Then we returned to Sincelejo to see another patient at another hospital, Maria Reina. We eat lunch at the apartment, en familia . Afterwards, we go back to the office to see patients before heading off to surgery. (We had to delay surgery for several hours because the patient decided to eat breakfast. I guess s/he was hungry too).

Finally after this delay (to prevent anesthesia complications), we head to the operating room. There are the typical delays while the patient is being prepped and prepared. This gives me a chance to get to know the rest of the crew, Anita (the instrumentador or surgical tech) who runs the operating room table, Raquel, an experienced instrumentador who is training to work in the cardiac suite, and the two circulating nurses, Patricia and Estebes.

Raquel (right) and Anita, the instrumentadors

The circulating nurses are responsible for taking care of all the duties that fall outside of the sterile field, like fetching additional supplies, medications or instruments. They also control the environment by regulating the temperature, and adjust the electronic machinery (like the electrocautery unit, or the sternal saw) according to the surgeon’s immediate needs and specifications.

Patricia and Estebes, circulating nurses

Dr. Salgua is the medical doctor who works in the office, seeing patients and assessing their medical (nonsurgical needs.) For the last year, she has also worked as Dr. Barbosa’s First Assistant in Surgery. If there is any chance for friction in the operating room, most likely it will come from her. I am cautiously nice but optimistic when I realize she is fairly quiet, and not overly aggressive. (I relax, but just a bit. I am still nervous about how the team will take to me, even though the common Oops! “accidental” needle stick scenario seems unlikely here.

Dr. Salgua

Everyone is very friendly and welcoming and even before starting the actual surgery, I am breathing easier and starting to think that maybe I could belong here, with this group.

The surgery went well (valve replacement and annuloplasty). After the surgery, we transport the patient to the intensive care unit and give report to the doctors and nursing waiting to assume care of the patient.

Note: patient did well and went home on POD # 3 on 3/28/2014.

26 March 2014 – Wednesday

More surgery today, but still no coronaries (and thus no saphenectomies). It was a great day in the operating room – I closed the sternal incision.. (BTW, surgery went beautifully). I am already starting to feel more at home with the operating room staff, and I feel like they don’t mind having me around. Dr. Salgua has been very kind in assisting me during procedures, which is a relief. She still stays pretty quiet during the cases, but I think maybe sometimes she is a bit nervous too.

with the team

After transferring the patient to the ICU, our second visit to the patient from yesterday finds her over in the general surgery ward. (This morning she had been sitting up in a chair in the ICU when we arrived.) She looks good and states she is sore, but otherwise fine.

The cardiac catheterization lab calls; there are four cath films they want us to review, and patients to discuss regarding surgery. The patients themselves are resting in the recovery area after the cath procedure, so our administrative assistant, Paola makes appointments for each of them and instructs them to bring their families, medications and any questions.

The most interesting part of the cath lab is who is doing the caths. It’s a nurse, while the cardiologist sits behind the protective radiation shielded glass enclosure viewing the films and calling out for additional views. I wonder if the nurse knows that in the United States, a similar position would pay over 100,000 dollars. But this is one of the things that I see a lot of her in Colombia and in Mexico. Well trained nurses being essentially nurse practitioners (making diagnoses, treating disease, performing invasive procedures) but without the status or the compensation.

My roommate and I talk about this disparity sometimes. She’s a master’s trained nurse herself, so it makes for some very interesting discourse and insights. (She doesn’t like to have her picture taken, so I haven’t.)

We finish seeing patients and head home. The doctors head off for a siesta. Dr. Barbosa has been up since before five for his daily exercise before surgery.

As for me – after some scouting of the immediate areas around the hospital and the apartment, I went on my motorcycle tour. It was great fun but I got an important reminder of the perils of motorcycles just a few days later.

Note: After and uneventful surgery (defect repair), patient recuperated quickly, and was discharged 3/29/2014.

27 March 2014 – Thurday

The week is really flying by. I’ve been having fun with the operating room team. They are a great group. Everyone has been extremely nice and welcoming. (You can never be sure how your presence is going to be tolerated or change the existing dynamic.) Dr. Melano and I have a couple of animated discussions over current practices, literature and recent meta-analyses. It’s an enjoyable discourse even though my vocabulary often fails me. I hear myself making grammatic mistakes and repeated errors in Spanish but it seems with some much going on (reviewing my anatomy, practicing my suture ties, assisting in the operating room and trying to keep up on my writing )- I just can’t seem to remember as much as I should in Spanish. I inwardly cringe when I substitute ‘conocer’ for ‘saber’ yet again, but the word is out of my mouth in reply to a question before I can corect myself.

Dr. Salgua assists Dr. Barbosa

I sit out this surgery (still no coronaries) and spend some time taking pictures to document my experiences here. I got a couple of shots that I really like, including one of Dr. Barbosa, Dr. Salgua and Raquel.

one of my favorite pictures from that day

Note: Patient discharged home 3/29/2014.

28 March 2014 Friday (and coronaries!)

Today is my big day – and I am excited and a little scared too. I got up at five this morning and went with Dr. Barbosa to the exercise park, so I would have a place to walk while he played tennis. It helped me get ready for the day, and I got to see where Dr. Barbosa uses up all of his pent-up aggression. He turns it into a power slam. (I don’t know tennis terms, but whatever swing he was doing – it must be responsible for his tranquil overall demeanor.)

After breakfast, we head to the hospital. We check on our hospitalized patients before going to see today’s surgical patient in pre-op.

Our patient is a bit fragile-looking so (of course!) I worry about her and how she will do with surgery. I also worry that I might not sew straight, now that it’s time for me to get to work.

Some of my previous OR “lessons” have been brutal, including several at a troubled facility that sent me running away from cardiac surgery (of all kinds) for several months*. This is what fuels my anxiety. (I am not anxious by nature).

But here in Sucre, in this OR, this experience is nothing of the sort – Dr. Barbosa is an excellent teacher. I don’t know why it’s a surprise. He’s always been a bit of a Clark Kent of the operating room; pleasant, calm and methodical.** This is just the same. In his soft burring voice he goes over the procedure with Dr. Salgua and I. The he oversees our attempts, gently encouraging and coaxing. It is yet again, a comfortable experience, instead of a traumatizing, horrible one.

a pretty great teacher

I don’t have any pictures which would show my twinkling eyes which are the main indication of my happy grin beneath my mask as I finished closing the last leg incision.

We wrap the leg when we finish and move up to the ‘top’ of the operating room table. (I’ve learned that the top and the bottom of the operating room table are two very different places.)

I close the chest incision – surgery is over. We transfer the patient to the ICU. She remains a little fragile but has no immediate problems.

After making sure the patient is stable, the team heads over to Clinica Maria Reina. We have received a call that a trauma patient is being placed on ECMO (to support his lungs) after developing a fat embolism. We are standing by to help, as needed.

As I look around, and talk to the staff, I find that there are three patients in the small ICU, all young men in their twenties, all intubated with critical injuries, all due to motorcycle accidents. One patient, just barely an adult has lost a limb as well. He is awake and hitting the siderails with his remaining hand to capture the nurse’s attention. She holds his hand and speaks soft to him and he calms down. Watching this, along with the patient struggling to survive as doctors rush to connect ECMO is a sobering reminder of how devastating my joyride could have been.

The patient is connected to ECMO without incident. As a weary unit, all four of us return home.

The view from my private dance floor..

Everyone is exhausted – but I am exhilarated! I just want to dance – so I do, by myself, on the balcony with my phone blaring out some music. Later that evening, we go out for dinner to celebrate a successful week. I am still in a joyous dancing mood which probably drives my companions a little crazy but it’s been such a great day.. so when we return home, I dance some more.

March 29th, 2014 – Saturday

In the morning after my dancing spree – Dr. Barbosa and I walk down to the hospital. Our fragile patient from yesterday is doing okay, and our other two patients are ready to go home. I review discharge instructions with each patient, and hope that I am not mangling my Spanish too badly. But they seem to understand me, so maybe I am doing alright. The doctor is nearby, writing prescriptions, to clarify anything I have trouble explaining.

One patient asks about getting out of a chair without using his arms (and stressing the sternal incision) so I demonstrate my favorite technique, and together we practice.

After we finish, we head back to the apartment to eat breakfast, finish packing and head back to Cartagena. Dr. Melano is staying behind (along with Dr. Salgua, who lives in Sincelejo) to check on our remaining patient.

The ride back is pleasant, but I start to feel some of the fatigue from all of the excitement of the week. I also feel a little sad to be leaving our little cardiac ‘family’ for a few days, which is probably crazy considering how much time we’ve all spent together. I guess it’s because I know it’s just temporary.

Iris and I head back to ‘our’ Cartagena apartment where the neighborhood cat, Ximena is waiting for us.

Now we will relax, write and get ready for the return trip on Tuesday.

* A deliberate elbow to the face was just the beginning of a series of humiliations at a previous facility.

**Pulling on his superman cape when needed.

Adventures in Sincelejo

Posted on March 27, 2014 by K Eckland

If there is such thing as a perfect day, it would have been today. The weather was still hot, humid and sticky. I still have student loans and the world continues to have accidents, disasters and wars. But for me, today was as good as it gets.

I spent the morning in the operating room while Dr. Barbosa performed a septal patch, and repair of the tricuspid valve. The case went well and the patient did beautifully. Before I left the hospital, the patient was already awake, alert and awaiting extubation. There was no hemodynamic instability or bleeding.

The local cardiologist did several cardiac catheterizations today – and we were consulted on four of them. 3 of the patients have excellent targets for bypass grafts and normal heart function. The fourth patient is a little more fragile, but is still a reasonable candidate for surgery.

Best way to see Sincelejo: On the back of a bike*

Lastly, I spent a nice, breezy hour touring the city on the back of a friend’s motorcycle. (Yes, mom – I wore my helmet – and he didn’t drive like a maniac.) We went all over Sincelejo; from the scenic overlook over the valley below, to the football stadium, past the University of the Caribbean, over to a public park with tennis courts, several pools and a small zoo. (I don’t have any pictures because I figured I’d probably drop it).

My guide was Omar, the spouse of my friend, Elena. He works in the Parks & Recreation department of the Sucre.

After returning home, I took a walk down to the Plaza to buy some local cheese. Then I spent the evening eating exotic fruits like guama, plums, uchuvas and fejoas.

*Also fairly dangerous..

All in all, it was a pretty awesome day.

The Road to Sincelejo

Posted on March 21, 2014 by K Eckland

The Road to Sincelejo

For me, the road to Sincelejo has been in the making for a long time. Since meeting Dr. Cristian Barbosa, cardiac surgeon in February 2010, I have wanted to know more about his work. I first meet Dr. Barbosa on my initial trip to Cartagena de Indias when I (literally) accosted him in a hallway in Hospital Bocagrande. At that time he was the chief of cardiovascular surgery of the now defunct cardiac surgery program at Hospital Bocagrande. He was minding his own business, walking down the hallway. As he passed, I read the title on his lab coat, “Cirguia Cardiovascular.”

Back on 2010, my Spanish was even worse than it is now – just forgotten bits of high school Spanish. But that didn’t deter me on my mission. I had entered the hospital under stealth (okay, not really, but I was just a ‘gringa’ wandering around without authorization) to meet and talk to surgeons, so I wasn’t about to let this opportunity pass by.

with Dr. Hector Pulido (left) and Dr. Barbosa in Cartagena (2010) after a chance encounter in a hallway,

Of course, since my Spanish was limited – I didn’t know how to express all the normal social graces in these sort of situations. Instead, I said, “please stop” as it was the first phrase that came to mind. He did, and we managed to exchange enough conversation for me to explain who I was, and what I would like to know. Despite my lack of manners, and random appearance, he didn’t seem to mind. A visiting cardiac surgery nurse, “por supuesto!” (of course!)

I knew I was successful when he then asked, “Do you want to go to the cath lab and review today’s films with me?” The rest is now history, on the pages of this blog, multiple articles and the Cartagena book.

Sometimes, the language of surgery is universal – which is what makes all of this possible.

in the operating room with Dr. Barbosa in 2010.

Since that first meeting, Dr. Barbosa and I have both improved our language skills (his English, my Spanish) and we’ve kept in contact. We’ve caught up with each at various conferences and meetings. Therefore, I was saddened to hear of the closure of the cardiac surgery program at Hospital Bocagrande due to financial difficulties*.

Cardiac Care

I was excited when Dr. Barbosa told me about his new position in Sincelejo (Sucre) a few years ago, providing cardiac surgery services to the local community. The program called Cardiac Care provides cardiac surgery services to a populace that would otherwise have to travel several hours (to Barranquilla or another large city).

When Dr. Barbosa invited to come join his team in Sincelejo, it took some re-arranging and re-scheduling to do – but it was an opportunity I just couldn’t miss.

The program remains small and relatively unknown even among Sincelejo residents. For this reason, Dr. Barbosa and his team (cardiac anesthesiologist, Dr. Sebastian Melano and nurse perfusionist, Sra. Iris Castro) all live in Cartagena but maintain another apartment in Sincelejo. When they have surgery scheduled, they stay in Sincelejo for several days to perform surgery and oversee the patient’s recovery.

Road trip

On Thursday, I took my first trip with the group to Sincelejo to see several patients (post-operative patients and new consultations).

Dr. Barbosa and his cardiac anesthesiologist see patients at the Clinic in Sincelejo

This trip itself was very interesting. Sucre is a region (state) of Colombia that is entirely new for me. Even though the trip is just 125 km from Cartagena, it’s a journey into a new landscape of rolling hills (Mountains de Maria) and takes over three hours.

Leaving Cartagena, we pass through the various areas of the city. We pass through barrio Manga, past several hospitals including Hospital San Juan de Dios, and toll stops. As we pass through the industrial areas of the city, the massive oil refinery expansion project dominates the landscape. Evidence of other ongoing construction and expansion outside city limits is also present.

Like most roads outside cities, we pass through several security checkpoints.

As we leave Bolivar we pass several palm plantations, where palm oil is produced. (Alas, no palm wine – one of my favorites)**.

Like Texas with hills

March is the tail end of the ‘drought season’ of this tropical locale so much of the landscape is brown, and barren appearing (think of Texas, with hills.) This year has been particularly dry with several wildfires due to the effects of the El Niño weather systems. This year, they tell me is even worse than previous El Niño years. A comparison to Texas is appropriate since this part of Sucre is mainly farms with livestock (horses, chickens etc.) and cattle grazing. For this reason, Sucre is well-known to Colombians for both its beef and the richness of the local cheese.

Along the way, we pass several small settlements of tiny houses along with the fincas (working farms) of the wealthy. Some of the homes are poured concrete with concrete floors and painted in gay colors, others are hard-packed manure with dirt floors.

one the modest dwellings roadside in Sucre

As part of a promise made to improve the infrastructure of Colombia during President Juan Manuel Santos’ famous “five points” most of the roadways are either newly paved or in the process of being paved and expanded.

During the drive, my companions give me the history of the various settlements.

Palenque

One the first settlements we pass while still in the state of Bolivar is the town of Palenque. Palenque is known for being the first settlement of escaped/ free Africans in Colombia. (As one of the main ports for the slavery trade, Cartagena – escaping slaves would make their way to small settlements to live as free members of society.)

Palenque is known for adhering to mainly of the African traditions of their ancestors, as female residents wear traditional dress. Residents speak a distinct dialect of a creole based, Spanish language mix also called Palenque.

photo courtesty of Proexport Colombia. Photo by Juan guFo.

photo courtesy of Proexport Colombia. Photo by Juan guFo.

A decade makes a difference – The Red Zone

Just ten years ago, this simple journey would have been venturing into dangerous territory***. Guerillas and paramilitary groups controlled the area, and terrorized residents and travelers alike. No where does the history of conflict in Colombia become more real than in the tiny town of Chinulito. This town was one of the first casualties of paramilitary activity in the area. Over 300 families had to flee the area for their very lives. Many more were killed. (For a bit of eye-opening, remember that while we often think of these massacres as a thing of the past, the violence is ongoing in parts of Colombia, and this incidence occurred in 2000, not 1970).

It wasn’t until 2008, that 56 of these former residents were able to return, under the protective watch of the Colombian military and police. The military presence is significantly heavier than any of the other areas I’ve been to.

Soon we enter the town of Sincelejo and head to the office to see patients.

Not a puebla

Despite being considered a somewhat rural area by more cosmopolitan coastal residents of Barranquilla and Cartagena, Sincelejo is no small puebla. The city, which is the capital of Sucre, has a population exceeding 200,000. The city has a long history and was initially inhabited by native peoples prior to Spanish exploration, and subsequent “discovered” in the 16th century. The city was formally founded in 1535 in the name of San Francisco de Asís de Sincelejo. (We will talk more about the city in future posts since I’ll be spending considerable time here.)

*Cardiac surgery services lines are particularly expensive to maintain in comparison to other hospital services.

** Apparently, I am not alone in my appreciation of this type of wine, which is widely considered among locals as the Colombian equivalent of “bum wines” like Thunderbird, Ripple, MD 20/20 or other cheap drinks favored by alcoholics.

*** If you are thinking of doing something like venturing solo into the Red Zones, particularly if unaccompanied by Colombians, please read this article, “Backpacking in a red zone.”

Cuidad Delirio and the spirit of Colombia

Posted on March 16, 2014 by K Eckland

This is Colombia!

One the reasons I have so many posts on local culture (in addition to medical tourism) is due to the fact that I struggle to impart the sentiments, the spirit, and the very essence of the destinations.

Viva Colombia!

The first time I came to Colombia, as we landed the JetBlue airline crew broadcast the song, Viva Colombia! and all the other passengers burst into cheers.. I guess it was that initial experience that has always stayed with me.

No, this isn’t the Spirit of Colombia.

Most of my writing is technically based so it is a huge challenge to attempt to draft essays that actually speak to the character of the people, the richness of the cultures.

there is more to Colombia than this..

But without these things, I think readers have a hard time separating the reputations of many of these places (for crime, or violence for example) from the people. The news media are so filled with negativity, and one limited perception or view of everything: Colombia is drugs and war, Mexico is violence and gangs, the United States is consumerism and spending, that it’s impossible for people to see, or read anything without this pervasive opinion poisoning our perceptions.

this is Colombia.. futbol

Now and then comes the occasional piece that takes a closer look – and I try to share those here.

and this..

I also try to include the often whimsical, charming or sweet details that give a better picture of what it is to be here. What it’s like as a foreigner wandering the streets – seeing everyday life.. Not just sickness and health in the corridors of hospitals and clinics. But the everyday lives and special occasions of the people I meet.

For example, one of the things that really, for me kind of captures the spirit and the pride of the people of Colombia is the twice daily broadcasts of the National Anthem of Colombia..

Cuidad Delirio

Another was the delightful film, “Cuidad Delirio” that I saw last night at the film festival in Cartagena. The film, which was made in Cali and directed by Chus Gutierrez is pure eye candy.

My response to the film was almost visceral.. I don’t usually like this type of film – the silly romantic stories.. But the film just captured the essence of Cali (and Colombia) so beautifully. The colors, the music, the liveliness.. In short, the film did in about 90 minutes what I have spent years trying to do – share the “feel” and some of the daily joy of life here*.

* I know skeptics are rolling their eyes – despite the many problems cause by socio-economic disparities and chronic warfare, many people here have a “Joie de vivre” that is unmistakable. It is this sentiment that brings me to Colombia, over and over.

Jewel of the caribe

Posted on March 13, 2014 by K Eckland

I’m back in Colombia and here in Cartagena just in time for the annual film festival, FESTIVAL INTERNACIONAL DE CINE
DE CARTAGENA DE INDIAS ..

Just because it’s not Cannes or Colorado (Sundance) doesn’t mean that the Cartagena Film Festival is anything less than a world-class event..

First, there’s the venue – Cartagena

gate at the entrance to the historic el centro district

sunset in Cartagena, Colombia

Cartagena de indias is often referred to as the jewel of the Caribbean, and it deserves the title. Bolivar’s star city is rich with history and ambiance. Couples flock to the romantic and colorful streets historic quarter to celebrate their nuptials with family and friends. Bridal parties are a common site on any given day, especially around the ever popular (and elegant) Sofitel Santa Clara. The former convent is in high demand year-round for its luxurious accommodations and extensive wine list.

In the midst of this charming setting is the hustle and bustle of a busy, active city with motorcycles, bicycles, taxis and buses circling the streets around the historic quarter. The city is a crazy mix of nationalities, ethnicities and other groups that all call Cartagena home. Add an assortment of lively Chivas buses and an array of business visitors, eco-tourists, backpackers, and sun -seeking tourists and readers can begin imagine what a lovely, vibrant, living city Cartagena is.

The people: Costenos

It’s not a Spanish you’ve ever heard before – but then, the coast of Colombia is unlike any other place you’ve ever been. The impact of the early Spaniards is unmistakable but Cartagena is no “Nueva Espana” (New Spain).

“The New World” as it was described in innumerable American grade school texts is (in this case) a wholly accurate and appropriate description.

This salsa of multiculturalism is the mainstay of Cartagena’s local culture and is reflected in every aspect of its art, music, dance and food. The Afro- Caribbean influences combine with the traditions of the indigenous peoples and Spanish explorers to make a distinct dialect, fashion, and way of living that is specific to Cartagena, Barranquilla and Santa Marta.

The Film Festival

Filmmakers from around the world (especially Latin America) flock to this festival every year to display their talents.

This year, of the 13 featured ‘Gems’, there is a particular film that I am hankering to see, called, “La Jaula de Oro” or The Golden Cage. This film, which won an award at the Cannes film festival is by Spanish born, Mexican filmmaker named Diego Quemada-Díez. The film is a detailed portrait of the lives and journeys of some of the people who travel illegally to the United States from Latin America. In light of all of the negative depictions, stereotypes and anti-latino sentiment in much of the United States, this film is a desperately needed reality check for Americans..

I was fortunate enough to sit next to the young, and eloquent filmmaker on our way to Cartagena. The soft-spoken, bilingual young man reminded me a bit of one of my favorite Colombian filmmakers, Andre Barrientos but that was probably due to both his humble nature and neatly trimmed beard. I would have liked to have interviewed him at length but a crowded airplane doesn’t seem like a fair venue. (Nothing like a captive interviewee at 35,000 feet).

He’s up against some stiff competition but I’m keeping my fingers crossed for him.

The first showing isn’t until the weekend but hopefully I’ll have some more pictures soon. If you are in Cartagena and are interested in attending – don’t worry, friends – all films are subtitled in English.

Home, again..

Posted on August 21, 2013 by K Eckland

fountain

I’ll be heading home again at the beginning of next week via a bit of a meandering journey. (The protests haven’t been as much of a disruption as anticipated in most of the bigger cities).,

First I am headed to Bogota to cover an upcoming conference before making my way to Northern Nevada. From there – it’s a brief trip to Baja California (Mexico) before starting the slow eastward caravan to my home in Southern Virginia. I hope to post something along the way – but first – a thank you to Medellin, a gracious city and wonderful host.

Colombia’s second city: Medellin

Medellin as seen from Metrocable

I’ve had an interesting time in Medellin, even if it didn’t turn out to be as productive as I would have hoped. I’ve come to better appreciate and enjoy a city that I had previously only known on a very superficial level.

public fountain for cooling off – parque de los pies descalzos

Medellin holds an endearing charm despite its rough edges: From the public parks, to the bustling life of the different barrios (like Aran Juez), to the upscale glamour of Poblado, El Tesoro mall and the high fashion excitement of Colombia Moda, it’s a vibrant life – lived in real-time and Technicolor.

indoor flower garden at upscale mall in Medellin

photo by Thor Gustafson
kids in the park

But whether I am in Poblado, El Centro, on the metro, or on the street – the one thing that really brings Medellin to life are it’s people.

my models help advertise the city of Medellin for it’s fashion-forwardness

Whether it’s Linda, offering me fresh fruit, or a cab driver watching to make sure I am safely inside before heading to the next destination – or the girl on the train who wants to practice her English, people in Medellin are genuine, down to earth and friendly.

selling fruit in the park (photo enhanced)

People, from all walks of life – surgeons, friends, professional photographers and even my hairdresser (Carmen) have embraced me like a long-lost friend.

rides for tots

So while Bogotá will always be my home away from home (in Colombia), the people of Medellin have captured a piece of my heart..

What’s next in Colombia? Sincelejo, more Barranquilla or maybe even Bucaramanga? Who knows…

Talking with Dr. Juan David Betancourt Parra, plastic surgeon

Posted on August 14, 2013 by K Eckland

I met Dr. Betancourt Parra at IQ interquirofanos while observing surgery with Dr. Luis Botero,. Dr. Betancourt was friendly, and immediately amendable to an interview but it took a little while to coördinate our schedules.

In person, he reminds me a bit of Dr.Carlos Ochoa Gaxiola, the kind and talented Mexican surgeon who graciously permitted me to study with him at Hospital General de Mexicali for several months while writing the Mexicali book.

Maybe it was his laid-back and open conversational style, or the braces on his teeth, giving him a bit of boyish charm that belies his years of experience. Maybe it was his enthusiasm for his work, but whatever it was, I found the discussion to be especially informative and interesting.

Aesthetic plastic and reconstructive surgery

Dr. Betancourt is a plastic surgeon in Medellin. He performs a wide range of aesthetic and reconstructive plastic surgery including corporal (body) and facial procedures such as rhinoplasty (nose), face-lifts, blepharoplasty (eyelid lift), breast augmentation, liposuction etc. but his true love is post-bariatric surgery procedures.

He also performs reconstructive surgery such as breast reconstruction after breast cancer.

Post-bariatric practice

Post-bariatric surgery is a subspecialty area of plastic surgery (reconstructive surgery). Many of these patients have lost very large amounts of weight (100+ pounds) and have large amounts of sagging, drooping and excess skin.

This skin is more than aesthetically displeasing – it can also contribute to the development of skin irritations such as intertriginous dermatitis and infections. It is particularly prone to causing problems for females – due to an excess build up of moisture, and friction in the genital areas. It can also make simple tasks like showering, getting dressed and cleaning after using the bathroom difficult. Patients sometimes have to “tuck” loose skin from the abdomen into support garments to prevent this skin from slipping down to their thighs. This excess of skin (and the resultant movement/ friction) can prevent people from participating in normal activities like exercise.

The psychological impact of the appearance of, and the challenges of daily living can be extremely distressing – especially for someone who have spent months or years trying to lose weight.

The group of procedures used to treat this problem is called “Body contouring”. For the majority of patients – this body contouring process will require several months and several separate surgeries.

Body Contouring

One of the primary procedures for body contouring is called a “lower body lift/ /belt lipectomy/ torsoplasty”. This is actually two separate but very similar techniques; with the belt lipectomy being a modified lower body lift procedure. However, they are often grouped together to simplify discussions about body contouring procedures. The lower body lift or belt lipectomy is usually one of the first procedures as part of the reconstructive process after massive weight loss.

This procedure is the core procedure – which removes the majority of excess skin and tissue which is usually in the abdominal/ torso area. This is a dramatic and large surgical procedure which I liken to “the open heart surgery of plastic surgery.” This procedure can take 2 to 6 hours, and often requires a 1 to 2 night hospital stay.

The remaining procedures are more of a ‘fine tuning;, as they are smaller procedures with lesser effects as they are aimed at smaller, more specific areas of the body. These procedures include brachioplexy to remove excess skin (aka “batwings”) from the upper arm/ bicep area, reduction mammoplasty to remove excess skin and drooping from the breast area, or a thighoplasty, to remove excess skin from the thighs/ upper legs.

One year minimum wait after bariatric surgery

Dr. Betancourt requires a minimum of one year after bariatric surgery before patients begin considering body contouring procedures.

This is important for two reasons:

1. Patient’s weight should be stable prior to performing surgical procedures.

2. This period gives patients a chance to adjust to their new weight. Several studies have demonstrated that it may take months to years to adjust the mind’s eye (mental image) to a person’s actual appearance.

For an excellent article by Salwar & Fabricatore (2008) on the psychological considerations for patients after massive weight loss – click here.

Mirror versus mind’s eye

This is why many people literally “do not see” recent changes in our weight / appearance (particularly subtle/ small changes) when looking in the mirror. However, as time passes, the mind’s perception of our image/ appearance usually changes to accommodate changes in our ‘real’ appearance – whether weight loss/ gain, signs of aging (fine lines, wrinkles) or even the loss of a limb or appendage.

photo from uhs.uk

When the mental / mirror image “mismatch” is dramatic, long-lasting, accompanied by depression/ anxiety or leads to dangerous practices like anorexia, hypergymnasia or self-mutilation – it is called body dismorphic disorder (BDD). Patients who have successfully adjusted to their new size and appearance are much more likely to have realistic expectations, be satisfied with surgical outcomes and be able to maintain their weight over the long-term.

Dr. Betancourt explained that he enjoys the intellectual challenges of caring for post-bariatric surgery patients for several reasons. These patients, often differ greatly from the majority of plastic surgery patients due to the presence of multiple co-morbid conditions relating to their previous obesity. Patients may also have body image issues following the initial bariatric surgery as they adjust to their new bodies. These patients may require multiple procedures for a complete reconstruction, making treatment a somewhat lengthy process.

Dr. Betancourt states that this is what makes it so gratifying; to be able to provide patients with dramatic body changes, help improve their self-image and enable patients to successfully adjust to their new lives. He also finds it very rewarding because of the high level of patient satisfaction after these procedures.

These patients account for approximately 1/3 of his practice.

Education and Training

Dr. Betancourt has been a plastic surgeon for twelve years. For eleven years, he worked in a public hospital, Manuel Uribe Angel in Enviagado, providing reconstructive surgery services to all patients at all socio-economic levels in Antioquia, Colombia . For the last several years, he has devoted a significant portion of his practice to the sub-specialty of post-bariatric surgery. He has attended several post-bariatric surgery conferences to learn new techniques and exchange ideas with many of the leaders in the field including Dr. Alaly (USA), Jean François Pascal (France) and Dr. Ricardo Baroudi (Brazil).

Dr. Betancourt attended medical school at Universidad CES (University of Health Sciences) and graduated in 1993. He is currently a professor at CES.

He competed in general surgical residency at the public hospital, Hospital Ipiranga in Sao Paulo, Brazil before completing his plastic surgery fellowship at the Universidad Santo Amaro, (in Sao Paulo, Brazil).

He is a member of the Colombian Society of Plastic Surgery (SCCP), as well as the Brazilian Society of Plastic Surgery.

Dr. Betancourt speaks Portuguese and English in addition to his native Spanish. He reports some trepidation with his English but was readily able to communicate with me without difficulties.

Dr. Juan David Betancourt Parra

Torre de Especialistas Intermedica

# 1816

Calle 7 No.39 – 137

Medellin

Tele: 352 0264

Email: plasticjdb1@une.net.co

Website: www.plasticjbd.com

International Patients

While the majority of Dr.Betancourt’s patients are from the local area, he does see international patients. After an initial contact by email, or via his internet page, Dr.Betancourt solicits a complete medical history including previous surgical reports (from previous bariatric or plastic surgery procedures) and current photos. Patients will also need to have blood work, and EKG as part of the pre-operative evaluation. Additional studies may be needed depending on the individual’s history and diagnostic test results. (Patients may be referred to Internal Medicine specialist, as needed).

Following the on-line/ email communications, patients will be seen, for an in-person consultation and full physical examination. Dr. Betancourt’s office will make arrangements for a translator and companion to accompany the patient, as needed. With the patient’s assistance, a full surgical treatment plan will be designed at that time – which discusses how many surgeries and what the anticipated timeline and recovery will be.

As discussed above, the torsoplasty/ belt lipectomy is usually the first procedure performed, often followed by reduction mammoplasty/ mammoplexy.

With the torsoplasty, patients are usually hospitalized for 1 to 2 nights. They are encouraged to be active and ambulatory as soon as possible after surgery to prevent post-operative complications such as thrombosis and pneumonia. Dr.Betancourt usually engages private nurses to assist patients following their discharge from the hospital.

Sufficient recovery from return travel usually requires 3 weeks, and is monitored by Dr.Betancourt.

Dr. Betancourt also provides psychological / counselling referrals as needed for patients.

Additional References / Reading and Resources on post-bariatric surgery

* Recommended reading: Langer V, Singh A, Aly AS, Cram AE. (2011). Body contouring following massive weight loss. Indian J Plast Surg [serial online] 2011 [cited 2013 Aug 11];44:14-20. Available from: http://www.ijps.org/text.asp?2011/44/1/14/81439

Excellent article with general overview of the issues and procedures with before and after photographs.

* Recommended reading: Shrivastava P, Aggarwal A, Khazanchi RK. Body contouring surgery in a massive weight loss patient: An overview. Indian J Plast Surg [serial online] 2008 [cited 2013 Aug 11];41:114-29. Available from: http://www.ijps.org/text.asp?2008/41/3/114/43607

Additional Readings

“Distressing skin problems” – a 2011 first person story about skin problems after massive weight loss from the UK paper, Daily Mail.

Aldaqal SM, Makhdoum AM, Turki AM, Awan BA, Samargandi OA, Jamjom H. (2013). Post-bariatric surgery satisfaction and body-contouring consideration after massive weight loss. N Am J Med Sci. 2013 Apr;5(4):301-5. doi: 10.4103/1947-2714.110442.

Giordano S, Victorzon M, Koskivuo I, Suominen E. (2013). Physical discomfort due to redundant skin in post-bariatric surgery patients. Plast Reconstr Aesthet Surg. 2013 Jul;66(7):950-5. doi: 10.1016/j.bjps.2013.03.016. Epub 2013 Apr 9. [free full text not available].

Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. (2006). Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring). 2006 Sep;14(9):1626-36. [no free full text available].

Talking with Dr. Ruy Rodrigo Diaz, plastic surgeon

Posted on July 31, 2013 by K Eckland

Dr. Rodrigo Diaz is a plastic surgeon at the Clinicas de Las Americas in Medellin. He primarily specializes in facial plastic surgery (rhinoplasty, blepharoplasty, forehead surgery, facial endoscopy, face-lifts and fillers) and breast surgery (augmentation/ reduction). He reports that he receives most of his clients by work of mouth but does see a significant percentage of medical tourists.

The majority of his patients are private practice (self-pay) patients but he does see patients from many of the major Colombian health care insurance plans such as Colseguro, Liberty, Sur America, Colsanitas. While American insurance companies do not traditionally cover elective cosmetic procedures, it is worth investigating with your insurer as many of the larger plans such as Blue Cross/ Anthem now have ancillary plans for cosmetic procedures.

Dr. Diaz has been a practicing plastic surgeon for thirty years, and a professor of plastic surgery at the Universidad de Antioquia for the past 12 years. He attended the Universidad de Antioquia medical school and completed his plastic surgery residency there as well.

Like all Colombian surgeons profiled here at Latin American Surgery.com, he is a member of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery. He is also a member of the American Society of Plastic Surgeons (ASPS) and the International Society of Plastic, Reconstructive and Aesthetic surgery.

Pre-operative process

As we talk, he reviews the pre-operative process for his patients. “It usually starts with an email from the patient,”he states. Then he solicits a complete medical history from the patient, including medications, past surgeries, social habits (smoking, drinking etc), current and past medical problems (like hypertension) and family history. This also includes photographs so he can best determine exactly what procedure(s) they will need, plan the procedure and discuss anticipated results.

If they have a single problem (like high blood pressure), then he sends the patient for a complete medical evaluation.

All smokers are required to quit at least 2 months before the procedure, and Aspirin (and other anti-platelets) must be discontinued 8 days before the scheduled procedure.

Out-of-town patients are encouraged to bring another adult with them, and additional translators are provided as needed.

Plan for adequate recovery time

One of the things he stresses heavily during our interview is the need for medical tourists to allocate adequate time to the recovery process before returning to their home country. This is something that has been brought up in previous interviews with other surgeons, as well but bears repeating. Even smaller surgeries require adequate healing time, so the idea of a ‘weekend surgical makeover’ should be dismissed from the minds of potential clients.

Most important aspect is post-operative care

The time necessary for adequate healing is usually 15 days to three weeks depending on the procedures. This period is also important for surgeons to be able to detect small problems such as delayed healing before it becomes a bigger problem. “It is better for me to see an incision that isn’t healing right away so I can treat it immediately, then for the patient to put it off – and then seek treatment weeks later when it is a much larger problem.”

Another reason he encourages patients to not to rush home, is that surgeons in their home countries may be unwilling to care for patients who have surgery elsewhere.

Patients take priority

Dr. Diaz prides himself in providing excellent post-operative care. All patients have his cell phone, and he encourages them to use it for all and every question or concern – day or night. “If they need me, I am here.”

And – don’t worry, if you are hesitant to call him – he is going to call you anyway, just to check in and make sure you are doing well, and your pain is controlled. He calls all of his patients the day after surgery, and continues to check-in and see patients frequently during the first weeks after surgery.

“My patients always take priority, even after they return home. If I have a patient Skyping me in the office – well, that takes priority over other things because I know what a hassle it is for them.”

He speaks English fluently but reports he continues to take weekly classes in English and American culture. He feels that it is impossible to have a complete understanding and good communication of his clients without understanding the culture.

Trends in facial plastic surgery

During his lengthy plastic surgery career, Dr. Diaz has seen a lot of trends come and go in aesthetics. He reports that one of the main trends he has seen over the last few years, is a trend for lesser facial procedures such as facial endoscopy, eyelid surgery or use of fillers by his clients versus a full face-lift. He states the reasons are multiple. Patients want to avoid the dreaded “plasticized / surgerized” artifical appearance that has been highly visible in popular media such as American reality shows, and prefer more subtle results, so his patients tend to seek treatment earlier, just a lines and folds appear. While many of these treatments are temporary like fillers or laser re-surfacing, the results are more natural and aesthetically pleasing.

Secondly, patients want to avoid the longer downtown involved with a larger procedure like a face-lift which may have residual bruising, or swelling for several weeks. These patients want to be refreshed and back in the office quickly.

Lastly, as he reflects on his career and the ‘style’ of plastic surgery – he reports that for many of his clients (particularly Colombian client), the focus is so heavily on the body (breast and buttock augmentation) that the face is secondary in consideration.

Dr. Ruy Rodrigo Diaz

Calle 32 No 72-28

Clinica de Las Americas, 4^th floor

Medellin

Tele: 345-9159

Email: rdiaz@une.net.co

Colombia Moda 2013 collections: Ipanema

Posted on July 28, 2013 by K Eckland

Since I returned from Colombia Moda with over 8,000 photos – I am going to post some of the collections here starting with Ipanema by Paradizia

Ipanema by Paradizia

Ipanema by Paradizia

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The designer with the models at the end of the show

Colombia Moda 2013: Made in Colombia

Posted on July 28, 2013 by K Eckland

Tentacion trade show models

The real reason for Colombia Moda isn’t just for people like me to gawk at the clothes and take pictures of models. It’s to promote Colombian textile and fashion internationally.

Loss of American manufacturing and textiles to India, Bangladesh and Thailand

As a resident of Danville, Virginia, the former home of Dan River Mills, which was one of the largest textile mills in the United States, I can attest to the importance of domestic textile production. As we found in 2006, with the closure of the mill, it has an immense impact on local economics, culture and politics. (Since the closure of the mill, our county in Virginia has had one of the highest unemployment rates in the USA.)

The worst thing about Danville’s woes; we aren’t alone – skilled manufacturing jobs have disappeared from the American landscape, leaving unemployment, poverty and hardship in its wake.

How does this relate to Colombia Moda?

In addition to showcasing home-grown talent and fashion, much of the focus of Colombia Moda’s lecture series this year has been on ‘re-shoring ‘ or bringing clothing production back to the Americas.

So with this background in mind – I set off to interview some of the smaller Colombian companies.

GlobalTex with Psique

I didn’t look for GlobalTex – Walberth Montoya of GlobalTex struck up a conversation with me as I walked out of the administrative offices of Colombia Moda with my new press pass around my neck. Secondly, GlobalTex isn’t technically a Colombian product – it’s a Chinese one, with offices in Bogotá, Colombia. But these distinctions fall to the side – after talking to both Sr. Montoyan and Ronald Frajales Bedoya of Psique.

GlobalTex is an industrial equipment company that supplies irons, sewing machines and all of the other machinery used for clothing manufacture. This equipment is imported from China, but differs distinctly from other industrial sewing machines (etc) in that it has been specially designed for use by disabled people. Sewing machines for example are set into tables designed to be wider than normal, and the proper height, with easy to reach instruments for people in wheelchairs or otherwise limited mobility. The foot pedals have been replaced with just a few buttons and knobs. As industrial machines, the y have already been streamlined (so there aren’t fifty stitch options like the average home sewer.) This makes the machinery easy to use even with people with learning disabilities, or emotional/ mental limitations.

Handicapped accessible machinery for clothing construction allows disabled Colombians to return to the workforce

Other machinery has been adapted for use by people missing fingers or even arms or other disabilities. This is particularly important in a region like Colombia that suffers from a devastating civil war that disproportionately affects the poorer residents, as well as limited pre-natal and post-natal services for any of the poorer or more rural areas of the country.

This gentleman lost his leg due to a landmine and supports himself by selling gum in the park

GlobalTex has partnered with the Psique Fundacion, which is an organization dedicated to assisting people with chronic illnesses or disability to lead full and normal lives. The organization helps disabled people find resources, gain access to rehabilitative therapies and to join the workforce as productive and self-sufficient members of society. This may not sound like a big thing – but in a moderate sized nation like Colombia with a vast gulf between rich and poor, the social network for supporting people with disabilities or mental illness is not as comprehensive as some nations.

Hot topic at home

Even in the USA, where depending on your political leanings, disability services such as social security/ ‘workfare’ etc. are polarized into being either critically insufficient or unnecessary, wasteful spending, programs similar to this one are essential for the emotional well-being of this vulnerable population.

GlobalTex (and Psique), in turn can supply much of the equipment and labor force for other Colombian companies in the textile industry.

Made in Colombia

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Drews

Drews is an exclusively male line of underwear. This Medellin-based company by the designer who goes simply by Drew, prides itself on the innovative and elegance of their pieces. The designer explained that it is the characteristic seaming of the garments which give each piece its support, and comfort while being an attractive option for consumers.

Drews

Calle 30 No 75 – 16

Belen parque

Medellin, Colombia

Email: contacto@drewsmale.com

The company is coming up on its fourteenth year – and as it looks to expand its brand to overseas markets – it’s 100% Colombian made. All of the designs, the models, and all of the clothing, even the fabric itself is made in Colombia, right here in Medellin.

German Artega Garrido (left) and founder, Luis Alejandro Diaz Rua

Tentacion

Tentacion is a three-year old Medellin company founded by Luis Alejandro Diaz Rua. Prior to his foray into fashion, Sr. Diaz reports that he did a wide variety of jobs to make ends meet, including at one point, selling couches and housewares.

He reports that his inspiration for the creation of the lingerie, swimwear and fitness line was his mother, and his female friends. It was based on their conversations regarding the lack of moderately priced lingerie. (Lingerie by the popular lines like Leonisa are quite pricey here). He also reported that women were seeking sexier, glamorous yet comfortable options.

Like Drew, Tentacion is entirely a Colombian operation, from the designers, models and garment construction, complete with the use of Colombian fabrics.

I wish all three of these companies the best of luck – and hope that American companies can find inspiration to revitalize our own industry at home.

Additional References and Resources

“The rise and fall of Dan River Mills” – WSLS 10 report

“Follow your labels” – a series by Kelsey Timmerman at the Christian Science Monitor that follows overseas garment construction.

DAV – Disabled American Veterans – to help people at home.

Poverty in America series – NBC written series on the growing poverty in the USA, and lack of hope for future employment.

The hopeless (homeless) generation – Today’s youth left behind, interview with homeless young adults in Las Vegas, NV

I had hoped to publish this, along with a series of articles over at Examiner.com – but the administrators tell me there is little interest in anything Colombian. I beg to differ, which is why I am publishing it here – even if it differs from our usual medical topics, so please let me know if you enjoy these glimpses into Colombian life.

Colombia Moda 2013: My week as a fashion photographer

Posted on July 26, 2013 by K Eckland

For more about my week as a fashion photographer, click here.

I’ll be publishing some more photos over the next week, as I sort through the over 8,000 images I collected during my short stint as a fashion photographer – but the standout collection belonged to the fashion design students at Universidad Pontificia Bolivariana here in Medellin, Colombia.

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Even the most fantastical designs presented have a plethora of fine detailing and seeming. It is this use of seaming, (and actual sewing techniques) more than fabric choice, use of color or other factors that really makes this collection stand apart from the rest of the runways at Colombia Moda.

It’s in the details..

This attention to detailing also united the different designers and design concepts within the collection – from the plastic ‘raincoat’ jackets, to the corseted black matching his and hers outfits – , the green and white dress princess seamed dress with flared hem and cape sleeves.. The Peter Pan blouse*..

It’s a welcome change from so many designs that rely on cheap accessories or flashy fabrics to carry the look. While these designs certainly benefitted from the lovely (and ethereal – in the case of some of the white outfits) fabrics – the designs could stand without them. Of course, this is the difference between high couture design and mass market items. Mass marketed cheap cotton jersey dresses at Wal-mart (or even the Mall) aren’t going to have this level of detail..

I have some great shots of the models with the designers, which I will add soon. (It’s been a long couple of days – and I can no longer keep my eyes open.

*It’s been over 20 years since I took a few costume studies classes at Dalhousie so some of the exact terminology is hidden in the far recesses of my brain.. But I haven’t forgotten what I like..