So what don’t you like about Colombia?

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..

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

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.


* 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

Made in Colombia

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.

Cartagena 010

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..

photo (44)

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

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.

bikes in el centro

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

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

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

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

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

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).

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.

photo (52)


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.

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?


!Eres Absurdo!

aortic barbosa

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).

Barbosa aortic


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.

aortic valve 010

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.

aortic valve 012


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.


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.

aortic valve 027

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.


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.



The Road to Sincelejo


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,

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.

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

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

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.


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

This is Colombia!

kids in Cartagena

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.

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..

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..

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..

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.

cartagena 014

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

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

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.

Cartagena update: Dr. Cristian Barbosa, cardiac surgeon

with Dr. Pulido (left) and Dr. Barbosa in Cartagena (2010).

I wanted to post an update on a fantastic surgeon (who has since become a good friend).  In fact, Dr. Cristian Barbosa was one of the first surgeons I ever interviewed back in 2010 – and without his encouragement, the first book would have never gotten off the ground.  Maybe not the second book (Bogotá!) either – since once I said the magic words, “Oh – I interviewed Dr. Barbosa in Cartagena last year,” plenty of other surgeons who might not have talked to me – started to take me seriously.

with Dr. Barbosa back in 2010

Ever since then – I try to keep in contact with Dr. Barbosa – he’s a great person and an absolutely phenomenal surgeon, so I email him every so often..

Since my last visit, back in August – Dr. Barbosa has left Hospital Neuvo Bocagrande – and is now operating in Clinica Santa Maria in Sincelejo, Colombia.

Sincelejo is the capital of the state of Sucre, which is part of the Caribbean region of Colombia.  Like most of this part of Colombia – it has a rich history, and was founded back in 1535 in the name of St. Francis de Assis, though it was long inhabited prior to that by native Colombian tribes such as the Zenu.  Unlike nearby Cartagena (125km north), Sincelejo is a more mountainous landscape, and is known for their agriculture, particularly cattle.  (wow – my stomach just rumbled  – must be missing those gourmet Corral burgers, which are my one Colombian indulgence.. Argentina has nothing on Colombian beef.)

Dr. Barbosa is still living in Cartagena and making a three-hour commute to perform life-saving surgery, while he works on creating a new cardiac surgery program back in our favorite seaside city.  (Hopefully, when he does – we’ll be invited back to take a look!)

gate at the entrance to the historic el centro district

sunset in Cartagena, Colombia

Summit of the Americas

cobblestone streets in the historic district of Cartagena, Colombia

Summit of the Americas – Cartagena, Colombia

As anticipated, President Obama is receiving some harsh criticisms for the Cuban embargo begun by fellow democrat, President John F. Kennedy in October of 1960.  (Despite the long-standing embargo, the United States remains the fifth largest exporter to the island nation.)

This embargo, which was initiated in response to the Cuban nationalization of private properties as part of the institution of a communist regime, reached full strength in February of 1962, and has continued unabated since then.  In fact, the American embargo was re-affirmed in 1992 with passage of the Cuban Democracy Act, and again in 1996 with Helms – Burton Act which further prevents private American citizens from having business relationships or trade with Cuba.

At the summit, the host of the event, President Juan Manual Santos (Calderon) has been one of the more outspoken critics of this on-going trade policy and public relations nightmare.  President Santos argues, fairly successfully in my opinion, that not only is the embargo an outmoded method of diplomatic negotiation, but that is has been an ineffective one (in inspiring governmental and philosophical change in Cuba.)

President Santos respectfully requests that Obama reconsider the decades old policies of trade embargo. Photo by AP press

This comes after President Obama was embarrassed by a prostitution scandal involving several of his private security detail.  At the time of this writing, eleven members of the secret service along with five members of the military has been openly disciplined, and returned home.

Colombian prostitutes – photo found at multiple sites, including another wordpress blog and
(If this is your photo – let me know, so I can give proper credit)

Protests against the United States have been small scale and without injury as small explosives were detonated near the American embassy.

President Obama also fielded criticism on America’s ‘War on Drugs’.  While conceding that the efforts have been a multi-billion dollar failure (with the exception of small scale victories such as the capture/ death of Pablo Escobar in 1994), Obama refused to consider efforts to legalize drugs, as are under discussion in several other nations.

In other news – in a surprise move that may predict more future instability for Venezuela, President Hugo Chavez has decided to forgo the summit as he pursues treatment for cancer (in Cuba).  This move leads to intense speculation regarding both the presidential and governmental prognosis in Venezuela.  Previously, President Chavez had been adamant that his cancer was curable and disputed reports of a more serious condition. There are now several media reports that the president has widespread metastasis affecting multiple organs.  (May I suggest that you consider HIPEC, President Chavez?)

The rise of Latin America

Big news out of Cartagena, Colombia as Hugo Chavez (Venezuela) and Bolivia’s president, Evo Morales come together with President Barack Obama and Secretary of State, Hilary Clinton along with 30 other member nations for the Summit of the Americas.  Most certainly on the agenda – discussions regarding both Mexico’s and Colombia’s decisions to decriminalize drugs, as well as the continued drug violence affecting both countries.  President Evo Morales’, a former coca grower, position on drugs and the so-called ‘Drug war’ are already well-known.

While Colombia’s crime has decreased dramatically, the reverse is true in certain parts of Mexico* – where the nightly news seems more like Vietnam footage, as reporters discuss caches of guns toted by young teenagers, and Cuidad de Juarez claims the title of ‘Murder capitol of the world.”   Much of this criminal activity has been attributed to illegal drug commerce to the United States leading several countries to blame the USA for creating havoc in their home countries as suppliers attempt to feed the hoards of American drug users.

Tensions between Venezuela, Bolivia, and Cuba against the United States are unlikely to change as a result of this Summit, but hopes remain.  The summit is also expected to put pressure on the United States regarding the 50-year-old Cuban embargo.

It’s an interesting turn of the tide – as these issues along with the economic problems plaguing the United States (and causing problems globally) put the US at a significant disadvantage.

In related news – here at Cartagena Surgery, readers are asking:

— So how dangerous is Mexico? —

Since I am currently living in a Mexican border city, you’ve picked the right time to ask.

* There are still plenty of safe and beautiful places in Mexico – but it remains a tragedy that the Sinoloa gang / drug activity have resulted in over 47,000 murders in the last five years.  ([To put this into context, let’s do some simply math.. Simple math since I’m a nurse not a statistician, so keep that in mind as you consider the limited variables here.]

1.  Mexico has over a hundred million people (or 1/3 the people of the USA)

with  47,000 murders over five years (or that’s the number that has been widely quoted.)  Divide 47,000 by five = 9,400 people murdered per year.

2.  The US has over 300 million people, and had 18,361 murders in 2007 (last year available by the US census.) So three times the people.  Hmmm.  I can already see that 18,361 divided by three is 6,120. 

3. But to be fair – let’s also look at cummulative average for the US – and compare apples to apples.. (or five years of data to five years of data.)  It’s still not entirely comparable since our latest available data is from 2007.

2007:  18,361

2006: 18,573

2005: 18,124

2004: 17,357

2003: 17,732

for a total of 90,147 murders over five years.  If we divide that by three, we get 30,039 which is only 69% of the murders in Mexico in the same number of years.  Now you can argue it either way – since the USA numbers aren’t current, etc. etc.. but Mexico’s rate IS significantly higher..

So what does that mean for travelers?  It means – stay the heck out of Juarez..  Be extra cautious in Tijuana, and Nuevo Larado – but otherwise,  use caution & commonsense when traveling in other parts of Mexico (like you would any where else!) – and enjoy yourselves.

Cartagena as an eco-tourism destination

Mother Nature Network, (MNN) a website promoting healthier alternatives and a greener lifestyle recently headlined our own Cartagena as the destination of the week

The article highlights the easy walk-ability of the historic district as well as the healthy, and affordable cuisine of this sea port city. This is just the latest in a series of articles highlighting the historic beauty of this Colombian – Caribbean treasure. Cartagena was also highlighted by Wanderlust magazine as one of their favored destinations earlier this month.  The New York Times also featured Cartagena as a newly ‘re-discovered’ destination.

photo by CNN

This, along with recent economic developments in the tourism industry are encouraging signs of an economic upswing for Colombia, Cartagena and all of Latin America.  Intercontinental Hotels Group is also planning on building several new properties in Colombia – including Bogotá, Barranquilla and Cartagena.

At the same time, Colombia and several nations in Latin America are showing unprecedented growth and strength on the economic markets.  The recent rise of the Colombian peso is only one indicator of the future potential of Colombia as a whole.

Recent reforms have also boosted the government’s tax revenues, and led to an increased credit rating from Standard & Poor.  (If you remember, they recently downgraded the USA’s own rating.)

Foreign investors are interested in more than historic streets, and the sandy beaches of Santa Marta.  Lured by the wealth of natural resources including oil and gas  – they are flocking to this new opportunities in this previously overlooked country.  Colombia, as the third largest producer of oil in Latin America is currently being courted by Royal Dutch Shell, Exxon and Chevron for their large gas reserves.

While the coffee industry has been hurt by flooding last year – Colombian imports were up more than 17%.

Recent arrests of several leaders of FARC along with successful negotiations and changes in drug enforcement legislation, along with President Juan Manual Santos continued popularity help boost the appeal of Colombia to investors.  But – as readers know – finance is not my area of expertise.. So I have asked several financial and economic analysts for their thoughts..

Cartagena skyline - business district

Hello, Cartagena!

Hello magazine says Hello to the beautiful Cartagena de Indias in this new article that highlights the romance and ambience of this charming, coastal city that was founded during the swashbuckling days of pirates and buccaneers..

Cartagena de Indias

In other news (from Colombia Reports) – if you can’t make it to Cartagena right now, don’t worry – the city is taking steps to safeguard and protect its rich history for generations of tourists to come.

Cartagena on CNN

It looks like our Hidden Gem of a city is finally getting some of the attention it deserves – earlier this month, the city of Cartagena was featured as a ‘secret treasure’ on CNN Travel.    The article talks about the Caribbean flavor of this bright, diverse and colorful city and its rich history.

photo by CNN

Across ‘the pond’ in the UK – the Telegraph was also singing the praises of this tropical, elegant paradise and it’s status as a ‘cultural capital’..

New Frankie Jazz single


As promised, my dear readers – more about the delightfully charming and sinfully attractive Frankie Jazz.. Since our fateful (but chance encounter) this summer, Frankie Jazz has released a new single, the acoustic version of one of my personal favorites, “Fight to Stay.”   This song, as well as his album, “Let me take my way” are available over at iTunes (and are now part of my newest playlist..  so move over, Wisin & Yandel – Frankie’s come to town!)

and I just couldn’t help myself – I lifted some of his album art from his website, Frankie Jazz.  (Let me tell you – the photos of Mr. Vergara don’t do him justice..)